Pathophysiology pre-test
Which of the following statements from a group of young adults demonstrates the need for further teaching related to HIV and prevention of the spread? Select one: a. "Having oral sex is one way I can prevent passing on HIV to my partner." b. "My HIV medications do not prevent me from passing the virus on to my partners." c. "Good perineal care following sex will not have an effect on the transmission of HIV." d. "A woman can still get pregnant if she is HIV positive."
a. "Having oral sex is one way I can prevent passing on HIV to my partner." Sexual contact is the most frequent mode of HIV transmission. There is a risk of transmitting HIV when semen or vaginal fluids come in contact with a part of the body that lets them enter the bloodstream. This can include the vaginal mucosa, anal mucosa, and wounds or sores on the skin. Condoms are highly effective in preventing the transmission of HIV. Unprotected sex between men is still the main mode of transmission. During the window period, a person's HIV antibody test result will be negative, but he or she can still transmit the virus.
Which of the following clients is most likely to experience impaired wound healing? Select one: a. A client with a diagnosis of type 1 diabetes and a history of poor blood sugar control b. A child whose severe cleft lip and palate have required a series of surgeries over several months c. A client with persistent hypertension who takes a β-adrenergic blocker and a potassium-wasting diuretic daily d. A client who takes nebulized bronchodilators several times daily to treat chronic obstructive pulmonary disease
a. A client with a diagnosis of type 1 diabetes and a history of poor blood sugar control Diabetes mellitus is a significant barrier to wound healing. Serial surgeries, chronic obstructive pulmonary disease (COPD), hypertension, and related medications are not directly linked to impaired wound healing.
Which of the following individuals likely faces the greatest risk for the development of chronic kidney disease? Select one: a. A client with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet b. A client who experienced a hemorrhagic stroke and now has sensory and motor deficits c. A first-time mother who recently lost 1.5 L of blood during a postpartum hemorrhage d. A client whose diagnosis of thyroid cancer necessitated a thyroidectomy
a. A client with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet (Chronic kidney disease (CKD) is a pathophysiologic process that results in the loss of nephrons and a decline in renal function that has persisted for more than 3 months. CKD can result from diabetes, hypertension, glomerulonephritis, lupus (SLE), and polycystic kidney disease. The prevalence and incidence of CKD continue to grow, reflecting the growing elderly population and the increasing number of people with diabetes and hypertension. Hemorrhage may result in acute renal failure, but it is not associated with chronic kidney disease. Stroke and loss of the thyroid gland are not noted to underlie cases of chronic kidney disease.)
When educating the parents of a cyanotic infant diagnosed with of tetralogy of Fallot, the nurse will include which of the following statements related to the physiological abnormalities? The infant has: Select all that apply. Select one or more: a. A small, narrow pulmonary outflow channel c. A large, thick, right ventricular wall d. A hole in the ventricular septal e. The pulmonary artery arises from the left ventricle
a. A small, narrow pulmonary outflow channel c. A large, thick, right ventricular wall d. A hole in the ventricular septal Tetralogy of Fallot consists of four associated defects: a ventricular septal defect; dextroposition of the aorta; obstruction or narrowing of the pulmonary outflow channel; and hypertrophy of the right ventricle. Narrowing, or coarctation, of the aorta is not associated with tetralogy of Fallot. Rising of pulmonary arteries from the left ventricle instead of the right is a sign of transposition of the great vessels.
Which of the following lab results confirm the client has developed an acute-phase inflammatory response? Select all that apply. Select one or more: a. C-reactive protein (CRP) 10.0 mg/L (high). b. Leukocytes (WBC) 18.7 cells/μL (high) c. Red blood cell count (RBC) 3.11 cells/μL (low). d. Erythrocyte sedimentation rate (ESR) 175 mm/h (high) e. Fibrinogen level 1.5 g/L (normal).
