NUR 325 Exam 2 New Latest Version Updated 2024-2025 Best Studying Material, Exams of Nursing

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NUR 325 Exam 2 New Latest Version Updated 2024- 2025

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Which term is used for black, sticky, tarry, foul-smelling stools from digested dark blood? A. Melena B. Coffee ground C. Hematochezia D. Occult bleeding ----------- Correct Answer ----------- A. Melena Which statement describes early symptoms of ovarian cancer? A. Early ovarian cancer can be detected by a Pap smear. B. Early ovarian cancer does not have any signs and symptoms. C. Early symptoms of ovarian cancer include abdominal pain, constipation, and irregular periods. D. Early symptoms of ovarian cancer include infertility, protruding abdomen, and constipation. - ---------- Correct Answer ----------- B. Early ovarian cancer does not have any signs and symptoms. Which assessment findings are concerning and would prompt further evaluation for breast cancer? Select all that apply. A. Painless lump in the breast B. Enlarged axillary lymph nodes C. Dimpling of the skin on the breast D. Abnormal discharge from the nipple E. Breast pain timed with the menstrual cycle ----------- Correct Answer ----------- A. Painless lump in the breast B. Enlarged axillary lymph nodes C. Dimpling of the skin on the breast D. Abnormal discharge from the nipple The first sign of breast cancer is usually a painless lump. Other presenting signs include palpable nodes in the axilla, retraction of tissue (dimpling), or bone pain caused by metastasis to the vertebrae. Abnormal discharge from the nipple can be a sign of breast cancer. Breast pain timed with the menstrual cycle is not characteristic of breast cancer and is usually a normal finding. Which condition is associated with human papillomavirus (HPV) infection of the cervix? A. Cervical atrophy B. Cervical dysplasia C. Cervical hyperplasia D. Cervical hypertrophy ----------- Correct Answer ----------- B. Cervical dysplasia

Infection with high-risk (oncogenic) types of HPV (predominantly types 16 and 18) is a necessary precursor to development of the precancerous dysplasia of the cervix that leads to invasive cancer. Atrophy is caused by chronic ischemia, decreased hormonal or neural stimulation, or decreased workload (disuse). Hyperplasia is caused by increased stimulation by hormones or growth factors. Hypertrophy is caused by increased workload. Which information should be included about clinical manifestations when writing an education pamphlet about the early detection of breast cancer? Select all that apply. A. Amenorrhea B. Skin retraction C. Orange-peel skin D. Nipple discharge E. Painful breast lump F. Menstrual-like cramps ----------- Correct Answer ----------- B. Skin retraction C. Orange-peel skin D. Nipple discharge A patient with diabetes has a morning glucose of 50. The patient is sweaty, cold, and clammy. Which of the following nursing interventions is the MOST important? A. Recheck the glucose level B. Give the patient ½ cup (4 oz) of fruit juice C. Call the doctor D. Keep the patient on nothing by mouth ----------- Correct Answer ----------- B. Give the patient ½ cup (4 oz) of fruit juice Treatment for a CONSCIOUS patient experiencing HYPOglycemia Which of the following patients is at most risk for Type 2 diabetes? A. A 6 year old girl recovering from a viral infection with a family history of diabetes. B. A 28 year old male with a BMI of 49. C. A 76 year old female with a history of cardiac disease. D. None of the options provided. ----------- Correct Answer ----------- B. A 28 year old male with a BMI of 49. Remember Type 2 diabetes risk factors are related to lifestyle - being obese is a risk factor (BMI

30 in males is considered obese). So, the 28 year old male with a BMI of 49 is most at risk for Type 2. The _____ ______ secrete insulin which are located in the _______. A. Alpha cells, liver B. Alpha cells, pancreas C. Beta cells, liver

D. Beta cells, pancreas ----------- Correct Answer ----------- D. Beta cells, pancreas A 36-year-old male is newly diagnosed with Type 2 diabetes. Which of the following treatments do you expect the patient to be started on initially? A. Diet and exercise regimen B. Metformin BID by mouth C. Regular insulin subcutaneous D. None, monitoring at this time is sufficient enough ----------- Correct Answer ----------- A. Diet and exercise regimen Which of the following statements are true regarding Type 2 diabetes treatment? A. Insulin and oral diabetic medications are administered routinely in the treatment of Type 2 diabetes. B. Insulin may be needed during times of surgery or illness. C. Insulin is never taken by the Type 2 diabetic. D. Oral medications are the first line of treatment for newly diagnosed Type 2 diabetics ----------- Correct Answer ----------- B What statement or statements are INCORRECT regarding Diabetic Ketoacidosis?A. DKA occurs mainly in Type 1 diabetics.B. Ketones are present in the urine in DKA.C. Cheyne-stokes breathing will always present in DKA.D. Severe hypoglycemia is a hallmark sign in DKA.E. Options C & DThe answer is E. ----------- Correct Answer ----------- A patient who has diabetes is nothing by mouth as prep for surgery. The patient states they feel like their blood sugar is low. You check the glucose and find it to be 52. The next nursing intervention would be to: A. Administer Dextrose 50% IV per protocol B. Continue to monitor the glucose C. Give the patient 4 oz of fruit juice D. None, this is a normal blood glucose reading ----------- Correct Answer ----------- A. Administer Dextrose 50% IV per protocol This question requires critical thinking because the patient is NPO for surgery and can NOT eat but is experiencing hypoglycemia. Which of the following symptoms do NOT present in hyperglycemia? A. Extreme thirst B. Hunger C. Blood glucose <60 mg/dL D. Glycosuria ----------- Correct Answer ----------- C. Blood glucose <60 mg/dL BG levels are: Euglycemia- 70 - 140mg/dL Hypoglycemia-<70mg/dL (low blood sugar) Hyperglycemia->140mg/dL (high blood sugar)

