Pathophysiology Exam 2
A client is on bed rest. Approximately what percentage of the blood volume will be in the central circulation?
25% Explanation: Body position affects the distribution of blood volume. In the recumbent position, approximately 25% to 30% of the total blood volume is in the pulmonary circulation. On standing, gravity causes a rapid displacement of this blood to the lower part of the body. Because the volume of the systemic circulation is approximately seven times that of the pulmonary circulation, a shift of blood from one system to the other has a much greater effect in the pulmonary than in the systemic.
A client who is in a room at 1 atmosphere (760 mm Hg) is receiving supplemental oxygen therapy that is being delivered at a concentration of 50%. What is the consequent PO2?
380 mm Hg Explanation: The law of partial pressures states that the total pressure of a mixture of gases, as in the atmosphere, is equal to the sum of the partial pressures of the different gases in the mixture. If the concentration of oxygen at 760 mm Hg (1 atmosphere) is 50%, its partial pressure is 380 mm Hg (50.54 kPa). The equation to calculate is 760 × 0.50 = 380.
The nurse is working in a pediatric clinic. Which child would the nurse recognize as having isosexual precocious puberty?
A 5-year-old black female with developing breasts and pubic hair. Explanation: Precocious puberty is now defined as the appearance of secondary sexual development before the age of 7 years in white girls and 6 years in black girls. In boys of both races, the lower age limit remains 9 years. However, it is recognized that puberty can develop earlier in boys with obesity.
Select the clinical situation that would result in increased diffusion of gases from the arterial blood into the alveoli.
A client who is receiving 100% oxygen via oxygen mask Explanation: Several factors influence the diffusion of gases in the lung. The administration of high concentrations of oxygen increases the difference in partial pressure between the two sides of the membrane and increases the diffusion of the gas. Diseases that destroy lung tissue (i.e., surface area for diffusion) or increase the thickness of the alveolar-capillary membrane adversely influence the diffusing capacity of the lungs.
A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching the client about the anatomical location of the infection. The nurse evaluates the effectiveness of the teaching when the client correctly identifies which of the following as the location of the pericardium?
A membranous sac that encloses the heart Explanation: The pericardium forms a fibrous covering around the heart, holding it in a fixed position in the thorax and providing physical protection and a barrier to infection. The pericardium is a tri-layer sac consisting of a tough, outer fibrous layer and a thin, inner serous layer.
Which client would be considered to be exhibiting manifestations of "prediabetes"?
A middle-aged overweight adult with a fasting plasma glucose level of 122 with follow-up OGTT of 189 mg/dL (10.49 mmol/L). Explanation: Persons with IFG (impaired fasting plasma glucose [IFG] defined by an elevated FPG of 100 to 125 mg/dL [5.55 to 6.94 mmol/L]) and/or IGT (impaired glucose tolerance [IGT] plasma glucose levels of 140 to 199 mg/dL [7.77 to 11.04 mmol/L] with an OGTT) are often referred to as having prediabetes, meaning they are at relatively high risk for the future development of diabetes as well as cardiovascular disease.
The nurse is caring for a client who is now 2 days post near-drowning. The focused assessment would involve which area of the lung involved in gas exchange?
Alveoli Explanation: The alveoli are located at the terminal portion of the bronchioles. They are small sacs with thin, single-celled walls surrounded by capillaries, which enables the exchange of gases to occur between the inspired air and the blood in the capillaries.
Dyspnea is defined as an uncomfortable sensation or difficulty in breathing that is subjectively defined by the client. Which disease state is not characterized by dyspnea?
Alzheimer disease Explanation: Dyspnea is observed in at least three major cardiopulmonary disease states: primary lung diseases, such as pneumonia, asthma, and emphysema; heart disease that is characterized by pulmonary congestion; and neuromuscular disorders, such as myasthenia gravis and muscular dystrophy that affect the respiratory muscles. Dyspnea is not an identified component of Alzheimer disease.
Select the correct sequence of blood return to the heart.
Capillaries, venules, veins, right atrium
The heart controls the direction of blood flow. What is the role of the aortic valve?
Controls the direction of blood flow from the left side of the heart to the systemic circulation Explanation: The heart valves control the direction of blood flow from the atria to the ventricles (the AV valves), from the right side of the heart to the lungs (pulmonic valves) and from the left side of the heart to the systemic circulation (aortic valve).
Above the glottis that opens and closes for speech, the epiglottis performs which physiologic function during swallowing?
