NURS 2210 Patho Final Exam Review Updated, Exams of Nursing

Download NURS 2210 Patho Final Exam Review Updated and more Exams Nursing in PDF only on Docsity! 1 Patho Final Review 1. Inflammation- mediators: - which causes increased capillary permeability: histamine; Bradykinin - causes increased capillary permeability - which causes pain: bradykinin release of substance P - what cells respond first: neutrophils - which is responsible for allergic response: eosinophils and IgE - what are the clinical manifestations in inflammation: redness, warmth, edema, pain, loss of function (particularly joints) - Basophils: release histamine - vasodilation occurs to help fight off what is happening in the body - Never Let Monkeys Eat Bananas: Neutrophils: first responders and most abundant, - -Lymphocytes: antibodies; immune response , Monocytes: macrophages - antigen presenting cells; produce inflammatory mediators, Eosinophils: allergy, Basophils (mast cells): histamine release; causes vasodilation; involved in allergic reactions 2. Temperature and the elderly - Decreased thermoregulatory function (may not present with fever when infected) - JP - Look out for other symptoms, such as confusion, worsening mental status, weakness and fatigue, weight loss 3. Differentiate between a benign versus malignant tumor. Know the characteristics of each - Benign: grow by expansion, encapsulated, grow slowly, well differentiated - Malignant: grow by invasion, lack capsules, grow rapidly; less differentiated; cancer 4. Know the sympathetic versus parasympathetic physiologic responses Both are apart of the autonomic nervous system- cardiac and smooth muscles, glands Sympathetic: “Fight or flight”, Increase heart rate, blood pressure -Dilate pupils, bronchioles -Blood from the GI, skin to skeletal muscles, brain Parasympathetic: “Rest or Digest”,Decrease heart rate, blood pressure -Constrict pupils - Blood to the GI tract, increased secretions 5. What lab value would indicate protein malnutrition ● Low serum albumin (3.5-5.5 g/dL) (QB) 6. Manifestations of bulimia nervosa - Bulimia nervosa is defined by recurrent binge eating and activities including vomiting, fasting, excessive exercise, and use of diuretics, laxatives, or enemas to compensate for that behavior page 237 GS - Enlarged parotid glands, eroded teeth - JP - Fluid and electrolyte disorders, dental caries, periodontal disease and sensitive teeth 2 7. Mononucleosis clinical manifestations and responsible organism or virus and transmission - caused by the Epstein-Barr virus (EBV) - Epstein-Barr virus spreads from person to person primarily through contact with infected oral secretions. Transmission requires close contact with infected persons. Thus, the virus spreads readily among young children in crowded conditions, where there is considerable sharing of oral secretions. Kissing is also an effective mode of transmission page 248 - Manifestations: enlarged lymph nodes, spleen may be enlarged, high fever, hepatitis and splenomegaly are common (248) 8. Functions of the Liver in relation to blood clotting ● The liver is responsible for synthesizing most coagulation factors ● Some factors require vitamin K for synthesis. The liver produces the bile salts essential for intestinal absorption of this vitamin ● Albumin is a major protein made by the liver that plays an important role in regulating blood volume and distribution of fluids in the body. One possible result of liver dysfunction is low albumin levels, which can lead to abnormal fluid retention causing swollen legs and abdominal distension. The liver also produces ferritin (a protein used to store iron in the body) 9. HPV- risks associated with contracting and spreading - Risks with spreading: asymptomatic so the carrier may not know of the infection and could spread it faster - No cure for viral infection but can be managed with medication - Transmission of HPV is usually through skin-to-skin contact, most often through penetration (oral–genital, manual–genital, and genital–genital contact) - HPV can also be transmitted though no nsexual routes including mother to newborn (vertical transmission) - fomites (objects such as clothing, towels, or utensils that harbor the agent) - Most HPV infections are asymptomatic and transient, and resolve without treatment. In some cases, however, HPV infection results in genital warts, abnormal Papanicolaou (Pap) test abnormalities, or, rarely, cervical cancer (QB) 10. Respiratory cilia functions - Hair-like processes that project from a cell. - They beat rhythmically to move cell around environment - They move mucous and fluids over the surface and help with the removal of mucous. 