NR507 Midterm Exam 2023: Advanced Pathophysiology, Exams of Nursing

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NR507 Midterm Exam 2023 / NR 507 Week 4 Midterm

Advanced Pathophysiology Midterm Exam Latest

Chamberlain College Of Nursing (VERSION A)

A 25 year old female is diagnosed with urinary tract obstruction. while planning care, the nurse realizes that the patient is expected to have hydronephrosis and a decreased glomerular filtration rate caused by? - ANSWER>>>Dilation of the renal pelvis and calyces proximal to a blockage A 27 year old male has a severe kidney obstruction leading to removal of the affected kidney. Which of the following would the nurse expect to occur? - ANSWER>>>Compensatory hypertrophy of the remaining kidney A 55 year old male presents reporting urinary retention. Tests reveal that he has a lower urinary tract obstruction. Which of the following is of most concern to the nurse? - ANSWER>>>Formation of renal calculi When a patient asks what the most common type of renal stones is composed of, how should the nurse respond? The most common type of renal stone is composed of? - ANSWER>>>Calcium While planning care for a patient with renal calculi, the nurse remembers the most important factor in renal calculus formation is - ANSWER>>>Urine pH A 24 year old female is diagnosed with renal calculus that is causing obstruction. Which of the following symptoms would she most likely experience - ANSWER>>>Flank pain A 25 year old female presents with burning urination. She was diagnosed with a urinary tract infection. When the nurse checks the culture results, which of the following organisms is most likely infecting her urinary tract - ANSWER>>>Escherichia coli A 75 year old male reports to his primary care provider loss of urine with cough, sneezing, or laughing. Which of the following is the most likely

diagnosis the nurse will observe on the chart - ANSWER>>>stress incontinence A nurse assesses a patient with a complicated urinary tract infection (UTI) for - ANSWER>>>Other health problems A 28 year old female presents with fever, chills, and flank pain. She is diagnosed with pyelonephritis. A nurse recalls the patient's infection is located in the - ANSWER>>>Renal pelvis A 28 year old female presents with fever, chills, and flank pain. She is diagnosed with pyelonephritis. A nurse recalls the patient's infection is located in the - ANSWER>>>urinary tract obstruction A 29 year old female presents with cloudy urine, flank pain, hematuria, and fever. which of the following does the nurse suspect the patient is most likely experiencing? - ANSWER>>>acute cystitis

. A 15 year old male was diagnosed with pharyngitis. Eight days later he developed acute glomerulonephritis. While reviewing the culture results, which of the following is the most likely cause of this disease - ANSWER>>>Group A B-hemolytic streptococcus When a nurse observes post-streptococcal glomerulonephritis as a diagnosis on a patient, which principle will the nurse remember? Acute post-streptococcal glomerulonephritis is primarily caused by - ANSWER>>>antigen-antibody complex deposition in the glomerular capillaries and inflammatory damage A 30 year old male is demonstrating hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin being the major protein. The most probable diagnosis the nurse will see documented on the chart is - ANSWER>>>acute glomerulonephritis A 45 year old male presents with oliguria. He is diagnosed with chronic glomerulonephritis. The nurse knows oliguria is related to - ANSWER>>>thickening of the glomerular membrane and decreased renal blood flow

A 42 year old male is involved in a motor vehicle accident during which he loses a lot of blood. the nurse realizes he is in acute renal failure caused by

• ANSWER>>>inadequate renal blood flow A 56 year old male presents with flank pain and polyuria. Tests reveal that he has an enlarged prostate. which of the following types of renal failure should the nurse monitor for as it is the most likely to occur - ANSWER>>>Postrenal A 60 year old male is diagnosed with renal failure. while the nurse is reviewing lab results, which of the following lab values would be most consistent with this diagnosis - ANSWER>>>Elevated plasma creatinine level A 45 year old female presents with hypertension, anorexia, nausea and vomiting, and anemia. She is diagnosed with chronic renal failure. When the patient asks what caused this anemia, how should the nurse respond? Your anemia is caused by - ANSWER>>>inadequate production of erythropoietin A 42 year old female is diagnosed with chronic renal failure and the nurse is discussing dietary treatment. Which information indicates the nurse understands dietary regimen? Treatment includes restricting - ANSWER>>>Proteins While turning a patient with chronic renal failure, which principle should the nurse recall? Bone fractures are a risk factor in chronic renal failure because - ANSWER>>>the kidneys fail to activate vitamin D Anemia accompanies chronic renal failure because of - ANSWER>>>inadequate production of erythropoietin A patient with end-stage renal disease has pruritus. When the patient asks what causes this, what is the nurse's best response? Pruritus, seen in patients with end-stage renal disease, is caused by high levels of - ANSWER>>>calcium When a nurse is teaching about urinary pathogens in men. Which information should the nurse include? Mechanisms for defense against

