Patho Exam 3

During a flu shot clinic, one of the questions the student nurse asks relates to whether the client has a history of Guillain-Barré syndrome. The client asks, "What is that?" How should the nursing student reply? "A degenerative disease where you have trouble walking without the help of a cane or walker." "Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot." "Swelling of your arm where you got your flu shot and maybe your eyes and lips had some swelling as well." "A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles."

"A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles." Gullain-Barré syndrome is an acute immune-mediated polyneuropathy. The majority of people report having had an acute, influenza-like illness before the onset of symptoms. It progresses along the ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. The rate of disease progression varies, and there may be disproportionate involvement of the upper or lower extremities. Swelling of the arm, eyes, and lips is anaphylaxis following the flu shot. It is not a degenerative disease.

A nurse practitioner is assessing a 7 year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's questions is least likely to yield data that will confirm or rule out of migraines as the cause of his problem? "Does your son have any food allergies that have been identified?" "When your son has a headache, does he ever have nausea and vomiting as well?" "Is your son generally pain-free during the intervals between headaches?" "Does your son have a family history of migraines?"

"Does your son have any food allergies that have been identified?" While food may trigger migraines in some individuals, food allergies are not an identified contributor to migraines, and their presence or absence would be unlikely to provide a differential diagnosis of migraine. Migraines have a strong genetic component and, in children, nausea and vomiting during a headache are suggestive of migraine. Individuals who are prone to migraines are pain-free in the times between episodes.

The nurse is caring for a female client with cholelithiasis. When teaching the client about the disease, the nurse includes which of these points?

"Gallstones have developed, which are typically composed of cholesterol." Cholelithiasis or gallstones is caused by precipitation of substances contained in bile, mainly cholesterol and bilirubin. It is most common in women, multiple pregnancies, those taking oral contraceptives or those who are obese.

A client is being taught how to use a TENS unit. The nurse determines that teaching was effective when the client states: "I will need to return to the doctor's office to have this TENS unit surgically implanted under my skin for the best pain relief." "The TENS unit is the easiest and most cost-effective way to manage my pain at home." "I should take my medication and apply the TENS unit to the painful area as soon as I feel the pain." "Anytime that the setting on my TENS unit needs to be changed I will have to return it to the company and wait for them to deliver a new one."

"I should take my medication and apply the TENS unit to the painful area as soon as I feel the pain." Early intervention for pain relief is the best practice. The client should understand that he or she should take his or her pain medication and apply the TENS unit. TENS units are noninvasive and should be applied as soon as the client starts to perceive pain. It is often used in conjunction with pain-relieving medication.

A client is diagnosed with Addison disease. What statement by the client indicates an understanding of the discharge instructions by the nurse?

"I will have to take my medication for the rest of my life." Addison disease, like type I diabetes, is a chronic metabolic disorder that requires lifetime hormone replacement therapy. The daily regulation of the chronic phase of Addison disease is usually accomplished with oral replacement therapy, with higher doses being given during periods of stress.

A 30-year-old female has suffered a third-degree burn to her hand after spilling hot oil in a kitchen accident. Which teaching point by a member of her care team is most appropriate? "Tell us as soon as you sense the beginnings of a round of pain and we will start with analgesics." "Opioids like morphine often cause constipation, but if this happens to you we will discontinue opioids and change to another family of medications." "Opioids aren't without side effects, but we will take action to manage these side effects so you can continue getting these drugs." "It's imperative that we prevent you from developing a tolerance for opioids while you're getting treatment for your burn."

"Opioids aren't without side effects, but we will take action to manage these side effects so you can continue getting these drugs." While opioids carry side effects such as constipation, these can be managed in order to continue treatment; constipation would not preclude the continued use of opioids, but would require management. Pain medication should precede the onset of pain, and tolerance is not grounds for discontinuing treatment.

The mother of a 2-year-old newly diagnosed with type 1 diabetes asks why insulin has to be given by injection. The best response by the nurse is:

"Insulin is destroyed by the stomach contents and has to be administered by injection." Insulin is destroyed by the gastrointestinal tract and needs to be administered via injection or inhalation. Type 1 diabetes is not treated with oral medications at this time. Insulin is administered subcutaneously rather than in the vein. The statement about the mother not having to give injections once the child is older does not address the mother's concerns.

The nurse is working with a client who has been diagnosed with recurring migraine headaches. Which advice by the nurse is most appropriate? "Migraine headaches usually respond poorly to medication, so I can help you explore nonpharmacologic options." "Many people find that maintaining regular eating and sleeping habits is beneficial." "It's likely in your best interest to move to a rural setting and explore getting a less stressful job." "Migraines are poorly understood and are generally considered unavoidable, so always have your medication with you."

"Many people find that maintaining regular eating and sleeping habits is beneficial." Nonpharmacologic treatment includes the avoidance of migraine triggers, such as foods, that precipitate an attack. Many persons with migraines benefit from maintaining regular eating and sleeping habits. The client may need to change her lifestyle, but not to the extent of moving and changing jobs. Migraines are avoidable, most of the time, if individuals adhere to their diets and watch the triggers. Medication is very useful for most clients.

A client asks if pain threshold and pain tolerance are the same. The best response by the health care provider would be: "Pain threshold is the point at which a stimulus is perceived as painful." "Pain threshold is not varied from person to person." "Pain tolerance is not affected by psychological, familial, cultural, and environmental factors." "Pain tolerance is the minimum intensity of pain a client will endure."

"Pain threshold is the point at which a stimulus is perceived as painful." Pain threshold is closely associated with the point at which a nociceptive stimulus is perceived as painful. Pain tolerance relates more to the total pain experience; it is defined as the maximum intensity or duration of pain that a person is willing to endure before the he or she wants something done about the pain. Psychological, familial, cultural, and environmental factors significantly influence the amount of pain a person is willing to tolerate. The threshold for pain is fairly uniform from one person to another, whereas pain tolerance is extremely variable.

A beta-adrenergic blocker has been prescribed for a client diagnosed with migraines. The most important information for the nurse to teach the client would be: "This medication will prevent you from having any more migraines." "Stop this medication immediately if you have dizziness after taking it." "Take the medication daily as you have been directed." "Take the medication only when feeling a migraine start."

"Take the medication daily as you have been directed." Preventive medications such as beta-adrenergic blockers should be taken consistently to prevent vascular changes from occurring. In most cases, preventive treatment must be taken daily for months to years. They should not be stopped abruptly and should be weaned or tapered off.

A client arrives in the clinic and informs the nurse that he is having pain in the left knee that has lasted for several weeks. The physician orders an x-ray of the left hip and knee. The client tells the nurse that the pain is in the knee, not the hip. What is the best response by the nurse? "The physician must have misunderstood what you were saying. We will change the order." "The pain you are having may be referred pain, which can cause the pain in the knee resulting from a hip problem." "The pain you are having is most likely caused by a disturbance in your nerve transmission." "You only think that the pain is in the knee when it really is in your hip."

"The pain you are having may be referred pain, which can cause the pain in the knee resulting from a hip problem." Referred pain is pain that is perceived at a site different from its point of origin but innervated by the same spinal segment. It may be difficult for the brain to correctly identify the original source of pain. The statements about the physician misunderstanding or the client being mistaken about origin of pain are nontherapeutic responses. It is beyond the scope of practice for the nurse to change a physician's order.

Following several days of intermittent upper right quadrant pain, a 29-year-old obese, Native American/First Nation woman has been diagnosed with cholelithiasis. The nurse at the clinic has taught the client about the pathophysiology and contributing factors to her health problem, as well as some of the likely treatment options. Which statement by the client demonstrates a sound understanding of her diagnosis?

"This explains why my skin was yellow-tinged lately and why I had those pains that spread to my upper back and right shoulder." Gallstones can be caused by abnormalities in the composition of bile (increased cholesterol) and stasis of bile. The formation of cholesterol stones is associated with obesity and occurs more frequently in women. These factors cause the liver to excrete more cholesterol into the bile. Estrogen reduces the synthesis of bile acid in women. Cholesterol stones are extremely common in Native American/First Nation persons. Jaundice and pain that radiates to the upper back and right shoulder are noted signs and symptoms of cholelithiasis. While cholesterol is a key element in the formation of gallstones, the particular amount ingested in the diet is not central to the development of the problem. Surgery, not medication, is the normal treatment modality. Fever and nausea are more closely associated with cholecystitis rather than cholelithiasis.

A client with Graves disease has opthalmopathy and asks the nurse if the eyes will stay like this forever. What is the best response by the nurse?

"With treatment of the hyperthyroid state, the opthalmopathy usually tends to stabilize." The ophlalmopathy of Graves disease can cause severe eye problems, including tethering of the extraocular muscles resulting in diplopia; involvement of the optic nerve, with some visual loss; and corneal ulceration because the lids do not close over the protruding eyeball. The opthalmopathy usually tends to stabilize after treatment of the hyperthyroidism.

What is considered the normal amount of serum bilirubin found in the blood?

<1.5 mg/dL Usually, only a small amount of bilirubin is found in the blood; the normal level of total serum bilirubin is <1.5 mg/dL.

Which statement accurately reflects the typical person afflicted with multiple sclerosis (MS)? A 25-year-old woman A 50-year-old man A 6-year-old girl A 26-year-old man

A 25-year-old woman The age of onset is typically between 20 and 30 years, with women being affected twice as frequently as men.

Which client on a hospital medical unit is most clearly demonstrating the signs and symptoms of liver failure?

A 44-year-old man with low hemoglobin levels, low platelet levels, and spider angiomas Anemia, thrombocytopenia, and the presence of spider angiomas are characteristic of liver failure. High blood pressure, excessive clotting, fever, and cardiac dyshythmias are not common symptoms of liver failure, and AST and ALT levels would rise, not fall.

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem? A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins Cerebellar lesions; surgical and immunosuppressive treatment Excess acetylcholinesterase production; treatment with thymectomy. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids.

A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins The etiology of myasthenia gravis involves a deficiency of acetylcholine receptors at neuromuscular junctions. Treatment can include corticosteroid therapy and intravenous immunoglobulins. Destruction of skeletal muscle cells, cerebellar lesions, and excess acetylcholinesterase are not noted to underlie the disease.

A client is diagnosed with hyperthyroidism and is exhibiting weight loss, diarrhea, and tachycardia. What does the nurse understand that these clinical manifestations are related to?

