Exam 7

A physician is explaining to a group of medical students the concept of Virchow triad as it applies to venous thrombosis. Which of the following clinical observations of a 50-year-old male client is most likely unrelated to a component of Virchow triad? A) The man has decreased cardiac output and an ejection fraction of 30%. B) The man's prothrombin time and international normalized ratio (INR) are both low. C) The man has a previous history of a dissecting aneurysm. D) There is bilateral, brown pigmentation of his lower legs.

Ans: A Feedback: Cardiac output is not a component of Virchow triad. However, decreased INR and prothrombin time indicate hypercoagulability; a dissecting aneurysm is an example of vessel wall injury; and pigmentation in the lower legs indicates stasis of blood.

A 74-year-old female has been diagnosed with osteoporosis after her bone density scan indicated osteopenia. Which of the following factors would her care team be most likely to rule out as contributors to her health problem? A) The woman is an African American and was exposed to asbestos in her work. B) She has been a heavy drinker for her whole adult life and has diabetes mellitus. C) The client takes corticosteroids for treatment of her long-standing osteoarthritis. D) The woman has an estrogen deficiency and has never undergone hormone therapy.

Ans: A Feedback: African American race is not a risk factor for the development of osteoporosis, and African Americans tend to have higher bone density than Whites and Hispanics. Asbestos exposure is not a noted risk factor for osteoporosis, while alcohol use, diabetes, steroids, and estrogen deficiency are all risk factors.

Which of the following individuals is most likely to be experiencing vasodilation? A) A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin-angiotensin-aldosterone system B) A 9-year-old boy who has been given an injection of epinephrine to preclude an anaphylactic reaction to a bee sting C) A 30-year-old woman who takes antihistamines to treat her seasonal allergies D) A 32-year-old man who takes a selective serotonin reuptake inhibitor for the treatment of depression

Ans: A Feedback: Angiotensin is a potent vasoconstrictor, and medications that block this induce vasodilation. Epinephrine is also a vasoconstrictor. Histamine is a vasodilator, so antihistamine medications are likely to induce vasoconstriction. Serotonin is a vasoconstrictor, so medications that block its reuptake and increase free levels are apt to promote vasoconstriction.

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 renin-angiotensin-aldosterone (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.

Ans: A Feedback: BNP is released to compensate for heart failure, and elevated levels help confirm the diagnosis of heart failure as opposed to respiratory etiologies. It does not measure the effectiveness of the RAA system, the risk of cognitive deficits, or the specific severity of pulmonary symptoms of heart failure.

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

Ans: A Feedback: Both increased and decreased urine output can be markers of heart failure, as can changes in mental status not attributable to other factors. While heart auscultation, pedal pulses, and activity tolerance are relevant parameters, integumentary inspection, pupil response, and pain assessment are less likely to be relevant assessment components.

An 80-year-old female with a diagnosis of osteoporosis receives daily supplements of calcitonin in the form of a nasal spray that she instills each morning. Which of the following phenomenon would her care providers expect to result from her supplementation? A) Decreased serum calcium levels B) Increased bone resorption C) Acceleration of osteoclast action D) An increase in bone formation

Ans: A Feedback: Calcitonin lowers both the rate of bone resorption and serum calcium levels. It does not accelerate osteoclast action, and it is not noted to increase bone formation.

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."

Ans: A Feedback: Cognitive changes can often accompany heart failure in the elderly. Pulmonary edema is a later sign, and they are less likely to display coughing, chest pain of flushed skin, and fever.

A new patient arrives at the clinic. The physician is suspecting that the patient may have systemic lupus erythematosus (SLE) given the clinical manifestations related to joint pain, skin changes, and a history of pleural effusions. The nurse should anticipate which of the following diagnostic test will be a priority to facilitate with the diagnosis? A) Anti-DNA antibody test B) Routine hemoglobin C) C-reactive protein D) B-cell lymphocytes

Ans: A Feedback: Ninety-five percent of people with untreated SLE have high ANA levels. However, ANA is not specific for SLE. The anti-DNA antibody test is more specific for the diagnosis of SLE. Hemoglobin may be low if the patient has severe anemia, but it is not specific for SLE. C-reactive protein will show an inflammatory response but again not specific for SLE.

A 51-year-old male with a history of hypertension has received a kidney transplant. The client's physician is explaining some of the consequences of the procedure, including the fact that he will need to be on long-term steroid therapy. Which of the following teaching points should the physician emphasize? A) "One of the risks that these steroids bring is the possibility that part of a bone might die." B) "Steroids will help your body to not reject your new kidney, but they bring a risk of bone infection." C) "You're going to have to avoid contact sports because the steroids will make your bones very susceptible to breakage." D) "If you notice sudden limb pain after taking your steroid pills, it could be an increase in pressure in the compartment around your muscles."

Ans: A Feedback: Osteonecrosis is strongly associated with steroid therapy. Osteomyelitis, decreased bone density, and compartment syndrome are not associated with steroid therapy.

The nurse practitioner working in an overnight sleep lab is assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient's blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles? A) During apneic periods, the patient experiences hypoxemia that stimulates chemoreceptors to induce vasoconstriction. B) When the patient starts to snore, his epiglottis is closed over the trachea. C) When the airway is obstructed, specialized cells located in the back of the throat send signals to the kidney to increase pulse rate. D) When airways are obstructed, the body will retain extracellular fluid so that this fluid can be shifted to intravascular space to increase volume.

Ans: A Feedback: People with sleep apnea also may experience an increase in BP because of the hypoxemia that occurs during the apneic periods. The specialized chemoreceptors are located in carotid bodies and aortic bodies of the aorta. Retention of fluid is not the cause of increased BP during sleep apnea episodes.

