N331 Patho adaptive quizzing (CH 4, 5, 24, 27)

For proper pH balance within a client's body, which ratio of bicarbonate ions to carbonic acid molecules needs to occur

20Bicarb: 1Carbonic acid

A client's serum sodium level is 150 mEq/L. The nurse expects which changes in the client's serum chloride and bicarbonate levels?

>145 is hypernatremia. Increased serum chloride levels (greater than 105 mEq/L) and decreased serum bicarbonate levels (less than 24 mEq/L) occur in clients with hypernatremia.

A client abuses alcohol and has cardiomyopathy. The nurse is caring for which client?

A client with dilated cardiomyopathy. dilated typically occurs from alcohol abuse.

A client has hyperthyroidism and develops a thyroid storm. The nurse will monitor the client for which type of heart failure?

A common cause of high-output failure is hyperthyroidism, especially if thyrotoxicosis or a thyroid storm develops. In high-output failure, the heart increases its output, but the body's metabolic needs are still not met.

Which information indicates a nurse has an accurate understanding of a dissecting aneurysm?

A tear that causes blood to enter the artery wall dissecting aneurysm occurs when there is a tear in the intima and blood enters the wall of the artery

A client has hyperkalemia. Which actions will the nurse take

Administer glucose Administer calcium gluconate Administer sodium bicarbonate Administer cation exchange resins

What does aldosterone do?

Aldosterone is secreted when circulating blood volume or blood pressure is reduced, potassium is increased, or sodium is decreased. It increases renal reabsorption of sodium and water to increase blood volume, blood pressure, and serum sodium levels

most common cause of hypoxemia is...

An abnormal ventilation-perfusion ratio is the most common cause of hypoxemia.

Which assessment findings does the nurse recognize as a potential exacerbation of the client's left heart failure?

An exacerbation of left heart failure causes blood to back up into the pulmonary circulation, creating pulmonary vascular congestion with dyspnea ("I can't catch my breath."), crackles, and a moist cough that can progress to the pink frothy sputum of pulmonary edema.

A nurse taught a client with coronary artery disease about fats. Which information indicates the client understood the teaching?

An example of monounsaturated fats is avocados-Avocados are high in oleic oil, a monounsaturated fat.

Which information indicates the nurse has an accurate understanding of multiple organ dysfunction syndrome (MODS)?

An uncontrolled inflammatory response can trigger MODS.

characteristics of arteriosclerosis

Arteriosclerosis is characterized by thickening and hardening of the vessel wall. It is caused by the accumulation of lipid-laden macrophages within the arterial wall

A client has heart failure. Which laboratory result should the nurse check to determine the severity of the heart failure?

B-type natriuretic peptide can help make the diagnosis of heart failure and give some insight into its severity

beta blockers and blood pressure

Beta-blockers slow the heart rate and reduce the force with which the heart muscle contracts, thereby lowering blood pressure.

A client with mitral stenosis asks the nurse, "Why are you listening to my lungs? My heart valve is the problem!" Which explanation given by the nurse is best?

Blood from your lungs empties into the left side of your heart. If your mitral valve gets too narrow, your heart cannot pump through the valve effectively, and blood can back up into your lungs. Blood flows from the lungs to the left side of the heart; the mitral valve is between the left atria and ventricle. Mitral stenosis may cause pulmonary congestion by blood backing up from the left atria to the lungs.

the nurse would assess hemoptysis as having which characteristics?

Blood produced with coughing (hemoptysis) is usually bright red, has an alkaline pH, and is mixed with frothy sputum.

A client has hyperkalemia. Which body system is the priority for the nurse to monitor?

Bradydysrhythmias and delayed conduction are common in hyperkalemia; severe hyperkalemia can cause ventricular fibrillation or cardiac arrest, making the cardiac system the priority.

Which information from the nurse indicates a correct understanding of the physiologic factor that has the most impact on the reabsorption of water into the client's capillary space from the interstitial space?

Capillary oncotic pressure attracts water from the interstitial space back into the capillary.

Which client is at risk for atherosclerosis from endothelial dysfunction?