A hypermetabolic state Many of the manifestations of hyperthyroidism are related to the increase in oxygen consumption and use of metabolic fuels associated with the hypermetabolic state, as well as to the increase in sympathetic nervous system activity that occurs.

Which hospital client is most likely to be diagnosed with complex regional pain syndrome II (CRPS II)? A man who has been admitted for treatment of continuing hyperalgesia after sustaining a nerve injury in a motor vehicle accident A female who has seemingly unprovoked attacks of pain that are accompanied by facial tics and spasms A male client with diabetes mellitus who requires analgesia prior to each dressing change on his chronic foot wound A woman who requires analgesia more than 3 months after an episode of shingles

A man who has been admitted for treatment of continuing hyperalgesia after sustaining a nerve injury in a motor vehicle accident CRPS is marked the presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve with evidence of edema, changes in skin blood flow, or abnormal sensorimotor activity in the region of pain. Pain related to shingles is an example of postherpetic neuralgia, while a need for analgesia prior to dressing changes would not indicated CRPS. Sudden attacks of pain accompanied by facial tics and spasms may be indicative of trigeminal neuralgia.

The health care provider is reviewing diurnal variation pattern in adrenocorticotropic (ACTH) levels. Select the typical diurnal variation pattern in adrenocorticotropic (ACTH) levels.

ACTH peaks in the morning and declines throughout the day. ACTH levels have diurnal variation in which they reach their peak in the early morning (around 6 to 8 AM) and decline as the day progresses related to rhythmic activity of the CNS. The diurnal pattern is reversed in people who work during the night and sleep during the day. The rhythm also may be changed by physical and psychological stresses, endogenous depression, and liver disease or other conditions that affect cortisol metabolism.

Which principle best explains symptoms of amyotrophic lateral sclerosis (ALS), including dysphagia, muscle weakness and spasticity, and dysphonia? ALS is caused by both an upper motor neuron and lower motor neuron disturbance. ALS is caused by muscular necrosis. ALS is caused by disruption to the cerebellum. ALS is caused by lack of dopamine in the body.

ALS is caused by both an upper motor neuron and lower motor neuron disturbance. ALS is both an upper motor neuron (UMN) and lower motor neuron (LMN) disorder, leading to wide variety of muscular symptoms.

A nurse who is testing a client's response to passive movement of the fingers with the client's eyes closed notes that the client cannot accurately identify on which side the movement occurred or in what position the finger was placed. What is an appropriate interpretation of this result? Normal reflex function Abnormal discrimination pathway function Intact thermal sensations That the sense of proprioception is intact

Abnormal discrimination pathway function The discriminative dorsal column-medial lemniscus pathway is able to sense fine touch and discriminate between two points as close as 5 mm. This pathway also mediates sense of position. Loss of this pathway means only that the anterolateral pathway is functioning and is unable to make fine distinctions in touch proprioception and points. The test does not test reflexes or temperature.

A client with multiple pain-related injuries to the back, knees, and hips is admitted with acute liver failure. Upon procuring a medication list, the nurse notes that the client is taking several over-the-counter medications that contain a preparation known to be the drug that most commonly causes liver failure. Which drug is this?

Acetaminophen The drug most commonly involved is acetaminophen, with half the cases reported to be unintentional overdoses. Unintentional overdoses may occur when people unknowingly take several over-the-counter preparations that contain acetaminophen (e.g., an acetaminophen containing cold preparation and acetaminophen pain medication). Phenylephrine is a nasal decongestant often combined with acetaminophen for relief of cold symptoms.

The nurse is assessing a male client and finds abnormally large hands and feet, a bulbous nose, and a broad face with a protruding jaw. Based on these findings, which endocrine abnormality is most likely the cause for these physical changes?

Acromegaly Enlargement of the small bones of the hands and feet and of the membranous bones of the face and skull results in a pronounced enlargement of the hands and feet, a broad and bulbous nose, a protruding jaw, and a slanting forehead. Bone overgrowth often leads to arthralgias and degenerative arthritis of the spine, hips, and knees. Virtually every organ of the body is increased in size. Enlargement of the heart and accelerated atherosclerosis may lead to an early death. Hyperthyroidism results from excess thyroid hormone. Myxedema and Cushing syndrome are the result of adrenal abnormalities and do not cause these bone changes.

A client is admitted to the hospital in Addisonian crisis 1 month after a diagnosis of Addison disease. The nurse knows which clinical manifestation would support this diagnosis?

Acute adrenal crisis is a life-threatening situation. Exposure to even a minor illness or stress can cause a client with Addison disease to develop nausea, vomiting, muscular weakness, hypotension, dehydration, and vascular collapse (which causes a change in LOC). Hemorrhage (low BP) can be caused by septicemia, adrenal trauma, anticoagulant therapy, adrenal vein thrombosis, or adrenal metastases. A hyperactive reflex may indicate disease of the pyramidal tract above the level of the reflex arc being tested. Generalized hyperactivity of DTRs may be caused by hyperthyroidism. Any tear or hole in the membrane that surrounds the brain and spinal cord (dura) can allow the fluid that surrounds those organs to leak. This fluid is called the cerebrospinal fluid (CSF). When it leaks out, the pressure around the brain and spinal cord drops. Causes of leakage through the dura include certain head, brain, or spinal surgeries; head injury; placement of tubes for epidural anesthesia or pain medications; or lumbar puncture. Irregular heart rates (dysrhythmias) may be caused by many different factors, including coronary artery disease, electrolyte imbalances in the blood (such as sodium or potassium), changes in the heart muscle, or injury from a heart attack.

A client fell from a ladder and broke his ankle and is being seen in the emergency department for severe ankle pain with swelling and limited range of motion. What type of pain does the nurse recognize the client is experiencing? Visceral pain Acute pain Subacute pain Chronic pain

Acute pain Acute pain is pain that is elicited by injury to body tissues and activation of nociceptive stimuli at the site of local tissue damage. It is generally of short duration and tends to resolve when the underlying pathologic process has resolved. Acute pain's purpose is to serve as a warning system. It alerts a person to the existence of actual or impending tissue damage and prompts a search for medical help.

While on tour, a 32-year-old male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal pain. He admits to a history of copious alcohol use in recent years, and his vital signs include temperature 38.8°C (101.8°F), blood pressure 89/48 mm Hg and heart rate 116 beats per minute. Blood work indicates that his serum levels of C-reactive protein, amylase, and lipase are all elevated. Which diagnosis would the care team suspect first?

Acute pancreatitis Alcohol use, fever, hypotension and tachycardia are often associated with pancreatitis, as are elevated serum amylase and lipase levels. These enzymes would be unlikely to rise in cases of hepatitis, cholecystitis, or cirrhosis. The precise mechanisms whereby alcohol exerts its action are largely unknown. The capacity for oxidative and nonoxidative metabolism of ethanol by the pancreas and the harmful byproducts that result have been related to the disease process. Hepatitis C has an incubation period. Most adults who acquire the infection usually are asymptomatic. Jaundice is uncommon. Direct measurement of HCV in the serum remains the most accurate test for infection. Cirrhosis represents the end stage of chronic liver disease. The end result is liver failure that affects many organs. The clients usually have anemia, thrombocytopenia, endocrine disorders, skin lesions, azotemia and renal failure, and hepatic encephalopathy.

The nurse is caring for a client who has returned from surgery after having a colon resection. What is the best method for the nurse to use when administering an opioid for pain in order to optimize pain control? Administer the opioid if the client is becoming restless. Administer the opioid each time the client asks for it. Administer the opioid preemptively and before pain becomes extreme. If the client is asleep, wait until she awakens to administer an opioid, because sleeping clients are not in pain.

Administer the opioid preemptively and before pain becomes extreme. When giving opioids for relief of severe pain, such as that occurring after surgery, there is much evidence that opioids given routinely before the pain starts (preemptive analgesia) or becomes extreme are far more effective than those administered in a sporadic manner. People who are treated in this manner seem to require fewer doses and are able to resume regular activities sooner.

Which of these substances should the nurse teach the client with pancreatitis to absolutely avoid?

Alcohol Clients with chronic pancreatitis must be told alcohol is forbidden as it frequently precipitates attacks.

The nurse is teaching a group of nursing students about alcohol-induced liver disease and the cytochrome P450 system (CYP P450). Which of these is correct for the nurse to include in the lesson?

Alcohol consumption enhances susceptibility to effects of drugs and toxins. Increased activity of the CYP P450 system enhances the susceptibility of persons with heavy alcohol consumption to the hepatotoxic effects of other substances.

Reflex activity involves which neurons? Afferent neurons Efferent neurons Interneurons All of the above

All of the above Afferent neurons synapse with efferent neurons directly, innervating a muscle, or with an interneuron that synapses with an effector neuron.

When assessing the client with acute pancreatitis, which of these diagnostic tests—consistent with the disease— does the nurse anticipate will be altered?

Amylase and lipase Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis.

A client arrives at the emergency department after experiencing multiple trauma. During the assessment, the client was unable to discern which side of the body was feeling pain or stimulus, was nauseous, and failed the two-point discrimination test. Which spinal pathway is still intact? Spinothalamic tract Discriminative tract Vestibulospinal tract Anterolateral tract

Anterolateral tract The anterolateral tactile pathways are tested with the person's eyes closed by gently brushing the skin with a wisp of cotton, touching an area with one or two sharp points, touching corresponding parts of the body on each side simultaneously or in random sequence, and passively bending the person's finger one way and then another in random order. If only the anterolateral pathway is functional, the tactile threshold is markedly elevated, two-point discrimination and proprioception are missing, and the client has difficulty discriminating which side of the body received stimulation.

Staff at the care facility note that a woman has started complaining of back pain in recent weeks and occasionally groans in pain. She has many comorbidities that require several prescription medications. The nurse knows that which factor is likely to complicate the clinician's assessment and treatment of the client's pain? Frequent reports of pain in older adults with dementia normally indicate hyperalgia rather than an underlying physical problem. Neural pain pathways in older adults differ from those in younger adults and are less responsive to treatment. Accurate pain assessment is not possible in clients with significant cognitive deficits. Assessment and treatment are possibly complicated by the large number of drugs that the client receives.

