Patho Quiz 9
Frustrated with his inability to lose weight despite attempting numerous fad diets, a 42 year-old male who is 5'11" (1.8 m) and 270 lbs (122.7 kg) has visited a clinic to gain tools to achieve long term weight loss. Which statement by the clinician is most accurate? "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." "A combined approach of behavior therapy, changing your lifestyle habits, and increased physical activity gives the highest chance of long term success." "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." "Combined with regular exercise, a diet taking in 500 to 1000 kilocalories per day will be the best approach."
"A combined approach of behavior therapy, changing your lifestyle habits, and increased physical activity gives the highest chance of long term success."
As part of the intake protocol at an eating disorders clinic, an interview precedes a physical examination. Which question 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? "Have you noticed any new hair growth on your body in the last several months?" "Have you had any episodes of shortness of breath in the recent past?" "Can you tell me about some of the habits that you have related to food in your daily routine?" "Do you remember when your last menstrual period was?"
"Have you had any episodes of shortness of breath in the recent past?"
A gastroenterologist is teaching a group of students about the enteric nervous system in preparation for a consult with a client who has experienced a spinal cord injury. Which teaching point is most accurate? "The myenteric plexus is responsible for controlling the function of each segment of the intestinal tract." "The enteric nervous system is made up of the myenteric and submucosal plexuses; these are located in the wall of the gastrointestinal (GI) tract." "Sympathetic innervation of much of the gastrointestinal (GI) tract occurs by way of the vagus nerve." "Parasympathetic stimulation blocks the release of the excitatory neuromediators and inhibits gastrointestinal (GI) motility."
"The enteric nervous system is made up of the myenteric and submucosal plexuses; these are located in the wall of the gastrointestinal (GI) tract."
A male client has just been diagnosed with esophageal cancer. He knew 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 client asks the nurse what he can expect if he agrees to the treatments. The nurse responds:
"The therapies may shrink the cancer in an effort to increase survival of the cancer."
Following several days of intermittent upper right quadrant pain, a 29-year-old obese, Native American/First Nation 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 statement by the client demonstrates a sound understanding of her diagnosis? "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." "Several factors like my genetics and gender may have contributed to this, but I'm glad that medications can cure it." "This explains why my skin was yellow-tinged lately and why I had those pains that spread to my upper back and right shoulder." "I suppose the fever and vomiting I had this week was probably a sign of my gallstones too."
"This explains why my skin was yellow-tinged lately and why I had those pains that spread to my upper back and right shoulder."
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 fistula (EA/TEF). Which explanation should the care team provide to the infant's parents? "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." "This problem will require respiratory therapy and supplementary feeding but it will likely resolve itself over time." "The biggest risk that will face your daughter until this is fixed is the danger of malnutrition and dehydration." "The priority in our immediate treatment prior to her surgery will be pain management, as the contents of her stomach can burn her lungs."
"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."
A 51-year-old male professional is in the habit of consuming 6 to 8 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? "You are more than likely inflicting damage on your liver, but this damage would cease as soon as you quit drinking." "That may be the case, but you are still creating a high risk of hepatitis A or B or liver cancer." "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." "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 by-products."
"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 by-products."
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 statement about colorectal cancer demonstrates a sound understanding of the disease? "If accurate screening test for this type of cancer existed, it could likely have been caught earlier." "The NSAIDs and aspirin that I've been taking for many years probably contributed to my getting cancer." "While diet is thought to play a role in the development of colorectal cancer, the ultimate causes are largely unknown." "A large majority of clients who have my type of colon cancer survive to live many more years."
"While diet is thought to play a role in the development of colorectal cancer, the ultimate causes are largely unknown."
A 70-year-old male with a 40 pack-year history of smoking and longstanding non-insulin dependent diabetes has been diagnosed with pancreatic cancer. Which teaching points should the physician provide? "While this is indeed serious, you should know that you have a good chance of beating this disease with appropriate treatment." "Most likely your pattern of high alcohol intake over the years contributed to your cancer." "You will likely be facing surgery in the near future, but know that this is very unlikely to eliminate your cancer." "I know it may seem trivial at this point, but the levels of pain that accompany cancer of the pancreas are normally quite low."
"You will likely be facing surgery in the near future, but know that this is very unlikely to eliminate your cancer."
Following a history of gastric pain and an endoscopy, a client has been diagnosed with a duodenal peptic ulcer. Which teaching point should his caregiver provide? "While your diet most certainly contributed to this problem, the good news is that changing your diet can help solve it." "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." "Your family history, your smoking history, and NSAID use may all have contributed to this problem." "While there aren't really any effective medications for these ulcers, changes in lifestyle can keep them well controlled."
"Your family history, your smoking history, and NSAID use may all have contributed to this problem."