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

Ans: A Feedback: The client's alternating bradycardic and tachycardic episodes are indicative of sick sinus syndrome. This pattern is not characteristic of ventricular arrhythmia, premature atrial contractions, or torsade de pointes.

A patient arrives at the ED complaining of numbness in the left lower leg. Upon assessment, the nurse finds the lower left leg to be cold to touch, pedal and posterior tibial pulses nonpalpable, and a sharp line of paralysis/paresthesia. The nurse's next action is based on the fact that A) acute arterial occlusion is a medical emergency requiring immediate intervention to restore blood flow. B) submersion in a whirlpool with warm water will improve the venous blood flow and restore pulses. C) the immediate infusion of tissue plasminogen activator (tPA) will not correct the problem and should only be used for CVAs. D) administration of an aspirin and sublingual nitroglycerin will vasodilate the artery to restore perfusion.

Ans: A Feedback: The presentation of acute arterial embolism is often described as that of the seven "P's": pistol shot, pallor, polar, pulselessness, pain, paresthesia, and paralysis. Treatment is aimed at restoring blood flow. Embolectomy, thrombolytic therapy, and anticoagulant therapy (heparin) are usually given. Application of cold should be avoided.

A physician is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the physician most likelyrule out hypertension as a contributing factor? A) A 61-year-old man who has a heart valve infection and recurrent fever B) An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness C) A 44-year-old man awaiting a kidney transplant requires hemodialysis three times per week D) A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

Ans: A Feedback: While cardiac complications are common sequelae of hypertension, a heart valve infection would be less likely to be so. Stroke, kidney failure, and angina are all identified as consequences of hypertension.

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 - and -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.

Ans: A Feedback: a - and b- adrenergic receptor activation is a central response to all types of shock. Hemolysis is not a noted accompaniment to shock. Bronchodilation, not bronchoconstriction, often results from adrenergic stimulation, and sodium-potassium pump failure results in increased extracellular potassium and intracellular sodium.

Which of the following hypertensive individuals is most likely to have his or her high blood pressure diagnosed as secondary rather than essential? A) A 51-year-old male who has been diagnosed with glomerulonephritis B) An African American man who leads a sedentary lifestyle C) A 69-year-old woman with a diagnosis of cardiometabolic syndrome D) A 40-year-old smoker who eats excessive amounts of salt and saturated fats

Ans: A Feedback:Damage to the organs that control and mediate the control of blood pressure, most notably the kidneys, is associated with secondary hypertension. Race, lifestyle, sodium intake, and associated cardiac and metabolic sequelae are associated with essential hypertension.

A 13-year-old girl and her father come in to the local health clinic hoping to see an orthopedic doctor about the girl's stiff and warm knee. The father reports that she hurt it sliding into base during a softball game, and the daughter concurs, but with further discussion, it becomes clear that the slide made an existing pain worse. Her knee had been stiff, warm, and shiny and had been keeping her awake at night for a week or so before the game. Which of the following might be the cause of the girl's symptoms? A) Osteosarcoma B) Osteoma C) Chondroma D) Osteochondroma

Ans: A Feedback:Osteosarcoma is the most common bone tumor in children and the third most common cancer in children and adolescents; they most commonly arise in the vicinity of knee. The primary clinical feature of osteosarcoma is deep localized pain with nighttime awakening and swelling in the affected bone. Because the pain is often of sudden onset, patients and their families often associate the symptoms with recent trauma. The skin overlying the tumor may be warm, shiny, and stretched, with prominent superficial veins. The range of motion of the adjacent joint may be restricted. The four most common types of benign bone tumors are osteoma, chondroma, osteochondroma, and giant cell tumor; pain is a feature common to almost all malignant tumors but may or may not occur with benign tumors; pain that persists at night and is not relieved by rest suggests malignancy.

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

Ans: A Feedback:Systemic emboli develop and break off the mitral valve and travel into the vascular system. There is a high probability that the emboli could lodge in the brain, kidneys, lower extremities, etc. Answer choice B refers that petechial hemorrhages are signs and symptoms of IE. GI upset is common following antibiotic therapy but is not usually life threatening. Stress can increase insulin needs but not associated with pancreas enlargement.

During a routine physical exam for a patient diagnosed with hypertension, the nurse practitioner will be most concerned if which of the following assessments are found? A) Noted hemorrhages and microaneurysms during evaluation of the internal eye B) Unable to feel vibrations when a tuning fork is placed on the skull C) Inability to locate the kidneys with deep palpation to the abdomen D) Slight increase in the number of varicose veins noted bilaterally

Ans: A Feedback: Hypertension affects the eye in sometimes devastating ways. If there are acute increases in BP, hemorrhages, microaneurysms, and hard exudates can manifest. Vibrations relate to hearing loss. The kidneys should not be palpable to touch. Varicose veins are not associated with hypertension.

Which of the following pathophysiological phenomena would be most indicative of ankylosing spondylitis? A) Loss of motion in the spinal column and eventual kyphosis B) A progressive loss of range of motion in the knee and hip joints C) A facial "butterfly rash" and multiorgan involvement D) Decreased bone density in long bones

Ans: A Feedback: The characteristic trait of ankylosing spondylitis is progressive loss of the spinal ROM and eventual kyphosis. Synovial joint involvement is not associated with the disease, and a butterfly rash and multisystem involvement are associated with SLE. Decreased bone density does not normally accompany ankylosing spondylitis.

A 71-year-old male with a suspected diagnosis of osteoarthritis is being scheduled for a knee aspiration. The client is surprised to learn that his knee joint contains fluid and asks the physician ordering the procedure what the main role of the fluid is. Which of the following statements best underlies the explanation that the physician will provide? A) Synovial fluid allows for joint movement by minimizing friction. B) Fluid in the synovial cavities is essential for its role in immunity, and deficits indicate autoimmune etiologies. C) Synovial fluid allows for the diffusion of gases and nutrients to cartilage that lacks blood supply. D) The fluid inhibits clot formation in bone surfaces that are in constant contact.

