Patho Exam 2
A client has developed chronic hypoxia and has developed pulmonary hypertension (HTN). The nurse recognizes that the most likely cause of pulmonary hypertension would be: -Hardening of the pulmonary vessels due to increased fat deposits -Constriction of the pulmonary vessels in response to hypoxemia Decreased vascular resistance in the pulmonary vessels Constant dilation of the pulmonary vessels in response to hypoxia
-Constriction of the pulmonary vessels in response to hypoxemia * Pulmonary HTN occurs as a result of chronic hypoxia. In response to hypoxia, the pulmonary vessels constrict. The pulmonary vessels differ from the systemic circulation vessels, which dilate in response to hypoxia and hypercapnia. Smooth muscle hypertrophy and proliferation of the vessel intima occur in pulmonary HTN.
A client with primary lung disease has developed right heart failure. The health care provider would document this as: -Adult respiratory distress syndrome -Cor pulmonale -Primary hypertension -Cardiac tamponade
-Cor pulmonale * The term cor pulmonale refers to right-sided heart failure resulting from primary lung disease or pulmonary hypertension
What intervention is appropriate for a client with sarcoidosis? -Lymph node radiation -Corticosteroids -Antifungal agents -Antihistamines
-Corticosteroids * Sarcoidosis treatment is directed at interrupting the inflammatory process with corticosteroid medications. Sarcoidosis is overgrowth of granulomas and does not have a fungal or allergy component.
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? -Ultrasound of the kidney -Chest x-ray -Echocardiogram -CT of the head
-Echocardiogram
Which description sums up the basic pathophysiology of heart failure that the nurse would include when educating a client? -Low cardiac output due to reduced pumping ability -Reduced tissue perfusion, especially to the kidney -Myocardial remodeling of scar tissue -Activated sympathetic (adrenergic) reflexes
-Low cardiac output due to reduced pumping ability * a loss of ventricular efficiency with a decrease in cardiac output. As a result, blood flow to body tissues declines, and sympathetic reflexes of vasoconstriction and increase in heart rate attempt to compensate. The renin-angiotensin-aldosterone system is activated, and aldosterone, which causes myocardial remodeling, is released.
Which statements are true concerning deep-vein thrombosis (DVT)? Select all that apply. -White blood cell counts tend to decrease with the presence of a DVT. -Inflammation is the root cause of many of the symptoms of DVTs. -Many individuals with DVT have no symptoms. -Sedimentation rates are a common diagnostic test for DVTs. -Deep muscle tenderness is a common symptom of DVT.
-Many individuals with DVT have no symptoms; Deep muscle tenderness is a common symptom of DVT; Sedimentation rates are a common diagnostic test for DVTs; Inflammation is the root cause of many of the symptoms of DVTs
The nurse is developing a community program since a recent increase in admissions to the acute care facility with tuberculosis infection. What is the most frequent form of tuberculosis that the nurse should focus on? -Ghon tuberculosis -Mycobacterium tuberculosis -Pneumocystis jirovecii tuberculosis -Mycobacterium avium-intracellulare complex
-Mycobacterium tuberculosis *Mycobacterium tuberculosis hominis is the most frequent form of tuberculosis that threatens humans.
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? -Pericarditis -Myocardial infarction -Pericardial effusion -COPD
-Pericardial effusion * Pericardial effusion refers to the accumulation of fluid in the pericardial cavity, usually as a result of an inflammatory or infectious process.
An older male client has fallen at home and sustained a bruised left hip. Assessment reveals shortness of breath and shallow respirations with a respiratory rate of 40 breaths/min. If the client develops a tension pneumothorax, what additional assessment finding would the nurse observe? -Increased blood pressure -Auscultation of pleural friction rub -Asymmetry of chest during inspiration -Presence of a mediastinal shift
-Presence of a mediastinal shift * Physical assessment findings of a mediastinal shift and neck vein distention would indicate a tension pneumothorax.