urinary pathogens in men include - ANSWER>>>the long length of the urethra antimicrobial secretions from the prostate A 15-year-old female presents with flank pain, irritability, malaise, and fever. Tests reveal glomerulonephritis. When the parents ask what could have caused this, how should the nurse respond - ANSWER>>>post streptococcal infection A urologist is discussing nephritic syndrome. Which information should be included? If nephrotic syndrome is not caused initially by kidney disease, it is termed ____ nephrotic syndrome - ANSWER>>>secondary A 4-year-old male is diagnosed with nephrotic syndrome. Which of the following assessment findings accompanies this condition? - ANSWER>>>proteinuria A 7-year-old female is diagnosed with nephrotic syndrome. Which of the following should the nurse ask the parents if they or the child has noticed recently - ANSWER>>>Frothy urine Which of the following clusters of symptoms would make a clinician suspect a child has developed glomerulonephritis - ANSWER>>>Gross hematuria, flank pain, and hypertension When a child is admitted with acute renal failure, a clinician realizes the most common cause of acute renal failure is - ANSWER>>>Hemolytic uremic syndrome (HUS) A 10-year-old male is diagnosed with glomerulonephritis. Tests reveal the deposition of immunoglobulin IgA i the glomerular capillaries. The nurse will monitor for recurrent - ANSWER>>>Hematuria What part of the kidney controls renal blood flow, glomerular filtration, and renin secretion? - ANSWER>>>Juxtaglomerular apparatus (JGA) Which term is used to identify the movement of gas and air into and out of the lungs? - ANSWER>>>ventilation

When an individual aspirates food particles, where would the nurse expect to hear decreased or absent breath sounds? - ANSWER>>>right lung The risk for respiratory distress syndrome (RDS) decreases for premature infants when they are born between how many weeks of gestation? - ANSWER>>>30 and 36 A person with type O blood is considered to be the universal blood donor because type O blood contains which of the following? - ANSWER>>>No antigens How is most of the oxygen in the blood transported? - ANSWER>>>bound to hemoglobin Blood vessels of the kidneys are innervated by the: - ANSWER>>>sympathetic nervous system What is the final stage of the infectious process? - ANSWER>>>to spread What is the first stage in the infectious process? - ANSWER>>>colonization What is the primary cause of respiratory distress syndrome (RDS) of the newborn? - ANSWER>>>surfactant deficiency In which primary immune deficiency is there a partial-to-complete absence of T-cell immunity? - ANSWER>>>DiGeorge syndrome Hemolytic disease of the newborn (HDN) can occur if the mother: - ANSWER>>>Is Rh-negative and the fetus is Rh-positive What is the ratio of coronary capillaries to cardiac muscle cells? - ANSWER>>>1:1 (one capillary per one muscle cell) What is the functional unit of the kidney called? - ANSWER>>>nephron The glomerular filtration rate is directly related to which factor? - ANSWER>>>Perfusion pressure in the glomerular capillaries

Decreased lung compliance means that the lungs are demonstrating which characteristic? - ANSWER>>>stiffness Deficiencies in which element can produce depression of both B- and T-cell function? - ANSWER>>>Zinc Which hormone is synthesized and secreted by the kidneys? - ANSWER>>>erythropoietin Which blood cell type is elevated at birth but decreases to adult levels during the first year of life? - ANSWER>>>Monocytes What is the purpose of the spirometry measurement? - ANSWER>>>To measure the volume and flow rate during forced expiration Hives (urticaria) are an example of a: - ANSWER>>>Type 1 hypersensitivity reaction. Anaphylaxis is what type of reaction? - ANSWER>>>type 1 hypersensitivity Which of the following are considered the "first responders" of the innate immune system? - ANSWER>>>neutrophils Allergic contact dermatitis is an example of what type of hypersensitivity reaction. - ANSWER>>>type 4 hypersensitivity reaction Type 2 (Cytotoxic) hypersensitivity reactions are mediated by: - ANSWER>>>IgG or IgM Type 1 hypersensitivity reaction is mediated by - ANSWER>>>IgE Allergic asthma is an example of - ANSWER>>>type 1 hypersensitivity reaction type 2 hypersensitivity - ANSWER>>>tissue specific Primary effector cells of type 2 - ANSWER>>>macrophages