Ans: A Feedback:Synovial fluid is responsible for lubrication. It does not perform a role in immunity or coagulation. While some diffusion takes place between the synovial fluid and adjacent structures, this is not the primary role.

The parents of an active 9-year-old are leaving the emergency department (ED) following cast placement for their son's lower extremity as a result of a fall in soccer. The nurse should emphasize that assessment of the cast is important and that they should bring their son back to the ED if they note which of the following signs and symptoms? Select all that apply. A) Cold, pale toes on the side with the cast. B) Patient complaining of tingling and numbness in the casted leg. C) Swelling in the lower leg has remained the same since they left the ED 12 hours ago. D) Pulses are palpable below the level of the cast. E) Bruising noted in the lower foot and toes.

Ans: A, B Feedback:If the circulation becomes inadequate (on a casted extremity), the parts that are exposed at the distal end of the cast (i.e., the toes with a leg cast and the fingers with an arm cast) usually become cold and cyanotic or pale. An increase in pain may occur initially, followed by paresthesia (tingling or abnormal sensation) or anesthesia as the sensory neurons that supply the area are affected. There is a decrease in amplitude of the pulse in areas where the arteries can be palpated. Bruising in the lower foot and toes would be considered normal following this type of fracture. Blood tends to pull in the lower tissues.

A 78-year-old male patient has undergone a total knee replacement. He just does not feel like getting out of bed and moving around. After 3 days of staying in bed, the physical therapist encourages him to get out of bed to the chair for meals. He starts to complain of dizziness and light-headedness. These symptoms are primarily caused by which of the following pathophysiological principles? Select all that apply. The patient('s) A) is experiencing a reduction in plasma volume. B) peripheral vasoconstriction mechanism has failed. C) is so stressed that he is releasing too many endorphins. D) is still bleeding from the surgical procedure. E) has lost all of his muscle tone.

Ans: A, B Feedback:Prolonged bed rest promotes a reduction in plasma volume, a decrease in venous tone, failure of peripheral vasoconstriction, and weakness of the skeletal muscles that support the veins and assist in returning blood to the heart. Endorphins make one feel better in mood. Three days post-op, there should be no further bleeding from the surgical site. If there is, then this is a complication that must be addressed immediately. Loss of vascular and skeletal muscle tone is less predictable but probably becomes maximal after 2 weeks.

A 22-year-old woman has sustained a lateral blow to her right knee during a game, and subsequent imaging has confirmed a severe meniscus injury. Which of the following consequences should the woman expect over the course of recovery? Select all that apply. A) Decreased lubrication in the knee joint B) Decreased stability of the knee C) Reduced shock absorption capacity D) Presence of infectious microorganisms in the synovial capsule E) Rapid restoration of the cartilage cells in the meniscus

Ans: A, B, C Feedback: Meniscal injuries have consequences for the lubricating and shock absorption capacities of the meniscus and would involve decreased range of motion. An infectious process is unlikely due to the internal nature of meniscal injuries, and healing is typically very slow.

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

Ans: A, B, D Feedback:ARDS, atelectasis, and acute renal failure are all noted consequences of shock that might be, respectively, treated by dialysis, an ostomy, or platelet transfusion. Plaque formation to heart vessels is not directly related to any of the identified consequences of shock. Pounding headache that coincides with each heart beat may occur with migraine headaches.

A physician is attempting a differential diagnosis of a 30-year-old female who is suspected of having systemic lupus erythematosus (SLE). Which of the following aspects of the physician's assessment and the client's history would be considered potentially indicative of SLE? Select all that apply. A) The client has a "butterfly rash" on her nose and cheeks. B) She complains of intermittent joint pain. C) The woman states that she has numerous environmental allergies. D) The client has been hospitalized twice in the past for pleural effusions. E) Blood work indicates low red cells, white cells, and platelets.

Ans: A, B, D, E Feedback:A butterfly rash, joint pain, pleural effusion, and low levels of blood cellular components are all associated with SLE. Environmental allergies are not noted to be risk factors or associated symptoms of the disease.

When educating the patient with ankylosing spondylitis, the nurse should emphasize which of the following treatment interventions? Select all that apply. A) Encourage sleeping supine on an extra firm mattress if possible. B) Prop self up in bed with extra pillows if having respiratory congestion. C) Try using the heating pad prior to exercise to help stretching and improve movement. D) Wear a knee immobilizer while biking to facilitate ability to exercise for longer periods. E) Modify diet to include more protein from red meat and green vegetables for vitamin K.

Ans: A, C Feedback: Treatment of ankylosing spondylitis is directed at controlling pain and maintaining mobility by suppressing inflammation. Proper posture and position are important. This includes sleeping in a supine position on a firm mattress using one small pillow. Therapeutic exercises are important. Heat applications or a shower or bath may be beneficial before exercise to improve ease of movement. Swimming is an excellent exercise. Immobilizing joints is not recommended. Maintaining ideal weight reduces the stress on weight-bearing joints. However, dietary changes are usually very individualized.

A nurse working on a gerontology unit notes that the majority of the clients on the unit are prescribed antihypertensive medications. When it comes to the aging process, which of the following phenomena are primarily the contributing factors to hypertension in the elderly population? Select all that apply. A) Stiffening of large arteries like the aorta B) Increased sensitivity of the renin-angiotensin-aldosterone system C) Decreased baroreceptor sensitivity and renal blood flow D) Increased peripheral vascular resistance E) Increase in renal perfusion

Ans: A, C, D Feedback:Increased sensitivity of the renin-angiotensin-aldosterone system is not a noted phenomenon among older adults. Stiffening of large arteries, increased peripheral vascular resistance, and decreased baroreceptor sensitivity and renal blood flow are all accompaniments of aging.