Cigarette smoking causes endothelial dysfunction and promotes atherosclerosis.

CNS effects of hypernatremia

Coma, convulsions, confusion. Hypernatremia causes osmotic shrinking of the brain cells

The nurse expects a client with a serum sodium level of 129 mEq/L to have which assessment findings?

Confusion and lethargy Clinical manifestations of hyponatremia (levels below 135 mEq/L) include confusion, lethargy, coma, and perhaps seizures.

Which assessment findings will the nurse typically observe with the presence of an AMI?

Cool, clammy skin Crushing chest pain Nausea and vomiting

what do corticosteroids do?

Corticosteroids are anti-inflammatory agents.

Which clinical condition will cause the nurse to closely monitor a client for hypernatremia?

Decreased antidiuretic hormone secretion is a cause of diabetes insipidus, which prevents water reabsorption in the kidneys, creating large volumes of dilute urine and leading to hypernatremia

Which information indicates the nurse has a correct understanding of the pathophysiologic processes that are important in cell injury

Defects in protein folding Depletion of adenosine triphosphate (ATP) Accumulation of oxygen-derived free radicals

What do you monitor for in a pt with hypokalemia

Diarrhea. Diarrhea increases the amount of potassium lost in the feces, making one predisposed to hypokalemia.

A client is diagnosed with third-degree block. A nurse categorizes this block as which disorder?

Disorder of impulse conduction. Left bundle branch block is classified as abnormal conduction within the heart.

A nurse administered a medication that will reduce preload in a client with left-sided heart failure. Which medication classification did the nurse give?

Diuretics reduce preload.

A client had an acute myocardial infarction (AMI). The nurse will monitor the client for which complications?

Dysrhythmia Pericarditis Heart failure Dressler syndrome

To help a nurse determine if a client has had a myocardial infarction (MI), which laboratory results will provide the best evidence?

Elevated serum levels of cardiac troponin. The cardiac troponins are the most specific indicators of MI.

A nurse plans to teach the staff about an embolism. Which information should the nurse include in the teaching plan?

Embolism can have serious consequences, such as myocardial infarction and stroke

A client with rheumatic fever has erythema marginatum. What will the nurse observe upon assessment?

Erythema marginatum is nonpruritic, pink, erythematous macules on the trunk that do not occur on the face or hands.

The nurse identifies that a client is experiencing an isotonic fluid loss, based on the presence of which assessment findings?

Flat neck veins Rapid heart rate Decreased urine output Decreased blood pressure Indicators of hypovolemia include a rapid heart rate, flattened neck veins, and normal or decreased blood pressure.

What lab result do you expect with hypoventilation.

Hypercapnia. With hypoventilation, CO 2 removal is slower than CO 2 production, and the level of CO 2 in the arterial blood (Paco 2) increases, causing hypercapnia (Paco 2 greater than 44 mm Hg), This results in respiratory acidosis, Inadequate alveolar ventilation in relation to metabolic demands

Which information indicates the nurse has an accurate understanding of hyperchloremia in a client?

Hyperchloremia is an elevation of serum chloride concentration above 105 mEq/L. occurs with increase in Na and a deficit of bicarb

A client had a myocardial infarction. The nurse is monitoring the glucose closely. What is the rationale for the nurse's action?

Hyperglycemia is noted approximately 72 hours after an acute myocardial infarction and is associated with an increased risk of death;

client with oliguria from renal failure should be closely monitored by the nurse for which electrolyte imbalance?

Hyperkalemia. The oliguric phase of renal failure decreases potassium excretion, which causes hyperkalemia.

A client is receiving intravenous magnesium sulfate to prevent seizures. What assessment finding would indicate to the nurse that the infusion rate is too fast

Hypermagnesemia causes decreased deep tendon reflexes.

manifestations of hypocalcemia and normal range

Hypocalcemia is a low blood calcium level (less than 8.5 mg/dl) and causes increased neuromuscular excitability, tingling, and muscle spasms.

A client with shock has an increased heart rate, vasoconstriction (increased systemic vascular resistance), and movement of interstitial fluid into the vascular compartment. Which type of shock will the nurse observe documented on the chart?

