Patho 2 Midterm Practice
A client who suffers from spastic bladder has been catheterized to promote bladder emptying. Which of the following medications should the nurse plan on the physician ordering to also treat this problem?
Anticholinergic medication
Which of the following types of pharmacological therapy does the nurse anticipate administering to a patient for treatment of a spastic bladder in order to decrease bladder hyperactivity?
Anticholinergic medications
Which of the following pain descriptions would lead the nurse to suspect the client is experiencing ureteral colic?
Excruciating pain in the flank and upper outer quadrant of abdomen that radiates to bladder area.
Which urinary structure helps to stop micturition when it is occurring and maintains continence under high bladder pressure?
External sphincter
Which of the following assessments indicates to the nurse that a patient may have a spastic bladder dysfunction?
Incontinence
A client reports that she frequently suffers from UTIs after engaging in sexual intercourse. Which would be the best information for the nurse to provide?
Increase fluid intake before intercourse
The nurse is assessing a patient who has a unilateral obstruction of the urinary tract. The nurse anticipates the patient may develop:
Increase in blood pressure
A patient diagnosed with flaccid neurogenic bladder is taught to apply pressure with the hand above the symphysis pubis while in the sitting position. What is the expected outcome of this technique?
Increase in intravesical pressure
Manifestations of polycystic kidney disease include which of the following?
Increase in kidney size bilaterally
A nurse advises a client with recurring UTIs to drink large amounts of water. What normal protective action is the nurse telling the client to utilize?
Increase washout of urine
The nurse is planning care for a patient with a urinary tract obstruction. The nurse includes assessment for which of the following possible complications?
Increased blood pressure
Unilateral obstruction of the urinary tract may result in renin secretion, thereby leading to which of the following?
Increased blood pressure
The most common clinical manifestation of portal hypertension is _____ bleeding.
esophageal
Urinary incontinence can be a problem with the elderly. One method of treatment is habit training, or bladder training. When using this treatment with an elderly person, how frequently should he or she be voiding?
Every 2 to 4 hours
The swallowing reflex is an entirely voluntary activity.
False
Serous fluid is contained in which of the following?
Peritoneal cavity
Drug-related nephropathies occur all too often. They involve functional and/or structural changes to the kidney after exposure to a drug. What does the tolerance to drugs depend on?
State of hydration
The production of chyme occurs in which of the following organs?
Stomach
A nurse is caring for a patient who has been diagnosed with kidney colic and has not yet passed the stone. Which of the following interventions should the nurse be sure to include when planning the care for this patient?
Strain the urine.
Which of the following are appropriate interventions in the care of a patient diagnosed with renal calculi? Select all that apply.
Straining the client's urine • Addressing the client's pain • Keeping track of intake and output
A client who has a problem with incontinence loses a small amount of urine every time she coughs or sneezes. This type of incontinence is known as which of the following?
Stress
Which complication is associated with gastric resection surgery?
anemia
A 19-year-old presents with abdominal pain in the right lower quadrant. Physical examination reveals rebound tenderness and a low-grade fever. A possible diagnosis would be:
appendicitis
A common cause of chronic mesenteric ischemia among the elderly is:
atherosclerosis
Select the phase of swallowing that prevents food from entering the nasopharynx when a patient is eating.
Pharyngeal
The swallowing reflex is an ordered sequence of events. In which of the following phases is the epiglottis moved so that it covers the larynx?
Pharyngeal phase
A patient diagnosed with Goodpasture's syndrome would require which of the therapies to remove proteins and autoantibodies from the system?
Plasmapheresis
Which one of the following would the nurse see as being liable to cause the most serious long-term problems?
Polycystic kidney disease
Acute pancreatitis often manifests with pain to which of the following regions?
epigastric
Pancreatic insufficiency is manifested by deficient production of:
lipase
Chronic gastritis is classified according to the:
location of lesions
The symptoms and signs of large bowel obstruction are _____.
Abdominal distention and hypogastric pain
Tissue damage in pancreatitis is initially triggered by _____.
Backup of pancreatic enzymes
Which statements identify bladder function? Select all that apply.
Control of function involves the autonomic and somatic nervous systems. The sympathetic nervous system promotes bladder filling. The parasympathetic nervous system promotes emptying.
A 22-year-old underwent brain surgery to remove a tumor. Following surgery, the patient experienced a peptic ulcer. This ulcer is referred to as a/an _____ ulcer.
Cushing
Acute pancreatitis often manifests with pain to which of the followng regions?
Epigastric
An increase in the rate of red blood cell breakdown causes which form of jaundice?
Hemolytic
Which factor contributes to the development of polycystic kidney disease?
Hereditary mutations in polycystin I and II
When assessing a patient with acute pylenephritis, the nurse would expect the patient to exhibit which of the following symptoms?
High fever Flank tenderness Nausea and vomiting Chills
A nurse is caring for a patient who has a recent history of passing calcium urinary stones. Which of the following is a priority nursing consideration for this patient?
Hydration
A client has a dilated renal pelvis due to obstruction of urine outflow from the kidney. The pressure of filtrate formation is damaging the renal structures. Which condition is most likely?
Hydronephrosis
A 45-year-old man is being treated for bladder cancer. Which therapy would have the least complications?
Intravesical chemotherapy
When educating the patient about possible treatments following surgery for bladder cancer, the nurse might include which of the following chemotherapy options? Select all that apply.
Intravesical chemotherapy with doxorubicin (Adriamycin). Bacillus Calmette-Guerin (BCG) vaccine. Endocan, a tumor angiogenesis inhibitor.
Which substance necessary for vitamin B12 absorption is produced by the parietal cells in the stomach?
Intrinsic factor
The risk of hypovolemic shock is high with acute mesenteric arterial insufficiency because _____.
Ischemia alters mucosal membrane permeability, and fluid loss occurs
Which of the following can be said about acute drug-induced interstitial nephritis? Select all that apply.
It is an autoimmune disease. It may be related to a sensitivity to sulfonamide drugs. It manifests as a fever, hematuria, mild proteinuria, and possibly a rash. It may result in acute renal failure.
A 67-year-old retired textile worker has developed bladder cancer. His history shows that he smoked for 25 years and is 14 kg overweight. What conclusion can the nurse best draw about the etiology and pathophysiology of his bladder cancer?
It is caused by carcinogens that are excreted in the urine and stored in the bladder.
Which statements are true regarding a Wilms tumor? Select all that apply.
It is the most common childhood malignant tumor. It presents with an abdominal mass Treatment includes chemotherapy, radiation and surgery
Which of the following conditions is thought to contribute to the development of obesity?
Leptin resistance
Chronic gastritis is classified according to the _____.
Location of lesions
The nurse should assess which of the following when assessing for the initial presence of edema in a patient with nephrotic syndrome?
Lower extremities
A nurse is teaching a client about the difference between digestion and absorption. Which action should the nurse describe as absorption?
Moving nutrients from the external environment of the GI tract into the internal environment
Which layer is produced by the bladder epithelia that binds water and forms a protective barrier between the bladder wall and the components of urine, thus protecting the bladder from carcinogens and infective organisms?
Mucin
Select the substances secreted by the large intestine.
Mucous and bicarbonate
Which nerve plexus controls the motility along the length of the gut?
Myenteric
A 31-year-old female is diagnosed with acute pancreatitis. Which of the following will be part of the treatment plan? (select all that apply)
Narcotic analgesics Restriction of food intake Nasogastric suctioning IV fluids
A nurse is caring for a patient who is diagnosed with acute poststreptococcal glomerulonephritis. Which of the following is the most common clinical presentation of this condition?
Nephritic syndrome
An elderly woman comes to the hospital and is diagnosed with urinary obstruction and retention. Which of the following symptoms would the nurse expect this client to demonstrate? Select all that apply.
Nladder distention • Hesitancy • Frequency • Overflow incontinence
A 71-year-old client reports to the nurse that he often notices a pink tinge to his urine. Upon further questioning, he states that he experiences no pain when voiding and has not noticed any change in the frequency of his voiding. Which response by the nurse is best?
Promptly report this finding to the client's primary care provider.
Which of the following substances would not be found in glomerular filtrate?
Protein
Which of the following statements is true concerning food digestion?
Protein digestion begins in the stomach.
The nurse is reviewing the lab results of a patient with suspected nephrotic syndrome. The nurse anticipates that the results to include:
Protein in the urine
A 39-year-old is diagnosed with a duodenal ulcer. Which of the following behaviors may have contributed to the development of the ulcer?
Regular NSAID use
An older adult states that he awakens at least three times each night to void. When assessing the client, what potential causative factor should the nurse prioritize?
The client takes his prescribed beta blocker and diuretic each evening at bedtime.
A client with a systemic infection has been given strong doses of broad-spectrum antibiotics for a period of 10 days. The infection recedes and he is taken off the antibiotic therapy. Two days later he presents with a Clostridium difficile infection. How should the nurse best interpret this situation?
The client's antibiotics disrupted the microbial balance and allowed overgrowth.
Administration of intravenous fluids
The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL. The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time?
Blood glucose will elevate.
The nurse and nursing student are caring for a client undergoing a severe stressor with release of epinephrine into the bloodstream. Which of these effects on blood glucose levels does the nurse teach the student epinephrine will cause?
Which of the following substances is broken down by the emulsification process?
Triglycerides
The symptoms and signs of large bowel obstruction are:
abdominal distention and hypogastric pain
In alcoholic cirrhosis, hepatocellular damage is caused by:
acetaldehyde accumulation
A child has been brought to an urgent care clinic. The parents state that the child is "not making water." When taking a history, the nurse learns the child had a sore throat about 1 week ago but seems to have gotten over it. "We [parents] only had to give antibiotics for 3 days for the throat to be better." The nurse should suspect the child has developed:
acute postinfectious glomerulonephritis.
In alcoholic cirrhosis, hepatocellular damaged is caused by _____.
Acetaldehyde accumulation
Polydipsia Polyuria Polyphagia
Select the most common symptoms of diabetes. Select all that apply.
Where in the GI tract is food digested and absorbed?
The jejunum and the ileum
Which of the following are risk factors for developing a UTI? (Select all that apply.)
Urinary obstruction Postmenopausal status Prostate disease Neurogenic bladder
A serious complication of paraesophageal hiatal hernia is:
strangulation
The nursing instructor who is teaching about disorders of the lower urinary tract realizes a need for further instruction when one of the students makes which of the following statements?
"Alterations in bladder function can only occur when there is incontinence."
The gastrointestinal laboratory nurse is learning about small intestine secretions. Which of the following explanations is most accurate?
"An extensive array of mucus-producing glands, called Brunner glands, is concentrated where contents from the stomach and secretions from the liver and pancreas enter the duodenum."
A 24 year-old man is currently in a rehabilitation facility following a spinal cord injury at level T2. He is discussing his long term options for continence management. Which of the following statements by the client demonstrates he has a clear understanding of the issue?
"An indwelling catheter certainly would work well, but it comes with a number of risks and possible complications."
