Pathopharm II Exam I

the osmotic pressure gradient draws water out of the intracellular space, increasing extracellular fluid volume

Hypertonic solution

decrease membrane potential threshold > hyper excitability of neuromuscular cells

Hypocalcemia

Hemophilia

X linked

Furosemide works on..

Ascending limb of Henle's loop

Increased neuromuscular excitability from excessive amount of acetylcholine

Hypomagnesemia

Insomnia Hyperactive reflexes Muscle cramps Muscle twitching, grimacing Positive Ckvostek sign Positive Trousseau sign

Hypomagnesemia

The nurse is caring for a patient who has had severe vomiting. The patient's serum sodium level is 130 mEq/L. The nurse will expect the patient's provider to order which treatment? A. Intravenous normal saline 0.9% B. Diuretic therapy C. Oral sodium supplements D. Intravenous hypertonic 5% saline

A. Intravenous normal saline 0.9% The patients sodium level is mildly low and they have been vomiting. They are most likely hyponatremic related to the vomiting. The sodium level is not so severe that sodium needs replacing at this time. Normal saline is the appropriate fluid replacement.

A person's genotype can be best described as: A. The genetic makeup of an individual B. Traits that are observable or apparent C. Traits that are inherited in a recessive pattern D. Traits that are inherited in a dominant pattern

A. The genetic makeup of an individual

Lethargy Confusion Diminished reflexes Seizures

Hyponatremia

Hypertonic Solution

-Have a higher solute concentration than isotonic solutions -Causes an unequal pressure gradient between the inside and outside of the cells -The osmotic pressure gradient draws water out of the intracellular space, increasing the extracellular fluid volume -Also used as volume expanders -May be prescribed for patients with severe hyponatremia or hypoglycemia

Saline Excess Etiologies

-Increase addition/retention of isotonic solutions -Excessive IV solution -Increased aldosterone secretion -Chronic heart failure

Aldosterone

-Increased Na and H2O absorption in the kidney -Urine volume decreases, stable concentration -Vasculature volume increases, stable concentration "salt water hormone"

Hyponatremia clinical manifestations

-Lethargy -Confusion -decreased reflexes -Seizures -Coma -Cerebral herniation -Dilutional -Weight gain -Edema -JVD -Hypotension, tachycardia, decreased urine output

Isotonic solutions

-Normal saline (0.9% NaCl) -D5W -Lactated ringers solution -Ringers solution

Electrolyte Excretion

-Occurs through urine, feces, and sweat -Influenced by hormones -Other factors: -Medications (potassium wasting) -Rate of renal tubular fluid flow

Saline Excess clinical manifestations

-Sudden weight gain -Bounding pulse -JVD -Edema -Crackles -Dyspnea/orthopnea -Frothy sputum (pulmonary edema) -Confusion -Convulsions -Weakness -Muscle twitching

Saline Deficit Clinical Manifestations

-Sudden weight loss -Postural hypotension -Oliguria -Hypovolemic shock > death -Flat neck veins -Decreased skin tutor -Dry oran mucosa -Hard stools -Soft, sunken eyeballs

Saline Excess Treatment implications

-Treat etiology -Diuretic use -Na/fluid restriction

Hyponatremia treatment implications

-Treat etiology -H20 restriction -Na tablets (make sure it doesn't go too fast, monitor consciousness of pt)

Antidiuretic Hormone (ADH)

-Vasopressin -Brings BP up -Reabsorption of H2O into the kidney -Urine volume decreases, concentration increases -Vasculature volume increases, concentration decreases "tap water hormone"

Normal Sodium range

135-145 MEQ/L

Sodium Chloride

3% or 5% Hypertonic solution Raise the sodium level in the bloodstream, osmosis comes into play, removing fluid from the intracellular space, and shifting it into the intravascular and interstitial spaces -Solutions are highly hypertonic and should be used only in critical situations to treat hyponatremia -Give slowly and cautiously to avoid intravascular fluid volume overload and pulmonary edema. We are worried about the brain, continuously monitor them.

Furosemide onset

60 minute (oral) 5 minute (IV)

Characteristics of X-linked recessive disorders include which of the following? A) All daughters of affected fathers are carriers. B) Boys and girls are equally affected. C) The son of a carrier mother has a 25% chance of being affected. D) Affected fathers transmit the gene to all of their sons.

A) All daughters of affected fathers are carriers.

Males are more likely than females to be affected by A) X-linked disorders. B) autosomal dominant disorders. C) autosomal recessive disorders. D) chromosomal nondisjunction disorders.

A) X-linked disorders.

Red-green color blindness shows X-linked recessive inheritance. Assume "X" is normal, "X1" is recessive for the trait, and "Y" is normal. Then, an individual with the genotype "XX1" will be a: A) normal female and a carrier. B) color-blind male. C) normal female and not a carrier. D) normal male.

