MN551 MIDTERM EXAM NEWEST ACTUAL EXAM COMPLETE 200 QUESTIONS AND CORRECT DETAILED ANSWER, Exams of Nursing

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MN551 MIDTERM EXAM NEWEST ACTUAL EXAM

COMPLETE 200 QUESTIONS AND CORRECT

DETAILED ANSWERS (VERIFIED ANSWERS)

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Which of the following individuals would be considered to be at risk for the development of edema? An 81-year-old man with right-sided heart failure and hypothyroidism The family of a 68-year-old man who is in the end stages of small cell lung cancer is distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the patient's anorexia and cachexia? Products of the tumor itself as well as a hypermetabolic state cause cachexia Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation? Question options: Negative intrapleural pressure holds the lungs against the chest wall Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which of the following results is most likely to be considered unexpected by the health care team? Increased thrombopoietin levels Which of the following situations related to the transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week. At which of the following locations in the nephron would a nurse practitioner first expect blood to be largely free of plasma proteins? Bowman Space A 51-year-old female patient who is 2 days postoperative on a surgical unit of a hospital is at risk for developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse practitioner is most appropriate? Question options: "You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed." A 66-year-old patient's echocardiogram reveals a hypertrophied left ventricle, normal chamber volume, and a normal ejection fraction from the heart. What is this patient's most likely diagnosis? Aortic valve stenosis A couple who are expecting their first child have been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple have approached their nurse practitioner with this request and are seeking clarification of exactly why stem cells are valuable and what they might expect to gain

from harvesting them. How can the nurse practitioner best respond to the couple's inquiry? "Stem cells can be used as a source of reserve cells for the entire blood production system." A child possesses a trait that is the result of the interaction of two different genes, neither of which could have produced the trait independently. Which of the following explanations best captures the genetic explanation for this? The outcome is the result of the interaction between collaborative genes. A 55-year-old man has made an appointment to see his nurse practitioner because he has been awakening three to four times nightly to void and often has a sudden need to void with little warning during the day. What is the man's most likely diagnosis and possible underlying pathophysiologic problem? Overactive bladder that may result from both neurogenic and myogenic sources As a result of dehydration, a patient's epithelial cells are producing insufficient amounts of mucus. Consequently, the patient's mucociliary blanket is compromised. Which of the following changes would a care provider most reasonably anticipate as a direct result of this change? Increased amounts of bacteria in the lungs. The primary role of the mucociliary blanket is to trap foreign particles and bacteria and thus prevent their entry into the lungs. The impaired ciliary function may result in an inadequate mucociliary blanket, but the opposite relationship is unlikely. Decreased oxygen and increased carbon dioxide levels may eventually result, but not as a direct or immediate consequence. An 81-year-old female patient of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the patient has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the patient's condition? Blood backs up into the jugular vein because there are no valves at the point of entry into the heart. Sputum samples from a patient with pneumonia contain an infective agent that has a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet. This pneumonia is most likely: bacterial A 45-year-old patient who experienced exposure to radiation during an industrial accident several years prior is being assessed. Which of the following phenomena may underlie the genetic changes that have been noted in the patient? Base pairs may have been rearranged by the radiation exposure. A child has been diagnosed with thalassemia. Which of the following other health problems is the child at risk for? splenomegaly and hepatomegaly Which of the following pregnant women has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly? A woman who has herpes simplex and recently recovered from endocarditis Which of the following patients would be considered to have a significant risk of developing the prerenal form of acute renal failure?

