PrepU Exam 2: Perfusion, Immunity, Metabolism

A nurse is caring for a client with an average heart rate of 56 beats/min. The client has no adverse symptoms associated with this heart rate and is receiving no treatment. Which activity modification should the nurse suggest to avoid further slowing of the heart rate?

"Avoid bearing down while having a bowel movement."

The nurse is administering a stool softener to a client who experienced a myocardial infarction. The client says, "I had a heart attack; I don't have a problem with constipation." What explanation will the nurse use to answer the client's question?

"If you strain to have a bowel movement, you can cause a drop in your heart rate that can be dangerous."

Which statement would help a nurse best explain an "incretin effect"?

"It is an increase in insulin release after ingestion of food."

A child will be undergoing a Holter monitor test. Which statement by the parent indicates the need for further instruction?

"My child cannot have any thing to eat or drink after midnight the day of the test."

A pregnant woman recently diagnosed with the genital herpes virus asks the nurse for more information on the virus. Which responses by the nurse would be appropriate? Select all that apply.

"The virus remains quiet until a stressful event occurs to reactivate it." "Infections may be transmitted by individuals unaware that they have it." "Transmission is through contact of infected mucous membranes."

A pregnant woman determined to be at high risk for gestational diabetes is undergoing a 1-hour glucose challenge test. The nurse schedules the client for a 3-hour glucose tolerance test based on which result?

146 mg/dL

Which client scenario best describes an example of infection originating with a fomite?

32-year-old man who contracts hepatitis B by sharing a syringe

The nurse is caring for four clients. Which client presents the most susceptibility for infection?

46-year old with a foley catheter following anesthesia

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure?

80 to 110 mg/dL

In which situation would blood most likely be rapidly relocated from central circulation to the lower extremities?

A client is helped out of bed and stands up.

The nurse is caring for a diverse group of medical clients. Which client should the nurse monitor most closely for signs and symptoms of Pneumocystis jiroveci pneumonia?

A client who has been admitted with an exacerbation of acquired immunodeficiency syndrome (AIDS)

The mother of 6-year-old male and female fraternal twins has brought her son to see a pediatrician because he is nearly 4 inches shorter than his sister. Which phenomenon would the physician most likely suspect as contributing factor to the boy's short stature?

A shortage of hypothalamic GHRH production

A clinician who works on a cardiac care unit of a hospital is providing care for a number of clients. Which client most likely has a genetic disorder arising from inheritance of a single gene?

A tall, thin, myopic, 28-year-old woman with mitral valve prolapse.

A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? A) Fasting plasma glucose greater than or equal to 126 mg/dL B) Random plasma glucose greater than 150 mg/dL C) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions D) Random plasma glucose greater than 126 mg/dL

A. Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL.

Which is a true statement regarding pharmacologic aspects of aging?

Absorption may be affected by changes in gastric pH.

The nurse is caring for a client in the ED with frostbite to the left hand. During the rewarming process of the hand, the nurse should perform which action?

Administer analgesic medications as ordered.

A patient has herpes simplex infection that developed after having the common cold. What medication does the nurse anticipate will be administered for this infection?

An antiviral agent such as acyclovir

A client presents with signs and symptoms of candidiasis and is concerned about why this occurs after taking antibiotics. The most appropriate information for the nurse to provide would be:

Antibiotics suppress the normal protective vaginal flora allowing overgrowth of C. albicans.

On her third postpartum day, a client complains of chills and aches. Her chart shows that she has had a temperature of 100.6° F (38.1° C) for the past 2 days. The nurse assesses foul-smelling, yellow lochia. What should the nurse do next?

Anticipate that the physician will order laboratory tests and cultures.

Which statement describes the blood supply to a synovial joint?

Articulating areas are nourished indirectly by the synovial fluid.

A client is postoperative following a graft reconstruction of the neck. What intervention is the most important for the nurse to complete with the client?

Assess the graft for color and temperature.

A nurse is providing care for a client who has had a cast applied to her fractured arm 6 hours prior. The client is now reporting severe pain that she describes as "even worse than when I broke my arm." What would be the nurse's best course of action?

Assessment of motor and sensory function with the goal of identifying compartment syndrome.

A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patient's initial phase of treatment? A) Monitoring the patient for dysrhythmias B) Maintaining and monitoring the patient's fluid balance C) Assessing the patient's level of consciousness D) Assessing the patient for signs and symptoms of venous thromboembolism

B In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the patient for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority.