11. Complications of atherosclerosis: CHAPTER 18 PG 408-411 -plaques block coronary arteries -can cause thrombosis in smaller vessels 5 ○ Depends on urinary pH ● An environment that allows the stone to grow ○ Dehydration → low urination ○ Obesity ○ medication→ ex. Like Vitamin C and calcium 17. Pathophysiology of stress incontinence ● Common problem for women of all ages, occurs as the result of weakness of pelvic floor muscles leading to poor support of the vesicourethral sphincters ○ Causes of weakness of the pelvic floor→ aging, childbirth or surgical procedures ● In men may result from trauma or surgery to the bladder outlet as occurs with prostatectomy (AP) 18. Hep A, Hep B, Hep C- transmission, risk factors and treatments or preventative measures Know how Hep A is transmitted and why it is different than B and C. A is fecal oral and is not typically spread through sex or drug use. It is not chronic it is acute from contaminated utensil etc.- ingesting food or water that is contaminated or has been prepared by infected hands. a. Hepatitis A: caused by a small, nonenveloped, single-stranded ribonucleic acid (RNA) picornavirus; contracted by the fecal-oral route. HAV vaccine is available to those who are at high risk for contracting Hep A virus (ppl traveling abroad to countries w poor sanitation, children in unsanitary environments, homosexual men, and illicit drug users) (B. Hippen) b. Hepatitis B: caused by a hepatotropic deoxyribonucleic acid (DNA)-containing Hepadnavirus. The virus usually is transmitted through inoculation with infected blood or serum. However, the viral antigen can be found in most body secretions and can be spread by oral or sexual contact. The vaccine, which is prepared from purified HBsAg produced in yeast, induces a protective antibody response in 95% of vaccinated infants, children, and adolescents. It is also available for adults who are at high risk, or are unvaccinated. (B. Hippen) c. Hepatitis C: Before 1990, the main route of transmission of HCV was through contaminated blood transfusions or blood products. Currently, recreational injection drug use is the most common mode of HCV transmission in the United States. No vaccine is currently available. (B. Hippen) 19. Clinical manifestations of acute cholecystitis: ● Acute cholecystitis is a diffuse inflammation of the gallbladder, usually secondary to obstruction of the gallbladder outlet ● Persons with acute cholecystitis usually experience a sudden onset of upper right quadrant (URQ) or epigastric pain, frequently associated with mild fever, anorexia, nausea, vomiting 6 ● Usually have an elevated white blood cell count and many have mild elevations in AST (indicates liver disease), ALT (indicates liver damage or inflammation), ALP (indicates biliary obstruction or liver disease), and bilirubin (N.L. Pg 746). 20. Know the functions of the pituitary gland and what is secreted from where and to which target organs ● Hypothalamus: Sends orders to pituitary gland ● Pituitary gland (“master gland”) ○ Posterior: Oxytocin → uterus ADH → kidneys ○ Anterior: growth hormone (GH) → bones prolactin (PRL) → breasts follicle-stimulating hormone (FSH) → ovaries and testes luteinizing hormone (LH) → ovaries and testes cortex adrenocorticotropic hormone (ACTH) → adrenal thyroid-stimulating hormone (TSH) → thyroid 21. Factors in the endocrine system that have a direct effect on glucose Cortisol from the adrenal cortex increases blood glucose Insulin decreases blood glucose levels if levels are too high “ glucose uptake” Glucagon increase blood glucose levels if the levels are too low (S Hoh) 22. Pathophysiology of diabetes type I and II and risk factors associated with them: Type I -Characterized by destruction of the pancreatic beta cells -Accounts for 5%-10% of those with diabetes -Leads to absolute insulin deficiency -Risk Factors: -FPG below 100 mg/dL or OGTT less than 140 mg/dL is normal -FPG at 100-125 mg/dL increased risk of diabetes -FPG 126 mg/dL and above is considered diabetes -Two types: Type 1A immune-mediated diabetes (most common ) -Type 1B idiopathic (non-immune related) diabetes (A. Pedi) Type 1A: -juvenile diabetes -Autoimmune disorder 7 -results from a genetic predisposition, environmental trigger, and T-lymphocyte- mediated hypersensitivity reaction against beta cell antigens -Autoantibodies may exist for years before hyperglycemia (two types: insulin autoantibodies and islet cell antibodies) -people require exogenous insulin replacement to reverse catabolic state, control blood glucose and prevent ketosis (A. Pedi) Type 