pathophysiology midterm

A deficiency in which of these would result in an inhibition of the inflammatory response? A. Histamine B. Helper T cells C. B cells D. Vitamin K

Rationale: Histamine is a key mediator in the inflammatory system, unlike helper T cells, B cells, or vitamin K.

A 16-year-old girl has broken her arm while snowboarding and is shocked at the amount of swelling at the injury site. Which statement best explains the physiologic rationale for her swelling? A. Migration and proliferation of mast cells, neutrophils, and platelets to the injury site occupy an increased volume of tissue. B. Potent vasodilation increases the total volume of vascular space at the site of inflammation. C. Osmotic flow of plasma into the intravascular space causes increased blood volume and interstitial fluid. D. Loss of plasma proteins causes an increase in interstitial osmotic pressure.

Rationale: Swelling is the result of plasma proteins leaving the interstitial space, resulting in increased osmotic pressure of interstitial fluid and movement of fluid into tissues. Neither blood components, vasodilation, nor increased intravascular volume account for swelling.

The nurse evaluates the ECG of a client who has developed hypokalemia secondary to diuretic use. Which manifestation of hypokalemia does the nurse anticipate on the ECG?

A prominent U wave and flattened T wave

Which physiologic process would be considered a positive feedback mechanism?

The platelet-aggregation mechanism activating clot formation

dysphagia, vision changes, unilateral weakness

A clinical nurse specialist is interested in developing a research study focused on clients living with the sequelae of ischemic stroke. Which clients should the nurse include? Select all that apply. The nurse should include clients with: aspiration pneumonia. -dysphagia (difficulty swallowing). -falls -vision changes. -unilateral weakness.

A nurse is developing a program to help clients reduce the impact of chronic stress on their health. Which clients should the nurse prioritize as being able to most benefit from the program? select all that apply

-A 22 yr old with an eating disorder -A 30 yr old with substance abuse -A 45 yr old with inflammatory bowel disease

A widow who lost her husband a few weeks ago is having trouble with insomnia. When visiting with her health care provider, the provider suggests a prescription to help her regain a normal circadian pattern. This is based on the fact that interruption of sleep-wake cycles can cause which problems? Select all that apply

-An increased risk in accidents when sleep deprived, similar to those under the influence of alcohol -Alterations in immune function that can result in an infection

The nurse is caring for a client who has a tumor that results in excess levels of catecholamines being released. Which assessments will the nurse prioritize in this client's plan of care? Select all that apply

-Blood glucose -Blood pressure -Heart rate and rhythm

The ICU nurse is concerned with her client's arterial blood gas results-especially the pH 7.30; and PCO2 49 mmHg. The nurse interprets these ABG results and assesses her client for which clinical manifestations of respiratory acidosis? Select all that apply

-Muscle twitching -Headache with complaints of blurred vision

A nurse is caring for a client with posttraumatic stress distress disorder. Which behaviors would the nurse expect the client to manfest? Select all that apply

-Reluctance to participate in group discussions -Difficulty concentrating on tasks -Sleep disturbance with vivid nightmares

A client is brought to the emergency dept for an overdose of aspirin. The nurse caring for this client should anticipate which clinical manifestations? Select all that apply.

-Respiratory rate of 40 -ABG report: pH 7.50, PCO2 31 mmHg, HCO3 level 19 mmol/L

During a period of extreme excess fluid volume, a renal dialysis client may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell?

3% sodium chloride

The client notes that he has increased work of breathing when lying supine.

A 77-year-old man is a hospital inpatient admitted for exacerbation of his chronic obstructive pulmonary disease (COPD), and a respiratory therapist (RT) is assessing the client for the first time. Which aspect of the client's current state of health would be best characterized as a symptom rather than a sign? -The client's oxygen saturation is 83% by pulse oximetry. -The client notes that he has increased work of breathing when lying supine. -The client's respiratory rate is 31 breaths per minute. -The RT hears diminished breath sounds to the client's lower lung fields bilaterally

The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime.

A community health nurse is teaching a group of recent graduates about the large variety of factors that influence an individual's health or lack thereof. The nurse is referring to the Healthy People 2020 report from the U.S. Department of Health and Human Services as a teaching example. Of the following aspects discussed, which would be considered a determinant of health that is outside the focus of this report? -The client has a good career with exceptional preventive health care benefits. -The client has a diverse background by being of Asian and Native American/First Nation descent and practices various alternative therapies to minimize effects of stress. -The client lives in an affluent, clean, suburban community with access to many health care facilities. -The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime.

the preclinical stage of disease

A male international business traveler has returned from a trip to Indonesia. While there, he hired a prostitute for companionship and engaged in unprotected sex on more than one occasion. Unbeknownst to him, this prostitute harbored the hepatitis C virus. Upon return to the U.S., he exhibited no symptoms and returned to his usual activities. During this period of no outward symptoms, the disease would be classified as being in: -the preclinical stage of disease. -remission and unlikely to develop hepatitis C. -the clinical disease stage of hepatitis C. -the chronic phase of hepatitis C.

