Patho Midterm PrepU Part 2

Which intervention is usually the first line of therapy when treating moderate pain in the older adult population?

Nonopioids such as acetaminophen

The nursing instructor who is teaching about incontinence in older adults recognizes a need for further instruction when a student makes which statement?

"Frequency is not a major problem for the elderly."

A young adult client has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause?

"Have you had any type of infection within the past 2 weeks?"

The nurse is evaluating client risk for the development of overactive bladder/urge incontinence and determines that which client is at highest risk for this condition?

A client with diabetes mellitus

What are the main neurotransmitters of the autonomic nervous system (ANS)? Select all that apply.

1. Acetylcholine 2. Epinephrine 3. Norepinephrine

What percentage of the body's oxygen does the brain consume?

20%

For which older adult client would pain assessment likely be most challenging for the nurse?

An 87-year-old client with vascular dementia and numerous other health problems, such as heart failure

Acute pyelonephritis is a result of:

Bacterial infection

The cerebellum, separated from the cerebral hemispheres by the tentorium cerebelli, lies in the posterior fossa of the cranium. What is one of the functions of the cerebellum?

Coordinates smooth and accurate movements of the body

The demyelination and degeneration of nerve fibers characteristic of multiple sclerosis (MS) is the result of which pathophysiologic event?

Decreased oligodendrocytes

Which statement best describes the pathophysiology of Parkinson disease?

Degeneration of the nigrostriatal dopamine system

The client presents with a traumatic complete spinal cord transection at the C5 level. Based on this injury, the health care worker can expect the client to have control of which body function/part?

Diaphragm

Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia have which effect on motor ability?

Disrupt movement without causing paralysis

Acute postinfectious glomerulonephritis, as its name implies, follows an acute infection somewhere else in the body. What is the most common cause of acute postinfectious glomerulonephritis?

Group A β-hemolytic streptococci

Which factor contributes to the development of polycystic kidney disease?

Hereditary mutations in polycystin I and II

Which assessment indicates to the nurse that a client may have a spastic bladder dysfunction?

Incontinence

Nystagmus due to cerebellar dysfunction would most likely interfere with which activity?

Reading

A 40-year-old mother of three reports incontinence. Her physician suggests Kegel exercises because they strengthen the pelvic floor muscles. Kegel exercises are most likely to help which type of incontinence?

Stress incontinence

If a client is experiencing acute pain, which clinical manifestation will the nurse assess?

Tachycardia

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 myasthenia crisis?

The client has a sudden onset of severe weakness.

The older adult client tells the health care provider about experiencing incontinence ever since starting diuretic therapy 2 weeks ago. What term should the provider document in the medical record related to the type of incontinence?

Transient

A client has experienced the α1-receptor stimulation. The nurse would assess the client for:

Vasoconstriction

The nurse recognizes the most common cause of acute postinfectious glomerulonephritis as:

a streptococcal infection 7 to 12 days prior to onset.

Neurons are characterized by the ability to communicate with other neurons and body cells through pulsed electrical impulses, or:

action potentials.

Urinary tract infections (UTIs) in children do not generally present as they do in adults. What are the signs and symptoms of a UTI in a toddler? Select all that apply.

1. Diarrhea 2. Abdominal pain 3. Poor growth

Cerebrospinal fluid (CSF) is produced by which structure?

Choroid plexus

One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which electrolyte?

Sodium

Neurons communicate through the use of synapses. These synapses may link neurons into functional circuits. What is the most common type of synapse?

Chemical synapse

What can the nurse assume about a child's behavior when faced with the need to repeat a painful procedure?

Children act to avoid pain based on their memory of past painful events.

Which peripheral nerve injury will likely result in cellular death with little chance of regeneration?

Nerve fibers destroyed close to the neuronal cell body

During embryonic development, which structure develops into the central nervous system (CNS)?

Neural tube

A client has a fever that was induced by damage to the hypothalamus due to intercranial bleeding. The nurse plans care for which type of fever?

Neurogenic

Place the four successive stages of fever in correct order.

Prodromal Chill Flush Defervescence

A client has a mild headache and fatigue. He also states he has some aches and pains. Which stage of fever does the nurse determine the client is experiencing?

Prodrome

In which way do neurotrophic factors contribute to the maintenance of homeostasis?

Promoting the growth and survival of neurons

A 71-year-old client reports to the nurse that he often notices a pink tinge to his urine. Upon further questioning, he states that he experiences no pain when voiding and has not noticed any change in the frequency of his voiding. Which response by the nurse is best?

Promptly report this finding to the client's health care provider.

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?

Proprioception

The nurse is conducting a community health education program on urinary retention and urinary incontinence. The nurse determines that the participants are understanding the education when they state that the most common cause of urinary retention is:

Prostate enlargement

There are two types of nervous tissue cells: neurons and supporting cells. What is the function of the supporting cells?

Protect the nervous system and provide metabolic support for the neurons

A client is admitted with a diagnosis of flaccid bladder. The nurse caring for this client understands this client will exhibit which disorder of the bladder?

