BIOL 121 PATHO EXAM 2 QUIZ WITH SOLUTIONS VERIFIED 2023, Exams of Nursing

Download BIOL 121 PATHO EXAM 2 QUIZ WITH SOLUTIONS VERIFIED 2023 and more Exams Nursing in PDF only on Docsity! BIOL 121 PATHO EXAM 2 QUIZ WITH SOLUTIONS VERIFIED 2023 Chapter 9: Infection and Inflammation Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A client reports persistent cough. The nurse suspects the client may have developed tuberculosis. Which diagnostic test does the nurse expect the primary health- care provider to prescribe to confirm this condition? 1. Histological examination 2. X-ray of the lungs 3. Both A and B 4. Electrocardiogram 2. The nurse is reviewing the complete blood count of a client who presents with fever. The white blood cell count of the client is 15,000 cells/mL. Which condition has the client developed? 1. Leukocytosis 2. Leukopenia 3. Neutrophilia 4. None of the above 3. A client reports fever and shortness of breath. The complete blood count with differential shows a white blood count of 16,000 cells/mL with90% neutrophils,2% eosinophils, and 1% basophils. Which condition has the client developed? 1. Viral pneumonia 2. Bacterial pneumonia 3. Both A and B 4. Systemic lupus erythematosus 4. While assessing the vital signs of a 35-year-old client, the nurse records a blood pressure of 130/85 and body temperature as 1030 F. The client’s complete blood count value indicates the presence of an acute infection. What is the best nursing intervention for this client? 1. Administer aspirin to reduce fever. 2. Avoid administering ibuprofen to reduce fever. 3. Avoid administering acetaminophen to reduce fever. 4. All of the above 5. A 2-year-old client was brought to the hospital with fever. Reports revealed that the client has developed an acute infection. What nursing intervention should the nurse implement for the client? 1. Administer aspirin. 2. Administer a salicylate-based nonsteroidal anti-inflammatory drug (NSAID). 3. Administer ibuprofen. 4. None of the above 6. A client has developed an infection after a dental implant surgery. Which condition is the client likely to develop if the infection is left untreated? 1. Septicemia 2. Anthracosis 3. Tuberculosis 4. None of the above 7. A client has been working in a coal mine for a long time. Which condition is the client likely to develop? 1. Celiac disease 2. Anthracosis 3. Chronic hepatitis 4. Rheumatoid arthritis 8. How is acute inflammation different from chronic inflammation? 1. Acute inflammation is characterized by the predominance of neutrophils. 2. Acute inflammation is characterized by the predominance of monocytes. 3. Acute inflammation is characterized by the predominance of lymphocytes. 4. Acute inflammation is characterized by the predominance of macrophages. 9. A registered nurse is teaching a group of student nurses about the cell cycle and tissue healing. Which statement made by a student nurse needs correction? 1. “Hepatocytes remain in the resting stage until stimulated.” 4. All of the above 19. An ultrasound performed on a client shows an abnormal connection between the trachea and esophagus. What term best describes the complication that the client has developed? 1. Evisceration 2. Fistula 3. Stricture 4. None of the above 20. Which component enables the blood vessels to dilate and become more permeable during the vascular phase of inflammation? 1. White blood corpuscles 2. Blood platelets 3. Inflammatory mediators 4. C-reactive proteins NARRBEGIN: Exhibit Exhibit NARREND 21. A nurse is caring for four clients in a hospital. Which wound takes extensive time and requires more support to heal? Client 1 Client 2 Client 3 Client 4 Appendectomy site Pressure ulcers First-degree burn on the arms Tonsillectomy site 1. Client 1 2. Client 2 3. Client 3 4. Client 4 Multiple Response Identify one or more choices that best complete the statement or answer the question. 22. Which components of the blood attract platelets to the site of the injury in the form of a chemical signal? Select all that apply. 1. Histamine 2. Interleukins 3. Microbial agents 4. Endothelial cells 5. White blood corpuscles 23. What are the inflammatory mediators that are released from white blood cells (WBCs)? Select all that apply. 1. TNF-alpha 2. Interleukins 3. Fibrinogen 4. Leukotrienes 5. Granuloma 24. A registered nurse is teaching a student nurse about C-reactive proteins. Which statement made by the student nurse indicates effective teaching? Select all that apply. 1. “It identifies the presence of foreign material in the immune system.” 2. “It stimulates other inflammatory cytokines.” 3. “It prevents WBC adhesion to endothelium.” 4. “It stimulates gastric mucous production.” 5. “It identifies the presence of tubercles.” 25. Which clients would benefit from hyperbaric oxygen therapy? Select all that apply. 1. A client with a skin graft 2. A client with diabetic foot ulcers 3. A client with anthracosis 4. A client with osteoarthritis 5. A client with gangrene in the toes Chapter 10: Infectious Diseases Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which disease is spread from human to human via droplet infections through coughing or sneezing? 1. Mumps 2. Poliomyelitis 3. Herpes simplex 4. West Nile virus infection 2. Which is a protozoan infection? 1. Enterobiasis 2. Creutzfeldt-Jakob disease 3. Giardiasis 4. Coccidiomycosis 3. Which is an antibiotic-resistant bacterium? 1. Staphylococcus saprophyticus 2. Staphylococcus aureus 3. Streptococcus pyogenes 4. Streptococcus viridians 4. Which is the key symptom of meningitis? 1. Abdominal pain 2. Nuchal rigidity 3. Sensitivity to sound 4. Dysuria 2. They are abnormal proteins. 3. They are fungal agents. 4. They are helminths. 16. Which fact would you select to justify why both the Ebola and Marburg viruses are classified as Category A bioterrorism agents? 1. They cause hemorrhagic fevers. 2. They are virulent, stable, and infective as small-particle aerosols. 3. They are transmitted by direct contact through blood and body fluids. 4. There is no standard treatment. 17. Which symptom is diagnostic for variant Creutzfeldt-Jakob disease? 1. Mental confusion 2. Personality changes 3. Problems with hearing, seeing, and smelling 4. Jerky muscle movements 18. Which diagnostic test confirms tapeworm infection? 1. Blood test 2. Stool test 3. Urine test 4. Antibody titers 19. Coccidiomycosis is an airborne disease.What conclusion can you draw about its mode of transmission? 1. Transmitted by fungal spores 2. Transmitted by vector bites 3. Transmitted by prions 4. Transmitted by contaminated food 20. How would you show your understanding of the fact that vaginal candidiasis a side effect of long-term antibiotic use? 1. By the fact that it is an opportunistic infection. 2. By the fact that it eradicates lactobacillus in the vagina. 3. By the fact that it is caused by an antibiotic-resistant bacteria in the vagina. 4. By the fact that it is caused by decreased vaginal pH due to antibiotic use. Multiple Response Identify one or more choices that best complete the statement or answer the question. 21. When would you recommend medical therapy in the treatment of infection? Select all that apply. 1. When there is prolonged manifestation of an infection 2. When there are no vaccines to prevent the infection 3. When there is undue risk to the people in contact with the client 4. When there is undue risk to the client 5. When the first line of defense fails to contain the infection 22. What aspects of culture analysis make the study so useful?Select all that apply. 1. Identification of microbes 2. Understanding the extent of infection 3. Studying the existence of antibodies 4. Studying the microbe’s susceptibility to antibiotics 5. Differentiating the gram-negative from the gram-positive bacteria 23. Which data is used to distinguish serological testing from other laboratory studies? Select all that apply. 1. Quantifying based on antibody titers 2. Analyzing for cell changes 3. Quantifying levels of immunoglobulin 4. Identifying antigen 5. Detection of microorganism’s genetic material 24. How would you justify that an emerging infectious disease is not always a new disease?Select all that apply. 1. Due to the disease being undetected 2. Due to reappearance of the disease 3. Due to antibiotic-resistant bacteria 4. Due to breakdown in public health measures 5. Due to realization about the mechanism of the disease process Other 25. An infectious process has several different stages before it progresses to a full- blown disease. (Enter the letter of each step in the proper sequence, do not use commas or spaces.) ANS= DAECB A. Prodromal stage B. Resolution phase C. Convalescent stage D. Incubation period E. Acute stage Chapter 11: Disorders of the Immune System Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which cells are known as granular lymphocytes? 1. Kupffer cells 2. Microglial cells 3. T cells 4. Natural killer cells 2. Where does maturation of T lymphocytes occur? 