Patho Exam 3 PrepU Questions

Myasthenia gravis is characterized by muscle weakness caused by antibody-mediated loss of which physiologic function? a) Periorbital muscles b) Thymus gland cells c) Skeletal muscle fibers d) Acetylcholine receptors

d) Acetylcholine receptors Now recognized as an autoimmune disease, myasthenia gravis is caused by an antibody-mediated loss of acetylcholine receptors in the neuromuscular junction, which disrupts motor neuron impulses to/from the skeletal muscle fibers. The result is muscle weakness, mainly the eye and periorbital muscles, and fatigability with sustained effort. Most persons with myasthenia gravis also have thymic abnormalities, such as a thymoma (i.e., thymus tumor) or thymic hyperplasia.

Acute pyelonephritis is a result of: a) Bacterial infection b) Renal failure c) Viral infection d) Chronic reflux

a) Bacterial infection Acute pyelonephritis represents a bacterial infection of the upper urinary tract, specifically the kidney parenchyma and renal pelvis. Gram-negative bacteria, including Escherichia coli and Proteus, Klebsiella, Enterobacter, and Pseudomonas species, are the common causative agents. Staphylococcus species and Streptococcus faecalis may also cause pyelonephritis, but they are uncommon.

Which brain structure makes continuous adjustments that result in smoothness of movement, particularly during delicate maneuvers? a) Cerebellum b) Limbic system c) Prefrontal lobe d) Temporal lobe

a) Cerebellum The cerebellum makes continuous adjustments, resulting in smoothness of movement, particularly during delicate maneuvers. The limbic system is involved in emotional experiences and in the control of emotion-related behavior. The prefrontal lobe is thought to be involved in anticipation and prediction of consequences of behavior. The temporal lobe is important in auditory functions and long-term memory recall.

Which statement best describes the pathophysiology of Parkinson disease? a) Degeneration of the nigrostriatal dopamine system b) Increase in the number of dopamine receptors by an alternate basal ganglion c) Failure of the cerebral cortex, which does not allow the use of acetylcholine d) Rise in acetylcholine levels, causing an inhibition of voluntary movement

a) Degeneration of the nigrostriatal dopamine system Parkinson disease presents with degenerative changes in the basal ganglia. Dopamine depletion results from degeneration in the nigrostriatal system. The cause of Parkinson disease is still unknown; it is widely believed that most cases are caused by an interaction of environmental and genetic factors.

During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description? a) The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction b) Muscle necrosis with resultant increase in fat/connective tissue replacing the muscle fibers c) Atherosclerotic destruction of circulation to the brain, resulting in lactic acid buildup that affects nerve transmission d) Autoimmune disease where antibody loss of acetylcholine receptors at the neuromuscular junction causes decreased motor response

a) The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction Multiple sclerosis (MS) is an immune-mediated disorder that occurs in genetically susceptible individuals. The pathophysiology of MS involves demyelination and subsequent degeneration of nerve fibers in the central nervous system (CNS), marked by prominent lymphocytic invasion in the lesion. The infiltrate in nerve fiber (rather than vascular) sclerotic plaques contains CD8+ and CD4+ T cells as well as macrophages, which are thought to induce oligodendrocyte injury. With muscular dystrophy, the muscle undergoes necrosis, and fat and connective tissue replace the muscle fibers, which increases muscle size and results in muscle weakness. Now recognized as an autoimmune disease, myasthenia gravis is caused by an antibody-mediated loss of acetylcholine receptors in the neuromuscular junction.

A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing: a) Transient ischemic attack (TIA) b) Cardiogenic embolic stroke c) Thrombotic stroke d) Lacunar infarct

a) Transient ischemic attack (TIA) Transient ischemic attacks are brief episodes of neurologic function resulting in focal cerebral ischemia not associated with infarction that usually resolve in 24 hours. The causes of transient ischemic attack are the same as they are for stroke. Embolic stroke usually has a sudden onset with immediate maximum deficit. Lacunar infarcts produce classic recognizable "lacunar syndromes" such as pure motor hemiplegia, pure sensory hemiplegia, and dysarthria with clumsy hand syndrome.

The nurse assesses a client in an ambulatory care facility. Which manifestation(s) leads the nurse to advocate for investigation of possible acute pyelonephritis? Select all that apply. a) flank pain in the back b) abrupt onset of fever and chills c) heart palpitations d) shortness of breath e) urinary urgency and frequency

a) flank pain in the back b) abrupt onset of fever and chills e) urinary urgency and frequency Acute pyelonephritis tends to present with an abrupt onset of chills, high fever, and an ache or tenderness in the flank area of the back. Lower urinary tract symptoms—dysuria, frequency, and urgency—also are common. Nausea and vomiting may occur along with abdominal pain. Heart palpitations and shortness of breath are specific to acute pyelonephritis, so would not be used as evidence to support further investigation for this condition.

The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary health care provider for further evaluation? a) random blood glucose 195 mg/dl (10.8 mmol/l) b) hemoglobin A1C 5.6% c) urine ketones negative d) fasting blood glucose 89 mg/dl (4.9 mmol/l)

a) random blood glucose 195 mg/dl (10.8 mmol/l) Laboratory values that are considered normal are hemoglobin A1C less than 6%, fasting plasma glucose (FPG) less than 100 mg/dl (5.5 mmol/l) or less than 140 mg/dl (7.8 mmol/l) 2 hours after an oral glucose tolerance test (GTT). Urine should be free of ketones. A hemoglobin A1C value that is greater than or equal to 6.5%, a fasting blood glucose greater than 126 mg/dl (7.0 mmol/l), or a blood glucose level greater than 200 mg/dl (11.1 mmol/l) 2 hours after a glucose tolerance test (GTT) indicate diabetes mellitus. Values between these levels are considered to place clients at increased risk for diabetes mellitus and require further evaluation. A random blood glucose level is expected to correlate with the 2-hour GTT results and should be below 200 mg/dl (11.1 mmol/l). Although the client does not have a result that meets the threshold to be diagnosed with diabetes, the elevated levels warrant assessment for prediabetes and early intervention.