A 22-year-old male who has lost a large amount of blood following a workplace injury As part of the diagnostic workup for a male patient with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements, and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? Echocardiogram, PET scan, ECG A female patient is requiring supplementary oxygen by facemask due to her reduced lung compliance. Which of the following pathophysiologic processes is most likely to be a contributor to her low lung compliance? Her thoracic cage is less flexible than when she was healthy. A 77-year-old female with a diagnosis of chronic obstructive pulmonary disease is experiencing impaired gas exchange and CO2 retention, despite a rapid respiratory rate. Which of the following phenomena would her care team most realistically anticipate? Her kidneys will adapt with an increase in plasma HCO3- and her pH will decrease. A nurse practitioner is performing patient teaching about the influenza virus with each patient who has come to the clinic to receive that year's vaccine. Which of the following statements by patients best reflects an accurate understanding of the flu virus? "I could come down with viral or bacterial pneumonia as a result of a bad flu bug." A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon? High afterload because of backpressure against the left ventricle A patient presented to the emergency department of the hospital with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus cellulitis. The patient's nurse practitioner has ordered a complete blood count and white cell differential. Which of the following blood components would the nurse practitioner most likely anticipate to be elevated? neutrophils The nurse practitioner is providing care for a patient with a diagnosis of cirrhosis, and he notes that the patient's sclerae are jaundiced. The nurse practitioner recalls that jaundice is caused by excess accumulation of bilirubin, a pigment that can accumulate in which part of the cell? Cytoplasm A patient who has a diagnosis of lung cancer is scheduled to begin radiation treatment. The NP providing pretreatment education is explaining some of the potential unwanted effects of the treatment. Which of the following statements by the nurse is most accurate? "Some patients experience longer-term irritation of skin adjacent to the treatment site." A nurse practitioner is providing prenatal care and education for a first-time expectant mother, 22 weeks' gestation, who has a diagnosis of a sexually transmitted infection. Which of the following statements by the expectant mother demonstrates an adequate understanding of vertical disease transmission and congenital infections? "my baby could become infected either across the placenta or during the birth itself."

A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his nurse practitioner. Which of the following aspects of hyperlipidemia would the nurse practitioner most likely take into account when teaching the patient? Cholesterol is a metabolic waste product that the liver is responsible for clearing. A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her diagnosis of emphysema. Which of the following processes would her care team be most justified in ruling out? In lung pathology such as emphysema, large amounts of air are trapped at the end of a given breath, a situation that corresponds to increased residual volume and decreased vital capacity. Elastic recoil would tend to suffer, and both alveolar and anatomical dead space consequently increase. A 34-year-old male patient has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The patient's family is questioning the care team about why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide to the family? The normally small transcellular fluid compartment, or third space, is becoming enlarged. Which of the following data would a clinician consider to be most indicative of acute renal failure? Increased nitrogenous waste levels, decreased glomerular filtration rate (GFR) Which of the following patients are NOT displaying known risk factors for the development of pulmonary emboli? A teenager male who plays basketball. Postsurgical immobility, smoking, and the use of oral contraceptives are all identified risk factors for the development of pulmonary emboli. Impaired Cl- and Na+ regulation are associated with cystic fibrosis, while amiodarone and radiation therapy are linked to interstitial lung diseases. Which of the following assessment findings in a newly admitted 30-year-old male patient would be most likely to cause his nurse practitioner to suspect polyarteritis nodosa? The man's blood pressure is 178/102 and he has abnormal liver function tests. A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma? the lymph nodes involved are located in a large number of locations in the lymphatic system A male patient of a nurse practitioner has an autosomal dominant disorder. The patient and his partner are considering starting a family. Which of the patient's following statements indicates the patient has an adequate understanding of the genetic basis of this health problem? "I know that a single mutant allele is to blame for the health problem." A 51-year-old woman diagnosed with multiple sclerosis (MS) five months prior is distressed that she has had several recent episodes of urinary incontinence. She has asked her nurse practitioner why this is the case. Which of the following statements best captures the facts that would underlie the nurse's response to the patient? She may be unable to sense her bladder filling as a result of her MS.

