Patho - Final Exam - Combined Sets

Norepinephrine and Epinephrine

Neurotransmitters for the sympathetic postganglionic neurons

Nitroglycerin is the drug of choice in treating angina. What does nitroglycerin release into the vascular smooth muscle of the target tissues?

Nitric oxide

3 Types of Thrombocytopenia

1) Drug-induced thrombocytopenia 2) Idiopathic thrombocytopenic purpura 3) Thrombotic thrombocytopenic purpura

Neurons are characterized by the ability to communicate with other neurons and body cells through pulsed electrical impulses, or:

action potentials.

Septicemia increases the risk of

acute respiratory distress syndrome.

If someone is exhibiting signs of a heart attack (outside hospital setting)

administer Aspirin to anticoagulate -The preferred antiplatelet agent for preventing platelet aggregation in persons with CAD -Inhibits synthesis of prostaglandin, thromboxane A2 * --Ticlopidine and clopidogrel may be used when aspirin is contraindicated

One of the recognized causes of emphysema is

an inherited deficiency of alpha-1-antitrypsin, an antiprotease enzyme that protects the lung from injury.

Labored breathing, an uncomfortable work of breathing sensation, is thought to be mediated by

excessive input from stretch receptors in the chest muscles.

Coronary blood flow is controlled by

physical, neural, and metabolic factors, and regulated by the need of the cardiac muscle for oxygen

Wernicke aphasia is an inability *

to comprehend the speech of others or written material

Incidence & Prevalence of Diabetes Mellitus

2015 statistics- 23.1 million adults (ages 18 or older) with diagnosed diabetes; of those diagnosed the majority has type 2 diabetes In the United States, diabetes is more prevalent among American Indians/Alaska Natives, non-Hispanic African Americans, and Hispanic Americans

hich diagnostic test will be performed for a client with a suspected pheochromocytoma?

24-hour urine test for catecholamines -The urine test for catecholamines would be elevated if the client had pheochromocytoma.

Monocytes and Macrophages (4) -% of the total leukocyte count _______ -Cells survive for _______ to _______ in the ______ -Important role in ___________ -Involved in _______

3% to 8% of the total leukocyte count -Cells survive for months to years in the tissues -Important role in chronic inflammation -Involved in the immune response: -Activating lymphocytes -Presenting antigen to T cells

Usually, _____ or more pairs of spinal nerves are present

32 -8 cervical -12 thoracic -5 lumbar -5 sacral -2 or more coccygeal -Efferent & afferent neurons

Without oxygen, brain cell death begins within

4 to 6 minutes

The nurse is assessing the blood pressure of a client who is experiencing cardiogenic shock. Which blood pressure reading is most likely? 210/100 180/90 90/75 96/40

90/75 Explanation: A blood pressure reading of 90/75 in a client experiencing cardiogenic shock is related to a decreased pulse pressure.

Amyotrophic Lateral Sclerosis (ALS)

A devastating neurologic disorder that selectively affects motor function -The disease typically follows a progressive course, with a mean survival period of 2 to 5 years from the onset of symptoms. -The symptom of ALS results from the effects of the disease on the upper and lower motor neurons

Secondary Pulmonary Hypertension Define & S&S (5)

A disorder characterized by an elevation of pressure within the pulmonary circulation Signs and Symptoms: -Dyspnea -Fatigue -Peripheral edema -Ascites -Signs of R heart failure (cor pulmonale)

Gallbladder (Define & Function)

A distensible, pear-shaped, muscular sac located on the ventral surface of the liver Function: store and concentrate bile

Functions of the Pericardium

A double-layered serous membrane sac that: 1) Isolates the heart from other thoracic structures 2) Maintains its position in the thorax 3) Prevents it from overfilling 4) Contributes to coupling the distensibility b/t the two ventricles during diastole; they both fill equally

Which medication is used to treat acute attacks of multiple sclerosis (MS)?

Corticosteroids Explanation: Corticosteroids are the mainstay of treatment for acute attacks of MS. These agents are thought to reduce inflammation, improve nerve conduction, and have important immunologic effects.

Basal ganglia are parts of the brain that are responsible for

movement control, such as starting, stopping, and monitoring movements.

Peripheral Nervous Disorders result in

muscle weakness, w/ or w/o atrophy and sensory changes -Peripheral nervous disorder = any primary disorder of the peripheral nerves

Glucocorticoids (such as cortisol), androgens (such as testosterone), and estrogens are synthesized by

non-vesicle-mediated pathways.

The neurotransmitter that raises BP is

norepinephrine -it triggers vasoconstriction (narrowing of blood vessels), which increases blood pressure.

Characteristics of Hormones

o A single hormone can exert various effects in different tissues o A single function can be regulated by several hormones

The manifestations of portal hypertension (6) **

o Ascites (fluid build-up in the peritoneal cavity of the abdomen) o Esophageal varices o Splenomegaly o Anemia o Bleeding o Hemorrhoids

Efferent or motor neurons

o Carry information from the CNS to the effector organs

Causes of Intestinal Malabsorption

o Celiac disease Inflammatory reaction Neoplasm Colorectal cancer

Disorders of GB

o Cholelithiasis - gallstones -Cholesterol, calcium salts, or mixed Risk factors: obesity, wt changes, estrogen therapy o Cholecystitis - inflammation of GB o Cholangitis - inflammation of the common bile duct) o Choledocholithiasis (common bile duct stones)

Types of Chronic Pancreatitis

o Chronic calcifying pancreatitis o Chronic obstructive pancreatitis

Disorders of Hyperpituitarism

o Cushings syndrome: excess cortisol o Acromegaly: excess growth hormone o Hyperthyroidism

Symptoms of Intestinal Malabsorption

o Diarrhea o Steatorrhea o Flatulence o Bloating o Abdominal pain o Cramps o Weakness, muscle wasting o Weight loss and abdominal distention

Ethanol Metabolism

o Directly absorbed in stomach -Alcohol dehydrogenase (ADH) system Acetaldehyde and hydrogen produced -NAD/HàNADH and increased lactic acid -Microsomal ethanol-oxidizing system (MEOS) pathway -Acetaldehyde and free radicals produced -Peroxisomes

Causes of Acute Pancreatitis (6)

o Gallstones (stones in the common duct) o Alcohol abuse o Hyperlipidemia, Hyperparathyroidism o Infections (particularly viral) o Abdominal and surgical trauma o Drugs such as steroids and thiazide diuretics

Factors Affecting the Glomerular Filtration Rate (3)

o Glomerular capillary hydrostatic pressure o Glomerular capillary osmotic pressure o Hydrostatic and osmotic pressures in the Bowman capsule

Development of the Embryonic Neural Tube: On cross section, the embryonic neural tube develops into a central canal surrounded by the following

o Gray matter The cellular portion of the CNS (more of the cell body) o White matter The tract system of the CNS

Causes of Peptic Ulcer Disease & 2 Common Forms

o H. pylori o Aspirin o Age o Warfarin o Smoking Common forms 1) Gastric (A) ulcers 2) Duodenal (B) ulcers

Layers of the GB (3)

o Outer serous peritoneal layer o Middle smooth muscle layer o Inner mucosal layer that is continuous with the linings of the bile duct

The larynx connects the _______ with the _______

oropharynx with the trachea

DEXA scan is routinely used for the diagnosis and monitoring of

osteoporosis and metabolic bone imagining.

Sinoatrial (SA) node

pacemaker of the heart; intrinsic rate: 60-100 beats/min

Shunting is

perfusion without ventilation; blood moves from right to the left side of the circulation w/o being oxygenated

Antidiuretic hormone (ADH or vasopressin) changes the

permeability of the tubules of the collecting duct to increase water absorption. It functions to increase the absorption of water in the kidneys.

CHOLECYST=

pertaining to the Gallbladder

Severe persistent asthma limits

physical activity

Curare

plant/neurotoxin that acts on the postjunctional membrane of the motor end plate to prevent the depolarizing effect of the neurotransmitter (causes paralysis) -Used during many types of surgical procedures

Because of its location between the afferent and efferent arterioles, the juxtaglomerular complex is thought to

play an essential feedback role in linking the level of arterial blood pressure and renal blood flow to the GFR and the composition of the distal tubular fluid.

Decreased blood pressure is present with tension pneumothorax, and a friction rub is present with

pleural effusion.

Which respiratory neurons function to turn off inspiration and assists in the control of the respiratory rate and inspiratory volume?

pneumotaxic center

Intrapulmonary pressure oscillates between

positive and negative relative to atmospheric pressure with expiration and inspiration.

A newborn is admitted to the hospital with a high bilirubin level of 13 mg/dL (222.35 µmol/L). The assessment data related to this lab value includes: Yellowish discoloration of the skin Colicky, intermittent pain associated with formula feeding Xanthomas Yellowing of the sclera of the eye Dark-colored urine

Yellowish discoloration of the skin Yellowing of the sclera of the eye Dark-colored urine

Most issues with blood supply in kidneys is going to be

pre-renal

Which factor(s) will ultimately affect stroke volume? Select all that apply. preload afterload myocardial contractility heart rate ventricular automaticity

preload afterload myocardial contractility

The apneustic center has an excitatory effect on inspiration, tending to

prolong inspiration.

Cerebrospinal (CSF) fluid

protects the brain from external forces.

Urea is a product of

protein metabolism; blood levels regulated by the kidneys

Hemoptysis (blood in the sputum) is usually associated with (2)

pulmonary emboli or lung cancers (to name a few)

Somatic is less _____ than autonomic

rapid

An esophageal motility disorder involves the

smooth muscle layer of the esophagus and the lower esophageal sphincter (LES).

Aldosterone is a hormone which increases

sodium and water reabsorption by the kidneys into the bloodstream

Urography is used to detect

space-occupying lesions of the kidneys, pyelonephritis, hydronephrosis, vesicoureteral reflux, and kidney stones. *In hydronephrosis, there is urine-filled dilation of the renal pelvis due to an obstruction of urine outflow from the kidney

Convulsion

specific seizure type of a motor seizure involving the entire body

Hormones act on ________, but they cause a variety of effects on tissues.

specific target cells -Hormones do not transport other substances; hormones are transported and present in body fluids at all times. The endocrine system uses hormones released into the blood and transported throughout the body to influence the activity of body tissues. Tissue and organ responses to endocrine hormones tend to take much longer than the response to neurotransmitters, but once initiated, they tend to be much more prolonged than those induced by the nervous system. The glands of the endocrine system are widely scattered throughout the body.

Asymmetry of the chest during inspiration would suggest a

spontaneous pneumothorax

Venous thrombi are associated with conditions that cause

stasis of blood flow with increased concentrations of coagulation factors.

Carotid arteries are involved in

stroke -usually implicated in an embolic stroke

MRI provides information about

structural changes within solid tissue.

A decrease in blood volume from shock stimulates the _________, causing _________.

sympathetic nervous system, causing an increase in the release of antidiuretic hormone (also known as vasopressin) -This hormone also greatly increases water retention by the kidneys.

Hypertension and ischemic heart disease are associated with

systolic heart failure, or impaired contractile performance.

Goiter

-Enlargement of the thyroid gland -T3 and T4 are not made -There is no negative feedback to the hypothalamus -TRH and TSH continue to be made-so levels normal -If it is able, the thyroid will grow in response to the TSH -If gets too large can cause compression and displacement of the trachea or esophagus

Risk Factors for Development of Gastric Cancer (4)

-Genetic predisposition -Carcinogenic factors in the diet -Autoimmune gastritis -Gastric adenomas or polyps

Most Critical Tests for Renal Function

-Glomerular filtration rate & Serum creatinine blood test (used in estimating the functional capacity of the kidneys - a rise in the creatinine level to three times its normal value suggests that there is a 75% loss of renal function) Other tests: -Urinalysis -Blood test: Blood urea nitrogen (BUN) -Cystoscopy -Ultrasonography -Radiologic and other image studies

Seizure

the abnormal behavior caused by an electrical discharge from neurons in the cerebral cortex

The following make up the Respiratory System:

the airways, two lungs, blood vessels, rib cage, respiratory muscles, & diaphragm

GERD refers to

the backward movement of gastric contents into the esophagus or beyond, into oral cavity or lung. This condition causes heartburn or pyrosis.

GERD (gastroesophageal reflux disease) is a condition that causes

the esophagus to become irritated and inflamed. -Clients with GERD usually feel a burning in the chest or throat called heartburn. Sometimes, they taste stomach fluid in the back of the mouth.

Kussmaul sign is an inspiratory distention of the jugular veins caused by

the inability of the right atrium, encased in its rigid pericardium, to accommodate the increase in venous return that occurs with inspiration.

Upper motoneurons (UMN) project from

the motor cortex to the brain stem or spinal cord. -Directly or indirectly innervate the lower motoneurons or contracting muscles.

The motor unit consists of *

the motor neuron and the muscle fibers it innervates.

The functional unit of the kidney

the nephron

Basophils (4) -% of total leukocytes ____ -Consist of _______ (5) -Similar to _____ -Involved in ______

0.3% to 0.5% of the total leukocytes -Consist of heparin, an anticoagulant, histamine, a vasodilator, and other mediators of inflammation -Similar to mast cells -Involved in allergic and hypersensitivity reactions

Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which component of his "white matter" has most likely been damaged?

the outer layer (neolayer)

The pacemaker properties of the respiratory center in the medulla result from the cycling of two groups of neurons:

the pneumotaxic center in the upper pons and the apneustic center in the lower pons.

Neurogenic bladder is

the spastic dysfunction of the bladder that makes the bladder lose its ability to store urine.

Hemostasis is designed to maintain the integrity of

the vascular compartment -Infection -Volume -Oxygen production -Tissue damage -Healing

The act of vomiting is thought to be a reflex that is integrated in

the vomiting center, which is located in the dorsal portion of the reticular formation of the medulla near the sensory nuclei of the vagus.

We suspect nephrotic syndrome in kidneys when

there is edema and proteinuria

Radionuclide ventriculography is recommended if

there is reason to suspect coronary artery disease or ischemia as the underlying cause for heart failure.

Since steroid hormones are bound to protein carriers for transport, this means:

they are inactive in the bound state. -Their activity depends on the availability of transport carriers.

Glomerular filtration has

three layers of filtration

Types of Angina

1) Chronic Stable Angina - Associated w/ a fixed coronary obstruction that produces a disparity b/t coronary blood flow &metabolic demands of the myocardium 2) Unstable Angina - The initial manifestation of ischemic heart disease in approximately half of persons with CAD

Causes of Chronic Obstructive Airway Disease (COPD) (4)

1) Chronic bronchitis 2) Emphysema 3) Bronchiectasis 4) Cystic fibrosis

Some causes of cerebellum-associated movement disorders (3)

1) Congenital defect 2) Vascular accident 3) Growing tumor

5 Main Functions of the Nervous System

1) Controls skeletal muscle movement 2) Helps to regulate cardiac and visceral smooth muscle activity 3) Enables the reception, integration, and perception of sensory information 4) Provides the substratum necessary for intelligence, anticipation, and judgment 5) Facilitates adjustment to an ever-changing external environment

Causes of Bleeding (2) *

1) Decrease in the number of circulating platelets -Depletion of platelets must be relatively severe before hemorrhagic tendencies of spontaneous bleeding occur 2) Impaired platelet function -Bleeding resulting from platelet deficiency commonly occurs in small vessels and is characterized by petechiae and purpura

Causes of Urinary Tract Obstruction (7)

1) Developmental defects 2) Calculi (stones) 3) Pregnancy 4) Benign prostatic hyperplasia 5) Scar tissue resulting from infection and inflammation 6) Tumors 7) Neurologic disorders such as spinal cord injury

Drug-Induced Liver Diseases (4)

1) Direct hepatotoxic injury 2) Idiosyncratic reactions 3) Cholestatic reactions 4) Chronic hepatitis

2 Types of Synapses Found in the Nervous System

1) Electrical Synapses ~Permit the passage of current-carrying ions through small openings called gap junctions that penetrate the cell junction of adjoining cells and allow current to travel in either direction 2) Chemical Synapses ~Involve special presynaptic and postsynaptic membrane structures, separated by a synaptic cleft

Treatment of Liver Failure (6)

1) Eliminating alcohol intake when the condition is caused by alcoholic cirrhosis 2) Preventing infections 3) Providing sufficient carbohydrates and calories to prevent protein breakdown 4) Correcting fluid and electrolyte imbalances 5) Decreasing ammonia production in the gastrointestinal tract by controlling protein intake 6) Liver transplantation

Functions of the Kidneys (5)

1) Elimination of water 2) Removal of wastes 3) Activation of vitamin D 4) Production of erythropoietin 5) Blood pressure regulation **See mnemonic slide to remember this**

Rh-negative

blood without Rh antigens

The chemoreceptor trigger zone is located outside the ________ in a small area between the medulla and the floor of the fourth ventricle, where it is exposed to both __________ and ___________.

blood-brain barrier blood and cerebrospinal fluid.

Hormones are transported in _____ and present all the time in greater or lesser amounts depending on ________

body fluids the body needs

Growth hormone (GH) stimulates growth of

bone and muscle.

The motor unit is found in

both CNS and PNS as a functional unit

Playing in soil could result in

botulism

On the third day following an acute myocardial infarction, the client asks the nurse how the heart muscle will heal. What is the nurse's best response?

"The body will clear away the dead cells and you will be left with some scar tissue on your heart muscle."

S&S of Chronic Pericarditis (4)

-Ascites -Pedal edema -Dyspnea on exertion -Fatigue

Conditions that cause accelerated activity of the coagulation system (6)

-Pregnancy and the puerperium -Use of oral contraceptives -Postsurgical state -Immobility -Congestive heart failure -Malignant diseases

Three Types of Lymphocytes

1) B lymphocytes 2) T lymphocytes 3) Natural killer cells

3 Characteristics of Disorders of the Basal Ganglia

1) Involuntary movements 2) Alterations in muscle tone 3) Disturbances in body posture

Which client is most likely to develop hepatocellular cancer? A client who had an overdose of acetaminophen several years ago and who takes several prescription medications A client who has been diagnosed with metastatic breast cancer A client who has been smoking marijuana for many years A client who received a liver transplant due to cirrhosis 6 years ago

A client who has been diagnosed with metastatic breast cancer

Development of Pulmonary Embolism

A blood-borne substance lodges in a branch of the pulmonary artery and obstructs the flow

According to Poiseuille's law, airway resistance would be largest in which part of the respiratory system?

A bronchiole

Crohn Disease

A recurrent, skip lesions, granulomatous type of inflammatory response that can affect any area of the gastrointestinal tract from the mouth to the anus Skip lesions - lesions in one area, not in the next, but found in another further down (lesions are not continuous)

Acute Pancreatitis

A reversible inflammatory process brought about by premature activation of pancreatic enzymes (autodigestion). Autodigestion is the premature activation of pancreatic enzymes into the surrounding tissues.

The pyloric sphincter

A ring of smooth muscle that connects the stomach and small intestine. It opens and closes to control the passage of partially digested food and stomach juices from the pylorus to the duodenum.

Clostridium botulinum blocks

ACH and results in paralysis -anaerobic

Cerebral Edema

An increase in brain volume -Occurs with an increase in water and sodium content

Coronary Artery Disease (CAD) may cause (6)

Angina Myocardial infarction or heart attack Cardiac arrhythmias Conduction defects Heart failure Sudden death

The nurse is caring for a client who is concerned he may have contracted hepatitis C from a sexual partner. Which of these is it correct for the nurse to teach the client about this disease?

Antibodies may be detected in the blood in 6 to 8 weeks.

Hypoglycemia

Any blood glucose concentration of less than 70 mg/dL, with or without symptoms Signs and symptoms of hypoglycemia can be divided into two categories: a) those caused by altered brain function (The brain is reliant on glucose as the major energy source) b) those related to activation of the autonomic nervous system

Although pressure pulses usually are not transmitted to the capillaries, there are situations in which this does occur. Under what conditions do cardiac pulsations occur? Select all that apply.

Aortic regurgitation Patent ductus arteriosus

Characteristics of Urine (2 pts)

Approximately 95% water and 5% dissolved solids Contains metabolic wastes and few or no plasma proteins, blood cells, or glucose molecules

The nurse teaches the client with acute pancreatitis that the pain is caused by prematurely activated pancreatic enzymes that have leaked into surrounding tissues, causing which outcome?

Autodigestion Explanation: Acute pancreatitis is associated with activated pancreatic enzymes inside the pancreas and surrounding tissues. These enzymes cause fat necrosis, or autodigestion, of the pancreas. Alcohol is known to be a potent stimulator of pancreatic secretions, and it also is known to cause partial obstruction of the sphincter of the pancreatic duct, rather than bowel obstruction. Acute pancreatitis also is associated with viral infections, abdominal and surgical trauma, and thiazide diuretics.

The nurse is caring for a group of clients with diabetes. Which method will the nurse most frequently use to determine the client's insulin levels?

Capillary blood glucose reading

CHOL(E)= indicating

BILE or gall

Hypercapnia

Build up of carbon dioxide in the blood

Asthma & Causes (4)

Chronic disorder of the airways -Caused by airway obstruction, bronchial hyperresponsiveness, airway inflammation, and airway remodeling

Purkinje fibers

supplies the ventricles

Order of signals that are sent via neurons

Dendrites to cell body to axon

Swallowing Mechanism

Depends on the coordinated action of the tongue and pharynx -These structures are innervated by cranial nerves V, IX, X, and XII.

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

Depression Inattentiveness Forgetfulness Explanation: Psychological manifestations, such as mood swings, may represent an emotional reaction to the nature of the disease or, more likely, involvement of the white matter of the cerebral cortex. Depression, euphoria, inattentiveness, apathy, forgetfulness, and loss of memory may occur.

Acute Complication of Diabetes Mellitus (3)

Diabetic ketoacidosis Hyperosmolar hyperglycemic state Hypoglycemia

2 Types of Horns of the Spinal Cord

Dorsal (from the back) horns: those that extend posterior o Contain IA neurons that receive afferent impulses through the dorsal roots and other connecting neurons Ventral (forward) horns: those that extend anteriorly o Contain OA neurons and the efferent LMNs that leave the cord through the ventral roots.

Most uncomplicated UTIs are caused by

E-coli

Cushing Syndrome (Hypercortisolism)

Glucocorticoid Hormone Excess; refers to the manifestations of increase in cortisol from any cause o Pituitary form, which results from excessive production of ACTH by a tumor of the pituitary gland o Adrenal form, caused by a benign or malignant adrenal tumor o Ectopic form, nonpituitary ACTH-secreting tumor

A health care provider suspects a client has heart failure. Which diagnostic procedure would give the staff information about pulmonary capillary pressures, which will lead to the most appropriate interventions?

Hemodynamic monitoring Explanation: Invasive hemodynamic monitoring may be used for assessment in acute, life-threatening episodes of heart failure. -These monitoring methods include: 1) central venous pressure (CVP) 2) pulmonary artery pressure monitoring 3) measurements of cardiac output 4) intra-arterial measurements of blood pressure.

Which laboratory values for a newly admitted client indicate a diagnosis of diabetes mellitus? Select all that apply. Fasting blood glucose level 75 mg/dL (4.16 mmol/L) Hemoglobin A1C 9.1% (.09) 2 hour oral GTT 245 mg/dL (13.6 mmol/L) Serum potassium 4.2 mEq/L (4.2 mmol/L)

Hemoglobin A1C 9.1% (.09) 2 hour oral GTT 245 mg/dL (13.6 mmol/L)

Bilirubin

Hemoglobin from RBC is broken to biliverdin ~> free bilirubin, which passes through the liver and is absorbed inside the hepatocytes ~> conjugated bilirubin, which passes through bile ducts into the small intestine ~> urobilinogen (highly soluble substance), which is absorbed back to the liver to be re-excreted into bile (rids in bile) The substance that gives bile its color The final product of the breakdown of heme (iron atom that reversibly binds oxygen as the blood travels b/t the lungs and the tissues) contained in aged red blood cells

Complications of Peptic Ulcer (3)

Hemorrhage o Caused by bleeding from granulation tissue or from rosion of an ulcer into an artery or vein Obstruction o Caused by edema, spasm, or contraction of scar tissue and interference with the free passage of gastric contents through the pylorus or adjacent areas Perforation o Occurs when an ulcer erodes through all the layers of the stomach or duodenum wall

Which type of stroke is the result of a ruptured blood vessel?

Hemorrhagic

Neurotransmitters are small molecules that exert their actions through specific proteins, called receptors, embedded in the postsynaptic membrane. Where are neurotransmitters synthesized?

In the axon terminal

Esophageal Tears Presumed Pathogenesis

Inadequate relaxation of the esophageal sphincter during vomiting with stretching and tearing of the esophageal junction at the moment of propulsive expulsion of gastric contents

The oxyhemoglobin buffer system changes with the metabolic needs of the tissues. What can cause a shift to the right in the dissociation curve?

Increased tissue metabolism

Pleuritis

Inflammation of the pleural space (in lungs)

Respiratory Pressures (3)

Intrapulmonary Pressure or Alveolar Pressure - Pressure inside the airways and alveoli of the lungs Intrapleural Pressure - Pressure in the pleural cavity Intrathoracic Pressure - Pressure in the thoracic cavity

STEMI (ST-Elevated Myocardial Infarction "heart attack")

Ischemic death of myocardial tissue associated with atherosclerotic disease of the coronary arteries

Acute Renal Failure

Most cases due to impaired renal perfusion or direct injury to the kidneys -Degree is related to severity or duration of shock

Heart Muscle Diseases: Myocarditis & Cardiomyopathies (CM)

Myocarditis: Inflammation of the heart muscle and conduction system without evidence of myocardial infarction Cardiomyopathies (CM) Associated with malfunctioning of the heart muscle that exhibit inappropriate ventricular hypertrophy or dilatation *Mechanical and/or electrical dysfunction; frequently are genetic **Cardiomyopathies can cause sudden death in young athletes because of the malfunction of the heart muscle.

Which statement best conveys an aspect of the respiratory pressures that govern ventilation?

Negative intrapleural pressure holds the lungs against the chest wall. Explanation: Negative intrapleural pressure holds the lungs in place against the chest wall and prevents their natural elastic properties from causing them to collapse.

A neurologic nurse is explaining the structure and function of motor units to a client who has a spinal cord injury. The nurse should describe which components of a motor unit? Select all that apply. Meninges Neuromuscular junction Skeletal muscle Lower motor neuron Cerebrospinal fluid

Neuromuscular junction Skeletal muscle Lower motor neuron

Where are Schwann cells located & what do they do? PNS

Peripheral Nervous System (PNS) -they produce myelin

The nurse is educating a client with a newly diagnosed thyroid cancer. Which testing procedure should be reviewed because it allows good examination of the tissue structure and provides information about the tissue function as well? Ultrasonography Dual-electron x-ray absorptiometry (DEXA) scan Positron emission tomography/CT (PET/CT) Magnetic-resonance imaging (MRI)

Positron emission tomography/CT (PET/CT) Explanation: PET/CT imaging is advantageous in that the CT component allows a good examination of the tissue structure, whereas the PET component provides information about tissue function. PET/CT has been demonstrated to be useful in managing thyroid cancers.

The nurse knows that the student understands the major causes of mechanical bowel obstruction when the student states that _____ is a possible cause?

Postoperative adhesions

Acute Lung Injury (ALI)/Acute Respiratory Distress Syndrome (ARDS)

Potentially lethal form of pulmonary injury that may be either the cause or result of shock -Rapid onset of profound dyspnea that usually occurs 12 to 48 hours after the initiating event

A client asks why his blood pressure pills seem to make him go to the bathroom to urinate frequently when they are not water pills (diuretics). Which physiologic process explains the long-term regulation of blood pressure most accurately?

Renal monitoring and adjustment of extracellular fluid volume

Potassium outflow from the cell is characteristic of which phase of the action potential?

Repolarization

The circulatory system is divided into two parts. What does the pulmonary circulation include? Select all that apply.

Right heart Pulmonary artery Pulmonary veins

Nerve Root Injuries

Ruptured intervertebral disk -Sensory deficits Spinal nerve root compression -Paresthesias and numbness Particularly of the leg and foot Knee and ankle reflexes also may be diminished or absent -Motor weakness

A child is experiencing difficulty with chewing and swallowing. The nurse knows that which cells may be innervating specialized gut-related receptors that provide taste and smell?

