Patho Exam 3

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 Thin mucus to prevent bacterial adherence Increase immune availability Decrease acidity of urine

The normal flow of urine functions to wash bacteria from the urinary tract. If a client is not drinking enough, urine can become stagnant and promote infection. Increased consumption of water will increase the washout. Water has no effect on acidity, consistency of mucus, or immune function.

A postmenopausal client questions the nurse about the diagnosis of osteoporosis. Which statement describes the pathology of osteoporosis?

The process of bone renewal after menopause is slowed in relation to the occurrence of bone breakdown. With aging, the process of bone formation (renewal) is slowed in relation to bone resorption (breakdown). Estrogen levels decrease with menopause and contribute to bone loss.

A nurse mentoring a new graduate nurse informs the graduate that urinary obstructions are usually classified according to which parameters? Select all that apply. Acute or chronic Simple or complex Upper or lower Congenital or acquired Partial or complete

Urinary tract obstructions are classified according to cause (congenital or acquired), degree (partial or complete), duration (acute or chronic), and level (upper or lower).

Unilateral obstruction of the urinary tract may result in renin secretion, thereby leading to which manifestation? Increased blood pressure Decreased heart rate Increased urinary output Decreased sodium retention

a In cases of unilateral obstruction of the kidney, renin secretion is enhanced, probably secondary to impaired renal blood flow. This would result in increased sodium retention, and increased blood pressure. Urine output would be decreased, and heart rate would not necessarily be affected.

A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing: Transient ischemic attack (TIA) Cardiogenic embolic stroke Thrombotic stroke Lacunar infarct

a Transient ischemic attacks are brief episodes of neurologic function resulting in focal cerebral ischemia not associated with infarction that usually resolve in 24 hours. The causes of transient ischemic attack are the same as they are for stroke. Embolic stroke usually has a sudden onset with immediate maximum deficit. Lacunar infarcts produce classic recognizable "lacunar syndromes" such as pure motor hemiplegia, pure sensory hemiplegia, and dysarthria with clumsy hand syndrome.

A nurse is caring for a client with diabetic glomerulosclerosis. The presence of which substance in the urine would be used in diagnosing this condition? hemoglobin potassium albumin sodium

albumin Microalbuminuria is an important predictor of future diabetic nephropathies and is evidence of glomerular damage. Normally, albumin as a large protein molecule, should not be passed through the glomerular filtration process. Microalbuminuria is defined as urinary albumin excretion of 30 to 300 mg in 24 hours. Presence of electrolytes or hemoglobin is not evidence of diabetic glomerulosclerosis.

Which statement accurately describes the etiology of stress incontinence? The involuntary release of urine related to a strong sense of urgency An increase in intra-abdominal pressure that results in involuntary urination Overactivity of the voiding reflexes related to the nervous system damage The decrease in smooth muscle of the bladder causing increased urination

b

The nurse assessing a client with a traumatic brain injury assesses for changes in which neurologic component? Select all that apply. Metabolic function Motor function Cognition Level of consciousness Sensory function

b c d e Brain injuries can cause changes in level of consciousness and alterations in cognition, motor, and sensory function; therefore, the nurse assessing a client with a traumatic brain injury should assess for changes in these areas.

What will the nurse teach a mother whose child has been diagnosed with impetigo?

"Treat the area with topical mupirocin and discourage scratching of the area." staphylcoccus aureas

A client who has developed rheumatoid arthritis can experience joint inflammation that involves of immunologic mediation triggered by which physiologic response? A T-cell-mediated response to an immunologic trigger, such as a microbial agent A macrophage-mediated response that attacks self A decreased production of inflammatory mediators and cytokines An exposure to a virus that triggers a B-cell response

A Rheumatoid arthritis is initiated in a genetically predisposed individual by the activation of a T-cell-mediated response to an immunologic trigger, such as a microbial agent. Activation of CD4+ helper T cells occurs with the local release of inflammatory mediators and cytokines (e.g., tumor necrosis factor [TNF], interleukin [IL]-1) that destroy the joint and formation of antibodies directed against joint-specific and systemic autoantigens.

A child has been diagnosed with myopathic neuromuscular scoliosis. What other concurrent diagnosis may the child have?