Examples of type 2 reactions - ANSWER>>>drug allergies, hemolytic anemia, blood transfusion mismatch, allergies against infectious agents Type 2 causes - ANSWER>>>The cell to be destroyed by the antibody Cell destruction through phagocytosis by macrophages Damage to the cell by neutrophils triggering phagocytosis Natural killer cells to release toxic substances that destroy the target cell Malfunction of the cell without destruction Type 3 hypersensitivity reaction - ANSWER>>>antigen-antibody response Where does the antibody bind to the antigen in type 3 response? - ANSWER>>>in blood or body fluids and then circulates to tissue Where does the antibody bind to the antigen in type 1, 2, and 4? - ANSWER>>>on cell surface Primary effector cell in type 3 - ANSWER>>>neutrophils example of type 3 reaction - ANSWER>>>serum sickness type 4 hypersensitivity reaction - ANSWER>>>cell-mediated response primary mediators of type 4 - ANSWER>>>lymphocytes and macrophages type 4 mediated by - ANSWER>>>T lymphocytes and do not use antibodies example of type 4 - ANSWER>>>localized contact dermatitis (poison ivy) Damage occurs with ABO incompatibility because: - ANSWER>>>Complement damages RBC membrane causing cell lysis. Which of the following is the underlying pathology for hay fever? - ANSWER>>>mast cell degranulation The diagnosis for an individual who presents to the office with sudden swollen lips and eyes, shortness of breath and throat tightness after a bee sting is: - ANSWER>>>anaphylaxis

Which of the following assessment findings would be expected in a patient who presents with urticaria? - ANSWER>>>Eosinophilia. An example of a primary immunodeficiency is: - ANSWER>>>Chronic Granulomatous Disease. what is a predominant cause of secondary immune deficiencies worldwide.

• ANSWER>>>Malnutrition Which of the following is an autoimmune disease? - ANSWER>>>Systemic Lupus Erythematosus (SLE). Which is true about a primary immunodeficiency? - ANSWER>>>It is the result of a single gene defect. (genetics) Examples of secondary immunodeficiency - ANSWER>>>HIV, cancer Secondary immunodeficiency caused by - ANSWER>>>external to immune system examples of primary immunodeficiency - ANSWER>>>Chronic granulomatous Disease of Childhood DiGeorge Syndrome Familial Mediterranean fever Job Syndrome Common Variable Immunodeficiency examples of secondary immunodeficiency - ANSWER>>>Human Immunodeficiency Virus Pneumocystis Carinii Pneumonia Sinus infection Lung cancer Select the best statement below that describes a primary immunodeficiency: - ANSWER>>>Are less common and occur due to a defect on the development of the immune system. Cancer is a secondary immunodeficiency. - ANSWER>>>true

Sinusitis is considered a primary immunodeficiency. - ANSWER>>>false A patient with human immunodeficiency virus (HIV) was admitted to the acute care facility with difficulty breathing. He is diagnosed with Pneumocytis carinii. Pneumocystis carinii an example of: - ANSWER>>>secondary immune disease Which of the following findings can be used to diagnose Systemic Lupus Erythematosus (SLE)? - ANSWER>>>Facial rash confined to the cheeks. A renal disease most often associated with autoimmunity is - ANSWER>>>Glomerulonephritis. The major immune system change associated with Sjogren's Syndrome is:

• ANSWER>>>Autoantibodies and auto-reactive T-cells against apoptotic cells. Which of the following can depress a person's normal immune function? - ANSWER>>>Psychological Stress Which of the following assessment findings would support a diagnosis of Rheumatoid Arthritis (RA)? - ANSWER>>>Swollen metacarpophalangeal joints. Which of the following statements best describes the symptoms of Systemic Lupus Erythematosus (SLE). - ANSWER>>>Tissue inflammation, vasculitis, rash, tissue inflammation. The presence of a low number of autoantibodies is an indicator that the individual will develop an autoimmune disease. - ANSWER>>>false *does not indicate The following immune components can be involved in autoimmune diseases: T-Cells, B-cells and autoantibodies. - ANSWER>>>true Which of the following microcytic anemias is characterized by hyperchromic RBCs? - ANSWER>>>Hereditary spherocytosis. Which of the following is NOT a clinical characteristic of anemia? - ANSWER>>>bradycardia

