Patho PrepU Chapter 1
The nurse is caring for a client in the burn unit who has sustained partial and full thickness burns over 16 percent of the body. What type of etiologic factor does the nurse recognize these burns are?
Physical forces Explanation: The causes of disease are known as etiologic factors. Among the recognized etiologic agents are: biologic agents (e.g., bacteria, viruses) physical forces (eg., trauma, burns, radiation) chemical agents (e.g., poisons, alcohol) one's genetic inheritance nutritional excess or defects.
The health care team is attempting to determine the cause of a client's disease. What does the nurse recognize that this will be documented as?
Etiology Explanation: The causes of disease are known as etiologic factors.
When the nurse is assisting with the diagnostic process for a client with an illness, what is a priority when compiling all of the data to have an accurate diagnosis? Select all that apply.
A careful history Detailed physical examination Diagnostic tests Rationale: The diagnostic process requires a careful history, physical examination, and diagnostic tests. The history is used to obtain a person's account of his or her symptoms and their progression, and the actors that contribute to a diagnosis. The physical examination is done to observe for signs of altered body structure or function. The diagnostic tests are ordered to validate what is thought to be the problem. They are also performed to determine other possible health problems that were not obtained from the history and physical examination, but may be present given the signs and symptoms identified.
A member of the health care team is researching the etiology and pathogenesis of a number of clients who are under her care in a hospital context. Which client situation best characterizes pathogenesis rather than etiology?
A client who has increasing serum ammonia levels due to liver cirrhosis Explanation: Pathogenesis refers to the progressive and evolutionary course of disease, such as the increasing ammonia levels that accompany liver disease. Bacteria, poisons, and traumatic injuries are examples of etiologic factors that set a disease in motion.
A client with hypertension is given an IV medication and has an anaphylactic reaction. This is considered to be:
A complication. Explanation: Complications are possible adverse extensions of a disease or outcome from treatment. An example is an anaphylactic reaction to a medication.
The nurse observes that blood pressure readings taken by a new unlicensed assistive personnel (UAP) are very different from what other nurses obtain. What does the nurse understand is occurring with these readings?
A lack of reliability in the readings of the UAP. Explanation: Reliability refers to the extent to which an observation, if repeated, gives the same result. A poorly calibrated blood pressure machine may give inconsistent measurements of blood pressure, particularly of pressures in either the high or low range. Reliability also depends on the person's skill in taking the measurements.
The nurse is performing an assessment on a client who states she fell and twisted her right ankle during a softball game. The nurse notes that the right ankle is edematous and will probably need to be x-rayed. What term does the nurse use to describe the changes that accompany this finding?
A sign Explanation: A sign is a manifestation that is noted by an observer. An elevated temperature, a swollen extremity, and changes in pupil size are objective signs that can be observed by someone other than the person with the disease.
Facility policies on wound dressing selection refer the nurse to a dressing algorithm. The nurse anticipates that the algorithm will include:
A step-by-step decision-making tree for dressing selection. Explanation: Algorithms are step-by-step methods for solving problems. An example would be a decision tree for selection of wound care dressings based on type of wound.
An infant has a difficult time passing through the birth canal and the physician uses forceps to deliver the child. In the process, the facial nerve was damaged, resulting in a facial droop. Which condition does the nurse recognize this to be?
Acquired defect Explanation: Acquired defects are those that are caused by events that occur after birth. These include injury, exposure to infectious agents, inadequate nutrition, lack of oxygen, inappropriate immune responses, and neoplasia. Congenital conditions are defects that are present at birth, although they may not be evident until later in life or may never manifest. Morphologic changes are concerned with both the gross anatomic and microscopic changes that are characteristic of a disease. Pathogenesis explains how the disease process evolves.
The community health nurse is creating a program to improve the health of a select group of clients in the community, based on Healthy People 2030 by the U.S. Department of Health and Human Services. The nurse will base the program on which determinant(s) of health? Select all that apply.
Attain lives free of preventable disease, disability, injury, and premature death. Achieve health equity and eliminate disparities. Promote healthy behaviors across the lifespan. Promote good health for all. Explanation: The U.S. Department of Health and Human Services in Healthy People 2030 describes the determinants of health as: 1) attain lives free of preventable disease, disability, injury, and premature death. 2) Achieve health equity and eliminate disparities. 3) Promote good health for all. 4) Promote healthy behaviors across the lifespan.
A client develops an infection with a resistant organism while hospitalized for surgery. After treatment, there are no obvious signs of infection, but a culture shows that the organism is present. Which term describes the client's status?
Carrier status Explanation: In carrier status, the client shows no symptoms, tests positive for the disease, and may still transmit the disease but is not infected. Chronic disease is a long-term, continuous process. In the preclinical stage of a disease, a client may show no symptoms but will progress to clinical disease. In clinical disease, the condition is overtly present.
