Patho Unit 2 (ch. 8, 9, 10)

Fat is a necessary part of the diet. The Food and Nutrition Board has set what adult AMDR for fats?

25% - 35%

During a humanitarian trip to an underdeveloped country a medical student is assessing a 6 year-old male who has a protuberant abdomen, dry hair and wrinkled skin. The child's heart rate is 59 beats per minute, blood pressure 89/50 and temperature 95.2°F (35.1°C). What is the most likely etiology of the child's health problems?

A diet deficient in both protein and calories.

Which statement is true concerning energy requirements across the lifespan?

A newborn requires more kcal/kg of body weight than a 10 year old.

The nurse is caring for a client with an acid-base imbalance. Which of these does the nurse recognize is correct regarding compensation?

A pH moves toward the normal range.

The control systems of the body act in many ways to maintain homeostasis. These control systems regulate the functions of the cell and integrate the functions of different organ systems. What else do they do?

Control life processes

Which of these is an endocrine regulator of pituitary and adrenal activity and a neurotransmitter involved in autonomic nervous system activity, metabolism, and behavior?

Corticotropin-releasing factor

A client who is being treated for malnutrition develops dependent pedal edema. What is the nurse's priority action?

Elevate the client's feet above the level of the heart.

A nurse is caring for an adolescent with posttraumatic stress syndrome. The client reports having difficulty concentrating and has an increased startle reflex. The nurse's documentation includes the presence of:

Hyperarousal

The nurse is caring for a client who survived a severe motor vehicle accident 2 months ago that killed her close friend. The client has expressed increased irritability and has started driving at least 15 miles/hour slower than the posted speed limit. Which stage of posttraumatic stress disorder (PTSD) is she experiencing?

Hyperarousal

A nurse observes peaked, narrow T waves on the electrocardiogram of a client suffering from renal failure. The nurse suspects that the client is experiencing which condition?

Hyperkalemia

Respiratory alkalosis can be caused by a respiratory rate in excess of that which maintains normal plasma PCO2 levels. What is a common cause of respiratory alkalosis?

Hyperventilation

When trying to explain the role of potassium and hydrogen related to acid-base, which statement is most accurate?

Hypokalemia stimulates H+ secretion.

A single mother who was raised in a traumatic environment is very protective of her child. She expresses a desire to keep her child from experiencing stressful situations in hopes of promoting healthy development. What response by the nurse is most helpful?

It is normal to experience stressors periodically and this can enhance healthy development."

A client has these arterial blood gas values: anion gap 20 mEq/L (20 mmol/L), pH 7.29, PCO2 37 mm Hg (4.92 mmol/L), HCO3- 11 mEq/L (11 mmol/L), base excess -6 mEq/L (-6 mmol/L). With what condition do these values correspond?

Lactic acidosis

Which of the following individualized plans does the nurse understand will be included in the initial plan of treatment for the patient who seeks treatment for obesity? Select all that apply.

Lifestyle modification with behavioral therapy Reduced-calorie diet Increased physical activity

When trying to explain to parents of school-aged children how to find the "good" fats that should used for cooking, which explanation is most accurate?

Look for plant-based oils like "canola" on the label.

The pathophysiology student is studying the general adaptation syndrome (GAS). Which statement by the student demonstrates understanding?

Epinephrine is released in the alarm stage."

The parents of a newborn are irritable and extremely tired due to their lack of sleep, yet are very happy. Selye described this type of stress as:

Eustress

Polydipsia

Excessive thirst, is normal when it accompanies conditions of water deficit not when it results in excess water intake

A client who is in the intensive care unit after experiencing a massive heart attack begins to go into renal failure. The nurse plans the client's care knowing that the client is in which phase of Selye's general adpatation syndrome?

Exhaustion

A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37 mEq/L (37 mmol/L). The nurse suspects the client may be experiencing:

Metabolic alkalosis

A client with an underlying heart condition is being admitted to the hospital with an upper respiratory infection. The nurse anticipates that this client will be admitted to which unit?

