PrepU (ch 38, 40, 41, 13, 15, 16)
Which gland acts as a signal relaying bridge between multiple body systems and the pituitary gland? Parathyroid Hypothalamus Posterior pituitary Thyroid
Hypothalamus Explanation: The activity of the hypothalamus is regulated by both hormonally mediated signals (e.g., negative feedback signals) and by neuronal input from a number of sources. Neuronal signals are mediated by neurotransmitters such as acetylcholine, dopamine, norepinephrine, serotonin, gamma-aminobutyric acid (GABA), and opioids. Cytokines that are involved in immune and inflammatory responses, such as the interleukins, also are involved in the regulation of hypothalamic function. This is particularly true of the hormones involved in the hypothalamic-pituitary-adrenal axis. Thus, the hypothalamus can be viewed as a bridge by which signals from multiple systems are relayed to the pituitary gland. This cannot be said of the other options.
The nurse is caring for a female client with cholelithiasis. When teaching the client about the disease, the nurse includes which of these points? "Stones in the gallbladder are most common in men. Your case is unusual." "You are unable to store bile in your gallbladder, which inhibits digestion of the foods you eat." "You have an inflammation of your gallbladder caused by an autoimmune process." "Gallstones have developed, which are typically composed of cholesterol."
"Gallstones have developed, which are typically composed of cholesterol." Explanation: Cholelithiasis or gallstones is caused by precipitation of substances contained in bile, mainly cholesterol and bilirubin. It is most common in women, multiple pregnancies, those taking oral contraceptives or those who are obese.
A client has just begun to experience an ischemic stroke. The blood supply from the middle cerebral artery is being blocked by a large blood clot. How long before brain cells begin to die due to lack of ATP? 4 to 6 minutes 10 seconds 30 to 40 minutes 20 minutes
4 to 6 minutes Explanation: Without oxygen, brain cells continue to function for approximately 10 seconds, and the death of brain cells begins within 4 to 6 minutes. Twenty minutes is the time of cardiac cell death, and 3 hours is the window of time that thrombolytic medications can be safely used. Testing is done at each segmental level, or dermatome, moving upward along the body and neck from coccygeal segments through the high cervical levels to test the functional integrity of all the spinal nerves.
A nurse is evaluating clients for the risk of developing type 2 diabetes. Which client has the highest risk for developing this metabolic disorder? A middle aged obese adult with a sedentary lifestyle An adult who has an active lifestyle and small waist-hip ratio An older adult with a history of gestational diabetes A young child whose grandmother has type 2 diabetes
A middle aged obese adult with a sedentary lifestyle Explanation: The person most at risk for developing type 2 diabetes is the client with obesity and with a sedentary lifestyle. Other risk factors include family history, age older than 40, and history of gestational diabetes. The young child, despite family history, would be at low risk as long as obesity and sedentary lifestyle are avoided. The woman most likely would have developed type 2 diabetes within 20 years after the pregnancy.
Sweating is mediated by which neurotransmitter? Glutamic acid Enkephalin Catecholamines Acetylcholine
Acetylcholine Explanation: Sweating occurs through the sweat glands and is controlled by the sympathetic nervous system. Sweating is mediated by acetylcholine. Proenkephalin peptides are present in areas of the spinal cord and PAG that are related to perception of pain. Glutamic acid is an important amino acid for the synthesis of proteins. The catecholamines serve as neuromediators. Catecholamines cause general physiologic changes that prepare the body for physical activity (fight-or-flight response).
Given the fact that acute pancreatitis can result in severe, life-threatening complications, the nurse should be assessing the client for which complication? Bilateral pneumothorax Acute tubular necrosis Complete heart block Cerebral hemorrhage
Acute tubular necrosis Explanation: Complications of acute pancreatitis include the systemic inflammatory response, acute respiratory distress syndrome, acute tubular necrosis, and organ failure. Cerebral hemorrhage, bilateral pneumothorax, and complete heart block are not associated with the complications of acute pancreatitis.
The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL (48.67 mmol/L). The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time? Administration of intravenous fluids Monitoring for fever Education related to prevention of DKA Orienting the client to the events surrounding his admission
Administration of intravenous fluids Explanation: Goals of care for clients with DKA include administration of insulin and intravenous fluid and electrolyte replacement solutions. A common reason for development of DKA is an infection; monitoring for a fever should not take priority over administration of insulin and fluid replacement.