Covers the larynx Explanation: During swallowing, the free edges of the epiglottis move downward to cover the larynx, thereby preventing liquids and foods from entering. When substances other than air manage to enter the airway, the vocal folds serve as a sphincter, causing the larynx muscles to constrict and close and/or collapse the airway as a protective measure.
A client arrives in the emergency department suffering a traumatic brain injury as a result of a car accident. While assessing this client, the nurse notices the client has an irregular breathing pattern consisting of prolonged inspiratory gasps interrupted by expiratory efforts. The underlying physiologic principle for these signs would include:
Damage has occurred at the connection between the pneumotaxic and apneustic centers. Explanation: Brain injury, which damages the connections between the pneumotaxic and apneustic centers, results in an irregular breathing pattern that consists of prolonged inspiratory gasps interrupted by expiratory efforts. If the occipital lobe was not functioning, the client would have no respiratory effort and require mechanical ventilation. Leaking of spinal fluid would not cause these respiratory signs. If nerves were severed to the lungs, the client would not be able in inflate/deflate the lungs with mechanical ventilation.
A client's recent history of emphysema has resulted in the functional loss of many alveoli. How will this impact the physiologic function of the type II alveoli?
Decrease the production of surfactant Explanation: Although macrophages are present in all alveoli, only type II alveoli produce surfactant. They do not participate directly in gas exchange or facilitate bronchial circulation.
The nurse is caring for a postoperative client in traction. Which activity would be most beneficial for preventing atelectasis in this client?
Encourage the client to cough and breathe deeply several times per hour. Explanation: The best technique to prevent atelectasis is coughing and deep breathing exercises. The client should not remain immobile and the head of the bed should be elevated. The other measures are more invasive.
Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of:
Graves disease Explanation: Graves disease is an autoimmune disorder characterized by abnormal stimulation of the thyroid gland by thyroid-stimulating antibodies (TSH-receptor antibodies) that act through the normal TSH receptors.
Which assessment finding of a client constitutes a criterion for a diagnosis of metabolic syndrome?
Has a high blood pressure that is consistently in the range of 140/90 mm Hg or greater. Explanation: Diagnostic criteria for metabolic syndrome include obesity, high levels of plasma triglycerides and low levels of high-density lipoproteins (HDLs), hypertension, systemic inflammation (CRP), abnormal fibrinolysis, abnormal function of the vascular endothelium, and macrovascular disease. Sedentary lifestyle, high resting heart rate, and a family history of type 2 diabetes are associated with other health problems, including diabetes, but these are not diagnostic criteria for metabolic syndrome.
The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding?
Heart rate 110 and bounding Explanation: Cardiovascular and respiratory functions are strongly affected by thyroid function. With an increase in metabolism, there is a rise in oxygen consumption and production of metabolic end products, with an accompanying increase in vasodilation. Blood volume, cardiac output, and ventilation are all increased. Heart rate and cardiac contractility are enhanced as a means of maintaining the needed cardiac output. Blood pressure is likely to change little because the increase in vasodilation tends to offset the increase in cardiac output.
A hospital client with a diagnosis of type 1 diabetes has been administered a scheduled dose of regular insulin. Which effect will result from the action of insulin?
Promotion of glucose uptake by target cells Explanation: The actions of insulin are threefold: (1) it promotes glucose uptake by target cells and provides for glucose storage as glycogen; (2) it prevents fat and glycogen breakdown; and (3) it inhibits gluconeogenesis and increases protein synthesis. Glucagon, not insulin, promotes glycogenolysis.
A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action?
Helping the client make meaningful changes to his diet and activity level. Explanation: Weight loss and dietary management are the initial focus of treatment for type 2 diabetes. For many people with type 2 diabetes, the benefits of exercise include a decrease in body fat, better weight control, and improvement in insulin sensitivity. If good glycemic control cannot be achieved with exercise and diet, then antidiabetic agents and even insulin can be added to the treatment plan. Education is imperative, but there is no need to emphasize hypoglycemia, since there is no evidence the client is on a medication that would cause hypoglycemia.
Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Select the factor that has a powerful vasodilator effect on arterioles and increases capillary permeability.
Histamine Explanation: Histamine has a powerful vasodilator effect on arterioles and has the ability to increase capillary permeability, allowing leakage of both fluid and plasma proteins into the tissues. Norepinephrine is a powerful vasoconstrictor. Serotonin causes vasoconstriction and plays a major role in control of bleeding. Prostaglandins produce either vasoconstriction or vasodilation.