A patient has been admitted with a fractured pelvis that occurred in an auto accident just a few hours ago. The nurse notices a slight change in behavior. Which of the following clinical manifestations would lead the nurse to suspect that the patient has fat emboli that has migrated? Select all that apply. A) Complaints of substernal chest pain B) Complaints of pain in the lower abdomen and back C) Pulse rate 120 with temperature of 99.7°F D) Profuse diaphoresis with pallor noted E) Urine output of 30ml/hour

Ans: A, C, D Feedback:Initial symptoms of FES are a subtle change in behavior and signs of disorientation resulting from emboli in the cerebral circulation combined with respiratory depression. There may be complaints of substernal chest pain and dyspnea accompanied by tachycardia and low-grade fever. Diaphoresis, pallor, and cyanosis become evident as respiratory function deteriorates. It would be expected that the patient have lower abdominal and back pain since they have a pelvic fracture. The normal urine output is a minimum of 30 mL/hour.

Following bone density scanning and diagnostic imaging, a 4-year-old boy has been diagnosed with Legg-Calvé-Perthes disease. Which of the following findings, signs, and symptoms would lead clinicians to this conclusion? Select all that apply. A) The boy has significant difficulty in walking. B) The boy's feet toe-in when standing upright. C) The child has limited abduction of the affected hip. D) His femoral head region is noted to be necrotic E) There are numerous microfractures where his patellar tendon and tibia articulate.

Ans: A, C, D Feedback:Pain and difficulty in walking commonly accompany Legg-Calvé-Perthes disease, in which necrosis exists in the epiphyseal growth center of the femoral head. Toe-in would not be an expected related finding, and microfractures where the patellar tendon and tibia articulate are associated with Osgood-Schlatter disease.

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

Ans: B Feedback: Low blood pressure accompanied by warm, flushed skin and cognitive changes is indicative of septic shock, as is vessel dilatation and decreased vascular resistance.

A patient with a new automatic implantable cardioverter-defibrillator (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.

Ans: B Feedback: AICD successfully treats individuals with life-threatening ventricular tachyarrhythmias by use of intrathoracic electrical countershock. It senses and detects ventricular dysrhythmias. It responds by delivering an electrical shock between intrathoracic electrodes within 10 to 20 seconds of its onset. It does not periodically fire to test lead placement. It does not utilize radiofrequency energy (this is used in ablations). The procedure does not remove scar tissue or aneurysms. This is a ventriculotomy.

A nurse is teaching a wellness group among a group of older adult women. One of the women has asked for advice about preventing osteoporosis, which affects many of her friends. What is the nurse's best response to the woman's query? A) "Osteoporosis has been shown to have a strong genetic basis, so there is little you can do to prevent it." B) "Weight-bearing exercise is helpful, as are calcium supplements." C) "If possible, scaling back your hormone replacement therapy will reduce your osteoporosis risk." D) "There are drugs called glucocorticoids that both prevent osteoporosis and treat it if you do develop it."

Ans: B Feedback: Exercise and calcium supplementation have been shown to reduce the incidence of osteoporosis. Use of steroids is a risk factor, and estrogen deficiency would contribute to, rather than preventing, osteoporosis. There is a genetic component to the disease, but this does not preclude prevention efforts.

The nurse knows that which of the following patients listed below is at high risk for developing a hip fracture? A) A 77-year-old male who runs marathons and maintains a BMI of 25. B) An 82-year-old female with macular degeneration and uses a walker to go to the bathroom. C) A 64-year-old male with uncontrolled diabetes and chronic kidney disease on dialysis. D) A 73-year-old nursing home patient with long-term continence issues but able to walk the hallways for exercise.

Ans: B Feedback: Hip fracture is a major public health problem in the Western world. The incidence of hip fractures increases with age. The incidence is also higher in white women compared with nonwhite women. Risk factors for hip fracture include low BMI, tall body structure, use of benzodiazepines, lack of exercise, previous injury to lower body extremity, vision problems, and confusion.

A patient arrived at the emergency department 2 days after the development of "chest pressure" and "tightness" was treated with antacids thinking it was indigestion. His enzymes show a massive myocardial infarction (MI). Following angioplasty, the patient asks why so much muscle was damaged if only one vessel was blocked, the left circumflex. The nurse responds, A) "With any blockage in the heart, muscle damage always occurs." B) "If a major artery like the circumflex is occluded, the smaller vessels supplied by that vessel cannot restore the blood flow." C) "Since the circumflex artery supplies oxygenated blood flow to the posterior surface of the left ventricle, any amount of blockage will result in vital muscle tissue being lost." D) "When it comes to arteries in the heart, all vessels are equal, and any blockage causes a massive amount of damage that will not be restored."

Ans: B Feedback: Hyperemia cannot occur when the arteries that supply the capillary beds are narrowed. For example, if a major coronary artery becomes occluded, the opening of channels supplied by that vessel cannot restore blood flow.

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."

Ans: B Feedback: Stable plaque is associated with obstruction of blood flow, while unstable plaque may dislodge and result in thrombus formation. Plaque disruption is noted to correlate with sympathetic events and is not seemingly random; infections and respiratory problems are not noted to be associated with obstruction of blood flow, however.

A group of novice nursing students are learning how to manually measure a client's blood pressure using a stethoscope and sphygmomanometer. Which of the following statements by students would the instructor most likely need to correct? A) "I'll inflate the cuff around 30 mm Hg above the point at which I can't palpate the client's pulse." B) "If my client's arm is too big for the cuff, I'm going to get a BP reading that's artificially low." C) "The accuracy of the whole process depends on my ability to clearly hear the Korotkoff sounds with the bell of my stethoscope." D) "With practice, my measurement of clients' blood pressures with this method will be more accurate than with automated machines."