A young mother asks,"Why can my 3-year-old daughter have a bowel movement on the toilet but she wets her pants?" Which of the following is the nurse's best response?
"Bowel control occurs earlier than bladder control."
A patient with diabetes mellitus states, "I can eat as many carbohydrates as I want and it will not affect my blood sugar." Which of the following is the nurse's best response?
"Carbohydrates are broken down into monosaccharides before being absorbed."
The nursing instructor who is teaching about incontinence in the elderly recognizes a need for further instruction when one of the students makes which of the following statements?
"Frequency is not a major problem for the elderly."
A patient has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause?
"Have you had any type of infection within the last 2 weeks?"
Which of the following would help a nurse best explain an "incretin effect"?
"It is an increase in insulin release after ingestion of food."
A diabetes education nurse is teaching a group of recently diagnosed diabetics about the potential genitourinary complications of diabetes and the consequent importance of vigilant blood glucose control. Which of the following teaching points best conveys an aspect of bladder dysfunction and diabetes mellitus?
"It's important for you to empty your bladder frequently because diabetes carries risks of kidney damage that can be exacerbated by incomplete bladder emptying."
A 63 year-old woman has visited a physician because she has been intermittently passing blood-tinged urine over the last several weeks, and cytology has confirmed a diagnosis of invasive bladder cancer. Which of the following statements by the physician is most accurate?
"It's likely that you'll need surgery; possibly a procedure called a cystectomy."
A student is comparing the two patterns of contractions in the small intestine. Which of the following statements is most accurate?
"Segmentation waves function mainly to mix the chyme with the digestive enzymes from the pancreas."
The client has just been diagnosed with bladder cancer and asks the nurse what causes it. Which of the following would be the nurse's best response to the client?
"The cause is unknown."
A patient has a spastic bladder. Which of the following is of most concern to the nurse?
"The patient has an elevated temperature."
While studying the esophagus, a student is able to correctly state which of the following to a faculty member?
"The smooth muscle layers provide the peristaltic movements needed to move food along the length of the esophagus."
A patient has a postvoid residual (PVR) volume of 40 mL. Which of the following information would the nurse teach the patient?
"This is a normal value."
A patient has a postvoid residual (PVR) volume of 250 mL. Which of the following information would the nurse tell the patient?
"This value indicates you are having difficulty emptying your bladder."
A 60 year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states that, "I don't know how this could happen to me, since I'm so careful about eating a healthy diet." What is the most appropriate response to the man's statement?
"What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved."
A client experienced asymptomatic UTIs while pregnant. The client asks the nurse if this places her at any risk for complications. Which would be the best response by the nurse?
"You are at risk for developing acute pyelonephritis."
A client has been diagnosed with having calcium oxalate kidney stones following intravenous pyelography. Which of the following teaching points about the treatment of the health problem are justifiable? Select all that apply:
"You may need to cut out cocoa, chocolate and some nuts from your diet." "Extracorporeal shock-wave lithotripsy treatment may be used to fragment larger stones."
A mother asks, "why can't my 1 year old go to the bathroom by himself?" Which of the following is the nurse's best response?
"Your child is too young to begin toilet training."
A 34 year-old man has been taking up to 2400 mg of ibuprofen per day following a motor vehicle several months ago and consequent chronic pain. He has recently been diagnosed with chronic analgesic nephritis as a result of his high analgesic intake. The man is surprised at the diagnosis, stating, "I thought that taking too many drugs hurt your liver if anything, not your kidneys." What is the most appropriate response to the man's statement?
"Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs."
A frantic mother brings her young child into the emergency department. She states that during the evening bath, she noticed a large mass in her child's abdomen. After diagnostic testing, the pediatrician tells the parents that their child has Wilms tumor, Stage IV. After the doctor leaves the room, the parents ask the nurse, "What does this mean?" The nurse will respond, "Your child ('s):
"has cancer of the kidney that has spread most likely to their lungs."
A client informs the nurse that he feels as if his bladder is getting full. The nurse understands that a client first experiences the sensation of bladder fullness when the bladder contains which of the following?
100-200 ml of urine
A 39-year-old is diagnosed with a duodenal ulcer. Which of the following behaviors may have contributed to the development of the ulcer? a. Regular NSAID use b. Drinking caffeinated beverages c. Consuming limited fiber d. Antacid consumption a. Regular NSAID use
A
Obesity is defined as a body mass index (BMI) greater than _____.
30
The nurse is teaching a patient with a spinal cord injury about self-catheterization. Which of the following measurements is important to include about the amount of urine that should be allowed to collect in the bladder between catheterizations?
300-400 mL
A patient will sense fullness of the bladder when the bladder contains what amount of urine?
400mL
Which of the following individuals are displaying identified risk factors for the development of lower urinary tract obstruction? Select all that apply.
68 year-old man who has been diagnosed with benign prostatic hyperplasia (BPH). 30 year-old woman who has been diagnosed with gonorrhea. 74 year-old woman who has developed a lower bowel obstruction following several weeks of chronic constipation. 20 year-old man who has spina bifida and consequent impaired mobility.
A 2-month-old female is brought to the emergency room (ER) for persistent bile-stained vomiting after feeding. Physical examination reveals dehydration, and x-ray reveals gas bubbles in the intestines. What is the most likely cause of this condition? a. Malrotation b. Ileocecal displacement c. Pyloric stenosis d. Meconium ileus
A
A 2-month-old is diagnosed with Hirschsprung disease with the resulting development of a megacolon. What is the most likely cause of this condition? A. Absence of intrinsic ganglion cells resulting in impaired peristalsis. B. The use of cow's milk instead of formula. C. Excessive use of glycerin suppositories to promote bowel elimination. D. Additional ganglion cells throughout the length of the colon.
A
A 2-week-old infant vomits forcefully immediately after feeding for no apparent reason and is frequently constipated. These signs support which diagnosis? A. Pyloric stenosis. B. Meconium ileus. C. Esophageal atresia. D. Galactosemia.
A
A 20-year-old recently diagnosed with lactose intolerance eats an ice cream cone and develops diarrhea. This diarrhea can be classified as _____ diarrhea. A. Osmotic. B. Secretory. C. Hypotonic. D. Motility.
A
A 50-year-old male reports episodes of frequently recurring crampy abdominal pain, diarrhea, and bloody stools. A possible diagnosis would be _____. A. Ulcerative colitis. B. Hiatal hernia. C. Pyloric obstruction. D. Achalasia.
A
A 60-year-old male is diagnosed with adenocarcinoma of the esophagus. Which of the following factors most likely contributed to his disease? a. Reflux esophagitis b. Intestinal parasites c. Ingestion of salty foods d. Frequent use of antacids
A
Assuming that midline epigastric pain is caused by a stimulus acting on an abdominal organ, the pain felt is classified as: a. visceral. b. somatic. c. parietal. d. referred.
A
Clinical manifestations of bile salt deficiencies are related to poor absorption of: a. fats and fat-soluble vitamins. b. water-soluble vitamins. c. proteins. d. minerals.
A
Early identification and treatment for metabolic disorders are important because _____. A. Permanent damage to vital organs can be prevented. B. Surgery is usually necessary. C. Cure rates are higher with early detection. D. Death usually occurs within the first month.
A
Gastroscopy reveals degeneration of the gastric mucosa in the body and fundus of the stomach. This condition increases the risk for the development of _____. A. Pernicious anemia. B. Osmotic diarrhea. C. Increased acid secretion. D. Decreased gastrin secretion.
A
In alcoholic cirrhosis, hepatocellular damaged is caused by _____. A. Acetaldehyde accumulation. B. Bile toxicity. C. Acidosis. D. Fatty infiltrations.
A
Marasmus is most common in children of which age group? A. Younger than 1 year. B. 1-2 years. C. 5-6 years. D. 12-15 years.
A
Occurrence of gastroesophageal reflux is highest in which pediatric population? A. Premature infants. B. Infants with Down syndrome. C. Children with cystic fibrosis. D. Children with esophageal atresia.
A
Outbreaks of hepatitis _____ often occur in young children attending daycare centers and can be attributed to poo handwashing. A. A. B. B. C. C. D. D.
A
The family learns that a 3D ultrasound of a 9-week fetus shows incomplete fusion of the nasomedial process. What is this defect commonly called? A. Cleft lip. B. Nasal passage atresia. C. Esophageal atresia. D. Lack of definition.
A
The primary complication of enterocolitis associated with Hirschsprung disease is related to which neonatal finding? A. Fecal impaction. B. Pancreatic insufficiency. C. Hyperactive peristalsis. D. Ileal atresia.
A
The symptoms and signs of large bowel obstruction are: a. abdominal distention and hypogastric pain. b. diarrhea and excessive thirst. c. dehydration and epigastric pain. d. abdominal pain and rectal bleeding.
A
What term is used to document the condition that exists when the esophagus ends in a blind pouch? A. Esophageal atresia. B. Tracheoesophageal stenosis. C. Esophagitis. D. Pyloric stenosis.
A
Which of the following characteristics is associated with an acute occlusion of mesenteric blood flow in the small intestine? A. Often precipitated by an embolism. B. Commonly associated with disease such as pancreatitis and gallstones. C. Caused by chronic malnutrition and mucosal atrophy. D. Often a complication of hypovolemic shock.
A
Select the client who is at the greatest risk of developing bladder cancer.
A 65-year-old white male with a history of bladder stones
"Even though it's hard to do, you need to continue so you don't go blind or need a kidney transplant down the road."
A 15 year-old boy with type 1 diabetes is exasperated by his regimen of blood sugar monitoring and insulin administration, and has told his mother that he wants to scale both back. Which of the following responses by his mother is most accurate?
Exogenous insulin injections
A 23-year-old man is admitted to the hospital. He is experiencing polyphagia, polyuria, and polydipsia. He states that the condition has come on very suddenly. This client is likely to require what treatment?
Promoting glucose uptake by target cells. Inhibiting protein breakdown Facilitating triglyceride synthesis from glucose in fat cells
A 30 year-old man with a diagnosis of type 1 diabetes is aware of the multiple effects that insulin has on his metabolism. Which of the following physiological processes are actions of insulin? Select all that apply.
Hypoglycemia
A 30-year-old male who manages his type 1 diabetes with glyburide presents at the emergency room complaining of headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half-marathon. Which of the following is likely to be the cause of his complaints?
hypoglycemia
A 30-year-old man who manages his type 1 diabetes with glyburide presents at the emergency room reporting headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half marathon. Which phenomenon is likely to be the cause of his symptoms?
Infections that are less serious in healthy people are often more virulent in people with diabetes due to hyperglycemia and glucosuria.
A 45-year-old client with type 1 diabetes has just been admitted with osteomyelitis. Which reason for diabetic susceptibility to infection is the most significant?
Oral antihyperglycemic medications and weight loss measures.