Cerebral palsy a. Neuromuscular scoliosis develops from neuropathic or myopathic disease. It is seen with cerebral palsy, myelodysplasia, and poliomyelitis.

A young adult client is currently in a rehabilitation facility following a spinal cord injury at level T2. The nurse and client are discussing long-term options for continence management. Which statement demonstrates the client has a clear understanding of the issue? "An indwelling urethral catheter is the option that best minimizes my chance of a urinary tract infection." "It is critical that intermittent catheterization be performed using sterile technique." "Self-catheterization can limit the recovery of my neural pathways that control my voiding if I do it too often." "An indwelling catheter certainly would work well, but it comes with a number of risks and possible complications."

D

The client asks, "What is reduction?" How will the nurse respond? "It is what happens when the fracture is immobilized." "It means the fracture will be casted." "It means the fracture is healed." "It refers to realigning the bone."

D (Reduction is the term for when bones are realigned to restore their original structure.)

Most common uncomplicated urinary tract infections are caused by ____ that enter through the urethra. Staphylococcus aureus Group B Streptococcus Escherichia coli Pseudomonas

E. coli Most commonly, urinary tract infections (UTIs) are caused by Escherichia coli bacteria that enter through the urethra. Other uropathic pathogens include Staphylococcus saprophyticus in uncomplicated UTIs, and both non-E. coli Gram-negative rods (Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas) and Gram-positive cocci (Staphylococcus aureus, Group B Streptococcus) in complicated UTIs.

The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication? Diluted urine Increased blood pressure Polyuria Decreased blood pressure

Increased blood pressure Urinary tract obstruction can lead to hypertension related to increased renin secretion. The urine output would be decreased and not diluted.

The nurse is assessing a female client's risk for osteoporosis. Which factor places this client at greatest risk?

Menopause a. Numerous studies have shown that bone mass loss occurs with aging regardless of sex, race, or body size. However, after menopause there is a rapid decline in bone mass due to estrogen deficiency. Therefore, menopause places this client at greater risk than gender, race, and body size.

The nurse is assessing a client's skin and notices a few papules. What is the best description to include in the assessment about papules? Small abscesses Small, raised superficial lesions Closed, rounded spaces containing fluid Flat-topped, solid lesions

Papules are small, raised superficial lesions. Plaque is a flat-topped solid lesion. Cyst is a closed, rounded space containing fluid.

A client diagnosed with Goodpasture syndrome would require which therapy to remove proteins and autoantibodies from the system? Intravenous calcium Plasmapheresis Renal transplant Kidney removal

Plasmapheresis Plasmapheresis is used to filter the blood for removal of proteins and the circulating anti-GBM antibodies. Renal transplantation would return the kidneys to normal function, but this is the extreme of treatment. The other options would not produce the necessary treatment outcomes

Which client is likely at the greatest risk of developing a urinary tract infection? A 79-year-old client with an indwelling catheter A client with a diagnosis of chronic kidney disease who requires regular hemodialysis A pregnant woman who has been experiencing urinary frequency A confused, 81-year-old client who is incontinent of urine

a Indwelling catheters are strongly associated with the development of UTIs, and this risk factor supersedes pregnancy and kidney disease. Frequency and incontinence may be signs and symptoms of UTIs, but they are not causative of the infections.

A client has a transverse fracture of the left humerus. Which assessment indicates a developing complication? New onset of shortness of breath Hematocrit 35% (0.35) Warm fingers White blood cells 9500 cells/mm³ (9.5 ×109/L)

a The laboratory values are within normal limits, but new onset of shortness of breath could indicate development of venous thromboembolic disorders, which include pulmonary embolism and deep vein thrombosis. The fracture of long bones such as the humerus, tibia, or femur could force the fat from within the bone marrow (yellow marrow) into the bloodstream where it could become an embolus.

Which of the following clients is at greatest risk for developing a urinary tract infection (UTI)? Older adult female client admitted with an indwelling Foley catheter that has been in place for 1 month Woman who has just given birth and had a straight urinary catheter inserted prior to delivery Middle-aged male client admitted for dehydration due to strenuous exercise in hot weather Male client 2 days postoperative hip fracture repair whose Foley catheter was removed on postoperative day 1

a Urinary catheters are a source of urethral irritation and provide a means for entry of microorganisms into the urinary tract. Catheter-associated bacteriuria remains the most frequent cause of Gram-negative septicemia in hospitalized clients. A catheter in place for 1 month places the client at greatest risk for a UTI.

