Pathophysiology Exam 5
Which of the following will conduct injurious stimuli to alert the body of potential damage?
Nociceptors
Peripheral neuropathies occur in people with diabetes mellitus. With the loss of sensation in the lower extremities, diabetics become predisposed to what?
Clawing of toes and denervation of the small muscles of the foot
The regulation of cerebral blood flow is accomplished through both autoregulation and local regulation. This allows for the brain to meet its metabolic needs. What is the low parameter for arterial blood pressure before cerebral blood flow becomes severely compromised?
60 mm Hg
Hypoglycemia has a sudden onset with a progression of symptoms. What are the signs and symptoms of hypoglycemia?
Altered cerebral function and headache
Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury?
Altered level of consciousness
The pancreas is an endocrine organ that is composed of acini and the islets of Langerhans. The islets of Langerhans have alpha, beta, and delta cells as well as the PP cell. Which cells secrete insulin? -Alpha cells -Beta cells -Delta cells -PP celss
Beta cells 1070
Using surgery to relieve severe, intractable pain has been successful to a degree. What can surgery be used for when a person is in pain?
Block transmission of phantom limb pain
Diabetic ketoacidosis (DKA) is a condition that mostly occurs in type 1 diabetics. What are the definitive diagnostic criteria for DKA
Blood glucose level greater than 250 mg/dL; bicarbonate less than 15 mEq/L and pH less than 7.3
Acromegaly is a disorder that is caused by the production of excessive GH in the adult. Because the person cannot grow taller, the soft tissues continue to grow, presenting a very distinctive appearance. What is it that is distinctive in a person with acromegaly? -Small hands and feet compared to length of arms and legs -Broad bulbous nose and a protruding lower jaw -Slanting forehead and a receding lower jaw -Protruding lower jaw and forehead
Broad bulbous nose and a protruding lower jaw 1053
Manifestations of brain tumors are focal disturbances in brain function and increased intercranial pressure (ICP). What causes the focal disturbances manifested by brain tumors?
Brain edema and disturbances in blood flow
When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present?
Brudzinski sign and Kernig sign
Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made?
CT scan
A 14-year-old girl has been thrown from the back of a pick-up truck. MRI shows complete cord injury at the level of C2. What is the main significance of an injury at this level of the spinal column?
Cannot breathe on own, needs ventilator assistance
Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy?
Carpal tunnel syndrome
A severe type of headache that occur more frequently in men than women and is described as having unrelenting, unilateral pain located most frequently in the orbit is called what?
Cluster headache
Which type of seizure begins in a localized area of the brain but may progress rapidly to involve both hemispheres?
Complex partial
The nurse is caring for a 31-year-old trauma victim admitted to the neurologic intensive care unit. While doing the initial assessment, the nurse finds that the client is flexing the arms, wrists, and fingers. There is adduction of plantar flexion of the lower extremities. How would the nurse describe this in the notes?
Decorticate posturing
In describing the ideal analgesic, what factor should NOT be included? -inexpensive -have mineral adverse effects -effective -decrease the level of consciousness
Decrease the level of consciousness
Type 2 diabetes is caused by metabolic abnormalities in the presence of insulin. Which of these is NOT an example of those metabolic abnormalities? -deranged secretion of insulin -decreased glucose production by the liver -insulin resistance -increase glucose production by the liver
Decreased glucose production by the liver 1076
Growth hormone exerts its effects on the body in many ways. Which of these is NOT an effect of GH? -enhances fatty acid metabolization -increases insulin levels -facilitates the rate of protein synthesis -decreases ATCH production
Decreases ATCH production 1050
Brain death is the term that is used when the loss of function of the entire brain is irreversible. A clinical examination must be done and repeated 6 hours later with the same findings for brain death to be declared. What is NOT assessed in the clinical examination for brain death? -blink reflex -responsiveness -electrocardiogram -respiratory effect
Electrocardiogram
When giving pain medicine for acute pain, health care workers are reluctant to provide much needed opioid pain medicine. What is the major concern of health care workers when providing opioid pain relief?
Fear of addiction
Approximately 6 months after a spinal cord injury, a 29-year-old man has an episode of autonomic dysreflexia. Which of the following is NOT characteristic of autonomic dysreflexia? -hypertension -fever -skin pallor -piloerector response
Fever
The spinal cord contains the basic factors necessary to coordinate function when a movement is planned. It is the lowest level of function. What is the highest level of function in planning movement?
Frontal cortex
Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur? -Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen -Genetic predisposition, physiologic triggering event, and an allergic reaction to pancreatic alpha cells -Diabetogenic gene from both parents, physiologic triggering event, and an allergic reaction to pancreatic delta cells -Diabetogenic gene from both parents, environmental triggering event, and B lymphocyte reaction to alpha cell antigens
Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen *
When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis? -Goiter -Thyroid tumor -Congenital hypothyroidism -Hashimoto thyroiditis
Hashimoto thyroiditis 1057 1060
The basal ganglia play a role in coordinated movements. Part of the basal ganglia system is the striatum, which involves local cholinergic interneurons. What disease is thought to be related to the destruction of the cholinergic interneurons?