A 46 year-old man who is obese has received news that he has type 2 diabetes. He is in the process of determining a plan of care with an interdisciplinary team at a hospital-based diabetes clinic. The nurse knows that the most likely treatment plan for the man will include:
The client states that he has been unable to maintain an erection in recent years. The client complains of bloating after eating a meal, and states that he is unable to eat much food at any one sitting. He states that his bowel movements are almost always loose.
A 54 year-old male who lives alone and has poorly controlled type 1 diabetes has been admitted to hospital for treatment of sepsis resulting from a chronic foot ulcer. Which of the other findings from the man's admission assessment and history would his care team be likely to attribute to his diabetes? Select all that apply.
Administration of 15 to 20 g of glucose in a concentrated carbohydrate source.
A 60 year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice?
Helping the client make meaningful changes to his diet and activity level.
A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action?
Onset before age 20 Abrupt onset of symptoms Autoimmune beta cell damage
A client admitted to the hospital with elevated blood glucose is diagnosed with type 1 diabetes mellitus. What characteristics commonly differentiate type 1 diabetes mellitus from type 2 diabetes mellitus? Select all that apply.
"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads."
A client diagnosed with type 2 diabetes has been instructed about managing his condition with diet. The nurse determines further teaching is necessary when the client states:
positive urine ketones low serum bicarbonate
A client is brought to the emergency department with a suspected diagnosis of DKA (diabetic ketoacidosis). Select the assessment/diagnostic data to confirm the diagnosis. Select all that apply.
Glycosylated hemoglobin 5.2%
A client is diagnosed with type 2 diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?
The client is achieving normal glycemic control.
A client is managing his diabetes with exercise and diet. The health care provider reviews the client's most recent lab results: fasting blood sugar level at 80 mg/dL and a hemoglobin A1C of 5%. Select the response that best identifies the client.
Recent weight loss Polyuria Blurred vision
A client presents to the emergency room with fatigue, weakness, dehydration and thirst. What additional symptoms would correlate with a diagnosis of type 1 diabetes mellitus? Select all that apply.
Glycosylated hemoglobin, hemoglobin A1C (HbA1C)
A client tells the health care provider that he has been very compliant over the last 2 months in the management of his diabetes .The best diagnostic indicator that would support the client's response would be:
The nurse on a geriatric unit is assessing four clients. Which client is most likely to exhibit pyuria and high counts of urine colony-forming units?
A client who has urinary catheter in place due to confusion
"You could regulate your diet, exercise regularly, and lose weight."
A client with a new diagnosis of type 2 diabetes mellitus states, "I am really worried that I might need to take injections. Is there something I can do to avoid that?" What is the best response by the nurse?
Short acting
A client with diabetes carries insulin with him at all times. At 11:35, he obtains a blood glucose reading of 12.1 mmol/l and self-administers a dose of insulin in anticipation of eating lunch at noon. What type of insulin did he most likely inject?
Check blood glucose
A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first?
check blood glucose at 2am
A client with diabetes mellitus reports morning hyperglycemia for several days. What action should taken?
Maintain healthy blood pressure and blood sugar levels.
A client with diabetic retinopathy develops a retinal bleed and asks the nurse, "How can I prevent this from happening again?" What response provides the most effective information?
Orange juice orally
A client with severe hypoglycemia is unconscious. Which method of providing glucose should be avoided?
Using an insulin infusion pump
A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate?
Hypoglycemia
A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the nurse suspect as a diagnosis?
"I've had a little sore on the sole of my foot for a few days, but I'm sure it will eventually heal."
A nurse educator is conducting a course for newly diagnosed diabetes clients. Which statement by participants should the nurse follow up first?
A 45-year-old obese woman with a sedentary lifestyle
A nurse is evaluating patients for the risk of developing type 2 diabetes. Which of the following patients has the highest risk?
Dry lips, excess urine output, and seizures.
A pancreatitis patient is admitted with weight loss, nausea, and vomiting. To maintain nutrition, the physician orders parental nutrition to be started. Knowing that a major side effect of parenteral nutrition is a hyperosmolar hyperglycemic state, the nurse should assess the patient for which clinical manifestations (listed below)?
"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads." "I need to carefully limit my protein consumption."
A patient diagnosed with type 2 diabetes has been instructed about managing her condition with diet. Which of the following statements by the patient indicates a need for additional education? Select all that apply.
Headaches, dizziness, change in level of consciousness.
A patient has been admitted with diabetic ketoacidosis. The Emergency Department starts an IV to improve circulatory volume. If there is a sudden change in extracellular fluid osmolality which results in a too rapid blood glucose lowering, the nurse will likely observe which of the following clinical manifestations?
Glucose uptake by muscle and adipose tissue Fat storage Protein synthesis
A patient hospitalized with type 1 diabetes has been administered a scheduled dose of regular insulin. Which of the following are processes of insulin? Select all that apply.
Hyperglucagonemia Glycosuria and dehydration Hepatic glycogenolysis Insulin deficiency
A patient is diagnosed with hyperglycemic hyperosmolar state (HHS). Which of the following factors contribute to the severe hyperglycemia that precipitates HHS? Select all that apply
Hypertriglyceridemia Body mass index (BMI) greater than 30 Coronary artery disease Elevated fasting blood glucose (FBG)
A patient is diagnosed with metabolic syndrome. Frequent concomitants of this syndrome include which of the following? Select all that apply.
The patient is achieving normal glycemic control.
A patient is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level (FBS) of 80 mg/dL and a hemoglobin A1C of 5%. Based on these findings, which of the following can the nurse assume?
Glargine (Lantus)
A patient with diabetes asks the nurse for advice in controlling between-meal blood glucose levels. Which of the following might the nurse suggest as a long-acting insulin to provide a consistent basal level?
Chronic neuropathies Vascular impairment
A patient with diabetes has been injured. The nurse will tell the patient that healing of the injury may be delayed due to which of the following diabetic complications? Select all that apply.
The nurse is evaluating patient risk for the development of overactive bladder/urge incontinence and determines that the patient at highest risk is which of the following?
A patient with diabetes mellitus
Loss of feeling or touch in the feet.
A patient with distal symmetric polyneuropathy usually begins by complaining of:
The nurse suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from which of the following disorders?
Autosomal recessive polycystic kidney disease (ARPD)
The nurse recognizes the most common cause of acute postinfectious glomerulonephritis as:
A streptococcal infection 7 to 12 days prior to onset
"The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin."
A three year-old girl has just been diagnosed with type 1A diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain to the parents the etiology (cause) of their daughter's diabetes?
In which client would the nurse recognize the symptoms of a lesion in the micturition centre of the sacral cord?
A trauma client whose bladder ultrasound reveals 1,140 mL of urine
glyburide insulin
A woman in her 28th week of pregnancy develops gestational diabetes mellitus and has persistent elevated blood glucose when using the diet plan. What medications are appropriate? Select all that apply.
Random blood glucose 85 mg/dl
A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?
Production of fatty acids and glycerol Ketone production by the liver Breakdown of triglycerides Decrease in pH Low serum insulin levels
A woman with poorly controlled type 1 diabetes has been admitted to a hospital unit for the treatment of ketoacidosis. Place the following events in the pathophysiology of ketoacidosis in the correct chronological order. Use all the options.
Which is the most beneficial medication treatment for a patient experiencing detrusor sphincter dyssynergia? a. Alpha-blocker b. Beta-blocker c. Vasodilator d. Diuretic
ANS: A Because the bladder neck consists of circular smooth muscle with adrenergic innervation, detrusor sphincter dyssynergia may be managed by alpha-adrenergic blocking (antimuscarinic) medications. Treatment for detrusor sphincter dyssynergia is not associated with beta-blockers, vasodilators, or diuretics. REF: p. 751
A 54-year-old female is diagnosed with nephritic syndrome. Which of the following is a common symptom of this disease? a. Hematuria b. Dysuria c. Oliguria d. Proteinuria
ANS: A Nephritic syndrome is hematuria and red blood cell casts in the urine. Proteinuria is usually less severe than in nephrotic syndrome. The patient with nephritic syndrome does not experience dysuria or oliguria. REF: p. 759
While planning care for a patient with renal calculi, the nurse remembers the most important factor in renal calculus formation is: a. urine pH. b. body temperature. c. gender. d. serum mineral concentrations.
ANS: A The most important factor in renal calculus formation is urine pH, not gender, although calculi form more often in men. Neither body temperature nor serum mineral concentrations are as important as urine pH. REF: p. 749
A 29-year-old female presents with cloudy urine, flank pain, and hematuria. These signs and symptoms support which diagnosis? a. Acute cystitis b. Renal calculi c. Chronic renal failure d. Postrenal renal failure
ANS: A The patient is demonstrating symptoms of acute cystitis. Although renal calculi can cause pain and hematuria, they are not manifested by fever and cloudy urine. Chronic renal failure is not manifested by cloudy urine. Postrenal renal failure is not manifested by hematuria and cloudy urine. REF: p. 754
Mechanisms for defense against urinary pathogens in men include: (select all that apply) a. the long length of the urethra. b. the alkaline pH of urine. c. the secretion of mucus that traps bacteria. d. the antimicrobial secretions from the prostate. e. the implantation of the ureters in the bladder.
ANS: A, D Both the longer urethra and prostatic secretions decrease the risk of infection in men. The urine is not more alkaline, and they do not secrete mucus that traps bacteria. The ureters in men and women are implanted in similar positions and in their normal position; it is not a factor in the development of cystitis. REF: p. 753
Acute poststreptococcal glomerulonephritis is primarily caused by: a. swelling of mesangial cells in the Bowman space in response to the presence of bacteria. b. immune complex deposition in the glomerular capillaries and inflammatory damage. c. inflammatory factors that stimulate cellular proliferation of epithelial cells. d. accumulation of antiglomerular basement membrane antibodies.
