PATHOLOGY EXAM 3 TEST Prep U 5&6
A client with a history of emphysema is experiencing hypoxemia after a taxing physical therapy appointment. Which physiologic phenomenon will occur as a consequence of hypoxemia?
Increased heart rate
The nurse is assessing a client who states he felt fine all day and then, within 5 minutes, began to feel extremely weak and tired and began having a fever. What do these symptoms indicate that the client may be experiencing?
Influenza
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to:
see the doctor for evaluation immediately.
The nurse is performing a health history for a male client who is having a series of diagnostic tests to determine the presence of squamous cell carcinoma. What question would be most beneficial for the nurse to ask that would correlate with this suspicion?
"Do you have a history of smoking, and if so, how much?"
A client asks the purpose of an exercise stress test. What is the nurse's best response?
"The test is used to measure functional status during stress."
monocytes to macrophages
-monocytes move into tissue and become macrophages, survive months to years, maintain memory so play an important role in chronic inflammation
A client tells the nurse that he is concerned he may be developing chronic bronchitis and asks how the diagnosis is made. The most appropriate information for the nurse to provide would be:
A diagnosis of chronic bronchitis requires a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years.
Erythropoietin
A hormone produced and released by the kidney in response to decreased oxygenation/perfusion and stimulates erythropoiesis which is the production of red blood cells by the bone marrow.
Neutrophils
A type of white blood cell that engulfs invading microbes, 50-60 percent 2/3 move to tissues in 1-3 days
Which client would the nurse recognize as needing to be assessed for orthostatic hypotension?
An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom
The nurse is caring for a client who suffered a massive myocardial infarction and is scheduled for an immediate permanent pacemaker insertion due to severe ischemia and damage to both SA and AV nodes. The nurse would expect which of the following?
Bradycardia with rate of 20-40
Which classification of medications used to self-treat the common cold should be avoided by those with a history of hypertension?
Decongestants they elevate blood pressure and cause systemic vasoconstriction
A diagnosis of tension pneumothorax would be suspected in which physical assessment finding?
Deviated trachea
A client arrives in the ED after an automobile accident. Which clinical manifestations lead the nurse to suspect a pneumothorax? Select all that apply.
Diminished breath sounds over painful chest area Respiratory rate 34. Asymmetrical chest movements, especially on inspiration
A nurse in a nursing home is concerned that a resident may be developing left-sided heart failure. Manifestations of left-sided heart failure would include which symptom?
Dyspnea, cough
When the semilunar valves open it signals the onset of the ejection period. The aortic pressure reflects changes in the ejection of blood from which part of the heart?
Left ventricle
The nurse is teaching a class on reduction of cardiovascular disease. Which action/activity demonstrates an intervention that is cognizant of the modifiable risk factors for hyperlipidemia?
Going for a brisk walk with a friend and talking to him about continuing to exercise regularly
Conditions responding to hematopoietic growth factors
Hematopoietic cells are controlled by cytokines which are growth factors. Can be caused by chemptherapy, aplastic anemia(body doesn't produce enough new blood cells), kidney failure, Aids, hematopoietic neoplasms(tumor), increase stem cells for transplantation, and accelerate cell proliferation after bone marrow graft
end result of coagulation defects
Hereditary disorders: Hemophilia A- factor 8 deficiency bleeding in the joints Hemohilia B- factor 9 deficiency Von Willebrand disease- factor 8 and von willebrand deficiency leads to spontaneous bleeding Acquired disorders- synthesis of clotting factors, vitamin k disorders, intestinal absorption is impaired, impaired gallbladder or liver, can be caused due to medication reducing the amount of normal flora
A client has been diagnosed with an advanced tumor that has invaded the mediastinum. The client would most likely manifest:
Hoarseness and difficulty swallowing
Older adults are very susceptible to pneumonia in all its varieties. The symptoms that older adults exhibit can be very different than those of other age groups who have pneumonia. What signs and symptoms are older adults with pneumonia less likely to experience than people with pneumonia in other age groups?
Marked elevation in temperature
Three days following surgical repair of a hip fracture a client becomes anxious and complains of sudden shortness of breath. What disorder is the client most likely experiencing?
Pulmonary embolism
As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to which complication?
Pulmonary hypertension
The heart is a four-chambered pump. What is the function of the right ventricle?