A dietitian is working with a morbidly obese client in an effort to facilitate weight loss. Which of the dietitian's teaching points about the nature of adipose tissue should be included in the client education? "Our ultimate goal is going to be eventually rid your body of adipose tissue, or fat." "Your fat cells can be considered to be one large energy-storage organ that also has a role in hormone production." "We ideally would like to maximize your levels of brown fat and minimize those of white fat." "Obesity is normally the result of the number of 'pre-fat' cells an individual is born with."
"Your fat cells can be considered to be one large energy-storage organ that also has a role in hormone production."
A client is diagnosed with pernicious anemia and asks, "Why is my body not able to absorb vitamin B12?" Which response by the nurse is most accurate? "You have too many ulcers in your stomach." "More than likely, you were born with deficient vitamin B12 stores." "Your stomach is not secreting a substance known as intrinsic factor, which is needed to absorb vitamin B12." "Your daily intake of high saturated fats is interfering with the stomach's ability to absorb the nutrients that it needs, especially vitamin B12."
"Your stomach is not secreting a substance known as intrinsic factor, which is needed to absorb vitamin B12."
Which clients would be most reasonably expected to have the highest basal metabolic rate (BMR), assuming none is obese or malnourished? A 22-year-old man, 69 in (1.75 m) tall, who has a sedentary lifestyle A 47-year-old woman, 65 in (1.65 m) tall, who swims 1 mile four times a week A 29-year-old woman, 61 in (1.55 m) tall, who is pregnant and on bed rest A 60-year-old man, 72 in (1.83 m) tall, who is recovering from heart surgery
A 60-year-old man, 72 in (1.83 m) tall, who is recovering from heart surgery
The nurse is caring for several clients. Given the typical treatments for each of the listed client conditions, which client should the nurse prioritize as most at risk for acute gastrointestinal bleeding? A 65-year-old client being treated for atrial fibrillation and coronary artery disease A 45-year-old with hypertension and type 2 diabetes being treated for a foot ulcer A 70-year-old with rheumatoid arthritis being treated for pneumonia An 85-year-old with failure to thrive who is confused and receiving intravenous fluids
A 65-year-old client being treated for atrial fibrillation and coronary artery disease
A parent reports that the child comes home with a stomachache and then a bout of diarrhea every time she has ice cream out with friends. Which conclusion by the nurse is likely most accurate for this child? Anxiety about eating too many calories A deficiency of lactase Gallbladder disease Premature peptic ulcer formation
A deficiency of lactase
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 per 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 diet lacking in fat-soluble vitamins. Fluid and electrolyte imbalances secondary to low carbohydrate intake. A diet that is low in high in carbohydrates but low in fat. A diet deficient in both protein and calories.
A diet deficient in both protein and calories.
Four weeks after returning from a tropical vacation, a 40-year-old man has presented to the emergency department with malaise, nausea, and yellow sclera. Serology has confirmed a diagnosis of hepatitis A (HAV). What teaching is most appropriate for this client? "You can expect these symptoms to disappear after about 2 months, but you will be a carrier of the disease indefinitely. A vaccine before your trip would have prevented this, but your body will rid itself of the virus in time. You likely came in contact with blood or body fluids at some point, and you will have to ensure no one is subsequently exposed to your own blood or body fluids. You likely got this by way of what we call the fecal-oral contamination. You will have chronic hepatitis now, but the symptoms can be controlled with medication.
A vaccine before your trip would have prevented this, but your body will rid itself of the virus in time.
The nurse is planning care for a group of female adolescents with either anorexia nervosa or bulimia nervosa. The nurse incorporates what common characteristic of both these conditions into the plan of care? Abnormal concern with body image Comorbid mental illness Amenorrhea Restriction of caloric intake
Abnormal concern with body image
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 38.8°C (101.8°F), blood pressure 89/48 mm Hg and heart rate 116 beats per minute. Blood work indicates that his serum levels of C-reactive protein, amylase, and lipase are all elevated. Which diagnosis would the care team suspect first? Hepatitis C Cholecystitis Liver cirrhosis Acute pancreatitis
Acute pancreatitis
A client with pancreatic cancer is admitted for portal hypertension and 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 medication to assist in maintaining an effective circulating fluid volume? Bumetanide Furosemide Albumin (Human) 5%. Epoetin alfa
Albumin (human) 5%
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 (36.8°C), pulse 88, BP 140/87, and respiratory rate 18. Which potential contributing factor would the health care team suspect first? Overuse of antacids Alcohol consumption Staphylococcal enterotoxins Effects of Helicobacter pylori
Alcohol consumption
The nurse is caring for a client who has dysphagia after suffering a stroke. Which principle related to the phases of swallowing will the nurse employ to best reduce the risk for aspiration? Sit the client up at an angle of 45° to 75° so food will be able to move more easily into the stomach during swallowing. Feed the client on the unaffected side to maximize the movement of the bolus during the esophageal phase. Allow the client to lean forward while eating to reduce the effects of gravity on the oral phase of swallowing. Have the client sit up for at least 30 minutes after eating to allow the completion of the pharyngeal phase.
