pathophysiology exam 1
The elderly client, with a history of congestive heart failure, is upset following the death of her husband yesterday. What should the practitioner observe the client for?
Arrhythmias
A nurse is caring for a client with an accumulation of 2.5cm of darkened tissue scar over the area of a 3mm injury. How does the nurse correctly document this finding in the medical record?
As a Keloid
What term is used to describe oscillations with a frequency similar to that of the 24-hour light-dark solar day?
Circadian
A patient has a fever that was induced by damage to the hypothalamus due to intercranial bleeding. The nurse plans care for the patient with which type of fever?
Neurogenic
During a lecture on inflammation, the physiology instructor discusses the major cellular components involved in the inflammation response. The instructor asks, "What cells arrive early in great number?" What is the students correct response?
Neutrophils
The emergency department nurse evaluates the orientee's understanding of the acute stress response in a trauma patient. The nurse knows the orientee understands it when he states what?
"There is facilitation of neural pathways mediating arousal, alertness, vigilance, cognition and focused attention."
A client has been brought to the emergency department with a large, gaping wound from a farming accident. The client is critically ill and has required blood products and surgery to clean and close the wound. Sharing with a student nurse the steps in wound healing, the nurse discusses the inflammatory phase, stating macrophages. What applies?
-Release growth factors that stimulate epithelial cell growth -facilitate the body's ability to grow new vessels in the injured area -remove debris from the wound
A client has presented to the emergency department after he twisted his ankle while playing soccer. Which assessment findings are cardinal signs that the client is experiencing inflammation?
-The ankle appears to be swollen -The client's ankle is visibly red -The ankle is warmer than the unaffected ankle -The client is experiencing pain
Which clients are showing manifestations of infection?
-a 25-year-old, temperature 40 degrees C (104 degrees F), sweating, shivering, states generalized pain -A 2-month-old, temperature 38.8 degrees C (100.4 degrees F), lethargy, poor feeding, and cyanosis. -a 75-year-old, temperature 37.3 degrees C (99.2 degrees F), declining mental status, weakness and fatigue.
in response to hearing about her negative prognosis, a client is experiencing stress. What neural structures will participate in the client's autonomic stress response?
-cerebral cortex -locus ceruleus -hypothalamus
A wound care nurse is teaching a group of nurses about wound healing. Presence of what type of situations that interfere with wound healing should the nurse include in the discussion?
-infections -hyperglycemia -malnutrition
What differences in the healing processes of a neonate versus an adult should the nurse consider when planning care for a neonate with a skin tear?
-rapid spread of infection -immature immune system
A patient with a rising temperature is pale and has begun to shiver. The nurse reports that the patient is in which phase of fever development?
2nd stage (Chill)
Based on assessment results what is an example of a hospital client who is most likely experiencing the effects of chronic stress?
45-year-old paraplegic who is experiencing delayed wound healing of an ischial ulcer.
A nurse is providing care for several clients on a neurologic unit of a hospital. With which client is the nurse justified in predicting a problem with thermoregulation?
66-year-old man with damage to his hypothalamus secondary to a cerebral vascular accident.
A client states, "I heard that my healed wound tissue is stronger than my normal tissue, is that true?" The nurse responds that roughly 3 months after a wound; the wound tensile strength is approximately what percentage fro normal?
70% of normal
What is an example of a patient who is at great risk for decreased wound healing?
A 30-year-old patient with type 1 diabetes and a foot ulcer.
The psychologist is leading a group session with clients who have recently undergone a variety of stressful events. What client will have the best adaptation?
A 50-year-old female who sees her new lie as a widow as a challenge rather than a threat. (Or anyone who sees their circumstances as challenges rather than threats)
What is an example of a client who will have an efficient adaptation?
A client who has been noticing small amounts of blood in his still over the past week.
a client is extremely anxious about his impending surgery. What measures should the nurse implement to create an atmosphere for effective use of relaxation techniques?