A) normal female and a carrier.

A couple seeks counseling about the risk of their child developing Hemophilia A. The man is not affected with Hemophilia A. Upon testing the woman is found to be a carrier of Hemophilia A. Which of the following is true? Select all that apply A. Any female offspring have a 50% of being a carrier. B. The male and female offspring will be at the same risk for being affected. C. Any female offspring have a 100% chance of being affected. D. Any male offspring have a 50% chance of being affected. E. No female offspring can be affected.

A, D, E Any female offspring have a 50% of being a carrier. Any male offspring have a 50% chance of being affected. No female offspring can be affected.

A 19-year-old male presents to his primary care provider reporting restlessness, muscle cramping, and diarrhea. Lab tests reveal that he is hyperkalemic. Which of the following could have caused his condition? A. Acidosis B. Insulin secretion C. Diuretic use D. Primary hyperaldosteronism

A. Acidosis During acute acidosis, hydrogen ions accumulate in the ICF and pushes potassium out of the cells in the ECF (serum potassium), causing hyperkalemia. Primary hyperaldosteronism and potassium wasting diuretics would cause serum potassium levels to decrease, not increase. Insulin secretion helps push potassium into the cells and would lower serum potassium levels.

Which of these conditions follows a multifactorial pattern of inheritance? A. Coronary artery disease B. Down syndrome C. Marfan syndrome D. Tay-Sachs disease

A. Coronary artery disease

The nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor to a patient who has hypertension. The nurse notes peripheral edema and swelling of the patient's lips. The patient has a blood pressure of 160/80 mm Hg and a heart rate of 76 beats per minute. What is the nurse's next action? A. Hold the dose and notify the provider of a hypersensitivity reaction. B. Request an order for serum electrolytes and renal function tests. C. Notify the provider and request an order for a diuretic medication. D. Administer the dose and observe carefully for hypotension.

A. Hold the dose and notify the provider of a hypersensitivity reaction. The peripheral edema and swelling of patient's lips are signs of a possible hypersensitivity reaction to the medication. The medication should be held and the health care provider notified.

Which clinical manifestations might be present if the serum sodium is 131 mEq/L? A. confusion, lethargy, coma, and perhaps seizures B. thirst, dry mucous membranes, and diarrhea C. weak pulse, low blood pressure, and increased heart rate D. cardiac dysrhythmias, paresthesias, and muscle weakness

A. confusion, lethargy, coma, and perhaps seizures Clinical manifestations of hyponatremia include confusion, lethargy, coma, and perhaps seizures, as they are manifestations of CNS dysfunction. Weak pulse, low blood pressure, and increased heart rate are characteristic of clinical dehydration. Hyponatremia does not cause thirst, dry mucous membranes, and diarrhea. Cardiac dysrhythmias, paresthesias, and muscle weakness are manifestations of electrolyte imbalances.

The person at highest risk for developing hypercalcemis is a person who A. takes thiazide diuretics. B. has low vitamin D levels. C. has frequent emesis. D. has carpal spasms.

A. takes thiazide diuretics. Hypercalcemias develop in those who take thiazide diuretics because they cause the body to reatin calcium. Low vitamin D levels is associated with hypocalcemia. Carpal spasms is a clinical manifestations of hypocalcemia. Frequent emesis leads to hypophosphatemia, hypomagnesemia and hypokalemia.

Clinical manifestations of extracellular fluid volume deficit (hypovolemia) include A. weak pulse, low blood pressure, and increased heart rate. B. cardiac dysrhythmias, paresthesias, and muscle weakness. C. thirst, dry mucous membranes, and diarrhea. D. confusion, lethargy, coma, and perhaps seizures.

A. weak pulse, low blood pressure, and increased heart rate. Clinical manifestations of extracellular fluid volume deficit include weak pulse, low blood pressure, and increased heart rate. Extracellular fluid volume deficit does not cause diarrhea. Confusion, lethargy, coma, and perhaps seizures are associated with osmolality imbalances such as hyponatremia. Cardiac dysrhythmias, paresthesias, and muscle weakness are manifestations of electrolyte imbalances.

A nurse is preparing to assist a nursing student in administering intravenous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the planof care for this patient. Which statement by the student indicates a need for further teaching? a."I will check to see when the last dose of the beta blocker was given." b."I will monitor vital signs closely to assess for hypotension." c."I will monitor the heart rate frequently to assess for reflex tachycardia." d."I will prepare to administer intravenous norepinephrine if necessary."

ANS C: "I will monitor the heart rate frequently to assess for reflex tachycardia."