A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be: -Avoiding frequent dental examinations -Prompt diagnosis and treatment of streptococcal infections -Yearly electrocardiography after the age of 50 -Annual blood specimen assessed for rheumatoid factor
-Prompt diagnosis and treatment of streptococcal infections * Rheumatic heart disease is normally caused by streptococcal infections; therefore, early diagnosis of these would decrease the risk for the disease
A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for: -Pulmonary embolism -Arterial insufficiency -Vasculitis -Polyarteritis nodosa
-Pulmonary embolism * Deep venous thrombosis (DVT) most commonly occurs in the lower extremities. DVT of the lower extremity is a serious disorder, complicated by pulmonary embolism, recurrent episodes of DVT, and development of chronic venous insufficienc
Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response? -Pulmonary vessels dilate -Pulmonary vessels spasm -Pulmonary vessels constrict -Pulmonary vessels infarct
-Pulmonary vessels constrict * Continued exposure of the pulmonary vessels to hypoxemia is a common cause of pulmonary hypertension. Unlike blood vessels in the systemic circulation, most of which dilate in response to hypoxemia and hypercapnia, the pulmonary vessels constrict
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? -Atherosclerotic occlusive disease -Frostbite related to hypothermia -Raynaud disease -Deep vein thrombosis
-Raynaud disease * The symptoms of this client represent Raynaud disease
A female client tells the health care provider that she has recently been experiencing episodes of changes occurring in the color of her fingertips, especially when she experiences cold temperatures. She further states that the tips become pale, turn a bluish color, and then become reddened. The client is most likely experiencing: -Vasculitis -Thromboangiitis obliterans -Raynaud phenomenon -Atherosclerosis
-Raynaud phenomenon * Raynaud phenomenon is seen in otherwise healthy young women, and it often is precipitated by exposure to cold or by strong emotions and usually is limited to the fingers. The ischemic phase of Raynaud phenomenon is manifested by changes in skin color that progress from pallor to cyanosis and progress to hyperemia.
The neonatologist explains to the parents of a neonate born at 35 weeks' gestation that their premature infant will be monitored for complications. Which respiratory complication is the most common? -Intraventricular hemorrhage -Periodic breathing -Respiratory distress syndrome -Asthma
-Respiratory distress syndrome *The respiratory distress syndrome is the most common complication of prematurity (neonates born before 37 weeks' gestation). In these neonates, pulmonary immaturity, together with surfactant deficiency, leads to alveolar collapse.
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? -cardiogenic shock -pericarditis -cor pulmonale -right-sided heart failure
-Right sided heart failure * A major effect of right-sided heart failure is the development of peripheral edema.
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 -Anaphylactic -Neurogenic -Cardiogenic
-Septic * Septic shock can result with the body's response to a severe infection.
A family member comes rushing out of a client's room telling the nurse that the loved one can't breathe. The nurse has just left the room after hanging IV penicillin. Which clinical manifestations lead the nurse to suspect the client is experiencing anaphylactic shock? Select all that apply. -Hives over entire body -Swelling around the lips and eyes -Wheezing sound on inspiration -Incontinent of urine -Severe bronchospasm
-Severe bronchospasm; Wheezing sound on inspiration; Hives over entire body; Swelling around the lips and eyes
A client with an 80-pack-year history of tobacco smoking has presented to the clinic complaining of "bronchitis" cough for the past 5 months, weight loss, and shortness of breath. Today, this client "got scared" when he coughed up blood in his sputum. The health care provider is concerned this client may have which possible diagnosis? -Pneumothorax related to chronic lung infection weakening the alveoli -Small cell lung cancer due to smoking history -Tuberculosis due to long period of coughing -Pulmonary embolism due to blood in sputum
-Small cell lung cancer due to smoking history * Small cell lung cancer has the strongest association with cigarette smoking and is rarely observed in someone who has not smoked; brain metastasis is common. The earliest symptoms (of lung cancer) usually are chronic cough, shortness of breath, and wheezing because of airway irritation and obstruction. Hemoptysis (i.e., blood in the sputum) occurs when the lesion erodes into blood vessels
A 6-month-old infant has been hospitalized with acute bronchiolitis. Which treatment should be prioritized in the infant's care? -Supplementary oxygen therapy -Transfusion of fresh frozen plasma -Tracheotomy -Intravenous antibiotics
-Supplementary oxygen therapy
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for: -Tearing or ripping-type pain in the chest or back -Tonic-clonic seizures -Late hypertensive crisis -Chest pain radiating to the right arm
-Tearing or ripping-type pain in the chest or back * A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping
Which client is at the greatest risk of developing rheumatic heart disease? -Teen w/ untreated strep throat -Older adult with shingles -Child with impetigo on the face -Young adult with viral meningitis
-Teen w/ untreated strep throat *Rheumatic fever is caused by group A (beta-hemolytic) streptococcal throat infection
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? -Raynaud disease -Varicose veins -Polyarteritis nodosa -Temporal arteritis
-Temporal arteritis * Temporal arteritis (i.e., giant cell arteritis), the most common of the vasculitides, is a focal inflammatory condition of medium-sized and large arteries. It predominantly affects branches of arteries originating from the aortic arch, including the superficial temporal, vertebral, ophthalmic, and posterior ciliary arteries
A parent of a toddler is concerned about possible side effects of influenza immunizations. What will the nurse teach the parent regarding the influenza vaccine? -Mercury-based preservatives are no longer used in vaccine administration, so the influenza vaccine is safe for all individuals. -The Centers for Disease Control and Prevention recommends that all people 6 months of age and older should receive the annual influenza vaccine. -Parents can win lawsuits if side effects occur following an influenza vaccine. -The evidence of vaccines leading to autism is only linked to the measles, mumps, and rubella (MMR) vaccine, not the influenza vaccine.