Special visceral afferent cells

The vertebral column provides protection of which parts of the body? Select all that apply. Spinal cord Spinal nerves Supporting structures Muscles Tendons

Spinal cord Spinal nerves Supporting structures

Esophageal Cancer

Squamous cell carcinoma --Alcohol and tobacco use Adenocarcinoma --Barrett esophagus

A 68-year-old black man who has smoked for at least 50 years reports that lately he feels as though food is getting stuck in his throat. At first this was a problem just with dry food, but now his morning oatmeal is getting "stuck." On questioning, he reports drinking at least 3 alcoholic beverages nearly every day. Which is most likely his problem? Achalasia Squamous cell carcinoma of the esophagus Dysphagia secondary to scleroderma Gastrointestinal reflux disease

Squamous cell carcinoma of the esophagus Explanation: Squamous cell carcinoma of the esophagus is the seventh leading cause of cancer death among men, particularly black men; mean age at diagnosis is 67 years. Alcohol and tobacco use are the main risk factors for this cancer, and dysphagia is a common presenting complaint.

Symptoms of Stroke/TIA

Sudden in onset, focal, and usually one sided -Common symptoms are a facial droop, arm weakness, and slurred speech -Other frequent stroke symptoms are unilateral numbness, vision loss in one eye or to one side (hemianopia), language disturbance, and sudden, unexplained imbalance (ataxia) -TIA symptoms resolve spontaneously, usually within minutes, although the underlying mechanisms are the same as for stroke

Sulci (sulcus - singular) & Gyri (gyrus - singular)

Sulci - groove in cerebral cortex Gyri - folds or bumps in the brain

S&S of Hypoglycemia (9)

Sweating Nervousness Hunger Mental confusion Argumentative Tremors Diaphoresis Loss of consciousness leading to seizures, coma and death COLD AND CLAMMY, NEED SOME CANDY!

Compensatory mechanisms of Circulatory Failure (Shock)

Sympathetic and renal systems

Findings in dilated cardiomyopathy (3)

Systolic dysfunction Enlarged chamber size Orthopnea

The nurse is assessing the ECG of a client who is experiencing unstable angina. The nurse observes:

T-wave changes Explanation: Unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI) is a clinical syndrome of myocardial ischemia ranging from angina to myocardial infarction. The ECG pattern associated with NSTEMI may display normal or ST-segment depression (or transient ST-segment elevation) and T-wave changes

Which clinical manifestations following thyroidectomy would alert the nurse that the client is going into a life-threatening thyroid storm? Select all that apply. Temperature of 104.2°F (40.1°C) Telemetry showing heart rate of 184 Unable to close eyelids completely together Extremely agitated Bruising on knees and feet

Temperature of 104.2°F (40.1°C) Telemetry showing heart rate of 184 Extremely agitated

Diabetic Complications Related to Counter-Regulatory Mechanisms of Glucose Control

The Somogyi effect The Dawn phenomenon

Appendicitis

The appendix becomes inflamed, swollen, and gangrenous, and it eventually perforates if not treated. -Appendicitis is related to intraluminal obstruction with a fecalith (i.e., hard piece of stool), gallstones, tumors, parasites, or lymphatic tissue.

When thinking in terms of airway radius with regard to resistance, the lung structure responsible for the most airway resistance to airflow would be:

The bronchioles near the trachea

A 60-year-old office worker has presented to a clinic reporting recent episodes of lower back pain. Which component of the client's assessment and history would be most indicative of a serious pathologic process? The client's pain is unrelieved by extended bed rest. When supine, passive raising of the leg to 90° results in hamstring pain. The client has needed regular nonsteroidal anti-inflammatory drugs to control the pain in recent weeks. The client's onset of pain has been gradual and the client has no prior history of back problems.

The client's onset of pain has been gradual and the client has no prior history of back problems.

4 Common Pathways of Brain Damage

The effects of ischemia Excitatory amino acid injury Cerebral edema Injury due to increased intracranial pressure (ICP)

When a client develops a pericardial effusion, which factors will influence what effect it will have on cardiac function? (3)

The elasticity of the pericardium Amount of fluid How quickly the fluid accumulates

Ventilation

The movement of air between the atmosphere and the respiratory portion of the lungs

The hallmark manifestations of Cushing syndrome are a moon face, a "buffalo hump" between the shoulder blades, and a protruding abdomen. What other manifestations of Cushing syndrome occur?

Thin extremities and muscle weakness

Vascular Constriction

Vessel spasm constricts the vessel and reduces blood flow. It is a transient event that usually lasts minutes or hours. -Vessel spasm is initiated by endothelial injury and caused by local and humoral mechanisms.

A client has been diagnosed with cholestasis and is experiencing pruritus. The nurse caring for this client should be educating the client about reduced bile flow that will interfere with intestinal absorption of which vitamins? Select all that apply. Vitamin A Vitamin B Vitamin C Vitamin D Vitamin K

Vitamin A Vitamin D Vitamin K

There are three main atrial pressure waves that occur during the cardiac cycle. Which wave occurs during the last part of diastole and is caused by atrial contraction?

a

When vitamin B12 is deficient, the red cells that are produced are

abnormally large because of excess cytoplasmic growth and structural proteins.

Two patterns of reversible cell injury can be seen: cellular swelling and fatty change. Cellular swelling is usually the result of:

hypoxic cell injury.

CHOLANGI/CHOLEDOCH=

bile duct

A client has developed shock and the physician has instructed the nurse to begin the administration of intravenous dopamine. The nurse anticipates that the medication will:

cause vasodilatation of the coronary blood vessels. Explanation: Dopamine, which is an intermediate compound in the synthesis of norepinephrine, also acts as a neurotransmitter. It is the principal inhibitory transmitter of interconnecting neurons in the sympathetic ganglia. It also has vasodilator effects on renal, splanchnic, and coronary blood vessels when given intravenously and is sometimes used in the treatment of shock. Level of consciousness is not affected.

Achalasia is characterized by

difficulty swallowing and regurgitation.

Anomic aphasia is a *

difficulty with finding singular words

Triglycerides break down into

fatty acids

Beta-1 receptors result in an

increased heart rate and stronger myocardial contraction

Salmonellosis and Shigellosis are

infectious diseases.

The hallmark of vitamin B12 deficiency is

megaloblastic anemia.

Thyroxine (T4) can increase

metabolic rate

Mild persistent asthma requires symptoms that occur

more than two times a week but less than daily.

Clinical Manifestations of Acute Pancreatitis

o Severe, diffuse mid-epigastric pain and back pain o After a heavy meal or ETOH, not relieved with antacids o Abd distention (Board-like), palpable mass, decreased bowel sounds, vomiting (no pain relief) o Rigid, board-like abdomen o Fever, jaundice, mental confusion o Hypovolemia, hypotension, tachycardia (shock) o Respiratory distress, hypoxia, dyspnea, tachypnea o Elevated amylase, lipase, WBC, and hypocalcemia

Functions of the Exocrine Pancreas

o Supplies the insulin and glucagon needed in cell metabolism

Functions of Liver

o Synthesizes glucose, plasma proteins, and blood clotting factors o Carbohydrate, protein, and fat metabolism o Is responsible for the degradation and elimination (metabolism) of drugs and steroid hormones o Production of bile salts o Elimination of bilirubin o Storage of mineral and vitamins o Filtration of blood and removal of bacteria

In hydronephrosis, there is urine-filled dilation of the renal pelvis due to an

obstruction of urine outflow from the kidney

The oral glucose tolerance test measures the body's ability to

remove glucose from the circulatory system.

Arterial thrombi are associated with conditions that produce

turbulent blood flow and platelet adherence.

Extrapyramidal System -Originates in ______ & provides ____

-Originates in the basal ganglia -Provides background for the more crude, supportive movement patterns

Neuromuscular Junction 1) Serves as ____ 2) Consists of _____ 3) The transmission of impulses is mediated by the _______ 4) Acetylcholine binds to _______

1) Serves as a synapse between a motor neuron and a skeletal muscle fiber. 2) Consists of the axon terminals of a motor neuron and a specialized region of the muscle membrane called the motor end-plate 3) The transmission of impulses is mediated by the release of the neurotransmitter acetylcholine (ACh) from the axon terminals. 4) Acetylcholine binds to receptors in the end-plate region of the muscle fiber surface to cause muscle contraction.

At times, it is necessary to give medications that suppress the adrenal glands on a long-term basis. When the suppression of the adrenals becomes chronic, the adrenal glands atrophy. What does the abrupt withdrawal of these suppressive drugs cause?

Acute adrenal insufficiency

The signs and symptoms of abrupt cessation of pharmacologic glucocorticoids closely resemble those of which disease process?

Addison disease

An adult client with growth-hormone deficiency related to hypopituitarism has been taking replacement therapy for several months. The client informs the nurse that she is having pain in the hand and wrist almost constantly. What does the nurse understand is a common side effect of this therapy that seems to have affected this client?

Carpal tunnel syndrome

A client with hypothyroidism has not taken medication for several months, informing the nurse that she lost her insurance and is unable to afford the medication. When assessing the client's temperature tolerance and skin, what does the nurse anticipate finding? Select all that apply. Thin and silky skin and hair Increased perspiration Coarse and dry skin and hair Intolerance to cold Decreased sweating

Coarse and dry skin and hair Intolerance to cold Decreased sweating

The nurse teaches that viral hepatitis damages the liver by which mechanism?

Direct cellular injury

A client diagnosed with metabolic syndrome and growth hormone (GH) deficiency will likely display which physical assessment finding?

Increased visceral fat Explanation: GH deficiency is associated with a cluster of cardiovascular risk factors including central adiposity (associated with increased visceral fat), insulin resistance, and dyslipidemia. These features also are associated with the metabolic syndrome.

The nurse recognizes which intervention is essential to reduce the pain of acute pancreatitis?

Withholding food and fluid

Cholestasis is a condition in which there is a decrease in bile flow through the intrahepatic canaliculi and a reduction in secretion of water, bilirubin, and bile acids by the hepatocytes. Cholestasis can have more than one cause, but in all types of cholestasis, there is:

accumulation of bile pigment in the liver.

Capillary blood glucose measures the

current level of circulating glucose.

The nurse is implementing a plan of care for a client who has developed acute pancreatitis. It is most important for the nurse to:

initiate gastric suctioning to prevent the synthesis of pancreatic enzymes.

Reflexes are

involuntary motor responses initiated by a stimulus at peripheral receptors **Reflexes are coordinated and involuntary** -Work as long as the spinal cord is intact

A client is suspected to have developed primary biliary cirrhosis. While taking the client's history, the nurse will note that the earliest symptoms of this disorder include:

itching, fatigue, and dark urine.

4 Clinical Manifestations of Parkinson Disease

1) Tremor 2) Postural changes 3) Rigidity 4) Bradykinesia

What should the nurse teach a client who is diagnosed with chronic hepatitis B infection about treatment? "Antiretroviral medications work for HIV, but not for hepatitis B." "You will need evaluation for a liver transplant in a few months." "The treatment is effective if your liver enzymes return to normal." "Steroids are often used to control hepatitis B infection."

"The treatment is effective if your liver enzymes return to normal."

3 Types of Brain Herniation

1) cingulate 2) central transtentorial 3) uncal

Major Functions of Thyroid Hormone (2)

1. Increases metabolism 2. Protein synthesis -Influence growth and development in children o Mental development and attainment of sexual maturity

What percentage of the body's oxygen does the brain consume?

20%

The nurse educates a client newly diagnosed with diabetes regarding diet and energy requirements. The nurse knows that 1 gram of fat will provide _____ kcal of energy.

9

A client with high blood pressure has swollen ankles. Which physiologic factor could relieve this condition?

A decrease in the hydrostatic pressure that drives fluid into the tissue

The Aldosterone Antagonists (potassium-sparing diuretics)

Aldosterone regulates the reabsorption of sodium and and also increases potassium secretion in the late distal tubule and cortical collecting tubule site regulated by aldosterone

Mechanism of Controlling Coordinated Movements: Agonists Antagonists Synergists

Agonists- Promote movement Antagonists- Oppose movement Synergists- assist the agonist muscles by stabilizing a joint or contributing additional force to the movement

What description is characteristic of the pathology of chronic bronchitis?

Airways are obstructed by mucus, causing hypoxemia. Explanation: Chronic bronchitis is a progressive obstructive lung disorder in which the airways are blocked by mucus or inflammation.

Which of the following may result in the development of a cardiomyopathy? A. Valvular stenosis B. Valvular regurgitation C. MI D. Ischemia E. All the above F. None of the above

All the above Rationale: All the above can contribute to the development of a cardiomyopathy.

When CO2 levels in the blood rise, a state of hypercapnia occurs in the body. What factors contribute to hypercapnia? Select all that apply. Alteration in carbon dioxide production Abnormalities in respiratory function Disturbance in gas exchange function Decrease in carbon dioxide production Changes in neural control of respiration

Alteration in carbon dioxide production Abnormalities in respiratory function Disturbance in gas exchange function Changes in neural control of respiration

The nurse is performing an assessment for a client with Cushing syndrome and observes a "buffalo hump" on the back, a moon face, and a protruding abdomen. What does the nurse understand contributes to the distribution of fat in these areas?

Altered fat metabolism

Hematemesis

Blood in the vomitus o May be bright red or have coffee ground appearance -GI Tract Bleeding

Upper Motoneuron Lesions

Can involve the motor cortex, the internal capsule, or other brain structures through which the corticospinal or corticobulbar tracts descend, or the spinal cord

The nurse is caring for an adult client with growth hormone deficiency. When performing an assessment of this client, which system should the nurse be sure to assess for complications related to this disorder?

Cardiovascular system -Evidence shows that cardiovascular mortality increases in GH-deficient adults. A higher prevalence of atherosclerotic plaques and endothelial dysfunction has been reported in both childhood and adult GH deficiency. The GH deficiency syndrome is associated with a cluster of cardiovascular risk factors, including central adiposity, insulin resistance, and dyslipidemia.

Many drugs are metabolized and detoxified in the liver. Most drug metabolizing occurs in the central zones of the liver. What condition is caused by these drug-metabolizing actions?

Centrilobular necrosis

The nurse assesses a client who is vomiting to ensure that which protective physiologic change is occurring during the act of vomiting?

Cessation of respiration

A client with persistent, recurring episodes of epigastric and upper left quadrant pain and anorexia, nausea, vomiting, constipation, and flatulence has been diagnosed with chronic pancreatitis. What is the cause of the symptoms of chronic pancreatitis?

Destruction of both the endocrine and exocrine pancreas

A nurse is reviewing laboratory results of a client with impaired liver function and anticipating which abnormal result indicating injury to liver cells?

Liver enzymes

Lower Motoneuron Lesions

Disrupt communication between the muscle and all neural input from spinal cord reflexes, including the stretch reflex, which maintains muscle tone

A 53-year-old woman with a history of chronic alcohol abuse but without visible jaundice comes to the clinic complaining of nausea and weakness. She admits to taking acetaminophen for persistent headaches but denies exceeding the recommended daily dose; she has not taken any other medications. She is suspected of having acetaminophen toxicity. Which diagnostic test finding would implicate a different cause of her symptoms?

Elevated serum HBsAG level Explanation: The presence of HBsAG would suggest that this woman is in the prodromal phase of hepatitis B infection. A normal serum acetaminophen level does not preclude toxicity if the drug is taken over a period of time. Steatosis is fatty infiltration of the liver. Steatosis is often but not exclusively an early histological feature of alcoholic liver disease (therefore, with chronic alcohol abuse, the nurse should expect the client may have steatosis). Drinking heavily without eating can block your liver from releasing stored glucose into your bloodstream, causing hypoglycemia.

Congenital adrenal hyperplasia is a congenital disorder in which a deficiency exists in any of the enzymes necessary for the synthesis of cortisol. Infants of both sexes are affected, although boys are not diagnosed at birth unless of enlarged genitalia. Female infants often have ambiguous genitalia because of the oversecretion of adrenal androgens. What are the manifestations of the ambiguous genitalia caused by congenital adrenal hyperplasia?

Enlarged clitoris, fused labia, and urogenital sinus

Host Factors Contributing to Susceptibility to Drug-Induced Liver Disease (5)

Genetic predisposition Age differences Underlying chronic liver disease Diet and alcohol consumption The use of multiple interacting drugs

Red Blood Cell Development

Erythroblasts are continuously being formed from the pluripotent stem cells in the bone marrow. -They move through a series of divisions to develop into mature red blood cells. -Normoblast to reticulocyte, the red blood cell accumulates hemoglobin as the nucleus condenses and is lost. -The red cell loses its mitochondria and ribosomes.

Loop Diuretics

Exert their effect in the thick ascending loop of Henle

Diabetic ketoacidosis (DKA) in a client with type 1 diabetes occurs when the lack of insulin leads to the release of which physiologic product?

Fatty acids

A 40-year-old man who is morbidly obese and leads a sedentary lifestyle has recently been diagnosed with type 2 diabetes. Which aspects of the man's obesity likely contributed to his new health problem?

Free fatty acids contribute to problems such as beta cell dysfunction and insulin resistance.

Which of the following does not involve an alteration in the esophagus or swallowing? A.Dysphagia B.Odynophagia C.Achalasia D.GERD

GERD Rationale: GERD refers to the backward movement of gastric contents into the esophagus or beyond, into oral cavity or lung. This condition causes heartburn or pyrosis. Dysphagia produces narrowing of the esophagus and difficulty swallowing. Odynophagia is pain on swallowing food or fluids and may be associated with disorders of the esophagus. Achalasia occurs when the lower esophageal sphincter fails to relax due to a disruption in the input from the enteric neural plexus and the vagus nerve.

The nursing student studying cardiomyopathies learns that the primary ones are classified into which categories? Select all that apply.

Genetic Acquired Mixed (based on their etiology)

Alternative anticoagulants that can also help reduce inflammation

Ginger & garlic, amongst other vegetables/oils

What is the major fuel source for the nervous system?

Glucose

Where gas exchange takes place

Lobules -Each lobule consists of: a branch of a terminal bronchiole, an arteriole, the pulmonary capillaries, and a venule.

When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis?

Hashimoto thyroiditis

The nursing instructor, while teaching the physiology of the heart, informs the students that there are 3 major determinants of myocardial oxygen demand, which include the heart rate, left ventricular contractility, and systolic pressure. Which does she tell them is the most important factor in myocardial oxygen demand?

Heart rate

Vascular Disorders that Cause Bleeding (4) **

Hemorrhagic telangiectasia -An uncommon autosomal dominant disorder characterized by thin-walled, dilated capillaries and arterioles Vitamin C deficiency (scurvy) -Results in poor collagen synthesis and failure of the endothelial cells to be cemented together properly, causing a fragile wall Cushing disease -Causes protein wasting and loss of vessel tissue support because of excess cortisol Senile purpura (bruising in elderly persons) -Caused by the aging process

A client diagnosed with liver cancer asks the doctor what the best treatment option is. The most appropriate response would be:

Hepatic resection

Which diagnosis causes an increased risk of developing intrahepatic jaundice? Select all that apply. Hepatitis Cirrhosis Cholelithiasis Bile duct malformation Liver cancer

Hepatitis Cirrhosis Liver cancer

The nurse is caring for a client with hepatitis A who is tired of feeling ill. Which of these does the nurse convey to the client?

Hepatitis A symptoms last for 8 weeks.

Endocrine

Hormones are released to circulation to act on a target organ.

Categories of Disturbances of Endocrine Function: Hyperfunction

Hyperfunction: excessive hormone production Causes o Excessive stimulation and hyperplasia of the endocrine gland o Hormone-producing tumor of the gland

Categories of Disturbances of Endocrine Function: Hypofunction

Hypofunction (means decreased function) or decreased hormone production Causes o Gland destruction o Absent receptors o Binding of defective, inactive hormone o Congenital defects o Disruption in blood flow, infection, inflammation, autoimmune responses, or neoplastic growth o Decline in function with aging o Atrophy as the result of drug therapy or unknown reasons o Receptor defects

A 30-year-old client who manages type 2 diabetes with glyburide presents at the emergency room reporting headache, confusion, and tachycardia. The client has come from a party at which the client drank two beers to celebrate running a half-marathon. Which is likely to be the cause of this client's?

Hypoglycemia

Causes of Precocious Sexual Development (5)

Idiopathic Gonadal disease Adrenal disease Hypothalamic disease Benign and malignant tumors of the central nervous system

Congenital Hypothyroidism -If untreated, causes.... -Manifestations of untreated congenital hypothyroidism are referred to as...

If untreated, congenital hypothyroidism causes mental retardation and impairs physical growth. -The manifestations of untreated congenital hypothyroidism are referred to as cretinism

The nurse is assessing antibody levels for a client recovering from hepatitis B. Which antibody does the nurse anticipate will be present at this time?

Immunoglobulin G (IgG)

Coronary Artery Disease (CAD): Define & Most common Cause

Impaired coronary blood flow -Most common cause: atherosclerosis

Causes of Respiratory Failure (3)

Impaired ventilation: Upper airway obstruction Weakness or paralysis of respiratory muscles Chest wall injury Impaired matching of ventilation and perfusion Impaired diffusion- pulmonary edema; respiratory distress syndrome

Hindbrain *

Includes the medulla oblongata, the pons, and the cerebellum. Cerebellum is responsible for coordination of motor movement, such as running, typing, and talking and the like.

A hormone has been synthesized in the rough endoplasmic reticulum of an endocrine cell after which it has moved into the Golgi complex, been packaged in a vesicle, and been released into circulation. Which hormone is synthesized and released in this manner?

Insulin Explanation: Insulin is a peptide hormone; as such, its synthesis and release are vesicle mediated.

Coronary Circulation

Left main coronary artery Left anterior descending artery Circumflex branch Right coronary artery Posterior descending artery -Coronary arteries lie on the surface of the heart

High pressure is on ______ side of heart

Left side

Fine crackles in all lung fields and frothy, pink sputum are common in

Left-sided HF

Cystitis

Lower UTI (type of bacterial infection)

Surfactant

Lines the inner surface of the alveoli to decrease surface tension

Common cause of cardiogenic shock

MI

A client is suspected of having liver cancer. Which diagnostic test would be ordered to confirm the diagnosis?

MRI of the liver

A client with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which process will accompany the actions of the neurotransmitter in a chemical synapse?

More neurotransmitters will cross the synaptic cleft and bond with postsynaptic receptors.

A client presents to the emergency department with some vague symptoms. After history and physical exam, the physician is suspecting the client may have viral hepatitis. Which clinical manifestation leads the nurse to suspect the client is in the prodromal period of viral hepatitis?

Muscle aches and pain along with fatigue

What stores glucose as glycogen?

Muscles & liver

Multiple Organ Dysfunction Syndrome (MODS)

Ominous complication of shock -Rapidly depletes the body's ability to compensate and recover from a shock state -Affects multiple organ systems—lungs, kidneys, liver, brain, heart

Exocrine

Opening w/ ducts to secrete juices -Pancreas & GB

The most common cause of thyrotoxicosis is Graves disease. When assessing this client, the nurse should put priority on which sign/symptom?

Ophthalmopathy

Pyramidal Motor System -Originates in _____ & provides control of _____

Originates in the motor cortex -Provides control of delicate muscle movement

Which disease can result in symptoms that can occur when a brain tumor causes damage to the nigrostriatal pathway?

Parkinson disease

A client is diagnosed with diabetic ketoacidosis (DKA) in the emergency department. Which clinical manifestations will the client likely exhibit?

Polyuria, polydipsia, vomiting, and fatigue

The nurse is caring for the client with extrahepatic cholestasis. Which symptom does the nurse anticipate uncovering during the history and assessment?

Pruritus with consequences of deficient levels of fat-soluble vitamins.

Semilunar valves

Pulmonary valve and Aortic valve

Which vein carries oxygenated blood?*

Pulmonary vein

Functions of the Autonomic Nervous System (ANS)

Regulating, adjusting, and coordinating vital visceral functions: o Blood pressure and blood flow o Body temperature o Respiration o Digestion o Metabolism o Elimination -involuntary functions

Components of the Nervous System "DAVE"

Remember DAVE o DA: Dorsal columns, where Afferent (sensory=input) neurons are located o VE: Ventral columns, where Efferent (motor=output) neurons are located

Spinal Reflexes: Segmental Reflexes vs. Suprasegmental Reflexes *

Segmental Reflexes o Involve neurons in a single cord segment (i.e., segmental reflexes) Suprasegmental Reflexes o Involve structures in the brain

What intervention does the nurse suggest to a client experiencing pain associated with pancreatic cancer?

Sleeping in a forward sitting position

Cardiac Tamponade

Slow or rapid compression of the heart due to accumulation of fluid, pus, or blood in the pericardial sac

Adrenal sex hormones (androgens)

Steroid hormone produced by the adrenal cortex o Serve mainly as source of androgens for women

Glucocorticoids (cortisol)

Steroid hormone produced by the adrenal cortex; Aid in regulating the metabolic functions of the body and in controlling the inflammatory o Essential for survival in stress situations

Mineralocorticoids (aldosterone)

Steroid hormone produced by the adrenal cortex; Function in sodium, potassium, and water balance

The kidney produces 1,25-dihydroxyvitamin D. This form of vitamin D is responsible for which action in the body?

Stimulates calcium absorption from the intestine

A client has developed the facial appearance that is characteristic of myxedema, along with an enlarged tongue, bradycardia, and voice changes. Which treatment modality is most likely to benefit this client? Synthetic preparations of T3 or T4 Beta-adrenergic blocking drugs (beta-blockers) Corticosteroid replacement therapy Oral or parenteral cortisol replacement

Synthetic preparations of T3 or T4

A parent brings his child to the clinic, concerned about her short stature and asking the nurse if there is a problem with her height. What indication is the nurse aware of when performing the assessment that determines whether this child has short stature?

The child's height is well below the 3rd percentile on several clinic visits.

A client has been recovering from a stroke for several weeks and has been reluctant to participate in physical therapy. As a result, the client has experienced disuse atrophy. The nurse should recognize that the client is experiencing the consequences of which physiologic process?

The diameter of the client's muscle cells has decreased Explanation: Disuse atrophy is the normal process of muscle shrinkage when less work is expected of the muscle. Muscle cells decrease in diameter but do not die.

Acetylcholine

The neurotransmitter for preganglionic neurons for both ANS divisions -skeletal muscle -binds to receptors on the outside of the muscle fiber.

Spinal nerves

The peripheral nerves that carry information to and from the spinal cord

The nurse is interviewing a client who has come in for the first round of radiation treatment of a large, right upper lobe lung tumor. The client asks how the tumor could get so large without causing any pain. The most accurate explanation would be:

There are no pain receptors in the lung tissue.

Epilepsy

a recurrent seizure condition

Patients with Atrial fibrillation are given *

anticoagulants

Acute shortness of breath and bronchoconstriction are associated with

asthma

Some forms of hepatitis are caused by viruses, but not all. For example...

autoimmune-, drug-, fatty-, and alcohol-induced hepatitis.

White matter is mostly

axons (and fewer cell bodies)

The bone marrow is where

blood cells have their origin

Gray matter is mostly

cell bodies

Carpal tunnel syndrome is caused by

compression mononeuropathy.

Multiple sclerosis (MS) is caused by

demyelination of nerve fibers in the brain and spinal cord

Pancreatitis causes severe epigastric pain after _________. S&S include _________.

eating a heavy meal with vino (wine). Signs and symptoms include decreased bowel sounds and a rigid, board-like abdomen.

The primary motor cortex is responsible for

execution of a movement.

The premotor cortex is responsible for

generating a plan of movement

Somatostatin from the pancreas delays intestinal absorption of

glucose.

Liver stores excess glucose as

glycogen

Ultrasonography scanning provides ___________ and is used frequently to aid in visualization of ____________.

good structural imaging, a lesion for biopsy.

The accumulation of serous transudate (clear fluid) in the pleural cavity often is referred to as

hydrothorax

An early feature of chronic bronchitis is

hypertrophy of the submucosal glands in the trachea and the bronchi.

Stimulation tests are used when

hypofunction of an endocrine organ is suspected

A possible outcome for pulmonary edema is

impaired diffusion

Basal ganglia function in the organization of

inherited and highly learned and rather automatic movement programs -They also are involved in cognitive and perception functions.

In the liver, the fatty acids are converted to

ketones

Early signs of decreased LOC

lack of attention and disorientation

Most hormones are regulated by

negative feedback mechanisms (the majority)

A major principle underlying the functioning of the nervous system is that

newer systems control older systems.

Mild intermittent asthma includes

nighttime symptoms occurring less than or equal to two times a month.

