Patho Final
A 17-year-old female has announced to her family physician a desire to wholly eliminate fats from her diet. Which of the following aspects of the role of fats would underlie the physician's response to the client? A) Apart from providing energy, fats are necessary as carriers of certain vitamins and are precursors to prostaglandins. B) An extreme low-fat diet is associated with an increase in undesirable HDL cholesterol. C) Fats are a key source of dietary nitrogen, and their elimination from the diet is associated with a negative nitrogen balance. D) The total elimination of fat from the diet is associated with the development of ketosis.
A
A 29-year-old female has been admitted to the emergency department following a suicide attempt by overdose of acetaminophen. What changes in the client's liver and diagnostic results would the care team most likely anticipate? A) Hepatocellular necrosis evidenced by increased ALT and AST levels B) Allergic inflammation accompanied by an increase in serum IgE and basophils C) Cholestatic reaction with increased bilirubin count D) Rapid onset of hepatitis and increased GGT, ALT, and bilirubin
A
A 42-year-old female client with a long-standing history of chronic nausea and vomiting but a near-insatiable appetite has had her symptoms attributed to an enzyme deficiency. Further diagnostic testing indicates that she has inadequate pancreatic enzyme levels and that her large appetite is due to a lack of enzyme control of food intake inhibition. In which of the following enzymes is the woman most likely deficient? A) Cholecystokinin B) Ghrelin C) Gastrin D) Secretin
A
A client in an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is complaining of intense, diffuse pain in her abdomen. Which of the following physiological phenomena is most likely contributing to her complaint? A) Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve pathways of the ANS. B) First-order neurons are inappropriately signaling pain to the dorsal root ganglion. C) The client is experiencing neuropathic pain. D) The client's C fibers are conducting pain in the absence of damaged Aδ fibers.
A
A female neonate has been in respiratory distress since delivery and is unresponsive to oxygen therapy. Endoscopy has confirmed a diagnosis of esophageal atresia and tracheoesophageal fistulae (EA/TEF). Which of the following explanations should the care team provide to the infant's parents? A) "We will have to perform surgery to correct the hole in her throat to make sure that she is able to swallow and breathe normally." B) "This problem will require respiratory therapy and supplementary feeding, but it will likely resolve itself over time." C) "The biggest risk that your daughter will face until this is fixed is the danger of malnutrition and dehydration." D) "The priority in our immediate treatment prior to her surgery will be pain management, as the contents of her stomach can burn her lungs.
A
A male patient has just been diagnosed with esophageal cancer. He knew that he was losing weight and fatigued most days, but he just attributed it to aging and working. The physician recommends chemotherapy and irradiation. However, the cancer has already metastasized. The patient asks the nurse what he can expect if he agrees to the treatments. The nurse responds, A) "The therapies may shrink the cancer." B) "The doctor is prescribing treatment measures to help you swallow better." C) "These therapies will most likely cure your cancer." D) "You need to talk with your physician some more. I will page him for you."
A
A number of clients on a geriatric subacute medical floor of a hospital have developed foul-smelling diarrhea over the last several days, and subsequent culture of stool samples has confirmed the presence of Clostridium difficile in each case. The care team in the unit would recognize that which of the following factors likely contributed to the health problem and would anticipate which of the following treatments? A) The use of broad-spectrum antibiotics likely played a role in the development of infections, and most clients would likely receive metronidazole as a treatment. B) Genetic predisposition and the presence of the bacterium in clients' normal flora likely contributed, and treatment would consist of broad-spectrum antibiotics. C) Poor hand washing practice on the part of care providers led to the outbreak, and treatment will consist of hydration and nutritional support. D) Ingestion of contaminated food probably contributed to the infections, and corticosteroids will be needed to treat them
A
A patient being seen in the clinic has just received his routine lab results. The patient has been told that his cholesterol level is extremely elevated. The physician plans to give the patient a prescription for medication to help control this condition. Which of the following medications should the nurse prepare to educate the patient on? A) Atorvastatin (Lipitor) B) Abilify (aripiprazole) C) Pancrecarb (Pancrelipase) D) Pancrelipase (Ultrase)
A
A stroke patient is having difficulty swallowing food and beverages. The patient complains that he feels like "the food is sticking to the back of his throat." Given this information, the priority nursing interventions would be to A) make the patient "nothing per os" (NPO) and call the physician. B) feed the patient while he is sitting in an upright position. C) add a thickening agent to all of the patient's beverages. D) warrant no action since this is a normal occurrence after a stroke.
A
A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the bag other than the phone. The nurse knows that which of the following terms best describes one's ability to sense of shape and size of an object in the absence of visualization? A) Stereognosis B) Astereognosis C) Modalities D) Somesthesia
A
Chronic anxiety and stress contribute to ulcers. Which of the following effects of the sympathetic nervous system is most responsible for this effect? A) Inhibition of the actions of Brunner glands B) Overstimulation of the oxyntic glands C) Suppression of cholecystokinin D) Inflammation of the parotid glands
A
When examining the types of energy expenditure, which of the following statements is accurate? A) People who are more active and who fidget may have less fat gain than those with decreased nonexercise activity thermogenesis. B) Parasympathetic stimulation will cause brown fat to generate more heat than other stimulations. C) Recent research indicates that obese patients with persistent excess caloric intake have decreased sympathetic activity. D) Carbohydrate intake increases the normal metabolic rate more significantly than other nutrients.
A
When the sympathetic nervous system is stimulated, the interstitial cells of Cajal, pacemaker cells of the GI tract, react by A) decreasing amplitude or abolishing the slow waves that control the spontaneous oscillations in membrane potentials. B) increasing the peristaltic motion of the GI tract, thereby causing explosive diarrhea. C) increasing the amount of secretions being entered into each segment of the intestinal tract. D) signaling the vagus nerve to slow down motility and increase absorption of water from the large intestine.
