Patho Quiz 4 Questions

Which of the following statements best conveys a characteristic of red blood cells? A) They lack organelles and soluble enzymes. B) They contribute to the maintenance of blood pH. C) They help maintain the body's fluid balance. D) They are self-replicating.

B) They contribute to the maintenance of blood pH.

In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis? A) A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated B) A 68-year-old former coal miner who has white cell levels exponentially higher than normal ranges C) An 81-year-old male resident of a long-term care home who has an uncommon bacterial pneumonia and who is unable to produce a fever D) A 70-year-old woman whose blood work reveals large numbers of immature granulocytes

A) A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated

Which of the following patients would be most likely to be experiencing an increase in renal erythropoietin production? A) A 71-year-old smoker admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD) B) A 70-year-old woman admitted with dehydration secondary to an overdose of her potassium-wasting diuretic C) A 68-year-old man with a long-standing diagnosis of polycythemia vera D) A 21-year-old man with acute blood loss secondary to a motor vehicle accident 3 hours prior

A) A 71-year-old smoker admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD)

Which of the following patients would be at risk for developing nonthrombocytopenic purpura? Select all that apply. A) A child adopted from India and displaying malaise, lethargy, and petechiae all over the body B) A 73-year-old patient admitted with concussion that resulted from a fall C) A 55-year-old patient diagnosed with Cushing disease displaying bruises, weight gain with a buffalo hump, and moon face D) A 15-year-old insulin-dependent diabetic with hypoglycemia displaying irritability with headaches and tachycardia E) A pregnant mother experiencing headaches and proteinuria

A) A child adopted from India and displaying malaise, lethargy, and petechiae all over the body C) A 55-year-old patient diagnosed with Cushing disease displaying bruises, weight gain with a buffalo hump, and moon face

Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node? A) A slow depolarization occurs when Na + is transported out of the cell and K + moves back in, resulting in resting membrane potential. B) The cells are capable of responding to a greater than normal stimulus before the resting membrane potential is reached. C) The fast sodium channels in the cellular membranes close, causing an abrupt decrease in intracellular positivity. D) Potassium permeability is allowing the cell membrane to remain depolarized, and Ca 2+ channel opens moving Ca 2+ back into the cell.

A) A slow depolarization occurs when Na + is transported out of the cell and K + moves back in, resulting in resting membrane potential.

A 32-year-old woman presents at her neighborhood health clinic complaining of weakness and a feeling of abdominal fullness. She reports that 6 months earlier she noticed that she had difficulty in maintaining the high level of energy she has relied on during her aerobic workouts over the past few years. Because she felt that she was in overall good health, but knew that women often need additional iron, she added a multiple vitamin with iron and some meat and leafy greens to her diet. She followed her plan carefully but had no increase in energy. Upon examination, her spleen is noted to be enlarged. Which of the following is most likely to be the cause? A) Accelerated CML B) Stage A Hodgkin disease C) Infectious mononucleosis D) CLL

A) Accelerated CML

Which of the following statements most accurately conveys an aspect of lymphatic system activity? A) B- and T-lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures. B) B cells and macrophages are released from the bone marrow in their completed state. C) Stem cells in the lymph nodes initiate and regulate the process of white cell synthesis. D) Leukocytes bypass vascular circulation and are distributed instead by the lymphatic system.

A) B- and T-lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures.

A female older adult client has presented with a new onset of shortness of breath, and her physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the most accurate rationale for the physician's choice of blood work? A) BNP is released as a compensatory mechanism during heart failure, and measuring it can help differentiate the client's dyspnea from a respiratory pathology. B) BNP is an indirect indicator of the effectiveness of the reninangiotensinaldosterone (RAA) system in compensating for heart failure. C) BNP levels correlate with the client's risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia. D) BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

A) BNP is released as a compensatory mechanism during heart failure, and measuring it can help differentiate the client's dyspnea from a respiratory pathology.

Following a bone marrow biopsy, which of the following assessments would indicate the patient is experiencing a complication as a result of this diagnostic procedure? A) BP 90/60, heart rate 132, excess bleeding, and hematoma noted at the insertion site B) BP 130/80, oxygen saturation 95%, and crackles heard on inspiration C) Respiratory rate 24 and complaining of pain at insertion site D) Heart rate regular 64 beats/minute and temperature 99.6F orally

A) BP 90/60, heart rate 132, excess bleeding, and hematoma noted at the insertion site

A patient, who is experiencing some angina associated with atrial tachycardia, has been placed on verapamil (Calan), a calcium channel blocker. Knowing that this medication blocks the slow calcium channels, thereby depressing phase 4 and lengthening phases 1 and 2 action potential, the nurse should assess this patient for which of the following adverse reactions? A) Bradycardia B) Ventricular tachycardia C) Sudden cardiac death D) Increased cardiac output

A) Bradycardia

Two years after chemotherapy and radiation therapy for lung cancer, a 72-year-old patient notices that he seems to be extremely tired all the time. The physician suspects the patient may have developed aplastic anemia. The nurse assessing the patient will likely find which of the following clinical manifestations of aplastic anemia? Select all that apply. A) Complaints of weakness and fatigue B) Small spots of skin hemorrhages over the entire body C) Excess bleeding from gums and nose D) Spoon-shaped deformity of the fingernails E) Hemolysis from renal dialysis treatments.

A) Complaints of weakness and fatigue B) Small spots of skin hemorrhages over the entire body C) Excess bleeding from gums and nose

A 66-year-old client's echocardiogram report reveals a hypertrophied left ventricle. The health care provider suspects the client has aortic stenosis. Which of the following clinical manifestations would be observed if this client has aortic stenosis? Select all that apply. A) Decrease in exercise tolerance B) Exertional dyspnea C) Palpitations D) Syncope E) Heartburn

A) Decrease in exercise tolerance B) Exertional dyspnea D) Syncope

A client with a diagnosis of atrophic gastritis and consequent pernicious anemia is receiving high oral doses of vitamin B 12 . Which of the following changes would be most likely expected by his care provider at the completion of his treatment? A) Decreased mean corpuscular volume B) Increased serum bilirubin C) Increased folic acid levels D) Decreased free heme levels

A) Decreased mean corpuscular volume

Following coronary bypass graft (CABG) surgery for a massive myocardial infarction (MI) located on his left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which of the following assessment findings would confirm that the client may be in the early stages of cardiogenic shock? Select all that apply. A) Decreasing mean arterial pressure (MAP) B) Low BP reading of 86/60 C) Urine output of 15 mL last hour D) Low pulmonary capillary wedge pressure (PCWP) E) Periods of confusion

A) Decreasing mean arterial pressure (MAP) B) Low BP reading of 86/60 C) Urine output of 15 mL last hour E) Periods of confusion

Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long-term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points is most accurate? A) Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure. B) Heart failure will often first show up with persistent coughing and lung crackles. C) Residents in early heart failure will often be flushed and have warm skin and a fever. D) Complaints of chest pain are actually more often related to heart failure than to myocardial infarction.

A) Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure.

As part of the diagnostic workup for a male client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? A) Echocardiogram, PET scan, ECG B) Ambulatory ECG, cardiac MRI, echocardiogram C) Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy D) Cardiac catheterization, cardiac CT, exercise stress testing

A) Echocardiogram, PET scan, ECG

All of the following interventions are ordered stat. for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first? A) Epinephrine (Adrenalin) B) Normal saline infusion C) Dexamethasone (Decadron) D) Diphenhydramine (Benadryl)

A) Epinephrine (Adrenalin)

Which of the following colony-stimulating factors (CSFs) is given to ESRD patients to help with their chronic anemia? A) Erythropoietin (EPO) B) Thrombopoietin (TPO) C) Neupogen D) Interleukin

A) Erythropoietin (EPO)

Which of the following nursing interventions would be a priority when caring for a newborn who is receiving phototherapy for high bilirubin levels? Select all that apply. A) Frequent monitoring of temperature B) Keeping diapers dry and clean C) Maintaining oral intake to prevent dehydration D) Putting lotion on his skin frequently to prevent drying/cracking of skin E) Applying sunscreen to prevent ultraviolet radiation

A) Frequent monitoring of temperature C) Maintaining oral intake to prevent dehydration

Which of the following glycoproteins is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia? A) Growth factors and cytokines B) Neutrophils and eosinophils C) T lymphocytes and natural killer cells D) Natural killer cells and granulocytes

A) Growth factors and cytokines

A 31-year-old African American female who is in her 30th week of pregnancy has been diagnosed with peripartum cardiomyopathy. Which of the following statements best captures an aspect of peripartum cardiomyopathy? A) Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes. B) Treatment is possible in postpartum women, but antepartum women are dependent on spontaneous resolution of the problem. C) Mortality exceeds 50%, and very few surviving women regain normal heart function. D) Symptomatology mimics that of stable angina and is diagnosed and treated similarly.

A) Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes.

Which of the following assessments and laboratory findings would be most closely associated with acute leukemia? A) High blast cell counts and fever B) Decreased oxygen partial pressure and weight loss C) Increased serum potassium and sodium levels D) Increased blood urea nitrogen and bone pain

A) High blast cell counts and fever

Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which of the following results is most likely to be considered unexpected by the health care team? A) Increased thrombopoietin levels B) Decreased platelet count C) Normal vitamin K levels D) Normal leukocyte levels

A) Increased thrombopoietin levels

Misinterpreting her physician's instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status? A) Irreversible acetylation of platelet cyclooxygenase activity has occurred. B) The patients prostaglandin (TXA 2 ) levels are abnormally high. C) She is at risk of developing secondary immune thrombocytopenic purpura (ITP). D) The binding of an antibody to platelet factor IV produces immune complexes.

A) Irreversible acetylation of platelet cyclooxygenase activity has occurred.

Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications? Select all that apply. A) Large amount of pink, frothy sputum and new onset of murmur B) Tachypnea with respiratory distress C) Frequent ventricular arrhythmia unrelieved with amiodarone drip D) Complaints of facial numbness and tingling E) Enhanced renal perfusion as seen as an increase in urine output

A) Large amount of pink, frothy sputum and new onset of murmur B) Tachypnea with respiratory distress C) Frequent ventricular arrhythmia unrelieved with amiodarone drip D) Complaints of facial numbness and tingling

A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice? A) Measurement of urine output and mental status assessment B) Pupil response and counting the patient's apical heart rate C) Palpation of pedal (foot) pulses and pain assessment D) Activity tolerance and integumentary inspection

A) Measurement of urine output and mental status assessment

Following cardiac surgery, the nurse suspects the patient may be developing a cardiac tamponade. Which of the following clinical manifestations would support this diagnosis? Select all that apply. A) Muffled heart tones B) Narrowed pulse pressure C) Low BPó84/60 D) Heart rate 78 E) Bounding femoral pulse

A) Muffled heart tones B) Narrowed pulse pressure C) Low BPó84/60

A pediatric nurse is assessing a newborn diagnosed with persistent patency of the ductus arteriosus. Which of the following findings are associated with this heart defect? Select all that apply. A) Murmur heard at the second intercostal space, during both systole and diastole B) BP 84/30 classified as a wide pulse pressure C) Shortness of breath with activity such as kicking D) Stridor with inspiratory wheezes E) Bulging jugular neck veins

A) Murmur heard at the second intercostal space, during both systole and diastole B) BP 84/30 classified as a wide pulse pressure

When discussing the sequence of clot dissolution, the science instructor will talk about which item that begins the process? A) Plasminogen B) Dabigatran C) Platelets D) a 2 -plasmin inhibitor

A) Plasminogen

A 71-year-old male patient with a history of myocardial infarction (MI) and peripheral vascular disease (PVD) has been advised by his family physician to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the physician's suggestion? A) Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin. B) Aspirin helps to inhibit ADP action and minimizes platelet plug formation. C) Aspirin can reduce unwanted platelet adhesion by inhibiting TXA 2 synthesis. D) Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation.

A) Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.

A client has many residual health problems related to compromised circulation following recovery from septic shock. The nurse knows that which of the following complications listed below are a result of being diagnosed with septic shock and therefore should be assessed frequently? Select all that apply. A) Profound dyspnea due to acute respiratory distress syndrome B) Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces C) Formation of plaque within vessels supplying blood to the heart causing muscle damage and chest pain D) Acute renal failure due to decreased/impaired renal perfusion as a result of low BP E) Flushed skin and pounding headache that coincides with each heart beat

A) Profound dyspnea due to acute respiratory distress syndrome B) Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces D) Acute renal failure due to decreased/impaired renal perfusion as a result of low BP

A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to touch. Which of the following hematological processes is most likely occurring in the bone marrow in response to the infection? A) Proliferation of immature neutrophils B) High circulatory levels of myeloblasts C) Increased segmented neutrophil production D) Phagocytosis by myelocytes

A) Proliferation of immature neutrophils

A 68-year-old male complains to his family physician that when he tests his blood pressure using a machine at his pharmacy, his heart rate is nearly always very low. At other times, he feels that his heart is racing, and it also seems to pause at times. The man has also had occasionally light-headedness and a recent syncopal episode. What is this client's most likely diagnosis and the phenomenon underlying it? A) Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias B) Ventricular arrhythmia as a result of alternating vagal and sympathetic stimulation C) Torsade de pointes as a result of disease of the bundle of His D) Premature atrial contractions that vacillate between tachycardic and bradycardic episodes as a consequence of an infectious process

A) Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias

A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client's husband is confused as to why a disease of coagulation can result in bleeding. Which of the nurse's following statements best characterizes DIC? A) So much clotting takes place that there are no available clotting components left, and bleeding ensues. B) Massive clotting causes irritation, friction, and bleeding in the small blood vessels. C) Excessive activation of clotting causes an overload of vital organs, resulting in bleeding. D) The same hormones and bacteria that cause clotting also cause bleeding.

