Patho Final
A female client with rheumatoid arthritis has taken high doses of aspirin for several years to control inflammatory pain. Which of the following statements leads the health care provider to suspect the client has developed ototoxicity? "I can't go to the movies anymore. It's so noisy, I miss half the words." "I've been getting dizzy and light-headed. I seem to have a constant ringing in my ear." "I almost got hit by a garbage truck. I didn't hear its backup beeper." "When my grandchildren whisper, I can't hear a word they are saying."
"I've been getting dizzy and light-headed. I seem to have a constant ringing in my ear."
The nurse is caring for a patient diagnosed with osteoarthritis (OA). Which of the following does the nurse teach the patient about the disease? "OA is a disease of the weight-bearing joints." "OA typically occurs in patients between 20 and 40 years of age." "OA is an autoimmune disorder." "OA is a genetic disorder."
"OA is a disease of the weight-bearing joints."
Which statement accurately reflects the typical person afflicted with multiple sclerosis (MS)? A 25 year old woman A 50 year old man A 6 year old girl A 26 year old man
A 25 year old woman
Which of the following clients presenting to the emergency department would most likely be diagnosed with a pathologic stress fracture? A teenager who fell of a ladder and hit the concrete driveway, landing on his hip A postmenopausal female who was diagnosed with breast cancer with metastasis to bone A competitive volleyball player diving to retrieve a volley and landing on his hip A weight lifter who bench-presses 200 kg lost balance and fell to the side, landing on his hip
A postmenopausal female who was diagnosed with breast cancer with metastasis to bone
A 26 year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced? A myoclonic seizure A tonic-clonic seizure. An absence seizure A complex partial seizure.
A tonic-clonic seizure.
The nurse is conducting a community prevention program on osteoporosis. The nurse determines that the participants are understanding the information when they identify that premature osteoporosis is being seen increasingly in female athletes because of an increased prevalence of which of these? Amenorrhea High protein intake Abnormal body fat Osteoarthritis
Amenorrhea
A young female relays to her healthcare provider, "I've had double-vision a few different times, and I get tired more easily than I ever have." The client's muscle strength is diminished, and inspection of her eyelids reveals the presence of ptosis. Which diagnostic testing should the nurse anticipate being prescribed? Electroencephalography (EEG) Anticholinesterase testing ACTH stimulation testing Magnetic resonance imaging (MRI)
Anticholinesterase testing The client's presentation is suggestive of myasthenia gravis, the diagnosis of which is based on history and physical examination, the anticholinesterase test, nerve stimulation studies, and an assay for acetylcholine receptor antibodies
The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first? Assess for other signs/symptoms of increased intracranial pressure Assess for signs/symptoms of cerebral vascular accident Contact physician for anti-nausea medication orders Document the finding as it is an expected symptom
Assess for other signs/symptoms of increased intracranial pressure
A soccer player has been diagnosed with a brain contusion after being injured in a game. The best explanation of the injury by the nurse would be: Bruising on the surface of the brain occurred. Tearing of brain tissue occurred. Transient neurogenic dysfunction caused by mechanical force to the brain occurred. Hypoxia to the brain occurred.
Bruising on the surface of the brain occurred.
Neurotoxins such as the botulism organism can produce paralysis by what mechanism? Causing a recessive gene defect on the X chromosome Loss of acetylcholine receptors Demyelination of multiple peripheral nerves By blocking release of acetylcholine
By blocking release of acetylcholine
A 14-year-old girl has been thrown from the back of a pick-up truck. MRI shows complete cord injury at the level of C2. What is the main significance of an injury at this level of the spinal column? Cannot breathe on own, needs ventilator assistance Partial or full diaphragmatic function; ventilation is diminished because of the loss of intercostal muscle function, resulting in shallow breaths and a weak cough Intercostal and abdominal musculature is affected; the ability to take a deep breath and cough is less impaired Needs maintenance therapy to strengthen existing muscles for endurance and mobilization of secretions
Cannot breathe on own, needs ventilator assistance
Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy? Guillain-BarrÉ syndrome Carpal tunnel syndrome Myasthenia gravis Phalen syndrome
Carpal tunnel syndrome
An 80-year-old patient with a history of heavy alcohol use is being seen by his provider for drowsiness, confusion, and headache. His family states that he fell and hit his head "several weeks ago." Which type of hematoma does the provider suspect? Epidural Acute subdural Chronic subdural Subacute subdural
Chronic subdural
The nurse assessing a patient with a traumatic brain injury assesses for changes in which of the following? Select all that apply. Cognition Level of consciousness Motor function Sensory function Metabolic function
Cognition Level of consciousness Motor function Sensory function
The nurse is assessing a client who sustained a fractured radius. A cast was applied to the extremity approximately 1 hour ago, and the client is now complaining of increased pain and numbness to the finger tips. The client is most likely experiencing: Compartment syndrome Complex regional pain syndrome Fracture blisters Thromboemboli
Compartment syndrome
The nurse is caring for a client who states that he is suddenly having severe pain at a leg fracture site. The nurse notes increased swelling in the limb and difficulty palpating a pulse. The nurse suspects that the client may have which of the following? Compartment syndrome Fracture blisters Reflex sympathetic dystropy Hematogenous osteomyelitis
Compartment syndrome Fracture blisters Reflex sympathetic dystropy Hematogenous osteomyelitis
A client had an arm cast fitted after suffering a right humeral fracture in a hockey game. The client reported a loss of sensation in the right hand, but sensation returned upon removal of the cast. Which was the most likely cause of the client's loss of sensation? Compression lesion of the musculocutaneous nerve. Severing of the musculocutaneous nerve followed by regeneration. Inflammation of the musculocutaneous nerve. Inhibition of the musculocutaneous nerve to protect the humerus.