Allow the client to lean forward while eating to reduce the effects of gravity on the oral phase of swallowing.
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. What aspect of the etiology of celiac disease would underlie the explanation that the physician provides? Bacterial or chemical invasion of the peritoneum leads to decreased nutrient absorption and transport. An inappropriate T-cell mediated response results in increased levels of antibodies and an inflammatory response. Neurogenic or muscular inhibition of peristalsis results in inappropriate motility of ingested food in the lower small intestine and the colon. Inability to process or absorb the fat content of breast milk results in malnutrition and deficiency of fat-soluble vitamins.
An inappropriate T-cell mediated response results in increased levels of antibodies and an inflammatory response.
A 17-year-old female has announced to her family physician a desire to wholly eliminate fats from her diet. Which aspect of the role of fats would underlie the physician's response to the client? Apart from providing energy, fats are necessary as carriers of certain vitamins and are precursors to prostaglandins. An extreme low-fat diet is associated with an increase in undesirable HDL cholesterol. Fats are a key source of dietary nitrogen and their elimination from the diet is associated with a negative nitrogen balance. The total elimination of fat from the diet is associated with the development of ketosis.
Apart from providing energy, fats are necessary as carriers of certain vitamins and are precursors to prostaglandins.
The nurse caring for a client with portal hypertension and subsequent development of esophageal varices will likely receive a prescription for which drug class to assist with decreasing portal pressure? Angiotensin-converting enzyme (ACE) inhibitors Sympathomimetic agents Beta-adrenergic blocking agent Inotropic agent
Beta-adrenergic blocking agent
For several years, a single mother of 2 has been averaging 2 to 3 bottles of wine each night and recently has added several ounces of brandy as well. She now has been diagnosed with cirrhosis. Which physical manifestations of cirrhosis would the nurse expect to find during assessment? Select all that apply. Ascites Anorexia Fever Bleeding tendencies Epigastric pain Obesity
Bleeding tendencies Epigastric pain Ascites Anorexia
A client who is on several medications has noticed an increase in gastrointestinal infections. What type of medication should the nurse advise the client to discuss with the health care provider as a possible cause for increased gastrointestinal infections? Broad-spectrum antibiotics Beta-1 selective adrenergic blocker H1 receptor blocker Enteric-coated aspirin
Broad-spectrum antibiotics
The nurse is assessing a client with suspected dysphagia. Which cranial nerves (CN) should the nurse assess? Select all that apply. CN I CN V CN IX CN X CN XI CN XII
CN V CN IX CN X CN XII
A client with kidney cancer who underwent exploratory surgery has returned to the postoperative unit with a report of severe burning and indigestion in the epigastric region. Which intervention by the nurse would be priority for this client? Call the surgeon for a prescription for a proton pump inhibitor (PPI) to prevent stress ulcer development. Sit the client up in a high-Fowler position and give ice chips to suck on. Call the dietary team to bring some milk products to the floor to counter excess gastric acid. Administer prescribed pain medications and dim the lights in the room.
Call the surgeon for a prescription for a proton pump inhibitor (PPI) to prevent stress ulcer development.
A client with a history of chronic nausea and vomiting but an insatiable appetite has the symptoms attributed to an enzyme deficiency. Which enzyme deficiency is primarily responsible for the large appetite and lack of control of food intake? Cholecystokinin Ghrelin Gastrin Secretin
Cholecystokinin
A 20-year-old male college student has recently finished a Thanksgiving dinner of heroic proportions while home for the holiday weekend. Which phenomenon would most likely have produced his sensation of satiety? Stretch receptors in the stomach and small intestine signal the feeding center in the medulla. Increased levels of leptin stimulate a decrease in appetite by way of the vagus nerve. The breakdown of products of lipids such as ketoacids produces a decrease in appetite. Cholecystokinin and glucagon-like peptide-1 suppress the hunger impulse.
Cholecystokinin and glucagon-like peptide-1 suppress the hunger impulse.
The nurse is planning care for a hospitalized client at risk for malnutrition. Which interventions should the nurse include in the plan of care? Select all that apply. Conduct a medication review. Assess for signs of refeeding syndrome. Educate client on risks of malnutrition. Educate client on dietary restrictions. Ensure privacy at mealtimes.
Conduct a medication review. Educate client on risks of malnutrition.