A 66-year-old male presents to the emergency department accompanied by his wife who claims that he has been acting confused. The man is complaining of a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F and his blood work indicates his sodium level is 126 mEq/L (normal is 135 to 145 mEq/L). What will be the assessing nurse practitioner's most likely suspicion? Legionnaire disease Confusion, dry cough, diarrhea, and hyponatremia are associated with Legionnaire disease and less so with bronchopneumonia, Mycoplasma pneumonia, or pneumococcal pneumonia. A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was "so fast I couldn't even count it." The child was determined to be in atrial flutter and his mother is seeking an explanation from the health care team. Which of the following points should underlie an explanation to the mother? The child is experiencing a reentry rhythm in his right atrium. A 23-year-old man has received a recent diagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse practitioner providing care for the man is explaining that while it is unpleasant, the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which of the following teaching points should the nurse practitioner eliminate from his teaching for the patient? "Inflammation helps your body to produce the right antibodies to fight the infection" A group of researchers has identified that the prevalence of two particular genetic disorders share a statistical correlation. Which of the following statements best conveys the genetic rationale for this situation? The genes causing each disorder are likely in the same section of the same chromosome. A 60-year-old male patient with an acute viral infection is receiving interferon therapy. The nurse practitioner is teaching the family of the patient about the diverse actions of the treatment and the ways that it differs from other anti-infective therapies. Which of the following teaching points should the nurse practitioner exclude? "interferon can bolster your father's immune system by stimulating natural killer cells that attack viruses" The NP is working with a family whose daughter has been recently diagnosed with the chromosomal disorder Turner syndrome. The NP would recognize that which of the following statements about the characteristics of human chromosomes is accurate? Autosomes contain the determination of an individual's sex. A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces? She is susceptible to isotonic fluid volume deficit and hypernatremia as a result of water losses. A 68-year-old male complains to his nurse practitioner that when he tests his blood pressure using a machine at his pharmacy, his heart rate is nearly always very low. At other times, he feels that his heart is racing, and it also seems to pause at times. The man has also occasionally had lightheadedness and a recent syncopal episode. What is this patient's most likely diagnosis and the phenomenon underlying it? Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias

Following a winter power outage, a patient who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning? To increase the amount of oxygen dissolved in plasma An 87-year-old male resident of an assisted living facility has been consistently continent of urine until the last several weeks. Which of the following actions by the care providers at the facility is the most likely priority? Performing a physical examination and history to determine the exact cause and character of the incontinence Which of the following clinical findings would be most closely associated with a patient who has interstitial lung disease rather than COPD? Increased respiratory rate with decreased tidal volume A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his nurse practitioner. The patient's nurse practitioner would anticipate that which of the following phenomena is most likely occurring? The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption. A patient has been admitted to an inpatient medical unit of a hospital with an acute viral infection. The health care team providing care for the patient would recognize which of the following statements as an accurate description of the role of viruses in human infections? Some viruses are capable of transforming normal host cells into malignant cells. The NP is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which of the following statements best captures the rationale underlying the NPs advice? Antioxidants inhibit the actions of reactive oxygen species (ROS). Which target of both chemotherapy and radiation treatment accounts for adverse as well as therapeutic effects? Rapidly proliferating cells Which of the following patients is most likely to benefit from transplantation of thymic tissue or major histocompatibility complex (MHC)-compatible bone marrow? A 7-year-old boy whose blood work indicates decreased IgA and IgG with increased IgM A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician. As part of the patient's diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring? Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording. A 3-year-old boy has developed croup following a winter cold. His nurse practitioner would recognize that which of the following causative microorganisms and treatments are most likely? Parainfluenza virus; treatment with a mist tent and oxygen therapy

A pediatric unit will be receiving from a rural medical outpost a patient transfer of an 8- day-old infant with a suspected congenital renal disorder. Which of the following possibilities is the care team most likely to be able to rule out early? Renal cell carcinoma may be present. May have upper and lower poles of the two kidneys may be fused, kidneys may be misshapen and have cysts, one of the infant's kidneys may have failed to develop to a normal size. Which of the following substances is most likely to be reabsorbed in the tubular segments of the nephron using passive transport mechanisms? Water A nurse practitioner is teaching a student NP about the physiologic basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by the student would warrant correction by the nurse practitioner? "Tension and vessel thickness increase proportionately." A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stools that has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely? She will have iron-deficiency anemia due to depletion of iron stores. Which of the following patients of a primary care nurse practitioner would not require extra screening for cancer? A 38-year-old female with Down syndrome and congenital scoliosis A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung cancer (SCLC). How can her nurse practitioner most appropriately respond to her? "This is very difficult to hear, I'm sure, and we have to observe to see if it spreads because that often happens." A 60-year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states, "I don't know how this could happen to me, since I'm so careful about eating a healthy diet." What is the most appropriate response to the man's statement? What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved. A nurse practitioner is doing the admission assessment on a patient who has been transferred to the floor after being diagnosed by the emergency room physician with bilateral pleural effusion. Which of the following findings from the nurse practitioner's initial assessment of the patient is incongruent with the patient's diagnosis, and would require further investigation? The patient complains of sharp pain exacerbated by deep inspiration. An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which of the following components of the pathologist's report is most suggestive of a possible history of poorly controlled blood pressure? "Arterial sclerosis of subcortical brain regions noted." A tourist presented to a primary care health clinic complaining of malaise, fever, and headache. She has subsequently been diagnosed with Rocky Mountain spotted fever, a