ANS: B Acute poststreptococcal glomerulonephritis is caused by an antigen-antibody complex. Acute poststreptococcal glomerulonephritis is not due to swelling of the Bowman space. It is not an inflammatory process nor is it caused by an accumulation of antiglomerular basement membrane antibodies. REF: p. 758, Table 30-6
A 35-year-old who was severely burned is now demonstrating symptomology associated with acute tubular necrosis (ATN). Which form of renal failure is this patient experiencing? a. Prerenal b. Intrarenal c. Extrarenal d. Postrenal
ANS: B Intrarenal acute kidney failure is associated with several systemic diseases but is commonly related to ATN. Prerenal renal failure occurs anterior to the kidney. Extrarenal renal failure occurs outside the kidney. Postrenal is due to diseases that obstruct the flow of urine from the kidneys. REF: p. 761
When a patient's CT scan reveals a lesion above the pontine micturition center, which condition would the nurse expect? a. Dyssynergia b. Detrusor hyperreflexia c. Detrusor areflexia d. Detrusor sphincter dyssynergia
ANS: B Neurologic disorders that develop above the pontine micturition center result in detrusor hyperreflexia, also known as an uninhibited or reflex bladder. Lesions that develop in upper motor neurons of the brain and spinal cord result in dyssynergia. Lesions that involve the sacral micturition center (below S1; may also be termed cauda equina syndrome) or peripheral nerve lesions result in detrusor areflexia (acontractile detrusor), a lower motor neuron disorder. Neurologic lesions that occur below the pontine micturition center but above the sacral micturition center (between C2 and S1) are also upper motor neuron lesions and result in detrusor hyperreflexia with vescico-sphincter dyssynergia. REF: p. 750
When considering pyelonephritis, where is the site of the infection? a. Bladder b. Renal pelvis c. Renal tubules d. Glomerulus
ANS: B Pyelonephritis is an infection of one or both upper urinary tracts (ureter, renal pelvis, and interstitium). Pyelonephritis is not associated with the bladder, renal tubules, or glomerulus. REF: p. 754
A 75-year-old reports loss of urine with cough, sneezing, or laughing. These symptoms support which diagnosis? a. Urge incontinence b. Stress incontinence c. Overflow incontinence d. Functional incontinence
ANS: B Reduced resistance is associated with the symptom of stress incontinence, which is incontinence with coughing or sneezing. Urge incontinence is the inability to hold the urine when the urge is felt. There is coordination between the contracting bladder and the external sphincter, but the detrusor is too weak to empty the bladder, resulting in urinary retention with overflow or stress incontinence. Functional incontinence is similar to overflow and is not associated with coughing. REF: p. 750, Table 30-1
A 45-year-old presents with hypertension, anorexia, nausea and vomiting, and anemia and is diagnosed with chronic renal failure. What is the cause of this patient's anemia? a. Red blood cells being lost in the urine b. Inadequate production of erythropoietin c. Inadequate iron absorption in the gut d. Red blood cells being injured as they pass through the glomerulus
ANS: B The kidneys are inadequate in their production of erythropoietin; red cells may be lost in the urine, but it is the lack of erythropoietin that leads to anemia. The anemia is not associated with inadequate iron absorption or red cell destruction. REF: p. 764, Table 30-13
A patient has a severe kidney obstruction leading to removal of the affected kidney. Which of the following would the nurse expect to occur? a. Atrophy of the remaining kidney b. Compensatory hypertrophy of the remaining kidney c. Dysplasia in the remaining kidney d. Renal failure
ANS: B The remaining kidney would hypertrophy to compensate for the increased workload of the loss of the affected kidney. Compensation for such a situation would not include atrophy or a change in cell structure of the remaining kidney. Renal failure would be avoided. REF: p. 748
A 55-year-old presents reporting urinary retention. Tests reveal a lower urinary tract obstruction. Which of the following is of most concern to the nurse? a. Vesicoureteral reflux and pyelonephritis b. Formation of renal calculi c. Glomerulonephritis d. Increased bladder compliance
ANS: B Urine stasis occurs with urinary tract obstruction and can lead to the formation of renal calculi. Reflux and pyelonephritis would not lead to calculi as much as stasis would. Neither glomerulonephritis nor increased bladder compliance causes the stasis that would lead to calculus formation. REF: p. 748
A patient is diagnosed with urinary tract obstruction. While planning care, the nurse realizes that the patient is expected to have hydronephrosis and a decreased glomerular filtration rate caused by: a. decreased renal blood flow. b. decreased peritubular capillary pressure. c. dilation of the renal pelvis and calyces proximal to a blockage. d. stimulation of antidiuretic hormone.
ANS: C Hydronephrosis occurs due to dilation of the renal pelvis and calyces proximal to a blockage. Hydronephrosis is not the result of a decrease in renal blood flow, or peritubular capillary pressure, or stimulation of the antidiuretic hormone. REF: p. 747
The form of polycystic kidney disease (PKD) that first manifests in the early infant period is most commonly characterized as which of the following?
Autosomal recessive
Bone fractures are a risk factor in chronic renal failure because: a. calcium is lost in the urine. b. osteoblast activity is excessive. c. the kidneys fail to activate vitamin D. d. autoantibodies to calcium molecules develop.
ANS: C Hypocalcemia is accelerated by impaired renal synthesis of 1,25 - dihydroxy-vitamin D3. The combined effect of vitamin D deficiency can result in renal osteodystrophies with increased risk for fractures. Calcium is not lost in the urine. Osteoblast activity is not accelerated. Antibodies do not develop. REF: pp. 765-766
When a 42-year-old is diagnosed with chronic renal failure, which dietary restriction will the nurse discuss with the patient? a. Fats b. Complex carbohydrates c. Proteins d. Sugars
ANS: C Low-protein diets are recommended. Management of chronic renal failure is not associated with diets that limit fats, carbohydrates, or sugars. REF: p. 767
What is the most common type of renal stone composed of? a. Struvite b. Cystine c. Calcium d. Uric acid
ANS: C The most common stone types are calcium oxalate or phosphate (70-80%). Struvite (magnesium-ammonium-phosphate) occurs 15% of the time. Cystine stoes are rare (less than 1%). Uric acid stones occur 7% of the time. REF: p. 748
A 30-year-old male is demonstrating hematuria with red blood cell casts and proteinuria exceeding 3-5 grams per day, with albumin being the major protein. The most probable diagnosis the nurse will see documented on the chart is: a. cystitis. b. chronic pyelonephritis. c. acute glomerulonephritis. d. renal calculi.
ANS: C Two major symptoms distinctive of more severe glomerulonephritis are: (i) hematuria with red blood cell casts and (ii) proteinuria exceeding 3-5 grams per day with albumin (macroalbuminuria) as the major protein. Cystitis is not associated with proteinuria and so is not relevant to the diagnosis of glomerulonephritis. Chronic pyelonephritis is manifested by dysuria, not proteinuria. Proteinuria is not seen with renal calculi. REF: p. 755 | p. 757
The most common condition associated with the development of acute pyelonephritis is: a. cystitis. b. renal cancer. c. urinary tract obstruction. d. nephrotic syndrome.
ANS: C Urinary obstruction and reflux of urine from the bladder are the most common underlying risk factors. Risk factors do not include cystitis, renal cancer, or nephrotic syndrome. REF: p. 754
A 42-year-old male is involved in a motor vehicle accident that has resulted in prerenal failure. What is the most likely cause of this patient's condition? a. Kidney stones b. Immune complex deposition in the glomerulus c. Inadequate renal blood flow d. Obstruction of the proximal tubule
ANS: C With blood loss, renal failure is due to inadequate blood flow since the trigger occurs outside of the kidney (prerenal). Kidney stones will lead to postrenal renal failure. Intrarenal renal failure is due to glomerular nephritis or obstruction of the proximal tubule. REF: p. 760
A patient is diagnosed with renal calculus that is causing a urinary obstruction. Which symptoms would be most likely experienced? a. Anuria b. Hematuria c. Pyuria d. Flank pain
ANS: D Significant flank pain is the most common manifestation. Neither anuria nor pyuria is a common manifestation. Hematuria does occur, but it is not the most common manifestation. REF: p. 749
A 25-year-old female is diagnosed with a urinary tract infection. When the nurse checks the culture results, which of the following organisms is most likely infecting her urinary tract? a. Streptococcus b. Candida albicans c. Chlamydia d. Escherichia coli
ANS: D The most common infecting microorganisms are uropathic strains of Escherichia coli. Urinary tract infections are not associated with Streptococcus, Candida albicans, or Chlamydia. REF: p. 754
An older male presents with flank pain and polyuria. Tests reveal that he has an enlarged prostate. Which type of renal failure is this patient at risk for? a. Prerenal b. Intrarenal c. Extrarenal d. Postrenal
ANS: D The patient will experience postrenal renal failure due to obstruction by the prostate. REF: p. 762
A client has been diagnosed with systemic lupus erythematosus. The client now presents with sudden hematuria, variable proteinuria, and a decreased glomerular filtration rate. Which of the following is a probable diagnosis?
Acute nephritic syndrome
A patient is being evaluated for kidney stones. The nurse anticipates the patient will manifest:
Acute onset of colicky or dull and achy intermittent flank pain
A 34-year-old woman presents with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in her lower back. She is also experiencing dysuria, urinary frequency, and a feeling of urgency. Her partner states that she has been very tired the last few days and that she looked like she may have the flu. What diagnosis is the most likely?
Acute pyelonephritis
A patient who developed acute pyelonephritis asks the nurse what caused the infection. Which should be included in thenurse's response? Select all that apply.
Acute pyelonephritis is caused by bacterial infection. • Escherichia coli is the causative agent in about 80% of cases. • Outflow obstruction, catheterization, and urinary instrumentation.
A warehouse worker is experiencing trouble with incontinence, especially when lifting heavy objects. What intervention is most appropriate for this client's needs?
Administration of a-adrenergic agonistic drugs as ordered
A patient is concerned that medication may damage his kidneys. Which factor(s) place the patient at most risk for developing a drug-related nephropathy? Select all that apply.
Age/elderly Prescription methicillin and other synthetic antibiotics Diuretics Procedures involving radiocontrast media Nonsteroidal anti-inflammatory drugs (NSAIDs)
A nurse is caring for a patient with diabetic glomerulosclerosis. The analysis is reviewed for the presence of which of the following manifestations?
Albumin
The autopsy of a 55-year-old revealed an enlarged liver, testicular atrophy, and mild jaundice secondary to cirrhosis. What is the most likely cause of this condition?
Alcoholic steatohepatitis
A four year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the healthcare team's initial differential diagnosis most likely be?
Alport syndrome
Which of the following accurately describes the etiology of stress incontinence?
An increase in intra-abdominal pressure which results in involuntary urination
Which additional physical finding would you anticipate seeing in a child suspected of having a Wilms tumor?
Anomalies of the genitourinary system
Which methods are most commonly used to treat detrusor-sphincter dyssynergia?
Anticholinergic medications and urinary catheterization
A 19-year-old presents with abdominal pain in the right lower quadrant. Physical examination reveals rebound tenderness and a low-grade fever. A possible diagnosis would be _____.
Appendicitis
A patient with diabetes mellitus type 1 has bladder atony with dysfunction. Which of the following assessments indicates a primary concern for this patient?
Ascending urinary tract infection
A patient has experienced a stroke affecting the reticular formation of the medulla and lower pons. The nurse tells the patient's wife that care must be taken with eating to prevent which of the following?
Aspiration pneumonia
A patient has bladder distension. Which of the following is the nurse's best action?
Assisting the patient to urinate
A common cause of chronic mesenteric ischemia among the elderly is _____.
Atherosclerosis
Most primary glomerular disease is caused by which of the following?
Autoimmunity
A 1-week-old female is brought to her pediatrician for abdominal distention and unstable temperature. Physical examination reveals bradycardia and apnea. Tests reveal portal venous gas and an intestinal perforation. This condition is referred to as _____. A. Infective enteropathy. B. Necrotizing enterocolitis. C. Mucoviscidosis. D. Ileus.