Monitored/telemetry

A hospital client is receiving an intravenous infusion of 0.45% NaCl at 100 mL/hour. What action by the nurse is the most appropriate?

Assess the client for resolution of fluid volume deficit.

A client experiencing an acute stress response has increased urination. What does the nurse determine is the cause of this clinical manifestation

The client has hyperglycemia.

Which clinical manifestation would lead the nurse to suspect a client has developed fluid volume excess?

Weight gain

Hypermagnesemia

excess of magnesium in the extracellular fluid above 2.5mg/dL 1.1mmol/L

Hypercalcemia

excessive calcium in the blood above 10.5 mg/dL 2.6mmol/L

Hyperphosphatemia

excessive phosphate in the blood above 4.5mg/dL 1.45mmol/L

Hyerkalemia

excessive potassium in the blood above 5.5 mmol/L

hyperparathyroidism

excessive production of parathormone

An 81-year-old male client who has a diagnosis of orthostatic hypotension is experiencing an episode of particularly low blood pressure. The man's body has responded by increasing levels of angiotensin II in the bloodstream, a hormone which decreases glomerular filtration rate in the kidneys and contributes to an increase in blood pressure. Which phenomena best describes what has occurred?

Negative feedback

What feedback system provides stability to the stress response?

Negative feedback mechanism

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

Negative feedback mechanism

The client experienced a traumatic event in the past that has caused chronic nightmares in which the event is relived. The client may have increased levels of which of the following?

Norepinephrine

The locus caeruleus (LC) is an area in the brain stem that produces which hormone?

Norepinephrine (NE)

Hypothalamic sensory neurons that promote thirst when stimulated are called:

Osmoreceptors

Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed:

Osmosis

Pressure generated as water moves across a membrane is also known as which of the following?

Osmotic pressure

Vitamin D, officially classified as a vitamin, functions as a hormone in the body. What other hormone is necessary in the body for vitamin D to work?

Parathyroid hormone

Select the stage of general adaptation when the body implements the most effective channels of defense.

Resistance

The nurse enters a client's hospital room and finds the client breathing rapidly, stating, "I must be having a stroke, my fingers are tingling!" Which acid-base balance disorder is this client experiencing due to hyperventilation?

Respiratory alkalosis

Hypernatremia

increased sodium levels above 145 mmol/L serum osmolality greater than 295 mOsm/kg H2O increases ECF tonicity movement out of ICF cellular dehydration increased temp, weakness, disorientation, dilusions, hypotension, tachycardia. give hypotonic solution.

Hypomagnesemia

insufficient amount of magnesium in the extracellular fluid less than 1.3mg/dL 0.65mmol/L

Which unit of measure best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?

mEq/L

A patient has a mineral deficiency that inhibits glucose absorption in the small intestine. Which of the following minerals would the nurse assess for deficiency?

Sodium

The effective circulating volume is the major regulator of water balance in the body. What else does it regulate?

Sodium

The condition of a client with metabolic acidosis from an intestinal fistula is not improving. The pulse is 125 beats/min and the BP 84/56 mm Hg. ABG values are: pH 7.1, HCO3- 18 mEq/L (18 mmol/L), PCO2 57 mm Hg (7.58 kPa). What IV medication should the nurse expect to provide next?