Function of Liver & Pancreas

o Produce digestive secretions

The supplemental motor cortex is responsible for

rehearsing motor sequences of movement.

Body tissues obtain glucose from

the blood

ACE inhibitors block

the conversion of angiotensin I to II

Horns of the Spinal Cord

the extensions of the gray matter that form the letter "H"

The alpha receptors affect

vasoconstriction of skeletal muscle

The pituitary is the _________ that tells many target glands and cells to _________

"master gland" secrete or inhibit the appropriate hormones?

Locations of Motoneurons Affected by ALS

**The UMNS of the cerebral cortex The anterior horn cells of the spinal cord The motor nuclei of the brain stem, particularly the hypoglossal nuclei Death of LMNs leads to denervation, with subsequent shrinkage of musculature and muscle fiber atrophy.

Conditions that create increased platelet function (5)

-Atherosclerosis -Diabetes mellitus (blood is thicker b/c too much sugar) -Smoking (causes vasoconstriction) -Elevated blood lipoid and cholesterol levels -Increased platelet levels

Hematopoietic Growth Factors

-Increase peripheral stem cells for transplantation -Accelerate cell proliferation after bone marrow engraftment

Right-sided Heart Failure (body)

-Peripheral edema, weight gain, congestion of viscera, jugular vein distention -Anorexia, Ascites, Liver congestion -Cor pulmonale (often caused by HBP in the arteries of the lung & R ventricle of the heart) **See mnemonic slide to remember this**

Chronic Pancreatitis (3 pts & Complications)

-Persistent, recurring episodes of epigastric and left upper quadrant pain -Attacks are precipitated by alcohol abuse or overeating -Progression leads to non-functioning pancreas o Complications: diabetes and malabsorption syndrome (weight loss and steatorrhea)

Hematopoiesis *

-Production of Blood Cells -Blood cells originate from pluripotent stem cells in the bone marrow. The production of blood cells is called hematopoiesis.

Paralytic (adynamic) obstruction accompanies ______1_____ conditions of the abdomen, occurs early in the course of _____2_____, and can result from chemical irritation caused by ________3_______.

1) inflammatory 2) peritonitis 3) bile, bacterial toxins, electrolyte imbalances as in hypokalemia, and vascular insufficiency.

4 Classifications of Skull Fractures

1) Simple or Linear- a break in the continuity of bone 2) Comminuted- a splintered or multiple fracture line. 3) Depressed- when bone fragments are embedded into the brain tissue, the fracture is said to be depressed. 4) Basilar- a fracture of the bones that form the base of the skull

4 Areas Affected by SCI #2

1) Skin integrity 2) Pain reception 3) Bladder and bowel function 4) Sexual function

Which client should the nurse see first? 1) Pleuritis, respirations 22/min, rates right sided pain with inspiration 7 out of 10. 2) Refractory asthma, PEF 210 mL out of best PEF 450 mL, diminished wheezing. 3) COPD, respirations 22/min, pulse ox 90%, reports fatigue and dyspnea with activity. 4) Bronchitis, increased mucus and painful cough, PEF 390 mL out of best PEF 475 mL.

2) Refractory asthma, PEF 210 mL out of best PEF 450 mL, diminished wheezing. Explanation: The client with the most acute and unstable condition should be seen first. Clients with refractory, or severe, asthma are at increased risk of a fatal asthma attack. When the peak expiratory flow drops below 50%, the air flow is so decreased that lung sounds may be inaudible and wheezing is diminished, indicating the onset of respiratory failure. The other clients are lower priority because they each demonstrate adequate pulmonary function.

PO2 of arterial blood normally is above

80 mm Hg

A 33-year-old client has been admitted to the hospital for the treatment of Graves disease. Which assessment should the client's care team prioritize?

Assessment of the client's vision and oculomotor function

Glomerulus Capillary System

A unique, high-pressure capillary filtration system located between the afferent & the efferent arterioles -Selectively dilates or constricts to regulate glomerular capillary pressure

Which of the following organs is directly responsible for the elements of cholelithiasis? A. Liver B. Gallbladder C. Pancreas D. Biliary tree

A. Liver Rationale: The liver is responsible for metabolizing cholesterol.

Anatomic Shunt vs. Physiologic Shunt

Anatomic Shunt- blood moves from the venous to the arterial side of the circulation without moving through the lungs Physiologic Shunt- mismatching of ventilation and perfusion with the lung; results in insufficient ventilation to provide the O2 needed to oxygenate the blood flowing through the alveolar capillaries

The neurotransmitter most often associated with Excitatory Postsynaptic Potentials (EPSPs) is the amino acid

Glutamate (tells to keep going; speed up)

Anatomy of Neurons & Their Functions (4)

Cell body or soma o Nucleus with DNA and RNA o Cytoplasm-filled Dendrites o Main source of information Axons o Conduct impulses Synaptic terminals or "synapses" - junction/gap o Functional connections

During a thyroid crisis, which medication may increase dissociation of free hormone from the binding proteins, resulting in a worsening effect on the client? Lisinopril, an ACE-inhibitor Atorvastatin, a statin drug Acetylsalicylic acid, a nonsteroidal anti-inflammatory drug (NSAID) Glucophage, a biguanide

Acetylsalicylic acid, a nonsteroidal anti-inflammatory drug (NSAID) Explanation: Acetylsalicylic acid (aspirin) competes with thyroid hormone for binding to transport proteins. When aspirin is administered to people with excessive levels of circulating thyroid hormone, such as during thyroid crisis, serious effects may occur because of the increased dissociation of free hormone from the binding proteins. The other medications do not have this effect.

One-way valves

Atrioventricular valves and semilunar valves are pressure valves that ensure one-way flow.

Which term describes how cells can adapt to changes in threats to survival? Select all that apply

Atrophy Hypertrophy Hyperplasia

Manifestations of Thrombocytopenia *

Bleeding Mucous membranes- nose, mouth, gastrointestinal tract, and uterine cavity -Commonly occurs in small vessels: -Petechiae—pinpoint purplish-red spots (seen almost exclusively in conditions of platelet deficiency) -Purpura—purple areas of bruising

Involved in allergic reactions

Basophils

A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the:

Bicuspid valve/Mitral valve

Which inotropic drugs increase cardiac contractility by increasing the influx of free extracellular calcium ions in the vicinity of the actin and myosin filaments?

Cardiac glycosides

Which mechanism mediates long-term autoregulation of local blood flow in circulation?

Collateral circulation pg. 623

Helicobacter pylori gastritis

Colonize the mucus-secreting epithelial cells of the stomach. *Causes peptic ulcer *Produce enzymes and toxins that have the capacity to interfere with the local protection of the gastric mucosa against acid. Produce intense inflammation. Elicit an immune response.

Which disorders are grouped under the category of inflammatory bowel disease? Select all that apply. Crohn disease Ulcerative colitis Celiac disease Salmonellosis Shigellosis

Crohn disease Ulcerative colitis

Useful Hematopoietic Growth Factors (4)

EPO TPO G-CSF GM-CSF

A MAJOR common sign of shock

Hypotension

Which physiologic response results from hyperinflation of the lungs that is seen in emphysema?

Increased total lung capacity Explanation: Emphysema is characterized by a loss of lung elasticity and abnormal enlargement of the air spaces distal to the terminal bronchioles with destruction of the alveolar walls. Enlargement of the alveolar air spaces lead to hyperinflation of the lungs and produce an increase in total lung capacity.

Types of Diarrhea

Large Volume o Osmotic o Secretory Small Volume o Inflammatory bowel disease o Infectious disease o Irritable colon

Effects of Growth Hormone Excess in Adults

Overgrowth of the cartilaginous parts of the skeleton Enlargement of the heart and other organs of the body Metabolic disturbances resulting in altered fat metabolism and impaired glucose tolerance

A client is being treated for the ingestion of a neurotoxin that interferes with the depolarization phase of action potentials. What physiologic process will be disrupted?

The inflow of sodium ions

"Angio" =

blood cells

Norepinephrine is responsible for

controlling blood pressure

The most common cause of C. botulinum in infants is:

ingestion of honey products containing C. botulinum spores. -Infants younger than one year of age have immature gastrointestinal tracts, allowing growth of C botulinum spores.

Brain scans may be advised after

initial suppression testing if a tumor is suspected

Afferent or sensory neurons

o Carry information to the CNS ~feeling

A newly introduced diagnostic test has been found to produce unacceptably low levels of reliability. The nurse should recognize that the test:

yields inconsistent results when repeated.

S&S Common to GI Disorders

Anorexia N/V/D Gastrointestinal bleeding

Major Causes of Gastric Irritation & Ulcer Formation (2)

Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) -Irritate the gastric mucosa and inhibit prostaglandin synthesis (from inside out) Infection with H. pylori (Helicobacter pylori) o Causes peptic ulcer o Thrives in an acid environment of the stomach o Disrupts the mucosal barrier that protects the stomach from harmful effects of its digestive enzymes

A toddler seems to have a little "cold" and runny nose. During the night, the parents awaken hearing a "tight" coughing sound. On arrival to the emergency department, the nurses suspect bronchial asthma based on which assessment data? Select all that apply. Audible wheezing "Crowing sound with inspiration" Respiratory rate—44 with prolonged exhalation Coughing up blood-tinged sputum Sitting upright, leaning forward, and using accessory muscles to breathe

Audible wheezing Respiratory rate—44 with prolonged exhalation Sitting upright, leaning forward, and using accessory muscles to breathe Explanation: Bronchial asthma represents a reversible form of obstructive airway disease caused by narrowing of airways due to bronchospasms, inflammation, and increased airway secretions. Healthy children develop what may seem to be a cold with rhinorrhea, rapidly followed by irritability, a tight and nonproductive cough, wheezing, tachypnea (respiratory rate—44), dyspnea with prolonged expiration, and use of accessory muscles of respiration. Cyanosis, hyperinflation of the chest, and tachycardia indicate increasing severity of the asthma attack.

Expressive aphasia

Characterized by partial loss of the ability to produce language (spoken, manual, or written), although comprehension generally remains intact.

Preventative Treatment of Kidney Stones (3)

-Dietary restriction/changes -Increased fluid intake -Thiazide diuretics

Mechanisms of Liver Injury in Viral Hepatitis

-Direct cellular injury -Induction of immune responses against the viral antigens

Alterations of Swallowing (3)

-Dysphagia: Difficulty in swallowing -Odynophagia: Painful swallowing -Achalasia: Failure of the esophageal sphincter to relax

Causes of Aplastic Anemia

-exposure to high doses of radiation, chemicals, and toxins that suppress hematopoiesis directly or through immune mechanisms.

Neurons communicate through the use of synapses. These synapses may link neurons into functional circuits. What is the most common type of synapse?

Chemical synapse

The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.

Tricuspid Mitral

Which nerve exits the pons and conveys the modalities of pain, temperature, touch, and proprioception to the superficial and deep regions of the face?

Trigeminal nerve

S&S Hyperglycemia (11)

Unusual thirst Frequent urination Fatigue and weakness Blurred vision Abdominal pains Nausea and vomiting Rapid weight loss Skin infections Changed mental status Warm, dry, flushed skin HOT AND DRY=SUGAR HIGH

Disseminated Intravascular Coagulation (DIC)

Widespread activation of the coagulation system with resultant formation of fibrin clots and thrombotic occlusion of small and midsized vessels -Systemic formation of thrombin

Bundle of His (AV bundle)

slows even more than AV node

The most common cause of COPD is

smoking

A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have?

Will prevent the conversion of angiotensin I to angiotensin II

Eggs have

all the amino acids

A client with advanced chronic obstructive pulmonary disease (COPD) has been taught methods to maintain maximum functioning. Which client statement indicates accurate understanding of the instructions? "I will spend more time standing to increase my endurance." "I will use my albuterol daily to reduce symptoms." "I will eat smaller, more frequent meals and reduce fluids in the evening." "I will skip church during flu season and wear a scarf when out in the cold."

"I will skip church during flu season and wear a scarf when out in the cold." Explanation: Instructions to improve respiratory function include physical conditioning and pulmonary rehabilitation, to reorganize work for energy conservation, to avoid crowds and gatherings where flu or other upper respiratory conditions are common, to engage in activities that provide psychosocial support, and to take medications as prescribed. pg. 820

Mneumonic for Left-sided Heart Failure S&S

"Purgatory Chasm Descends Sinners Downward Evermore" Pulmonary edema Cough w/ frothy sputum Decreased CO Signs of hypoxia Dyspnea/DOE Elevated pulmonary venous pressure

A client awakes after being in a coma several days following a traumatic head injury. The client is able to give the family a detailed account of what was said at the bedside while the client was in a coma. The family asks the nurse, "How is this possible?" Which response is most accurate?

"The thalamus can interpret highly emotional auditory experiences and remember them." Explanation: The thalamus is divided into distinct nuclei, which are the major relay stations for information going to and from the cerebral cortex. All sensory pathways have direct projections to thalamic nuclei, which conveys the information to restricted areas of the sensory cortex. Coordination and integration of peripheral sensory stimuli occur in the thalamus, along with some crude interpretation of highly emotional-laden auditory experiences that not only occur but can be remembered. For example, a person can recover from a deep coma in which cerebral cortex activity is minimal and remember some of what is said at the bedside.

A toddler is displaying signs/symptoms of weakness and muscle atrophy. The pediatric neurologist suspects it may be a lower motor neuron disease called spinal muscular atrophy (SMA). The client's family asks how he got this. The nurse will respond: "This could result from playing in soil and then ingesting bacteria that is now attaching his motor neurons." "No one really knows how this disease is formed. We just know that in time, he may grow out of it." "This is a degenerative disorder that tends to be inherited as an autosomal recessive trait." "This is a segmental demyelination disorder that affects all nerve roots and eventually all muscle groups as well."

"This is a degenerative disorder that tends to be inherited as an autosomal recessive trait."

A client with an ST elevation myocardial infarction (STEMI) receives a coronary stent in the obstructed vessel. Which instruction will the client receive for the immediate postprocedure period?

"Watch for bleeding at the catheter insertion site." Explanation: A client with a stent placement will follow protocols similar to a cardiac catheterization. The leg should be kept straight for 6-8 hours. The client should monitor for bleeding at the insertion site, and the client should take a daily dose of aspirin or clopidogrel to prevent thrombosis long term

A client's primary care provider has prescribed an oral glucose tolerance test (GTT) as a screening measure for diabetes. Which instruction should the client be given? "You will drink a sugar solution and then your blood sugar will be measured at specified intervals." "Your blood sugar will be checked when fasting and then 2 hours after you eat a meal." "You will have a sample taken to measure how much sugar is attached to your red blood cells." "You will be given a sugary drink and then have blood glucose measured once 2 hours later."

"You will drink a sugar solution and then your blood sugar will be measured at specified intervals."

A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which statement by the physician best captures an aspect of these differences?

"You'll find that, in pediatric clients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles."

Forebrain *

(Front area) Consists of two hemispheres covered by the cerebral cortex, contains central masses of gray matter, the basal ganglia, and the rostral end of the neural tube, the diencephalon with its adult derivatives—the thalamus and hypothalamus. Basal ganglia

Clinical Manifestations of Hypovolemic Shock

*Depend on severity 1) Thirst 2) Increased HR 3) Cool and clammy 4) Decreased arterial BP 5) Decreased U/O 6) Mental changes

Upon admission to the ICU, a client with a history of cor pulmonale will likely be exhibiting which clinical manifestations of right-sided heart failure? Select all that apply. Fine crackles throughout both lung fields +4 pitting edema in lower extremities Expectorating copious amounts of frothy, pink sputum Jugular vein distension Altered level of consciousness

+4 pitting edema in lower extremities Altered level of consciousness Jugular vein distension (Altered level of consciousness may occur as the result of carbon dioxide retention.)

When discussing the AV node's role in the electrical conduction of the heart with a client newly diagnosed with an AV block, which statements are accurate? Select all that apply.

-A block at the AV bundle of His interferes with the normal delay of the impulse, thereby interfering with complete ejection of blood from the atria prior to ventricular contraction. -When there is an AV block, impulses from the atria and ventricles beat independently of each other, so the heart rhythm is usually chaotic and irregular.

Control of Hormone Levels

-Affected by diurnal fluctuations that vary with the sleep-wake cycle o Growth hormone (GH) and adrenocorticotropic hormone (ACTH) -Secreted in a complicated cyclic manner o Female sex hormones -Regulated by feedback mechanisms that monitor substances such as glucose (insulin) and water (ADH) in the body -Regulated by feedback mechanisms that involve the hypothalamic-pituitary target cell system

Colorectal Cancers

-Age -Family history -Crohn disease -Ulcerative colitis -Familial adenomatous polyposis -Diet Stool occult blood tests Digital rectal examination X-ray studies using barium (e.g., barium enema) Flexible sigmoidoscopy and colonoscopy

Elements of the Hematopoietic System (3)

-All the blood cells and their precursors (what brings it about) -The bone marrow, where blood cells have their origin -The lymphoid tissues where some blood cells circulate as they develop and mature

Structure of the Lungs: Apex, Base, & Pleura

-Apex: upper part of the lung; lies against the top of the thoracic cavity -Base: lower part of the lung; lies against the diaphragm -Pleura: Transparent double layered membrane that lines the thoracic cavity, supporting and protecting the lungs.

Prevention of GERD (7)

-Avoiding large meals -Avoiding alcohol use and smoking -Eating meals sitting up -Avoiding recumbent position several hours after a meal -Avoiding bending for long periods -Sleeping with the head elevated -Losing weight if overweight

Growth Hormone Excess (Before puberty & After puberty)

-Before puberty: gigantism (Gigantism: a rare condition that causes abnormal growth in children. This change is most notable in terms of height, but girth is affected as well. It occurs when your child's pituitary gland makes too much growth hormone, which is also known as somatotropin) -After puberty: acromegaly (Acromegaly: a hormonal disorder that develops when your pituitary gland produces too much growth hormone during adulthood. When this happens, your bones increase in size, including those of your hands, feet and face)

Function of Hormones Produced by the Anterior Pituitary

-Body growth and metabolism (GH) -Function of the thyroid gland (TSH) -Glucocorticoid hormone levels (ACTH) -Function of the gonads (FSH and LH) -Breast growth and milk production (Prolactin) -Regulates melanin production of melanocyte-stimulating hormones (MSH). MSH is produced in the intermediate part of the pituitary gland. MSH regulates the production of melanin which provides protection against harmful ultraviolet rays from the sun.

Constrictive Pericarditis (2 pts) & S&S

-Calcified scar tissue develops between the visceral and parietal layers of the serous pericardium -Cardiac output and cardiac reserve become fixed S&S: ascites, pedal edema, dyspnea on exertion, and fatigue, Kussmaul sign

Causes of Pancreatic Cancer

-Cause of pancreatic cancer is unknown. -Smoking appears to be a major risk factor -The second most important factor appears to be diet: o Increasing total calorie intake o High intake of fat, meat, salt, dehydrated foods, fried foods, refined sugars, soy beans, and nitrosamines

S&S of Addison Disease

-Caused by destruction of the adrenal gland and glucocorticoid insufficiency S&S: Anorexia and weight loss Fatigue and weakness Gastrointestinal symptoms, nausea, diarrhea Myalgia, arthralgia, abdominal pain Orthostatic hypotension Hyponatremia Hyperkalemia Hyper pigmentation Secondary deficiency of select hormones Associated autoimmune conditions -a clinical finding of adrenal insufficiency

Platelets (PLT)/Thrombocytes (3)

-Circulating cell fragments of the large megakaryocytes -Function to form the platelet plug to help control bleeding -8 to 9 days in circulation

Globulins (Plasma Protein) *

-Comprise approximately 38% of plasma proteins -Alpha globulins transport bilirubin and steroids. -Beta globulins transport iron and copper. -Gamma globulins constitute the antibodies of the immune system.

Albumin (Plasma Protein) *

-Comprises approximately 54% of the plasma proteins -Contributes to plasma osmotic pressure and the maintenance of blood volume -Serves as a carrier for certain substances

Causes of Tall Stature

-Constitutional tall stature o A child who is taller than his or her peers and is growing at a velocity that is within the normal range for bone age -Genetically tall -Others o Marfan syndrome o Endocrine causes: -Sexual precocity - early onset of estrogen and androgen secretion and excessive GH

Kidney Stones Define & Requirements for Formation (2)

-Crystalline structures that form from components of the urine Requirements for formation: o A nidus to form o A urinary environment that supports continued crystallization of stone components

An acutely ill client is developing multiple organ dysfunction syndrome (MODS). The nurse knows that which statements regarding multiple organ dysfunction syndrome are accurate? Select all that apply. (4)

-Homeostasis is disrupted. -Risk factors for development of MODS include severe trauma, hepatic dysfunction, and prolonged hypotension. -Organs affected include kidneys, lungs, liver, brain, and heart. -Treatment is primarily supportive of the affected organs.

*Clinical Manifestations of Sepsis & Septic Shock (7)

-Hypotension -Hypovolemia -Warm, flushed skin -Fever -Increased WBCs -Elevated lactate/metabolic acidosis -Tissue hypoxia

Hypothalamic Hormones Regulating the Secretion of Anterior Pituitary Hormones

-Hypothalamus = releasing hormones to the anterior pituitary gland -The anterior pituitary release the following hormones: *Growth hormone (GHRH) *Somatostatin *Luteinizing hormone *Follicle-stimulating hormone (FSH) *Thyroid stimulating hormone (TSH)

Locations of Hormonal Glands (10)

-Hypothalamus: releasing and inhibiting hormones -Anterior and Posterior Pituitary: Growth hormone ADH -Adrenal cortex: aldosterone, cortisol -Adrenal medulla: epinephrine, norepinephrine -Thyroid: T3 & T4 -Parathyroid: parathyroid hormone (PTH) -Pancreatic islet cells: insulin -Kidney: 1,25-dihydroxy vitamin D -Ovaries: Estrogen -Testes: Testosterone

Conditions Causing Altered Intestinal Function (7)

-Irritable bowel disease -Inflammatory bowel disease -Diverticulitis -Appendicitis - Right lower quadrant -Alterations in bowel motility -Malabsorption syndrome -Cancer of the colon and rectum

Precocious Puberty

-Isosexual precocious puberty is early activation of the hypothalamic-pituitary-gonadal axis. o Resulting in the development of appropriate sexual characteristics and fertility -Persons with precocious puberty usually are tall for their age as children but short as adults because of the early closure of the epiphyses.

The nurse is evaluating a client who is in her last month of pregnancy and at risk for peripartum cardiomyopathy. Which is the most appropriate information for the nurse to consider? Select all that apply. It is an acquired cardiomyopathy. It is a disorder that can occur in the last month of pregnancy. The incidence is greater in women with twin fetuses. It is a disorder that can occur 1 year after delivery. The incidence is greater in white women.

-It is a disorder that can occur in the last month of pregnancy. -It is an acquired cardiomyopathy. -The incidence is greater in women with twin fetuses.

Endocrine Functions of the Kidney

-Juxtaglomerular Complex - releases renin which starts the renin-angiotensin-aldosterone pathway in response to decreased blood flow. -The Renin-Angiotensin-Aldosterone Mechanism -plays important part in regulation of blood pressure -Erythropoietin - regulates the differentiation of red blood cells in bone marrow -Vitamin D

Fibrinogen (Plasma Protein) *

-Makes up approximately 7% of the plasma proteins -Is converted to fibrin in the clotting process

Intestinal Obstruction (2 pts)

-Mechanical obstruction can result from post operative causes such as external hernia and postoperative adhesions. -Paralytic, or adynamic, obstruction results from neurogenic or muscular impairment of peristalsis.

S&S of Hypothyroidism

-Mental and physical sluggishness -Myxedema -Somnolence -Decreased cardiac output, bradycardia -Constipation -Decreased appetite -Hypoventilation -Cold intolerance -Coarse dry skin and hair -Weight gain

Causes of Acromegaly

-Most common cause (95%): o Somatotrope adenoma -Other causes (<5%) o Excess secretion of GHRH by hypothalamic tumors o Ectopic GHRH secretion by nonendocrine tumors such as carcinoid tumors or small cell lung cancers o Ectopic secretion of GH by nonendocrine tumors

Components of the Neuromuscular System

-Neuromuscular unit containing motoneurons -Myoneural junction -Muscle fibers -Spinal cord -Descending pathways from the brain stem circuits

Disorders of Esophageal Structure: Esophageal Lacerations

-Nonpenetrating mucosal tears -Mm to cm in length -Usually cross gastroesophageal junction -10% all Upper GI bleeding

A common risk factor for Esophageal Tears aka Mallory-Weiss Syndrome

-Often in people with chronic alcoholism after a bout of severe retching or vomiting -Also in those with acute illness with severe vomiting

Clinical Manifestation of Alcohol-Induced Liver Disease & Most deaths from alcoholic cirrhosis are attributed to...

-One of the clinical manifestation of the necrosis of liver cells in alcoholic liver disease is rapid onset of jaundice. -Most deaths from alcoholic cirrhosis are attributable to liver failure, bleeding esophageal varices, or kidney failure.

Disorders of Esophageal Structure: Esophageal Diverticula (3 pts)

-Outpouching of esophageal wall - retains food -Sx: complain food stops before reaches stomach, gurgling, belching, coughing, foul smelling breath -Consequences: esophagitis & ulceration

Characterizations of MS

-exacerbations and remissions over many years in several different sites in the CNS -Initially, there is normal or near-normal neurologic function between exacerbations. -As the disease progresses, there is less improvement between exacerbations and increasing neurologic dysfunction.

Classification of Diabetes

-Prediabetes: Elevated blood glucose that is below the diagnostic criteria for diabetes. -Type 1 DM: Insulin deficiency, usually due to autoimmune disease that destroys the pancreatic beta cells This can also be idiopathic and happen due to other causes. -Type 2 DM: A disease of insulin resistance and eventual destruction of the overworked pancreatic beta-cells. Commonly accompanied by co-occurring clinical manifestations called the "metabolic syndrome." -Gestational DM: Abnormalities of glucose regulation presenting initially during pregnancy, primarily during the second or third trimester. -Diabetes due to other causes: Includes monogenic diabetic syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), as well as diabetes related to conditions such as cystic fibrosis and organ transplantation.

Growth Hormones (Somatotropin)

-Produced by somatotropes in the anterior pituitary -Necessary for linear bone growth in children -Stimulates cells to increase in size and divide more rapidly -Enhances amino acid transport across cell membranes -Increases the rate at which cells use fatty acids -Decreases the rate at which cells use carbohydrates

Functions of Cerebrospinal Fluid (CSF) (3 pts)

-Provides a supporting and protective fluid for the brain and spinal cord. -CSF protects the brain from external forces -Cushions the skull and spine

Left-sided Heart Failure (lungs)

-Pulmonary edema/congestion -Decreased CO, elevated pulmonary venous pressure -Dyspnea, dyspnea on exertion (DOE) -Signs of hypoxia (cyanosis) -Cough with frothy sputum **See mnemonic slide to remember this**

Circulatory Failure (Shock) (2 pts) & Types (4)

-Results in hypoperfusion of organs and tissues -Insufficient supply of oxygen and nutrients for cellular function = cellular hypoxia = SHOCK Types: 1) Cardiogenic 2) Hypovolemic 3) Obstructive 4) Distributive

The ejection fraction (EF)

-SV divided by end-diastolic volume -The percentage of end-diastolic volume ejected during systole. e.g. A client with a history of heart failure has the following echocardiogram results: heart rate 80 beats/minute; end-diastolic volume 120 mL; and end-systolic volume 60 mL. What is this client's ejection fraction (EF)? -50%

Hormone Synthesis & Secretion

-Steroid hormones are secreted upon synthesis. The adrenal cortex produce the following hormones: o Adrenal androgens o Glucocorticoids o Mineralocorticoids -Protein and polypeptide hormones are synthesized and stored in vesicles in the cytoplasm of the endocrine cell until secretion is required

The Lobular Structure of the Liver (4 pts) **

-The liver is the largest visceral organ in the body, weighing approximately 1.3 kg (3 lb) in the adult. -The liver is located below the diaphragm and occupies much of the right hypochondrium. -The liver receives blood from the stomach, spleen and pancreas -The liver is anatomically divided into two large lobes (the right and left lobes) and two smaller lobes (the caudate and quadrate lobes).