1. Spleen 2. Bone marrow 3. Thymus gland 4. Lymph nodes 3. Which is the predominant immunoglobulin produced after a host’s re-exposure to an antigen? blood cell count, and weight gain 1. Client 1 2. Client 2 3. Client 3 4. Client 4 13. A nurse is reviewing the prescriptions of four clients in the hospital. Compare the effects of the medications prescribed to the clients and identify the client who is most likely being treated for systemic lupus erythematosus (SLE). Client 1 Client 2 Client 3 Client 4 Amoxicillin, vancomycin, Imodium Hydrocortisone, hydroxychloroquine, methotrexate Cyclophosphamide, mycophenolate, infliximab Codeine, ibuprofen, naproxen 1. Client 1 2. Client 2 3. Client 3 4. Client 4 14. A registered nurse is teaching a student nurse about the common side effects of methotrexate therapy, which is used to treat clients with rheumatoid arthritis. Which statement made by the student nurse indicates effective learning? 1. “The client’s white blood cell count will be below 4,500 cells per microliter.” 2. “The client’s weight will increase by 2 kg.” 3. “The client’s urine specific gravity will be 1.030.” 4. All of the above. 15. A client with scleroderma complains of painful ulcers on the knees. Which condition has the client? 1. Telangiectasis 2. Calcinosis 3. Sclerodactyly 4. Raynaud’s phenomenon 16. A registered nurse is teaching a nursing student about the diagnostic test done for chronic mucocutaneous candidiasis. What statement made by the student nurse indicates effective teaching? 1. “Potassium hydroxide wet mount is used to diagnose candida infection.” 2. “An antinuclear antibodies test is used to diagnose candida infection.” 3. “A C-reactive protein test is used to diagnose candida infection.” 4. “Urinalysis is used to diagnose candida infection.” 17. A nurse is reviewing the prescriptions of four clients. Assess the effects of the medication prescribed and identify the client who is most likely being treated for chronic mucocutaneous candidiasis. Client 1 Client 2 Client 3 Client 4 Ketoconazole Codeine Amoxicillin Acyclovir 1. Client 1 2. Client 2 3. Client 3 4. Client 4 18. A nurse is reviewing the prescriptions of four clients who are being treated for chronic mucocutaneous candidiasis. Compare the effects of the medications and choose the medication that is least effective in treating chronic mucocutaneous candidiasis (CMC). Client 1 Client 2 Client 3 Client 4 Itraconazole Amorolfine Fluconazole Amphotericin B 1. Client 1 2. Client 2 3. Client 3 4. Client 4 19. A client has a positive ELISA test. On examination, the client is found to have fever, weight loss, and candida infections. The client also complains of night sweats. What would be the CD4 levels? 1. 700 cells per microliter 2. 500 cells per microliter 3. 200 cells per microliter 4. 350 cells per microliter 20. A nurse who is engaged in maternal-child health care has a blood sample drawn for rubella antibody screening. The test result shows very low titer values. Compare the nursing intervention stated and choose the best nursing intervention for the given situation. 1. The nurse should consult the physician and receive the rubella vaccine immediately. 2. The nurse should consult the physician and receive the MMR vaccine immediately. 3. The nurse does not require any vaccinations. 4. None of the above 21. Which is an autoimmune disease? 1. Osteoarthritis 2. Rheumatoid arthritis 3. Type II diabetes 4. All of the above Multiple Response Identify one or more choices that best complete the statement or answer the question. 22. A registered nurse is teaching nursing students about CD4 cells. Which statements made by a student nurse indicate effective teaching? Select all that apply. 1. “The CD4 cells directly attack antigens.” 2. “The CD4 cells produce immunoglobulins.” 3. “The CD4 cells mature into plasma cells.” 4. “The human immunodeficiency virus attacks CD4 cells.” 5. “The CD4 cells are T cells that take part in cell-mediated immunity.” 23. A registered nurse is teaching a student nurse about interpreting blood test reports and urinalysis reports of clients with systemic lupus erythematosus (SLE). Which statements made by the student nurse indicate effective teaching? Select all that apply. 1. “A high antinuclear antibodies (ANA) level is more specific to clients with SLE.” 2. “Erythrocyte sedimentation rate is high in clients with SLE.” 1. Leukopenia 2. Leukocytosis 3. Thrombocytopenia 4. None of the above 7. A 65-year-old client undergoes chemotherapy for treating cancer. A complete blood count report after chemotherapy shows red blood cells -3.02 million cells/microliter, white blood cells -3,200 cells/microliter, and platelets -100,000/microliter. What disorder does the nurse suspect in the client? 1. Myelodysplastic syndrome 2. Lymphocytosis 3. Monocytic leukocytosis 4. None of the above 8. An 8-year-old child presents to the hospital with a lymphocytopenia. Based on this diagnosis, what would the nurse expect to find? 1. A lymphocyte count greater than 9,000/ microliter in infants 2. A lymphocyte count less than 3,000/ microliter in children 3. A lymphocyte count greater than 7,000/ microliter in children 4. All of the above 9. The registered nurse is teaching the student nurse about hematological cancer. Which statement made by the student nurse indicates effective learning? 1. “Exposure to intense radiation causes cancer.” 2. “Contact with benzene causes cancer.” 3. “Damaged deoxyribonucleic acid causes cancer.” 4. All of the above. 10. Which blood component is developed from megakaryocytes? 1. Platelets 2. Red blood cells 3. White blood cells 4. None of the above 11. A client comes to the hospital with petechiae. The complete blood count report shows a decrease in the platelet count. What should the nurse include in the plan of care based on the information? 1. Avoid invasive procedures. 2. Discourage the use of stool softeners. 3. Assess the temperature every 6 hours. 4. Encourage the use of a hard bristle toothbrush. 12. A nurse is formulating a nursing diagnosis for a client with chronic lymphoid leukemia. Which nursing measure should be included in the process? 1. Placing the client in protective isolation 2. Limiting visitors with cold and infections 3. Ensuring that all visitors wash their hands before coming in contact with the client 4. All of the above 13. A nurse is analyzing the report of a 5-year-old client with leukemia, who is receiving chemotherapy. The platelet count is 20,000/microliter. What would be the best intervention for the nurse to include in the client’s plan of care? 1. Monitor the client’s vital signs. 2. Check the temperature every six hours. 3. Initiate protective isolation precautions. 4. Use a soft toothbrush for oral care. 14. A client with leukemia received chemotherapy 2 days ago and has subsequently developed acute renal failure. Which laboratory result should the nurse assess? 1. The release of high amounts of calcium 2. The release of high amounts of uric acid 3. The release of high amounts of potassium 4. The release of high amounts of phosphate 15. A client comes to the hospital with reports of chest pain due to lymphoma. Reports show that the lymphoma cells have a rapid growth, but are curable. How would this lymphoma be classified? 1. Low-grade lymphoma 2. Intermittent-grade lymphoma 3. High-grade lymphoma 4. None of the above 16. A client comes to the hospital with symptoms of an allergic reaction from an antibiotic. Which blood cells would show an increase in the complete blood count report? 1. Neutrophils 2. Eosinophils 3. Basophils 4. None of the above 17. The nurse is reviewing the complete blood count of a client who presents with a fever. It shows that the white blood cell count is 3,000/microliter. What should the nurse use when documenting this finding? 1. Leukocytosis 2. Leukopenia 3. Neutrophilia 4. None of the above 18. An 85-year-old client comes to the hospital and reports severe back pain. The client’s blood report shows IgA concentration of 2 grams/deciliter and plasma cells of 8% in the bone marrow. The client does not show symptoms of anemia or hypercalcemia. Based on these findings, what should the nurse suspect? 1. Multiple myeloma 2. Monoclonalgammopathy of undetermined significance 3. Both A and B 4. None of the above 19. Which clinical sign signifies leukocytosis? 1. A white blood count of 3,000/microliter 2. A white blood count of 52,000/microliter 3. A decrease in signs and symptoms of infection 4. Wounds that show no evidence of healing 1. Neutrophilia 2. Neutropenia 3. Leukocytosis 4. Eosinophilia Chapter 13: Infection and Inflammation Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A client’s pulse oximetry reading is 100%; however, the hemoglobin level is 8.5 g/dL. The client’s spouse asks the nurse what activities the client can safely carry out. Which activity would the nurse recommend? 1. Rock climbing 2. Skiing 3. Trekking 4. Road trip 2. Which is a characteristic of secondary polycythemia? 1. High erythropoietin level 2. Normal erythropoietin level 3. Increased platelet count 4. Elevated white blood cell count 3. People with what blood type are known as universal recipients? 1. A positive 2. B negative 3. AB positive 4. None of the above 4. Which condition would a nurse expect in a client with polycythemia vera? 1. Hyperuricemia 2. Orthopnea 3. Angina 4. Ulcers on lower extremities 5. A child with sickle cell anemia experiences vaso-occlusive episodes. Which is the primary nursing objective while caring for the child? 1. Managing pain 2. Administering antibiotics 3. Heating the room to comfort the client 4. Restricting fluids 6. A registered nurse is teaching a student nurse about the treatments given for sickle cell anemia. Which statement made by the student nurse indicates effective teaching? 