Failure to empty urine

The adrenal medulla is innervated by parasympathetic nerve fibers.

False

The autonomic nervous system innervates the somatic organs.

False

The nurse notes that the client is experiencing visible squirming and twitching movements that can be seen as flickers under the skin. The nurse would recognize this as:

Fasciculations

Which assessment finding correlates to the prodromal stage of a fever?

Fatigue

A woman has sought care because of recurrent urinary tract infections that have been increasing in both frequency and severity. Which factor is likely to contribute to recurrent UTIs?

Reflux flow of urine

What is the most common cancer of the kidney?

Renal cell carcinoma

Which symptom is unique to amyotrophic lateral sclerosis (ALS) and is not observed in multiple sclerosis (MS)?

Respiratory muscle impairment

A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on upper and lower motor neurons. The health care provider caring for this client will focus on which priority intervention for this client?

Respiratory ventilation assessment and prevention of aspiration pneumonia

Antipyretic drugs, such as aspirin, ibuprofen, and acetaminophen, are often used to alleviate the discomforts of fever and protect vulnerable organs, such as the brain, from extreme elevations in body temperature. The use of aspirin is limited in children, however, because it can sometimes cause which disease?

Reye syndrome

A sudden, traumatic, complete transection of the spinal cord results in what type of injury below the site?

Flaccid paralysis

In what part of the body does the highest level of motor function occur?

Frontal cortex of the brain

An older adult client who is immobile and has difficulty seeing—but is otherwise healthy—would be at a high risk for which type of incontinence?

Functional

The nurse is studying sensory systems. She understands that signal transduction of an impulse to the thalamus for processing is accomplished by:

Second-order neurons

Drug-related nephropathies involve functional and/or structural changes to the kidney after exposure to a drug. What does the tolerance to drugs depend on?

State of hydration

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?

Stimulus-induced analgesia

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:

ventilatory assessment and support.

A client presents to a health clinic complaining of several vague symptoms. As the history/physical continues, the health care provider clearly thinks the client may have myasthenia gravis. Which statements by the client would correlate with this diagnosis? Select all that apply.

1. "Sometimes I have double vision." 2. "I have more energy in the morning but get worse as the day goes by." 3. "I feel like I don't have enough energy to chew my food sometimes."

Which temperature readings indicate to the nurse that the clients have fever? Select all that apply.

1. 35-year-old with pulmonary artery reading of 37.9ºC (100.2ºF) 2. 19-year-old with oral reading of 38.4ºC (101.1ºF) 3. 3-day-old with rectal reading of 38ºC (100.4ºF)

Which neuroglial cells of the CNS provide protection and metabolic support to neurons? Select all that apply.

1. Astrocytes 2. Ependymal cells 3. Microglia cells 4. Oligodendrocytes

A nurse is assessing a client with suspected urine retention. Which assessment findings will help to confirm this diagnosis? Select all that apply.

1. Frequency 2. Straining when initiating urination 3. Feelings of incomplete bladder emptying

Which statements are true regarding a Wilms tumor? Select all that apply.

1. It is the most common childhood malignant tumor. 2. It presents with an abdominal mass. 3. Treatment includes chemotherapy, radiation and surgery.

Which is a manifestation(s) of peripheral neuropathy? Select all that apply.

1. Muscle weakness 2. Muscle wasting 3. Sensory changes

A client who is having problems with his bladder and kidneys is scheduled for a cystoscopy. He asks the nurse why he has to have the test. What would be the best response by the nurse?

"A cystoscopy enables direct visualization of the urethra, bladder, and ureteral orifices."

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 type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles."

How will the nurse explain to a client the changes in blood flow during exercise?

"Heat dilates blood vessels and increases local blood flow to skeletal muscles."

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

"All glomeruli and all parts of the glomeruli are involved."

A young mother asks, "Why can my 3-year-old daughter have a bowel movement on the toilet but she wets her pants?" What is the nurse's best response?

"Bowel control occurs earlier than bladder control."

A client who has just been diagnosed with a spastic bladder asks the nurse what that means. What would be the nurse's best response?

"It is a problem with storing urine."

A diabetes education nurse is teaching a group about the potential genitourinary complications of diabetes. Which teaching point best conveys an aspect of bladder dysfunction and diabetes mellitus?

"It is important for you to empty your bladder frequently because diabetes carries risks of kidney damage that can be exacerbated by incomplete bladder emptying."

A student presents to the campus clinic with reports of frequent, burning urination and is diagnosed with an acute lower urinary tract infection (UTI) caused by Escherichia coli. What teaching will the health care provider most likely provide to the student?

"Many of these bacteria are now resistant to some antibiotics, but I will take that into account when I choose which antibiotic to prescribe."

The client who has just been diagnosed with bladder cancer asks the nurse what treatment he will have to undergo. What would be the nurse's best response to this question?

"The methods used depend on the grade of the tumor and the lesion's invasiveness."