When educating the public about hepatitis A, the nurse will stress which accurate teaching points? Select all that apply. Hepatitis is only transmitted via blood; therefore, just don't touch anything that looks like it contains blood. The onset of symptoms include high fever, malaise, abdominal pain, and jaundice. Persons working in various food industries like in a restaurant can pass on hepatitis A if they do not properly wash their hands after going to the toilet. Be careful if traveling to a foreign country since many countries do not require vaccination of their workers. The incubation period averages 25 to 26 weeks following exposure.

-The onset of symptoms include high fever, malaise, abdominal pain, and jaundice. -Persons working in various food industries like in a restaurant can pass on hepatitis A if they do not properly wash their hands after going to the toilet. -Be careful if traveling to a foreign country since many countries do not require vaccination of their workers.

In regards to the bladder, the parasympathetic nervous system promotes ________, while the sympathetic nervous system promotes __________.

-The parasympathetic nervous system promotes bladder emptying. -The sympathetic nervous system promotes bladder filling.

S&S of Hyperthyroidism

-Thyroid storm -Restlessness, irritability, anxiety -Wakefulness -Increased cardiac output -Tachycardia and palpitations -Diarrhea, increased appetite -Dyspnea -Heat intolerance, increased sweating -Thin and silky skin and hair -Weight loss

Type I Alveolar Cells vs. Type II Alveolar Cells

-Type I Alveolar Cells - Flat squamous epithelial cells across which gas exchange takes place -Type II Alveolar Cells - Produce surfactant, a lipoprotein substance that decreases the surface tension in the alveoli and allows for greater ease of lung inflation

Hypopituitarism

-Usually occur gradually -Can present as an acute and life-threatening condition Symptoms: o Being chronically unfit o Weakness and fatigue o Loss of appetite o Impairment of sexual function o Cold intolerance

Causes of Short Stature

-Variants of normal -Low birth weight -Chronic illness and malnutrition -Functional endocrine disorders -Chromosomal disorders -Skeletal abnormalities -Unusual syndromes -Genetic short stature o Be well proportioned and to have a height close to the midparental height of their parents -Constitutional short stature o Have moderately short stature, thin build, delayed skeletal and sexual maturation, and absence of other causes of decreased growth -Protein-calorie malnutrition -Chronic diseases o End-stage renal disease o Poorly controlled diabetes mellitus -Malabsorption syndromes -Excessive glucocorticoid administration -Emotional disturbances

Characteristic of ulcerative colitis (rather than Crohn disease) are (3)

-crypts of Lieberkuhn lesions in the base of the mucosal layer -formation of pinpoint mucosal hemorrhages -development of crypt abscesses that become necrotic

Eosinophils (4) -% of total # of WBC ____ -Increase in # during _____ -Agents associated with ______

1% to 3% of the total number of white blood cells -Increase in number during allergic reactions and parasitic infections -The agents associated with allergic reactions -In parasitic infections, the eosinophils use surface markers to attach themselves to the parasite and then release hydrolytic enzymes.

Predisposing Factors for Endocarditis

1) A damaged endocardial surface 2) A portal of entry by which the organism gains access to the circulatory system -The presence of valvular disease, prosthetic heart valves, or congenital heart defects provides an environment conducive to bacterial growth. -In persons with preexisting valvular or endocardial defects, simple gum massage or an innocuous oral lesion may afford the pathogenic bacteria access to the bloodstream.

Clinical Manifestations of Myocardial Infarction (heart attack) (9)

1) Abrupt-onset 2) Severe and crushing pain, usually substernal, radiating to the left arm, neck, or jaw 3) Nausea and vomiting (n/v) 4) Gastrointestinal complaints (nausea and vomiting) 5) Complaints of fatigue and weakness 6) Tachycardia and feelings of impending doom 7) Anxiety 8) Restlessness 9) Pale, cool, and moist skin

2 Types of Gastritis

1) Acute Gastritis o A transient inflammation of the gastric mucosa o Most commonly associated with local irritants such as bacterial endotoxins, alcohol, and aspirin *usually only lasts a few days 2) Chronic Gastritis o Characterized by the absence of grossly visible erosions and the presence of chronic inflammatory changes (e.g. ulcers) o Leads eventually to atrophy of the glandular epithelium of the stomach

Manifestations of Rheumatic Fever

1) Acute Stage - history of an initiating streptococcal infection -Involves mesenchymal connective tissue of the heart, blood vessels, joints, and subcutaneous tissues 2) Recurrent Phase - extension of the cardiac effects of the disease 3) Chronic Phase -permanent deformity of the heart valves

The nurse should intervene in myocardial ischemia by doing the following ASAP (3)

1) Administer supplemental oxygen 2) Administer vasodilators (e.g. sublingual nitroglycerin) as ordered 3) Transfer patient for appropriate treatment

9 Risk Factors of Stroke

1) Age, sex, race 2) Family/prior history 3) Hypertension 4) Smoking 5) Diabetes mellitus 6) Asymptomatic carotid stenosis 7) Hypercholesterolemia 8) Hypercoagulopathy (i.e. polycythemia, sickle cell) 9) Atrial fibrillation

Causes of Atelectasis (3)

1) Airway obstruction (blocked airway - most common cause) 2) Lung compression such as that occurs in pneumothorax or pleural effusion (pressure from outside the lung - nonobstructive) 3) Increased recoil of the lung due to loss of pulmonary surfactant

S&S of Cushing Syndrome (11)

1) Altered fat metabolism 2) Muscle weakness 3) Moon face 4) Muscle wasting 5) Buffalo hump 6) Purple striae 7) Osteoporosis 8) Derangements in glucose metabolism 9) Hypokalemia 10) Gastric acid secretion 11) Hirsutism, mild acne, and menstrual irregularities

4 Common Signs and Symptoms of Stroke

1) Aphasia - an inability to comprehend or formulate language because of damage to specific brain regions 2) Numbness 3) Headache 4) Hemianopia - when you lose sight in half of your visual field

Causes of Hepatitis (4)

1) Autoimmune disorders 2) Reactions to drugs and toxins (e.g., alcohol) 3) Infectious disorders o Malaria, infectious mononucleosis, salmonellosis, and amebiasis 4) Hepatotropic viruses that primarily affect liver cells or hepatocytes o Direct hepatocyte cellular injury and induction of immune responses against the viral antigens can lead to hepatitis.

6 Areas Affected by SCI #1

1) Autonomic nervous system** 2) Spinal reflexes 3) Ventilation and communication 4) Temperature regulation 5) Edema and deep vein thrombosis 6) Sensorimotor function

Signs of Outflow Obstruction & Urine Retention**

1) Bladder distention 2) Hesitancy (want to go but urine won't come out) 3) Straining when initiating urination (having to force the urine out) 4) Small and weak stream (not a lot when toileting) 5) Frequency (often) 6) Feeling of incomplete bladder emptying 7) Overflow incontinence (the bladder retains too much urine but person doesn't feel the need to go, and then they involuntarily release the urine)

6 Conditions Responding to Use of Hematopoietic Growth Factors

1) Bone marrow failure caused by chemotherapy or aplastic anemia 2) Anemia of kidney failure 3) Hematopoietic neoplasms 4) Infectious diseases such as acquired immunodeficiency syndrome (AIDS) 5) Congenital and myeloproliferative disorders (e.g. leukemia) 6) Some solid tumors

COPD is characterized by (4)

1) Bronchial wall inflammation 2) Bronchial wall fibrosis 3) Hyper-secretion of mucus 4) Loss of elastic lung fibers

2 Components of the Nervous System

1) CNS (Central Nervous System) o Consists of the brain and spinal cord, which are protected by the skull and vertebral column o Concentration of computational and control functions 2) PNS (Peripheral Nervous System) o Found outside the structures of the CNS o Functions as an input-output system for relaying information to the CNS and transmits output messages that control effector organs

Types of Kidney Stones (4)

1) Calcium stones - oxalate or phosphate 2) Magnesium ammonium phosphate stones 3) Uric acid stones 4) Cystine stones

Function of the Plasma Components of Blood (3)

1) Carry the cells that transport gases 2) Aid in body defenses 3) Prevent blood loss

Classification of Coronary Heart Disease (2)

1) Chronic Ischemic Heart Disease -Chronic stable angina, silent myocardial ischemia, and variant or vasospastic angina 2) Acute Coronary Syndromes -Represent the spectrum of ischemic coronary disease ranging from unstable angina through myocardial infarction

3 Types of Hematomas

1) Epidural Hematoma- usually caused by head injury in which the skull is fractured -Develops between the inner table of the bones of the skull and the dura 2) Subdural Hematoma- usually is the result of a tear in the small bridging veins that connect veins on the surface of the cortex to dural sinuses -Develops in the area between the dura and the arachnoid (subdural space) 3) Traumatic Intracerebral Hematomas- may be single or multiple -Occur in any lobe of the brain but are most common in the frontal or temporal lobes

Causes of Jaundice (4)

1) Excessive destruction of red blood cells 2) Impaired uptake of bilirubin by the liver cells 3) Decreased conjugation of bilirubin 4) Obstruction of bile flow in the canaliculi of the hepatic lobules or in the intrahepatic or extrahepatic bile ducts

Alcohol-induced Liver Disease: The spectrum of alcoholic liver disease includes...

1) Fatty liver disease (steatosis): enlarged liver d/t its cells containing fat deposits 2) Alcoholic hepatitis: liver inflammation and cell failure 3) Cirrhosis: scar tissue that blocks sinusoids and bile canaliculi. Cirrhosis represents end-stage liver disease

Treatment Measures to Correct & Reverse Shock (4)

1) Fluid resuscitation 2) Restore blood flow 3) Improve oxygen delivery 4) Hemodynamic stability

3 Types of Injuries to the Vertebral Column

1) Fractures 2) Dislocations 3) Subluxations

Common Causes of Acute Pancreatitis

1) Gallstones (stones in the common duct) 2) Alcohol abuse 3) Hyperlipidemia 4) Hyperparathyroidism 5) Infections (particularly viral) 6) Abdominal and surgical trauma 7) Drugs such as steroids and thiazide diuretics

Actions of Cortisol (6)

1) Glucose metabolism 2) Protein metabolism 3) Fat metabolism 4) Anti-inflammatory action 5) Psychic effect 6) Permissive effect

Manifestations of Liver Failure (5)

1) Hematologic disorders 2) Endocrine disorders 3) Skin disorders 4) Hepatorenal syndrome 5) Hepatic encephalopathy

Define: 1) Hematuria 2) Oliguria 3) Proteinuria 4) Dysuria 5) Anuria

1) Hematuria: Blood in urine 2) Oliguria: Decreased urine output 3) Proteinuria: Protein in the urine 4) Dysuria: Difficulty urinating 5) Anuria: No urine output

3 Regions the Brain is Divided Into

1) Hindbrain 2) Midbrain 3) Forebrain

Mechanisms of Hormone Action

1) Hormones interact with high-affinity receptors. o These are linked to one or more effector system in the cell. 2) Some receptors are located on the surface of the cell. o These act through second messenger mechanisms. 3) Others are located in the cell. o They modulate the synthesis of enzymes, transport proteins, or structural proteins.

Common Causes of Chronic Renal Disease (3 Main, 9 Total)

1) Hypertension 2) Diabetes mellitus 3) Polycystic kidney disease 4) Obstructions of the urinary tract 5) Glomerulonephritis 6) Cancers 7) Autoimmune disorders 8) Diseases of the heart or lungs 9) Chronic use of pain medication

Prerenal Causes of Acute Renal Failure (4)

1) Hypovolemia 2) Decreased vascular filling 3) Heart failure & cardiogenic shock 4) Decreased renal perfusion d/t vasoactive mediators, drugs, diagnostic agents

6 Mechanisms of Brain Injury

1) Hypoxic and Ischemic Injury -Global Ischemia 2) Excitotoxic Brain Injury 3) Increased Intracranial Pressure 4) Brain Herniation- one part of brain keeps swelling, cells push into another part of the brain causing brain to herniate 5) Cerebral Edema 6) Hydrocephalus- too much water in the brian, increasing pressure

Causes of Polyneuropathies (3)

1) Immune mechanisms (Guillain-Barré syndrome) 2) Toxic agents (arsenic polyneuropathy, lead polyneuropathy, alcoholic polyneuropathy) 3) Metabolic diseases (diabetes mellitus, uremia)

3 Manifestations of Anemia

1) Impaired oxygen transport with the resulting compensatory mechanisms 2) Reduction in red cell indices and hemoglobin levels 3) Signs and symptoms associated with the pathologic process that is causing the anemia

Noted compensatory mechanisms for long-standing heart failure are (5)

1) Increased preload 2) Sympathetic stimulation 3) Increased levels of epinephrine and norepinephrine 4) Activation of the renin-angiotensin-aldosterone system 5) Secretion of brain natriuretic peptide (BNP)

2 Types of Stroke

1) Ischemic- no blood, usually blocked by emboli/stenosis Caused by an interruption of blood flow in a cerebral vessel and are the most common type of strokes, accounting for 70% to 80% of all strokes. -Transient Ischemic Attacks (TIAs): brain angina -Thrombotic: large vessel -Lacunar infarct: small vessel -Embolic: cardiogenic 2) Hemorrhagic - caused by bleeding into brain tissue o Usually from a blood vessel rupture caused by hypertension, aneurysms, arteriovenous malformations, head injury, or blood dyscrasias

Risk Factors for Development of Stress Ulcers (7)

1) Large surface area burns 2) Trauma 3) Sepsis 4) Acute respiratory distress syndrome 5) Severe liver failure 6) Major surgical procedures 7) Zollinger-Ellison syndrome

Varying Factors of Hepatotropic Viruses

1) Mode of transmission and incubation period 2) Mechanism, degree, and chronicity of liver damage 3) Ability to evolve to a carrier state

3 Stroke-related Deficits

1) Motor deficits 2) Dysarthria and aphasia 3) Cognitive and other deficits

2 Major Cells of the Nervous System

1) Neurons o Functional information-processing cells o Form a signaling network that includes a motor and sensory system 2) Neuroglia or Neuroglial cells o Protect the nervous system and supply metabolic support

Factors Affecting Response of a Target Cell to a Hormone

1) Number of receptors present o Up-regulation o Down-regulation 2) Affinity of these receptors for hormones o Affected by a number of conditions o For example, the pH of the body fluids plays an important role in the affinity of insulin receptors

3 Statements that are True Regarding the Capillary System

1. Flow out of the system is controlled by hydrostatic pressure. 2. Albumin plays a significant role in maintaining the function of this system. 3. Flow into the system is controlled by colloidal osmotic pressure.

4 Phases of the Acute Kidney Injury Course (AKI)

1) Onset phase: lasts hours or days, is the time from the onset of the precipitating event until tubular injury occurs 2) Oliguric (anuric) phase: lasts 8 to 14 days or longer depending on the nature of AKI; marked decrease in the GFR=decreased urine output 3) Diuretic phase: when the kidneys try to heal and urine output increases, but tubule scarring and damage occur 4) Recovery phase: the period during which tubular edema resolves and renal function improves

4 Layers of the Bladder

1) Outer Serosal Layer - covers upper surface; is continuous with the peritoneum 2) Detrusor Muscle - a network of smooth muscle fibers 3) Submucosal Layer - loose connective tissue 4) Inner Mucosal Lining - transitional epithelium

Common Symptoms of Urinary Obstruction (3)

1) Pain 2) Signs and symptoms of UTI 3) Manifestations of renal dysfunction

Types of Hormone Actions

1) Paracrine Actions o Hormones acting locally on cells other than those that produced the hormone o For example, the action of sex steroids on the ovary 2) Autocrine Actions o Hormones exerting action on the cells from which they were produced/hormones produce a biologic action on the cell that released them. o For example, the release of insulin from pancreatic beta cells can inhibit its release from the same cells.

Categories of Jaundice (3) **

1) Prehepatic o Major cause is excessive hemolysis of red blood cells o Unconjugated bilirubin 2) Intrahepatic o Caused by disorders that directly affect the ability of the liver to remove bilirubin from the blood or conjugate it so it can be eliminated in the bile o Conjugated bilirubin 3) Posthepatic o Occurs when bile flow is obstructed between the liver and the intestine o Conjugated bilirubin

Requirements for Blood Clotting Process (3)

1) Presence of platelets produced in the bone marrow 2) Von Willebrand factor generated by the vessel endothelium and is responsible for platelet adhesion during the process of clotting 3) Clotting factors synthesized in the liver using vitamin K

Stages of Adrenal Cortical Insufficiency (3)

1) Primary adrenal cortical insufficiency (Addison disease) o ACTH levels are elevated because of lack of feedback inhibition. 2) Secondary adrenal cortical insufficiency o Occurs as a result of hypopituitarism or because pituitary gland has been surgically removed 3) Acute adrenal crisis o Life-threatening situation occurs

Categories of Endocrine Disorders **

1) Primary disorders o Originate in the target gland responsible for producing the hormone 2) Secondary disorders o The target gland is normal, but its function is altered by defective levels of stimulating hormones or releasing factors from the pituitary system 3) Tertiary disorders o Result from hypothalamic dysfunction o Both the pituitary and target organ are understimulated

Types of TBIs (Traumatic Brain Injuries) (2)

1) Primary or Direct Injuries -Damage is caused by an impact -Include diffuse axonal injury and the focal lesions of laceration, contusion, and hemorrhage 2)Secondary Injuries -Damage results from the subsequent brain swelling, infection, and cerebral hypoxia. -Often diffuse or multifocal, including concussion, infection, and hypoxic brain injury

Peripheral Nerve Regeneration Factors (2)

1) Proximity to soma 2) Crushing versus cutting

2 Types of Ventilation

1) Pulmonary ventilation: exchange of gases between atmosphere and lungs 2) Alveolar ventilation: exchange of gases within the gas exchange part of the lungs

Laboratory Tests for RBC's (4) *

1) Red blood cell count (RBC)- measures the total number of red blood cells in 1 mm3 of blood 2) Percentage of reticulocytes (normally approximately 1%)- provides an index of the rate of red cell production 3) Hemoglobin (grams per 100 mL of blood)- measures the hemoglobin content of the blood 4) Hematocrit- measures the volume of red cell mass in 100 mL of plasma volume

2 Main Types of Peripheral Nervous Disorders

1) Segmental demyelination: d/o Schwann cell=damage to the myelin sheath 2) Axonal degeneration: injury to neuronal cell body or its axon

S&S of Transfusion Reactions (7) **

1) Sensation of heat along the vein where the blood is being infused 2) Flushing of the face 3) Urticaria, headache, pain in the lumbar area 4) Chills, fever, constricting pain in the chest 5) Cramping pain in the abdomen 6) Nausea, vomiting 7) Tachycardia, hypotension, and dyspnea

Risk Factors for Multiple Organ Dysfunction Syndrome (MODS) (7)

1) Sepsis 2) Prolonged periods of hypotension 3) Hepatic dysfunction 4) Infarcted bowel 5) Advanced age 6) Severe trauma 7) Alcohol abuse

Assessments of Liver Function (5)

1) Serum aminotransferase levels: assess injury to liver cells 2) Serum bilirubin, GGT, and alkaline phosphatase: measure hepatic excretory function 3) Ultrasonography, CT scans, and MRI: evaluate liver structures 4) Angiography: visualizes the hepatic or portal circulation 5) Liver biopsy: used to obtain tissue specimens for microscopic examination

Coronary Artery Disease (CAD): Risk Factors

1) Smoking 2) HTN (hypertension) 3) High LDL 4) Low HDL 5) Diabetes 6) Age 7) Obesity 8) Physical inactivity

Characteristics of Chronic Bronchitis D (10)

1) Smoking history 2) Age of onset 30 to 40 years 3) Barrel chest may be present 4) Shortness of breath, a predominant early symptom* 5) Rhonchi often present* 6) Sputum frequent, an early manifestation* (thick mucus) 7) Often dramatic cyanosis in nail beds, mucous membranes and skin (blue bloater)* 8) Hypercapnia and hypoxemia may be present.* 9) Frequent cor pulmonale and polycythemia 10) Numerous life-threatening episodes due to acute exacerbations*

Characteristics of Type A Pulmonary Emphysema (8)

1) Smoking history 2) Age of onset: 40 to 50 years 3) Often dramatic barrel chest** 4) Weight loss 5) Decreased breath sounds 6) Normal blood gases until late in disease process 7) Cor pulmonale only in advanced cases 8) Slowly debilitating disease

Types of Neurogenic Bladder Disorders (2)

1) Spastic Bladder Dysfunction - Failure to store urine 2) Flaccid Bladder Dysfunction - Bladder emptying is impaired

Lymphocytes (2)

20% to 30% of the total blood leukocytes -Function in the lymph nodes or spleen to defend against microorganisms through the immune response

Types of Incontinence (4)

1) Stress Incontinence - involuntary loss of urine during coughing, laughing, sneezing, or lifting; increases intra-abdominal pressure 2) Urge Incontinence - involuntary loss of urine associated with a strong desire to void (urgency) 3) Overflow Incontinence - involuntary loss of urine that occurs when intravesicular pressure exceeds the maximal urethral pressure because of bladder distention in the absence of detrusor activity 4) Mixed Incontinence - combination of stress and urge incontinence

3 Causes of Injury from Excitatory Amino Acids

1) Stroke 2) Hypoglycemic injury 3) Trauma to chronic degenerative disorders such as Huntington disease and Alzheimer dementia

Causes of Neurogenic Bladder (7)

1) Stroke and advanced age 2) Parkinson disease 3) Spinal cord injury 4) Injury to the sacral cord or spinal roots 5) Radical pelvic surgery 6) Diabetic neuropathies 7) Multiple sclerosis

Factors Affecting Alveolar-Capillary Gas Exchange (4)

1) Surface area available for diffusion 2) Thickness of the alveolar-capillary membrane 3) Partial pressure of alveolar gases 4) Solubility and molecular weight of the gas

2 Divisions of the ANS

1) Sympathetic (internal and peripheral actions) o Maintains vital functions o Responds when there is a critical threat to the integrity—the "fight-or-flight" response o Motor/sensory 2) Parasympathetic (internal actions) - "rest & digest" o Concerned with conservation of energy o Resource replenishment o Maintenance of organ function during inactivity o Sensory/motor

Determining Factors of Renal Clearance (how quickly a substance is removed from the plasma by the kidneys and excreted in the urine)

1) The ability of the substance to be filtered in the glomeruli 2) The capacity of the renal tubules to reabsorb or secrete the substance

3 Major Thyroid-Binding Proteins

1) Thyroid hormone-binding globulin (TBG) o Carries approximately 70% of T4 and T3 2) Thyroxine-binding prealbumin (TBPA) o Binds approximately 10% of circulating T4 and lesser amounts of T3 3) Albumin o Binds approximately 15% of circulating T4 and T3

5 Types of Involuntary Movement Disorders (there are more, these are the main to know)

1) Tremor - Involuntary, oscillating contractions of opposing muscle groups around a joint (usually fairly uniform in frequency and amplitude) 2) Tics 3) Chorea - abnormal writhing movements (dancing-like) 4) Dystonia - abnormal, simultaneous contractions of agonist and antagonist muscles, leading to abnormal postures 5) Dyskinesias - involuntary, erratic, writhing movements of the face, arms, legs or trunk

Types of Cerebral Edema

1) Vasogenic edema: occurs with conditions that impair the function of the blood-brain barrier and that allow transfer of water and protein from the vascular into the interstitial space 2) Cytotoxic edema: involves an increase in intracellular fluid 3) Interstitial cerebral edema: of the central white matter as in hydrocephalus affecting the brain.

3 Types of Cerebellum-associated Movement Disorders

1) Vestibulocerebellar ataxia 2) Decomposition of movement 3) Cerebellar tremor

Infections of the Intestines (3)

1) Viral Infection o Rotavirus 2) Bacterial Infection o Clostridium difficile colitis (seen often in ppl who have had a lot of antibiotic treatment) o Escherichia coli O157:H7 Infection 3) Protozoal Infection o E. histolytica

Types of Mucus Protecting the Gastric Mucosa (2 Types, 3 pts each)

1) Water-Insoluble Mucus o Forms a thin, stable gel that adheres to the gastric mucosal surface o Provides protection from the proteolytic (protein-digesting) actions of pepsin o Forms an unstirred layer that traps bicarbonate, forming an alkaline interface between the luminal contents of the stomach and its mucosal surface 2) Water-Soluble Mucus o Washed from the mucosal surface o Mixes with the luminal contents o Its viscid nature makes it a lubricant that prevents mechanical damage to the mucosal surface.

Manifestations of Cirrhosis (12)

1) Weight loss (sometimes masked by ascites) 2) Weakness 3) Anorexia 4) Diarrhea or constipation 5) Hepatomegaly 6) Jaundice 7) Abdominal pain 8) Portal hypertension 9) Ascites 10) Esophageal varices 11) Splenomegaly 12) Fluid build-up in the peritoneal cavity of the abdomen is ascites

Vomiting involves two functionally distinct medullary centers:

1) the vomiting center and 2) the chemoreceptor trigger zone

Three shock states that share basic pattern

1. Neurogenic shock 2. Anaphylactic shock 3. Septic shock

Five Cell Types of the Anterior Pituitary Gland (5)

1. Somatotrophs: produce growth hormone (GH) 2. Thyrotrophs: produce thyrotropin, also called thyroid stimulating hormone (TSH) 3. Corticotrophs: produce corticotrophin, also called adrenocorticotropic hormone (ACTH) 4. Gonadotrophs: produce the gonadotropins, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) 5. Lactotrophs: produce prolactin

Five Stages of Hemostasis **

1. Vessel spasm (Vasoconstriction) 2. Formation of the platelet plug 3. Blood coagulation or development of an insoluble fibrin clot 4. Clot retraction 5. Clot dissolution

The kidneys normally produce approximately ____ of urine each day.

1.5 L

BUN-to-creatinine ratio provides useful diagnostic information. Normal ratio is approximately _______. Ratios greater than ____ represent prerenal conditions.

10:1 >15:1 = prerenal conditions

RBC live for *

120 days -When checking someone for diabetes w/ A1C, we check glycohemoglobin ~> how much glucose they have produced in the past 120 days

A client lives in Calgary, where the high elevation results in an atmospheric pressure of 672 mm Hg. What is the partial pressure of oxygen where this client lives?

141 mm Hg PO2 = atmospheric pressure × 0.21. Thus, 672 × 0.21 = 141 mm Hg.

The brain receives ______ cardiac output & consumes ______ of its oxygen

15-20% 20%

4 Major ABO blood types are determined by the presence or absence of

2 red cell antigens: A & B -the presence of D antigen determines the Rh-positive type -the absence of the D antigen determine the Rh-negative type

Disseminated Intravascular Coagulation (DIC) **

A condition in which blood clots are formed throughout the vascular system. This extensive clot formation causes the platelets to be used up which results in hemorrhage. Hemorrhage can then be a clinical manifestation of DIC

Parkinson Disease Define & Characteristics

A degenerative disorder of basal ganglia function that results in variable combinations of tremor, rigidity, and bradykinesia -Characteristics Progressive destruction of the nigrostriatal pathway, with subsequent reduction in striatal concentrations of dopamine

Polycythemia & 3 Types *

A condition in which the red blood cell mass is increased. Types: 1) Relative polycythemia- results from a loss of vascular fluid and is corrected by replacing the fluid 2) Primary polycythemia- a proliferative disease of the bone marrow with an absolute increase in total red blood cell mass accompanied by elevated white cell and platelet counts 3) Secondary polycythemia- results from increased erythropoietin levels caused by hypoxic conditions such as chronic heart and lung disease

Mneumonic for Kidney Functions: "A Wet Bed"

A - Acid-base balance W - Water elimination E - Erythropoiesis (production of RBCs) T - Toxin/waste removal B - Blood pressure control E - Electrolyte balance D - Vitamin D activation

A number of clients have presented to the emergency department in the last 32 hours with reports that are preliminarily indicative of myocardial infarction. Which client is least likely to have an ST-segment myocardial infarction (STEMI)?

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest Explanation: STEMI pain is not normally relieved by rest, nor would fever be a common symptom.

A client with a new diagnosis of heart failure has received a new prescription. Which medication category is likely to improve the client's cardiac function by increasing the force and strength of ventricular contractions?

