Patho Exam 2 (quizzes)

An adult client has been diagnosed with polycystic kidney disease. Which of the client's following statements demonstrates an accurate understanding of this diagnosis?

"I suppose I should be tested to see if my children might inherit this.

Blue Bloaters is an acronym for patients with emphysema.

False - chronic bronchitis

While taking a history from an adult client newly diagnosed with renal cell cancer, the nurse can associate which of the following high-risk factors with the development of this cancer?

Heavy smoking Reason: Epidemiologic evidence suggests a correlation between heavy smoking and kidney cancer

Which of the following manifestations typically accompanies an asthmatic attack?

Hyperinflation of the lungs Reason:During a prolonged attack, air becomes trapped behind the occluded and narrowed airways, causing hyperinflation of the lungs. This produces an increase in the residual volume of the lungs. Pulmonary arterial pressure tends to increase and expiration becomes prolonged.

The nurse is providing care for a client who has a diagnosis of kidney failure. Which of the following laboratory findings is consistent with this client's diagnosis?

Hypocalcemia Reason: Diagnostic findings that are congruent with a diagnosis of kidney failure include hyperphosphatemia, hypocalcemia, a decrease in active vitamin D levels, and secondary hyperparathyroidism.

A client has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which of the following measures should the client integrate into his lifestyle to reduce the risk of recurrence?

Increased fluid intake and dietary changes

Glomerulonephritis is usually caused by:

antigen-antibody complexes

Shortness of breath when lying down is apnea

false --> orthopnea

A father experienced the onset of chest pain and dies suddenly. The family asks, "What caused him to die so suddenly?" The health care provider's reply that is most appropriate would be, "There's a high probability that your loved one developed an acute heart attack and experienced:

"Acute ventricular arrhythmia." Reason: Sudden death from an acute myocardial infarction in an adult is usually caused by fatal (ventricular) arrhythmias. Hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in the young, since the disorder can be inherited as an autosomal dominant trait. Troponin is normally present in cardiac muscle; serum levels of troponin enzymes are diagnostic and will elevate within 3 hours of the acute event. Myocarditis is an inflammation of the heart muscle and conduction system without evidence of myocardial infarction.

A neighbor is complaining to a friend (who happens to be a nurse) about several changes in their body. Which of the following complaints raises a "red flag" because it could be a sign of epithelial cell bladder cancer?

"I noticed my urine is pinkish red, but I'm not having any pain when I pee." Reason: The most common sign of bladder cancer is intermittent painless hematuria. Fluid retention, stress incontinence, and pain with exercise are not usual signs of cancer.

A 51-year-old man has been diagnosed with chronic bronchitis after a long history of recurrent coughing. Which of the man's following statements 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." Reason: Smoking is frequently implicated in the etiology of chronic bronchitis. Infections do not typically initiate the disease, and exercise is not noted to have preventative value. Enzyme deficiency is associated with emphysema, but not bronchitis.

A public health nurse is conducting a health promotion class for a group of older adults. Which of the participants' following statements demonstrates an accurate understanding of the risk factors for bladder cancer?

"More than ever, I guess it would worthwhile for me to quit smoking." Reason: Smoking is implicated in 30% to 50% of all bladder cancers among males who are current or past smokers. Cranberry juice may be of benefit in the prevention of UTIs, not cancer, and neither poor diet nor family history is as significant as cigarette smoking in the etiology of bladder cancer.

In anatomy class, the instructor asks, "Explain how urine is expelled from the bladder during voiding." The student with the most accurate response would be:

"The detrusor muscle contract down on the urine and the ureteral orifices are forced shut. The external sphincter relaxes as urine moves out of the bladder." Reason: During the act of micturition, the detrusor muscle of the bladder fundus and bladder neck contracts down on the urine and the ureteral orifices are forced shut. The bladder neck is widened and shortened, and the external sphincter relaxes as urine moves out of the bladder. Descent of the diaphragm and contraction of the abdominal muscles raise intra-abdominal pressure and aid in the expulsion of urine from the bladder.

If a CKD client is developing uremic encephalopathy, the earliest manifestations may include: Select all that apply.

(1) Diminished awareness, (2) Decreased alertness Reason: Reductions in alertness and awareness are the earliest and most significant indications of uremic encephalopathy. Late in the disease process, the client may develop delirium, coma, and seizures.

Which of the following clients would be at high risk for developing primary varicose veins? Select all that apply.