A toddler is displaying signs/symptoms of weakness and muscle atrophy. The pediatric neurologist suspects it may be a lower motor neuron disease called spinal muscular atrophy (SMA). The client's family asks how he got this. The nurse will respond:

"This is a degenerative disorder that tends to be inherited as an autosomal recessive trait."

A client has a postvoid residual (PVR) volume of 40 mL. Which information would the nurse teach the client?

"This is a normal value."

A client with bladder cancer asks the nurse, "What did the doctor mean by intravesicular chemotherapy? Am I going to lose all my hair and have to go for treatments over months and months?" The best response would be:

"This is when they put the chemotherapy directly into the bladder to kill any cancer cells."

A nurse assessing an older adult 3 hours postoperative notes guarding, grimacing, and stiff body movement when changing positions. The client denies feeling pain. Which response will help the nurse best manage this client's pain?

"You seem to be uncomfortable. Pain is common with surgery. I can bring you pain medication."

A client has been taking up to 2400 mg of ibuprofen per day for chronic pain following a motor vehicle accident. The client is diagnosed with chronic analgesic nephritis. The client states, "I thought that taking too many drugs hurt your liver if anything, not your kidneys." What is the most appropriate response to the client's statement?

"Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs."

An adult client is diagnosed with a low-grade bladder tumor and undergoes a cystectomy with resection of the pelvic lymph nodes and the prostate and seminal vesicles. Which response by the health care provider is the most plausible when asked about prognosis?

"Your prognosis is excellent, and you are likely to have a full recovery."

The parents of a 3-year-old boy have brought him to a pediatrician for assessment of the boy's late ambulation and frequent falls. Subsequent muscle biopsy has confirmed a diagnosis of Duchenne muscular dystrophy. Which teaching point should the physician include when explaining the child's diagnosis to his parents?

"Your son will be prone to heart problems and decreased lung function because of this."

A neurologic nurse is explaining the structure and function of motor units to a client who has a spinal cord injury. The nurse should describe which components of a motor unit? Select all that apply.

1. Neuromuscular junction 2. Skeletal muscle 3. Lower motor neuron

Select the manifestations of renal cell carcinoma. Select all that apply.

1. Often silent in the early stages 2. Hematuria 3. Palpable flank mass

A client has recently been diagnosed with systemic lupus erythematosus (SLE) glomerulonephritis. Knowing the treatment options, the nurse should anticipate educating the client (who has a positive renal biopsy result) on which medications usually prescribed? Select all that apply.

1. Prednisone, a corticosteroid 2. Captopril, an ACE inhibitor

What are appropriate interventions in the care of a client diagnosed with renal calculi? Select all that apply.

1. Straining the client's urine 2. Addressing the client's pain 3. Keeping track of intake and output

When lecturing about heart attacks (myocardial infarctions), the instructor will emphasize the client may present with:

1. Substernal chest pain 2. Neck pain 3. Pain that radiates to the left arm

Which client should be assessed for fever based on other presenting symptoms? Select all that apply

1. The client with anorexia 2. The client with myalgia

A nurse is caring for a 60-year-old client who experiences headaches several times a month. Which additional characteristics would support a diagnosis of tension headaches? Select all that apply.

1. The pain is described as dull and aching. 2. The pain responds to NSAIDs.

In addition to medication efficacy, what should the nurse consider when assessing the appropriateness of a pain medication prescribed to an older adult client? Select all that apply.

1. The possibility of drug interaction 2. The effects of normal aging on metabolism 3. The existence of chronic illnesses 4. The cost of the medication

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.

1. Tremor 2. Rigidity 3. Bradykinesia

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.

1. flank pain in the back 2. abrupt onset of fever and chills 3. urinary urgency and frequency

The nurse is assessing a client who is suspected of having acute postinfectious glomerulonephritis. Which assessment(s) will the nurse prioritize as related to acute postinfectious glomerulonephritis? Select all that apply.

1. history of recent illnesses 2. urine output and appearance 3. blood pressure 4. edema

The nurse is teaching a client about the effects of amyotrophic lateral sclerosis (ALS). Which area(s) of the nervous system will the nurse teach the client are affected by ALS? Select all that apply.

1. motor nuclei of the brain stem 2. lower motor neurons of the spinal cord 3. upper motor neurons of the cerebral cortex

A client has just begun to experience an ischemic stroke. The blood supply from the middle cerebral artery is being blocked by a large blood clot. How long before brain cells begin to die due to lack of ATP?

4 to 6 minutes

A nurse is working at the medical booth at a marathon on a hot summer day. Which individual is at greatest risk for hyperthermia?

83-year-old spectator with congestive heart failure

In women, stress incontinence is a common problem. The loss of the angle between the urethrovesical junction and the bladder contributes to stress incontinence. What is the normal angle between the bladder and the urethrovesical junction?

90 to 100 degrees

Which statement accurately reflects the typical person afflicted with multiple sclerosis (MS)?

A 25-year-old woman

Which symptom indicates the next stage of a fever after a prodrome?

A chill

Infants are at greater risk of hypothermia than children because of which of the following?