A client has developed a tumor of the posterior pituitary gland. The client is at risk for problems with secretions of: Adrenocorticotropic hormone (ACTH) and vasopressin Growth hormone-releasing hormone (GHRH) and dopamine Antidiuretic hormone (ADH) and oxytocin Somatostatin and prolactin
Antidiuretic hormone (ADH) and oxytocin Explanation: The posterior pituitary secretes ADH and oxytocin/vasopressin, while the anterior pituitary secretes the hormones listed in the other choices.
The release of insulin from the pancreatic beta cells can inhibit further release of insulin from the same cells. This is an example of which type of hormone action? Autocrine Juxtaposed Arachidonic Retinoid
Autocrine Explanation: Hormones can exert autocrine action on the cells from which they were produced. Retinoids are compounds with hormone-like actions. Juxtacrine action involves a chemical messenger imbedded in a plasma membrane that interacts with a specific receptor on a juxtaposed cell. Arachidonic acid is a precursor for eicosanoid compounds (similar to retinoids).
When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which organ does the nurse recognize is reliant on glucose as the major energy source? Spleen Lungs Heart Brain
Brain Explanation: Although many tissues and organ systems are able to use other forms of fuel, such as fatty acids and ketones, the brain and nervous system rely almost exclusively on glucose as a fuel source. Because the brain can neither synthesize nor store more than a few minutes' supply of glucose, normal cerebral function requires a continuous supply from the circulation.
A teenager has been in a car accident and experienced an acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication? Brain contusions and hematomas TIAs and cerebrovascular infarction Momentary unconsciousness Status epilepticus
Brain contusions and hematomas Explanation: Contusions (focal brain injury) cause permanent damage to brain tissue. The bruised, necrotic tissue is phagocytized by macrophages, and scar tissue formed by astrocyte proliferation persists as a crater. The direct contusion of the brain at the site of external force is referred to as an acceleration injury, whereas the opposite side of the brain receives the deceleration injury from rebound against the inner skull surfaces. As the brain strikes the rough surface of the cranial vault, brain tissue, blood vessels, nerve tracts, and other structures are bruised and torn, resulting in contusions and hematomas. TIAs and cerebral vascular infarction (stroke) are often caused by atherosclerotic brain vessel occlusions that cause ischemic injuries. In mild concussion head injury, there may be momentary loss of consciousness without demonstrable neurologic symptoms or residual damage, except for possible residual amnesia. Status epilepticus is not related to this situation.
Which area of the brain is responsible for respiration? Midbrain Diencephalon Brain stem Frontal lobe
Brain stem
Which area of the brain is responsible for respiration? Brain stem Diencephalon Midbrain Frontal lobe
Brain stem Explanation: The respiratory center is located in the brain stem.
Many drugs are metabolized and detoxified in the liver. Most drug metabolizing occurs in the central zones of the liver. What condition is caused by these drug-metabolizing actions? Lobular necrosis Central cirrhosis Centrilobular necrosis Lobular cirrhosis
Centrilobular necrosis Explanation: Because of the greater activity of the drug-metabolizing enzymes in the central zones of the liver, these agents typically cause centrilobular necrosis.
Which intracranial volume is most capable of compensating for increasing intracranial pressure? Surface sulci fluid Cerebrospinal fluid Brain cell tissue Intravascular blood
Cerebrospinal fluid Explanation: Initial increases in intracranial pressure (ICP) are largely buffered by a translocation of cerebrospinal fluid (CSF) to the spinal subarachnoid space and increased reabsorption of CSF. Of the intracranial volumes, the tissue volume is least capable of undergoing change. Surface sulcus fluid is negligible and not a factor in increased ICP. The compensatory ability of the intravascular blood compartment is also limited by the small amount of blood that is in the cerebral circulation. As the volume-buffering capacity of this compartment becomes exhausted, venous pressure increases and cerebral blood volume and ICP rise.
All diseases have risk factors. What is the most significant environmental risk factor for pancreatic cancer? Water pollution Cigarette smoking Heavy metal toxicity Air pollution
Cigarette smoking Explanation: In pancreatic cancer, the most significant and reproducible environmental risk factor is cigarette smoking.
A client's emergency room report includes the presence of a contrecoup injury. The nurse plans care for a client with which of the following? Closed head injury in the area of impact Infection resulting from exposed brain tissue Open spinal cord injury with complete severing of neurons Closed head injury opposite the area of impact
Closed head injury opposite the area of impact Explanation: In a contrecoup injury, the client experiences a rebound injury on the side of the brain opposite the site of external force.