Ans: B Feedback: Undercuffing yields a blood pressure reading that is overestimated. The cuff should indeed be inflated to 30 mm Hg above palpated systolic pressure and is both dependent on clear auscultation of the Korotkoff sounds. The properly performed manual method is more accurate than automated measurement.

When advising a morbidly obese patient about the benefits of weight reduction, which of the following statements would be most accurate to share? A) "All you need to do is stop drinking sodas and sugary drinks." B) "A 10 lb loss of weight can produce a decrease in blood pressure." C) "An increased 'waist-to-hip' ratio can lead to too much pressure on the liver and intestines." D) "If your leptin (hormone) level is too low, you are at increased risk for developing high BP.

Ans: B Feedback: Weight reduction of as little as 4.5 kg (10 lb) can produce a decrease in BP in a large proportion of overweight people with hypertension. There are no data to suggest this patient has a history of high intake of sodas. An increased waist-to-hip ratio is associated with hypertension. Leptin acts on the hypothalamus to increase BP by activating the SNS.

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

Ans: B Feedback:An echocardiogram would help visualize the heart, while blood cultures would confirm the presence or absence of microorganisms in circulation, and temperature would gauge the presence of infection. A chest x-ray, blood pressure measurement, and cardiac catheterization would be less likely to indicate infective endocarditis.

An 81-year-old female client of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client's condition? A) Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest. B) Blood backs up into the jugular vein because there are no valves at the point of entry into the heart. C) Peripheral dilation is associated with decreased stroke volume and ejection fraction. D) Heart valves are not capable of preventing backflow in cases of atrial congestion.

Ans: B Feedback:Because there are no valves at the entry points to the atria, congestion can result in engorgement of the jugular veins, which are proximal to the heart. Increased cardiac demand is not associated with engorgement of vessels or peripheral dilation.

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

Ans: B Feedback:Diuretics, ACE inhibitors, and beta-blockers are all commonly used in the treatment of heart failure. Antiplatelet aggregators, calcium and potassium supplements, and anticoagulants are less likely to relate directly to a diagnosis of heart failure.

During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the client, who is unfamiliar with aneurysms. Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? A) Aneurysms are commonly a result of poorly controlled diabetes mellitus. B) Hypertension is a frequent modifaible contributor to aneurysms. C) Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures. D) Aneurysms can normally be resolved with lifestyle and diet modifications.

Ans: B Feedback:Hypertension is associated with over half of aneurysms. They are not consequences of diabetes, and while some are asymptomatic in early stages, this is not necessarily the norm and does not necessarily culminate in a rupture. Aneurysms normally require surgical repair.

While reviewing the role of the parathyroid hormone in the balance of calcium and phosphate levels, the nursing faculty will emphasize that the kidney responds to parathyroid stimulation by A) increasing reabsorption of sodium in the distal tubules. B) reducing the reabsorption of phosphate. C) stimulating production of red blood cells. D) decreasing the reabsorption of calcium.

Ans: B Feedback:In the kidney, PTH stimulates tubular reabsorption of calcium while reducing the reabsorption of phosphate. The latter effect ensures that increased release of phosphate from bone during mobilization of calcium does not produce an elevation in serum phosphate levels.

A 17-year-old male has been diagnosed with osteosarcoma of the upper tibia following several months of leg pain. Which of the following statements by the client demonstrates that he has an accurate understanding of his diagnosis? A) "I guess it's good that at least my tumor's a benign type." B) "I'm really nervous about having to get surgery and chemo." C) "I'm gaining hope from the fact that it's really rare for someone to die from this." D) "It still feels surreal that I'm going to have to get my leg amputated."

Ans: B Feedback:Osteosarcomas are malignant bone tumors that are treatable by surgery and chemotherapy. Survival is in the range of 55% to 70%, so death is not uncommon. Amputation is sometimes necessary but is certainly not an inevitability.

Although the client's primary care provider has downplayed the symptoms, a geriatrician suspects that an 82-year-old female has polymyalgia rheumatica. Which characteristic symptomatology would most likely have led the specialist to suspect this health problem? A) Extended periods of walking cause pain that extends from her ankles, knees, and sciatic nerve. B) The woman complains of aching and morning stiffness in her neck, shoulder, and pelvis. C) Range of motion in the woman's wrists and ankles is greatest in the morning and decreases over the course of a day. D) The woman's metatarsal joints are inflamed and sensitive to touch.

Ans: B Feedback:Polymyalgia rheumatica is an inflammatory condition of unknown origin characterized by aching and morning stiffness in the cervical regions and shoulder and pelvic girdle areas. Lower limb pain, wrist and ankle stiffness, and pain in the joints of the foot would not be as clearly suggestive of polymyalgia rheumatica.

A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon? A) Increased preload due to vascular resistance B) High afterload because of backpressure against the left ventricle C) Impaired contractility due to aortic resistance D) Systolic impairment because of arterial stenosis

Ans: B Feedback:Increased pressure in the aorta and other arteries constitutes a greater amount of afterload work. This situation is not indicative of increased preload or impaired contractility. Systolic impairment is not a recognized characterization of inadequate cardiac performance.

A patient asks the nurse why his hip fracture (head of the femur) bone has died (osteonecrosis). The nurse responds based on which of the following pathophysiological principles? A) All fractured bones interrupt blood supply and thereby results in death of the bone no matter where it is located. B) Most of the time when the head of the femur breaks, the entire neck region is disconnected to the rest of the bone so the blood vessels are severed. C) Since the head of the femur has only limited collateral circulation, interruption in the blood flow from the fracture causes necrosis and irreversible damage. D) When the femur head breaks, it dislocates and crushes the surrounding area causing the blood vessels to be occluded.