A quiet, dim environment
A client presents with an oral temperature of 38.7 degrees C and painful, swollen cervical lymph nodes. Laboratory results indicate neutrophilia with a shift to the left. What diagnosis is most likely?
A severe bacterial infection
A honey farmer is stung by a bee and experiences an anaphylactic allergic reaction. The bee stung is best described as what type of stressor? A) exogenous B) endogenous C) Homogenous D) Monogamous
A. Exogenous
The client is hospitalized for four days with an acute myocardial infarction. After a coronary artery stent is placed, the client is discharged to home in stable condition. This would be an example of which pattern of stress?
Acute Time Limited
The nurse is selecting a dressing for a vascular wound that has a dry wound surface. The most appropriate dressing for this wound is one that what?
Adds moisture to wound bed
A nurse assisting in the assessment of a patient's cumulative effects of stress should include considering what?
Allostatic load
What is an example of wound healing by secondary intention?
An infected burn of the arm (because the wound cannot be closed off by sutures or staples)
The nurse is assessing a client with diabetes and notes and area on the client's right food as inflamed, necrotic, and eroded. The client stated he accidentally slammed his foot in a door 2 weeks ago. What would the nurse document this finding as?
An ulceration
Adrenocorticotropic hormone (ACTH) is released from which gland?
Anterior pituitary
What can a nurse tell a patient about antipyretic drugs during fever?
Antipyretics help to protect the body.
A healthcare provider suspects a client has developed post-traumatic stress disorder (PTSD). What is the necessary criterion to validate the diagnosis?
At least 1 month of clinically significant distress affecting a person after witnessing or experiencing a traumatic event that affects other parts of his or her life. 3 symptoms for at least 1 month.
An instructor is educating nursing students on the role of hormones in the activation of the sympathetic nervous system (SNS). Which of the following statements made by the student indicates that further teaching is necessary? A) Cardiovascular effects are manifested as an increased heart rate, increased force of contraction, and increased blood pressure. B) pulmonary compensation includes constricted bronchioles. C) the skeletal muscles contract in response to activation from the reticular activating system (RAS) D) Gastrointestinal changes may lead to irritable bowels and changes in bowel elimination.
B. Pulmonary compensation includes constricted bronchioles.
Catecholamine's such as epinephrine and norepinephrine are secreted from which gland in the body? A) the pancreas B) Adrenal Medulla C) Adrenal Cortex D) Hypothalamus
B. The adrenal medulla
Why are infants at a greater risk of hypothermia than children?
Because they have a higher ratio of surface area to body mass
Nonshivering thermogenesis occurs in which of the following to help the newborn infant fight hypothermia?
Brown Fat
Your anatomy GSA arrives to class with a mild headache and general feelings of achiness. You inform him that he is in which stage of fever? A) biofeedback B) Chill C) prodomal D) defervescence
C) prodomal
Researchers wish to reactivate the cell cycle in nonproliferating cells to assist the body to repair tissue. To reactivate the cycle, which substance will the researchers need to remove from the cell?
CDK inhibitors
During a review session discussing cells, a student asks, "What do you call it when a cell becomes more specialized in terms of structure?" What response would answer the question correctly?
Cell differentiation
While explaining to a young child while he should be careful with a wound, the nurse reviews healing with the parent. The nurse educated the parent about how strength in the healing wound site is developed based on which substance being available?
Collagen Synthesis
A client underwent an open cholecystectomy 4 days ago, and her incision is now in the proliferation phase of healing. What is the dominant cellular process that characterizes this phase of the client healing?
Collagen secretion by fibroblasts
What factor the may influence a client's relative risk for development of a stress-related pathologic process?
Conditioning
The loss of heat from the body through circulation of air currents is known as which of the following?
Convection
What is an endocrine regulator of pituitary and adrenal activity and neurotransmitter involved in autonomic nervous system activity, metabolism, and behavior?