A client with type 2 diabetes experiences unexplained elevations of fasting blood glucose in the early morning hours. Which conditions can account for this effect? Autonomic neuropathy Diabetic ketoacidosis Dawn phenomenon Inadequate bedtime insulin
Dawn phenomenon Explanation: The dawn phenomenon involves increased levels of fasting blood glucose or insulin requirement during the early morning hours. It is not preceded by hypoglycemia. Circadian release of growth hormone and cortisol may be contributing factors. The other answer selections are not characterized by increased early morning levels of blood glucose.
The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be: Decreased level of PCO2 Decreased hydrogen ions Decreased level of carbon dioxide Decreased level of oxygen
Decreased level of oxygen Explanation: Regulation of blood flow to the brain is controlled largely by autoregulatory or local mechanisms that respond to the metabolic needs of the brain. Metabolic factors affecting cerebral blood flow include an increase in carbon dioxide and hydrogen ion concentrations; cerebral blood flow is affected by decreased O2 levels and increased hydrogen ions, carbon dioxide, and PCO2 levels.
A client with Parkinson disease presents with bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain? Limbic system Serotonergic system Dopamine nigrostriatal system Cerebellum
Dopamine nigrostriatal system Explanation: The destruction of the dopamine nigrostriatal system upsets the balance of the basal ganglia, resulting in uncontrolled and uncoordinated movement. The cortex is involved in higher processing, serotonin is involved in the limbic system, and the cerebellum is unrelated to Parkinson disease; cerebellar disorders, however, will cause Parkinsonism.
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 at least 6 hours later with the same findings for brain death to be declared. What is not assessed in the clinical examination for brain death? Responsiveness Electrocardiogram Blink reflex Respiratory effort
Electrocardiogram
Which pathophysiologic phenomenon may result in a diagnosis of Cushing disease? Malfunction of the HPA system Autoimmune destruction of the adrenal cortex Hypopituitarism Excess ACTH production by a pituitary tumor
Excess ACTH production by a pituitary tumor Explanation: Three important forms of Cushing syndrome result from excess glucocorticoid production by the body. One is a pituitary form, which results from excessive production of ACTH by a tumor of the pituitary gland. Hypopituitarism and destruction of the adrenal cortex are associated with Addison disease. Disruption of the HPA system is not implicated in the etiology of Cushing disease.
The nurse is caring for a client with hepatitis and jaundice. The nurse recognizes that without sufficient circulating bile salts the client will have intolerance to which ingested substance? Carbohydrates Protein Fats Amino acids
Fats Explanation: Lack of production of bile salts causes malabsorption of fat and fat-soluble vitamins.
A client has sustained damage to cranial nerve VIII. The nurse recognizes that the client may experience difficulty with: Taste Motor Smell Hearing
Hearing Explanation: Cranial nerve VIII (vestibulocochlear nerve) is associated with hearing. The other options involve different nerves.
A client diagnosed with liver cancer asks the doctor what the best treatment option is. The most appropriate response would be: Radiation therapy to shrink the tumor Hepatic resection Chemotherapy to eliminate the cancer Aggressive treatment for hepatitis C
Hepatic resection Explanation: The treatment of choice is hepatic resection if conditions permit. Depending on size and placement of the tumor, other available treatments include liver transplantation, tumor-directed radiofrequency ablation, chemoembolization, and radioembolization, while chemotherapy and radiation therapy are mostly palliative. Untreated chronic hepatitis C is often the etiology of the development of liver cancer but would not be a treatment option.
A health care provider suspects a client may have developed pancreatitis. Which laboratory value will confirm this diagnosis? Chymotrypsin level and fibrinogen level Altered alkaline phosphatase and red blood cell count Change in platelet count and prothrombin level High serum amylase and lipase
High serum amylase and lipase Explanation: Laboratory criteria for the diagnosis of pancreatitis are serum amylase or lipase greater than three times the upper limit of normal. Altered alkaline phosphatase and prothrombin levels may indicate liver disease. Alkaline phosphatase is one kind of enzyme found in the body. It can show signs of liver disease or a bone disorder. The red blood cell count is used to measure the number of oxygen-carrying blood cells in a volume of blood. Chymotrypsin digests proteins in the intestine. Fibrinogen is a soluble protein in the plasma that is broken down to fibrin by the enzyme thrombin to form clots. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Having more than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia. Prothrombin time is a blood test that measures how long it takes blood to clot.