A client who is has increasing serum ammonia levels due to liver cirrhosis

A member of the health care team is researching the etiology and pathogenesis of a number of clients who are under his care in a hospital context. Which aspect of clients' situations best characterizes pathogenesis rather than etiology? -A client with multiple skeletal injuries secondary to a motor vehicle accident. -A client who was admitted with the effects of methyl alcohol poisoning. cirrhosis. -A client who is has increasing serum ammonia levels due to liver cirrhosis -A client who has been exposed to the mycobacterium tuberculosis bacterium.

Staffing a booth where community residents who are attending a baseball tournament can have their blood glucose levels checked.

A multidisciplinary healthcare team operates a program aimed at the prevention, identification, and treatment of diabetes on a large Indian reservation. Which aspect of the program would most likely be classified as secondary prevention? -Staffing a booth where community residents who are attending a baseball tournament can have their blood glucose levels checked. -Regularly scheduled wound dressing changes for clients who have foot ulcers secondary to peripheral neuropathy and impaired wound healing. -Administering oral antihyperglycemic medications to clients who have a diagnosis of diabetes -Teaching school children how a nutritious, traditional diet can lessen their chances of developing adult-onset diabetes.

"Sounds like this began because of inflammation inside my artery that made it easy to form fatty streaks which led to my clogged artery."

A new client who suffered a myocardial infarction requires angioplasty and stent placement. He has arrived to his first cardiac rehabilitation appointment. In this first session, a review of the pathogenesis of coronary artery disease is addressed. Which statement by the client verifies to the nurse that he has understood the nurse's teachings about coronary artery disease? -"Sounds like this began because of inflammation inside my artery that made it easy to form fatty streaks which led to my clogged artery." -" If vou do not exercise regularly to get your heart rate up. blood pools in the veins causing a clot which stops blood flow to the muscle and you have a heart attack." -"My artery was clogged by fat so I will need to stop eating fatty foods like french fries every day' lack -"All l have to do is stop smoking and then I won't have any more heart attacks"

be asymptomatic at an early stage

A nurse is considering setting up a screening program for a specific health condition in a population. What characteristic of the condition would need to be true for the nurse to justify screening a population? The condition should: • be asymptomatic at an early stage. •have a high mortality rate. •be curable with available treatment •have a noninvasive diagnostic test available

-The geographic location of women diagnosed with breast cancer -The age of women at the time of diagnosis

A nurse is investigating the epidemiologic factors influencing breast cancer for women in a population. What information should the nurse include? Select all that apply. -The geographic location of women diagnosed with breast cancer -The currently known incidence and prevalence for this population -The age of women at the time of diagnosis -The number of women whose diagnosis was assisted by the use of mammography How cancer cells divide and multiply in breast tissue

cohort

A nurse practitioner is working in a crowded neighborhood where the population is primarily immigrants from China. The nurse has designed a research study to follow children from kindergarten to the age of 25. She is going to be looking at their diet, successful progression in school, health practices, and development of disease, to name a few items. This type of research is known as: •Cohort study •Case-control study • Cross-sectional study •Epidemiologic study

Focusing on clients who did not receive treatment for the condition

A nurse researcher is interested in the natural history of a disease being studied. What should the nurse focus on to best understand the condition's natural history? -Examining outcomes across a wide variety of treatment approaches -Focusing on clients who did not receive treatment for the condition -Interviewing clients for their first-hand experience with the condition -Following client cases from initial diagnosis and throughout treatment

high morbidity, low mortality, high prevalence, low incidence

A particular disease has a debilitating effect on the ability of sufferers to perform their activities of daily living, and is a significant cause of decreased quality of life. However, few people die as a result of the disease's direct effects. There are hundreds of thousands of Americans living with the disease but relatively few new cases in recent years. Which statement best conveys an accurate epidemiologic characterization of the disease? -High morbidity; low mortality; high prevalence, low incidence. -High mortality: low morbidity; high incidence; low prevalence -Low mortality; high morbidity; low prevalence: high incidence. -Low mortality high morbidity; high incidence; low prevalence.

When explaining how carbon dioxide combines with water to form carbonic acid as part of acid-base lecture, the faculty instructor emphasizes that which enzyme is needed as a catalyst for this reaction?

Carbonic anhydrase

A 45 year old woman with a diagnosis of shingles is experiencing an acute onset of severe neuropathic pain. Which stage of Selye's characterization of stress response is the woman most likely experiencing at the moment?

Alarm

case- control study

An epidemiologist is conducting a program of research aimed at identifying factors associated with incidence and prevalence of congenital cardiac defects in infants. The researcher has recruited a large number of mothers whose infants were born with cardiac defects as well as mothers whose infants were born with healthy hearts. The researcher is comparing the nutritional habits of all the mothers while their babies were in utero. Which type of study is the epidemiologist most likely conducting? • Cohort study -Cross-sectional study • Case-control study -Risk factor study

tertiary prevention

An occupational therapist conducts a group therapy program called MindWorks with older adults who have diagnoses of dementia and Alzheimer's disease. The goal of the group is to slow the cognitive decline of clients by engaging them in regular, organized mental activity such as reading maps and solving puzzles. How would the program most likely be characterized? •Secondary prevention • Prognosis enhancement •Primary prevention • Tertiary prevention

Tumor necrosis factor-α and IL-1 are major cytokines that mediate inflammation. If the client is developing a systemic response to an infection, the nurse will likely assess which clinical manifestations? Select all that apply. A. Elevated temperature B. Hypertension C. Tachycardia D. Decrease in urine output E. Anorexia

Answer: A, C, E Rationale: IL-1 and TNF-α are mediators of the acute-phase responses associated with infection or injury. Features of these systemic responses include fever [elevated temperature], hypotension, tachycardia [increased heart rate], anorexia, increase in neutrophil count, and increased levels of corticosteroid hormones.