Which of the following is considered a microcytic anemia? - ANSWER>>>Iron deficiency. Which of the following indices measures the average size of red blood cells? - ANSWER>>>Mean Corpuscular Volume (MCV). What is anemia? - ANSWER>>>reduction in the total number of circulating red blood cells (RBCs) and/or a decrease in hemoglobin (Hb) amount or function Anemia can be caused by - ANSWER>>>1) impaired RBC production, 2) excessive blood loss, 3) increased RBC destruction OR any combination of the three. Microcytic anemia - ANSWER>>>(MCV<80 fL) describes RBCs that are small. Examples of microcytic anemia - ANSWER>>>Iron deficiency Sideroblastic Thalassemia Anemia of chronic disease Macrocytic anemia - ANSWER>>>(MCV>100 fL) describes RBCs that are large. examples of macrocytic anemia - ANSWER>>>B 12 deficiency (pernicious anemia) folate deficiency Normocytic anemia - ANSWER>>>(MCV 80-99 fL) describes RBCs that are normal in size examples of normocytic anemia - ANSWER>>>Anemia of inflammation and chronic disease hereditary spherocytosis G6PD deficiency paroxysmal nocturnal hemoglobinuria

Hypochromic anemia - ANSWER>>>RBCs with less hemoglobin than normal. As a result, the RBCs appear pale in color (MCHC is low). Hyperchromic anemia - ANSWER>>>RBCs with more hemoglobin than normal. As a result, the RBCs appear a dark hue or red than normal cells (MCHC is high). Normochromic anemia - ANSWER>>>RBCs that have a normal amount of hemoglobin. As a result, the RBCs appear neither pale nor dark (MCHC is normal). Clinical manifestations of anemia - ANSWER>>>Severe fatigue Pallor Weakness Dyspnea Dizziness The terms normocytic, microcytic, and macrocytic characterizes red blood cells by their - ANSWER>>>size Which of the following is a type of macrocytic anemia? - ANSWER>>>Vitamin B-12 deficiency. Identification of the type of anemia involves an examination of size of the RBC only. - ANSWER>>>false Which of the following would normocytic-normochromic indicate? - ANSWER>>>The cell is normal in size and normal in hemoglobin level Which of the following anemias can be categorized as microcytic- hypochromic? - ANSWER>>>Sideroblastic anemia. Iron deficiency anemia. Anemia of inflammation and chronic disease. Which of the following conditions could result in iron deficiency anemia? - ANSWER>>>excessive bleeding The most common type of anemia is - ANSWER>>>iron deficiency anemia

The treatment of iron deficiency anemia includes: - ANSWER>>>iron supplementation examples of microcytic hypochromic anemia - ANSWER>>>iron deficiency sideroblastic thalassemia examples of microcytic normochromic - ANSWER>>>anemia of inflammation and chronic disease examples of microcytic hyperchromic - ANSWER>>>hereditary spherocytosis Causes of iron deficiency anemia - ANSWER>>>nadequate dietary intake. Chronic and or occult bleeding: hemorrhage, colitis, cirrhosis, GI ulcers, esophageal lesions, or menorrhagia; note that it only takes 2-4 mL (about 1 tsp) of blood loss per day to lose 1-2 mg of iron). Decreased ability to utilize Fe for heme synthesis (e.g. transferrin deficiencies and mitochondrial defects). These are a less common cause of IDA. When iron stores are depleted, the cell's mitochondria are still able to utilize iron effectively due to compensatory mechanisms. - ANSWER>>>false Which of the following are iron rich foods - ANSWER>>>Spinach. Lima beans. Meat. Although less common, transferrin deficiencies and mitochondrial defects can lead to iron deficiency anemia. - ANSWER>>>true A transferrin deficiency will most likely result in: - ANSWER>>>iron- deficiency anemia Folic acid is essential to the body because it: - ANSWER>>>Plays a major role in the maturing of RBCs. A non-megaloblastic anemia would be caused by - ANSWER>>>liver disease