Ans: C Feedback: Bone has a rich blood supply that varies from site to site. The flow in the medullary portion of bone originates in nutrient vessels from an interconnecting plexus that supplies the marrow, trabecular bone, and endosteal half of the cortex. Some bony sites, such as the head of the femur, have only limited collateral circulation, so that interruption of the flow, such as with a hip fracture, can cause necrosis of a substantial portion of medullary and cortical bone and irreversible damage. Not all fractures interrupt blood supply to the bone. It is not common for the entire head of the femur to break off leaving the area with no blood supply.

A 56-year-old male is obese and has poorly controlled type 2 diabetes mellitus. The home care nurse who changes the dressing on his chronic foot ulcer three times weekly has noted that the client's bone is now visible in the wound bed. The client has a fever and has not complained of an noticeable increase of pain in his foot. Which of the following statements best captures what is likely occurring? A) The client is possibly experiencing direct penetration osteomyelitis in which microorganisms have entered through his foot wound. B) Infectious microorganisms in his blood supply have proliferated in the distal portions of his skeletal system. C) Vascular insufficiency has contributed to infection in both soft tissue and now his bone. D) His immunocompromised status associated with diabetes has allowed skin flora to penetrate his foot bone via the surface wound.

Ans: C Feedback: Diabetes is strongly associated with vascular insufficiency; this process is more likely than infection from the bloodstream, and his situation is not indicative of direct penetration osteomyelitis. Decreased immune status is not directly responsible for his problem.

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.

Ans: C Feedback: It is imperative that activity level be correlated with Holter monitor results in order to draw accurate diagnostic conclusions. It is the long-term gathering of data, rather than sensitivity or accuracy that gives Holter monitoring an advantage over standard ECG measurement. The goal is to diagnose arrhythmias, not cardiomyopathies. The hallmark of Holter monitoring is its continuous, rather than intermittent, measurement.

A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which of the leader's following teaching points is most accurate? A) "It's important to minimize the amount of potassium and, especially, sodium in your diet." B) "High blood pressure is largely controllable, except for those with a significant family history or African Americans." C) "Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure." D) "Hypertension puts you at a significant risk of developing type 2 diabetes later in life."

Ans: C Feedback: Obesity, excess alcohol consumption, and a sedentary lifestyle are all linked with hypertension. Inadequate, rather than excessive, potassium intake is thought to be causative, and while race and family influence an individual's predisposition to hypertension, it does not render the condition untreatable or uncontrollable. Diabetes is thought to be a contributor to hypertension, not vice versa.

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.

Ans: C Feedback: The chest pain of myocardial infarction does not respond to rest or to nitrates. Ischemic injury to the myocardium alters the ECG patterns, often elevating the ST segment and inverting T waves. Abnormal Q waves indicate necrosis. Cardiac markers are released in response to myocardial injury; rising levels indicate damage to the heart. The other patients have angina of varying severity.

Following prosthetic joint replacement of the knee, the patient continues to complain of pain and discomfort above what would be expected. There is poor incisional healing. The clinic nurse is concerned when she sees that the incision is still draining after 3 weeks post-op. The nurse suspects a prosthetic joint infection. The nurse should anticipate the physician will prescribe A) complete bed rest with immobilization of the knee. B) high doses of nonsteroidal anti-inflammatory drugs. C) antimicrobial treatment depending on the microbe. D) wound irrigations with hydrogen peroxide twice daily.

Ans: C Feedback: Treatment includes the use of antibiotics and selective use of surgical interventions. Antimicrobial agents are usually used prophylactically in persons undergoing bone surgery. For persons with osteomyelitis, early antimicrobial treatment, before there is extensive destruction of bone, produces the best results. Bed rest is not encouraged. The patient may be given NSAIDs for pain, but usually he or she will require a more potent pain killer. Wound irrigations are usually performed in OR rather than at bedside for infected prosthetic joints.

A 16-year-old boy has been diagnosed with ankylosing spondylitis. Which of the following etiologies is responsible for his health problem? A) Infection B) Friction between bones C) Immune response D) Inappropriate bone remodeling

Ans: C Feedback:Ankylosing spondylitis is thought to have an etiology that suggests an immune response. Physical wear and tear, infection, and inappropriate remodeling are not considered primarily responsible for the disease.

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

Ans: C Feedback:In contrast to hypovolemic shock, in which the heart rate is faster than normal and the skin is cold and clammy, a person in neurogenic shock is likely to have a slower than normal heart rate and dry, warm skin. Fainting due to emotional causes is a transient form of neurogenic shock, while increased thirst is an early sign of hypovolemic shock.

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.

Ans: C Feedback:Right-sided failure is associated with peripheral edema, fatigue, and, on occasion, upper right quadrant pain. Abdominal distention can occur with right-sided failure when the liver becomes engorge. Facial edema, pulmonary edema, peripheral cyanosis, low urine output, and low blood pressure are less associated with right-sided failure. Left-sided failure is primarily associated with pulmonary signs and symptoms like dyspnea, pulmonary edema, frothy pink sputum, and respiratory congestion.

A 70-year-old male client presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable, and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which of the following medical diagnosis/possible treatment plans listed below? A) Acute arterial occlusion that will be treated with angioplasty B) Raynaud disease that will require antiplatelet medications C) Atherosclerotic occlusive disease necessitating thrombolytic therapy D) Giant cell temporal arteritis that will be treated with corticosteroids

Ans: C Feedback:The client's symptoms of calf pain with intermittent claudication and diminished pulses are the hallmarks of atherosclerotic occlusive disease. These signs and symptoms are not as closely associated with acute arterial occlusion or giant cell temporal arteritis and are not related to Raynaud disease.