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? Hypernatremia Hypoglycemia Hyponatremia Hyperglycemia
Hypoglycemia 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 health care provider is assessing a client for a potential endocrine disorder. Assessment findings identify abnormalities with emotion, pain, and body temperature. Which mechanism of endocrine control will require further laboratory/diagnostic assessment? Cerebellum Anterior pituitary Hypothalamus Cerebral cortex
Hypothalamus Explanation: The hypothalamus is the coordinating center of the brain for endocrine, behavioral, and autonomic nervous system function. It is at the level of the hypothalamus that emotion, pain, body temperature, and other neural input are communicated to the endocrine system. The anterior pituitary regulates several physiologic processes, including stress, growth, reproduction, and lactation. The cerebellum is involved in motor control, and the cerebral cortex is associated with sensory, motor, and association.
Reflexes are basically "hard-wired" into the CNS. Anatomically, the basis of a reflex is an afferent neuron that synapses directly with an effector neuron to cause muscle movement. Sometimes the afferent neuron synapses with what intermediary between the afferent and effector neurons? Suprasegmental effectors Intersegmental effectors Neurotransmitter Interneuron
Interneuron Explanation: The anatomic basis of a reflex consists of an afferent neuron, which synapses either directly with an effector neuron that innervates a muscle or with an interneuron that synapses with an effector neuron.
Which neuron connects sensory and motor neurons? Interneurons Efferent neurons Afferent neurons Cranial nerves
Interneurons
The nurse reading a client's lumbar puncture results notifies the physician of findings consistent with meningitis when which sign/symptom is noted? Increased glucose Decreased protein count Large number of polymorphonuclear neutrophils Clear cerebrospinal fluid
Large number of polymorphonuclear neutrophils Explanation: Lumbar puncture findings, which are necessary for accurate diagnosis, include a cloudy and purulent CSF under increased pressure. The CSF typically contains large numbers of polymorphonuclear neutrophils (up to 90,000/mm3), increased protein content, and reduced sugar content.
The hormone levels in the body need to be kept within an appropriate range. How is this accomplished for many of the hormones in the body? Negative feedback loop Positive feedback loop Regulated feedback loop Sensory feedback loop
Negative feedback loop Explanation: The level of many of the hormones in the body is regulated by negative feedback mechanisms.
While teaching a family member about the development of hepatic encephalopathy, which cause is likely to be mentioned? Hypersplenism High sodium level in foods and beverages Neurotoxin accumulation Steroid hormone deficiency
Neurotoxin accumulation Explanation: Although the cause of hepatic encephalopathy is unknown, the accumulation of neurotoxins, which appear in the blood because the liver has lost its detoxifying capacity, is believed to be a factor. The liver metabolizes the steroid hormones; therefore, these hormones are often elevated in persons with liver failure and cause feminization (rather than encephalopathy) of male clients. Hypersplenism associated with liver failure is a factor in the development of anemia, thrombocytopenia, and leukopenia. Although the mechanisms responsible for the development of ascites are not completely understood, several factors seem to contribute to fluid accumulation, including salt and water retention by the kidney and increase in capillary pressure due to portal hypertension and obstruction of venous flow through the liver.
Which hormone will elicit a more rapid response than the others? Insulin Prolactin Adrenocorticotropic hormone Norepinephrine
Norepinephrine Explanation: Neurotransmitter hormones open ion channels and produce extremely rapid responses, whereas peptides and proteins change cell metabolism over a period of days.
When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which description? Pain in the left lower quadrant, radiating to the back Pain that starts as a diffuse ache and localizes over 24 to 48 hours Pain in the right upper quadrant referred to the same shoulder Pain in the back, radiating to the groin
Pain in the right upper quadrant referred to the same shoulder Explanation: The pain of biliary colic begins abruptly and increases in intensity. It is usually located in the upper right quadrant or epigastric area and may be referred to the upper back, the right shoulder, or midscapular region.
A client receives steroids for several months to treat an inflammatory condition. Which action by the primary health care provider indicates an understanding of the negative feedback mechanism when the client no longer needs the medication? Instructing the client to stop taking the medication Measuring urine catecholamine levels before stopping the drug Prescribing a tapering dose of the medication over weeks Scheduling a positron emission tomography scan a week after stopping the drug
Prescribing a tapering dose of the medication over weeks Explanation: Negative feedback occurs when secretion of one hormone causes a reduction in the secretion of the hormone that stimulates production of the first hormone. In this case, adrenocorticotropic hormone (ACTH) manufactured by the anterior pituitary would normally stimulate release of cortisol, but with the increase of cortisol produced by the secreting tumor, enough cortisol already floods the system that there should be a reduction in the ACTH level. Sudden withdrawal of the medication would leave the client without glucocorticoids and risk an Addisonian crisis. Gradual withdrawal of the medication allows the pituitary to measure the drop in cortisol levels and begin secreting ACTH.