Which phenomena best accounts for the increased presence of leukocytes at the site of inflammation? A. Existing leukocytes stick to the epithelial cells and move along blood vessel walls. B. Increased numbers of leukocytes are released into circulation via cytokine stimulation. C. Leukocytes are osmotically drawn from circulation into the interstitial space as a result of swelling. D. Epithelium expresses leukocyte stimulation factors in response to cell injury.

Answer: A Rationale: During inflammation, leukocytes accumulate at the point of epithelial contact in the processes of margination, adhesion, and transmigration. This is not directly achieved by way of increased leukocyte production or release, nor by osmotic pressure. The epithelium does not produce leukocyte stimulation factors.

The nurse is caring for a group of postoperative clients. Who should the nurse prioritize as having the greatest risk for infection at the surgical site? A. A 45-year-old with external fixation of a fractured tibia B. A 15-year-old 1 day post-tonsillectomy C. A 65-year-old awaiting pacemaker insertion D. A 22-year-old 2 days post-appendectomy

Answer: A Rationale: External fixation involves surgical pins that stabilize the bone and exit the body to be attached to a frame. Because these pins offer a route for pathogen entry—and are themselves foreign bodies—this client should be regarded as the highest risk compared to the other clients. A 65-year-old may have a less robust immune system, but in this case, the client has not yet undergone an invasive PRIMEXAM.COM procedure. The client post-appendectomy has no foreign body and will have the wound approximated via sutures, which will protect from infection. The client post-tonsillectomy is also at low risk. There is no external wound; additionally, there is protective antimicrobial action saliva and the rapid division of the mucosal epithelium at the site of surgery.

The nurse is caring for a client with a diabetic foot ulcer who has difficulty adhering to dietary restrictions. This has resulted in elevated blood glucose levels. What information is most important for the nurse to share with the client? A. Elevations in blood glucose make it more difficult for your white blood cells to fight the infection. B. We can have the registered dietitian come to speak to you about the importance of following your diet. C. High blood glucose levels damage your arteries and reduce the blood flow to your wound. D. When you do not comply with your diet, it makes it more difficult for us to help you get well.

Answer: A Rationale: In this case, the nurse should focus on the immediate consequences of the client's choices. In the short-term, hyperglycemia diminishes chemotactic and phagocytic function, including engulfment and intracellular killing of bacteria. The changes related to peripheral artery disease and diminished blood flow to the wound are also a factor, but these changes take years to occur; conversely, even short-term elevations of blood glucose impair phagocytosis, so this information is more relevant to the client's situation with an active infection. The nurse should not refer the client to a dietitian until first discussing the immediate consequence of the current choices. Finally, the nurse should not shift the focus to the health care providers by telling the client the choices make their job more difficult.

A nurse is changing the wound dressing on a coccyx-region pressure injury of an immobilized client. The existing dressing is saturated with both watery, clear discharge and foul, grayish-colored liquid. Which entry in the client's chart most accurately documents these findings? A. "Large amounts of suppurative and serous exudates noted." B. "Purulent discharge and fibrinous exudates noted on existing dressing." C. "Abscess activity noted to coccyx wound." D. "Plasma proteins and membranous exudates present on existing dressing."

Answer: A Rationale: Serous discharge is clear and low in plasma proteins, while suppurative (or purulent) exudates are a mass of degraded cells. An abscess would be physically contained with no discharge, and the exudate is neither fibrinous nor membranous.

When explaining the final stages of the inflammatory response to pathogens, the nurse should include which educational topics? PRIMEXAM.COM A. How the body can kill the pathogen by generating toxic oxygen and nitrogen products, producing such things as nitric oxide and hydrogen peroxide B. Margination, which is a process whereby white cells (leukocytes) stick to the endothelium and accumulate along the blood vessel C. The increase in vascular permeability, which lets fluids leak into the extravascular tissues D. The promotion of tissue regeneration, whereby monocytes and macrophages produce potent prostaglandins and leukotrienes.

Answer: A Rationale: The latter stages of phagocytosis result in intracellular killing of pathogens, accomplished by several mechanisms, including toxic oxygen and nitrogen products, lysozymes, proteases, and defensins. The metabolic burst pathways generate toxic oxygen and nitrogen products (e.g., nitric oxide, hydrogen peroxide, and hypochlorous acid). Margination is the early stages of the inflammatory response. Vascular changes occur with inflammation but are prior to the final stage. Macrophages arrive within hours at the inflammation site.

An 80-year-old client has a stage 3 decubitus ulcer on the left ischial tuberosity which has not shown much improvement despite optimal local wound treatment. What other interventions should the nurse recommend to promote wound healing? Select all that apply. A. A review of the client's medications B. Positioning the client in a chair three times a day C. Placing the client on an alternating pressure mattress D. Administering corticosteroids E. Nutritional supplements

Answer: A, C, E Rationale: Actions that will promote wound healing in this case include optimizing the client's nutritional status; reviewing the client's medications for any drugs such as corticosteroids that may impede wound healing (it would, therefore, be incorrect to recommend this treatment); and using an alternating pressure mattress to offload the pressure on the area and promote blood flow. Sitting in a chair would place pressure on the ischial tuberosities so would not be recommended.