A cardiac glycoside

Heart Failure

A complex syndrome resulting from any functional or structural disorder of the heart that results in or increases the risk of developing manifestations of low CO and/or pulmonary/systemic congestion -Occurs in any age group but common in older adults

Basal ganglia

A group of deep, interrelated subcortical (below the cortex) nuclei that play an essential role in control of movement

Peptic Ulcer Disease

A group of ulcerative disorders that occur in areas of the upper gastrointestinal tract that are exposed to acid-pepsin secretions *Spontaneous remissions and exacerbations are common

The nurse recognizes hepatic encephalopathy may be aggravated by which situation? A high-protein meal The lack of hemoglobin in the blood Increased clotting factors in the blood Excess albumin in the blood

A high protein meal

Peritubular Capillary System

A low-pressure re-absorptive system that originates from the efferent arteriole

Ulcerative Colitis

A nonspecific inflammatory condition of the colon, typically in the rectum. *specific to the colon

A young man and his friend started a business sandblasting and refinishing wrought iron. Following a rapid onset of respiratory symptoms, the client was diagnosed with silicosis. What aspect of silicosis should underlie the nurse's care planning?

A quick decline in lung function is likely, and the client is likely to face an early death Explanation: Acute silicosis has poor outcomes; severe disability and death can take place in just a few years.

What happens during the depolarization phase of nerve cells?

A rapid change in polarity to one that is positive on the inside, and the membrane becomes open to sodium ions.

A client comes to a scheduled appointment in the endocrine clinic. The primary care physician referred the client, suspecting acromegaly. Knowing the usual testing involved, the nurse should educate the client about which lab/diagnostic procedure?

A suppression test Explanation: Suppression tests are used when hyperfunction of an endocrine organ is suspected. When an organ or tissue is functioning autonomously (i.e., is not responding to the normal negative feedback control mechanisms and continues to secrete excessive amounts of hormone), a suppression test may be useful to confirm the situation. For example, when a GH-secreting tumor is suspected, the GH response to a glucose load is measured as part of the diagnostic workup. Normally, a glucose load would suppress GH levels. However, in adults with GH-secreting tumors (a condition known as acromegaly), GH levels are not suppressed.

Endocrine System

A system of ductless glands, and they function to release hormones into the blood to act on organs. Their hormones affect the actions of systems and organ. -Consists of glands, specialized cell clusters, and hormones -Regulates and integrates the body's metabolic activities and maintains homeostasis with the central nervous system (CNS)

Four weeks after returning from a tropical vacation, a 40-year-old man has presented to the emergency department with malaise, nausea, and yellow sclera. Serology has confirmed a diagnosis of hepatitis A (HAV). What teaching is most appropriate for this client? You can expect these symptoms to disappear after about 2 months, but you will be a carrier of the disease indefinitely. A vaccine before your trip would have prevented this, but your body will rid itself of the virus in time. You likely came in contact with blood or body fluids at some point, and you will have to ensure no one is subsequently exposed to your own blood or body fluids. You likely got this by way of what we call the fecal-oral contamination. You will have chronic hepatitis now, but the symptoms can be controlled with medication.

A vaccine before your trip would have prevented this, but your body will rid itself of the virus in time.

The nurse is caring for a client with angina. If wanting to reduce the Frank-Starling effect on myocardial oxygen consumption, what type of medication would the nurse expect to be prescribed?

A venous vasodilator

The number of hormone receptors on a cell may be altered for any of several reasons. The most appropriate response would be: A) Antibodies may destroy or block the receptor proteins. B) Altered hormone levels will not induce changes in the activity of the genes that regulate receptor synthesis. C) Decreased hormone levels often produce an increase in receptor numbers by means of a process called down-regulation. D) Sustained levels of excess hormone often bring about a decrease in receptor numbers by up-regulation.

A) Antibodies may destroy or block the receptor proteins. Explanation: The number of hormone receptors on a cell may be altered for any of several reasons. Antibodies may destroy or block the receptor proteins. Increased or decreased hormone levels often induce changes in the activity of the genes that regulate receptor synthesis. Decreased hormone levels often produce an increase in receptor numbers by means of a process called up-regulation, increasing the sensitivity of the body to existing hormone levels. Sustained levels of excess hormone often bring about a decrease in receptor numbers by down-regulation, producing a decrease in hormone sensitivity.

A client with kidney cancer who underwent exploratory surgery has returned to the postoperative unit with a report of severe burning and indigestion in the epigastric region. Which intervention by the nurse would be priority for this client? A) Call the surgeon for a prescription for a proton pump inhibitor (PPI) to prevent stress ulcer development. B) Sit the client up in a high-Fowler position and give ice chips to suck on. C) Call the dietary team to bring some milk products to the floor to counter excess gastric acid. D) Administer prescribed pain medications and dim the lights in the room.

A) Call the surgeon for a prescription for a proton pump inhibitor (PPI) to prevent stress ulcer development.

DIC is associated with which of the following? A. Endothelial damage B. Activation of factor X C. Release of tissue factor D. A, B, and C are all correct.

A, B, and C are all correct

An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which short term and longer term compensatory mechanisms are LEAST likely to decrease the symptoms of his heart failure?

AV node pacemaking activity and vagal nerve suppression

A nurse caring for a client with an intestinal obstruction anticipates which assessment findings? Select all that apply. Abdominal pain Abdominal distension Diarrhea Vomiting

Abdominal pain Abdominal distension Vomiting

Pleural effusion

Abnormal collection of fluid in the pleural cavity -Transudate or exudate, purulent (containing pus called an empyema), chyle (lymphatic fluid called chylothorax), sanguineous (bloody called hemothorax)

Cheyne-Stokes Respiration

Abnormal pattern of breathing characterized by oscillation of ventilation between apnea and hyperpnea -Compensate for changing serum partial pressures

Diabetes Mellitus

Abnormality in blood glucose regulation and nutrient storage related to absolute deficiency of insulin (Type 1) or relative deficiency of insulin and/or resistance to the actions of insulin (Type 2) vAffects 30.3 million people in the US (American Diabetes Association, 2018) o1.25 million with type 1 o23.1 million were diagnosed o84.1 million Americans age 18 and older with pre-diabetes vDiabetes remains the 7th leading cause of death in the US

A nurse is speaking to a client who tested positive for the presence of M. tuberculosis but has a normal chest x-ray. The nurse explains that the client does not have the active disease because of which function of the alveolar macrophages?

Accumulate and encase the M. tuberculosis.

Life-threatening Complications of Hepatic Encephalopathy

Accumulation of ammonia and other toxic metabolites in the blood. Encephalopathy involves the shunting of ammonia from the intestine into the blood because of hepatic portal hypertension.

The shortness of breath and cyanosis that occur in clients experiencing acute heart failure syndrome are primarily caused by which physiologic response? Select all that apply. Accumulation of fluid in the alveoli and airways Lung stiffness Worsening renal failure Myocardial muscle necrosis Impaired gas exchange

Accumulation of fluid in the alveoli and airways Lung stiffness Impaired gas exchange

Pericardial Effusion

Accumulation of fluid in the pericardial cavity (can lead to cardiac tamponade)

A client admitted with septic shock has a blood pressure of 70/46 mm Hg, pulse 125 bpm, respirations 30 breaths/min, temperature 103°F (39.4°C), and blood glucose 266 mg/dL (14.76 mmol/L). Which intervention prescribed by the health care provider should the nurse implement first?

Administer a fluid bolus of normal saline IV at 500 mL/hr. Explanation: Because of the low systemic vascular resistance (SVR) associated with septic shock, swift and aggressive fluid administration is needed to compensate for third spacing. Early administration of fluids (aggressive administration to include crystalloids) within the first hours and broad-spectrum antibiotics are priority treatments for sepsis.

Diagnosis of Acute Pancreatitis

Acute pancreatitis is best defined clinically by two of the following three criteria: 1) Symptoms (e.g., severe epigastric/periumbilical pain), 2) Elevated serum amylase or lipase, and 3) Radiologic imaging consistent with pancreatitis, usually using CT or MRI.

An ACTH stimulation test is used to test for

Addison disease -because it should cause an increase in the secretion of glucocorticoids

Hydrocephalus Define, Caused by, Types (2)

An abnormal increase in CSF volume in any part or all of the ventricular system -Caused by decreased CSF absorption and CSF flow obstruction -Types 1) Communicating: impaired CSF reabsorption -Decreased absorption of CSF 2) Noncommunicating: obstruction -Overproduction of CSF

Which intervention would the nurse know is *not* a primary treatment for the client in hypovolemic shock? Surgery to repair the site of bleeding Administration of intravenous fluids Administration of vasoconstrictive drugs Infusion of blood and blood products

Administration of vasoconstrictive drugs Explanation: The treatment of hypovolemic shock is directed toward correcting or controlling the underlying cause and improving tissue perfusion. Ongoing loss of blood must be corrected [such as in surgery]. Oxygen is administered to increase oxygen delivery to the tissues. Medications usually are administered intravenously. In hypovolemic shock, the goal of treatment is to restore vascular volume. This can be accomplished through intravenous administration of fluids and blood. The crystalloids (e.g., isotonic saline and Ringer's lactate) are readily available and effective, at least temporarily. Plasma volume expanders (e.g., pentastarch and colloidal albumin) have a high molecular weight, do not necessitate blood typing, and remain in the vascular space for longer periods than do the crystalloids, such as dextrose and saline. Blood or blood products (packed or frozen red cells) are administered based on hematocrit and hemodynamic findings. Fluids and blood are best administered based on volume indicators such as CVP and urine output. Vasoactive medications are agents capable of constricting or dilating blood vessels. Considerable controversy exists about the advantages or disadvantages related to the use of these drugs. As a general rule, vasoconstrictor agents are not used as a primary form of therapy in hypovolemic shock and may be detrimental. These agents are given only when volume deficits have been corrected but hypotension persists.

Anemia Define & Causes *

An abnormally low number of circulating red blood cells or level of hemoglobin, or both -Results in diminished oxygen-carrying capacity Causes 1) Excessive loss or destruction of red blood cells 2) Deficient red blood cell production because of a lack of nutritional elements or bone marrow failure

Stroke

An acute focal neurologic deficit from a vascular disorder that injures brain tissue -A leading cause of mortality and morbidity in the United States

Pericarditis

An acute inflammatory process of the pericardium -Can be acute, chronic, or constrictive

Which client with a diagnosis of asthma and a history of GI reflux is at greatest risk for developing an asthma attack? Adult woman after her menstrual period Child playing an afterschool soccer game Child of parents who are contract painters for construction company Adult with a respiratory virus

Adult with a respiratory virus Explanation: Asthma attacks can be precipitated by stress and emotional factors, sex hormones during the premenstrual period, exercise, allergy, and environmental triggers such as dust mites, tobacco smoke, and esophageal reflux. The viral infection coupled with reflux places that client at greatest risk of an attack. pg. 816-817

What could cause a client to develop a partial obstruction of the sphincter of the pancreas confirmed by X-ray?

Alcoholic beverages Explanation: Alcohol is a potent stimulator of pancreatic secretions, and it is also known to cause partial obstruction of the sphincter of the pancreas.

Hypoglycemia has a sudden onset with a progression of symptoms. What are the signs and symptoms of hypoglycemia?

Altered cerebral function and headache -The signs and symptoms of hypoglycemia can be divided into two categories: (1) those caused by altered cerebral function and (2) those related to activation of the autonomic nervous system. Because the brain relies on blood glucose as its main energy source, hypoglycemia produces behaviors related to altered cerebral function. Headache, difficulty in problem solving, disturbed or altered behavior, coma, and seizures may occur.

The physician mentions that a client has developed alveolar dead space. The nurse interprets this to mean which finding?

Alveoli are ventilated but not perfused.

Which long-term care resident is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)? A 79-year-old lifetime smoker who reports shortness of breath and pain on deep inspiration. An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells. An 81-year-old male who has a productive cough and recurrent respiratory infections. An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke.

An 81-year-old male who has a productive cough and recurrent respiratory infections.

Bronchiectasis D & Manifestations (6)

Bronchiectasis is the permanent dilation of the bronchi and bronchioles -Secondary to persisting infection or obstruction Manifestations: 1) Atelectasis 2) Obstruction of the smaller airways 3) Diffuse bronchitis 4) Recurrent bronchopulmonary infection 5) Coughing; production of copious amounts of foul-smelling, purulent sputum; and hemoptysis 6) Weight loss & anemia are common

Common Causes of Heart Failure (4)

CAD HTN DCM (Dilated cardiomyopathy) Valvular heart disease

Upper motor neurons project from the brain and are completely within the

CNS

All of the following are cellular components of blood except which one? A. Macrophages B. Mast cells C. Neutrophils D. Eosinophils

B. Mast cells Mast cells are not blood cells; rather they are found in connective tissue and initiate the inflammatory response.

A client with a history of diabetes presents to the emergency department following several days of polyuria and polydipsia with nausea/vomiting. On admission, the client labs show a blood glucose level of 480 mg/dL (26.64 mmol/L) and bicarbonate level of 7.8 mEq/L (7.8 mmol/L). The nurse suspects the client has diabetic ketoacidosis (DKA). The priority intervention should include: Limit fluid intake to only 250 mL/4 hours. Begin a loading dose of IV regular insulin followed by a continuous insulin infusion. Give at least 50 units of regular insulin IV stat and recheck blood glucose in 2 hours. Push a stat dose of bicarbonate followed by a double-dose (loading) of metformin.

Begin a loading dose of IV regular insulin followed by a continuous insulin infusion. Explanation: The goals in treating DKA are to improve circulatory volume and tissue perfusion, decrease blood glucose, and correct the acidosis and electrolyte imbalances. These objectives usually are accomplished through the administration of insulin and intravenous fluid and electrolyte replacement solutions. An initial loading dose of short-acting (i.e., regular) or rapid-acting insulin often is given intravenously, followed by continuous low-dose, short-acting insulin infusion. Frequent laboratory tests are used to monitor blood glucose.

Which classification of medication does the nurse prepare to administer to the client with hyperthyroidism that will block the effects of the hyperthyroid state on sympathetic nervous system function?

Beta-adrenergic blocking agent (beta-blocker)

Melena

Blood in the stool o Ranges in color from bright red to tarry black o May be occult (hidden) -GI Tract Bleeding

Measures for Assessing Endocrine Function & Hormone Levels

Blood tests Urine tests Stimulation and suppression tests Genetic tests Imaging

Testing for Diabetes

Blood tests o Fasting plasma glucose test (FPG) o Random glucose test o Oral glucose tolerance test (OGTT) o Capillary whole blood glucose monitoring o Hemoglobin A1C Urine tests

A client has been involved in a motor vehicle accident and has sustained spinal cord damage. The client has voluntary motor function loss on one side and a loss of pain and temperature sensation from the contralateral side below the level of the lesion. What type of cord syndrome does the nurse recognize the client has sustained?

Brown-Sequard syndrome Explanation: Brown-Sequard syndrome results from damage to a hemisection of the anterior and posterior cord. The effect is an ipsilateral loss of voluntary motor function from the corticospinal tract and proprioception loss with a contralateral loss of pain and temperature sensation from the lateral spinothalamic tracts for all levels below the lesion.

CNS Infections -By structure (4) -By type of invading organism (4) *

By structure: 1) Meninges: meningitis 2) Brain parenchyma: encephalitis 3) Spinal cord: myelitis 4) Brain and spinal cord: encephalomyelitis By type of invading organism: 1) Bacterial 2) Viral- self-limiting 3) Fungal- incredibly difficult to treat; medications are pretty toxic 4) Other

Glial Cells (CNS & PNS)

CNS o Astrocytes o Oligodendrocytes o Microglia PNS o Schwann cells - release myelin o Satellite cells -All glial cells are supportive

Neuroglial Cells

CNS o Astrocytes: part of the BBB (blood brain barrier); protects o Oligodendrocytes: produce myelin o Microglia: cleans up debris PNS o Schwann cells: produce myelin o Satellite cells: secrete basement membrane to protect cell body

Automatic Regulation of Ventilation

Controlled by input from two types of sensors or receptors: 1) Chemoreceptors: monitor blood levels of oxygen, carbon dioxide and adjust ventilation to meet the changing metabolic needs of the body 2) Lung receptors: monitor breathing patterns and lung function

What site in the neurologic system is responsible for vomiting?

Chemoreceptor trigger zone Explanation: The act of vomiting is integrated in the vomiting center, which is located in the dorsal portion of the reticular formation of the medulla near the sensory nuclei of the vagus. The vomiting center can be activated directly by irritants or indirectly following input from four different sources, one of which is the chemoreceptor trigger zone (which is activated by chemical agents such as drugs and toxins).

Gluconeogenesis

Convert amino acids (proteins), lactate, and glycerol into glucose o Blood glucose levels reflect the difference between the amount of glucose released into the circulation by the liver and the amount of glucose removed from the blood by body tissue

Compliance (2 pts & equation)

C = V/P -A change in volume (V) causes less of an increase in transmural pressure (P) in a more compliant vessel -A vein is 24x more compliant than its corresponding artery b/c it is 8x more distensible & has 3x the volume.

Lung Compliance Equation

C = ΔV/ΔP The change in lung volume (ΔV) that can be accomplished with a given change in respiratory pressure (ΔP)

Which of the following is not a cause of jaundice? A. Excessive destruction of red blood cells B. Impaired uptake of bilirubin by the liver cells C. Ingestion of iron supplements D. Decreased conjugation of bilirubin E. Obstruction of bile flow in the canaliculi of the hepatic lobules or in the intrahepatic or extrahepatic bile ducts

C. Ingestion of iron supplements Rationale: Ingestion of iron supplements does not affect the metabolism of RBCs.

Traumatic Brain Injury (TBI)

Can involve the scalp, skull, meninges, or brain

The ability in the heart to increase output as needs of the body change depends on which physiologic factors? Select all that apply.

Cardiac contractility Preload Afterload Heart rate

Which of the following conditions will result in pathological changes arising from pulseless electrical activity? A. Pericardial effusion B. Cardiac tamponade C. Pericarditis

Cardiac tamponade Rationale: Cardiac tamponade is the result of restricted movement of the muscle and will inhibit ventricular contraction. The conduction is intact, but there will be little or no SV.

A 36-year-old woman with a history of endometriosis and ectopic pregnancies is admitted to the hospital with severe dyspnea and abnormal lung sounds on the right side. What is the most likely diagnosis?

Catamenial pneumothorax Explanation: Catamenial pneumothorax occurs in relation to the menstrual cycle and usually is recurrent in women who are 30 to 40 years of age and have a history of endometriosis.

Cause of Acute tubular necrosis

Caused by Sloughing and dying of epithelial cells

Asthma Define & Characteristics (9)

Caused by airway obstruction, bronchial hyper-responsiveness, airway inflammation, and airway remodeling Characteristics: Respiratory tract infections Genetic Occupational exposure Environmental (Viruses and allergens) Exercise Drugs and chemicals Hormonal changes and emotional upsets Airborne pollutants Gastroesophageal reflux

Causes of Hypercapnia & Effects of Hypercapnia

Caused by hypoventilation or mismatching of ventilation and perfusion -Effects: Acid-base balance (decreased pH, respiratory acidosis) Kidney function Nervous system function Cardiovascular function

If glucagon binds to surface receptors on liver cells to send an intracellular message for glycogen breakdown, this process is known as which mechanism of action?

Cell surface receptors Explanation: An example of cell surface receptors is when a first messenger hormone signals the need for action; however, the hormone itself never enters the cell. It is the second messenger molecules inside the cell that interact directly with the intracellular control mechanisms to effect the change. For example, the first messenger hormone glucagon binds to surface receptors on liver cells to send a second intracellular message for glycogen breakdown. Lipid-soluble hormones are typically nonpolar and can pass freely through cell membranes to bind with intracellular receptors. Intracellular hormone-receptor complex can then directly exert the hormonal effects by entering the cell nucleus to bind with hormone response elements that activate or suppress intracellular mechanism of protein synthesis. The degree of responsiveness of a target cell to a hormone varies with the number of receptors present.

A client is admitted to the hospital in Addisonian crisis 1 month after a diagnosis of Addison disease. The nurse knows which clinical manifestation would support this diagnosis?

Change in level of consciousness and profound hypotension

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. Daily intake of baby aspirin Chemotherapeutic agents Salmonella food poisoning Intake of carbohydrate beverages Increased intracranial pressure

Chemotherapeutic agents Salmonella food poisoning Increased intracranial pressure Explanation: The chemoreceptor trigger zone is located outside the blood-brain barrier in a small area between the medulla and the floor of the fourth ventricle, where it is exposed to both blood and cerebrospinal fluid. This region may be stimulated by drugs, chemotherapeutic agents, toxins like Salmonella food poisoning, and increased intracranial pressure.

Forms of Chronic Pancreatitis (2)

Chronic calcifying pancreatitis Chronic obstructive pancreatitis

Obstructive Shock & Causes (5)

Circulatory shock that results from mechanical obstruction of the flow of blood through the central circulation (great veins, heart, or lungs) Causes: 1) Dissecting aortic aneurysm 2) Cardiac tamponade 3) Pneumothorax 4) Atrial myxoma 5) Evisceration of abdominal contents into the thoracic cavity

Five hours after presenting to the emergency department with substernal chest pain, a client's laboratory results demonstrate that troponin I is elevated and the creatine kinase-myoglobin (CK-MB) levels are within normal range. What is the nurse's interpretation of these results?

Client is currently experiencing an MI. Explanation: Troponin assays are highly specific for identifying myocardial infarction (MI). A rise in troponins can be seen as soon as 3 hours after MI and will remain elevated for 7-10 days. -Creatine kinase is an intracellular enzyme found in muscle cells. The CK-MB isoenzyme is specific to myocardial muscle injury and can rise between 4 and 8 hours after injury. They will return to normal within 2-3 days. Thus, a client with an elevated troponin I level 5 hours after the first symptoms is already showing signs of MI, but the CK-MB has another 3 hours before the elevation might develop

Hyperpituitarism (Common Cause & S&S)

Common cause: adenoma (tumor) arising from the anterior pituitary-cause unknown Signs and Symptoms: Close to the optic nerve, so visual impairments, headache, nausea and vomiting (from increased intracranial pressure)

HHS (hyperglycemic hyperosmolar syndrome)

Common in Type II Hyperglycemia Hyperosmolarity with dehydration Absence of ketoacidosis Depression of the sensorium

DKA

Common in type I Hyperglycemia Ketosis Metabolic acidosis

Rheumatic Heart Disease & Rheumatic Fever (RF)

Complications of the immune-mediated response to group A streptococcal throat infection -RF can develop in chronic valvular disorders that produce permanent cardiac dysfunction and later fatal heart failure

Motor and sensory branches of the cranial and spinal nerves

Components of the Peripheral Nervous System (PNS)

Structure of the Airways

Conductings: Nasal passages Mouth & Pharynx (nasopharynx, oropharynx, laryngeal pharynx) Larynx & vocal cords Esophagus Trachea Bronchi (R bronchus & L bronchus) Bronchioles

A client has been diagnosed with amyotrophic lateral sclerosis, a disease resulting in the loss of efferent signals. Which aspect of neurologic function will be primarily affected by this client's condition?

Conduction of information away from central nervous system (CNS)

Which action/bodily function characterizes a function of the parasympathetic nervous system (PNS)?

Conservation of energy

Neutrophils

Constitute 50% to 60% of white blood cells -Primarily responsible for maintaining normal host defenses against invading substances -First cells to arrive at the site of infection -Have their origins in the myeloblasts found in the bone marrow -Move to the tissue for approximately 1 to 3 days -Die in the tissue discharging phagocytic function or die of senescence --regenerate quickly

The nurse is assessing a client whose recent health history is suggestive of sarcoidosis. What assessment should the nurse prioritize? Obtaining the client's allergy status Assessment of the client's occupational history and possible recurrent infections Obtaining a sputum sample for culture and sensitivity Constructing a genogram from the client's report of her family history

Constructing a genogram from the client's report of her family history Explanation: Sarcoidosis has a strong genetic component and a detailed family history is appropriate.

"Cobblestone" appearance of intestinal mucosa is associated with

Crohn disease.

Which diagnosis will present the highest risk for hypercapnic/hypoxemic respiratory failure? Drug overdose Severe pneumonia Atelectasis Pulmonary edema

Drug overdose

Endocrine glands are epithelial structures that have had their connection with the surface obliterated during development. How are these glands described?

Ductless and produce secretions

Causes of Endocrine Disorders

Dysfunction in: o The gland, release of trophic hormones, hormone transport or of the target tissue Caused by: o Hyposecretion or hypersecretion o Hyporesponsiveness or hormone receptors o Inflammation of glands o Gland tumors

A 20-year-old woman has visited her family physician due to occasional bouts of bloody diarrhea over the past several weeks, a phenomenon that she experienced 2 years prior as well. Her physician has diagnosed her with ulcerative colitis based on her history and visualization of the affected region by colonoscopy and sigmoidoscopy. Which pathophysiologic phenomenon is most likely to underlie the client's health problem? A) Fissures and crevices developing in the mucosa that are seen as a characteristic "cobblestone" appearance. B) Erosion of the endothelial lining of the distal small intestine by a combination of genetic, autoimmune, and environmental factors. C) Compromise of the mucosal layer of the large intestinal surface by the effects of H. pylori. D) Mucosal hemorrhages that have developed into crypt abscesses, which have in turn necrotized and ulcerated.

D) Mucosal hemorrhages that have developed into crypt abscesses, which have in turn necrotized and ulcerated.

Which statement about immunoradiometric assay (IRMA) testing for measuring plasma hormone levels is most accurate? A) This bioassay test uses an intact animal or a portion of tissue from an animal to calculate specificity and sensitivity. B) This testing procedure uses antibody-coated plates to produce colored reaction. C) A 24-hour urine test will be required along with blood tests to calculate specific results. D) These tests are very specific since they utilize two antibodies instead of one.

D) These tests are very specific since they utilize two antibodies instead of one. Explanation: Immunoradiometric assay (IRMA) testing is very specific since it utilizes two antibodies instead of one. These two antibodies are directed against two different parts of the molecule, and therefore IRMA assays are more specific. Hormones circulating in the plasma were first detected by bioassay test, which used an intact animal or a portion of tissue from an animal to calculate specificity and sensitivity. ELISA testing procedure utilizes antibody-coated plates to produce colored reaction. The IRMA is a blood test, not a urine test.

Symptoms of Esophageal Cancer (5)

Dysphagia Weight loss Anorexia Fatigue Painful swallowing **Not easily caught

Sickle cell disease is an inherited disorder in which **

an abnormal hemoglobin (hemoglobin S [HbS]) leads to chronic hemolytic anemia, pain, and organ failure. In sickle cell anemia, decreased oxygen levels predisposes the patient to the sickling of the hemoglobin.

Which manifestations most clearly suggest the need for endoscopy to rule out esophageal cancer? Heartburn after an individual consumes high-fat meals Dysphagia in an individual with no history of neurologic disease New onset of gastroesophageal reflux in a previously healthy individual Recurrent episodes of gastritis that do not respond to changes in diet

Dysphagia in an individual with no history of neurologic disease

Which of the following is directly responsible for gas exchange?A. Trachea B. Bronchi C. Bronchial circulation D. Pulmonary circulation E. Respiratory membrane

E. Respiratory membrane Rationale: The respiratory membrane is the anatomical site of gas exchange in the lungs. It is located in the alveoli.

Hydrocephalus *

an abnormal increase in cerebrospinal fluid volume in the ventricular system

Spinal Cord Injury (SCI) Define, Causes (4), & Involvement

Damage to the neural elements of the spinal cord Causes: Motor vehicle crashes Falls Violence Sporting activities Involvement - most SCIs involve damage to the vertebral column and/or supporting ligaments as well as the spinal cord. -Commonly involve both sensory and motor function

Dead Space & Types (3)

Dead space occurs when there is ventilation but no perfusion. 1) Anatomic Dead Space- that contained in the conducting airways 2) Alveolar Dead Space- that contained in the respiratory portion of the lung 3) Physiologic Dead Space- the anatomic dead space plus alveolar dead space

A client with asbestosis-induced pulmonary fibrosis asks the nurse why breathing is so difficult at times. The nurse explains that the scar tissue in the client's lung tissues causes which of these?

Decreased compliance of the lung tissue Explanation: The work of breathing is directly influenced by the effort required to move air through the conducting airways and the compliance of the lung tissue. Pulmonary fibrosis caused by asbestosis is the stiffening of the lung tissue due to the development of scar tissue.

A client has just experienced stimulation of the vagus nerve. Which sign would the nurse anticipate the client to manifest?

