Advanced Pathophysiology Midterm Exam 6501 Walden University, Exams of Nursing

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Advanced Pathophysiology Midterm

Exam 6501 Walden University.

A runner has depleted all the oxygen available for muscle energy. Which of the following will facilitate his continued muscle performance? - Correct answer Answer: Anaerobic glycolysis What causes the rapid change in the resting membrane potential that initiates an action potential? - Correct answer Answer: Sodium gates open, and sodium rushes into the cell, changing the membrane potential from negative to positive. A 12-year-old male is diagnosed with Klinefelter syndrome. His karyotype would reveal which of the following? - Correct answer Answer: XXY A nurse is reviewing the pedigree chart. When checking for a proband, what is the nurse looking for? - Correct answer Answer: The person who is first diagnosed with a genetic disease An aide asks the nurse why people who have neurofibromatosis will show varying degrees of the disease. Which genetic principle should the nurse explain to the aide? - Correct answer Answer: Expressivity In teaching a patient with cirrhosis, which information should the nurse include regarding cholesterol? - Correct answer Answer: Cholesterol decreases the membrane fluidity of the erythrocyte, which reduces its ability to carry oxygen. When a patient asks what causes cystic fibrosis, how should the nurse respond? Cystic fibrosis is caused by an _____ gene - Correct answer Answer: Autosomal recessive How are potassium and sodium transported across plasma membranes? - Correct answer Answer: By adenosine triphosphate enzyme (ATPase) The nurse would be correct in identifying the predominant extracellular cation as: - Correct answer Answer: Sodium The early dilation (swelling) of the cell's endoplasmic reticulum results in: - Correct answer Answer: Reduced protein synthesis What principle should the nurse remember when trying to distinguish aging from diseases? - Correct answer Answer: It is difficult to tell the difference because both processes are believed to result from cell injury. What is the diagnosis of a 13-year-old female who has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present? Her

features include a short stature, widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair. - Correct answer Answer: Turner syndrome A eukaryotic cell is undergoing DNA replication. In which region of the cell would most of the genetic information be contained? - Correct answer Answer: Nucleolus The nurse is teaching staff about the most common cause of Down syndrome. What is the nurse describing? - Correct answer Answer: Maternal nondisjunction A 50-year-old male was recently diagnosed with Huntington disease. Transmission of this disease is associated with: - Correct answer Answer: Delayed age of onset A patient wants to know the risk factors for Down syndrome. What is the nurse's best response? - Correct answer Answer: Pregnancy in women over age 35 What is the role of cytokines in cell reproduction? - Correct answer Answer: Provide growth factor for tissue growth and development A newborn male is diagnosed with albinism based on skin, eye, and hair appearance. Which finding will support this diagnosis? - Correct answer Answer: Inability to convert tyrosine to DOPA (3,4 dihydroxyphenylalanine) Sodium and water accumulation in an injured cell are a direct result of: - Correct answer Answer: Decreased ATP production A nurse is reading a chart and sees the term oncotic pressure. The nurse recalls that oncotic pressure (colloid osmotic pressure) is determined by: - Correct answer Answer: Plasma proteins The ion transporter that moves Na + and Ca 2+ simultaneously in the same direction is an example of which of the following types of transport? - Correct answer Answer: Symport A 20-year-old pregnant female gives birth to a stillborn child. Autopsy reveals that the fetus has 92 chromosomes. What term may be on the autopsy report to describe this condition? - Correct answer Answer: Tetraploidy Why is potassium able to diffuse easily in and out of cells? - Correct answer Answer: Because the resting plasma membrane is more permeable to potassium Hypothyroidism - Correct answer A disorder caused by a thyroid gland that is slower and less productive than normal, does not produce enough T3 and T T3, T4, TSH - Correct answer Diagnosing hypo/hyperthyroidism T3/T4 = thyroid. TSH = Pituitary.