Assessment and treatment are possibly complicated by the large number of drugs that the client receives. Polypharmacy complicates both assessment and treatment of pain in the older adult. While minor changes in pain pathways do occur as an age-related change, these do not mean that treatment is unsuccessful. Pain assessment is more difficult in clients with cognitive deficits, but it is not impossible. Reports of pain in older adults, as with any client, may signal an underlying health problem.

A 47-year-old woman was diagnosed with amyotrophic lateral sclerosis 3 years ago and has experienced a progressive onset and severity of complications. She has been admitted to a palliative care unit due to her poor prognosis. What assessments and interventions should the nursing staff of the unit prioritize in their care? Regular pain assessment and administration of opioid analgesics as needed Cardiac monitoring and administration of inotropic medications. Assessment and documentation of cognitive changes, including confusion and restlessness Assessment of swallowing ability and respiratory status.

Assessment of swallowing ability and respiratory status. The late stages of ALS normally involve deterioration in swallowing and speech and in the respiratory musculature. Cognitive changes are not common complications and pain and cardiac complications are not noted to be paramount in the course of ALS.

Approximately 6 months after a spinal cord injury, a 29-year-old man has an episode of autonomic dysreflexia. What are the characteristics of autonomic dysreflexia? Select all that apply. Vasoconstriction Fever of 102.2 F Cool, pale skin Gooseflesh noted on extremities BP 200/112

BP 200/112 Cool, pale skin Gooseflesh noted on extremities Autonomic dysreflexia is characterized by vasospasm, hypertension ranging from mild (20 mm Hg above baseline) to severe (as high as 240/120 mm Hg or higher), skin pallor, and gooseflesh associated with the piloerector response. Fever and vasoconstriction are not manifestations of autonomic dysreflexia.

When conducting a health assessment that focuses on the pain experienced by an older client diagnosed with early dementia, the nurse will pay particular attention to which of the following? The client's verbal perception of pain The client's comfort level regarding the discussion of pain Cultural beliefs held by the client regarding the cause of pain Behavioral signs of pain demonstrated by the client

Behavioral signs of pain demonstrated by the client The assessment of pain in older adults can range from relatively simple in a well-informed, alert, cognitively intact person with pain from a single source and no comorbidities to extraordinarily difficult in a confused person. When possible, a person's report of pain is the gold standard, but behavioral signs of pain should also be considered. This is especially true when the client's cognitive function is impaired. While the other options should be considered, the client's nonverbal behaviors should be of particular interest to the nurse.

The diabetes nurse educator is teaching a community education class for new diabetics. Which of these does the nurse include in the discussion of signs and symptoms of hyperglycemia? Select all that apply.

Blurred vision Weight loss Thirst The most commonly identified signs and symptoms of diabetes are polydipsia, polyuria, and polyphagia. Other symptoms include weight loss, blurred vision, fatigue, and skin infections, especially candida in women.

When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which organ does the nurse recognize is reliant on glucose as the major energy source?

Brain Although many tissues and organ systems are able to use other forms of fuel, such as fatty acids and ketones, the brain and nervous system rely almost exclusively on glucose as a fuel source. Because the brain can neither synthesize nor store more than a few minutes' supply of glucose, normal cerebral function requires a continuous supply from the circulation.

A client with acromegaly comes to the clinic and informs the nurse that she is having a productive cough and a low grade fever. This is the client's fourth visit in 1 year for the same problem. What condition does the nurse understand results from this client's enlarged cartilaginous structures?

Bronchitis The cartilaginous structures in the larynx and respiratory tract become enlarged, resulting in a deepening of the voice and tendency to develop bronchitis.

Loss of diaphragm control would most likely occur with a spinal injury at which level? T9-T12 C7-T1 C1-2 S1-S5

C1-2 Ventilation requires inspiratory and expiratory effort that requires nerve innervation by the spinal cord. Nerves that innervate the diaphragm are located at the level of C3-C5. An injury above this level will compromise this function.

The nurse expects that loss of respiratory effort occurs with a spinal injury at which level? C1-3 T9-T12 S1-S5 C7-T1

C1-3 Cord injuries involving C1 to C3 result in a lack of respiratory effort, and affected people require assisted ventilation.

What will the nurse teach a client with trigeminal neuralgia about the condition? Carbamazepine is a first-line treatment. Avoid eating if it triggers the pain. Surgery will relieve the condition. It is good to spend time alone every day.

Carbamazepine is a first-line treatment. Trigeminal neuralgia is a condition in which clients experience brief, severe, repetitive lightninglike or throbbing pain along the distribution of one or more of the branches of the fifth cranial nerve. Clients should be taught to avoid triggers when possible, but although eating may be a trigger, it is necessary for the client to maintain nutrition. Social isolation is a possible problem arising from the condition. Time alone does not contribute significantly to improvement of the condition. Although treatment rarely provides total relief, trigeminal neuralgia can be controlled with carbamazepine and surgical release of vessels, nerve roots, or scar tissue. If other treatments are ineffective, partial destruction of the nerve branches with heat, balloon compression, or glycerol injection may be performed. Newer therapies to be considered are botulinum toxin injection and gamma radiation with stereotactic surgery.

Which complication of acromegaly can be life threatening?

Cardiac structures increase in size While all the complications can exist, it is the enlargement of the heart and accelerated atherosclerosis that may lead to an early death. The teeth become splayed, causing a disturbed bite and difficulty in chewing. Vertebral changes often lead to kyphosis, or hunchback. Bone overgrowth often leads to arthralgias and degenerative arthritis of the spine, hips, and knees. Virtually every organ of the body is increased in size.

Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy? Guillain-Barré syndrome Myasthenia gravis Phalen maneuver Carpal tunnel syndrome

Carpal tunnel syndrome The most common clinical presentation is slowly progressive weakness and atrophy in distal muscles of one upper extremity.

What can the nurse assume about a child's behavior when faced with the need to repeat a painful procedure? A child will resist any intervention that involves contact with his or her body. Pain causes similar responses in people regardless of their age. Children act to avoid pain based on their memory of past painful events. A child will benefit from a matter-of-fact approach on the part of the nurse.

Children act to avoid pain based on their memory of past painful events. Children do feel pain and have been shown to reliably and accurately report pain. They also remember pain. This is evidenced in studies of children with cancer, whose distress during painful procedures increases over time without intervention, and in neonates in intensive care units, who demonstrate protective withdrawal responses to a heel stick after repeated episodes. The other options may not necessarily be true of most children.

The nursing instructor is teaching a class on diabetes and discusses complications of the disease. The instructor further states that diabetic retinopathy is one of the leading causes of blindness. What does the instructor tell the students are major risk factors for developing diabetic retinopathy? Select all that apply. Hypertension Smoking Chronic hyperglycemia Chronic hypoglycemia Hypotension

Chronic hyperglycemia Hypertension Smoking Diabetic retinopathy is one of the leading causes of blindness. Chronic hyperglycemia, hypertension, hypercholesterolemia, and smoking are risk factors for the development and progression of the disorder.

A client with a history of chronic pancreatitis asks about potential long-term complications. Which response by the nurse would be most accurate?

Clients can develop signs of diabetes and malabsorption. Chronic hepatitis is manifested by episodes that are similar to those of acute pancreatitis. As the disease progresses, the endocrine and exocrine pancreatic functions become deficient and the client develops signs of diabetes and malabsorption syndrome. Cholelithiasis may cause liver disorder. Chronic pancreatitis is irreversibility of pancreatic function, not liver function.

A severe type of headache that occurs more frequently in men than women and is described as having unrelenting, unilateral pain located most frequently in the orbit is called: Cluster headache Tension headache Migraine headache Chronic daily headache

Cluster headache Cluster headache is a type of primary neurovascular headache that typically includes severe, unrelenting, unilateral pain located, in order of decreasing frequency, in the orbital, retro-orbital, temporal, supraorbital, and infraorbital region.

Which criterion about insulin would prompt a diagnosis of type 1 diabetes?

Complete failure of insulin secretion In type 1 diabetes there is an absolute lack of insulin due to complete failure of the pancreas. In type 2 diabetes some insulin is produced but may not be properly used.

A woman with poorly controlled type 1 diabetes has been admitted to a hospital unit for the treatment of ketoacidosis. Place the following events in the pathophysiology of ketoacidosis in the correct chronological order. Use all the options.

Decrease in pH Breakdown of triglycerides Low serum insulin levels Ketone production by the liver Production of fatty acids and glycerol During ketoacidotic episodes, the lack of insulin leads to mobilization of fatty acids from adipose tissue because of the unsuppressed adipose cell lipase activity that breaks down triglycerides into fatty acids and glycerol. The increase in fatty acid levels leads to ketone production by the liver and ultimately metabolic acidosis.

The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes that which altered diagnostic test is consistent with development of edema?

Decreased albumin Altered function of the liver causes decreased levels of plasma proteins, particularly albumin, which contributes to edema formation.

A client with hypothyroidism has not taken medication for several months, informing the nurse that she lost her insurance and is unable to afford the medication. When assessing the client's temperature tolerance and skin, what does the nurse anticipate finding? Select all that apply.

Decreased sweating Coarse and dry skin and hair Intolerance to cold The client with hypothyroidism experiences an intolerance to cold, decreased sweating, and coarse and dry skin and hair, related to the decrease in metabolic rate from the deficient thyroid secretion.

Regarding the pathophysiology of Parkinson disease, which statement is true? Acetylcholine levels rise and inhibit voluntary movement. Failure of the cerebral cortex interferes with the use of acetylcholine. The dopamine receptors increase from an alteration in neuronal basal ganglia. Degeneration of the nigrostriatal dopamine neurons occurs.

Degeneration of the nigrostriatal dopamine neurons occurs. The primary brain abnormality found in all persons diagnosed with Parkinson disease is degeneration of the nigrostriatal dopamine neurons. Acetylcholine has no bearing on Parkinson development. There is a decrease in dopamine rather than an increase.

Which metabolic abnormalities can cause type 2 diabetes? Select all that apply.

Deranged secretion of insulin Insulin resistance Increased glucose production by the liver The metabolic abnormalities that lead to type 2 diabetes include (1) insulin resistance, (2) deranged secretion of insulin by the pancreatic beta cells, and (3) increased glucose production by the liver.