A deficiency of intrinsic factor will result in - ANSWER>>>pernicious anemia One of the common precipitating factors of folate deficiency is alcohol abuse. - ANSWER>>>true macrocytic megaloblastic examples - ANSWER>>>folate deficiency vitamin B12 deficiency macrocytic non-megaloblastic examples - ANSWER>>>liver disease myelodysplastic syndrome increased reticulocyte count (hemorrhage) clinical manifestations of macrocytic anemia - ANSWER>>>fatigue dyspnea loss of appetite/weight diarrhea pale examples of dietary sources of vitamin B12 - ANSWER>>>liver, beef, chicken, pork, caption, whole egg, dairy products (milk, cheese, yogurt) Foods rich in folic acid - ANSWER>>>green leafy vegetables beans citrus fruits rice and cereal folate-fortified foods Which of the following lab values will be low in a patient with folate deficiency? - ANSWER>>>Reticulocyte count. In a patient with pernicious anemia, what lab values can be normal or low?

• ANSWER>>>folate The blank lab values will be normal in a patient with pernicious anemia - ANSWER>>>MCHC Which of the following lab values are normal for the patient with folate deficiency? - ANSWER>>>ferritin

Which of the following is a cause of hemolytic anemia? - ANSWER>>>Drugs. Infection. Transfusion reaction. autoimmune reactions hemolytic disease of the newborn Acute blood loss of anemia is usually associated with acute GI bleeding and labor and delivery complications. - ANSWER>>>true Aplastic anemia can be caused by: - ANSWER>>>Antibiotics congenital defects chemical or radiation exposure viral induced tumors In hemolytic anemia, the destruction of lysis of RBCs is due to: - ANSWER>>>Enzymes or toxins produced by an infectious agent. Chemical release medication by one's immune system. Effects of drugs. chronic blood loss is commonly associated with chronic GI bleeding - ANSWER>>>true The MCHC will be normal in which of the following anemias? - ANSWER>>>Aplastic anemia Post-hemorrhagic anemia Hemolytic anemia the blank lab value will be normal in post-hemorrhagic anemia - ANSWER>>>MCHC the blank lab values are low in aplastic anemia. - ANSWER>>>reticulocyte count the blank lab values are normal for hemolytic anemia. - ANSWER>>>MCV The patient with sickle cell anemia is at high risk for stroke. - ANSWER>>>true

Which of the following statements are correct regarding thalassemia? - ANSWER>>>May have many possible genetic mutations. Cells that contain abnormal types of hemoglobin are more susceptible to infection by the parasite that causes malaria - ANSWER>>>false *RESISTANT There are four genes involved in encoding synthesis of the alpha protein chains for Hb and are located on chromosome number 16. - ANSWER>>>true The pathophysiology of sickle cell anemia involves a single amino-acid change on the beta-chain. - ANSWER>>>true There are two genes involved in encoding synthesis of the beta protein chains for Hb. These genes are located on chromosome number 11. - ANSWER>>>true Two examples of hemoglobinopathies - ANSWER>>>sickle cell anemia and thalassemia Sickle cell anemia correct statements - ANSWER>>>Involves a single amino acid change on the beta-chain Increased red blood cell (RBC) hemoglobin S concentration, RBC dehydration, acidosis, and hypoxemia Characterized by acute painful episodes Thalassemia correct statements - ANSWER>>>May have many possible genetic mutations Ineffective erythropoiesis Occurs primarily in persons from southeast Asia and China The patient with thalassemia is at high risk for stroke. - ANSWER>>>false Sickle-cell anemia is an: - ANSWER>>>Autosomal recessive genetic disorder. Thalassemia is similar to sickle cell anemia in that the individual with thalassemia: - ANSWER>>>Inherits an abnormal Hb gene from both parents