a. C-reactive protein (CRP) 10.0 mg/L (high). b. Leukocytes (WBC) 18.7 cells/μL (high) d. Erythrocyte sedimentation rate (ESR) 175 mm/h (high). During the acute-phase response, the liver dramatically increases the synthesis of acute-phase proteins such as fibrinogen, C-reactive protein (CRP), and serum amyloid A protein (SAA) that serve several different defense functions. The synthesis of these proteins is stimulated by cytokines, especially TNF-α, IL-1 (for SAA), and IL-6 (for fibrinogen and CRP). The accelerated erythrocyte sedimentation rate (ESR) that occurs in disease conditions is characterized by the systemic inflammatory response. Leukocytosis, or the increase in white blood cells, is a frequent sign of an inflammatory response, especially those caused by bacterial infection. In acute inflammatory conditions, the white blood cell count commonly increases from a normal value of 4000 to 10,000 cells/μL.
For which of the following types of shock might intravenous antibiotic therapy be indicated? Select one: a. Distributive shock b. Cardiogenic shock c. Obstructive shock d. Hypovolemic shock
a. Distributive shock Septic shock is a subtype of distributive shock. The treatment of sepsis and septic shock focuses on control of the causative agent and support of the circulation and the failing organ systems. The administration of antibiotics that are specific for the infectious agent is essential. Swift and aggressive fluid administration is needed to compensate for third spacing, though which type of fluid is optimal remains controversial. Equally, aggressive use of vasopressor agents, such as norepinephrine or epinephrine, is needed to counteract the vasodilation caused by inflammatory mediators.
In comparison to children with acute otitis media (AOM), those with otitis media with effusion (OME) have: Select one: a. Excess middle ear fluid b. Earache and fever c. Sensorineural hearing loss d. Systemic infection
a. Excess middle ear fluid Otitis media with effusion (OME) is a condition in which the tympanic membrane is intact and there is an accumulation of fluid in the middle ear without fever or other signs or symptoms of infection. Acute otitis media (AOM) is characterized by otalgia (earache), fever, temporary conductive hearing loss, and excess middle ear fluid in combination with signs and symptoms of an acute or systemic infection.
A public health nurse has cited a reduction in cancer risk among the many benefits of maintaining a healthy body mass index. Which of the following facts underlies the relationship between obesity and cancer? Select one: a. Obesity can cause inflammation and hormonal changes that are associated with cancer b. Adipose tissue is more susceptible to malignancy than other types of connective tissue. c. Increased numbers of body cells increase the statistical chances of neoplastic cell changes. d. Increased cardiac workload and tissue hypoxia can interfere with normal cell differentiation.
a. Obesity can cause inflammation and hormonal changes that are associated with cancer. Obesity has a complex interplay with the development of cancer that is thought to result from the influence of hormonal changes and inflammation. It is not thought to be due to the increased number of cells in the body or to any particular susceptibility of adipose tissue. Increased cardiac workload and hypoxia are not known to cause neoplastic changes.
A client with a history of emphysema from long-term cigarette smoking has loss of many alveoli. When comparing the type I alveolar cell physiologic function with the primary role of type II alveoli, the nurse would be aware that the type II alveoli are responsible for: Select one: a. Production of surfactant b. Production of macrophages c. Facilitation of bronchial circulation d. Gas exchange
a. Production of surfactant Although macrophages are present in all alveoli, only type II alveoli produce surfactant. They do not participate directly in gas exchange or facilitate bronchial circulation.
The pathogenic capacity of the tubercle bacillus is related to: Select one: a. The initiation of a cell-mediated immune response b. Its inherent destructive capabilities c. Formation of a Ghon focus lesion d. Rapid viral replication in host cells
a. The initiation of a cell-mediated immune response The pathogenesis of tuberculosis, in previously unexposed immunocompetent people, is a cell-mediated immune response that confers resistance to the organism and development of hypersensitivity to the tubercular antigens. Pathologic manifestations of tuberculosis, such as caseating granuloma and cavitation, are the result of the hypersensitivity reaction rather than its inherent destructive capabilities. In persons with intact cell-mediated immunity, the cell-mediated immune response results in the development of a granulomatous lesion, called a Ghon focus, that contains the tubercle bacilli, modified macrophages, and other immune cells.