1. “Hydroxyurea is used to cure sickle cell anemia.” 2. “Acetaminophen is used to manage pain during vaso-occlusive episodes.” 3. “Prednisone is used to treat spleen dysfunction in sickle cell anemia” 4. “Nitric acid is effective in decreasing vaso-occlusive episodes.” 7. A nurse is caring for a child with sickle cell anemia. The parent is asking the nurse about a treatment that would cure the child. Which is the best answer the nurse can provide the parent? 1. “Improving the nitric acid bioavailability can cure the child.” 2. “Blood transfusion done at frequent intervals can cure the child.” 3. “Splenectomy can cure the child.” 4. “Treatments are aimed at reducing complications, but do not cure the condition.” 8. A 27-year-old male client tells a nurse that his siblings have sickle cell anemia, and he is concerned that his children might be affected by sickle cell anemia in the future. Which is the most appropriate advice the nurse should provide the client? 1. “Your partner and you should consult a genetic counselor.” 2. “You will not pass sickle cell anemia to your offspring, so relax.” 3. “You might pass sickle cell anemia to your offspring, so adopt a child.” 4. None of the above. 9. Which diagnostic finding is most likely to be observed in a client with aplastic anemia? 1. Decreased production of T cells 2. Decreased red blood cells, white blood cells, and platelets 3. Decreased level of immunoglobulin A 4. Decreased number of Kupffer cells 10. Which is the most common cause of erythropoietin deficiency? 1. Spleen dysfunction 2. Renal failure 3. Hyperthyroidism 4. Bone marrow damage 11. A 65-year-old client is diagnosed with aplastic anemia. Which condition should the nurse monitor primarily in the client? 1. Hypertension 2. Dyspnea 3. Hematochezia 4. Bleeding diathesis 12. A 39-year-old client complains that he/she feels tired all the time. The client has tachycardia and is pale. The complete blood count with differential reports shows the hemoglobin count as 10 g/dL and the mean corpuscular volume as 75 femoliters. Which condition has the client developed? 1. Microcytic hypochromic anemia 2. Normocytic normochromic anemia 3. Megaloblastic anemia 4. None of the above 13. What factor would contribute to a client having a high hemoglobin count? 1. Being a female 2. Living at high altitudes 3. Being of African-American decent 4. None of the above 22. The complete blood count with differential of a client who complains of weakness shows the following. Red blood cells 3.2 cells x 106 Hemoglobin 9 g/dL Hematocrit 35% Mean corpuscular value 75 Hemoglobin A 0% Hemoglobin F 80% Hemoglobin A2 10% Which red blood cell disorder has the client developed? 1. Alpha thalassemia 2. Sickle cell anemia 3. Beta thalassemia 4. None of the above 23. The complete blood count report of a client who complains of headache and weakness shows the following. Red blood cells 3.4 cells x 106 White blood cells 7 x 103 g/dL Platelets 200,000 Hemoglobin 10 g/dL Which condition has the client developed? 1. Anemia 2. Leukopenia 3. Thrombocytopenia 4. None of the above Multiple Response Identify one or more choices that best complete the statement or answer the question. 24. A nurse is teaching a client with iron-deficiency anemia about the diet that he or she has to follow. Which statements made by the client indicate effective learning? Select all that apply. 1. “Consuming orange juice daily will increase iron absorption.” 2. “Drinking a cup of black tea after having meals will increase iron absorption.” 3. “Adding meat to my diet will help improve iron deficiency.” 4. “Consuming grapes every day will increase iron absorption.” 5. “Adding broccoli, beans, and tomato sauce to my diet will help improve iron deficiency.” 25. Which conditions increase the hemoglobin affinity for oxygen? Select all that apply. 1. Hypothermia 2. Hyperthermia 3. Alkalosis 4. Acidosis 5. Hypercapnia Chapter 14: Disorders of Platelets, Hemostasis, and Coagulation Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A nurse is caring for a client who reports with severe bleeding. The primary health-care provider prescribes a diagnostic test that would measure the time taken for the blood to clot and examine the extrinsic pathway of coagulation cascade. Which diagnostic test does the nurse expect to be performed? 1. Fibrinogen test 2. Activated partial thromboplastin time test 3. Platelet aggregation test 4. Prothrombin time test 2. A client reports shortness of breath and severe pain in the back, chest, and muscles. Which condition could the client possibly be diagnosed with? 1. Hemophilia B 2. Hemophilia A 3. Disseminated intravascular coagulation 4. Von Willebrand disease 3. A client with hemolytic-uremic syndrome reports fever, abdominal pain, pale skin, bruising, and bleeding of the skin. Which medication or treatment will be beneficial for the client? 1. Supportive treatment with dialysis and plasma exchange 2. Aspirin and antiplatelet drugs 3. Desmopressin acetate 4. Immunomodulatory drugs 4. A 30-year-old client who presents with symptoms of redness, heat, and pain in the joints undergoes a complete blood count test. The blood report shows an increased white blood cell count. Which condition does this indicate? 1. Inflammation 2. Anemia 3. Increased bleeding tendency 4. Pulmonary embolism 5. A client reports fullness of the stomach, fatigue, nausea, vomiting, and abdominal bloating. The client is diagnosed with stomach cancer. Which medication does the nurse expect the primary health-care provider to prescribe? 1. Cisplatin 2. Ticlopidine 3. Cyclosporine 4. Tacrolimus 6. While reviewing a client’s medical history, a nurse understands that the client is at risk of bleeding because the client’s platelet count is 80,000/uL. Which condition is this? 1. Thrombocytosis 2. Thrombocytopenia diarrhea. The client was learning to swim. The vital signs of the client show a body temperature of 101°F and blood pressure of 125/85 mm Hg. With which condition might the client be diagnosed? 1. Hemolytic-uremic syndrome 2. Von Willebrand disease 3. Essential thrombocytosis 4. Hemophilia 17. A 35-year-old male client with severe bleeding from an accident is brought to a hospital. The result of the complete blood count report shows red blood cells (RBCs) at 4.9 millions/microliter, white blood cells (WBCs) at 5,000/microliter, platelets at 80,000/microliter, and hemoglobin at 12 grams/deciliter. Which condition has the client developed? 1. Leukopenia 2. Leukocytosis 3. Thrombocytopenia 4. Neutropenia 18. Which statement made by the student nurse indicates effective learning about the coagulation factors and intrinsic pathway? 1. “The clotting time is measured by prothrombin time.” 2. “The clotting time is measured by activated partial thromboplastin time (aPTT).” 3. “TF-factor VII is formed by factor VII and tissue factor.” 4. All of the above 19. A client visits a health-care unit with acute immune thrombocytopenic purpura. Which is a unique feature of acute immune thrombocytopenic purpura? 1. Occurs in children 2. Occurs in adults 3. Occurs in persons aged between 20 to 50 years 4. Occurs twice as often in men than in women 20. What is a supportive treatment for a client with disseminated intravascular coagulation? 1. Transfuse fresh frozen plasma. 2. Maintain fluid and electrolyte balance. 3. Start prophylactic treatment with phenytoin. 4. None of the above Multiple Response Identify one or more choices that best complete the statement or answer the question. 21. Which statements are correct regarding platelets? Select all that apply. 1. Platelet formation is stimulated by the hormone thrombopoietin. 2. Platelets increase in the bone marrow. 3. Platelets have a lifespan of less than 7 days. 4. Platelets spend one-third of their lives in the spleen. 5. Platelet adhesion results in the activation of the glycoprotein. 22. A registered nurse is teaching a student nurse about the features of the extrinsic pathway of the coagulation cascade. Asses the statements made by the student nurse and choose the ones that indicate effective learning. Select all that apply. 1. “It is measured by the activated partial thromboplastin time (aPTT).” 2. “It is stimulated by tissue damage incurred by injury to the endothelial lining.” 3. “It is also known as tissue factor pathway.” 4. “It leads to the ultimate conversion of fibrinogen into fibrin.” 5. “It leads to the conversion of prothrombin to thrombin.” 23. Which statements are true regarding the final pathway in the coagulation cascade? Select all that apply. 1. It converts fibrinogen to fibrin. 2. It requires minerals and vitamins. 3. It stores vitamin K in fatty tissue. 4. It increases the absorption of vitamin K. 5. It converts thrombin into prothrombin. 24. How does the drug heparin compare to the drug warfarin? Select all that apply. 1. Both heparin and warfarin are based on a partial thromboplastin time (aPTT) value which requires 30 to 45 seconds. 2. Both heparin and warfarin are administered intravenously or subcutaneously. 3. Both heparin and warfarin are anticoagulant drugs. 4. Both heparin and warfarin take same amount of time to reach therapeutic levels. 5. Both heparin and warfarin have bleeding as side effect. 