1B: -beta cell destruction in which no evidence of autoimmunity is present -Strongly inherited -Episodic DKA (diabetic ketoacidosis) due to insulin deficiency -periods of absolute insulin deficiency -rate of beta cell destruction is rapid (infants & children) -slow in adults -diabetic ketoacidosis (first manifestation of the disease) -Absence of insulin → ketosis develops (fatty acids released from fat cells & converted to ketones in liver) (A. Pedi) Type 2: -occurs when beta cells are worn out & are not able to secrete insulin to facilitate glucose into the cells = insulin resistance -cause: genetic predisposition -acquired insulin resistance -risk factors: age, weight, inactivity, family history, fat distribution, diet -manifestations: thirsty (polydipsia), excess urination (polyurea), increase appetite (polyphagia) -systemic complications: CV disease, kidney damage, eye damage (retinopathy), foot damage (A. Pedi) 23. Teaching for pts with Diabetes and insulin -diabetic ketoacidosis: no insulin, Type 1 -hyperglycemic hyperosmolar state: insulin around, but dehydrated, Type 2, higher glucose -both above treated with insulin to bring glucose down and IV fluids to hydrate -diabetics need to keep a snack with them especially for exercise -highest insulin level: after first, big, fatty meal -lowest insulin level: when not eating -insulin decreases blood glucose levels (A. Pedi) 24. Know somogyi and dawn phenomena ● The Somogyi effect describes a cycle of insulin-induced post-hypoglycemic episodes. ○ Occurs in people with diabetes ○ Hypoglycemia in the late evening causes a rebound effect in the body leading to hyperglycemia in the early morning ● Dawn phenomena ○ Occurs in people with diabetes 10 -secondary prevention measure for early recognition of cervical cancer -tests cells of cervix -looks for dysplasia or undifferentiated cells 29. Risk factors for fractures, traumatic and pathological ● Pathological ○ Chronic Kidney Disease - inadequate Vitamin D to absorb calcium ○ Osteoporosis ● Traumatic ○ Car accident, fall or any kind of force 30. Pagets disease of the bone clinical manifestations - Due to abnormal bone turnover, it becomes disorganized leading to bone deformities and fractures. - The bone pushes on the cranial nerve causing hearing loss or deafness due to cranial nerve suppression with overgrowth of bone. 31. Osteoarthritis verses rheumatoid arthritis manifestations - Rheumatoid Arthritis ● Swan neck, ulnar drift, they will experience pain in the morning and it will get better throughout the day - Osteoarthritis ● Joint pain, stiffness, limitation of motion and sometimes joint instability and deformity ● Heberden’s and Bouchard’s nodes 32. Pathophysiology of psoriasis a. A genetic component is supported by population studies indicating a greater incidence of psoriasis among relatives of persons with the disease than among the general population. There is a strong association between psoriasis and the human leukocyte antigen-C (HLA-C), particularly the HLA-Cw6 allele. Immunologically, T lymphocytes may be the key to the pathogenesis of psoriasis. Eruption of psoriatic lesions coincides with T-cell infiltration into the epidermis, and resolution of the lesions follows disappearance or reduction in epidermal T cells, suggesting a T-cell–mediated release of cytokines and growth factors that stimulate abnormal growth of keratinocytes and dermal blood vessels. Psoriasis is a common, chronic, inflammatory skin disease characterized by raised erythematous plaques with silvery scales.(A Adorno pg. 1164) 33. Cancer in situ- what does this mean - Didn’t cross the basement membrane and can easily be removed - JP 34. Risk factors for hepatocellular carcinoma PAGE 744 -most common form of liver cancer -etiologic agents: chronic Hep. B & C, chronic alcoholism, nonalcoholic fatty liver disease, long term exposure to environmental agents such as aflatoxin (caused by food spoilage molds) (A. Pedi) 35. Risk factors for inadequate erythropoietin production 11 ● Patients in renal failure ○ Kidneys produce hormone erythropoietin which produces RBCs; if kidneys are unable to produce the hormone → insufficient erythropoietin and anemia 36. Interpret expected values of WBC, HCT, HGB, and Platelets - WBC: 4,500 - 10,500 cells/mcL - Platelets: 150,000 - 400,000 - HGB: women: 12.0 - 16.0 g/dL, men: 14.0 - 17.4 g/dL - HCT: women: 37% - 47% , men: 40% - 50% 37. What does an fecal occult blood test mean and what hematological disorder can accompany a Gastrointestinal bleed ● Fecal occult blood test determines if blood is present in stool ● Ulcerative colitis → blood in stool ● Hematological disorder → iron-deficiency anemia 38. Know the pathological differences between the anemias (iron def, pernicious, folic acid, hemolytic, thalassemias etc) and the risk factors for each - Thalassemias: heterogeneous group of inherited disorders caused by mutations that affect a or b- globin chains. (decreased the rate of synthesis). - a-thalassemias: deficient synthesis of a-chain - b-thalassemias: deficient synthesis of b-chain - This can lead to anemia due to deficiency of hemoglobin and excess production of the unaffected chain. - Decreased hemoglobin = hypochromic, microcytic anemia - Accumulation of unaffected chain ruins normal RBC maturation and contributes to memory changes due to hemolysis and anemia. - Iron Deficiency: Iron-deficiency anemia is characterized by low hemoglobin and hematocrit, decreased iron stores, and low serum iron and ferritin levels. The red cells are decreased in number and are microcytic and hypochromic - Common cause is chronic blood loss ( In men and postmenopausal women, blood loss may occur from gastrointestinal bleeding because of peptic ulcer, intestinal polyps, hemorrhoids, or cancer) - At Risk: women, pregnancy, infants at low birth weight/premature - Clinical manifestations: pallor, dyspnea, tachycardia, spoon-shaped deformity of fingernails. - Folic Acid-Deficiency Anemia: Folic acid is also required for DNA synthesis and red cell maturation, and its deficiency produces the same type of megaloblastic red cell changes that occur in vitamin B12–deficiency anemia - Most common causes are malnutrition and dietary lack - Folic Acid is found in vegetables (green leafy types), fruits, cereals, and meats - Malabsorption of folic acid may be due to syndromes such as celiac disease or other intestinal disorders 12 - Risk Factors: overcooked foods, vitamin-poor diet, heavy alcoholism, medications, pregnancy - Pernicious Anemia: - result from immunologically mediated, possibly autoimmune, destruction of the gastric mucosa. The resultant chronic atrophic gastritis is marked by loss of parietal cells and production of antibodies that interfere with binding of vitamin B12 to intrinsic factor. - Risk: Northern European and African descent, people who can’t absorb vitamin B12. (BMJ 288-289) - Hemolytic: - Characterized by the premature destruction of red cells, the retention of iron and the other products of hemoglobin destruction, and a compensatory increase in erythropoiesis. (RBCs are destroyed faster than they’re made). - RBC shortened life span → Hyperactive bone marrow → increased circulating reticulocytes in blood. - Clinical manifestations: easy fatigability, dyspnea, and other signs and symptoms of impaired oxygen transport. - Intrinsic: described for all components of the red cell, including the cell membrane, enzyme systems, and hemoglobin, most of which are hereditary. - Extrinsic or acquired factors include immune mechanisms, mechanical trauma, and infections. - Risk factors: those with sickle cell anemia develop a hemolytic anemia (not an iron deficient one). (Pg 283, IZ) 39. Be familiar with the pathophysiology and complications of polycythemia vera -Neoplastic disease of the pluripotent cells of the bone marrow characterized by an absolute increase in total red blood cell mass accompanied by elevated white cell and platelet counts. It most commonly is seen in men and may occur at any age with a median age of 62 years at the time of diagnosis. In polycythemia vera, the manifestations are variable and are related to an increase in the red cell count, hemoglobin level, and hematocrit with increased blood volume and viscosity. (KNP 291) 40. Know acromegaly, gigantism and dwarfism at a pathophysiological level and manifestations - Acromegaly: excess of growth hormone in adulthood, occurs after puberty - Exaggerated growth of the ends of extremities; most common cause is GH-secreting adenomas which are typically benign. - Manifestations: heat intolerance, moderate weight gain, muscle weakness and fatigue, menstrual irregularities, and decreased libido. Hypertension and sleep apnea are also common. - Gigantism: occurs before puberty, fusion of the epiphyses of the long bones. Develops when excessive secretion of GH, occurs in KIDS (page 773) 15 ii. Also occurs when the head of the bed is elevated, causing the torso to move toward the foot of the bed while friction and moisture cause the skin to remain fixed to the bed linens. iii. Occurs as people who are bedridden use their elbows and heels to aid in movement. 