A
Which of the following clients in a hospital medical unit is most clearly demonstrating the signs and symptoms of liver failure? An adult with A) low hemoglobin levels, low platelet levels, and spider angiomas present. B) blood pressure of 189/103, jaundice, and multiple thromboses. C) sudden onset of confusion, a history of alcohol abuse, and low levels of serum AST and ALT. D) ascites, fever, and recent onset of atrial fibrillation.
A
Which of the following hospital patients is most likely to be diagnosed with complex regional pain syndrome II (CRPS II)? A) A man who has been admitted for treatment of continuing hyperalgesia after sustaining a nerve injury in a motor vehicle accident B) A woman who requires analgesia more than 3 months after an episode of shingles C) A male client with diabetes mellitus who requires analgesia prior to each dressing change on his chronic foot wound D) A female who has seemingly unprovoked attacks of pain that are accompanied by facial tics and spasms
A
Which of the following medications used in the treatment of peptic ulcers and gastroesophageal reflux binds to H2 receptors and blocks the action of histamine on parietal cells? A) Cimetidine (Tagamet) B) Levbid (hyoscyamine) C) Lotronex (alosetron) D) Nexium (esomeprazole)
A
Match the pain theory to the correct physiologic basis for the pain. A. Specificity theory B. Pattern theory C. Gate control theory D. Neuromatrix theory 1. Light touch applied to the skin would produce the sensation of touch through low-frequency firing of the receptor. 2. Repeated sweeping of a soft-bristled brush on the skin over or near a painful area may result in pain reduction for several minutes. 3. Proposes that the brain contains a widely distributed neural network that contains somatosensory, limbic, and thalamocortical components. 4. Describes how an acute injury is predicted to be but does not take into account the person's feelings of how the pain feels to him or her.
A - 4 B- 1 C - 2 D - 3
Parents have brought their 7-year-old child into the emergency room with abdominal pain. Which of the following clinical manifestations would lead the health care team to suspect the child has appendicitis? Select all that apply. A) Tenderness in right lower quadrant with palpation B) Rebound tenderness in inguinal areas with palpation C) Redness and warmth over right lower quadrant D) Bloating and flatulence noticeable E) Urine has the smell of stool with brown coloring
A B
A teenage female has been admitted for complications resulting from bulimia nervosa. She has abused laxatives for many years and has been self-inducing vomiting since the age of 9. The nurse's admission assessment should pay close attention to which of the following complications that can arise from this disorder? Select all that apply. Assess for A) dry, cracked lips and poor skin turgor. B) missing tooth enamel and increased number of dental cavities. C) painful swallowing and stomach cramping related to reflux and esophagitis. D) fruity breath and labored, deep, gasping respirations. E) jaundice of the skin and eyes.
A B C
The physician has asked a newly diagnosed cardiac patient to begin taking omega-3 fatty acids to help prevent inflammation and blood clotting. The patient asks the nurse what types of food sources are high in omega-3 fatty acids. The nurse should educate the patient to increase his intake of which of the following items? Select all that apply. A) Salmon B) Walnuts C) Seeds D) Avocados
A B C
When explaining the role of protein and the nine essential amino acids' needs of the body to a group of students, the nurse should emphasis that which of the following foods are complete proteins (foods that provide the essential amino acids in adequate amounts)? Select all that apply. A) Milk B) Fish C) Poultry D) Nuts E) Grains
A B C D E
A patient has just been admitted to a nursing unit with the diagnosis of obstructive jaundice. Which of the following assessment findings would the nurse expect to see in this patient? Select all that apply. A) Clay-colored stools B) Dark urine C) Elevated conjugated bilirubin levels D) Decreased serum alkaline phosphatase levels E) Severe itching
A B C E
For several years, a 39-year-old female has been averaging two to three bottles of wine each night after her children go to sleep and has included several ounces of brandy in recent years as well. Despite negative consequences to her career and the dissolution of her marriage, her drinking has culminated in a diagnosis of cirrhosis. Which of the following physical manifestations of the health problem would her care team anticipate? Select all that apply. A) Ascites B) Anorexia C) Fever D) Bleeding tendencies E) Epigastric pain F) Obesity
A B D E
The patient who has been consuming a very low-calorie diet (VLCD) of 450 kcal/day should be assessed for which of the following high-risk complications? Select all that apply. A) Irregular heart rhythms B) Bone/joint inflammation C) Abdominal pain related to gallstones D) Flank pain and spasm associated with kidney sludge E) Elevated cholesterol levels
A C
While explaining to a group of nursing students what the function of the first mucosal layer of the lower two thirds of the esophagus, the pathophysiology instructor mentions which of the following functions? Select all that apply. A) Secretion of mucus to lubricate and protect the inner surface of the alimentary canal B) Smooth muscle cells that facilitate movement of contents of the GI tract C) Holding the organs in place and storage of fats D) Barrier to prevent the entry of pathogenic organisms E) A cushioning to protect against injury from sports or car accidents
A D
A 22-year-old student has developed a fever and diarrhea while on a backpacking trip in Southeast Asia. His oral temperature is 101.4°F. The diarrhea is bloody, frequent, and small in volume. These clinical manifestations are sufficiently distressing that he is visiting a local medical clinic in the area. Which of the following diagnoses best characterizes this health problem? A) Noninflammatory diarrhea B) Inflammatory diarrhea C) Factitious diarrhea D) Secretory diarrhea
B
A 40-year-old man who uses heroin intravenously was diagnosed with hepatitis C (HCV) 1 year ago and is now considered to have chronic viral hepatitis. Which of the following statements by the client to his care provider would warrant correction? A) "I know the medications to treat this aren't fantastic, but at least there are some options for controlling the virus." B) "It's at least a bit reassuring that my liver isn't undergoing damage when I'm not experiencing symptoms." C) "Even though I'm sick, at least I won't feel sick most of the time." D) "I'm not looking forward to all the side effects of the drug treatments for my HCV, but I hope I don't end up needing a liver transplant."