1) A 47-year-old waitress who works 12-hour shifts three or four times/week, 2) A morbidly obese (>100 pounds overweight) male who works behind the counter of a convenience store 10 hours/day, 5 days/week Reason: Prolonged standing and increased intra-abdominal pressure are important contributing factors in the development of primary varicose veins. Because there are no valves in the inferior vena cava or common iliac veins, blood in the abdominal veins must be supported by the valves located in the external iliac or femoral veins. Immobility may cause DVTs (a secondary cause of varicose veins). Peritoneal dialysis has no effect on the development of varicose veins.

A child with asthma is walking outside and develops a bronchospasm. The school nurse knows this bronchospasm has what effects on bronchioles with airflow? Select all that apply.

1) Impairs airflow, 2) Narrowing of bronchioles Reason: Bronchospasm, or contraction of these muscles, causes narrowing of the bronchioles and impairs airflow. Bronchospasm does not exert tension on the walls of the bronchi, cause atelectasis, or inhibit filtering of dust particles.

A 2-year-old child is admitted to the pediatric unit with bronchiolitis. The nurse calls the physician fearing the child is going into respiratory failure based on which of the following assessment findings? Select all that apply.

1) Substernal retractions becoming more pronounced, 2) Increased respiratory rate to 44 breaths/minute, 3) New-onset expiratory grunting Reason: Children with impending respiratory failure due to airway or lung disease have rapid breathing; exaggerated use of accessory muscles; retractions, which are more pronounced in the child than in the adult because of higher chest compliance; nasal flaring and grunting during expiration.

Which of the following individuals is experiencing an immunologic lung disorder affecting ventilation that has caused the formation of a granuloma on chest x-ray?

A 30-year-old African American man who has been diagnosed with sarcoidosis Reason: Sarcoidosis is an example of restrictive lung disease, whereas cystic fibrosis (CF), emphysema, and asthma are considered obstructive.

Which of the following individuals likely faces the greatest risk for the development of chronic kidney disease?

A client with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet Reason: Chronic kidney disease (CKD) is a pathophysiologic process that results in the loss of nephrons and a decline in renal function that has persisted for more than 3 months. CKD can result from diabetes, hypertension, glomerulonephritis, lupus (SLE), and polycystic kidney disease. The prevalence and incidence of CKD continue to grow, reflecting the growing elderly population and the increasing number of people with diabetes and hypertension. Hemorrhage may result in acute renal failure, but it is not associated with chronic kidney disease. Stroke and loss of the thyroid gland are not noted to underlie cases of chronic kidney disease.

Which of the following clients is at risk for developing a preventable disorder related to prolonged immobility?

A postsurgical client who is refusing to get out of bed and walk and will not wear those "uncomfortable elastic stocking" Reason: A lack of mobility can result in secondary atelectasis (through incomplete lung expansion) and pulmonary embolism (from deep vein thrombosis). This is not the case with the other listed disorders of ventilation and gas exchange.

A child is recovering from a bout with group A β-hemolytic Streptococcus infection. They return to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed:

Acute postinfectious glomerulonephritis Reason: The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days—the time needed for the development of antibodies.

Which of the following is a non modifiable risk factor for the development of primary hypertension?

African American race Reason: Hypertension not only is more prevalent in blacks than whites, but also is more severe, tends to occur earlier, and often is not treated early enough or aggressively enough. Blacks also tend to experience greater cardiovascular and renal damage at any level of pressure. High salt intake and obesity are modifiable risk factors for hypertension. Male gender is not identified as a risk factor for hypertension.

A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse what diffuse means. The nurse responds:

All glomeruli and all parts of the glomeruli are involved.

Which of the following clients should most likely be assessed for orthostatic hypotension?

An 80-year-old elderly client who has experienced two falls since admission while attempting to ambulate to the bathroom Reason: Dizziness and syncope are characteristic signs and symptoms of orthostatic hypotension, and both predispose an individual to falls; this is especially the case among older adults. Headaches, edema, diabetes, and vision changes are not associated with orthostatic hypotension.

A client is beginning to recover from acute tubular necrosis. The nurse would likely be assessing which of the following manifestations of the recovery phase of ATN?

Diuresis Reason: The recovery phase is first noticed as increased/excessive output (diuresis) of dilute urine and a fall in serum creatinine, indicating that the nephrons have recovered to the point at which urine excretion is possible. Potassium will remain elevated or continue to rise, since the diuresis occurs before renal function fully returns to normal. Edema/fluid retention is characteristic of the maintenance phase. Proteinuria is characteristic of glomerular disease and/or chronic kidney disease.