T3/T4 abnormality = problem with THYROID. T3/T4 normal + TSH abnormal = Secondary thyroid problem If too much T3/T4, then TSH will be down. Vice Versa. calcium - Correct answer parathyroid glands responsible for regulating ___ levels. metabolism, temperature - Correct answer Thyroid produces hormones T3, T4, and plays big role in __, ___ regulation and growth and development iodine - Correct answer Brain cannot make T3 and T4 without ___ slows - Correct answer hypothyroidism everything __. stimulates sympathetic nervous system, drowsy, lethargic constipated, food move slows, weight gain body temp decreases Hyperthyroidism - Correct answer excessive activity of the thyroid gland: increased levels of T3, T4 and TSH loss - Correct answer Hyperthyroidism: burning calories at an excessive rate weight ___ stimulates sympathetic nervous system: alert, quick reflexes, increased HR & BP (fight or flight response Heat intolerance: increased body temp Active GI: diarrhea anterior pituitary gland - Correct answer the anterior part of the pituitary gland; an endocrine gland whose secretions are controlled by the hypothalamic hormones produces thyroid stimulating hormone (TSH) Cushing's disease - Correct answer (Remember: UP, UP, UP, DOWN, UP) HYPERnatremia, HYPERtension, INCREASED blood volume, HYPOkalemia, HYPERglycemia adrenal cortex - Correct answer outer section of each adrenal gland; secretes cortisol, aldosterone, and sex hormones Aldosterone - Correct answer Hormone that stimulates the kidney to retain sodium ions and water to regulate BP via angiotensin-aldosterone system, retention of sodium and secretes potassium

cortisol - Correct answer stress hormone released by the adrenal cortex helps the body deal with stress such as illness or injury increases blood glucose breaks down fats, proteins, carbs electrolyte regulations Negative feedback - Correct answer Hypothalamus releases CRH corticotropin releasing hormone --> pituitary gland releases ATCH adrenocorticotropic hormone --> adrenal cortex to release cortisol increased - Correct answer Cushings disease has ___ secretion of cortisol decreased - Correct answer Addison's disease has __ secretion of cortisol and aldosterone Need to ADD some steroids syndrome - Correct answer Cushing ___ is when an outside cause results in too much production of cortisol, like treatment with steroids disease - Correct answer Cushings ___ is when an internal issue is causing over production of cortisol autoimmune - Correct answer Addison's disease is typically an ____ disorder where the body is attacking the adrenal cortex on top of the adrenal gland Cushing's - Correct answer ___ symptoms: skin fragile truncal obesity, small extremities with striae on them excessive hair "moon face" buffalo hump females --> no menstruation males--> ED hyperglycemia d/t high cortisol Addison's - Correct answer ___ symptoms: brownish hyperpigmentation of skin

diarrhea, nausea hyponatremia d/t low aldosterone levels --> hyperkalemia hypoglycemia d/t low cortisol low bp, risk for vascular collapse going into shock Anti-diuretic hormone - Correct answer aka Vasopressin ADH is a hormone made by the hypothalamus in the brain and stored in the posterior pituitary gland. It tells your kidneys how much water to conserve. ADH constantly regulates and balances the amount of water in your blood. increase - Correct answer SIADH will have ___ in antidiuretic hormone decrease - Correct answer Diabetes insipidus will have a __ in ADH posterior pituitary gland - Correct answer stores and secretes ADH after hypothalamus produces ADH Pheochromocytoma - Correct answer a benign tumor of the adrenal medulla that causes the gland to secrete catecholamines (epinephrine, norpinephrine, dopamine, and dopa) leading to high BP, headache, sweating and symptoms of a panic attack. diabetic ketoacidosis - Correct answer acidity of the blood caused by the presence of ketone bodies produced when the body is unable to burn sugar; thus, it must burn fat (triglycerides and amino acids instead of glucose) for energy hyperglycemia hyperketonemia metabolic acidosis occurs mostly in type 1 diabetes mellitus cerebral, coma - Correct answer DKA causes nausea, vomiting, and abd pain and can progress to __ edema, __ and death deficiency - Correct answer DKA: hyperglycemia d/t insulin ___ causes an osmotic diuresis leading to marked urinary losses of water and electrolytes urinary excretion of ketones leads to additional loss of sodium and potassium