Type 1 diabetics typically have the following clinical characteristics: A. Thin, young with ketones present in the urine B. Overweight, young with no ketones present in the urine C. Thin, older adult with glycosuria D. Overweight, adult-aged with ketones present in the urine ----------- Correct Answer ----------- A. Thin, young with ketones present in the urine Type 1- deficiency of insulin due to autoimmune destruction of beta cells (cells responsible for insulin synthesis and release) Normally, you could give the patient 15 grams of a simple carbohydrate like 4 oz of fruit juice or soda, glucose tablets, gel etc. per hypoglycemia protocol However, the patient can NOT eat due to surgery prep. Therefore the nurse would need to administer Dextrose 50% IV per protocol to help increase the blood glucose and recheck the glucose level. A Type 2 diabetic may have all the following signs or symptoms EXCEPT: A. Blurry vision B. Ketones present in the urine C. Glycosuria D. Poor wound healing ----------- Correct Answer ----------- B. Ketones present in the urine How to recognize when an individual is experiencing hypoglycemia? ----------- Correct Answer - ---------- Reduced cognition, tremors, diaphoresis (abnormal sweating), weakness, hunger, headache, irritability, seizure, dizziness, anxious, cold, clammy, tachycardia, no respiration changes, normal hydration and no ketones in urine *Remember to think BRAIN is more affected, think how much the brain relies on glucagon as its only fuel source, low glucagon to brain means low functions) How to recognize when an individual is experiencing hyperglycemia? ----------- Correct Answer ----------- polyuria (abnormally large volumes of dilute urine), polydipsia (abnormally great thirst), dehydration, fatigue, fruity odor to breath, kussmaul breathing, weight loss, hunger, poor wound healing, nausea, vomiting, cramps, warm and moist, ketones in urine *Remember to think more of the GI and urinary is more affected You walk into your patients room and assess your unconscious patient, taking their BG levels, noticing they are cold, clammy and unresponsive? How do you treat them? ----------- Correct Answer ----------- The patient is suffering from hypoglycemia. To treat an unconscious patient, you must give them IM form of glucagon, especially if there is no central IV set up and you don't have the time to spare to start one. IM administration of glucagon is faster absorption than Sub-q. You assess your responsive and conscious patients blood glucose levels and get a reading of 50mg/dL. What do you do? ----------- Correct Answer ----------- The patient is suffering from hypoglycemia. To treat a conscious patient you can give 2-3 tsp of sugar, glass of fruit juice, OJ, honey or corn syrup dissolved in water, candy or 4 oral glucose tablets

After assessing a patient at the conclusion of their meal, you determine their glucose levels read at 160. What are your nursing interventions? ----------- Correct Answer ----------- Fast acting insulin to provide immediate action (It is also important to educate patient on importance of activity and encourage patient to eat foods like whole grains, fruits, veggies, oatmeal, nuts and garlic for treating hyperglycemia) Which pathophysiologic processes occur in diabetic ketoacidosis? Select all that apply. a. Decreased lipolysis b. Increased serum pH c. Increased fatty acids d. Increased glyconeogenesis e. Increased hormonal levels, including cortisol levels ----------- Correct Answer ----------- c. Increased fatty acids d. Increased glyconeogenesis e. Increased hormonal levels, including cortisol levels The health care provider (HCP) teaches an individual with type 1 diabetes mellitus about recurrent infections. Which statement indicates that teaching was successful? A. "My immune system has become overactive. B. "My pancreas became infected and is damaged." C. "Sugar in the blood provides nutrition for bacteria D. "Insulin is needed to kill both bacteria and viruses." ----------- Correct Answer ----------- C. "Sugar in the blood provides nutrition for bacteria Two individuals, one with type 1 diabetes mellitus and one with type 2, have polydipsia, polyphagia, and polyuria. The health care provider (HCP) would interpret these findings as which condition? A. Both have hyperglycemia. B. Both have an acute illness. C. Both have too much insulin. D. Both have pancreatic necrosis. ----------- Correct Answer ----------- A. Both have hyperglycemia. The health care provider (HCP) would monitor an individual with diabetes and microvascular disease for which conditions? Select all that apply. A. Stroke B. Neuropathy C. Retinopathy D. Nephropathy E. Coronary artery disease F. Peripheral vascular disease ----------- Correct Answer ----------- B. Neuropathy C. Retinopathy D. Nephropathy