The nurse researcher has gathered the above data. (showing stats for patients who got the flu shot and those who did not; how many got the flu, etc....) The nurse will apply this data in what type of study?
Case-control study Explanation: Case-control studies are designed to compare people known to have the outcome of interest (cases) and those known not to have the outcome of interest (controls). In the study outlined, the condition of interest is influenza and the exposure wishing to be measured is vaccination against influenza. This helps the nurse calculate the degree of protection against the condition that may have been created by the vaccine; other influencing factors would need to be controlled. In a cohort study (also called a longitudinal study), people are followed over a period of time to observe a specific health outcome that does not fit the data presented. A randomized control trial of this topic would involve not knowing who received the vaccine prior to gathering the data.
The nurse is caring for clients with chronic illnesses. Which characteristic of chronic illness will the nurse apply when developing plans of care?
Chronic illnesses may have periods of stability and acute exacerbations. Explanation: Chronic illnesses generally last longer than 6 months and often have insidious, or gradual, onset. With chronic disease, the person can have remissions, or symptom-free periods, and acute exacerbations when symptoms are more pronounced, making the course not always predictable. Chronic illnesses do not necessarily produce more systemic manifestations than local ones; this will depend on the type of illness. Although lifestyle management is often part of treatment, this is not always adequate and medications are often required.
When considering the clinical course, a disease that is characterized by remissions and exacerbations is considered to be:
Chronic. Explanation: The clinical course describes the evolution of a disease. A disease can have an acute or chronic course. Chronic disease implies a continuous, long-term process. A chronic disease can run a continuous course or can present with exacerbations (aggravation of symptoms and severity of the disease) and remissions (a period during which there is a decrease in severity and symptoms). An acute disorder is one that is relatively severe, but self-limiting. The terms preclinical and subclinical are used when discussing the severity of the disease.
A group of nurses have been tasked with developing a policy for their facility aimed at ideal care for the client with diabetes. Which resource should the group prioritize as most informative for the goal?
Clinical practice guidelines Explanation: Clinical practice guidelines will be the most informative resource for the group. These guidelines, published by organizations such as the American Diabetes Association® or Diabetes Canada®, have been developed by industry experts, converted into algorithms and directions for care based on recent systematic reviews, and then combined with clinical expertise. The current facility policy and research on local clients offers less robust information in comparison with either systematic reviews or clinical practice guidelines.
Researchers have designed a study where the health of a large group of recent newborns will be followed for several years. What type of study is this?
Cohort Explanation: When a certain group of persons are enrolled in study, they are known as a cohort. Cohort members are chosen to have specific similar characteristics. These studies are often longitudinal, following the cohort over time to observe one or more specific health outcomes. A case-control study is done on an individual, case-by-case situation. The double-blind placebo is a drug study. Repetition is a type of study carried out in a laboratory with very tight controls in place.
A client delivers a child via vaginal birth after having an uneventful prenatal course. After the infant is born, the nurse discovers an extra digit. The client states that she had the same thing when she was born. What does the nurse recognize that this defect is considered?
Congenital condition Explanation: Congenital conditions are defects that are present at birth, although they may not be evident until later in life or may never manifest. Congenital conditions may be caused by genetic influences, environmental factors, maternal drug use, irradiation, or gestational problems in utero, or a combination of genetic and environmental factors.
The Framingham cohort study examined characteristics of people who would later develop which disease?
Coronary disease Explanation: The Framingham cohort studied examined the characteristics of the people who would later develop coronary disease. The study was set up in 1950 by the U.S Public Health Service.
A client is diagnosed with Crohn disease and is informed that there is no cure; however, the client will have periods when there are no symptoms and other times when symptoms will be quite severe. What term should the nurse teach the client applies to this disease course?
Correct response: chronic Explanation: A chronic disease implies a continuous, long-term process that is generally thought of as manageable, but incurable. It can run a continuous course or can present with exacerbations (periods of more pronounced symptoms) and remissions (asymptomatic periods). An acute disorder is one that is relatively severe, but self-limiting. A subacute disease is intermediate or between acute and chronic. It is not as severe as an acute disease and not as prolonged as a chronic disease. A carrier state describes having an infectious organism present in the body that could be spread to others, but does not produce any symptoms in the carrier.
Which attribute is a benefit of health care providers using an evidence-based practice guideline?
It directs research into forming a diagnosis and treatment for a certain condition. Rationale: Evidence-based practice guidelines often use methods to combine evidence from different studies to produce a more precise estimate of the accuracy of a diagnostic method or the effects of an intervention method. Practice guidelines require continuous updates as new research is conducted and supported. Practice guidelines are developed on numerous research studies. Not all research is directed toward healing time.