Sickle cell anemia and thalassemia are more prevalent in which of the following geographic areas? - ANSWER>>>Africa blood flow through heart - ANSWER>>>deoxygenated blood arrives to the right side of the heart, travels to the pulmonary arteries to release CO2 and pick up oxygen. At this point, the oxygenated blood is carried from the lungs through the pulmonary veins to the left side of the heart where it eventually reaches the aorta to carry oxygenated blood out to the body organs. Which electrolytes play a major role in muscle contraction - ANSWER>>>sodium, potassium, calcium Which of the following is a non-modifiable risk factor for Coronary Artery Disease? - ANSWER>>>family history Which of the following statements correctly describes the flow of blood between the heart and lungs: - ANSWER>>>Oxygenated blood is transported from the lungs to the heart via the pulmonary veins. Coronary artery disease (CAD) is mainly the result of: - ANSWER>>>Longstanding atherosclerosis. In Coronary Artery Disease (CAD), pumping ability of the heart can be impaired due to the deprivation of oxygen. - ANSWER>>>true Which of the following is a modifiable risk factor for Coronary Artery Disease (CAD)? - ANSWER>>>obesity Modifiable risk factors for CAD - ANSWER>>>dyslipidemia, DM, obesity, smoking, hypertension, sedentary lifestyle Non-modifiable risk factors for CAD - ANSWER>>>age, male, family history, menopause Cor Pulmonale is: - ANSWER>>>Right ventricular failure secondary to pulmonary hypertension.

Which of the following conditions can decrease preload? - ANSWER>>>Hemorrhage. the most common cause of right-sided heart failure is: - ANSWER>>>pulmonary hypertension Hypertension has its most immediate effect on: - ANSWER>>>Afterload In the healthy heart, the response to an increase in preload is for the stroke volume to - ANSWER>>>increase Right sided heart failure - ANSWER>>>JVD peripheral edema hepatosplenomegaly cor pulmonale tricuspid valve damage left sided heart failure - ANSWER>>>increased left ventricle afterload decreased ejection fraction increased left ventricular preload pulmonary edema dyspnea The patient with aortic stenosis would most likely present with: - ANSWER>>>Mid-systolic crescendo-decrescendo murmur. A patient with mitral regurgitation would most likely present with - ANSWER>>>a blowing, holosystolic murmur The patient with aortic regurgitation would most likely present with: - ANSWER>>>An early, high-pitched diastolic murmur heard at the left lower sternal border A diastolic rumbling murmur heart at the apex of the heart A systolic crescendo-decrescendo murmur heart at the left upper sternal border A patient with mitral stenosis would most likely present with: - ANSWER>>>Rumbling, decrescendo diastolic murmur heard at apex of the heart.

Rheumatic fever is a common cause for what valve disorder. - ANSWER>>>mitral stenosis A 64-year old female reports to the primary care office with a complaint of "fainting". She reported that the episode occurred while she was engaged in her usual low impact aerobics class. She also noticed, for the first time, during exercise that her heart "hurt". The NP conducts a symptom analysis of the chest pain and determined that the patient describes it as chest pressure. The patient reports no dyspnea with exercise and denies orthopnea or paroxysmal nocturnal dyspnea. On examination, the NP notes that all vital signs are normal, lungs are clear to auscultation; There is a laterally displaced, sustained apical impulse and a grade 4/6 mid-systolic crescendo-decrescendo murmur, heard loudest at the base and radiating to the neck. There is also an S4 gallop. no peripheral edema noted. There is a laterally displaced, sustained apical impulse and a grade 4/6 mid-systolic crescendo-decrescendo murmur, heard loudest - ANSWER>>>aortic stenosis A 60-year old male reports to the primary care office with "shortness of breath" that started a few days after being released from the hospital following angioplasty and stent placement. Upon exam, the NP observes that the patient does have dyspnea and jugular vein distention. Crackles are also noted in lung bases bilaterally. A blowing holosystolic murmur is also heard at the heart's apex with radiation into the axilla. - ANSWER>>>mitral regurgitation A woman brings her 67-year old father to see the NP at the primary care clinic. The patient reports that he has experienced shortness of breath for the last two months that has continued to get progressively worse. He expresses great concern that this development has kept him from participating in his Silver Sneaker's program that he enjoys with his friends. He reports that he can barely walk a city block or walk up the stairs in his home without becoming short of breath. Upon exam, the NP notes a blood pressure of 180/58 mmHg and peripheral pulses are palpable at 4+. The cardiac exam reveals several murmurs: an early diastolic murmur that is high-pitched located loudest at the left lower sternal border; a diastolic rumbling sound heard at the heart's apex and a systolic crescendo- decrescendo murmur heard at the left upper sternal border. A chest x-ray is performed at the office and shows pulmonary edema and cardiome - ANSWER>>>aortic regurgitation

