Patho EAQ for Final Prep

Which rationale would the nurse use when explaining the purpose of pursed-lip breathing to a client with emphysema?

Decreases air trapping in lung Rationale Pursed-lip breathing provides positive pressure in the airways during expiration, prolonging expiration and decreasing the air trapping, which is characteristic of emphysema. Pursed-lip breathing will not decrease bronchospasm, which is characteristic of asthma. Alveolar surface area is not changed by pursed-lip breathing. Diaphragmatic contraction is not strengthened by pursed-lip breathing.

Which chemical buffers excessive acetoacetic acid?

Sodium bicarbonate Rationale Sodium bicarbonate is a base and one of the major buffers in the body. Potassium, a cation, is not a buffer; only a base can buffer an acid. Carbon dioxide is carried in aqueous solution as carbonic acid (H2CO3); an acid does not buffer another acid. Sodium chloride is not a buffer; it is a salt.

The nurse is evaluating the effectiveness of a treatment for a client with excessive fluid volume. Which clinical finding indicates that treatment was successful?

Clear breath sounds Rationale Excess fluid can move into the lungs, causing crackles; clear breath sounds support that treatment was effective. Although it may make palpation more difficult, excess fluid will not diminish pedal pulses. A normal potassium level can be maintained independently of fluid excess correction. As the client excretes excess fluid, the urine specific gravity will increase, not decrease.

Which are the pathophysiological factors of acne? Select all that apply. One, some, or all responses may be correct.

Comedogenesis Alteration in follicular growth Production of excessive sebum Colonization of Propionibacterium acnes Rationale Pathophysiologic factors of acne include comedogenesis (the formation of comedones), the production of excessive sebum, an alteration in follicular growth, and the colonization of Propionibacterium acnes. Consuming dairy products may potentiate acne in some people, but it is not a pathophysiological factor.

Which clinical finding would the nurse anticipate when admitting a client with an extracellular fluid volume excess?

Distended jugular veins Rationale Because of fluid overload in the intravascular space, the neck veins become visibly distended. Rapid, thready pulse and elevated hematocrit level occur with a fluid deficit. If sodium causes fluid retention, its concentration is unchanged; if fluid is retained independently of sodium, its concentration is decreased.

Which statement is true regarding primary dysmenorrhea? Select all that apply. One, some, or all responses may be correct.

During the lute.al phase, F2-alpha is secreted. Pain usually begins at the onset of menstruation and lasts for 8 to 48 hours. Rationale Primary dysmenorrhea is a condition associated with the ovulatory cycle. During the luteal phase and subsequent menstrual flow, F2-alpha is secreted. The pain usually begins at the onset of menstruation and lasts for 8 to 48 hours. Anovulatory bleeding, which is common in the few months or years after menarche, is painless. Primary dysmenorrhea usually appears 6 to 12 months after menarche when ovulation is established. Excessive release of prostaglandin F2-alpha increases the amplitude and frequency of uterine contractions.

Which education would the nurse provide the parents of an infant about the cause of galactosemia?

Error in carbohydrate metabolism Rationale Galactosemia results from an absence of the hepatic enzyme that converts galactose to glucose, a step in carbohydrate metabolism. Intolerance to grains is found in children with celiac disease. An inability to metabolize an essential amino acid (phenylalanine) describes phenylketonuria. When parasympathetic ganglion cells are absent from the colon, megacolon (congenital aganglionic megacolon) develops.

The nurse teaching a prenatal class is asked why infants of diabetic mothers are larger than those born to women who do not have diabetes. On which information about pregnancy and diabetes would the nurse base the response?

Extra circulating glucose causes the fetus to acquire fatty deposits. Rationale It is difficult to maintain maternal normoglycemia throughout pregnancy; excess glucose passes into the fetus, where it is converted to fat. The problem is excess glucose, which is why exogenous insulin must be administered. Although all pregnant women consume extra calories to meet the increased metabolism associated with pregnancy, fetal insulin does not pass from the fetus to the mother. In diabetes it is the pancreatic hormone insulin that is affected, not the pancreatic enzymes.

The nurse is caring for a school-aged child with cystic fibrosis. Which pathophysiologic factor has the greatest effect on the child's health status?