A 48-year-old male client, who normally enjoys good health, has been admitted to the hospital for the treatment of polycythemia vera. The nurse who is providing care for the client should prioritize assessments aimed at the early identification of which of the following health problems? Select one: a. Thromboembolism b. Hyperventilation c. Vasculitis d. Orthostatic hypotension
a. Thromboembolism The increased blood viscosity that accompanies primary polycythemia creates a significant risk of thromboembolism. Hypertension, not hypotension, is also a common sign. Vasculitis and hyperventilation are unlikely to result directly from polycythemia vera.
Which one of the following skin disorders seen in elderly persons is considered a premalignant lesion? Select one: a. Cherry angiomas b. Actinic keratosis c. Solar lentigines d. Telangiectases
b. Actinic keratosis Actinic keratoses are the most common premalignant skin lesions that develop on sun-exposed areas. Solar lentigines are tan to brown, benign spots on sun-exposed areas. They are commonly referred to as liver spots. Senile angiomas (cherry angiomas) are smooth, cherry-red or purple, dome-shaped papules, usually found on the trunk. Telangiectases are single dilated blood vessels, capillaries, or terminal arteries that appear on areas exposed to sun or harsh weather, such as the cheeks and the nose.
Major histocompatibility complex (MHC) molecules, with human leukocyte antigens (HLAs), are markers on all nucleated cells and have an important role in: Select one: a. Cell membrane transport b. Avoiding transplant rejections c. Identifying blood types d. Suppressing viral replication
b. Avoiding transplant rejections MHC and HLA markers are unique for each individual, except possibly for identical twins. Tissue and organ transplantation success is dependent on how closely matched the MHC molecules and HLAs are on the donor and recipient. MHC molecules and HLAs are not involved in transport or viral replication. Red blood cells do not have a nucleus and thus do not have HLA or MHC molecules on the surface.
A 59-year-old woman with a recent diagnosis of breast cancer has begun a course of hormone therapy. What is the goal of this pharmacologic treatment? Select one: a. Increasing serum hormone levels to promote tumor cell lysis b. Blocking effects of estrogen on the growth of malignant cells c. Blocking the entry of malignant cells into the axillary lymph nodes d. Blocking the effects of progesterone on tumor growth
b. Blocking effects of estrogen on the growth of malignant cells Hormone therapy is used to block the effects of estrogen on the growth of breast cancer cells. Among the most common drugs used for hormone therapy is tamoxifen, a nonsteroidal antiestrogen that binds to estrogen receptors and blocks the effects of estrogens on the growth of malignant cells in the breast. Such drugs do not directly block axillary node involvement or induce tumor cell lysis.
Hypoparathyroidism causes hypocalcemia by: Select one: a. Increasing phosphate excretion b. Blocking release of calcium from bone c. Blocking action of intestinal vitamin D d. Increasing serum magnesium
b. Blocking release of calcium from bone The most common causes of hypocalcemia are abnormal losses of calcium by the kidney, impaired ability to mobilize calcium from bone due to hypoparathyroidism, and increased protein binding or chelation such that greater proportions of calcium are in the nonionized form. Magnesium deficiency inhibits PTH release and impairs PTH action on bone resorption. Phosphate and calcium are inversely related, and PTH does not control phosphate excretion. PTH does not exert control of vitamin D action in the intestine, but elevated vitamin D levels can suppress PTH release.
Which of the following signs and symptoms most clearly suggests the need for endoscopy to rule out esophageal cancer? Select one: a. Recurrent episodes of gastritis that do not respond to changes in diet b. Dysphagia in an individual with no history of neurologic disease c. Heartburn after an individual consumes high-fat meals d. A new onset of gastroesophageal reflux in a previously healthy individual
b. Dysphagia in an individual with no history of neurologic disease Dysphagia is by far the most frequent complaint of persons with esophageal cancer. It is apparent first with ingestion of bulky food, later with soft food, and finally with liquids. Heartburn, reflux, and gastritis are not health problems that are closely associated with the development of esophageal cancer.