-The Centers for Disease Control and Prevention recommends that all people 6 months of age and older should receive the annual influenza vaccine.
A person receiving a 2-step testing procedure to test for tuberculosis (TB) exposure would be considered positive for TB exposure when which findings occur? -The client exhibits signs and symptoms of TB. -The first test is positive or negative and the second test is positive. -A chest x-ray confirms active TB. -Both the first and second testing procedures are positive.
-The first test is positive or negative and the second test is positive * The 2-step procedure requires a positive or negative first test, with a second test repeated in 7 days that is positive to consider the person positive for TB exposure. If the first test is positive, there is not need to repeat the test and the client should have a chest x-ray plus additional follow-up.
An infant born prematurely is in the neonatal intensive care unit (NICU) for observation and to ensure hemodynamic stability when the nurse observes the infant beginning to have nasal flaring. What does the nurse understand that this may indicate? -The infant is attempting to decrease oxygen consumption. -The infant is using nasal flaring to take in more air. -The infant is having atelectasis. -The infant is attempting to rid the lungs of fluid
-The infant is using nasal flaring to take in more air. * Nasal flaring is a method that infants use to take in more air. This method of breathing increases the size of the nares and decreases the resistance of the small airways.
The nurse knows that the primary long-term regulation of blood pressure is exerted by which body system? -Neural mechanisms -Hormonal activity -The kidneys -Humoral influence
-The kidneys * The kidneys exert long-term control of blood pressure by modulating sodium content and extracellular fluid volume. An increase in extracellular fluid will yield an increase in blood volume and an increase in cardiac output. If this results in too great an increase in blood pressure, the kidneys will excrete sodium and water
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. -Cystic fibrosis decreases the amount of salt in the infant's sweat. -Abnormal pancreatic enzymes may cause the infant to sweat more. -The sweat test evaluates the infant's ability to sweat in response to heat.
-The sweat test measures the concentration of salt in the infant's sweat * Cystic fibrosis is a genetic disorder that produces abnormal functioning in the epithelial cell chloride channels. The chloride is not reabsorbed, leaving high concentrations of sodium chloride in the sweat.
A teenager comes to the emergency room with a history of strep throat and symptoms that lead the staff to suspect rheumatic fever. Which tests can best establish a diagnosis of rheumatic fever? -CBC -Echo -There is no definitive test for diagnosing RF. -Blood cultures
-There is no definitive test for diagnosing RF * There are no specific lab tests that can establish a diagnosis of rheumatic fever. Because of the variety of signs and symptoms, the Jones criteria for the diagnosis of rheumatic fever are used.
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 most likely to resolve the client's most recent health problem? -Administration of bronchodilators -Administration of corticosteroids -Supplementary oxygen therapy -Thoracentesis
-Thoracentesis * With large effusions, thoracentesis may be used to remove fluid from the intrapleural space and allow for reexpansion of the lungs
Which blood vessel layer is composed primarily of smooth muscle cells? -Tunica intima -Endothelium -Tunica externa -Tunica media
-Tunica media * The tunica media consists primarily of circumferentially arranged layers of smooth muscle cells. The tunica externa is composed of loose connective tissue and the tunica intima of endothelial cells. The endothelium is the lining of the vascular system and is composed of endothelial cells
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 -When the electrocardiogram (ECG) shows sinus tachycardia -When the heart rate reaches 135 beats/min -When the client states feeling soreness in the muscles
-When the client experiences chest pain *It will be stopped when the client experiences abnormal ECG or vital signs, chest pain, severe shortness of breath or a decrease in blood pressure.