A mother rushes her toddler into the emergency department stating, "My baby can't breathe." Initial assessment reveals the child is struggling to breathe in an upright position. He has both inspiratory and expiratory stridor and is using his chest muscles to breathe. The nurse suspects the child has which of the following acute respiratory infections?

Epiglottitis Reason: Epiglottitis typically presents with an acute onset of a sore throat and fever. The child appears pale, toxic, and lethargic and assumes a distinctive position—sitting up with the mouth open and the chin thrust forward

The most recent assessment of a client with a diagnosis of type 1 diabetes indicates a heightened risk of diabetic nephropathy. Which of the following assessment findings is most suggestive of this increased risk?

Microalbuminuria Reason: The increased glomerular filtration rate (GFR) that occurs in persons with early alterations in renal function is associated with microalbuminuria, which is an important predictor of future diabetic nephropathies.

A drug abuser was found unconscious after shooting up heroin 2 days prior. Because of the pressure placed on the hip and arm, the client has developed rhabdomyolysis. The nurse knows this can:

Obstruct the renal tubules with myoglobin and damage tubular cells

COPD clients live with persistently elevated PCO 2 levels. Therefore, which assessment finding would likely initiate a stimulus for ventilation in this client population?

PO 2 level of 50 mm Hg Reason: The central chemoreceptors are extremely sensitive to short-term changes in blood PCO 2 levels. An increase in PCO 2 of the blood produces an increase in ventilation that reaches its peak within a minute or so and then declines if the PCO 2 level remains elevated. Thus, persons with chronically elevated blood PCO 2 levels no longer respond to this stimulus for increased ventilation but rely on the stimulus provided by a decrease in arterial PO 2 levels that is sensed by the peripheral chemoreceptors.

A teenaged cystic fibrosis client presents to the clinic. The health care provider (HCP) knows that cystic fibrosis (CF) causes severe chronic respiratory disease in children. In addition, the HCP should also focus his or her assessment on which of the other body systems affected by CF?

Pancreatic Reason: Cystic fibrosis (CF) is manifested by pancreatic exocrine deficiency and elevation of sodium chloride in the sweat. Cystic fibrosis (CF) is an inherited disorder involving fluid secretion by the exocrine glands in the epithelial lining of the respiratory, gastrointestinal, and reproductive tracts. Excessive loss of sodium in the sweat predisposes young children to salt depletion episodes. Respiratory manifestations are caused by an accumulation of viscid mucus in the bronchi, impaired mucociliary clearance, lung infections, bronchiectasis, and dilatation. The renal, cardiac, and CNS are usually not involved with CF manifestation.

Following surgery, a client had a chest x-ray that reported some opacities in the lung bases likely due to atelectasis. Which of the following pathophysiologic processes will result from this condition?

Perfusion without ventilation Reason: With shunt, there is perfusion without ventilation, resulting in a low ventilation-perfusion ratio. This occurs in conditions such as atelectasis in which there is airway obstruction. Ventilation without perfusion (dead air space) is a consequence of impaired pulmonary circulation. Hypoxemia will result in vasodilation, not vasoconstriction.

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

Pet dander Reason: Extrinsic or atopic asthma is typically initiated by a type I hypersensitivity reaction induced by exposure to an extrinsic antigen or allergen such as pet dander. Intrinsic or nonatopic asthma triggers include respiratory tract infections, exercise, hyperventilation, cold air, drugs and chemicals, hormonal changes and emotional upsets, airborne pollutants, and gastroesophageal reflux.

A client with a history of emphysema from long-term cigarette smoking has loss of many alveoli. When comparing the type I alveolar cell physiologic function with the primary role of type II alveoli, the nurse would be aware that the type II alveoli are responsible for:

Production of surfactant Reason: Although macrophages are present in all alveoli, only type II alveoli produce surfactant. They do not participate directly in gas exchange or facilitate bronchial circulation.

Which of the following assessment findings would lead the nurse to suspect the client has nephrotic syndrome?

Proteinuria and generalized edema Reason: The nephrotic syndrome is characterized by massive proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized edema, and hyperlipidemia.

As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to:

Pulmonary hypertension Reason: Hypoxemia causes reflex vasoconstriction of the pulmonary vessels and further impairment of gas exchange in the lung. Hypoxemia also stimulates red blood cell production, causing polycythemia. As a result, persons with chronic obstructive bronchitis may develop pulmonary hypertension and right-sided heart failure. With breakdown and loss of lung elasticity and hyperinflation of the lungs with emphysema, the airways often collapse during expiration.