Corticotropin-releasing factor
A client who has been receiving cortisol as treatment for an illness states he "is constantly developing colds and fevers." What is the nurse's best response to the client?
Cortisol inhibits the function of the immune system, making you more susceptible to disease.
A nurse on the diabetic/renal floor is taking care of a patient with diabetes. The patient states that her diabetes is typically very well controlled, but when she is under a lot of stress at work her blood sugar rises and she experiences delayed wound healing. The nurse explains to the patient the there symptoms are primarily a result of wha=t?
Cortisol stimulating the breakdown of glycogen
A hostage situation has occurred at a high school campus. The school superintendent and faculty are concerned about the students experiencing post-traumatic stress disorder (PTSD). What would the most important intervention be?
Debriefing with a crisis team about the event as soon as possible.
A previously healthy 42-year-old client was recently diagnosed with hypertension. What response best describes a positive reaction to the acute stress?
Decreasing dietary sodium and fat intake.
When assessing a a client's incision, the nurse notes that the edges of the once approximated incision has begun to pull apart. The nurse documents that the client's incision has what?
Dehisced
An older adult's dysfunctional temperature regulator function places the client at greatest risk for what?
Delayed initiation of appropriate treatment
A nursing student's current clinical placement has been a source of stress due to high client acuity combined with interpersonal conflict with some of the unit staff. At the same time, the student has been fighting a cold for more than 2 weeks and has been unable to regain a normal feeling of health. How might these two phenomena be related?
Endocrine-immune interactions may suppress the student's immune response.
Selye suggested that stress could have positive influences on the body. What are the se periods of positive stress called?
Eustress
Events or environmental agents responsible for initiating the stress response that arise from outside of the body are known as what?
Exogenous stressors
T/F: Most physiologic control systems function under positive feedback mechanisms.
FALSE
A nurse's hand-off reports states that the patient has pyrexia. The nurse plans care for the patient with what event?
Fever
A client has an increase in core body temperature. What assessment findings does the nurse expect?
Flushed skin
What therapy guides the client to focus on creating a specific mental image designed to bring about positive physical and/or emotional effects to combat stress?
Guided imagery
How does the nurse best define hardiness to a client?
Hardiness describes a personalty characteristic that assists in the stress response.
The nurse is caring for a client whose temperature is increasing The nurse is aware that the client will also experience an increase in what?
Heart Rate
Although stress exposure initiates integrated responses by multiple systems, the functional changes are first manifested by which of the following systems?
Neuroendocrine
A hiker presents to the emergency department with reports of flu-like symptoms, thirst, nausea, and inability to urinate. Upon assessment it is determined that the patient has a rectal temperature of 102.2 degrees F (39 degrees C) and is tachycardic. These symptoms support a diagnosis of what?
Heat exhaustion
A nurse is planning care for a patient coming into the emergency department via ambulance on a hot summer day with the following symptoms: temperature of 105F, absence of sweating, and loss of consciousness. What condition does the nurse anticipate the patient to have?
Heatstroke
A client with environmental allergies is experiencing respiratory inflammation. Which mediator causes vasodilation during the vascular stage of the inflammatory response?
Histamine
A nurse is caring for a client who has developed facial swelling related to a hypersensitivity reaction to a medication. What substance does the nurse recognize is implicated in causing this type of reaction?
Histamine
A nurse is caring for an adolescent with post-traumatic stress syndrome. The patient reports having difficulty concentrating and has an increased startle reflex. The nurse's documentation includes the presence of what?
Hyperarousal
What is the most common cause of drug fever?
Hypersensitivity reaction to medication
Where is oxytocin synthesized?
Hypothalamus
The client is receiving chronic glucocorticoid therapy for chronic obstructive pulmonary disease (COPD). What lab results would the provider expect to see?
Increased blood glucose
Which manifestation of stress reflects the nonspecific "fight-or-flight" response?