A client with persistent, recurring episodes of epigastric and upper left quadrant pain and anorexia, nausea, vomiting, constipation, and flatulence has been diagnosed with chronic pancreatitis. What is the cause of the symptoms of chronic pancreatitis?

Destruction of both the endocrine and exocrine pancreas Chronic pancreatitis is characterized by progressive destruction of the exocrine pancreas, fibrosis, and, in the later stages, by destruction of the endocrine pancreas. Blockage of the bile duct would cause acute pancreatitis.

Which types of damage can cause visceral pain? Select all that apply. Strong contractions Inflammatory chemicals Direct pressure Ischemia Distention

Distention Strong contractions Ischemia Visceral pain is caused by strong contractions, distention, or ischemia affecting organ walls. There are fewer nociceptors in the viscera than in the skin. Viscera that are inflamed will respond to the distention of inflammation, not the chemicals that cause inflammation.

A client with Parkinson disease presents with bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain? Dopamine nigrostriatal system Cerebellum Serotonergic system Limbic system

Dopamine nigrostriatal system The destruction of the dopamine nigrostriatal system upsets the balance of the basal ganglia, resulting in uncontrolled and uncoordinated movement. The cortex is involved in higher processing, serotonin is involved in the limbic system, and the cerebellum is unrelated to Parkinson disease; cerebellar disorders, however, will cause Parkinsonism.

A client with Parkinson disease presents with bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain? Serotonergic system Cerebellum Limbic system Dopamine nigrostriatal system

Dopamine nigrostriatal system The destruction of the dopamine nigrostriatal system upsets the balance of the basal ganglia, resulting in uncontrolled and uncoordinated movement. The cortex is involved in higher processing, serotonin is involved in the limbic system, and the cerebellum is unrelated to Parkinson disease; cerebellar disorders, however, will cause Parkinsonism.

A client with a suspected diagnosis of primary hypothyroidism would most likely demonstrate which serum laboratory value?

Elevated thyroid-stimulating hormone (TSH) and decreased thyroxine (T4) A low serum T4 and elevated TSH levels are characteristic of primary hypothyroidism. Elevated TSH, T4, and T3 may indicate hyperthyroidism. Decreased levels may be due to suppression by medication.

A nurse on a medical unit is providing care for a 37-year-old female client who has a diagnosis of Graves disease. Which assessments should the nurse prioritize?

Eye health and visual acuity The ophthalmopathy of Graves disease can cause severe eye problems, including tethering of the extraocular muscles resulting in diplopia; involvement of the optic nerve, with some visual loss; and corneal ulceration because the lids do not close over the protruding eyeball (due to the exophthalmos). Eye assessment is consequently a priority over assessment of skin integrity, cognition, or musculoskeletal status.

The underlying causative problem in Parkinsonism is: Failure of dopamine release Genetic defect Viral infection Autoimmune disorder

Failure of dopamine release Lack of dopamine release is the primary cause of Parkinson disease and associated symptoms.

Bradykinesia occurring in Parkinson disease places the Parkinson's client most at risk for: Incontinence Weight loss Emotional dysfunction Falls and injury

Falls and injury Slowed initiation of movement and poor response to sudden movements are characteristics of bradykinesia. These factors strongly correlate to risk of falls and injury.

The nurse recognizes which of these complications results from liver failure with decrease in production of bile salts?

Fat-soluble vitamin deficiencies The malabsorption of fat and fat-soluble vitamins results from a decrease in bile salts. Jaundice results from an elevation in serum bilirubin or impaired elimination of bilirubin. Glucocorticoid dysfunction causes signs of increased cortisol levels (i.e., Cushing syndrome). Hypoglycemia may develop when glycogenolysis and gluconeogenesis are impaired by faulty carbohydrate metabolism.

The nurse is caring for a client with hepatitis and jaundice. The nurse recognizes that without sufficient circulating bile salts the client will have intolerance to which ingested substance?

Fats Lack of production of bile salts causes malabsorption of fat and fat-soluble vitamins.

When giving pain medicine for acute pain, health care workers are reluctant to provide much-needed opioid pain medicine. What is the major concern of health care workers when providing opioid pain relief? Fear of adverse reactions Fear of oversedation Fear of depressed respirations Fear of addiction

Fear of addiction Part of the reluctance of health care workers to provide adequate relief for acute pain has been fear of addiction. However, addiction to opioid medications is thought to be virtually nonexistent when these drugs are prescribed for acute pain.

A client has just been diagnosed with cirrhosis and has been told he needs a transplant. What changes have occurred in the liver due to cirrhosis that results in an inability to heal and require transplant?

Fibrosis has occurred and there are constrictive bands that disrupt biliary flow Cirrhosis is characterized by diffuse fibrosis and conversion of normal liver architecture into nodules containing proliferating hepatocytes encircled by fibrosis. The fibrous tissue that replaces normally functioning liver tissue forms constrictive bands that disrupt flow in the vascular channels and biliary duct systems of the liver. The loss of tissue is not caused by apoptosis or anoxic conditions. The liver does not become necrotic during cirrhosis.

Adult strabismus is almost always of the paralytic variety. What is a cause of adult strabismus? Huntington disease Graves disease Addison disease Parkinson disease

Graves disease Paralytic strabismus is uncommon in children, but accounts for nearly all cases of adult strabismus. It can be caused by infiltrative processes, including Graves disease, myasthenia gravis, stroke, and direct optical trauma. The other diseases have nothing to do with adult strabismus.

The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding?

Heart rate 110 and bounding Cardiovascular and respiratory functions are strongly affected by thyroid function. With an increase in metabolism, there is a rise in oxygen consumption and production of metabolic end products, with an accompanying increase in vasodilation. Blood volume, cardiac output, and ventilation are all increased. Heart rate and cardiac contractility are enhanced as a means of maintaining the needed cardiac output. Blood pressure is likely to change little because the increase in vasodilation tends to offset the increase in cardiac output.

A client tells the nurse that he is concerned about developing hepatitis after being exposed to contaminated feces, saliva, and food. The nurse is aware that the client is at risk for:

Hepatitis A Hepatitis A is normally transmitted through the fecal-oral route by drinking contaminated milk or water and eating shellfish from infected waters. Hepatitis B is transmitted through infected blood or serum. Hepatitis C is transmitted by recreational injection drug use. Hepatitis D occurs largely to persons at high risk for HBV infection.

A health care provider suspects a client may have developed pancreatitis. Which laboratory value will confirm this diagnosis?

High serum amylase and lipase Laboratory criteria for the diagnosis of pancreatitis are serum amylase or lipase greater than three times the upper limit of normal. Altered alkaline phosphatase and prothrombin levels may indicate liver disease. Alkaline phosphatase is one kind of enzyme found in the body. It can show signs of liver disease or a bone disorder. The red blood cell count is used to measure the number of oxygen-carrying blood cells in a volume of blood. Chymotrypsin digests proteins in the intestine. Fibrinogen is a soluble protein in the plasma that is broken down to fibrin by the enzyme thrombin to form clots. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Having more than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia. Prothrombin time is a blood test that measures how long it takes blood to clot.

When caring for the client with acute pancreatitis, which alterations does the nurse recognize is consistent with the disease?

Hyperglycemia Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis. The white blood cell count may be increased, and hyperglycemia and an elevated serum bilirubin level may be present.

A 30-year-old male who manages his type 1 diabetes with glyburide presents at the emergency room reporting headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half-marathon. Which of the following is likely to be the cause of his complaints?

Hypoglycemia In hypoglycemia, headache, difficulty in problem solving, disturbed or altered behavior, coma, and seizures may occur. At the onset, activation of the parasympathetic nervous system often causes hunger, and the initial parasympathetic response is followed by activation of the sympathetic nervous system; this causes anxiety, tachycardia, sweating, and constriction of the skin vessels (i.e., the skin is cool and clammy). In diabetic ketoacidosis, the client typically has a history of one or two days of polyuria, polydipsia, nausea, vomiting, and marked fatigue. Abdominal pain and tenderness may be experienced without abdominal disease, and the breath has a characteristic fruity smell. The most prominent manifestations of hyperosmolar hyperglycemic state are dehydration and neurologic signs including grand mal seizures, hemiparesis, Babinski reflexes, aphasia, muscle fasciculations, hyperthermia, hemianopia, nystagmus, and visual hallucinations; the client will also experience excessive thirst. The Somogyi effect describes a cycle of insulin-induced posthypoglycemic hyperglycemic episodes.

A nurse working in a busy orthopedic clinic is asked to perform the Tinel sign on a client having problems in her hand/wrist. In order to test Tinel sign, the nurse should give the client which direction? I'm going to tap (percuss) over the median nerve in your wrist; tell me what sensation you feel while I am doing this. Does the sensation stay in the wrist or go anywhere else? I'm going to tap this tuning fork; place it on the side of your thumb, then tell me what you are feeling in your hand and wrist. Stand tall, arms at your side, shut your eyes; place the tip of your index finger to your nose. Hold your wrist in complete flexion, keep it in this position for 60 seconds. How does your hand feel after placing it in a neutral position?

I'm going to tap (percuss) over the median nerve in your wrist; tell me what sensation you feel while I am doing this. Does the sensation stay in the wrist or go anywhere else? A positive Tinel sign will help diagnose carpel tunnel syndrome. The client will have a tingling sensation radiating into the palm of the hand when lightly percussed over the median nerve at the wrist. The holding of the wrist in complete flexion is Phalen sign, which is also a test to help diagnose carpel tunnel syndrome.

When the nurse is performing a health history for a client who is being admitted for hyperthyroidism, what symptom does the client report that the nurse would find associated with this disorder?

Increase in appetite Thyroid hormone enhances gastrointestinal function, causing an increase in motility and production of GI secretions that often results in diarrhea. An increase in appetite and food intake accompanies the higher metabolic rate that occurs with increased thyroid hormone levels. At the same time, weight loss occurs because of the increased use of calories.

A client comes to the clinic with fatigue and muscle weakness. The client also states she has been having diarrhea. The nurse observes the skin of the client has a bronze tone and when asked, the client says she has not had any sun exposure. The mucous membranes of the gums are bluish-black. When reviewing laboratory results from this client, what does the nurse anticipate seeing?