inflammation - Correct answer Pericarditis is ___ of the pericardium, often with fluid accumulation in the pericardial space (pericardial effusion) cardiac tamponade - Correct answer acute compression of the heart caused by fluid accumulation in the pericardial cavity--> impairs cardiac filling leading to low cardiac output. infective endocarditis - Correct answer inflammation of endothelium that lines heart and cardiac valves. most commonly damages mitral valve, then aortic and tricuspid valves. commonly caused by bacteria that are normally present in the body. can also occur after an invasive medical or dental procedure. symptoms: valvular dysfunction, may affect organ systems, chest pain, CHF, clubbing, meningitis, low back pain, arthralgia, arthritis myocarditis - Correct answer inflammation of the myocardium with necrosis of cardiac myocytes biopsy shows inflammatory infiltrate of the myocardium with lymphocytes, neutrophils, eosinophils, and granulomas direct cardiomyocyte injury cased by an infectious or other cardiotoxic agent OR myocardial injury caused by an autoimmune reaction to an infectious or cardiotoxic agent aortic regurgitation - Correct answer (aortic insufficiency) incompetent aortic valve that allows backward flow of blood from the aorta into left ventricle during diastole aortic stenosis - Correct answer calcification of aortic valve cusps that restricts forward flow of blood during systole narrowing of the aortic valve, obstructing blood flow from the left ventricle to the ascending aorta during systole mitral regurgitation - Correct answer mitral insufficiency; incompetent mitral valve allows regurgitation of blood from the left ventricle back into left atrium during systole mitral stenosis - Correct answer narrowing of the mitral valve orifice that impedes blood flow from the left atrium to the left vetricle mitral valve prolapse - Correct answer Improper closure of the valve between the heart's upper and lower left chambers. billowing of mitral valve leaflets into the left atrium during systole pulmonic regurgitation - Correct answer pulmonic insufficiency; backflow of blood through incompetent pulmonic valve into the right ventricle

causes blood from from the pulmonary artery into the right ventricle during diastole pulmonic stenosis - Correct answer narrowing of the opening and valvular area between the pulmonary artery and right ventricle narrowing of the pulmonary outflow tract causing obstruction of blood flow from the right ventricle to the pulmonary artery during systole deep vein thrombosis - Correct answer blood clot forms in a large vein, usually in a lower limb d/t impaired venous return, endothelial injury or hypercoagulability thrombi - Correct answer __ consist of thrombin, fibrin, and red blood cells with few platelets and without treatment can travel to the lungs causing PE Hypertension - Correct answer high blood pressure sustained SBP > BP= cardiac output x total peripheral vascular resistance (TPR) HTN leads to ↑ CO, ↑ TPR peripheral artery disease - Correct answer Atherosclerotic disease of the arteries that perfuse the limbs especially the lower extremites. can cause intermittent claudation and may not be painful and can go undetected for years. coronary artery disease - Correct answer disease of the arteries surrounding the heart. leads to dylipidemia which is abnormal concentrations of serum lipoproteins. an increased serum concentration of LDL is an indicator of coronary risk. other risk factors, age, diabetes and CHD stable angina (angina pectoris) - Correct answer chest pain caused by myocardial ischemia; pain is usually relieved by nitrates Pain describes the sensation by clenching fist over left sternal border. common sx chest pain, palpitations, sense of unease and severe fatigue myocardial infarction (MI) - Correct answer heart attack; death of myocardial tissue (infarction) caused by ischemia (loss of blood flow) as a result of an occlusion (plugging) of a coronary artery; usually caused by atherosclerosis; symptoms include pain in the

chest or upper body (shoulders, neck, and jaw), shortness of breath, diaphoresis, and nausea Tricuspid regurgitation - Correct answer holosystolic, high pitched "blowing murmur" that is loudest at the tricuspid area and radiates to right sternal border. Enhanced by maneuvers that increase RA return (e.g. inspiration). TR can be caused by RV dilation. Rheumatic fever and infective endocarditis can cause either MR or TR right sided heart failure - Correct answer 1. Jungular Vein Distention