Pumps blood to the lungs
Red Blood Cell destruction corrilation to bilirubin
RBC's live about 120 days then they are broken down in the liver and iron and amino acids are recycled, Heme molecule is converted to bilirubin and transported to the liver Unconjugated(indirect)-removed and rendered water soluble/pee Conjugated(direct)- elimination in bili(poop) if unable to secrete leads to jaundice
A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis (TB) and has subsequently developed latent tuberculosis infection. Which statement is accurate regarding this nurse?
The nurse is likely asymptomatic.
transfusion reaction
The sensation of heat along the vein where the blood is being infused, Flushing of the face, Urticaria, headache pain in the lumbar area, Chills, fever, constricting pain in the chest, Cramping pain in the abdomen, Nausea, vomiting, Tachycardia, hypotension, dyspnea, STOP THE INFUSION AT FIRST SIGN!
A postoperative client asks, "Why do I have to take all these deep breathing and coughing exercises every hour?" What response by the nurse is the most accurate rationale for this client?
These exercises enhance the spread of surfactant and prevent atelectasis.
A client is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as:
Valvular regurgitation
Preload, the stretch on the heart before contraction, is largely determined by which factor?
Venous blood return
sickle cell anemia
a genetic disorder that causes abnormal hemoglobin in which erythroctyes take on an abnormal curved or "sickle" shape
petechiae
a small red or purple dotc caused by bleeding into the skin.
Disseminated Intravascular Coagulation (DIC)
abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels which uses up all the bodies blood clotting factors causes the body to bleed uncontrollably; causes are cancer, infections, shock, trauma or surgery, and blood conditions
Effect of aging on red blood cells
age associated decline in hematopoietic reserve-reduction in hematopoietic progenitors-reduced production of hematopoietic growth factors-inhibition of erythropoietin-inflammatory cytokines interfere with erythropoietin interaction within its receptors-Hb decreases-RBC production decreases
infectious mononucleosis
an infection caused by the Epstein-Barr virus (EBV) member of the herpes virus family, that is characterized by fever, a sore throat, and enlarged lymph nodes, transmitted by saliva, highest in young adults and addolescents
Platelets (thrombocytes)(megakaryocytes)
blood cell fragments that help with blood clotting
primary thrombocythemia
bone marrow makes too many platelets, leads to blood not being able to clot, headache, chest pain, numbness, weakness, bleeding
Valvular disease especially aortic disease
can cause increased pressure needed to pump across a stenosed valve, or the backflow of blood during regurgitation or insufficient valve.
The nurse is monitoring trends in the client's arterial blood gases and recognizes that changes in ventilation will result from which of the following? Select all that apply.
carbon dioxide, ph, oxygen
Information obtained from a CBC complete blood count
counts cells that make up your blood- red blood cells, white blood cells, and platelets Hemoglobin which is the oxygen-carrying protein in red blood cells hematocrit which is the portion of red blood cells to liquid or platelets in the blood
Intrinsic pathway of coagulation
damage to a vessel (inside)
Things that cause bleeding
decreased number of circulating platelets, impaired platelet function
An adult client recently had a cerebrovascular accident that resulted in dysphagia. What is the nurse's priority action to prevent the aspiration of gastric contents?
elevate the head of the bed
aplastic anemia
failure of blood cell production in the bone marrow, caused by exposure to radiation and chemicals/toxins, loss of all types of blood cells, shortened life span of leukocytes and platelets, results in lack of cells
extrinsic pathway of coagulation
from injury to tissue (outside)
Globulins
gamma globulins constitute antibodies of the immune system
What is the most important factor in myocardial oxygen demand?
heart rate
deoxygenated blood
in the pulmonary arteries
Hodkin's Lymphoma
malignant lymphoproliferative disorder of uncertain origin, malignant cells are Reed-Sternberg, bimodal age incidence 15-35, over 50 Stage A: lack constitutional symptoms firm non-tender lymph nodes Stage B: significant weight loss, fevers, pruritus, or night sweats Advanced stage: Fatigue and anemia, liver, lungs, digestive tract, and CNS may be involved, Bigger the stage number worse it is radiation or combination chemotherapy
TB- only look at the pulmonary symptoms
tired/lethargy, night sweats, rusty colored sputum, dyspnea/shortness of breath.