B
A 43-year-old male client has presented to the emergency department with vomiting that he claims is of a sudden onset. The client also states that the emesis has often contained frank blood in the hours prior to admission. His vital signs are stable with temperature 98.3°F, pulse 88, BP 140/87, and respiratory rate 18. Which of the following potential contributing factors would the health care team suspect first? A) Overuse of antacids B) Alcohol consumption C) Staphylococcal enterotoxins D) Effects of Helicobacter pylori
B
A 53-year-old woman with a history of chronic alcohol abuse but without visible jaundice comes to the clinic complaining of nausea and weakness. She admits to taking acetaminophen for persistent headaches but denies exceeding the recommended daily dose; she has not taken any other medications. She is suspected of having acetaminophen toxicity. Which of the following diagnostic test findings would implicate a different cause of her symptoms? A) Normal serum acetaminophen level B) Elevated serum HBsAg level C) Evidence of steatosis on liver biopsy tissue sample D) Hypoglycemia
B
A 68-year-old African American man who has smoked for at least 50 years reports that lately he feels as though food is getting stuck in his throat. At first, this was a problem just with dry food, but now his morning oatmeal is getting "stuck." On questioning, he reports drinking at least three alcoholic beverages nearly every day. His problem is most likely A) achalasia. B) squamous cell carcinoma of the esophagus. C) dysphagia secondary to scleroderma. D) gastrointestinal reflux disease
B
A 7-year-old child had an emergency appendectomy during the night. When trying to assess his pain, the nurse should A) ask him to rate his pain on a scale of 0 to 10, with 0 = no pain and 10 = worse pain ever. B) show him a scale with faces of actual children and have him point to the picture that best describes how he is feeling. C) consider his pulse and BP readings to be the most specific indicators of the amount of pain he is experiencing. D) try to distract him by blowing bubbles to minimize the use of opioids so that he does not become addicted to the narcotic.
B
A dietitian is working with a morbidly obese client in an effort to facilitate weight loss. Which of the dietitian's following teaching points about the nature of adipose tissue should be included in the client education? A) "Our ultimate goal is going to be eventually rid your body of adipose tissue or fat." B) "Your fat cells can be considered to be one large energy storage organ that also has a role in hormone production." C) "We ideally would like to maximize your levels of brown fat and minimize those of white fat." D) "Obesity is normally the result of the number of 'pre-fat' cells an individual is born with."
B
A gastroenterologist is teaching a group of medical students about the enteric nervous system in preparation for a consult on client who has suffered a spinal cord injury. Which of the physician's teaching points is most accurate? A) "The myenteric plexus is responsible for controlling the function of each segment of the intestinal tract." B) "The enteric nervous system is made up of the myenteric and submucosal plexuses; these are located in the wall of the GI tract." C) "Sympathetic innervation of much of the GI tract occurs by way of the vagus nerve." D) "Parasympathetic stimulation blocks the release of the excitatory neuromediators and inhibits GI motility.
B
A male patient comes to the clinic asking to speak to a health care provider privately. He reveals that he had shared a needle/syringe with a prostitute (shooting up cocaine) and then had unprotected sex. Upon questioning, it was revealed that the patient had not had any immunization for hepatitis B. Which of the following medications would the nurse anticipate administering today to this patient? A) Tenofovir disoproxil fumarate plus emtricitabine B) Hepatitis B immunoglobulin (HBIG) C) Hepatitis C immunoglobulin (HCIG) D) Hepatitis A vaccine
B
A middle-aged male walks into the emergency department complaining of chest pain radiating to the neck, shortness of breath, and nausea. His heart rate is 120 and BP is 94/60. The ED physician recognizes the patient is having an acute MI with decreased cardiac output. The nurse identifies the nausea to be in response to A) the patient not having a very high pain tolerance. B) hypoxia exerting a direct effect on the chemoreceptor trigger zone. C) the patient not having digested his meal completely. D) fear of having to make major lifestyle changes.
B
A mom asks her neighbor, a nurse, why every time she takes her daughter (10 years old) out for ice cream she comes home with a stomachache and then experiences a bout of diarrhea. The nurse is thinking that this girl is experiencing A) anxiety about increasing too many calories. B) a deficiency of lactase. C) gallbladder disease. D) premature peptic ulcer formation.
B
A mother is placing her child into the bathtub. The child immediately jumps out of the tub and begins to cry, stating his feet are "burning." The nurse in the emergency department knows that the child's response is based on which of the following pathophysiological principles listed below? A) Children react much quicker to contact with hot water than adults. B) The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex reacts first. C) It takes a long time for thermal signals to be processed before the brain can send a signal through the spinal cord and tell the foot to withdraw. D) The thermal processing center is located on the rapid conducting anterolateral system on the same side of the brain as the injury.
B
A patient has recently been diagnosed with H. pylori gastritis. The nurse knows that this form of gastritis is usually treated with a combination of an antibiotic and A) antianxiety medications. B) proton pump inhibitors. C) lactulose, to reduce the blood ammonia levels. D) calcium carbonate, an antacid.
