Prep U Exam 3 Pathology

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

A group of vascular disorders called vasculitides cause inflammatory injury and necrosis of the blood vessel wall (vasculitis). Which condition is the most common of the vasculitides?

Temporal arteritis

A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Which type of reaction is most likely occurring with this client?

anaphylactic shock

Which cardiac drug classification decreases sympathetic outflow to the heart and is the is the cornerstone of therapy for catecholaminergic polymorphic ventricular tachycardia (CPVT)?

Beta-adrenergic blockers

A 51-year-old man has been diagnosed with chronic bronchitis after a long history of recurrent coughing. Which statement by the client demonstrates a sound understanding of his new diagnosis?

"If I had quit smoking earlier than I did, I think I could have avoided getting bronchitis."

The nurse working on a cancer unit is assessing clients for neutropenia. Which client has the greatest risk?

Client receiving IV chemotherapy -Chemo therapeutics are a large contributor to neutropenia in patients (low neutrophil count)

Which of the following describes surgical correction of tetralogy of Fallot?

Closure of the ventricular-septal defect and relief of the right ventricular outflow obstruction

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

The emergency room provider diagnoses a client with a hemothorax. Which could be possible causes of this condition?

Fractured ribs following car accident

A 17-year-old athlete died suddenly during a track meet and it was subsequently determined that he had heart disease. Which condition was the most likely cause of his heart failure?

Hypertrophic cardiomyopathy

A nurse caring for a client with asthma monitors respiratory function. Which data indicate the client has mild intermittent asthma?

PEF 400 mL in AM, 390 mL at noon, symptoms occur twice a week

A client with asthma comes to the emergency department very anxious due to increasing shortness of breath. Physical assessment reveals tachypnea, and an arterial blood gas shows decreased carbon dioxide levels and hypoxemia. What is the most likely cause of the decreased carbon dioxide levels?

hyperventilation

A client admitted to the emergency department is experiencing sinus tachycardia. What can cause this dysrhythmia that the nurse should monitor for? Select all that apply.

Pain Fever Hyperthyroidism Blood loss

A monitored hospitalized client with a pulmonary embolism has been in atrial fibrillation (AF) for 4 days. The nurse observes the rhythm spontaneously convert to a normal sinus rhythm. Which form of AF is this?

Paroxysmal

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be:

Prompt diagnosis and treatment of streptococcal infections

Which disease is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?

constrictive pericarditis

Low Hemoglobin levels can be related to which disorders?

Anemia, bleeding, malnutrition, cirrhosis, or cancer

A client calls the health care provider's office and frantically tells the nurse his TB test is red, and he is afraid this means he has tuberculosis. The best response by the nurse would be:

"A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques."

A nurse is caring for a client with an average heart rate of 56 beats/min. The client has no adverse symptoms associated with this heart rate and is receiving no treatment. Which activity modification should the nurse suggest to avoid further slowing of the heart rate?

"Avoid bearing down while having a bowel movement."

A client awaiting a heart transplant is experiencing decompensation of the left ventricle that will not respond to medications. The health care provider (HCP) suggests placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. Which response most accurately describes the purpose of a VAD?

"Decreases the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

What should the nurse teach the client prior to ergometry?

"This test evaluates cardiac function."

Erythropoiesis

-production of red blood cells -occurs in the long bones in kids, in vertebrae, sternum, ribs, & pelvis in adults

Common results of acute respiratory failure are hypoxemia and:

Hypercapnia

A newborn is diagnosed with Tetralogy of Fallot. Prior to surgery, which abnormality should be corrected to prevent a stroke?

Iron deficiency anemia

Hemorrhage, bruising, bleeding, petechiae and enlarged spleen indicate which hemostasis disorder?

Thrombocytosis

Platelets start as which stem cells?

pluripotent stem cells

An adult client with a history of worsening respiratory symptoms has presented for care. Which assessment question will best allow the clinician to address the possibility of chronic bronchitis?

"Do you tend to have a cough even when you don't feel sick?"

The dietitian is teaching a client about cholesterol reduction strategies. Which comment by the client indicates that he understands the teaching?

"I should avoid fats that are manufactured from vegetable oils and used to extend the shelf life of fast foods."

The nurse is teaching a client with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which statement by the client shows that the client understands this condition?

"I should report episodes of dizziness or fainting."

A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which statement demonstrates an accurate understanding of his new diagnosis?

"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."

When explaining a new diagnosis of complete heart block to a client and family, the nurse should include which statement?

"One consequence of this type of block is a very slow heart rate that limits circulation to the brain."

An older adult client who was recently diagnosed with emphysema asks the nurse what caused the disease. Which statement is the best response?

"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?"