The nurse is caring for a client with end-stage liver disease who is at risk for hepatic encephalopathy. For which complications that increase the risk for hepatic encephalopathy should the nurse assess? Select all that apply. Constipation Gastrointestinal bleeding High colonic pH Hypoalbuminemia Hyponatremia
Constipation Gastrointestinal bleeding High colonic pH
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 treatment is most likely to be effective for her? Lamivudine Peginterferon and ribavirin Interferon-alfa-2b Corticosteroids and immunosuppressant drugs
Corticosteroids and immunosuppressant drugs
A 28-year-old man presents with reports 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 reports pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which diagnosis would his care team first suspect? Crohn disease Ulcerative colitis Diverticulitis Colon cancer
Crohn disease
Following a 14-day course of broad-spectrum antibiotics for the treatment of sepsis, a client develops watery diarrhea attributed to the elimination of normal intestinal flora. What other phenomena are most likely accompanying the low levels of normal flora? Decreased mineral and nutrient absorption; decreased carbohydrate metabolism Decreased pH of the stomach; increased pH of the lower gastrointestinal tract Decreased fermentation of undigestible dietary residue; decreased vitamin absorption Proliferation of vitamin K; lower gastrointestinal bleeding
Decreased fermentation of undigestible dietary residue; decreased vitamin absorption
When the sympathetic nervous system is stimulated, the interstitial cells of Cajal react in which way? Decreasing amplitude of the slow waves, which control the spontaneous oscillations in membrane potentials. Increasing the peristaltic motion of the gastrointestinal tract, thereby causing explosive diarrhea. Increasing the amount of secretions being entered into each segment of the intestinal tract. Signaling the vagus nerve to slow down motility and increase absorption of water from the large intestines.
Decreasing amplitude of the slow waves, which control the spontaneous oscillations in membrane potentials.
A teenager is admitted for complications resulting from bulimia nervosa. The nurse's admission assessment should pay close attention to which manifestations relating to complications associated with this disorder? Select all that apply. Dry, cracked lips and poor skin turgor. Missing tooth enamel and increased number of dental caries. Painful swallowing and stomach cramping related to reflux and esophagitis. Fruity breath and labored, deep, gasping respirations. Painless enlargement of the parotid gland due to vomiting.
Dry, cracked lips and poor skin turgor. Missing tooth enamel and increased number of dental caries. Painful swallowing and stomach cramping related to reflux and esophagitis. Painless enlargement of the parotid gland due to vomiting.
The nurse is preparing to care for a client with anorexia nervosa (AN). Which diagnostic results will the nurse examine to best determine risk for sudden death? Select all that apply. Echocardiogram Body mass index (BMI) Serum albumin level Chest x-ray Cortisol level
Echocardiogram Body mass index (BMI)
A client reports having diarrhea that has lasted days. Which intervention would the nurse recommend to decrease the diarrhea? Electrolyte drink containing sodium and glucose Diet soda Water Drink with caffeine
Electrolyte drink containing sodium and glucose
A client who is being treated for malnutrition develops dependent pedal edema. What is the nurse's priority action? Assess the client's most recent serum albumin level. Ask the health care provider about diuretic therapy. Obtain the client's weight and monitor urine output. Elevate the client's feet above the level of the heart.
Elevate the client's feet above the level of the heart.
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 diagnostic test finding would implicate a different cause of her symptoms? Normal serum acetaminophen level Elevated serum HBsAG level Evidence of steatosis on liver biopsy tissue sample Hypoglycemia
Elevated serum HBsAG level
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 health problem would the care team first suspect? Rotavirus infection Appendicitis Esophagitis from gastrointestinal reflux Hirschsprung disease
Esophagitis from gastrointestinal reflux
The nurse is caring for a client with a disorder that prevents the pyloric valve from closing properly. For which priority complication should the nurse assess? Gastrointestinal bleeding Pancreatitis Intestinal obstruction Jaundice
Gastrointestinal bleeding
The nurse is caring for a client with achalasia. Which interventions should the nurse prioritize in the plan of care? Select all that apply. Allow client to consume thickened fluids only. Have oropharyngeal suctioning equipment at bedside. Position client with head of bed elevated. Arrange for small, frequent meals. Administer antiemetics before meals.
Have oropharyngeal suctioning equipment at bedside. Position client with head of bed elevated. Arrange for small, frequent meals.
A client has developed hypersplenism caused by portal hypertension. Which laboratory value(s) will the nurse recognize as correlating with this diagnosis? Select all that apply. Hemoglobin level of 9.5 g/dL (95 g/L) White blood cell count of 3,000/μL (3.0 × 109/L) Neutrophil count of 25,000 to 75,000/μL (2.5-7.5 x 109/L) Platelet count of 90,000/μL (90 ×109/L) Phosphorous is 8.2 mg/dL (2.65 mmol/L)
Hemoglobin level of 9.5 g/dL (95 g/L) White blood cell count of 3,000/μL (3.0 × 109/L) Platelet count of 90,000/μL (90 ×109/L)
A baby is born to a mother with active hepatitis B. Which medication does the nurse anticipate administering today? Tenofovir disoproxil fumarate plus emtricitabine Hepatitis B immune globulin (HBIG). Hepatitis C immune globulin (HCIG). Hepatitis A vaccine (HAV).