The parent of a toddler with Duchenne muscular dystrophy reports that the child has an increase in muscle size but a decrease in strength. The nurse documents this using which medical term? Pseudohypertrophy Dysdiadochokinesia Chorea Fasciculations
Pseudohypertrophy Explanation: Pseudohypertrophy, as occurs with Duchenne muscular dystrophy (DMD), refers to an increase in bulk without an accompanying increase in strength.
Neurotransmitters exert their actions through specific proteins that are known as: Autoantigens Receptors Transformers Antibodies
Receptors Explanation: Neurotransmitters exert their actions through specific proteins that are known as receptors, embedded in the postsynaptic membrane.
The nurse teaches the client that which of these contributed to the development of acute cholelithiasis? Rapid elimination of bile Stasis of bile Excessive alcohol consumption Chronic pancreatitis
Stasis of bile Explanation: Two primary factors contribute to the formation of gallstones: abnormalities in the composition of bile and the stasis of bile (rather than rapid elimination). Inflammation of the gallbladder alters the absorptive characteristics of the mucosal layer, allowing excessive absorption of water and bile salts. Although a number of factors are associated with the development of acute pancreatitis, most cases result from gallstones (rather than cause gallstone formation) or alcohol use disorder. Alcohol is known to be a potent stimulator of pancreatic secretions, and it also is known to cause partial obstruction of the sphincter of the pancreatic duct; alcohol intake is not a factor in the development of cholesterol or bilirubin stones.
The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with: Encephalitis Subarachnoid hemorrhage Lacunar infarct Thrombotic stroke
Subarachnoid hemorrhage Explanation: The rupture of a berry aneurysm leads to a subarachnoid hemorrhage.
A client is diagnosed with choledocholithiasis and acute suppurative cholangitis and is being rushed to surgery to prevent which possible complication? Hepatitis that can result from the distention of the bile duct. Impaired nutritional absorption The accumulation of purulent bile, which can cause sepsis. Neurologic damage that can be caused by toxic bilirubinemia.
The accumulation of purulent bile, which can cause sepsis. Explanation: Complications of choledocholithiasis include acute suppurative cholangitis when purulent bile fills and distends bile ducts. It is characterized by the presence of an altered sensorium, lethargy, and septic shock. Bilirubinuria and malabsorption are not emergency situations. This situation is not part of the etiology of hepatitis.
Hyperthyroidism that is inadequately treated can cause a life-threatening condition known as a thyroid storm. What are the manifestations of a thyroid storm? Select all that apply. Very low fever Bradycardia Very high fever Tachycardia Delirium
Very high fever Tachycardia Delirium
When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby: the pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction. the pancreas is irreversibly damaged and will not recover to normal functioning (chronic). stones will develop in the common bile duct, resulting in acute jaundice. activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue.
activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. Explanation: Acute pancreatitis is associated with the escape of activated pancreatic enzymes into the pancreas and surrounding tissues. These enzymes cause fat necrosis, or autodigestion, of the pancreas. Alcohol is known to be a potent stimulator of pancreatic secretions, and it also is known to cause partial obstruction of the sphincter of the pancreatic duct, rather than bowel obstruction. The pancreas is irreversibly damaged and will not recover to normal functioning results from chronic pancreatitis. Acute pancreatitis also is associated with viral infections. The pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction occurring with cancer of the pancreas. Presence of stones in the common bile duct with jaundice is primarily a result of gallstones.
Which physiologic process best exemplifies a positive feedback mechanism? release of antidiuretic hormone when sodium levels are higher than normal increase in prolactin secretion that occurs with more frequent breastfeeding release of parathyroid hormone in response to decreased serum calcium levels regulation of blood glucose levels by insulin
increase in prolactin secretion that occurs with more frequent breastfeeding Explanation: A positive feedback mechanism occurs when one hormonal or physiologic factor stimulates further hormonal release, creating a cascade that will increase until the stimulus is reduced. Because the stimulation of breastfeeding releases prolactin that enhances milk production, this is a positive feedback mechanism. Correction of alterations in homeostasis is normally achieved using negative feedback mechanisms, such as those accomplished by insulin, parathyroid hormone, and antidiuretic hormone. In each of these cases, the stimulus results in an response that causes an opposite physiologic effect. For example, high blood glucose levels stimulate the release of insulin which then results in a lowering of the blood glucose level.