Sodium bicarbonate

Interstitial or tissue hydrostatic pressure

opposes the movement of water out of the capillary

A client with chronic obstructive pulmonary disease (COPD) receives oxygen in the emergency department at a rate of 4 L/min for acute respiratory distress. Later, the nurse finds the client unresponsive with a respiratory rate of 8/minute. What ABG values would the nurse expect to obtain?

pH 7.29, pCO2 67mm Hg, HCO3- 26 mEq/L, pO2 64mm Hg

The nurse caring for a client with metabolic acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic acidosis is improving?

pH has increased

The nurse is caring for a client with metabolic alkalosis. Which of these arterial blood gas results supports this diagnosis?

pH of 7.50 and HCO3 of 45 mEq/L (45 mmol/L)

Edema

palpable swelling produced by an increase in interstitial fluid volume. Factors: 1) Increase capillary filtration pressure 2) Decrease the capillary colloidal pressure 3) Increase capillary permeability 4) Produce obstruction to lymph flow Interstitial volume increased by 2.5-3 L

A client who is a performer expends a tremendous amount of energy while on stage, but his body is not harmed by the added stress. Protection against the harmful effects of stress is primarily a result of:

physiologic reserve.

Respiratory Alkalosis

primary decrease in arterial PCO2 elevation in pH and a decrease in HCO3 caused by hyperventilation

sodium salts

provides 90-93% of ECF solutes

Water

provides 90-93% of the volume of body fluids

capillary colloid osmotic pressure

pulls water back into the capillary

interstitial colloidal osmotic pressure

pulls water out of the capillary into the interstitial spaces

capillary filtration pressure

pushes water out of the capillary into the interstitial spaces

(SIADH) Syndrome of inappropriate Antidiuretic hormone

results from a failure of the negative feedback system that regulates the release and inhibition of ADH continues even when serum osmolality is decreased causing marked water retention and dilutional hyponatremia

A nurse is caring for a client with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is high, and serum osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which problem could the client be diagnosed with?

Syndrome of inappropriate antidiuretic hormone (SIADH)

Metabolic Alkalosis

systemic disorder by increase in serum pH due to a primary excess in HCO3-

A male client with a history of heavy alcohol use has been admitted to the hospital for malnutrition and suspected pancreatitis. The client's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas, but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him?

"The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough.

A female client with a new diagnosis of systemic lupus erythematosus (SLE) has been told that this is an autoimmune disease whereby the immune system is attacking the body's cells and tissue. She knows that she has inflammation and tissue damage. She asks her nurse to explain "What cells in the body are triggering this inflammation?" The nurse responds:

"The lymphocytes that migrate to the brain where they secrete cytokines, which trigger inflammation."

A client is admitted to the emergency department with possible internal bleeding after being involved in an automobile accident. What type of isotonic intravenous (IV) solution does the nurse prepare to infuse?

0.9% NaCl

Body weight consists of what % of body water?

60%

When counseling a group of overweight individuals, the nurse should stress that during parties, the oxidation of alcohol provides how many kilocalorie/gram to one's diet?

7 kcal/g.

The nurse has just received the lab results of a client's calcium level. The nurse identifies a normal calcium level as:

9.0 to 10.5 mg/dL (2.25 mmol/L to 2.63 mmol/L))

The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis.

A 26-year-old female with anxiety who has been hyperventilating

A nurse is assigned to care for a group of patients. Which of the following patients is most likely to be diagnosed with malabsorption syndrome?

A 40-year-old with severe inflammatory bowel disease

Based on assessment results, which hospitalized client is most likely to be experiencing the effects of chronic stress?

A 45-year-old paraplegic who is experiencing delayed wound healing of an ischial ulcer.

Which clients would be most reasonably expected to have the highest basal metabolic rate (BMR), assuming none is obese or malnourished?

A 60-year-old man, 72 in (1.83 m) tall, who is recovering from heart surgery

The client is hospitalized for 4 days with an acute myocardial infarction. After a coronary artery stent is placed, the client is discharged to home in stable condition. This would be an example of which pattern of stress?

Acute time limited

As a nurse prepares to change a client's dressing, the client states that she is afraid that it will be painful. Noting that the client's heart rate and respiratory rate have increased, the nurse adjusts the plan of care to reflect care for a client in which phase of Selye's general adaptation syndrome?