Which of the following pathophysiologic phenomena may result in a diagnosis of Cushing disease? Select one: a. Autoimmune destruction of the adrenal cortex b. Excess ACTH production by a pituitary tumor c. Malfunction of the HPA system d. Hypopituitarism
b. Excess ACTH production by a pituitary tumor Three important forms of Cushing syndrome result from excess glucocorticoid production by the body. One is a pituitary form, which results from excessive production of ACTH by a tumor of the pituitary gland. Hypopituitarism and destruction of the adrenal cortex are associated with Addison disease. Disruption of the HPA system is not implicated in the etiology of Cushing disease.
A genetic test result returns noting that the specimen (client) has inclusion bodies in the sample. The health care provider can associate this result with the development of which pathologic disease process? Select all that apply. Select one or more: a. Myasthenia gravis b. Parkinson disease c. Alzheimer disease d. Multiple myeloma
b. Parkinson disease c. Alzheimer disease Disruption of chaperoning mechanisms causes intracellular molecules to become denatured and insoluble. These denatured proteins tend to stick to one another, precipitate, and form inclusion bodies. The development of inclusion bodies is a common pathologic process in Parkinson, Alzheimer, and Huntington diseases.
As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to: Select one: a. Expiratory airway collapse b. Pulmonary hypertension c. Breakdown of elastin d. Left-sided heart failure
b. Pulmonary hypertension Hypoxemia causes reflex vasoconstriction of the pulmonary vessels and further impairment of gas exchange in the lung. Hypoxemia also stimulates red blood cell production, causing polycythemia. As a result, persons with chronic obstructive bronchitis may develop pulmonary hypertension and right-sided heart failure. With breakdown and loss of lung elasticity and hyperinflation of the lungs with emphysema, the airways often collapse during expiration.
Which of the following characteristics differentiates a migraine with aura from a migraine without aura? Select one: a. Lack of response to nonpharmacologic treatments b. Visual symptoms that precede the headache c. A decrease in mood and affect prior to the headache d. Gastrointestinal involvement in the hours leading up to the headache
b. Visual symptoms that precede the headache An aura is visual (flickering lights, spots, or loss of vision), sensory (feeling of pins and needles, or numbness), and/or speech disturbance that precedes a migraine. Nonpharmacologic treatments may be used with varying success in both types of migraine, and nausea and vomiting may precede or accompany each. Changes in mood and affect are not central to an aura.
Which of the following clients presenting to the emergency department would most likely be diagnosed with a pathologic stress fracture? Select one: a. A competitive volleyball player diving to retrieve a volley and landing on his hip b. A weight lifter who bench-presses 200 kg lost balance and fell to the side, landing on his hip c. A postmenopausal female who was diagnosed with breast cancer with metastasis to bone d. A teenager who fell of a ladder and hit the concrete driveway, landing on his hip
c. A postmenopausal female who was diagnosed with breast cancer with metastasis to bone A pathologic stress fracture occurs in bones that already are weakened by disease or tumors. Fractures of this type may occur spontaneously with little or no stress. The underlying disease state can be local, as with infections, cysts, or tumors, or it can be generalized, as in osteoporosis, Paget disease, or disseminated tumors. A fatigue fracture results from repeated excessive wear on a bone. The most common fractures are those resulting from sudden direct impact, such as from a fall or blow, or indirect, such as a massive muscle contraction injury.
A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the client's increased blood pressure? Select one: a. Coarctation of the client's aorta b. Increased sympathetic stimulation by the autonomic nervous system (ANS) c. Activation of the renin-angiotensin-aldosterone mechanism d. Increased levels of adrenocortical hormones
c. Activation of the renin-angiotensin-aldosterone mechanism Renovascular hypertension refers to hypertension caused by reduced renal blood flow and activation of the renin-angiotensin-aldosterone mechanism. It is the most common cause of secondary hypertension, accounting for 1% to 2% of all cases of hypertension. The reduced renal blood flow that occurs with renovascular disease causes the affected kidney to release excessive amounts of renin, increasing circulating levels of angiotensin II. Angiotensin II, in turn, acts as a vasoconstrictor to increase peripheral vascular resistance and as a stimulus for increased aldosterone levels and sodium retention by the kidney. One or both of the kidneys may be affected. A renal etiology is not associated with secondary hypertension due to hormonal factors, sympathetic stimulation, or coarctation of the aorta.