pathology caused by Rickettsiaceae. Which of the followed statements best captures a characteristic trait of Rickettsiaceae? They have both RNA and DNA. A 7-year-old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which of the following assessment findings is most congruent with the patient's diagnosis? hi Hemoglobin 9.9 g/dL A 16-year-old female has been brought to her primary care nurse practitioner by her mother due to the girl's persistent sore throat and malaise. Which of the following facts revealed in the girl's history and examination would lead the nurse practitioner to rule out infectious mononucleosis? Chest auscultation reveals crackles in her lower lung fields bilaterally. The NP is providing care for a 21-year-old female patient with gas gangrene of a compound fracture in her arm. Which of the following assessment findings would the nurse most reasonably expect to find when caring for a patient with a diagnosis of gas gangrene? Spreading edema A patient with poorly controlled diabetes mellitus presents to the emergency department with suspected ketoacidosis. Which of the following diagnostic results would be most likely to confirm this diagnosis? Increased CO2, increased anion gap, base deficit A patient has suffered damage to his pericardium following a motor vehicle accident. Which of the following consequences should the nurse practitioner be most likely to rule out? Impaired regulation of myocardial contraction A short, nonsmoking middle-aged man presents to the emergency department with left- sided chest pain and a cough. He says that the pain started abruptly, just after lunch, and that breathing and coughing make it worse. He denies recent injury. He is breathing shallowly and rapidly and expresses fear that he may be having a heart attack. Breath sounds are normal, and he is not cyanotic. Which condition is most likely causing his symptoms? Pleuritis related to infection Which diuretic acts by inhibiting sodium chloride reabsorption in the thick ascending limb of the loop of Henle? Bumetanide (Bumex) Which of the following situations would be most deserving of a pediatrician's attention? A midwife notes that a newborn infant's chest is retracting on inspiration and that the child is grunting. A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia and she is suspected of having sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion? Holter monitoring

A 29-year-old construction worker got a sliver under his fingernail four days ago. The affected finger is now reddened, painful, swollen, and warm to the touch. Which of the following hematological processes is most likely occurring in response to the infection? Proliferation of immature neutrophils A community health nurse practitioner is teaching a group of female high school students about the importance of regular Papanicolaou (Pap) smears. The nurse recognizes that which of the following items underlies the rationale for this teaching? Cancer of the uterine cervix develops incrementally at a cellular level. Which of the following statements most accurately conveys an aspect of cell injury due to impaired calcium homeostasis? Injured cells tend to accumulate calcium. As part of his diagnostic workup, a 77-year-old man's nurse practitioner has ordered blood work that includes ferritin levels. The man is very interested in the details of his health care and is unfamiliar with ferritin and its role. He asks his nurse practitioner to explain the significance of it and the rationale for testing it. Which of the following explanations by the nurse practitioner is most accurate? "Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills." In which of the following patient situations would a nurse practitioner be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient's health problems? A 77-year-old with diminished S3 and S4 sounds, an irregular heart rate, and a history of atrial fibrillation An 82-year-old resident of a long-term care facility with a recent history of repeated urinary tract infections and restlessness is suspected of having urinary retention. Which of the following actions by the care team is most appropriate? Ultrasound bladder scanning to determine the residual volume of urine after voiding A 21-year-old male patient has suffered a head injury during a crash on his motorcycle, and a deficit that assessments have revealed is an impaired swallowing mechanism. He has also developed aspiration pneumonia. Which of the following statements most accurately capture an aspect of his condition? His vocal folds have been compromised. A 14-year-old boy who appears to be intoxicated is brought to the emergency department by ambulance. The EMTs report that the boy has denied consuming anything out of the ordinary, but an open antifreeze container was found in the boy's room. Which of the following is likely to be used to treat the patient's symptoms? Fomepizole A 44-year-old woman developed calf pain during a transatlantic flight followed by acute shortness of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE), which resolved with anticoagulant therapy. Which of these statements best characterizes the underlying problem of her PE? She was short of breath because ventilation was occurring but perfusion was inadequate. A 70-year-old male patient presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly

palpable and his leg distal to the pain is noticeably reddened. What would his care provider's preliminary diagnosis and anticipated treatment most likely be? Atherosclerotic occlusive disease necessitating thrombolytic therapy A nurse practitioner is teaching her colleagues about the role of cytokines in a variety of pathologies. Which of the following teaching points best captures an aspect of the functions and nature of cytokines? "A particular cytokine can have varied effects on different systems, a fact that limits their therapeutic use." A woman is surprised to read on the Internet that certain infections can cause cancer and has sought clarification from her nurse practitioner during an office visit. How can the NP best respond to the woman's query? "There are many viruses, but only a very few of them have been shown to cause cancer in humans." Which of the following phenomena would be least likely to result in activation of the complement system? Activation of Toll-like receptors (TLRs) on complement proteins The nurse practitioner working in occupational health has been asked to speak to a group of factory workers about the importance of wearing gloves when working with strong chemicals such as turpentine and paint thinner. Which of the following characteristics of cell membranes underlies the nurse's teaching? Cell membranes are impermeable to all but lipid-soluble substances. A nurse practitioner has ordered the measurement of a cardiac patient's electrolyte levels as part of the patient's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart? Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells. As a consequence of long-standing lung disease, a patient is in a chronic state of hypoxia. Which of the following phenomena would the patient's nurse practitioner be most justified in anticipating? Select all that apply: Increased erythropoietin production, Hyperventilation, Personality changes Which of the following patients on a medical unit of a hospital is most likely to be experiencing health problems that may be attributable to kidney disease? An 81-year-old female patient with osteoporosis and anemia A 68-year-old woman with a new onset of vascular dementia has recently begun retaining urine. Which of the following physiological phenomena would her care providers most realistically expect to be currently occurring as a result of her urinary retention? Hypertrophy of the bladder muscle and increased bladder wall thickness Due to complications, a male postoperative patient has been unable to mobilize for several days following surgery and has developed atelectasis. Which of the following processes would his care team anticipate with relation to his health problem? Redirection of blood flow away from the lung regions that are hypoxic

A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest A 71-year-old male patient with a history of myocardial infarction and peripheral vascular disease has been advised by his nurse practitioner to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the nurse practitioner's suggestion? Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin. A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community health clinic. Which of the following assessments would be the health care professional's lowest priority? Tests of kidney function A 4-year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the care team's initial differential diagnosis most likely be? Alport syndrome The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son's condition. Which of the following teaching points is most justifiable? "Research has shown that viruses may actually be a factor in many children's asthma." An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? AV node pacemaking activity and vagal nerve suppression The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating? Acid-base imbalances A nurse practitioner employed in a hospitalist notices that a patient is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which of the following factors has most likely contributed to the atrophy of the patient's muscle cells? A reduction of skeletal muscle use secondary to the traction treatment A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? Injections of allergens simulate production of IgG, which blocks antigens from combining with IgE. A nurse practitioner is educating a patient with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose

must enter the cell in order to provide energy for the patient. The nurse practitioner knows that which of the following processes allows glucose to enter body cells Facilitated diffusion A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man? Infusion of normal saline of Ringer lactate to maintain the vascular space A 31-year-old patient with a diagnosis of end-stage liver failure has been admitted to the intensive care unit of a hospital. Arterial blood gas sampling indicates that the man has an acid-base imbalance. Which of the following situations is most likely to result in an inappropriate pH? Low albumin and plasma globulin levels A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercle scarring site, located in a peripheral area of his bronchiolar tissue. What is this patient's most likely diagnosis? Adenocarcinoma Which of the following individuals are displaying identified risk factors for the development of lower urinary tract obstruction? A 68-year-old man who has been diagnosed with benign prostatic hyperplasia (BPH) A patient who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. What would her care team anticipate when observing her breathing? Short, shallow breaths A nurse practitioner is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor? A 61-year-old man who has a heart valve infection and recurrent fever A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has: A severe bacterial infection A researcher is involved in the production of insulin through recombinant DNA technology. Which of the following statements could the researcher best provide as a rationale for her work? The gene fragment responsible for insulin production can be isolated and reproduced. Which of the following statements most accurately conveys an aspect of lymphatic system activity? B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures. A student nurse practitioner asks her preceptor about the origins of different tissues, and their cellular origins during the process of development. Which of the following statements by the preceptor best describes the process of cell differentiation? "A fertilized ovum undergoes a series of divisions, yielding many different cell types." An older adult female patient has presented with a new onset of shortness of breath, and the patient's nurse practitioner has ordered measurement of her BNP levels along with

other diagnostic tests. What is the most accurate rationale for the nurse practitioner's choice of blood work? BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient's dyspnea from a respiratory pathology. Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold? A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F A patient is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in the lower lung fields bilaterally. What is the patient's most likely diagnosis? Fluid volume excess A 61-year-old woman who has had an upper respiratory infection for several weeks has presented to her nurse practitioner with complaints of a recent onset of urinary retention. She reveals to her nurse practitioner that she has been taking over-the-counter cold medications at higher than the suggested dose for the past two weeks. Which of the following phenomena will her nurse practitioner most likely suspect is contributing to her urinary retention? The anticholinergic effects of the medication are impairing normal bladder function. Which of the following phenomena is most likely occurring during a child's alveolar stage of lung development? A single-capillary network exists and the lungs are capable of respiration. A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her? Platelet count, serum creatinine, and liver enzymes A 22-year-old female who adheres to a vegan diet has been diagnosed with iron- deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation? Decreased erythropoietin levels A 77-year-old male patient with a diagnosis of stomach cancer has been found to have metastases in his liver. The patient and his family are surprised at this turn of events, stating that they don't see how he could have developed cancer in his liver. Which of the following facts would underlie the reply that the care team provides? The portal circulatory system brings venous blood from the gastrointestinal tract into the liver. Following several days in an acidotic state, a hospital patient has returned to the desired pH. Which of the following processes could have contributed to the resolution of the patient's health problem? Phosphate and ammonia buffer systems in the renal tubules A male lifetime smoker has died as a result of chronic obstructive pulmonary disease. Which of the following phenomena regarding his alveoli would his care team have most reasonably expected in the weeks prior to his death? Large numbers of alveolar macrophages in septal connective tissue

A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient's most likely diagnosis? Septic shock A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient's bleeding? Vitamin K deficiency The nurse practitioner is seeing a client who has an acute exacerbation of Crohn's disease. The NP recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which of the following types of tissue is most likely involved in the patient's pathology? Simple columnar epithelium An infant who is four days postpartum has been diagnosed with a single-gene disorder. The parents of the child have a number of questions about the etiology of the health problem, which the physician is attempting to address in detail. Which of the following teaching points most accurately captures an aspect of single-gene congenital disorders? A particular defect can be caused by mutations at one of several different loci. A nurse practitioner student is familiarizing herself with the overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as being least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history? A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session? "Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk." A definitive test for cystic fibrosis is The sweat test An 81-year-old female has long-standing hypocalcemia secondary to kidney disease and will shortly be moving into an assisted living facility from her own apartment. Which of the following findings should staff at the facility be instructed to observe for? Muscular spasms and complaints of cramps A 25-year-old Asian American man arrives at the emergency department in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What is the most likely cause of his hematuria and how should it be treated? His immunoglobulin A (IgA) nephropathy has no known effective treatments. Which of the following statements best captures the etiology of the acute response phase of extrinsic (atopic) asthma?