A nurse is teaching a patient who will begin taking verapamil (Calan) for hypertension about the drug's side effects. Which statement by the patient indicates understanding of the teaching? a."I may become constipated, so I should increase fluids and fiber." b."I may experience a rapid heart rate as a result of taking this drug." c."I may have swelling of my hands and feet, but this will subside." d."I may need to increase my digoxin dose while taking this drug."

ANS. A Constipation is common with verapamil and can be minimized by increasing dietary fiber and fluids. Verapamil lowers the heart rate. Peripheral edema may occur secondary to vasodilation, and patients should notify their prescriber if this occurs, because the prescriber may use diuretics to treat the condition. Verapamil and digoxin have similar cardiac effects; also, verapamil may increase plasma levels of digoxin by as much as 60%, so digoxin doses may need to be reduced.

A patient is being treated for shock after a motor vehicle accident. The provider orders 6% dextran 75 to be given intravenously. The nurse should expect which outcome as the result of this infusion? a. Decreased urine output b. Improved blood oxygenation c. Increased interstitial fluid d. Stabilization of heart rate and blood pressure

ANS. D d. Stabilization of heart rate and blood pressure

The nurse is caring for a patient who has a heart rate of 98 beats per minute and a blood pressure of 82/58 mm Hg. The patient is lethargic, is complaining of muscle weakness, and has had gastroenteritis for several days. Based on this patient's vital signs, which sodium value would the nurse expect? a. 126 mEq/L b. 140 mEq/L c. 145 mEq/L d. 158 mEq/L

ANS: A 126 mEq/L Patients who are hyponatremic will have tachycardia and hypotension along with lethargy and muscle weakness. The normal range for serum sodium is 135 mEq/L to 145 mEq/L; a serum sodium level of 126 mEq/L would be considered hyponatremic.

A patient who has been taking an antihypertensive medication for several years is recovering from a myocardial infarction. The prescriber changes the patient's medication to an ACE inhibitor. The patient asks the nurse why a new drug is necessary. What is the nurse's response? a."ACE inhibitors can prevent or reverse pathologic changes in the heart's structure." b."ACE inhibitors help lower LDL cholesterol and raise HDL cholesterol." c."ACE inhibitors increase venous return to the heart, improving cardiac output." d."ACE inhibitors regulate electrolytes that affect the cardiac rhythm."

ANS: A ACE inhibitors have many advantages over other antihypertensive medications, the most important of which is their ability to prevent or reverse pathologic changes in the heart and reduce the risk of cardiac mortality caused by hypertension. They are useful in patients with high low-density lipoprotein (LDL) or low high-density lipoprotein (HDL) cholesterol, but they do not directly affect this comorbidity. They reduce venous return to the heart, thereby

A patient with volume overload begins taking a thiazide diuretic. The nurse will tell the patient to expect which outcome when taking this drug? a.Improved exercise tolerance b.Increased cardiac output c.Prevention of cardiac remodeling d.Prolonged survival

ANS: A Diuretics help reduce fluid volume overload which, by reducing pulmonary edema, can improve exercise tolerance. Diuretics do not improve cardiac output. ACE inhibitors are used to prevent cardiac remodeling and to improve long-term survival.

A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha-blocking agent to be given preoperatively. What does the nurse understand about this agent? a. It is ordered to prevent perioperative hypertensive crisis. b. It prevents secretion of catecholamines by the adrenal tumor. c. It reduces contraction of smooth muscles in the adrenal medulla. d. It is given chronically after the surgery to prevent hypertension

ANS: A Manipulation of the adrenal tumor in patients with pheochromocytoma can cause a massive catecholamine release. Alpha-adrenergic antagonists are given to reduce the risk of acute hypertension during surgery. These agents do not prevent secretion of catecholamines; they block catecholamine receptor sites. They do not act on the tissue of the adrenal medulla. They are given chronically in patients who have inoperable tumors

A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do? a.Instruct the patient not to get up without assistance. b.Make sure the patient takes a potassium supplement. c.Report the presence of a dry cough to the prescriber. d.Request an order for a diuretic to counter the side effects of the ACE inhibitor

ANS: A Severe hypotension can result with the first dose of an ACE inhibitor. The patient should be discouraged from getting up without assistance. Potassium supplements are contraindicated. Adry cough is an expected side effect that eventually may cause a patient to discontinue the drug; however, it is not a contraindication to treatment. Diuretics can exacerbate hypotension and should be discontinued temporarily when a patient starts an ACE inhibitor.