The nurse is assessing four clients who are reporting joint or bone pain. Which client will the nurse identify as being at highest risk for suffering a fracture secondary to osteoporosis?

68-year-old woman who reports shoulder pain after being roughly bumped on the bus Despite not having the history of a significant impact, women with osteoporosis may still sustain a fracture

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. The client states that the majority of his fluid intake during the day is tea or coffee. The client takes over-the-counter glucosamine supplements for the treatment of arthritis. The client's father was diagnosed with bladder cancer when he was in his 60s.

A

Nursing students are studying metabolic disorders of the skeletal system and correctly identify which factor to be the major cause of osteoporosis?

Although osteoporosis can occur as the result of a number of disorders and risk factors, it is most often associated with the aging process.

Which clients should the nurse assess to determine if they have premature osteoporosis?

Anyone with an eating disorder. a. Having an eating disorder places clients at increased risk due to malabsorption of medications.

Which substance would not be found in glomerular filtrate? Sodium Potassium Water Protein

Protein The glomerular filtrate has a chemical composition similar to plasma (which contains sodium, potassium and water), but it contains no proteins because large molecules do not readily cross the glomerular wall.

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 Stress incontinence Overflow incontinence Transient incontinence

Urge incontinence is the involuntary loss of urine associated with a strong desire to void (urgency). Stress incontinence represents the involuntary loss of urine that occurs when, in the absence of detrusor muscle action, the intravesical pressure exceeds the maximum urethral closure pressure. Overflow incontinence is an involuntary loss of urine that occurs when intravesical pressure exceeds the maximal urethral pressure because of bladder distention in the absence of detrusor activity. Incontinence may occur as a transient and correctable phenomenon, or it may not be totally correctable and may occur with various degrees of frequency.

An obese client with a history of gout and a sedentary lifestyle has been advised by the primary health care provider to avoid organ meats, certain fish, and other foods that are high in purines. This treatment would be advised for which type of kidney stones? Uric acid stones Calcium stones Cystine stones Magnesium ammonium phosphate stones

Uric acid stones develop in conditions of gout and when high concentrations of uric acid develop in the urine. Unlike radiopaque calcium stones, uric acid stones are not visible on x-ray films. These stones develop in clients who eat a high-purine diet like Atkins.

The client had a full cast applied for a left humerus fracture in the emergency department 3 hours ago and now complains of increased pain at the site. The client cannot feel the pressure applied to the nail beds when the nurse tests capillary refill pressure, which is found to be 4.5 seconds. What action should the nurse take? Call for assistance and prepare to split the client's cast immediately. Elevate the client's left arm on three pillows and reassess in 15 minutes. Complete a neurovascular assessment and notify the physician of the findings. Administer analgesia and perform range-of-motion exercises with the left hand.

a

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 of the gallbladder Impairment of neurologic control of bladder function Structural changes in the bladder Structural changes in the urethra Structural changes in the pancreas

b c d Urinary obstruction and urinary incontinence can be caused by several factors, including structural changes in the bladder, structural changes in the urethra, and impairment of neurologic control of bladder function. Changes in the gallbladder or pancreas do not cause urinary obstruction or incontinence.

In anatomy class, the instructor asks, "Explain how urine is expelled from the bladder during voiding." Which student has given the most accurate response? "The beginning of micturition occurs when neurons send messages down to the pudendal nerve." "It's really the external sphincter muscle that controls urination. The somatic nervous system innervates the muscles of the external sphincter and the pelvic floor muscles that together control the outflow of urine." "The detrusor muscle contracts down on the urine and the ureteral orifices are forced shut. The external sphincter relaxes as urine moves out of the bladder." "The urothelium acts as a barrier to prevent urine from seeping into capillaries."

c

A nurse at a long-term care facility provides care for a client who has had recent transient ischemic attacks (TIAs). What significance should the nurse attach to the client's TIAs? TIAs result in an accumulation of small deficits that may eventually equal the effects of a CV. TIAs are relatively benign phenomena that necessitate monitoring, but not treatment. TIAs, by definition, resolve rapidly, but they constitute an increased risk for stroke. The small bleeds that define TIAs can be a warning sign of an impending stroke.

c TIAs can be considered a warning sign for future strokes. They are not hemorrhagic in nature and their effects are not normally cumulative. They may require treatment medically or surgically.