B
A 22-year-old underwent brain surgery to remove a tumor. Following surgery, the patient experienced a peptic ulcer. This ulcer is referred to as a(n) _____ ulcer. a. infectious b. Cushing c. H. pylori d. Curling
B
A 54-year-old reports vomiting blood. Tests reveal portal hypertension. Which of the following is the most likely cause of this condition? a. Thrombosis in the spleen b. Cirrhosis of the liver c. Left ventricular failure d. Renal stenosis
B
A newborn is diagnosed with biliary atresia. What is the long-term treatment for this disorder? A. Immunoglobulins. B. Liver transplant. C. Bone marrow transplant. D. Dietary modifications.
B
A serious complication of paraesophageal hiatal hernia is _____. A. Hemorrhage. B. Strangulation. C. Peritonitis. D. Ascites.
B
An 8-week-old is diagnosed with a congenital heart disease and Down syndrome. The infant is at risk for the development of which gastrointestinal disorder? A. Intussesception. B. Imperforate anus. C. Meckel diverticulum. D. Cystic fibrosis.
B
An increase in the rate of red blood cell breakdown causes which form of jaundice? a. Obstructive b. Hemolytic c. Hepatocellular d. Metabolic
B
Celiac disease, or sprue, is caused by alterations of the intestinal _____. A. Glands. B. Villi. C. Smooth muscle wall. D. Sphincters.
B
Cholecystitis is inflammation of the gallbladder wall usually causd by _____. A. Accumulation of bile in the hepatic duct. B. Obstruction of the cystic duct by a gallstone. C. Accumulation of fat in the wall of the gallbladder. D. Viral infection of the gallbladder.
B
Chronic gastritis is classified according to the _____. A. Severity. B. Location of lesions. C. Patient's age. D. Signs and symptoms.
B
Prolonged diarrhea is more serious in children than adults because: a. children have lower adipose reserves. b. fluid reserves are lower in children. c. children have a lower metabolic rate. d. children are more resistant to antimicrobial therapy.
B
The icteric phase of hepatitis is characterized by which clinical manifestations? a. Fatigue, malaise, vomiting b. Jaundice, dark urine, enlarged liver c. Resolution of jaundice, liver function returns to normal d. Fulminant liver failure, hepatorenal syndrome
B
The nurse assessing the patient with biliary atresia would expect to find which primary clinical manifestation? A. Anemia. B. Jaundice. C. Hypobilirubinemia. D. Ascites.
B
The nurse assessing the patient with biliary atresia would expect to find which primary clinical manifestation? a. Anemia b. Jaundice c. Hypobilirubinemia d. Ascites
B
The risk of hypovolemic shock is high with acute mesenteric arterial insufficiency because _____. A. The resulting liver failure causes a deficit of plasma proteins and a loss of oncotic pressure. B. Ischemia alters mucosal membrane permeability, and fluid loss occurs. C. Massive bleeding occurs in the GI tact. D. Overstimulation of the parasympathetic nervous system results in ischemic injury to the intestinal wall.
B
What is the cause of peptic ulcer disease? A. Hereditary hormonal imbalances with high gastrin levels. B. Breaks in the mucosa and presence of corrosive secretions. C. Decreased vagal activity and vascular engorgement. D. Gastric erosions related to high ammonia levels and bile reflux.
B
What is the primary clinical manifestation of a stress ulcer? a. Bowel obstruction b. Bleeding c. Pulmonary embolism d. Hepatomegaly
B
When a newborn has a lack of bilirubin uptake, what does the nurse suspect is occurring in the patient? A. Biliary hypertrophy. B. Physiologic jaundice. C. Hepatitis A. D. Infantile cirrhosis.
B
Which condition should the nurse assess for in mothers carrying fetuses affected by esophageal malformations? A. Enlarged placentas. B. Excessive amniotic fluid. C. Short umbilical cords. D. Foul-smelling vaginal discharge.
B
Which of the following conditions is thought to contribute to the development of obesity? A. Insulin excess. B. Leptin resistance. C. Adipocyte failure. D. Malabsorption.
B
Which of the following types of diarrhea would most likely occur with a bacterial infection? A. Osmotic. B. Secretory. C. Hypotonic. D. Motility.
B
A 19-year-old presents with abdominal pain in the right lower quadrant. Physical examination reveals rebound tenderness and a low-grade fever. A possible diagnosis would be _____. A. Colon cancer. B. Pancreatitis. C. Appendicities. D. Hepatitis.
C
A 3-month-old female presents with intention tremors, dystonia, greenish-yellow rings in the cornea, and hepatomegaly. Tests reveal a defect on chromosome 13. Which of the following is the most likely diagnosis? a. Galactosemia b. Fructosemia c. Wilson disease d. Cirrhosis
C
b, c, d
Specific genetic links have been shown for: (Select all that apply) a. cervical cancer b. testicular cancer c. breast cancer d. prostatic cancer
Acute pyelonephritis is a result of which of the following?
Bacterial infection
A client has just been diagnosed with urinary incontinence. His primary nurse knows that the treatment/management of incontinence can include which of the following? Select all that apply.
Behavioral measures Surgical correction Pharmacologic measures Non-catheter devices to obstruct urine flow Indwelling catheter
Which clinical manifestations would you expect to see in an infant diagnosed with autosomal recessive polycystic kidney disease (ARPKD)?
Bilateral flank masses and impaired lung development
The nursing instructor informs the students during a lecture on the lower urinary tract that which of the following controls the elimination of urine from the body?
Bladder
The nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is which of the following?
Bladder
A middle-aged man with diabetes reports that he must strain to urinate and that his urine stream is weak and dribbling. He also reports feeling that his bladder never really empties. The nurse knows that all of his complaints is likely caused by which of the following medical diagnosis?
Bladder atony with dysfunction
A nurse is assessing a patient with suspected urine retention. Which of the following assessments help to confirm this diagnosis? Select all that apply.
Bladder distension Hesitancy Straining when initiating urination Frequency
A nurse is caring for a patient with systemic lupus erythematosis (SLE). The patient asks why a urinalysis is necessary. The best answer is that a urinalysis would determine whether which of the following factors was present in the urine?
Blood or protein
An adult client presents to the emergency department with manifestations of acute cystitis. For which would the nurse assess the client? Select all that apply.
Burning on urination Back discomfort Cloudy urine
A 50-year-old is diagnosed with gastroesophageal reflux. This condition is caused by _____. A. Fibrosis of the lower third of the esophagus. B. Sympathetic nerve stimulation. C. Loss of muscle tone at the lower esophageal sphincter. D. Reverse peristalsis of the stomach.
C
A 6-month-old male infant is brought to the ER after the sudden development of abdominal pain, irritability, and vomiting followed by passing of "currant jelly" stool. Ultrasound reveals intestinal obstruction in which the ileum collapsed through the ileocecal valve. Which term is used to describe this type of obstruction? A. Prolapse. B. Pyloric stenosis. C. Intussusception. D. Imperforation.
C
A sign that a newborn infant may have pyloric stenosis is: a. diarrhea. b. bile regurgitation. c. olive-sized mass in the upper abdomen. d. ascites with a fluid wave visible across the abdomen.
C
Acute pancreatitis often manifests with pain to which of the followng regions? A. Right lower quadrant. B. Right upper quadrant. C. Epigastric. D. Suprapubic.
C
Bright red bleeding from the rectum is referred to as _____. A. Melena. B. Occult bleeding. C. Hematochezia. D. Hematemesis.
C
Kwashiorkor is a severe dietary deficiency of: a. fat-soluble vitamins. b. carbohydrates. c. protein. d. calcium and magnesium.
C
Manifestations associated with hepatic encephalopathy from chronic liver disease are the result of: a. hyperbilirubinemia and jaundice. b. fluid and electrolyte imbalances. c. impaired ammonia metabolism. d. decreased cerebral blood flow.
C
Meconium ileus is associated with which of the following disorders? A. Pyloric stenosis. B. Esophageal atresia. C. Cystic fibrosis. D. Esophagitis.
C
Pancreatic insufficiency is manifested by deficient production of: a. insulin. b. amylase. c. lipase. d. bile.
C
Tests reveal narrowing of the opening between the stomach and the duodenum. This condition is referred to as _____. A. Ileocecal obstruction. B. Hiatal hernia. C. Pyloric obstruction. D. Hiatal obstruction.
C
The autopsy of a 55-year-old revealed an enlarged liver, testicular atrophy, and mild jaundice secondary to cirrhosis. What is the most likely cause of this condition? a. Bacterial infection b. Viral infection c. Alcoholic steatohepatitis d. Drug overdose
C
The most common clinical manifestation of portal hypertension is _____ bleeding. A. Rectal. B. Duodenal. C. Esophageal. D. Intestinal.
C
The most common disorder associated with upper GI bleeding is _____. A. Diverticulosis. B. Hemorrhoids. C. Esophageal varices. D. Cancer.
C
Tissue damage in pancreatitis is initially triggered by _____. A. Insulin toxicity. B. Autoimmune destruction of the pancreas. C. Backup of pancreatic enzymes. D. Hydrochloric acid reflux into the pancreatic duct.
C
What is the most common symptom of Meckel diverticulum observed in children? A. Constipation. B. Vomiting. C. Rectal bleeding. D. Ascites.
C
Where does the nurse expect the obstruction to be in a patient with extrahepatic portal hypertension? A. Sinusoids. B. Bile ducts. C. Hepatic portal vein. D. Hepatic artery.
C
Which complication is associated with gastric resection surgery? A. Constipation. B. Acid reflux gastritis. C. Anemia. D. Hiccups.
C
When maltose is not broken down into two glucose molecules in the gastrointestinal tract, which of the following may occur?
Diarrhea
A patient who has had an intestinal bypass has developed a kidney stone. Which of the following types of kidney stone does the nurse recognize that this patient will most likely be treated for?
Calcium
Which of the following statements is true concerning the digestion of carbohydrates?
Carbohydrates are broken down into monosaccharides before being absorbed.
A school nurse is teaching a group of fourth-grade girls about personal hygiene. Important teaching points aimed at reducing the incidence of urinary tract infection (UTI) include which of the following? Select all that apply.
Careful hand washing • Wiping from front to back after a bowel movement • Avoiding bubble baths
Hospitalized patients are at the greatest risk of developing septicemia related to which procedure?
Catheter-associated bacteriuria
What is the most common gram-negative bladder infection found in hospitalized clients?
Catheter-induced infection
A nurse correctly identifies which of the following to be approved treatments for a client who is admitted with a diagnosis of neurogenic bladder? Select all that apply.
Catheterization Bladder training Meds to manipulate bladder function Surgery
A student is studying gallbladder function. Which of the following gastrointestinal hormones stimulates contraction of the gallbladder?
Cholecystokinin
An analysis of most gallstones would reveal a high concentration of _____.
Cholesterol
A 54-year-old reports vomiting blood. Tests reveal portal hypertension. Which of the following is the most likely cause of this condition?
