NUR 239 Exam 4
While lecturing on COPD, the instructor mentions emphysema. The instructor asks the students, "If the client is a smoker, explain the physiology behind cellular changes occurring in the lung which allow destruction of the alveoli." Which students have an accurate response? Select all that apply.
"Antiprotease production and release is not adequate to neutralize the excess protease production." "There is α1-antitrypsin deficiency, so this enzyme can't protect the lung from damage."
An 80-year-old patient has been prescribed an anticholinergic agent for treatment of Parkinson-related symptoms. What patient education should be provided?
"Avoid high environmental temperatures."
A pregnant client's α-fetoprotein (AFP) returns elevated. The couple ask the health care worker to explain what this means. Which of the following is the best response?
"Elevated levels means your baby is at risk of having a neural tube defect like spina bifida (an opening in the spine)."
A patient with long-standing Parkinson's disease has been prescribed entacapone (Comtan). The patient asks the nurse to describe exactly how this medication works. Which of the following responses is most appropriate?
"Entacapone inhibits COMT so that dopamine is active for a longer time."
A patient has been diagnosed with asthma. Which of the following health education topics is most important?
"Exposure to cold temperatures can trigger asthma."
A woman who has just learned that she is pregnant for the first time has sought advice from her health care provider about the safe use of alcohol during pregnancy. What advice should the clinician provide to the woman?
"It's likely best to eliminate alcohol from your diet while you're pregnant."
A patient is discharged from the hospital with a prescription of warfarin (Coumadin). Which of the following statements indicates successful patient teaching?
"I will avoid herbal remedies."
The physician has ordered scopolamine transdermally for motion sickness. Which of the following statements by the patient indicates an understanding of the medication's administration guideline?
"I will change the patch every 3 days."
A client with a history of chronic obstructive pulmonary disease (COPD) is undergoing pulmonary function testing. Which of the following instructions should the technician provide in order to determine the client's forced vital capacity (FVC)?
"I'll ask you to breathe in as deep as you can, and then blow out as much of that air as possible."
Which of the following statements by the husband of a client with Alzheimer disease demonstrates an accurate understanding of his wife's medication regimen?
"I'm really hoping these medications will slow down her mental losses."
The nurse is teaching a woman who has Parkinson's disease about the dietary implications of her upcoming treatment with levodopa/carbidopa. What should the nurse teach this patient?
"It's important to take this medication on a full stomach so that it doesn't make you nauseous."
A 51-year-old man has been diagnosed with chronic bronchitis after a long history of recurrent coughing. Which of the man's following statements demonstrates a sound understanding of his new diagnosis?
"If I had quit smoking earlier than I did, I think I could have avoided getting bronchitis."
A patient is receiving low molecular weight heparin to prevent thromboembolic complications. The nursing student asks the nursing instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin?
"LMWH is associated with less thrombocytopenia than standard heparin."
A patient with a recent diagnosis of asthma is anxious because she experienced an asthma attack and was unable to relieve the symptoms despite taking several puffs of her prescribed salmeterol (Serevent). How should the nurse respond to the patient's concerns?
"Remember that your Serevent isn't effective when you take it at the time of an asthma attack."
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.
"Sometimes I have double vision." "I have more energy in the morning but get worse as the day goes by." "I feel like I don't have enough energy to chew my food sometimes."
A young, male child is born with severe respiratory failure. Over the course of months, the parents note his body looks swollen. They ask, "Is our baby's kidneys not working right? Why is he so swollen?" The nurse bases his or her reply on which of the following physiological principles?
"The right side of his heart (cor pulmonale) is not pumping effectively. Blood is backlogging in his body, which is why he is so swollen."
A female patient has been diagnosed with tuberculosis and begun multiple-drug therapy. The woman has asked the nurse why it is necessary for her to take several different drugs instead of one single drug. How should the nurse best respond to the patient's question?
"The use of multiple drugs prevents the development of drug-resistant TB."
A patient is being administered heparin IV and has been started on warfarin (Coumadin). The patient asks the nurse why she is taking both medications. What is the nurse's most accurate response?
"Warfarin takes 3 to 5 days to develop anticoagulant effects, and you still need heparin."
The parents of a newborn infant are relieved that their baby was born healthy, with the exception of a cleft lip that will be surgically corrected in 10 or 12 weeks. Which of the nurse's following statements to the parent's best conveys the probable cause of the infant's cleft lip?
"Your child's cleft lip likely results from the interplay between environment and genes."
The nurse is providing care for a patient who is taking isoniazid and rifampin (Rifadin) for the treatment of active tuberculosis. The patient should be taught that an improvement in symptoms will likely be noticed within
2 to 3 weeks.
Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?
Pet dander
Common manifestations of acute meningococcal meningitis, a highly contagious and lethal form of meningitis, include:
Petechiae
A patient asks the nurse what dose of acetylsalicylic acid (Aspirin) is needed each day for antiplatelet effects to prevent heart attacks. What dose is most appropriate to reduce platelet aggregation?
30 mg
Completion of a client's pulmonary function study has yielded the following data: tidal volume, 500 mL; inspiratory reserve, 3100 mL; expiratory reserve, 1200 mL; residual volume, 1200 mL; functional residual capacity, 2400 mL. What is this client's inspiratory capacity?
3600 mL.
A client who is in a room at 1 atmosphere (760 mm Hg) is receiving supplemental oxygen therapy that is being delivered at a concentration of 50%. What is the consequent PO2?
380 mm Hg.
Prenatal genetic testing that counts the number of Barr bodies in a chromosome is able to determine:
The genetic sex of a child
Which of the following processes is most likely to occur as a result of a spinal reflex?
Withdrawal of a hand from a hot stove element
Following a head injury on the football field, the medical team is assessing the player for injury. One of the earliest signs of decreased level of consciousness to assess for would be:
Inattention
Which of the following pathophysiologic processes occurs in cases of bacterial meningitis?