2. Ascending Dependent Edema
3. Weight Gain
4. Hepatomegaly (Liver Enlargement) Left sided heart failure - Correct answer 1. Pnea, SOB
5. Crackles
6. Oliguria
7. Frothy Sputum
8. Displaced Apical Pulse (Hypertrophy) gas exchange in lungs - Correct answer Occurs via diffusion O2 concentration is higher in the lungs than in the blood, so O2 diffuses into blood. CO2 concentration in the blood is higher than in the lungs, so CO2 diffuses out of blood. Ventilation - Correct answer movement of air in and out of the lungs controlled by the parasympathetic and sympathetic nervous system lung compliance - Correct answer measure of change in lung volume that occurs with given change in transpulmonary pressure determined by the adequate production of surfactant and the elastic recoil of the lungs and chest wall airway resistance - Correct answer the increase in pressure that occurs as the diameter of the airways decreases from mouth/nose to alveoli. spirometer - Correct answer measures volume of air inhaled/exhaled and length of time required for each breath Dyspnea - Correct answer shortness of breath orthopnea - Correct answer difficulty breathing when lying down paroxysmal nocturnal dyspnea - Correct answer awakening from sleep with SOB and needing to be upright to achieve comfort

Aspiration - Correct answer Breathing fluid, food, vomitus, or an object into the lungs atelectasis - Correct answer collapsed lung; incomplete expansion of alveoli bronchiectasis - Correct answer dilation of the bronchi usually secondary to infection or chronic inflammation Bronchiolitis - Correct answer Inflammation of the bronchioles that usually occurs in children younger than 2 years and is often caused by the respiratory syncytial virus. pulmonary edema - Correct answer accumulation of fluid in the lungs common cause of LHF ARDS (acute respiratory distress syndrome) - Correct answer respiratory insufficiency marked by progressive hypoxia Asthma - Correct answer A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing. COPD (chronic obstructive pulmonary disease) - Correct answer A group of lung diseases that block airflow and make it difficult to breathe. consist of bronchitis and emphysema Chronic bronchitis - Correct answer Chronic inflammation of the bronchi that causes airway obstruction resulting from bronchial smooth muscle hypertrophy. Emphysema - Correct answer a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness. function of kidneys - Correct answer filter blood and produce urine Renal blood flow - Correct answer 1000- 1200 ml/min GFR (glomerular filtration rate) - Correct answer 90-120 mL/min Renal function function of nephron - Correct answer regulate the concentration of water and soluble substances like sodium salts by filtering the blood, reabsorbing what is needed and excreting the rest as urine. proximal convoluted tubule - Correct answer Reabsorbs 60% to 70% of filtered sodium and water