Alarm

Which of the following is a condition that can cause decreased antidiuretic hormone (ADH) level or action?

Alcohol

The physician places his client with liver failure on spironolactone to decrease sodium absorption by the kidney. Which hormone is this medication affecting?

Aldosterone

There are both metabolic and respiratory effects on the acid-base balance in the body. How do metabolic disorders change the pH of the body?

Alter the plasma HCO3-

A client asks the nurse the best way to estimate protein utilization by the body. The best response would be:

By measuring the amount of nitrogen excreted in the urine

The nurse caring for a client with respiratory acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's respiratory acidosis is improving?

CO2 has decreased

When caring for a client in the medical clinic who has tried to lose weight multiple times, the client asks the nurse if she should try a high-protein, very low-calorie restricted diet. The nurse encourages her to seek guidance from the health care provider as these diets may cause which complication?

Cardiac dysrhythmias

In a person with fluid volume deficit, there is a dehydration of brain and nerve cells. What can occur if fluid volume deficit is corrected too rapidly?

Cerebral edema occurs with potentially severe neurologic impairment.

Which clent, when faced with acute stressful situations, would be considered highest risk for becoming noncompliant with his/her medication regimen?

Client with end-stage renal failure experiencing electrolyte imbalances related to having trouble sticking to the prescribed diet

Select the factor that may influence a client's relative risk for development of a stress-related pathologic process.

Conditioning

A previously healthy 42-year-old client was recently diagnosed with hypertension. Select the response that best describes a positive reaction to the acute stress.

Decreasing dietary sodium and fat intake

The nurse is caring for a client with diabetic ketoacidosis. Which assessment finding is characteristic of metabolic acidosis?

Deep and rapid respirations

A nurse is reviewing laboratory values for an older adult client admitted for changes in mental status. The laboratory values are a urine-serum ratio of 4:1 and urine osmolality of 1100 mOsm/kg H2O. Based on these lab results, the nurse anticipates treatment for which problem?

Dehydration

Which medication is the preferred drug for treating chronic diabetes insi

Desmopressin acetate (DDAVP)

For the most part, the stress response is meant to be acute and ongoing.

False

Most physiologic control systems function under positive feedback mechanisms.

False

The clinic nurse is providing teaching for an obese client who expresses the desire to lose weight. Which of these does the nurse teach the client to consume to increase satiety?

Fiber

The nurse is caring for a client with a tumor obstructing the lymphatic system. For which consequence does the nurse assess?

Fluid accumulating in the interstitial spaces distal to the tumor

A client is brought to the emergency department with reports of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. The nurse notifies the physician to obtain orders for which of these problems?

Fluid volume excess

The nurse is caring for a client with left-sided heart failure causing chronic activation of the renin-angiotensin-aldosterone system (RAAS). What is the nurse's priority assessment?

Fluid volume excess

A child is brought to the emergency department an hour after ingesting ethylene glycol. What intervention will minimize toxicity?

Fomepizole

Which of the following measures would likely be rejected as part of a first-line weight loss plan for a client with a BMI of 30.2, type 2 diabetes, and hypertension?

Gastric bypass

After exposure to poison ivy, the client has hives on his trunk and extremities. In an effort to decrease his immune response the practitioner places him on which medication?

Glucocorticoid

A nursing student is learning how to apply the Henderson-Hasselbalch equation for the calculation of pH. What elements must be known to perform this equation? Select all that apply.

HCO3 level CO2 level

The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of:

HCO3−

As part of the intake protocol at an eating disorders clinic, an interview precedes a physical examination. Which of the following questions would a clinician be justified in excluding from an intake interview of a 16 year-old female referred by her pediatrician for the treatment of anorexia nervosa?

Have you had any episodes of shortness of breath in the recent past?"

Parents are concerned that their child may be at risk for the development of childhood obesity. Select the factors that would place a child at risk. Select all that apply.