Compression lesion of the musculocutaneous nerve.
Select the laboratory blood test that would be a used to suggest a diagnosis of muscular dystrophy (MD). Serum glucose Rheumatoid factor Amylase levels Creatine kinase
Creatine kinase
The nurse performing a musculoskeletal assessment of a patient with osteoarthritis would evaluate the presence of which of the following as a normal finding in this patient? Spongy joints Cartilage hypertrophy Crepitus and grinding Systemic inflammation
Crepitus and grinding
A 70-year-old female client comes to the clinic with back pain. An x-ray reveals vertebral fractures and she is diagnosed with osteoporosis. Which of the following factors most likely contributed to her condition? Excessive dietary calcium Decreased estrogen levels Strenuous exercise Prolonged standing
Decreased estrogen levels
An 80 year-old female with a diagnosis of osteoporosis receives daily supplements of calcitonin in the form of a nasal spray that she instills each morning. Which of the following phenomenon would her care providers expect to result from her supplementation? Decreased serum calcium levels Increased bone resorption Acceleration of osteoclast action An increase in bone formation
Decreased serum calcium levels
The nurse is caring for an elderly client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for which of the following conditions? Disuse atrophy Muscular dystrophy Involuntary movements Pseudohypertrophy
Disuse atrophy
Which of the following is the main cause of decubitus ulcers (bedsores) that impairs the flow of blood and lymph? External pressure Shearing forces Tissue edema Thrombosis
External pressure
The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced which of the following? Generalized seizure Focal seizure without impairment of consciousness Focal seizure with impairment of consciousness Unknown type of seizure
Generalized
A nurse is assessing a client with symptoms of botulism. The nurse will question the client regarding ingestion of which of the following? Dairy products Unrefrigerated meat Home-grown and canned vegetables Fresh fish
Home-grown and canned vegetables
An individual experiencing spinal cord damage (SCD) is at high risk for developing deep vein thrombosis (DVT) and pulmonary emboli (PE) due to which pathophysical cause? Impaired mobility Impaired vasomotor tone Hypercoagulation of blood Impaired pain perception Stasis of blood flow
Impaired mobility Impaired vasomotor tone Hypercoagulation of blood Stasis of blood flow
The geriatrician providing care for a 74 year-old man with diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem? Increasing the functional ability of the underactive dopaminergic system. Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions. Preventing axonal degradation of motor neurons. Preventing demyelization of the efferent cerebellar pathways.
Increasing the functional ability of the underactive dopaminergic system.
An older adult is being evaluated for dementia. Which assessments are not considered part of normal aging? Select all that apply.
Is easily agitated when routines are not followed Is unable to explain the meaning of a proverb Needs cues to perform hygiene activities
Muscular dystrophy is characterized by what pathophysiologic changes? Antibody-controlled loss of acetylcholine receptors Muscular necrosis, with replacement with fat and connective tissue Compression mononeuropathy caused by compression of nerves Acute immune-related polyneuropathy
Muscular necrosis, with replacement with fat and connective tissue
Following a knee replacement surgery, a nurse's next door neighbor asks, "I don't think I am healing right. Can you come look at my knee?" Upon assessment, the nurse notices the client is warm to touch and has a fever; the incision is inflamed and not well approximated with foul-smelling drainage around the incision line. At this point, the nurse tells the client she needs to go see her surgeon because the client may have: Contaminated the wound with MRSA Osteomyelitis An abscess in the pocket of the incision Potential bone cancer
Osteomyelitis
Multiple sclerosis is characterized by what type of neuron damage?
Polyneuropathy
kidney responds to parathyroid stimulation by Increasing reabsorption of sodium in the distal tubules. Reducing the reabsorption of phosphate. Stimulating production of red blood cells. Decreasing the reabsorption of calcium.
Reducing the reabsorption of phosphate.