A patient with Stage C heart failure (HF) who has been taking an ACE inhibitor, a beta blocker, and a diuretic begins to have increased dyspnea, weight gain, and decreased urine output. The provider orders spironolactone (Aldactone). The nurse will make sure that the patient: a.does not take potassium supplements. b.monitors for a decreased heart rate. c.takes extra fluids. d.uses a salt substitute instead of salt

ANS: A Spironolactone is added to therapy for patients with worsening symptoms of HF. Because spironolactone is a potassium-sparing diuretic, patients should not take supplemental potassium. Patients taking digoxin need to monitor their heart rate. Extra fluids are not indicated. Salt substitutes contain potassium

The potassium-sparing diuretic spironolactone (Aldactone) prolongs survival and improves heart failure symptoms by which mechanism? a.Blocking aldosterone receptors b.Increasing diuresis c.Reducing venous pressure d.Reducing afterload

ANS: A Spironolactone prolongs survival in patients with HF primarily by blocking receptors for aldosterone. Spironolactone cause only minimal diuresis. Spironolactone does not reduce afterload, and it does not reduce venous pressure enough to prolong survival, because it causesonly minimal diuresis.

The nurse is caring for a patient who is receiving isotonic intravenous (IV) fluids at an infusion rate of 125 mL/hour. The nurse performs an assessment and notes a heart rate of 102 beats per minute, a blood pressure of 160/85 mm Hg, and crackles auscultated in both lungs. Which action will the nurse take? a. Decrease the IV fluid rate and notify the provider. b. Increase the IV fluid rate and notify the provider. c. Request an order for a colloidal IV solution. d. Request an order for a hypertonic IV solution

ANS: A The patient shows signs of fluid volume excess, so the nurse should slow the IV fluid rate and notify the provider. Increasing the rate would compound the problem. Colloidal and hypertonic fluids would pull more fluids into the intravascular space and compound the problem.

A patient will begin taking propranolol (Inderal) for hypertension. Which statement by the nurse is important when teaching this patient about the medication? a. "Check your hands and feet for swelling and report that to your provider." b. "It is safe to take this medication with a calcium channel blocker." c. "Stop taking the drug if you become short of breath." d. "Take your pulse and do not take the medication if your heart rate is fast."

ANS: A Patients taking propranolol can develop heart failure because of the suppression in myocardial contractility. Patients should be taught to watch for signs, which include shortness of breath, night coughs, and swelling of the extremities. Use of these agents with calcium channel blockers is contraindicated, because the effects are identical and excessive cardiosuppression can occur. Shortness of breath should be reported to the provider, but abrupt cessation of the drug can cause rebound cardiac excitability. Propranolol reduces the heart rate and should not be given if the pulse is less than 60 beats per minute

The nurse is administering intravenous fluids to a patient who is dehydrated. On the second day of care, the patient's weight is increased by 2.25 pounds. The nurse would expect that the patient's fluid intake has a. equaled urine output. b. exceeded urine output by 1 L. c. exceeded urine output by 2.5 L. d. exceeded urine output by 3 L

ANS: B A weight gain of 1 kg, or 2.2 to 2.5 lb, is equivalent to 1 L of fluid

The fraction of total body water (TBW) volume contained in the intracellular space in adults is a. three-fourths. b. two-thirds. c. one-half. d. one-third

ANS: B Approximately two-thirds of TBW is contained inside the cells. Two-thirds, not three-fourths, of TBW is contained inside the cells. Two-thirds, not one-half, of TBW is contained inside the cells. One-third of the TBW is extracellular in adults

When the nurse is teaching the staff about X-linked recessive disorders, which information should the nurse include? (Select all that apply.) a. The trait is seen much more often in females than in males. b. The trait is never transmitted from father to son. c. The gene can be transmitted through a series of carrier females. d. The gene is passed from an affected father to all his daughters. e. The trait never skips generations.

ANS: B, C, D The principles of X-linked recessive inheritance include: the trait is seen much more often in males than in females; the trait is never transmitted from father to son; the gene can be transmitted through a series of carrier females; the gene is passed from an affected father to all his daughters, who, as phenotypically normal carriers, transmit it to approximately half their sons, who are affected. X-linked recessive disorders can skip generations since it is a 1 in 4 chance.

Marfans

Autosomal dominant

Sickle Cell anemia

Autosomal recessive

A nurse is caring for a newborn 1 day after delivery. The infant's mother used betaxolol during pregnancy. The nurse will expect to monitor this infant for which condition? a. Hyperglycemia b. Hyperthyroidism c. Respiratory distress d. Tachycardia

ANS: C Use of beta blockers during pregnancy can affect a newborn for several days after birth. Newborns are at risk for bradycardia, respiratory distress, and hypoglycemia. Hyperglycemia, hyperthyroidism, and tachycardia are not expected residual effects

Abnormalities in intracellular regulation of enzyme activity and cellular production of ATP are associated with a. hyponatremia. b. hypocalcemia. c. hypophosphatemia. d. hypokalemia.