At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure is at the low end of the normal range; at 6 AM, the client's MAP has fallen definitively below normal. The client is at risk for A) pulmonary hypertension. B) left ventricular hypertrophy. C) organ damage and hypovolemic shock D) orthostatic hypotension.

Ans: C Feedback:The mean arterial pressure, which represents the average blood pressure in the systemic circulation, is a good indicator of tissue perfusion. Hospitalization and bed rest predispose to dehydration and low blood volume. Blood pressure normally follows a diurnal pattern in which pressures are highest in the morning. The fact that this client's MAP is falling at a time when it should be at its daily peak is the cause for grave concern; blood volume is likely low, and vital organs, which depend on adequate perfusion, are at risk.

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

Ans: C Feedback:With RV function impaired, systemic venous congestion develops. Hepatomegaly due to liver congestion often is one of the first signs on systemic venous congestion in infants and children.

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

Ans: C Feedback: Maintenance of vascular volume is the primary goal in the treatment of hypovolemic shock and can be achieved in the short term through intravenous administration of saline or Ringer lactate. Resolution of pulmonary edema and heart arrhythmias and infusion of vasodilators are associated with treatment of cardiogenic shock, while oxygen and epinephrine would address anaphylactic shock.

While intubated for surgery, a patient has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe? A) Decreased vascular perfusion due to parasympathetic stimulation B) Decreased heart rate, contractility, and afterload C) Decreased heart rate as a result of parasympathetic innervation of the heart D) Decreased heart rate as a result of impaired acetylcholine reuptake

Ans: C Feedback: Vagal stimulation results in lowered heart rate as a result of parasympathetic stimulation. Vascular perfusion, contractility, and afterload would not be under direct effect. Acetylcholine reuptake would not be influenced.

A 68-year-old woman has had her mobility and quality of life severely affected by rheumatoid arthritis (RA). Place the following pathophysiological events involved in her health problem in the correct order that they most likely occurred. Use all the options. A) Inflammatory response B) Interaction between rheumatoid factor (RF) and IgG C) T-cell-mediated immune response D) Pannus invasion E) Destruction of articular cartilage

Ans: C, B, A, D, E Feedback: RA is thought to begin with a T-cell-mediated immune response that precipitates interaction between IgG and RF that constitutes an immune response. Pannus invasion is one consequence of this interaction, the ultimate result of which is destruction of cartilage.

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

Ans: C, D Feedback:Changes with aging contribute to the development of HF in older adults. First is reduced responsiveness to -adrenergic stimulation. Second is increased vascular stiffness that contributes to ventricular hypertrophy. Third, the heart itself becomes less compliant with age. Fourth relates to altered myocardial metabolism at the level of the mitochondria. Older adults usually develop aortic stenosis and mitral regurgitation. Kidney stones do not contribute to HF. Increase in diastolic pressure compromises LV filling leading to increases in pressures predisposing to HF. Arthritis is not associated with heart failure.

A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The patient's physician would anticipate that which of the following phenomena is most likely occurring? A) The patient's juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation B) Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system. C) Vasopressin is exerting an effect on his chemoreceptors and baroreceptors resulting in vasoconstriction. D) The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.

Ans: D Feedback: Angiotensin conversion in the lungs is a component of the renin-angiotensin-aldosterone system that ultimately increases blood pressure and sodium reabsorption. Juxtaglomerular cells release renin, and epinephrine (vasopressin) is responsible for neither initiating the renin-angiotensin-aldosterone system nor directly influencing chemoreceptors and baroreceptors.

When a 55-year-old patient's routine blood work returns, the nurse notes that his C-reactive protein (CRP) is elevated. The patient asks what that means. The nurse responds, A) "You must eat a lot of red meat since this means you have a lot of fat floating in your vessels." B) "You are consuming high levels of folate, which works with the B vitamins and riboflavin to metabolize animal protein." C) "This means you have high levels of HDL to balance the LDL found in animal proteins." D) "This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease

Ans: D Feedback: CRP is a serum marker for systemic inflammation. Elevated levels are associated with vascular disease. The normal metabolism of homocysteine requires adequate levels of folate, vitamin B6, vitamin B12, and riboflavin. CRP is not associated with red meat consumption. LDL is an independent risk factor for the development of premature coronary heart disease.

Following a progressive onset of fatigue, aching, and joint stiffness over the last 2 years, a 69-year-old male has recently been diagnosed with rheumatoid arthritis (RA). Which of the following teaching points should his primary care physician include during the office visit in which this diagnosis is communicated to the client? A) "The symptoms you've been experiencing are the result of damage inside your joints, but I'll start you medications that will reverse this damage." B) "It's important that you maximize your level of activity, since decreasing your mobility will worsen the disease C) "The best treatment plan is to try all other available treatments before resorting to using medications." D) "Steroids and anti-inflammatory drugs that I'll prescribe will likely bring some relief to your symptoms."

Ans: D Feedback: Current treatment guidelines for RA involve early and aggressive pharmacological treatment, including NSAIDs and corticosteroids. Damage cannot be reversed, and while therapeutic exercise plays a role in treatment, rest is also important.

Which of the following individuals who has recently presented to a hospital emergency department is displaying an injury that involves his or her fibrocartilage? A) A 7-year-old girl whose ear has been lacerated during a dog attack B) A 24-year-old male who has had his trachea crushed in a workplace accident C) A 15-year-old boy who has suffered a knee injury during a football game D) A 78-year-old man who has fallen and is suspected of having a "slipped disc" in his back

Ans: D Feedback: Intervertebral discs are constructed of fibrocartilage, while the ear is largely constructed of elastic cartilage. Cartilage of the respiratory system and joints is most often hyaline cartilage.