A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the nurse suspect as a diagnosis?
Hypoglycemia Explanation: Alcohol decreases liver gluconeogenesis, and people with diabetes need to be cautioned about its potential for causing hypoglycemia, especially if alcohol is consumed in large amounts or on an empty stomach.
A client comes to the clinic with fatigue and muscle weakness. The client also states she has been having diarrhea. The nurse observes the skin of the client has a bronze tone and when asked, the client says she has not had any sun exposure. The mucous membranes of the gums are bluish-black. When reviewing laboratory results from this client, what does the nurse anticipate seeing?
Increased levels of ACTH Explanation: Hyperpigmentation results from elevated levels of ACTH. The skin looks bronzed or suntanned in exposed and unexposed areas, and the normal creases and pressure points tend to become especially dark. The gums and oral mucous membranes may become bluish-black. The amino acid sequence of ACTH is strikingly similar to that of melanocyte stimulating hormone; hyperpigmentation occurs in more than 90 percent of persons with Addison disease and is helpful in distinguishing the primary and secondary forms of adrenal insufficiency.
Which metabolic abnormality can lead to the development of type 2 diabetes?
Insulin resistance Explanation: The metabolic abnormalities that lead to type 2 diabetes include (1) peripheral insulin resistance, (2) deranged secretion of insulin by the pancreatic beta cells, and (3) increased glucose production by the liver. Obese people have increased resistance to the action of insulin and impaired suppression of glucose production by the liver, resulting in both hyperglycemia and hyperinsulinemia. Lifestyle and overeating seem to be the triggering events (rather than metabolic abnormalities). Acute pancreatitis is a reversible impairment of alpha and beta cell function, with hypoinsulinemia as a complication.
When the semilunar valves open it signals the onset of the ejection period. The aortic pressure reflects changes in the ejection of blood from which part of the heart?
Left ventricle Explanation: The aortic pressure reflects changes in the ejection of blood from the left ventricle.
The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation?
Left ventricle Explanation: The right atrium receives blood returning to the heart from the system circulation. The left atrium receives oxygenated blood from the lungs. The right ventricle pumps blood to the lungs. The left ventricle pumps blood into the systemic circulation.
The home care nurse is caring for a client who has sustained phrenic nerve damage from a skiing accident. The nurse understands that the client must be on a ventilator for which reason?
Loss of diaphragmatic function Explanation: The diaphragm is the primary muscle of respiration and is essential to ventilation. The phrenic nerve, which exits the spinal cord between C3 and C5, stimulates the diaphragm to contract, increasing the space in the chest cavity and thus causing a decrease in the intrathoracic pressure, allowing air to flow into the lungs.1
A nurse is assessing a female client and notes that her left arm is swollen from the shoulder down to the fingers, with non-pitting edema. The right arm is normal. The client had a left-sided mastectomy 1 year ago. What does the nurse suspect is the problem?
Lymphedema Explanation: The lymphatic system filters fluid at the lymph nodes and removes foreign particles such as bacteria. When lymph flow is obstructed, a condition called lymphedema occurs. Involvement of lymphatic structures by malignant tumors and removal of lymph nodes at the time of cancer surgery are common causes of lymphedema.
A client admitted to the hospital with heart failure tells the nurse he has developed a condition that interferes with movement of blood through sections of the lungs. The nurse recognizes this as:
Physiologic shunting Explanation: Shunt refers to blood that moves from the right to the left side of the circulation without being oxygenated. Physiologic shunting of blood usually results from destructive lung disease that impairs ventilation or from heart failure that interferes with movement of blood through sections of the lungs. Anatomic shunting of blood is most commonly due to congenital heart defects. Abdominal and ventricular peritoneal shunting would not alter blood flow with the lungs.
Which of the following factors affect cardiac performance? Select all that apply.
Preload Afterload Myocardial contractility Explanation: The four factors that affect cardiac performance include preload, afterload, myocardial contractility, and heart rate (not rhythm).
A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?
Random Blood Glucose 85 mg/dL (4.72 mmol/L) Explanation: The goals of the nutritional plan for gestational diabetes mellitus (GDM) include normal glucose levels, no ketosis, proper weight gain for the pregnancy, and adequate nutrition for fetal health.
A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?
Right-sided heart failure
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.
The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues. Explanation: The circulatory system consists of the heart, which pumps blood; the arterial system, which distributes oxygenated blood to the tissues; the venous system, which collects deoxygenated blood from the tissues and returns it to the heart; and the capillaries, where exchange of gases, nutrients, and waste takes place.