Decreased heart rate

The Evaluation of Coronary Blood Flow and Myocardial Perfusion (4)

ECG -Changes in the pattern or orientation of wave forms Echocardiogram -M-mode, two-dimensional, Doppler, and esophageal Exercise Stress Testing -Motorized treadmill and bicycle ergometer Nuclear Cardiovascular Imaging Methods -Myocardial perfusion imaging, infarct imaging, radionuclide angiocardiography, and positron emission tomography

Signs of Decreased in LOC *

Early Signs** -Inattention, mild confusion, disorientations, & blunted responsiveness -Delirium- markedly inattentive & variably lethargic or agitated

The client presents with a traumatic complete spinal cord transection at the C5 level. Based on this injury, the health care worker can expect the client to have control of which body function/part?

Diaphragm Explanation: The functional levels of cervical injury are related to C5, C6, C7, or C8 innervation. All motor and sensory function is absent below the level of cord transection. At the C5 level, deltoid and biceps function is spared, allowing full head, neck, and diaphragm control with good shoulder strength and full elbow flexion. At the C8 level, finger flexion is added. Thoracic cord injuries (T1 to T12) allow full upper extremity control with limited to full control of intercostal and trunk muscles and balance. Sacral (S1 to S5) innervation allows for full leg, foot, and ankle control and innervation of perineal musculature for bowel, bladder, and sexual function.

A client has developed pericarditis. The nurse knows this condition will increase the risk for developing which condition?

Diastolic dysfunction

The thalamus is located in which part of the brain?

Diencephalon

Which type of synapse allows the quickest transmission from one neuron to another?

Electrical

A health care provider has completed an assessment on a client diagnosed with cirrhosis. The client asks, "What, if any, serious complications are associated with cirrhosis?" Which response is the most accurate for the provider to relay to the client?

Esophageal varices -Esophageal varices are a life-threatening complication of cirrhosis related to the risk of rupturing and producing a massive amount of hemorrhage.

Peritoneal Cavity & Peritonitis (10 pts)

Permits rapid absorption of bacterial toxins Favors the dissemination of contaminants Great inflammatory response o Thick, fibrinous protective substance Perforated peptic ulcer Ruptured appendix Perforated diverticulum Gangrenous bowel Pelvic inflammatory disease Gangrenous gallbladder Abdominal trauma and wounds

A client with quadriplegia adheres to a regular bowel protocol. Which action performed by the client's caregiver is likely to promote defecation?

Digital stimulation of the client's rectum Explanation: When the nerve endings in the rectum are stimulated, signals are transmitted first to the sacral cord and then reflexively back to the descending colon, sigmoid colon, rectum, and anus by the pelvic nerves. These impulses greatly increase peristaltic movements as well as relax the internal sphincter, resulting in defecation.

Treatment of Pleural Effusion

Directed at the cause of the disorder -Thoracentesis -Injection of a sclerosing agent into the pleural cavity -Open surgical drainage

Due to complications, a male postoperative client has been unable to mobilize secretions for several days following surgery and develops atelectasis. Which process would his care team anticipate with relation to his health problem?

Directing blood flow away from the lung regions that are hypoxic Explanation: Regional hypoxia, such as with a diagnosis of atelectasis, is associated with vasoconstriction and redirection of blood away from, not toward, the affected area of the lung. This also contributes to an increased workload for the right side of the heart.

Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia have which effect on motor ability?

Disrupt movement without causing paralysis Explanation: Disorders of the basal ganglia comprise a complex group of motor disturbances characterized by tremor and other involuntary movements, changes in posture and muscle tone, and poverty and slowness of movement. They include tremors and tics, spasticity, hypokinetic disorders, and hyperkinetic disorders. Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement but do not cause paralysis. Disorders of the upper motor neuron pyramidal tracts are characterized by spasticity and paralysis.

Regurgitation (Incompetent valve)

Disruption occurring with Valvular Heart Disease in which there is distortion of the valve, so it does not close properly -Incompetent or regurgitant valve permits backward flow to occur when the valve should be closed

Stenosis

Disruption occurring with Valvular Heart Disease in which there is narrowing of the valve opening, so it does not open properly. Narrowing of valve reduces blood flow though the valve.

Guillain Barré is caused by

an acute immune-related polyneuropath

A client with mitral valve regurgitation and left heart failure reports shortness of breath and fatigue with activities of daily living. Which instructions by the nurse will be *ineffective* in reducing these symptoms?

Elevating legs for 20 minutes daily Explanation: Mitral regurgitation can lead to reduced cardiac output and left heart failure. Elevating the legs would promote venous return and increase the fluid volume the heart needs to pump, thus exacerbating the symptoms.

A client with a history of myocardial infarction tells the health care provider that he has started to experience more episodes of angina pectoris than before. The provider should tell this client that which activity can precipitate his angina pectoris? Select all that apply. (3)

Emotional stress Physical exertion Exposure to cold

Encephalopathy in Portal Hypertension

Encephalopathy involves the shunting of ammonia from the intestine into the blood because of hepatic portal hypertension.

Clients with chronic autoimmune hepatitis may display which clinical manifestations upon physical exam? Select all that apply. Jaundice Bacterial meningitis Nuchal rigidity Edematous joints Enlarged liver

Enlarged liver Jaundice

COPD: Emphysema

Enlargement of air spaces and destruction of lung tissue. In emphysema, there is abnormal increase in dead air spaces and alveolar tissue is destroyed.

Treatment of Peptic Ulcer

Eradicate the cause and promote a permanent cure for the disease o Eradicating H. pylori o Relieving ulcer symptoms o Healing the ulcer crater § Acid-neutralizing, acid-inhibiting drugs, and mucosal protective §Antacids § Proton pump inhibitors (prevent the proton pump from producing (?) hydrogen ions: stomach acid is reduced ~> message sent to brain there isn't enough acid ~> more proton pumps are made but it makes symptoms worse)

Characteristics of IBS

Persistent or recurrent abdominal pain that is relieved with defecation. Altered bowel function Varying complaints of flatulence, bloatedness Nausea and anorexia Constipation or diarrhea Anxiety or depression

Which of the following is an example of a positive feedback system? Insulin and glucagon Cortisol and adrenocorticotropic hormone (ACTH) Estradiol and follicle-stimulating hormone (FSH) Somatostatin and thyroid-stimulating hormone (TSH)

Estradiol and follicle-stimulating hormone (FSH) Explanation: In positive feedback control, rising levels of a hormone cause another gland to release a hormone that stimulates the first. Release of the female hormone estradiol during the follicular stage of the menstrual cycle causes increased release of gonadotropin (FSH), which further increases release of estradiol until the follicle dies and ceases production. The other options are examples of negative feedback.

Which hormone triggers the positive feedback mechanism that controls the secretion of luteinizing hormone (LH) levels?

Estrogen Explanation: An example of positive feedback is the preovulatory surge in luteinizing hormone (LH) levels that trigger ovulation. At that time, an increase in estrogen levels exerts a positive feedback effect on the anterior pituitary secretion of LH. The other hormones are not associated with LH in this manner.

A 38-year-old woman takes clomiphene, an infertility drug that works by competing with, and thereby blocking, cellular receptors for estrogen. Which statement is most likely to be true of this client?

Estrogen will continue to pass freely through the cellular membranes. Explanation: Because estrogen is a steroid hormone, its receptors in target cells are located inside the cell membrane, and their blockage does not affect the movement of the hormone into and out of the cell. Receptors are specific for each hormone, so no hormones other than estrogen will be blocked. Up-regulation occurs when hormone levels are decreased, and in this case the estrogen level will increase. Second messengers, such as cAMP, are only activated by peptide hormones and catecholamines.

Hormone Receptor Interactions—Intracellular Interactions (5)

Estrogens Testosterone Progesterone Adrenal cortical hormones Thyroid hormones

Postsynaptic Potential (2)

Excitatory Postsynaptic Potential (EPSP) o Combination of a neurotransmitter with a receptor site causes partial depolarization of the postsynaptic membrane. Inhibitory Postsynaptic Potential (IPSP) o Combination of a transmitter with a receptor site is inhibitory in that it causes the local nerve membrane to become hyperpolarized and less excitable.

Pancreas: Exocrine vs. Endocrine

Exocrine acini ~> digestive juices ~> duct ~> duodenum The acinar cells in the exocrine pancreas secrete digestive enzymes into the duodenum Endocrine islets of Langerhans ~> hormones ~> blood o Alpha cells ~> Glucagon o Beta cells ~> Insulin, amylin o Delta cells à Somatostatin o F/PP cells à Pancreatic polypeptide

Common Causes of Constipation (7)

Failure to respond to the urge to defecate Inadequate fiber in the diet Inadequate fluid intake Weakness of the abdominal muscles Inactivity and bed rest Pregnancy Hemorrhoids

The nurse notes that the client is experiencing visible squirming and twitching movements that can be seen as flickers under the skin. The nurse would recognize this as:

Fasciculations -They are caused by spontaneous contractions of all the muscle fibers in a motor unit due to irritation and hyperexcitability of the cell body and its motor neuron and suggest LMN disease.

Which statement best describes an aspect of the normal process of glucose metabolism? Blood glucose levels are primarily a result of the timing, quantity, and character of food intake. Ingested glucose that is not needed for cellular metabolism circulates in the blood until it is taken up to meet cellular needs. Blood glucose levels are kept in a steady state by selective excretion and reuptake by the kidneys. Glucose that exceeds metabolic needs is converted and stored by the liver.

Glucose that exceeds metabolic needs is converted and stored by the liver.

Pyelonephritis & S&S

Upper UTI -Acute pyelonephritis is the infection of the renal parenchyma and renal pelvis -S&S: in acute pyelonephritis, there is fever, chills, flank pain and urinary urgency -If untreated, it can lead to sepsis, renal abscesses, chronic pyelonephritis, and chronic renal failure

A client with diabetes will be undergoing an evaluation of the fluctuation of blood glucose over the previous 120-day span. Which test will this client undergo? Glucose tolerance test Fasting blood glucose Capillary blood glucose Glycosylated hemoglobin

Glycosylated hemoglobin Explanation: Glycosylated hemoglobin (A1C) is hemoglobin into which glucose has been irreversibly incorporated. Because glucose entry into the red blood cells is not insulin dependent, the rate of hemoglobin glycation depends on blood glucose levels. Red blood cells have a 120-day life span, and A1C estimates blood glucose levels over the previous 6 to 12 weeks

Which of these project from the motor strip in the cerebral cortex to the ventral horn and are fully contained within the CNS?

Upper motor neurons

Which motor system is responsible for crude muscle movements?

Extrapyramidal motor system -originates in the basal ganglia and provides background for the more crude, supportive movement patterns.

A client has been admitted to the hospital for new-onset dyspnea and is undergoing testing for obstructive lung disease. In reviewing the results of the pulmonary function studies, the nurse would expect to note a decrease in which value with obstructive lung disease?

FEV1 Explanation: Pulmonary function studies with obstructive lung disease would show a decrease in both the FEV1 and FVC because the client is unable to effectively expel air from the lungs. (The FRC, RV, and TLC would all typically be increased due to air trapping and hyperinflation of the lungs.)

Achalasia

Failure of the esophageal sphincter to relax

Composition of Blood **

Fluid/dissolved components -Water (major component of plasma) -Proteins -Small molecular substances Cellular elements -Red blood cells (erythrocytes). Erythrocytes are biconcave (spherical; sunk in the middle) disks that carry oxygen* -Thrombocytes (cause clotting) or platelets -White blood cells: Lymphocytes Leukocytes

Urinary Tract Infections (UTIs) Lower & Upper Called

Frequent types of bacterial infection -Can be asymptomatic -Cystitis= Lower UTIs -Pyelonephritis= Upper UTIs o Acute pyelonephritis is the infection of the renal parenchyma and renal pelvis (in acute pyelonephritis, there is fever, chills, flank pain and urinary urgency). -If untreated, it can lead to sepsis, renal abscesses, chronic pyelonephritis, and chronic renal failure

Segments of the Brain

Frontal lobe: extends from the frontal pole to the central sulcus (fissure) and is separated from the temporal lobe by the lateral sulcus Parietal lobe: lies behind the central sulcus (postcentral gyrus) and above the lateral sulcus Temporal lobe: lies below the lateral sulcus and merges with the parietal and occipital lobes Occipital lobe: lies posterior to the temporal and parietal lobes and is arbitrarily separated from them

Levels of Consciousness (LOC)

Full - awake, alert, & oriented Confusion - disoriented to time, place, or person *lack of attention and disorientation are early signs of decreased level of consciousness* Delirium - mental confusion & emotional disruption (sudden onset other reasons; but dementia is insidious/slow onset) Lethargy - very slow; responds appropriately to pain Obtundation Stupor Coma

Hormones

Function as chemical messengers o Move through the blood to distant target sites of action o Or, act more locally as paracrine or autocrine messengers that incite more local effects o Most are present in body fluids at all times in greater or lesser amounts as needed

______ is responsible for much of the work of the Inhibitory Postsynaptic Potentials (IPSPs) in the external tufted cells

GABA (slows down)

Growth Hormone in Children

GH deficiency o Interferes with linear bone growth o Results in short stature or dwarfism GH excess o Results in increased linear bone growth o Gigantism

Which physiologic abnormality is thought to be a precursor of gallstones?

Gallbladder sludge -Gallbladder sludge = thickened gallbladder mucoprotein with tiny trapped cholesterol crystals

The nurse is assessing a client with acute pancreatitis who denies use of alcohol. When teaching the client about additional causes of acute pancreatitis, the nurse includes which of these in the discussion? Select all that apply. Gallstones Hypocalcemia Increased cholesterol Potassium-sparing diuretics Abdominal trauma

Gallstones Increased cholesterol Abdominal trauma

Factors Contributing to the Protection of the Gastric Mucosa

Gastric Mucosal Barrier -An impermeable epithelial cell surface covering -Mechanisms for the selective transport of hydrogen and bicarbonate ions -The characteristics of gastric mucus

The nurse is counseling a group of clients about screening and diagnosing colon cancer. Place in order, from least to most specific for colon cancer, the diagnostic procedures involved. Use all the options.

Gathering a list of risk factors such as age and family history Performing a stool for occult blood test Performing a colonoscopy to observe for polyps Performing a tissue biopsy for cell morphology

A client who has just been diagnosed with dilated cardiomyopathy asks the nurse what caused the condition. The most appropriate response would be:

Genetic abnormalities

Muscular Dystrophy

Genetic disorders that produce progressive deterioration of skeletal muscles because of mixed muscle cell hypertrophy, atrophy, and necrosis -Disorder of skeletal muscle group

A male client has been diagnosed with a low sperm count. Which endocrine imbalances could contribute to this condition? Select all that apply. Lack of follicle-stimulating hormone (FSH) Excess calcitonin Insufficient androgens Excess thyroid hormone Increased growth hormone

Lack of follicle-stimulating hormone (FSH) Insufficient androgens

Which type of inflammation is characteristic of Crohn disease? Granulomatous lesions Ulcerative erosions Fibrotic smooth muscle Necrotic crypt abscesses

Granulomatous lesions Explanation: Crohn disease is a recurrent, granulomatous type of inflammatory response with formation of multiple sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. There is usually a relative sparing of the smooth muscle layers of the bowel, with marked submucosal layer inflammatory and fibrotic changes.

Expressive or nonfluent aphasia is characterized by *

an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing

The most common symptom of gastroesophageal reflux (GERD)

Heartburn -30 to 60 minutes after meal -Evening onset -Pain in the epigastric area that radiates to the throat, shoulder, or back

Major Types of Chronic Gastritis (4)

Helicobacter pylori gastritis Autoimmune gastritis Multifocal atrophic gastritis Chemical gastropathy

Main Functions of the Larynx (2)

Help to produce speech Protect the lungs from substances other than air

Known Hepatotropic Viruses (5)

Hepatitis A virus (HAV) Hepatitis B virus (HBV) Hepatitis B-associated delta virus (HDV) Hepatitis C virus (HCV) Hepatitis E virus (HEV)

The nurse is caring for a client with liver disease who has elevated serum alpha fetoprotein levels. The nurse recognizes this lab result is consistent with which condition in an adult? Toxic hepatitis Rejection of transplanted liver Hepatocellular cancer Pregnancy

Hepatocellular cancer

Types of Primary Liver Cancer (2)

Hepatocellular carcinoma o Arises from the liver cells Cholangiocarcinoma o A primary cancer of bile duct cells

A female client is requiring supplementary oxygen by face mask due to her reduced lung compliance. Which pathophysiologic process is most likely to be a contributor to her low lung compliance?

Her thoracic cage is less flexible than when she was healthy.

A nurse on a respiratory unit of a hospital is providing care for a client with end-stage lung disease. Consequently, measurement of the client's arterial blood gases indicates increased PCO2. Which associated consequence would the nurse anticipate?

Higher than normal production of H+ Explanation: As a result of the combination of water and carbon dioxide, hydrogen ions are produced along with bicarbonate. This would be associated with a shift to the right of the oxygen-hemoglobin dissociation curve, increased bicarbonate output, and higher than normal levels of carbaminohemoglobin. pg. 775

Histamine

Histamine has a powerful vasodilator effect on arterioles and increases capillary permeability, allowing leakage of fluid and plasma proteins into tissues.

Intracrine

Hormone action is within the cell that produced it.

Neuroendocrine

Hormone produced within a neuron and then travels through circulation to exert effects on target cells.

Cytokines *

Hormone-like growth factors/chemical messengers that regulate blood cell production.

Paracrine action

Hormones act locally on cells in the vicinity of where they are released. Paracrine action: the hormone acts locally by diffusing from its source to target cells in the neighborhood.

Select the most appropriate statement that describes the function of hormones. Hormones function as modulators of cellular and systematic responses. Hormones initiate reactions of cellular and systematic responses. Hormones have little involvement in cellular and systematic responses. Hormones respond to cellular and systematic interactions.

Hormones function as modulators of cellular and systematic responses. (rather than initiate them)

The nurse is suctioning a client with a C3 spinal cord injury when the client's heart rate drops from 86 bpm to 42 bpm. What intervention does the nurse understand should be provided prior to suctioning to prevent this vasovagal response from occurring?

Hyperoxygenate prior to suctioning.

A 30-year-old man who manages his type 1 diabetes with glyburide presents at the emergency room reporting headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half marathon. Which phenomenon is likely to be the cause of his symptoms?

Hypoglycemia

Clinical Manifestations of Cardiogenic Shock (3)

Hypoperfusion, hypotension, cyanosis

Alterations of Thyroid Function (2)

Hypothyroidism o Decreased metabolic rate o Accumulation of hydrophilic mucopolysaccharide substance (myxedema) in the connective tissues o Elevated serum cholesterol Hyperthyroidism o Increased metabolic rate and oxygen consumption o Increased use of metabolic fuels o Increased sympathetic nervous system responsiveness

The health care provider is assessing the muscle tone of a client who has been diagnosed with a lower motor neuron (LMN) lesion. Which assessment finding is congruent with the client's diagnosis? Rigidity Hypotonia Spasticity Tetany

Hypotonia

Muscular Atrophy

If a normally innervated muscle is not used for long periods, the muscle cells shrink in diameter, lose much of their contractile protein, and weaken. -Disorder of skeletal muscle group

Cranial Nerves * 12

Olfactory I - * Optic II - * Oculomotor III - * Trochlear IV Trigeminal V - * Abducens VI Facial VII - * Auditory (vestibulocochlear) VIII Glossopharyngeal IX Vagus X (** really know about this one ** connection between Vagus X nerve & cardiac nerves) Spinal accessory XI Hypoglossal XII - lower part of tongue; swallowing * = she will focus on these especially

Coup-Contrecoup

Impact on the brain that moves the brain and makes it hit another part of the skull (injury from the direct impact is croup, and indirect impact injury from where the brain hits the other side of the skull which is contrecoup) Formal Definition: Blunt force to the head accelerates the brain within the skull, and then the brain decelerates abruptly on hitting the inner skull surfaces Coup—direct contusion of the brain at the site of external force Contrecoup—rebound injury on the opposite side of the brain

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 health consequence would be attributable to her low levels of cortisol?

Impaired immunologic and inflammatory response

Dysarthria

Imperfect articulation of speech sounds or changes in voice pitch or quality

While trying to explain the physiology behind type 2 diabetes to a group of nursing students, the instructor will mention which accurate information? -The destruction of beta cells and absolute lack of insulin in people with type 2 diabetes means that they are particularly prone to the development of diabetic complication. -Because of the loss of insulin response, all people with type 2 diabetes require exogenous insulin replacement to control blood glucose levels. -In skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance. -They have increased predisposition to other autoimmune disorders such as Graves disease, rheumatoid arthritis, and Addison disease.

In skeletal muscle, insulin resistance prompts decreased uptake of glucose. Following meals (postprandial), glucose levels are higher due to diminished efficiency of glucose clearance.

Midbrain *

Includes two pairs of superior and inferior colliculi

2 Motor Pathways in Both CNS & PNS

Incoming (afferent) sensory pathways Outgoing (efferent) motor pathways - carries information from the central nervous system to the muscles

Atelectasis

Incomplete expansion of a lung or portion of a lung

The nurse is caring for a client with alcoholism who now presents with gastrointestinal bleeding. What alteration does the nurse anticipate related to the bleeding?

Increase in ammonia level

As a result of dehydration, a client's epithelial cells are producing insufficient amounts of mucus. Consequently, the client's mucociliary blanket is compromised. Which change would the care provider anticipate as a direct result of this change?

Increased amounts of bacteria in the lungs

Electrical burns over a large surface area of a client's body have resulted in hypovolemic shock. Following physical assessment, which findings lead the nurse to believe the client's body is compensating for this fluid loss? (3) & 3 additional

Increased heart rate The client complaining of extreme thirst Deep, rapid respirations -Also: 1) peripheral vasoconstriction 2) fluid and sodium retention in order to preserve vascular volume 3) urine output decreases very quickly in hypovolemic shock

Following a meal, a client's blood glucose level has increased. In addition, the client's pancreas has increased the amount of insulin produced and released. Which phenomenon has occurred?

Increased hormone level according to a negative feedback mechanism Explanation: The level of some hormones is adjusted according to the amount of the substance that they control. In this case, insulin controls glucose levels and would increase in response to the increase in serum glucose that follows a meal. Positive feedback and hypothalamic-pituitary control are not evident in this situation. Nor is the time of day relevant to release of insulin.

Following a stroke that disrupts blood flow to the pituitary gland, a client develops signs of hypopituitarism. Which manifestation is an unexpected finding? Bradycardia and hypotension Increased volume of dilute urine Weakness and fatigue Hyperkalemia and fluid deficit

Increased volume of dilute urine Explanation: The hypothalamus produces a number of hormones that stimulate the anterior pituitary. It also produces antidiuretic hormone and oxytocin, the hormones that are stored and released in the posterior pituitary. If the pituitary is damaged or removed, expected manifestations that correspond to lack of thyroid-adrenocorticotropic hormone. These signs and symptoms include bradycardia, hypotension, cessation of menstruation, fluid volume deficit, and hyperkalemia. Because the posterior pituitary hormones are manufactured in the hypothalamus and would be unaffected by the tissue damage, the nurse would not expect symptoms of a lack of antidiuretic hormone, indicating the presence of diabetes insipidus.

Myelin

Increases conduction velocity and essential for the survival of larger neuronal processes -neuroglial cells -makes it skip to Nodes of Ranvier

Complications of Esophageal Tears (aka Mallory-Weiss Syndrome)

Infection ~> inflammatory ulcer or mediastinitis

Crohn disease is a recurrent inflammatory disease that can affect any area of the bowel. Characteristic of Crohn disease are granulomatous lesions that are sharply demarcated from the surrounding tissue. The nurse caring for a client with newly diagnosed Crohn disease would know to include what in the teaching? -A definition of Crohn disease noting that it is a recurrent disease that affects only the large intestine -Information on which nonsteroidal anti-inflammatory drugs (NSAIDs) to take and how often to take them -Information on sulfasalazine, including dosage, route, frequency, and side effects of the drug -Information on the chemotherapy that will be ordered to cure the disease

Information on sulfasalazine, including dosage, route, frequency, and side effects of the drug -A characteristic feature of Crohn disease is the sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. When the lesions are multiple, they often are referred to as skip lesions because they are interspersed between what appear to be normal segments of the bowel.

Injury from Excitatory Amino Acids

Injury to neurons caused by overstimulation of receptors for specific amino acids that act as excitatory neurotransmitters

The sensation of chest tightness due to an impending asthmatic attack appears to be related to which physiologic cause?

Input from lung receptors that monitor bronchial constriction.

3 things that enter the brain with relative ease

Only water, carbon dioxide, and oxygen enter w/ relative ease -the transport of other substances between the brain and the blood is slower and more controlled.

Voluntary Regulation of Ventilation

Integrates breathing with voluntary acts such as speaking, blowing, and singing. These acts, initiated by the motor and premotor cortex, cause a temporary suspension of automatic breathing.

Iron-deficient Anemia

Iron deficiency is a common worldwide cause of anemia affecting people of all ages. The anemia results from dietary deficiency, loss of iron through bleeding, or increased demands. -Because iron is a component of heme, a deficiency leads to decreased hemoglobin synthesis and consequent impairment of oxygen delivery.

A nursing instructor is explaining arterial circulation to a group of nursing students. What is the most appropriate information for the nurse to provide concerning arterial pressure gradient in the arterial side of systemic circulation?

It contains one-sixth of the total blood volume

What is an advantage of assessing hormone levels through collection of a 24-hour urine?

It does not require serum collection for an accurate reading. -it does not require blood sampling

The scar tissue that occurs between the layers of the pericardium becomes rigid and constrictive from scar tissue in constrictive pericarditis. What is a physiologic sign of constrictive pericarditis?

Kussmaul sign

Which lipoprotein is the main carrier of cholesterol?

LDL

Signs of Intracranial Pressure*

LOC - early sign decreased alertness to drowsy; late sign stupor or coma Pupil size & reaction to light Motor function Vital signs

The nurse is assessing a client exposed to viral hepatitis who is thought to be in the prodromal phase. When assessing the client, which symptoms does the nurse recognize are consistent with this phase? Select all that apply. Lack of appetite Lack of energy Jaundice Myalgia Right upper quadrant tenderness

Lack of appetite Lack of energy Myalgia

Ischemia

Lack of blood supply / Reduced or interrupted blood flow: -focal cerebral ischemia—stroke -Global cerebral ischemia—MI

When teaching about heart attacks, the nursing instructor tells the students that most heart attacks (approximately 40 to 50%) affect which coronary artery?

Left anterior descending artery Explanation: ~30 to 40% of infarcts affect the RIGHT coronary artery -40 to 50% affect the LEFT anterior descending artery -the remaining 15 to 20% affect the left circumflex artery -The pulmonary artery does not come into play with an infarct

Which aspect of the coronary circulation is termed "the widowmaker" because a deadly heart attack will occur if that portion is blocked?

Left anterior distending artery

A client has a diagnosis of right-sided heart failure. Which body organ should the nurse assess regularly?

Liver Explanation: As right-sided heart failure occurs, blood backs up in the venous circulation, including the hepatic veins that drain into the inferior vena cava. The liver becomes engorged, and with prolonged right-sided failure, hepatic cell death occurs. The kidneys are further down in the venous circulation and are less affected. The jugular veins and gastrointestinal tract are affected, but are not organs.

Liver Blood Flow & Accessory Organs

Liver o Hepatic portal vein -Digestive tract and major abdominal organs o Hepatic veins -Valveless veins that empty into the inferior vena cava o Hepatic artery Gallbladder Exocrine pancreas

Hematomas

Localized bleeding outside of the vessels -Result from vascular injury & bleeding

Agnosia

Localized lesions of the parietal lobe that can result in the inability to recognize the meaningfulness of an object e.g. With the person's eyes closed, a screwdriver can be felt and described as to shape and texture. Nevertheless, the person cannot integrate the sensory information required to identify it as a screwdriver.

Chronic Heart Failure

Long-term condition characterized by decreased cardiac function -Volume overload -Venous congestion becomes more prominent in both pulmonary & systemic circulations

Esophageal Tears aka Mallory-Weiss Syndrome

Longitudinal tears in the esophagus at the esophagogastric junction

Which of the following alterations may affect drug efficacy in a patient with CKD? A.Loss of K+ B.Alteration in pH C.Loss of albumin D.Increased Ca2+

Loss of albumin -Loss of albumin will result in altered drug metabolism via increased intermediates and faster action.