Extremely thick mucus causing obstructed airways Rationale Dysfunction of the exocrine glands leads to an excessive accumulation of thick mucus, a slower flow rate of mucus, and incomplete expectoration of mucus, all of which contribute to airway obstruction. Acute inflammation of the lung parenchyma is associated with pneumonia, not cystic fibrosis. The endocrine glands are not affected in cystic fibrosis. Increased irritability of the airways that causes obstruction is associated with asthma, not cystic fibrosis.

Which organ is commonly affected in children with juvenile idiopathic arthritis (JIA)?

Eyes Rationale Juvenile idiopathic arthritis can cause inflammation of the iris and ciliary body of the eyes, which may lead to blindness. The ears are not affected. The liver may become enlarged, but this does not occur as frequently as visual problems do. The brain is not affected.

A 7-year-old child is admitted for a diagnostic workup and is transferred from the emergency department to the pediatric unit. The nurse reviews the admission note and physical assessment. The nurse obtains the child's vital signs and talks with the parents. The parents ask the nurse why their child has severe headaches. Which explanation would the nurse give for the cause of the headaches?

Increased blood pressure

A child who has iron-deficiency anemia tells the school nurse, "I get dizzy in gym class." Which explanation is most likely for the development of this symptom?

Insufficient cerebral oxygenation Rationale Decreased oxygen (O2)-carrying capacity of the blood may result in hypoxia during exercise, when O2 demand is greater. Although the other options may cause dizziness, they are not directly related to anemia.

Which information would the nurse include when teaching parents about the basic problem in celiac disease?

Intolerance of gluten Rationale Celiac disease is an immunological small intestine enteropathy characterized by the inability to metabolize the gliadin component of gluten found in grains such as wheat, barley, rye, and oats; this results in excessive glutamine that is toxic to the mucosal cells. The stools are fatty and yellow. The intestinal villi are present but will atrophy if exposed to foods containing gluten. Fluid balance is not the basic problem with celiac disease; however, dehydration may occur in celiac crisis.

Which description would the nurse provide the parents of an infant who are asking about what a patent ductus arteriosus (PDA) is?

It is a connection between the pulmonary artery and the aorta. Rationale Before birth, oxygenated fetal blood is shunted directly into the systemic circulation by way of the ductus arteriosus, a connection between the pulmonary artery and the aorta. After birth, the increased oxygen tension causes a functional closure of the ductus arteriosus. Occasionally, particularly in preterm infants, this vessel remains open, a condition known as patent ductus arteriosus. Enlargement of the diameter of the aorta is not the problem in patent ductus arteriosus. A defective wall between the right and left ventricles is a description of ventricular septal defect. A narrowing of the entrance to the pulmonary artery is a description of pulmonic stenosis.

A client describes abdominal discomfort after ingestion of milk. Which enzyme, as a result of a genetic deficiency, would the nurse consider to be the cause of the client's discomfort?

Lactase Rationale Milk and milk products are not tolerated well because they contain lactose, a sugar that is converted to galactose by lactase. Sucrase assists in the digestion of sucrose, which is not a milk sugar. Maltase assists in the digestion of maltose, which is not a milk sugar. Amylase assists in the digestion of starch, which is not a milk sugar.

Which client conditions does the nurse associate with bluish-colored mucous membranes? Select all that apply. One, some, or all responses may be correct.

Methemoglobinemia Cardiopulmonary disease Rationale A bluish color of the mucous membranes may indicate methemoglobinemia (the presence of methemoglobin in the blood, which is an oxidized form of hemoglobin) and cardiopulmonary disease in the client. The presence of a white color of the mucous membranes may indicate edema in the client. Diabetes mellitus is associated with a yellow-orange color of the palms and soles. The presence of a brown color of the distal lower extremities may indicate hemochromatosis (deposition of iron salts in the tissues).Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

A client asks the nurse what causes the sudden loss of vision common in persons with multiple sclerosis. Which factor would the nurse include in the explanation?

Optic nerve inflammation Rationale Optic nerve inflammation is a common early effect of multiple sclerosis caused by lesions in the optic nerves or their connections (demyelization). This effect may resolve during periods of remission. At present, there is no evidence of viral infection of the eyes in multiple sclerosis. Tumors of the brain and cerebral edema, not multiple sclerosis, cause increased intracranial pressure because the skull cannot expand. Closed-angle glaucoma causes blindness as a result of increased intraocular pressure, not inflammation of the optic nerve, which is commonly associated with multiple sclerosis. Closed-angle glaucoma is unrelated to multiple sclerosis.