A) So much clotting takes place that there are no available clotting components left, and bleeding ensues.

An IV drug abuser walks into the ED telling the nurse that, he is sick. He looks feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The assessment reveals a loud murmur. An echocardiogram was ordered that shows a large vegetation growing on his mitral valve. The patient is admitted to the ICU. The nurse will be assessing this patient for which possible life-threatening complications? A) Systemic emboli, especially to the brain B) Petechial hemorrhages under the skin and nail beds C) GI upset from the massive amount of antibiotics required to kill the bacteria D) Pancreas enlargement due to increased need for insulin secretion

A) Systemic emboli, especially to the brain

A hospital laboratory technician is performing routine blood analysis as part of an inpatient's assessment and is examining the sample in a test tube following processing in a centrifuge and the addition of an anticoagulant. Which of the following observations would the technician most likely interpret as an anomaly? A) The bottom layer of blood in the tube accounts for around one third of the total volume. B) The middle layer of cells appears white to gray in color. C) The top layer of cells is too thin to visualize without microscopy. D) The yellowish fluid on the top of the sample appears to constitute around one half of the total volume.

A) The bottom layer of blood in the tube accounts for around one third of the total volume.

A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was so fast I couldn't even count it. The child was determined to be in atrial flutter, and his mother is seeking an explanation from the health care team. Which of the following points should underlie an explanation to the mother? A) The child is experiencing a reentry rhythm in his right atrium. B) The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions. C) The child is likely to have a normal ECG apart from the rapid heart rate. D) The boy's atria are experiencing abnormal sympathetic stimulation.

A) The child is experiencing a reentry rhythm in his right atrium.

Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place? A) The man's a- and b-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate. B) Hemolysis and blood pooling are taking place in the man's peripheral circulation. C) Bronchoconstriction and hyperventilation are initiated as a compensatory mechanism. D) Intracellular potassium and extracellular sodium levels are rising as a result of sodium potassium pump failure.

A) The man's a- and b-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate.

A nurse who provides care in a geriatric subacute medicine unit of a hospital has noted that a large number of patients receive b-adrenergic blocking medications such as metoprolol. Which of the following statements best conveys an aspect of the use of beta-blockers? A) They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential. B) They inhibit the potassium current and repolarization, extending the action potential and refractoriness. C) They counteract arrhythmias and tachycardias by increasing vagal stimulation. D) They decrease myocardial oxygen demand by blocking the release of intracellular calcium ions.

A) They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential.

Which of the following statements by a client of a cancer center who has a new diagnosis of non-Hodgkin lymphoma (NHL) demonstrates a sound understanding of the diagnosis and treatment of the health problem? A) They confirmed my diagnosis with a lymph node biopsy, and I'll get radiation treatment soon because its fairly early stage. B) They took a sample of my lymph nodes, and I'll be having surgery soon that will hopefully cure my lymphoma. C) My blood work came back positive for NHL, and I'm meeting with my oncologist to discuss chemotherapy soon. D) Since the tests show NHL, I'm going to pursue my options for palliative care because I'm committed to dying with dignity.

A) They confirmed my diagnosis with a lymph node biopsy, and I'll get radiation treatment soon because its fairly early stage.

A newly diagnosed leukemia patient begins hemorrhaging from every orifice. The physician is concerned that the patient has developed disseminated intravascular coagulation (DIC). The nurse should anticipate which of the following orders to be prescribed for this patient? Select all that apply. A) Transfuse 2 units of platelets. B) Transfuse fresh frozen plasma. C) Give aspirin twice per day. D) Administer IV Toradol stat. E) Place in reverse isolation.

A) Transfuse 2 units of platelets. B) Transfuse fresh frozen plasma.

A patient with rheumatoid arthritis has been diagnosed with a secondary immune- associated neutropenia called Felty syndrome. The nurse has had to research this and found that she should be assessing this patient for which of the following manifestations of Felty syndrome. Select all that apply. A) Upper left quadrant pain on palpation B) An area of diminished breath sounds related to pneumonia C) Intermittent pain that radiates from the flank to the groin D) Swelling and pain in all joints when put through full range of motion E) Headache that worsens when exposed to bright lights

A) Upper left quadrant pain on palpation B) An area of diminished breath sounds related to pneumonia

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 of the physician's following statements best captures an aspect of these differences? A) You'll find that in pediatric patients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles. B) Because of their higher relative blood volume, jugular venous distention is a better assessment technique for suspected heart failure in young patients. C) Signs and symptoms in children may sometimes mimic those of shock, with a low blood pressure and high heart rate. D) Fever is a sign of heart failure in children that you are unlikely to see in older adults.

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

A patient diagnosed with low-risk chronic lymphocytic leukemia (CLL) has recently developed thrombocytopenia. One of the medications utilized to treat this would be A) dexamethasone, a corticosteroid. B) cisplatin, a chemotherapeutic. C) vincristine, a Vinca alkaloid. D) doxorubicin, a cytotoxic antibiotic.

A) dexamethasone, a corticosteroid.

During science class, a student asks, What's the difference between plasma and serum in the blood? The nurse responds that the primary difference between plasma and serum is that plasma contains A) fibrinogen. B) heparin. C) white blood cells. D) hydrogen ions.

A) fibrinogen.

Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the A) neutrophils. B) erythrocytes. C) albumin. D) basophils.

A) neutrophils.

If an Rh-negative mother is giving birth to an Rh-positive infant, the nurse should be prepared to administer A) antihistamines like Benadryl. B) alpha interferon. C) Rh immune globulin. D) a monoclonal antibody like infliximab.

C) Rh immune globulin.

Which of the following patients has an absolute neutrophil count that is critically low and that the standard of care would recommend they be placed on neutropenic precautions? A) A patient on long-term steroids for rheumatoid arthritis with WBC of 7000 B) A 37-year-old patient with leukemia being treated with chemotherapy with ANC of 400 C) A 65-year-old prostate cancer patient receiving radiation therapy with neutrophil count of 2000 D) A 75-year-old renal failure patient receiving Epogen for anemia with hemoglobin level of 9.7.