25. A nurse is caring for a 50-year-old client with symptoms of trouble in speaking, sudden numbness, and weakness of the face. The client is diagnosed with a stroke. A physician orders thrombolytic therapy. How is thrombolytic therapy effective to treat the condition? Select all that apply. 1. It is used to dissolve the clot. 2. It is used to reestablish blood flow. 3. It is used to treat the client with more than 3 to 4 hours from the time of the acute event. 4. It is used to treat the client within 24 hours of the onset of symptoms. 5. It is used to convert plasminogen to plasmin. Chapter 33: Cerebrovascular Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Why is the incidence of strokes rising every year? 1. There is an increased number of older adults. 2. There is an increased incidence of cardiovascular disease. 3. Both A and B. 4. None of the above. 2. The caregiver of a client tells a nurse that the client has paralysis of the upper and lower left limbs. On assessment, the nurse finds motor and sensory loss in the client’s limbs. Which diagnostic procedure should the nurse expect the primary health-care provider to prescribe? 1. Blood studies 2. Electrocardiogram 11. A nurse is assessing the level of consciousness of a client who has a head injury. The client is totally unresponsive. What could be the score using the National Institutes of Health Stroke Scale (NIHSS)? 1. 0 2. 1 3. 2 4. 3 12. A research nurse, while participating in clinical trials, finds that a client has receptive aphasia. Which pathophysiological change should the nurse expect to be the cause of this condition in the client? 1. Damage to the brain stem 2. Dysfunction in Broca’s area 3. Dysfunction in Wernicke’s area 4. Damage to one side of cerebellum 13. A computed tomography (CT) scan report of a client who has a neurological disorder reveals the presence of bleeding in a specific area of the brain. On assessment, the nurse finds elevated blood pressure and cerebral edema. The primary health care provider instructs the nurse to administer intravenous (IV) mannitol. Which condition should the nurse expect the client to have? 1. Lacunar infarct 2. Ischemic stroke 3. Hemorrhagic stroke 4. Transient ischemic attack 14. A nursing instructor is teaching a group of student nurses about cerebrovascular disorders and associated pathophysiology. Which statement of the student nurse requires correction? 1. “A small blood vessel infarction that is associated with hypertension is known as a lacunar infarct.” 2. “The right atrium undergoes atrial fibrillation with stasis of blood and clot formation in an ischemic stroke.” 3. “The ischemia of the brain is caused by a thromboembolism from a carotid stenosis in a transient ischemic attack.” 4. “The cerebral artery ruptures and causes a large amount of blood to compress the brain tissue in a hemorrhagic shock.” 15. A nurse administers intravenous (IV) recombinant tissue-type plasminogen activator (rt- PA) to a client who was diagnosed with an ischemic stroke. On further evaluation, the nurse finds that the client still has persistent vessel occlusion. Which treatment strategy should the nurse expect the primary health-care provider to prescribe for the client? 1. Thrombectomy 2. Endarterectomy 3. Dabigatran (Pradaxa) 4. Dipyrimadole (Aggrenox) 16. Which lobe of cerebrum is associated with analyzing and interpreting visual information? 1. Frontal 2. Parietal 3. Occipital 4. Temporal 17. After performing a neurological examination of a client who is suspected of having a stroke, a nurse concludes that the client has a moderately severe impairment based on the National Institutes of Health Stroke Scale (NIHSS). Which score enabled the nurse to reach this conclusion? 1. 4 2. 10 3. 16 4. 28 18. A nurse is assessing the visual fields in a client who was diagnosed with a stroke. The nurse uses the National Institutes of Health Stroke Scale (NIHSS) to document a score of 3 in the client’s assessment records. Which condition is associated with the score? 1. No visual loss 2. Partial hemianopia 3. Bilateral hemianopia 4. Complete hemianopia NARRBEGIN: Exhibit Exhibit NARREND 19. A nurse is caring for four clients who were diagnosed with different cerebrovascular disorders. Client Condition Client 1 Lacunar infarct Client 2 Ischemic stroke Client 3 Hemorrhagic stroke Client 4 Transient ischemic attack Which client requires an endarterectomy surgical procedure to prevent the reoccurrence of the condition? 1. Client 1 2. Client 2 3. Client 3 4. Client 4 20. A nurse is caring for four clients who have different cerebrovascular disorders. Client Condition Client 1 Brain tumor 2. Dopamine 3. Acetylcholine 4. None of the above 2. A nursing instructor is teaching a group of student nurses about athetosis movements in clients with Huntington’s disease. Which statement made by the student nurse indicates effective learning? 1. “Athetosis refers to twisting and writhing movements.” 2. “Athetosis refers to brief, irregular dancing-like movements.” 3. “When athetosis is severe, there are thrashing motions referred to as ballismus.” 4. “Antipsychotic medications, such as haloperidol, may be symptomatically beneficial to treat athetosis.” 3. In a client with Guillain–Barré syndrome, the health-care provider has found that the possibility of performing plasmapheresis is low. Which other alternative treatment can be recommended to this client to produce the same effect as that of plasmapheresis? 1. Corticosteroids 2. Cerebrospinal fluid filtration 3. Intravenous immunoglobulin 4. None of the above 4. A client suffering from myasthenia gravis is admitted to the intensive care unit after being diagnosed with respiratory failure. Which factor could have precipitated this condition in the client? 1. A tapered dose of immunosuppressants 2. Microbial infection 3. Surgery 4. All the above 5. The nursing instructor is teaching a group of student nurses about the most important intervention for clients with myasthenic crisis. Which statement made by a student nurse indicates effective learning? 1. “The most important intervention by the nurse in clients with myasthenia gravis is to constantly monitor the arterial blood gases.” 2. “The forced vital capacity and negative inspiratory force of the client should be monitored every 2 to 4 hours.” 3. “The client must be closely monitored in an intensive care unit for decreased heart rate.” 4. “Immunosuppressant agents should be completely withdrawn in clients who experienced a myasthenic crisis.” 6. The nursing instructor is teaching a group of student nurses about the preventive therapy for migraine. Which client requires preventive therapy to be prioritized first? 1. A client who experiences one or two migraine attacks per month. 2. A young female client who stopped the use of oral contraceptives. 3. A female client who is on therapy with vasodilators. 4. A client who withdrew from consuming alcohol. 7. Which type of epileptic seizure is characterized by a sudden lapse of consciousness for 5 to 30 seconds? 1. Tonic seizure 2. Clonic seizure 3. Petit mal seizure 4. Tonic-clonic seizure 8. Which statement by the student nurse indicates the need for further teaching about cerebrospinal fluid (CSF) analysis? 1. “The CSF from the client is obtained by performing the lumbar puncture technique.” 2. “While taking the CSF, the client is asked to lie on one side, in a ball position with knees close to the chest.” 3. “An anesthetic injection is given on the lower back of the client between the two vertebras.” 4. “To lessen the after-effect of lumbar puncture, the client is asked to stand still.” 9. Which instruction should the nurse provide to a client who is prescribed an anticholinergic drug for symptomatic relief of Parkinson’s disease? 1. “You should watch out for side effects such as dry mouth and double vision after taking the medication.” 2. “You will be able to perform daily activities at a normal pace after taking the medication.” 3. “You should stay away from exercise therapy during the course of medication.” 4. “You should remember that the medication may precipitate tremors during initiation of therapy.” 10. Which neurotransmitter is depleted in clients with Parkinson’s disease? 1. Acetylcholine 2. Serotonin 3. Dopamine 4. Glutamate 11. Which client is expected to have status epilepticus? 1. A client who is experiencing a series of three tonic-clonic seizures 2. A client who is experiencing rapid alternate contraction and relaxation of muscles 3. A client who is experiencing seizure or appears to be staring into space for a few moments 4. A conscious client with rhythmic jerking movements of the arms and legs 12. Which diagnostic test is used to measure the brain and body activity during sleep? 1. Myelography 2. Thermography 3. Polysomnogram 4. Evoked potentials 4. “It is the phase between seizures when multiple seizures occur in a short time frame.” Multiple Response Identify one or more choices that best complete the statement or answer the question. 21. The primary health-care provider is assessing a client who lost consciousness. Which assessment techniques would the nurse expect the primary health-care provider to order? Select all that apply. 1. Hearing 2. Vital signs 3. Orientation 4. Pupil response 5. Glasgow Coma Scale 22. What supportive care should be provided to a client diagnosed with Guillain–Barré syndrome? Select all that apply. 1. Provide mechanical ventilation. 2. Monitor hemodynamics continuously. 