Thrombocytosis
too many platelets, myeloproliferative(bone marrow) disorder, chronic inflammatory conditions, polycythemia vera(too many red blood cells), and myelogenous leukemia(myleoid cells growth)
Function of red blood cells
transport oxygen and carbon dioxide, can carry 4 oxygens, red bone marrow is where they are produced
When educating a college student who lives in a crowded apartment and was recently diagnosed with tuberculosis, the school nurse will emphasize which treatment plan?
"To destroy this bacterium, you must strictly adhere to a long-term drug regimen of several medications."
A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which teaching point would be most accurate to convey to the client?
"Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."
Lymphocytes
1/3 20-30 percent, function in lymph nodes or spleen, b lymphocytes mature to plasmacytes, t helper cd4, cytotoxic t cells cd8, natural killer cells
Common results of respiratory failure are hypoxemia and:
Hypercapnia
Atherosclerosis begins in an insidious manner with symptoms becoming apparent as long as 20 to 40 years after the onset of the disease. Although an exact etiology of the disease has not been identified, epidemiologic studies have shown that there are predisposing risk factors to this disease. What is the major risk factor for developing atherosclerosis?
Hypercholesterolemia
The student attends a health fair and has his serum cholesterol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?
It is believed to play an active role in the pathogenesis of the atherosclerotic lesion.
ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?
Most ECG-detected ischemic events are clinically silent.
A client has developed cardiogenic shock. The most frequent cause of this type of shock is:
Myocardial infarction(heart attack)
Which of the following are characteristic signs of acute arterial embolism?
Pallor, pulselessness, and pain
A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250 mL of fluid in the pericardial cavity. Which disease should the nurse suspect this client is suffering?
Pericardial effusion
Microcytic
Smaller than normal cells
Role of the spleen in the management of blood cells; how the lose of splenic function would affect the types and numbers of circulating blood cells
Spleen breaks down red blood cells, if not we wouldn't be able to recycle iron and emino acids, and bilirubin wouldn't get to the liver to be eliminated and would cause jaundice
A client's blood pressure is persistently in the range of 130 to 135 mm Hg systolic and 85 to 88 mm Hg diastolic. How will the nurse classify this client's blood pressure?
Stage 1 hypertension
An IV drug abuser walks into the ED telling the nurse, "I am sick." The client looks feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The assessment reveals a loud murmur. An echocardiogram was ordered that shows a large vegetation growing on the client's mitral valve. The client is admitted to ICU. The nurse will be assessing this client for which possible life-threatening complication?
Systemic emboli, especially to brain.
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.
The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues.
Folate (folic acid)
The decrease of neural tube defects such as Spina Bifida has been in large measure due to the increase of the use of this B Vitamin by pregnant women; mainly effects pregnant women
Effect of coagulation on liver
The liver produces the coagulation factors so if the liver cannot synthesize the coagulation factors there will be increased bleeding, if the liver produces too many there could be increased clotting
Things that result in hypercoagulabilty
atherosclerosis(hardening of arteries), diabetes, smoking, elevated blood lipids and cholesteral, pregnancy, hormone changes/oral contracetives, post-surgery immobility, congestive heart fialure, malignant diseases(cancer)
iron deficiency anemia
anemia caused by inadequate iron intake, blood loss, poor diet; spoon shaped nails(koilonychia), red smooth tongue, sores in the corner of mouth, microcytic hypochromic cells( small pale), anyone of any age can be affected
hemolytic anemia
anemia caused by the destruction of red blood cells, normocytic normochromic cells (normal color and size)
Hypertension resulting in heart failure is due to
hypertrophy of the left ventricle. The afterload (systemic vascular resistance) is greater resulting in the left ventricle having to work harder to pump against the resistance in the aorta, this does mean there is increased pressure needed in systole.
gas exchange in lungs
remember your acid-base balance, mainly that any decrease in respirations will result in acidosis, any increase in respirations may result in alkalosis. Also review that the main drive to breathe is an increase in CO2 and/or the hydrogen ion (H+) in the central chemoreceptors will trigger an increase in breathing, EXCEPT when there is a chronic increase in these such as in COPD and the central chemoreceptors become used to the high numbers and do not respond as they should. At that time the peripheral chemoreceptors will take over, but they respond to low oxygenation. If we give that person too much O2 they will lose the drive to breathe. We can override that with putting them on a ventilator and not having to worry about their drive to breathe.