Inflammation allows pathogens to cross into the cerebrospinal fluid.
Which of the following individuals is experiencing an immunologic lung disorder affecting ventilation that has caused the formation of a granuloma on chest x-ray?
A 30-year-old African American man who has been diagnosed with sarcoidosis
Which of the following individuals has the highest chance of having a medulloblastoma?
A 4-year-old child who has become uncoordinated in recent months
Neurotrophic factors contribute to the maintenance of homeostasis by promoting the growth and survival of neurons. Which of the following clients may be experiencing an alteration in neurotrophin levels? Select all that apply.
A 55-year-old who is exhibiting clinical manifestations of early-onset Alzheimer disease A 44-year-old with a family history of Huntington disease who is exhibiting jerky, uncontrollable movements
An older mother (age 41) is worried about having a baby with birth defects. She wants to get tested so she can be prepared for the outcome. Which of the following tests should the clinic nurse prepare the client for? Select all that apply.
A blood test (circulating cell-free DNA) will tell if the baby is mentally retarded. Withdrawing a sample of amniotic fluid will reveal any chromosomal defects.
Which of the following clients are likely experiencing a shift to the right in the dissociation curve? Select all that apply.
A client with respiratory influenza with a temperature of 102.6°F A COPD client with pneumonia with blood gas pH level of 7.31 A renal failure client with admitting hemoglobin level of 8.0 mg/dL
A client who experienced a traumatic head injury from a severe blow to the back of his head now lives with numerous function deficits, including an inability to maintain steady posture while he is in a standing position, although he is steadier when walking. Which of the following disorders most likely resulted from his injury?
A vestibulocerebellar disorder
Which of the following clients is at risk for developing acute respiratory failure?
A middle-aged male diagnosed with amyotrophic lateral sclerosis (ALS) who has pneumonia with low O2 saturation
Which of the following clients is at risk for developing a preventable disorder related to prolonged immobility?
A postsurgical client who is refusing to get out of bed and walk and will not wear those "uncomfortable elastic stocking"
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.
Aneuploidy of the X chromosome can result in a monosomy or polysomy disorder. The clinical manifestations of a female with monosomy X include: Select all that apply.
A short-stature female individual Difficulty with fine motor skills Nonpitting lymphedema of the feet
Which of the following clients are more than likely experiencing impairment of the mucociliary blank with cilia dysfunction? Select all that apply.
A smoker who smokes 2 packs of cigarettes/day and currently hospitalized with pneumonia A mountain skier who spends all day outside teaching ski lessons A nursing home client diagnosed with H1N1 influenza with fever of 102°F
A patient receiving isoniazid (INH) and rifampin (Rifadin) has a decreased urinary output and decreased sensation in his great toes. Which laboratory values should be assessed?
ALT and AST
In contrast to the sympathetic nervous system, the functions of the parasympathetic nervous system include:
Anabolism
A client's emergency magnetic resonance imaging (MRI) has been examined by the physician and tissue plasminogen activator (tPA) has been administered to the client. What was this client's most likely diagnosis?
Ischemic stroke
A patient being treated for tuberculosis is determined to be drug resistant. Which of the following medications will the patient be resistant to in the treatment of the tuberculosis?
Isoniazid (INH) and rifampin
A patient is administered isoniazid (INH) for tuberculosis. Which of the following adverse effects will result in discontinuation of the medication?
Jaundice
A patient seen in the clinic has symptoms of persistent cough, fever, and night sweats. He recently entered the United States from the Philippines. Which of the following is the most plausible explanation for the patient's condition?
Active tuberculosis
A child is prescribed an inhaled corticosteroid agent to decrease respiratory inflammation. The child's parent administers high doses of the drug after 2 days of administration. What is the patient at risk for?
Adrenal insufficiency
A patient with a long-standing history of asthma has failed to achieve adequate symptom control with first-line drugs. As a result, her care provider has prescribed theophylline. The nurse is aware of the narrow therapeutic range of this drug and has taught the patient to recognize the signs and symptoms of toxicity. These include which of the following?
Agitation and dysrhythmias
Respiratory movement of air that does not participate in alveolar gas exchange is known as alveolar dead space. Dead space increases when alveolar/alveoli:
Air supply exceeds blood flow.
The gene responsible for a particular congenital cardiac anomaly is said to have complete penetrance. What are the clinical implications of this fact?
All the individuals who possess the gene will exhibit the anomaly.
College students were given various amounts of alcohol within a specified timeframe 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 79-year-old woman has been brought to the emergency department by ambulance with signs and symptoms of ischemic stroke. The care team would consider the STAT administration of what drug?
Alteplase (Activase)
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.
Alzheimer disease Parkinson disease
A 55-year-old man has been diagnosed with coronary artery disease and begun antiplatelet therapy. The man has asked the nurse why he is not taking a "blood thinner like warfarin." What is the most likely rationale for the clinician's use of an antiplatelet agent rather than an anticoagulant?
Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis.
A car accident client is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a "sucking" chest wound. After calling a "code blue," the next priority intervention would be to:
Apply a Vaseline gauze (airtight) dressing over the insertion site
A patient has been administered heparin to prevent thromboembolism development status postmyocardial infarction. The patient develops heparin-induced thrombocytopenia. Which of the following medications will be administered?
Argatroban (Acova)
A client with a spinal cord injury at T8 would likely retain normal motor and somatosensory function of her:
Arms
Following a stroke, injury to nerve cells within the central nervous system needs to be repaired. The health care provider knows that which of the following processes explains how this occurs?
Astrocytes fill up the space to form a glial scar, repairing the area and replacing the CNS cells that cannot regenerate.