3. Provide physical and occupational therapy. 4. Administer antipsychotic medications as prescribed. 5. Provide speech therapy and swallowing interventions. 23. A client with cluster headaches is prescribed dihydroergotamine. What signs in the client indicate the effectiveness of the therapy? Select all that apply. 1. Decreased nasal discharge 2. Reduced tearing from the eye 3. Relaxed cervicothoracic muscle 4. Reduced bradykinesia 5. Normalized deep tendon reflexes 24. Which function is associated with the frontal lobe of the cerebral cortex? Select all that apply. 1. Orientation 2. Planning 3. Reasoning 4. Problem solving 5. Visual processing Other 25. The student nurse is taught about lumbar puncture. Prioritize the steps performed by the student nurse to indicate effective learning.(Enter the letter of each step in the proper sequence, do not use commas or spaces.) ANS=CBAD A. Clean the area and inject local anesthetic. B. Locate the site for puncture in the lower back. C. Instruct the client to lean forward while sitting on a table or bed. D. Insert a special needle into the spinal sac and remove a small amount of fluid. Chapter 35: Brain and Spinal Cord Injury Multiple Choice Identify the choice that best completes the statement or answers the question. 1. While assessing the motor strength in a client with a spinal cord injury, the nurse finds that the movements of the client are active against gravity. Which score should the nurse record? 1. Two 2. Three 3. Four 4. Five 2. While assessing the extent of spinal cord injury in a client using the American Spinal Injury Association (ASIA) impairment scale, the nurse concludes that the client belongs to category C. Which findings enabled the nurse to reach this conclusion? 1. The sensory and motor functions are normal. 2. There is no sensory or motor function preserved in the sacral segments S4–S5. 3. The sensory function is preserved with no motor function below the neurological level. 4. There is motor function is preserved, and most key muscles below the neurologic level have a muscle grade less than 3. 3. The registered nurse is teaching about the diagnostic tests for spinal cord injury to a group of student nurses. Which statement made by the student nurse indicates the need for further teaching? 1. “Myelography demonstrates intrinsic spinal cord pathology.” 2. “X-rays show injury or malalignment of bones.” 3. “Subtle fractures and soft tissue injury are more evident with computerized topography (CT) scans.” 4. “Magnetic resonance imaging (MRI) provides detailed pictures of the spinal cord, intervertebral discs, and CSF spaces.” 4. The medical reports of a client who suffered an accident show injuries at the sixth thoracic vertebra. Which condition does the nurse suspect in the client? 1. Concussion 2. Neurogenic shock 3. Diffuse axonal injury 4. Conus medullaris syndrome 5. While reviewing the clinical history of a client with brain injury, the nurse finds that there is a bruising of the mastoid process behind the ear of the affected side. Which fracture should the nurse suspect in the client? 1. Linear fracture 2. Basilar skull fracture 3. Depressed fracture 4. Frontal fossa fracture 2. Cauda equina syndrome 3. Brown-Séquard syndrome 4. Anterior spinal artery syndrome 15. Which symptom should the nurse expect in a client with a skull fracture in the frontal fossa? 1. Whiplash 2. Battle’s sign 3. Thunderclap headache 4. Periorbital ecchymosis 16. The laboratory reports of a client who had an accident show a fracture in the temporal bone of the middle ear. Which type of fracture should the nurse suspect in this client? 1. Basilar skull fracture 2. Linear fracture 3. Depressed fracture 4. Both A and C 17. After assessing the sensory function in a client with a skull fracture, the nurse records the sensory index score as one. What does this score in the client indicate? 1. Intact sensitivity to stimuli 2. Impaired sensitivity to stimuli 3. Absence of sensitivity to stimuli 4. Both A and B 18. While caring for a client with a neck injury, the nurse finds that the client has no sensation in the arms and hands. Which disorder should the nurse suspect in the client? 1. Horner’s syndrome 2. Central cord syndrome 3. Cauda equina syndrome 4. Conus medullaris syndrome 19. The registered nurse is teaching about subdural hematomas to a group of student nurses. Which statement made by the student nurse indicates effective teaching? 1. “Subdural hematomas cause bleeding in the space below the skull bone and above the dura mater.” 2. “Subdural hematomas cause bleeding in the space below the dura mater and above the arachnoid membrane.” 3. “Subdural hematomas cause cerebral aneurysms occurring in the terminal portion of the internal carotid artery.” 4. “Subdural hematomas cause tearing of the cerebral and meningeal vessels within the subarachnoid space of the brain.” 20. Which factor can cause herniation of the brain stem? 1. Cerebral vasospasm 2. Rupture of a cerebral artery 3. Compression of optic nerve 4. Oculomotor nerve dysfunction 21. A client with diffuse axonal injury is experiencing difficulty with speech. Which region of the brain does the nurse suspect to be affected? 1. Brain stem 2. Broca’s area 3. Occipital lobe 4. Cerebral motor cortex 22. The nurse suspects cerebral edema in a client with a cerebral contusion. Which diagnostic test will help in confirming the diagnosis? 1. Skull x-ray 2. Cerebral angiography 3. Magnetic resonance imaging (MRI) 4. Computed tomography (CT) scan Multiple Response Identify one or more choices that best complete the statement or answer the question. 23. The registered nurse is teaching about neurogenic shock to a group of student nurses. Which statement made by the student nurse indicates the need for further teaching? Select all that apply. 1. “Neurogenic shock reduces the systemic blood pressure.” 2. “Neurogenic shock results in peripheral vasodilation.” 3. “Neurogenic shock causes flaccid muscles and paralysis.” 4. “Loss of the anal reflex is the hallmark sign of neurogenic shock.” 5. “Neurogenic shock causes a lack of normal sympathetic outflow from the T1- L2 region of the spinal cord.” 24. The computed tomography (CT) scan of a client shows traumatic subarachnoid hemorrhage. What are the possible causes for this condition in the client? Select all that apply. 1. Trauma to the carotid artery 2. Stretching of the vertebral artery 3. Rupture of the middle meningeal artery 4. Rotational-acceleration injury of the brain 5. Defects in the muscle layers of the artery wall 25. What are the symptoms of Horner’s syndrome? Select all that apply. 1. Constipation 2. Incontinence 3. Lack of sweat 4. Drooping eyelid 2 Cryoglobulinemia . 3 Raynaud’s Disease . 4 Wegener's granulomatosis . 16. Which is the optimal level of low-density lipoprotein (LDL) cholesterol? 1 70 mg/dL . 2 110 mg/dL . 3 135 mg/dL . 4 170 mg/dL . 17. Which is the most common type of vasculitis of small-sized arterioles? 1 Raynaud’s disease . 2 Polyarteritis nodosa . 3 Temporal arteritis . 4 None of the above . 18. A 55-year-old client reports severe headache, weight loss, fatigue, stiffness, and pain in the shoulders. Which condition has the client developed? 1 Temporal arteritis . 2 Polymyalgia rheumatic . 3 Takayasu arteritis . 4 None of the above . 19. A registered nurse is teaching a nursing student about the diagnosis of Takayasu arteritis. Which statement made by the student nurse indicates effective learning? 1 “A decreased level of erythrocyte sedimentation rate (ESR) will be observed in clients . who are diagnosed with Takayasu arteritis” 2 “A decreased leukocyte count will be observed in clients who are diagnosed with . Takayasu arteritis.” 3 “Normocytic anemia might be present in clients who are diagnosed with Takayasu . arteritis.” 4 All of the above . 20. A nurse is teaching a client who has cardiovascular disease about the dietary sources of cholesterol and their effects on the body. Which statement made by the client indicates the need for further teaching? 1 “I can use sesame and safflower oil for cooking.” . 2 “I can have salmon and sardines in my diet.” . 3 “I should avoid using peanut and canola oil.” . 4 “I can have oatmeal and flaxseeds daily.” . NARRBEGIN: Exhibit Exhibit NARREND 21. A nurse is recording the blood pressure of four clients. Client 1 Client 2 Client 3 Client 4 130/90 mm Hg while lying and 121/90 mm Hg upon standing 118/80 mm Hg while lying and 120/80 mm Hg upon standing 140/90 mm Hg while lying and 130/80 mm Hg upon standing 112/ 76 mm Hg while lying and 112/70 mm Hg upon standing Which client’s blood pressure indicates that the client has orthostatic hypotension? 1 Client 1 . 2 Client 2 . 3 Client 3 . 4 Client 4 . 22. A nurse is reviewing the ankle-brachial index of four clients who are suspected of having peripheral artery disease (PAD). Client 1 Client 2 Client 3 Client 4 0.6 1.0 1.3 0.95 Which client has developed moderate PAD? 1 Client 1 . 2 Client 2 . 3 Client 3 . 4 Client 4 . 23. A nurse is reviewing the prescription of four clients. Client 1 Client 2 Client 3 Client 4 Aspirin and amlodipine Clopidogrel and heparin Prednisone and etanercept Warfarin and heparin Which client is being treated for Takayasu arteritis? 1 Client 1 . 2 Client 2 . 3 Client 3 . 4 Client 4 . Multiple Response Identify one or more choices that best complete the statement or answer the question. 