Increased cardiopulmonary rates
The student is studying the control systems that mediate the physical, emotional and behavioral reactions to stressors. The student explains that the cerebral cortex functions as which part of this system?
Integrator
A nurse evaluating the bloodwork results of a client with an infected leg ulcer. The white blood cell count is 18,000 cells/uL. What does the nurse interpret this as?
Leukocytosis
One of the pathophysiology students recognized hyaluronic acid (a component of the extracellular matrix) as a supplement she buys at the health store following a knee injury. Knowing what this substance is, the student shares with her peers that is does what?
Lubricates joints and serves as a supportive structure in the extracellular space throughout the body
What feedback system provides stability to the stress response?
Negative feedback mechanism,
A client is experiencing stress as a nurse prepares to insert a peripheral intravenous catheter into his forearm. The client's locus ceruleus (LC) is consequently producing which of the following hormones?
Norepinephrine (NE)
The client experienced a traumatic event in the past that has caused chronic nightmares in which the event is relived. The client may have increased levels of what?
Norepinephrine (NE)
The locus ceruleus (LC) is an area in the brain stem that produces what hormone?
Norepinephrine (NE)
A client asks why his temperature is always below 98.6 degrees F. How should the nurse respond?
Normal core temperature varies between individuals within the range of 97.0 degrees F to 99.5 degrees F.
A two-day postoperative patient's temperature was 98.5 degrees F at 3:00pm. At 6:00pm, the unlicensed assistant notifies the nurse that the patient's temperature is 102.0 degrees F. What action should the nurse take?
Notify the physician
A client who lives with many psychosocial and physiologic stressors is experiencing the exhaustion stage of stress. The client is likely to develop what consequence of this stage?
Physiologic damage
The nurse is assessing the wound of a postoperative client. The client has a 6-inch abdominal wound that is well approximated and closed with surgical suture. The wound does not display redness or drainage. What would the nurse document this healing process as?
Primary intention
A nurse on the pediatric oncology unit needs to obtain a core temperature. Which of the following methods should she use? A) axillary B) rectal C) oral D) temporal
Rectal
The nurse is attempting to obtain the most accurate core body temperature of a patient. What method should the nurse use?
Rectal
The nurse needs to assess a 1-year-old child for fever. Which approach will produce the most accurate reading?
Rectal
What route is considered the most accurate to measure a core body temperature?
Rectal
Which of the following interventions provides the most accurate information about core temperature?
Rectal temperature
A client who had an implantable cardioverter-defibrillator (ICD) returns the next week with a fever, chills, and elevated WBC. The physician suspects the wound is infected. If this wound does not respond to antibiotic therapy, the nurse can anticipate that the client will undergo what?
Remove of device
Antipyretic drugs, such as aspirin, ibuprofen and acetaminophen, are often used to alleviate the discomforts of fever and protect vulnerable organs, such as the brain, from extreme elevations in body temperature. The use of aspirin is limited in children, however, because it can sometime cause what disease?
Reye Syndrome
While sponging a client who has a high temperature, the nurse observes the client begins to shiver. At this point, the priority nursing intervention would be to do what?
Stop sponging the client and retake a set of vital signs.
What mechanism may be a contributor to symptoms in a child who has "failure to thrive"?
Stress response on growth hormone.
Chronic and excessive activation of the stress response has been shown to play a part in the development of long-term health problems. The stress response can also result from chronic illness. What health problems have been linked to stress response that is chronic and excessive?
Suicide and immune disorders
The fight-or-flight response is a manifestation of the stress reaction caused by which part of the nervous system?
Sympathetic
A client's primary care provider has recommended biofeedback in an effort to address her chronic stress and reduce the potential for complications. What will be the goal of this intervention?
Teaching the client to consciously control her own body functioning.
The psychologist is counseling a client who is overwhelmed by losing his job and the recent death of a parent. What strategy would be effective for stress reduction?