A family brings their elderly mom to the emergency department. The client had a short period of time where she was confused, had slurred speech and appeared to have a weak arm. Now she is back to her normal self. Suspecting a transient ischemic attacks (TIAs), the health care provider will order diagnostic testing looking for:
Atherosclerotic lesions in cerebral vessels
A toddler seems to have a little "cold" and runny nose. At bedtime, he appears to be OK. A few hours later, parents awaken hearing a "tight" coughing sound. They recognize the child is not breathing well, so they rush to the emergency department. On arrival, the nurses suspect bronchial asthma based on which of the following assessment data? Select all that apply.
Audible wheezing Respiratory rate—44 with prolonged exhalation Sitting upright, leaning forward, and using accessory muscles to breathe
Albuterol (Proventil) is administered to a patient to promote bronchodilation. Administration of this beta2-adrenergic agonist results in increased production of
cyclic AMP.
A teenager has been in a car accident and experienced acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication?
Brain contusions and hematomas
Which area of the brain is responsible for respiration?
Brain stem
A patient is experiencing an acute asthma attack. What is the most common first-line therapy for relief of an acute asthma attack?
Beta2-adrenergic agonist
Soon after delivery, the mother grabs the nurses arm and states, "Something's wrong...I can't get my breath." Which of the following assessments lead the nurse to suspect the client has had an amniotic emboli travel to the lungs? Select all that apply.
BP 90/65; pulse 130, irregular; respiratory rate 35, shallow. Productive cough with blood-streaked sputum.
A patient is taking warfarin (Coumadin) after open heart surgery. The patient tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the complaint of pain, what does the nurse suspect is the cause of the pain?
Bleeding
A newly pregnant female is worried about her baby. She recently returned from a mission trip to Africa. She was told there was a rubella outbreak in the next village. She has been given a TORCH screening test. If she has exposed her fetus to rubella, the nurse would expect the infant to display which of the following possible birth defects?
Blindness
A child with cystic fibrosis (CF) asks the nurse why he has this disease, but his parents are perfectly healthy. The nurse explains:
Both parents are carriers and have a recessive genotype with alleles for CF.
A patient who is recovering in hospital from a bilateral mastectomy has developed minor bleeding at one of her incision sites. During the process of clot formation, plasminogen will become part of a clot by which of the following means?
By binding with fibrin
An elderly male client has been brought to the emergency department after experiencing stroke-like symptoms a few hours ago, and has been subsequently diagnosed with an ischemic stroke. The care team is eager to restore cerebral perfusion despite the likely death of the brain cells directly affected by the stroke. What is the rationale for the care team's emphasis on restoring circulation?
Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored.
The nurse is caring for a spinal cord injury client. Assessment reveals shallow breath sounds with a very weak cough effort. The nurse correlates this with which level of injury on the spinal column?
C5
Diffusion of gases in the lung is decreased, as in pulmonary edema or pneumonia, by causing an increase in alveolar:
Capillary membrane thickness
While discussing carbon dioxide transport within the body, the instructor asks, "What enzyme helps carbon dioxide with water to form bicarbonate?" Which student response is correct?
Carbonic anhydrase
Which of the following statements about multifactorial inheritance disorders are accurate to share with a family of a child born with a cleft lip and palate? Multifactorial inheritance disorders: Select all that apply.
Carry the same risk for recurrence with future pregnancies Have an increased risk among first-degree relatives of the affected person
When trying to explain the difference between vasogenic versus cytotoxic cerebral edema, the physiology instructor mentions that cytotoxic edema displays which of the following functions in the brain? Select all that apply.
Causes ischemia to build up lactic acid due to anaerobic metabolism Allows cells to increase volume to the point of rupture, damaging neighboring cells
An elderly client has been brought to his primary care provider by his wife, who is concerned about his recent decrease in coordination. Upon assessment, his primary care provider notes that the client's gait is wide-based, unsteady, and lacking in fluidity, although his muscle tone appears normal. This client requires further assessment for which of the following health problems?
Cerebellar disorders
The intracranial volume that is most capable of compensating for increasing intracranial pressure is the:
Cerebrospinal fluid
Drugs like diazepam (Valium), a benzodiazepine, exert their action on ion channels. These drugs do not open the GABA-operated ion channel, but they:
Change the effect that GABA has when it binds to the channel at the same time as the drug
A client with a diagnosis of epilepsy has required surgical removal of part of her prefrontal cortex. Which of the following effects should her family and care team anticipate?
Changes in behavior and judgment
A client has suffered a stroke that has affected his speech. The physician has identified the client as having expressive aphasia. Later in the day, the family asks the nurse to explain what this means. The most accurate response would be aphasia that is:
Characterized by an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing
A patient with Parkinson's disease is being treated with rasagiline (Azilect). This medication inhibits the metabolism of dopamine by monoamine oxidase. Which of the following foods should the patient be instructed to avoid?
Cheddar cheese and Polish sausage
A patient with HIV has been infected with Mycobacterium avium complex from an indoor pool. Which of the following medications is the recommended treatment for MAC?
Clarithromycin
A 40-year-old man has been living with HIV for several years but experienced a significant decrease in his CD4+ levels a few months ago. The patient has just been diagnosed with Mycobacterium avium complex disease. The nurse should anticipate administering which of the following medications? Select all that apply.
Clarithromycin Azithromycin
A patient has begun taking antiasthmatic drugs. The patient should avoid excessive intake of what beverage?
Coffee
Bronchial circulation differs from the pulmonary circulation by providing blood for the:
Conducting airways
A physiology instructor asks the students about the purpose of the promoter region on a DNA strand. Which student response is most accurate?
Contains amino acids that the RNA polymerase recognized and binds to, thus starting the replication process
Which of the following would be an example of gene expression? Select all that apply.
Control of insulin expression so it gives a signal for blood glucose regulation Increasing the amount of UV light exposure to end up with darker skin
A 25-year-old cystic fibrosis client presents to the clinic in obvious respiratory distress. Following physical exam, the health care provider suspects bronchiectasis based on which of the following findings? Select all that apply.
