Patho Hesi

Which of the following assessment findings would lead the nurse to suspect the client has nephrotic syndrome? A) Hematuria and anemia B) Proteinuria and generalized edema C) Renal colic and increased serum sodium D) Increased creatinine with normal blood urea nitrogen

Ans: B Feedback: The nephrotic syndrome is characterized by massive proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized edema, and hyperlipidemia.

Which of the following characteristics distinguishes kwashiorkor from marasmus? A) Impairment of immune function B) Lack of dietary fat intake C) High intake of carbohydrates D) Impaired pigment synthesis

Ans: C Feedback: Kwashiorkor is a protein deficiency coupled with a high-carbohydrate diet; marasmus is a deficiency in both calories and protein. Both forms of malnutrition impair immune function and pigment synthesis, and each is normally accompanied by inadequate intake of dietary fats.

When educating a client with possible glucocorticoid dysfunction, the nurse will explain that the CRH controls the release of ACTH. The best time to perform the blood test to measure peak ACTH levels would be: A) 06:00 to 08:00 AM B) 10:00 to 12:00 AM C) 04:00 to 6:00 PM D) 09:00 to 11:00 PM

Ans: A Feedback: Levels of cortisol increase as ACTH levels rise and decrease as ACTH levels fall. There is considerable diurnal variation in ACTH levels, which reach their peak in the early morning (around 6 to 8 AM) and decline as the day progresses.

Which of the following assessment questions is most likely to address the causation of a woman's new case of candidiasis? A) "Have you recently begun a new sexual relationship?" B) "Have you been on antibiotics recently?" C) "Have you noticed any new growths on your vagina in recent months?" D) "Do you use condoms during sexual activity?"

Ans: B Feedback: Recent antibiotic therapy frequently underlies causes of candidiasis. The disease is not normally transmitted by sexual contact, and tissue growth is not an associated sign.

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? A) Peripheral vasodilation B) Necrosis C) Hypoventilation D) Increased heart rate

Ans: D Feedback: Consequences of hypoxemia include peripheral vasoconstriction, hyperventilation, and increased heart rate. Mild to moderate hypoxemia does not result in cell death and necrosis.

The most prevalent vaginal infection to be spread through sexual contact is: A) Candidiasis B) Trichomoniasis C) Vulvovaginitis D) Bacterial vaginosis

Ans: B Feedback: Candidiasis is a yeast infection with a white cheesy discharge that causes vulvovaginitis. Bacterial vaginosis is a nonspecific type of infection that produces a characteristic fishy-smelling discharge, the result of an imbalance of the normal vaginal flora. These infections are not normally spread by sexual contact. Trichomoniasis is usually spread through sexual contact.

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? A) Weakness in the muscular wall of an artery B) Impaired synthesis of clotting factors C) Deficits in the autonomic control of blood pressure D) Increased levels of cerebrospinal fluid

Ans: A Feedback: Aneurysms are direct manifestations of a weakness that exists in the muscular wall of an arterial vessel. Hypertension is a significant risk factor, but autonomic contributions are not common. Levels of cerebrospinal fluid (CSF) and hypo- or hypercoagulability are not implicated in the pathogenesis of aneurysms.

What pain theory proposes that pain receptors share pathways with other sensory modalities and that different activity patterns of the same neurons can be used to signal painful or nonpainful stimuli? A) Pattern B) Specificity C) Gate control D) Neuromatrix

Ans: A Feedback: A group of pain theories known as the pattern theory proposes that receptors share pathways with other sensory modalities, and different activity patterns of the same neurons can be used to signal painful or nonpainful stimuli. The specificity theory regards pain as a separate sensory modality evoked by the activity of specific receptors that transmit information to forebrain pain centers, where pain is experienced. Gate control theory postulated the presence of neural gating mechanisms at the segmental spinal cord level to account for interactions between pain and other sensory modalities. The neuromatrix theory proposes that the brain contains a widely distributed neural network

A couple has chosen to pay for the harvesting and storage of umbilical cord blood after the delivery of their child to secure a future source of embryonic stem cells. What is the most likely rationale for the couple's decision? A) The stem cells may be able to produce a wide range of body cells. B) The embryonic stem cells allow stable and permanent tissues to enter mitosis. C) The stem cells can change the proliferative capacity of other cells. D) The embryonic stem cells remove cyclin-dependent kinase inhibitors from the body.

Ans: A Feedback: Embryonic stem cells hold the potential for broad differentiation. They do not change the proliferative capacity of existing cells and they do not foster mitosis by removing CKIs.

Which of the following facts underlies the concept of replicative senescence? A) Genes controlling longevity are present or absent in varying quantities among different individuals. B) Telomeres become progressively shorter in successive generations of a cell. C) The damaging influence of free radicals increases exponentially in later generations of a cell. D) Aging produces mutations in DNA and deficits in DNA repair.

Ans: B Feedback: Replicative senescence implies that cells have limited capacity for reproduction, largely as a result of the shortening of telomeres and consequent chromosomal damage. Genetic theories, the influence of free radicals, and DNA mutation are not central to the concept of replicative senescence.

The most common causes of left-sided heart failure include: A) Acute myocardial infarction B) Chronic pulmonary disease C) Impaired renal blood flow D) Tricuspid valve regurgitation

Ans: A Feedback: The most common causes of left-sided heart failure are acute myocardial infarction and hypertension. Acute or chronic pulmonary disease can cause right heart failure, referred to as cor pulmonale. The causes of right-sided heart failure include stenosis or regurgitation of the tricuspid or pulmonic valves, right ventricular infarction, and cardiomyopathy. Manifestations (rather than causes) of heart failure reflect the physiologic effects of the impaired pumping ability of the heart, including decreased renal blood flow.

When a person is stung on the index finger by a bee, the thalamus interprets the pain as: A) Somewhere on the hand B) A spot on the index finger C) Attributable to a bee stung D) Similar to a previous bee sting

Ans: A Feedback: The basic sensation of hurtfulness, or pain, occurs at the level of the thalamus. In the neospinothalamic system, interconnections between the lateral thalamus and the somatosensory cortex are necessary to add precision and discrimination to the pain sensation. In addition, association areas of the parietal cortex are essential to the learned meaningfulness of the pain experience. For example, if a person is stung on the index finger by a bee and only the thalamus is functional, the person reports pain somewhere on the hand. With the primary sensory cortex functional, the person can localize the pain to the precise area on the index finger. With the association cortex functional, the person can interpret the buzzing and sight of the bee that preceded the pain as being related to the bee sting.

A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung tumor in a client. Which of the following characteristics is associated with this client's neoplasm? A) The tumor will grow by expansion and is likely encapsulated. B) The cells that constitute the tumor are undifferentiated, with atypical structure. C) If left untreated, the client's tumor is likely to metastasize. D) The tumor is likely to infiltrate the lung tissue that presently surrounds it.

Ans: A A polyp is a growth that projects from Feedback: Benign neoplasms typically grow by expansion rather than invasion. As well, they are usually contained within a fibrous capsule. Malignant tumors are associated with undifferentiated cells, metastasis, and infiltration of surrounding tissue.

Assessment of an elderly female client reveals the presence of bilateral pitting edema of the client's feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the client's lungs reveals clear air entry to bases, and the client's oxygen saturation level is 93%, and vital signs are within reference ranges. What is this client's most likely health problem? A) Right-sided heart failure B) Pericarditis C) Cardiogenic shock D) Cor pulmonale

Ans: A Feedback: A major effect of right-sided heart failure is the development of peripheral edema. A client who is in shock would not have stable vital signs. Cor pulmonale would be accompanied by manifestations of lung disease. Pericarditis is an inflammation of the pericardium exhibited by fever, precordial pain, dyspnea, and palpitations.

A couple has just learned that their newborn infant has been diagnosed with osteogenesis imperfecta, and they have responded by seeking out as much information as possible about their child's diagnosis. What should the clinician teach the couple about their child's health problem? A) "This is something that your child may have inherited from one or both of you." B) "This might have been caused by something you were exposed to during the early part of your pregnancy." C) "You'll have to be vigilant of your child's safety for the next few years, but the disease often resolves spontaneously." D) "With aggressive treatment, most children with osteogenesis imperfecta are cured within several months."

Ans: A Feedback: Osteogenesis imperfecta can be inherited as an autosomal recessive or dominant trait; environmental factors are not thought to cause the disease. It is not self-limiting, and there is no known cure.

Preload represents the volume work of the heart and is largely determined by: A) Venous blood return B) Vascular resistance C) Force of contraction D) Ventricular emptying

Ans: A Feedback: Preload represents the amount of blood the heart must pump with each beat and represents the volume of blood stretching the ventricular muscle fibers at the end of diastole. Pressure (resistance), contraction, and ventricular emptying relate to afterload.