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have? -Will have a direct vasoconstrictive effect on vessels of splanchnic circulation -Will increase oxygen consumption of the heart -Will increase extracellular fluid and decrease venous pressure -Will prevent the conversion of angiotensin I to angiotensin II
-Will prevent the conversion of angiotensin I to angiotensin II * The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction, aldosterone levels, intrarenal blood flow, and glomerular filtration rate. ACE inhibitors are increasingly used as the initial medication in mild to moderate hypertension.
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? -CF is autosomal dominant, so you have a 50% risk in another child. -You have a 25% chance that your next child will have CF. -Now that you have one child with CF, the rest will also have it. -Since the male carries the CF gene, you might consider a sperm donor.
-You have a 25% chance that your next child will have CF.
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: -try to calm down the client by maintaining therapeutic communication. -apply a Vaseline gauze (airtight) dressing over the insertion site. -observe and wait for the "code blue" team to bring equipment. -place the client's meal napkin over the wound.
-apply a Vaseline gauze (airtight) dressing over the insertion site * Sucking chest wounds, which allow air to pass in and out of the chest cavity, should be treated by promptly covering the area with an airtight covering
A mother in premature labor asks the nurse why her doctor has prescribed corticosteroids. The nurse's response is based on the fact that: -corticosteroids can perform anti-inflammatory acts that may prevent infections. -corticosteroids cause blood glucose levels to rise, thus preventing hypoglycemia in premature infants. -cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant. -cortisol administration will enhance the secretion of insulin, which is needed for surfactant production.
-cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant. * Surfactant synthesis is influenced by several hormones, including insulin and cortisol. Insulin tends to inhibit surfactant production. Cortisol can accelerate maturation of type II cells and formation of surfactant.
An older adult client is newly diagnosed with hypertension. Which vascular changes in the aging adult can lead to hypertension? -increased elasticity of the arterial connective tissue -decreased elasticity of the venous connective tissue -decreased elasticity of the aorta and large arteries -increased elasticity of the venous connective tissue
-decreased elasticity of the aorta and large arteries * In aging adults, there is a decrease in the elasticity of the aorta and large arteries making them more rigid, thereby increasing systolic blood pressure. This can lead to increased cardiac afterload and hypertension.
A client with hypercholesterolemia is being treated with diet and exercise. Which assessment finding is a positive outcome of this treatment regimen? -lowered high-density lipoproteins -increased blood glucose levels -increased low-density lipoproteins -increased high-density lipoproteins
-increased high-density lipoproteins
A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be: -chest x-ray. -arterial blood gas analysis. -insertion of a large-bore needle or chest tube. -administration of oxygen by face mask.
-insertion of a large-bore needle or chest tube. *Emergency treatment of tension pneumothorax involves the prompt insertion of a large-bore needle or chest tube into the affected side of the chest along with one-way valve drainage or continuous chest suction to aid in lung reexpansion
A parent brings a child into the urgent care clinic. The health care provider suspects the child has a "common cold" based on which clinical manifestation(s)? Select all that apply. -mild fever -coughing -watery, clear nasal secretions -nuchal rigidity -photosensitivity
-mild fever, coughing & watery, clear nasal secretions
A client from Texas is suspected of being infected with coccidioidomycosis and has been admitted to the hospital with fever, cough, pleuritic chest pain, and skin lesions. When performing a health history, which question would be most valuable to assist with diagnosis? -"Do you have a history of cancer?" -"Do you work in construction and dig soil?" -"Do you have cats and clean litter boxes?" -"Do you smoke?"