The health care provider (HCP) teaches a pregnant individual about gestational diabetes. Which statement indicates a need for further teaching? A. "After I have the baby, this will go away permanently." B. "I will need to be evaluated closely for type 2 diabetes." C. "The baby is affected if my blood glucose levels are high." D. "I will most likely develop gestational diabetes again for my next pregnancy." ----------- Correct Answer ----------- A. "After I have the baby, this will go away permanently." The health care provider (HCP) teaches the staff about the effects of advanced glycation end products (AGEs) in individuals with diabetes. Which statement from the staff indicates teaching was effective? A. "AGEs increase tissue injury." B. "AGEs decrease platelet adhesion." C. "AGEs increase ketoacid formation." D. "AGEs reduce chronic complications." ----------- Correct Answer ----------- A. "AGEs increase tissue injury." Which individual meets the diagnostic criteria for diabetes mellitus? A. An individual with a glycosylated hemoglobin of 5.5% B. An individual with a fasting blood glucose of 128 mg/dL C. An individual with a random serum glucose of 197 mg/dL D. An individual with a serum glucose of 185 mg/dL two hours after taking 75 grams of glucose ----------- Correct Answer ----------- B. An individual with a fasting blood glucose of 128 mg/dL Which condition results in hormone deficiency from lack of ACTH, TSH, FSH, and LH? A. Hypothyroidism B. Graves disease C. Panhypopituitarism D. Hypoparathyroidism ----------- Correct Answer ----------- C. Panhypopituitarism Which information would the health care provider (HCP) include when teaching staff about the two mechanisms responsible for the development of type 2 diabetes mellitus? A. Insulin resistance and beta-cell dysfunction B. Ketone formation and nonenzymatic glycation C. Insulin deficiency and autosomal dominant mutations D. Pancreatic enzyme deficiency and autoantibody production ----------- Correct Answer --------- -- A. Insulin resistance and beta-cell dysfunction Which clinical manifestations will alert the health care provider (HCP) that an individual with type 1 diabetes is experiencing hypoglycemia? Select all that apply. A. Coma B. Confusion C. Diaphoresis D. Tachycardia E. Ketoacidosis

F. Kussmaul respirations ----------- Correct Answer ----------- A. Coma B. Confusion C. Diaphoresis D. Tachycardia Which disease characteristics would the health care provider (HCP) include when teaching a community group about type 1 diabetes mellitus? Select all that apply. A. Individuals are prone to diabetic ketoacidosis. B. This type of diabetes results in insulin dependence. C. Most individuals are diagnosed before 30 years of age. D. It often is associated with dyslipidemia and hypertension. E. The genetic abnormality is an autosomal dominant gene mutation. ----------- Correct Answer - ---------- A. Individuals are prone to diabetic ketoacidosis. B. This type of diabetes results in insulin dependence. C. Most individuals are diagnosed before 30 years of age. Which treatments would the health care provider (HCP) include when teaching an individual diagnosed with type 1 diabetes mellitus? Select all that apply. A. Meal planning B. Insulin therapy C. Exercise schedule D. C-peptide supplements E. Oral hypoglycemic drugs ----------- Correct Answer ----------- A. Meal planning B. Insulin therapy C. Exercise schedule Which information would the health care provider (HCP) include when teaching the staff about metabolic mechanisms that contribute to chronic complications of diabetes mellitus? Select all that apply. A. Polyol pathway B. Protein kinase C C. Hexosamine pathway D. Nonenzymatic glycation E. Hypothalamic malfunction F. Excess production of cortisol ----------- Correct Answer ----------- A. Polyol pathway B. Protein kinase C C. Hexosamine pathway D. Nonenzymatic glycation Which information would the health care provider (HCP) include when teaching the staff the difference between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)? A. Glucose levels are considerably higher in DKA than in HHNKS because of volume excess.

B. Glucose levels are considerably higher in DKA than in HHNKS because of volume depletion. C. The degree of insulin deficiency is more profound in HHNKS, and the degree of fluid deficiency is more marked in DKA. D. The degree of insulin deficiency is more profound in DKA, and the degree of fluid deficiency is more marked in HHNKS. ----------- Correct Answer ----------- D. The degree of insulin deficiency is more profound in DKA, and the degree of fluid deficiency is more marked in HHNKS. Which acute complications would the health care provider (HCP) monitor for in an individual with diabetes mellitus? Select all that apply. A. Hypoglycemia B. Diabetic retinopathy C. Coronary artery disease D. Diabetic ketoacidosis (DKA) E. Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) ----------- Correct Answer ------ ----- A. Hypoglycemia D. Diabetic ketoacidosis (DKA) E. Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) The health care provider (HCP) is reviewing laboratory reports. Which individual would be at most risk for developing diabetes mellitus? A. One with a glycosylated hemoglobin of 5.4% B. One with a fasting blood glucose of 96 mg/dL C. One with a random serum glucose of 125 mg/dL D. One with a serum glucose of 140 mg/dL 2 hours after taking 75 grams of glucose ----------- Correct Answer ----------- D. One with a serum glucose of 140 mg/dL 2 hours after taking 75 grams of glucose Which macrovascular complications of diabetes mellitus would the health care provider (HCP) monitor for in an individual with diabetes? A. Retinopathy B. Nephropathy C. Autonomic neuropathy D. Cerebrovascular accident ----------- Correct Answer ----------- D. Cerebrovascular accident An individual with type 1 diabetes states, "My feet are numb." Which condition would the health care provider (HCP) suspect? A. Autonomic neuropathy B. Peripheral neuropathy C. Diabetic nephropathy D. Macrovascular complications ----------- Correct Answer ----------- B. Peripheral neuropathy