Following delivery, the parents have chosen to have their infant's cord blood frozen. A blood test is performed on the cord blood and found to contain IgM antibodies. The nurse interprets this to mean: A) The infant has been exposed to an intrauterine infection. B) The infant has received active antibodies from the mother. C) The child's placenta was defective since it did not filter the IgM out of the blood. D) The child likely already has developed an immunocompromised disease.

Ans: A Feedback: Protection of a newborn against antigens occurs through transfer of maternal antibodies. Maternal IgG antibodies cross the placenta during fetal development and remain functional in the newborn for the first months of life. IgG is the only class of immunoglobulins to cross the placenta. Cord blood does not normally contain IgM or IgA. If present, these antibodies are of fetal origin and represent exposure to intrauterine infection.

A client's cell-mediated immune response has resulted in the release of regulator T cells. These cells will perform which of the following roles? A) Suppressing the immune response to limit proliferation of potentially harmful lymphocytes B) Presenting antigens to B cells to facilitate the production of antibodies C) Differentiating into subpopulations of helper T cells D) Destroying target cells by releasing cytolytic enzymes and other toxins

Ans: A Feedback: Regulatory T cells suppress immune responses by inhibiting the proliferation of other potentially harmful self-reactive lymphocytes. They do not present antigens to B cells, and activated CD4+ T cells differentiate into subpopulations of other helper T cells. Cytotoxic T cells participate in the active destruction of target cells.

When asking pathophysiology students, "Why do sebaceous glands secrete sebum?" the student with the correct answer would be: A) To lubricate skin and hair B) To supply energy in the form of fibrous protein C) To increase water amounts released via perspiration D) To supply a nutritional source for vitamin D

Ans: A Feedback: Sebaceous glands secrete sebum, an oily mixture consisting of lipids, including triglycerides, cholesterol, and wax, that lubricates hair and skin. Keratinocytes of the epidermis produce a fibrous protein called keratin, which is essential to the protective function of skin. Sweat glands produce watery secretions. The dermis supports the epidermis and serves as its primary source of nutrition.

The most damaging effects of urinary obstruction are the result unrelieved obstruction of urine outflow and: A) Urinary stasis B) Concentrated urine C) Kidney hyperplasia D) Renal hypertension

Ans: A Feedback: The most damaging effects of urinary obstruction are stasis of urine, which predisposes to infection and stone formation, and unrelieved obstruction of urine outflow. Most commonly, the person has pain, signs, and symptoms of urinary tract infection (UTI) and manifestations of renal dysfunction, such as an impaired ability to concentrate urine. Progressive atrophy of the kidney is caused by obstruction of the outflow of urine. Hypertension is an occasional complication of urinary tract obstruction, since urine flow is obstructed rather than renal blood flow.

A client has been diagnosed with an anterior pituitary tumor, and synthesis and release of follicle-stimulating hormone has become deranged. What are the potential consequences of this alteration in endocrine function? A) Dysfunction of spermatogenesis B) Overproduction of luteinizing hormone C) Inhibition of testosterone synthesis D) Impaired detumescence

Ans: A Feedback: Two gonadotropic hormones are secreted by the pituitary gland: FSH and luteinizing hormone (LH). In the male, LH also is called interstitial cell-stimulating hormone. The production of testosterone by the interstitial cells of Leydig is regulated by LH. FSH binds selectively to Sertoli cells surrounding the seminiferous tubules, where it functions in the initiation of spermatogenesis. FSH does not directly affect the production of LH, since both are produced by the anterior pituitary. FSH does not stimulate testosterone synthesis, and impaired detumescence is unlikely to be a direct consequence of changes in FSH synthesis and release

While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by: A) Weighing every day at the same time with same type of clothing B) Measuring all of the client's urine output daily to check for a decrease in output C) Listening to the breath sound with a stethoscope every morning D) Take blood pressure daily and call doctor if it is decreased

Ans: A Feedback: When the right heart fails, a damming back of blood occurs, leading to its accumulation in the systemic venous system, causing an increase in right atrial, right ventricular end-diastolic, and systemic venous pressures. The accumulation of fluid (edema) is evidenced by a gain in weight (i.e., 1 pint of accumulated fluid results in a 1-pound weight gain). Shortness of breath due to congestion of the pulmonary circulation is one of the major manifestations of left-sided heart failure. It is unrealistic to expect clients to listen to their own breath sounds. BP measurement could be an intervention; however, it is not a primary indicator of edema from right-sided heart failure. With impairment of left heart function, there is a decrease in cardiac output, with resulting decreased renal perfusion and output.

A client with a complete tear of the rotator cuff in the right shoulder was given the choice between surgery and stem cell transplant. The client chose to try the stem cell injection. The client asked the health care provider, "How does this work on my shoulder?" The best response would be: A) Bone marrow stem cells have been shown to generate cartilage, bone, and muscle when injected directly into the injured site. B) The stem cells will circulate through your arterial system and come to rest in any area that is inflamed and in need of repair. C) Stem cell injection is similar to a blood transfusion in that the cells will bring more oxygen and nutrients to the damaged tissue. D) In addition to stem cells, the physician will give you some growth factor to help your body build more muscle mass.

Ans: A Feedback: Whether adult stem cells have a differentiation capacity similar to that of embryonic stem cells remains the subject of current debate and research. Thus far, bone marrow stem cells have been shown to have very broad differentiation capabilities, being able to generate not only blood cells but also fat, cartilage, bone, endothelial, and muscle cells.

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? A) Thoracentesis B) Supplementary oxygen therapy C) Administration of corticosteroids D) Administration of bronchodilators

Ans: A Feedback: With large effusions, thoracentesis may be used to remove fluid from the intrapleural space and allow for reexpansion of the lung.

Following an episode of strep throat, the school nurse notices the fourth grade child has not recovered from this illness a week later. Upon further investigation, the nurse notices that the child has developed water retention. Which of the following assessments support this conclusion? Select all that apply. A) Periorbital edema B) BP 100/70 C) Swelling of the hands and fingers D) Vomiting after intake of any solid food E) Dizziness and right ear pain

Ans: A, B Feedback: Generalized edema, a hallmark of nephrosis, results from salt and water retention and a decrease in plasma colloid osmotic pressure due to loss of albumin in the urine. Glomerulonephritis is characterized by sodium and water retention that causes edema, particularly of the face and hands. Fluid retention usually results in an elevated BP, not a normal one. Vomiting and dizziness are not associated with this diagnosis.

When caring for a cancer client experiencing chemotherapy-induced nausea and vomiting, which of the following drugs work to delay this nausea and vomiting by acting on the CNS to block the activation of the NK-1 receptors? Select all that apply. A) Serotonin (5-hydroxytryamine) antagonists B) Neurokinin-1 receptor antagonists C) Promethazine, a neuroleptic medication D) Compazine, a dopamine (D2) receptor antagonist

Ans: A, B Feedback: The recently developed Neurokinin-1 (NK-1) receptor antagonists are used for the treatment of acute and delayed chemotherapy-induced nausea and vomiting. These drugs act centrally to block the activation of the NK-1 receptors in the vomiting center. Serotonin (5-hydroxytryamine) antagonists are involved in the nausea and emesis associated with cancer chemotherapy and radiation. Promethazine is a neuroleptic medication. Compazine, a dopamine (D2) receptor antagonist, depresses vomiting caused by stimulation of the chemoreceptor trigger zone

A person eating peanuts starts choking and collapses. His airway obstruction is partially cleared, but he remains hypoxic until he reaches the hospital. The health care providers will be assessing this client for which of the following physiological events? Select all that apply. A) Cerebral infarction B) Coagulation necrosis C) Rapid phagocytosis D) Protein p53 deficiency

Ans: A, B Feedback: Tissue infarction is caused by prolonged oxygen deprivation, and the resulting large group of dead cells coagulates in the damaged area. During coagulation necrosis, acidosis develops and denatures the enzymatic and structural proteins of the cell. Phagocytosis occurs rapidly during apoptosis, so it does not elicit an inflammatory response. Protein p53 activation initiates apoptosis.

A 16-year-old girl has been admitted to the emergency department after ingesting 20 g of acetaminophen (Tylenol) in a suicide attempt. The care team would recognize that this client faces a severe risk of acute fulminant hepatitis, with elevated ammonia levels that can result in: Select all that apply. A) Flapping tremor (asterixis) B) Confusion C) Convulsions D) Elevated creatinine levels E) Photosensitivity

Ans: A, B, C Feedback: Among the manifestations of the direct, predictable liver injury that accompanies overdoses of acetaminophen is acute fulminant hepatitis. A very early sign of hepatic encephalopathy is a flapping tremor called asterixis. It also results in CNS signs/symptoms of confusion, coma, and convulsions. Elevated creatinine levels are not usually associated with acute fulminant hepatitis.