A parent brings a 12-year-old to the emergency room with multiple bite wounds to the arms and hands from a stray cat. Which interventions should the nurse be prepared to apply? Select all that apply. A. A review of the client's immunization record B. Administration of corticosteroids C. Rabies prophylaxis D. Suturing of the wounds E. Irrigation of the wounds F. Administration of prophylactic antibiotics

Answer: A, C, E, F Rationale: Animal bites, and particularly cat bites, are often infected at the time of presentation and require irrigation, debridement, and prophylactic antibiotics; neither suturing nor corticosteroids are recommended. Postexposure rabies prophylaxis should be administered since this was a stray cat and its vaccination history is unknown. The nurse should also inquire as to the client's last tetanus immunization.

A client who is recovering from burn injuries is discussing his prognosis with a physician. Which teaching point about expectations for healing should the physician offer? A. "Once your healing is complete, your skin will be just as strong as before your accident." B. "You may find that the scar is a bit smaller than the area of the wound." C. "You'll find that your new tissue is more elastic and fragile than the rest of your skin D. "The final remodeling phase of healing may last up to 3 months in your case."

Answer: B Rationale: An injury that heals by secondary intention [like burns] undergoes wound contraction. As a result, the scars are often smaller than the original area of the wound. There is nearly always an accompanying loss of strength and elasticity, and remodeling can take over 6 months.

Which aspect of a client's site of inflammation would help the care provider rule out chronic inflammation? A. High levels of macrophages B. Increased neutrophils C. Proliferation of fibroblasts D. Infiltration of lymphocytes

Answer: B Rationale: Chronic inflammation lacks the sudden and marked proliferation of neutrophils that is associated with acute inflammation. Chronic inflammation is associated with increased presence and action of fibroblasts, macrophages, and lymphocytes.

A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has: A. A mild parasitic infection B. A severe bacterial infection C. A mild viral infection D. A severe fungal infection

Answer: B Rationale: Fever and painful, palpable lymph nodes are nonspecific inflammatory conditions; leukocytosis is also common but is a particular hallmark of bacterial infection. Neutrophilia also indicates a bacterial infection, whereas increased levels of other leukocytes would indicate other etiologies. The shift to the left—the presence of many immature neutrophils—indicates that the infection is severe, because the demand for neutrophils exceeds the supply of mature cells.

A student arrives at the health clinic anxious and afraid. The student found an enlarged lymph node in the groin area that is extremely painful to touch and "knows" it is cancer. What information should the health care provider relay to this student about lymphadenitis? A. The student is correct. A warning sign of cancer is a lump or bump that should not be there. B. Not all swollen lymph nodes are due to cancer. It could be caused by an infection in the genital region. C. Swollen lymph nodes that are painful to touch are most likely characteristic of neoplasms. D. Increased sexual activity in college is a precurser to development of genital cancers.

Answer: B Rationale: Localized acute and chronic inflammation may lead to a reaction in the lymph nodes that drain the affected area. This response represents a nonspecific response to mediators released from the injured tissue or an immunologic response to a specific antigen. Painful, palable nodes are commonly associated in inflammatory processes, whereas nonpainful lymph nodes are more characteristic of neoplasms. If the student has experienced an increase in sexual activity, he or she should be evaluated for a sexually transmitted or other genital infection.

Which client would have a very poor response related to tissue regeneration of his or her injured area? A. 21-day-old infant undergoing a diaphragmatic hernia repair B. 54-year-old male who had a massive MI 4 days ago and came to the ED today for treatment. C. 73-year-old female who is undergoing lithotripsy for kidney stones. D. 33-year-old athlete undergoing surgery to repair a torn MCL in the right knee

Answer: B Rationale: Permanent or fixed cells cannot undergo mitotic division. The fixed cells include nerve cells, skeletal muscle cells, and cardiac muscle cells.

Which process would most likely be considered an anomaly during the cellular phase of inflammation? A. Platelet aggregation B. Vasoconstriction C. Migration of phagocytic white cells D. Macrophage activity

Answer: B Rationale: While vasoconstriction is a component of the immediate inflammatory response, the later cellular phase of inflammation is accompanied by vasodilation. Platelet aggregation, migration of phagocytic white cells, and macrophage activity are all associated with the cellular phase.

A 23-year-old man has received a recent diagnosis of appendicitis. The nurse providing care for the man is explaining that the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which teaching points should the nurse eliminate from client education? A. "Inflammation can help to remove the body tissue cells that have been damaged by infection." B. "Inflammation will start your body on the path to growing new, healthy tissue at the site of infection." C. "Inflammation helps your body to produce the right antibodies to fight the infection." D. "Inflammation ultimately aids in eliminating the initial cause of the cell injury in your appendix."

Answer: C Rationale: Antibody production is not a noted component of the inflammatory response. Removing damaged cells, generating new tissue, and eliminating the cause of cell injury are all documented components of the inflammatory response.