Hypovolemic shock. In response to hypovolemia, sympathetic nervous system activation causes tachycardia and vasoconstriction.

A client is experiencing cellular swelling. Which pathophysiologic process should the nurse remember while planning care?

Increased intracellular sodium concentration increases osmotic pressure, drawing more water into the cell.

Which findings will cause a shift of potassium out of the client's cells?

Insulin deficiency, aldosterone deficiency, acidosis, cell lysis, and strenuous exercise facilitate the shift of potassium out of cells.

A nurse plans to help a client with diabetes mellitus to reduce the risk of coronary artery disease. What is the rationale for the nurse's action

Insulin resistance and diabetes have multiple effects on the cardiovascular system, including endothelial damage, thickening of the vessel wall, and increased inflammation.

Which findings will cause a shift of potassium into the client's cells?

Insulin, aldosterone, epinephrine, and alkalosis facilitate the shift of potassium into cells.

actions of aldosterone in regulating water and electrolyte balance?

It is secreted when blood pressure is low. It is secreted when serum potassium levels are increased. It promotes renal reabsorption of water to increase blood volume.

A client is having problems with bicarbonate reabsorption and regeneration. Which acid/base organ should the nurse assess

Kidneys

In a client with mitral stenosis, cardiac catheterization findings would indicate increased pressure in which heart chamber?

Left atrium. Impedance to blood flow results in incomplete emptying of the left atrium and elevated atrial pressure as the chamber tries to force blood through the stenotic valve.

A client is diagnosed with aortic stenosis. Which chamber of the heart will the nurse monitor most closely?

Left ventricle. Aortic stenosis can cause incomplete emptying of the left ventricle.

If a client in liver failure has a decreased production of protein, what pathophysiologic process will occur, resulting in edema?

Lost or diminished plasma albumin production (e.g., from liver disease or protein malnutrition) contributes to decreased plasma oncotic pressure, leading to edema.

Which laboratory result will alert the nurse that a client with atherosclerosis may be predisposed to coronary artery disease?

Low levels of HDL cholesterol (200 mg/dl), high levels of LDL (>160 mg/dl), and high levels of triglycerides (>200 mg/dl) are indicative of coronary artery disease.

While teaching about atherosclerosis the nurse includes the type of white blood cell that plays a major role in the formation of the fatty streak. Which white blood cell is the nurse describing?

Macrophages phagocytize low-density lipoproteins and accumulate in the arterial wall, forming the fatty streak.

Which conditions would require the nurse to administer magnesium replacement therapy?

Malnutrition Chronic alcoholism Malabsorption syndromes

Which client is most at risk for right heart failure?

Man with left heart failure Left heart failure causes pressure to back up into the pulmonary circulation, causing increased right ventricular afterload and the potential for right heart failure.

Which piece of equipment should the nurse obtain to best monitor a client with complicated hypertension for early signs of impending renal dysfunction?

Microalbuminuria (small amounts of protein in the urine) is now recognized as an early sign of impending renal dysfunction. A urine test kit can detect it.

Which heart valves should the nurse monitor because they are the most commonly affected in valvular dysfunction?

Mitral and Aortic: those of the left heart (mitral and aortic valves) are far more commonly affected than those of the right heart (tricuspid and pulmonic valves).

A client has a loud holosystolic murmur that radiates to the back and axilla. Based on this assessment finding, which valvular abnormality does the nurse suspect the client is experiencing?

Mitral regurgitation allows backflow of blood from the left ventricle into the left atrium during ventricular systole, producing a holosystolic (throughout systole) murmur heard best at the apex, which radiates into the back and axilla.

Which pathophysiologic mechanism should the nurse remember when planning care for a client with neurogenic shock?

Neurogenic shock (sometimes called vasogenic shock) is the result of widespread and massive vasodilation that results from parasympathetic overstimulation and sympathetic understimulation of vascular smooth muscle.

A nurse is conducting health screenings at a local clinic. Which risk factors will place the individuals at a higher risk for hypertension?