ANS: C Phosphate is an important component of ATP. Hypophosphatemia results in decreased ATP to cells. Hyponatremia, hypocalcemia, and hypokalemia do not affect ATP production

A 50-year-old male was recently diagnosed with Huntington disease. Transmission of this disease is associated with: a. Penetrance b. Recurrence risk c. Expressivity d. Delayed age of onset

ANS: D A key feature of Huntington disease is its delayed age of onset such that symptoms are not seen until 40 years of age or later.

A patient with hypertension is prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse reviewing this patient's chart before administering the medication will be most concerned about which other disease process? a.Bronchial asthma b.Coronary artery disease c.Diabetes mellitus d.Renal artery stenosis

ANS: D ACE inhibitors can cause severe renal insufficiency in patients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney. Bronchial asthma, coronary artery disease, and diabetes mellitus are not comorbidities that are contraindications to treatment with an ACE inhibitor.

When a patient asks what causes cystic fibrosis, how should the nurse respond? Cystic fibrosis is caused by an _____ gene. a. X-linked dominant b. X-linked recessive c. Autosomal dominant d. Autosomal recessive

ANS: D Cystic fibrosis is an autosomal recessive disorder. Cystic fibrosis is not X linked, but autosomal. Cystic fibrosis is not X linked, but recessive. Cystic fibrosis is not dominant.

The nurse is caring for a newly admitted patient who will receive digoxin to treat a cardiac dysrhythmia. The patient takes hydrochlorothiazide (HydroDIURIL) and reports regular use of over-the-counter laxatives. Before administering the first dose of digoxin, the nurse will review the patient's electrolytes with careful attention to the levels of which electrolytes? a. Calcium and magnesium b. Sodium and calcium c. Potassium and chloride d. Potassium and magnesium

ANS: D Hypomagnesemia, like hypokalemia, enhances the action of digitalis and causes digitalis toxicity. Laxatives and diuretics can deplete both of these electrolytes

A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate: a.complete blood count. b.ejection fraction. c.maximal exercise capacity. d.serum electrolyte levels

ANS: D Patients taking thiazide diuretics can develop hypokalemia, which can increase the risk for dysrhythmias; therefore, the serum electrolyte levels should be monitored closely. A complete blood count is not recommended. This patient is taking the drugs recommended for patients with Stage C heart failure; although the patient's quality of life and ability to participate in activities should be monitored, routine measurement of the ejection fraction and maximal exercise capacity is not recommended

A patient has a blood pressure of 135/85 mm Hg on three separate occasions. The nurse understands that this patient should be treated with a. a beta blocker. b. a diuretic and a beta blocker. c. a diuretic. d. lifestyle changes.

ANS: D Prehypertension is defined as a systolic pressure of 120 to 139 and a diastolic pressure between 80 and 89. Drug therapy is recommended if the blood pressure is greater than 20/10 over the goal, which would be140/90. Prehypertension is generally treated first with lifestyle changes.

A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take? a.Withhold the drug for an hour and reassess the level. b.Withhold the drug and notify the prescriber immediately. c.Administer Digibind to counteract the toxicity. d.Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.

ANS: D The optimum plasma digoxin range is 0.5 to 0.8 ng/mL. The patient's pulse should be checkedbefore administration, as always, and the digoxin should be administered. The digoxin does not have to be withheld, nor does the prescriber need to be notified. If the digoxin level is demonstrating a trend of increasing, the issue should be discussed in rounds. Digibind is not indicated, because the digoxin level is therapeutic

The genetic code is transmitted to offspring in discrete, independent units that are called: A) chromosomes. B) genes. C) gametes. D) nucleosomes.

B) genes.

The condition called trisomy results from a(n): A) mistake in mitosis called nondisjunction. B) mistake in meiosis called nondisjunction. C) abnormality in a single gene. D) genetic predisposition.

B) mistake in meiosis called nondisjunction.

A patient is taking a beta-adrenergic antagonist medication for angina pectoris and asks the nurse how the drug works to relieve the discomfort associated with this condition. Which statement by the patient after the nurse's teaching indicates understanding of the drug's effects? A. "It causes bronchodilation, which increases oxygen flow" B. "It helps reduce the heart's oxygen need" C. "It improves blood flow to the heart" D. "It increases cardiac output"

B. "It helps reduce the heart's oxygen need" Blockade of beta1 receptors in the heart recedes cardiac work by reducing the heart rate, the force of the contraction and the velocity of impulse conduction through the AC node. Beta blockers result in bronchoconstriction, not bronchodilation. They do not increase blood flow to the heart. Cardiac output is decreased, not increased.

A child is born with blue eyes (bb). The child's mother has blue eyes and the father has brown eyes. Which of the following represents the father? A. bb B. Bb C. BB D. Bbb

B. Bb

The nurse is caring for an 80-year-old patient who has just begun taking a thiazide diuretic to treat hypertension. What is an important aspect of care for this patient? A. Providing a low potassium diet B. Initiating a fall risk protocol C. Encouraging increased fluid intake D. Increasing activity and exercise

B. Initiating a fall risk protocol An 80 year old patient will need to understand that they will urinate more frequently and nurses need to be aware that this could increase the risk for falls. Thiazide diuretics are potassium wasting so patients may need to increase their dietary potassium.