24. Which factors should a nurse assess for in a client who has peripheral artery disease (PAD)? Select all that apply. 1 Throbbing pulse in the lower extremities . 2 Absence of pulsation in the lower extremities . 3 Coolness in the lower extremities . 4 Increased sensation in the feet . 5 Paresthesias in the lower extremities . Completion Complete each statement. 25. The average heartbeat of a client is 80 beats per minute. The volume of the blood ejected per contraction from the client’s left ventricle is 72 mL. What is the cardiac output of the client? Record your answer as a whole number. 80X72 = 5750ml/min 2 Decreased muscle mass . 3 Decreased systemic blood pressure . 4 None of the above . 11. A client presents with chest pain that has not been relieved by nitroglycerin medication. A review of the client’s medical record shows that the client has type 2 diabetes. The blood pressure of the client is 150/90 mm Hg. Which condition has the client developed? 1 Myocardial infarction . 2 Angina . 3 Pericarditis . 4 Myocarditis . 12. A client whose neck vein has bulged presents with a sharp pain in the chest. The electrocardiogram shows an elevated ST segment, and the laboratory report shows an increase in the serum creatinine and blood urea nitrogen. Which condition has the client developed? 1 Myocarditis . 2 Pericarditis . 3 Infective endocarditis . 4 None of the above . 13. A client visits the hospital with chest pain, and the vital signs are 101.5°F body temperature and 125/85 mm HG blood pressure. The echocardiogram of the client shows valve perforation, and a new regurgitant murmur is heard through the stethoscope on examination. Which condition has the client developed? 1 Infective endocarditis . 2 Myocarditis . 3 Pericarditis . 4 None of the above . 14. A nurse is caring for a client with infective endocarditis. Which is the appropriate nursing intervention for this client? 1 Administering nitroglycerin . 2 Administering amphicillin . 3 Administering urokinase . 4 None of the above . 15. The nurse is caring for a client with angina pectoris. Which precautionary measures should the nurse advise the client to follow? 1 To consume a low-fat diet . 2 To exercise 3 days a week . 3 To avoid taking aspirin tablets . 4 To avoid high-fiber foods . 16. A client complains of chest pain. On examination, a scratchy sound is heard through the stethoscope. Which intervention should be provided to the client? 1 Administering aspirin . 2 Administering amphicillin . 3 Administering glucocorticoids . 4 All of the above . 17. A client reports myalgia and fever. On physical examination, an S3 gallop rhythm was heard through the stethoscope. Which finding confirms that the client has developed myocarditis? 1 Elevated number of white blood cells . 2 Elevated cardiac troponin . 3 Elevated erythrocyte sedimentation rate . 4 All of the above . 18. A client presents with chest pain. Complete blood reports show an elevated level of white blood cells. Which clinical manifestation confirms that the client has myocarditis? 1 Dyspnea . 2 Tonsillitis . 3 Arthralgia . 4 All of the above . 19. A registered nurse is teaching a student nurse about infective endocarditis. Which statements made by the student nurse about the complication of the condition indicates effective learning? 1 “The client may develop regurgitant heart valve defects.” . 2 “The client may develop heart failure.” . 3 “The client may develop abscess of the heart.” . 4 All of the above . 20. Which condition is characterized by the deposition of immune complexes, causing inflammation and fluid accumulation in the pericardial sac? 1 Dressler’s syndrome . 2 Myocarditis . 3 Infective endocarditis . 4 Unstable angina . 21. Which wave in the electrocardiogram represents ventricular repolarization? 1 P wave . 2 Q wave . 3 S wave . 4 T wave . Multiple Response Identify one or more choices that best complete the statement or answer the question. 22. Which statements regarding angina are correct? Select all that apply. 1 “Stress is the cause of the chest pain.” . 2 “The chest pain lasts for more than 15 minutes.” . 3 “Taking a rest does not relieve the chest pain.” . 4 “The chest pain is reduced by taking a deep breath.” . 5 “The chest pain is reduced on resting.” . 23. A nurse is assessing a client with pericarditis. Which assessment findings indicate pericarditis? Select all that apply. 1 Flat neck veins . 2 Increased blood pressure . 3 Muffled or distant heart sounds . 4 Pericardial friction rub . . 2 The ventricular muscle pumps the excessive blood out. . 3 The stroke volume decreases when the ventricle ejects its blood. . 4 The contractility and stroke volume decreases. . 6. A registered nurse is teaching nursing students about ischemic cardiomyopathy. Which statement made by one of the student nurses indicates effective learning? 1 “Ischemic cardiomyopathy is the scarring of the heart muscle caused by coronary . artery insufficiency.” 2 “Ischemic cardiomyopathy is the enlargement and hypertrophy of the left or right . ventricles.” 3 “Ischemic cardiomyopathy is the disorder that restricts the ventricle’s ability to fully . expand.” 4 “Ischemic cardiomyopathy is a genetic predisposition for the muscular enlargement of . the interventricular septal wall.” 7. What is oncotic pressure? 1 A pressure reading within the inferior vena cava . 2 A force that attempts to pull fluid from the interstitial and intracellular spaces . 3 A force that attempts to push fluid out of the capillary pores into interstitial and . intracellular spaces 4 A pressure reading upon inflation of the balloon on the tip of the Swan-Ganz catheter . 8. Which fluid is found at the capillary-cell interface fluid compartment that is found inside the capillary? 1 Intracellular fluid . 2 Interstitial fluid . 3 Extracellular fluid . 4 None of the above . 9. How is chronic heart failure different from acute heart failure? 1 Chronic heart failure is the rapid, sudden development of heart failure. . 2 Chronic heart failure gradually develops over a long period of time. . 3 Chronic heart failure is caused by substantial ventricular muscle injury. . 4 Chronic heart failure is referred to as cardiogenic shock. . 10. How is systolic dysfunction different from diastolic dysfunction? 1 In systolic dysfunction, the ventricle has difficulty ejecting blood out of the . chamber. 2 In systolic dysfunction, the ventricle has difficulty relaxing and is unable to expand fully. . 3 In systolic dysfunction, the ventricle pumps out insufficient blood volume. . 4 In systolic dysfunction, the ventricle has low blood volume. . 11. How is high-output failure different from low-output failure? 1 In high-output failure, the heart can weaken and the ventricle can fail. . 2 In high-output failure, the heart is unable to fill with adequate amounts of blood. . 3 In high-output failure, there is a lack of delivery of adequate oxygen to the tissues. . 4 In high-output failure, there is a lack of sufficient blood to recirculate through the heart. . 12. A registered nurse is teaching nursing students about the normal level for central venous pressure. Which statement made by one of the student nurses indicates effective learning? 1 “The normal range for central venous pressure is 4 to 13 mm Hg.” . 2 “The normal range for central venous pressure is 60 to 80 mm Hg.” . 3 “The normal range for central venous pressure is 12 to 15 mm Hg.” . 4 “The normal range for central venous pressure is 1 to 5 mm Hg.” . 13. Which is a potent vasodilator produced by vascular endothelial cells? 1 Nitric oxide . 2 Endothelin . 3 Tumor necrosis factor-alpha . 4 None of the above . 14. A registered nurse is teaching nursing students about the renin-angiotensin-aldosterone system (RAAS). Which statement made by the nursing student indicates effective learning? 1 “RAAS is a mechanism that regulates arterial blood pressure.” . 2 “RAAS is a mechanism that decreases blood pressure.” . 3 “RAAS is a mechanism that increases blood volume in response to increased renal . perfusion.” 4 “RAAS is a mechanism with detrimental effects that decrease workload for the left . ventricle.” 15. What is the term for ‘rapid irregular rhythms’ of the ventricle? 1 Tachydysrhythmias . 2 Bradydysrhythmias . 3 Atrial dysrhythmias . 4 None of the above . 16. A 78-year-old man presents to his physician for evaluation of edema. He reports a 3-month history of peripheral edema. Which edema may have developed in the client? 1 Edema in the skin . 2 Edema in the ankle . 3 Edema in the feet and lower legs . 4 None of the above . 17. A 60-year-old client who complains of swelling in the ankles and fingers, abdominal swelling, fullness of the stomach, and a weight gain of 2 lbs. or more per day is diagnosed with mild or moderate heart failure. What are the symptoms that could be observed secondary to decreased cerebral perfusion? 1 Dyspnea and nocturnal cough . 2 Confusion, difficulty concentrating, and headache . 3 Cold, pale legs and feet . 4 None of the above . 18. Which condition, according to the Framingham Criteria for Diagnosis of Congestive Heart Failure is caused by night time cough? 1 Paroxysmal nocturnal dyspnea . 2 Jugular vein distension . 3 Pulmonary crackles . 4 Cardiomegaly . 19. A registered nurse is teaching nursing students about cardiac output. Which statement indicates effective learning by the student nurse? 