Which clinical manifestations would be observed in an individual with hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)? Select all that apply. A. Stupor B. Ketonuria C. Hypokalemia D. Severe dehydration E. Kussmaul respirations ----------- Correct Answer ----------- A. Stupor C. Hypokalemia D. Severe dehydration Which factors may cause endocrine abnormalities? Select all that apply. A. Gland dysfunction B. Faulty feedback system C. Altered metabolism of the hormones D. Adequate quantity of hormone precursors E. Hormone production by nonendocrine tissues ----------- Correct Answer ----------- A. Gland dysfunction B. Faulty feedback system C. Altered metabolism of the hormones E. Hormone production by nonendocrine tissues Which finding is associated with diabetic neuropathy? A. Hypertension B. Loss of vision C. Cerebrovascular accident D. Decreased peripheral sensation ----------- Correct Answer ----------- D. Decreased peripheral sensation Which are the signs of diabetic ketoacidosis? Select all that apply. A. Pallor B. Tremors C. Sweating D. Fruity breath E. Kussmaul respirations ----------- Correct Answer ----------- D. Fruity breath E. Kussmaul respirations A patient with diabetic ketoacidosis has fruity breath and Kussmaul respirations due to elevated blood glucose levels and reduced insulin production. Pallor, tremors, and sweating are signs and symptoms of hypoglycemia.

Which assessment findings are characteristic of acute kidney injury? Select all that apply. A. Paresthesia B. Crystals in the urine C. Increased serum calcium D. Decreased glomerular filtration E. Accumulation of nitrogenous waste products in the blood ----------- Correct Answer ----------- D. Decreased glomerular filtration E. Accumulation of nitrogenous waste products in the blood Acute kidney injury is a sudden decline in kidney function, with a decrease in glomerular filtration and accumulation of nitrogenous waste products in the blood, as demonstrated by an elevation in plasma creatinine and blood urea nitrogen (BUN) levels. Increased serum calcium is not characteristic of acute kidney injury; increased creatinine and BUN are. Crystals in the urine are not characteristic of acute kidney injury. Paresthesia is not characteristic of renal failure; increased creatinine and BUN are. A patient has urinary calculi. While planning care, the nurse considers which most important factor in the formation of renal calculi? A. Urine pH B. Urine sodium levels C. Serum lactate levels D. Temperature of the urine ----------- Correct Answer ----------- A. Urine pH Rationale The temperature and pH of the urine influence the risk of precipitation and calculus formation, and pH is most important. Urine sodium levels and serum lactate levels do not have a major influence on formation of renal calculi. Which are causes of chronic kidney disease? Select all that apply. A. Infection B. Hypertension C. Diabetes mellitus D. Chronic pyelonephritis E. Toxic injury to kidney cells F. Acute bladder neck obstruction ----------- Correct Answer ----------- B. Hypertension C. Diabetes mellitus D. Chronic pyelonephritis Systemic diseases, such as hypertension and diabetes mellitus, or intrinsic kidney diseases, such as chronic

pyelonephritis, are causes of chronic kidney disease. Infection, acute bladder neck obstruction, and toxic injury to kidney cells are more likely associated with acute kidney injury than with chronic kidney disease. An individual has a lower urinary tract obstruction. Which findings will typically be observed upon assessment? Select all that apply. A. Nocturia B. Flank pain C. Urinary urgency D. Intermittent urinary stream E. Increased voiding frequency ----------- Correct Answer ----------- A. Nocturia C. Urinary urgency D. Intermittent urinary stream E. Increased voiding frequency An individual recently underwent a release of a unilateral complete ureteral obstruction, resulting in postobstructive diuresis. Which clinical manifestation is to be expected? A. Edema B. Weight gain C. Increased urine output D. Increased blood pressure ----------- Correct Answer ----------- C. Increased urine output Diuresis is an increase in urine output. Relief of bilateral, partial urinary tract obstruction or complete obstruction of one kidney is usually followed by a brief period of diuresis (commonly called postobstructive diuresis). Increased blood pressure, edema, and weight gain are indications of increased fluid volume, not decreased volume. An individual with a kidney obstruction developed compensatory hypertrophy and hyperfunction. Which physiologic process occurred? A. Relief of obstruction followed by a brief period of diuresis B. Increase in glomerular and tubular size to increase filtration of the unaffected kidney C. Sympathetic nervous system responses to compensate for fluid volume depletion D. Release of somatomedin to break down renal calculi in the affected kidney ----------- Correct Answer ----------- B. Increase in glomerular and tubular size to increase filtration of the unaffected kidney Rationale The body is able to partially counteract the negative consequences of unilateral obstruction by processes called compensatory hypertrophy and hyperfunction. These processes cause the unobstructed kidney to increase the size of individual glomeruli and tubules but not the total number of functioning nephrons. Relief of