The nurse is conducting a community health education program on urinary retention and urinary incontinence. The nurse determines that the participants are understanding the education when they state that the most common cause of urinary retention is: Chronic stress response Psychosocial disorders Pelvic inflammatory disease Prostate enlargement

d In men, the enlarged prostate (due to hypertrophy or hyperplasia) frequently causes nonrelaxing external sphincter with urine retention. The stress response can cause retention of urine as part of the "fight-or-flight" response, unrelated to sphincter dysfunction. Developmental delays are associated with female or male children (not men). Psychosocial disorders sometimes have a transient effect on bladder function, and are rarely a cause of sphincter dysfunction in female or male clients.

The nurse is evaluating the urinalysis results of a client presenting with polyuria and lower abdominal pain due to a suspected urinary tract infection (UTI). Which finding should the nurse report as evidence of a UTI? increased nitrites positive glucose specific gravity of 1.025 solid formations

The nurse would expect the urinalysis of a client with a UTI to have increased nitrites. Bacteria reduce (i.e., break down) nitrates in the urine into nitrites; therefore, increased nitrite levels support bacterial activity. Glucose and protein are not normal findings associated with a UTI and would require follow-up. Specific gravity of 1.025 is within normal limits, which may be present in a UTI but does not support its diagnosis; solid formations in the urine suggest calculi.

Urinary incontinence can be a problem with older adults. One method of treatment is habit training, or bladder training. When using this treatment with an older adult, how frequently should he or she be voiding? Every 3 to 5 hours Every 2 to 4 hours Every 1 to 3 hours Every 4 to 6 hours

b Habit training with regularly scheduled toileting—usually every 2 to 4 hours—often is effective.

According to the Glasgow Coma Scale, opening one's eyes to only painful stimuli would receive which score? 3 1 2 4

c Only opening eyes to painful stimulation is scored as a 2. Spontaneously opening eyes is scored as a 4; opening eyes to speech is scored as a 3; no opening is scored as a 1.

The nurse is conducting a community education program on concussions. The nurse will include that the brain is protected from external physical forces by which part of the nervous system? cerebral cortex reticular formation blood-brain barrier cerebrospinal fluid

d The brain is protected from external physical forces by the rigid confines of the skull (musculoskeletal system) and the cushioning afforded by the cerebrospinal fluid (nervous system). The blood-brain barrier assists with protection from chemical or metabolic sources of potential injury. The reticular formation receives input from sensory pathways, and the cerebral cortex is the outermost layer of the cerebrum.

The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as: a) rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet. b) active range of motion with increased strength in the upper extremities when painful stimulation applied. c) flexion of the arms, wrists, and fingers, with abduction of the upper extremities, internal rotation, and plantar flexion of the lower extremities. d) prone position with arms placed above the head and legs elevated; deep tendon reflexes showing hyperreflexia.

a Decerebrate (extensor) posturing results from increased muscle excitability. It is characterized by rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet. Flexion of the arms, wrists, and fingers, with abduction of the upper extremities, internal rotation, and plantar flexion of the lower extremities, would be a response of decorticate posturing. The other options are not specific to a diagnosis.

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 Overflow incontinence Urge incontinence Mixed incontinence

Stress incontinence is commonly caused by weak pelvic floor muscles, which allow the angle between the bladder and the posterior proximal urethra to change so that the bladder and urethra are positioned for voiding when some activity increases intra-abdominal pressure. Overflow incontinence results when the bladder becomes distended and detrusor activity is absent. Urge incontinence is probably related to CNS control of bladder sensation and emptying or to the smooth muscle of the bladder. Mixed incontinence, a combination of stress and urge incontinence, probably has more than one cause.