1 “Cardiac output is the amount of blood that the heart pumps out of the left . ventricle.” 2 “Cardiac output is increased in heart failure.” . 3 “Cardiac output is unvaried by body size.” . 4 “Adrenergic stimulation slows heart rate and cholinergic stimulation raises heart rate.” . Chapter 19: Disorders of the Venous System Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A registered nurse is teaching a group of nursing students about Homan’s sign. Which statement made by the student nurse indicates effective learning? 1 “Place the client in the supine position with a straight knee and dorsiflex the client’s . foot.” 2 “Place the client in a prone position and flex the knee to a right angle.” . 3 “Place the client such that the back is rested and knees are flexed, and then dorsiflex the . ankle. 4 “Place the client in a sitting position and extend the legs one at a time, and then both . together. 2. A client with left lower extremity swelling and tenderness along a vein has to be assessed to rule out deep vein thrombosis (DVT). Which criteria would rule out DVT? 1 A negative D-dimer assay and Wells criteria score of 3 . 2 A positive D-dimer assay and Wells criteria score of less than 1 . 3 A negative D-dimer assay and Wells criteria score of less than 2 . 4 A positive D-dimer assay and Wells criteria score of 0 . 3. What is the purpose of a Greenfield filter? 1 To prevent the formation of a blood clot . 2 To help burst a blood clot . 3 To prevent a blood clot from traveling . 4 To detect a blood clot . 4. The nurse uses Homan’s sign to assess a client for the presence of deep venous thromboembolism (DVT). Pain in what area is an indication of positive Homan’s sign? 1 Hip . 2 Calf . 3 Knee . 4 Thighs . 5. A 60-year-old client is seen at the clinic with skin inflammation. There is dusky discoloration around the ankle and in the lower leg of the client. What might be the cause of this condition? 1 Reduced blood pressure in the veins . 2 Insufficient oxygenation to the tissues . 3 Buildup of hemosiderin . 4 Blockage of sweat gland . 6. A nurse is caring for a client with chronic venous insufficiency. Which instruction is appropriate to include in the client’s care plan? 1 Try to reduce your walking throughout the day. . 2 Wear constriction garments. . 3 Apply a cold compression. . 4 Elevate your legs periodically during the day. . 7. Which diagnostic test is used to identify the pattern of collateral blood flow? 1 Venography . 2 Ultrasonography . 3 Photoplethysmography . 4 None of the above . 8. A client reports to the hospital with a swollen mass on the left leg. Physical examination reveals that the swollen mass is red, tender, and is textured like a rope. A review of the client’s records show that the client has recently undergone an orthopedic surgery on his right leg. Which condition has the client developed? 1 Deep venous thromboembolism . 2 Pulmonary embolism . 3 Chronic venous insufficiency . 4 Varicose vein . 9. Which test is most commonly used to diagnose varicose vein? 1 D-dimer test . 2 Duplex ultrasound . 3 Wells criteria . 4 Magnetic resonance imaging . 10. Which drug administered to clients with deep venous thromboembolism (DVT) requires an international normalized ratio monitoring? 1 Low molecular weight heparin . 2 Factor Xa inhibitor . 3 Warfarin . 4 None of the above . 11. A client works as a sales associate in a garment outlet and has to stand for the duration of each work shift. Clinical examination reveals a presence of a dusky discoloration around the ankle, instep, and lower leg. What condition do these findings indicate? 1 Deep venous thromboembolism . 2 Pulmonary embolism . 3 Chronic venous insufficiency . 4 Varicose vein . 12. A client presents with a painful, swollen mass at the ankle of the right leg. Physical examination revealed that the edema is dark red in color, with drainage just above the medial malleolus of the leg. Which condition has the client developed? 1 Deep venous thromboembolism . 2 Pulmonary embolism . 3 Venous ulcer . 4 Varicose vein . 13. Which is a cause for the occurrence of varicose veins? 1 Valvular incompetence in the legs . 2 Sluggish circulation . 3 Poor tissue oxygenation . 4 Impaired removal of fluid and waste products . 14. What is the outermost layer of the walls of a vein? 1 Tunica adventitia . 2 Parietal layer . 3 Tunica intima . 1 Magnetic Resonance Imaging (MRI) . 2 Photoplethysmography . 3 Computed tomography (CT) . 4 Doppler ultrasonography . 5 Venography . 23. A student nurse is learning to care for a variety of clients in a hospital setting. Which clients are most at risk for developing venous insufficiency? Select all that apply. 1 An obese client . 2 A client with pulmonary embolism . 3 A pregnant client at 30 weeks gestation . 4 A client who is recovering from a shoulder surgery . 5 A client who uses a walker for support . Other 24. Arrange the pathophysiological changes involved in a pulmonary embolism (A-D). (Enter the number of each step in the proper sequence; do not use commas or spaces.)CABD A. The thrombus becomes an embolus and travels into the inferior vena cava. B. The thrombus travels into the right side of the heart. C. Inflammation and thrombus form in the vein. D. The thrombus then enters the pulmonary artery. 25. Arrange the symptoms in the proper order to describe the pathophysiology of varicose veins (A-D). (Enter the number of each step in the proper sequence; do not use commas or spaces.)CBAD A. Damaged valves B. Pressure on the valves C. Blood stagnation and pooling in the lower extremities D. Compromised venous return Chapter 37: Musculoskeletal Trauma Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Why is a dual energy x-ray absorptiometry scan used for a client with a musculoskeletal disorder? 1 It detects soft tissue abnormalities. . 2 It identifies stress fractures and bony metastases. . 3 It determines mechanical derangement of the knee. . 4 It visualizes the bone mineral density (BMD) of the hip and lumbar vertebrae. . 2. While assessing a client with a musculoskeletal disorder, the nurse abducts the client’s arm to 90 degrees and places anteriorly directed force on the posterior humeral head from behind. Which test is the nurse performing? 1 Hawkins test . 2 Relocation test . 3 Apprehension test . 4 Neer impingement test . 3. While teaching a group of student nurses about different types of fractures, the nursing instructor says, “This fracture is characterized by the crushing of cancellous bone.” Which type of fracture is the nursing instructor describing? 1 Complete . 2 Transverse . 3 Comminuted . 4 Compression . 4. When assessing a client’s muscle strength using the Lovett scale, the nurse finds that the client has no joint motion with palpable contraction of the muscle. What grade does the nurse assign to the client based on this finding? 1 Fair . 2 Poor . 3 Good . 4 Trace . 5. Which cervical root is associated with forearm pronation and supination? 1 C5 . 2 C6 . 3 C7 . 4 C8 . 6. Which musculoskeletal disorder is also called adhesive capsulitis? 1 Bursitis . 2 Plantar fasciitis . 3 Frozen shoulder . 4 Carpel tunnel syndrome . 7. The nurse is performing a physical examination on a client with a suspected musculoskeletal disorder. What is the first nursing intervention during the examination? 1 Testing sensation using perception . 2 Measuring muscle girth for symmetry . 3 Evaluating peripheral vascular integrity . 4 Assessing general appearance, contour, and symmetry . 8. A client complains of pain and immobility of the wrist. On assessment, the nurse finds decreased range of motion (ROM), edema, and ecchymosis of the distal radius. The primary health-care provider recommends a neurovascular exam for confirmation. What does the nurse infer from these findings? 1 The client has a Smith fracture. . 2 The client has a Colles fracture. . 3 The client has a clavicle fracture. . 4 The client has a green stick fracture. . 9. When obtaining the health history of a client with a suspected musculoskeletal disorder, why does the nurse ask the client about travel destinations within the past year? 1 To check if the client has osteoporosis . 2 To check if the client has recent allergies . 3 To identify the loading forces involved . 4 To evaluate for exposure to Lyme disease . Exhibit NARREND 19. The nurse is reviewing the medical records of four clients. Client Description Client 1 Injury to menisci Client 2 Slightly abducted leg Client 3 Sustained a fall on flexed hand Client 4 Sustained a fall on extended hand Which client’s medical record indicates the need to perform the McMurray test to assess the condition? 1 Client 1 . 2 Client 2 . 3 Client 3 . 4 Client 4 . 20. The nurse is caring for four clients diagnosed with different musculoskeletal disorders. Client Disorder Client 1 Hip fracture Client 2 Stress fracture Client 3 Femur shaft fracture Client 4 Vertebral compression fracture Which client requires treatment with calcitonin, calcium or vitamin D supplements, analgesics, and muscle relaxants? 1 Client 1 . 2 Client 2 . 3 Client 3 . 4 Client 4 . Multiple Response Identify one or more choices that best complete the statement or answer the question. 21. What are the common predisposing factors that cause cervical strain? Select all that apply. 1 Bruxism . 2 Abnormal posture . 3 Lifting heavy objects . 4 Motor vehicle accidents . 5 Fall on a supinated forearm . 