A nurse is observing a client's cardiac status by telemetry monitoring. On the monitor, the P wave changes shape and an impulse frequently occurs before the next expected sinoatrial (SA) node impulse. The nurse interprets this rhythm by stating:

"The client is experiencing premature atrial contractions (PACs)."

The nurse working in the health department recognizes which clients in her group meet the criteria for beginning antimycobacterial therapy for tuberculosis? Select all that apply.

-A client who is HIV positive and has not been exposed to the infection -A client with active tuberculosis -A client who has had contact with a family member with active tuberculosis

Panycytopenia

-All blood cells are too few; anemia, thrombocytopenia, leukopenia -deficiency of all types of blood cells

Immune thrombocytopenic purpura (ITP),

-Autoimmune platelet destruction is a common cause of thrombocytopenia and should be supsected in patients with echymoses, petechiae, mucosal bleeding, and no other obvious causes of thrombocytopenia (ex- medications, bone marrow failure) . -Autoimmune disorder, Splenomegaly - Treat with steroids of IVIg (Intravenous Immunoglobulin (IVIG)

The nurse knows that which statements regarding the physiology of blood pressure are accurate? Select all that apply.

-Blood pressure is very variable. -Constant elevation of blood pressure can be lethal. -A decrease in blood flow can be an immediate threat to life.

Which diagnostic tests may be used for Thrombocytosis, Thombopenia or related disorders?

-CBC -PT -aPTT -INR -D-dimer -Fibrinogen levels

Thrombocytosis can be treated how?

-Compression -Meds = Antiplatelets + Anticoagulants

Which client is at greatest risk for orthostatic hypotension?

A 66-year-old postoperative client on bed rest

pluripotent stem cells

-Stem cells that can become almost all types of tissues and cells in the body. -Undifferentiated blood cells

Clotting Cascade: External

-Stimulated by external trauma -Prothrombin time (PT) measures clotting time

Question 17 of 20 The parents of a child diagnosed with cystic fibrosis (CF) ask about the risk of any future children having the condition. How should the nurse respond?

25%

The nurse is caring for four clients. Select the client at risk for the development of a pulmonary embolism.

A 62-year-old male who is postoperative for repair of a fractured femur

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.

Ecchymosis

A discoloration of the skin resulting from bleeding underneath, typically caused by bruising but can be caused by other things.

Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?

A hypercyanotic attack brought on by periods of stres

Epistaxis

A nosebleed. One of the most common ear, nose, and throat (ENT) emergencies that present to the emergency room or primary care. There are two types of nosebleeds: anterior (more common), and posterior (less common, but more likely to require medical attention).

Allogeneic stem cell transplantation

A procedure in which a patient receives healthy blood-forming cells (stem cells) from a donor to replace their own stem cells that have been destroyed by treatment with radiation or high doses of chemotherapy.

The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which initial sign of this condition?

A pulsating mass in the abdomen

The nurse is caring for a client with chronic myelogenous leukemia (CML) and notes that the client has splenomegaly and an increased basophil count as well as night sweats, bone pain, and a low grade fever. The nurse interprets the symptoms as indicating that the client is in which phase of the clinical course of CML?

Accelerated - Splenomegaly is an enlarged spleen caused by certain cancers. - CML has 3 phases; chronic, accelerated or blast/acute

ST-elevated myocardial infarction (STEMI) is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?

Action decreases metabolic demands of the heart.

A client with chronic renal failure secondary to diabetes has just been diagnosed with secondary hypertension. This increase in blood pressure is likely caused by which physiologic factor?

Activation of the renin-angiotensin-aldosterone mechanism

The practitioner's assessment of a client reveals a left leg that has no pedal pulses and is pale from the knee down. The client states that "the pain in my foot started suddenly and is severe." The practitioner suspects which condition?

Acute arterial occlusion

A client has been diagnosed with atrial flutter. Which assessment finding correlates with this diagnosis?

An atrial heart rate above 240 beats/min

Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity?

Inherent spontaneous action-potential

A client's bone marrow study report reveals the findings of blast cells in the bone marrow. What does the nurse interpret this as indicating?

Leukemia -When a patient has leukemia, abnormal immature white blood cells (called blasts) multiply uncontrollably - They fill up the bone marrow, and prevent production of other cells important for survival - red blood cells and platelets - This leads to infections, anemia and abnormal bleeding.

Hypoxia

Low oxygen saturation of the body, not enough oxygen in the blood

Which measure is the best modality to diagnose hypertension?

Repeated blood pressure determinations.

Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels?

Vascular smooth muscle cells (SMCs)

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?

Vasoconstriction

A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experiences while mowing his lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect?

Vasodilating effects reducing preload and afterload

Thrombocytosis is associated with what medical emergency?

Venous Thromboembolism (VTE)

which dysrhythmia is considered to be the most fatal and requires immediate treatment?