A client presents to a STI clinic. Her primary complaint is related to purulent exudate and bleeding after intercourse. The health care worker will primarily focus on the diagnosis of which STI? Select one: a. Human papillomavirus infection b. Chlamydial infection c. Gonorrhea d. Genital herpes simplex virus infection
c. Gonorrhea The gonococcus is a pyogenic (i.e., pus-forming), gram-negative diplococcus that evokes inflammatory reactions characterized by purulent exudates. Internal human papillomavirus (HPV) condylomata acuminata warts are cauliflower-shaped lesions that affect the mucous membranes of the vagina, urethra, anus, or mouth. The initial symptoms of primary genital herpes (herpes simplex virus, HSV) infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles.
Some viruses have the ability to transform host cells into cancer cells. For which of the following viruses should the client be assessed regularly for the potential development of cancer? Select all that apply. Select one or more: a. Varicella b. Hepatitis A c. Human papillomavirus d. Hepatitis B
c. Human papillomavirus d. Hepatitis B Certain viruses have the ability to transform normal host cells into malignant cells during the replication cycle. This group of viruses is referred to as oncogenic and includes certain retroviruses and DNA viruses, such as the Epstein-Barr virus, hepatitis B virus, and human papillomavirus.
A 70-year-old male client has been admitted to a hospital for the treatment of a recent hemorrhagic stroke that has left him with numerous motor and sensory deficits. These deficits are most likely the result of which of the following mechanisms of cell injury? Select one: a. Free radical injury b. Impaired calcium homeostasis c. Hypoxia and ATP depletion d. Interference with DNA synthesis
c. Hypoxia and ATP depletion Stroke is characterized by impaired cerebral circulation and consequent death of neurons from cellular hypoxia. Free radical injury, abnormal DNA synthesis, and impaired calcium homeostasis are not direct consequences of lack of blood flow to body cells.
The region of the brain involved in emotional experience and control of emotional behavior is the: Select one: a. Cerebral hemisphere b. Occipital lobe c. Limbic system d. Parietal lobe
c. Limbic system The limbic region of the brain is involved in emotional experience and in the control of emotion-related behavior. Stimulation of specific areas in this system can lead to feelings of dread, high anxiety, or exquisite pleasure. It also can result in violent behaviors, including attack, defense, or explosive and emotional speech. The occipital lobe plays an important role in the meaningfulness of visual experience, including experiences of color, motion, depth perception, pattern, form, and location in space. The parietal lobe is necessary for perceiving the meaningfulness of integrated sensory information from various sensory systems, especially the perception of "where" the stimulus is in space and in relation to body parts. Axons of the olfactory nerve, or cranial nerve I, terminate in the most primitive portion of the cerebrum—the olfactory bulb, where initial processing of olfactory information occurs.
Magnetic resonance imaging of a client's knee has revealed the presence of bursitis. The nurse should anticipate performing which intervention for bursitis? Select one: a. Administering an antihistamine like Benadryl to minimize inflammation b. Obtaining a surgical permit to repair the bursae c. Placing an ice pack on the knee to decrease swelling d. Applying Buck's traction with 10-pound weights
c. Placing an ice pack on the knee to decrease swelling (Bursae contain synovial fluid, and they exist to prevent friction on a tendon. They are necessary in areas where pressure is exerted because of close approximation of joint structures. Bursae may become injured or inflamed, causing discomfort, swelling, and limitation in movement of the involved area. Buck's traction, Benadryl, and surgery are not the standard treatment for bursitis.)