Which client is most likely to have impairments to the wound healing process? A client with: A. chronic obstructive pulmonary disease. B. a diagnosis of multiple sclerosis and consequent impaired mobility. C. poorly controlled blood sugars with small blood vessel disease. D. congenital heart defects and anemia.

Answer: C Rationale: Diabetes mellitus is strongly associated with impaired wound healing. The other noted pathologies are less causative of deficiencies in the healing process.

A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her body. Which physiologic process could best underlie her care provider's teaching about her new diet? A. Free radicals act as direct mediators in the inflammatory process. B. Free radicals inhibit the inflammatory response, limiting pre-adaptive response to infection. C. Free radicals increase cytokine expression and adhesion molecule levels, resulting in increased inflammation. D. Free radicals contribute to atherosclerosis and decreased immune response.

Answer: C Rationale: Free radicals are thought to bring about an inappropriate inflammatory response by increasing cytokine and numbers of adhesion molecules. They are not direct mediators of inflammation and are not associated with decreased immune response, but rather inappropriate inflammation. Free radicals are not associated with inhibition of the inflammatory response.

A client with a large decubitus ulcer asks the nurse, "How it is possible for a wound this deep to ever fully heal?" What is the nurse's best response? A. Deep wounds like this require surgical intervention and skin grafting before they will be healed. B. It will be difficult, but you have many experts planning your care so the chances of healing are good. C. Once the first layer of new granulation tissue is formed, the speed of the repair will increase greatly. D. With adequate resources, the body is capable of regenerating tissue and blood flow to the area over time.

Answer: D PRIMEXAM.COM Rationale: Even large wounds can heal over time given adequate blood and nutritional supply. The formation of early granulation tissue is one of the more rapid phases; the subsequent healing by secondary intention takes much longer. Surgery may be required, but this is not true for all large wounds. Telling the client there are experts planning the care does not address the client's question and is dismissive.

When educating a client with a wound that is not healing, the nurse should stress which dietary modifications to ward off some of the negative manifestations that can occur with inflammation? A. Increase the amount of calcium in the diet, especially drinking milk and eating cheese. B. This is the one time whereby you should eat more fat (both polyunsaturated and saturated) so you can absorb more fat-soluble vitamins. C. Since there is a loss of plasma proteins, you should increase your intake of organ meats like liver. D. Increase your intake of oily fish and fish oil so that you will increase absorption of omega-3 polyunsaturated fatty acids.

Answer: D Rationale: Dietary modification of the inflammatory response through the use of omega-3 polyunsaturated fatty acids, specifically eicosatetraenoic acid and docosahexaenoic acid, which are present in oily fish and fish oil, may be effective in preventing some negative manifestations of inflammation.

A client with a surgical wound has developed excessive granulation tissue extending above the wound edges. Which action should the nurse take? A. Contact the health care provider to order wet-to-dry dressings to promote debridement of the tissue. B. Take no action; this overgrowth of tissue is referred to as "keloids" and is not amenable to treatment. C. Apply an occlusive dressing to increase moisture in the wound bed as excessive granulation tissue is due to dryness. D. Ask the health care provider about surgical options to remove the excess tissue and promote wound healing.

Answer: D Rationale: During the proliferative phase of healing, excessive granulation tissue, sometimes referred to as "proud flesh," may form and extend above the edges of the wound, preventing reepithelialization. The nurse should inquire about surgical removal or chemical cauterization to allow healing to proceed. This is not necrotic tissue and would not be responsive to debridement via wet-to-dry dressings. This tissue differs from keloids, which is an overgrowth of scar tissue (rather than granulation tissue) and is not caused by a dry wound bed.

A hospital client has a large, superficial wound on her elbow that was the result of shearing action when she was moved up in her bed. The client's husband mentions that the wound looks infected and irritated since it is completely red. Which response by the nurse would be inappropriate? A. "Even though it is red, it doesn't mean that the wound is infected." B. "The red areas show that there is enough circulation to facilitate healing." C. "Those are fresh blood vessels that are a sign of healthy healing." D. "A thin sheet of blood clotting is actually desirable and not a sign that your wife's wound is infected."

Answer: D Rationale: Granulation tissue indicates sufficient circulation and angiogenesis associated with healthy wound healing. Granulation tissue consists of new blood vessels, not clotted cellular components.

A client presented to the emergency department of the hospital with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) cellulitis. The client's physician has ordered a complete blood count and white cell differential. Which blood component would the physician most likely anticipate to be elevated? A. Basophils B. Eosinophils C. Platelets D. Neutrophils

Answer: D Rationale: Increased neutrophils are associated with inflammation, in general, and bacterial infections in particular. Platelets play a role in inflammation but their levels would not rise to the same extent as would neutrophils. Eosinophils are not strongly associated with bacterial infection and basophils would not increase to the same degree as neutrophils.

A 79-year-old female resident of an assisted living facility receives care from a community nurse on a regular basis for treatment of a chronic venous leg ulcer. Which factor would the nurse be most justified in ruling out as a contributing factor to the client's impaired wound healing? A. A lower skin collagen content than in younger adults B. Decreased fibroblast synthesis C. Slow re-epithelialization D. Decreased antibody levels

Answer: D Rationale: Older adults do not normally have diminished antibody levels. Low collagen levels, decreased fibroblast activity, and slow re-epithelialization are common impediments to wound healing in older adults.

the incidence of people who are at risk for developing hantavirus while staying in Yosemite National Park.