A 79-year-old client has been confined to bed after a severe hemorrhagic stroke that has caused hemiplegia. Which of the following measures should his care team prioritize in the prevention of pressure ulcers? Prophylactic antibiotics Repositioning the patient on a scheduled basis Applying protective dressings to vulnerable areas Parenteral nutrition
Repositioning the patient on a scheduled basis
Death caused by muscular dystrophy in early adulthood is usually due to which of the following? Respiratory and cardiac muscle involvement Severe skeletal muscle weakness Severe long bone fractures Malnutrition
Respiratory and cardiac muscle involvement
Which of the following would be a symptom that is unique to amyotrophic lateral sclerosis (ALS) and is not observed in multiple sclerosis (MS)? Dysarthria Optic nerve dysfunction Respiratory muscle impairment Fatigue
Respiratory muscle impairment
To maintain adequate serum calcium levels, what does parathyroid hormone reduce? Activation of vitamin D Serum phosphate levels Calcium release from bone Intestinal absorption of calcium
Serum phosphate levels
Coordinated muscular movement requires proper functioning of four areas of the nervous system. Which system controls posture and balance? The motor system The sensory system The cerebellar system The vestibular system
The vestibular system
The health care provider is assessing a client to differentiate a herniated disk from other causes of acute back pain. The most important test for the provider to perform would be: Straight-leg test Pain rating scale Deep tendon reflex test Apgar test
Straight-leg test
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 resident'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.
TIAs, by definition, resolve rapidly, but they constitute an increased risk for stroke.
A client has been recovering from a stroke for several weeks and has been reluctant to participate in physical therapy. As a result, the client has experienced disuse atrophy. The nurse should recognize that the client is experiencing the consequences of which physiologic process? The client's muscle cells have become denervated due to disuse A significant proportion of the client's muscle cells have died The diameter of the client's muscle cells has decreased The upper motor neurons controlling voluntary motor units have stopped firing
The diameter of the client's muscle cells has decreased
A patient suffering a thrombotic stroke is brought into the emergency department by ambulance and the health care team is preparing to administer a synthetic tissue plasminogen activator for which of the following purposes? Thrombolysis Thrombogenesis Hemolysis Hemostasis
Thrombolysis
The most common cause of an ischemic stroke is which of the following? Intracerebral arterial vasculitis Cardiogenic embolus Thrombosis Vasospasm
Thrombosis
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
Transient ischemic attack (TIA)
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
Transient ischemic attack (TIA)
The nurse is caring for a client with rheumatoid arthritis (RA). Which assessment findings correlate with this diagnosis? (Select all that apply.) Fatigue Increased appetite Flushed skin Weight loss Anorexia
fatigue weight loss anorexia
Burning pain from rash is r/t
herpes zoster
The most common cause of ischemic stroke is: thrombosis. arterial vasculitis. vasospasms. cryptogenesis.
thrombosis
A post-menopausal female client diagnosed with osteoporosis asks the nurse how a decrease in estrogen can cause problems with bone density. Which of the following statements is the best response from the nurse? "A decrease in estrogen levels, which occurs at menopause, results in increased resorption of bone." "Estrogen is needed to push calcium into the bone." "A lack of estrogen reduces the number and function of the osteoclasts." "Menopause causes a decrease in all circulating hormones, such as PTH which lead to a decrease in bone strength."
"A decrease in estrogen levels, which occurs at menopause, results in increased resorption of bone."
During a flu shot clinic, one of the questions the student nurse asks relates to whether the client has a history of Guillain-Barre syndrome. The patient asks, "What is that?" How should the nursing student reply? "A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles." "Swelling of your arm where you got your flu shot and maybe your eyes and lips had some swelling as well." "A degenerative disease where you have trouble walking without the help of a cane or walker." "Influenza-like illness where you had fever and chills for 2-3 days after your last flu shot."
"A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles."
A patient recently diagnosed with rheumatoid arthritis (RA) tells the nurse she is glad there is nothing "really wrong with her" but some joint swelling. Which of the following information should the nurse tell the patient about RA? "Joint involvement is typically the only manifestation of the disease in most clients." "Extra-articular manifestations may include anemia and deformities of the affected joints." "The disease can be reversed with medication and exercise." "Myocardial infarction develops in clients who have had the disease for an extended period."
"Extra-articular manifestations may include anemia and deformities of the affected joints."