A client discharged from the hospital 5 days ago following a stroke has come to the emergency department with facial droop that progressed with hemiplegia and aphasia. The client's spouse is extremely upset because the physician stated that the client cannot receive thrombolytic medications to reestablish cerebral circulation and the spouse asks the nurse why. What is the nurse's most accurate response? "Thrombolytics may cause cerebral hemorrhage." "All the brain tissue damage is already done." "The stroke is hemorrhagic, not thrombotic." "The medications do not work with subsequent strokes."

a A previous stroke occurring within 3 months of the administration of thrombolytics significantly increases the risk of intracranial hemorrhage.

A client presents to the orthopedic clinic for evaluation since the primary care provider thinks the client may have rheumatoid arthritis (RA). Which statement by the client correlates with the diagnosis of RA? Select all that apply. "I'm having a hard time opening doors since it hurts so bad." "Look, I didn't button all my shirt buttons....it just hurts too much and look at the swelling in my hands." "Look how my hand is deformed. My doctor calls it hyperextension." "Just look at my face. It looks like I have varicose veins on my cheeks." "Every time I get something out of the freezer, my hands turn reddish purple in color."

a b c Rheumatoid arthritis (RA) joint involvement usually is symmetric and polyarticular. Pain with turning door knobs, opening jars, and buttoning shirts is commonly reported due to swelling of the wrists and small joints of the hand. Hyperextension of the PIP joint and partial flexion of the distal interphalangeal (DIP) joint is called a swan neck deformity. As the RA inflammatory process progresses, synovial cells and subsynovial tissues undergo reactive hyperplasia. With osteoarthritis (OA), joint changes result from the inflammation caused when the cartilage attempts to repair itself, creating osteophytes or spurs. Raynaud phenomenon (a vascular disorder characterized by reversible vasospasm of the arteries supplying the fingers) and telangiectasia (dilated skin capillaries) are characteristic of scleroderma.

A child is recovering from a bout with group A beta-hemolytic Streptococcus infection. The child returns to the clinic 1 week later reporting decrease in urine output with puffiness and edema in the face and hands. The health care provider suspects the child has developed which condition? autosomal recessive polycystic kidney disease (ARPKD) acute nephritic syndrome adult-onset medullary cystic disease acute postinfectious glomerulonephritis

acute postinfectious glomerulonephritis The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days—the time needed for the development of antibodies. Oliguria, which develops as the glomerular filtration rate (GFR) decreases, is one of the first symptoms. Proteinuria and hematuria follow because of increased glomerular capillary wall permeability. Sodium and water retention gives rise to edema (particularly of the face and hands) and hypertension. Adults with medullary cystic kidney disease present first with polyuria, polydipsia, and enuresis (bed-wetting), which reflect impaired ability of the kidneys to concentrate urine. The typical infant with autosomal recessive polycystic kidney disease (ARPKD) presents with bilateral flank masses, accompanied by severe kidney injury, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension. Acute nephritic syndrome is characterized by sudden onset of hematuria, variable degrees of proteinuria, diminished GFR, oliguria, and signs of impaired kidney function.

A client presents with joint pain and suspected rheumatoid arthritis (RA). Which intervention is appropriate for the nurse to implement? Increase in the client's activity to provide sufficient joint stress Muscle-strengthening exercises to support joints Intravenous opioid to control pain Admission to the intensive care unit for cardiac monitoring

b Clients with RA can focus on muscle strengthening to support joints. Range-of-motion exercises and isometric exercises may be used to strengthen muscles. Rest, rather than increased activity, is beneficial. IV opioids are not generally used, and admission to the intensive care unit is not needed. Heat and cold modalities can be used as well as teaching the client about proper body mechanics.

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? Ability to suppress urination is increased. The stretch receptors in the bladder wall become hypersensitive. Bladder contraction weakens. The bladder begins to shrink.

b During the early stage of obstruction, the bladder begins to hypertrophy and becomes hypersensitive to afferent stimuli arising from stretch receptors in the bladder wall. The ability to suppress urination is diminished, and bladder contraction can become so strong that it virtually produces bladder spasm. There is urgency, sometimes to the point of incontinence, and frequency during the day and at night.