Which of the following clients coming to a small free clinic are at high risk for malnutrition? Select all that apply. A) An 88-year-old senior citizen on a fixed budget B) A 60-year-old homeless Vietnam veteran complaining of pain C) A 4-year-old child who lives with a single mom in a rooming house D) A 17-year-old female who thinks she might have been exposed to syphilis E) A 32-year-old construction working having muscle spasms in his back

Ans: A, B, C Feedback: Among the many causes of malnutrition are poverty and lack of knowledge, acute and chronic illness, and self-imposed dietary restrictions. Homeless people, the elderly, and the children of the poor often demonstrate the effects of protein and energy malnutrition, as well as vitamin and mineral deficiencies. Sexually active teenagers and working young adults are not usually at high risk for malnutrition.

Chlamydiaceae have characteristics of both viruses and bacteria and are a rather common sexually transmitted infectious organism. After entry into the host, they transform into a reticulate body. The health care provider should monitor which of the following clients for this possible infection? Select all that apply. A) An adult male who raises a number of exotic birds in his home B) A drug abuser looking to share needles/syringes C) A newborn with a noticeable eye infection D) A teenager who swims in the lake regularly

Ans: A, B, C Feedback: Chlamydiaceae are in the form of an elementary body when infectious and outside of the host cell. Once an organism enters the cell, it transforms into a large reticulate body. This undergoes active replication into multiple elementary bodies, which are then shed into the extracellular environment to initiate another infectious cycle. Chlamydial diseases of humans include sexually transmitted genital infections (Chlamydophila trachomatis); ocular infections and pneumonia of newborns (C. trachomatis); upper and lower respiratory tract infections in children, adolescents, and young adults (Chlamydophila pneumoniae); and respiratory disease acquired from infected birds (Chlamydophila psittaci).

The physiology instructor asks the students, "How does growth factor affect cell proliferation?" Which students have the most accurate responses? Growth factors: Select all that apply. A) Regulate the inflammatory process B) Act as a chemoattractant for many cells like neutrophils and macrophages C) Inhibit the beginning stages of cell changes that can result in cancer D) Stimulate new blood vessel growth E) Inhibit cell proliferation

Ans: A, B, D Feedback: The term growth factor is generally applied to small proteins that increase cell size and cell division. In addition to cell proliferation, most growth factors have other effects. They assist in regulating the inflammatory process; serve as chemoattractants for neutrophils, monocytes (macrophages), fibroblasts, keratinocytes, and epithelial cells; stimulate angiogenesis; and contribute to the generation of the ECM

Which of the following clinical manifestations following thyroidectomy would alert the nurse that the client is going into a life-threatening thyroid storm? Select all that apply. A) Temperature of 104.2°F B) Telemetry showing heart rate of 184 C) Unable to close eyelids completely together D) Extremely agitated E) Bruising on knees and feet

Ans: A, B, D Feedback: Thyroid storm, or crisis, is an extreme and life-threatening form of thyrotoxicosis, rarely seen today. When it does occur, it is seen most often in undiagnosed cases or in person with hyperthyroidism that has not been adequately treated. It often is precipitated by stress such as an infection, diabetic ketoacidosis, physical or emotional trauma, or manipulation of a hyperactive thyroid gland during thyroidectomy. It is manifested by a very high fever, extreme cardiovascular effects (tachycardia, HF, angina), and severe CNS effects (agitation, restlessness, and delirium)

Which of the following outpatients are at a greater risk for developing Treponema pallidum, the cause of syphilis? Select all that apply. A) A homeless adolescent female performing oral sex for money B) A male who frequents clubs catering to exotic dancers and sexual favors C) A homosexual male couple who have had a monogamous relationship for the past 20 years D) An older adult female living in a condominium who regularly has sex with three to four different men/week

Ans: A, B, D Feedback: Treponema pallidum is a sexually transmitted infection that is spread by direct physical contact. The Borrelia type of spirochete is spread from animals to humans through lice or tick bites. Leptospira spirochetes spread from animals to humans through contact with infected animal urine. Spirochetes are anaerobic; therefore, they would not invade the host through oxygen-filled aerobic lungs.

A woman who has developed vulvovaginal candidiasis will likely go to her health care provider complaining of: Select all that apply. A) Redness B) Edema C) Frothy, foul-smelling discharge D) Painful urination E) Pustules on labia

Ans: A, B, D Feedback: Women with vulvovaginal candidiasis commonly complain of vulvovaginal pruritus accompanied by irritation, erythema, swelling, dysuria, and dyspareunia. The characteristic discharge, when present, is usually thick, white, and odorless. Trichomoniasis manifestations include presentation with copious, frothy, malodorous green or yellow discharge.

A homeless client asks, "Why can't I get this wound on my foot to heal?" Knowing that the client is not receiving good nutrition on a regular basis, the nurse will reply: A) "Maybe if you could come to the clinic every day, we can help you change your dressing." B) "Right now your immune system is decreased because you are not eating a balanced diet." C) "Maybe if you could find a place to sleep that is cleaner than where you usually sleep that will help." D) "We just need to make sure you are getting the right antibiotics."

Ans: B Feedback: As protein is lost from the liver, hepatic synthesis of proteins declines, and plasma protein levels decrease. There also is a decrease in immune cells. Wound healing is poor, and the body is unable to fight off infection because of multiple immunologic malfunctions throughout the body.

Following the diagnosis of nephrotic syndrome, the nurse knows the clinical manifestations occur as a result of a decreased plasma colloidal osmotic pressure. Therefore, the nurse should assess the client for: Select all that apply. A) Moist crackles in both lung fields B) Areas of diminished breath sounds due to pleural effusions C) Liver enlargement D) Kidneys palpable to deep palpation E) Increased circumference in the abdomen related to fluid excess

Ans: A, B, E Feedback: Generalized edema, which is a hallmark of the nephrotic syndrome, results from a decrease in the plasma colloidal osmotic pressure due to the hypoalbuminemia that develops as albumin is lost from the vascular compartment. Initially, the edema presents in dependent parts of the body such as the lower extremities, but becomes more generalized as the disease progresses. Dyspnea due to pulmonary edema, pleural effusions, and diaphragmatic compromise due to ascites (increase fluid in the abdominal cavity) can develop in persons with nephrotic syndrome. Live enlargement is not associated with nephrotic syndrome, but increased synthesis of lipoproteins in the liver secondary to a compensatory increase in albumin production may occur. Palpable kidney mass is associated with cancer

Which of the following lab results may be associated with metastatic bone disease? Select all that apply. A) Elevated alkaline phosphatase B) Decreased creatinine levels C) High serum calcium levels D) Lower serum phosphate levels

Ans: A, C Feedback: Although any cancer can ultimately involve the skeleton, tumors that frequently spread to the skeletal system are those of the breast, lung, prostate, kidney, and thyroid. Serum levels of alkaline phosphatase and calcium often are elevated in persons with metastatic bone disease. Creatinine levels are not affected by this diagnosis

A client is admitted with late manifestations of cirrhosis. Which of the following clinical manifestations confirm this diagnosis? Select all that apply. A) Hepatomegaly felt on deep palpation B) Diffuse liver fibrosis with large, palpable lumps C) GI bleeding related to esophageal varices D) Acute renal failure with electrolyte imbalances E) Splenomegaly with bleeding tendencies

Ans: A, C, E Feedback: The manifestations of cirrhosis are variable, ranging from asymptomatic hepatomegaly to hepatic failure. Often there are no symptoms until the disease is far advanced. The late manifestations of cirrhosis are related to portal hypertension and liver failure. Splenomegaly, ascites, and portosystemic shunts (i.e., esophageal varices, gastric varices, and caput medusae) result from portal hypertension. Other complications include bleeding due to decreased clotting factors and thrombocytopenia due to splenomegaly. Hepatorenal syndrome refers to a functional renal failure seen during the terminal stages of liver failure with ascites. The end stage of chronic liver disease is characterized by diffuse liver fibrosis that replaces normally functioning liver tissue and forms constrictive bands that disrupt flow in the vascular channels and biliary duct systems.

At the cellular level, cardiac muscle cells respond to an increase in ventricular volume to the point of overload by: Select all that apply. A) Elongating the cardiac muscle cells B) Thickening of the individual myocytes C) Replicating the myofibrils D) Decreasing the ventricular wall thickness E) Symmetrically widening and lengthening the hypertrophy

Ans: A, D Feedback: At the cellular level, cardiac muscle cells respond to stimuli from stress placed on the ventricular wall by pressure and volume overload by initiating several different processes that lead to hypertrophy. With ventricular volume overload, the increase in wall stress leads to replication of myofibrils in series, elongation of the cardiac muscle cells, and eccentric hypertrophy. Eccentric hypertrophy leads to a decrease in ventricular wall thickness or thinning of the wall with an increase in diastolic volume and wall tension. Production of a symmetric hypertrophy occurs with a proportionate increase in muscle length and width, as occurs in athletes; concentric hypertrophy with an increase in wall thickness, as occurs in hypertension; and eccentric hypertrophy with a disproportionate increase in muscle length, as occurs in dilated cardiomyopathy. When the primary stimulus for hypertrophy is pressure overload, the increase in wall stress leads to parallel replication of myofibrils, thickening of the individual myocytes, and concentric hypertrophy. Concentric hypertrophy may preserve systolic function for a time, but eventually the work performed by the ventricle exceeds the vascular reserve, predisposing to ischemia.