For a physician to diagnose a client, which process must be followed? Select all that apply.
Getting a complete history Performing a careful physical examination Diagnostic testing Explanation: The diagnostic process requires a careful history, physical examination (PE), and diagnostic tests. The history is used to obtain a person's account of his or her symptoms and their progression and the factors that contribute to a diagnosis. The PE is done to observe signs of altered body structure or function. Diagnostic tests are ordered to validate what is thought to be the problem. Tests are also performed to determine other possible health problems that were not obtained from the history and PE but may be present, given that the signs and symptoms are identified.
Pathogenesis is the term used to describe the sequence of cellular and tissue events that occur from the time of first contact with an etiologic agent until the disease becomes evident. What is another way of defining pathogenesis?
How the disease process evolves Explanation: The pathogenesis of a disease is the mechanism by which an etiologic factor causes the disease. It encompasses the period between when the disease process first begins to the point when the disease presents itself. Etiology is what sets the disease process in motion, or what causes the disease. Risk factors are multiple factors that predispose a person to a particular disease.
In 2014, an outbreak of Ebola virus disease began in West Africa in which there was a sharp increase in the number of people being diagnosed with this disease. At the same time, a very high proportion of those who were diagnosed died from the disease. The epidemiologic characteristics of this disease include:
Increased incidence and high mortality. Explanation: Incidence is the rate of new cases of a disease and mortality is the death rate associated with it; Ebola is associated with high incidence and mortality. Morbidity consists of the functional effects of a disease and prevalence is the proportion of the population currently living with a disease.
Despite using the same screening tools as previous years, which have been confirmed as highly valid, reliable, sensitive, and specific, the public health nurse notes an increase in the number of people in the population testing positive for type 2 diabetes this year. What action should the nurse take?
Investigate the population for factors that would cause an increase in the prevalence of diabetes. Explanation: Since the validity, reliability, sensitivity, and specificity of the test has been confirmed, the reason for the increase in prevalence should be investigated. Repeating the same test on the same people would be a measure of reliability; this has already been established. Sending the people for laboratory testing would only be needed if validity was in question. Examining the commonalities of those who did not test positive is not the priority compared to investigating the commonalities of those who did test positive.
The nurse is interested in conducting an epidemiologic research study. Which research question should the nurse choose as appropriate for an epidemiologic study?
Is there a relationship between smoking rates and incidence of heart disease? Explanation: Epidemiologic studies look for patterns of people affected with a particular disorder such as age, race, or lifestyle habits. Epidemiologists are concerned with whether something happens versus how it happens or the best treatment for a particular disease. A study examining the components of cigarette smoke, or the effects of medications would both be examples of biomedical studies. Studies examining quality of life are usually qualitative in nature and may be case-controlled or cohort in design, but are not focused on patterns of disease in a population, so are not related to epidemiology.
A physician is examining a college student who is exhibiting the classic symptoms of schizophrenia. In the course of the evaluation, the physician begins developing a treatment strategy based on what he knows about the disease, available therapies, medications, and consequences of not following the treatment regimen. What aspect of the disease is the physician using?
Natural history Explanation: The natural history of a disease refers to the progression and outcome of the disease without medical intervention. Knowledge of the natural history can be used to determine disease outcome, establish services, and compare the results of treatments to the expected outcome without treatment. The causation, etiology, and morbidity are all parts that are necessary in understanding the natural history of the disease.
When attempting to reach a health diagnosis, the health care provider commonly applies four primary steps. Place the steps for reaching a diagnosis in order. Use all the options.
Obtain clinical history. Conduct a physical examination. Perform diagnostic testing. Determine the most likely cause of the client's presentation. Explanation: The client's presentation, including clinical history and any initial complaints, helps to direct the rest of the steps. For example, when a client presents reporting chest pain, this will direct the focus of the examination and diagnostic testing. This course would be different for a client presenting with hip pain. The findings of the physical examination will direct more specific diagnostic testing, though some basic investigations may be done concurrently with the examination. Finally, the health care provider would need to weigh the findings against client characteristics and determine the most likely cause of the clinical findings.
Which assessment data would a nurse identify as a complication of a disease or disorder?
Pulmonary emboli following deep vein thrombosis (DVT) Explanation: Pulmonary emboli are a dangerous complication of DVT. Sequelae are lesions or impairments that follow or are caused by a disease. Reduced range of motion following a fracture is a common, often temporary, result of the injury. Weight gain of 1 to 2 pounds per week during pregnancy is considered normal. Hyperlipidemia is a common cause of cardiovascular disease, not the result of the disease.
The nurse notes that a colleague neglects to wipe away the first drop of blood from the sample during point-of-care blood glucose testing; this in contradiction of the unit policy. What action should the nurse take first?