Increased levels of ACTH Hyperpigmentation results from elevated levels of ACTH. The skin looks bronzed or suntanned in exposed and unexposed areas, and the normal creases and pressure points tend to become especially dark. The gums and oral mucous membranes may become bluish-black. The amino acid sequence of ACTH is strikingly similar to that of melanocyte stimulating hormone; hyperpigmentation occurs in more than 90 percent of persons with Addison disease and is helpful in distinguishing the primary and secondary forms of adrenal insufficiency.

The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem? Preventing demyelization of the efferent cerebellar pathways Preventing axonal degradation of motor neurons Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions Increasing the functional ability of the underactive dopaminergic system

Increasing the functional ability of the underactive dopaminergic system Antiparkinson drugs act by increasing the functional ability of the underactive dopaminergic system. The cerebellar pathways, acetylcholine levels and axonal degradation are not components of the etiology of Parkinson disease.

In describing the ideal analgesic, what factors would be included? Select all that apply. Addictive Inexpensive Effective Have minimal adverse effects Decrease the level of consciousness

Inexpensive Effective Have minimal adverse effects The ideal analgesic would be effective, nonaddictive, and inexpensive. In addition, it would produce minimal adverse effects and not affect the person's level of consciousness.

The diagnosis of type 1 diabetes would be confirmed by which principle?

Insulin is not available for use by the body. Type 1 diabetes is a catabolic disorder characterized by an absolute lack of insulin. In type 2 diabetes, some insulin is produced.

Reflexes are basically "hard-wired" into the CNS. Anatomically, the basis of a reflex is an afferent neuron that synapses directly with an effector neuron to cause muscle movement. Sometimes the afferent neuron synapses with what intermediary between the afferent and effector neurons? Neurotransmitter Intersegmental effectors Suprasegmental effectors Interneuron

Interneuron The anatomic basis of a reflex consists of an afferent neuron, which synapses either directly with an effector neuron that innervates a muscle or with an interneuron that synapses with an effector neuron.

Which neuron connects sensory and motor neurons? Afferent neurons Cranial nerves Interneurons Efferent neurons

Interneurons Neurons that connect sensory and motor neurons are known as interneurons. Motor neurons receive input from axons descending from higher centers. These supraspinal signals can modify reflex responses to peripheral stimuli by facilitating or inhibiting different populations of interneurons. They also coordinate movements through these interneurons.

The client in the GI clinic tells the nurse she is concerned she has something wrong with her gallbladder like what her friend with gallstones and inflammation had. Which of these complaints does the nurse recognize that supports the client's concern?

Intolerance to greasy food; burping The manifestations of chronic cholecystitis are more vague than those of acute cholecystitis. There may be intolerance to fatty foods, belching, and other indications of discomfort.

A client reports a sudden intense headache. Which factor would indicate the presence of a possible subarachnoid hemorrhage? History of smoking Sleep disturbance at night Intractable pain Family history of migraine

Intractable pain Subarachnoid hemorrhage causes a severe intractable headache. Headaches that disturb sleep or occur with exercise or sexual activity may be caused by neurologic lesions. Migraine headaches tend to run in families but do not contribute to hemorrhage.

Diabetics are at higher risk than are the majority of the population for injury to organ systems in the body. Which organs are most at risk?

Kidneys and eyes Diabetic nephropathy is the leading cause of chronic kidney disease, accounting for 40% of new cases. Also, diabetes is the leading cause of acquired blindness in the United States. The liver and pancreas are not organs that diabetes attacks.

A nurse on a postsurgical unit is providing care for a 76-year-old female client who is two days post-hemiarthroplasty (hip replacement) and who states that her pain has been out of control for the last several hours, though she is not exhibiting signs of pain. Which guideline should the nurse use for short-term and long-term treatment of the client's pain? Reconciling the client's need for opioid analgesics with the risk of addiction to these drugs Recognizing the client's pain is not likely self-limiting Knowing that the client's self-report of pain is the most reliable indicator of pain Realizing that chronic pain is likely to require innovative and complex treatment

Knowing that the client's self-report of pain is the most reliable indicator of pain Clinically, the client's self-report of pain is the most reliable indicator of pain. The risk of addiction to opioids is extremely low and since the client's pain is acute rather than chronic, it is likely self-limiting.

A client with diabetic retinopathy develops a retinal bleed and asks the nurse, "How can I prevent this from happening again?" What response provides the most effective information?

Maintain healthy blood pressure and blood sugar levels. Diabetic retinopathy occurs when blood vessels have increased permeability, develop microaneurysms, vascular proliferation, scarring, and retinal detachment. These conditions are worsened when the client has poor glycemic control, poorly controlled hypertension, and hyperlipidemia. Laser photocoagulation can be used to stop vessel proliferation and bleeding. An annual examination will evaluate the disease, but does not prevent recurrence. Eye use patterns do not change retinopathy.

A client has been diagnosed with Guillain-Barré syndrome and is being treated in the intensive care unit. The client is experiencing rapidly ascending paralysis. What is the nurse's priority intervention when caring for this client? Inserting a Foley catheter Assessing distal peripheral pulses Restarting the IV when it infiltrates Maintenance of the client's airway

Maintenance of the client's airway. The rate of disease progression varies. Paralysis may progress to involve the respiratory muscles, which will mandate the use of a ventilator for this client. Maintenance of the airway is the priority intervention at this time.

The nurse instructs the unlicensed assistive personnel (UAP) to be sure to turn the client every 2 hours in order to avoid pressure on the skin and avoid a pressure ulcer. What type of stimuli is the nurse encouraging the UAP to avoid? Thermal stimuli Chemical stimuli Mechanical stimuli Pain stimuli

Mechanical stimuli Mechanical stimuli can arise from intense pressure applied to skin or from the violent contraction or extreme stretch of a muscle. Chemical stimuli arise from a number of sources, including tissue trauma, ischemia, and inflammation. Thermal stimuli can result from extremes of heat or cold. Pain stimuli is not a stimuli.

A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over her face. Which source is most likely to provide the input that allows for the woman's unique ability? Ruffini end-organs Pacinian corpuscles Free nerve endings Meissner corpuscles

Meissner corpuscles Meissner corpuscles, which are present on the hair-free areas like palms and fingers, are responsible for fine tactile sensation. Pacinian corpuscles provide input on vibration, while Ruffini end-organs exist in deeper structures that signal continuous states of deformation. Free nerve endings also detect touch and pressure, but not to the highly differentiated degree of Meissner corpuscles.

A nurse is assessing a client for manifestations of chronic pain. Which finding is characteristic of chronic pain? Select all that apply. Sweating Withdrawal from activities Pulse rate 120 beats/min Loss of appetite Mental depression Breathing shallow, 26 breaths/min

Mental depression Loss of appetite Withdrawal from activities Acute pain generally is classified as being of short duration and arises from a specific pathologic process that resolves. Acute pain may lead to tachycardia, increased sympathetic activity such as sweating, decreased mobility, and shallow breathing. Chronic pain lasts longer than expected and may fluctuate. Signs of chronic pain include insomnia, depression, and loss of appetite. Clients may withdraw from outside activities.

In an acute adrenal crisis with Addison disease, the onset of symptoms are sudden and can be precipitated by exposure to a minor illness or stress. What are the manifestations of acute adrenal crisis? Select all that apply.

Muscle weakness Dehydration Altered mental status Vascular collapse If Addison disease is the underlying problem, exposure to even a minor illness or stress can precipitate nausea, vomiting, muscular weakness, hypotension, dehydration, and vascular collapse.

Which disease is thought to be caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction? Parkinson syndrome Guillain-Barré syndrome Myasthenia gravis Huntington disease

Myasthenia gravis Myasthenia gravis is an autoimmune disease caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction. Guillain-Barré syndrome is an acute immune-mediated polyneuropathy characterized by rapidly progressive, ascending symmetrical limb weakness and loss of tendon reflexes. Parkinson disease is a degenerative disorder of basal ganglia function associated with deneration of the nigrostriatal dopamine neurons. Huntington disease is a hereditary disorder which produces localized death of brain cells.

Which of the following diseases is associated with fewer acetylcholine receptors, resulting in a lower-amplitude endplate potential, muscle weakness, and fatigability? Parkinson disease Myasthenia gravis Muscular dystrophy Guillain-Barré syndrome

Myasthenia gravis People with myasthenia gravis have a reduced postsynaptic membrane area and fewer acetylcholine receptors, causing each release of acetylcholine from the presynaptic membrane to result in a lower-amplitude endplate potential.

Antibiotics such as gentamicin can produce a disturbance in the body that is similar to botulism by preventing the release of acetylcholine from nerve endings. In persons with preexisting neuromuscular transmission disturbances, these drugs can be dangerous. What disease falls into this category? Becker muscular dystrophy Multiple sclerosis Duchenne muscular dystrophy Myasthenia gravis

Myasthenia gravis The function of the striatum also involves local cholinergic interneurons, and their destruction is thought to be related to the choreiform movements of Huntington disease, another basal ganglia-related syndrome. The other answers do not involve the cholinergic interneurons of the striatum.

Which statement explains how nonsteroidal anti-inflammatory drugs (NSAIDs) control pain? NSAIDs allow thermal conduction of noxious stimuli. NSAIDs inhibit nociceptor sites from receiving signals. NSAIDs relay mechanical signal transmission to receptors. NSAIDs block the enzyme that synthesizes prostaglandins.

NSAIDs block the enzyme that synthesizes prostaglandins. Nociceptors respond to three different types of stimuli: chemical, thermal, and mechanical. The chemical mediators such as bradykinin, histamine, serotonin, and potassium activate or sensitize nociceptors and continue the inflammatory response by releasing prostaglandins. Aspirin, ibuprofen, and other NSAIDs block inflammation by blocking the enzyme needed to synthesize prostaglandins.

If the client's dorsal columns are not functioning, the nurse will observe which response during neuro testing, where the nurse asks the client to close his eyes and then proceeds to touch corresponding parts of the body on each side simultaneously with two sharp points? Grimacing when body touched with sharp points Inability to identify which way his finger was moved during the test No response to two-point discrimination Heightened proprioception response

No response to two-point discrimination When comparing discriminative dorsal column-medial lemniscus pathway compared with anterolateral tactile pathways with testing (with eyes closed), gently brush the skin with cotton, touch an area with 1 or 2 sharp points, touch corresponding parts of the body on each side simultaneously or random sequence, and passively bend the person's finger one way and then another. If dorsal columns are not functioning, the tactile threshold two-point discrimination and proprioception are missing and the person has difficulty discriminating which side of the body received stimulation.