Chemical mediators are released from presensitized mast cells. A 66-year-old obese man with a diagnosis of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? Ventricular dilation and wall tension are significantly lower than normal. A 30-year-old man has spent 5 hours on a cross-country flight seated next to a passenger who has been sneezing and coughing, and the man has been inhaling viral particles periodically. Which of the following situations would most likely result in the stimulation of the man's T lymphocytes and adaptive immune system? Question options: A. Presentation of a foreign antigen by a familiar immunoglobulin B.Recognition of a foreign MHC molecule D.Cytokine stimulation of a T lymphocyte with macrophage or dendritic cell mediation Following a biopsy, a 54-year-old man has been diagnosed as having a benign neoplastic tumor. Which of the following characteristics most likely applies to his tumor? The well-differentiated neoplastic cells are clustered together in a single mass. Which of the following individuals is at the highest risk for developing a urinary tract infection (UTI)? A 30-year-old obese woman with poorly controlled diabetes mellitus About 3 weeks after razing an old chicken house, a 71-year-old retired farmer has developed a fever, nausea, and vomiting. After ruling out more common health problems, his care provider eventually makes a diagnosis of histoplasmosis. Which of the following processes is most likely taking place? Macrophages are able to remove the offending fungi from the bloodstream but can't destroy them. A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider be most likely to suspect? Coarctation of the aorta A nurse practitioner is explaining to a 40-year-old male patient the damage that Mycobacterium tuberculosis could do to lung tissue. Which of the following phenomena would underlie the nurse practitioner's explanation? Macrophages are unable to digest the bacteria, resulting in immune granulomas. As part of an orientation to a genetic counseling practice, a group of medical students is differentiating between autosomal recessive disorders and autosomal dominant disorders. Which of the following statements is true of autosomal recessive disorders? They tend to have a more uniform symptomatology than autosomal dominant disorders. A 2-year-old girl has had repeated ear and upper respiratory tract infections since she was born. A pediatrician has determined a diagnosis of transient

hypogammaglobulinemia of infancy. What is the physiological origin of the child's recurrent infections? Antibody production by plasma cells is compromised because of impaired communication between B and T cells. A nurse practitioner employed in the emergency department admits a patient who has experienced severe frostbite to his hands and toes after becoming lost on a ski trail. The NP recognizes that which of the following phenomena has caused the tissue damage? Decreased blood flow has induced hypoxia. A 22-year-old female with a history of intermittent flank pain, repeated UTIs, and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of her health problem? She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately. The nurse practitioner for a cardiology practice is responsible for providing presurgical teaching for patients who are about to undergo a coronary artery bypass graft. Which of the following teaching points best conveys an aspect of the human circulatory system? "Your blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation." A premature infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD) and is showing signs and symptoms of hypoxemia, low lung compliance, and respiratory distress syndrome (RDS). Which of the following is the most likely contributor to the infant's present health problem? High inspired oxygen concentration and injury from positive-pressure ventilation A nurse educator is orientating new nurses to a renal unit of a hospital. Which of the following teaching points should the nurse include as part of a review of normal glomerular function? "Glomerular filtrate is very similar in composition to blood plasma found elsewhere in circulation." Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)? An 81-year-old male who has a productive cough and recurrent respiratory infections During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms. Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? Hypertension is a frequent modifiable contributor to aneurysms. A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms? Viruses are killing some of his B cells and becoming incorporated into the genomes of others. A new older female patient at a long-term care facility has a diagnosis of type 1 neurofibromatosis (NF-1). As part of the intake assessment protocol for the facility, the clinical educator is teaching the care staff about the diagnosis. Which of the following statements most accurately conveys an aspect of neurofibromatosis?