From the following clients, who are at high risk for developing heart failure as a result of diastolic dysfunction? Select all that apply. A) A 48-year-old client with uncontrolled hypertension B) A marathon runner with history of chronic bradycardia whose pulse rate is 46 C) A 57-year-old client with history of ischemic heart disease D) A 70-year-old with enlarged left ventricle due to myocardial hypertrophy

Ans: A, D Feedback: Conditions that reduce the heart's ability to adequately fill during diastole, such as myocardial hypertrophy and tachycardia, can lead to heart failure. Hypertension remains the leading cause of diastolic dysfunction. Ischemic heart disease is associated with systolic heart failure, or impaired contractile performance. It is normal for athletes, like marathon runners, to have slow pulses.

Although growth rate is variable among types of bacteria, the growth of bacteria is dependent on: A) Biofilm communication B) Availability of nutrients C) An intact protein capsid D) Individual cell motility

Ans: B Feedback: Bacterial growth is dependent upon the availability of nutrients and physical growth conditions. Bacteria prefer to colonize as biofilm and communicate with other bacteria within the biofilm, but biofilm is not necessary for growth. Viruses (not bacteria) form a capsid. Although some bacteria have projections for motility, these are not necessary for growth.

A client is suspected of having the onset of alcoholic liver disease. The nurse should be assessing for which of the following manifestations related to the necrosis of liver cells? A) Tremors of the hands B) Rapid onset of jaundice C) Long muscle group atrophy D) Development of multiple skin nodules

Ans: B Feedback: Alcoholic hepatitis is the intermediate stage between fatty changes and cirrhosis and is characterized by inflammation and necrosis of liver cells. The condition is always serious and sometimes fatal. The cardinal sign of alcoholic hepatitis is rapid onset of jaundice. Hand tremors are not specific to alcoholic hepatitis. Long muscle group atrophy can occur but is not the primary sign. Development of nodules is not caused by alcoholic hepatitis

Which of the following physiologic processes results from the synthesis and release of testosterone? A) Protein catabolism B) Musculoskeletal growth C) Release of luteinizing hormone (LH) D) Prostatic hyperplasia

Ans: B Feedback: Among the numerous effects of testosterone are the promotion of musculoskeletal growth in particular and protein anabolism in general. LH and FSH precede the synthesis and release of testosterone, whereas prostatic hyperplasia is not a normal effect of testosterone.

A client with a history of chronic pyelonephritis has been admitted several times with recurrent bacterial infection of the urinary tract. The nurse should anticipate educating this client with regard to which common treatment regimen? A) Increase intake of cranberry juice to 2 L/day. B) Continue taking antibiotics for full 10 to 14 days even if symptoms of infection disappear. C) Force micturition every 2 hours while awake. D) Take prescribed diuretics early in the day to avoid having to get up during the night

Ans: B Feedback: Chronic pyelonephritis involves a recurrent or persistent bacterial infection superimposed on urinary tract obstruction, urine reflux, or both. Chronic obstructive pyelonephritis can be bilateral, caused by conditions that obstruct bladder outflow; or unilateral, such as occurs with ureteral obstruction. Cranberry juice, forced micturition, and diuretics are not standard treatments for chronic pyelonephritis.

Common risk factors associated with erectile dysfunction due to generalized penile arterial insufficiency include: A) Cryptorchidism B) Cigarette smoking C) Testicular torsion D) Benign prostate hypertrophy

Ans: B Feedback: Common risk factors for generalized penile arterial insufficiency include hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus, and pelvic irradiation. Cigarette smoking induces vasoconstriction and penile venous leakage because of its effects on cavernous smooth muscle. Cryptorchidism is a major risk factor for testicular cancer. Benign prostate hypertrophy (BPH) is a risk factor for ejaculatory pathway obstruction rather than erectile difficulties. With testicular torsion, testicular arterial perfusion is impaired.

A client with a history of heart failure has been referred for an echocardiogram. Results of this diagnostic test reveal the following findings: heart rate 80 beats/minute; end-diastolic volume 120 mL; and end-systolic volume 60 mL. What is this client's ejection fraction? A) 200 mL B) 50% C) 0.80 D) 180 mL

Ans: B Feedback: Ejection fraction = stroke volume ÷ end-diastolic volume, whereas stroke volume equals the difference between end-diastolic and end-systolic volume. Therefore, EF = 60 ÷ 120, or 50%.

A heart failure client has an echocardiogram performed revealing an ejection fraction (EF) of 40%. The nurse knows this EF is below normal and explains to the client: A) "This means you have a lot of pressure built-up inside your heart." B) "This means your heart is not pumping as much blood out of the heart with each beat." C) "You need to increase the amount of exercise you do to get your heart muscle back in shape." D) "Your ventricular muscle is getting too stiff to beat normally."

Ans: B Feedback: Ejection fraction is the percentage of diastolic volume ejected from the heart [left ventricle] during systole. Stroke volume is determined by the difference between end-diastolic and end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level.

The basement membrane surrounding a client's foot wound remains intact, a fact that bodes well for the wound-healing process. Which types of substances/cells are responsible for the synthesis of collagen and elastic fibers? A) Prostaglandins B) Fibroblasts C) Lymphocytes D) Glycoproteins

Ans: B Feedback: Fibroblasts are responsible for the synthesis of collagen, elastic, and reticular fibers. Prostagladins are inflammatory mediators. Lymphocytes are the smallest of the leukocytes, the major cellular components of the inflammatory response. Glycoproteins are responsible for maintaining the cell membrane.

A client with a history of several previous abdominal surgeries has been admitted to the hospital with several abdominal pains. Knowing that fibrous strands of collagen can form following abdominal surgery resulting in adhesions, the nurse should assess the client for: A) Excess fluid in the abdomen B) Intestinal obstruction causing constipation C) Peritoneal fluid leaking from the umbilicus D) Tight, rigid abdomen caused by bleeding from old surgical sites

Ans: B Feedback: If fibrosis occurs in any tissue space occupied by an inflammatory exudate, it is called organization. It occurs in serous cavities such as the pericardium and peritoneal cavities. Fibrous strands sometimes become organized within the peritoneal cavity following abdominal surgery or peritonitis. These strands of collagen, called adhesions, can trap loops of bowel and cause obstruction. Adhesions do not cause ascites (fluid in abdomen), leakage of serum from the umbilicus, or bleeding from old surgical scars.

When asked to name the parts of the pilosebaceous unit of the skin, which student has the correct answer? A) Eccrine secretions B) Sebaceous glands C) Keratinized plates D) Connective tissues

Ans: B Feedback: Most hair follicles are associated with sebaceous glands, and these structures combine to form the pilosebaceous unit. The nails are hardened keratinized plates. Eccrine sweat glands transport sweat to the outer skin surface to regulate body temperature. The subcutaneous tissue layer consists primarily of fat and connective tissues that lend support to the vascular and neural structures supplying the outer layers of the skin.

Nociceptors are sensory receptors that are activated by: A) Cortisol B) Noxious stimuli C) Pressure and touch D) Sudden movements

Ans: B Feedback: Nociceptors, or pain receptors, are sensory receptors that are activated by noxious insults to peripheral tissues and respond to several forms of painful stimulation, including mechanical, thermal, and chemical. Nociceptive stimuli are objectively defined as stimuli of such intensity that they cause or are close to causing tissue damage. Hormones do not activate nociceptors. Pressure, touch, and startle are not considered painful stimuli unless sufficiently extreme to elicit the reflexive withdrawal response.

Pleuritic chest pain associated with respiratory movements is usually described as: A) Bilateral B) Localized C) Continuous D) Substernal

Ans: B Feedback: Pleuritis is usually unilateral and tends to be localized to the lower and lateral part of the chest; pain worsens with chest movements, such as deep breathing and coughing that accentuate pressure changes in the pleural cavity and increase movement of the inflamed or injured pleural surfaces. Musculoskeletal pain usually is bilateral and may occur as the result of frequent, forceful coughing. The pain associated with irritation of the bronchi usually is substernal and dull. Myocardial pain usually is located in the substernal area and is not affected by respiratory movements.