The nurse is caring for a client who has been taking prednisone for the treatment of asthma. The nurse is monitoring the client for increased levels of stress. When glucocorticoid levels are increased, what symptoms should the nurse monitor for? a) Bradycardia b) Tachycardia c) Lethargy d) Fatigue

b) Tachycardia Any situation sufficiently stressful to evoke increased levels of glucocorticoids also increases epinephrine levels. Catecholamines can cause excitation or inhibition of smooth muscle contraction, depending on the site, dose, and type of receptor present. Tachycardia, hypertension, or any state of excitation can be provoked.

During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur? a) Hepatomegaly b) Portal hypertension c) Hyperglycemia d) Adrenal hyperplasia

c) Hyperglycemia In predisposed persons, the prolonged elevation of glucocorticoid hormones can lead to hyperglycemia and the development of diabetes mellitus and starvation. They stimulate gluconeogenesis by the liver, sometimes producing a 6- to 10-fold increase in hepatic glucose production. A prolonged increase in glucocorticoid hormones does not cause hepatomegaly, portal hypertension, or adrenal hyperplasia.

There are several sources and effects of brain neurochemicals. What is the proposed action of serotonin? a) It has an important role in learning and memory. b) It is involved in involuntary motor movement. c) It has a role in control of appetite. d) It mobilizes energy.

c) It has a role in control of appetite. Serotonin plays a role in control of appetite. Acetylcholine has an important role in learning and memory. Dopamine is involved in involuntary motor movement, and cortisol mobilizes energy.

Disorders of the pyramidal tracts, such as a stroke, are characterized by which physical finding? a) Hypotonia b) Muscle rigidity c) Paralysis d) Involuntary movements

c) Paralysis Disorders of the pyramidal tracts (e.g., stroke) are characterized by spasticity and paralysis, whereas those affecting the extrapyramidal tracts (e.g., Parkinson disease) are characterized by involuntary movements, muscle rigidity, and immobility without paralysis. Hypotonia is a condition of less-than-normal muscle tone. Hypertonia or spasticity is a condition of excessive tone. Paralysis refers to a loss of muscle movement. Upper motor neuron (UMN) lesions produce spastic paralysis and lower motor neuron (LMN) lesions flaccid paralysis.

The nursing assistant reports to the registered nurse that a client with a brain tumor has a blood pressure of 180/100 mm Hg and a pulse of 50 bpm. Which action is the correct nursing intervention? a) Ask the nursing assistant to obtain a glucose reading. b) Initiate intravenous fluids. c) Report to physician the client's signs of increased intracranial pressure. d) Contact the physician for "do not resuscitate" orders.

c) Report to physician the client's signs of increased intracranial pressure. Hypertension, together with bradycardia and a widened pulse pressure make up the Cushing reflex, an indicator of increased intracranial pressure that should be reported to the physician.

A nurse at a long-term care facility provides care for a client who has had recent transient ischemic attacks (TIAs). What significance should the nurse attach to the client's TIAs? a) TIAs result in an accumulation of small deficits that may eventually equal the effects of a CV. b) TIAs are relatively benign phenomena that necessitate monitoring, but not treatment. c) TIAs, by definition, resolve rapidly, but they constitute an increased risk for stroke. d) The small bleeds that define TIAs can be a warning sign of an impending stroke.

c) TIAs, by definition, resolve rapidly, but they constitute an increased risk for stroke. TIAs can be considered a warning sign for future strokes. They are not hemorrhagic in nature and their effects are not normally cumulative. They may require treatment medically or surgically.

A nurse is caring for a client experiencing muscle fasciculations. Fasciculations appear as: a) increased muscular resistance with range of motion. b) weakness and loss of movement. c) spontaneous contractions of muscle fibers presenting as twitching. d) rhythmic movements.

c) spontaneous contractions of muscle fibers presenting as twitching. Fasciculations are characterized by twitching or squirming movements of muscle fibers. Paresis is weakness/loss of movement. Spasticity is increased resistance with ROM. Rhythmic movements describe tremors.

A client who has had an intestinal bypass has developed a kidney stone. Which type of kidney stone does the nurse recognize that this client will most likely be treated for? a) Cystine b) Uric acid c) Magnesium ammonium d) Calcium

d) Calcium Most kidney stones are calcium stones—calcium oxalate, calcium phosphate, or a combination of the two materials. Clients who have had intestinal bypass surgery are at a higher risk for developing calcium kidney stones.

Which condition/disorder would the nurse see as being likely to cause the most serious long-term problems? a) Horseshoe kidney b) Unilateral renal agenesis c) Simple renal cyst d) Polycystic kidney disease

d) Polycystic kidney disease Polycystic kidneys may be associated with aneurysm, and subarachnoid hemorrhage is a frequent cause of death. Agenesis refers to failure of an organ to develop at all. The other kidney usually undergoes compensatory hypertrophy and performs the function of the missing kidney. Most simple cysts do not produce signs or symptoms or compromise renal function. A horseshoe kidney occurs when the upper and lower poles of the two kidneys are fused, producing a horseshoe-shaped structure. The condition usually does not cause problems.