Ventricular fibrillation

A client presents with uncharacteristic chest pain, and his ECG reveals T-wave elevation. This finding suggests an abnormality with which aspect of the cardiac cycle?

Ventricular repolarization

A 45-year-old client is undergoing exercise stress testing. At which point will the test be halted and not allowed to continue?

When the client experiences chest pain

A client is diagnosed with pneumoconiosis. Which aspect of the client's history is most likely the cause of this diagnosis?

Worked in a coal mine for 20 years

Hypogammaglobulinemia

a below normal concentration of gamma globulin in the blood associated with a decreased resistance to infection

Bone marrow Biopsy

a diagnostic test that may be necessary after abnormal types or numbers of red or white blood cells are found in a complete blood count test

A client has been experiencing anemia and thrombocytopenia. Subsequent diagnostic testing has revealed the presence of immature granulocyte types and the Philadelphia chromosome. This client is likely to experience:

a prolonged chronic phase of leukemia.

Antibody

a substance produced by the body that destroys or inactivates an antigen that has entered the body

Which intervention will the nurse prioritize for the medical management of a client with a dissecting aortic aneurysm?

administration of vasodilators and beta-adrenergic blocking medications (beta-blockers)

A child is experiencing an acute exacerbation of asthma. Which quick-acting treatment is most appropriate for this client?

beta-adrenergic agonists

Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving the symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications?

beta-adrenergic blocking drugs (beta-blockers)

The term chronic obstructive pulmonary disease (COPD) can be a combination of two types of obstructive airway diseases. Which disease processes have been identified as being part of COPD?

chronic bronchitis and emphysema

Cirrhosis

chronic degenerative disease of the liver/ scarring of the liver

Which client is exhibiting signs of advanced chronic obstructive pulmonary disease (COPD)?

client sitting in bed resting elbows on the overbed table, expiratory wheezes noted

When a person rises from a lying to a standing position, heart rate increases. Which physiologic trigger results in this increase in heart rate?

decrease in the stretch of baroreceptors

An older adult client is newly diagnosed with hypertension. Which vascular changes in the aging adult can lead to hypertension?

decreased elasticity of the aorta and large arteries

Hyperuricemia

excess uric acid in the blood - prerequisite for gout - The most common cause is alcohol consumption - associated with vitamin d deficit - limit foods high in purine/ organ meats, game, herrings and a few other types of seafood, and beer, limit use of diuretics

plasmapheresis

removal of plasma (from withdrawn blood)

Which three proteins are associated with plasma?

1. Albumin 2. Globulin 3. Fibrinogen

What three things does plasma help with?

1. Transport 2. Electrolyte Balance 3. Thermoregulation

A client is diagnosed with pulmonary embolism. Which symptom would most likely be present?

Chest pain and dyspnea

Endemic

(of a disease or condition) regularly found among particular people or in a certain area.

Philadelphia chromosome

- An abnormal chromosome called the Philadelphia chromosome is associated with chronic myelogenous leukemia. - forms when chromosome 9 + chromosome 22 break and exchange portions. - This creates an abnormally small chromosome 22 and a new combination of instructions for your cells that can lead to the development of chronic myelogenous leukemia.

Intravenous Immunoglobulin / IVIG

- Intravenous Immunoglobulin (IVIG) is a therapy treatment for patients with antibody deficiencies - from donor - Immunoglobulins are made by the immune system of healthy people for the purpose of fighting infections.

What does Erythropoietin do for RBCs and where is it produced?

- Kidneys produce erythropoietin - Erythropoietin stimulates RBC maturation

What might you observe in a patient with Vonwillebrand disease? How can you treat this?

- Spontaneous bleeding, Excessive menstrual flow, Prolonged bleeding, Normal platelet count - Treatment: Avoid aspirin

Thrombotic thrombocytopenic purpura (TTP)

- Thrombocytopenia, hemolytic anemia, renal failure, neurological deficits - Multiple etiologies - Clinical manifestations are purpura, headaches, seizures, altered LOC - Treatment: plasmapheresis

Thrombocytopenia

- a condition in which there is an abnormally small number of platelets circulating in the blood - < 150,000/μL

thrombocytosis

- an abnormal increase in the number of platelets in the circulating blood - Platelet count >1,000,000/μL

Hemolytic Transfusion Reaction

- destruction of red blood cells as a result of transfusion of incompatible blood - Hemolysis of donor RBC by antibody in recipient serum - Occurs within 24 hours - ABO incompatibility - Hemoglobin from lysed RBCs filter to kidney & damage kidneys - Oliguria/anuria - Kidney failure

Iron combines with what and is stored where?

-Combines with protein to form transferrin -Stored in liver & tissues as ferritin

Name two common coagulation factor disorders.