Heredity Ethnicity Mother had gestational diabetes during pregnancy

A nurse is caring for a client whose serum potassium level is 2.6 mEq/L (2.6 mmol/L). The nurse anticipates which intervention will be prescribed?

IV infusion of 10 mEq potassium chloride in 100-mL normal saline solution over 1 hour times three doses

The nurse is caring for a client with ketoacidosis who is complaining of increasing lethargy and occasional confusion following several weeks of rigid adherence to a carbohydrate-free diet. The nurse understands which phenomenon is most likely occurring?

In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids.

A client with ethylene glycol toxicity is restless, and stating he has flank pain. What intervention should the nurse perform to minimize complications?

Increase IV fluids

The client is receiving chronic glucocorticoid therapy for chronic obstructive pulmonary disease (COPD). Which lab result would the provider expect to see?

Increased blood glucose

What will the nurse assess as the end result of activation of the renin-angiotensin-aldosterone system?

Increased blood pressure

A client who has been awaiting the results of a bone marrow biopsy for several days is experiencing stress as a result of uncertainty and the possibility that abnormal cell growth may be detected. A physical examination and blood work would most likely yield which result?

Increased blood pressure and heart rate; increased antidiuretic hormone (ADH).

A client who has experienced posttraumatic stress disorder (PTSD) tells the nurse he now has "flashbacks" during waking hours or nightmares in which the past traumatic event is relived, often in vivid and frightening detail. What term for this experience will the nurse document in the client's record?

Intrusion

The nurse is caring for a client diagnosed with marasmus. The nurse would expect the client to manifest:

Loss of subcutaneous tissue, stunted growth, protuberant abdomen

A patient informs the nurse that he or she feels as though he or she have a kidney stone again. The patient is on a diet for weight loss and feels as though this may be a contributing factor as it never occurred before going on the diet. Which of the following diets does the nurse suspect the patient may be on?

Low-carbohydrate/high protein

Which systems regulate the pH of body fluids? Select all that apply.

Lungs Bone Kidneys

The nurse is caring for a client with worsening respiratory acidosis. Which of these interventions does the nurse anticipate if the client's condition continues to deteriorate?

Mechanical ventilation

A child accidentally consumes a container of wood alcohol. The ED physician knows that the child is at risk of developing which of the following?

Metabolic acidosis

A nurse is caring for a client with bulimia nervosa who has been admitted to the hospital with weakness, hypotension, and abdominal discomfort. Which types of acid-base imbalance should the nurse assess the client for?

Metabolic acidosis

The nurse is caring for a client with renal failure experiencing shortness of breath and increased respiratory rate. The arterial blood gas reflects a pH of 7.10 and HCO3 level of 18 mEq/L (18 mmol/L). How does the nurse interpret these findings?

Metabolic acidosis

The nurse is reviewing the following lab results of a client diagnosed with renal failure: pH: 7.24 PCO2: 38 mm Hg (5.05 kPa) HCO3:18 mEq/L (18 mmol/L) The nurse would interpret this as:

Metabolic acidosis

The renal control mechanism of restoring the acid-base balance is accomplished through which process?

Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms.

A nurse is educating a group of patients about adequate nutrition. Which of the following should the nurse include when discussing diets that are adequate in calories but deficient in protein?

Patients may be at risk for developing kwashiorkor.

The Olympic athlete is able to increase her cardiac output sevenfold during exercise. This is an example of:

Physiologic reserve

The nurse suspects that a client who had a colon resection 4 days ago, is unable to pass flatus, and has no audible bowel sounds has a paralytic ileus. The nurse recognizes that which abnormal laboratory result is consistent with this problem?

Potassium level of 2.8 mEq/L (2.8 mmol/L)

The parents of a male child who has been exposed to chronic stress are concerned about the long-term effects that may develop. The best response by the nurse would be:

Prolonged stress may lead to suppression of growth hormone."