A high ratio of surface area to body mass

A client has been diagnosed with a fever of unknown cause. The nurse recognizes this as:

A prolonged fever that does not have an identified source

What happens during the depolarization phase of nerve cells?

A rapid change in polarity to one that is positive on the inside, and the membrane becomes open to sodium ions.

Which statement about the use of angiotensin-converting enzyme (ACE) inhibitors and autosomal recessive polycystic kidney disease (ARPKD) is accurate?

ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction.

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?

Abnormal discrimination pathway function

Sweating is mediated by which neurotransmitter?

Acetylcholine

One of the many tests done during urodynamic studies is the sphincter electromyelogram. What does this test study?

Activity of the voluntary muscles of the perineal area

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

Acute postinfectious glomerulonephritis

Neuromodulators can produce slower and longer-lasting changes in membrane excitability by acting on postsynaptic receptors. What do neuromodulators do?

Alter the release of, or response to, neurotransmitters

A client has just been diagnosed with multiple sclerosis (MS). The nurse recognizes that the client's condition is a result of:

An immune-mediated response that is caused by the demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and optic nerve

Which statement accurately describes the etiology of stress incontinence?

An increase in intra-abdominal pressure that results in involuntary urination

An 88 year old resident of a long term care home has been suffering from a three day onset of increasing shortness of breath and decreased oxygen saturation. At the hospital, an anterior-posterior chest X-ray and sputum culture and sensitivity has confirmed a diagnosis of bacterial pneumonia, yet the client's tympanic temperature has not exceeded 37.3°C (99.2°F). The health care team would recognize that which of the following phenomena likely underlies this situation?

An older adult's hypothalamus has diminished thermoregulatory ability.

The nurse is performing an assessment for a client with diabetes who has peripheral neuropathy. When the nurse assesses pain response in the lower extremities, the client does not have any reaction. What would the nurse document this response as?

Analgesia

A client who suffers from spastic bladder has been catheterized to promote bladder emptying. Which medication should the nurse plan on the physician ordering to also treat this problem?

Anticholinergic medication

A client reports general malaise and has a temperature is 103.8°F (39.9°C). What is the rationale for administering a prescribed aspirin, an antipyretic, to this client?

Antipyretics protect vulnerable organs, such as the brain, from extreme temperature elevation.

Which disorder is a manifestation of a serious condition that causes new-onset back pain in persons age 50 years or older?

Aortic aneurysm

Which intervention is an appropriate action by a nurse to take in attempting to decrease a client's temperature through conduction?

Apply cooling blanket

A client with type 1 diabetes mellitus has bladder atony with dysfunction. Which assessment indicates a primary concern for this client?

Ascending urinary tract infection

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?

Assessment of swallowing ability and respiratory status.

The parasympathetic nervous system is part of which system?

Autonomic nervous system

The form of polycystic kidney disease (PKD) that first manifests in the early infant period is most commonly characterized as:

Autosomal recessive

Fever in infants and young children is not an uncommon event. Many trips to the pediatrician's office occur because of fever in children ages 1 day to 3 years. Which sign or symptom does not indicate fever in an infant?

Avid feeding

Which clinical manifestations would you expect to see in an infant diagnosed with autosomal recessive polycystic kidney disease (ARPKD)?

Bilateral flank masses and impaired lung development

A middle-aged man with diabetes reports that he must strain to urinate, that his urine stream is weak and dribbling, and that his bladder never really empties. The nurse knows that all of his symptoms are likely caused by which diagnosis?

Bladder atony with dysfunction

Neurotoxins such as the botulism organism can produce paralysis by what mechanism?

By blocking release of acetylcholine

The nurse expects that loss of respiratory effort occurs with a spinal injury at which level?

C1-3

At which level of the cervical spine would a complete cord injury result in the client retaining the ability to flex and extend the fingers?

C8

Which statement best conveys an aspect of the role of cerebrospinal fluid (CSF)?

CSF cushions the brain and provides a near-water medium for diffusion of nutrients.

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?

Calcium

What will the nurse teach a client with trigeminal neuralgia about the condition?

Carbamazepine is a first-line treatment.

A client is experiencing pain, tingling, and numbness of the thumb and first, second, third, and half of the fourth digits of the hand. She states that she has pain in the wrist and hand, which worsens at night, and she has noticed that they have become clumsy. The nurse recognizes these manifestations as:

Carpal tunnel syndrome

Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy?

Carpal tunnel syndrome

A middle-aged woman is brought to the emergency room after a minor auto accident. Her gait is staggering and unsteady, her speech is slurred, and she displays slight nystagmus. The police officer who brought her in says she has not been drinking. Her blood pressure is very high. Which health problem most likely underlies her present state?

Cerebellar damage caused by a cerebrovascular accident

An older adult has had a recent decrease in coordination, with gait being described as wide-based, unsteady, and lacking in fluidity, although the client's muscle tone appears normal. This client requires further assessment for which condition that is involved with coordination of movement?