A 40-year old male reports to the primary care office with a chief complaint of dyspnea, especially with activity, over the last 5 days. He also notices that several times during the last two days that he could feel his heart "pounding and racing". On collecting the medical history, the patient indicates that he had rheumatic heart disease as a young child but remembers little about it. On exam, the NP determines that he is tachycardic with a heart rate of 120 beats/minute that is irregularly irregular. A low-pitched murmur is also auscultated and is heard most prominently at the apex. The NP also notes jugular vein distention (JVD) and bilateral crackles in the lung bases. The NP performs an ECG in the office that reveals atrial fibrillation and left atrial hypertrophy. - ANSWER>>>mitral stenosis The NP notes that a patient's FEV1/FVC ratio is severely reduced. Which of the following conditions is most likely the patient's pulmonary issue? - ANSWER>>>chronic asthma The NP reviews the results of a patient's pulmonary function tests and notes that the FEV1, FVC, and total lung capacity (TLC) are reduced. The FEV1/FVC ratio is normal. Based on interpretation, this reflects: - ANSWER>>>restrictive lung disease Simple spirometry can be used to measure any of the following EXCEPT: - ANSWER>>>residual volume Simple spirometry can be used to measure: - ANSWER>>>tidal volume, vital capacity, inspiratory reserve volume A patient with normal lungs should be able to exhale blank of the forced vital capacity within the first second. - ANSWER>>>80% The NP is seeing a patient with chronic bronchitis that needs spirometry on today's visit. What pulmonary function test (PFT) findings are anticipated based on the diagnosis of chronic bronchitis? - ANSWER>>>Decreased forced expiratory flow (FEV1). Chronic bronchitis will decrease which of the following parameters? - ANSWER>>>decreased forced expiratory flow (FEV1)

Which of the following spirometry results indicate restrictive lung disease? - ANSWER>>>FEV1, FVC, and total lung capacity reduced; FEV1/FVC ratio normal. The NP notes that a patient's FEV1/FVC ratio is normal. Which of the following conditions is most likely the patient's pulmonary issue? - ANSWER>>>pulmonary fibrosis Simple spirometry includes a measure of residual capacity - ANSWER>>>false Which of the following would indicate obstructive lung disease? - ANSWER>>>chronic asthma Which of the following pulmonary function test results are expected in a patient with chronic bronchitis? - ANSWER>>>Decreased FEV1/FVC ratio. The number one cause of chronic bronchitis is - ANSWER>>>cigarette smoking A patient with chronic bronchitis is most likely to experience: - ANSWER>>>Respiratory acidosis due to inability to exhale CO2. The effects of an Alpha-antitrypsin 1 deficiency is: - ANSWER>>>inability to block the effects of proteolysis Which of the following is considered a late effect of emphysema? - ANSWER>>>Hypoxemia and Hypercapnia. Hyperresonance found on lung percussion with a patient with COPD is primarily due to - ANSWER>>>air trapping A lung volume measurement that indicates air trapping in a COPD patient is: - ANSWER>>>increased residual volume An expected chest x-ray finding for a patient with COPD is a - ANSWER>>>flattened diaphragm

The NP is examining a patient with a longstanding history of chronic bronchitis. Cor pulmonale is expected in the patient that presents with: - ANSWER>>>hepatomegaly A patient with chronic bronchitis is at risk for developing pneumonia due to:

• ANSWER>>>mucous plugs In normal gas exchange, which of the following is correct? - ANSWER>>>After air is breathed in, it diffuses into the pulmonary veins. Asthma results in - ANSWER>>>decreased alveolar ventilation Extrinsic asthma is - ANSWER>>>triggered by an allergic reaction Asthma is a chronic disease characterized by: - ANSWER>>>Intermittent, reversible airflow obstruction. Symptoms common to both intrinsic and extrinsic asthma include: - ANSWER>>>Wheezing Extrinsic - ANSWER>>>Triggered by allergic chronic reaction (pollen, dust mites, pet dander) Elevated IgE is diagnostic More common, especially in children Intrinsic - ANSWER>>>Triggered by non-allergic factors (chemical, air borne irritants, infections, exercise, stress, anxiety, GERD, obesity) No elevation in IgE More common in adults less than 40 years of age Which of the following pulmonary function test results are consistent with asthma? - ANSWER>>>decreased peak expiratory flow rate Interstitial lung disease (ILD) includes infectious and neoplastic lung diseases. - ANSWER>>>false A subjective finding in interstitial lung disease is rhonchi in the upper posterior airways. - ANSWER>>>false (fine crackles)