B) A 37-year-old patient with leukemia being treated with chemotherapy with ANC of 400

Which of the following patients should the nurse be assessing for long QT syndrome? A) A 95-year-old patient with Alzheimer's who is having periods of apnea B) A 32-year-old male admitted for cocaine overdose with long history of illicit drug abuse C) A 56-year-old female admitted for total hysterectomy due to excessive bleeding and clotting D) A 68-year-old male who was in a car accident with sternal bruising and fractured femur

B) A 32-year-old male admitted for cocaine overdose with long history of illicit drug abuse

A nurse is providing care for several patients on an acute medical unit of a hospital. Which of the following patients would be most likely to benefit from hematopoietic growth factors? A) A 51-year-old female patient with liver failure secondary to hepatitis B) A 61-year-old female patient with end-stage renal cancer C) A 55-year-old obese male patient with peripheral neuropathy secondary to diabetes D) A 44-year-old man with a newly diagnosed brain tumor

B) A 61-year-old female patient with end-stage renal cancer

A number of patients in an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention? A) A 46-year-old man whose cardiac telemetry shows him to be in ventricular tachycardia B) A 69-year-old woman who has entered ventricular fibrillation C) A 60-year-old man with premature ventricular contractions (PVC) and a history of atrial fibrillation D) A 60-year-old woman who has just been diagnosed with a first-degree AV block

B) A 69-year-old woman who has entered ventricular fibrillation

In which of the following patient situations would a physician be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient's health problems? A) A 61-year-old man whose ECG was characterized by widespread T-wave inversions on admission but whose T waves have recently normalized B) A 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and a history of atrial fibrillation C) A 56-year-old obese man who is complaining of chest pain that is exacerbated by deep inspiration and is radiating to his neck and scapular ridge D) A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels

B) A 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and a history of atrial fibrillation

While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB-GYN physician has called in a specialist who thinks that the patient is experiencing heparin- induced thrombocytopenia. The nurse should anticipate which of the following orders? A) Decrease the dose of heparin from 5000 units b.i.d to 3000 units b.i.d B) Immediately discontinue the heparin therapy C) Switch to Coumadin 2.5 mg once/day D) Infuse FFP stat

B) Immediately discontinue the heparin therapy

A student makes the statement to a colleague, Blood plasma is essentially just a carrier for the formed elements like red blood cells and white blood cells. What would be the most accurate response to this statement? A) That's not really true. Plasma is crucial in the immune and inflammatory responses. B) Actually, plasma plays a significant role in nutrient and waste transport. C) Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis. D) Actually, plasma is integral to the proper function of the liver and maintenance of acid base balance.

B) Actually, plasma plays a significant role in nutrient and waste transport.

A medical student is working with a 61-year-old male client in the hospital who has presented with a new onset of atrial fibrillation. Which of the following courses of treatment will the student most likely expect the attending physician to initiate? A) Immediate cardioversion followed by surgery to correct the atrial defect B) Anticoagulants and beta-blockers to control rate C) Antihypertensives and constant cardiac monitoring in a high acuity unit D) Diuretics, total bed rest, and cardioversion if necessary

B) Anticoagulants and beta-blockers to control rate

A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure? A) Antihypertensive, diuretic, antiplatelet aggregator B) Diuretic, ACE inhibitor, beta-blocker C) Anticoagulant, antihypertensive, calcium supplement D) Beta-blocker, potassium supplement, anticoagulant

B) Diuretic, ACE inhibitor, beta-blocker

The family members of an elderly patient are wondering why his blood counts are not rising after his last GI bleed. They state, He has always bounced back after one of these episodes, but this time it isnt happening. Do you know why? The nurse will respond based on which of the following pathophysiological principles? A) Everything slows down when you get older. You just have to wait and see what happens. B) Due to stress, the red blood cells of older adults are not replaced as promptly as younger people. C) The doctor may start looking for another cause of his anemia, maybe cancer of the bone. D) Don't worry about it. We can always give him more blood.

B) Due to stress, the red blood cells of older adults are not replaced as promptly as younger people.

The nurse working in the ICU knows that chronic elevation of left ventricular end- diastolic pressure will result in the patient displaying which of the following clinical manifestations? A) Chest pain and intermittent ventricular tachycardia B) Dyspnea and crackles in bilateral lung bases C) Petechia and spontaneous bleeding D) Muscle cramping and cyanosis in the feet

B) Dyspnea and crackles in bilateral lung bases

A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics? A) CT of the heart, chest x-ray, and ECG B) Echocardiogram, blood cultures, and temperature C) ECG, blood pressure, and stress test D) Cardiac catheterization, chest x-ray, electrolyte measurement, and white cell count

B) Echocardiogram, blood cultures, and temperature

A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy's spleen. Which of the following teaching points would be most accurate? A) Ferritin is the activated and usable form of iron that your red blood cells can use to transport oxygen. B) Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills. C) Ferritin is a proteinñiron complex that allows your red blood cells to make use of the iron that you consume in your diet. D) Ferritin is the form of iron that is transported in your blood plasma to red blood cells that need it.

B) Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills.

A 13-year-old African American boy comes to the ER complaining of fatigue and a rapid heartbeat. In conversation with the father, it becomes apparent to you that the boy has grown 2 inches in the previous 5 months. What is the first problem the health care team would attempt to rule out? A) Sickle cell anemia B) Iron deficiency anemia C) Thalassemia D) Aplastic anemia

B) Iron deficiency anemia

A 30-year-old males blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the mans most likely diagnosis? A) Acute myelogenous leukemia B) Multiple myeloma C) Acute lymphocytic leukemia D) Hodgkin lymphoma

B) Multiple myeloma

A physician has ordered the measurement of a cardiac patient's electrolyte levels as part of the client's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart? A) Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation. B) Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells. C) The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions. D) The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential.

B) Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.

Which of the following statements best captures an aspect of the process of hematopoiesis? A) Colony-stimulating factors (CSFs) produce cytokines that activate progenitor cells. B) Progenitor cells differentiate into precursor cells. C) Various subtypes of pluripotent stem cells eventually differentiate into the cellular components of blood. D) Self-replicating precursor cells differentiate into specific CSFs.

B) Progenitor cells differentiate into precursor cells.

A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis? A) Hypovolemic shock B) Septic shock C) Neurogenic shock D) Obstructive shock

B) Septic shock

A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stool that has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely to occur? A) The woman has depleted blood volume due to her ongoing blood loss. B) She will have iron deficiency anemia due to depletion of iron stores. C) The patient will be at risk for cardiovascular collapse or shock. D) She will have delayed reticulocyte release.

B) She will have iron deficiency anemia due to depletion of iron stores.

Following electrophysiological testing that included ablation therapy, the nurse should be assessing the patient for which complication that may occur postprocedure? A) Complaints of nausea and spitting up bile-looking secretions along with stomach cramps B) Sudden onset of dysonea, tachypnea, and chest pain of a pleuritic nature (worsened by breathing) C) Bleeding from the nose that requires packing, excessive swallowing of mucus, and coughing D) Complaints of heart palpitations, frequent PVCs noted on monitor, and substernal chest pain

B) Sudden onset of dysonea, tachypnea, and chest pain of a pleuritic nature (worsened by breathing)

A hospital client is receiving intravenous infusion of heparin for treatment of a pulmonary embolus. Which of the following phenomena is most likely to occur, resulting in the drug's therapeutic effect? A) Inhibition of vitamin K synthesis in the liver B) Suppression of fibrin formation C) Deactivation of the intrinsic clotting pathway D) Inhibition of ADP-induced platelet aggregation

B) Suppression of fibrin formation

A patient asks the health care provider why his lower legs look purple. The health care provider will base her response on which pathophysiological principle? A) Too much trauma breaks capillaries, and they bleed into the tissue. B) The bruising around the ankles is due to the fact that it is a dependent area where the capillary pressure is higher. C) There is a problem with his plasminogen levels. D) Morbid obesity causes veins to enlarge and bleed into tissues due to stress the abdomen is placing on the vascular system.