obstruction followed by a brief period of diuresis is commonly called postobstructive diuresis, not compensatory hypertrophy and hyperfunction. Sympathetic nervous system responses can compensate for fluid volume depletion by release of hormones and neurotransmitters, but such release does not cause compensatory hypertrophy and hyperfunction. Somatomedins cause the obligatory growth that occurs in compensatory hypertrophy, not the breakdown of renal calculi. Which information is correct regarding physiologic mechanisms that protect against urinary tract infections? Select all that apply. A. Prostatitis B. Acidic urine C. Hypercalcemia D. Tamm-Horsfall protein E. Uroepithelial secretions ----------- Correct Answer ----------- B. Acidic urine D. Tamm-Horsfall protein E. Uroepithelial secretions Several factors normally combine to protect against urinary tract infections. Most bacteria are washed out of the urethra during micturition. The low pH (acidic urine) and high osmolality of urea, the presence of Tamm- Horsfall protein, and secretions from the uroepithelium provide a bactericidal effect. Inflammation of the prostate (prostatitis) causes urinary stasis and increases the risk of urinary tract infection, whereas hypercalcemia promotes renal calculi and urinary stasis. Which laboratory result would indicate a 25-year-old woman experiencing urinary frequency, urgency, and dysuria has interstitial cystitis? A. Urinalysis demonstrating an acidic pH B. Urinalysis demonstrating cloudy urine C. Urine culture demonstrating no bacteria D. Urine culture demonstrating Escherichia coli ----------- Correct Answer ----------- C. Urine culture demonstrating no bacteria Interstitial cystitis occurs most commonly in women ages 20 to 30 years who have symptoms of cystitis, such as frequency, urgency, dysuria, and nocturia, but with negative urine cultures and no other known cause. Urine pH is supposed to be acidic, and cloudy urine is associated with a urinary tract infection. Interstitial cystitis would have a negative urine culture, not a culture with E. coli, which would indicate a urinary tract infection. Which should be considered about the calcium level in an individual in chronic renal failure?

A. Calcium will be abnormally high due to acidosis. B. Calcium will be abnormally low in the blood serum. C. Calcium will be abnormally high in the blood serum. D. Calcium will be absorbed in larger amounts from the gastrointestinal tract. ----------- Correct Answer ----------- B. Calcium will be abnormally low in the blood serum. Rationale Low serum calcium results from decreased absorption from the gastrointestinal tract. Hypocalcemia (low levels) develops in chronic renal failure, not high levels (hypercalcemia). Acidosis also contributes to a negative calcium balance. Which pathophysiologic mechanism should be considered when a laboratory result indicates an individual with nephrotic syndrome has hyperlipidemia? A. Triglycerides are decreased. B. Liver synthesizes lipoproteins. C. Loss of immunoglobulins occurs. D. Lipids are not excreted in the urine. ----------- Correct Answer ----------- B. Liver synthesizes lipoproteins. Hyperlipidemia in nephrotic syndrome is caused by increased hepatic synthesis of lipoproteins. Triglycerides are increased, not decreased. People who have nephrotic syndrome have both hyperlipidemia and lipiduria (loss of fat in the urine). Loss of immunoglobulins may increase susceptibility to infections; it does not affect lipids. Which clinical manifestation are expected in an individual with prolonged upper urinary tract obstruction? A. Fluid overload B. Metabolic alkalosis C. Elevated serum sodium level D. Elevated serum potassium level ----------- Correct Answer ----------- D. Elevated serum potassium level The affected kidney is unable to conserve sodium, bicarbonate, and water or to excrete hydrogen or potassium, leading to metabolic acidosis (not metabolic alkalosis) and dehydration (not fluid overload). The loss of bicarbonate and the excess of hydrogen and potassium leads to metabolic acidosis and elevated serum potassium levels. Because the kidney cannot conserve sodium, bicarbonate, or water, these are lost in the urine. Hydrogen and potassium cannot be excreted, so they build up in the blood. The loss of water and sodium leads to dehydration and low levels of sodium.

Which information is correct regarding the possible causes of acute kidney injury? Select all that apply. A. Cardiac failure B. Neurogenic bladder C. Renal artery occlusion D. Childbirth complications E. Chronic glomerulonephritis ----------- Correct Answer ----------- A. Cardiac failure B. Neurogenic bladder C. Renal artery occlusion D. Childbirth complications Rationale Cardiac failure, neurogenic bladder, renal artery occlusion, and childbirth complications are possible causes of acute kidney injury. Chronic glomerulonephritis is most often associated with chronic kidney disease. Which should be goals for an individual with acute kidney injury? Select all that apply. A. Treating infections B. Maintaining nutrition C. Correcting fluid disturbances D. Monitoring the kidney transplant E. Remembering that drug excretion is impaired ----------- Correct Answer ----------- A. Treating infections B. Maintaining nutrition C. Correcting fluid disturbances E. Remembering that drug excretion is impaired The four main management principles of acute kidney injury are correcting fluid and electrolyte disturbances, treating infections, maintaining nutrition, and remembering that excretion of drugs or their metabolites is impaired. Kidney transplant is used in the management of chronic kidney disease. An individual has end-stage chronic renal disease. Which is the rationale for monitoring for renal osteodystrophy and spontaneous bone fractures? A. Erythropoietin secretion is impaired B. Deficiency of active vitamin D occurs. C. Urea causes demineralization of bone. D. Excess potassium leaches calcium from bone. ----------- Correct Answer ----------- B. Deficiency of active vitamin D occurs. Which of the following are correct regarding the predisposing factors associated with pyelonephritis? Select all that apply.