48. Age related vision and hearing loss - Presbiopia - gradual vision loss - Presbycusis - gradual loss of hearing (sensorineural loss) - JP 49. Cerebellar disorders, Parkinson disease, ALS, MS, know patho and clinical manifestations of each A. Cerebellar disorder a. Caused by congenital defect, cerebrovascular event, or growing tumor b. Signs include cerebellar ataxia and tremors B. Parkinson Disease a. Patho→ dopamine deficiency→ increased ACH b. Manifestations→ cogwheel rigidity, stooping, loss of smell, tremors at rest c. Low protein diet because digestion is slow but high caloric intake d. Tend to get depression and constipation C. ALS a. Damage to the upper and lower neurons i. Upper neuron damage lead to muscle weakness and lack of motor control ii. Lower neuron damage leads to denervation atrophy and hyporeflexia b. Respiratory status is a priority D. MS a. Autoimmune demyelination against the myelin sheath b. Immune system eats away at the protective covering on the nerve c. Destruction of the myelin coating on axons so myelin sheath is not transmitted to synapse d. Manifestations→ optic neuritis (inflammation of the optic nerve), tingling, blindness/ blurred vision and dark spots (AP) 50. What are the fat soluble vitamins that are metabolized in the liver that may have an impact on their absorption in those with biliary obstructions a. Vitamins A, D, E, and K (A Adorno pg. 226) b. Biliary obstruction causes malabsorption of these vitamins (727) 51. Acute pancreatitis pathophysiology ● Reversible inflammatory process of the pancreatic acini brought about by premature activation of pancreatic enzymes ● Involves the autodigestion of pancreatic tissue by inappropriately activated pancreatic enzymes 16 ● In the US alcohol abuse and gallstones account for 70 to 80% of all cases (AP) 52. How are gallstones formed - Caused by precipitation of substances contained in bile-cholesterol and bilirubin - Also caused by a diet high in cholesterol, fatty acids, carbohydrates and high alcohol intake. - They are composed of 80% cholesterol and 20% calcium salts with bilirubin. 53. High risk factors for chronic pancreatitis - Alcohol consumption 54. Normal physiology of urination from the bladder (ON RENAL-URINARY QUIZ) -The detrusor muscle contracts down on the urine and the ureteral orifices are forced shut. The external sphincter relaxes as urine moves out of the bladder (A. Pedi) 55. Education on prevention of UTIs, risk factors for UTIs ● Education and prevention→ ○ Practice good hygiene- wipe front to back ○ Drink plenty of fluids ○ Empty bladder completely as soon as you feel the urge ○ Wear cotton underwear ● increased risk→ urinary obstruction and reflux, in people with neurogenic disorders that impair bladder emptying, in women who are sexually active, in postmenopausal women, in men with diseases of the prostate, and in elderly persons (PG 667) (APitts) 56. Risk factors for Chronic kidney disease ● Diabetes ● Hypertension ● Family history ● Age (over 60) ● race/ethnicity→ african americans, hispanics, native americans, asian americans ● other→ polycystic kidney disease, glomerulonephritis, acute kidney injury, kidney cancer (APitts) pg 645 57. Clinical manifestations of viral influenza, who should be priority vaccinated ● abrupt onset of fever and chills; malaise; muscle aching; headache; profuse, watery nasal discharge; nonproductive cough; and sore throat pg 543 ● The symptoms of uncomplicated rhinotracheitis usually peak by days 3 to 5 and disappear by days 7 to 10. ● Weakness, cough, and malaise may persist for weeks after clinical resolution ● Flu vaccine is a priority (APitts) ● Elderly people should be vaccinated because viral pneumonia occurs as a complication of the flu 58. Know clinical manifestations and patho of epiglottitis, asthma, COPD a. Epiglottitis- 17 i. Affects upper airways as inflammation causes the lumen of the airway to become more narrow ii. Caused by bacteria (Streptococcus pyogenes, S. pneumoniae, and S. aureus now represent the most common causes of pediatric epiglottitis) [p560] iii. Causes stridor, nasal flaring, and retraction of intercostal spaces iv. Do not lay the patient down b. Asthma- i. Reactive ii. production of IgE antibodies, which coat mast cells causing mast cells to release histamine and prostaglandins iii. Wheezing upon expiration COPD- Emphysema and Chronic Obstructive Bronchitis (Pg 578)(power point) (B.Harris) •Inflammation and fibrosis of the bronchial wall • Hypertrophied mucous glands à excess mucus • Obstructed airflow •Loss of alveolar tissue • Decreased surface area for gas exchange •Loss of elastic lung fibers • Airway collapse, obstructed exhalation, air trapping 1. Emphysema: Enlargement of air spaces and destruction of lung tissue (pink puffer) •Increase respiration to maintain oxygen levels • Dyspnea; increased ventilatory effort • Use accessory muscles; pursed-lip breathing • Neutrophils in the alveoli secrete trypsin. •Increased neutrophil numbers due to inhaled irritants can damage alveoli. •α1-antitrypsin inactivates the trypsin before it can damage the alveoli. •A genetic defect in α1-antitrypsin synthesis leads to alveolar damage. 