Which physiologic process best exemplifies a positive feedback mechanism? release of parathyroid hormone in response to decreased serum calcium levels regulation of blood glucose levels by insulin increase in prolactin secretion that occurs with more frequent breastfeeding release of antidiuretic hormone when sodium levels are higher than normal
increase in prolactin secretion that occurs with more frequent breastfeeding Explanation: A positive feedback mechanism occurs when one hormonal or physiologic factor stimulates further hormonal release, creating a cascade that will increase until the stimulus is reduced. Because the stimulation of breastfeeding releases prolactin that enhances milk production, this is a positive feedback mechanism. Correction of alterations in homeostasis is normally achieved using negative feedback mechanisms, such as those accomplished by insulin, parathyroid hormone, and antidiuretic hormone. In each of these cases, the stimulus results in an response that causes an opposite physiologic effect. For example, high blood glucose levels stimulate the release of insulin which then results in a lowering of the blood glucose level.
A nurse caring for a client in myasthenic crisis identifies a priority concern as: maintenance of airway and respiration. monitoring for difficulty chewing. ongoing physical therapy to maintain strength. monitoring for ptosis.
maintenance of airway and respiration. Explanation: All symptoms and issues are present with myasthenia gravis. However, a priority concern during crisis is maintenance of airway and ventilatory support because of muscular weakness that may compromise breathing/respiration.
A nurse is caring for a client experiencing muscle fasciculations. Fasciculations appear as: rhythmic movements. spontaneous contractions of muscle fibers presenting as twitching. increased muscular resistance with range of motion. weakness and loss of movement.
spontaneous contractions of muscle fibers presenting as twitching. Explanation: Fasciculations are characterized by twitching or squirming movements of muscle fibers. Paresis is weakness/loss of movement. Spasticity is increased resistance with ROM. Rhythmic movements describe tremors.
A client has just begun to experience an ischemic stroke. The blood supply from the middle cerebral artery is being blocked by a large blood clot. How long before brain cells begin to die due to lack of ATP? 4 to 6 minutes 20 minutes 10 seconds 30 to 40 minutes
4 to 6 minutes Explanation: Without oxygen, brain cells continue to function for approximately 10 seconds, and the death of brain cells begins within 4 to 6 minutes. Twenty minutes is the time of cardiac cell death, and 3 hours is the window of time that thrombolytic medications can be safely used. Testing is done at each segmental level, or dermatome, moving upward along the body and neck from coccygeal segments through the high cervical levels to test the functional integrity of all the spinal nerves.
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. Assisting the client with the appropriate choice of oral antihyperglycemics. Teaching the client about the action and safe administration of insulin. Educating the client about the risks and management of hypoglycemia.
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.
A client with multiple pain-related injuries to the back, knees, and hips is admitted with acute liver failure. Upon procuring a medication list, the nurse notes that the client is taking several over-the-counter medications that contain a preparation known to be the drug that most commonly causes liver failure. Which drug is this? Acetaminophen Ibuprofen Phenylephrine Aspirin
Acetaminophen Explanation: The drug most commonly involved is acetaminophen, with half the cases reported to be unintentional overdoses. Unintentional overdoses may occur when people unknowingly take several over-the-counter preparations that contain acetaminophen (e.g., an acetaminophen containing cold preparation and acetaminophen pain medication). Phenylephrine is a nasal decongestant often combined with acetaminophen for relief of cold symptoms.
The release of insulin from the pancreatic beta cells can inhibit further release of insulin from the same cells. This is an example of which type of hormone action? Retinoid Autocrine Juxtaposed Arachidonic
Autocrine Explanation: Hormones can exert autocrine action on the cells from which they were produced. Retinoids are compounds with hormone-like actions. Juxtacrine action involves a chemical messenger imbedded in a plasma membrane that interacts with a specific receptor on a juxtaposed cell. Arachidonic acid is a precursor for eicosanoid compounds (similar to retinoids).
Which cardinal assessment finding would lead the nurse to suspect a client has developed Parkinson disease? Paresthesia Bradykinesia Lack of sweating Hypotonia
Bradykinesia Explanation: The cardinal symptoms of Parkinson disease are tremor, rigidity (hypertonicity), and bradykinesia (slowness of movement). Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Because the basal ganglia also influence the autonomic nervous system, persons with Parkinson disease often have excessive and uncontrolled sweating, sebaceous gland secretion, and salivation. Paresthesia is characteristic of demyelinating disease such as multiple sclerosis, rather than Parkinson disease.