As of Nov. 1, 2012, there were a total of 10 confirmed cases of hantavirus infection in people who were recent visitors (mid-June to end of August, 2012) to Yosemite National Park. Three visitors with confirmed cases died. Health officials believe that 9 out of the 10 cases of hantavirus were exposed while staying in Curry Village in the Signature Tent Cabins. This is an example of: -the low rate of morbidity one can expect while traveling to Yosemite National Park -the incidence of people who are at risk for developing hantavirus while staying in Yosemite National Park. -the prevalence of hantavirus one can anticipate if he or she is going to vacation in Yosemite National Park. -what the anticipated mortality rate would be if a family of five were planning to vacation in Yosemite National Park

primary prevention

As part of a community class, student nurses are developing curriculum to teach expectant parents the importance of having their child properly secured in a child safety seat. During the class, the students are going to have a safety officer examine the car seats that the parents have installed in their vehicle. This is an example of which type of prevention? •Prognosis enhancement •Secondary prevention •Tertiary prevention • Primary prevention

All of the men who had high PSA levels developed prostate cancer: several men who had low PSA levels also developed prostate cancer.

As part of a screening program for prostate cancer, men at a senior citizens center are having their blood levels of prostate-specific antigen (PSA) measured. Which statement would best characterize high positive predictive value but low negative predictive value for this screening test? -Men who had low PSA levels also displayed false positive results for prostate cancer; men with high levels were often falsely diagnosed with prostate cancer -All of the men who had low PSA levels were cancer-free; severa men who had high levels also remained free of prostate cancer. -All of the men who had high PSA levels developed prostate cancer: several men who had low PSA levels also developed prostate cancer. -The test displayed low sensitivity but high specificity.

The nurse is caring for a client hospitalized yesterday with acute coronary syndrome. The client also has difficulty dealing with life stressors. On what should the nurse focus as the priority of care?

Assessing the heart rate and blood pressure and interviewing the client about chest pain

Which client, when faced with acute stressful situations, would be considered highest risk for becoming noncompliant with his/her medication regimen?

Client with end-stage renal failure experiencing electrolyte imbalances related to having trouble sticking to a prescribed diet.

A client is brought to the ED with reports of SOB. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. The nurse notifies the physician to obtain orders for which of these problems?

Fluid volume excess

The nurse is caring for a client with left-sided heart failure causing chronic activation of the renin-angiotensin-aldosterone system (RAAS). What is the nurse's priority assessment?

Fluid volume excess

A 14 yr old boy, appearing to be intoxicated, arrives in the emergency dept where the EMTs report the boy denies consuming anything out of the ordinary. However, an open antifreeze container was found in the boy's room. Which intervention is likely to be prescribed to treat the client's symptoms?

Fomepizole

The nurse volunteering in the medical tent for a road race on a hot, humid day is asked to see a runner who has collapsed on the road. The nurse notes he has sunken eyes, a temp of 100 F, and dissiness. These are the signs of a fluid volume deficit. Recognizing fluid volume deficit, which of these interventions does the nurse carry out first?

Give him an electrolyte solution by mouth

During a period of stress, the nurse asks the client to close his eyes and think of a calm, relaxing place where he can feel the wind blowing on his cheek and smell the salty air from the ocean. This is an example of utilizing which type of treatment for stress reduction?

Guided imagery

A client with Parkinson disease has challenged himself to maintain mobility for longer than the physician predicts. He strives every day to walk 5 to 10 steps farther than the day before. This phenomenon, being researched by social physcologists, is known as:

Hardiness

A client arrives in the ED reporting muscle cramps and spasms in the legs and feet; tingling in the fingers, toes, and lips; and anxiety. Serum calcium level is 4.8 mg/dL. Syspecting tetany, which medication should the nurse be prepared to administer?

IV calcium gluconate

A single mother who was raised in a traumatic environment is very protective of her child. She expresses a desire to keep her child from experiencing stressful situations in hopes of promoting healthy development. What response by the nurse is most helpful?

It is normal to experience stressors periodically and this can enhance healthy development

A client who has been awaiting the results of a bone marrow biopsy for several days is experiencing stress as a result of uncertainty and the possibility that abnormal cell growth may be detected. A physical examination and blood work would most likely yield which result?

Increased BP and HR; increased antidiuretic hormone (ADH)

A client with poorly controlled diabetes mellitus presents to the emergency department with suspected ketoacidosis. Which diagnostic results would be most likely to confirm this diagnosis?

Increased anion gap, base deficit

A 61 year old client with a 40 pack year history of cigarette smoking and chronic obstructive pulmonary disease (COPD) is experiencing an increase in arterial levels of CO2. This change stimulates the inspiratory center in the medulla oblongata, which in turn causes the diaphragm to contract more forcefully and increase respiratory rate. Which term best describes the role of the inspiratory center?

Integrator

A nurse is providing care for a client who has been diagnosed with metabolic alkalosis after several days of antacid use. Which treatment should the nurse prepare to give?

Intravenous administration of KCl solution

a normal value represents the test results that fall within the bell curve.