A client is diagnosed with thrombophlebitis. What nursing action would demonstrate the appropriate level of activity for this client?

Bed rest with the affected extremity elevated

Which statement is true concerning the digestion of carbohydrates?

Carbohydrates are broken down into monosaccharides before being absorbed.

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

Cell surface receptors

A client presents to the urgent care and tells the health care provider he came home from vacation 4 days ago and does not feel well. Upon assessment, the provider notes the client's right upper thigh area is red, warm, and painful, and the lymph nodes are palpable. The client states he had been swimming in a lake all week. The health care provider recognizes these manifestations as:

Cellulitis

The nurse is caring for a group of clients at a public health clinic. Which sexually transmitted disease would the nurse focus the client education on curative goals?

Chlamydia

A patient was suspected of being in direct contact with anthrax but is exhibiting no signs or symptoms. What type of prophylaxis does the nurse know this patient will have to take?

Ciprofloxacin (Cipro) for 60 days

A physical assessment of a 28-year-old female client indicates that the blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which possibility would her care provider be most likely to suspect?

Coarctation of the aorta

Which criterion about insulin would prompt a diagnosis of type 1 diabetes?

Complete failure of insulin secretion

After having a very stressful day in pathophysiology class, the student knows that which hormone (secreted by the adrenal cortex) will help decrease the effects of stress?

Cortisol, a glucocorticoid

Which of the following medications needs to be withheld for 5 to 7 days prior to cataract surgery?

Coumadin

Which clinical manifestations in an aging male client are due to decreased levels of testosterone? Select all that apply.

Decreased sexual energy Decreased testicular size Infertility

When the sympathetic nervous system is stimulated, the interstitial cells of Cajal react in which way?

Decreasing amplitude of the slow waves, which control the spontaneous oscillations in membrane potentials.

An obese Hispanic client, age 65, is diagnosed with type 2 diabetes. Which statement about diabetes mellitus is true?

Diabetes mellitus is more common in Hispanics and Blacks than in Whites.

In a busy sexually transmitted infection clinic on a university campus, a group of students have developed tetracycline- and penicillin-resistant strains of N. gonorrhoeae. Given these results, the nurse can expect that which treatment will be prescribed?

Dual therapy with ceftriaxone and azithromycin

When caring for a client who is being screened for osteoporosis, the nurse plans to evaluate the results of which diagnostic test?

Dual-energy x-ray absorptiometry (DXA)

A client is diagnosed with herpes simplex. Which statement about herpes simplex infection is true?

During early pregnancy, herpes simplex infection may cause spontaneous abortion or premature birth.

The older adult client with a history of congestive heart failure is upset following the death of her husband yesterday. The practitioner observes the client for which of the following?

Dysrhythmias

A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the client to be in atrial fibrillation. Which test will the practitioner order to find the source of the emboli?

Echocardiogram

A client has been diagnosed with a superficial fungal infection. Which assessment technique is most likely assisted with this diagnosis?

Examination of the area with a Wood's light

Which pathophysiologic phenomenon may result in a diagnosis of Cushing disease?

Excess ACTH production by a pituitary tumor

A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Based on the typical signs and symptoms of this disorder, which nursing diagnosis will the nurse identify as relating to this client?

Excess fluid volume

The nurse is caring for a client with a condition of deficiency of antidiuretic hormone (ADH). When assessing the client, which finding does the nurse anticipate?

Excessive urine output

A client has been diagnosed with inherited hypercoagulability. Select the most likely cause.

Factor V gene mutation

The nurse is caring for a client with hepatitis and jaundice. The nurse recognizes that without sufficient circulating bile salts the client will have intolerance to which ingested substance?

Fats

A school nurse is called to assess a 12-year-old child with type 1 diabetes mellitus who is experiencing lightheadedness, tachycardia, and pallor during physical education class. What is the priority action by the nurse?

Give the child some fruit juice to drink.

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand?

Glucagon

In the balance of secretions in the gastric mucosa by the parietal cells, which ion is produced to buffer the production of hydrochloric acid?

HCO3-

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

Hashimoto thyroiditis

In collecting assessment data on the school-aged population, which factor could be the most significant predictor of childhood obesity?

Having parents who are obese

A female client is found to have genital warts during a routine pelvic examination. Which sexually transmitted infection will the nurse prepare to test for?