A client is managing diabetes with exercise and diet. The health care provider reviews the client's most recent laboratory results: fasting blood glucose level at 80 mg/dL (4.44 mmol/L) and a hemoglobin A1C of 5% (0.05). Select the response that best identifies the client.
The client is achieving normal glycemic control. Explanation: The reading for the fasting blood glucose is appropriate, and the hemoglobin A1C level estimates good control of glucose levels over a 6- to 12-week period. This client should continue the exercise and diet routine as planned.
The nurse is educating a newly diagnosed client with Hashimoto thyroiditis who is to be discharged from the acute care facility. What should the nurse be sure to include in the education to prevent complications?
The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention. Explanation: Prevention is preferable to treatment and entails special attention to high-risk populations, such as women with a history of Hashimoto thyroiditis. These persons should be informed about the signs and symptoms of severe hypothyroidism and the need for early medical treatment.
A newborn is screened for congenital hypothyroidism and is found to have the disorder. When educating the mother about the importance of the infant taking thyroid hormone supplement, what should be included in the education?
The infant will have dosage levels adjusted as he grows. Explanation: Congenital hypothyroidism is treated by hormone replacement. Evidence indicates that it is important to normalize T4 levels as rapidly as possible because a delay is accompanied by poorer psychomotor and mental development. Dosage levels are adjusted as the child grows. When early and adequate treatment regimens are followed, the risk of intellectual disability in infants detected by screening programs is essentially nonexistent.
Which blood vessel layer is made primarily of muscle?
Tunica media Explanation: The middle layer (tunica media) of a vessel is largely a smooth muscle layer that constricts to regulate and control the diameter of the vessel. The outermost layer of a vessel is called the tunica externa (or tunica adventitia) and is composed of loosely woven collagen fibers. The innermost layer is the tunica intima, which consists of a single layer of flattened endothelial cells.
A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate?
Using an insulin infusion pump Explanation: Clients with type 1 diabetes mellitus require exogenous insulin because they have absolute lack of their own secretion. Insulin is a protein that would be digested if taken orally. To avoid injections, clients could use an insulin pump, which provides continuous infusion through a catheter placed under the skin that is changed every few days. While some herbal preparations may help lower blood glucose, they do not replace insulin. While aerobic activity helps mobilize glucose, it does not replace insulin. Metformin is an insulin sensitizer that enhances insulin utilization, but does not replace insulin.
The nurse is explaining to the parents of a 23-week premature infant the reason their baby needs to be on mechanical ventilation. The education is successful when the parents state that they understand their baby was born before the type II alveolar cells could mature, which has caused a:
deficiency of surfactant. Explanation: Surfactant is essential in supporting lung compliance by the reduction of surface tension, allowing a greater ease of lung inflation. Type II alveolar cells synthesize surfactant, which is composed of phospholipids, neutral lipids and proteins. Type II alveolar cells do not begin to mature until the 26th to 27th week of gestation; therefore, it is not unusual for premature infants to have insufficient levels of surfactant leading to alveolar collapse and respiratory distress. Mechanical ventilation helps to support the respiratory system.
A distressed, confused client is admitted to the hospital emergency department with a penetrating right chest stab wound. The nurse assesses the client and notes a lack of breath sounds in the right lung. The nurse knows this is likely the result of:
loss of intrapleural negative pressure. Explanation: Intrapleural pressure is always negative in comparison to atmospheric pressure, and this is essential to maintain inflation of the lungs and alveoli. The loss of the negative pressure due to air, blood, fluids, or pus in the pleural space causes the lungs to collapse. The collapse of the right lung would result in decreased or absent breath sounds in that lung.
A client with severe hypoglycemia is unconscious. Which method of providing glucose should not be used for this client?
orange juice orally Explanation: When clients are unconscious it is not safe to attempt to have them swallow liquids. Alternate routes that reduce the risk of choking such as buccal absorption, intramuscular or intravenous injections are preferred.