Copious amounts of foul-smelling purulent sputum Blood-tinged sputum Wheezing throughout the lung fields
Above the glottis that opens and closes for speech, the epiglottis performs which physiologic functions during swallowing?
Cover the larynx
Which cranial nerves that have their origin in the pons assist with the manipulation of the jaw during chewing and speech? Select all that apply.
Cranial nerve VI Cranial nerve VII Cranial nerve VIII
A patient is experiencing an acute asthma attack. Which of the following medications is contraindicated for the treatment of acute bronchospasm?
Cromolyn (Intal)
When evaluating the pulmonary function test results for a COPD client, which one correlates to the mismatch of ventilation and perfusion associated with this diagnosis?
Forced expiratory volume (FEV) is decreased.
Splicing of mRNA during processing permits a cell to:
Form different proteins
A client arrives in the emergency department suffering a traumatic brain injury as a result of a car accident. While assessing this client, the nurse notices the client has an irregular breathing pattern consisting of prolonged inspiratory gasps interrupted by expiratory efforts. The underlying physiological principle for these signs would include:
Damage has occurred at the connection between the pneumotaxic and apneustic centers.
A respiratory therapist has asked a client to breathe in as deeply as possible during a pulmonary function test. Inspiration is normally the result of which of the following phenomena?
Decreased intrathoracic pressure
A traumatic brain injury client has developed extreme cerebral edema. The nurse is monitoring the client closely for signs of brain herniation. Which clinical manifestations would correlate to upward herniation of the midbrain from the infratentorial compartment? Select all that apply.
Deep coma Respiratory rate of 8 with intermittent sighs Bilateral small, fixed pupils
A client has just been admitted to the postsurgical unit following a below-the-knee amputation. Which of the following measures should her care team prioritize to prevent atelectasis during the client's immediate recovery?
Deep-breathing exercises and early mobilization
The family of a multiple sclerosis client asks, "What psychological manifestations may we expect to see in our mother?" The health care provider informs them to expect which of the following? Select all that apply.
Depression Inattentiveness Forgetfulness
A client works as a data entry worker for a large company. The client goes to employee health with pain in the wrist/hand. The nurse suspects that it is carpal tunnel syndrome based on which of the following assessment findings? Select all that apply.
Describes numbness/tingling in the thumb and first digit Precision grip weakness in the affected hand Pain interferes with sleeping
The client has 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
A patient is being treated for active tuberculosis with ethambutol (Myambutol). The patient states to the nurse that he cannot identify the red and green on the traffic lights when he is driving. Based on this finding, what medical intervention is most appropriate?
Discontinue ethambutol (Myambutol).
A client's recent diagnosis of Parkinson disease has prompted his care provider to promptly begin pharmacologic therapy. The drugs that are selected will likely influence the client's levels of:
Dopamine
Which of the following catecholamines 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 patient has been diagnosed with chronic obstructive pulmonary disease. The patient is to be administered tiotropium bromide (Spiriva HandiHaler). The patient's creatinine level is 25. What is the patient at risk for developing?
Drug toxicity
A patient is hospitalized with active tuberculosis. The patient is receiving antitubercular drug therapy and is not responding to the medications. What do you suspect the patient is suffering from?
Drug-resistant tuberculosis
Which of the following statements is true of autosomal recessive disorders?
Effects are typically the result of alterations in enzyme function.
A patient is admitted with thrombophlebitis and sent home on enoxaparin (Lovenox). Which statement indicates a good understanding of why enoxaparin is being administered?
Enoxaparin inhibits the formation of additional clots.
A patient is admitted to the emergency room with inspiratory stridor and air hunger after a bee sting. Which of the following medications will the nurse prepare for administration?
Epinephrine (Adrenalin)
A woman is admitted to the emergency department with a diagnosis of sinus bradycardia. The patient has been prescribed atropine 0.5 mg IV. How often can atropine be administered?
Every 3 to 5 minutes
A teratogenic environmental agent can cause birth defects when:
Exposed during early pregnancy
Fetal alcohol syndrome (FAS) is unlike other teratogens in that the harmful effects on the fetus:
Extend throughout the pregnancy
The health care provider for a client with degenerative Alzheimer-type dementia recognizes the client has moved from the initial stage to the moderate stage based on which of the following clinical manifestations? Select all that apply.
Extreme confusion and disorientation Need for direct supervision for ADLs Inability to problem solve simple tasks
The pathophysiologic effects of spina bifida are due to:
Failure of one or more neural arches to close within the vertebral column of the neural tube
Which of the following facts underlies the application of RNA interference in the treatment of disease?
Faulty gene activity that produces unwanted proteins can sometimes be stopped.
A sudden traumatic complete transection of the spinal cord results in what type of injury below the site?
Flaccid paralysis
A patient has been administered atropine for sinus bradycardia. Which of the following symptoms is noted with large doses of atropine?
Flushing
A client with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the client appears confused but is oriented to person and place but not time. What type of seizure did this client most likely experience?
Focal seizure with impairment to consciousness
Knowing that she is a carrier for Duchene muscular dystrophy (DMD), a pregnant woman arranged for prenatal genetic testing, during which her child was diagnosed with DMD. As her son develops, the woman should watch for which of the following early signs that the disease is progressing?
Frequent falls and increased muscle size
Following surgery for a large malignant brain tumor, the nurse should anticipate discussing which further treatment option with the family that may ensure that any remaining cancer cells will be killed?
Gamma knife radiation
Which of the following meals would be considered high in folic acid intake?
Green leafy salad, beef and bean burrito on whole-wheat shell
A patient has developed symptoms of rigidity and bradykinesia. Which of the following medications has been linked to secondary parkinsonism?
Haloperidol
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?