B) The bruising around the ankles is due to the fact that it is a dependent area where the capillary pressure is higher.

An ECG technician is placing leads on a patient who has presented to the emergency department with a sudden onset of chest pain. The technician would recognize which of the following facts about the placement of leads and the achievement of a clinically accurate ECG? A) The electrical potential recorded by a lead on an extremity will vary significantly depending on where the lead is placed on the extremity. B) The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane. C) Limb leads measure the electrical activity of the heart indirectly through the activity of adjacent skeletal muscle. D) A total of 12 chest leads are necessary to attain the most accurate ECG.

B) The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane.

A hospital laboratory technologist is analyzing the complete blood count (CBC) of a patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC? A) Platelets originate with granulocyte colony forming units (CFU). B) The half-life of a platelet is typically around 8 to 12 days. C) The a-granules of platelets contribute primarily to vasoconstriction. D) New platelets are released from the bone marrow into circulation.

B) The half-life of a platelet is typically around 8 to 12 days.

A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma? A) Her neoplasm originates in secondary lymphoid structures. B) The lymph nodes involved are located in a large number of locations in the lymphatic system. C) The presence of Reed-Sternberg cells has been confirmed. D) The woman complains of recent debilitating fatigue.

B) The lymph nodes involved are located in a large number of locations in the lymphatic system.

Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health? A) People with plaque in their arteries experience attacks of blood flow disruption at seemingly random times. B) The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel. C) Infections of any sort are often a signal that plaque disruption is in danger of occurring. D) The impaired function of the lungs that accompanies pneumonia or chronic obstructive pulmonary disease is a precursor to plaque disruption.

B) The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel.

Which of the following ECG patterns would the nurse observe in a patient admitted for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)? Select all that apply. A) Atrial flutter B) Ventricular tachycardia with left bundle branch block pattern C) T-wave inversion in the right precordial leads D) Sinus arrhythmia with a first-degree AV block E) Development of a ìUî wave following a normal T wave

B) Ventricular tachycardia with left bundle branch block pattern C) T-wave inversion in the right precordial leads

A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms? A) The Epstein-Barr virus (EBV) is lysing many of the boys neutrophils. B) Viruses are killing some of his B cells and becoming incorporated into the genome of others. C) The EBV inhibits the maturation of white cells within his peripheral lymph nodes. D) The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.

B) Viruses are killing some of his B cells and becoming incorporated into the genome of others.

A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient's bleeding? A) Excess calcium B) Vitamin K deficiency C) Hemophilia B D) Idiopathic immune thrombocytopenic purpura (ITP)

B) Vitamin K deficiency

A 70-year-old woman has received a diagnosis of chronic myelogenous leukemia (CML) after a clinical investigation sparked by the presence of leukocytosis in her routine blood work. What clinical course should her care provider tell her to expect? A) You can expect your blood results, fatigue, and susceptibility to infection to gradually worsen over a few years. B) You could remain the chronic stage of CML for several years before it accelerates and culminates in a crisis. C) It's likely that this will give you chronic fatigue and malaise for the rest of your life, but that will probably be the extent of your symptoms. D) Unfortunately, your leukemia will likely enter a crisis mode within a few weeks if we don't treat it immediately.

B) You could remain the chronic stage of CML for several years before it accelerates and culminates in a crisis.

A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to the client? A) The normal tissue that makes up the valve between the right sides of your heart has stiffened. B) Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation. C) Your heart's mitral valve isn't closing properly so blood is flowing backward in your heart and eventually into your lungs. D) The valve between your left ventricle and left atria is infected and isn't allowing enough blood through.

B) Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation.

A 77-year-old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of impending doom. Based on pathophysiologic principles, the nurse knows the rapid heart rate could A) decrease renal perfusion and result in the development of ascites. B) be a result of catecholamines released from SNS that could increase the myocardial oxygen demand. C) desensitize the a-adrenergic receptors leading to increase in norepinephrine levels. D) prolong the electrical firing from the SA node resulting in the development of a heart block.

B) be a result of catecholamines released from SNS that could increase the myocardial oxygen demand.

A 13-year-old boy has had a sore throat for at least a week and has been vomiting for 2 days. His glands are swollen, and he moves stiffly because his joints hurt. His parents, who believe in ìnatural remedies, `have been treating him with various herbal preparations without success and are now seeking antibiotic treatment. Throat cultures show infection with group A streptococci. This child is at high risk for A) myocarditis. B) mitral valve stenosis. C) infective endocarditis. D) vasculitis.

B) mitral valve stenosis

A patient has visited his physician because he found an enlarged lymph node along the mediastinal border. When questioned, the physician may be alerted to a possible diagnosis of Hodgkin lymphoma (HL) if the patient also displays: Select all that apply. A) yeast infection in the mouth. B) night sweats. C) unexplained pruritus. D) joint swelling. E) sore throat with pustules on tonsils.

B) night sweats. C) unexplained pruritus.

A patient with a new automatic implantable cardioverterñdefibrillator (AICD) asks the nurse what happens if he goes into that deadly heart rhythm again. The nurse will base her response knowing that the AICD will A) periodically fire just to test for lead placement and battery life. B) respond to ventricular tachyarrhythmia by delivering a shock within 10 to 20 seconds of its onset. C) use radiofrequency energy to deliver an electrical shock through the site where the lethal rhythm originates. D) remove scar tissue and aneurysm during placement of electrodes and then will shock if paradoxical ventricular movement is located.

B) respond to ventricular tachyarrhythmia by delivering a shock within 10 to 20 seconds of its onset.

A child has been diagnosed with thalassemia. Which of the following comorbidities may occur as a result of having thalassemia? A) Hypocoagulation B) Iron deficiency C) Splenomegaly D) Neutropeniabb

C) Splenomegaly

A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiologist by her family physician. As part of the client's diagnostic workup, the cardiologist has ordered her to wear a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring? A) A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity B) The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies. C) Accurate interpretation of the results requires correlating the findings with activity that the woman was doing at the time of recording. D) Holter monitors are normally set to record electrical activity of the heart at least once per hour.

C) Accurate interpretation of the results requires correlating the findings with activity that the woman was doing at the time of recording.

Assuming that they have not responded to drug therapy, which of the following clients is likely to be the best candidate for surgical cardiac ablation? A) A 62-year-old woman with peripheral vascular disease who has experienced multiple episodes of torsade des pointes B) A 75-year-old man with diabetes but no previous heart disease that suddenly develops syncope due to sick sinus syndrome C) A 46-year-old man with unstable angina and a history of myocardial infarction who is found to have long QT syndrome and episodes of frequent ventricular arrhythmias D) A 22-year-old woman with an atrial septal defect who has recurrent paroxysmal atrial flutter with rapid ventricular rate associated with her caffeine intake.