A 41-year-old woman has made the recent decision to start a family and is eager to undergo testing to mitigate the possibility of having a child with Down syndrome. Which of the following tests is most likely to provide the data the woman seeks? Select one: a. Ultrasonography b. Genetic testing of the woman c. Prenatal blood tests d. Genetic testing of the woman and the father
c. Prenatal blood tests Down syndrome is a result of chromosomal abnormality and is not a single-gene disorder. As a result, genetic testing of the mother and/or father is not relevant. Ultrasonography does not have predicative value for Down syndrome, but blood tests such as α-fetoprotein, human chorionic gonadotropin (HCG), unconjugated estriol, inhibin A, and pregnancy-associated plasma protein A have helped ascertain the risks.
Which of the following factors is likely to result in decreased renal blood flow? Select one: a. Release of nitric oxide b. Action of prostaglandins c. Sympathetic nervous system stimulation d. Action of dopamine
c. Sympathetic nervous system stimulation Sympathetic nervous system (SNS) stimulation results in decreased renal blood flow by vasoconstriction. Dopamine, nitric oxide, and prostaglandins are all vasodilators.
Which body tissue exhibits the highest rate of turnover and renewal? Select one: a. The nervous tissue that constitutes the central nervous system b. The skeletal muscle that facilitates movement c. The squamous epithelial cells of the skin d. The connective tissue supporting blood vessels
c. The squamous epithelial cells of the skin Cells making up the epithelial tissues generally exhibit a high rate of turnover, which is related to their location and function. Renewal of connective and muscle tissue takes place at a much slower pace, whereas nervous tissue is incapable of postnatal regeneration.
A female teenager has experienced three uncomplicated urinary tract infections in the last 3 months. Knowing the anatomical location of the urethra, the nurse should educate this teenager about: Select one: a. Washing hands prior to inserting a tampon to minimize the risk of group B Streptococcus b. Wearing gloves when wiping perineum after defecation to prevent Staphylococcus aureus infection c. Wiping from front to back to prevent Escherichia coli contamination of the urethra d. Proper handwashing to decrease amount of Pseudomonas growing on the hands
c. Wiping from front to back to prevent Escherichia coli contamination of the urethra Most commonly, urinary tract infections (UTIs) are caused by Escherichia coli that enter through the urethra. Escherichia coli are abundant in fecal matter. Other uropathic pathogens include Staphylococcus saprophyticus in uncomplicated UTIs and both non-E. coli gram-negative rods (Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas) and gram-positive cocci (Staphylococcus aureus, group B Streptococcus) in complicated UTIs.
When explaining a new diagnosis of complete heart block to a client/family, the nurse should include which of the following statements? Select one: a. "This means that your atria are not contracting normally, they are quivering." b. "It's pretty common for everyone to experience this arrhythmia, especially during times of stress in their lives." c. "This type of arrhythmia requires defibrillation, which will occur in the cardiac catheter lab later today." d. "One consequence of this type of block is a very slow heart rate that limits circulation to the brain."
d. "One consequence of this type of block is a very slow heart rate that limits circulation to the brain." In complete heart block, the atria and ventricles beat independently of each other. The most serious effect of some forms of AV block is a slowing of heart rate to the extent that circulation to the brain is compromised. Atria fibrillation is where there is interruption of the normal contraction of the atria, and the atria are quivering rather than contracting. Ventricular fibrillation requires immediate defibrillation for the client to survive. Complete heart block is not common. However, PVCs do occur under times of stress.
Which of the following individuals most likely faces the highest risk of developing chronic pancreatitis? Select one: a. A woman who takes two Tylenol tablets five to six times a day b. A man who has become profoundly ill during a tropical vacation c. An obese man who has a high-fat diet and has a sedentary lifestyle d. A woman who has six to eight alcoholic beverages each evening
d. A woman who has six to eight alcoholic beverages each evening By far, the most common cause of chronic pancreatitis is long-term alcohol abuse. The other cited factors are not noted to contribute significantly to the pathogenesis of chronic hepatitis.