The nurse screening for diabetes mellitus at a health fair obtains these results. Which client should be referred to a primary health care provider for further evaluation?
random blood glucose 195 mg/dl (10.8 mmol/l) Explanation: Laboratory values that are considered normal are hemoglobin A1C less than 6%, fasting plasma glucose (FPG) less than 100 mg/dl (5.5 mmol/l) or less than 140 mg/dl (7.8 mmol/l) 2 hours after an oral glucose tolerance test (GTT). Urine should be free of ketones. A hemoglobin A1C value that is greater than or equal to 6.5%, a fasting blood glucose greater than 126 mg/dl (7.0 mmol/l), or a blood glucose level greater than 200 mg/dl (11.1 mmol/l) 2 hours after a glucose tolerance test (GTT) indicate diabetes mellitus. Values between these levels are considered to place clients at increased risk for diabetes mellitus and require further evaluation. A random blood glucose level is expected to correlate with the 2-hour GTT results and should be below 200 mg/dl (11.1 mmol/l). Although the client does not have a result that meets the threshold to be diagnosed with diabetes, the elevated levels warrant assessment for prediabetes and early intervention.
Which sequence is the correct pathway for blood flow through the heart?
right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta
Clients who have been bedridden for a long time likely will experience:
shallow, quiet breathing, which impairs the spreading of surfactant. Explanation: At low lung volumes, the molecules of surfactant become tightly packed, and at higher lung volumes, they spread out to cover the alveolar surface. In surgical clients and bedridden persons, shallow and quiet breathing often impairs the spreading of surfactant. Premature infants may require recombinant forms of surfactant to treat infant respiratory distress syndrome. Suctioning cannot be done at the alveolar level. One of the treatments for bedrest clients is cough and deep breathing exercises to enhance the spread of surfactant to prevent atelectasis.
A college student is training for a marathon in the mountains. One day, she experiences a sharp pain and suddenly becomes short of breath. At the emergency room, chest x-ray reveals a spontaneous pneumothorax. The client asks the nurse to explain why this happened. The nurse states:
"For unknown reasons, you lost intrapleural negative pressure. This means your lungs collapsed and expelled its air when you lose negative pressure." Explanation: The intrapleural pressure is always negative in relation to alveolar pressure in the normally inflated lung: approximately 4 mm Hg between breaths when the glottis is open and the alveolar spaces are open to the atmosphere. Although the intrapleural pressure of the inflated lung is always negative in relation to alveolar pressure, it may become positive in relation to atmospheric pressure (e.g., as during forced expiration and coughing). A spontaneous pneumothorax is a collapsed lung with loss of negative pressures.
A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is:
"You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked." Explanation: Collateral circulation is a mechanism for the long-term regulation of local blood flow. In the heart, anastomotic channels exist between some of the smaller arteries. These channels permit perfusion of an area by more than one artery. When one artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel. For example, persons with extensive obstruction of a coronary blood vessel may rely on collateral circulation to meet the oxygen needs of the myocardial tissue normally supplied by that vessel. There is no indication that the client is on a blood thinner.
A client is having blood work done. What percentage of red blood cells represents the formed elements of the blood?
40 - 45% Explanation: The red blood cells constitute 40 to 45 percent of the formed elements of the blood.
A client with a history of heart failure has the following echocardiogram results: heart rate 80 beats/minute; end-diastolic volume 120 mL; and end-systolic volume 60 mL. What is this client's ejection fraction (EF)?
50% Explanation: Ejection fracture = stroke volume ÷ end-diastolic volume. Stroke volume equals the difference between end-diastolic and end-systolic volume. Therefore, EF = 60 ÷ 120, or 50%.
What is the normal tidal volume for a person at rest?
500 mL Explanation: Tidal volume (about 500 mL at rest); expiratory reserve volume (about 1100 mL); inspiratory reserve volume (about 3000 mL); and vital capacity (about 4600 mL)
While discussing carbon dioxide transport within the body, the instructor asks, "What enzyme helps carbon dioxide with water to form bicarbonate?" Which student response is correct?
Carbonic anhydrase Explanation: Most of the carbon dioxide diffuses into the red blood cells, where it either forms carbonic acid or combines with hemoglobin. Carbonic acid (H2CO3) is formed when carbon dioxide combines with water (CO2 + H2O = H+ + HCO3−). The process is catalyzed by an enzyme called carbonic anhydrase, which is present in large quantities in red blood cells. Carbonic anhydrase increases the rate of the reaction between carbon dioxide and water approximately 5000-fold. Carbonic acid readily ionizes to form bicarbonate (HCO3−) and hydrogen (H+) ions.
During the admission interview the client, who is admitted with bacterial pneumonia, reveals a 20 pack per year smoking history. The nurse relates the possible cause of this pneumonia to the decreased defense of the pulmonary system caused by cigarette smoking. Smoking affects the pulmonary defense system in what way?