B
A patient with diabetes mellitus has just undergone a right, below-the-knee amputation following gangrene infection. A few days post-op, the patient confides in the nurse that he still feels his right foot. Knowing the pathophysiologic principles behind this, the nurse can A) administer a psychotropic medication to help the patient cope with the loss of his leg. B) explain that many amputees have this sensation and that one theory surmises that the end of a regenerating nerve becomes trapped in the scar tissue of the amputation site. C) call the physician and ask him for an order for a psychological consult. D) educate the patient that this area has an usually abnormal increase in sensitivity to sensation but that it will go away with time.
B
Following a knee injury, a football player is taking ibuprofen, a nonsteroidal anti-inflammatory drug, for the control of pain. Which of the following drug actions is most likely to result in diminished sensation of pain for the player? A) The drug inhibits communication by third-order neurons between the thalamus and cerebral cortex. B) The drug inhibits the enzyme needed for prostaglandin synthesis. C) The drug changes the postexcitatory potential in C fibers, leading to pain sensitization. D) The drug slows the conduction velocity of myelinated Aδ fibers in the pain pathway.
B
Four weeks after returning from a tropical vacation, a 40-year-old man has presented to the emergency department with malaise, nausea, and "yellow eyes." Serology has confirmed a diagnosis of hepatitis A (HAV), to the shock of the client. What teaching is most appropriate for this client? A) "You can expect these symptoms to disappear after about 2 months, but you'll be a carrier of the disease indefinitely." B) "A vaccine before your trip would have prevented this, but be assured your body will rid itself of the virus in time." C) "You likely came in contact with blood or body fluids at some point, and you'll have to ensure no one is subsequently exposed to your own blood or body fluids." D) "You likely got this by way of what we call the 'fecal-oral' route; you will have chronic hepatitis now, but the symptoms can be controlled with medication."
B
Frustrated with his inability to lose weight despite attempting numerous fad diets, a 42-year-old male who is 5′11″ and 270 lb has visited a clinic to gain tools to achieve long-term weight loss. Which of the following statements by the clinician is most accurate? A) "Recent findings have determined that obesity is largely genetic and not preventable, but that doesn't mean we can't work together to help you lose weight and keep it off." B) "A combined approach of behavior therapy, changing your lifestyle habits, and increased physical activity gives the highest chance of long-term success." C) "By significantly changing the way you live your life, you could set and meet a goal of losing about 5% of your body weight each month." D) "Combined with regular exercise, a diet of taking in 500 to 1000 kcal/day will be the best approach."
B
If the patient's dorsal columns are not functioning, the nurse will observe which of the following responses during neurotesting, where the nurse asks the patient to close his eyes and then proceeds to touch corresponding parts of the body on each side simultaneously with two sharp points? A) Grimacing when body touched with sharp points B) No response to two-point discrimination C) Heightened proprioceptive response D) Inability to identify which way his finger was moved during the test
B
Staff at the care facility note that a woman has started complaining of back pain in recent weeks and occasionally groans in pain. She has many comorbids that require several prescription medications. The nurse knows that which of the following factors is likely to complicate the clinician's assessment and treatment of the client's pain? A) Neural pain pathways in the elderly differ from those in younger adults and are less responsive to treatment. B) Assessment and treatment are possibly complicated by the large number of drugs that the client receives. C) Accurate pain assessment is not possible in clients with significant cognitive deficits. D) Frequent complaints of pain in older adults with dementia normally indicate hyperalgesia rather than an underlying physical problem.
B
The mother of a 19-week-old infant has brought her baby in for assessment to a pediatrician because of the baby's persistent weight loss and diarrhea. An intestinal biopsy has confirmed a diagnosis of celiac disease, and the child's mother is anxious to know what caused the disease. Which of the following aspects of the etiology of celiac disease would underlie the explanation that the physician provides? A) Bacterial or chemical invasion of the peritoneum leads to decreased nutrient absorption and transport. B) An inappropriate T-cell-mediated response results in increased levels of antibodies and an inflammatory response. C) Neurogenic or muscular inhibition of peristalsis results in inappropriate motility of ingested food in the lower small intestine and the colon. D) Inability to process or absorb the fat content of breast milk results in malnutrition and deficiency of fat-soluble vitamins.
B
To reduce hepatic blood flow and decrease portal pressures in persons with cirrhosis, the nurse should be prepared to administer which of the following medications? A) Bevacizumab, an angiogenesis inhibitor B) Octreotide, a long-acting synthetic analog of somatostatin C) Filgrastim, granulocyte colony-stimulating factor (G-CSF) analog D) Diltiazem (Cardizem), a calcium channel blocker
B
Which of the following clients is most clearly displaying the signs and symptoms of irritable bowel disease (IBD)? A) A 32-year-old mother who complains of intermittent abdominal pain that is worse during her menstrual period B) A 51-year-old male who states that his stomach pain is in his lower abdomen, "comes and goes," and "feels more like a cramp than a dull ache" C) A 44-year-old man who works the evening shift at a factory and who states that his lower abdominal pain is much worse at night than during the day D) A 24-year-old man who has a stressful job but whose diarrhea and cramping do not worsen during periods of high stress
B
Which of the following measures would likely be rejected as part of a first-line weight loss plan for a client with a BMI of 30.2, type 2 diabetes, and hypertension? A) Prescription drug therapy B) Gastric bypass C) Calorie reduction by 500 to 1000 kcal/day D) 30 minutes or more of moderate-intensity activity at least 3 days per week
B
Which of the following statements about types of obesity is most accurate? A) Upper body obesity is often referred to as being shaped like a "pear." B) A waist-hip ratio greater than 1.0 in men can be interpreted to mean upper body obesity. C) Waist circumference is a measurement of subcutaneous abdominal adipose tissue but not intra-abdominal adipose tissue. D) A waist circumference of 40 inches or less in women is considered normal and therefore not associated with increased health risk.