A client reports urinary incontinence, specifically not feeling the urge to urinate until the bladder voids uncontrollably. Client history shows type 1 diabetes of 40+ years and compliance with medication and diet. What is the most likely diagnosis? Incontinence caused by stress on the bladder Incontinence related to neuropathy causing overactive bladder Incontinence caused by a physical block in the urethra Incontinence related to having large volumes stored in the bladder

b Neural damage is brought about by chronic diabetes and can result in the loss of control of the detrusor muscle. Stress, urge, and functional incontinence are all caused by pressure or blockage.

The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to which substance? Inflammatory cells Plasma proteins Antibody complexes Red blood cells

b The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to plasma proteins. Some of nephrotic glomerular injury results from circulating antigen-antibody complexes that become trapped in the glomerular membrane. The nephritic syndromes are characterized by hematuria with red cell casts.

What is a priority concern for a client who has a hip dislocation? Pain Blood supply to the femoral head Tendonitis Edema

b The major cause for concern for a client with a hip dislocation is that the dislocated position puts tension on the blood supply to the femoral head and avascular necrosis may result. Restoring or preserving circulation is the priority. Tendonitis and edema are not usually a concern. Pain is a secondary concern.

Which assessment finding would lead the nurse to suspect the client has developed nephrotic syndrome? Renal colic and increased serum sodium Proteinuria and generalized edema Hematuria and anemia Increased creatinine with normal blood urea nitrogen

b The nephrotic syndrome is characterized by massive proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized edema, and hyperlipidemia. Hematuria and anemia may be associated with a cancer. Renal colic is characteristic of kidney stones. Increased creatinine may be associated with systemic lupus erythematosus.

The nurse is teaching a client with rheumatoid arthritis about pannus, which develops in the affected joint area. What does the nurse include to describe pannus? Muscles in the area that atrophy from disuse Vascular granulation tissue that destroys cartilage and bone Microorganisms that attack the joint space causing stiffness Reversible calcium deposits affecting the joints

b A network of new blood vessels in the synovial membrane that contributes to the advancement of the rheumatoid synovitis, called pannus, develops. This destructive vascular granulation tissue extends from the synovium to involve a region of unprotected bone at the junction between cartilage and the subchondral bone. Inflammatory cells found in the pannus have a destructive effect on adjacent cartilage and bone leading to reduced joint motion and the possibility of eventual ankylosis.

When teaching a client about areas of the body typically affected by gout, the nurse would include which locations? Select all that apply. Heart Metatarsals Instep Hip Heel

b c The typical acute attack of gout is monoarticular and usually affects the first metatarsophalangeal joint. The tarsal joints, insteps, ankles, heels, knees, wrists, fingers, and elbows also may be initial sites of involvement.

A client experienced a humeral fracture during an physical assault, and treatment has now begun. During the healing process, which physiologic process(es) will take place? Select all that apply. Spongy bone will eventually replace compact bone at the end of the healing process. The client will develop a callus of cartilage and woven bone near the fracture site. Granulation tissue replaces the hematoma at the healing site. Remodeling will take place near the beginning of the healing process. The client will develop a hematoma in the first 48 hours after the injury.

b c e Hematoma formation occurs during the first 1 to 2 days after fracture; granulation tissue replaces the hematoma after a few days. Callus formation is an expected phase of wound healing and consists of cartilage and woven bone near the fracture site. Compact bone eventually replaces spongy bone, which is temporary. Remodeling is the final phase of the healing process

The nurse is caring for a client who sustained a femur fracture 3 days before. The nurse notes that the client, who was previously oriented, now doesn't know where he is. The nurse suspects which condition? Osteomyelitis Reflex sympathetic dystrophy Fat embolism syndrome (FES) Compartment syndrome

c

The nurse recognizes the most common cause of acute postinfectious glomerulonephritis as: uncontrolled diabetes with increased proteinuria. prolonged blockage of the ureter with a stone. a streptococcal infection 7 to 12 days prior to onset. drug-induced damage to the renal glomeruli.

c Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of group A beta-hemolytic streptococci and is caused by deposition of immune complexes. It also may occur after infections by other organisms, including staphylococci and a number of viral agents, such as those responsible for mumps, measles, and chickenpox.

he 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 statement? "Alterations in bladder function can include urinary obstruction with retention or stasis of urine." "Alterations in bladder function can include urinary incontinence with involuntary loss of urine." "Alterations in bladder function can only occur when there is incontinence." "Alterations in bladder function occurs frequently in the elderly."

c Alterations in bladder function include urinary obstruction with retention or stasis of urine and urinary incontinence with involuntary loss of urine. Alterations in bladder function does occur more frequently with aging.