Teaching the client to systematically contract and relax major muscle groups.
a client with pneumonia is admitted with these vital signs: temperature 99.7F, pulse 80 beats/min, respirations 18/minute, and BP 120/80 mmHg. What set of vital signs does the nurse anticipate wen the client beings to shiver and requests another blanket several hours later?
Temperature: 100.9F (increase) Pulse: 90 beats/min (increase) Respiration: 20/min (increase) BP: 126/80 mmHg (increase)
What responsibility of the extracellular matrix (ECM) is most accurate?
The ECM provides the scaffolding for tissue renewal.
The manifestations of the stress response are strongly influenced by which system?
The Nervous System
A client who has just had a "fight-or-fight" reaction asks the nurse what causes the quick changes he experienced. What would the best response be?
The Sympathetic Nervous System is what causes the quick changes.
Following hip replacement surgery, the client has had many weeks of physical therapy. Upon assessing the wound, it is still red and draining thick, green, odoriferous secretion. The client has limited range-of-motion and is constantly reporting pain. The physician explains that the hip device needs to be removed. Why is removal required?
The body considers the hip replacement device a foreign body and an infection has developed around the joint.
A child has been experiencing hypoglycemic episodes. "How does the body know when to secrete insulin and when to stop secreting it?" What is the best response by the nurse, explaining the physiologic background?
The body knows that if the blood glucose level falls, it will inhibit insulin secretion and release glycogen to release glucose from the liver.
A patient arrives at the hospital with severe dehydration. During the assessment, the nurse notes that the patient's blood pressure is very low. When asked, the patient states "I have not had anything to drink, and I have not urinated once today." What best explains why the patient has not urinated today?
The renin-angiotensin-aldosterone-system (RAAS) has caused the retention of sodium and water.
A student is participating in an extended fast as part of a charitable fundraising effort. What is an example of the physiologic reserve that will facilitate the student's adaptation to the stress of this sudden change in diet?
The student's adipose tissue contains large and accessible stores of energy.
While studying for a pathophysiology exam on cells and tissue repair, a student asks, "What happens if, in the process of going through the cell cycle, a cell is damaged?" What is the best response?
There are built in checkpoints in the cell cycle to allow for defects to be edited and repaired.
A 33-year-old client is brought into the emergency room with a core temperature of 39C (102.2F). The client is red in the face, chest, and back due to significant cutaneous vasodilation. The client is likely in which stage of fever?
Third (Flush)
What is the objective of tissue regeneration in wound healing?
To restore injured tissue to its original structure.
A client who has developed a fever is now complaining of a headache. The nurse would recognize this manifestation as a result of what?
Vasodilation of cerebral vessels.
A recovery room nurse monitoring a patient for adverse effects of cold cardiplegia assesses for what?
Ventricular dysrhythmia
A 29-year-old mother of three is suffering from chronic stress. The cause of her stress are her young children, the need for and lack of money, and the potential loss of her job. Assessment release that she is experiencing eustress. This will likely cause her to do what?
Work harder to maintain employment.
Where is oxytocin secreted from?
posterior pituitary
A nurse is caring for a post-operative patients documents that the surgical incision is healing by what?
primary intention
After many years of cigarette smoking, a client is admitted to have a "mass" removed from the lung. When explaining the surgery and recovery, the physician notes that the client is likely to have a good amount of fibrosis develop at the surgical area. After the physician leaves the room, the client asks the nurse what was meant by "fibrosis" in the lung. The nurse bases the response on the fact that tissue repair can what?
result in replacement tissue in the form of connective (fibrous) tissue which leads to scar formation or fibrosis of the lung.
You're a nurse in the ER, and a patient comes to you from a recent car accident. Their blood pressure is significantly elevated. As the nurse, you understand their blood pressure elevation is a result of what?
the release of renin and vessel constriction from stimulation of the alpha receptors.
What statement best describes stem cells?
undifferentiated cells of continuously dividing tissues that have the capacity to generate multiple cell types.