Cerebellar disorder

An individual will experience problems with rapid muscular activities such as running as a result of damage to which structure?

Cerebellum

Which brain structure makes continuous adjustments that result in smoothness of movement, particularly during delicate maneuvers?

Cerebellum

The nurse is assessing a client with an elevated temperature. Which additional assessment findings provide the most useful information for the nurse?

Client's heart rate is more rapid than anticipated.

A client has been diagnosed with amyotrophic lateral sclerosis, a disease resulting in the loss of efferent signals. Which aspect of neurologic function will be primarily affected by this client's condition?

Conduction of information away from central nervous system (CNS)

The thick area of myelinated axons that connects the two sides of the cerebral cortex is known as which component?

Corpus callosum

The family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. What is the nurse's best response?

Corticosteroids

Which medication is used to treat acute attacks of multiple sclerosis (MS)?

Corticosteroids

Select the laboratory blood test that would be a used to suggest a diagnosis of muscular dystrophy (MD).

Creatine kinase

The nurse is conducting preoperative teaching for a client with bladder cancer who is scheduled to undergo surgical creation of an alternative bladder reservoir. The nurse determines that the client is understanding the preoperative teaching when the client identifies the surgical treatment as:

Cystectomy

A nursing instructor who is teaching students about urinary incontinence in older adults suggests that an easy and effective way to remember the transient and treatable causes of urinary incontinence is to use which acronym?

DIAPPERS

Disruption of which muscle's contraction can lead to the inability to expel urine from the bladder?

Detrusor

Which catecholamine may have a vasodilator effect on the renal blood vessels and be prescribed for clients in shock who are experiencing renal insufficiency manifestations?

Dopamine

A client who sustained a complete C6 spinal cord injury 6 months ago has been admitted to the hospital for pneumonia. The nurse observes the client with diaphoresis above the level of C6 and the blood pressure is 260/140 mm Hg. What is the first intervention the nurse should provide?

Elevate the head of the bed.

The underlying causative problem in Parkinsonism is:

Failure of dopamine release

Which structure is essential to the regeneration of peripheral nerves?

Endoneurial sheath

The nurse is caring for a 9-year-old child who has been diagnosed with urinary tract infection (UTI). Which is a commonly associated manifestation of this disorder?

Enuresis

Urinary incontinence can be a problem with older adults. One method of treatment is habit training, or bladder training. When using this treatment with an older adult, how frequently should he or she be voiding?

Every 2 to 4 hours

Which pain descriptions would lead the nurse to suspect the client is experiencing ureteral colic?

Excruciating pain in the flank and upper outer quadrant of abdomen that radiates to bladder area

Which reserve urinary structure helps to stop micturition when it is occurring and maintains continence under high bladder pressure

External sphincter

A client experiencing acute pain finds relief for several hours after the light touch of a soft-bristled brush has been applied over the area. Which pain theory is best supported by this event?

Gate control

While studying the GU system the nursing students learn that which sex achieves continence first?

Girls

A client is having an upper endoscopy to determine the presence of a gastric ulcer. After the procedure is performed, the nurse instructs the client that he cannot have anything to eat or drink until the return of the gag reflex. Which nerve is the nurse testing for return of function?

Glossopharyngeal

The nurse measures a blood glucose level of 40 mg/dL (2.22 mmol/L) for a client with type 1 diabetes. Why would it be important for the nurse to institute an intervention to elevate the glucose level in this client?

Glucose is not stored in the brain and is a major fuel source for brain function.

A hiker presents to the emergency department with reports of flu-like symptoms—thirst, nausea, and inability to urinate. Upon assessment, it is determined that the client has a rectal temperature of 102.2°F (39°C) and is tachycardic. These symptoms support a diagnosis of:

Heat exhaustion

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

Heavy smoking

A nurse is assessing a client with symptoms of botulism. The nurse will question the client regarding ingestion of which food?

Home-grown and canned vegetables

A client has a dilated renal pelvis due to obstruction of urine outflow from the kidney. The pressure of filtrate formation is damaging the renal structures. Which condition is most likely?

Hydronephrosis

The nurse is suctioning a client with a C3 spinal cord injury when the client's heart rate drops from 86 bpm to 42 bpm. What intervention does the nurse understand should be provided prior to suctioning to prevent this vasovagal response from occurring?

Hyperoxygenate prior to suctioning.

Maintenance of blood gas concentrations, water balance, and food consumption are controlled by which part of the brain?

Hypothalamus

The health care provider is assessing the muscle tone of a client who has been diagnosed with a lower motor neuron (LMN) lesion. Which assessment finding is congruent with the client's diagnosis?

Hypotonia

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?

Which current multiple sclerosis drug treatments are designed to slow the progress of myelin degeneration?

Immunomodulators

The nurse is assessing a client diagnosed with myasthenia gravis (MG). The nurse would expect the assessment to include:

Inability to move eyes in multiple positions

Manifestations of polycystic kidney disease include which of the following?

Increase in kidney size bilaterally

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?