Laboratory testing is ordered for a male client during a clinic visit for routine follow-up assessment of hypertension. When interpreting lab values, the nurse knows: -all lab values are adjusted for gender and weight. -if the result of a very sensitive test is negative, that does not mean the person is disease free. -if the lab result is above the 50% distribution, the result is considered elevated -a normal value represents the test results that fall within the bell curve.

A student is attempting to trace the feedback cycle involved in the stress response. Which neural structure is thought to be the central integrating site for the stress response?

Locus Caeruleus

A client with a diagnosis of end-stage liver failure has arterial blood gas results indicating altered pH. Which of these consequences of liver failure has most likely cause the acid-base distrubance?

Low albumin and plasma globulin levels

A client's arterial blood gases reveal normal oxygen level, pH 7.50, PCO2 level of 50 mmHg, and HCO3 level of 30. The client's respiratory rate is 12 breaths/min and all other vital signs are within normal range. What is this client's most likely diagnosis?

Metabolic alkalosis

A pregnant client having premature labor cramps and is diagnosed with preeclampsia. The admitting prescriptions include starting an IV infusion of magnesium sulfate. What intervention will the nurse provide this client?

Monitoring for changes in neuromuscular status like lethargy, confusion, or hyporeflexia

A client with a diagnosis of schizophrenia has been admitted with suspected hyponatremia after consuming copious quantities of tap water. Which finding does the nurse anticipate uncovering related to this problem?

Muscle weakness, lethargy, and headaches

The nurse is caring for a client with a longstanding diagnosis of hypocalcemia secondary to kidney disease. The nurse observes which clinical manifestations in this client?

Muscular spasms and reports of tingling in hands/feet

An 81 year old male client who has a diagnosis of orthostatic hypotension is experiencing an episode of particularly low blood pressure. The man's body has responded by increasing levels of angiotensin II in the bloodstream , a hormone which decreases glomerular filtration rate in the kidneys and contributes to an increase in blood pressure. Which phenomena best describes what has occurred?

Negative Feedback

The nurse at a long-term care facility encourages the older adults to drink even though they may not feel thirsty at the time. Which statement supports the nurse's action?

Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high

The nurse is caring for a client who is suffering from high levels of chronic stress. On what should the nurse focus, as a negative effect on the client's health due to chronically elevated levels of cortisol?

Osteoblast activity and protein synthesis are suppressed to refocus energy

An 80 year old woman is slated for total hip replacement the following day, and is experiencing a large amount of stress around her potential surgical outcomes. Which is most likely to be uninvolved in the physiologic response to her stress?

Parathyroid

A client with hypercalcemia has just passed a kidney stone. The nurse recognizes which of these laboratory studies should also be assessed?

Parathyroid hormone level

A client has been diagnosed with a brain tumor that cannot be removed surgically. During each office visit the nurse will be assessing the client for syndrome of inappropriate antidiuretic hormone (SIADH). Which assessment would alert the clinic nurse that the client may be developing the complication?

Report of decreased urine output, no edema noted in ankles, increasing headache

In the neurotrauma unit, a teenage with a closed head injury related to an automobile accident is experiencing high intracranial pressure (ICP). He is intubated and on a ventilator. One treatment for this is to allow him to progress into which acid-base imbalance in an attempt to lower ICP?

Respiratory alkalosis

A 77 yr old female hospital client has contracted Clostridium Difficile during her stay and is experiencing severe diarrhea. Which statement best conveys a risk that this woman faces?

She is susceptible to isotonic fluid volume deficit

A 12 yr old client who experienced trauma is now having trouble dealing with many forms of conflict in the home and becomes distraught. What is the best approach for the nurse to recommend to the parents?

Talk about the past trauma often and encourage the child to think positively about the future.

An occupational health nurse working with police officers wishes to apply Selye's general adaptation syndrome theory in practice. Which concept should the nurse apply?

The alarm stage involves the release of cortisol and catecholamines

A male client with a history of heavy alcohol use has been admitted to the hospital for malnutrition and suspected pancreatitis. The client's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas, but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him?

The chemical process that takes place throughout your body are thrown off very easily when your body is too acidic or not acidic enough

A counseling psychologist is working with a 30 year old female client who is experiencing the symptoms of posttraumatic stress disorder (PTSD) following a house fire several months prior. Which of the client's diagnostic results could most likely be interpreted as a manifestation of PTSD?

The client has decreased levels of cortisol

A 56 yr old female hospital client with a history of alcohol abuse is receiving IV phosphate replacement. Which health problem will this IV therapy most likely resolve?

The client is acidotic and has impaired platelet function

The guidelines will combine individual expertise with external systematic evidence

The clinical educator of a hospital medical unit has the mandate of establishing evidence-based practice guidelines for the nursing care on the unit. Which statement most accurately captures a guiding principle of the nurse's task? -The need for continuity and standardization of guidelines will mean that they will be fixed rather than changeable. -Guidelines are synonymous with systematic research reviews. -Evidence-based practice guidelines will be rooted in research rather than nurses' subjective practice preferences and experiences -The guidelines will combine individual expertise with external systematic evidence.

When explaining to a client admitted for stress-induced supraventricular tachycardia, the nurse will incorporate which statement about what happens in the body as a result of excess stress?