To express a polygenic trait: A. Genes must interact with the environment. B. Several genes must act together. C. Multiple mutations must occur in the same family. D. Penetrance must occur.

B. Several genes must act together.

A patient asks the nurse about taking calcium supplements to avoid hypocalcemia. The nurse will suggest that the patient follow which instruction? A. Take calcium with antacids to reduce stomach upset. B. Take a calcium and vitamin D combination supplement. C. Use aspirin instead of acetaminophen when taking calcium. D. Take calcium along with phosphorus to improve absorption.

B. Take a calcium and vitamin D combination supplement. Vitamin D must taken along with calcium so that calcium can be absorbed.

A person's phenotype can be best described as: A. The genetic make up of an individual B. Traits that are observable or apparent C. Traits that are inherited in a recessive pattern D. Traits that are inherited in a dominant pattern

B. Traits that are observable or apparent

The nurse for a patient with a serum magnesium level of 1.2mg/dL tells the patient that this lab value is likely due to A. diarrhea B. chronic alcoholism C. oliguric kidney injury D. dehydration

B. chronic alcoholism Hypomagnesemia commonly occurs as a result of chronic alcoholism. Oliguric renal failure and clinical dehydration reduce magnesium excretion. Committing, not diarrhea, would lead to hypomagnesemia.

Genetic diseases that follow predictable patterns of inheritance usually affect A) chromosomal structure. B) chromosomal number. C) single genes. D) sex chromosomes.

C) single genes.

A patient has heart failure and is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart and vessels. The nurse expects the provider to order which medication to counter this development? a. Direct renin inhibitor (DRI) b. Angiotensin II receptor blocker (ARB) c. Aldosterone antagonist d. Beta blocker

C. Aldosterone antagonist Aldosterone antagonists are added to therapy for patients with worsening symptoms of HF. Aldosterone promotes myocardial remodeling and myocardial fibrosis, so aldosterone antagonists can help with this symptom. ARBs are given for patients who do not tolerate ACE inhibitors. Beta blockers do not prevent fibrotic changes. DRIs are not widely used.

A nurse is teaching nursing students about the use of alpha-adrenergic antagonist. Which statement by the student indicates the need for further teaching? A) Alpha-adrenergic antagonist block alpha 1 receptors on arterioles and veins B) Dilation of arterioles has a direct effect on arterial pressure C)Dilation of veins by alpha adrenergic antagonist improves cardiac output, D)Venous dilation by alph-adrenergic antagonist indirectly lowers arterial pressure

C. Dilation of veins by alpha-adrenergic antagonist improves cardiac output Cardiac output is decreased as a result of the venous dilation caused by alpha-adrenergic antagonists. Alpha-adrenergic antagonists block alpha 1 receptors on both arterioles and veins. When alpha 1 receptors on arterioles are blocked by alpha-adrenergic antagonists, a direct effect on arterial pressure occurs. When alpha 1 receptors on veins are blocked by alpha-adrenergic antagonists, an indirect effect on arterial pressure occurs

A patient is admitted after experiencing vomiting and diarrhea for several days. The provider orders intravenous lactated Ringer's solution. The nurse understands that this fluid is given for which purpose? A. To increase interstitial and intracellular hydration B. To pull water from the interstitial space into the extracellular fluid C. To replace water and electrolytes D. To maintain plasma volume over time

C. To replace water and electrolytes Lactated Ringers is an Isotonici solution containing electrolytes. Normal saline does not contain electrolytes.

Clinical manifestations of severe symptomatic hypophosphatemia are caused by A. excess proteins B. renal damage C. deficiency of ATP D. hypocalcemia

C. deficiency of ATP Clinical manifestations of severe symptomatic hypophosphatemia are caused by a deficiency of ATP. Phosphate is an important component of ATP, which is the major source of energy for the many cellular substances. Severe symptomatic hypophosphatemia does not cause excess protein accumulation, damage the kidneys, or use hypocalcemia.

Decreased neuromuscular excitability is often the result of A. hypocalcemia and hypokalemia. B. hypernatremia and hypomagnesemia. C. hypercalcemia and hypermagnesemia. D. hypomagnesemia and hyperkalemia.

C. hypercalcemia and hypermagnesemia. Hypercalcemia and hypermagnesemia result in decreased neuromuscular excitability. Hypomagnesemia, hypocalcemia, and hypomagnesemia result in increased neuromuscular excitability.

The various forms of any one gene are called A) homologous. B) homozygous. C) heterozygous. D) alleles.