A. Pregnancy B. Viral infection C. Catheterization D. Neurogenic bladder E. Urinary obstruction ----------- Correct Answer ----------- A. Pregnancy C. Catheterization D. Neurogenic bladder E. Urinary obstruction Predisposing factors of pyelonephritis include urinary obstruction, neurogenic bladder, instrumentation (e.g., catheterization), and pregnancy. Viral infection is not known to be a predisposing factor of pyelonephritis; bacterial infections can be a common cause. Which are the possible mechanisms that could account for oliguria in an individual with acute kidney injury? Select all that apply. A. Backleak B. Nerve damage C. Tubular obstruction D. Decreased fluid intake E. Alterations in renal blood flow ----------- Correct Answer ----------- A. Backleak C. Tubular obstruction E. Alterations in renal blood flow Three mechanisms have been proposed to account for the decrease in urine output in acute kidney injury: backleak, tubular obstruction, and alterations infrenal blood flow. In backleak, glomerular filtration remains normal, but tubular reabsorption of filtrate is accelerated as a result of permeability caused by ischemia. Necrosis of the tubules causes sloughing of cells, cast formation, or ischemic edema that results in tubular obstruction, increasing pressure and reducing the glomerular filtration rate (GFR). Efferent arteriolar vasoconstriction may be produced, or there may be redistribution of blood flow from the cortex to the medulla. Autoregulation of blood flow may be impaired, resulting in decreased GF. Nerve damage and decreased fluid intake are not considered mechanisms that may cause a decrease in urine output in acute kidney injury. Which neurologic effects should be assessed for in an individual with chronic kidney failure? Select all that apply. A. Stupor B. Nausea C. Fatigue D. Twitching E. Chest pain F Loss of vibration sense ----------- Correct Answer ----------- A. Stupor C. Fatigue

D. Twitching F Loss of vibration sense Neurologic effects from chronic kidney failure can result in stupor, fatigue, twitching, and loss of vibration sense. Nausea is a gastrointestinal effect. Chest pain is a cardiovascular effect. Which information is correct regarding renal calculi? A. Calcium inhibits stone formation. B. Alkaline urine promotes the formation of uric acid stones. C. Urinary stasis increases the likelihood of renal stone formation. D. Stones that are 2 to 3 mm have no chance of passing through the urinary tract. ----------- Correct Answer ----------- C. Urinary stasis increases the likelihood of renal stone formation. Urinary stasis increases the risk of stone formation by preventing prompt flushing of crystals from the urinary system. Acidic, not alkaline, urine greatly increases the risk for uric acid stones. Calcium is the most common type of renal stone. Stones smaller than 5 mm have a 50% chance of passing. Stones greater than or equal to 1 cm have little chance of passing. Which findings are consistent with cholelithiasis? Select all that apply. A. Jaundice B. Biliary colic C. Bloody diarrhea D. Left lower quadrant pain E. Fatty meals causing pain ----------- Correct Answer ----------- A. Jaundice B. Biliary colic E. Fatty meals causing pain Abdominal pain and jaundice are the cardinal manifestations of cholelithiasis. Vague symptoms include heartburn, flatulence, epigastric discomfort, and food intolerances, particularly to fats and cabbage. The pain (biliary colic) occurs 30 minutes to several hours after a fatty meal is eaten. Cholelithiasis pain usually occurs in the right upper quadrant, not the left lower. Which information is correct regarding Crohn disease? Select all that apply. A. Weight loss B. Increased cancer risk C. Presence of "skip" lesions D. Involvement of only the mucosal layer E. Cobblestone appearance of the gastrointestinal tract F. Common stool pattern of bloody diarrhea about 4 times per day ----------- Correct Answer ----- ------ A. Weight loss B. Increased cancer risk C. Presence of "skip" lesions

E. Cobblestone appearance of the gastrointestinal tract In Crohn disease, there is a cobblestone appearance of the gastrointestinal tract; the entire intestinal wall is involved; there are "skip" lesions involved; there is an increased cancer risk; and there is weight loss. Bloody diarrhea and involvement of only the mucosal layer occur with ulcerative colitis. In Crohn disease, diarrhea is common but blood therein is not. Which assessment findings are expected in an individual with cirrhosis? Select all that apply. A. Dark urine B. Spider angiomas C. Light-colored stools D. Increased body hair E. Bleeding tendency ----------- Correct Answer ----------- A. Dark urine B. Spider angiomas C. Light-colored stools E. Bleeding tendency Hepatic failure causes dark urine, spider angiomas, light-colored stools, and bleeding tendencies. There is loss of body hair in cirrhosis, not increased body hair. Which clinical manifestation should be expected in a client with ascites? A. Soft abdomen B. Hematemesis C. Increased abdominal girth D. Decreased respiratory rate ----------- Correct Answer ----------- C. Increased abdominal girth Which assessment findings would help confirm the diagnosis of appendicitis? Select all that apply. A. Fever B. Nausea C. Vertigo D. Diarrhea E. Rebound tenderness present F. Elevated white blood cell count ----------- Correct Answer ----------- A. Fever B. Nausea D. Diarrhea E. Rebound tenderness present F. Elevated white blood cell count Manifestations of appendicitis include pain followed by nausea, vomiting, anorexia, low-grade fever, and, in some cases, diarrhea. Elevated white blood cell count with rebound tenderness