Hepatitis B immune globulin (HBIG).
A 29 year-old female has been admitted to the emergency department following a suicide attempt by overdose of acetaminophen. What physiologic changes in the client's liver and accompanying altered diagnostic results does the nurse anticipate?
Hepatocellular necrosis evidenced by increased ALT and AST levels.
A nurse practitioner is providing care for a male client with a longstanding hiatal hernia. Which statement most accurately captures an aspect of the pathophysiology of hiatal hernias?
If esophageal acid clearance is impaired, esophagitis can result.
A 20-year-old male who is addicted to crystal methamphetamine has been admitted to hospital with a diagnosis of protein-calorie malnutrition after many months of inadequate food intake. Which treatment plan would the care team most likely favor? Intravenous infusion of albumin coupled with vitamin supplementation Total parenteral nutrition Incrementally feeding combined with vitamin and mineral supplementation Rapid administration of normal saline and carbohydrates
Incrementally feeding combined with vitamin and mineral supplementation
A resident of a long-term care facility has contracted Clostridium difficile with frequent diarrhea and hyperactive bowel sounds. What process in the small intestine is most likely accompanying the current status? Pathogenic microorganisms are causing dilation of the small intestine, increasing motility. Segmentation waves have become more frequent as a result of the infection. Intestinal stasis brought on by infection is preventing the small intestine from sufficiently slowing the rate of motility. Inflammation is accompanied by an increase in peristaltic movements of the small intestine.
Inflammation is accompanied by an increase in peristaltic movements of the small intestine.
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 (38.6°C). The diarrhea is bloody, frequent, and small in volume. These clinical manifestations are distressing enough that he is visiting a local medical clinic in the area. Which diagnosis best characterizes this health problem? Non-inflammatory diarrhea Inflammatory diarrhea Factitious diarrhea Secretory diarrhea
Inflammatory diarrhea
Which effect of the sympathetic nervous system is most responsible for the development of duodenal ulcers due to anxiety and stress? Inhibition of the actions of Brunner glands Overstimulation of the oxyntic glands Suppression cholecystokinin Inflammation of the parotid glands
Inhibition of the actions of Brunner glands
The client who has been consuming a very low calorie diet (VLCD) of 450 kcal/day should be assessed for which high risk complications? Select all that apply. Irregular heart rhythms Bone/joint inflammation Abdominal pain related to gallstones Flank pain and spasm associated with kidney sludge Elevated cholesterol levels
Irregular heart rhythms Abdominal pain related to gallstones
The instructor asks a group of nursing students to explain the function of the omentum. The students will respond based on which pathophysiologic principle? It holds organs in place. It attaches the jejunum and ileum to the abdominal wall. It has substantial mobility and moves around in the peritoneal cavity with peristaltic movements. It is mainly there to prevent any noxious substance from entering into the gut.
It has substantial mobility and moves around in the peritoneal cavity with peristaltic movements.
A 40-year-old man who uses heroin intravenously was diagnosed with hepatitis C (HCV) 1 year ago and now has chronic viral hepatitis. Which statement by the client to his care provider would warrant correction by the nurse? I know the medications to treat this aren't fantastic, but at least there are some options for controlling the virus. It is at least a bit reassuring that my liver isn't undergoing damage when I'm not experiencing symptoms. Even though I'm sick, at least I won't feel sick most of the time. 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.
It is at least a bit reassuring that my liver isn't undergoing damage when I'm not experiencing symptoms.
A client has been following a low-fat diet due to a diagnosis of high triglycerides and to lose weight. The client asks the nurse how it is possible that the extra weight and high triglycerides persist despite taking in such low levels of fat. What is the nurse's best response? Perhaps the fats you are consuming are especially high in triglycerides. It is important to reduce your total caloric intake, including carbohydrates. You must include exercise to effectively reduce weight and triglycerides. If high cholesterol continues after this change in diet, you will require medication.
It is important to reduce your total caloric intake, including carbohydrates.
The nurse is caring for a client with severe acute pancreatitis. Which interventions should the nurse prioritize? Select all that apply. Keep client NPO. Infuse intravenous fluids. Administer morphine parenterally. Maintain nasogastric tube. Provide antidiarrheal medication.
Keep client NPO. Infuse intravenous fluids. Maintain nasogastric tube.
Which statement best communicates the nature of movements in the colon?
Large segments of the colon contract as a unit for around 30 seconds.