2. Chronic obstructive bronchitis: Obstruction of small airways (blue bloater) 20 - Cells replicating fast, dysfunctional cells producing at a rapid rate, abnormal WBCs take up space, RBCs can’t be normally produced - Acute myelogenous bone marrow (AML children), CML- philadelphia chromosome - adult Indwelling cath - source of infection - not a good thing yo Never Let Monkeys Eat Bananas SELECT ALL THAT APPLY QUESTIONS: Brooke Hippen, Brianna Jones, Nicole Leonhardt 1. Glaucoma is a chronic, pressure induced degenerative neuropathy that produces changes in the optic nerve and visual field loss. Open-angle glaucoma would be suspected if, in a routine eye exam, the following were found (select all that apply): a. Blurred or iridescent vision b. Abnormal intraocular pressure measurements c. Corneal injury d. Halo’s or glares present around objects in sight e. Optic disc abnormalities Alyssa Pedi, Savannah Franklin, Amanda Moustafa 2. Which of the following are the mediators of inflammation? Select all that apply. (think of the sentence from class: Never Let Monkeys Eat Bananas) A.) Neutrophils B.) Lymphocytes C.) Monocytes D.) Eosinophils E.) Basophils Shannon Sullivan, Collin Mullanaphy, Katie Polsky 3. Which risk factors should a nurse include when conducting a class about erectile dysfunction? (Select all that apply.) a. The client is more than 64 years old. b. The client takes propranolol. c. The client has diabetes mellitus. d. The client uses herbal supplements. e. The client is morbidly obese. Kate Bortz, Alexis Capuano, Stephanie Daniels, Taylor Faraone 21 4. A health care provider is educating a patient with a history of asthma on the ways to prevent upper respiratory infections. Which of these pieces of information are most important to include? Select all that apply. a. “Avoid small children during flu season” b. “Make sure you get the flu shot annually” c. “Avoid sudden changes in temperature” d. “Consider pretreating before activity” e. “You should wash your hands frequently” Rachael Dalrymple, Ally Buccine, Emma Kochel, Bri Harris 5. A physician suspects that a cancer patient may have developed aplastic anemia. The nurse assessing the patient will likely see which of the following symptoms? Select all that apply. A. Complaints of weakness and fatigue B. Vomiting C. Excess bleeding from gums D. Unexplained bruising E. Decreased heart rate Erin Litterer, Irena Zak, Gabrielle Smith, Deanna Vagueiro, Alyssaminna Manongsong, and Kaitlyn Sze 6. Tetralogy of Fallot, the most common cyanotic congenital heart defect, consists of four associated defects. Which of the following are correctly associated with this abnormality? Select all that apply. A. Ventricular septal defect B. Shifting to the right of the aorta and overriding into the right ventricle C. Obstruction/narrowing of the aortic channel D. Hypertrophy of the right ventricle E. Hypertrophy of the left ventricle Kacie; Liz; Caitlyn T. 7. A 62-year-old overweight male patient has been diagnosed with acute pancreatitis after experiencing severe abdominal pain in the left upper quadrant. The nurse needs to explain the diagnosis and disease to the patient. What information will the nurse tell the patient? Select all that apply. 22 a. Acute pancreatitis is reversible with the correct care. b. Autodigestion of the pancreatic tissue occurs with the activation of trypsin. c. The patient may experience hypertension due to the pancreatitis. d. This type of pancreatitis is hereditary. e. The patient must eat fewer fatty foods and lead a healthier lifestyle to reverse the damage. Qiyahra Brown, Alyssia Adorno, Samantha Hoh, Alivia Pitts, & Chidiebube Nwadiogbu 8. You’re explaining to a group of outpatients about the signs and symptoms that may be present in osteoarthritis. Select all the signs and symptoms that may be seen in this condition. A. Bouchard’s nodes B. Swan neck C. Joint soreness D. Heberden’s nodes E. Ulnar drift Justin Tuman, Kyle Gatchalian, Mario Grupico, Matt Quille, Tyler Richards 9. An elderly patient is assigned to a new nurse shows signs of kidney injury. The nurse believes they are experiencing postrenal injury. Which of the following