Huntington disease
There are several types of brain injuries that can occur. Which of these is NOT a primary (or direct) brain injury? -focal lesions of laceration -contusion -hypoxic -diffuse axonal
Hypoxic
Diabetics are at higher risk than are the majority of the population for injury to organ systems in the body. Which organs are most at risk?
Kidneys and eyes
It is often necessary to assess a client's pain. What factors would you assess when assessing pain?
Nature and severity of pain
Gestational diabetes mellitus is a disorder of glucose intolerance that occurs during pregnancy. It is associated with increased risk for developing type 2 diabetes and with fetal abnormalities. What fetal abnormalities are associated with gestational diabetes mellitus? -Microsomia and polycythemia -Macrosomia and hypocalcemia -Hypercalcemia and hyperbilirubinemia -Hypoglycemia and hypercalcemia
Macrosomia and hypocalcemia
Hormones that counteract insulin's storage function when regulating blood glucose during times when glucose intake is limited, or glucose stores are depleted are called counterregulatory hormones. Which of these is NOT a counterregulatory hormone? -glucocorticoids -growth hormone -catecholamines -mineralocorticoids
Mineralocorticoids 1072
Migraine headaches affect millions of people worldwide. What are first-line agents for the treatment of migraine headaches?
Naproxen sodium and metoclopramide
What are the hallmark signs of diabetes mellitus?
Polyuria, polydipsia, and polyphagia
When testing nociceptive stimuli to elicit a withdrawal reflex in the body, what stimuli are commonly used?
Pressure from a sharp object
Amyotrophic lateral sclerosis is considered a disease of the upper motor neurons. What is the most common clinical presentation of amyotrophic lateral sclerosis?
Slowly progressive weakness and atrophy in distal muscles of one upper extremity
Research has identified a cycle of insulin-induced post hypoglycemic episodes. What is this phenomenon called?
Somogyi effect
Herniated disks occur when the nucleus pulposus is compressed enough that it protrudes through the annulus fibrosus, putting pressure on the nerve root. This type of injury occurs most often in the cervical and lumbar region of the spine. What is an important assessment technique for a herniated disk in the lumbar region?
Straight-leg test
Phantom limb pain is a little understood pain that is difficult to treat, even though the client is experiencing severe pain. What are the treatments for phantom limb pain?
Sympathetic blocks and hypnosis
The hallmark manifestation of Cushing syndrome is a moon face, a "buffalo hump" between the shoulder blades, and a protruding abdomen. What other manifestation of Cushing syndrome occur?
Thin extremities and muscle weakness 1067 *not on test
Children feel pain just as much as adults do. What is the major principle in pain management in the pediatric population.
Treat on individual basis and match analgesic agent with cause and level of pain.
In myasthenia gravis, periods of stress can produce myasthenia crisis. When does myasthenia crisis occur?
When muscle weakness becomes severe enough to compromise ventilation
Hyperthyroidism that is inadequately treated can cause a life-threating condition known as thyroid storm. Which of these is NOT a manifestation of thyroid storm? -tachycardia -very low fever -delirium -very high fever
very low fever 1062
Much like brain death, there are criteria for the diagnosis of a persistent vegetative state, and the criteria have to have lasted for more than 1 month. Which of these is NOT a criteria for the diagnosis of persistent vegetative state? -bowel and bladder incontinence -ability to open the eyes -lack of language comprehension -variable preserved cranial nerve reflexes
Ability to open the eyes
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?
Hypogylcemia
Growth hormone is secreted by adults as well as by children. Growth hormone deficiency in children is treated by injections of GH on a daily basis. When teaching a family or child to give injections of GH, what is important to teach them? -Give the injections in the morning so the peak effect is before noon, like the body does. -Give the injections at bedtime to produce the greatest effect at night, like the body does. -Give the injections about 3 in the afternoon to produce the greatest effect in the evening, like the body does. -Give the injections in the early afternoon to produce the greatest effect at dinner time, like the body does
Give the injections at bedtime to produce the greatest effect at night, like the body does. 1050
In Addison disease, the majority of the adrenal cortex has been destroyed. This causes a lack of mineralocorticoids and glucocorticoids. Therapy consists of oral replacement with what drug? -Cortisol -Aldosterone -Glucocorticoid -Hydrocortisone
Hydrocortisone 1067
In an acute adrenal crisis, the onset of symptoms is sudden and in the case of Addison disease, can be precipitated by exposure to a minor illness or stress. Which of these is NOT a manifestation of acute adrenal crisis? -hypertension -muscle weakness -dehydration -altered mental status
Hypertension 1067
Generalized convulsive status epilepticus is a medical emergency caused by a tonic-clonic seizure that does not spontaneously end or recurs in succession without recovery. What is the first-line drug of choice to treat status epilepticus?
Intravenous lorazepam
Which of the following types of pain is characterized by severe, brief, often repetitive pain?
Neuralgia
What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia?
Parkinson disease