A young pregnant adolescent is diagnosed as having bacterial vaginosis. Which complications related to bacterial vaginosis may occur? Select all that apply. One, some, or all responses may be correct.

Preterm labor and birth Intraamniotic infection Postpartum endometritis Rationale Preterm birth and labor may occur because bacteria that enters the cervix irritates the uterus, which cause contractions. Bacterial vaginosis is associated with high risk of intraamniotic infection and postpartum endometritis. Neonatal sepsis occurs because of gonococcal infections. Cervical dysplasia occurs in clients with human immunodeficiency virus infections.

Which ion is the regulator of extracellular osmolarity?

Sodium Rationale Sodium is the most abundant extracellular fluid cation and regulates serum (extracellular) osmolarity, as well as nerve impulse transmission and acid-base balance. Potassium is the major intracellular osmolarity regulator, and it also regulates metabolic activities, transmission and conduction of nerve impulses, cardiac conduction, and smooth and skeletal muscle contraction. Chloride is a major extracellular fluid anion and follows sodium. Calcium is an extracellular cation necessary for bone and teeth formation, blood clotting, hormone secretion, cardiac conduction, transmission of nerve impulses, and muscle contraction.

Which education would the nurse provide the parents of an infant with bilateral cryptorchidism about the infant's prognosis if the problem is not corrected?

Sterility upon maturity Rationale In cryptorchidism (undescended testes), the sperm-producing capacity of the testes is destroyed by the heat of the body, resulting in sterility. Inflammation of the epididymis may occur whether or not cryptorchidism is corrected. A hydrocele is an enlargement of the scrotum with fluid; it is not related to cryptorchidism. A varicocele is dilation and tortuosity of the scrotal veins; it is not caused by undescended testicles.

Which statement explains why toddlers are prone to middle ear infections?

Structural differences between eustachian tubes of younger and older children Rationale The eustachian tube in young children is shorter and wider, allowing a reflux of nasopharyngeal secretions. Immunologic differences are not a factor in the development of otitis media. There is no difference in the function of the eustachian tube among age groups. The size of the middle ear does not play a role in the occurrence of otitis media in young children.

Parents whose child has cystic fibrosis (CF) have no history of CF in their family and ask how their child inherited this disorder. How would the nurse clarify the way in which the disease was inherited?

The inheritance is autosomal recessive. Rationale Both parents are carriers; the gene for CF is recessive, not dominant, and the parents do not have the disease. The gene for CF is not a mutant gene, nor is it located on the X or Y chromosome.

A child's mother asks the school nurse how her child got head lice. Which explanation would the nurse share with the mother?

Transmission occurs through contact with contaminated children and objects. Transmission occurs through direct contact with infected individuals and contaminated objects such as infested clothing, personal articles, and bedding. Animals and birds do not carry or transmit head lice. Although crowded conditions can contribute to an infestation, direct contact with contaminated people and objects is the origin of an infestation. All socioeconomic groups are affected equally.

Arrange the pathophysiological events of acne in the correct sequence.

1. Excessive sebum production 2. Alterations in follicular growth and differentiation 3. Colonization of Propionibacterium acnes 4. Immune response and inflammation Rationale Excessive sebum production occurs with the maturation of adrenocortical glands. This action is followed by alterations in follicular growth and differentiation. Propionibacterium acnes proliferate and increase in number. This proliferation leads to an accumulation of neutrophils, which causes the formation of papules, pustules, nodules, and cysts and subsequent inflammation.

When ammonia is excreted by healthy kidneys, which mechanism usually is maintained?

Acid-base balance of the body Rationale The excreted ammonia combines with hydrogen ions in the glomerular filtrate to form ammonium ions, which are excreted from the body. This mechanism helps rid the body of excess hydrogen, maintaining acid-base balance. Osmotic pressure of the blood and normal red blood cell production are not affected by excretion of ammonia. Ammonia is formed by the decomposition of bacteria in the urine; ammonia excretion is not related to the process and does not control bacterial levels.

A client who experienced extensive burns is receiving intravenous fluids to replace fluid loss. The nurse would monitor for which initial symptom of fluid overload?