The corticotrophin-releasing factor stimulates the release of norepinephrine, which is responsible for "fight-or-flight" reaction to the stress

An electrician who has been working 14 to 16 hour days for several weeks to ensure the financial survival of his business presents to his family physician with a report of persistent headaches and insomnia. His family physician attributes the physical symptoms to the ongoing stress likely caused by which component of the stress response?

The fact that he has previously had difficulty coping with stress

A 77 yr old client diagnosed with chronic obstructive pulmonary disease (COPD) is experiencing impaired gas exchange and CO2 retention, despite a rapid respiratory rate. Which pathophysiologic principle would the health care team expect if the client's compensatory mechanisms are working?

The kidneys will adapt with an increase in plasma HCO3 and the pH will increase

High sensitivity, low specificity

The laboratory technologists are a discussing a new blood test that helps establish a differential diagnosis between shortness of breath with a cardiac etiology and shortness of breath with a respiratory/pulmonary etiology. A positive result is purported to indicate a cardiac etiology. The marketers of the test report that 99.8% of clients who have confirmed cardiac etiologies test positive in the test. However, 1.3% of clients who do not have cardiac etiologies for their shortness of breath also test positive. Which statement best characterizes this blood test? -High specificity; low reliability -High sensitivity; low reliability -High sensitivity, low specificity -Low validity; high reliability

A female client with a new diagnosis of systemic lupus erythematosus (SLE) has been told that this is an autoimmune disease whereby the immune system is attacking the body's cells and tissue. She knows that she has inflammation and tissue damage. She asks her to explain What cells in the body are triggering this inflammation? The nurse responds:

The lymphocytes that migrate to the brain where they secrete cytokines, which trigger inflammation

-The development of evidence-based practice guidelines require a research review from different studies to develop the most accurate diagnostic method to implement. -A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method. -When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test it for further feedback.

The neuroscience nursing unit has developed a set of step-by-step directions of what should occur if a nursing assessment reveals the client may be exhibiting clinical manifestations of a cerebrovascular accident (CVA). Which statement about clinical practice guidelines are accurate? Select all that apply. -Step-by-step guidelines are usually developed and based primarily on "how it has always been done before.' -Once developed, practice guidelines only need to be reviewed if a national committee sends out an update on new research. -The development of evidence-based practice guidelines require a research review from different studies to develop the most accurate diagnostic method to implement. -A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method. -When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test for further testing

Compare clients' results to measurements taken using arterial blood gas analyses.

The nurse is questioning the validity of oxygen saturation readings from the new oximeters on the unit. Which action should the nurse take to best determine if the results from the oximeter are valid? •Compare the findings with all clients' results on the unit to determine if there is a trend in the results •Repeat the test on the same client to determine if the oximeter offers the same results •Review the literature about this brand of oximeter provided by the company. •Compare clients' results to measurements taken using arterial blood gas analyses.

Cardiovascular disease

The public health nurse is designing a course about risk factors for various chronic illnesses. For risk factors about which chronic illness will the nurse consult the Framingham study? •Cardiovascular disease • Type 2 diabetes mellitus •Chronic obstructive pulmonary disease (COPD' •Breast cancer

-Massive pulmonary emboli following diagnosis of new onset atrial fibrillation -Development of pulmonary fibrosis following treatment with bleomycin, an antibiotic chemotherapy agent used in treatment of lymphoma.

Which situation would be classified as a complication of a disease or outcome from the treatment regimen? Select all that apply. -Burning, intense incision pain following surgery to remove a portion of colon due to intestinal aganglionosis. -Massive pulmonary emboli following diagnosis of new onset atrial fibrillation Gradual deterioration in ability to walk unassisted for a client diagnosed with Parkinson disease. -Development of pulmonary fibrosis following treatment with bleomycin, an antibiotic chemotherapy agent used in treatment of lymphoma. -Loss of short-term memory in a client diagnosed with Alzheimer disease

-Increase in the number of chair aerobics classes provided in the skilled care facilities -Interventions geared toward keeping the older adult population diagnosed with diabetes mellitus under tight blood glucose control by providing in-home cooking classes -Providing handwashing teaching sessions to a group of young children -Interests in keeping the older adult population engaged in such

While attending an international nursing conference, many discussions and break-out sessions focused on the World Health Organization's (WHO) views on health. Of the following comments made by nurses during a discussion session, which statements would be considered a good representation of the WHO definition? Select all that apply. -Increase in the number of chair aerobics classes provided in the skilled care facilities -Interventions geared toward keeping the older adult population diagnosed with diabetes mellitus under tight blood glucose control by providing in-home cooking classes -Providing handwashing teaching sessions to a group of young children -Interests in keeping the older adult population engaged in such activities as book reviews and word games during social time -Providing transportation for renal dialysis clients to and from their hemodialvsis sessions

A health care professional has recommended biofeedback to a client as a method of dealing with the high levels of stress. Which explanation should the nurse offer the client to explain biofeedback treatment?

You will be taught to gain control over skeletal muscle contractions

The nurse on the cardiac unit has noted that the client's potassium level is 6.1 mEq/L. The nurse has notified the physician and removed the banana from the client's meal tray. When explaining the nursing actions to the client, which statement is appropriate?

Your potassium level is high so I need you to let me know if you feel numbness, tingling, or weakness.