Characterizations of Distributive or Vasodilatory Shock (3)

Loss of blood vessel tone, enlargement of the vascular compartment, and displacement of the vascular volume away from heart and central circulation

Hypoxemia

Low concentration of oxygen in the blood.

When an acute event occurs and the circulatory system can no longer provide the body with adequate perfusion of its tissues and organs, cellular hypoxia occurs and the body goes into shock. What are the causes of shock in the human body? Select all that apply. Maldistribution of blood flow Hypovolemia Excessive vasoconstriction Obstruction of blood flow Hypervolemia

Maldistribution of blood flow (distributive shock) Hypovolemia (hypovolemic shock) Obstruction of blood flow (obstructive shock) -It can also be caused by an alteration in cardiac function (cardiogenic shock; heart is weakened & its not pushing enough blood)

Manifestation of Chronic Hypoxemia

Manifestations of chronic hypoxia may be insidious in onset and attributed to other causes; compensation masks the condition -Increased ventilation -Pulmonary vasoconstriction -Increased production of red blood cells -Cyanosis

Graves Disease (4 pts) **

Manifested as a state of hyperthyroidism, goiter, restlessness and ophthalmopathy/ocular problems. -An autoimmune disorder characterized by abnormal stimulation of the thyroid gland by thyroid-stimulating antibodies (thyroid-stimulating immunoglobulins [TSI]) that act through the normal TSH receptors -Familial tendency is evident

Coagulation & Vitamin K *

Vitamin K is an essential cofactor for synthesis of clotting factors -Fat-soluble vitamin synthesized by intestinal bacteria -In vitamin K deficiency, the liver produces inactive clotting factor resulting in abnormal bleeding

Cardiac Reserve

Maximum percentage of increase in cardiac output achieved above normal resting level -Young adult's normal reserve=300-400%

Glomerular Filtration Rate (GFR)

Measured clinically by collecting timed samples of blood and urine -determines how well the kidneys are working

Measures to Use to Diagnose Thyroid Disorders

Measures of T3, T4, and TSH Resin uptake test Assessment of thyroid autoantibodies Radioiodine (123I) uptake test Thyroid scans (i.e., 123I, 99mTc-pertechnetate) Ultrasonography CT and MRI scans Fine-needle aspiration (FNA) biopsy of a thyroid nodule

4 Types of Intestinal Obstruction

Mechanical Paralytic Abdominal distention Loss of fluids and electrolytes

Treatment of Renal Failure (Medical Management & Dietary)

Medical Management -Dialysis §Hemodialysis §Peritoneal dialysis -Transplantation Dietary Management -Protein -Carbohydrates, fat, calories -Potassium -Sodium and fluid intake

Manifestations of Mild Hypoxemia

Metabolic acidosis Increase in heart rate Peripheral vasoconstriction Diaphoresis Increase in blood pressure Slight impairment of mental performance

The nurse is teaching an adult client about treatment for uncomplicated diarrhea. Which information would be most appropriate for the nurse to provide? Full-strength infant formula as a supplement Fatty foods high in calories Oral replacement therapy (ORT) Foods higher in fiber content

Oral replacement therapy (ORT) -Complete ORT solutions contain carbohydrates, sodium, potassium, chloride, and base to replace what is lost in the diarrhea stool. -Fatty foods and foods high in simple sugars are best avoided.

Chronic Complications of Diabetes Mellitus

Microvascular complications Macrovascular complications Diabetic foot ulcers Injections

Classifications of Asthma (4)

Mild intermittent - symptoms < or = to 2x/week Mild persistent - symptoms >2x/week but <1x/day Moderate persistent - daily symptoms, some limitations to normal activity Severe persistent - continual symptoms, limited physical activity, frequent exacerbations, nighttime awakenings > or = to 7x/week

Antibodies directed against the M protein of certain strains of streptococcal bacteria seem to cross-react with glycoprotein antigens in the heart, joint, and other tissues to produce an autoimmune response resulting in rheumatic fever. This occurs through what phenomenon?

Molecular mimicry

Two weeks after receiving a prosthetic mitral valve, a client presents to the emergency department with fever, anorexia, and splinter hemorrhages of the nails. Which interventions will the nurse likely implement? Select all that apply. (3)

Monitoring for emboli Blood cultures Antibiotics

A nurse is assessing a client diagnosed with severe mitral valve stenosis. The nurse anticipates which classic assessment finding?

Orthopnea Explanation: The symptoms of mitral valve stenosis are those of pulmonary congestion, including nocturnal paroxysmal dyspnea and orthopnea. Atrial tachycardia and atrial fibrillation develop in 30% to 40% of clients with mitral valve stenosis.

The nurse is providing care for a medical client who has a complex regimen of care. Normal function of the client's blood-brain barrier will have what implication for the client's health status?

Most of the drugs that are administered to the client will not reach the nervous tissue of the client's brain.

Most common nontraumatic cause of neurologic disability among young and middle-aged adults

Multiple sclerosis

Extensors & Flexors

Muscles that increase the angle of a joint Muscles that decrease the angle of a joint

Muscular dystrophy is characterized by which pathophysiologic changes?

Muscular necrosis and replacement with fat and connective tissue

Which health problem is associated with heart failure as a result of diastolic dysfunction?

Myocardial hypertrophy Explanation: Conditions that reduce the heart's ability to adequately fill during diastole, such as myocardial hypertrophy and tachycardia, can lead to heart failure

A client is admitted with dilated cardiomyopathy with left ventricular dysfunction. The nurse should assess for which clinical manifestations? Select all that apply.

Orthopnea Dyspnea Extreme fatigue with activity

Lower motor neurons are found in the

PNS

Types of Reactions Involved in Hepatic Detoxification & Metabolism (2 Phases & Biotransformations)

Phase 1 reactions o Involve chemical modification or inactivation of a substance Phase 2 reactions o Involve conversion of lipid-soluble substances to water-soluble derivatives Biotransformations - a metabolic process that takes place mainly in the liver & helps facilitate the excretion of both exogenous and endogenous substances

Stimulation of the sympathetic nervous system during stress or exercise causes local constriction because of the release of which hormone?

Norepinephrine

The nurse is assessing the function of a client's cranial nerves. Which technique should the nurse use in assessing cranial nerve XII function?

Note any deviation when the client sticks out the tongue.

Conditions Associated with Disseminated Intravascular Coagulation (6)

Obstetric conditions Cancers Infections Shock Trauma or surgery Hematologic conditions

COPD: Chronic Obstructive Bronchitis

Obstruction of small airways

The body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process?

Peripheral vascular resistance

COPD clients live with persistently elevated PCO2 levels. Therefore, which assessment finding would likely initiate a stimulus for ventilation in this client population?

PO2 level of 50 mm Hg Explanation: The central chemoreceptors are extremely sensitive to short-term changes in blood PCO2 levels. An increase in the PCO2 of the blood produces an increase in ventilation that reaches its peak within a minute or so and then declines if the PCO2 level remains elevated. Thus, persons with chronically elevated blood PCO2 levels no longer respond to this stimulus for increased ventilation but rely on the stimulus provided by a decrease in arterial PO2 levels that is sensed by the peripheral chemoreceptors.

Symptoms of Diverticulitis (5)

Pain in the lower left quadrant Nausea and vomiting Tenderness in the lower left quadrant A slight fever An elevated white blood cell count

Fecal Impaction (7)

Painful anorectal disease Tumors Neurogenic disease Use of constipating antacids or bulk laxatives A low-residue diet Drug-induced colonic stasis Prolonged bed rest and debility

Odynophagia

Painful swallowing

A newly diagnosed paraplegic client maintains control of bladder emptying. The health care provider explains to the client/family stating which portion of the nervous system allows the motor component of the neural reflex to assist with bladder emptying?

Parasympathetic division of the ANS.

Tremor, rigidity, and bradykinesia are associated with

Parkinson disease.

Hormones that cause the subsequent stimulation or release of another hormone, such as thyroid-stimulating hormone, typically belong to which structural classification?

Peptide proteins and glycoproteins Explanation: Hormones whose effect includes the stimulation and release of other hormones belong to the structural category of peptide proteins and glycoproteins.

The newborn nursery nurse is preparing to perform a required neonatal screening for congenital hypothyroidism. What should the nurse do to obtain the necessary sample?

Perform a heel stick to obtain a drop of blood for a T4 and TSH.

A nurse assesses a client with normal biomarkers who reports angina. Which additional manifestations are late signs of aortic stenosis? Select all that apply. (3)

Peripheral cyanosis Syncope Dyspnea

Mneumonic for S&S of Cor Pulmonale (AKA Pulmonary Heart Disease or Right-sided Heart Failure): "Please read his text"

Peripheral edema Raised JVP Hepatic enlargement AKA hepatomegaly Tricuspid regurgitation AKA tricuspid incompetence

A client admitted to the hospital with heart failure tells the nurse he has developed a condition that interferes with movement of blood through sections of the lungs. The nurse recognizes this as:

Physiologic shunting

Lung Circulation

Pulmonary Circulation - Arises from the pulmonary artery; provides for the gas exchange function of the lungs Bronchial Circulation - Arises from the thoracic aorta; supplies the lungs and other lung structures with oxygen; distributes blood to the conducting airways; warms and humidifies incoming air

The nurse is caring for a group of clients and is reviewing the arterial blood gas results for each. Which client should the nurse assess first? The client with: -Morphine infusion and a PaO2 of 80 mm Hg (10.64 kPa) and a PaCO2 of 50 mm Hg (6.65 kPa) -Chronic obstructive pulmonary disease and a PaO2 of 75 mm Hg (9.98 kPa) and a PaCO2 of 55 mm Hg (7.32 kPa) -Pneumonia and a PaO2 of 60 mm Hg (7.98 kPa) and a PaCO2 of 40 mm Hg (5.32 kPa) -Tuberculosis and a PaO2 of 85 mm Hg (11.30 kPa) and a PaCO2 of 50 mm Hg (6.65 kPa)

Pneumonia and a PaO2 of 60 mm Hg (7.98 kPa) and a PaCO2 of 40 mm Hg (5.32 kPa) Explanation: The nurse should recognize the hypoxia in the client with pneumonia as the priority. This could be a sign the client has developed acute respiratory distress syndrome (ARDS), a complication of infection that progresses quickly and can be fatal. (The client on morphine has a normal oxygen level but may be hypoventilating d/t respiratory suppression -the nurse should assess this client second.)

Lead toxicity would result in which of the following conditions?

Polyneuropathies -would result due to the systemic exposure to lead.

The nurse is performing an assessment for a client suspected of having symptoms that correlate with carpal tunnel disorder. The client states he feels a tingling sensation that radiates into the palm of the hand when the nurse lightly percusses over the median nerve. How would the nurse document this finding?

Positive Tinel sign

Congestive heart failure would be a(n) __________ cause of renal failure. A.Prerenal B.Intrarenal C.Postrenal

Prerenal Prerenal causes of acute kidney injury include profound depletion of vascular volume, impaired perfusion due to heart failure and cardiogenic shock, and decreased vascular filling because of increased vascular capacity.

An older male client has fallen at home and sustained a bruised left hip. Assessment reveals shortness of breath and shallow respirations with a respiratory rate of 40 breaths/min. If the client develops a tension pneumothorax, what additional assessment finding would the nurse observe?

Presence of a mediastinal shift Explanation: Physical assessment findings of a mediastinal shift and neck vein distention would indicate a tension pneumothorax.

Manifestations of Classic Form of Celiac Disease -Presents in ________ -Manifests as _______ (4)

Presents in infancy Manifests as o Failure to thrive o Diarrhea o Abdominal distention o Occasionally, severe malnutrition

A nurse is taking a manual measure of a client's blood pressure. The nurse knows that which factors related to blood flow underlies the ability to hear blood pressure by auscultation (listening)?

Pressure pulsation that exceeds the velocity of blood flow is audible and coincides with systolic BP.

Thiazide Diuretics

Prevent the reabsorption of NaCl in the distal convoluted tubule

Complications of Shock (5)

Pulmonary injury Acute renal failure GI ulceration Disseminated intravascular coagulation (DIC) Multiple organ dysfunction syndrome (MODS)

A client has developed acute encephalopathy from lead toxicity. The nurse will likely assess which manifestations in this client? Select all that apply.

Vomiting Ataxia Seizures Papilledema Coma

Categories of Pituitary Tumors (4)

Primary tumors Secondary tumors o Metastatic lesions Functional tumors o Secrete pituitary hormones Nonfunctional tumors o Do not secrete hormones *A patient has developed a tumor of the posterior pituitary gland. What would the patient be at risk for problems with secretion of antidiuretic hormone and oxytocin

A 62-year-old female client presents to the emergency department and is diagnosed with acute heart failure syndrome. Which assessment finding would the nurse expect?

Productive cough with frothy sputum. Explanation: The signs and symptoms of acute heart failure syndromes include shortness of breath and other respiratory manifestations (i.e., exertional dyspnea, orthopnea), fatigue and limited exercise tolerance, fluid retention and edema, cachexia and malnutrition, and cyanosis. Acute pulmonary edema is the most dramatic symptom of AHFS. The client would have an increased heart rate as a result of the exertional process.

Acute tubular necrosis (ATN)

Prolonged renal ischemia (intrarenal) -Caused by exposure to nephrotoxic drugs, metals, organic solvents -Intratubular obstruction resulting from hemoglobinuria, myoglobinuria, myeloma light chains, or uric acid casts -Acute renal disease

Muscle spindles and Golgi tendon organs are two types of sensory receptors that provide information to the central nervous system (CNS). This information is relayed to the thalamus and sensory cortex and is experienced as:

Proprioception Explanation: Specialized sensory nerve terminals in the skeletal muscles (muscle spindles) and tendons (Golgi tendon organs) relay information about muscle stretch and joint tension to the CNS. This information is relayed to the thalamus and sensory cortex and is experienced as proprioception, the sense of body movement and position.

There are two types of nervous tissue cells: neurons and supporting cells. What is the function of the supporting cells?

Protect the nervous system and provide metabolic support for the neurons

A client has sustained an acute spinal cord injury in a fall from a tree stand during a hunting trip. The client will require surgical intervention for the unstable spinal cord. What does the nurse recognize is the goal of early surgical intervention for this client?

Provide internal skeletal stabilization.

Many hormones are measured for diagnostic reasons by using the plasma levels of the hormones. What is used today to measure plasma hormone levels?

Radioimmunoassay methods

Bilirubin is an important indicator of which of the following: A. Rate of RBC production B. Rate of hemoglobin production C. Rate of RBC breakdown D. Rate of hemoglobin oxidation

Rate of RBC breakdown -Bilirubin is a product of RBC breakdown and will be elevated if breakdown is accelerated (hemolytic anemia).

Erythropoiesis

Red cells are produced in the red bone marrow after birth. -Until 5 years of age, almost all bones produce red cells to meet growth needs; after 5 years, bone marrow activity gradually declines. -After 20 years, red cell production takes place mainly in the membranous bones of the vertebrae, sternum, ribs, and pelvis. -With this reduction in activity, the red bone marrow is replaced with fatty yellow bone marrow.

The health care provider is preparing to assess a client who has been diagnosed with -hypertrophic cardiomyopathy-. The provider anticipates the assessment data will include which finding?

Reduced chamber size Explanation: Hypertrophic cardiomyopathy (HCM) is characterized by unexplained left ventricular hypertrophy with disproportionate thickening of the ventricular septum, abnormal diastolic filling, cardiac arrhythmias and, in some cases, intermittent left ventricular outflow obstruction.

Which is the period during repolarization when a portion of the recovery cycle is where the membrane can be excited, although only by a stronger-than-normal stimulus?

Relative refractory period

A client is experiencing circulatory shock. The nurse is aware that compensation will occur with stimulation of the beta-2 (β2) receptors. The nurse anticipates the client will experience which physiologic response?

Relaxation of the bronchioles

Hemoglobin Structure (5)

Representation of the iron cycle: -Absorption from the GI tract -Transport in the circulation -Storage in the liver -Recycling from aged red cells destroyed in the spleen -Use in the bone marrow synthesis of RBCs (see slide for visual)

Acute Heart Failure

Represents a gradual or rapid change in heart failure signs and symptoms, indicating need for urgent therapy -Pulmonary congestion due to elevated L ventricular filling pressures, with or without a low CO

The pathogenesis of multi-organ dysfunction syndrome (MODS) is not clearly understood at this time. Supportive management is currently the focus of treatment in this disorder. What is *NOT* a major risk factor in MODS?

Respiratory dysfunction

Which symptom is unique to amyotrophic lateral sclerosis (ALS) and is not observed in multiple sclerosis (MS)? Optic nerve dysfunction Respiratory muscle impairment Dysarthria Fatigue

Respiratory muscle impairment

Which diagnosis puts a client at risk for developing an immunologic form of interstitial lung disease? Rheumatoid arthritis Cancer Asbestosis Septicemia

Rheumatoid arthritis

Cor Pulmonale

Right heart failure resulting from primary lung disease and long-standing primary or secondary pulmonary hypertension -Involves hypertrophy and the eventual failure of the right ventricle -Manifestations include the S&S of the primary lung disease and the signs of right-sided heart failure

Shortness of breath, vague chest discomfort, fatigue, GI symptoms and radiating substernal pain are all associated with

STEMI

Which disease results from a nutritional deficiency?

Scurvy

Which protective measure of the peritoneum helps keep abdominal inflammation and infection localized?

Secretes fibrinous substance Explanation: The peritoneum produces an inflammatory response as a means of controlling infection. It tends, for example, to exude a thick, sticky, and fibrinous substance that adheres to other structures, such as the mesentery and omentum, as a means of sealing off the perforation and localizing the process. Localization is enhanced by sympathetic stimulation that limits/decreases intestinal motility. The peritoneum is connective tissue without the ability to constrict. The vasoconstriction can decrease dissemination of the bacteria in the blood but also causes ischemic bowel damage that may be irreversible.

A client with a pathophysiologic condition that affects the desmosomes is most likely to exhibit which problem?

Separation at the junctions between epithelial cells

The diagnosis of chronic stable angina is based on a detailed pain history, the presence of risk factors, invasive and noninvasive studies, and laboratory studies. Which diagnostic test is usually not prescribed since the results are normal for clients with the diagnosis of chronic stable angina? Serum biochemical markers Cardiac catheterization Echocardiogram Nuclear imaging studies

Serum biochemical markers Explanation: Serum biochemical markers for MI are normal in clients with chronic stable angina. All other answers are tests used in the diagnosis of angina.

Measurement of Hypothalamic-Pituitary Target Cell Hormones (6)

Serum cortisol Serum prolactin Serum thyroxine and TSH Serum testosterone (male)/serum estrogen (female) and serum LH/FSH Serum GH/insulin-like growth factor-1 Plasma osmolality and urine osmolality

Clients with chronic diseases such as chronic obstructive pulmonary disease (COPD), when given oxygen at a level that increases PO2 above 60 mm Hg (7.98 kPa) would experience:

Severely depressed ventilation

An important factor in the mortality of severe shock is acute renal failure. What impacts the extent of renal damage in shock?

Severity and duration of shock

Unstable plaque, a condition of atherosclerotic heart disease, occurs in unstable angina and myocardial infarction. Unstable plaque can rupture, causing platelet aggregation and thrombus formation. What are the major determinants of the vulnerability of plaque to rupture? (4)

Size of lipid-rich core Presence of inflammation Thickness of fibrous cap Lack of smooth muscle cells

Water, Electrolyte, and Acid-Base Balance in Kidneys

Sodium and water balance -The kidneys function in the regulation of extracellular fluid volume. Potassium balance -Approximately 90% of potassium excretion is through the kidneys. Acid-base balance -The kidneys normally regulate blood pH by eliminating hydrogen ions produced in metabolic processes and regenerating bicarbonate.

A client with diabetes mellitus is reporting burning pain of the feet and some numbness. These symptoms are likely due to which cause?

Somatic neuropathy -Somatic neuropathy is usually bilateral and symmetric and associated with paresthesia, burning sensations, and numbness along with decreased senses of vibration, pain, temperature, and proprioception, particularly in the lower extremities. -The autonomic neuropathies result in disorders of vasomotor function, decreased cardiac responses, inability to empty the bladder, gastrointestinal motility problems, and sexual dysfunction.

Which breathing-related actions are affected by voluntary respiratory control? Select all that apply. Speaking Singing Hiccupping Swallowing Blowing

Speaking Singing Blowing

Which type of angina is brought about by exercise or stress? A. Stable B. Unstable

Stable Rationale: Stable angina does not present as a problem until there is an increase in workload.

The nurse is caring for a client with hypovolemic shock. Which of these does the nurse recognize is the liver's contribution to compensate for shock states?

Stored blood in the liver can shift to general circulation to restore blood volume.

The health care provider is assessing a client to differentiate a herniated disk from other causes of acute back pain. The most important test for the provider to perform would be: Straight-leg test Pain rating scale Deep tendon reflex test Apgar test

Straight-leg test

The nurse is educating a client with hyperthyroidism who has recovered from thyrotoxicosis (thyroid storm) and is preparing for discharge. What can the nurse inform the client that this hypermetabolic state can be caused by in order to decrease exacerbation? Select all that apply Stress Physical or emotional trauma Manipulation of the thyroid gland Moderate physical exercise such as walking. Eating spicy foods

Stress Physical or emotional trauma Manipulation of the thyroid gland

The nurse cares for a client with severe chronic obstructive pulmonary disease who has been taking oral steroids for several years. Which response in the client's endocrine control will the nurse expect? Suppression of the client's hypothalamic-pituitary-target cell system Increased levels of adrenocorticotropic hormone (ACTH) Increased levels of epinephrine and norepinephrine Suppression of the body's positive feedback mechanisms

Suppression of the client's hypothalamic-pituitary-target cell system Explanation: Exogenous forms of hormones (given as drug preparations) can influence the normal feedback control of hormone production and release. One of the most common examples of this influence occurs with the administration of the corticosteroid hormones, which causes suppression of the hypothalamic-pituitary-target cell system that regulates the production of these hormones. Positive feedback control occurs when rising levels of a hormone cause another gland to release a hormone that is stimulating to the first. The steroid will not cause increase in the levels of the hormones.

Bronchial smooth muscle relaxation and vascular smooth muscle constriction are caused by the direct actions of which system?

Sympathetic nervous system

Which is a criterion for diagnosing moderately persistent asthma?

Symptoms occur daily.

After neurotransmitters are synthesized, in which structure are they stored in the axon terminal?

Synaptic vesicles

A 66-year-old client's echocardiogram report reveals a hypertrophied left ventricle. The health care provider suspects the client has aortic stenosis. Which clinical manifestations would be observed if this client has aortic stenosis? Select all that apply. Decrease in exercise tolerance Exertional dyspnea Palpitations Syncope Heartburn

Syncope Decrease in exercise tolerance Exertional dyspnea Explanation: Because of the slow onset of aortic valve stenosis, the heart is able to compensate by hypertrophying and may still maintain a normal chamber volume and ejection fraction. As the stenosis progresses, the client will experience classic symptoms of angina, syncope, heart failure, decrease in exercise tolerance, or exertional dyspnea.

A nurse is administering norepinephrine via a continuous IV infusion. Which assessment finding indicates that the infusion rate may need to be adjusted?

Systemic vascular resistance (SVR) is elevated.

A woman with a diagnosis of type 2 diabetes has been ordered a hemoglobin A1C test for the first time by her primary care provider. The woman states, "I don't see why you want to test my blood cells when it's sugar that's the problem." What aspect of physiology will underlie the care provider's response to the client? The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell. Hemoglobin synthesis by the bone marrow is inversely proportionate to blood glucose levels, with low A1C indicating hyperglycemia. The high metabolic needs of red cells and their affinity for free glucose indicate the amount of glucose that has been available over 6 to 12 weeks. Insulin is a glucose receptor agonist on the hemoglobin molecule and high glucose suggests low insulin levels.

The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell.

Circulatory System Pressure

The circulatory system is a closed system in which the heart consists of two pumps in series. ●Blood pressure -Arterial ●Higher pressure, 90-100 mm Hg ●Propel blood to all other tissues of the body (i.e., systemic circulation) -Venous ●Lower pressure, 12 mm Hg ●Propel blood through the lungs (i.e., pulmonary circulation)

During an assessment of a client with ankle swelling, the nurse observes jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. What is the correct interpretation of this finding?

The client has increased pressure related to right-sided heart failure.

The nurse is performing a test to determine a client's neurologic function related to a suspected lesion in the parietal lobe. What would the nurse determine is a normal finding after assessment?

The client is able to determine correctly that the item placed in his hand is a paper clip.

A respiratory therapist is describing the characteristics of the oxygen-hemoglobin dissociation curve to a group of nurses caring for some respiratory clients. The respiratory therapist is describing what will happen to a client's oxygen saturation level if the partial pressure of oxygen decreases from 100 to 95 mm Hg. What will happen if this occurs?

The client will experience a negligible decrease in oxygen saturation Explanation: Because of the relatively flat appearance of the curve at higher PO2, there is virtually no decrease in oxygen saturation until PO2 falls below 50% or 60%.

Transmural Infarcts vs. Subendocardial Infarcts

Transmural Infarcts - Involve the full thickness of the ventricular wall -Occur when there is obstruction of a single artery Subendocardial Infarcts - Involve the inner one third to one half of the ventricular wall -Occur more frequently in the presence of severely narrowed but still patent arterial ductus

Which statement best describes a secondary disorder of endocrine function? The disorder occurs when the target organ is normal, but stimulating hormones alter its function. The disorder occurs in the target gland responsible for producing the hormone. The disorder occurs from hypothalamic dysfunction resulting in understimulation of the target organ. The disorder occurs when the target organ becomes dysfunctional.

The disorder occurs when the target organ is normal, but stimulating hormones alter its function.

Perfusion

The flow of blood through the lungs

Complaints Accompanying Esophageal Diverticulum (5)

The food stops before it reaches the stomach. Gurgling Belching Coughing Foul-smelling breath

Frank-Starling Mechanism

The greater the volume of blood in the heart before contraction, the greater the volume of blood ejected from the heart -Increased contractility from EDV stretch -The normal relationship b/t the length & tension of the myocardium. The greater the stretch on the myocardium before systole (preload), the stronger the ventricular contraction

Bilirubin *

The heme unit is converted to bilirubin. -Unconjugated bilirubin is insoluble in plasma and attaches to plasma proteins for transport. ** -Conjugated bilirubin is removed from the blood by the liver and conjugated with glucuronide to render it water soluble to be excreted as bile -Jaundice=yellowing of the skin occurs if RBCs are broken down > bilirubin removal **

Thrombosis & Bleeding *

The inappropriate formation of clots within the vascular system Failure of blood to clot in response to appropriate stimulus

Diverticulitis

The infection or inflammation of pouches that can form in your intestines. *Pouches can rupture

Liver Bile

The liver produces approximately 500 to 600 mL of yellow-green bile daily.

Clinical Manifestations of Diabetes Mellitus

The most commonly identified signs and symptoms of diabetes are referred to as the three polys: 1)Polyuria (i.e., excessive urination) 2)Polydipsia (i.e., excessive thirst) 3)Polyphagia (i.e., excessive hunger) The 3P's + add weight loss in uncontrolled Type 1 DM

Diffusion (Respiratory)

The movement of anything from high concentration to low concentration. In the respiratory system, it refers to the movement of O2 and CO2 from higher concentration to lower concentration of gases

A pathologist is examining histological (tissue) samples from a client with an autoimmune disease. Which characteristic of muscle samples would signal the pathologist that the samples are cardiac rather than skeletal muscle?

The muscle cells are arranged as an interconnecting lattice-work.

Hepatocellular cancer usually has a poor prognosis due in part to which factor?

The nonspecific symptomatology of liver cancer leads to a diagnosis at a late stage.

What is a function of the bronchial circulation?

Warms and humidifies incoming air

Characteristics of Pain Associated with Unstable Angina

The pain has a more persistent and severe course -Can occur at rest (or with minimal exertion), usually lasting more than 20 minutes (if not interrupted by nitroglycerin) -Severe and described as frank pain; new onset -It occurs with a pattern that is more severe, prolonged, or frequent than previously experienced

Red Blood Cell Destruction

The red blood cell has a life span of approximately 120 days. -Broken down in the spleen -The degradation products (iron and amino acids) are recycled The heme molecule is converted to bilirubin and transported to the liver. -It is removed and rendered water soluble for elimination in the bile.