Remind the colleague that the purpose of discarding the first drop is to improve the reliability of the results. Explanation: Reliability of a diagnostic result depends on a combination of the tools being used and the person's skill in taking the measurements. If the colleague does not perform the steps correctly, the reliability of the results are in question. The nurse should remind the colleague as to why the step of wiping away the initial drop is important for reliability. This approach is the most direct and professional of the options provided. Reporting the colleague to the nurse in charge would only be needed if the colleague did not heed the nurse's direction. Retaking the sample without first explaining to the colleague why the nurse was taking the action would be confusing for the colleague and the client. Threatening the nurse regarding disciplinary action is not necessary in this scenario.
There are three fundamental types of prevention used in health care: primary, secondary, and tertiary. Which statement accurately describes secondary prevention?
Secondary prevention detects disease early, and most is done in clinical settings. Explanation: Secondary prevention detects disease early in its course when it is still asymptomatic and treatment measures can effect a cure or stop the disease from progressing. Most secondary prevention is undertaken in clinical settings. Tertiary prevention goes beyond treating the presenting problem. Tertiary prevention programs are located within health care systems and involve the services of a number of different types of health care professionals. Primary prevention is often accomplished outside the health care system at the community level.
Which statement is an example of a prognosis?
The client's chance of a full recovery is 50%. Explanation: A prognosis refers to the probable outcome and prospect of recovery from disease as demonstrated by "The client's chance of a full recovery is 50%." Stating the occurrence of a disease in a given population is the incidence. Statements that relate information about causes of death refer to mortality.
When the nurse questions the blood glucose level obtained via a glucometer, a serum blood level is ordered. This protocol is directed toward ensuring which measure of standardization?
Validity Explanation: Validity refers to the extent to which a measurement tool measures what it is intended to measure, and is assessed by comparing a measurement method with the best possible method of measure that is available. Thus, the validity of a fingerstick method of testing blood glucose is compared with serum testing in the laboratory. Reliability refers to the extent to which an observation, if repeated, gives the same result. Predictive value is the extent to which an observation or test result is able to predict the presence of a given disease or condition. In the field of clinical laboratory measurements, standardization is aimed at increasing the accuracy and reliability of measured values.
The nurse is performing an assessment on a newly admitted client with asthma and hears wheezes in the upper lobes of the lungs. When the nurse documents this finding, the nurse recognize this to be:
a sign. Explanation: A sign is a manifestation that is noted by the observer, in this case the nurse auscultating the breath sounds. A symptom is a subjective report by the client. A diagnosis is not formed by the nurse auscultating lung sounds, as wheezes can be a manifestation of other illnesses. A complication is a possible adverse extension of a disease or outcomes from treatment.
A nurse who has worked with ostomy clients for several years is adept at measuring and cutting the stoma wafer to the correct size for each client's stoma. This is an example of the nurse using:
clinical expertise Explanation: The term "clinical expertise" refers to proficiency and judgment that individual clinicians gain through clinical experience, such as becoming adept at measuring and cutting stoma wafers for ostomy clients.
Which action is an example of a nurse delivering care at the tertiary care level?
educating a client with diabetes about good foot care Explanation: Tertiary prevention is directed at clinical interventions that prevent further deterioration or reduce the complications of a disease once it has been diagnosed. Educating a client with diabetes about good foot care will not eliminate or prevent the disease process but will help prevent further deterioration. Screening assessments are secondary prevention, where asymptomatic conditions may be identified and treated early in the course of the disease. Immunizations and education directed toward preventing an illness or injury are examples of the primary level of care.
In 2014, an outbreak of Ebola virus disease began in West Africa in which there was a sharp increase in the number of people being diagnosed with this disease. At the same time, a very high proportion of those who were diagnosed died from the disease. The epidemiologic characteristics of this disease include:
increased incidence and high mortality. Explanation: Incidence is the rate of new cases of a disease and mortality is the death rate associated with it; Ebola is associated with high incidence and mortality. Morbidity consists of the functional effects of a disease and prevalence is the proportion of the population currently living with a disease.
A client has been diagnosed with a heart attack and has been placed on beta-blockers to reduce the workload on the heart, as well as a statin drug and a low-fat diet to lower cholesterol. Which level of prevention of disease would these therapies be classified?
tertiary Explanation: Because the client has already been diagnosed with an end-point disease, treatment of this disease with medications is tertiary prevention. Secondary prevention could have occurred had the client been tested (screened) for dyslipidemia while asymptomatic and treated to prevent the end point disease of a myocardial infarction (heart attack). Primary prevention would be the use of the lifestyle interventions of diet and exercise to prevent dyslipidemia from developing in the first place. While primary prevention is about treating risk factors to prevent cardiovascular disease, primordial prevention refers to avoiding the development of risk factors in the first place. Primordial prevention is population-based.