Human papillomavirus

The nurse is caring for the client with pancreatic cancer. The nurse monitors the client for which complication?

Hyperglycemia due to inability to synthesize insulin

A client is admitted with an alteration in arterial blood gases. Cellular injury is most likely to result from which aspect of this abnormality?

Hypoxia

In addition to direct invasion of the vascular wall by an infectious agent, what pathogenic mechanism is a common cause of vasculitis?

Immune-mediated inflammation

A 9-year-old girl has a diffuse collection of symptoms that are indicative of deficits in endocrine and autonomic nervous system control. She also suffers from persistent fluid and electrolyte imbalances. On which aspect of the nervous system listed below would her health care providers focus their diagnostic efforts?

Impaired function of her hypothalamus

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites?

Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

The nurse is caring for a client who has been on an oral corticosteroid for several years for an autoimmune condition. The nurse notes several bruises of different stages of resolution on the client. What is the nurse's best response to this finding?

Interview the client regarding side effects of corticosteroid therapy.

A client is being seen at the clinic on a monthly basis for assessment of blood pressure. The client has been checking blood pressure at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this client is experiencing?

Isolated systolic hypertension

Which of these is a clinical manifestation of osteoporosis?

Loss of mineralized bone mass

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?

Low T4 level and high TSH level

ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?

Most ECG-detected ischemic events are clinically silent.

When thyroxine (T4) in the thyroid is low, it triggers the pituitary to increase thyroid stimulating hormone (TSH), which then increases T4 secretion. This is an example of which of the following?

Negative feedback mechanism

On the fourth day after surgery, a client's incision is red and inflamed. There is moderate drainage from the incision. The client has a temperature of 102°F (38.9°C). The total white blood cell (WBC) count is 10,000/mm3 (10 × 109/L). What should the nurse do first?

Notify the health care provider (HCP).

Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome?

Observe the color of stool.

A 24-year-old woman has presented to an inner city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman's most likely treatment and prognosis?

Oral antiprotozoals to client and sexual partners to help prevent complications.

Which statement correctly describes osteogenesis imperfecta, or brittle bone disease?

Osteogenesis imperfecta is caused by deficiencies in the synthesis of type I collagen.

A client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings?

Osteomyelitis

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be:

Prompt diagnosis and treatment of streptococcal infections

A client with hepatitis C is scheduled to begin a new therapy that would block the progression of the virus by interfering with its genetic replication. What type of therapy is this client beginning?

RNA interference

A nurse practitioner student is trying to distinguish the various rashes she will be seeing in her pediatric rotation. Their nurse preceptor is assisting by describing the rash associated with rubeola. Which characteristics would apply to rubeola? Select all that apply.

Rash is macular and blotchy. The rash usually begins on the face and then spreads to the legs/arms.

When performing the square wave test on the arterial line, the nurse notes an underdamped square wave. What is the priority action by the nurse?

Remove air bubbles from the system.

Which of the following medications used for obesity improves cardiovascular disease risk factors in obese patients with metabolic syndrome?

Rimonabant (Acomplia)

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?

Risk for infection

A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension?

Secondary

A client is seen in the emergency department complaining of chest discomfort, productive cough, and a fever of over 101°F (38.3°C) for 3 days. The nurse performs an electrocardiogram and observes a rate of 110 beats per minute (bpm) with a normal P wave and a PR interval of 0.12 second preceding each QRS complex. What does the nurse determine the rhythm to be?

Sinus tachycardia

What statement is true concerning the use of ATP [adenosine triphosphate] by skeletal muscles?

Skeletal muscles use ATP at a rapid rate during exercise.

A nurse explains to a client with thyroid disease that the thyroid gland normally produces:

T3, thyroxine (T4), and calcitonin.

Which condition follows a Mendelian pattern of recessive inheritance?

Tay-Sachs disease

A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder?

The child has had 8 ounces of formula in the past 24 hours.

The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client?

The client must protect the entire body from cold, not just the extremities.

Which client would the nurse be most concerned about?

The client with herpes zoster affecting the trigeminal nerve

A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following?

The functioning of endocrine glands

You work on a long-term care unit. In the last two weeks more than half the clients on your unit have been diagnosed with gastroenteritis. What is the most likely reason?

The infection is being transmitted by healthcare personnel.