A client on an acute medicine unit with a diagnosis of small bowel obstruction is reporting intense, diffuse abdominal pain. Which physiologic phenomenon is most likely contributing to the client's pain? First-order neurons are inappropriately signaling pain to the dorsal root ganglion. The client is experiencing neuropathic pain. An overlap of nerve fiber distribution between the dermatomes is causing the pain. Nociceptive afferents are conducting along the cranial and spinal nerve pathways of the ANS.

Nociceptive afferents are conducting along the cranial and spinal nerve pathways of the ANS. Visceral pain, as characterized by the client's description of her pain, is conducted by way of nociceptive afferents that use the cranial and spinal nerve pathways of the ANS. The problem is not likely rooted in the inappropriate firing of first order neurons or the substitution of conduction by C fibers. Pain that is attributable to a pathologic process apart from the neural pain network is not normally considered to be neuropathic. An overlap of nerve fiber distribution between the dermatomes occurs with cutaneous pain, not visceral pain.

What will conduct injurious stimuli to alert the body to potential damage? Thermoreceptors Nociceptors Odorant Proprioceptors

Nociceptors Nociceptors are sensitive to painful and noxious stimuli and alert the system to injury. Thermoreceptors will perceive heat, proprioceptors will perceive body position, and odorant receptors will perceive the sensation of smell.

One of the jobs the liver performs is to export triglyceride. When the liver's capacity to export triglyceride is exceeded, excess fatty acids accumulate in the liver. To what disease do these excess fatty acids contribute?

Nonalcoholic fatty liver disease When the capacity of the liver to export triglyceride is saturated, excess fatty acids contribute to the formation of fatty liver.

A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as: Signs of clinical improvement Normal manifestations of Parkinson disease Manifestations of another disease process Signs of clinical deterioration

Normal manifestations of Parkinson disease The client is manifesting normal responses of the disease. The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia (slowness of movement).

When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which description?

Pain in the right upper quadrant referred to the same shoulder The pain of biliary colic begins abruptly and increases in intensity. It is usually located in the upper right quadrant or epigastric area and may be referred to the upper back, the right shoulder, or midscapular region.

When a peripheral nerve is irritated enough, it becomes hypersensitive to the noxious stimuli, which results in increased painfulness or hyperalgesia. Health care professionals recognize both primary and secondary forms of hyperalgesia. What is primary hyperalgesia? Pain sensitivity that lasts longer than 1 week Pain that occurs in the tissue surrounding an injury Pain sensitivity that occurs directly in damaged tissues Pain sensitivity that occurs in the viscera

Pain sensitivity that occurs directly in damaged tissues Primary hyperalgesia describes pain sensitivity that occurs directly in damaged tissues.

A client reports feeling a tingling sensation in the last two fingers of one hand after hitting the inner surface of the elbow on a desk. What is the cause of this symptom? Hyperpathia from localized ischemia Hypoesthesia from an inherited response Paresthesia from temporary nerve compression Hypersensitivity reaction to nerve injury

Paresthesia from temporary nerve compression Temporary mild compression of a peripheral nerve can lead to paresthesia. Hypersensitivity is an increased response to mild stimuli. Hyperpathia is a syndrome in which pain is explosive after the raised sensory threshold is reached. Hypoesthesia is reduced or lost sensation of touch or temperature and may be an inherited trait.

Which disease can result in symptoms that can occur when a brain tumor causes damage to the nigrostriatal pathway? Truncal ataxia Guillain-Barré syndrome Alzheimer disease Parkinson disease

Parkinson disease Symptoms of parkinsonism can occur when damage to the nigrostriatal pathway occurs in such conditions as cerebral vascular disease, brain tumors, repeated head trauma, or a degenerative neurologic disease.

What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia? Myasthenia gravis Huntington disease Guillain-Barré syndrome Parkinson disease

Parkinson disease The aminoglycoside antibiotics (e.g., gentamicin) may produce a clinical disturbance similar to botulism by preventing the release of acetylcholine from nerve endings. These drugs are particularly dangerous in persons with preexisting disturbances of neuromuscular transmission, such as myasthenia gravis.

A nurse assesses a client with a cerebral infarct for sensation. Which result indicates that second-order neurons are intact? Flaccid hemiparesis Dysphagia Patellar reflex +2 Alert and oriented x3

Patellar reflex +2 First-order neurons transmit sensory information from the periphery of the neurons to the central nervous system. Second-order neurons communicate directly with the thalamus and work with the reflex networks and sensory pathways in the spinal cord. Third-order neurons relay information from the thalamus to the cerebral cortex. Level of consciousness does not indicate sensation.

The newborn nursery nurse is preparing to perform a required neonatal screening for congenital hypothyroidism. What should the nurse do to obtain the necessary sample?

Perform a heel stick to obtain a drop of blood for a T4 and TSH. Screening is usually done in the hospital nursery. In this test, a drop of blood is taken from the infant's heel and analyzed for T4 and TSH.

A pregnant client asks the nurse if she is at risk for developing gestational diabetes. The nurse reviews the risk factors with the client and determines that which factors are most likely associated with gestational diabetes? Select all that apply.

Polycystic ovary syndrome Severe obesity Glycosuria Factors that indicate a high risk for gestational diabetes include glycosuria, strong family history of type 2 diabetes, severe obesity, previous newborn with fetal anomaly, advanced maternal age, more than five pregnancies, or delivery of a previous large-for-gestational age infant.

Select the most common symptoms of diabetes. Select all that apply.

Polydipsia Polyphagia Polyuria The most commonly identified signs and symptoms of diabetes are often referred to as the three polys: (1) polyuria (i.e., excessive urination), (2) polydipsia (i.e., excessive thirst), and (3) polyphagia (i.e., excessive hunger). Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac. Polycythemia is a condition of increased red blood cells.

Multiple sclerosis is characterized by what type of neuron damage? Aneuropathy Transneuropathy Mononeuropathy Polyneuropathy

Polyneuropathy MS is classified as a polyneuropathy due to many nerves being affected by the disease, involving demyelination of peripheral nerves.

Guillain-Barré syndrome is characterized by which form of neuron damage? Aneuropathy Transneuropathy Polyneuropathy Mononeuropathy

Polyneuropathy Polyneuropathies involve demyelination or axonal degeneration of multiple peripheral nerves that leads to symmetric sensory, motor, or mixed sensorimotor deficits. Guillain-Barré syndrome is an acute immune-mediated polyneuropathy.

A client presents to the emergency room with fatigue, weakness, dehydration, and thirst. What additional symptoms would correlate with a diagnosis of type 2 diabetes mellitus? Select all that apply.

Polyuria Blurred vision Candida infection The cardinal manifestations of diabetes mellitus are the three "polys": polyuria, polydipsia, and polyphagia. Type 2 diabetes is less likely to cause weight loss. Additional symptoms include fatigue and weakness, blurred vision, and skin infections.

Which treatment should take place immediately in a client experiencing autonomic dysreflexia? Apply binders and support hose to shunt the blood to the main organs. Place the client in a supine position, and increase intravenous fluids. Increase the client's blood pressure to allow for adequate perfusion. Position the client in upright position, and correct the initiating stimulus.

Position the client in upright position, and correct the initiating stimulus. Autonomic dysreflexia is a clinical emergency, and requires monitoring of blood pressure while correcting the initiating stimulus (e.g., full bladder, pain). The nurse should place the client in an upright position and remove all support hose binders to promote venous pooling to help decrease an extremely elevated blood pressure. Intravenous fluids are not an immediate intervention for this condition.

Which client is exhibiting headache symptoms that indicate a need for further evaluation? College student with unilateral headache after eating a chocolate bar Pregnant mother with drowsiness and unrelenting headache Older adult with a headache after missing the evening meal Parent with general head pain after a night caring for an ill child

Pregnant mother with drowsiness and unrelenting headache Primary headaches such as migraine, tension headache, cluster headache, and chronic daily headache do not require additional evaluation. Clients with secondary headaches should receive further evaluation. Possible causes of secondary headaches are cerebral hemorrhage or aneurysm, meningitis, cancer, and nerve lesions. Additionally, clients requiring further evaluation include those with sudden onset or progression of headaches, someone who is immunosuppressed, or a woman who is pregnant.

When teaching a client about chronic pancreatitis, which of these does the nurse relate is the long term result of this condition?

Progressive destruction of the organ The chief distinction between acute and chronic pancreatitis is the irreversibility of pancreatic function with chronic pancreatitis. Chronic pancreatitis is characterized by progressive destruction of the exocrine pancreas, by fibrosis, and, in the later stages, by destruction of the endocrine pancreas. While the most common cause of chronic pancreatitis is alcohol abuse, it is not the consequence.

A client is asked to stand with feet together, eyes open, and hands by the sides. Then the client is asked to close the eyes while the nurse observes for a full minute. What assessment is the nurse performing? Crossed-extensor reflex Segmental reflex Proprioception Posture

Proprioception Information from the sensory afferents is relayed to the cerebellum and cerebral cortex and is experienced as proprioception (the sense of body movement and position independent of vision). The knee-jerk reflex is a form of stretch reflex. The crossed-extensor reflex serves to integrate motor movements so they function in a coordinated manner.

A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which cause can best explain this? A side effect of treatment Likely a preexisting mental illness Depression over new diagnosis Psychological manifestation due to involvement of white matter of cerebral cortex

Psychological manifestation due to involvement of white matter of cerebral cortex Involvement of the cerebral cortex can lead to a variety of mood and cognitive disruptions.

A client experiencing deep somatic pain would manifest which clinical symptoms? Select all that apply. Localized pain Pain reproduced by stimuli Radiation of pain Sharp pain with a burning quality that may be abrupt or slow in onset Pain that occurs superficially

Radiation of pain Pain reproduced by stimuli Deep somatic pain originates in deep body structures, such as the periosteum, muscles, tendons, joints, and blood vessels. This pain is more diffuse than cutaneous pain. Various stimuli, such as strong pressure exerted on bone, ischemia to a muscle, and tissue damage, can produce deep somatic pain. Radiation of pain from the original site of injury can occur. Cutaneous pain is a sharp pain with a burning quality, abrupt or slow in onset, and can be localized.