The pathogenic capacity of the tubercle bacillus is related to:

The initiation of a cell-mediated immune response Reason: The pathogenesis of tuberculosis, in previously unexposed immunocompetent people, is a cell-mediated immune response that confers resistance to the organism and development of hypersensitivity to the tubercular antigens. Pathologic manifestations of tuberculosis, such as caseating granuloma and cavitation, are the result of the hypersensitivity reaction rather than its inherent destructive capabilities. In persons with intact cell-mediated immunity, the cell-mediated immune response results in the development of a granulomatous lesion, called a Ghon focus, that contains the tubercle bacilli, modified macrophages, and other immune cells.

A college student is training for a marathon in the mountains. One day, she experiences a sharp pain and suddenly becomes short of breath. At the emergency room, chest x-ray reveals a spontaneous pneumothorax. The client asks the nurse to explain why this happened. The nurse states, "For unknown reasons, you lose intrapleural negative pressure.

This means your lungs collapsed and expelled its air when you lose negative pressure." Reason: The intrapleural pressure is always negative in relation to alveolar pressure in the normally inflated lung: approximately 4 mm Hg between breaths when the glottis is open and the alveolar spaces are open to the atmosphere. Although the intrapleural pressure of the inflated lung is always negative in relation to alveolar pressure, it may become positive in relation to atmospheric pressure. Although the intrapleural pressure of the inflated lung is always negative in relation to alveolar pressure, it may become positive in relation to atmospheric pressure (e.g., as during forced expiration and coughing). A spontaneous pneumothorax is a collapsed lung with loss of negative pressures.

A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a life-threatening condition because:

Trapped, inspired air collapses the lung. Reason: 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. Spontaneous pneumothorax occurs when an air-filled bleb, or blister, on the lung surface ruptures. Rupture of these blebs allows atmospheric air from the airways to enter the pleural cavity. This results in a rapid increase in pressure in the chest with a compression atelectasis of the unaffected lung.

A client had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased, and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute:

Tubular necrosis Reason: Ischemic acute tubular necrosis (ATN) occurs most frequently in persons who have major surgery with prolonged renal hypoperfusion—this directly damages the tubular epithelial cells with acute suppression of renal function. Nephrotoxic ATN is caused by toxic agents or drugs. Prerenal vasoconstriction is associated with acute-onset loss of renal output. Bladder (postrenal) obstruction would not affect the BUN, since it rarely causes renal failure.

Many factors contribute to the incontinence that is common among the elderly. A major factor is increased:

Use of multiple medications Use of multiple medications for other health problems can affect bladder function, especially diuretics. Drugs such as hypnotics, tranquilizers, and sedatives can interfere with the conscious inhibition of voiding, leading to urge incontinence. Detrusor muscle function and urethral closing pressure are decreased in the elderly, causing incontinence. Decreased fluid and water intake causes problems of bowel impaction and urinary tract infection.

Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by:

Vegetative valve destruction Reason: Murmurs are sounds produced by blood flow through incompetent valves. Both infective endocarditis and myocarditis of rheumatic heart disease are characterized by growth of vegetation on valve leaflets, causing destruction, regurgitation, and murmur. Atrial fibrillation is a conduction disorder that impairs atrial emptying rather than valve function. Myocardial inflammation is present but does not cause murmurs. Valve dysfunctions can chronically decrease emptying and lead to left ventricular hypertrophy.

A female client asks, "Why do I leak urine every time I cough or sneeze?" The health care worker's response is based on which physiologic principle?

When intravesical pressure exceeds maximal urethral closure pressure

A female teenager has experienced three uncomplicated urinary tract infections in the last 3 months. Knowing the anatomical location of the urethra, the nurse should educate this teenager about:

Wiping from front to back to prevent Escherichia coli contamination of the urethra Reason: Most commonly, urinary tract infections (UTIs) are caused by Escherichia coli that enter through the urethra. Escherichia coli are abundant in fecal matter. Other uropathic pathogens include Staphylococcus saprophyticus in uncomplicated UTIs and both non- E. coli gram-negative rods ( Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas) and gram-positive cocci ( Staphylococcus aureus, group B Streptococcus) in complicated UTIs.

T/F: Dyspnea is difficulty breathing

true

The respiratory drive in patients with chronic obstructive pulmonary disease can be diminished when administering oxygen to them.

true