Damage or destruction of cilia Explanation: There are over 4,000 chemicals in cigarette smoke; these chemicals and tar stick to the cilia that line the conducting airway, causing decreased movement and eventual destruction of this vital pulmonary defense system. With the destruction of the cilia, which are essential in keeping foreign particles out of the lungs, dust, particles, pathogens and other harmful substances enter the lungs where they can cause damage or disease. Nicotine increases the release of neurotransmitters in the brain and is extremely addictive; it has no known effect on the cilia.
An extremely lethargic client arrives by ambulance at the emergency department. His blood glucose level is 32 mg/dL (1.78 mmol/L). The nurse will anticipate that this client will be diagnosed with:
Hypoglycemia Explanation: Hypoglycemia is a blood glucose level of less than 60 mg/dL (3.33 mmol/L). Blood glucose levels would be elevated in diabetic ketoacidosis and in the dawn phenomenon. Autonomic neuropathy causes disorders of autonomic (for example, cardiovascular) function.
A client is admitted with a diagnosis of pulmonary embolism (PE) associated with severe dyspnea for the past week. The nurse would explain that which of the following is the most likely cause for the dyspnea? Select all that apply.
Impaired gas exchange Ventilation/perfusion mismatch Increased dead space Impaired alveolar blood flow Explanation: Pulmonary emboli usually develop from thrombi in the lower extremities. They break off, travel through the right side of the heart, and land in the smaller vessels of the pulmonary vasculature, causing impairment of alveolar blood flow, increased dead space, ventilation/perfusion mismatch, and impaired gas exchange.
Which related circulatory complication can result from surgical treatment for metastatic breast cancer?
Lymphedema in the affected arm Explanation: Involvement of lymphatic structures by malignant tumors and removal of lymph nodes at the time of cancer surgery are common causes of lymphedema. The other options are not related to the surgery that would have removed any affected lymph nodes.
A nursing student is studying the respiratory airways in the lungs, in particular the alveoli. A fellow student asks which cells are most instrumental in the destruction of foreign substances that may enter the alveoli with inspired air. The most accurate response would be:
Macrophages Explanation: Macrophages develop from monocytes and are phagocytic cells that not only destroy foreign substances but also initiate the inflammatory response and release cytokines that alert other cells in the immune system.
The heart consists of four valves. Which are the semilunar valves? Select all that apply.
Pulmonary Aortic Explanation: The heart's semilunar valves are the pulmonary and aortic values. The heart's atrioventricular valves are the tricuspid and the mitral.
The heart is a four-chambered pump. What is the function of the right ventricle?
Pumps blood to the lungs Explanation: The right ventricle pumps blood to the lungs. The right atrium receives blood returning to the heart from the system circulation. The left atrium receives oxygenated blood from the lungs. The left ventricle pumps blood into the systemic circulation.
An individual has sensitivity to perfumes and experiences shortness of breath when exposed to them. This occurs because:
stimulation of irritant receptors causes bronchoconstriction. Explanation: It is possible that irritant receptors are involved in the bronchoconstriction response that occurs in some persons with bronchial asthma when exposed to irritants such as tobacco, smoke, or perfume. A type III hypersensitivity reaction is an immune complex response, which does not exist in this case. Toxins do not normally compete with oxygen for binding sites. Artificial scents do not directly disrupt gas diffusion.
A child has been removed from a home in which she has experienced severe neglect and emotional abuse, and has been placed in foster care. The child has psychosocial dwarfism and the foster parents ask the nurse what this means for the future of the child. What is the best response by the nurse?
"The prognosis of the child depends on an improvement in behavior and catch-up growth." Explanation: Psychosocial dwarfism involves a functional hypopituitarism and is seen in some emotionally deprived children. These children usually present with poor growth, potbelly, and poor eating and drinking habits. Typically, there is a history of disturbed family relationships in which the child has been severely neglected or disciplined. Often, the neglect is confined to one child in the family. GH function usually returns to normal after the child is removed from the constraining environment. The prognosis is dependent on improvement in behavior and catch-up growth.
A client with Graves disease has ophthalmopathy and asks the nurse if the eyes will stay like this forever. What is the best response by the nurse?
"With treatment of the hyperthyroid state, the ophthalmopathy usually tends to stabilize." Explanation: The ophthalmopathy of Graves disease can cause severe eye problems, including tethering of the extraocular muscles resulting in diplopia; involvement of the optic nerve, with some visual loss; and corneal ulceration because the lids do not close over the protruding eyeball. The ophthalmopathy usually tends to stabilize after treatment of the hyperthyroidism.