usually referred to the right lower quadrant is characteristic of appendicitis. Vertigo is not a symptom of appendicitis. Which complications are associated with appendicitis? Select all that apply. A. Peritonitis B. Perforation C. Hiatal hernia D. Abscess formation E. Intestinal Obstruction ----------- Correct Answer ----------- A. Peritonitis B. Perforation D. Abscess formation Which information is correct regarding cholelithiasis? Select all that apply. A. Risk factors include male gender. B. Cholesterol stones are the most common. C. This means inflammation of the gallbladder. D. Pigmented stones are made primarily of cholesterol. E. Cholelithiasis is more prevalent in developed countries. ----------- Correct Answer ----------- B. Cholesterol stones are the most common. E. Cholelithiasis is more prevalent in developed countries. Which information is correct regarding the most common causes of cirrhosis? Select all that apply. A. Idiopathy B. Alcoholism C. Hepatitis C D. Hemochromatosis E. Antibiptic overdose ----------- Correct Answer ----------- A. Idiopathy B. Alcoholism C. Hepatitis C Which location should be observed for ascites in a person? A. In the face B. In the feet C. In the ankles D. In the abdomen ----------- Correct Answer ----------- D. In the abdomen An individual with which disease should be assessed for ascites because it is common with the disease? A. A client who has gastritis B. A client who has cirrhosis C. A client who has pancreatitis

D. A client who has acute hepatitis ----------- Correct Answer ----------- B. A client who has cirrhosis Which factor contributes to ascites in an individual having ascites from cirrhosis of the liver? A. Increased arterial vasodilation B. Decreased hydrostatic pressure C. Decreased capillary permeability D. Increased capillary oncotic pressure ----------- Correct Answer ----------- A. Increased arterial vasodilation Rationale Peripheral vasodilation, associated with increased nitric oxide produced by the diseased liver, decreases effective circulating blood volume, activating aldosterone and antidiuretic hormone, which promote renal sodium and water retention, thereby accelerating portal hypertension and ascites formation. Decreased, not increased, capillary oncotic pressure leads to ascites. Increased, not decreased, capillary permeability leads to ascites. Increased, not decreased, hydrostatic pressure leads to ascites. Which information is correct regarding cirrhosis? Select all that apply. A. Cirrhosis develops rapidly. B. Portal hypertension can develop. C. The pathology is not clearly understood. D. Severity is determined by the amount of toxin. E. Removal of the toxin slows the progression of liver damage. ----------- Correct Answer -------- --- B. Portal hypertension can develop. C. The pathology is not clearly understood. D. Severity is determined by the amount of toxin. E. Removal of the toxin slows the progression of liver damage. An individual has portal hypertension with ascites. Which pathophysiologic process for ascites is correct? A. Bacteria causes inflammation that decreases mesenteric capillary permeability. B. Esophageal varices form in the lower esophagus, placing pressure on arteries. C. Reduced hepatic lymph production causes weeping into the peritoneal cavity. D. Hepatic capillary hydrostatic pressure exceeds hepatic capillary osmotic pressure. ----------- Correct Answer ----------- D. Hepatic capillary hydrostatic pressure exceeds hepatic capillary osmotic pressure. Portal hypertension and reduced serum albumin levels cause capillary hydrostatic pressure to exceed capillary osmotic pressure. Lymph production is increased, not decreased. Bacteria cause an inflammatory response that increases, not decreases, mesenteric capillary permeability. Esophageal varices do not cause ascites but can cause bleeding.

Which information is correct regarding the risk factors for esophageal cancer? Select all that apply. A. Cirrhosis B. Male gender C. Low-fiber diet D. Tobacco use E. Chronic alcohol intake ----------- Correct Answer ----------- B. Male gender D. Tobacco use E. Chronic alcohol intake Which pathophysiologic process is occurring in an individual with reflux esophagitis? A. Congenital anomaly of the esophagus B. Dysplasia of the epithelial lining of the esophagus C. Autoimmune destruction of the esophageal mucosa D. Inflammatory response to gastric contents in the esophagus ----------- Correct Answer --------- -- D. Inflammatory response to gastric contents in the esophagus An individual has portal hypertension with ascites. Which pathophysiologic process for ascites is correct? A. Bacteria causes inflammation that decreases mesenteric capillary permeability. B. Esophageal varices form in the lower esophagus, placing pressure on arteries. C. Reduced hepatic lymph production causes weeping into the peritoneal cavity. D. Hepatic capillary hydrostatic pressure exceeds hepatic capillary osmotic pressure. ----------- Correct Answer ----------- D. Hepatic capillary hydrostatic pressure exceeds hepatic capillary osmotic pressure. Portal hypertension and reduced serum albumin levels cause capillary hydrostatic pressure to exceed capillary osmotic pressure. Lymph production is increased, not decreased. Bacteria cause an inflammatory response that increases, not decreases, mesenteric capillary permeability. Esophageal varices do not cause ascites but can cause bleeding. Which assessment finding confirms the diagnosis of hematochezia? A. Bloody vomitus B. Bright red stools C. Presence of tarry stools D. Low urine output that is cloudy ----------- Correct Answer ----------- B. Bright red stools Which information should be included when teaching about the hormonal abnormalities associated with the development of breast cancer? Select all that apply.