C) A 46-year-old man with unstable angina and a history of myocardial infarction who is found to have long QT syndrome and episodes of frequent ventricular arrhythmias

A 44-year-old Caucasian woman is being treated in an airport infirmary after she developed a painful, swollen leg during a transatlantic flight in economy class. The woman is suspected of having deep vein thrombosis (DVT) and is questioning the paramedics about why this might be the case, given that she has twice previously had similar experiences. Which of the following teaching points by the airport medical staff would be most appropriate? A) A lot of Caucasian people have a genetic mutation that causes platelets to stick to their blood vessel walls. B) There is a genetic disorder that causes many Caucasians to form more clots in their blood vessels. C) A lot of Caucasians have an inherited inability to dissolve clots that form in their bodies. D) Your doctor might be able to tell you if you've inherited a predisposition to bleeding in your veins.

C) A lot of Caucasians have an inherited inability to dissolve clots that form in their bodies.

Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction? A) A 33-year-old male whose pain started at 7 AM during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable. B) A 67-year-old female whose pain started at 2 AM while she was asleep and responded to nitrates; the ECG showed arrhythmias and ST-segment elevation; cardiac markers remained stable. C) An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose. D) A 61-year-old man whose pain started at 9 AM during a short walk and responded to nitrates, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened.

C) An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose.

When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant? A) Neutrophils B) Eosinophils C) Basophils D) Lymphocytes

C) Basophils

A nurse who works on a pediatric cardiology unit of a hospital is providing care for an infant with a diagnosis of tetralogy of Fallot. Which of the following pathophysiologic results should the nurse anticipate? A) There is a break in the normal wall between the right and left atria that results in compromised oxygenation. B) The aortic valve is stenotic, resulting in increased afterload. C) Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis. D) The right ventricle is atrophic as a consequence of impaired myocardial blood supply.

C) Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.

Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the student's following statements best captures an aspect of the two health problems? A) Both diseases can result from inadequate production of thrombopoietin by megakaryocytes. B) ITP can be either inherited or acquired, and if its acquired, it involves an enzyme deficiency. C) Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis. D) TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma.

C) Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis.

Your ESRD patient is receiving 2 units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56. What is the nurse's priority action? A) Slow the rate of the blood infusion to 50 mL/hour. B) Document the assessment as the only action. C) Discontinue the transfusion and begin an infusion of normal saline. D) Recheck the type of blood infusing with the chart documentation of patient's blood type.

C) Discontinue the transfusion and begin an infusion of normal saline.

A 30-year-old woman presents at a hospital after fainting at a memorial service, and she is diagnosed as being in neurogenic shock. Which of the following signs and symptoms is she most likely to display? A) Faster than normal heart rate B) Pain C) Dry and warm skin D) Increased thirst

C) Dry and warm skin

Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome? A) Increased serum creatinine and troponin I as a result of enzyme release from damaged cells B) Increased serum potassium and decreased sodium as a result of myocardial cell lysis, release of normally intracellular potassium, and disruption of the sodium potassium pump C) Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation D) Low circulatory levels of myoglobin and creatine kinase as a result of the inflammatory response

C) Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation

Which of the following changes associated with aging contributes to heart failure development in older adults? Select all that apply. A) Increased incidence of mitral stenosis B) Sludge buildup in the kidneys C) Elevated diastolic BP D) Increased vascular stiffness E) Inflammation in the joints due to arthritis

C) Elevated diastolic BP D) Increased vascular stiffness

A 3-year-old child with right-sided heart failure has been admitted for worsening of his condition. Which of the following assessments would be considered one of the earliest signs of systemic venous congestion in this toddler? A) Breathlessness with activity B) Excessive crying C) Enlargement of the liver D) Increased urine output

C) Enlargement of the liver

A 62-year-old female with a diagnosis of acute and chronic renal failure secondary to diabetes mellitus is receiving her weekly injection of epoetin, a supplementary form of erythropoietin. Which of the following statements best captures the necessity of this medication? A) Erythropoietin is needed in order for stem cells to proliferate into committed erythroid precursors. B) Erythropoietin is necessary for the accurate sensation of hypoxia that stimulates erythropoiesis. C) Erythropoietin causes the erythrocyte colony forming units to proliferate and mature. D) Erythropoietin facilitates the extrusion of the reticulocyte nucleus and the formation of true erythrocytes.

C) Erythropoietin causes the erythrocyte colony forming units to proliferate and mature.

A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points should the physician include in his explanation of the man's new diagnosis? A) I'll be able to help track the course of your angina through regular blood work that we will schedule at a lab in the community. B) With some simple lifestyle modifications and taking your heparin regularly, we can realistically cure you of this. C) I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising. D) There are things you can do to reduce the chance that you will need a heart bypass, including limiting physical activity as much as possible.

C) I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising.

Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)? A) Inadequate ventricular end-diastolic pressure B) Use of calcium channel blocker medications C) Increased aortic pressure D) Ventricular atrophy

C) Increased aortic pressure

A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems? A) Jaundice B) Anemia C) Infections D) Blood clots

C) Infections

A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man? A) Resolution of compensatory pulmonary edema and heart arrhythmias B) Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility C) Infusion of normal saline or Ringer lactate to maintain the vascular space D) Administration of oxygen and epinephrine to promote perfusion

C) Infusion of normal saline or Ringer lactate to maintain the vascular space

The initial medical management for a symptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications? A) Lisinopril, an ACE inhibitor B) Lasix, a diuretic C) Propranolol, a b-adrenergic blocker D) Lanoxin, an inotropic

C) Propranolol, a b-adrenergic blocker

A 44-year-old male hospital client with a diagnosis of end-stage acquired immunodeficiency syndrome (AIDS) has been placed on neutropenic precautions that limit his interaction with visitors, staff, and other clients. What is the underlying rationale for these precautions? A) His antibody-mediated immunity is compromised by his low production of neutrophils. B) Neutropenia limits the ability of his CD4 helper cells to present antigens. C) Insufficient levels of neutrophils make him particularly susceptible to infections. D) Cyclic neutropenia limits his body's ability to fight various infections.

C) Insufficient levels of neutrophils make him particularly susceptible to infections.

A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician's explanation? A) Tissue destruction results from neutrophil deactivation. B) Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis. C) Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas. D) Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.

C) Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas.

Which of the following teaching points would be most appropriate with a client who has a recent diagnosis of von Willebrand disease? A) It's important that you avoid trauma. B) Your disease affects your platelet function rather than clot formation. C) Make sure that you avoid taking aspirin. D) Clotting factor VIII can help your body compensate for the difficulty in clotting.

C) Make sure that you avoid taking aspirin.

On a routine physical exam visit, the physician mentions that he hears a new murmur. The patient gets worried and asks, What does this mean? The physician responds, A) It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit. B) This could be caused by an infection. Have you been feeling well the past few weeks? C) One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problem. D) This may make you a little more fatigued than usual. Let me know if you start getting dizzy or light-headed.

C) One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problem.