-"Do you work in construction and dig soil?" * The disease resembles tuberculosis, and its mechanisms of infection are similar to those of histoplasmosis
Diagnostic testing has resulted in a diagnosis of small cell lung cancer (SCLC) in an older adult client. When exploring the etiology of the client's disease, what assessment question is most relevant? -"Is there any history of cancer among your grandparents, parents, or siblings?" -"Have you ever been a smoker?" -"Do you have chronic obstructive pulmonary disease?" -"Have you ever been exposed to radiation during your working life?"
-"Have you ever been a smoker?" *Most cases of SCLC are attributable to smoking, and it is rare among nonsmokers
An older adult client who was recently diagnosed with emphysema asks the nurse what caused the disease. Which statement is the best response? -"This disease is seen most commonly in middle-aged men and is associated with chronic irritation from smoking and recurrent infections." -"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?" -"Emphysema is a permanent dilation of the bronchi and bronchioles caused by destruction of the muscle and elastic supporting tissue as the result of infection and inflammation." -"There is no known cause for emphysema; however, it does seem to run in families. Has anyone in your family been diagnosed with this disease?"
-"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?" * The causes of emphysema are smoking, which incites lung injury, and an inherited deficiency of alpha 1-antitrypsin, an antiprotease enzyme that protects the lung from injury.
While educating a smoking cessation class, a client asks the nurse, "If I can still get lung cancer, what should I be looking for?" Which response by the nurse is best? -"The earliest symptoms relate to a chronic cough and shortness of breath." -"When you can no longer get up or have the energy to go to work [fatigue], you should make an appointment with your physician." -"If you wake up with dried blood on your pillow, call your doctor right away." -"If you start losing weight without trying and coughing up thick, yellow sputum, you should seek medical attention.
-"The earliest symptoms relate to a chronic cough and shortness of breath. * The earliest symptoms usually are chronic cough, shortness of breath, and wheezing because of airway irritation and obstruction. Hemoptysis (i.e., blood in the sputum) occurs when the lesion erodes into blood vessels.
A client in the nursing home wonders why he is having these signs and symptoms of left-sided heart failure. Which explanation will the nurse give the client? -"The left ventricle is pumping excessive amounts of blood through the carotid arteries causing headache." -"The left ventricle is not adequately perfusing your gastrointestinal tract, leading to diarrhea and vomiting." -"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs." -"The left ventricle is having problems pumping blood forward, so blood is backing up systemically causing edema in your feet."
-"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs." * In left-sided failure, the left ventricle pumps inefficiently, blood backs up in the pulmonary circulation, and less, rather than more, blood enters the carotid arteries.
A client newly diagnosed with lung cancer asks the nurse why the health care provider has ordered a positron emission tomography (PET) scan. Which response by the nurse is best? -"This test will evaluate whether your tumor cells will be receptive to chemotherapy treatment." -"This test will tell the doctor how well your immune system is working." -"This procedure will evaluate every inch of your brain to see if there are any tumors there." -"This diagnostic procedure will let the doctor know if you have any metastatic lesions in your body.
-"This diagnostic procedure will let the doctor know if you have any metastatic lesions in your body. *Positron emission tomography (PET) is a noninvasive alternative for identifying metastatic lesions in the mediastinum or distant sites
A client diagnosed with tuberculosis asks the nurse how long the antitubercular medication will need to be taken. What is the best response? -"Drug therapy will continue until all symptoms of tuberculosis have stopped." -"Drug therapy will continue unless a drug resistance develops." -"You can take drug therapy for as long as 24 months or until all tubercle bacilli are eliminated." -"You will be on multiple drug therapy for the rest of your life."
-"You can take drug therapy for as long as 24 months or until all tubercle bacilli are eliminated." * The goal of treatment is to eliminate all tubercle bacilli from an infected person while avoiding emergence of significant drug resistance. Treatment of active tuberculosis requires the use of multiple drugs. Tuberculosis is an unusual disease in that drug therapy is required for a relatively long period.
Which client is exhibiting signs of advanced chronic obstructive pulmonary disease (COPD)? -client reclining in semi-Fowler position, talking on phone, taking breaths in mid-sentence -client sitting in high-Fowler position and exhibiting a shorted expiratory phase -client sitting in bed resting elbows on the overbed table, expiratory wheezes noted -client walking in hall with a respiratory rate of 16 breaths/min
--client sitting in bed resting elbows on the overbed table, expiratory wheezes noted *The client sitting in a tripod position with expiratory wheezes is the most typical presentation for a client with COPD. COPD progresses from relatively mild manifestations in the early stages to severe respiratory impairment where breathing is labored, even at rest.