Cirrhosis of the liver
The nurse is caring for a patient with a sacral cord injury that resulted in loss of the perception of bladder fullness and loss of voluntary urination. When planning care for the patient, the nurse should include nursing interventions for which of the following?
Flaccid bladder dysfunction
A 55-year-old is diagnosed with extrahepatic obstructive jaundice that is a result of the obstruction of the _____.
Common bile duct
Incontinence can be transient. What are the causes of transient urinary incontinence? (Select all that apply.)
Confusional states Stool impaction Recurrent urinary tract infections
The nurse is conducting pre-operative teaching for a patient with bladder cancer who is scheduled to undergo surgical creation of an alternative bladder reservoir. The nurse determines that the patient is understanding the pre-operative teaching when the patient identifies the surgical treatment as which of the following?
Cystectomy
A 45-year-old male complains of heartburn after eating and difficulty swallowing. These symptoms support which diagnosis? a. Pyloric stenosis b. Gastric cancer c. Achalasia d. Hiatal hernia
D
A 55-year-old is diagnosed with extrahepatic obstructive jaundice that is a result of the obstruction of the: a. intrahepatic bile canaliculi. b. gallbladder. c. cystic duct. d. common bile duct.
D
A 7-month-old female presents with jaundice, clay-colored stool, and an enlarged liver. Testing reveals the absence of intrahepatic bile ducts. This condition is referred to as _____ atresia. A. Hepatic. B. Portal. C. Sinusoidal. D. Biliary.
D
A common cause of chronic mesenteric ischemia among the elderly is _____. A. Anemia. B. Aneurysm. C. Lack of nutrition in gut lumen. D. Atherosclerosis.
D
An 8-week-old male was recently diagnosed with cystic fibrosis (CF). Which of the following digestive alterations would be expected? a. Insufficient bile production b. Gastric atrophy c. Hypersecretion of stomach acid d. Nutrient malabsorption
D
An analysis of most gallstones would reveal a high concentration of _____. A. Phosphate. B. Bilirubin. C. Urate. D. Cholesterol.
D
A nursing instructor who is teaching students about urinary incontinence in older adults suggests that an easy and best way to remember the transient and treatable causes of urinary incontinence is to use which of the following acronyms?
DIAPPERS
Which physiologic change in the elderly population contributes to urinary incontinence?
Decline in detrusor muscle function
While studying about the process of urination, the nursing student learns that which of the following is known as the "muscle of micturition"?
Detrusor muscle
When explaining about the passage of urine to a group of nursing students, the clinic nurse asks them which muscle is primarily responsible for micturition? Their correct reply is the:
Detrusor.
Blood glucose level greater than 250 mg/dL; bicarbonate less than 15 mEq/L and pH less than 7.3
Diabetic ketoacidosis is a condition that mostly occurs in type 1 diabetics. What are the definitive diagnostic criteria for DKA?
foot problems
Diabetics are hospitalized for a number of reasons. What is the most common complication of diabetes requiring hospitalization?
The patient tells the nurse that she is very anxious and that her pulse is racing. Which of the following will the nurse expect to see in the gastrointestinal (GI) tract?
Dry mouth
The common bile duct opens into which of the following parts of the gastrointestinal tract?
Duodenum
Hyperglycemia
During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur?
Which laboratory findings should you expect to see in a patient diagnosed with nephritic syndrome?
Elevated urine protein and hypoalbuminemia
An older male comes to the clinic with the chief complaint of having difficulty voiding. The physician diagnoses him with a lower urinary tract obstruction and stasis. Which of the following should the nurse suspect to be the most frequent cause of this client's problem?
Enlargement of prostate gland
An newborn has been diagnosed with renal agenesis. The nurse caring for the mother mentions some of the classic signs/symptoms of this disease. Which characteristic should the nurse mention to the parents as it relates to this disease? Select all that apply.
Epicanthic folds (skin of the upper eyelid) are present Low-set ears Receding chin
Which of the following is the most common cause of lower uncomplicated urinary tract infections?
Escherichia coli
What is a common cause of spastic bladder dysfunction?
External sphincter spasticity
Which of the following is a nonsurgical method of treatment for renal calculi (kidney stones)?
Extracorporeal shock wave lithotripsy (ESWL)
A nurse on an acute medical unit of a hospital has admitted a 62 year-old female from the emergency department who has been diagnosed with acute pyelonephritis. Which of the following statements most accurately conveys an aspect of the knowledge base that the nurse needs to perform adequate care and teaching?
Flank pain, dysuria and nausea and vomiting are likely assessment findings.
"Your baby could become too large or have low blood sugars if we're not vigilant about controlling your sugars."
Following an oral glucose tolerance, a 36 year-old mother of 4 has been diagnosed with gestational diabetes mellitus (GDM), a problem that was not present in any of her previous pregnancies. What should her primary care provider tell her about this new health problem?
A patient is experiencing reflux of stomach contents into the esophagus. The nurse determines that the problem may result from:
Gastroesophageal sphincter
A student is comparing the actions of the gastrointestinal hormones. Which of the following hormones acts as an appetite-stimulating signal?
Ghrelin
A patient has passed a kidney stone composed of uric acid (urate). Which of the following pathological conditions is a contributing factor for the development of this type of kidney stone?
Gout
A client informs the nurse that she is afraid of developing bladder cancer because her mother had it. She asks the nurse what signs and symptoms are present with this cancer. What does the nurse tell the client is the most common sign of bladder cancer?
Gross hematuria
Acute postinfectious glomerulonephritis, as its name implies, follows an acute infection somewhere else in the body. What is the most common cause of acute postinfectious glomerulonephritis?
Group A Β-hemolytic streptococci
A science teacher is talking to a group of fifth graders about the role of "spit". During the course of the discussion, the teacher asks the students which of the following are functions of saliva? Select all that apply.
Has antibacterial action to help keep the mouth clean.
A nurse is administering medications to a patient with a kidney stone. Which medication does the nurse administer that will lower urinary calcium by increasing tubular reabsorption to decrease the amount of calcium in the urine?
Hydrochlorothiazide (HCTZ)
A 68 year-old woman with a new onset of vascular dementia has recently begun retaining urine. Which of the following physiological phenomena would her care providers most realistically expect to be currently occurring as a result of her urinary retention?
Hypertrophy of the bladder muscle and increased bladder wall thickness.
Signs of nephrotic syndrome include proteinuria, edema, hyperlipidemia, and which of the following?
Hypoalbuminemia
A nine year-old boy has been diagnosed with the nephritic syndrome. Place the following stages in the development of his health problem in ascending order. Use all the options.
Hypoalbuminemia Increased glomerular membrane permeability. Decreased colloidal osmotic pressure Proteins escape from plasma to glomerular filtrate. Accumulation of fluid in interstitial tissue (edema).
A female client asks the nurse if there is any noninvasive treatment to help with the involuntary loss of urine that occurs when she coughs or sneezes. Which is the best response by the nurse?
Kegel exercises
Which stresses can cause injury to the kidney glomerulus? Select all that apply.
Immunologic Nonimmunologic Heredity Diabetes
The nurse is teaching a client about the different treatments used with bladder cancer. Which type of therapy does she inform the client can be done by instilling directly into the bladder?
Immunotherapuetic agents
Manifestations associated with hepatic encephalopathy from chronic liver disease are the result of _____.
Impaired ammonia metabolism
NPO before surgery
In which situation would an increase of glucagon be expected?
The patient who has been admitted with a problem with his bladder has a postvoid residual (PVR) of 250 ml. The nurse understands that this indicates which of the following?
Inadequate bladder emptying
A patient is to receive a radiocontrast media as part of a diagnostic scan. Which of the following is intended to reduce the nephrotoxic effects of the radiocontrast media?
Increasing the normal saline intravenous infusion rate to 125 mL/hour
Magnesium renal stones are associated with which of the following conditions?
Infection
Which one of the following is the usual cause of acute pyelonephritis?
Infection
A nurse is giving discharge instructions for a patient who was diagnosed with acute pyelonephritis 3 days previously. Which of the following is important for the nurse to discuss when instructing the patient?
It is important that the patient take the prescribed antibiotic for the duration of the prescription.
The icteric phase of hepatitis is characterized by which clinical manifestations?
Jaundice, dark urine, enlarged liver
The dietitian explains to the patient that food is digested and absorbed in which of the following?
Jejunum
Colonic microorganisms play a role in the synthesis of which of the following vitamins?
K
A patient tells the nurse that he experiences diarrhea after eating ice cream or cheese. The nurse tells the patient he may have a deficiency of which of the following?
Lactase
Wilms tumor is a tumor of childhood. It is usually an encapsulated mass occurring in any part of the kidney. What are the common presenting signs of a Wilms tumor?
Large asymptomatic abdominal mass and hypertension
Elevated fibrinogen levels and hyperinsulinemia
Macrovascular disease includes coronary artery disease, cerebrovascular disease, and peripheral vascular disease. People with both type 1 and type 2 diabetes are at high risk for developing macrovascular disease. What are the risk factors for macrovascular disease in diabetics?
A nurse is explaining the clinical manifestations of diabetic nephropathy (diabetic glomerulosclerosis) to a patient. Which would be the most important information for the nurse to provide?
Microalbuminemia is a predictor of future nephropathies.
Cholecystitis is inflammation of the gallbladder wall usually causd by _____.
Obstruction of the cystic duct by a gallstone
A 20-year-old recently diagnosed with lactose intolerance eats an ice cream cone and develops diarrhea. This diarrhea can be classified as _____ diarrhea.
Osmotic
A 55 year-old man has made an appointment to see his family physician because he has been awakening three to four times nightly to void, and often has a sudden need to void with little warning during the day. What is the man's most likely diagnosis and possible underlying pathophysiological problem?
Overactive bladder that may result from both neurogenic and myogenic sources.
A 56-year-old is diagnosed with gastric ulcers. Which of the following characterizes this disorder? (select all that apply
Pain occurs immediately after eating Anorexia History of NSAID use.
When teaching a community education class about the 7 warning signs of cancer, the nurse will note that the most common sign of bladder cancer is:
Painless bloody urine
A client asks the nurse what the most common sign/symptom of bladder cancer is. Which is the best response by the nurse?
Painless hematuria
A patient who has suffered a spinal cord injury at C4 is experiencing a sudden change in condition. Their BP is 186/101; heart rate 45; profusely sweating and complaining of "not feeling right." The nurse should:
Palpate their bladder for overdistention.
A patient is concerned about the possibility of having bladder cancer after his brother was diagnosed with it 2 years ago. Which of the following assessment data obtained by the nurse would indicate that the patient should be screened for this disease?
Patient reports that he occasionally has blood in his urine but has no pain with it.
The nurse is evaluating her patient's risk for an urinary tract infection. Which of the following patients has the highest risk?
Patient with obstructed urinary outflow from the kidney
A nurse is caring for a patient in spinal shock. Which of the following interventions is appropriate in relation to the patient's urinary status?
Perform intermittent catheterization
An 87 year-old male resident of an assisted living facility has been consistently continent of urine until the last several weeks. Which of the following actions by the care providers at the facility is the most likely priority?