While breaking in a new pair of shoes, a client develops a large (1.0 cm) blister filled with clear fluid. The dermatologist diagnoses this as: Select one: a. Nodule b. Vesicle c. Wheal d. Bullae
d. Bullae Bullae are large (1.0 cm or larger in diameter) fluid-filled blisters, whereas vesicles are small (<1.0 cm in diameter). Nodules are solid marble-like lesions (>0.5 cm) that are deeper and firmer than a papule. A wheal is a somewhat irregular, relatively transient area of localized skin edema, such as a mosquito bite.
A diabetic client is controlled on Avandia (rosiglitazone), a thiazolidinedione medication that acts at the level of nuclear peroxisome proliferator-activated receptors (PPARs) to promote: Select one: a. Stimulation of the beta cells in the pancreas b. Increase in basal metabolic rate c. Weight loss by shrinking fat cells d. Glucose uptake
d. Glucose uptake The thiazolidinedione medications, which are used in the treatment of type 2 diabetes mellitus, act at the level of nuclear PPAR-γ receptors to promote glucose uptake and utilization by adipose tissue cells. These drugs do not increase release of insulin from the pancreas, increase BMR, or promote weight loss.
A high school senior sustained a concussion during a football game. Which of the following signs and symptoms would indicate the presence of postconcussion syndrome in the days and weeks following his injury? Select one: a. Unilateral weakness and decreased coordination b. Recurrent nosebleeds and hypersomnia c. Neck pain and decreased neck range of motion d. Headaches and memory lapses
d. Headaches and memory lapses (Postconcussion syndrome includes mild symptoms, such as headache, irritability, insomnia, and poor concentration and memory. Nosebleeds, hypersomnia, unilateral motor changes, and neck pain are indicative of more severe brain injury and/or soft tissue injury.)
While assessing a client who is experiencing diarrhea caused by Clostridium difficile, the nurse should anticipate hearing: Select one: a. Hypoactive bowel sounds b. Absence of bowel sounds c. Normal bowel sounds d. Hyperactive bowel sounds
d. Hyperactive bowel sounds Inflammatory changes increase motility, which would lead to hyperactive bowel sounds. In many instances, it is not certain whether changes in motility occur because of inflammation or are secondary to the effects of toxins or unabsorbed materials.
A 55-year-old male client has reported joint pain in his feet. Which of the following blood work results should prompt further testing to rule out primary gout? Select one: a. Increased polymorphonuclear leukocytes b. Increased C-reactive protein (CRP) c. Increased serum cortisol d. Increased serum uric acid
d. Increased serum uric acid Although hyperuricemia is not diagnostic of gout, it is suggestive and should prompt further assessment. Increases in CRP, polymorphonuclear leukocytes, and cortisol levels are not as closely associated with the body's response to gout.
A diabetic client was visiting the endocrinologist for annual checkup. The client's blood work reveals an increased level of which lab result that reveals early signs of diabetic nephropathy? Select one: a. Hyperlipidemia b. Hypokalemia c. Oliguria d. Microalbuminuria
d. Microalbuminuria One of the first manifestations of diabetic nephropathy is increased urinary albumin excretion (i.e., microalbuminuria). Risk factors, rather than renal manifestations, include glycosylated hemoglobin levels greater than 8.1%, genetic and familial predisposition, hypertension, poor glycemic control, smoking, and hyperlipidemia. Usually, serum potassium levels are elevated (hyperkalemia) in diabetic nephropathy. The presence of ketones in the urine is a sign of ketoacidosis and severe hyperglycemia rather than nephropathy.
Which of the following statements best conveys the endocrine function of adipose tissue? Adipose tissue: Select one: a. Antagonizes the effects of insulin on cell membranes b. Produces and secretes cholecystokinin (CCK), which stimulates the hypothalamic feeding center c. Produces ghrelin, which stimulates both appetite and eating d. Produces leptin, which mediates body weight
d. Produces leptin, which mediates body weight Adipose tissue is now recognized as an endocrine organ that produces several hormones, including leptin, an important mediator of body weight. It does not produce CCK or ghrelin, however, and adipose tissue does not directly antagonize the effects of insulin.