-Vonwillebrand disease -Hemophilia A

Antigen

-a toxin or other foreign substance that induces an immune response in the body, especially the production of antibodies. -A protein that, when introduced in the blood, triggers the production of an antibody

Disseminated Intravascular Coagulation (DIC)

-abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues -Complex, acquired disorder in which clotting and hemorrhage simultaneously occur

Venous Thromboembolism (VTE)

-medical emergency caused when a blood clot breaks loose and travels in the blood vessels -A term that refers to both deep vein thrombosis and pulmonary embolism; obstruction by a thrombus.

von Willebrand factor (vWF)

-plasma protein secreted by endothelial cells; facilitates adherence of platelets to damaged vessel wall -protein that anchors platelets to collagen fibers during the platelet adhesion phase of hemostasis

Intrinsic Clotting Cascade

1)Platelet finds exposed collagen of damaged vessel 2) Platelet releases chemical that causes neighboring platelets to adhere to each other (platelet plug) 3) collected platelets and damaged tissue both released thromboplastin 4) Thromboplastin and calcium and vit.K converts inactive prothrombin to its active form thrombin 5) Thrombin converts fibrinogen into fibrin 6) fibrin threads coat damaged area and trap blood cells to form clot -Stimulated by tissue damage -Activated partial thromboplastin time (aPTT) measures clotting time

The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion?

140 mm Hg or higher

A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are prescribed by the health care provider. Which intervention should the nurse complete first?

Administer epinephrine (adrenaline).

A nurse is caring for a client with persistent atrial fibrillation (AF) unresponsive to antiarrhythmic therapy. Prior to an elective cardioversion, the nurse anticipates which intervention?

Administration of anticoagulants

A client sustained a puncture injury to the chest resulting in development of a tension pneumothorax. What is the pathogenesis behind a tension pneumothorax?

Air is permitted to enter but not leave the pleural space, causing lung collapse.

The nurse is elaborating treatment options for a client with multiple myeloma . Which treatment options would the nurse include in this discussion? Select all that apply.

Allogeneic stem cell transplantation, Alkalizing agents and prednisone, & "Mini" transplants. - Corticosteroids, such as dexamethasone and prednisone, are an important part of the treatment of multiple myeloma / they reduce nausea caused by chemo -

Which individual should have priority for receiving a seasonal influenza vaccination?

An older adult resident of a long-term care facility

Pruritus

An uncomfortable, irritating sensation that creates an urge to scratch that can involve any part of the body.

A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment prioritiesfor this child?

Antibiotics and anti-inflammatory drugs

The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels?

Arterioles

Prolonged immobility is implicated in the development of which disorder?

Atelectasis and pulmonary embolism

Paroxysmal supraventricular tachycardia arises from which form of reentry?

Atrioventricular (AV) nodal

The health care provider is reviewing the results of a client's magnetic resonance imaging (MRI). The results indicate a small spherical dilation at the circle of Willis. The provider would interpret this as:

Berry aneurysm

Which antiarrhythmic medication works by blunting the effect of sympathetic nervous system stimulation on the heart?

Beta-blockers, such as metoprolol

A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.

Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy

A client's laboratory report indicates neutropenia, most likely drug induced. The nurse should frequently assess for which complication related to neutropenia?

Bronchial Infection - key word : infection - The main complication of neutropenia is an increased risk of infection. - Neutrophils are made in the bone marrow. They are short-lived cells that travel extensively throughout the body and can enter tissues other cells cannot.

Burkitt lymphoma

Burkitt lymphoma is a rare but highly aggressive (fast-growing) B-cell non-Hodgkin lymphoma (NHL) - This disease may affect the jaw, central nervous system, bowel, kidneys, ovaries, or other organs. Burkitt lymphoma may spread to the central nervous system (CNS)

Lymphoma

Cancer of the lymph nodes (usually malignant) / cancer of the white blood cells of the lymphatic, or immune, system

A nurse is planning a community education program on hypertension. Which parameter should be included to explain the regulation of arterial blood pressure?

Cardiac output and systemic vascular resistance

A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment, the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make?

Cardiac tamponade

Which vascular changes can occur in older adults because of the increase in blood pressure during the aging process?

Decreased elasticity in arterial connective tissue - With aging, the elastin fibers in the walls of the arteries are gradually replaced by collagen fibers that render the vessels stiffer and less compliant - Arterial elasticity decreases as one ages, causing increased systemic vascular resistance and increased blood pressure and after load - Elasticity does not increase in arterial tissue or venous tissue.

How is Disseminated Intravascular Coagulation (DIC) diagnosed? how is it treated?

Diagnosed through CBC, d-dimer, clotting times Treat the underlying cause, treat by replacing clotting factors

How can you diagnose Hemophilia A? How can you treat it?