Crackles in the lungs Rationale Crackles, or rales, in the lungs are an early sign of pulmonary congestion and edema caused by fluid overload. Clients with fluid overload will usually demonstrate an increased heart rate and increased blood pressure. A decreased heart rate and decreased blood pressure and cyanosis in a client with fluid overload would be very late and fatal signs.

Which adverse hemodynamic effect typically occurs when a client develops tachycardia? Select all that apply. One, some, or all responses may be correct.

Decreased ventricular filling time Lower cardiac output Weaker pulse quality

Which statement should be considered when teaching measures to prevent lead poisoning in children?

Environmental factors are involved because lead is available for ingestion and inhalation. Rationale Lead poisoning is caused by lead in the environment. Sources of lead may include deteriorating paint in a home (inhaled or ingested); lead in products that are used daily, such as batteries, pottery, and glass (ingested); and lead in the atmosphere (which may be inhaled or fall on food that is then ingested). Unless the fat has been exposed to lead, it is not a causative factor. The inability to metabolize ingested protein is phenylketonuria. Milk does not counteract the effects of lead. Also, the teaching regards causes of lead poisoning, not treatments.

Which part of the upper respiratory system is involved in equalizing the pressure within the middle ear while swallowing?

Eustachian tubes

Which mediator of injury is involved in the client with pruritic lesions from an immunoglobulin E (IgE)-mediated hypersensitivity reaction?

Histamine Rationale Histamine is one of the mediators of injury involving IgE-mediated injury and potentially causes pruritus. Cytokines are the mediators of injury in delayed hypersensitivity reaction. Neutrophils are involved in immune complex-mediated hypersensitivity reactions. Macrophages in tissues are involved in cytotoxic reactions.

Which eye disorders are caused by Staphylococcus aureus? Select all that apply. One, some, or all responses may be correct.

Hordeolum Conjunctivitis Rationale A hordeolum is an infection of the eyelid sweat gland caused by S. aureus and S. epidermidis. Bacterial conjunctivitis is most often caused by S. aureus. An ectropion is the turning outward and sagging of the eyelid caused by muscle relaxation or weakness. Trachoma is a chronic conjunctivitis caused by Chlamydia trachomatis. Chalazion is an inflammation of a sebaceous gland in the eyelid.

Which complication of cystic fibrosis is related to frequent stools and tenacious mucus?

Rectal prolapse Rationale Rectal prolapse, a common gastrointestinal complication of cystic fibrosis, results from the wasting of perirectal supporting tissues because of malnutrition. Anal fissures usually do not occur with cystic fibrosis. Intussusception is not associated with cystic fibrosis. Meconium ileus is associated with cystic fibrosis in newborns; it prevents the passage of meconium.

The mother of a child with acute poststreptococcal glomerulonephritis (APSGN) is concerned that a younger sibling may also have the disorder. What does the nurse recall when preparing to explain the cause of the disease process?

An immune complex disorder occurring after a group A β-hemolytic Streptococcus infection Rationale The β-hemolytic Streptococcus immune complex becomes trapped in the glomerular capillary loop, causing APSGN. APSGN is usually precipitated by a localized pharyngitis. Clots do not form in the small renal tubules with APSGN. Prevention depends on treating an individual with a group A β-hemolytic Streptococcus infection with antibiotics to eliminate the organism before an immune response can occur. APSGN is an acquired, not an inherited, disorder.

The nurse is caring for a preterm neonate with physiological jaundice who requires phototherapy. Which action is the physiological mechanism of this therapy?

Breaks down the bilirubin into a conjugated form Rationale Phototherapy changes unconjugated bilirubin in the skin to conjugated bilirubin bound to protein, permitting excretion in the urine and feces. Phototherapy does not affect liver function; the liver does not dispose of bilirubin. Vitamin K is necessary for prothrombin formation, not bilirubin excretion. The bilirubin is not excreted by way of the skin.

The nurse is caring for an infant with bacterial meningitis. Which etiology would the nurse consider as the most likely route of transmission to the central nervous system?

Cranial apertures or sinuses Rationale Infections of cranial structures, such as apertures or sinuses, can cause meningitis because bacteria travel by way of direct anatomical route to the meninges and cerebrospinal fluid (CSF). The genitourinary tract, the gastrointestinal tract, and the skin do not come into contact with CSF.