Which statement best describes the pathophysiology of Parkinson disease? Failure of the cerebral cortex, which does not allow the use of acetylcholine Degeneration of the nigrostriatal dopamine system Increase in the number of dopamine receptors by an alternate basal ganglion Rise in acetylcholine levels, causing an inhibition of voluntary movement
Degeneration of the nigrostriatal dopamine system Explanation: Parkinson disease presents with degenerative changes in the basal ganglia. Dopamine depletion results from degeneration in the nigrostriatal system. The cause of Parkinson disease is still unknown; it is widely believed that most cases are caused by an interaction of environmental and genetic factors.
Loss of pituitary function can result in deficiencies (or loss) of secretions of which hormones? Select all that apply. Luteinizing hormone Follicle stimulating hormone Prolactin Growth hormone Corticotropin-releasing hormone
Growth hormone Luteinizing hormone Follicle stimulating hormone Prolactin
Release and synthesis of anterior pituitary hormones are mainly regulated by which part of the body? Adrenal gland Thymus gland Hypothalamus Cell receptors
Hypothalamus Explanation: The hypophysis (pituitary plus hypothalamus) and hypothalamus stimulatory hormones regulate the release and synthesis of anterior pituitary hormones. The adrenal gland and thymus gland hormones are regulated by the hypothalamus. Cell receptors are involved with the target cell response to the hormones.
When caring for the client with Laennec cirrhosis, the nurse recognizes which pathophysiologic finding to be an expected etiology of jaundice? Increased conjugation of bilirubin Impaired uptake of bilirubin Decreased oxygen at birth Increased red cell development
Impaired uptake of bilirubin Explanation: The five major causes of jaundice are excessive destruction of red blood cells, impaired uptake of bilirubin by the liver cells, decreased conjugation of bilirubin, and obstruction of bile flow in the canaliculi of the hepatic lobules or in the intrahepatic or extrahepatic bile ducts, and excessive extrahepatic production of bilirubin. Hypoxia is not a factor in jaundice.
A client's emergency magnetic resonance imaging (MRI) has been examined by the physician and tissue plasminogen activator (tPA) has been administered to the client. What was this client's most likely diagnosis? Subarachnoid hemorrhage Ischemic stroke Status epilepticus Encephalitis
Ischemic stroke Explanation: Thrombolytic therapy for the acute treatment of ischemic stroke consists of the intravenous administration of tPA. This drug would exacerbate a subarachnoid hemorrhage by inhibiting the clotting mechanism, and it is not relevant to the care of clients with encephalitis or status epilepticus.
Feelings of dread, high anxiety, or exquisite pleasure can be elicited by stimulation of areas in which structure? Temporal lobe Occipital lobe Limbic system Cerebellum
Limbic system Explanation: Stimulation of specific areas of the limbic system can lead to feelings of dread, high anxiety, or exquisite pleasure. The temporal lobe is involved with auditory functions, the cerebellum with proprioception, and the occipital lobe with visual function.
While teaching a family member about the development of hepatic encephalopathy, which cause is likely to be mentioned? Steroid hormone deficiency High sodium level in foods and beverages Hypersplenism Neurotoxin accumulation
Neurotoxin accumulation Explanation: Although the cause of hepatic encephalopathy is unknown, the accumulation of neurotoxins, which appear in the blood because the liver has lost its detoxifying capacity, is believed to be a factor. The liver metabolizes the steroid hormones; therefore, these hormones are often elevated in persons with liver failure and cause feminization (rather than encephalopathy) of male clients. Hypersplenism associated with liver failure is a factor in the development of anemia, thrombocytopenia, and leukopenia. Although the mechanisms responsible for the development of ascites are not completely understood, several factors seem to contribute to fluid accumulation, including salt and water retention by the kidney and increase in capillary pressure due to portal hypertension and obstruction of venous flow through the liver.
When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which description? Pain that starts as a diffuse ache and localizes over 24 to 48 hours Pain in the right upper quadrant referred to the same shoulder Pain in the back, radiating to the groin Pain in the left lower quadrant, radiating to the back
Pain in the right upper quadrant referred to the same shoulder Explanation: The pain of biliary colic begins abruptly and increases in intensity. It is usually located in the upper right quadrant or epigastric area and may be referred to the upper back, the right shoulder, or midscapular region.
A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which abnormality in the client's gait? Difficulty putting weight on soles of feet and tends to walk on tiptoes Hyperactive leg motions like he just can't stand still Takes large, exaggerated strides and swings arms/hands wildly Slow to start walking and has difficulty when asked to "stop" suddenly
Slow to start walking and has difficulty when asked to "stop" suddenly Explanation: The cardinal symptoms of Parkinson disease (PD) are tremor, rigidity (hypertonicity), and bradykinesia or slowness of movement. Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Persons with the disease have difficulty initiating walking and difficulty turning. While walking, they may freeze in place and feel as if their feet are glued to the floor, especially when moving through a doorway or preparing to turn. When they walk, they lean forward to maintain their center of gravity and take small, shuffling steps without swinging their arms.