A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked what the first chromosomal abnormality that identified cancer was, one student correctly answered A) interleukin cells. B) BRCA-1. C) Philadelphia. D) PSA.

C) Philadelphia.

A nurse educator is teaching a group of nurses at a long-term care facility about atrial fibrillation in light of its prevalence in older adults. Which of the following statements by the nurses would the educator most want to correct? A) The electrical impulses go in chaotic directions, and so the atria can't contract properly. B) An ECG of someone in atrial fibrillation would be almost random in appearance. C) The contraction of the ventricles and the atria can range from 400 to 600 beats/minute. D) It can be hard to measure at the bedside because not all ventricular beats make a palpable pulse.

C) The contraction of the ventricles and the atria can range from 400 to 600 beats/minute.

A 71-year-old man is slated for pacemaker insertion for treatment of a third-degree AV block. The man's nurse has been educating him about his diagnosis and treatment and answering the numerous questions he has about his health problem. Which of the following teaching points should the nurse include in this patient teaching? A) This is almost certainly a condition that you were actually born with, but that is just now becoming a serious problem. B) Because the normal electrical communication in lacking, the bottom parts of your heart are beating especially fast to compensate for inefficiency. C) The root problem is that the top chambers of your heart and the bottom chambers of your heart aren't coordinating to pump blood efficiently. D) If left untreated, this would have put you at great risk of stroke or heart attack.

C) The root problem is that the top chambers of your heart and the bottom chambers of your heart aren't coordinating to pump blood efficiently.

The cardiologist just informed a patient that he has a reentry circuit in the electrical conduction system in his heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to him. Which of the following statements most accurately describes what is happening? A) This means that the SA node (which is the beginning of your heart's electrical system) has been damaged and is no longer functioning normal. B) You must have a large clot in one of your arteries that supply oxygenated blood to the special conduction cells in your heart. C) There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast. D) For some reason, your electrical system is not on full charge, so they will have to put in new leads and a pacemaker to make it work better.

C) There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast.

A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy's spleen. Which of the following teaching points would be most accurate? A) We believe that your son's spleen is causing the destruction of many of his blood platelets, putting him at a bleeding risk. B) Your son's spleen is inappropriately filtering out the platelets from his blood and keeping them from normal circulation. C) Your son's spleen is holding on to too many of his platelets, so they're not available for clotting. D) We think that his spleen is inhibiting the production of platelets by his bone marrow.

C) Your son's spleen is holding on to too many of his platelets, so they're not available for clotting.

A couple who is expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting it. How can their caregiver best respond to the couple's enquiry? Stem cells can A) help correct autoimmune diseases and some congenital defects. B) be used to regenerate damaged organs should the need ever arise. C) be used as source of reserve cells for the entire blood production system. D) help treat some cancers and anemias, but they must come from your child himself or herself.

C) be used as source of reserve cells for the entire blood production system.

A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client A) has a distended bladder, facial edema, and nighttime difficulty breathing. B) complains of dyspnea and has adventitious breath sounds on auscultation (listening). C) has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. D) has cyanotic lips and extremities, low urine output, and low blood pressure.

C) has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.

When talking about the lifespan of various blood components, the students should know that once a neutrophil moves into tissue, it lives approximately for how long? A) 12 hours B) 24 hours C) 2 days D) 4 days

D) 4 days

A 5th grade elementary student asks the school nurse how much blood is in an entire body. The nurse should respond that the average grown-up adult has A) 2 to 4 cups of blood in his or her body. B) 3 pints of blood in total. C) 3 to 4 quarts of blood in his or her body. D) 5 to 6 L of blood throughout his or her body.

D) 5 to 6 L of blood throughout his or her body.

A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level of 5.8 g/dL has been ordered a transfusion of packed red blood cells. The client possesses type B antibodies but lacks type D antigens on his red cells. Transfusion of which of the following blood types would be least likely to produce a transfusion reaction? A) B - B) B + C) A + D) A -

D) A -

A medical student is familiarizing herself with recent overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history? A) A 66-year-old obese male with left-sided hemiplegia secondary to a cerebrovascular accident B) A 90-year-old female resident of a long-term care facility who has been experiencing transient ischemic attacks C) A 30-year-old female with a diagnosis of left leg deep vein thrombosis and a pulmonary embolism D) A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use

D) A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use

In which of the following patients, would diagnostic investigations least likely reveal increased thrombopoietin production? A) An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive B) A 55-year-old man with dehydration secondary to Crohn disease C) A 66-year-old woman with a diagnosis of lung cancer with bone metastases D) A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia

D) A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia

A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)? A) A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort B) A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin C) A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw D) A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

D) A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

Which of the following individuals would most likely possess normal plasma cell synthesis and fully differentiated myeloid and lymphoid cells? A) A 7-year-old boy with a diagnosis of acute lymphocytic leukemia (ALL) B) A 70-year-old male who has acute myelogenous leukemia (AML) C) A 58-year-old female with HIV and multiple myeloma D) A 78-year-old male who has been diagnosed with chronic lymphocytic leukemia (CLL)

D) A 78-year-old male who has been diagnosed with chronic lymphocytic leukemia (CLL)

An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms are least likely to decrease the symptoms of his heart failure? A) An increase in preload via the Frank-Starling mechanism B) Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine C) Activation of the reninangiotensinaldosterone system and secretion of brain natriuretic peptide (BNP) D) AV node pacemaking activity and vagal nerve suppression

D) AV node pacemaking activity and vagal nerve suppression

A 16-year-old female has been brought to her primary care physician by her mother due to the girls persistent sore throat and malaise. Which of the following facts revealed in the girls history and examination would lead the physician to rule out infectious mononucleosis? A) The girl has a temperature of 38.1C (100.6F) and has enlarged lymph nodes. B) Her liver and spleen are both enlarged. C) Blood work reveals an increased white blood cell count. D) Chest auscultation reveals crackles in her lower lung fields bilaterally.

D) Chest auscultation reveals crackles in her lower lung fields bilaterally.

A 22-year-old female who adheres to a vegan diet has been diagnosed with iron deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation? A) Decreased mean corpuscular volume (MCV) B) Decreased hemoglobin and hematocrit C) Microcytic, hypochromic red cells D) Decreased erythropoietin levels

D) Decreased erythropoietin levels

A community health nurse is conducting a class on the nutritional component for new mothers. Which of the following teaching points would be most justified? A) Iron supplementation is not necessary provided you are breast-feeding your infant. B) Be aware that cow's milk depletes your baby's supply of iron. C) Your infant needs the same amount of iron as you but has far fewer sources for obtaining it. D) If you choose to feed your baby with formula, ensure that it is iron fortified.

D) If you choose to feed your baby with formula, ensure that it is iron fortified.