D) Alleles

What is the risk of a mother with the genetic mutation that causes Fragile X syndrome passing the gene on to offspring? A. 100% of females affected B. 50% of females affected C. 100% of males affected D. 50% of males affected

D. 50% of males affected

The nurse is admitting a patient who has been taking minoxidil (Loniten) to treat hypertension. Prior to beginning therapy with this medication, the patient had a blood pressure of 170/95 mm Hg and a heart rate of 72 beats per minute. The nurse assesses the patient and notes a blood pressure of 130/72 mm Hg and a heart rate of 78 beats per minute, and also notes a 2.2-kg weight gain since the previous hospitalization and edema of the hands and feet. The nurse will contact the provider to discuss which intervention? A. Adding metoprolol (Lopressor) to help decrease the heart rate B. Restricting fluids to help with weight reduction C. Increasing the dose of minoxidil to lower the blood pressure D. Adding hydrochlorothiazide to help increase urine output

D. Adding hydrochlorothiazide to help increase urine output One of the side effects of minoxidil (Loniten) is an increase in fluid retention. This can result in weight gain and peripheral edema, adding a thiazide diuretic would help with this side effect. Minoxidil is used when other anti-hypertensives have been unsuccessful. Restricting fluids would not decrease the edema. Adding metoprolol (Lopressor) would decrease the heart rate and blood pressure to perhaps unhealthy levels.

When a patient asks what causes cystic fibrosis, how should the nurse respond? Cystic fibrosis is caused by an _____ gene. A. X-linked dominant B. X-linked recessive C. Autosomal dominant D. Autosomal recessive

D. Autosomal recessive

A 50-year-old male was recently diagnosed with Huntington disease. Transmission of this disease is associated with: A. Penetrance B. Recurrence risk C. Expressivity D. Delayed age of onset

D. Delayed age of onset

On admission, a patient with a history of cardiac insufficiency complains of shortness of breath. The nurse auscultates the lungs and notes bilateral crackles throughout both fields. In addition, there is bilateral +2 edema of the lower extremities. Which medication does the nurse anticipate that the health care provider will prescribe? A.Mannitol B. Diphenhydramine (Benadryl) C. Allopurinol (Zyloprim) D. Furosemide (Lasix)

D. Furosemide (Lasix) Allopurinol is used to treat gout. Diphenhydramine is an antihistamine and is not used for diuresis. Mannitol is used mainly to treat cerebral edema. Diuretics, such as furosemide, are the mainstays of treatment in heart failure and hypertension.

A normal male and a female carrier for red-green color blindness mate. Given that red-green color blindness is an X-linked recessive trait, what is the likelihood of their children being affected? A. 25% B. 50% C. Females most affected; no males affected D. Males most affected; no females affected

D. Males most affected; no females affected

When teaching a patient who is taking thiazide diuretics, the nurse will encourage the patient to increase the intake of which electrolyte? A. Magnesium B. Sodium C. Calcium D. Potassium

D. Potassium The patient taking thiazide diuretics does not need to increase calcium intake. Although sodium levels are altered in patients taking thiazide diuretics, patients do not need to increase sodium intake. Thiazide diuretics cause a decrease in the level of potassium. The patient taking thiazide diuretics does not need to increase magnesium intake.

A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question? A. Furosemide [Lasix] B. Hydrochlorothiazide [HydroDIURIL] C. Bumetanide [Bumex] D. Spironolactone [Aldactone]

D. Spironolactone Spironolactone is a potassium sparing diuretic and the patients potassium is already high.

A patient is diagnosed with borderline hypertension and states a desire to make lifestyle changes to avoid needing to take medication. The nurse will recommend which changes? A. Decreased fluid intake and increased potassium intake B. Changing from weight bearing exercise to yoga C. Stress reduction and increased protein intake D. Weight reduction and decreased sodium intake

D. Weight reduction and decreased sodium intake Weight reduction and decreasing salt intake will help decrease hight blood pressure. Changing from a weight bearing exercise to yoga will not decrease high blood pressure. Stress reduction will help lower blood pressure but decreasing fluid intake and increasing potassium and protein will not lower blood pressure.

Total body water in older adults is A. increased due to decreased adipose tissue and decreased bone mass. B. increased due to decreased renal function and hormonal fluctuations. C. decreased due to renal changes that cause diuresis with sodium excretion. D. decreased due to increased adipose tissue and decreased muscle mass.

D.decreased due to increased adipose tissue and decreased muscle mass. Older adults have decreased total body water due to increased adipose tissue and decreased muscle mass. Older adults have increased adipose tissue. Hormonal fluctuations and diuresis with sodium excretion are not characteristic of older adults

Thiazides work on..