The nurse is explaining to a client's family how vasogenic brain edema occurs. The most appropriate information for the nurse to provide would be: Normal physiologic circumstances result in decreased adsorption of CSF. There is a decrease in the amount of fluid volume in the brain. The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. There is an increase in the production of cerebrospinal fluid volume.
The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. Explanation: Vasogenic brain edema occurs with conditions that impair the function of the blood-brain barrier and allow the transfer of water and protein from the vascular space into the interstitial space. Increased production of CSF and decreased absorption result in hydrocephalus. It occurs in conditions such as hemorrhage, brain injury, and infectious processes.
The nurse is providing discharge instructions for a client with Graves disease who has ophthalmopathy. What should the nurse be sure to include in the instructions to decrease exacerbation of this clinical manifestation? The client should be informed that if he begins to feel symptoms getting worse, he should take an extra dose of medication. The client should be strongly encouraged not to drink any alcohol. The client should be informed that he should not be in contact with other people during the acute phase. The client should be strongly urged not to smoke.
The client should be strongly urged not to smoke. Explanation: Ophthalmopathy can also be aggravated by smoking, which should be strongly discouraged. It is not necessary for the client to avoid contact with others. Alcohol is not contraindicated but should be limited when taking any medication regimen. The client should not adjust the doses of medications without first consulting the physician.
The spouse of a client admitted to the hospital after a motor vehicle accident reports to the nurse that the client has become very drowsy. The nurse should: prepare the client for EEG testing. contact the physician. assess the client for additional signs/symptoms of increased intracranial pressure. instruct the spouse not to let the client fall asleep until the physician has assessed the client.
assess the client for additional signs/symptoms of increased intracranial pressure. Explanation: Since decreased alertness and/or drowsiness can be an early sign of increased intracranial pressure, the nurse should assess for additional signs/symptoms of increased intracranial pressure. Then, once the assessment is complete, the nurse should contact the physician as needed. There is no indication that the client will undergo EEG testing at this time and the spouse should not be instructed to keep the client awake.
The nurse is caring for a client with a hormonal disorder that is widely affecting many body systems. The nurse recognizes that which form of hormone signalling pathway is most likely involved in the client's disorder? paracrine endocrine autocrine local mediation
endocrine Explanation: The endocrine pathway involves hormones being produced, secreted, and traveling through blood vessels to distant cells to have an effect, thus having the potential to affect entire body systems. In the paracrine pathway hormones are produced in a cell, secreted, and act directly on nearby receptive cells. The autocrine pathway is similar to the paracrine pathway except that the receptor cells are also secretory cells meaning the cell is able to produce the hormone and exert an effect on itself. There is no pathway known as local mediation.
The most common cause of C. botulinum in infants is: ingestion of honey products containing C. botulinum spores. the bacteria spreading via direct contact with those infected with C. botulinum. poor hand washing by caregivers preparing food. transmission of C. botulinum through breast milk.
ingestion of honey products containing C. botulinum spores. Explanation: Infants younger than one year of age have immature gastrointestinal tracts, allowing growth of C botulinum spores. This is the most frequent cause of botulism.
A client with severe hypoglycemia is unconscious. Which method of providing glucose should not be used for this client? glucagon IM orange juice orally glucose gel in the buccal pocket dextrose IV
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 has just completed an assessment on a client admitted with Guillain-Barré syndrome. The nurse determines that a priority of care will be: ventilatory assessment and support. administration of antibiotics. emotional support. feeding the client.
ventilatory assessment and support. Explanation: Guillain-Barré syndrome usually is a medical emergency. There may be a rapid development of ventilatory failure and autonomic disturbances that threaten circulatory function. Assessment of the airway is the top priority. Treatment includes support of vital functions and prevention of complications such as skin breakdown and thrombophlebitis.
A client's low serum T4 level has led to a diagnosis of hypothyroidism. When planning this client's care, the nurse should: teach the client about the safe and effective use of synthetic thyroid hormones. teach the client about the signs and symptoms of Graves disease. educate the client about the need to report any weight changes promptly. ensure the client knows that the physician may propose surgery.
teach the client about the safe and effective use of synthetic thyroid hormones. Explanation: Hypothyroidism is treated by replacement therapy with synthetic preparations of T3 or T4. Graves disease is associated with hyperthyroidism, not hypothyroidism. Surgery is not a usual treatment modality.