Diagnosed through: - Genetic testing - Labs: CBC, coagulation tests, factor VIII & IX assays Treatment: - Prevent trauma - Avoid anti platelet meds - Donor coagulation factors

The nurse is conducting a staff in-service program on non-Hodgkin lymphomas. The nurse should include that essentially all people with Burkitt lymphoma have evidence of infection with:

EBV - The Epstein-Barr virus - It is best known as the cause of infectious mononucleosis. - EBV infection can affect a person's blood and bone marrow. The virus can cause the body to produce an excessive number of white blood cells

A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the client to be in atrial fibrillation. Which test will the practitioner order to find the source of the emboli?

Echocardiogram

A client has been diagnosed with runs of intermittent ventricular tachycardia where the client loses consciousness and needs to be stimulated to recovery. Knowing this history, the nurse will educate the client about which treatment intervention/procedure that will depolarize the heart to allow the sinoatrial node to regain control of the heart?

Education involving automatic implantable cardioverter-defibrillators implantation

The nursing student correctly identifies which major risk factors for coronary artery disease? Select all that apply.

Elevated LDL Elevated blood pressure Abdominal obesity Cigarette smoking Diabetes

Which diagnosis places a child at the greatest risk for airway obstruction?

Epiglottitis

A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms?

Headache and confusion

The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:

History of cigarette smoking and elevated blood pressure

A client is suspected of having lymphoma and is having diagnostic tests performed to determine the type of lymphoma. Which form of lymphoma does the nurse recognize has the classic symptoms of pruritus and intermittent fevers associated with night sweats?

Hodgkin lymphoma (HL) -Pruritus and intermittent fevers associated with night sweats are classic symptoms of HL. - Most people with HL present with painless enlargement of a single lymph node or a group of nodes. - There may be reports of chest discomfort with cough or dyspnea. - Involvement of subdiaphragmatic lymph nodes at the time of presentation is unusual and more common in older men. - Additional symptoms include fever, chills, night sweats, and weight loss.

A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting ECG reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which diagnostic method is the best choice to investigate the suspicion?

Holter monitoring

A young college football player was bought to the emergency room after collapsing on the football field during practice. When arriving he was unconscious and his ECG was abnormal. Subsequently he died after arresting in the emergency room. What does the physician suspect is the likely cause of this?

Hypertrophic cardiomyopathy

Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells?

Hypertrophy

The nurse is assisting a client who had a myocardial infarction 2 days ago during a bath. The client suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the client was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. What is a priorityintervention at this time?

Immediate defibrillation

A client is brought into the emergency department with severe crushing injuries to the chest wall and signs of respiratory failure following a motor vehicle accident. Which laboratory value would be expected?

Increase in PCO2

A client with hypercholesterolemia is being treated with diet and exercise. Which assessment finding is a positive outcome of this treatment regimen?

Increased high-density lipoproteins

A 60-year-old woman is hospitalized after losing an extensive amount of blood in a work-related accident. She tells the nurse that she heard the doctor say that she would keep feeling faint until her brain made more blood. The nurse recognizes that when the woman's blood pressure dropped, the pressure in her carotid arteries decreased. This was detected by baroreceptors in the carotid arteries, with which subsequent effect?

Increased sympathetic stimulation of the heart and blood vessels. - When the baroreceptors in the carotid arteries detected the fall in blood pressure as blood volume was depleted, reflex sympathetic activity increased: - rate/ force of contraction via beta-1 receptors in the heart - increased vasoconstriction via alpha-1 receptors in blood vessels - Both of these effects serve to support blood pressure and blood flow to vital organs.

A child has developed respiratory stridor and is displaying a crowing sound. The parents ask the nurse what is causing this sound. The best response would be:

Increased turbulence of air moving through the obstructed airways

A nurse is teaching a client with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the knowledge is understood when the client correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor?

Inhibits the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction

Respiratory sinus dysrhythmia is considered a more optimal rhythm than a rhythm where all RR intervals are equal. In respiratory sinus dysrhythmia, what is the variation in cardiac cycles related to?

Intrathoracic pressure changes that occur with respiration

When a client has a recurrent, life-threatening arrhythmia originating either supraventricularly or ventricularly, ablation therapy is an option for treatment. What does ablation therapy do?

Isolates and destroys arrhythmogenic cardiac tissue

A client is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which action is important for the nurse to tell the client to ensure accuracy in correlating dysrhythmias with symptoms?

It is important to keep a diary of activities and symptoms.

The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states the blood is shunted to which part of the body?

Left side of the heart to the right side of the heart

A 30-year-old client arrives with these vital signs: Blood pressure 50/30 mm Hg, pulse 100 beats/min, respiratory rate 12 breaths/min, temperature 101°F (38.3°C). The nurse interprets these results as the client being in shock based on which reading?