A client is experiencing chest pain that radiates to the left arm and neck. The nurse would interpret this pain as: Referred Visceral Somatic Cutaneous

Referred Referred pain is pain that is perceived at a site different from its point of origin but innervated by the same spinal segment. Visceral pain originates in the visceral organs and is one of the most common pains produced by disease. Cutaneous pain arises from superficial structures. Somatic pain originates in deep body structures.

Phantom limb pain is a little understood pain that is difficult to treat, even though the client is experiencing severe pain. Which treatments will most likely help the phantom limb pain? Relaxation training and transcutaneous electrical nerve stimulation on the afferents in the area Sympathetic blocks and alternating heat and cold application. Narcotic analgesics and relaxation training Biofeedback and nonsteroidal anti-inflammatory drugs

Relaxation training and transcutaneous electrical nerve stimulation on the afferents in the area Treatment of phantom limb pain has been accomplished by the use of sympathetic blocks, transcutaneous electrical nerve stimulation of the large myelinated afferents innervating the area, hypnosis, and relaxation training.

The nurse assessing a client with a diagnosis of cholelithiasis will look for pain in which area?

Right upper quadrant The pain is usually located in the upper right quadrant or epigastric area and may be referred to the upper back, right shoulder, or midscapular region. Typically, the pain is abrupt in onset, increases steadily in intensity, persists for 2 to 8 hours, and is followed by soreness in the upper right quadrant.

The nurse is studying sensory systems. She understands that signal transduction of an impulse to the thalamus for processing is accomplished by: Fourth-order neurons Third-order neurons First-order neurons Second-order neurons

Second-order neurons Second-order neurons communicate with various reflex networks and sensory pathways in the spinal cord and travel directly to the thalamus. First-order neurons transmit sensory information from the periphery to the CNS. Third-order neurons relay information from the thalamus to the cerebral cortex.

Following destruction of the pituitary gland, ACTH stimulation stops. Without ACTH to stimulate the adrenal glands, the adrenal glands' production of cortisol drops. This is an example of which type of endocrine disorder?

Secondary In secondary disorders of endocrine function, the target gland is essentially normal, but defective levels of stimulating hormones or releasing factors from the pituitary system alter its function.

The nurse is providing nonpharmacologic pain relief for a client who has a pain level of 2 in the leg. What intervention provided by the nurse would be considered distraction? Slow, rhythmic breathing exercises Having the client imagine that she is at the beach listening to the waves Sitting with the client and having a conversation Applying heat to the legs

Sitting with the client and having a conversation Distraction does not eliminate pain, but it can make pain more tolerable. It may serve as a type of sensory shielding whereby attention to pain is sacrificed to pay attention to other stimuli that are easily perceived. Examples of distraction include counting, repeating phrases or poems, and engaging in activities that require concentration, such as projects, activities, work, conversation, or describing pictures. Television, adventure movies, music, and humor also can provide distraction.

What is the most common clinical presentation of amyotrophic lateral sclerosis? Slowly progressive weakness and atrophy in distal muscles of one lower extremity Rapidly progressive weakness and atrophy in distal muscles of both lower extremities Slowly progressive weakness and atrophy in distal muscles of one upper extremity Rapidly progressive weakness and atrophy in distal muscles of both upper extremities

Slowly progressive weakness and atrophy in distal muscles of one upper extremity The most common clinical presentation is slowly progressive weakness and atrophy in distal muscles of one upper extremity.

A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the bag other than the phone. The nurse knows that which term best describes one's ability to sense the shape and size of an object in the absence of visualization? Somesthesia Modalities Astereognosis Stereognosis

Stereognosis The sense of shape and size of an object in the absence of visualization is known as stereognosis. Astereognosis is a deficit whereby a person can correctly describe the object but does not recognize that it is a screwdriver. Modalities is a term used for qualitative, subjective distinctions between sensations such as touch, heat, and pain. Somesthesia describes most of the perceptive aspects of body sensation and requires the function of the parietal association cortex.

A client who is being treated for chronic low back pain is using a TENS unit for relief of pain. The nurse is aware that the use of this device is considered what type of pain relief? A physical agent Stimulus-induced analgesia Biofeedback Distraction

Stimulus-induced analgesia Stimulus-induced analgesia is one of the oldest known methods of pain relief. Electrical stimulation methods of pain relief include TENS, electrical acupuncture, and neurostimulation. A physical agent would be the use of heat or cold. Distraction is a nonpharmacologic method of reduction of pain by distracting the client from his pain. Biofeedback is used to provide feedback to a person concerning the current status of some body function, temperature, temporal artery pulsation, blood pressure, or muscle tension.

Hyperthyroidism that is inadequately treated can cause a life-threatening condition known as a thyroid storm. What are the manifestations of a thyroid storm? Select all that apply.

Tachycardia Very high fever Delirium Thyroid storm is manifested by a very high fever, extreme cardiovascular effects (e.g., tachycardia, congestive failure, and angina), and severe CNS effects (e.g., agitation, restlessness, and delirium). The mortality rate is high. Very low fever and bradycardia are not manifestations of a thyroid storm.

The nurse on the pediatric unit is implementing distraction strategies for a child who is experiencing pain. Which strategies would be best for the nurse to implement? Select all that apply. Silence Acetaminophen Television Games Bubbles Music

Television Games Bubbles Music Distraction helps children of any age divert their attention away from pain and onto other activities. Common diversions include bubbles, music, television, conversation, and games.

The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to nonpharmacologic therapy? Cluster Tension Migraine Sinus

Tension Tension-type headaches often are more responsive to nonpharmacologic techniques, such as biofeedback, massage, acupuncture, relaxation, imagery, and physical therapy, than other types of headache. For people with poor posture, a combination of range-of-motion exercises, relaxation, and posture improvement may be helpful. The other options are usually best treated with medications that focus on the cause of the pain.

A woman with a diagnosis of type 2 diabetes has been ordered a hemoglobin A1C test for the first time by her primary care provider. The woman states, "I don't see why you want to test my blood cells when it's sugar that's the problem." What aspect of physiology will underlie the care provider's response to the client?

The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell. Glucose entry into red blood cells is not insulin dependent, and the rate at which glucose becomes attached to the hemoglobin molecule depends on blood glucose levels. A1C levels thus indirectly indicate glucose levels. Hemoglobin synthesis, the metabolic needs of hemoglobin, and an agonist role of insulin do not underlie the A1C test.

The nurse is caring for a client with myasthenia gravis. Which symptoms displayed by the client would indicate to the nurse that the client may be experiencing mysasthenia crisis? The client begins to have tremors. The client has a sudden onset of severe weakness. The client has a fever, tachycardia, and low blood pressure. The client begins to have projectile vomiting.

The client has a sudden onset of severe weakness. People with myasthenia gravis may experience a sudden exacerbation of symptoms and weakness known as myasthenia crisis. Myasthenic crisis occurs when muscle weakness becomes severe enough to compromise ventilation, to the extent that ventilatory support and airway protection are needed. Myasthenic crisis usually occurs during a period of stress, such as infection, emotional upset, pregnancy, alcohol ingestion, cold exposure, or surgery.

A client has recently been diagnosed with chronic back pain that requires the daily use of hydromorphone, an opioid analgesic. For the first few weeks, the client achieved relief with 4 mg every 6 hours. However, the client now requires 6 mg doses to achieve the same effect. How should the nurse best interpret this phenomenon? The client is developing opioid tolerance, which is expected The client's medication should be replaced with nonpharmacologic interventions The client is exhibiting the early signs of opioid addiction The opioid should likely be replaced with a nonsteroidal anti-inflammatory drug (NSAID)

The client is developing opioid tolerance, which is expected The client is developing a tolerance to the opioid, which is not unexpected and which is not synonymous with addiction. There may be a need to include nonpharmacologic interventions or NSAIDs, but these do not need to replace the opioid.

The nurse is providing discharge instructions for a client with Graves disease who has ophthalmopathy. What should the nurse be sure to include in the instructions to decrease exacerbation of this clinical manifestation?

The client should be strongly urged not to smoke. Ophthalmopathy can also be aggravated by smoking, which should be strongly discouraged. It is not necessary for the client to avoid contact with others. Alcohol is not contraindicated but should be limited when taking any medication regimen. The client should not adjust the doses of medications without first consulting the physician.

The nurse is providing education to a client with Addison disease who has been treated for hyponatremia and hypoglycemia related to the disease. The nurse inform the client that which action should be taken to ensure control of these conditions?

The client should eat and exercise on a regular schedule. Because people with Addison disease are likely to have episodes of hyponatremia and hypoglycemia, they need to have a regular schedule for meals and exercise. It is not necessary to limit carbohydrate and fat intake or salt related to this disorder.

A nurse is providing education to a client newly diagnosed with Guillain-Barré syndrome. Which statement reflects accurate information about the course of the disease? It is an acute disorder that usually resolves after treatment with antibiotics. The client can expect prolonged isolation due to contagious viral nature of disorder. The disorder may present with rapid life-threatening symptoms or may present as a slow insidious process. Most clients do not sustain residual dysfunction from the disorder.

The disorder may present with rapid life-threatening symptoms or may present as a slow insidious process. It is a chronic disorder that is often progressive, but may present with life-threatening cardiopulmonary symptoms. Clients need considerable, supportive nursing and medical care. It is not contagious, but a viral connection is suspected as many report a flu-like illness preceding onset of symptoms.

Following a knee injury, a football player is taking ibuprofen, a nonsteroidal anti-inflammatory drug, for the control of pain. Which drug action is most likely to result in diminished sensation of pain for the player? The drug inhibits the enzyme needed for prostaglandin synthesis. The drug changes the post-excitatory potential in C fibers, leading to pain sensitization. The drug slows the conduction velocity of myelinated Aδ fibers in the pain pathway. The drug inhibits communication by third-order neurons between the thalamus and cerebral cortex.

The drug inhibits the enzyme needed for prostaglandin synthesis. Analgesia can be achieved by inhibition of prostaglandin synthesis, as in the case many NSAIDs. These drugs do not affect the function of third-order neurons, the action potential of C fibers, or the conduction velocity of Aδ fibers.

A 51-year-old male has been diagnosed with alcohol-induced liver disease. He admits to the nurse he does not understand what the liver does in the body. Which of these statements best explains the liver's function?