The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating? A) Impaired immune function B) Acidñbase imbalances C) Impaired thermoregulation D) Fluid imbalances

D) Fluid imbalances

A 63-year-old male client has been diagnosed with a bundle branch block. How will this client's care team most likely expect his condition to be expressed diagnostically? A) His AV node will be performing the primary pacemaker role due to inadequacy of the SA node. B) His ECG will show a flattened P wave as a result of impaired atrial depolarization. C) Conduction from the Purkinje fibers to the bundle branches is compromised by inadequate conduction. D) His ECG will show an inordinately wide QRS complex because impulses are bypassing the normal conduction tissue.

D) His ECG will show an inordinately wide QRS complex because impulses are bypassing the normal conduction tissue.

A 31-year-old woman with a congenital heart defect reports episodes of light-headedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion? A) Signal-averaged ECG B) Exercise stress testing C) Electrophysiologic study D) Holter monitoring

D) Holter monitoring

An oncologist has ordered a bone marrow biopsy for a client and is explaining the reasons for the test and what the client might expect during the test. Which of the following explanations best reflects an aspect of a bone marrow biopsy? A) I'll take a sample of your bone marrow from your breastbone or your spine. B) I will be harvesting a sample of your stem cells for examination. C) I need a more accurate count of your blood components than normal blood work is able to provide. D) I need to get samples of the types of blood cells that your body is producing.

D) I need to get samples of the types of blood cells that your body is producing.

Amniocentesis has suggested that a couple' s first child will be born with sickle cell disease. The parents are unfamiliar with the health problem, and their caregiver is explaining the complexities. Which of the following statements by the parents would suggest a need for further teaching or clarification? A) Our baby's red cells are prone to early destruction because of his or her weak membranes. B) Not all of his or her red cells will be sickled, but low oxygen levels can cause them to become so. C) Sickled cells can block his or her blood vessels, especially in the abdomen, chest, and bones. D) Our son or daughter likely won't show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies.

D) Our son or daughter likely won't show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies.

Which of the following situations related to transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? A) Pressure in pulmonary circulation and the right side of the infant's heart fall markedly. B) Alveolar oxygen tension increases causing reversal of pulmonary vasoconstriction of the fetal arteries. C) Systemic vascular resistance and left ventricular pressure are both increasing. D) Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week.

D) Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week.

A 70-year-old woman with ongoing severe atrial fibrillation is scheduled for defibrillation. What is an aspect of the rationale and physiology of defibrillation treatment? A) Interruption of disorganized impulses by the current allows the AV node to readopt its normal pacemaker role. B) Defibrillation can be achieved using either a transcutaneous or transvenous pacemaker. C) Defibrillation must be coincided with the R wave of the ECG in order to be successful. D) The goal is to depolarize the entire heart during the passage of current.

D) The goal is to depolarize the entire heart during the passage of current.

A client with a diagnosis of hemolytic anemia has gone to a community-based laboratory for follow-up blood work. The lab technician confirms with the client that hematocrit is one of the components of the blood work. The client replies, I thought the point of the blood work was to see how many red blood cells I have today. How could the technician best respond to the clients statement? A) This result will tell your care provider about the number of red blood cells in a given quantity of your blood plasma. B) Your hematocrit measures the average size of your red blood cells and indirectly measures your oxygen-carrying capacity. C) The result will indicate how many of your red blood cells are new and young and will indicate your bodys production rate of red cells. D) The hematocrit measures the mass that your red blood cells account for in a quantity of your blood.

D) The hematocrit measures the mass that your red blood cells account for in a quantity of your blood.

A 40-year-old male client is shocked to receive a diagnosis of mature B-cell lymphoma and is doing research on his diagnosis on the Internet. Which of the following statements that he reads on various Web sites is most reliable? A) Like most forms of Hodgkin lymphoma, mature B-cell lymphoma often requires radiation treatment. B) Doctors are able to diagnose mature B-cell lymphoma by the presence of Reed-Sternberg cells. C) Unlike many other lymphomas, mature B-cell lymphoma is often self-limiting, and treatment is focused on symptoms. D) The lymph nodes are usually affected, and often the spleen and bone marrow.

D) The lymph nodes are usually affected, and often the spleen and bone marrow.

A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies, A) They will wash your RBCs and then mix the cells with a reagent to see if they clump together. B) They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis). C) They will be looking to see if you have enough ferritin in your blood. D) They are looking for the presence of antibody or complement on the surface of the RBC.

D) They are looking for the presence of antibody or complement on the surface of the RBC.

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. What will be the primary goal of his treatment? A) To control his hypertension B) To increase the amount of oxygen distributed by his red blood cells C) To reduce the mean size of his red cells D) To reduce the viscosity of his blood

D) To reduce the viscosity of his blood

A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor? A) The fact that the infant is being breast-fed B) Hypoxia C) Hepatic immaturity of the infant D) Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA)

D) Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA)

A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? A) His resting blood pressure is normally in the range of 150/90, and an echocardiogram indicates his ejection fraction is 30%. B) His end-diastolic volume is higher than normal, and his resting heart rate is regular and 82 beats/minute. C) He is presently volume overloaded following several days of intravenous fluid replacement. D) Ventricular dilation and wall tension are significantly lower than normal.

D) Ventricular dilation and wall tension are significantly lower than normal.

A 36-year-old woman with a diagnosis of antiphospholipid syndrome is receiving a scheduled checkup from her nurse practitioner. Which of the following teaching points would the nurse most likely prioritize? A) It's important for you to do regular physical activity and maintain a healthy body weight. B) Good nutrition and blood sugar control are important in your case. C) You'll need to avoid taking nonsteroidal anti-inflammatory drugs when you have menstrual cramps. D) You need to ensure your birth control pills don't contain estrogen.

D) You need to ensure your birth control pills don't contain estrogen.

Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate of 112, respiratory rate of 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is to A) have medical supply department bring up suction equipment. B) apply oxygen via nasal cannula at 3 lpm. C) page the respiratory therapist to come give him a breathing treatment. D) call for emergency assistance utilizing hospital protocol.

D) call for emergency assistance utilizing hospital protocol.

The school nurse knows several children with hemophilia A. After recess, one student with hemophilia comes to the school nurse complaining of pain in his knee from falling on the playground. The nurse notes there is swelling in the knee and pain on palpation. The nurse should A) administer some NSAIDs to relieve the pain. B) wrap the knee in an ace bandage for compression. C) apply some warm compresses to the knee. D) notify parents to pick up the child and possibly administer factor VIII.

D) notify parents to pick up the child and possibly administer factor VIII.

When looking at a granulocyte under a microscope, the anatomy student would describe it as a cell A) lacking granules. B) having a kidney-shaped nucleus. C) having no nuclei. D) shaped like a sphere with multilobar nuclei.

D) shaped like a sphere with multilobar nuclei.

A geriatrician is following a number of clients on a subacute geriatric medical unit, some of whom require diagnostic blood work. Which of the following clients would be most likely to have an erythrocyte sedimentation rate (ESR) screening test ordered? An adult with A) a diagnosis of Alzheimer disease and depression. B) orthostatic hypotension and syncopal episodes. C) congestive heart failure. D) systemic lupus erythematosus.

D) systemic lupus erythematosus.