Headaches and memory lapses
When discussing linkage studies, the instructor mentions that colorblindness is found in a small section of the X chromosome and has been linked to development of which of the following diseases? Select all that apply.
Hemophilia A Adrenal hyperplasia
A patient has a history of clot formation. She is scheduled for bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically?
Heparin
A patient has experienced the formation of clots and has bruising. It is determined that there is a depletion of the patient's coagulation factors and widespread bleeding. Which of the following medications will be administered?
Heparin
A late indicator of increased intracranial pressure is:
High mean arterial pressure
A patient is receiving IV heparin every 6 hours. An activated partial thromboplastin time (aPTT) is drawn 1 hour before the 08:00 dose. The PTT is 92 seconds. What is the most appropriate action by the nurse?
Hold the dose and call the aPTT result to the physician's attention.
A patient is suffering from urinary urgency and frequency. Which of the following medications will assist in treating the patient's symptoms of urinary frequency?
Hyoscyamine (Anaspaz)
Which of the following manifestations typically accompanies an asthmatic attack?
Hyperinflation of the lungs
The physician orders benztropine mesylate (Cogentin). What disease process would contraindicate the administration of this anticholinergic medication?
Hyperparathyroidism
A patient is admitted to the intensive care unit with status asthmaticus. The patient is administered high doses of nebulized albuterol (Proventil). What electrolyte imbalance should the nurse assess for this patient?
Hypokalemia
A clinician is assessing the muscle tone of a client who has been diagnosed with a lower motor neuron (LMN) lesion. Which of the following assessment findings is congruent with the client's diagnosis?
Hypotonia
Identifying the genetic sex of a child is based on finding intracellular Barr bodies that consist of:
Inactive chromatin material
Following routine newborn testing, an infant has been diagnosed with an elevated phenylalanine level. The nurse teaches the parents to follow a strict low-protein diet to prevent which of the following major complications for the infant?
Impaired brain development
A family brings a client to the emergency department with increasing lethargy and disorientation. They think the client had a seizure on the drive over to the hospital. The client has been sick with a "cold virus" for the last few days. On admission, the clients' temperature is 102°F. Which other clinical manifestations may lead to the diagnosis of encephalitis?
Impaired neck flexion resulting from muscle spasm
A patient with a diagnosis of active TB has begun second-line therapy that includes the use of pyrazinamide. When monitoring this patient, the nurse should suspect that adverse effects of this drug may account for which of the following laboratory values?
Increased AST, ALT, and GGT
While lecturing to a group of physiology students, the instructor asks, "What metabolic factors cause vasodilation of cerebral vessels thereby increasing cerebral blood flow to the brain?" The student with the best response would be:
Increased carbon dioxide level
A client with a history of emphysema is experiencing hypoxemia after a taxing physical therapy appointment. Which of the following physiologic phenomena will occur as a consequence of hypoxemia?
Increased heart rate
When a client with a kidney transplant develops graft versus host disease, a suicide gene transfer can be accomplished by:
Infusion of donor lymphocytes
A patient is instructed on the administration of inhaled corticosteroid agents to treat asthma. How do inhaled corticosteroid agents assist in the treatment of asthma?
Inhaled corticosteroid agents will reduce airway inflammation.
The sensation of chest tightness due to an impending asthmatic attack appears to be related to which of the following physiological causes?
Input from lung receptors that monitor bronchial constriction.
From the following list, which medications have been developed utilizing recombinant DNA technology? Select all that apply.
Insulin, for clients with diabetes Erythropoietin to help the body generate more RBCs Tissue plasminogen activator (tPA) to dissolve a clot in the brain
Among the treatments for multiple sclerosis (MS), which medication will reduce the exacerbation of relapsing-remitting MS?
Interferon-β, a cytokine injection
A patient with myasthenia gravis is experiencing rhinorrhea. Which of the following medications should not be administered to the patient?
Ipratropium (Atrovent)
Following a head injury, a client is diagnosed with a possible intracranial epidural hematoma. During the initial assessment, the client suddenly becomes unconscious. Other clinical manifestations that correlate with this diagnosis may include:
Ipsilateral pupil dilation
Genetic testing has revealed that a male infant has been born with an extra X chromosome. What are the most likely implications of this finding? The child:
Is likely to have no manifestations of this chromosomal abnormality
When comparing and contrasting the various forms of RNA, the pathophysiology instructor identifies that ribosomal RNA (rRNA) is unique in that it:
Is produced in the nucleolus
A patient is administered atropine to increase the heart rate. What is the action of atropine?
It blocks the parasympathetic vagal stimulation.
A nursing student is learning about the effects of bactericidal agents. How does rifampin (Rifadin) achieve a therapeutic action against both intracellular and extracellular tuberculosis organisms?
It inhibits synthesis of RNA.
A patient is scheduled for a hemithyroidectomy. She has been prescribed an anticholinergic agent prior to surgery. Why is it important to administer the anticholinergic agent in the preoperative phase?
It will decrease respiratory secretions.
Which of the following practitioners is most likely to be of immediate assistance in the first 24 hours following delivery of an infant with a cleft lip?
Lactation consultant
A college student has a TB test prior to starting the semester. The tuberculin test site is noted with a reddened, raised area. What condition will the student be diagnosed with if the chest radiograph is negative? 1
Latent tuberculosis 1
A patient who was frequently homeless over the past several years has begun a drug regimen consisting solely of isoniazid (INH). What is this patient's most likely diagnosis? 2
Latent tuberculosis 2
A patient is bothered with nighttime episodes of bronchoconstriction related to asthma. Which of the following medications can be administered to decrease the nighttime episodes and prevent asthma attacks?
Leukotriene modifiers
A patient is being treated for Parkinson's disease and has been prescribed both levodopa (L-dopa) and carbidopa (Lodosyn). Why is this course of combination treatment most effective?
Levodopa restores dopamine and carbidopa decreases peripheral breakdown of levodopa.