Cirrhosis

The replacement of hepatic tissue with fibrotic tissues which results in loss of function. Cirrhosis happens in end-stage liver disease. In cirrhosis, there is fibrosis and loss of liver function

Monitoring Changes in Hormone Levels

The sensors that detect changes in hormone level and elicit a hormonal response that will return the level to that within normal range is called feedback. -Positive feedback -Negative feedback (focus on this in particular) -Level of the substance the hormone regulates

Bile is made up of (7)

Water, bile acids, cholesterol and other phospholipids, electrolytes, some trace elements and pigments, and other metabolic waste (including drug metabolites).

A client asks the nurse when during embryonic growth the nervous system develops. The best response would be:

Week 3

The nurse is teaching a group of nursing students about exudative pleural effusion. Which statement by the students verifies that the teaching was effective? The specific gravity of the pleural exudate is greater than 1.020. One of the causes of pleural effusion is hyperalbuminemia. A possible treatment for pleural effusion is paracentesis. Pleural effusion is defined as an abnormal collection of air in the pleural space.

The specific gravity of the pleural exudate is greater than 1.020. Explanation: Pleural effusion refers to an abnormal collection of fluid in the pleural cavity. The fluid that accumulates in a pleural effusion may be a transudate or exudate, purulent (containing pus), chyle, or sanguineous (bloody). An exudate is a pleural fluid that has a specific gravity greater than 1.020 and often contains inflammatory cells. Conditions that produce exudative pleural effusions are bacterial pneumonia, viral infection, pulmonary infarction, and malignancies. Thoracentesis may be used to remove fluid from the intrapleural space.

Alveoli **

The terminal air spaces of the respiratory tract and the actual sites of gas exchange between the air and blood -Composed of two types of cells: 1) Type I Alveolar Cells - Flat squamous epithelial cells across which gas exchange takes place 2) Type II Alveolar Cells - Produce surfactant, a lipoprotein substance that decreases the surface tension in the alveoli and allows for greater ease of lung inflation

Peritonitis is an inflammatory condition of the lining of the abdominal cavity. What is one of the most important signs of peritonitis?

The translocation of extracellular fluid into the peritoneal cavity (through weeping or serous fluid from the inflamed peritoneum) and into the bowel as a result of bowel obstruction.

Airway Resistance

The volume of air that moves into and out of the air exchange portion of the lungs -Directly related to the pressure difference between the lungs and the atmosphere -Inversely related to the resistance the air encounters as it moves through the airways

Renal Clearance

The volume of plasma that is completely cleared each minute of any substance that finds its way into the urine

An 8-year-old child has been diagnosed with gigantism. Which criteria would the nurse correlate with the diagnosis of gigantism? The child has an increase in thyroid-stimulating hormone (TSH) level and has a goiter. There is increased growth hormone levels and the epiphyses of the long bones are not fused. The child is exceptionally tall for chronological age and has a low body mass index. The child has increased cortisol levels, truncal obesity, and altered fat distribution.

There is increased growth hormone levels and the epiphyses of the long bones are not fused.

A teenager comes to the emergency room with a history of strep throat and symptoms that lead the staff to suspect rheumatic fever. Which tests can best establish a diagnosis of rheumatic fever?

There is no definitive test for diagnosing RF. Explanation: There are no specific lab tests that can establish a diagnosis of rheumatic fever. Because of the variety of signs and symptoms, the Jones criteria for the diagnosis of rheumatic fever are used.

Bronchial blood vessels have several functions. They warm and humidify incoming air as well as distribute blood to the conducting airways and the supporting structures of the lung. What is it that makes bronchial blood vessels unique in the body?

They can undergo angiogenesis. Explanation: The bronchial blood vessels are the only ones that can undergo angiogenesis (formation of new vessels) and develop collateral circulation when vessels in the pulmonary circulation are obstructed, as in pulmonary embolism. The development of new blood vessels helps to keep lung tissue alive until the pulmonary circulation can be restored. The blood in the bronchiole blood vessels is unoxygenated, so they neither carry oxygen-rich blood to the lung tissues nor participate in gas exchange. Bronchiole blood vessels drain blood into the bronchial veins.

Which situation is most likely to result in an increased binding affinity of hemoglobin for oxygen?

Three of four binding sites on a client's hemoglobin molecule are occupied by oxygen. Explanation: As each binding site on a hemoglobin molecule is occupied, the affinity of the remaining sites for oxygen binding is increased. Increased affinity is associated with alkalosis, not acidosis, and fever causes reduced affinity. Exercise increases the unloading of oxygen, a situation characterized by low affinity.

Platelet Defects (2) *

Thrombocytopenia- results from a decrease in platelet production, increased sequestration of platelets in the spleen, or decreased platelet survival 3 Types- Drug-induced thrombocytopenia; Idiopathic thrombocytopenic purpura; Thrombotic thrombocytopenic purpura Impaired platelet function

Manifestations of Thyroid Storm

Thyrotoxic crisis or thyroid storm happens when there is overproduction of triiodothyronine (T3) and thyroxine (T4) , and -Very high fever -Extreme cardiovascular effects o Tachycardia, congestive failure, and angina -Severe CNS effects o Agitation, restlessness, and delirium -High mortality rate`

Local control of blood flow is regulated by mechanisms that match blood flow to the metabolic needs of the tissue. Which components of the vascular system are involved in the short-term control of blood flow? Select all that apply.

Tissue Smooth muscle Endothelial cells

An angiogram reveals 80% to 90% occlusions in several coronary arteries but the client's troponin I level is normal. The client asks the nurse, "How it was possible to have such blockage yet have no symptoms?" How should the nurse respond?

To compensate for long-standing narrowing of the vessels, new arteries formed to increase blood supply.

Following a winter power outage, a client who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning?

To increase the amount of oxygen carried in the dissolved state Explanation: While increased alveolar PO2 improves the oxygen saturation of hemoglobin, carbon monoxide occupies the hemoglobin sites usually available for oxygen. With much of the blood composed, temporarily, of carboxyhemoglobin, it is necessary to rely upon alternate means to deliver oxygen to the tissues. Plasma's normally low carrying capacity for dissolved oxygen can be increased by administration of 100% oxygen in the high atmospheric pressure of a hyperbaric chamber.

A client is admitted with an exacerbation of Crohn disease and has been experiencing a weight loss of 20 pounds in 2 weeks. The client is unable to absorb nutrients from the intestine. The nurse would expect which type of diet to be ordered for this client? High-fiber diet High-calorie, low-fat diet Total parenteral nutrition Low-residue diet

Total parenteral nutrition Explanation: Total parenteral nutrition consists of intravenous administration of hypertonic glucose solutions to which amino acids and fats may be added. This form of nutritional therapy may be needed when food cannot be absorbed from the intestine.

A client experiencing fulminant disease of ulcerative colitis would be at risk for developing which complication associated with colonic dilation?

Toxic megacolon -People with fulminant disease have features that include more than 10 bowel movements a day, continuous bleeding, fever, and other signs of toxicity, abdominal tenderness and distention, need for blood transfusion, and colonic dilation on abdominal radiographs. These people are at risk for development of toxic megacolon, which is characterized by dilation of the colon and signs of systemic toxicity. It results from extension of the inflammatory response, with involvement of neural and vascular components of the bowel.

A nurse finds a client unconscious and not responding to stimuli, lying in a supine position, and snoring loudly. What should the nurse do immediately?

Turn the client to a side-lying position. Explanation: When the client is lying supine, the tongue can fall back into the oropharynx and occlude the upper airway, which creates the snoring sound that is being heard. Turning the client to the side allows the tongue to fall forward, offering airway protection compared to lying on the back. The client is snoring, so he or she is breathing and does not need resuscitative measures. The airway must be protected before taking any other measures. For example, applying oxygen before opening the airway means that oxygen would not effectively be inspired.

Flaccid Bladder Dysfunction

Type of neurogenic bladder disorder where bladder emptying is impaired -Neurologic disorders affect motor neurons in the sacral cord or peripheral nerves that control detrusor muscle contraction and bladder emptying.

Spastic Bladder Dysfunction

Type of neurogenic bladder disorder where there is a failure to store urine -Neurologic lesions above level of the sacral cord allow neurons in the micturition center to function reflexively without control from the CNS centers.

Types of Pulmonary Embolism (3) & S&S (3)

Types: 1) Thrombus: arising from DVT 2) Fat: mobilized from the bone marrow after a fracture or from a traumatized fat depot 3) Amniotic fluid: enters the maternal circulation after rupture of the membranes at the time of delivery Signs and symptoms: Pain, Tachypnea (increase in RR), dyspnea

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 imaging technique will be most helpful to the surgeon in visualization of the nodes for fine needle aspiration?

Ultrasound

A 70 year-old male has been diagnosed with a stroke that resulted in an infarct to his cerebellum. Which clinical finding would be most closely associated with cerebellar insult?

Unsteady gait and difficulty speaking and swallowing

Following coronary bypass graft (CABG) surgery for a massive myocardial infarction (MI) located on their left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which assessment findings would confirm the client may be in the early stages of cardiogenic shock? Select all that apply. Decreasing mean arterial pressure (MAP) Low BP reading of 86/60 Urine output 15 mL last hour Low pulmonary capillary wedge pressure (PCWP) Periods of confusion

Urine output 15 mL last hour Low BP reading of 86/60 Periods of confusion Decreasing mean arterial pressure (MAP) Explanation: Signs/symptoms of cardiogenic shock include indications of hypoperfusion with hypotension (BP 96/60), decrease in mean arterial pressure (MAP) due to poor stroke volume, and a narrow pulse pressure. Urine output decreases because of lower renal perfusion pressures. PCWP is usually elevated due to increased preload. Periods of confusion or altered cognition/ consciousness may occur because of low cardiac output.

Hydronephrosis

Urine-filled dilation of the renal pelvis and calices associated with progressive atrophy of the kidney caused by an obstruction of urine outflow --water in the kidney (backed up); this fluid accumulation can cause a block in ureters & kill kidney cells

A client has experienced the α1-receptor stimulation. The nurse would assess the client for:

Vasoconstriction

A client has developed atelectasis postoperatively. Which physiologic response to the atelectasis is expected?

Vasoconstriction of pulmonary vessels surrounding alveoli that are hypoxic.

Dopamine is an intermediate compound made during the synthesis of norepinephrine. It is the principal inhibitory transmitter of the internuncial neurons in the sympathetic ganglia. What other action does it have?

Vasodilates renal and coronary blood vessels when given intravenously

A 44-year-old woman has developed calf pain during a transatlantic flight. She is extremely short of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE) that resolved with anticoagulant therapy. Which statement best characterizes the underlying problem of her PE?

Ventilation was occurring but perfusion was inadequate, causing shortness of breath.

Ventiliation

Ventilation- the mechanical movement of air into and out of the lungs -Consists of inspiration (air into lungs) & expiration (air out of lungs)

Red Blood Cell Components Used in Transfusion Therapy (5)

Whole blood Red blood cells Leukocyte-reduced blood cells Washed red blood cells Frozen red blood cells

The nurse is caring for client who has been living with Parkinson disease for the past 10 years and is being treated with levodopa-carbidopa. The client often leaves the unit with family for extended periods. What should the nurse prioritize when teaching the client? -It is essential that you eat a healthy diet with adequate amounts of protein if dining out. -Your medication needs to be taken at equal intervals to reduce symptom fluctuation. -Frequent assessments are needed to prevent complications related to your condition. -Due to your risk for falls it is recommended you do not leave the unit with family.

Your medication needs to be taken at equal intervals to reduce symptom fluctuation.

Cholestasis represents *

a decrease in bile flow through the intrahepatic canaliculi & a reduction in secretion of water, bilirubin, and bile acids by the hepatocytes.

The neuromuscular junction (NMJ) is

a highly specialized synapse b/t a motor neuron nerve terminal and its muscle fiber that are responsible for converting electrical impulses generated by the motor neuron into electrical activity in the muscle fibers.

The earliest signs of aortic stenosis are

a loud systolic ejection murmur or a single (or paradoxically split) second heart sound

Plasminogen

a plasma protein that is converted to plasmin

The most common direct causes of peritonitis include

a ruptured appendix.

The chemoreceptor trigger zone is located in & It is thought to

a small area on the floor of the fourth ventricle, where it is exposed to both blood and cerebrospinal fluid. -It is thought to mediate the emetic effects of blood-borne drugs and toxins.

Myasthenia gravis is an

autoimmune disease caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction -Disorder of transmission at the neuromuscular junction that affects communication between the motoneuron and the innervated muscle cell. -a specific type of Neuromuscular Junction Disorders (NMJ)

A client with chronic asthma is experiencing a severe asthma attack and is becoming increasingly agitated. The nurse supports the client's ability to move more air in and out of the lungs by instructing the client to stabilize his accessory muscles. The nurse understands that by stabilizing the accessory muscles, the:

accessory muscles can assist in ventilation. Explanation: Accessory muscles assist ventilation by elevating the ribs and the sternum, which enlarges the chest cavity allowing more air to flow in. To stabilize the accessory muscles, the client should brace his shoulders by pressing down on a hard surface along with putting his head back to engage the scalene and sternocleidomastoid muscles.

An adult with excess growth hormone due to an adenoma has the precursors to

acromegaly

Neurons cannot store glucose so they rely on ______ and _______

blood glucose and glycogen stores of supporting neuroglial cells

Difficulties with starting movement, stopping movement, and maintaining rhythmic movements are indicative of

basal ganglia disorders

Postrenal acute kidney/renal failure occurs when there is

blockage BELOW the kidneys - in ureters: -Bilateral ureteral obstruction (a blockage in one or both of the ureters that carry urine from the kidneys to the bladder) or -Bladder outlet obstruction (blockage at base of the bladder) e.g. calculi, fetus in utero blocking the ureter *something is blocking the urine causing back-up

Basal ganglia receive indirect input from the ________ and from _______, including ____________

cerebellum and from all sensory systems, including vision, and direct input from the motor cortex.

Drugs like diazepam, a benzodiazepine, exert their action on ion channels. These drugs do not open the GABA-operated ion channel, but they:

change the effect that GABA has when it binds to the channel at the same time as the drug.

The nurse receives report that a client is hypercapnic. For which type of pathophysiologic condition will the nurse assess? conditions that lead to hypoventilation conditions that lead to increased metabolic rate conditions that lead to tissue hypoxia conditions that cause inflammation of the airway

conditions that lead to hypoventilation

Atrioventricular (AV) node

conduction slows

Sensory feedback from the involved muscles are

continuously relayed to the cerebellum basal ganglia and sensory cortex

Hypothalamus is the

coordinating center of the brain for endocrine, behavioral, and autonomic nervous system function. The hypothalamus integrates the central nervous and the endocrine system by releasing hormones to the anterior pituitary gland. The anterior pituitary release the following hormones

The cerebellum brain is responsible for

coordination of motor movement, such as running, typing, and talking

Cranial Meninges

cover the brain

The proliferation, differentiation, and functional abilities of the various blood cells are controlled by

cytokines.

The nurse is assessing a client experiencing shock. The nurse associates which finding with compensatory neurohormonal responses to shock?

decreased urine output Explanation: In states of shock, a decrease in renal blood flow and glomerular filtration rate results in activation of the renin-angiotensin-aldosterone mechanism. Aldosterone is a hormone which increases sodium and water reabsorption by the kidneys into the bloodstream. The decrease in blood volume also stimulates the sympathetic nervous system causing an increase in the release of antidiuretic hormone, also known as vasopressin. This hormone also and greatly increases water retention by the kidneys. The retention of water from the filtrate results in lower amounts of more concentrated urine. If glomerular filtration is reduced, there is an expected increase in the serum creatinine, not a decrease. Because of peripheral vasoconstriction and shunting of fluid to organs, peripheral pulses become weaker when compensating for a shock state.

Polyneuropathy involves

demyelination or axonal degeneration of multiple peripheral nerves that leads to symmetric sensory, motor, or mixed sensorimotor deficits -Typically, the longest axons are involved first, with symptoms beginning in the distal part of the extremities (e.g. Guillain-Barré syndrome) - Guillain-Barre causes a concerning complication of respiratory failure as the disease progresses.

A client has had severe heartburn associated with persistent gastroesophageal reflux for many years. Which statement made by the client leads the nurse to suspect the client is having a complication related to his reflux? The client is having: difficulty in swallowing with feelings that food is "stuck" in the throat. burning sensation a half-hour after a meal. substernal chest pain that radiates to the shoulder and arm. "hoarseness" unrelieved by coughing or taking a drink of water.

difficulty in swallowing with feelings that food is "stuck" in the throat. Explanation: Complications can result from persistent reflux, which produces a cycle of mucosal damage that causes hyperemia (an excess of blood in the vessels supplying an organ or other part of the body), edema, and erosion of the luminal surface. Strictures are caused by a combination of scar tissue, spasm, and edema, which narrow the esophagus. The most frequent symptom of gastroesophageal reflux is heartburn. Other symptoms include belching, wheezing, chronic cough, hoarseness, and epigastric or retrosternal area chest pain, radiating to the throat, shoulder, or back. Because of its location, the pain may be confused with angina.

Cardiac magnetic resonance imaging and cardiac computed tomography are used to (3)

document ejection fraction, ventricular preload, and regional wall motion.

People with Parkinson's disease do not have

dopamine -Dopamine is given as treatment

Echocardiography plays a key role in assessing (6)

ejection fraction (EF) right and left ventricular wall thickness ventricular chamber size valve function heart defects pericardial disease

Action potentials are the movement of

electrical charge along the axon membrane; frequency conveys information -Na+ influx in the soma results in depolarization. o Triggers voltage-gated Na+ and K+ channels in the axon -K+ efflux repolarizes the membrane.

Clients with infective endocarditis are at risk for

emboli (as the vegetations on the valves may break off and travel to other parts of the body) & they are also at risk for heart failure. -Treatment focuses on preventing emboli, preventing heart failure, and treating the infection.

Aphasia

encompasses varying inabilities to comprehend, integrate, and express language -Can be receptive (fluent) or expressive (nonfluent) - Fluency is defined by the rate of speech

The diagnosis of genetic diseases using DNA analysis is rapidly becoming a routine part of

endocrine practice.

Nephrotic syndrome is a syndrome that results from

increase in glomerular permeability in which the urine contains abnormally high levels of proteins, lipids (including fatty casts) and loss of plasma proteins in urine. Nephrotic syndrome results in generalized edema and proteinuria.

Cardiac glycosides improve cardiac function by

increasing the force and strength of ventricular contractions.

Major triggering causes of mechanical bowel obstruction include (2)

external hernia (e.g., inguinal, femoral, or umbilical) and postoperative adhesions.

Exudative pleural effusion

fluid leaking into the pleural space d/t inflammation & increased capillary permeability e.g. of causes: pneumonia, cancer, TB

Transudative pleural effusion is caused by

fluid leaking into the pleural space from either increased pressure in the blood vessels or a low blood protein count. -Heart failure is the most common cause -Can also be caused by cirrhosis, nephrotic syndrome

Esophageal lacerations are often seen with chronic alcoholism d/t

frequency of vomiting, or acute illness with severe vomiting

In chronic kidney diseases, people tend to have... (2)

high BP & anemia (d/t reduction in erythropoietin)

In the endocrine system, the chemical messengers called ______ control information between ___________

hormones different cells and tissues

The endocrine system uses chemical messengers called _____________ as a means of controlling the flow of information between the different tissues and organs of the body.

hormones -It does not act alone, however, but interacts with the nervous system to coordinate and integrate the activity of body cells. -Hormones regulate and integrate body functions.

Hyper or hypo secretion may originate in the _______, ________, or ________. Regardless of origin, the result is _______________

hypothalamus, the pituitary effector glands, or the target gland. -the result is abnormal hormone concentrations in the blood

Celiac disease is an

immune mediated disorder.

Conduction aphasia is

impaired repetition and speech riddled with letter substitutions, despite good comprehension and fluency

The nurse is caring for a client who is 2 days postoperative following a total hip replacement. The client is refusing to participate in physical therapy, complaining of extreme fatigue and severe pain with any movement. The nurse administers pain medication and then encourages the client to sit up to more effectively cough and deep breathe to increase ventilation by:

increasing the spread of surfactant. Explanation: It is essential for bedridden and postoperative clients to change positions and to move. This not only increases ventilation in all areas of the lungs, but also enhances the spread of surfactant which prevents atelectasis. Coughing and deep breathing also enhances ventilation by spreading the surfactant in the alveoli. With this client, who is refusing to participate in physical therapy, it is a good way to start the client moving.

Cholecystitis Define, Causes, S&S

inflammation of GB; impairment of the release of bile, therefore causing impaired digestion of fats. o Caused by irritation due to concentrated bile o S&S: pain, tenderness, rigidity of RUQ, n/v

Intrapleural pressure is negative in relation to the

inflated lung, and the chest wall exerts negative pressure on the lungs that keeps them from contracting and contributes to inspiration.

Damage to a peripheral nerve axon due to _________ results in _______

injury or neuropathy degenerative changes, followed by breakdown of the myelin sheath and Schwann cells

Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a:

large lipid core. Explanation: Plaque disruption causes thrombus formation, with white platelet-containing thrombi being associated with unstable angina. The major determinants of plaque vulnerability to disruption include the size of its lipid-rich core, lack of stabilizing smooth muscle cells, presence of inflammation with plaque degradation, and stability and thickness of its fibrous cap.

Beta-adrenergic blockers decrease

left ventricular dysfunction associated with activation of the sympathetic nervous system.

Right and left bundle branches

lie beneath the endocardium

Cardiac tamponade and pericardial effusion are

life threatening when the pericardial sac fills rapidly and compresses the heart -Pulsus paradoxus: weakened or absent arterial pulse during inspiration and strong with expiration

Functioning neuromuscular junction

links nervous system activity with muscle contraction

Most deaths from alcoholic cirrhosis are attributable to

liver failure, bleeding esophageal varices, or kidney failure.

Mononeuropathies are caused by

localized conditions such as trauma, compression, or infections that affect a single spinal nerve, plexus, or peripheral nerve trunko Fractured bones may lacerate or compress nerves.o Excessively tight tourniquets may injure nerves directly or produce ischemic injury.o Infections such as herpes zoster may affect a single segmental afferent nerve distribution. One group of nerves (e.g. Carpal tunnel syndrome)

Myasthenia gravis is characterized by

loss of acetylcholine receptors

The blood-brain barrier and the blood-CSF barrier work to __________.

maintain a stabile environment for neural function

The most important goal of treatment in Cystic Fibrosis (CF) is to

maintain optimal airway clearance

Brain tumors, whether or benign or malignant, can cause

major issues because of intracranial pressures & can cause brain cells to die

The blood-brain barrier prevents

many drugs (and other harmful things) from entering the brain -However, alcohol, nicotine, and heroin are highly lipid-soluble and can enter the brain easily

Renal casts

molds of the distal nephron lumen -develop when the protein concentration of the urine is high (as in nephrotic syndrome), urine osmolality is high, and urine pH is low -sign of many types of kidney diseases

The general pattern of lung dysfunction includes (3)

reduced diffusing capacity of the lung diminished lung volume some degree of hypoxemia

When comparing the endocrine and nervous system functions, the nurse knows that the endocrine system: sends signals to neurons over a short distance to muscles. responds to neurotransmitter molecules within milliseconds. releases hormones into the blood that is transported throughout the body. glands are widely scattered throughout the body. takes longer to respond to innervations but has prolonged actions when they arrive.

releases hormones into the blood that is transported throughout the body. glands are widely scattered throughout the body. takes longer to respond to innervations but has prolonged actions when they arrive.

Spinal reflexes: A reflex is a

response between a stimulus and an elicited motor reaction. They are coordinated and involuntary

Interstitial lung diseases are characterized by

restriction of lung function due to loss of elasticity in collagen and connective tissues in the interstitium of the alveolar walls.

The nurse is caring for a client with end-stage chronic obstructive pulmonary disease (COPD). The client is extremely agitated and dyspneic, demanding that the oxygen be turned all the way up. The nurse states that this situation must be very frustrating for the client and then explains that the consequence of increasing the oxygen could cause:

serious depression of respirations. Explanation: The stimulus for breathing in a person without lung disease is an increase in PCO2, which stimulates the central chemoreceptors in the medulla causing respirations. Because the PCO2 levels are frequently high in people with lung disease, hypoxia stimulates the peripheral receptors located in the carotid and aortic bodies, which initiates breathing. If supplemental oxygen is given to raise the oxygen level significantly above the level needed to stimulate the peripheral receptors, the respirations could be severely depressed.

Major risk factors for the development of MODS are (7)

severe trauma sepsis prolonged periods of hypotension hepatic dysfunction infarcted bowel advanced age alcohol abuse

TPA

tissue plasminogen activator

The CSF-brain barrier removes

toxic waste products from the CNS

Information is processed in the nervous system by

transient changes in the electrochemical gradient, known as action potentials and are always the same.

Plasma plays a significant role in

transporting nutrients, chemical messengers, metabolites, and other materials. -Plasma is the river that moves things along (metaphor of boat on river, river moves the boat)

Lipid (fat = fuel for the body) is stored in adipose tissue as

triglycerides

A client with rheumatoid arthritis is being started on immunosuppressive therapy. It would be most important for the nurse to inform the health care provider about the client's history of:

tuberculosis Explanation: While all aspects of a client's medical history should be disclosed, the most important aspect related to a client starting on immunosuppressive therapy is the history of tuberculosis. None of the other conditions have a direct risk related to this new therapy. Mycobacterium tuberculosis can be encapsulated and be held in a dormant state inside the client's lung in a tubercle. The infective bacilli in the tubercle are more likely to become active when the client has a compromise to the immune system, such as with immunosuppressive therapy.

Autoantibody testing is most commonly used for autoimmune disorders such as (4 examples)

type 1 diabetes mellitus Graves disease hypoparathyroidism Addison disease

The resting membrane potential is the

undisturbed period of the action potential during which the nerve is not transmitting impulses.

Actions of Hormones Released into the Bloodstream

vCirculate as free, unbound molecules oPeptide hormones and protein hormones usually circulate unbound in the blood vCirculate as hormones attached to transport carriers oSteroid hormones and thyroid hormone are carried by specific carrier proteins synthesized in the liver vIntracellular and extracellular mechanisms participate in the termination of hormone function

Functions of Endocrine System

vGrowth and development vSex differentiation vMetabolism vAdaptation to an ever-changing environment oRegulation of digestion oUse and storage of nutrients oElectrolyte and water metabolism oReproductive functions

Intrahepatic Biliary Diseases

vThis is the disruption of the flow of bile. vCaused by the following: oPrimary biliary cirrhosis oSecondary biliary cirrhosis oPrimary sclerosing cholangitis vEarly symptoms oUnexplained pruritus or itching oWeight loss oFatigue vLater symptoms oDark urine and pale stools oOsteoporosis in 51% of women oJaundice

Hepatic Encephalopathy

vTwo major alterations underlie its development in acute and chronic liver disease oHepatic insufficiency: the inability of the liver to detoxify toxic by-products of metabolism oPortosystemic shunting: collateral vessels develop allowing elements of the portal blood (laden with potentially toxic substances usually extracted by the liver) to enter the systemic circulation vEarly signs: mental changes and motor disturbances

Beta-2 receptors cause

vasodilation of the skeletal muscle bed and relaxation of the bronchioles

Main functions of the respiratory system are

ventilation and gas exchange

Fasting blood glucose levels, measured after food has been withheld for at least 8 hours, will determine

whether glucose is being efficiently removed from the blood.

An 82-year-old man with chronic obstructive pulmonary disease (COPD) is at the clinic for a regular checkup. Because of his diagnosis, the nurse would expect his respiratory rate under normal circumstances to be: Tachypneic <16 breaths/min ≥18 to 20 breaths/min Hyperpneic

≥18 to 20 breaths/min Explanation: The work of breathing is determined by the amount of effort required to move air through the conducting airways and by the ease of lung expansion, or compliance. Expansion of the lungs is difficult for persons with stiff and noncompliant lungs; they usually find it easier to breathe if they keep their tidal volume (TV) low and breathe at a more rapid rate (e.g., 300 × 20 = 6000 mL) to achieve their minute volume and meet their oxygen needs. In contrast, persons with obstructive airway disease usually find it less difficult to inflate their lungs but expend more energy in moving air through the airways. As a result, these persons take deeper breaths and breathe at a slower rate (e.g., 600 × 10 = 6000 mL) to achieve their oxygen needs.