In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which level indicates inadequate renal perfusion? -60—40 mL/hour -80—60 mL/hour -40—20 mL/hour -20 mL/hour
-20 mL/hour
Which client is at greatest risk for orthostatic hypotension? -A 20-year-old pregnant client at 36 weeks' gestation -A 70-year-old female client who has taken the same antihypertensive medication for 10 years -A 66-year-old postoperative client on bed rest -A 42-year-old male client with history of pulmonary embolism
-A 66-year-old postoperative client on bed rest
Which client most likely faces the highest risk of developing secondary pulmonary hypertension? -A client with COPD and a 35 pack-year smoking history. -An older adult client who has been hospitalized for the treatment of community-acquired pneumonia -A client who suffered a thermal injury to his lungs in a fire -A client with asthma who uses her inhaled bronchodilator more often than prescribed
-A client with COPD and a 35 pack-year smoking history. * COPD is a major risk factor for secondary pulmonary hypertension
When trying to educate a client about the release of free radicals and the role they play in formation of atherosclerosis, which statement is most accurate? -The end result of oxidation is rupture of the plaque, resulting in hemorrhage. -Oxidized free radicals produce toxic metabolic waste that can kill liver cells. -Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. -Activated cells roam the vascular system looking for inflammatory cells to engulf.
-Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. * Activated macrophages release free radicals that oxidize LDL. Oxidized LDL is toxic to the endothelium, causing endothelial loss and exposure of the subendothelial tissue to the blood components. This leads to platelet adhesion and aggregation and fibrin deposition.
A client sustained a puncture injury to the chest resulting in development of a tension pneumothorax. What is the pathogenesis behind a tension pneumothorax? -Expired air exits the bleeding wound at a faster rate than inhalation. -The opposite lung hyperinflates to compensate for the collapsed lung. -Air is permitted to enter but not leave the pleural space, causing lung collapse. -Blebs on the lung surface rupture due to increased intrapleural pressure.
-Air is permitted to enter but not leave the pleural space, causing lung collapse * Tension pneumothorax occurs when the intrapleural pressure exceeds atmospheric pressure. It is a life-threatening condition and occurs when injury to the chest or respiratory structures permits air to enter but not leave the pleural space.
Which is the most common cause of atelectasis? -Inflammation of the pleura -Chronic, forceful coughing -Airway obstruction -Pulmonary embolism
-Airway obstruction *Atelectasis is caused most commonly by airway obstruction rather than a vascular obstruction. Obstruction can be caused by a mucus plug in the airway or by external compression
A client is rushed to the emergency department with assessment findings of urticaria, wheezing, chest tightness, and difficulty breathing. The client is most likely experiencing which type of shock? -Septic -Anaphylactic -Cardiogenic -Neurogenic
-Anaphylactic
The nurse is providing instructions to a client for the treatment of a common cold. The most appropriate information would be: -Antipyretic medications and rest -Antibiotics and antihistamines -Complete isolation and bed rest -Antibiotics administered for 7 days
-Antipyretic medications and rest
A nurse who works in a neonatal intensive care unit is providing care for an infant who was born at 26 weeks' gestation. Which initial assessment should be the nurse's priority? -Regular measurement of the infant's blood pressure and temperature -Assessment of the infant's motor skills and limb range of motion -Assessment of the infant's respiratory status and oxygen saturation levels -Assessment of the infant's neurologic status
-Assessment of the infant's respiratory status and oxygen saturation levels *The most common complications of prematurity involve respiratory function. Respiratory disorders develop in infants who are born prematurely or who have other problems that impair this transition.