Which hospitalized client is most clearly demonstrating the signs and symptoms of liver failure? Low hemoglobin levels, low platelet levels, and spider angiomas present Blood pressure of 189/103, jaundice, and multiple thromboses Sudden onset of confusion, a history of alcohol abuse and low levels of serum AST and ALT Ascites, fever, and recent onset of atrial fibrillation
Low hemoglobin levels, low platelet levels, and spider angiomas present
A husband and wife who both have type 2 diabetes are taking part in a weight loss program. The woman asks why her husband, who has the same starting height and weight, has lost more weight than her despite identical interventions. What is the nurse's best response? Men burn more calories than women as part of their metabolism. The number on the scale is not as important as your sense of wellness. Men have less water weight than women so your fat loss is similar. Women's response to weight loss intervention is slower than men's.
Men burn more calories than women as part of their metabolism.
When explaining the role of protein and the nine essential amino acid needs of the human body to a group of students, the nurse should emphasize that which foods are complete proteins (foods that provide the essential amino acids in adequate amounts)? Select all that apply. Milk Fish Poultry Nuts Grains
Milk Fish Poultry
The nurse is caring for a client with end-stage biliary cirrhosis. What should the nurse include in this client's plan of care? Select all that apply. Inspect skin for evidence of breakdown. Temperature assessment and administration of antipyretics Encourage intake of 3 to 4 L of fluids per day. Monitor client for signs of acute blood loss. Promote intake of foods rich in vitamin D.
Monitor client for signs of acute blood loss. Promote intake of foods rich in vitamin D. Inspect skin for evidence of breakdown.
When examining types of energy expenditure, which statement is accurate? More active people and those who fidget may have less fat gain than those with decreased non-exercise activity thermogenesis (NEAT). Parasympathetic stimulation will cause brown fat to generate more heat than other stimulations. Recent research indicates that obese clients with persistent excess caloric intake have decreased sympathetic activity. Carbohydrate intake increases the normal metabolic rate more significantly than other nutrients.
More active people and those who fidget may have less fat gain than those with decreased non-exercise activity thermogenesis (NEAT).
A speech therapist is performing a swallowing assessment on a client who had a stroke, because the health care team is considering the introduction of oral food. The client will most likely have conscious control over which process? Initiation of primary peristalsis Moving the epiglottis back to cover the larynx Moving a bolus to the posterior wall of the pharynx Moving the bolus backwards in the esophagus
Moving a bolus to the posterior wall of the pharynx
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 pathophysiologic phenomenon is most likely to underlie the client's health problem? Fissures and crevices developing in the mucosa that are seen as a characteristic "cobblestone" appearance. Erosion of the endothelial lining of the distal small intestine by a combination of genetic, autoimmune, and environmental factors. Compromise of the mucosal layer of the large intestinal surface by the effects of H. pylori. Mucosal hemorrhages that have developed into crypt abscesses, which have in turn necrotized and ulcerated.
Mucosal hemorrhages that have developed into crypt abscesses, which have in turn necrotized and ulcerated.
An older adult is reporting increasing fatigue and dark stools. On assessment, the nurse notes pale mucous membranes, low hemoglobin and red cell counts, and upper gastrointestional bleed in the stomach via endoscopy. Questioning reveals excess nonsteroidal anti-inflammatory drug (NSAID) usage to control rheumatoid arthritis pain. Which phenomenon is responsible for the present health problems? NSAIDs increase the gastric production of gastrin, increasing gastric secretions and lowering stomach pH. Drugs such as NSAIDs increase the H+ levels and thus decrease gastric pH, resulting in insult to the stomach lining. NSAIDs, aspirin, and other drugs increase prostaglandin synthesis, resulting in disruption of cellular structures lining the stomach. NSAIDs can disrupt the permeability of the gastric mucosa, causing hydrogen ions to accumulate in the mucosal cells of the lining.
NSAIDs can disrupt the permeability of the gastric mucosa, causing hydrogen ions to accumulate in the mucosal cells of the lining.
The nurse is caring for a client on several new medications and is experiencing diarrhea. What medication should the nurse associate with an increased risk for diarrhea? Non-selective adrenergic blocker Anticholinergic Opioid analgesic Calcium channel blocker
Non-selective adrenergic blocker
The nurse is caring for a client suspected of having contracted C. difficile. Assessment reveals abdominal distension and new onset fever. What is the nurse's best action? Notify the health care provider immediately of the findings. Administer the client's dose of metronidazole. Administer an antipyretic and assist client into side-lying position. Prepare to administer vancomycin via enema.
Notify the health care provider immediately of the findings.