Both prehepatic and posthepatic causes of portal hypertension include the formation of: A) Fibrous nodules B) Venous thrombosis C) Collateral circulation D) Portosystemic shunts

Ans: B Feedback: Portal hypertension can be caused by a variety of conditions that increase resistance to hepatic blood flow. Prehepatic causes of portal hypertension include portal vein thrombosis; posthepatic obstruction is caused by conditions such as hepatic vein thrombosis and venoocclusive disease. Fibrous tissue bands and fibrous nodules that increase the resistance to portal blood flow are intrahepatic causes of portal hypertension. With the gradual obstruction of venous blood flow in the liver, portal vein pressure increases, resulting in the development of collateral channels between the portal and systemic veins. The increased pressure also leads to the formation of portopulmonary shunts that cause blood to bypass the pulmonary capillaries, thus interfering with blood oxygenation and producing cyanosis

Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client: A) Is not allergic to shell fish or iodine B) Will not undergo an acute kidney injury by decreasing renal blood flow C) Does not have a kidney stone obstructing the urethra D) Is in good enough health to withstand a walking on a treadmill

Ans: B Feedback: Some drugs, such as diuretics, high molecular weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus, and the nonsteroidal anti-inflammatory drugs (NSAIDs), can cause acute kidney injury by decreasing renal blood flow. Checking creatinine levels do not predict the client's allergies, a kidney stone, or tolerance for stress testing.

A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a life-threatening condition because: A) Expired air exits the bleeding wound. B) Trapped, inspired air collapses the lung. C) The opposite lung hyperinflates. D) Blebs on the lung surface rupture.

Ans: B Feedback: Tension pneumothorax occurs when the intrapleural pressure exceeds atmospheric pressure. It is a life-threatening condition and occurs when injury to the chest or respiratory structures permits air to enter but not leave the pleural space. Spontaneous pneumothorax occurs when an air-filled bleb, or blister, on the lung surface ruptures. Rupture of these blebs allows atmospheric air from the airways to enter the pleural cavity. This results in a rapid increase in pressure in the chest with a compression atelectasis of the unaffected lung.

Stretch-sensitive receptors in the skin (Ruffini end organs, Pacinian corpuscles, and Merkel cells) help signal postural information and are processed through the: A) Third-order neurons B) Dorsal column-medial lemniscus pathway C) Anterolateral pathway D) Posterior column of the spinal cord

Ans: B Feedback: There are two submodalities of proprioception: the stationary or static component (limb position sense) and the dynamic aspects of position sense (kinesthesia). Both of these depend on constant transmission of information to the CNS regarding the degree of angulation of all joints and the rate of change in angulation. In addition, stretch-sensitive receptors in the skin (Ruffini end organs, pacinian corpuscles, and Merkel cells) also signal postural information. Signals from these receptors are processed through the dorsal column-medial lemniscus pathway. In addition, stretch-sensitive receptors in the skin (Ruffini end organs, pacinian corpuscles, and Merkel cells) also signal postural information. Third-order neurons forward information from the thalamus to the somatosensory cortex. The anterolateral pathway crosses within the first few segments of entering the spinal cord and consists of bilateral, multisynaptic, slow-conducting tracts that transmit information such as pain, thermal sensations, crude touch, and pressure. Lesions affecting the posterior column of the spinal cord impair position sense.

Which of the following clients is at the greatest risk for developing an intracellular pathogen infection? A) A teenager who attends a crowded high school B) An AIDS client with a decreased CD4+ TH1 count C) A breast cancer client who has a WBC count of 8000 D) A hyperthyroid client who has received treatment with radioactive iodine

Ans: B Feedback: Thus, the CD4+ TH1 cell controls and coordinates host defenses against certain intracellular pathogens, a function that helps to explain why a decreased CD4+ TH1 count in persons with acquired immunodeficiency syndrome (AIDS) places them at high risk for intracellular pathogen infections. If the teenager has a healthy immune system, high school should not place him or her at high risk for infection. A WBC of 8000 is normal. Radioactive iodine attacks the thyroid gland and does not usually interfere with immunity.

A client presents to the GYN clinic complaining of large amounts of frothy yellow-green discharge that smells very foul. Immediately, the health care provider is thinking this client most likely has: A) Candidiasis B) Trichomoniasis C) Bacterial vaginosis D) Chlamydial infection

Ans: B Feedback: Trichomoniasis causes a copious, frothy, malodorous, green or yellow discharge. The characteristic vaginal discharge of candidiasis, when present, is usually odorless, thick, and cheesy. The predominant symptom of bacterial vaginosis is a thin, grayish white discharge that has a foul, fishy odor. Chlamydial STD may be asymptomatic, but most women have mucopurulent drainage or hypertrophic cervical changes on examination.

A client's complex and worsening pressure ulcer has necessitated the use of numerous antibiotics over the last several months. Which of the following consequences may result from this client's medication regimen? A) Impaired mucus production B) Vitamin K deficiency C) Impaired protein metabolism D) Excessive release of pepsin

Ans: B Feedback: Vitamin K is synthesized by colonic flora, and long-term antibiotic use can result in vitamin K deficiency. Antibiotic use does not curtail mucus production or protein metabolism, and it does not precipitate excessive release of pepsin.

Which of the following findings are considered part of normal aging? Select all that apply. A) Increased absolute number of lymphocytes B) Decrease in CD4+ count C) Decreased IL-2 level D) Elevated CD8+ T cells E) Increase in B-cell production

Ans: B, C Feedback: There is a decrease in the size of the thymus gland, which is thought to affect T-cell function. A suggested biologic clock in T cells that determines the number of times it divides may regulate cell number with age. Some researchers have reported a decrease in the absolute number of lymphocytes, and others have found little, if any, change. The most common finding is a slight decrease in the proportion of T cells to other lymphocytes and a decrease in CD4+ and CD8+ T cells. Evidence indicates that aged T cells have a decreased rate of synthesis of the cytokines that drive the proliferation of lymphocytes and a diminished expression of the receptors that interact with those cytokines. For example, it has been shown that IL-2, IL-4, and IL-12 levels decrease with aging. Although B-cell function is compromised with age, the range of antigens that can be recognized is not diminished

While studying to become chemo-certified, the nurse reviews some basic concepts about cancer cells. When a client asks about why the tumor grows so fast, the nurse will respond based on which of the following physiological principles? Select all that apply. A) Cancer cells have shorter cell cycle times than normal cells. B) Cancer cells do not die when they are programmed to die. C) Growth factors prevents cancer cells from entering resting (G0) cell cycle phase. D) Cancer cells will reach a balance between cell birth and cell death rate. E) Cancer cells never reach a flattened growth rate.

Ans: B, C Feedback: One of the reasons cancerous tumors often seem to grow so rapidly relates to the size of the cell pool that is actively engaged in cycling. It has been shown that the cell cycle time of cancerous tissue cells is not necessarily shorter than that of normal cells. Rather, cancer cells do not die on schedule, and growth factors prevent cells from exiting the cell cycle and entering the G0 or noncycling phase. The ratio of dividing cells to resting cells in a tissue mass is called the growth fraction. The doubling time is the length of time it takes for the total mass of cells in a tumor to double. As the growth fraction increases, the doubling time decreases. When normal tissues reach their adult size, an equilibrium between cell birth and cell death is reached. Cancer cells, however, continue to divide until limitations in blood supply and nutrients inhibit their growth. When this occurs, the doubling time for cancer cells decreases. The initial growth rate is exponential and then tends to decrease or flatten out over time.

The physician suspects that a client with kidney stones has developed magnesium ammonium phosphate (struvite) stones based on which of the following urinalysis results? Select all that apply. A) Elevated uric acid levels B) Alkaline urine pH C) High urine phosphate level D) High bacterial count E) Presence of cystine particles

Ans: B, C, D Feedback: Magnesium ammonium phosphate stones, also called struvite stones, form only in alkaline urine and in the presence of bacteria that possess an enzyme called urease, which splits the urea in the urine into ammonia and carbon dioxide. The ammonia that is formed takes up a hydrogen ion to become an ammonium ion, increasing the pH of the urine so that it becomes more alkaline. Because phosphate levels are increased in alkaline urine and because magnesium always is present in the urine, struvite stones form. Uric acid stones develop in conditions of gout and high concentrations of uric acid in the urine. Cystine stones account for less than 1% of kidney stones overall but represent a significant proportion of childhood calculi. They are seen in cystinuria, which results from a genetic defect in renal transport of cystine.

While explaining to a group of nursing students the difference between benign and malignant bone tumors, the instructor will emphasize that a benign tumor: Select all that apply. A) Is associated with constant, deep aching pain that does not go away with rest B) May be asymptomatic and detected incidentally C) Is a painful mass that is detected on a long bone and seems to be increasing in size D) May cause the client to have a pathological fracture

Ans: B, D Feedback: There are three major manifestations of bone tumors: pain, presence of a mass, and impairment of function. Although benign tumors are frequently asymptomatic and are detected as an incidental finding, malignant tumors are associated with constant, deep aching pain that does not go away with rest and is present at night. A mass or hard lump may be the first sign of a bone tumor. A malignant tumor is suspected when a painful mass exists that is enlarging or eroding the cortex of the bone. Benign and malignant tumors may cause the bone to erode to the point where it cannot withstand the strain of ordinary use. A sudden increase in pain followed by trivial trauma that is preceded by a history of mild, dull aching pain is suggestive of a pathologic fracture.