Increasing the functional ability of the underactive dopaminergic system

In which client with a transecting spinal cord injury should the nurse anticipate an impaired ability for temperature regulation?

Injury at T2

Among the treatments for multiple sclerosis (MS), which medication will reduce the exacerbation of relapsing-remitting MS?

Interferon-β, a cytokine injection

A client's temperature readings are as follows: 99.6°F (37.5°C) at 4 pm; 102°F (38.9°C) at 8 pm; and 97.9°F (36.6°C) at 12 am. The nurse's hand-off should include which note?

Intermittent fever

If a client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema?

Lower extremities

A client reports a sudden intense headache. Which factor would indicate the presence of a possible subarachnoid hemorrhage?

Intractable pain

A 67-year-old retired textile worker has developed bladder cancer. His history shows that he smoked for 25 years and is 30.8 lb (14 kg) overweight. What conclusion can the nurse best draw about the etiology and pathophysiology of his bladder cancer?

It is caused by carcinogens that are excreted in the urine and stored in the bladder.

Feelings of dread, high anxiety, or exquisite pleasure can be elicited by stimulation of areas in which structure?

Limbic system

A nurse is explaining the clinical manifestations of diabetic nephropathy (diabetic glomerulosclerosis) to a client. Which statement would be the most important information for the nurse to provide?

Microalbuminuria is a predictor of future nephropathies.

A 60-year-old woman has been recently diagnosed with multiple sclerosis, a disease in which the oligodendrocytes of the client's central nervous system (CNS) are progressively destroyed. Which physiologic process within the neurologic system is most likely to be affected by this disease process?

Nerve conduction

A client with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which process will accompany the actions of the neurotransmitter in a chemical synapse?

More neurotransmitters will cross the synaptic cleft and bond with postsynaptic receptors.

Muscular dystrophy is characterized by which pathophysiologic changes?

Muscular necrosis and replacement with fat and connective tissue

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?

Myasthenia gravis

A client asks why his temperature is always below 98.6°F (37°C). The nurse responds:

Normal core temperature varies between individuals within the range of 97°F (36.1°C) to 99.5°F (37.5°C).

The nurse is assessing the function of a client's cranial nerves. Which technique should the nurse use in assessing cranial nerve XII function?

Note any deviation when the client sticks out the tongue.

A male client reports awakening three to four times nightly to void, and often has a sudden need to void with little warning during the day. What is this client's most likely diagnosis and possible underlying pathophysiologic problem?

Overactive bladder that may result from both neurogenic and myogenic sources

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 occurs directly in damaged tissues

A nurse is caring for a client in spinal shock. Which intervention is appropriate in relation to the client's urinary status?

Perform intermittent catheterization

A client who has suffered a spinal cord injury at C4 is experiencing a sudden change in condition. Blood pressure is 186/101 mm Hg; heart rate is 45 beats/min. The client is profusely sweating and reporting "not feeling right." Which intervention should the nurse perform at this time?

Palpate the bladder for overdistention.

A client who has experienced a spinal cord injury still has use of the arms but has impaired motor and sensory function of the trunk, legs, and pelvic organs. Which term best describes how this injury is classified?

Paraplegia

Which disease can result in symptoms that can occur when a brain tumor causes damage to the nigrostriatal pathway?

Parkinson disease

An older adult resident of an assisted living facility has been inconsistently continent of urine until the last several weeks. Which intervention by the care providers at the facility is the most likely priority?

Performing a physical examination and history to determine the exact cause and character of the incontinence.

The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to which substance?

Plasma proteins

Spinal nerves that form complex nerve networks are called which of the following?

Plexuses

Guillain-Barré syndrome is characterized by which form of neuron damage?

Polyneuropathy

Which treatment should take place immediately in a client experiencing autonomic dysreflexia?

Position the client in upright position, and correct the initiating stimulus.

The nurse is performing an assessment for a client suspected of having symptoms that correlate with carpal tunnel disorder. The client states he feels a tingling sensation that radiates into the palm of the hand when the nurse lightly percusses over the median nerve. How would the nurse document this finding?

Positive Tinel sign

Duchenne muscular dystrophy usually does not produce any signs or symptoms until age 2 to 3. What muscles are usually first to be affected in Duchenne muscular dystrophy?

Postural muscles of the hip and shoulder

Which client is exhibiting headache symptoms that indicate a need for further evaluation?

Pregnant mother with drowsiness and unrelenting headache

A client has sustained an acute spinal cord injury in a fall from a tree stand during a hunting trip. The client will require surgical intervention for the unstable spinal cord. What does the nurse recognize is the goal of early surgical intervention for this client?

Provide internal skeletal stabilization.

A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which cause can best explain this?

Psychological manifestation due to involvement of white matter of cerebral cortex

An older adult client with a history of chronic obstructive pulmonary disease (COPD) develops a fever of 38.3ºC (101ºF). What is the primary reason for the nurse to implement temperature-lowering measures?

Reduce oxygen demand

A client's primary care provider has prescribed a β-adrenergic receptor blocker. About which desired therapeutic effects should the nurse educate the client?