Performing a physical examination and history to determine the exact cause and character of the incontinence.
Clawing of toes and denervation of the small muscles of the foot
Peripheral neuropathies occur in people with diabetes mellitus. With the loss of sensation in the lower extremities, diabetics become predisposed to what?
Gastroscopy reveals degeneration of the gastric mucosa in the body and fundus of the stomach. This condition increases the risk for the development of _____.
Pernicious anemia
A client has a tubulointerstitial disorder and is no able to concentrate urine. The nurse will likely assess which manifestations associated with this disorder? Select all that apply.
Polyuria Nocturia
Congenital disorders of the kidneys are fairly common, occurring in approximately 1:1000 live births. What is the result to the newborn when bilateral renal dysplasia occurs? (Select all that apply.)
Potter facies Oligohydramnios Pulmonary hypoplasia Renal failure
Acute pyelonephritis is an infection of the renal parenchyma and renal pelvis. What is a common cause of acute pyelonephritis?
Pseudomonas species
Tests reveal narrowing of the opening between the stomach and the duodenum. This condition is referred to as _____.
Pyloric obstruction
An anatomy student is studying the stomach. The student explains that the funnel-shaped portion that connects with the intestine is which of the following?
Pyloric region
Regurgitation of bile salts and duodenal contents can lead to gastric ulcers. Which of the following structures prevents this from happening?
Pyloric sphincter
The nurse reviews the lab results for a patient who has advanced autosomal dominant polycystic kidney disease (ADPKD). The patient 's hemoglobin is 8.8 g/dL. The nurse suspects this lab value is related to which of the following causes?
Reduced production of erythropoietin
A client who is admitted to the hospital receives a diagnosis of lower urinary tract obstruction. What does the nurse pick to be the immediate treatment for this problem?
Relief of bladder distention
Which of the following is the most common cancer of the kidney?
Renal cell carcinoma
Somogyi effect
Research has identified a cycle of insulin-induced posthypoglycemic episodes. What is this phenomenon called?
Which of the following are accessory organs that also aid in digestion? Select all that apply.
Salivary glands Liver Pancreas
Which of the following types of diarrhea would most likely occur with a bacterial infection?
Secretory
Inspect the feet for blisters daily
Select the most appropriate intervention for the nurse to teach a client diagnosed with distal symmetric neuropathy related to diabetes.
The nurse working in the nursery is caring for a 4-day-old infant with autosomal recessive polycystic kidney disease (ARPKD). Which physical assessment findings would the nurse associate with this disease process? Select all that apply.
Severe hypertension 120/90 • Hypoventilation due to impaired lung development • Palpable masses located in the flank area bilaterally
A 22 year-old female with a history of intermittent flank pain, repeated UTIs and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of this diagnosis?
She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately.
In adults, which part of the intestine is most often involved in volvulus?
Sigmoid colon
A patient is admitted to the hospital for further evaluation of problems experienced with gastrointestinal digestion and absorption. The nurse anticipates the health care provider will further assess the:
Small intestine
Villi are anatomic features that contribute to the enlarged surface area of which of the following?
Small intestine
The nurse is assessing a patient with diabetic nephropathy whose blood pressure is 124/80. The patient smokes two packs of cigarettes a day and consumes a diet high in saturated fats and sodium. The nurse's plan of care should focus on which of the following to decrease the patient's risk for progression of the diabetic nephropathy?
Smoking cessation program
One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which of the following electrolytes?
Sodium
A 40-year-old mother of three reports incontinence. Her physician suggests Kegel exercises, because they strengthen the pelvic floor muscles. Kegel exercises are most likely to help which type of incontinence?
Stress incontinence
A patient is describing difficulty with urinating and informs the nurse that every time she coughs or laughs, she urinates and has begun to wear a thin pad. Which of the following types of urinary incontinence is the patient describing?
Stress incontinence
Because they strengthen the pelvic floor muscles, Kegel exercises are most likely to help:
Stress incontinence
Which layer of the digestive tract contains the blood vessels, nerves, and other structures responsible for secreting digestive enzymes?
Submucosal
The nurse working on a GU floor caring for clients who have bladder cancer identifies which of the following to be acceptable treatments for this cancer? Select all that apply.
Surgical removal• Radiation therapy• Chemotherapy
A 61 year-old woman who has had an upper respiratory infection for several weeks has presented to her family physician with complaints of a recent onset of urinary retention. She reveals to her physician that she has been taking non-prescription cold medications over and above the suggested dose for the past two weeks. Which of the following phenomena will her physician most likely suspect is contributing to her urinary retention?
The anticholinergic effects of the medication are impairing normal bladder function.
Thirst Weight loss Blurred vision
The diabetes nurse educator is teaching a community education class for new diabetics. Which of these does the nurse include in the discussion of signs and symptoms of hyperglycemia? Select all that apply.
Insulin is not available for use by the body.
The diagnosis of type 1 diabetes would be confirmed by:
Glucose is unused without insulin, so body fats are used for energy.
The family of a client in the hospital with diabetes mellitus out of control asks the nurse to explain the client's recent weight loss while eating more than usual. How will the nurse respond?
"Take the medication 15 to 30 minutes before each meal."
The health care provider has prescribed Repaglinide 2 mg for a client diagnosed with type 2 diabetes. The most important information for the nurse to give the client would be:
A client suffering from chronic hypertension is beginning to show the symptoms of glomerular disease. This client's kidney damage is due to what phenomenon?
The higher pressures force protein and cells through the glomerular membrane, resulting in glomerular inflammation.
"Insulin is destroyed by the stomach contents and has to be administered by injection."
The mother of a 2-year-old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. The best response by the nurse is:
During male ejaculation, which of the following statements addresses why sperm is not normally seen inside the bladder?
The musculature of the trigone area, bladder neck, and prostatic urethra contract at the same time.
Glucocorticoids Oral contraceptives Loop diuretics
The nurse and nursing student are performing medication reconciliation. Which of these medications taken by the client does the nurse teach the student are implicated in causing hyperglycemia? Select all that apply.
9
The nurse educates a patient newly diagnosed with diabetes regarding diet and energy requirements. The nurse knows that one gram of fat will provide _____ kcal of energy.
Lispro
The nurse has just completed teaching a client newly diagnosed with type 1 diabetes about rapid-acting insulin. The nurse determines that teaching was effective when the client selects:
Somatic neuropathy
The nurse is caring for a client diagnosed with diabetes mellitus who is reporting burning pain of his feet. The nurse would interpret this as:
Give the client a concentrated carbohydrate.
The nurse is caring for a client who received regular insulin at 7 am. Four hours later the nurse finds the client diaphoretic, cool, and clammy. Which of these interventions is the priority?
Vomiting after eating
The nurse is caring for a client with diabetes who has developed gastroparesis. Which of these symptoms does the nurse expect the client to report?
A 45-year-old obese female with a sedentary lifestyle
The nurse is reviewing assessment data on four clients. Select the client at highest risk for developing type 2 diabetes.
Loop diuretics Oral contraceptives Total parenteral nutrition Antipsychotics
The nurse is teaching a client with diabetes about medications that will increase the blood glucose level. The most important information for the nurse to provide would be: Select all that apply.
The brain relies on blood glucose as its main energy source.
The nurse is teaching a client with diabetes and the family about the signs and symptoms of hypoglycemia. The client asks what produces signs and symptoms of headache, disturbed behavior, coma, and seizures. The best response would be:
Random blood glucose 195 mg/dl
The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary healthcare provider for further evaluation?
Woman with a family history of diabetes
The obstetrical nurse is caring for a client who has been treated for gestational diabetes. When teaching the client about the causes of gestational diabetes, the nurse should include which of these risk factors in the teaching?
Which of the following patients should have a feeling of bladder fullness?
The patient with 200 mL of urine in their bladder
A nurse observes that a patient's urine is cola colored and considers which of the following as a possible reason?
The patient's urine contains material from the degradation of red blood cells.
Urinary obstruction in the lower urinary tract triggers changes to the urinary system to compensate for the obstruction. What is an early change the system makes in its effort to cope with an obstruction?
The stretch receptors in the bladder wall become hypersensitive.
A young woman presents with signs and symptoms of urinary tract infection (UTI). The nurse notes that this is the fifth UTI in as many months. What would this information lead the nurse to believe?
There is possible obstruction in the urinary tract.
Which of the following statements is true concerning gastric enterocytes?
They secrete enzymes that aid in digestion of proteins.
The nurse is conducting a health education program on bladder cancer. The nurse teaches that which of the following is the most common type of bladder cancer?
Transitional carcinoma
The nursing student learns in her anatomy and physiology class that the bladder has how many main components?
Two
Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen
Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur?
Deranged secretion of insulin Insulin resistance Increased glucose production by the liver
Type 2 diabetes is caused by metabolic abnormalities in the presence of insulin. What are these metabolic abnormalities? (Select all that apply.)
When determining the treatment and management for incontinence, the physician considers which of the following? Select all that apply.
Type of incontinence Accompanying health problems Person's age
The family members of a client who has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD) asks the nurse what they should do to find out if they have this disease. The nurse will respond that they should visit with their healthcare provider and ask about having which lab/diagnostic test to screen for the disease?
Ultrasound of the kidney
The nursing student, while studying anatomy and physiology, correctly identifies which of the following to be responsible for carrying urine to the bladder?
Ureters
A client tells the nurse that he is experiencing involuntary loss of urine associated with a strong desire to void (urgency). The nurse would recognize this as:
Urge incontinence
The nurse understands that medications although very beneficial to clients can also have harmful effects. When working with elderly clients the nurse should recognize which of the following is a common result of potent, fast-acting diuretics?
Urge incontinence
A patient is being treated with colchicine (Colcrys) for pain in the big right toe. The patient begins to complain of severe right flank pain and is diagnosed with kidney stones. Which of the following types of kidney stones does the nurse recognize this patient is most likely affected by?
Uric acid
A patient is admitted with lower urinary tract obstruction and stasis. Which of the following is the primary intervention?
Urinary catheterization
Which clients have an increased risk for developing UTIs? A client who is or is diagnosed with: Select all that apply.
Urinary obstruction • Neurogenic disorders • Elderly • Prostate disease
Because the associated nephropathy is an important cause of end-stage renal failure in children and adolescents, a toddler who has had an uncomplicated bout of urinary tract infection (UTI) should still be evaluated for:
Vesicoureteral reflux
A teenager has been admitted with the diagnosis of Alport Syndrome. The client has been passing large amounts of blood in the urine. Knowing that this disorder is inherited and associated with other abnormalities, the nurse should focus assessment on which area?