A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relates to these health problems? A) The patient is male and has a history of hypertension. B) The patient's cardiac ejection fraction was 40% during his last echocardiogram. C) The patient has a history of acute and chronic renal failure. D) The client is 89 years old and takes a diuretic medication for his congestive heart failure.

Ans: D Feedback: Old age and diuretic use are strongly associated with orthostatic hypotension, which is normally marked by falls and syncope. Gender, hypertension, stroke volume, and kidney disease are less likely to be causative factors.

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 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

Ans: D Feedback: STEMI pain is not normally relieved by rest, nor would fever be a common symptom. Shortness of breath, vague chest discomfort, fatigue, GI symptoms, and radiating substernal pain are all associated with STEMI.

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 complaining of severe pain that she describes as "even worse than when I broke my arm." What would be the nurse's best course of action? A) Administration of analgesics and teaching the client about the normal course of pain after a fracture B) Teaching the client simple range of motion exercises to promote circulation and perfusion C) Taking the client's temperature due to the possibility of infection D) Assessment of motor and sensory function with the goal of identifying compartment syndrome

Ans: D Feedback: Severe pain in the site of a fracture that is out of proportion to the original injury is a hallmark of compartment syndrome. Assessment of sensory and motor function would be an appropriate first action. Analgesia alone and exercises would be insufficient to diagnose or address compartment syndrome, and infection would be an unlikely etiology of sudden pain after cast application.

An 8-year-old child has just been diagnosed with systemic lupus erythematosus (SLE). The parents wonder what the child's prognosis is going to be. Which of the following findings would be considered a good prognostic indicator of the extent/seriousness of the disease? A) Complaints of arthralgias and arthritis in joints with movement B) Ligaments and tendons hurt during passive ROM C) Has a rash on the nose and cheeks D) Swelling in the face and eyes and rust/blood-colored urine

Ans: D Feedback: The clinical manifestations of SLE in children reflect the extent and severity of systemic involvement. The best prognostic indicator in children is the extent of renal involvement, which is more common and more severe in children than in adults with SLE. Edema and rusty or bloody urine are classic signs of glomerulonephritis. It is expected that people/children with SLE have arthralgias/arthritis in joints, sore ligaments and tendons, as well as integumentary signs and symptoms like a rash on the nose and cheeks (butterfly rash).

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 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

Ans: D Feedback:Because sick sinus syndrome frequently involves intermittent or alternating types of arrhythmias, Holter monitoring, which can record changes in rhythm that occur over a period of up to 48 hours, is likely to provide the best picture of the spectrum of cardiac changes in any particular client. Signal-averaged ECG is most useful for identifying specific arrhythmias that may not be clear on traditional surface ECG. Exercise stress testing measures changes in rhythm specifically in response to exercise. Electrophysiologic studies are used diagnostically to determine a person's potential for arrhythmia formation.

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.

Ans: D Feedback:Systolic dysfunction is associated with increased ventricular dilation and wall tension. Hypertension, low ejection fraction, high preload, and volume overload are all commonly associated with systolic dysfunction.

A 35-year-old woman who has been in recovery from alcoholism for 2 years presents at her primary care physician's office with chronic hip pain. She reports that as part of her commitment to her recovery, she began exercising regularly about a year earlier. After a month or two, her hip began to hurt when she ran on the treadmill. She stretches, has had a physical trainer check her form to ensure that it is correct, and rests adequately between each workout. six months ago the pain began waking her at night, and now it is constant. She is not aware of any injury to her hip and has no other outward symptoms. Which of the following is most likely to be the cause of her pain? A) Hematogenous osteomyelitis B) Osteomyelitis with vascular insufficiency C) Tuberculosis of the bone D) Osteonecrosis

Ans: D Feedback:The symptoms associated with osteonecrosis are varied and depend on the extent of infarction. Typically, subchondral infarcts cause chronic pain that is initially associated with activity, but that gradually becomes more progressive until it is experienced at rest. Osteonecrosis is a common complicating disorder of Legg-Calvé-Perthes disease, slipped capital epiphysis, sickle cell disease, steroid therapy, alcohol abuse, and hip trauma, fracture, or surgery. In adults, hematogenous osteomyelitis is seen most commonly in debilitated patients; in those with a history of chronic skin infections, chronic urinary tract infections, and intravenous drug use; and in those who are immunologically suppressed. Osteomyelitis with vascular insufficiency is characterized by local cellulitis with inflammation and necrosis. Local symptoms of tuberculosis of the bone include pain, immobility, and muscle atrophy; joint swelling, mild fever, and leukocytosis also may occur.

Laparoscopic knee surgery in a 22-year-old basketball player has necessitated entry into the synovial cavity. The surgeon performing the procedure would be aware of which of the following relevant characteristics of synovial tissue? A) Synovial tissue has a slow rate of healing compared to muscle tissue. B) Damage to synovial tissue is known to be excruciatingly painful. C) The synovial membrane lacks direct blood supply, precluding bleeding into the joint. D) Few pain receptors are located in the synovial membrane.

Ans: D Feedback:The synovial membrane is innervated only by autonomic fibers that control blood flow. It is relatively free of pain fibers. Synovial tissue heals relatively quickly, and it receives a blood supply.

An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which of the following components of the pathologist's report is most suggestive of a possible history of poorly controlled blood pressure? A) "Scarring of the urethra suggestive of recurrent urinary tract infections is evident." B) "Bilateral renal hypertrophy is noted." C) "Vessel wall changes suggestive of venous stasis are evident." D) "Arterial sclerosis of subcortical brain regions is noted."

Ans: D Feedback: Neurological consequences of hypertension include narrowing and sclerosis of subcortical regions. Urethral scarring and impaired venous return would be less likely to derive from hypertension, and while nephrosclerosis and glomerular damage are associated with hypertension, hypertrophy of the kidneys themselves is not noted as an indicator.