The nurse is evaluating client risk for the development of overactive bladder/urge incontinence and determines that which client is at highest risk for this condition? A client whose arthritis makes walking difficult A client embarrassed to use a bedpan A client with diabetes mellitus A client who gave birth to two large-for-gestational age infants

c Overactive bladder/urge incontinence can be caused by disorders of the detrusor muscle structure, which can occur as the result of the aging process or disease conditions such as diabetes mellitus. A stroke client develops this condition as a result of neurogenic causes rather than having a disorder of detrusor muscle problem.

Which statement accurately describes the etiology of stress incontinence? Overactivity of the voiding reflexes related to the nervous system damage The decrease in smooth muscle of the bladder causing increased urination An increase in intra-abdominal pressure that results in involuntary urination The involuntary release of urine related to a strong sense of urgency

c Stress incontinence results in involuntary passage of urine related to increased intra-abdominal pressure with coughing, sneezing, or laughing. The other options refer to the etiology of overactive/urge incontinence.

When teaching a client with rheumatoid arthritis (RA), which factor does the nurse explain is an underlying cause of this disease? Immunocompromised host Tissue necrosis Autologous antibodies Lysosomes

c The pathogenesis of RA can be viewed as an aberrant immune response that leads to synovial inflammation and destruction of the joint architecture. Approximately 70%-80% of people with the disease have a substance called rheumatoid factor, which is an autologous (self-produced) antibody that causes joint destruction.

A nurse observes that a client's urine is cola colored and considers which factor as a possible reason? The client's urine has a decrease in the specific gravity. The client has an elevation of urine potassium. The client's urine contains material from the degradation of red blood cells. The client has ingested a dark-colored drink.

c When red blood cells degrade in the urine, urine may appear cola colored.

The nurse notices that an adolescent client has several whiteheads on the face. Which description best describes the whiteheads? white lesions that are open to the skin surface central cores that contain purulent material pale, slightly elevated papules with no visible orifice greater than 5 mm in diameter

c Whiteheads are pale, slightly elevated papules with no visible orifice and are less than 5 mm in diameter. If larger, they are referred to as nodules, and these larger lesions may become suppurative or hemorrhagic. Pustules can develop from whiteheads if inflammation occurs and purulent material accumulates in the core, but a normal whitehead is not considered a pustule. Blackheads open to the surface of the skin, but a whitehead does not.

A client who is diagnosed with seizures describes feeling a strange sensation before losing consciousness. The family members report that the client has been smacking his lips prior to having a seizure. Which type of seizure disorder presents with these symptoms? Simple partial seizure or prodrome Generalized seizures Complex partial or focal seizure with impairment of consciousness Atonic seizure

c Complex partial seizures, or focal seizures with impairment of consciousness, are often accompanied by automatisms, which are repetitive, nonpurposeful activities such as lip smacking, grimacing, patting, or rubbing clothing. They are sometime called psychomotor seizures. Simple partial seizures, or prodromes, would not have a loss of consciousness. Atonic seizures, a category of generalized seizures, indicate involvement of both brain hemispheres at the onset.

The nurse is caring for a client experiencing a seizure. During the seizure the nurse notes that the client repetitively rubs his/her clothing. When contacting the client's physician, the nurse notes that the client exhibited: aura. hallucination. automatisms. myoclonic activity.

c The nurse reports that the client exhibited automatisms, defined as repetitive nonpurposeful activities such as lip smacking, grimacing, patting and/or rubbing clothing.

A rheumatology nurse is teaching a client about extra-articular signs and symptoms of rheumatoid arthritis (RA). Which item does the nurse include in the teaching session? Select all that apply. Steady, chronic decline of health Wheezing Loss of appetite Weight gain Fatigue Temperature 99.3°F (37.4°C)

c e f RA often is associated with extra-articular as well as articular manifestations; systemic manifestations include fatigue, anorexia, weight loss, and low-grade fever. The disease, characterized by exacerbations and remissions, may involve only a few joints for brief durations, or it may become relentlessly progressive and debilitating.