A patient presents to the clinic with severe edema. Which of the following types of deficiency should be suspected in this patient?

Protein

A client with schizophrenia is admitted to the behavioral health department and is observed drinking copious amounts of water and voiding large amounts of dilute urine. The nurse recognizes this behavior is consistent with which problem?

Psychogenic polydipsia

A client who has just had a "fight-or-flight" reaction asks the nurse what causes the quick changes that they experienced. Which response by the nurse would be considered the best?

Sympathetic Nervous System

When explaining to a client admitted for stress-induced supraventricular tachycardia, the nurse will incorporate which statement about what happens in the body as a result of excess stress?

The corticotrophin-releasing factor stimulates the release of norepinephrine, which is responsible for "fight-or-flight" reaction to stress.

The nurse is teaching a basic nutrition course for the community. Which statement should the nurse include about fat-soluble vitamins?

The fat-soluble vitamins are stored in adipose tissue and may reach toxic levels.

Potassium is the major cation in the body. It plays many important roles, including the excitability of nerves and muscles. Where is this action particularly important?

The liver

The nurse teaches the client with end-stage kidney disease and hyperphosphatemia to take sevelamer HCl, a phosphate binder, with meals. How does the nurse explain the rationale for the timing of this medication?

The medication should be taken at meal time to allow the binding of phosphate."

The nursing student is studying failure to thrive in children. She explains to her peers that which component is a possible cause for failure to thrive?

The prolonged presence of cortisol leads to suppression of growth hormone.

The emergency department nurse evaluates the orientee's understanding of the acute stress response in a trauma client. The nurse knows the orientee understands it when he states:

There is facilitation of neural pathways mediating arousal, alertness, vigilance, cognition and focused attention."

The health care provider reviews the waist-hip ratio of a male. The ratio is 1.0. What interpretation is most accurate for this result?

Upper body obesity

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

Waist/hip circumference

The poison control nurse is helping calm a hysterical mother who called because her child ingested 10 tablets of B-complex vitamins. The mother keeps repeating over and over again, "Is my child is going to die?" Which of these should the nurse convey to the mother?

Water-soluble vitamins are excreted into the urine, making toxicity less likely.

A dietitian is working with a morbidly obese client in an effort to facilitate weight loss. Which of the dietitian's following teaching points about the nature of adipose tissue should be included in the client education?

Your fat cells can be considered to be one large energy-storage organ that also has a role in hormone production.

Hypodipsia

a decrease in the ability to sense thirst commonly associated with lesions in the area of the hypothalamus also in elderly persons

During a humanitarian trip to an underdeveloped country a senior nursing student is assessing a 6-year-old boy who has a protuberant abdomen, dry hair, and wrinkled skin. The child's heart rate is 59 beats per minute, blood pressure 89/50, and temperature 35.1°C. The student should assess the child for:

a diet deficient in both protein and calories.

Diabetes Insipidus

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect (ADH) Unable to concentrate their urine during periods of water restriction Neurogenic or central DI- defect in synthesis or release of ADH Nephrogenic DI- kidneys do not respond to ADH

Hypophosphatemia

below-normal serum concentration of inorganic phosphorus less than 2.5mg/dL 0.81mmol/L

Respiratory Acidosis

decrease in pH caused by an elevation in arterial PCO2 impair alveolar ventilation

Metabolic Acidosis

decreased serum HCO3-, decrease in pH in blood and body tissues as a result of an upset in metabolism increasing respiratory rate

Hypoparathyroidism

deficient PTH secretion, low serum levels of ionized calcium

Hypocalcemia

deficient calcium in the blood less than 8.5 mg/dL 2.1mmol/L ionized levels of Ca++ less than 4.6 mg/dL 1.25mmol/L

Hypokalemia

deficient potassium in the blood below 3.5 mmol/L

Hyponatremia

deficient sodium in the blood less than 135 mEg/L (135 mmol/L) Electrolyte disorder