A. Elevated cortisol B. Decreased insulin C. Elevated estrogen D. Increased progesterone E. Increased prolactin levels ----------- Correct Answer ----------- C. Elevated estrogen D. Increased progesterone E. Increased prolactin levels Which genes have been linked to breast cancer? Select all that apply. A. MYC B. PSA C. BRCA1 D. BRCA2 E. Her2/neu ----------- Correct Answer ----------- A. MYC C. BRCA1 D. BRCA2 E. Her2/neu Which information should be included when teaching a young women's group the risk factor associated with virtually all cases of cervical cancer? A. Cigarette smoking B. Overuse of antibiotics C. Exposure to diethylstilbestrol (DES) in utero D. Infection with the human papillomavirus (HPV) ----------- Correct Answer ----------- D. Infection with the human papillomavirus (HPV) Which rationale explains the importance of routine Pap smears in a woman recently diagnosed with human papillomavirus infection? A. There is an increased risk for colon cancer. B. There is an increased risk for breast cancer. C. There is an increased risk for uterine cancer. D. There is an increased risk for cervical cancer. ----------- Correct Answer ----------- D. There is an increased risk for cervical cancer. Which functions can be impaired with male sexual dysfunction? Select all that apply. A. Erection B. Emission C. Ejaculation D. Incontinence E. Urinary excretion ----------- Correct Answer ----------- A. Erection B. Emission C. Ejaculation

Which assessment findings are typically associated with benign prostatic hypertrophy (BPH)? Select all that apply. A. Urgency B. Low back pain C. Delay in starting urination D. Incomplete bladder emptying E. Decreased force of urinary stream ----------- Correct Answer ----------- C. Delay in starting urination D. Incomplete bladder emptying E. Decreased force of urinary stream Which assessment findings are typical of benign prostatic hyperplasia (BPH)? Select all that apply. A. Increased scrotal pain B. Testicular enlargement C. Increased urge to urinate D. Delay in starting urination E. Decreased force of urinary stream ----------- Correct Answer ----------- C. Increased urge to urinate D. Delay in starting urination E. Decreased force of urinary stream Which information should be included in a teaching session about benign prostatic hyperplasia (BPH)? Select all that apply. A. It is an uncommon condition. B. Its relationship to aging is well documented. C. It occurs more often in Westernized countries. D. It may be problematic if urethral compression occurs. E. The prostate is largest at birth and continues to shrink. ----------- Correct Answer ----------- B. Its relationship to aging is well documented. C. It occurs more often in Westernized countries. D. It may be problematic if urethral compression occurs. Which diagnostic test is used to diagnose diabetes mellitus? A. Serum insulin levels B. Pancreatic serum amylase C. Presence of urinary ketones D. Glycosylated hemoglobin (HbA 10) ----------- Correct Answer ----------- D. Glycosylated hemoglobin (HbA 10) A health care provider (HCP) is preparing to teach the staff about diabetic ketoacidosis

(DKA). Which information would the HCP include? Select all that apply. A. An increase in insulin is observed. B. Condition peaks in the older adult. C. It is more common in type 1 diabetes. D. Assessment shows a decrease in catecholamines. E. Increased glyconeogenesis and ketogenesis are present. ----------- Correct Answer ----------- C. It is more common in type 1 diabetes. E. Increased glyconeogenesis and ketogenesis are present. Which statement indicates an understanding of the defects causing diabetes mellitus? A. "Diabetes results due to calcium levels and utilization." B. "Diabetes results due to utilization of fats and glucose." C. "Diabetes results due to metabolism of glycogen stores." D. "Diabetes results due to a defect in insulin secretion or action.' ----------- Correct Answer ------ ----- D. "Diabetes results due to a defect in insulin secretion or action.' Two individuals, one with type 1 diabetes mellitus and one with type 2, have polydipsia, polyphagia, and polyuria. The health care provider (HCP) would interpret these findings as which condition? A. Both have hyperglycemia. B. Both have an acute illness. C. Both have too much insulin. D. Both have pancreatic necrosis. ----------- Correct Answer ----------- A. Both have hyperglycemia. Which statement describes the purpose for obtaining a glycosylated hemoglobin (hemoglobin A 1c) level in an individual with diabetes? A. "To check for hyperlipidemia." B. "To measure fasting glucose levels." C. "To detect acute complications of diabetes." D. "To monitor long-term blood glucose control." ----------- Correct Answer ----------- D. "To monitor long-term blood glucose control." The health care provider (HCP) instructs an individual with type 2 diabetes about risk for infections. Which statement would indicate that teaching was successful? A. "I will notice early signs that an infection is occurring." B. "My body will make stronger white blood cells during infections." C. "High blood sugars will increase blood flow to my legs and feet." D. "I may not realize that a sore has developed on the bottom of my foot." ----------- Correct Answer ----------- D. "I may not realize that a sore has developed on the bottom of my foot."

Which information would the health care provider (HCP) include when teaching the staff about treatment of type 2 diabetes mellitus? A. Diet and exercise are usually adequate treatments for obese clients. B. Gastric bypass surgery is contraindicated for clients with type 2 diabetes. C. Oral hypoglycemic agents are rarely needed to maintain normal blood glucose levels. D. Insulin injections may be needed because of beta-cell dysfunction later in the disease. --------- -- Correct Answer ----------- D. Insulin injections may be needed because of beta-cell dysfunction later in the disease.