The liver metabolizes most components of food and also cleans the blood of bacteria and drugs. Protein, carbohydrate and fat metabolism are performed by the liver. As well, it metabolizes drugs and removes bacteria by Kupffer's cells. Absorption of nutrients takes place in the intestines and the liver does not produce the bulk of fluids secreted in the GI tract. The liver does not have a primary role in the maintenance of acid-base or electrolyte balance.

A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the backpack. Which component of somatosensory conduction is most likely to provide the detailed sensory information that will help her distinguish her phone from other items? A bilateral, multisynaptic, slow-conducting tract The primary dorsal root ganglion neuron, dorsal column neuron, and the thalamic neuron A slow-conducting pathway that projects into the intralaminar nuclei of the thalamus The opposite anterolateral pathway that travels to the reticular activating system

The primary dorsal root ganglion neuron, dorsal column neuron, and the thalamic neuron The discriminative pathway, which is associated with the fine touch of item discrimination, involves just three neurons: the primary dorsal root ganglion neuron, the dorsal column neuron, and the thalamic neuron. Slow-conduction and anterolateral pathways that involve the reticular activating system are associated with pain, thermal sensation, and indiscriminate touch.

A mother is placing her child into the bathtub. The child immediately jumps out of the tub and begins to cry, stating her feet are "burning." The nurse in the emergency department knows that the child's response is based on which pathophysiologic principle listed below? It takes a long time for thermal signals to be processed before the brain can send a signal through the spinal cord and tell the foot to withdraw. The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex reacts first. Child react much quicker to contact with hot water than adults. The thermal processing center is located on the rapid-conducting anterolateral system on the same side of the brain as the injury.

The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex reacts first. If a person places a foot in a tub of hot water, the tactile sensation occurs well in advance of the burning sensation. The foot has been removed from the hot water by the local withdrawal reflex well before the excessive heat is perceived by the forebrain.

The health care provider is assessing the functional integrity of all spinal nerves utilizing a pinpoint pressed against the skin. A normal response would be interpreted as: The withdrawal reflex is activated. Verifying the intensity of the pin's force of compression. No response when the pin is pressed. Saying "Ouch" when the pin is pressed.

The withdrawal reflex is activated. Observation of a normal withdrawal reflex rules out peripheral nerve disease, disorders of the dorsal root and ganglion, disease of the myoneural junction, and severe muscle diseases. Having no response is abnormal and may identify neurologic damage. A verbal response is not a reflex response.

The nurse is taking a health history from a client with acromegaly. The client informs the nurse that he is waking up several times a night and has been told he has sleep apnea. What does the nurse inform the client is the rationale for this syndrome?

There is an increase in pharyngeal soft tissue accumulation. The pathogenesis of sleep apnea syndrome is obstructive in the majority of people due to increased pharyngeal soft tissue accumulation.

The hallmark manifestations of Cushing syndrome are a moon face, a "buffalo hump" between the shoulder blades, and a protruding abdomen. What other manifestations of Cushing syndrome occur?

Thin extremities and muscle weakness The major manifestations of Cushing syndrome represent an exaggeration of the many actions of cortisol. Altered fat metabolism causes a peculiar deposition of fat characterized by a protruding abdomen; subclavicular fat pads or "buffalo hump" on the back; and a round, plethoric "moon face." There is muscle weakness, and the extremities are thin because of protein breakdown and muscle wasting.

The nurse is conducting a neurologic assessment and has gently poked the client's forearm with two ends of a paper clip 0.5 cm apart. The client is unable to state that there were two discrete points of contact. Which is the nurse's best interpretation of this finding? There is a need to perform further assessments related to possible deficits in nociception. This is a normal finding when assessing discrimination at this location. The nurse should perform the same test on the other forearm to assess for the presence of hemiplegia. The nurse should perform further testing of proprioception, even though this finding is normal.

This is a normal finding when assessing discrimination at this location. It is possible to assess two-point discrimination by using an open paperclip with its ends bent together to 5 mm apart. When placed on the lips or cheek, the person will readily detect two points of contact. On the back or arm, the ends of the paper clip must be moved progressively farther apart before two points of contact can be detected. Consequently, the nurse should likely interpret this finding as expected. This test does not address proprioception. Bilateral testing is always prudent, but there is no suggestion of hemiplegia or impaired nociception.

The community health nurse is teaching about prevention of hepatitis A. Which group does the nurse suggest will benefit from this vaccine?

Those traveling to Third World countries International hepatitis A vaccine is suggested for travelers to regions where sanitation is poor and endemic HAV infections are high, children living in communities with high rates of HAV infection, homosexually active men, and users of illicit drugs.

Children feel pain just as much as adults do. What is the major principle in pain management in the pediatric population? Treat on individual basis and match analgesic agent with cause and level of pain. Always use nonpharmacologic pain management before using pharmacologic pain management. Base treatment of pain on gender and age group. Treat pediatric pain the way the parents want it treated.

Treat on individual basis and match analgesic agent with cause and level of pain. The overriding principle in all pediatric pain management is to treat each child's pain on an individual basis and to match the analgesic agent with the cause and the level of pain.

A client comes to the clinic and informs the nurse that he believes he is suffering from Parkinson disease. What objective data assessed by the nurse would correlate with the client's concern? Select all that apply. Rigidity Tremor Tachycardia Bradykinesia Rapid speech

Tremor Rigidity Bradykinesia The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia (slowness of movement). Tremor is the most visible manifestation of the disorder. The tremor affects the distal segments of the limbs, mainly the hands and feet; head, neck, face, lips, and tongue; or jaw.

A client comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as "like an electric shock." The pain occurs on only one side of her face. It seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. Often it is accompanied by involuntary grimacing. What diagnosis is most likely? Postherpetic neuralgia Trigeminal neuralgia Complex regional pain syndrome Migraine headache

Trigeminal neuralgia Her symptoms are characteristic of trigeminal neuralgia, caused by damage to cranial nerve V, which carries impulses of touch, pain, pressure, and temperature to the brain from the face and jaw. Postherpetic neuralgia is a complication of shingles. Migraine headache symptoms feel as if they occur in one or more regions of the head, not the face. Complex regional pain syndrome affects either one arm or leg.

A 58-year-old woman comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as, "like an electric shock." The pain occurs only on one side of her face; it seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. There is no numbness associated with the pain. What is most likely causing her pain? Trigeminal neuralgia Post-herpetic neuralgia Complex regional pain syndrome Migraine headache

Trigeminal neuralgia Her symptoms are characteristic of trigeminal neuralgia, caused by damage to the fifth cranial nerve, which carries impulses of touch, pain, pressure, and temperature to the brain from the face and jaw.

A 70 year-old male has been diagnosed with a stroke that resulted in an infarct to his cerebellum. Which clinical finding would be most closely associated with cerebellar insult? Flaccid loss of muscle tone Difficulty starting movement, stopping movement, and maintaining rhythmic movements. Tremor, rigidity, and bradykinesia Unsteady gait and difficulty speaking and swallowing

Unsteady gait and difficulty speaking and swallowing An unsteady gait characterizes cerebellar ataxia and both swallowing and speaking are partly the domain of the cerebellum. Flaccid loss of muscle tone is not noted to accompany cerebellar insult. Difficulties with starting movement, stopping movement, and maintaining rhythmic movements are indicative of basal ganglia disorders. Tremor, rigidity, and bradykinesia are associated with Parkinson disease.

A client is admitted to the acute care facility with severe pain in the abdomen related to inflammatory bowel disease. What type of pain will the nurse be administering medication to relieve? Somatic pain Visceral pain Cutaneous pain Referred pain

Visceral pain Visceral pain has its origin in the visceral organs and is one of the most common pains produced by disease. While similar to somatic pain in many ways, both the neurologic mechanisms and the perception of visceral pain differ from somatic pain. One of the most important differences between surface pain and visceral pain is the type of damage that causes pain. Strong contractions, distention, or ischemia affecting the walls of the viscera can induce severe pain.

A client with diabetes mellitus has just undergone a right, below-the-knee amputation following gangrene infection. A few days after the amputation, the client confides in the nurse that he still feels his right foot. Knowing the pathophysiologic principles behind this, the nurse can: call the physician and request an order for a psychological consult. educate the client that this area has an usually abnormal increase in sensitivity to sensation but that it will go away with time. administer a psychotropic medication to help the client cope with the loss of his leg. explain that many amputees have this sensation and that one theory surmises the end of a regenerating nerve becomes trapped in the scar tissue of the amputation site.

explain that many amputees have this sensation and that one theory surmises the end of a regenerating nerve becomes trapped in the scar tissue of the amputation site. Multiple theories exist related to the causes of phantom limb pain. One rationale is that the end of the regenerating nerve becomes trapped in the scar tissue that forms a barrier to regenerating outgrowth of the axon. The usual treatment includes the use of sympathetic blocks; TENS of the large myelinated afferents innervating the area; hypnosis; and relaxation training.

A nurse caring for a client in myasthenic crisis identifies a priority concern as: monitoring for difficulty chewing. ongoing physical therapy to maintain strength. maintenance of airway and respiration. monitoring for ptosis.

maintenance of airway and respiration. All symptoms and issues are present with myasthenia gravis. However, a priority concern during crisis is maintenance of airway and ventilatory support because of muscular weakness that may compromise breathing/respiration.

A client is experiencing a cluster headache. The client would most likely manifest: severe pain behind the eye. nausea with vomiting. sensitivity to light. symptoms aggravated by physical activity.

severe pain behind the eye. Symptoms of cluster headache include severe, unrelenting unilateral pain located in the orbital area. The pain radiates behind the eye to the ipsilateral trigeminal nerve. The client may also experience symptoms such as restlessness or agitation, conjunctival redness, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, and eyelid edema. The other options are associated with migraine headache.

The nurse has just completed an assessment on a client admitted with Guillain-Barré syndrome. The nurse determines that a priority of care will be: emotional support. feeding the client. ventilatory assessment and support. administration of antibiotics.

ventilatory assessment and support. Guillain-Barré syndrome usually is a medical emergency. There may be a rapid development of ventilatory failure and autonomic disturbances that threaten circulatory function. Assessment of the airway is the top priority. Treatment includes support of vital functions and prevention of complications such as skin breakdown and thrombophlebitis.