B
Which of the following statements best captures an aspect of the process of fat digestion and absorption? A) Ingested triglycerides are broken down into absorbable form by gastric lipase. B) Triglycerides are digested with the aid of bile salts. C) Long-chain fatty acids are absorbed directly into the portal blood. D) Stool is not excreted until all fat is absorbed.
B
Which of the following would be an example of a child born with congenital insensitivity to pain? A child who A) develops pins-and-needles sensation after jumping out of a tree. B) fell off a skate board and fractured ankle but did not feel any pain and just noted swelling in foot. C) skinned knee from a bike accident but only told parents when it started burning. D) cries every time the wind blows because it hurts his face and ears.
B
A 40-year-old female has been categorized as being obese, with a body mass index (BMI) of 33.2. Which of the following health problems place the client at a significantly increased risk for when compared with individuals with a BMI below 25? Select all that apply. A) Cardiac arrhythmias B) Osteoarthritis C) Multiple sclerosis D) Atelectasis E) Gallbladder disease F) Insulin resistance
B E F
A 20-year-old male who is addicted to crystal methamphetamine has been admitted to a hospital with a diagnosis of protein-calorie malnutrition after many months of inadequate food intake. Which of the following treatment plans would the care team most likely favor? A) Intravenous infusion of albumin coupled with vitamin supplementation B) Total parenteral nutrition C) Incrementally feeding combined with vitamin and mineral supplementation D) Rapid administration of normal saline and carbohydrates
C
A 25-year-old woman who works as an air-traffic controller presents with facial pain and severe headache. She reports that she sometimes feels the pain in her neck or ear and that it is particularly bad during very busy times at the airport. What is the most likely diagnosis? A) Migraine headache B) Cluster headache C) Temporomandibular joint syndrome D) Sinus headache
C
A 28-year-old man presents with complaints of diarrhea, fecal urgency, and weight loss. His stool is light colored and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and complains of pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which of the following diagnoses would his care team first suspect? A) Crohn disease B) Ulcerative colitis C) Diverticulitis D) Colon cancer
C
A 30-year-old female has suffered a third-degree burn to her hand after spilling hot oil on it in a kitchen accident. Which of the following teaching points by a member of her care team is most appropriate? A) "Tell us as soon as you sense the beginnings of a round of pain, and we will start with analgesics." B) "Opioids like morphine often cause constipation, but if this happens to you, we will discontinue opioids and change to another family of medications." C) "Opioids aren't without side effects, but we will take action to manage these side effects, so you can continue getting these drugs." D) "It's imperative that we prevent you from developing a tolerance for opioids while you're getting treatment for your burn."
C
A 51-year-old male has been diagnosed with alcohol-induced liver disease. He admits to the nurse providing his care that, "I know what the lungs do, and I know what the heart does, but honestly I have no idea what the liver does in the body." Which of the following statements would best underlie the explanation that the nurse provides? A) The liver is responsible for the absorption of most dietary nutrients as well as the production of growth hormones. B) The liver contributes to the metabolism of ingested food and provides the fluids that the GI tract requires. C) The liver metabolizes most components of food and also cleans the blood of bacteria and drugs. D) The liver maintains a balanced level of electrolytes and pH in the body and stores glucose, minerals, and vitamins.
C
A 55-year-old man has been diagnosed with a gastroesophageal reflux disease (GERD), in which the function of his lower esophageal sphincter is compromised. Which of the following consequences of this condition is most likely to occur? A) Decreased absorption of ingested foods and fluids B) Impaired control of the gastric emptying rate C) Protrusion of the stomach or regurgitation of stomach contents into the esophagus D) Inappropriate release of gastric enzymes
C
A 70-year-old male with a 40 pack-year history of smoking and long-standing non-insulin-dependent diabetes has been diagnosed with pancreatic cancer. Which of the following teaching points should the physician provide? A) "While this is indeed serious, you should know that you have a good chance of beating this disease with appropriate treatment." B) "Most likely your pattern of high alcohol intake over the years contributed to your cancer." C) "You will likely be facing surgery in the near future, but know that this is very unlikely to eliminate your cancer." D) "I know it may seem trivial at this point, but the levels of pain that accompany cancer of the pancreas are normally quite low."
C
A 71-year-old male has been recently diagnosed with a stage III tumor of colorectal cancer and is attempting to increase his knowledge base of his diagnosis. Which of the following statements about colorectal cancer demonstrates a sound understanding of the disease? A) "If accurate screening test for this type of cancer existed, it could likely have been caught earlier." B) "The NSAIDs and aspirin that I've been taking for many years probably contributing to me getting cancer." C) "While diet is thought to play a role in the development of colorectal cancer, the ultimate causes are largely unknown." D) "A large majority of patients who have my type of colon cancer survive to live many more years."
C
A male client complaining of chronic cramping, bloating, and diarrhea has been determined to have a deficiency in brush border enzymes within his small intestine. Which of the following meals or snacks high in carbohydrates and protein will likely exacerbate the client's signs and symptoms? A) Grapefruit and prunes B) Tossed salad with an oil and vinegar dressing C) Roast beef and a baked potato D) Tortilla chips and guacamole
C
A male infant is brought into the clinic because of colic-like symptoms. The mother states he acts like something is hurting. After eating, he vomits most of the feeding and then assumes a fetal position. He is also not gaining weight. The nurse practitioner is thinking that he is displaying clinical manifestations of obstruction and may have which of the following medical diagnoses? A) Duodenal ulceration B) Constipation C) Pyloric stenosis D) Erosive esophagitis
C
A nurse on a postsurgical unit is providing care for a 76-year-old female client who is 2 days posthemiarthroplasty (hip replacement) and who states that her pain has been out of control for the last several hours, though she is not exhibiting signs of pain. Which of the following guidelines should the nurse use for short-term and long-term treatment of the client's pain? A) Reconciling the client's need for opioid analgesics with the risk of addiction to these drugs B) Recognizing the client's pain is not likely self-limiting C) Knowing that the client's self-report of pain is the most reliable indicator of pain D) Realizing that chronic pain is likely to require innovative and complex treatment
C
A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's following questions is least likely to yield data that will allow for a confirmation or ruling out of migraines as the cause of his problem? A) "Does your son have a family history of migraines?" B) "When your son has a headache, does he ever have nausea and vomiting as well?" C) "Does your son have any food allergies that have been identified?" D) "Is your son generally pain free during the intervals between headaches?"