A 51-year-old male has been diagnosed with alcohol-induced liver disease. He admits to the nurse he does not understand what the liver does in the body. Which of these statements best explains the liver's function?

The liver metabolizes most components of food and also cleans the blood of bacteria and drugs.

A public health nurse is teaching a group of parents at a community health center about feeding and nutrition for toddlers. Which information is most important for the nurse to include in the teaching?

Toddlers often eat one food for many days in a row.

The pregnant client asks if there are any precautions she should take in caring for the family cat. The nurse explains that she should limit contact with the cat's litter box. The litter box may contain which organism that can cause fetal malformations?

Toxoplasmosis

Two types of obesity are recognized: upper body obesity and lower body obesity. How is the type of obesity determined?

Waist/hip circumference

A 2-month-old infant is breastfed and diagnosed with cystic fibrosis. The infant is being evaluated for possible pancreatic abnormalities based on which clinical assessment finding(s)? Select all that apply.

Weight has remained the same as birth 8 to 10 liquid stools/day Too much fat in the stools

The primary reason genital herpes has reached epidemic proportions throughout the world relates to the fact that:

a large percentage (70%) of those infected experience no symptoms of the disease.

A client has been diagnosed with an abscess. Upon assessment of the client, the nurse would expect to find:

a localized pocket of infection composed of devitalized tissue, microorganisms, and the host's phagocytic white blood cells.

A charge nurse is completing client assignments for the nursing staff on the pediatric unit. Which client would the nurse refrain from assigning to a pregnant staff member?

an 8-year-old with Rubella

The pediatric nurse would use standard precautions in caring for which client on her floor?

an adolescent who has a broken arm

A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last six months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of antimicrobial medication is most likely to clear her symptoms?

an azole antifungal agent

The nurse notes that the client demonstrates generalized pallor and recognizes that this finding may be indicative of

anemia.

A client reports pain and cramping in the thigh when climbing stairs and numbness in the legs after exertion. Which diagnostic test with the physician likely perform right in the office to determine PAD?

ankle-brachial index

The nurse is caring for a client with possible Cushing's syndrome undergoing diagnostic testing. The health care provider orders lab work and a dexamethasone suppression test. Which parameter would the nurse assess on the dexamethasone suppression test?

cortisol levels before and after the system is challenged with a synthetic steroid

During a routine assessment the nurse notes the postpartum client is tachycardic. What is a possible cause of tachycardia?

delayed hemorrhage

When explaining to a client why there was only minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain that this is primarily due to:

development of collateral circulation that build channels between some of the smaller arteries, usually when the flow is decreased gradually.

The spirochete Leptospira is primarily transmitted to farmers by:

direct contact with infected animals.

Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart.

fills rapidly; compresses

While assessing a newborn, the nurse notes that half the body appears red while the other half appears pale. The nurse interprets this finding as:

harlequin sign.

A skin infection caused by beta-hemolytic streptococci common in children is:

impetigo.

A neonate undergoing phototherapy treatment must be monitored for which adverse effect?

increased insensible water loss

Smooth muscle contractions are typically characterized as:

involuntary.

The nurse is preparing a teaching plan for new parents about why newborns experience heat loss. Which information about newborns would the nurse include?

limited voluntary muscle activity

A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. What is an important education topic regarding ingestion of medications?

metabolism of medications

A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn?

microcephaly

A preventive measure to decrease the risk of developing rheumatic heart disease includes:

prompt diagnosis of streptococcal infections with a throat culture.

Which action is contraindicated for a client who develops a temperature of 102° F (38.9° C)?

providing a low-calorie diet

Despite continuous health teaching, a client will use only the left thigh for insulin administration. The nurse is aware this is happening because:

repeatedly using the same site is less painful.

Laboratory studies indicate a client's blood glucose level is 185 mg/dl (10.2 mmol/L). Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use?

serum glycosylated hemoglobin (Hb A1c)

A 40-year-old woman is being discharged from the walk-in health care clinic after a diagnosis of pelvic inflammatory disease (PID). Which health teaching topic should the nurse address?

sexually transmitted infections (STIs)

A nurse is assessing a client with hepatitis A. The client reports having a poor appetite and the presence of food causes nausea. What should the nurse encourage the client to eat?

the majority of the calories in the morning during small frequent snacks

The nurse teaches the parent of a child with chickenpox that the child is no longer contagious to others when

the vesicles and pustules have crusted.