A client is taking methotrexate, an antimetabolite, for cancer known to interfere with cellular DNA synthesis. Which assessments should the nurse prioritize based on the expected gastrointestinal (GI) side effects of this medication? Select all that apply. Oral mucosa Bowel movements Nausea Level of consciousness Oxygen saturation
Oral mucosa Bowel movements Nausea
A 40-year-old female has been categorized as being obese, with a body mass index (BMI) of 33.2. Which health problems place the client at a significantly increased risk when compared with individuals with a BMI below 25? Select all that apply. Cardiac dysrhythmias Osteoarthritis Multiple sclerosis Atelectasis Gallbladder disease Type 2 diabetes
Osteoarthritis Gallbladder disease Type 2 diabetes
A client with bulimia nervosa has a temperature of 38.5°C (101.3°F). What is the nurse's priority action? Administer antipyretic medication. Notify the health care provider. Assess for dysuria and urinary frequency. Perform a respiratory assessment.
Perform a respiratory assessment.
A nurse who works on an oncology ward is providing care for a 68-year-old female client 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 factor is most likely contributing to the client's malnutrition? Autoimmune responses associated with acute illness are inhibiting anabolism. Chronic hypoxia is precluding many of the aerobic processes required in body maintenance and repair. Protein mass is being lost from the liver and other organs and the liver is synthesizing fewer serum proteins. Intestinal malabsorption is occurring as a result of tumor metastases.
Protein mass is being lost from the liver and other organs and the liver is synthesizing fewer serum proteins.
After several months of persistent heartburn, a 57-year-old female client has been diagnosed with gastroesophageal reflux disease (GERD). Which treatment regimen is likely to best address the woman's health problem? Surgical correction of the incompetent pylorus. Antacids; avoiding positions that exacerbate reflux; a soft-textured diet Weight loss and administration of calcium channel blocking medications. Proton pump inhibitors; avoiding large meals; remaining upright after meals
Proton pump inhibitors; avoiding large meals; remaining upright after meals
An adult has been diagnosed with gastroesophageal reflux disease, in which the function of the lower esophageal sphincter is compromised. Which consequence of this condition is most likely? Decreased absorption of ingested foods and fluids. Impaired control of the gastric emptying rate. Protrusion of the stomach or regurgitation of stomach contents into the esophagus. Inappropriate release of gastric enzymes.
Protrusion of the stomach or regurgitation of stomach contents into the esophagus.
The nurse is caring for the client with extrahepatic cholestasis. Which symptom does the nurse anticipate uncovering during the history and assessment? Complaints of lower flank pain with consequences of impaired fat metabolism. Anorexia with consequences of impaired drug metabolism and blood filtration. Skin xanthomas (focal accumulations of cholesterol) with consequences of increased risk of bleeding due to deficient clotting factors. Pruritus with consequences of deficient levels of fat-soluble vitamins.
Pruritus with consequences of deficient levels of fat-soluble vitamins.
An infant is being examined for colic-like symptoms that the parent attributes to "hurting." After feeding, the infant vomits most of the feeding and then assumes a fetal position. The health care provider is associating these clinical manifestations with which childhood complication? Duodenal ulceration Constipation Pyloric stenosis Erosive esophagitis
Pyloric stenosis
A client reports chronic cramping, bloating, and diarrhea and is diagnosed with a deficiency in brush border enzymes within the small intestine. Which meal/snack, high in carbohydrates and protein, will likely exacerbate the client's signs and symptoms? Grapefruit and prunes Tossed salad with an oil and vinegar dressing Roast beef and a baked potato Tortilla chips and guacamole
Roast beef and a baked potato
A science teacher is talking to a group of fifth graders about the role of "spit." During the course of the discussion, the teacher informs students about which functions of saliva? Select all that apply. Saliva provides good protection for oral mucosa. People will have more saliva production when anxious, such as right before a test. Saliva has antibacterial action to help keep the mouth clean. Saliva secretes acid to chemically break down starches. Saliva secretes the enzyme pepsin.
Saliva has antibacterial action to help keep the mouth clean. Saliva secretes acid to chemically break down starches. Saliva provides good protection for oral mucosa.
The physician has asked a newly diagnosed cardiac client to begin taking omega-3 fatty acids to help prevent inflammation and blood clotting. The nurse should educate the client to increase intake of which food items? Select all that apply. Salmon Walnuts Flax seeds Avocados
Salmon Walnuts Flax seeds
While explaining the function of the first mucosal layer of the lower two-thirds (2/3) of the esophagus, the pathophysiology instructor mentions which type of functions? Select all that apply. Secretion of mucus to lubricate and protect the inner surface of alimentary canal. Smooth muscle cells that facilitate movement of contents of the gastrointestinal tract. Hold the organs in place and storage for fats. Barrier to prevent the entry of pathogenic organisms. A cushioning to protect against injury from sports or car accidents.