A patient who is being administered isoniazid (INH) for tuberculosis has a yellow color in the sclera of her eye. What other finding would lead you to believe that hepatotoxicity has developed?
Light-colored stools
The region of the brain involved in emotional experience and control of emotional behavior is the:
Limbic system
Pleuritic chest pain associated with respiratory movements is usually described as:
Localized
The client with emphysema should be educated about changes in lung tissue that may include which of the following changes? Select all that apply.
Loss of elastic recoil Difficulty exhaling due to inability to recoil Increased lung compliance
When an infant is born with gene mutations in his cells, the nurse explains to the parents that accidental errors may be a result of: Select all that apply.
Loss of one or more base pairs Substitution of one base pair for another Rearrangement of the base pairs
When discussing upcoming chromosome studies, a client asks, "What kind of sample are they going to take to do these tests?" The nurse replies, "The most common cells used for this purpose are:
Lymphocytes from a venous blood specimen."
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 motor vehicle accident has resulted in critical injury for the driver of the car. The driver has hit the steering wheel with his chest and fractured his sternum and some ribs. Which of the following manifestations would lead the staff to suspect the driver has developed a tension pneumothorax? Select all that apply.
Mediastinal shift of the trachea toward one side Subcutaneous emphysema palpated in the upper chest/neck region
Genetic disorders that involve a single-gene trait are characterized by:
Mendelian patterns of transmission
When explaining genetic coding to a group of students, the instructor discusses gene activation and deactivation. It was stressed that inactivation of a gene requires which of the following processes?
Methylation of histone amino acid
Which of the following peripheral nerve injuries will likely result in cellular death with little chance of regeneration?
Nerve fibers destroyed close to the neuronal cell body
Following surgery, a client had a chest x-ray that reported some opacities in the lung bases likely due to atelectasis. Which of the following pathophysiologic processes will result from this condition?
Perfusion without ventilation
Which of the following variables determine the extent of teratogenic drug effects? Select all that apply.
Molecular weight of the drug Stage of pregnancy when the drug was taken Duration of drug exposure
Since catecholamines can be degraded by enzymes, the medication category usually prescribed to treat a Parkinson disease client, thereby controlling this interaction, is:
Monoamine oxidase (MAO) inhibitor
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
Which of the following statements is true of genetic mutations?
Mutations may result from environmental agents.
A patient who suffers from Parkinson's disease is being treated with levodopa/carbidopa. Which of the following disorders will result in the discontinuation of this drug based on a disease-related contraindication?
Narrow-angle glaucoma
A child with asthma is walking outside and develops a bronchospasm. The school nurse knows this bronchospasm has what effects on bronchioles with airflow? Select all that apply.
Narrowing of bronchioles Impairs airflow
A 16-year-old male presents to the clinic complaining of headaches, trouble hearing the teacher in the front of the classroom, and ringing in the ears. He also revealed that every time he goes swimming underwater, he gets disorientated (which never happened when he was younger). Given these manifestations, the health care provider is going to start testing for:
Neurofibromas
A woman who is a carrier for which of the following diseases possesses the greatest likelihood of passing the disease to her future children when heterozygous pairing exists?
Neurofibromatosis
Which genetic disorders (body system) have a high requirement for oxidative metabolism associated with mitochondrial DNA?
Neuromuscular disorders
Crossing-over of chromatid segments during meiosis division 1 results in:
New gene combinations
While explaining the role of skeletal muscle relaxants, such as succinylcholine, used during anesthesia, the faculty mentions that these effects are caused by blocking:
Nicotinic acetylcholine receptors, muscle-type receptor (NM)
While lecturing on inheritance patterns, a student asks, "My mother has blue eyes and my father has brown eyes. All my siblings have brown eyes except me. How can this happen?" Which of the following is the most accurate response?
Phenotypically, the brown-eyed persons are the same, but genotypically they are different.
An elderly client who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which of the following treatment modalities is most likely to resolve the client's most recent health problem?
Thoracentesis
A patient with asthma has been taking ibuprofen (Advil) twice daily for 2 weeks after an ankle injury. The patient calls her health care provider and states she is bothered by shortness of breath and rapid breathing. What will the patient's health care provider suspect?
The patient has a sensitivity to the drug.
When a client with a history of asthma takes a walk outside on a windy day with high pollen counts, she may experience an asthma attack, resulting in an increase in respiration rate and wheezing. The body's response is likely related to which pathophysiological principle?
Parasympathetic nervous system stimulation resulting in airway constriction
The perception of "where" a stimulus is in space and in relation to body parts is a function of the:
Parietal lobe
A 60-year-old male patient has developed a tremor of the right hand with a pill-rolling motion. Upon interviewing the patient, he states he sustained several head injuries playing football. Based on this information, what do you suspect the patient is suffering from?
Parkinson's disease
A patient is hospitalized due to nonadherence to an antitubercular drug treatment. Which of the following is most important for the nurse to do?
Observe the patient taking the medications.
A patient has been diagnosed with tuberculosis and will soon begin first-line drug treatment. How will rifampin most likely be administered to this patient by the nurse?
Orally, on an empty stomach
COPD clients live with persistently elevated PCO2 levels. Therefore, which assessment finding would likely initiate a stimulus for ventilation in this client population?
PO2 level of 50 mm Hg
A patient is taking warfarin (Coumadin) to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin (Coumadin) monitored?
PT and INR
A teenaged cystic fibrosis client presents to the clinic. The health care provider (HCP) knows that cystic fibrosis (CF) causes severe chronic respiratory disease in children. In addition, the HCP should also focus his or her assessment on which of the other body systems affected by CF?
Pancreatic
Disorders of the pyramidal tracts, such as a stroke, are characterized by:
Paralysis
A pregnant mother (16 weeks' gestation) forgot and emptied her cat's litter box without gloves. She is extremely anxious and wants tested right away. Which test would the nurse prepare her for that would give rapid cytogenic analysis?