Reduction in heart rate and blood pressure

A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which abnormality in the client's gait?

Slow to start walking and has difficulty when asked to "stop" suddenly

Full localization, discrimination of intensity, and interpretation of somatosensory stimuli requires processing by which region of the brain?

Somatosensory cortex

Which afferent (sensory) neurons in the dorsal root ganglia innervate specialized gut-related receptors, such as taste buds and receptors of olfactory mucosa?

Special visceral afferents

Through what specific component do neurotransmitters exert their action?

Specific proteins

The health care provider is assessing a client to differentiate a herniated disk from other causes of acute back pain. The most important test for the provider to perform would be:

Straight-leg test

A nurse caring for a client with a spinal cord injury knows that control of sweat gland activity and temperature regulation is managed by the direct action of which body system?

Sympathetic nervous system

After neurotransmitters are synthesized, in which structure are they stored in the axon terminal?

Synaptic vesicles

A client with pneumonia is admitted with these vital signs: temperature 99.7ºF (37.6°F), pulse 80 beats/min, respirations 18/minute, and BP 120/80 mm Hg. Which set of vital signs does the nurse anticipate when the client begins to shiver and requests another blanket several hours later?

T 100.9ºF (38.3°C), P 90/min, R 20/min, BP 126/80 mm Hg

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?

Tachycardia

An older adult client with an upper respiratory infection for several weeks has presented with urinary retention. The client reports taking nonprescription cold medications over and above the suggested dose. Which medication most likely is contributing to this urinary retention?

The anticholinergic effects of the medication are impairing normal bladder function.

During a clinical assessment of a 68-year-old client who has suffered a head injury, a neurologist suspects that a client has a sustained damage to her vagus nerve (CN X). Which assessment finding is most likely to lead the physician to this conclusion?

The client has difficulty swallowing and has had recent constipation and hypoactive bowel sounds.

A nurse is providing care for a 44-year-old male client who is admitted with a diagnosis of fever of unknown origin (FUO). Which characteristic of the client's history is most likely to have a bearing on his current diagnosis?

The client is HIV-positive and homeless.

The nurse is performing a test to determine a client's neurologic function related to a suspected lesion in the parietal lobe. What would the nurse determine is a normal finding after assessment?

The client is able to determine correctly that the item placed in his hand is a paper clip.

A client who has been exercising for a few weeks begins to sweat as soon as he exercises. What will the nurse determine from this assessment?

The client is reacting normally.

An older adult states that he awakens at least three times each night to void. When assessing the client, what potential causative factor should the nurse prioritize?

The client takes his prescribed beta-blocker and diuretic each evening at bedtime.

The nurse asks the client to hold her left wrist in complete flexion for approximately 1 minute. The client states she feels tingling and numbness when she does this, pointing to the medial nerve. What does the nurse anticipate the client will be prepared for after this assessment?

The client will be prepared for further diagnostic tests such as an electromyogram (EMG).

A 60-year-old office worker has presented to a clinic reporting recent episodes of lower back pain. Which component of the client's assessment and history would be most indicative of a serious pathologic process?

The client's onset of pain has been gradual and the client has no prior history of back problems.

A nurse observes that a client's urine is cola colored and considers which factor as a possible reason?

The client's urine contains material from the degradation of red blood cells.

A client with a neurogenic bladder has a lesion at the level of sacral reflexes/peripheral nerves that innervate the bladder. The nurse anticipates the client will experience which type of bladder dysfunction?

flaccid bladder dysfunction

Which events would suggest that an individual's physiologic response to an obstruction has progressed beyond the compensatory stage and is now in the decompensatory stage?

The detrusor muscle contraction becomes too short to expel urine completely.

A client has been recovering from a stroke for several weeks and has been reluctant to participate in physical therapy. As a result, the client has experienced disuse atrophy. The nurse should recognize that the client is experiencing the consequences of which physiologic process?

The diameter of the client's muscle cells has decreased

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?

The disorder may present with rapid life-threatening symptoms or may present as a slow insidious process.

A client is said to be in the chill stage of the fever process when the nurse:

observes piloerection on the skin

Which message is most likely to be carried by general somatic afferent (GSA) neurons?

The sensation of cold when touching ice

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?

The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex reacts first.

The health care provider is assessing a client for carpal tunnel syndrome. The health care provider performs light percussion over the median nerve at the wrist. This assessment is known as:

Tinel sign

An older adult client who recently started taking furosemide tells the nurse about now experiencing problems with urine incontinence. Which type of incontinence is this client likely experiencing?

Transient

The nurse is conducting a health education program on bladder cancer. What is the most common type of bladder cancer?

Transitional carcinoma

The nurse teaches a client about a new diagnosis of astrocytoma. Which statement indicates an accurate understanding?

Treatment is hard since glial cells support neurons and blood vessels in the brain.

An older adult resident of a long term care facility with a recent history of repeated urinary tract infections and restlessness is suspected of having urinary retention. Which intervention by the care team is most appropriate to confirm urine retention?