"Her diagnosis puts her at higher risk of developing a malignant neoplasm." gas exchange primary function of the respiratory system cardiac reserve Ability to increase cardiac output during increased activity Cytoplasm composed of water, proteins, neutral fats, and glycogen. Eukatyote an organism made up of cells that have a nucleus and membrane-bound organelles preload volume of blood in ventricles at end of diastole conducting airways through which air moves as it passes between the atmosphere and the lungs respiratory tissues where gas exchange takes place afterload The force or resistance against which the heart pumps. Prokaryote unicellular organism that lacks a nucleus Conducting airways include: nasal cavity ➔ nasopharynx ➔ oropharynx ➔ larynx ➔ trachea ➔ bronchi ➔ bronchioles Frank-Starling Mechanism A mechanism by which the stroke volume of the heart is increased by increasing the venous return of the heart (thus stretching the ventricular muscle). DNA within the nucleus, which serves as the template for making all the RNA air moves through the conducting airways warmed, filtered and moistened Inotrophy myocardial contractility RNA later used to direct the synthesis of proteins in the cytoplasm. mucous produced by the epithelial cells in the conducting airways forms a layer that protects the respiratory system by entrapping dust, bacteria, and other foreign particles that enter the airways. Ribosomes site of protein synthesis glottis vocal folds and opening between them Rough Endoplasmic Reticulum An internal membrane system with ribosomes on its surface where proteins are assembled hyaline cartilage

horseshoe or c-shaped rings that supports the walls of the trachea and prevent collapsing when the pressure in the thorax becomes negative Golgi complex organelle that modifies, packages, and transports material out of the cell. hilum slit in the primary bronchus of the lungs which allows for pulmonary arteries, veins, and lymph vessels to enter. Lysosomes cell organelle filled with enzymes needed to break down certain materials in the cell pulmonary lobule supplied by one terminal bronchiole, an arteriole, the pulmonary capillaries and a venule. Perioxisomes contains a special enzyme that degrades perioxides alveoli Terminal air sacs that constitute the gas exchange surface of the lungs. Mitochondria Powerhouse of the cell, organelle that is the site of ATP (energy) production and cellular respiration pulmonary artery Carries deoxygentated blood from the heart to the lungs Microtubules transport along the axon of neuronal cells takes place along the primary cytoskeletal component Lympathic vessels remove particulate matter entering the lungs and plasma proteins that have escaped from the pulmonary capillaries. Microfilaments actin and myosin Parasympathetic stimulation through the vagus nerve, that is responsible for slightly constricted smooth muscle tone in the normal resting lung. Reactive Oxygen Species (ROS) chemically reactive molecules containing oxygen sympathetic nervous system stimulation causes airway relaxation, blood vessel constriction, and inhibition of glandular secretions. partial pressue pressure exerted by a single gas in the mixture pressure difference Air moves between the atmosphere and the lungs because of this intraplueral pressure pressure in the pleural cavity Valsalva maneuver used to study the cardiovascular effects of increased intrathoracic pressure on peripheral venous pressures, cardiac filling, and cardiac output, as well as poststrain heart rate and blood pressure receptors.

lung compliance the ease with which lungs can be expanded Tidal Volume (TV) volume of air inhaled or exhaled in a normal breath inspiratory reserve volume Amount of air that can be forcefully inhaled after a normal tidal volume inhalation Exiratory Reserve Volume Amount of air that can be exhaled in excess of a normal tidal volume inspiratory capacity amount of air that you can draw into your lungs after you have completed a quiet respiratory cycle vital capacity inspiratory reserve volume + tidal volume + expiratory reserve volume and is the amount of air that can be exhaled from the point of maximal inspiration. minute volume amount of air that is exchanged in one minute. pulmonary ventilation total exchange of gases between the atmosphere and the lungs alveolar ventilation exchange of gases within gas exchange portion of the lungs preventing collapse some air remains in the alveoli of the lower portion of the lungs dead space Any portion of the airway that does contain air and cannot participate in gas exchange, such as the trachea and bronchi. Mismatching of ventilation and perfusion both dead air space and shunt produce Blood transports gases between the lungs and other body tissues hemoglobin Oxygen carrying pigment in red blood cells oxygen binds cooperatively with the heme groups on the hemoglobin molecule pH, Carbon dioxide, and temperature hemoglobin's affinity for oxygen is influenced by pH, CO2 concentration, and body temperature. Carbon dioxide is transported in the blood in 3 forms as dissolved Co2, attached to hemoglobin, and as bicarb Brush cells act as receptors to monitor air quality Type I pneumocytes Form part of respiratory membrane Type II pneumocytes synthesize surfactant Angiogenesis

formation of new blood vessels