Low blood pressure

Sick sinus syndrome is suspected in the case of a child who is postoperative following cardiac surgery. Which nursing action is most appropriate?

Monitor the child's ECG for bradycardia.

The nurse working in the emergency room triages a client who comes in reporting chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myocardial infarction. The client is given a nitrate, which does nothing for his pain. Which medication should the nurse suspect the doctor will order next for the pain?

Morphine

What is the normal ESR (erythrocyte sedimentation rate) for men? What is the normal rate for women?

Normal for men: 0-15mm/hr Normal for women: 1-20 mm/hr

A client hospitalized for 72 hours has developed symptoms of a lower respiratory tract infection. Sputum cultures reveal S. aureus as the infectious organism. The nurse explains to the client that the most likely cause of this infection is:

Nosocomial hospital-acquired infection (HAI)

A nurse is assessing a client diagnosed with severe mitral valve stenosis. The nurse anticipates which classic assessment finding?

Orthopnea

Too much unconjugated bilirubin leads to what?

Overproduction of unconjugated bilirubin leads to jaundice

Considering the PQRST complex of an electrocardiogram (ECG), which letter designation represents atrial depolarization?

P wave

The nurse assesses the electrocardiogram for depolarization of the atria. What portion of the ECG will the nurse be assessing?

P wave above the baseline

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

On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis?

Peripheral edema, weight gain

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process?

Peripheral vascular resistance

Which factor is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?

Pet dander

Pain is an expected assessment finding in clients who have which lung disease?

Pleuritis

A client presents with venous congestion, peripheral edema, shortness of breath, fatigue, and a productive cough. The client appears drowsy and has a hard time maintaining consciousness. The client is diagnosed with cor pulmonale. What compensatory mechanism may be present?

Polycythemia

The nurse is evaluating a client with cardiac problems and notes that the client's peripheral pulse is different than the apical pulse. To which physiologic response would the nurse attribute the difference in rates?

Premature beats not following normal conduction pathways

A client recently had surgery for a hip fracture. Which nursing intervention would be mosteffective for preventing pulmonary emboli in this client?

Prevention of the development of a deep vein thrombosis

A client experiencing a sinus arrest would demonstrate which symptom or finding?

Prolonged periods of asystole demonstrated on an electrocardiogram

The nurse knows that vasopressin (antidiuretic hormone, ADH) plays which role in blood pressure control?

Promotes retention of water

Cystic fibrosis (CF) is an autosomal recessive disorder involving the secretion of fluids in specific exocrine glands. The genetic defect in CF inclines a person to chronic respiratory infections from a small group of organisms. Which organism most commonly creates chronic infection in a child with cystic fibrosis?

Pseudomonas aeruginosa

The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent:

Pulmonary embolism

Question 14 of 20 As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to which complication?

Pulmonary hypertension

Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response?

Pulmonary vessels constrict

The nurse needs to assess the oxygen status of a client who is suddenly experiencing shortness of breath. The most appropriate noninvasive measurement technique would be:

Pulse oximetry

The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?

QRS complex

A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education?

Raising the head of the bed to a high Fowler's position

A client presents to the emergency department reporting bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. What is a potential diagnosis for this client?

Raynaud disease

A client asks why his blood pressure pills seem to make him go to the bathroom to urinate frequently when they are not water pills (diuretics). Which physiologic process explains the long-term regulation of blood pressure most accurately?

Renal monitoring and adjustment of extracellular fluid volume

What is released in response to loss of RBC?

Reticulocytes released in response to hypoxia or loss of RBC

What is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?

SA node - AV node - bundle of His - bundle branches - Purkinje fibers

The postoperative client has a catheter in his brachial artery for continuous blood pressure monitoring. Which assessment would be a concern for the nurse?

The client states his hand is numb.

A 56-year-old woman presents at the clinic complaining of the unsightliness of her varicose veins and wants to know what can be done about them. The nurse explains that the treatment for varicose veins includes which intervention?

Sclerotherapy or surgery

A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF (40°C) in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this client most likely is experiencing which type of shock?

Septic

A nurse witnesses an older adult woman sitting outside who suddenly faints and is helped to the ground by family. She is awake, although confused, heart rate 130, RR 28. The woman states that all of a sudden she felt dizzy, but denies other symptoms. She says that her husband died last week and she has been very upset. The nurse determines that which of the following is the most likely reason for the syncopal episode?

Severe anxiety

Which description of symptoms would the nurse expect to obtain from a client with exacerbation of sarcoidosis?

Shortness of breath, non-productive cough, and chest pain

A client with digoxin toxicity is hospitalized and told that a cardiac monitor will be necessary because the client may develop which complication? Select all that apply.