distal tubules function - Correct answer transport, reabsorb, and secrete the glomerular filtrate (so secretion) Creatinine - Correct answer 0.6-1.2 mg/dL BUN - Correct answer blood urea nitrogen 10-20 mg/dL indicator of hydration status Urinart tract infection (UTI) - Correct answer Presence of an organism in one or more areas of the urinary tract Pyleonephritis - Correct answer inflammation of the renal pelvis and the kidney acute glomerulonephritis - Correct answer (AGN): immune disease after strept infection. Decreases GFR=excessive acculmulation of water and retention of sodium, onset appears after latent period of about 10 days. s/s: oliguria, edema, hematuria "tea-colored" mild HTN, lethargy, proteinuria, loss of appetite. Rx: none, spontaneous recovery, supportive-diet low in sodium, protein, K. Nursing: montor fluid, edema, rest periods. AGN is an inflammatory disease of both kidneys that usually affects children between the ages of 2 and 12. It is an inflammation of the glomeruli that typically follows a streptococcal infection of the skin or throat, or an autoimmune condition. Kidney symptoms usually begin two to three weeks after the initial infection. AGN is not contagious. lupus erythematosus - Correct answer An autoimmune disease wherein the body produces antibodies against a variety of organs, especially connective tissues of skin and joints. Mild Lupus may involve a distinctive butterfly-shaped rash over the nose and cheeks. Mild lupus may also involve myalgia and arthralgia (remember these words?) Severe or systemic lupus (SLE) involves inflammation of multiple organ systems such as the heart, lungs, or kidneys. By the way, lupus means "wolf" in Latin. Maybe a reference to the facial rash that might give a patient a wolf-like appearance. Acute Kidney Injury - Correct answer abrupt loss of kidney function resulting in retention of urea and nitrogen. Prerenal=decrease renal blood flow s/s: hypotension, hypoperfusion Intrarenal=injury to renal tissue d/t toxins/ischemia s/s: edema, glomerulonephritis Postrenal=stop/slow urine flow down the urinary tract s/s: hx of obstruction, difficulty voiding Oliguric/anuric=less than 500ml UO in 24 hrs, diuretic phase 24hr UO more than 500ml and no longer rise in BUN/Cr, recovery phase months-year, scar tissue. Rx: no nephrotoxic drugs( aminoglycosides, ACEI, NSAIDS, radiocontrast), give IVF if dehydrated, hemodialysis Complications: infection, arrhythmias (hyperkalemia) electrolyte imbalances, GI bleeding, multiple organ system failure.

Nursing: assess, montor I&O, daily weight, regulate protein intake, high carb diet, restrict foods high in K, Phosphorus, Na Chronic Kidney Disease (CKD) - Correct answer Inability of kidneys to excrete wastes; staged from 1 (mild damage to kidney) to 5 (complete kidney failure requiring either dialysis or a renal transplant). Stage 5 is also called end stage renal disease Duodenum Function of the Small Intestine - Correct answer chemical digestion of carbs, proteins, and lipids Bile - Correct answer a bitter greenish-brown alkaline fluid that aids digestion and is secreted by the liver and stored in the gallbladder. Liver functions - Correct answer Responsible for: The metabolism of fats, proteins, and carbohydrates. Excretion of bilirubin, cholesterol, hormones, and drugs. Enzyme activation. Storage of glycogen, vitamins, and minerals. Synthesis of plasma proteins, such as albumin, and clotting factors. Blood detoxification and purification. Bile production and secretion. hepatic portal vein - Correct answer A vein connecting the capillary bed of the intestines with the capillary bed of the liver. This allows amino acids and gluocse absorbed from the intestines to be delivered first to the liver for processing before being transported throughout the circulatory system. Bilirubin - Correct answer an orange-yellow pigment formed in the liver by the breakdown of hemoglobin and excreted in bile. Gallbladder function - Correct answer Store & concentrate bile produced by the liver until it is needed in the small intestine Pancreas - Correct answer An organs in the abdominal cavity with two roles. The first is an exocrine role: to produce digestive enzymes and bicarbonate, which are delivered to the small intestine via the pancreatic duct. The second is an endocrine role: to secrete insulin and glucagon into the bloodstream to help regulate blood glucose levels. anorexia - Correct answer loss of appetite vomiting - Correct answer expelling matter from the stomach through the mouth (also called emesis) Primary constipation - Correct answer results from lifestyle factors such as inactivity, inadequate in take of fiber, insufficient fluid intake, or ignoring the urge to defecate Diarrhea causes - Correct answer spicy or spoiled foods bacteria (E. coli), virus, toxins drug reactions