Percutaneous umbilical cord blood sampling
A client's recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which of the following treatment measures is most likely to resolve this health problem?
Placement of a shunt
More complex patterns of movements, such as throwing a ball or picking up a fork, are controlled by which portion of the frontal lobe?
Premotor cortex
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?
Prenatal blood tests
A newly admitted critical head injury client presents to the neuro-ICU. The client is unresponsive to painful stimuli but able to breathe on his own. As the shift progresses, the nurses note a decrease in the client's respiratory effort. The client cannot maintain his O2 saturation above 70%. The nurses should anticipate assisting in beginning what type of pulmonary support?
Prepare for mechanical ventilation.
A client with laryngeal dystonia has gotten to the point that people on the telephone cannot understand her. She has heard about getting Botox injections into her vocal cords. The nurse will teach about the actions of Botox. Which is the most accurate description? This drug:
Produces paralysis of the larynx muscles by blocking acetylcholine release
Which of the following is an application of recombinant DNA technology?
Production of human insulin
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:
Production of surfactant
A patient with asthma has been prescribed ipratropium (Atrovent) 2 puffs QID. The nurse should recognize which of the following as the most likely goal of this treatment?
Promoting long-term management of asthma symptoms
As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to:
Pulmonary hypertension
Following a car accident that has resulted in partial amputation of the lower limbs, the client's body has implemented a compensatory mechanism releasing antidiuretic hormone (ADH) into the blood stream, causing retention of water and vasoconstriction of blood vessels. This is accomplished as a result of:
Rapid axonal transport of ADH from the hypothalamus into the posterior pituitary
Following his annual influenza vaccination, a client begins to feel achy, like he has developed the flu. An hour later, the client is rushed to the emergency department. Diagnosis of Guillain-Barré syndrome was made based on which of the following assessment findings? Select all that apply.
Rapid deterioration of respiratory status Flaccid paralysis of limbs BP 90/62
While walking down the street, a cat jumps out of an alley into the pathway of an adult. They note that his heart is "racing." This response is primarily due to:
Reflex circuitry produced by the ANS reflexes
A client's primary care provider has prescribed a β-adrenergic receptor blocker. Which of the following therapeutic effects do the client and care provider likely seek?
Reduction in heart rate and blood pressure
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
A client diagnosed with a cancer has been prescribed monoclonal antibodies as a treatment option. He asks the health care provider, "What are you talking about? I've never heard of this treatment. Is it experimental?" The health care provider explains somatic cell hybridization to the client by explaining that:
Researchers inject mice with an antigen from human cancer cells. They then harvest the antibody-producing cells from the mice and individually fuse them with a cancerous cell.
A client with a history of heart failure and COPD (caused by 60 pack/year smoking) presents to the clinic with the following complaints: auscultation of breath sounds reveal absent/diminished breath sounds in the right lower lobe. Which other manifestations lead the health care provider to suspect the client may have developed atelectasis? Select all that apply.
Respiratory rate—32; pulse rate—122 beats/minute. "Having a hard time catching my breath." Using accessory muscles to help him breathe.
A client has started having uncontrolled seizures that are not responding to usual medications. Nursing working with the client must pay special attention to which of the following priority aspects of this clients care? Assessment of:
Respiratory status and oxygen saturation
A client with a diagnosis of myasthenia gravis has required a mastectomy for the treatment of breast cancer. The surgery has been deemed a success, but the client has gone into a myasthenic crisis on postoperative day 1. Which of the following measures should the care team prioritize in this client's immediate care?
Respiratory support and protection of the client's airway
When quizzing obstetrical nursing students regarding tissues affected by mitochondrial DNA mutations, the instructor accepts which of the following responses? Select all that apply.
Retinal degeneration Deafness
While teaching a class of nursing students about spinal cord injury, the instructor mentions that male SCI clients will be able to have a sexual response if their injury is at which level on the spinal column?
S4
A recently injured (3 months ago) client with a spinal cord injury at T4 to T5 is experiencing a complication. He looks extremely ill. The nurse recognizes this as autonomic dysreflexia (autonomic hyperreflexia). His BP is 210/108; skin very pale; gooseflesh noted on arms. The priority nursing intervention would be to:
Scan his bladder to make sure it is empty
A patient is prescribed an adrenergic bronchodilator for airway constriction. Which of the following conditions will require it to be administered cautiously?
Seizure disorder
Clients who have been bed-ridden for a long time likely will experience:
Shallow, quiet breathing, which impairs the spreading of surfactant
A client has experienced a bout of coughing after aspirating some of his secretions. The client's coughing was triggered by which of the following?
Signals from receptors in the tracheobronchial wall
When providing discharge teaching related to some newly prescribed medications, the client who received a head injury on the left temporal lobe area will need for the health care provider to:
Sit on the right side and speak slowly and clearly during the education
A first-time pregnant mother asks, "Why do I need an ultrasound? I'm worried that my insurance won't cover it." The nurse responds that an ultrasonography can diagnose prenatal abnormalities like which of the following? Select all that apply.
Skeletal defects like facial structural problems Congenital heart defects
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 of the following abnormalities in the client's gait?
Slow to start walking and has difficulty when asked to "stop" suddenly
While explaining the individual differences in physical traits in the family group, the health care provider states this is usually a result of:
Small DNA sequence variation
When a male child inherits an X-linked disorder from his heterozygous carrier mother:
Some of his sisters will be carriers.
A patient is being discharged from the hospital with warfarin (Coumadin) to be taken at home. Which of the following foods should the patient be instructed to avoid in his diet?
Spinach
A patient with Parkinson's disease has been prescribed rasagiline. When educating this patient on this medication, which herbal supplement has the potential to produce hyperpyrexia and death with rasagiline?