22. What are the signs and symptoms of musculoskeletal trauma? Select all that apply. 1 Edema . 2 Paresthesia . 3 Joint clicking . 4 Joint swelling . 5 Gait disturbance . 23. After assessing a client with a musculoskeletal disorder, the nurse concludes that the client has skeletal muscle injuries. Which characteristics observed in the client support the nurse’s conclusion? Select all that apply. 1 Spasm . 2 Crepitus . 3 Numbness . 4 Clumsiness . 5 Tingling sensation . 24. What are the modifiable risk factors for vertebral compression fracture? Select all that apply. Other 1 Estrogen deficiency . 2 Presence of dementia . 3 Bilateral ovariectomy . 4 Susceptibility to falling . 5 Presence of osteoporosis . 25. Place the events associated with fracture healing in the order they occur. (Enter the letter of each step in the proper sequence, do not use commas or spaces.)EDBCA A. Remodeling B. Callus formation C. Lamellar bone deposition D. Granulation tissue formation E. Fracture and inflammatory phase Chapter 38: Degenerative Diseases of the Musculoskeletal System Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A client is diagnosed with degenerative disc disorder (DDD). Which form of physical therapy does the nurse anticipate the primary care provider will prescribe to reduce the movement of the spine and enhance the healing process? 1 Braces . 2 Massage . 3 Electrotherapies . 4 Heat and cold packs . 2. Which diagnostic test does the nurse expect the primary care provider to prescribe to confirm a diagnosis of osteoporosis? 1 Electromyography (EMG) . 2 Computed tomography (CT) scan . 3 Magnetic resonance imaging (MRI) scan . 4 Dual-energy x-ray absorptiometry (DEXA) scan . 3. The nurse is caring for a client whose bone mineral density is -2 based on a T-score value, which compares the client’s bone mineral density to the mean for young adult women. Which condition does this score indicate? 1 Osteomalacia . 2 Osteopenia . 3 Osteoporosis . 4 Severe osteoporosis . 4. A client is diagnosed with osteomalacia and undergoes therapy to correct the vitamin D deficiency and normalize phosphate levels. Which outcome indicates the successful completion of therapy? 1 The client does not experience any cervical back pain. . 2 The client is able to walk up and down stairs comfortably. . 3 The client does not report any numbness in the lower extremities. . 4 The client reports normal bowel and bladder function. . 5. The nurse observes that an older client has a hunched back. Which disorder does the nurse suspect? 2 Take the medication in a sitting or upright position. . 3 Both A and B. . 4 None of the above. . 16. A nurse is caring for a client who has Bouchard’s nodes. Which joints does the nurse anticipate to be swollen in this client? 1 Vertebral joints . 2 Metacarpophalangeal joints . 3 Distal interphalangeal joints . 4 Proximal interphalangeal joints . 17. Which physiological process takes place more rapidly after an individual is 30 years of age? 1 Bone growth . 2 Osteoblastic activity . 3 Osteoclastic activity . 4 All of the above . 18. The nurse is caring for a client with degenerative disc disease (DDD). Which outcome indicates effective chiropractic therapy? 1 The client’s discs are realigned. . 2 The client has diminished inflammation. . 3 The client has decreased neuropathic pain. . 4 The client has been relieved of pain caused by spinal nerve impingement. . 19. A client with osteoporosis was prescribed teriparatide therapy. Which outcome indicates the therapeutic effect of the medication has been achieved? 1 Reduced pain . 2 Fortification of the bone . 3 Reduced inflammation . 4 Strengthening of the bone . 20. The nursing instructor is teaching a group of student nurses about degenerative disc disease (DDD). Which statement made by the student nurse indicates effective learning? 1 “Degenerative disc disease occurs only in the cervical region of the vertebral column.” . 2 “Age-related degenerative changes in the intervertebral discs are the main causes of . lower back pain.” 3 “Males are more susceptible to lumbar degenerative disc disease.” . 4 “Onset of lumbar degenerative disc disease occurs most often between the ages of . 30 and 50.” 21. Which hormone indirectly helps in the formation of bone by stimulating muscle growth? 1 Testosterone . 2 Calcitriol . 3 Calcitonin . 4 Parathyroid hormone . 22. Why does the registered nurse instruct the parents of a young girl to reduce the use of sunblock and cover-ups with their child? 1 Overuse of sunblock and cover-ups will inhibit the production of estrogen. . 2 Absorption of calcium by the gastrointestinal tract is inhibited by the overuse of . sunblock and cover-ups. 3 The production of osteoblast cells is inhibited by the excessive use of sunblock and . cover-ups. 4 The level of parathyroid hormone decreases with the excessive use of sunblock and . cover-ups. Multiple Response Identify one or more choices that best complete the statement or answer the question. 23. Which disorders result from vitamin D deficiency? Select all that apply. 1 Rickets . 2 Osteoporosis . 3 Osteoarthritis . 4 Osteomalacia . 5 Spinal stenosis . 24. Which type of joint is the shoulder joint classified as? Select all that apply. 1 Synovial . 2 Vertebral . 3 Diarthrosis . 4 Synarthrosis . 5 Amphiarthrosis . Other 25. Arrange the steps that are involved in maintaining the calcium balance in the body in the order that they occur (1-6). (Enter the letter of each step in the proper sequence; do not use commas or spaces.)FECADB A. Release of calcium B. Activation of osteoblasts C. Activation of osteoclasts D. Increased calcitonin level E. Increased parathyroid hormone F. Decreased blood calcium levels . 2 Bone biopsy . 3 Electromyography . 4 Radionuclide bone scan . 11. The radiographic reports of a client reveal inflammation of the metatarsophalangeal joint of the great toe. Which disorder should the nurse suspect in the client? 1 Gout . 2 Lyme disease . 3 Septic arthritis . 4 Polymyalgia rheumatica . 12. A nurse is caring for a client with hyperuricemia. Which part(s) of the client’s body does the nurse assess for the presence of tophi? 1 Achilles tendon . 2 Pinnae of the ears . 3 Joints of the hands . 4 All of the above . 13. A nurse is caring for a client with gout. Which medication in the client’s prescription does the nurse suspect to decrease uric acid synthesis? 1 Probenecid . 2 Colchicine . 3 Allopurinol . 4 Both A and B . 14. While reviewing an x-ray of the fingers of a client, the nurse observes that the end of the bone was whittled down to a sharp point. Which musculoskeletal disorder does the nurse suspect in the client?” 1 Lyme disease . 2 Psoriatic arthritis . 3 Ankylosing spondylitis . 4 Pott’s disease . 15. A nurse is teaching a client nonpharmacological therapy to treat gout. Which statement by the client indicates the need for further teaching? 1 “I should avoid rapid weight loss.” . 2 “I should increase the intake of dietary meats.” . 3 “I should avoid binge drinking.” . 4 “I should drink 2 to 3 liters of fluid per day.” . 16. A client complains of pitting, ridging, and separation of nails from the nail bed. Which musculoskeletal disorder does the nurse suspect in the client? 1 Septic arthritis . 2 Psoriatic arthritis . 3 Ankylosing spondylitis . 4 Polymyalgia rheumatic . 17. Which pathogen may cause ankylosing spondylitis? 1 Escherichia coli (E. coli) . 2 Borrelia burgdorferi . 3 Klebsiella pneumoniae . 4 Staphylococcus aureus . 18. Which is the most definitive diagnostic test for polymyositis and dermatomyositis? 1 Muscle biopsy . 2 Western blot test . 3 Immunofluorescent assay . 4 Dual-energy x-ray absorptiometry (DEXA) scan . 19. A client is having a skin rash presented as an oval-shaped and red-colored lesion. On assessment, the nurse finds enlargement of lymph nodes in this client. Which condition should the nurse suspect in the client? 1 Sacroilitis . 2 Dactylitis . 3 Lyme disease . 4 Psoriatic arthritis . 20. Which statement made by a student nurse indicates the need for further teaching about treatment of various musculoskeletal disorders? 1 “Doxycycline is the first-line treatment for Lyme disease.” . 2 “Immunosuppressive agents are first-line agents for psoriatic arthritis.” . 3 “Oral corticosteroids are the first-line treatment for polymyalgia rheumatica.” . 4 “Nonsteroidal antiinflammatory drugs (NSAIDs) are the first-line agents for gout.” . 21. Which condition is related to ankylosing spondylitis? 1 Formation of abscesses in the bone . 2 Inflammation at the joint of the great toe . 3 Formation of abscesses in the paravertebral muscles . 4 Inflammation at the point where tendons and ligaments join the bone around a joint . Multiple Response Identify one or more choices that best complete the statement or answer the question. 22. A nurse is caring for a client with Lyme disease. Which symptoms in the client lead the nurse to suspect early localized disease? Select all that apply. 1 Arthralgia . 2 Cranial neuritis . 3 Bull’s-eye rash . 4 Lymphadenopathy . 5 Subacute encephalopathy . 23. A client is diagnosed with ankylosing spondylitis. Which complications should the nurse expect to be present in the client? Select all that apply. 1 Neural inflammation . 2 Paralysis of facial nerves . 3 Inflammation of the eyes . 4 Scarring throughout the lungs . 5 Inflammation of joints in extremities .