Secretion of mucus to lubricate and protect the inner surface of alimentary canal. Barrier to prevent the entry of pathogenic organisms.
A 68-year-old black 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 3 alcoholic beverages nearly every day. Which is most likely his problem? Achalasia Squamous cell carcinoma of the esophagus Dysphagia secondary to scleroderma Gastrointestinal reflux disease
Squamous cell carcinoma of the esophagus
Parents have brought their child to the emergency department with abdominal pain. Which clinical manifestations would lead the health care team to suspect the child has appendicitis? Select all that apply. Tenderness in right lower quadrant with palpation. Rebound tenderness in inguinal areas upon palpation. Redness and warmth over right lower quadrant. Bloating and flatulence noticeable. Urine has the smell of stool with brown coloring.
Tenderness in right lower quadrant with palpation. Rebound tenderness in inguinal areas upon palpation
When explaining the role of liver Kupffer cells to a group of nursing students, which statement about the function of these cells is most accurate? The primary function of Kupffer cells is to secrete bile. These cells are the functional unit of the liver and are responsible for all liver secretions. The cells are capable of removing and phagocytizing old and defective blood cells. The role of the Kupffer cells is to provide at least 50% of cardiac output each minute to each lobular of the liver.
The cells are capable of removing and phagocytizing old and defective blood cells.
A 51-year-old male has been diagnosed with alcohol-induced liver disease. He admits to the nurse he does not understand what the liver does in the body. Which of these statements best explains the liver's function? The liver is responsible for the absorption of most dietary nutrients as well as the production of growth hormones. The liver contributes to the metabolism of ingested food and provides the fluids that the GI tract requires. The liver metabolizes most components of food and also cleans the blood of bacteria and drugs. The liver maintains a balanced level of electrolytes and pH in the body and stores glucose, minerals and vitamins.
The liver metabolizes most components of food and also cleans the blood of bacteria and drugs.
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 on the unit would recognize that which factor likely contributed to the health problem and would anticipate which treatment?
The use of broad spectrum antibiotics likely played a role in the developments of the infections, and most clients would likely receive metronidazole as a treatment.
The nurse is caring for a client with late stage cirrhosis who is prescribed the beta-blocker propranolol. Which complications of cirrhosis will the nurse expect to be reduced by administration of propranolol? Select all that apply. Thrombocytopenia Esophageal varices Hyperaldosteronism Ascites Jaundice
Thrombocytopenia Esophageal varices Ascites
Which statement best captures an aspect of the process of fat digestion and absorption?
Triglycerides are digested with the aid of bile salts.
The nurse walks into a room and finds the client forcefully expelling stomach contents into a wash basin. When documenting this occurrence, the nurse will use the term: Nauseous Retching Vomiting Expatriate
Vomiting
Which statement about types of obesity is most accurate?
Waist circumference is a measurement of subcutaneous abdominal adipose tissue but not intra-abdominal adipose tissue.
A male client has a body mass index (BMI) of 31. What information should the nurse include when teaching the client? Select all that apply. We will need to further investigate your nutritional status to supplement the BMI value. Due to your BMI, you have an increased risk of type 2 diabetes and heart disease. A BMI of 31 places you in the category of moderately overweight, bordering on obesity. Genetic factors play a major role in determining your weight; lifestyle is only a small factor. Even moderate reduction from your current BMI can offer a wide range of health benefits.
We will need to further investigate your nutritional status to supplement the BMI value. Due to your BMI, you have an increased risk of type 2 diabetes and heart disease. Even moderate reduction from your current BMI can offer a wide range of health benefits.
The nurse notes a client's bilirubin level is 2.5 mg/dL (42.8 μmol/L). Which assessment is most relevant for the nurse to perform based on these results? The nurse should assess the client's: eyes. oral mucosa. level of orientation. abdominal girth.
eyes.
A middle-aged man walks into the emergency department reporting 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 client is having an acute MI with decreased cardiac output. The nurse identifies the nausea to be in response to: the client doesn't have a very high pain tolerance. hypoxia exerting a direct effect on the chemoreceptor trigger zone. the client hasn't digested his meal completely. fear of having to make major lifestyle changes.
hypoxia exerting a direct effect on the chemoreceptor trigger zone.
A client who suffered a stroke is having difficulty swallowing food and beverages. The client complains that it feels like "the food is sticking to the back of my throat." Given this information, the priority nursing interventions would be to: make the client "nothing per os" (NPO) and call the physician. feed the client while he or she is sitting in an upright position. add a thickening agent to all of the client's beverages. do nothing; no action is warranted since this is a normal occurrence after a stroke.
make the client "nothing per os" (NPO) and call the physician.
A client 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: anti-anxiety medications. proton pump inhibitors. lactulose, to reduce the blood ammonia levels. calcium carbonate, an antacid.
proton pump inhibitors.