St. John's wort
A patient is using an albuterol (Proventil) inhaler, which is a bronchodilator. Which of the following patient teaching interventions is a priority for the patient who experiences shortness of breath related to constriction of airways?
Stop smoking due to the bronchoconstriction.
When thinking in terms of airway radius with regard to resistance, the lung structure responsible for the most airway resistance to airflow would be:
The bronchioles near the trachea
A pregnant female has been told she is a carrier for fragile X syndrome. She asks, "What does that mean?" The health care provider explains that she is heterozygous for fragile X recessive trait, but this will only be a problem if:
The expressed pairing becomes homozygous.
Which of the following medications helps treat the inflammatory reaction of asthma clients diagnosed with late-phase asthma response?
Systemic corticosteroids
A patient is started on albuterol (Proventil). Of what adverse reaction should the patient be warned?
Tachycardia
Which of the following physiologic principles would be considered a function of the somatic nervous system?
The act of typing a report using a computer keyboard
During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description?
The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction
A 50-year-old man has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the man's medical history would contraindicate the use of heparin for DVT prophylaxis?
The man has a diagnosis of ulcerative colitis.
A homeless man was screened for tuberculosis (TB) during a health consultation at a shelter, and the results indicate latent TB. The community health nurse who is liaising with the providers of the shelter would anticipate what component of this man's plan of care?
The man will be treated for TB using first-line antitubercular drugs.
A patient is being treated for latent tuberculosis on an outpatient basis and tells the nurse during a scheduled follow-up visit, "I've been feeling pretty good lately, so I haven't actually been all that consistent with taking my drugs." Subsequent health education should focus on what subject?
The need to consistently take the prescribed drugs in order to cure TB
A neuron has been hyperpolarized. How will this affect the excitability of the neuron?
The neuron will have a membrane potential farther from the threshold.
Which of the following messages is most likely to be carried by general somatic afferent (GSA) neurons?
The sensation of cold when touching ice
With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiological principle behind this respiratory distress is related to:
The stiffening of the lung, making it more difficult to inflate
A hospital patient's medication administration record specifies concurrent doses of nebulized ipratropium and albuterol at 08:00 and 20:00. When administering these drugs, which of the following statements is true?
The two drugs can be mixed in the nebulizer immediately before administration.
A patient is administered rifampin (Rifadin). Which of the following facts should the patient be taught?
The urine, tears, sweat, and other body fluids will be a discolored red-orange.
A college student is training for a marathon in the mountains. One day, she experiences a sharp pain and suddenly becomes short of breath. At the emergency room, chest x-ray reveals a spontaneous pneumothorax. The client asks the nurse to explain why this happened. The nurse states, "For unknown reasons, you lose intrapleural negative pressure.
This means your lungs collapsed and expelled its air when you lose negative pressure."
A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a life-threatening condition because:
Trapped, inspired air collapses the lung.
Clients with chronic obstructive lung disease (COPD) may experience airway closure at the end of normal instead of low lung volumes, which result in:
Trapping of large amounts of air that cannot participate in gas exchange
A patient has been administered chlorpromazine (Thorazine) for many years to treat his psychotic disorder. He has recently developed extrapyramidal symptoms related to long-term administration of this drug. Which of the following medications can be administered to assist in relieving these symptoms?
Trihexyphenidyl (Trihexy)
A patient is prescribed eptifibatide (Integrilin), which inhibits platelet aggregation by preventing activation of GP IIb/IIIa receptors on the platelet surface and the subsequent binding of fibrinogen and von Willebrand factor to platelets. Which of the following syndromes are treated with eptifibatide?
Unstable angina
The newborn has been born with distinctive physical features of trisomy 21, Down syndrome. The mother asks the nurse, "What is wrong? My baby looks different than his brother." The nurse assesses the infant and notes which of the following characteristics that correlate with trisomy 21? Select all that apply.
Upward slanting of eyes Large tongue sticking out the mouth Flat facial profile
A patient is being assessed by the home care nurse on the appropriate use of her metered-dose inhalers. Which of the following will assist in proper administration of the inhaler?
Use of a spacer
In one family, a son was born with polydactyly toes while his sister had polydactyly fingers. In explaining this phenomenon in genetic terms to the parents, which concept should be addressed?
Variable expressivity of a gene
A client with a long history of cigarette smoking and poorly controlled hypertension has experienced recent psychomotor deficits as a result of hemorrhagic brain damage. The client's psychomotor deficits are likely the result of:
Vascular dementia
Generalized acute hypoxia in lung tissue, when alveolar oxygen levels drop below 60 mm Hg, causes pulmonary:
Vasoconstriction
A patient who has been treated with warfarin (Coumadin) after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors?
Vitamin K
A patient who is receiving warfarin (Coumadin) has blood in his urinary catheter drainage bag. What medication will likely be ordered by the physician?
Vitamin K
A client has been diagnosed with a cerebral aneurysm and placed under close observation before treatment commences. Which of the following pathophysiologic conditions has contributed to this client's diagnosis?
Weakness in the muscular wall of an artery
Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement:
Without causing paralysis
Which of the following statements is true of messenger RNA (mRNA)?
mRNA provides the template for protein synthesis.
A nurse at a long-term care facility is conducting a medication reconciliation for a man who has just moved into the facility. The man is currently taking clopidogrel (Plavix). The nurse is most justified is suspecting that this man has a history of
myocardial infarction.
An adult patient with a diagnosis of asthma has been prescribed montelukast (Singulair). The nurse should teach the patient that this drug will help relieve symptoms by
preventing the bronchoconstriction and inflammation that is caused by leukotrienes.
A 77-year-old male patient with Parkinson's disease will soon begin treatment with levodopa, carbidopa, and entacapone (Stalevo). Prior to starting this course of treatment, the nurse must ensure that
the patient has completed an anticholinergic challenge in a clinical setting.