Obesity High dietary sodium Glucose intolerance Positive family history for hypertension

A client who is diagnosed with infective endocarditis asks the nurse, "I was told that these strange lines in my fingernails are splinter hemorrhages. How could a heart infection cause me to get splinters? I haven't been working with wood." Which information by the nurse is best?

Owing to the infection in your heart, little pieces of fibrin and bacteria can break off and circulate in the blood. If they land in the nail beds, they can look like splinters.

A nurse is teaching a women's group about the symptoms of coronary artery disease and myocardial infarction for women. Which clinical manifestations should the nurse include?

Palpitations Sudden fatigue Sense of unease Mild back discomfort

A client has pericardial effusion. What primary pathophysiologic process will the nurse consider while planning care?

Pericardial effusion is a collection of fluid in the pericardial sac.

The nurse teaches a coworker about pericardial effusions. Which information from the coworker indicates teaching was successful?

Pericardial effusion is not always clinically significant if the fluid accumulates gradually However, if fluid, in either large or small amounts, accumulates rapidly, a serious condition called tamponade may result.

A client has atherosclerosis. Which clinical manifestation will the nurse find upon assessment?

Physical examination of a client with atherosclerosis may reveal bruits

A client has an accumulation of protein. Which systems will the nurse most closely monitor?

Protein excess accumulates primarily in the epithelial cells of the renal convoluted tubules (in the kidneys) and in the antibody-forming plasma cells (B lymphocytes) of the immune system.

A client has diastolic heart failure. Which clinical manifestation will the nurse expect to find upon assessment?

Pulmonary edema, dyspnea on exertion, and fatigue. EF is normal.

untreated mitral valve stenosis leads to...

Pulmonary hypertension, pulmonary edema (crackles), opening snap, and right-sided heart failure (edema)

manifestations of metabolic acidosis

Rapid, deep breathing (kussmauls), lethargy, abdominal pain, dysrhythmias

Which change in laboratory values will the nurse assess as evidence of renal compensation for a client's respiratory acidosis?

Renal compensation or respiratory acidosis occurs by elimination of hydrogen ions and retention of bicarbonate

A client has aortic stenosis. How is the blood flow affected?

Resistance to blood flow from the left ventricle into the aorta--- In aortic stenosis, the orifice of the aortic valve narrows, causing resistance to blood flow from the left ventricle into the aorta.

A client has Buerger disease. Which findings will the nurse observe upon assessment?

Rubor, cyanosis, thin shiny skin.

which ion has a higher concentration in the client's major extracellular fluid than in the client's intracellular fluid?

Sodium

hypomagnesia and normal rates

Symptoms of low magnesium include irritability, increased reflexes, muscle cramps, ataxia, convulsions, and tetany. The serum magnesium level is normal when between 1.8 and 3.0 mEq/L

A nurse monitors a client with bacterial pneumonia for hypoxemia. What is the rationale for the nurse's actions?

The inflammatory response to bacterial pneumonia causes accumulation of exudates in the acini and terminal bronchioles and impairs oxygenation, leading to hypoxemia

A client has inflammation of the internal lining of the cardiac chambers and valves. Which term should the nurse use during report to describe this condition?

The internal lining of the cardiac chambers and valves is the endocardium, and its inflammation is termed endocarditis.

A client has chronic venous insufficiency. Which area should the nurse assess first?

The lower extremities should be assessed first, because symptoms of chronic venous insufficiency include edema of the lower extremities and hyperpigmentation of the skin of the feet and ankles.

Which body system is usually the first organ to fail in a burn client that is high risk for multiple organ dysfunction syndrome (MODS)?

The lung is often the first organ to fail, resulting in acute respiratory distress syndrome. The liver and kidney usually fail next, then the gastrointestinal system and finally, the cardiac system.

What acid/base do the lungs deal with?

The lungs regulate retention or elimination of CO2.

The nurse teaches a client about mitral valve prolapse syndrome. Which information from the client indicates teaching was effective?

The mitral valve balloons back into the left atrium during contraction.

Which laboratory result would cause the nurse to realize that the client has met the criteria for a diagnosis of dyslipidemia?