The nursing instructor who is teaching about incontinence in older adults recognizes a need for further instruction when a student makes which statement? "Many factors can contribute to incontinence." "Incontinence can increase social isolation in the elderly." "A number of factors that contribute to incontinence can be altered." "Frequency is not a major problem for the elderly."

d Incontinence can increase social isolation in the older adult population and frequency can lead to institutionalization of older adults. Many factors can contribute to incontinence but many of these can be altered.

A nurse is caring for a client who has developed vasculitis as a result of a rheumatology disorder. Which factor does the nurse expect to uncover in assessing this client? Compression fractures Pancreatitis Bone tenderness Ulcers of the lower extremities

d Vasculitis, or inflammation of small and medium-sized arteries, manifests as ischemic areas in the nail fold and digital pulp that appear as brown spots. Ulcerations may occur in the lower extremities, particularly around the malleolar areas.

Which clinical manifestations would tell a nurse that a client is having progressive decompensation related to obstruction of urinary outflow? Client states that he or she is incontinent. Client complains of urinary urgency. Client complains of waking up several times in the night to void. When tested for residual urine volume, 1400 mL of urine is obtained when client is catheterized.

d When compensatory mechanisms are no longer effective, signs of decompensation begin to appear. The period of detrusor muscle contraction becomes too short to expel the urine completely, and residual urine remains in the bladder. At this point, symptoms of obstruction become pronounced. These symptoms include frequency of urination, hesitancy, need to strain to initiate urination, a weak and small stream, and termination of the stream before the bladder is completely emptied. With progressive decompensation, the bladder may become severely overstretched with a residual urine volume of 1000 to 3000 mL. Urinary urgency is a compensatory mechanism. Incontinence may be caused by many different factors and does not indicate decompensation.

A 55-year-old client has reported joint pain in the feet. Which laboratory result should prompt further testing to rule out primary gout? Increased polymorphonuclear leukocytes Increased serum cortisol Increased C-reactive protein (CRP) Increased serum uric acid

d Although hyperuricemia is not diagnostic of gout, it is suggestive and should prompt further assessment. Increases in CRP, polymorphonuclear leukocytes, and cortisol levels are not as closely associated with the body's response to gout.

A client with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the client appears confused—he is oriented to person and place but not time. What type of seizure did this client most likely experience? Atonic seizure Tonic-clonic seizure Myoclonic seizure Focal seizure with impairment to consciousness

d Focal seizures with impairment of consciousness, sometimes referred to as psychomotor seizures, are often accompanied by automatisms or repetitive nonpurposeful activities such as lip smacking, grimacing, patting, or rubbing clothing. Confusion during the postictal period (after a seizure) is common. Atonic seizures are characterized by loss of muscle tone, and myoclonic seizures involve brief involuntary muscle contractions induced by stimuli of cerebral origin. With tonic-clonic seizures, formerly called grand mal seizures, a person has a vague warning (probably a simple focal seizure) and experiences a sharp tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness.

An older adult is brought to the emergency department after experiencing some confusion, slurred speech, and a weak arm. Now the client is back to acting normally. Suspecting a transient ischemic attack (TIA), the health care provider prescribes diagnostic testing looking for which cause of this episode? Aneurysm leakage Minor residual deficits Diffuse cerebral electrical malfunctions Atherosclerotic lesions in cerebral vessels

d The traditional definition of TIA as a neurologic deficit resolving within 24 hours was developed before the mechanisms of ischemic cell damage and the penumbra were known and before the newer, more advanced methods of neuroimaging became available. A more accurate definition now is a transient deficit without time limits, best described as a zone of penumbra without central infarction. TIAs are important because they may provide warning of impending stroke. The causes of TIAs are the same as those of ischemic stroke, and include atherosclerotic disease of cerebral vessels and emboli. The most common predisposing factors for cerebral hemorrhage are advancing age and hypertension; other causes include aneurysm rupture. Cerebral electrical malfunctions usually occur with seizure activity.