Intravascular hemolysis
result of complement fixation in transfusion reactions, mechanical injury or toxic factors
Vitamin B-12 (Cobalamin)
requires intrinsic factors from the stomach parietal cells to absorb from the gut(pernicious anemia), needed for myelin maintenance, parasthesia, loss of vibratory and position sense, beefy red tongue
STEMI
ST elevation myocardial infarction Heart attack when blockage in the heart occurs
Blood flow through the heart
SVC --> Rt atria --> Tricuspid --> Rt ventricle --> Pulmonic valve --> Lungs --> Lt atria --> Mitral valve --> Lt ventricle --> aortic valve --> aorta --> Body
Red Blood cell reticulocytes
immature red blood cell, reticulocyte index can let us know if the bone marrow is producing enough red blood cells
oxygenated blood
in the pulmonary veins
Intrinsic factor in the absorption of vitamin b 12 and where its produced
in the stomach lining we have parietal cells that produce intrisic factors to absorb vitamin b 12, if not intrinsic factors vitamin b 12 can't be absorbed
Leukocytosis
increase in the number of white blood cells
Hypercoagulability
increased ability of the blood to clot or thrombus formation; Arterial thrombi- conditions that produce turbulent blood flow and platelet adherence Venous thrombi- conditions that cause stasis of blood flow with increased concentrations of coagulation factors
Hyperchromic
increased concentration of hemoglobin, excessive/darker color
systole
is cardiac contractions or Depolarization
Diastole
is when the heart is resting or repolarization.
macrocytic
larger than normal cell size
Thrombocytopenia
less than 150,000, results from a decrease in platelet production, spleen takes over many, or decreased platelet survival
An 80-year-old male client arrives for his yearly physical without any complaints, and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder, the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:
many people live with atrial fibrillation without even knowing they have it.
ANP and BNP
natriuretic peptides, these are produced when the atria and/or ventricles of the heart are being stretched (usually secondary to increased volume -preload). The one we can measure and actually can give the person an IV preparation of this is BNP. Looking at the word, natri means sodium, uretic means diuretic (or increased fluid excretion). These work by causing excretion of sodium through the kidneys and remember that water follows solute (sodium), so we increase the urine output and thus decrease preload.
Normochromic
normal RBC color
Normocytic
normal cell size
nonhodgkins lymphoma
not in the node it can travel from outside to inside it orginates at extra nodal sites and spreads to anatomically contagious nodes, reed sternberg cells aren't present; adjuvant radiation treatment, and monoclonal antibodies
Extravacular hemolysis
occurs when red blood cells become less deformable, making it difficult to transverse the splenic sinusoids
hypochromic
pale in color, as in red blood cells when hemoglobin is deficient
Correlation of atherosclerotic plaques and platelets. Atherosclerosis is the hardening and thickening of your arteries
plaques distrub the blood flow causing endothelial damage which promotes platletes to stick to the vessel walls
Fibrinogen
plasma protein that is converted to fibrin in the clotting process
What is needed for blood clotting
presence of platelets, von willebrand facto, clotting factors synthesized in the liver using vitamin k, requires vitamin k and calcium
Hematopoiesis
production of blood cells from the pluriotent stem cels in the bone marrow
Albumin
protein in blood; maintains the proper amount of water in the blood
purpura
red-purple bruises under the skin due to blood in tissues from breaks in blood vessels
A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?
right sided heart failure
PAD (peripheral arterial disease)
that it decreases flow of blood so that limbs, organs, tissues can become hypoxic and ischemic, which can result in decreased function or death of the limb, organ, or tissue. Pistol shot (acute onset), Pallor (followed by cyanosis, mottling), Polar (cold) (often distinct levels), Pulselessness (below lesion), Pain (intense), Paresthesia (loss of sensory and motor reflexes), Paralysis
function of plasma components in blood
transport red blood cells which trasport gases, aid in body defenses, and prevent blood loss(platelets)
PAD (peripheral arterial disease)
understand that it decreases flow of blood so that limbs, organs, tissues can become hypoxic and ischemic, which can result in decreased function or death of the limb, organ, or tissue