The triglyceride level of 210 mg/dl is high and meets the criteria for dyslipidemia.

A client has hypercapnia. What probably caused the hypercapnia?

There are many causes of hypercapnia (increased carbon dioxide in the arterial blood). Most are a result of decreased drive to breathe or an inadequate ability to respond to ventilatory stimulation.

A client has high-output failure. Which action by the nurse is most appropriate?

Thiamine deficiency (beriberi) causes high output failure where CO is higher than normal due to increased peripheral demand. administering thiamine will reverse effects of beriberi

Hyperaldosteronism

causes excessive renal retention of sodium and water and excessive potassium excretion, which lead to isotonic fluid excess and hypokalemia. Retention of water and sodium leads to extracellular fluid volume excess, rather than deficit. Excess aldosterone results in hypernatremia and hypokalemia

A client has an injury that causes free radicals to be released in the body. Which pathophysiologic mechanisms that cause cellular damage will occur?

cell membrane damage and DNA mutations

dysplasia

changes the size, shape, and organization

manifestations of acute hypoxemia?

edema, cyanosis, confusion, decreased renal output.

A client had an occlusion of a blood vessel from a bolus of circulating matter in the bloodstream. The nurse will use which term in report to describe the client's condition?

embolus-An embolus detaches from the wall of a vessel, and this bolus of matter circulates within the vascular system until it reaches a vessel small enough for it to occlude

hypertrophy

increased cell size

hyperphosphatemia

increased levels of phosphate serum. can be caused by acute or chronic renal failure

A nurse is teaching the staff about the role that increased sympathetic nervous system (SNS) activity plays in the development of hypertension. Which information should the nurse include?

increased renin levels. Mechanisms of SNS-induced hypertension include structural changes in blood vessels (vascular remodeling), renal sodium retention, insulin resistance, increased renin and angiotensin levels, and procoagulant effects. SNS increases heart rate.

A nurse is assessing a client with a restrictive lung disorder. Which clinical manifestation is characteristic of restrictive respiratory disorders?

individuals with lung restriction complain of dyspnea and have an increased respiratory rate and decreased tidal volume. Restrictive lung diseases are characterized by decreased compliance of the lung tissue.

manifestations of hypokalemia and normal range

normal serum potassium level is 3.5 to 5 mEq/L. Moderate to severe hypokalemia causes skeletal muscle weakness and cardiac dysrhythmias, decreased bowel sounds, U wave on ECG.

A client experiences spinal cord damage after a motorcycle accident. The nurse will monitor the client for which type of shock?

Vasogenic shock results from an increase in parasympathetic nervous stimulation and a decrease in sympathetic nervous stimulation, usually from spinal cord or medulla trauma.

what system compensates during an acid/base imbalance?

When metabolic acids are out of balance, the respiratory system compensates for the altered pH by adjusting the amount of carbon dioxide in the blood.

Which adult client should the nurse monitor for the development of valvular stenosis or valvular regurgitation of the mitral or aortic valves?

a patient with heart failure.

What is Status asthmaticus

a severe condition in which asthma attacks follow one another without pause. can be life threatening if not reversed.

Intracellular fluid has a higher concentration of...

potassium ions, phosphate ions, and magnesium ions than does extracellular fluid.

A client's osmoreceptors are stimulated. Which action should the nurse take?

provide glass of water. Increased osmolality stimulates hypothalamic osmoreceptors. In addition to causing thirst, these osmoreceptors signal the posterior pituitary gland to release antidiuretic hormone.

A client has small cell lung cancer but is displaying signs and symptoms of inappropriate antidiuretic hormone secretion.

signs and symptoms (called paraneoplastic syndromes) may be the first manifestation of the underlying cancer. Small cell carcinomas most commonly produce antidiuretic hormone, resulting in the syndrome of inappropriate antidiuretic hormone secretion.

A client has aortic valve stenosis. Which findings will the nurse typically find on assessment?

symptoms include angina, syncope, and dyspnea.

A client has the most common site of intracellular lipid accumulation. Which organ will the nurse monitor?

the most common site of intracellular lipid accumulation, or fatty change, is liver cells.