Ultrasound bladder scanning to determine the residual volume of urine after voiding.

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?

Unsteady gait and difficulty speaking and swallowing

A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on which region of the brain?

Upper and lower motor neurons

Which of these project from the motor strip in the cerebral cortex to the ventral horn and are fully contained within the CNS?

Upper motor neurons

The nurse understands that medications, although very beneficial to clients, can have harmful effects. When working with older adult clients the nurse should recognize that which outcome is a common result of potent, fast-acting diuretics?

Urge incontinence

A client is being treated with colchicine for pain in the big right toe. The client begins to complain of severe right flank pain and is diagnosed with kidney stones. Which type of kidney stone does the nurse recognize this client is most likely affected by?

Uric acid

Autonomic dysreflexia (autonomic hyperreflexia) is characterized by which of the following?

Vasospasms and hypertension

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?

Visceral pain

A teenager has been admitted with the diagnosis of Alport syndrome. The client has been passing large amounts of blood in the urine. Knowing that this disorder is inherited and associated with other abnormalities, the nurse should focus assessment on which area?

Visual disturbances and hearing loss

Ion channels in nervous system cells generate action potentials in the cells. What are the ion channels guarded by?

Voltage-dependent gates

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

When intravesical pressure exceeds maximal urethral closure pressure

Which clinical manifestations would tell a nurse that a client is having progressive decompensation related to obstruction of urinary outflow?

When tested for residual urine volume, 1400 mL of urine is obtained when client is catheterized.

A cytotechnologist is performing genetic testing on a series of tissues. One tissue comes back with the WT1 mutation, and it's mapped to chromosome 11. What disease will the client most likely develop?

Wilms tumor

Which process is most likely to occur as a result of a spinal reflex?

Withdrawal of a hand from a hot stove element

Which type of reflex is stimulated by a nociceptive stimulus?

Withdrawal reflex

The nurse is caring for client who has been living with Parkinson disease for the past 10 years and is being treated with levodopa-carbidopa. The client often leaves the unit with family for extended periods. What should the nurse prioritize when teaching the client?

Your medication needs to be taken at equal intervals to reduce symptom fluctuation.

A child has been brought to an urgent care clinic. The parents state that the child is "not making water." When taking a history, the nurse learns the child had a sore throat about 1 week ago but seems to have gotten over it. "We [parents] only had to give antibiotics for 3 days for the throat to be better." The nurse should suspect the child has developed:

acute postinfectious glomerulonephritis

A nurse is caring for a client with diabetic glomerulosclerosis. The presence of which substance in the urine would be used in diagnosing this condition?

albumin

College students were given various amounts of alcohol within a specified time frame and then asked to drive an obstacle course. The rationale for poor performance in driving as the amount of alcohol intake increased includes, "The blood-brain barrier:

allows alcohol, a very lipid-soluble molecule, to rapidly enter the brain."

A client has been recently diagnosed with Alzheimer disease and has been prescribed a cholinesterase inhibitor. This drug will slow the progression of the client's symptoms by:

decreasing ACh breakdown.

A surgical client is at greatest risk for hypothermia during a surgical procedure related to:

impaired thermoregulatory mechanisms brought on by anesthesia.

As you are walking in the park, a huge black Labrador [dog] runs up to you and places his paws on your shoulders. Immediately your heart starts racing, you feel palpations, anxiety, and your hands become a little shaky. The nurse knows that this response is primarily caused by:

increased levels of glucocorticoids by the adrenal glands that result in an increase in epinephrine level.

The nurse is evaluating the urinalysis results of a client presenting with polyuria and lower abdominal pain due to a suspected urinary tract infection (UTI). Which finding should the nurse report as evidence of a UTI?

increased nitrites

The most common cause of C. botulinum in infants is:

ingestion of honey products containing C. botulinum spores.

A client has sought care because of recent malaise and fever. Upon assessment, the client states that for the past week there has been a cycle of high fever in the evening but normal temperature in the mornings. Which fever pattern will the nurse document?

intermittent fever

The nurse is aware that the primary function of the sympathetic nervous system is:

maintenance of vital functions and responding when there is a critical threat to the integrity of the individual.

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

mechanical stimuli

The health care provider is performing the withdrawal reflex test on a client. Which response would be expected?

moving away from the stimulus

A client has been brought to the emergency department following an overdose of insulin that resulted in unconsciousness. When explaining the rationale for this to the family, the nurse will emphasize that neurons:

must rely on glucose from the blood to meet their energy needs.

Death caused by muscular dystrophy in early adulthood is usually due to:

respiratory and cardiac muscle involvement.

A 45-year-old diabetic male is experiencing erectile dysfunction. If his erectile dysfunction is caused by the nervous system, then the nurse can educate the client that the venous blood supply to the penis is controlled by:

sacral parasympathetic fibers.

A client reports frequent severe migraines upon waking with frequent nausea and vomiting. Which treatment will the health care provider offer the client as most appropriate?

sumatriptan intranasal spray