Sinus arrest Atrial tachycardia Atrial fibrillation

A 28-year-old marathon runner comes to the clinic to obtain a physical exam for a new job. The nurse assesses a regular pulse rate of 52 beats per minute (bpm). Which common dysrhythmia is the nurse aware this client most likely has related to maintaining a large stroke volume?

Sinus bradycardia

A client's history and physical documents the presence of an indolent lymphoma. The nurse plans care for which type of lymphoma?

Slow Growing - Indolent lymphoma is a type of non-Hodgkin's lymphoma (NHL) that grows and spreads slowly - An indolent lymphoma usually won't have any symptoms

Which of the following is the site of chylomicron synthesis?

Small intestine

A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. About which topics should the nurse educate the client? Select all that apply.

Smoking cessation Dietary measures to reduce LDL levels Weight reduction if overweight

Chronic lymphocytic leukemia (CLL) commonly causes hypogammaglobulinemia. This makes clients with CLL more susceptible to infection. What is the most common infectious organism that attacks clients with CLL?

Staphylococcus aureus

A 6-month-old infant has been hospitalized with acute bronchiolitis. Which treatment should be prioritized in the infant's care?

Supplementary oxygen therapy

A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of:

Sympathetic nervous system

Which client is at the greatest risk of developing rheumatic heart disease?

Teenager with untreated strep throat

A client diagnosed with giant cell arteritis will likely experience pain located in which region of the head?

Temporal

The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading?

The client just smoked a cigarette.

The nurse is caring for the following clients. Select the client at highest risk for the development of atelectasis.

The client who is postoperative after a total knee replacement and receiving patient-controlled analgesia

The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason?

The disabling effects that result from involvement of heart valves

Question 12 of 20 The parents of a child with cystic fibrosis ask the nurse to explain the sweat test performed on their newborn. How should the nurse respond?

The sweat test measures the concentration of salt in the infant's sweat.

A client has been diagnosed with Stokes-Adams attacks and has been having "dizziness and fainting spells." Which rhythm does the nurse expect to observe on the monitor?

Third-degree heart block

An older adult client who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which treatment modality is mostlikely to resolve the client's most recent health problem?

Thoracentesis

Bleeding gums, Bruising/petechiae, Nosebleeds, Melena and Abnormal menstrual bleeding indicate which hemostatic disorder?

Thrombocytopenia

Immune thrombocytopenic purpura (ITP), Thrombotic thrombocytopenic purpura (TTP), and Heparin-induced thrombocytopenia (HIT) are all associated with what?

Thrombocytopenia

Immobility, cardiac disease, cancer, obesity, smoking, OCP, high estrogen and Platelet count >1,000,000/μL put you at risk for which hemostasis disorder?

Thrombocytosis

Platelets are stimulated by which hormone from the liver?

Thrombopoietin

Which client will the nurse prioritize to assess first?

client with sinus arrest

A client with a 2-week history of hyperthyroidism due to a virus is admitted for nonemergent cardioversion. The client states that she has been experiencing intermittent episodes of palpitations over the past week along with shortness of breath and fatigue. The nurse attaches the client to a cardiac monitor and notes that the client is in normal sinus rhythm with frequent episodes of atrial fibrillation. The nurse anticipates which of the following to be ordered prior to the cardioversion to avoid a possible stroke?

Transesophageal echocardiography

A client comes to the emergency room with all the symptoms of a myocardial infarction. Which lab value, known to have a high specificity for myocardial tissue considered the primary biomarker test for diagnosing an MI, does the nurse suspect the physician will order?

Troponin assays

Congenital heart defects can cause a right heart-to-left heart shunting of blood that results in increased:

Unoxygenated blood flow

A telehealth nurse is talking with a client who has a history of right-sided heart failure. The nurse should question the client about which assessment finding that would indicate the client's condition is worsening?

Weight gain

Erythrocytes

another name for red blood cells

A client involved in a car accident is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a "sucking" chest wound. After calling a "code blue," the next priority intervention would be to:

apply a Vaseline gauze (airtight) dressing over the insertion site.

The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of deep vein thrombosis (DVT). Which nursing intervention should the nurse implement?

apply sequential pneumatic compression devices to lower extremities

The nurse is planning care for several clients. The nurse determines which client will benefit mostfrom respiratory muscle retraining as part of the plan of care?

client with chronic obstructive pulmonary disease and hypercapnia

A health care provider is providing care for a client who developed deep vein thrombosis (DVT) and a pulmonary embolism following a period of bed rest. Which factor will the nurse determine did not contribute to the formation of a DVT?

increased heart rate

Hemophilia A is characterized by what?

internal bleeding - it is X-linked and recessive - Insufficient production of factor VIII

Which is an adverse effect of emboli on pulmonary circulation and airways?

local vasoconstriction

orthostatic hypotension

low blood pressure that occurs upon standing up Orthostatic hypotension can have causes that aren't due to underlying disease. Examples include dehydration, standing up too quickly, medication side effects, surgery or aging.