C
A nurse practitioner is providing care for a male client with a long-standing hiatal hernia. Which of the following statements most accurately captures an aspect of the pathophysiology of hiatal hernias? A) Paraesophageal hiatal hernias are common and are normally not treated if the client is asymptomatic. B) The root causes of hiatal hernias are normally treatable with medication. C) If esophageal acid clearance is impaired, esophagitis can result. D) An incompetent pyloric sphincter and high-fat diet are commonly implicated in the development of hiatal hernias.
C
A nurse who works on an oncology ward is providing care for a 68-year-old female patient with a diagnosis of lung cancer with bone metastases. The client is experiencing rapid weight loss and is exhibiting the signs and symptoms of malnutrition. The nurse would recognize that which of the following factors is most likely contributing to the client's malnutrition? A) Autoimmune responses associated with acute illness are inhibiting anabolism. B) Chronic hypoxia is precluding many of the aerobic processes required in body maintenance and repair. C) Protein mass is being lost from the liver and other organs, and the liver is synthesizing fewer serum proteins. D) Intestinal malabsorption is occurring as a result of tumor metastases.
C
A patient has just been diagnosed with pernicious anemia. The patient asks the nurse why his body is not able to absorb vitamin B12. The nurse responds, A) "You have too many ulcers in your stomach." B) "More than likely, you were born with deficient vitamin B12 stores." C) "Your stomach is not secreting a substance known as intrinsic factor, which is needed to absorb vitamin B12." D) "Your daily intake of high saturated fats is interfering with the stomach's ability to absorb the nutrients that it needs, especially vitamin B12."
C
A patient with pancreatic cancer is admitted for portal hypertension in which he is symptomatic with ascites. Following paracentesis and removal of 7.5 L of ascitic fluid, the nurse should anticipate that the physician will order which of the following medications to assist in maintaining an effective circulating fluid volume? A) Bumetanide (Bumex) B) Furosemide (Lasix) C) Albumin (human) 5% D) Epogen (epoetin alfa)
C
A science teacher is talking to a group of fifth graders about the role of "spit." During the course of the discussion, the teacher asks the students which of the following are functions of saliva? A) Good protection device if someone is being attacked B) Will have more saliva production when anxious, such as right before a test C) Has antibacterial action to help keep the mouth clean D) Secretes acid to chemically break down fatty foods like French fries E) Secretes the enzyme pepsin
C
A speech therapist is performing a swallowing assessment on a 72-year-old man who has suffered a stroke 3 weeks ago. The man has been NPO (nothing by mouth) since his stroke, and the health care team is considering the introduction of oral food. The speech therapist is cueing the client to swallow to preclude either aspiration of food or pocketing of food in the sides of his mouth. The client most likely to have conscious control over which of the following processes listed below involved in swallowing? A) Initiation of primary peristalsis B) Moving the epiglottis back to cover the larynx C) Moving a bolus to the posterior wall of the pharynx D) Moving the bolus backward in the esophagus
C
A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over their face. Which of the following sources is most likely to provide the input that allows for the woman's unique ability? A) Pacinian corpuscles B) Ruffini end organs C) Meissner corpuscles D) Free nerve endings
C
As part of the intake protocol at an eating disorders clinic, an interview precedes a physical examination. Which of the following questions would a clinician be justified in excluding from an intake interview of a 16-year-old female referred by her pediatrician for the treatment of anorexia nervosa? A) "Do you remember when your last menstrual period was? B) "Have you noticed any new hair growth on your body in the last several months?" C) "Have you had any episodes of shortness of breath in the recent past?" D) "Can you tell me about some of the habits that you have related to food in your daily routine?"
C
Following a 14-day course of broad-spectrum antibiotics for the treatment of sepsis, a 60-year-old woman has developed watery diarrhea. Her care team attributes this to likely elimination of normal intestinal flora by the antibiotics. What other phenomena is most likely accompanying her low levels of normal flora? A) Decreased mineral and nutrient absorption; decreased carbohydrate metabolism B) Decreased pH of the stomach; increased pH of the lower GI tract C) Decreased fermentation of undigestible dietary residue; decreased vitamin absorption D) Proliferation of vitamin K; lower GI bleeding
C
Following a history of gastric pain and an endoscopy, a client has been diagnosed with a duodenal peptic ulcer. Which of the following teaching points should his caregiver provide? A) "While your diet most certainly contributed to this problem, the good news is that changing your diet can help solve it." B) "Ulcers like yours do not penetrate all layers of the stomach or duodenum, so you don't have to worry about losing too much blood." C) "Your family history, your smoking history, and NSAID use may all have contributed to this problem." D) "While there aren't really any effective medications for these ulcers, changes in lifestyle can keep them well controlled."