Which component of sea water is known to be responsible for making sea water hypertonic compared with body fluids?

Salt Rationale Salt makes sea water hypertonic compared with body fluids. Mud, algae, and chlorine are present in abundance in fresh water, which is hypotonic.

Which condition is associated with unevenly curved surfaces of the client's cornea?

Astigmatism Rationale Astigmatism is a refractive error caused by unevenly curved surfaces on or in the eye, especially of the cornea. These uneven surfaces distort vision. Myopia (nearsightedness) occurs when the eye overbends the light and images converge in front of the retina. Hyperopia (farsightedness) occurs when the eye does not refract light enough. As a result, images actually converge behind the retina. Emmetropia is the perfect refraction of the eye, in which light rays from a distant source are focused into a sharp image on the retina.

Which information would the nurse include when explaining the cause of transient ischemic attacks (TIAs) to a client?

Atherosclerotic plaques within arteries Rationale Atherosclerotic plaques within arteries progressively narrow the lumens of the carotid arteries, causing TIAs. Valvular defects usually cause cerebral emboli that result in a brain attack. Brain aneurysms are developmental defects that may rupture, resulting in a brain attack. Emboli arising from the lower extremities usually result in occlusions in the pulmonary vascular system, causing a pulmonary embolus.

A client's respiratory tract infection, which started with a common cold, has progressed to whooping cough. The client reports "coughing fits" lasting for several minutes. Which organism is responsible for the client's condition?

Bordetella pertussis Rationale Bordetella pertussis causes whooping cough. Pertussis is a respiratory tract infection beginning with the common cold and progresses to whooping cough. The client also develops coughing episodes lasting for several minutes. Inhalation anthrax is caused by Bacillus anthracis. Streptococcus pneumoniae may cause pneumonia. Mycobacterium tuberculosis infection leads to tuberculosis.

Which organism is responsible for causing Lyme disease in clients?

Borrelia burgdorferi Rationale Lyme disease is a bacterial infection caused by Borrelia burgdorferi, which is transmitted by ticks. Phthirus pubis causes pediculosis. Scabies is caused by Sarcoptes scabiei. Pediculus humanus var. corporis also causes pediculosis.

Which clinical manifestations are associated with rabies infection?

Seizures and difficulty swallowing Rationale Seizures and swallowing difficulties are characteristics of rabies infection, which affects the nervous system; the disease is usually fatal if it goes untreated. Rabies is not a bacterial infection. Aphasia and opisthotonos are not characteristic of rabies; however, hypersensitivity and fluctuating consciousness are associated with rabies. Septicemia and bone deterioration are not usual symptoms of rabies; however, severe spasms of the respiratory muscles can occur. Although rabies is a viral infection, it is not characterized by immunosuppression and opportunistic infections. Immunosuppression and opportunistic infections are associated with acquired immunodeficiency syndrome (AIDS).

What microorganism would the nurse suspect as the cause of acute glomerulonephritis?

Streptococcus Rationale Acute glomerulonephritis, an immune complex disease, is a reaction that occurs as a sequela of streptococcal infection; it is known as acute poststreptococcal glomerulonephritis. Haemophilus is associated with conjunctivitis and meningitis, not with glomerulonephritis. Pseudomonas is associated with many diseases of human beings but not with glomerulonephritis in children. Staphylococcus is associated with localized suppurating infections, not with glomerulonephritis.

Which statement describes scoliosis?

There is a rotary deformity of the lateral curvature of the spine. Rationale A rotary deformity of the lateral curvature of the spine is the correct definition of scoliosis. An exaggerated concave lumbar curvature is a description of lordosis. There are no pathological changes in the vertebrae with scoliosis. A curvature of the thoracic spine with an increased convex angulation is a description of kyphosis.

Which education would the nurse provide about the occurrence of febrile seizures?

They may occur in minor illnesses. Rationale Febrile seizures are usually not associated with major neurological problems; they may occur during minor illnesses. Between 95% and 98% of these children do not experience epilepsy or other neurological problems. The cause of febrile seizures is still uncertain. Most febrile seizures occur after 6 months of age and before age 3 years, with the average age of onset between 18 and 22 months. Boys are affected about twice as frequently as girls.