Agranulocytes

lymphocytes and monocytes

A client is admitted with hypersensitivity pneumonitis which has been described to the client as "farmer's lung." Which factor could have caused this condition?

moldy grain dust

A client reports severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate:

myocardial infarction.

Granulocytes

neutrophils, eosinophils, basophils N. E. B

A preventive measure to decrease the risk of developing rheumatic heart disease includes:

prompt diagnosis of streptococcal infections with a throat culture.

A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for hypertension. The nurse questions the prescription of an ACE inhibitor for a client with which condition?

renal artery stenosis

Which client is showing signs of chronic hypoxemia? A client who is:

restless, has clubbed fingers, and frequently drops items.

Assessment of an older adult client reveals bilateral pitting edema of the client's feet and ankles; difficult to palpate pedal pulses; breath sounds clear on auscultation; oxygen saturation level of 93% (0.93); and vital signs normal. What is this client's most likely health problem?

right-sided heart failure

A client arrives at the emergency room with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 beats/min and blood pressure of 86/50 mm Hg. The cardiac monitors show regular rhythm as above. The client states the health care provider has been running blood work to rule out hypothyroidism. Based on the rhythm, what does the nurse report the client has?

symptomatic bradyarrhythmia

A client who is being treated for small-cell lung cancer has been placed in protective isolation due to neutropenia. The most likely cause of this client's neutropenia is:

the effects of chemotherapy on white blood cell development.

The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is:

unknown

The nurse is reviewing laboratory results for a client who is experiencing angina. Which finding might be expected in a client with dyslipidemia?

Elevated total cholesterol

A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?

Elevation of triglycerides

which children may be considered high risk for developing hypertension? Select all that apply.

- Diagnosed with coarctation of the aorta as an infant - Recent scan showing a pheochromocytoma -Takes cyclosporine daily since a kidney transplant

Allergic Transfusion Reaction

- From antibodies against donor IgA - Occurs during or soon after cessation of transfusion - 2 + symptoms: edema, hypotension, rash, bronchospasm - May result in anaphylaxis

Heparin-induced thrombocytopenia (HIT)•

- Immune reaction - Symptoms start in 1-2 days - Treatment: discontinue heparin

From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?

Deep vein thrombophlebitis of the leg

Endemic Burkitt lymphoma (eBL)

Endemic Burkitt lymphoma (eBL) is an aggressive B cell non-Hodgkin lymphoma associated with antigenic stimulation from Plasmodium falciparum malaria. - most common childhood cancer in sub-saharan Africa

The client has been diagnosed with an acute leukemia. Which signs and symptoms would the practitioner expect to assess in this client? Select all that apply.

Epistaxis, Ecchymosis, fatigue

Endemic Burkitt lymphoma occurs in regions of Africa where what other infections are common?

Epstein-Barr and malaria

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:

Fixed coronary obstruction

The nurse's plan of care for a client with multiple myeloma should include interventions to prevent:

Fractures. - Hypercalcemia caused by bone destruction is also a priority concern in the client with multiple myeloma.

An 86-year-old client is disappointed to learn that he or she has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which age-related change predisposes older adults to the development of heart failure?

Increased vascular stiffness

High Hemoglobin levels can be related to which disorder?

Polycythemia or dehydration

A child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which drug will the nurse anticipate administering first?

Short-acting beta 2-adrenergic agonists such as albuterol (SABA)

What is the reason why bed rest and analgesics are expected treatments for infectious mononucleosis?

To relieve fever, headache, and sore throat. - Infectious mononucleosis, also called "mono," is a contagious disease - Epstein-Barr virus (EBV) is the most common cause - It is common among teenagers and young adults, especially college students. - Mono is transmitted by saliva. Symptoms include fatigue, fever, rash, and swollen glands.

Thrombopoietin

hormone from liver that stimulates platelet formation

A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:

hypovolemic shock due to acute intravascular volume loss.

An intensive care unit nurse is caring for a client who suffered a myocardial infarction involving the anterior wall, and notes a change in the cardiac rhythm. The rhythm has a PR interval that does not change, but there are twice as many P waves as there are R waves. The nurse prepares for a temporary pacemaker insertion because the client has developed:

second-degree, type 2 AV block.

A client who is experiencing angina at rest that has been increasing in intensity should be instructed to:

see the doctor for evaluation immediately.

A 26-year-old client has an absolute neutrophil count of less than 500 cells/mm3 (0.50 x 109/L) Which interpretation of this lab value is accurate?

severe neutropenia -less than 500 considered severe