Choose the types of interstitial lung diseases (ILD) that are commonly associated with smoking: - ANSWER>>>Desquamative interstitial pneumonia Pulmonary langerhans cell histiocytosis respiratory bronchiolitis interstitial lung disease Interstitial lung disease refers to any disease affecting the pulmonary interstitium and typically excludes infectious and neoplastic diseases - ANSWER>>>true Choose the drugs that are commonly associated with development of a medication-induced interstitial lung disease (ILD): - ANSWER>>>Amiodarone (drugs for heart conditions) methotrexate (immunosuppressant drugs) nitrofurantoin (antibiotics)

• not lisinopril, warfarin, omeprazole The symptoms that are common to all types of interstitial lung disease are shortness of breath and non-productive cough. - ANSWER>>>true The characteristic finding of on a chest x-ray of an individual with ILD is a honey-comb pattern - ANSWER>>>true An objective finding in a patient with ILD include productive cough. - ANSWER>>>false- subjective Choose the interstitial lung diseases that are the most diagnosed: - ANSWER>>>1. radiation pnemonitis

2. pneumonconioses
3. hypersensitivity - pneumonitis The four key diagnostic tests for interstitial lung disease are pulmonary function tests, high resolution CT scan, bronchoalveolar lavage and lung biopsy. - ANSWER>>>true PFT's - ANSWER>>>non-invasive test that provides information about lung function

When to order PFT's - ANSWER>>>When signs and symptoms of a respiratory problem requires evaluation (cough, dyspnea, cyanosis, wheezing, hypoxemia, hypercapnia and lung hyperinflation). When disease progression needs to be determined. When monitoring the effectiveness of drug therapy. When monitoring for potential toxic effects of certain drugs. Forced vital capacity (FVC) - ANSWER>>>measures volume of air in the lungs that can be exhaled normal: 80-120% Pt inhales as deep possible and then exhales as long and as forcefully as possible amount of air patient can inspire and expire Forced expiratory volume in one second (FEV1) - ANSWER>>>Normal: 80 - 120% Amount of air forcefully exhaled from the lungs in the first second The patient inhales and forcefully exhales as fast as possible FEV1/FVC ratio - ANSWER>>>Determines if the pattern is obstructive, restrictive, or normal Diffusing Capacity - ANSWER>>>how well the lungs are able to exchange gas most efficient in lungs with high surface area bc easier for the blood to pick up the gas that's being exchanged Example of condition that decreases diffusing capacity - ANSWER>>>emphysema Residual volume - ANSWER>>>amount of air that remains in lungs after forceful exhalation cannot be measured by spirometry RV + FVC = - ANSWER>>>TLC RV and TLC elevated - ANSWER>>>obstructive disease Restrictive - ANSWER>>>TLC is needed to confirm true restrictive

Respiratory exam COPD - ANSWER>>>hyperresonance due to air trapping COPD PFT's - ANSWER>>>FEV1/FVC ratio <70% decreased FEV1 predicted COPD chest xray - ANSWER>>>flattened diaphragm, distended lung fields, and increased thoracic diameter Chronic bronchitis characterization - ANSWER>>>bronchial inflammation, hypersecretion of mucus, and chronic productive cough that persists for at least 3 consecutive months for at least 2 successive years. Classic sign of chronic bronchitis - ANSWER>>>Productive cough Classic sign of emphysema - ANSWER>>>barrel chest Extrinsic asthma - ANSWER>>>Triggered by allergic, chronic reaction (pollen, dust mites, pet dander) Elevated IgE is diagnostic More common, especially in children Intrinsic asthma - ANSWER>>>Triggered by non-allergic factors (chemicals- NSAIDS or aspirin, air borne irritants, infection, exercise, stress, anxiety, GERD, obesity) No elevation in IgE More common in adults less than 40 years of age Symptoms present during asthma exacerbation - ANSWER>>>non- productive cough wheezing heard on end-expiration chest tightness Asthma different from other obstructive diseases - ANSWER>>>variable and reversible