Visual disturbances and hearing loss
c
What is a major predisposing factor to cervical cancer? a. high estrogen levels b. familial incidence c. infection with HPV d. early age for onset of menstrual cycles
b
What is a significant early sign of endometrial carcinoma? a. a positive Pap test b. minor vaginal bleeding or spotting c. infection resistant to treatment d. painful intercourse
c
What is a useful serum maker during treatment for prostatic cancer? a. human chorionic gonadotropin b. alpha-fetoprotein c. prostate-specific antigen d. luteinizing hormone
Brain
When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which of these organs does the nurse recognize is reliant on glucose as the major energy source?
Has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours.
When educating a patient about glargine (Lantus), the nurse should explain that this medication:
Which of the following clinical manifestations would tell a nurse that a patient is having progressive decompensation related to obstruction of urinary outflow?
When tested for residual urine volume, 1400 mL of urine is obtained when patient is catheterized.
Select the option that best describes the sensory process involved in the inhibition of micturition.
When the bladder is distended to 150 to 250 mL in the adult, the sensation of fullness is transmitted to the spinal cord and then to the cerebral cortex, allowing for conscious inhibition of the micturition reflex.
An instructor is assisting a nursing student with inserting an indwelling catheter for a patient with urinary retention and acute overdistention of the bladder. The student inserts the catheter and gets an immediate return of clear yellow urine. When should the student clamp the catheter?
When the patient returns 1000 mL of urine from the bladder at once
d
Which is considered to be the stage of carcinoma in situ in cervical cancer? a. the invasive stage b. the stage of mild dysplasia c. the time before it can be detected by a Pap test d. noninvasive severe dysplasia
Hemoglobin A1c 9.1% 2 hour oral GTT 245 mg/dl
Which laboratory values for a newly admitted client indicate a diagnosis of diabetes mellitus? Select all that apply.
2 hour oral GTT 175 mg/dl
Which manifestation indicates a client is at risk for developing diabetes mellitus?
c
Which of the following applies to benign prostatic hypertrophy? a. the tumor usually becomes malignant in time b. the gland becomes small, nodular, and firm c. manifestations include hesitancy, dribbling, and frequency d. lower abdominal or pelvic pain develops
b
Which of the following applies to carcinoma of the breast? a. It resents as a tender, painful, firm nodule. b. Tumor cells may demonstrate estrogen receptors on the membrane. c. Occasionally, a genetic factor may have a small role in tumor development. d. The tumor is invasive but does not metastasize until very late.
Complete failure of insulin secretion
Which of the following criteria about insulin would prompt a diagnosis of type 1 diabetes?
a
Which of the following is the common first site for metastasis from prostatic cancer? a. bone b. lungs c. liver d. testes
c
Which of the following may result from cryptorchidism? a. infertility b. testicular cancer c. both a and b d. neither a and b
a
Which of the following refers to fibrocystic breast disease? a. progressive development of fluid-filled cysts and fibrous tissue b. proliferation of atypical cells with high risk of malignancy c. benign tumors that develop after menopause d. any tissue changes other than the normal response to hormonal changes
Glucose that exceeds metabolic needs is converted and stored by the liver.
Which of the following statements best describes an aspect of the normal process of glucose metabolism?
d
Why does frequency occur with benign prostatic hypertrophy? a. increased volume of dilute urine b. irritation of the bladder and urethra c. impaired micturition reflex d. incomplete emptying of the bladder
A cytotechnologist is performing genetic testing on a series of tissues. One tissue comes back with the WT1 mutation, and it's mapped to chromosome 11. What disease will the client most likely develop?
Wilms tumour
a
With pelvic inflammatory disease, why does infection spread easily into the peritoneal cavity? a. The fallopian tubes are obstructed, and purulent exudate cannot drain into the uterus. b. The uterus is perforated because of infection, allowing bacteria to leak out. c. Most of the primary infections do not respond to antimicrobial drugs. d. Microbes are highly virulent.
The nurse is providing care for a 16-year-old male client, newly diagnosed with a spinal cord injury. He asks why he can no longer control his bladder. What would the nurse explain to him? (Select all that apply.)
Your spinal cord injury has disrupted the control your brain has over your bladder. • You will have to learn how to in-and-out catheterize yourself. • You have a condition known as detrusor-sphincter dyssynergia.
Tests reveal narrowing of the opening between the stomach and the duodenum. This condition is referred to as:
pyloric obstruction
The most common cause of mechanical bowel obstruction is
adhesions
A 52-year-old female presents with continuous abdominal pain that intensifies after eating. She is diagnosed with chronic pancreatitis. Contributing factors include: (select all that apply)
alcohol abuse. history of gallstones. smoking
Tissue damage in pancreatitis is initially triggered by:
backup of pancreatic enzymes
A middle-aged man with diabetes reports that he must strain to urinate and that his urine stream is weak and dribbling. He also reports feeling that his bladder never really empties. His problem is most likely:
bladder atony and dysfunction arising from peripheral neuropathy.
What is the primary clinical manifestation of a stress ulcer?
bleeding
Which of the following type(s) of hepatitis has an incubation period of up to 180 days? (select all that apply)
both hepatitis B and D have incubation periods of up to 180 days
A 54-year-old male is diagnosed with peptic ulcer disease. This condition is most likely caused by:
breaks in the mucosa and presence of corrosive secretions
What is the cause of peptic ulcer disease?
breaks in the mucosa and presence of corrosive secretions
your patient has been diagnosed with liver failure. Which of the following might you notice upon assessment?
bruised areas noted over both arms
An analysis of most gallstones would reveal a high concentration of:
cholesterol
A 55-year-old is diagnosed with extrahepatic obstructive jaundice that is a result of the obstruction of the:
common bile duct
The family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. The nurse responds:
corticosteroids.
A 22-year-old underwent brain surgery to remove a tumor. Following surgery, the patient experienced a peptic ulcer. This ulcer is referred to as a(n) _____ ulcer.
cushing
A 65-year-old Caucasian female who smokes presents with increased urinary frequency, dysuria, and sporadic, painless hematuria. The client's follow-up will likely include.
cystoscopy.
What is the first change in arterial blood gases with diarrhea?
decreased bicarbonate
The most common disorder associated with upper GI bleeding is
esophageal varices
The most common disorder associated with upper GI bleeding is:
esophageal varices
Clinical manifestations of bile salt deficiencies are related to poor absorption of:
fats and fat-soluble vitamins
A client with a neurogenic bladder has a lesion at the level of sacral reflexes/peripheral nerves that innervate the bladder. The nurse anticipates the client will experience:
flaccid bladder dysfunciton
Bright red bleeding from the rectum is referred to as:
hematochezia
A 45-year-old male complains of heartburn after eating and difficulty swallowing. These symptoms support which diagnosis?
hiatal hernia
Manifestations associated with hepatic encephalopathy from chronic liver disease are the result of:
impaired ammonia metabolism
The risk of hypovolemic shock is high with acute mesenteric arterial insufficiency because:
ischemia alters mucosal membrane permeability, and fluid loss occurs.
What is the definition of achalasia?
lack of a nerve plexus to relax the lower esophageal sphincter
which of the following conditions is thought to contribute to the development of obesity?
leptin resistance
A 50-year-old is diagnosed with gastroesophageal reflux. This condition is caused by:
loss of muscle tone at the lower esophageal sphincter
A 50-year-old male is experiencing reflux of chyme from the stomach. He is diagnosed with gastroesophageal reflux. This condition is caused by:
loss of muscle tone at the lower esophageal sphincter
The primary causes of duodenal ulcers include: (select all that apply)
non steroidal anti-inflammatory drugs (NSAIDs) H. pylori infection
Cholecystitis is inflammation of the gallbladder wall usually caused by
obstruction of the cystic duct by a gallstone
Painful swallowing is known as
odynophagia
Which of the following characteristics is associated with an acute occlusion of mesenteric blood flow to the small intestine?
often precipitated by an embolism
Gastroscopy reveals degeneration of the gastric mucosa in the body and fundus of the stomach. This condition increases the risk for the development of:
pernicious anemia
A child has been admitted to the pediatric unit with a tentative diagnosis of lipoid nephrosis. While taking the history, which items lead the nurse to suspect the diagnosis is accurate? The child has a history of: Select all that apply.
recent upper respiratory infection. recent routine vaccines.
A 60-year-old male is diagnosed with adenocarcinoma of the esophagus. Which of the following factors most likely contributed to his disease?
reflux esophagitis
A 34-year-old male was diagnosed with a bacterial GI infection. Which of the following types of diarrhea would most likely occur with his condition?
secretory
Which of the following types of diarrhea would most likely occur with a bacterial GI infection?
secretory
A patient presents to the physician with reports infrequent bowel movements and is diagnosed with functional constipation. What can be a contributing factor to this condition? (select all that apply)
sedentary lifestyle low residue diet low fluid intake
During a lecture about the function of the intestine related to food digestion, the faculty mentions that when the students consume foods high in acid, the intestines will:
stimulate the release of secretin which then inhibits release of gastrin.
When conducting an admission interview with a client with a history of urinary incontinence, the nurse will specifically ask whether the client is prescribed which classification of medications in order to determine a possible cause? Select all that apply.
• Diuretics • Hypnotics • Sedatives
A 50-year-old male reports episodes of frequently recurring crampy abdominal pain, diarrhea, and bloody stools. A possible diagnosis would be:
ulcerative colitis
During a physical assessment of a newborn in the nursery, the nurse palpates a mass over the kidney area. Testing reveals the infant has multicystic dysplastic kidney disorder. While educating the family, the nurse will share that many times the cysts will regress without intervention. However, the parents need to know the child will need annual: Select all that apply.
ultrasound, assessing cysts for possible cancer formation. blood pressure measurement, assuring proper functioning of unaffected kidney
Assuming that midline epigastric pain is caused by a stimulus acting on an abdominal organ, the pain felt is classified as:
visceral
What is a common sign of acute gastritis?
vomiting with epigastric tenderness
A client who is suspected of having acute renal failure would first be assessed by which of the following blood tests? Select all that apply.
• Blood urea nitrogen • Creatinine
A nurse is caring for a patient diagnosed with nephrotic syndrome. The nurse is aware that the patient may manifest which of the following? Select all that apply.
• Massive proteinuria (>3.5 g/day) • Lipiduria • Generalized edema • Hyperlipidemia
A nurse is caring for a child with Wilms tumor, stage I. Which of the following can be said regarding this diagnosis? Select all that apply.
• Prognosis is good with treatment. • The tumor is limited to the kidney and can be excised with the capsular surface intact.
The nursing students have learned in class that causes of urinary obstruction and urinary incontinence include which of the following? Select all that apply.
• Structural changes in the bladder • Structural changes in the urethra • Impairment of neurologic control of bladder function
A client has been admitted with suspected kidney cancer. The client has had blood in the urine and some flank pain, but associated these sympstoms with a kidney stone, because of a previous experience This episode didn't go away, so the client sought treatment. The client asks the nurse what testing procedures would be ordered to confirm the diagnosis? The nurse responds: Select all that apply.
• ultrasound of the kidney looking for masses. • computerized tomography (CT) scan looking for lesions and metastasis. • magnetic resonance imaging (MRI) to identify if the inferior vena cava is involved