The client is undergoing diagnostic workup for possible Hodgkin type of lymphoma. Which of the following laboratory results would confirm the diagnosis of Hodgkin lymphoma? Select one: a. Philadelphia chromosome b. M-type protein antibodies c. Bence Jones proteins d. Reed-Sternberg cells
d. Reed-Sternberg cells Hodgkin lymphoma is diagnosed by the presence of Reed-Sternberg cells. Philadelphia chromosomes are found in chronic myelogenous leukemia cells. M-type protein antibodies are diagnostic for multiple myeloma. Bence Jones proteins are found in the urine of people with multiple myeloma.
The most recent blood work of a client with a diagnosis of acute myelogenous leukemia (AML) reveals thrombocytopenia. Where is the client most likely to experience abnormal bleeding as a result of low platelets? Select one: a. Nephrons and ureters b. Inside the brain c. Sclerae of the eyes d. Skin and mucous membranes
d. Skin and mucous membranes Common sites for spontaneous bleeding from platelet disorders are the skin and mucous membranes of the nose, mouth, gastrointestinal tract, and uterine cavity. Intracranial hemorrhage is rare, and neither the sclerae nor the kidneys are typical sites of spontaneous bleeding.
A 70-year-old client admitted to a hospital for a prostatectomy is surprised to learn that his physician has prescribed insulin on a sliding scale, despite the fact that the client successfully manages his type 2 diabetes using diet and oral antihyperglycemics when at home. Which of the following facts may underlie the physician's action? Select one: a. The stress of illness stimulates the hypothalamus to release corticotropin-releasing factor (CRF). b. Stress-induced release of vasopressin increases serum blood glucose. c. Increased levels of epinephrine and norepinephrine cause alterations in glucose metabolism. d. Stress and illness can increase glycogenolysis and insulin resistance.
d. Stress and illness can increase glycogenolysis and insulin resistance. Stress-induced hyperglycemia results from numerous factors, including enhanced release of glucose from glycogen stores, increased production of glucose from noncarbohydrate sources such as amino acids, and an accompanying state of insulin resistance that impairs glucose uptake into skeletal muscle. CRF, vasopressin, epinephrine, and norepinephrine do not have direct and pronounced effects on blood glucose levels during times of stress and illness.
During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description? Select one: a. Autoimmune disease where antibody loss of acetylcholine receptors at the neuromuscular junction causes decrease motor response b. Atherosclerotic destruction of circulation to the brain resulting in lactic acid buildup that affects nerve transmission c. Muscle necrosis with resultant increase in fat/connective tissue replacing the muscle fibers d. The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction
d. 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.
An obese, male client with a history of gout and a sedentary lifestyle has been advised by his primary care provider to avoid organ meats, certain fish, and other foods that are high in purines. The care provider is demonstrating an awareness of the client's susceptibility to which of the following types of kidney stones? Select one: a. Cystine stones b. Calcium stones c. Magnesium ammonium phosphate stones d. Uric acid stones
d. Uric acid stones Uric acid stones develop in conditions of gout and when high concentrations of uric acid in the urine. Unlike radiopaque calcium stones, uric acid stones are not visible on x-ray films. According to Table 25-2, these stones develop in clients who eat a high-purine diet like Atkins.
Men older than age 50 are at high risk for prostatic hypertrophy with complications that include: Select one: a. Scrotal edema b. Testicular cancer c. Hypospadias d. Urine retention
d. Urine retention Benign prostatic hypertrophy (BPH) is a common disorder in men over 50; because the prostate encircles the urethra, BPH exerts its effect through obstruction of urinary outflow from the bladder. Hypospadias is a congenital condition in which the termination of the urethra is on the ventral surface of the penis. Scrotal edema is often the result of testicular disease or inflammation rather than prostate enlargement. Often the first sign of testicular cancer is a slight enlargement of the testicle that may be accompanied by some degree of discomfort.