fecal impaction, laxative abuse malabsorption disorders, bowel tumor, inflammatory bowel disease Stress, anxiety GI bleeding s/s - Correct answer Abdominal pain and tenderness Hematemesis Hematochezia Melena ALOC Signs of shock Tachycardia Peptic Ulcer Disease - Correct answer A break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum Dudoenal Ulcer - Correct answer Increased number of parietal cells in the stomach increased gastric levels Rapid gastric emptying gastric ulcer - Correct answer persistent pain in the upper abdomen, often described as burning pain is somewhat or completely relieved by eating bland foods often have hematernesis or melana Zollinger-Ellison syndrome - Correct answer hypersecretion of gastric acid that produces peptic ulcers as a result of a non-beta-cell tumor of the pancreatic islets stress ulcers - Correct answer gastric mucosal lesions that develop in patients who are critically ill from trauma, shock, hemorrhage, sepsis, burns, acute respiratory distress syndrome, major surgical procedures, or other severe illnesses Cushing ulcer - Correct answer increased stimulation of vagus nerve secondary to increased ICP leads to increased acid production, increased vagus stim causes increase of ACh which binds parietal cells and increases acid production Dumping syndrome - Correct answer increase fat and protein, small frequent meals, lie down after meal to decrease peristalsis. Wait 1 hr after meals to drink

ulcerative colitis - Correct answer a chronic condition of unknown cause in which repeated episodes of inflammation in the rectum and large intestine cause ulcers and irritation Chron's disease - Correct answer A chronic inflammatory bowel disease that affects the lining of the digestive tract. irritable bowel syndrome - Correct answer a common condition of unknown cause with symptoms that can include intermittent cramping, abdominal pain, bloating, constipation, and/or diarrhea Diverticulitis - Correct answer inflammation of the diverticula appendicitis - Correct answer inflammation of the appendix portal hypertension - Correct answer A potential complication of chronic alcoholism resulting in liver damage and obstruction of venous blood flow through the liver. The rising blood pressure in the veins between the gastrointestinal tract and liver causes engorgement of veins around the umbilicus (navel). splenomegaly - Correct answer enlargement of the spleen Acites - Correct answer is excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity). Hepatic encephalopathy - Correct answer impaired ammonia metabolism causes cerebral edema. s/s: change in LOC, memory loss, asterixis (flapping tremor) impaired handwriting, hyperventilation w/ resp alkalosis. Rx: lactulose, low protein, safety, rest Hepatitis - Correct answer Inflammation of the liver, usually caused by a viral infection, that causes fever, loss of appetite, jaundice, fatigue, and altered liver function. Hepatitis B virus - Correct answer virus that causes inflammation of the liver; transmitted through any body fluid, including vaginal secretions, semen, and blood Hepatitis C (HCV) - Correct answer bloodborne viral disease that affects the liver; transmitted by blood exposure, sharing needles, or from infected mother to infant; rarely transmitted by sexual contact Hepatitis D (HDV) - Correct answer A bloodborne virus, it can only exist in combination with the hepatitis B virus. HBV vaccine will offer protection against HDV. Viral Hepatitis Symptoms - Correct answer -Fatigue -Myalgia/Arthralgia -Mild Fever -N/V

-Abdominal pain -Aversion to smoking -Hepatosplenomegaly -Dark urine -Jaundice (symptoms improve with onset of jaundice; more common in adults than children) Cirrhosis causes - Correct answer alcoholism (most common) nutritional deprivation hepatitis or other infections Cholecystitis - Correct answer inflammation of the gallbladder; usually associated with gallstones Pancreatitis (chronic) - Correct answer EtOH (adults), cystic fibrosis (kids) LDL cholesterol - Correct answer "bad" blood cholesterol, delivers plaque to the arterial walls. < 100 mg/dl HDL cholesterol - Correct answer good. high density lipoprotein. high protein, low fat GERD (gastroesophageal reflux disease) - Correct answer A digestive disease in which stomach acid or bile irritates the food pipe lining. Type one diabetes - Correct answer When the pancreatic cells fail to fuction properly and insulin is not secreted normally, this is known as? Three P's of diabetes - Correct answer Polyuria (excessive urination) Polydipsia (excessive thirst) Polyphagia (excessive hunger) type 2 diabetes - Correct answer Diabetes of a form that develops especially in adults and most often obese individuals and that is characterized by high blood glucose resulting from impaired insulin utilization coupled with the body's inability to compensate with increased insulin production. COPD (chronic obstructive pulmonary disease) - Correct answer COPD (chronic obstructive pulmonary disease) - Correct answer