A child has been diagnosed with marasmus due to the fact that the parents have both lost their jobs and have very limited funds for food. Which of the following clinical manifestations would the school nurse assess that would confirm this diagnosis? Select all that apply. A) Discolored hair B) Bradycardia C) Enlarged liver D) Pitting edema E) Stunted growth pattern

Ans: B, E Feedback: Inadequate food intake, with equal deficiencies of calories and protein, is the cause of marasmus, which is characterized by low heart rate, blood pressure, and body temperature; dull hair; and an emaciated appearance. Hair discoloration, enlarged liver, and pitting edema are manifestations of kwashiorkor, which is a severe protein deficiency.

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. A) Audible friction rub over the affected lung B) Mediastinal shift of the trachea toward one side C) Marked peripheral edema in lower limbs and ascites D) Atrial fibrillation noted on ECG printout E) Subcutaneous emphysema palpated in the upper chest/neck region

Ans: B, E Feedback: With tension pneumothorax, the structures in the mediastinal space shift toward the opposite side of the chest. There may be distention of the neck veins, subcutaneous emphysema (i.e., presence of air in the subcutaneous tissues of the chest and neck), and clinical signs of shock. Pneumothoraces do not typically cause a friction rub or dysrhythmias. Marked peripheral edema is associated with right-sided heart failure.

The intestinal absorption of glucose and amino acids is facilitated by which of the following transport systems? A) Bile salt micelles B) Fat emulsification C) Sodium linked D) Brush border enzyme

Ans: C Feedback: As with glucose, many amino acids are transported across the mucosal membrane in a sodium-linked transport system (for absorption) that utilizes APT as an energy source. Fat uses bile salts that form micelles for transport to the intestinal villi. Fat emulsification is a digestive process. Brush border enzymes break down carbohydrates for transport

A teenage male develops a severe case of "athlete's foot." He asks, "How did I get this?" The health care worker explains that certain fungi become infectious (called dermatophytes) and exhibit which of the following characteristics? A) Prefer to grow in warm environments like shoes/socks B) Like a moist environment C) Limited to cooler cutaneous surfaces D) Need higher blood flow to survive

Ans: C Feedback: Dermatophytes are not able to grow at core body temperature, preferring the cooler surface skin areas instead of moist skin folds. Diseases caused by these organisms, including ringworm, athlete's foot, and jock itch, are collectively called superficial mycoses.

A client with diabetes and severe peripheral vascular disease has developed signs of dry gangrene on the great toe of one foot. The client asks, "How this can happen?" Which of the following pathophysiologic processes should the nurse explain to this client? "More than likely, your gangrene is caused by: A) Inappropriate activation of apoptosis, which means death of your cells." B) Bacterial invasion into the foot and toe." C) Impaired arterial blood supply to your toe." D) Metaplastic cellular changes in your toe."

Ans: C Feedback: Dry gangrene is often a result of impaired arterial blood supply to the extremities. A bacterial etiology is more common in wet gangrene, whereas neither metaplasia nor activation of apoptosis is implicated in cases of dry gangrene.

A client has been diagnosed with Coxiella burnetii infection. She asked the health care provider how she could have gotten this disease. The health care provider's best response is: A) "Probably while walking outside without your shoes on." B) "While swimming in an unsanitary pond." C) "Drinking contaminated milk." D) "Eating undercooked fish."

Ans: C Feedback: In humans, Coxiella infection produces a disease called Q fever, characterized by a nonspecific febrile illness often accompanied by headache, chills, arthralgias, and mild pneumonia. The organism produces a highly resistant sporelike stage that is transmitted to humans when contaminated animal tissue is aerosolized (e.g., during meat processing) or by ingestion of contaminated milk.

While discussing the physiological process behind penile erection, the anatomy and physiology instructor mentions that what substance is released to facilitate smooth muscle relaxation and shunting of blood into the sinusoids? A) Norepinephrine B) Nitroglycerine C) Nitric oxide D) Nicotinic acid

Ans: C Feedback: Parasympathetic innervation must be intact and nitric oxide synthesis must be active for erection to occur. Parasympathetic stimulation results in release of nitric oxide, a nonadrenergic-noncholinergic neurotransmitter, which causes relaxation of the trabecular smooth muscle of the corpora cavernosa. This relaxation permits inflow of blood into the sinuses of the cavernosa at pressures approaching those of the arterial system. The nicotinic acid in cigarette smoke can induce vasoconstriction and penile venous leakage because of its effects on cavernous smooth muscle. Nitroglycerine is a vasodilator that has no effect on trabecular smooth muscle. A norepinephrine action is vasoconstriction, rather than relaxation, as part of sympathetic nervous system response.

Primary adrenal insufficiency is manifested by: A) Truncal obesity and 3+ pitting edema in lower legs B) Potassium level of 2.8 mEq/L and weight gain of 3 pounds overnight C) Serum sodium level of 120 mmol/L (low) and blood glucose level of 48 mg/dL (low) D) Hypopigmentation over neck and BP greater than 150/90

Ans: C Feedback: Primary adrenal insufficiency is adrenal cortical hormone deficiency with elevated adrenocorticotropic hormone (ACTH) levels caused by a lack of feedback inhibition. Manifestations are related primarily to mineralocorticoid deficiency, causing increased urinary losses of sodium, chloride, and water, along with decreased excretion of potassium. The result is hyponatremia, loss of extracellular fluid, decreased cardiac output, and hyperkalemia. Because of a lack of glucocorticoid, the person with Addison disease has poor tolerance to stress. This deficiency causes hypoglycemia, lethargy, weakness, fever, and gastrointestinal symptoms such as anorexia, nausea, vomiting, and weight loss. Hypopigmentation results from elevated ACTH levels.

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? A) Failure to restore blood flow creates a severe risk for future transient ischemic attacks. B) Necrosis will continue unabated throughout the brain unless blood flow is restored. C) Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored. D) Unless blood flow is restored, the client faces the risk of progressing to hemorrhagic stroke.

Ans: C Feedback: Prompt return of circulation increases the chance that the cells of the penumbra will continue to survive. Cell death does not spread to areas that are not normally supplied by the affected vessel, and future risk of transient ischemic attacks (TIAs) is not an immediate priority. Ischemic stroke does not progress to hemorrhagic stroke because the two types have distinct etiologies.

A school nurse has identified a student with noticeable loss of lean tissues and muscle mass. More than likely, this is caused by protein-calorie malnutrition. The nurse should ask the student if he is experiencing which of the following clinical manifestations that helps confirm this diagnosis? A) Respiratory muscle stimulation B) Excessive blood cell production C) Diarrhea D) Increased cardiac contractility

Ans: C Feedback: Protein-calorie malnutrition results in skeletal muscle loss and diarrhea. This type of malnutrition is also characterized by respiratory muscle weakness and blood cell loss that impairs the immune response.

A client presents to the emergency department vomiting large amounts of bright red blood. The client has a history of alcohol abuse, and the physician suspects esophageal varices. The drug that is used to reduce splanchnic and hepatic blood flow and portal pressures is: A) Propranolol, a -adrenergic blocking agent B) Lisinopril, an ACE inhibitor C) Ocetrotide, a long-acting synthetic analog of somatostatin D) Famotidine, a histamine-2 blocker to decrease stomach acid

Ans: C Feedback: Several methods are used to control acute hemorrhage, including pharmacologic therapy, balloon tamponade, and emergent endoscopic therapy. Pharmacologic methods include administration of ocetrotide, a long-acting synthetic analog of somatostatin. Beta blockers are commonly used to lower portal venous pressure, thereby preventing the initial hemorrhage. ACE inhibitors do not control acute hemorrhage

A client had a positive Pap smear. The surgeon diagnosed "cancer in situ of the cervix." The client asks, "What does this mean?" From the following statements, which is most appropriate in response to this question? The tumor has: A) Been walled off within a strong fibrous capsule B) Developed a distant infiltration C) Not crossed the basement membrane, so it can be surgically removed with little chance of growing back D) Grown undifferentiated cells that no longer look like the tissue from which it arose

Ans: C Feedback: Cancer in situ is a localized preinvasive lesion. As an example, in breast ductal carcinoma, in situ the cells have not crossed the basement membrane. Depending on its location, an in situ lesion usually can be removed surgically or treated so that the chances of recurrence are small. For example, cancer in situ of the cervix is essentially 100% curable

The employee health nurse is working with a nursing student who has just sustained a needlestick injury and has received a dose of hepatitis B immune globulin. The nurse is counseling the student about vaccination against hepatitis B. Which statement by the student indicates understanding? A) "I will make an appointment to start the hepatitis B vaccination series within the next 3 months." B) "I will only need to receive two doses of the hepatitis B vaccine because you just gave me one dose of the immune globulin." C) "I need to start the hepatitis B vaccination series as soon as possible." D) "I don't need to receive the hepatitis B vaccine because I will now produce antibodies against hepatitis B."