Prolonged immobility is implicated in the development of which disorder? -Atelectasis and pulmonary embolism -Sarcoidosis and idiopathic pulmonary fibrosis -Bronchitis and bronchiectasis -Pulmonary hypertension and cor pulmonale
-Atelectasis and pulmonary embolism * Lack of mobility can result in secondary atelectasis (through incomplete lung expansion) and pulmonary embolism (from deep vein thrombosis)
Soon after delivery, the mother grabs the nurse's arm and states, "Something's wrong!...I can't get my breath." Which assessments lead the nurse to suspect the client has had an amniotic emboli travel to the lungs? Select all that apply. -Trachea has shifted and is no longer midline. -Intercostal traction noted on inspiration. -BP 90/65; pulse 130, irregular; respiratory rate 35, shallow. -Productive cough with blood-streaked sputum -+3 pitting edema in lower extremities
-BP 90/65; pulse 130, irregular; respiratory rate 35, shallow; Productive cough with blood-streaked sputum * Persons with moderate-sized emboli often present with breathlessness accompanied by pleuritic pain, apprehension, slight fever, and cough productive of blood-streaked sputum. Tachycardia often occurs to compensate for decreased oxygenation, and the breathing pattern is rapid and shallow
Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences? -Backup of blood from the right atrium into the superior vena cava -Backflow from the right ventricle to the right atrium during systole -Backflow from the left ventricle to left atrium -Inhibition of the SA node's normal action potential
-Backflow from the left ventricle to left atrium * The mitral valve separates the left ventricle from the left atrium; failure of this valve would cause backflow from the former to the latter during systole.
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." -"Pulls your blood from the right side of the heart and runs it through a machine to oxygenate it better, and then return it to your body." -"Has a probe at the end of a catheter to obtain thermodilution measures, so cardiac output can be calculated." -"Measures the pressures inside your heart continuously to asses pumping ability of your left ventricle."
-"Decreases the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
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? -Talking to a friend about using more saturated and less unsaturated fats when cooking -Encouraging a friend to cook with trans fats, as they extend the shelf life of foods -Encouraging a friend to be tested for familial hypercholesterolemia -Going for a brisk walk with a friend and talking to him about continuing to exercise regularly
-Going for a brisk walk with a friend and talking to him about continuing to exercise regularly * The management of hypercholesterolemia focuses on dietary and therapeutic lifestyle changes. Therapeutic lifestyle changes include an increased emphasis on physical activities such as walking and exercise
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? -Restlessness and nervousness -Headache and confusion -Stupor and hyperreflexia -Papilledema and lethargy
-Headache and confusion
Anaphylactic shock causes severe hypoxia very quickly because of which reason? -Heart rate and contractility are reduced. -Histamine release causes massive vasodilation. -Metabolic rate is greatly increased. -Generalized vasoconstriction reduces venous return.
-Histamine release causes massive vasodilation * Anaphylactic shock, a severe allergic reaction, rapidly causes severe hypoxia as histamine release results in massive vasodilation. The volume of blood is no longer able to fill the greatly dilated vascular compartment
During assessment of a 66-year-old woman, the nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. Which aspects of the pathophysiology of aneurysms would the health care provider explain to this client? -Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures. -Hypertension is a frequent modifiable contributor to aneurysms. -Aneurysms can normally be resolved with lifestyle and diet modifications. -Aneurysms are commonly a result of poorly controlled diabetes mellitus.
-Hypertension is a frequent modifiable contributor to aneurysms * Hypertension is associated with over half of aneurysms
Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death? -Hypertrophic cardiomyopathy (HCM) -Dilated cardiomyopathy (DCM) -Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) -Takotsubo cardiomyopathy
-Hypertrophic cardiomyopathy (HCM) *HCM is characterized by a massively hypertrophied left ventricle with a reduced chamber size.
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? -venous injury -increased heart rate -impaired venous return -increased blood viscosity
-Increased HR * Increased heart rate cannot contribute to venous thromboembolism
A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process? -Myocardial infarction -Cardiomyopathy -Infective endocarditis -Pericarditis
-Infective endocarditis
A client asks the nurse if it is possible to contract influenza by being exposed to wound secretions. On what knowledge should the nurse base her response to the client? -Influenza may be contracted by touching a surface that an infected person has touched. -Influenza is transmitted by exposure to urine, blood, and body secretions. -Influenza transmission occurs by inhalation of droplet nuclei. -Influenza transmission occurs through contact with the skin of an infected person.
-Influenza transmission occurs by inhalation of droplet nuclei *transmission occurs by inhalation of droplet nuclei rather than touching contaminated objects
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 -Decreases vascular volume by suppressing renal reabsorption of sodium -Decreases the heart rate, which will cause a decrease in cardiac output -Inhibits the movement of calcium into cardiac and vascular smooth muscle
-Inhibits the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction * The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction.