C
Following several days of intermittent upper right quadrant pain, a 29-year-old obese, Native American woman has been diagnosed with cholelithiasis. The nurse at the clinic has taught the client about the pathophysiology and contributing factors to her health problem, as well as some of the likely treatment options. Which of the following statements by the client demonstrates a sound understanding of her diagnosis? A) "All in all, I guess this is a result of the fact that I've been eating a diet too high in cholesterol for too long." B) "Several factors like my genetics and gender may have contributed to this, but I'm glad that medications can cure it." C) "This explains why my skin was yellow-tinged lately and why I had those pains that spread to my upper back and right shoulder." D) "I suppose the fever and vomiting I had this week was probably a sign of my gallstones too."
C
Parents of a 20-month-old infant report that he refuses food or eats poorly and that he grimaces when he swallows. He also is irritable and cries a lot. The mother is worried that he ate something inappropriate this morning, because he vomited something that looked like coffee grounds. Which of the following health problems would the care team first suspect? A) Rotavirus infection B) Appendicitis C) Esophagitis from gastrointestinal reflux D) Hirschsprung disease
C
The instructor asks a group of nursing students to explain the function of the omentum. The students will respond based on which pathophysiologic principle? A) It holds organs in place. B) It attaches the jejunum and ileum to the abdominal wall. C) It has lots of mobility and moves around in the peritoneal cavity with peristaltic movements. D) It is mainly there to prevent any noxious substance from inner into the gut.
C
The nurse walks into a room and finds the patient forcefully expelling stomach contents into a wash basin. When documenting this occurrence, the nurse will use the term A) nauseous. B) retching. C) vomiting. D) expatriate.
C
When counseling a group of overweight individuals, the nurse should stress that during parties, the oxidation of alcohol provides how many kilocalorie/gram to one's diet? A) 4 kcal/g B) 5 kcal/g C) 7 kcal/g D) 9 kcal/g
C
When explaining the role of liver Kupffer cells to a group of nursing students, which of the following statements about the function of these cells is most accurate? A) The primary function of Kupffer cells is to secrete bile. B) These cells are the functional unit of the liver and are responsible for all liver secretions. C) The cells are capable of removing and phagocytizing old and defective blood cells. D) The role of the Kupffer cells is to provide at least 50% of cardiac output each minute to each lobular of the liver.
C
Which of the following statements most accurately captures an aspect of the basal metabolic rate (BMR)? A) The resting BMR constitutes a small fraction of the total body energy needs. B) Females tend to have a lower BMR than males due to a smaller skeletal muscle mass. C) Variations in muscle mass account for much of the differences in the BMR that exist between individuals. D) The BMR remains consistent throughout the life span.
C
While batting, a baseball player is struck in the ribs by a pitch. Place the following components of the player's pain pathway in the chronological order as they contribute to the player's sensation of pain. Use all the options. A) Thalamus B) Dorsal root ganglion body C) Dorsal root ganglion periphery D) Axon E) Cerebral cortex
C B D A E
A male infant who is 48 hours postpartum is undergoing phototherapy for the treatment of jaundice and accompanying high levels of bilirubin. Place the following components of the production of bilirubin in the correct chronological order. Use all the options. A) Conjugated bilirubin B) Urobilinogen C) Red blood cells D) Biliverdin E) Free bilirubin
C D E A B
A 20-year-old male college student has recently finished a Thanksgiving dinner of heroic proportions while home for the holiday weekend. Which of the following phenomena would most likely have produced his sensation of satiety? A) Stretch receptors in the stomach and small intestine signal the feeding center in the medulla. B) Increased levels of leptin stimulate a decrease in appetite by way of the vagus nerve. C) The breakdown of products of lipids such as ketoacids produces a decrease in appetite. D) Cholecystokinin and glucagon-like peptide-1 suppress the hunger impulse.
D
A 20-year-old woman has visited her family physician due to occasional bouts of bloody diarrhea over the past several weeks, a phenomenon that she experienced 2 years prior as well. Her physician has diagnosed her with ulcerative colitis based on her history and visualization of the affected region by colonoscopy and sigmoidoscopy. Which of the following pathophysiological phenomena is most likely to underlie the client's health problem? A) Fissures and crevices developing in the mucosa that are seen as a characteristic "cobblestone" appearance B) Erosion of the endothelial lining of the distal small intestine by a combination of genetic, autoimmune, and environmental factors C) Compromise of the mucosal layer of the large intestinal surface by the effects of H. pylori D) Mucosal hemorrhages that have developed into crypt abscesses, which have in turn necrotized and ulcerated
D
A 24-year-old woman undergoing a premarital screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which of the following treatments is most likely to be effective for her? A) Lamivudine B) Peginterferon and ribavirin C) Interferon alfa-2b D) Corticosteroids and immunosuppressant drugs
D
A 43-year-old male who is 5′10″ tall and weighs 216 lb has been informed by his nurse practitioner that his body mass index (BMI) is 31. Which of the following clinical conclusions based on these data would his nurse be most justified in rejecting? A) Further investigation of his nutritional status is needed to supplement the BMI value. B) The client faces an increased risk of type 2 diabetes and hyperlipidemia. C) He is classified as being obese, likely as the result of the interplay of genetic and lifestyle factors. D) The client is borderline obese but is not yet at the point of significantly increased risks to health.
D
A 48-year-old woman has been diagnosed with extrahepatic cholestasis following a thorough history, ultrasound, and blood work. Which of the following symptoms most likely caused her to seek medical treatment, and what consequence to her health problem would the medical team anticipate? A) Complaints of lower flank pain with consequences of impaired fat metabolism B) Anorexia with consequences of impaired drug metabolism and blood filtration C) Skin xanthomas (focal accumulations of cholesterol) with consequences of increased risk of bleeding due to deficient clotting factors D) Pruritus with consequences of deficient levels of fat-soluble vitamins
D
A 51-year-old male professional is in the habit of consuming six to eight rum and cokes each evening after work. He assures the nurse practitioner who is performing his regular physical exam that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the client's statement? A) "You are more than likely inflicting damage on your liver, but this damage would cease as soon as you quit drinking." B) "That may be the case, but you are still creating a high risk of hepatitis A or B or liver cancer." C) "In spite of that, the amount of alcohol you are drinking is likely to result first in cirrhosis and, if you continue, in hepatitis or fatty liver changes." D) "When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic byproducts."