Ans: C Feedback: Some protection against infectious disease can be provided by the injection of hyperimmune serum, which contains high concentrations of antibodies for a specific disease, or immune serum or gamma globulin, which contains a pool of antibodies from many individuals, providing protection against many infectious agents. Passive immunity produces only short-term protection that lasts weeks to months.

A male client with a history of angina has presented to the emergency department with uncharacteristic chest pain, and his subsequent ECG reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle? A) Atrial depolarization B) Ventricular depolarization C) Ventricular repolarization D) Depolarization of the AV node

Ans: C Feedback: The T wave on electrocardiography (ECG) corresponds to ventricular repolarization. Atrial depolarization is represented by the P wave and ventricular depolarization by the QRS complex. The isoelectric or zero line between the P wave and the Q wave represents depolarization of the AV node, bundle branches, and Purkinje system.

A child is recovering from a bout with group A -hemolytic Streptococcus infection. They return to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed: A) Autosomal recessive polycystic kidney disease B) Adult-onset medullary cystic disease C) Acute postinfectious glomerulonephritis D) Acute nephritic syndrome

Ans: C Feedback: The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days—the time needed for the development of antibodies. Oliguria, which develops as the GFR decreases, is one of the first symptoms. Proteinuria and hematuria follow because of increased glomerular capillary wall permeability. Sodium and water retention gives rise to edema (particularly of the face and hands) and hypertension. Adults with medullary cystic kidney disease present first with polyuria, polydipsia, and enuresis (bed-wetting), which reflect impaired ability of the kidneys to concentrate urine. The typical infant with ARPKD presents with bilateral flank masses, accompanied by severe renal failure, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension. Acute nephritic syndrome is characterized by sudden onset of hematuria, variable degrees of proteinuria, diminished glomerular filtration rate (GFR), oliguria, and signs of impaired renal function.

A client with a diagnosis of small cell lung carcinoma has developed bone metastases, a finding that has prompted a series of new interventions. What are the primary goals of the treatment regimen for this client's bone cancer? A) Prevention of brain metastasis and early identification of osteonecrosis B) Promotion of bone remodeling at tumor sites through calcium and vitamin D supplements C) Prevention of pathologic fractures and maximization of function D) Pain management and prevention of osteomyelitis

Ans: C Feedback: The primary goals in treatment of metastatic bone disease are to prevent pathologic fractures and promote survival with maximum functioning, allowing the person to maintain as much mobility and pain control as possible. Osteonecrosis, osteomyelitis, and brain metastasis are not typical sequelae of bone metastasis. Tumor sites do not normally undergo remodeling, and dietary supplements alone would not foster this process.

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? A) Status epilepticus B) Subarachnoid hemorrhage C) Ischemic stroke D) Encephalitis

Ans: C Feedback: Thrombolytic therapy for the acute treatment of ischemic stroke consists of the intravenous administration of tPA. This drug would exacerbate a subarachnoid hemorrhage by inhibiting the clotting mechanism, and it is not relevant to the care of clients with encephalitis of status epilepticus.

An obese, male client with a history of gout and a sedentary lifestyle has been advised by his primary care provider to avoid organ meats, certain fish, and other foods that are high in purines. The care provider is demonstrating an awareness of the client's susceptibility to which of the following types of kidney stones? A) Calcium stones B) Magnesium ammonium phosphate stones C) Uric acid stones D) Cystine stones

Ans: C Feedback: Uric acid stones develop in conditions of gout and when high concentrations of uric acid in the urine. Unlike radiopaque calcium stones, uric acid stones are not visible on x-ray films. According to Table 25-2, these stones develop in clients who eat a high-purine diet like Atkins.

During ventricular systole, closure of the atrioventricular (AV) valves coincides with: A) Atrial chamber filling B) Aortic valve opening C) Isovolumetric contraction D) Semilunar valves opening

Ans: C Feedback: Ventricular systole is divided into two parts: isovolumetric contraction when the AV valves close and ventricles fill; and the ejection period, when the semilunar valves open and blood is ejected through the aortic valve into circulation. Immediately after closure of the AV valves, there is a 0.02- to 0.03-second period during which the pulmonic and aortic valves remainclosed. During this period, the ventricular volume remains the same while the ventricles contract, producing an abrupt increase in pressure. At the end of systole, the ventricles relax, causing a precipitous fall in intraventricular pressures. As this occurs, blood from the large arteries flows back toward the ventricles, causing the aortic and pulmonic valves to snap shut—an event marked by the second heart sound.

A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse what diffuse means. The nurse responds: A) Only some of the glomeruli are affected. B) Only one segment of each glomerulus is involved. C) That the mesangial cells are being affected. D) All glomeruli and all parts of the glomeruli are involved

Ans: D Feedback: Glomerular changes can be diffuse, involving all glomeruli and all parts of the glomeruli; focal, meaning only some of the glomeruli are affected; segmental, involving only a certain segment of each glomerulus; and mesangial, affecting only mesangial cells

A newly diagnosed lung cancer client asks how his tumor spread (metastasized) so fast without displaying many signs/symptoms. The nurse responds that malignant tumors affect area tissues by: A) Increasing tissue blood flow B) Providing essential nutrients C) Liberating enzymes and toxins Ans: C Feedback: Malignant tumors affect area tissues by liberating enzymes and toxins that destroy tumor tissue and normal tissue. In addition, the malignant cells compress area vessels, causing ischemia and tissue necrosis. The high metabolic rate of tumor growth causes the tumor to deprive the normal tissues of essential nutrients.D) Forming fibrous membranes

Ans: C Feedback: Malignant tumors affect area tissues by liberating enzymes and toxins that destroy tumor tissue and normal tissue. In addition, the malignant cells compress area vessels, causing ischemia and tissue necrosis. The high metabolic rate of tumor growth causes the tumor to deprive the normal tissues of essential nutrients.

Following routine colonoscopy screening, a client is told that he had several polyps removed. The client began crying stating, "I just can't deal with cancer. I'm too young." The nurse responds: A) "Don't worry. We have some great cancer doctors on staff. I'm sure chemo will help you fight it." B) "Maybe if you're lucky, they have stopped it from metastasizing to your liver." C) "A simple intestinal surgery will cure you." D) "Most colon polyps are not cancerous. The biopsy results will direct your care."

Ans: D Feedback:A polyp is a growth that projects from a mucosal surface, such as the intestine. Although the term usually implies a benign neoplasm, some malignant tumors also appear as polyps. Adenomatous polyps are considered precursors to adenocarcinomas of the colon.

Opioid receptors are highly concentrated in which region of the CNS and produce pain relief through the release of endogenous opioids? A) The enkephalins B) Primary afferent neurons C) Thalamus D) Periaqueductal gray (PAG) region

Ans: D Feedback: A major advance in understanding pain was the discovery of neuroanatomic pathways that arise in the midbrain and brain stem, descend to the spinal cord, and modulate ascending pain impulses. One such pathway begins in an area of the midbrain called the periaqueductal gray (PAG) region. Opioid receptors are highly concentrated in this region of the CNS and produce analgesia (pain relief) through the release of endogenous opioids. Three families of opioid peptides have been identified—the enkephalins, endorphins, and dynorphins. Although they appear to function as neurotransmitters, their full significance in pain control and other physiologic functions is not completely understood. There is evidence that opioid receptors and endogenously synthesized opioid peptides are found on the peripheral processes of primary afferent neurons and in many regions of the CNS.

Of the following STIs, for which STI should the nurse anticipate a prescription for antibiotics such as tetracycline or doxycycline since this infection will respond to antibiotic treatment? A) Human papillomavirus (HPV) infection B) Herpes simplex virus type 2 (HSV-2) infection C) Candidiasis D) Lymphogranuloma venereum (LGV)

Ans: D Feedback: Because HSV-2 and HPV infections and candidiasis have nonbacterial etiologies, these infections are insensitive to antibiotics. Lymphogranuloma venereum (LGV) is an acute and chronic venereal disease caused by Chlamydia trachomatis and is consequently sensitive to antibiotics.

A client has been diagnosed with cholecystitis (gallbladder inflammation) that has impaired the normal release of bile. Which of the following gastrointestinal consequences is this client likely to experience? A) Incomplete digestion of starches B) Impaired glucose metabolism C) Inadequate gastric acid production D) Impaired digestion of fats

Ans: D Feedback: Bile performs a central role in fat metabolism. Gallbladder disease and the accompanying disruption of normal bile release do not result in impaired digestion of carbohydrates, impaired glucose metabolism, or inadequate gastric acid synthesis.

A client who has been taking 80 mg of prednisone, a glucocorticoid, each day has been warned by his primary care provider to carefully follow a plan for the gradual reduction of the dose rather than stopping the drug suddenly. What is the rationale for this directive? A) Sudden changes in glucocorticoid dosing may reverse the therapeutic effects of the drug. B) Stopping the drug suddenly may "shock" the HPA axis into overactivity. C) Sudden cessation of a glucocorticoid can result in adrenal gland necrosis. D) Stopping the drug suddenly may cause acute adrenal insufficiency.