Early distal convoluted tubule

A patient with heart failure who has been given digoxin [Lanoxin] daily for a week complains of nausea and vomiting. Before giving the next dose, the nurse will: a. assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute. b. review the serum electrolyte values and withhold the dose if the potassium level is greater than 3.5 mEq/L. c. contact the provider to report possible digoxin toxicity. d. request an order for a decreased dose of digoxin.

Either a or c ... hmm

Potassium Magnesium Phosphate

Electrolytes higher inside cells

Sodium Chloride Bicarbonate Ions

Electrolytes higher outside of the cells

Most commonly prescribed diuretic

Furosemide

Most frequently prescribed loop diuretic

Furosemide

Causes decreased neuromuscular excitability caused by elevated of the threshold potential of excitable cells

Hypercalcemia

Polyuria Constipation Headache, confusion, lethargy, personality change Renal calculi Pathological fractures

Hypercalcemia

Membrane hypopolarization > increase neuromuscular excitability > inability to depolarize resulting in muscle weakness

Hyperkalemia

-A gain of relatively more water than salt -Prolonged/excess release of ADH (tells your body to hold onto fluid, dilutes amount of sodium, keeps adding more water to the same amount of sale) -Excess water intake -Decrease in Na intake -A loss of relatively more salt than water -Thiazide diuretics -Salt wasting renal disease

Hyponatremia etiologies

Decrease in Na concentration > increase in H20 in interstitial space > increase H20 in cell (cellular swelling) decrease in osmolality

Hyponatremia pathogenesis

Decreased ATP in the cells and tissue hypoxia

Hypophosphatemia

Respiratory failure Confusion, stupor Seizures Coma

Hypophosphatemia

A solution that has a concentration of dissolved particles is similar to that plasma

Isotonic solution

Serum K = 5.2 mEq/L

Lab value for hyperkalemia

Serum Na = 150 mEq/L

Lab value for hypernatremia

Serum Ca = 4.0 mg/dL

Lab value for hypocalcemia

Serum Na = 2.5 mEq/L

Lab value for hyponatremia

Fluid of choice for burn victims

Lactaced ringers

Do not give to patients allergic to lactase or with liver disease

Lactated ringers

Electrolyte content is most closely related to the composition of the body's blood serum and plasma

Lactated ringers

Electrolyte contents similar to composition of the body's blood serum & plasma

Lactated ringers

Spironolactone works on..

Late distal convoluted tubule & collecting duct (distal duct)

works on the proximal convoluted tubule

Mannitol

Fluid of choice for resuscitation efforts

Normal saline

Only fluid used with administration of blood products

Normal saline

Saline Deficit Etiologies

Removal of Na-containing fluid -GI excretion: diarrhea, emesis -Renal excretion: excessive diuretic & renal disease -Hemmorhage -Excessive diaphoresis -Burns -3rd spacing (in places that the body cannot access)

Electrolytes higher inside cells

Potassium Magnesium Phosphate

Mannitol works on..

Proximal convoluted tubule most diureses

↓ Na & H2O > ↓ vascular volume > ↓ interstitial volume Normal osmolality

Saline Deficit pathogenesis

-Treat etiology -Rehydrate using isotonic solutions -D5W -Normal saline

Saline Deficit treatment implications

^ Na & H2O>^ vascular volume>^ interstitial volume Normal osmolality

Saline Excess pathogenesis

decreased Na & H20 > decreased vascular volume > decreased interstitial volume Normal osmolality

Saline deficit

Electrolytes higher outside of the cells

Sodium Chloride Bicarbonate Ions

Diuretic not effective when urine is scant

Thiazides

Not effective when urine flow is scant

Thiazides

A couple has three offspring: one child with an autosomal dominant disease trait and two who are normal. The father is affected by the autosomal dominant disease, but the mother does not have the disease gene. What is the recurrence risk of this autosomal dominant disease for their next child? a. 50% b. 33% c. 25% d. Impossible to determine

a. 50%

The parents of a child with phenylketonuria (PKU) are concerned about the risk of transmitting the disorder in future pregnancies. Neither parent is affected with PKU. The correct assessment of the risk is a.each child has a 25% chance of being affected. b. since one child is already affected, the next three children will be unaffected. c. each child has a 25% chance of being a carrier. d. one cannot predict the risk for future pregnancies.

a.each child has a 25% chance of being affected.

Children with phenylketonuria (PKU) must avoid phenylalanine in the diet. Phenylalanine is most likely to be a component of a.fat. b.carbohydrate. c.protein. d.sugar.

c.protein.

Down syndrome

chromosomal abnormality

A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct? a. Request an order to administer fosinopril instead of captopril. b. Administer the captopril and monitor for adverse effects. c. Reassure the patient that this is not a serious side effect. d. Hold the dose and notify the provider.

d. Hold the dose and notify the provider.