Which of the following is the definition of a congenital deformity? Abnormalities occurring after birth Abnormalities present at birth Deformities occurring at inception Deformities occurring from the birthing process
Abnormalities present at birth
The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer's disease. What intervention will be implemented to slow cognitive decline? Psychotherapy Acetylcholinesterase inhibitors Lipid-lowering agents Antioxidant therapy
Acetylcholinesterase inhibitors
A client is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by CT scan. The most important treatment for this client would be to: Administer IV tissue-type plasmin activator (tPA) Administer analgesics for the relief of pain Monitor vital signs closely for improvement Prepare the client for emergency surgery
Administer IV tissue-type plasmin activator (tPA)
The nurse is caring for a client admitted to the emergency room with suspected meningitis. The nurse prepares to perform which nursing intervention upon physician orders, while diagnostic testing is being completed? Administration of antibiotics Administration of TPN Administration of oxygen Adminstration of pain medication
Administration of antibiotics
The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include? CT scan MRI Intravenous antibiotics ain medication
CT scan
A middle-aged woman is brought to the emergency room after a minor auto accident. Her gait is staggering and unsteady, her speech is slurred, and she displays slight nystagmus. The police officer who brought her in says she has not been drinking. Her blood pressure is very high. Which of the following health problems most likely underlies her present state? Multiple sclerosis Guillain-Barre syndrome Myasthenia crisis Cerebellar damage caused by a cerebrovascular accident
Cerebellar damage caused by a cerebrovascular accident
A client has suffered a stroke that has affected his speech. The physician has identified the client as having expressive aphasia. Later in the day, the family asks the nurse to explain what this means. The most accurate response would be aphasia that is: Characterized by an inability to comprehend the speech of others or to comprehend written material Nearly normal speech except for difficulty with finding singular words Manifested as impaired repetition and speech riddled with letter substitutions, despite good comprehension and fluency Characterized by an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing
Characterized by an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing
When teaching a community education class on osteoarthritis (OA), the nurse should include which of the following in discussing which individuals are at risk for this problem? Select all that apply.
Elderly individuals Older women Obese people
A client has developed global ischemia of the brain. The nurse determines this is: Inadequate to meet the metabolic needs of the entire brain Inadequate perfusion of the nondominant side of the brain Inadequate perfusion of the right side of the brain Inadequate perfusion to the dominant side of the brain
Inadequate to meet the metabolic needs of the entire brain
A 68 year-old woman has had her mobility and quality of life severely affected by rheumatoid arthritis (RA). Place the following pathophysiological events involved in her health problem in the correct order that they most likely occurred. Use all the options. Inflammatory response Interaction between rheumatoid factor (RF) and IgG T-cell mediated immune response Pannus invasion Destruction of articular cartilage
Inflammatory response Interaction between rheumatoid factor (RF) and IgG T-cell mediated immune response Pannus invasion Destruction of articular cartilage
A client is admitted to a rehabilitation center after hospital treatment for an ischemic stroke. What aspects of the client's history are risk factors for ischemic stroke? Select all that apply. The client: Is a Black male. Takes iron supplements for the treatment of chronic anemia. Blood pressure has historically been in the range of 150's/90's. Was diagnosed with type 2 diabetes 8 years ago. Takes corticosteroids for the treatment of rheumatoid arthritis.
Is a Black male. Blood pressure has historically been in the range of 150's/90's. Was diagnosed with type 2 diabetes 8 years ago.
A nurse is assessing a patient with rheumatoid arthritis (RA). What does the nurse expect to find when evaluating the patient's joints? (Select all that apply.) Asymmetrical joint involvement Joint pain lasting for 30 minutes to several hours Decreased joint motion Nodules on joints
Joint pain lasting for 30 minutes to several hours Decreased joint motion Nodules on joints
Due to her progressing osteoarthritis (OA), an 80 year-old woman is no longer able to perform her activities of daily living without assistance. Which of the following phenomena most likely underlies the woman's situation? Inappropriate T-cell mediated immune responses have resulted in articular cartilage degeneration. Loss of articular cartilage and synovitis has resulted from inflammation caused when joint cartilage attempted to repair itself. Excessive collagen deposits have accumulated in the woman's synovial joints. Bone overgrowth in synovial joints has resulted in fusing of adjacent bones that normally articulate.
Loss of articular cartilage and synovitis has resulted from inflammation caused when joint cartilage attempted to repair itself.
A client with an acute spinal cord injugy is developing spinal shock. The nurse should perform which priority assessment? Inability to move lower extremities Loss of tendon reflexes below the injury Vasoconstriction causing hypertension Paresthesia of the extremities below the injury
Loss of tendon reflexes below the injury
The nurse is explaining how vasogenic brain edema occurs to a client's family. The most appropriate information for the nurse to provide would be: The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. There is an increase in the production of cerebral spinal fluid volume. Normal physiologic circumstances result in decreased adsorption of CSF. There is a decrease in the amount of fluid volume in the brain.
The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid.
In myasthenia gravis, periods of stress can produce myasthenic crisis. When does myasthenic crisis occur? When muscle weakness becomes severe enough to compromise ventilation When the client is too weak to hold the head up When the client is so weak he or she cannot lift the arms When the client can no longer walk
When muscle weakness becomes severe enough to compromise ventilation