Ans: D Feedback: Chronic suppression of the HPA system by the use of steroids causes atrophy of the adrenal gland, and the abrupt withdrawal of drugs can cause acute adrenal insufficiency. Activity of the HPA system is consequently insufficient. The efficacy of the drug is not the primary concern, and necrosis of the gland itself does not occur.

A group of elderly residents were commenting on how many cell functions decline with age. One resident commented that many of his friends who lived under large electromagnetic towers seemed to experience aging at an accelerated rate in comparison with residents who lived nearby in lakefront housing. This observation is the basis for which theory on aging? A) Theories of genetic influences B) Programmed cell receptor theories C) Insufficient telomerase enzyme theory D) Error theory associated with DNA damage

Ans: D Feedback: Error theory suggests that aging results from DNA mutation or faulty repair. Another group of theories of aging focuses on programmed cell changes with genetic influences that systematically cause cell senescence. Elimination of receptor sites is not part of aging theory. Telomerase enzyme is thought to reduce the shortening of the chromosomes and loss of telomere DNA with each cell replication

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: A) Characterized by an inability to comprehend the speech of others or to comprehend written material B) Nearly normal speech except for difficulty with finding singular words C) Manifested as impaired repetition and speech riddled with letter substitutions, despite good comprehension and fluency D) Characterized by an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing

Ans: D Feedback: Expressive or nonfluent aphasia is characterized by an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing. Conduction aphasia is manifest as impaired repetition and speech riddled with letter substitutions, despite good comprehension and fluency. Anomic aphasia is speech that is nearly normal except for difficulty with finding singular words. Wernicke aphasia is characterized by an inability to comprehend the speech of others or to comprehend written material.

The immune suppressive and anti-inflammatory effects of cortisol cause: A) Moderate insulin resistance B) Increased capillary permeability C) Increased cell-mediated immunity D) Inhibition of prostaglandin synthesis

Ans: D Feedback: Large quantities of cortisol are required for an effective anti-inflammatory action. The increased cortisol blocks inflammation at an early stage by decreasing capillary permeability and stabilizing the lysosomal membranes so that inflammatory mediators are not released. Cortisol suppresses the immune response by reducing humoral and cell-mediated immunity. Cortisol also inhibits prostaglandin synthesis, which may account in large part for its anti-inflammatory actions. Cortisol stimulates glucose production by the liver; as glucose production by the liver rises and peripheral glucose use falls, a moderate resistance to insulin and hyperglycemia develop.

In science class, a group of sixth graders are "freaked out" when they learn that nails grow continuously and are the end product of which of the following components? A) Hypertrophy of arrector pili muscle B) Anagen follicles C) Telogen phase D) Dead cells pushed outward from the nail matrix

Ans: D Feedback: Like hair, nails are the end product of dead matrix cells that are pushed outward from the nail matrix. Unlike hair, nails grow continuously rather than cyclically. The arrector pili muscle, located under the sebaceous gland, provides a thermoregulatory function by contracting to cause goose bumps. Anagen hair has long inner roots and outer root sheaths, is deeply rooted in the dermis, is difficult to detach, and does not come out with regular brushing. Telogen hair has short, white, club-shaped roots. With formation of new anagen hair below the root, the developing follicle will eventually replace the telogen hair, leading to the shedding of approximately 50 to 100 hairs a day.

A client presents to a health care clinic reporting sudden onset of deep, localized pain and swelling in her proximal femur. The client is currently undergoing diagnostic workup for suspected lung cancer. The nurse suspects the client may have developed which of the following neoplasms of the skeletal system? A) Exostosis B) Osteochondroma C) Endochondroma D) Osteosarcoma

Ans: D Feedback: Osteosarcoma is an aggressive and highly malignant bone tumor that normally requires surgery and chemotherapy. Exostosis and osteochondroma are synonymous terms for types of benign neoplasms that often require no treatment. Endochondroma is also benign and may self-resolve.

While lecturing about frostbite, the instructor asks the students, "Which substance prevents undue evaporation from the stratum corneum during the cold winter weather which then helps conserve body heat?" The most correct student answer is: A) A Langerhans cell, which produces antigen-presenting cells B) An eccrine sweat gland C) A nerve ending D) Sebum, secreted by the sebaceous gland

Ans: D Feedback: Sebum lubricates the hair and skin, prevents undue evaporation of moisture from the stratum corneum during cold weather, and helps to conserve body heat. Langerhans cells are dendritic cells that reside principally in the stratum spinosum of the epidermis and play a major role in the functioning of the skin's immune system. Their major function is to phagocytose and process foreign antigens. Most hair follicles are associated with sebaceous glands, and these structures combine to form the pilosebaceous unit. Langerhans cells are not paired with hair follicles, and apocrine, not eccrine, glands are often associated with a hair follicle. Nerve endings are widely distributed throughout the skin, but these are not paired with hair follicles.

A child who is experiencing the signs and symptoms of influenza has vomited frequently over the last 24 hours. While discussing vomiting with a group of nursing students, the instructor asks, "What site in the neurologic system is responsible for vomiting?" Which student response is most accurate? A) Myenteric plexus B) Intramural plexus C) Vagus nerve D) Chemoreceptor trigger zone

Ans: D Feedback: The act of vomiting is integrated in the vomiting center, which is located in the dorsal portion of the reticular formation of the medulla near the sensory nuclei of the vagus. The vomiting center can be activated directly by irritants or indirectly following input from four different sources, one of which is the chemoreceptor trigger zone (which is activated by chemical agents such as drugs and toxins).

A client has been diagnosed with gram-negative pneumonia of the lower lobe. Knowing that gram-negative bacteria have a lipopolysaccharide endotoxin on their outer cell membrane, the health care provider should be assessing the client for which pathophysiological end result? A) Damage to cellular mitochondria B) Increased ATP levels C) Activation of the p53 protein D) Apoptosis

Ans: D Feedback: The extrinsic pathway of apoptosis involves extracellular signaling proteins that bind to cell surface molecules called death receptors and trigger apoptosis. The end result includes activation of endonucleases that cause fragmentation of DNA and cell death. In addition to TNF and Fas ligand, primary signaling molecules known to activate the extrinsic pathway include TNF-related apoptosis-inducing ligand (TRAIL); the cytokine interleukin-1 (IL-1);and lipopolysaccharide (LPS), the endotoxin found in the outer cell membrane of gram-negative bacteria. DNA damage, activation of the p53 protein, and decreased ATP levels are associated with the intrinsic pathway.

A 14-year-old presents to the dermatologist clinic with a severe case of acne. The nurse explains that this acne is a result of inflamed A) Follicular bulbs B) Dermal papillae C) Apocrine glands D) Sebaceous glands

Ans: D Feedback: The sebaceous glands are the structures that become inflamed in acne. Growth of the hair is centered in the bulb (i.e., the base) of the hair follicle, which is just one part of the hair structure. Apocrine sweat glands are located deep in the dermal layer and open through a hair follicle. Dermal papillae minimize separation of the dermis and the epidermis and contain capillary venules that nourish the epidermal layers of the skin.

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: A) Aneurysm leakage B) Cause of minor residual deficits C) Diffuse cerebral electrical malfunctions D) Atherosclerotic lesions in cerebral vessels

Ans: D Feedback: The traditional definition of TIAs as a neurologic deficit resolving within 24 hours was developed before the mechanisms of ischemic cell damage and the penumbra were known and before the newer, more advanced methods of neuroimaging became available. A more accurate definition now is a transient deficit without time limits, best described as a zone of penumbra without central infarction. TIAs are important because they may provide warning of impending stroke. The causes of TIAs are the same as those of ischemic stroke, and include atherosclerotic disease of cerebral vessels and emboli. The most common predisposing factors for cerebral hemorrhage are advancing age and hypertension; other causes include aneurysm rupture. Cerebral electrical malfunctions usually occur with seizure activity.

A 41-year-old male client is planning on having a vasectomy. While explaining this surgery to the client, the health care worker will include which physiologic principle as the basis for this contraception technique? A) "Spermatogenesis is inhibited because sex hormones no longer stimulate the Sertoli cells." B) "Spermatozoa can no longer reach the epididymis and do not survive." C) "The rete testis becomes inhospitable to sperm." D) "Sperm can no longer pass through the ductus deferens."

Ans: D Feedback: When the male ejaculates, the smooth muscle in the wall of the epididymis contracts vigorously, moving sperm into the next segment of the ductal system, the ductus deferens, also called the vas deferens. A vasectomy severs this conduit, rendering the male effectively infertile within a few weeks of the procedure. The procedure has no hormonal effect and neither the epididymis nor the rete testis is altered.