D
A 58-year-old woman comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as, "like an electric shock." The pain occurs only on one side of her face; it seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. There is no numbness associated with the pain. What is most likely causing her pain? A) Postherpetic neuralgia B) Migraine headache C) Complex regional pain syndrome D) Trigeminal neuralgia
D
A 60-year-old male client with a long history of back pain has had little success with a variety of analgesic regimens that his family physician has prescribed. He has recently been diagnosed with a chronic pain disorder. Which of the following teaching points about chronic pain would his physician most likely emphasize to the client? A) "If your pain comes and goes, then we won't characterize it as chronic, and it will require different treatment." B) "You need to remind yourself that this is a purely physical phenomenon that requires physical treatment." C) "Our challenge is to bring you relief but still treat the underlying back problem that your body is telling you about." D) "These pain signals your body is sending likely serve no real, useful, or protective function."
D
A 77-year-old woman has been admitted to hospital following several weeks of increasing fatigue. On observation, she is pale, and blood work indicates she has low hemoglobin and red cell counts. Stool tests for occult blood are positive, and following endoscopy, she has been diagnosed with an upper GI bleed that has been shown to originate in her stomach. She admits to regularly exceeding the recommended doses of nonsteroidal anti-inflammatory drugs (NSAIDs) in an effort to control her rheumatoid arthritis. Which of the following phenomena is most likely responsible for her present health problems? A) NSAIDs increase the gastric production of gastrin, increasing gastric secretions and lowering stomach pH. B) Drugs such as NSAIDs increase the H+ levels and thus decrease gastric pH, resulting in insult to the stomach lining. C) NSAIDs, aspirin, and other drugs increase prostaglandin synthesis, resulting in disruption of cellular structures lining the stomach. D) NSAIDs can disrupt the permeability of the gastric mucosa, causing hydrogen ions to accumulate in the mucosal cells of the lining.
D
A 79-year-old male resident of a long-term care facility has contracted Clostridium difficile and is experiencing consequent diarrhea. Auscultation of the man's abdomen indicates hyperactive bowel sounds. What process in the man's small intestine is most likely accompanying his current status? A) Pathogenic microorganisms are causing dilation of his small intestine, increasing motility. B) Segmentation waves have become more frequent as a result of his infection. C) Intestinal stasis brought on by infection is preventing his small intestine from sufficiently slowing the rate of motility. D) Inflammation is accompanied by an increase in peristaltic movements of his small intestine.
D
A female client with bone metastases secondary to lung cancer is admitted for palliative radiation treatment and pain control. The client is presently experiencing pain that she rates at 9 out of 10. Which of the following nonpharmacological treatments is most likely to be a useful and appropriate supplement to pharmacological analgesia at this point? A) Teaching the client guided imagery and meditation B) Initiating neurostimulation C) Heat therapy D) Relaxation and distraction
D
After several months of persistent heartburn, a 57-year-old female client has been diagnosed with gastroesophageal reflux disease (GERD). Which of the following treatment regimens is likely to best address the woman's health problem? A) Surgical correction of the incompetent pylorus B) Antacids; avoiding positions that exacerbate reflux; a soft-textured diet C) Weight loss and administration of calcium channel blocking medications D) Proton pump inhibitors; avoiding large meals; remaining upright after meals
D
During a humanitarian trip to an underdeveloped country, a medical student is assessing a 6-year-old male who has a protuberant abdomen, dry hair, and wrinkled skin. The child's heart rate is 59 beats/minute, blood pressure 89/50, and temperature 95.2°F (35.1°C). What is the most likely etiology of the child's health problems? A) A diet lacking in fat-soluble vitamins B) Fluid and electrolyte imbalances secondary to low -carbohydrate intake C) A diet that is low or high in carbohydrates but low in fat D) A diet deficient in both protein and calories
D
Which of the following clients would be most reasonably expected to have the highest basal metabolic rate (BMR), assuming none is obese or malnourished? A) A 22-year-old man, 69 inches tall, who has a sedentary lifestyle B) A 47-year-old woman, 65 inches tall, who swims 1 mile four times a week C) A 29-year-old woman, 61 inches tall, who is pregnant and on bed rest D) A 60-year-old man, 72 inches tall, who is recovering from heart surgery
D
Which of the following statements best communicates the nature of movements in the colon? A) The internal and external anal sphincters control the movement of feces into and through the colon. B) Haustrations move the colon contents along with 2- to 3-minute rest periods between movements. C) Segmentation waves ensure that all surfaces of the feces are exposed to the colon surface. D) Large segments of the colon contract as a unit for around 30 seconds.
D
While on tour, a 32-year-old male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal pain. He admits to a history of copious alcohol use in recent years, and his vital signs include temperature 46.8°C (101.8°F), blood pressure 89/48 mm Hg, and heart rate 116 beats/minute. Blood work indicates that his serum levels of C-reactive protein, amylase, and lipase are all elevated. Which of the following diagnoses would the care team suspect first? A) Hepatitis C B) Cholecystitis C) Liver cirrhosis D) Acute pancreatitis
D
Place the following components of the gastrointestinal tract in the chronological order that a bolus of food would pass through them. Use all the options. A) Ileum B) Pylorus C) Jejunum D) Hiatus E) Cecum F) Duodenum
D B F C A E