findings would support her thought process (select all that apply): A. Enlarged prostate B. Dysuria C. Ischemia D. Dehydration E. Urinary Tract Infection Olivia, Lisette, Merlyn 10. Which of the following clinical manifestations would you see in SIADH? Select all that apply. A. Water retention B. Hyponatremia C. Edema D. Low serum osmolarity E. Pulmonary retention Kaitlyn Ambrose, Lauren Rosati, Gabriela Sferrazza, Gianna Farese 25 A: The cells will not proliferate and will be replaced with scar tissue. Q: A client with diabetes has impaired sensation, circulation, and oxygenation of his feet. He steps on a piece of glass, the wound does not heal, and the tissue area becomes necrotic. The necrotic cell death is characterized by: A: Cellular breakage Q: An 84-year-old client's blood cultures have come back positive, despite the fact that his oral temperature has remained within normal range. Which of the following phenomena underlies the alterations in fever response that occur in the elderly? A: Disturbance in the functioning of the thermoregulatory center Q: A breast cancer client has just learned that her tumor clinical stage is T3, N2, M0. After the physician leaves, the client asks the nurse to explain this to her again. The nurse will use which of the following statements in his or her answer? Your: A: Tumor is large and at least two lymph nodes are positive for cancer cells. Q: A client has arrived in the emergency department with massive blood loss from a lacerated liver. Knowing the physiological principles behind the capacity for cells to regenerate, the client's body will likely: A: Stimulate rapid proliferation of RBCs by the blood-forming progenitor cells of the bone marrow Q: A client presents for a scheduled Papanicolaou (Pap) smear. The clinician who will interpret the smear will examine cell samples for evidence of: A: Changes in cell shape, size, and organization Q: A diabetic client has injured his foot while walking barefoot on the lawn. On admission, which of the following assessment findings would be considered a localized cardinal sign of acute inflammation? A: Redness and edema at the injured site Q: A client with diabetes and severe peripheral vascular disease has developed signs of dry gangrene on the great toe of one foot. The client asks, “How this can happen?” Which of the following pathophysiologic processes should the nurse explain to this client? “More than likely, your gangrene is caused by: A: Impaired arterial blood supply to your toe.” Q: A nursing student is cleaning and changing the dressing on a client's sacral ulcer. The student has vigorously cleansed the wound bed to remove all traces of the beefy, red tissue that existed in the wound bed. The student has most likely removed: 26 A: Granulation tissue Q: During lecture on wound care, the instructor mentions the final stage of the cellular response of acute inflammation. Of the following statements, which describes what physiologically occurs in the final stage? A: Neutrophils, monocytes, and macrophages engulf and degrade the bacteria/cellular debris. Q: During a lecture on inflammation, the physiology instructor discusses the major cellular components involved in the inflammatory response. The instructor asks, “Which of the following cells arrives early in great numbers?” The student with the correct response is: A: Neutrophils Q: A frail, 87-year-old female client has been admitted to a hospital after a fall and has been diagnosed with failure to thrive. Which of the following laboratory values would suggest that the client may be experiencing malnutrition? A: Low prealbumin Q: While assessing a teenage girl suspected of having bulimia nervosa, the health care provider may find which of the following clinical manifestations that would confirm the diagnosis? Select all that apply A: Large number of teeth with dental caries A: Eroded tooth enamel leading to sensitive teeth A: painless parotid gland enlargement Q: Which of the following assessments should be prioritized in the care of a client who is being treated for a serum potassium level of 2.7 mEq/L? A: Cardiac monitoring looking for prolonged PR interval and flattening of the T wave Q: Hypoparathyroidism causes hypocalcemia by: A: Blocking release of calcium from bone Q: A client with a diagnosis of liver cirrhosis secondary to alcohol abuse has a distended abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which of the following pathophysiologic processes contributes to this third spacing? A: Abnormal increase in transcellular fluid volume Q: In addition to facilitating bowel movements, a diet that is high in fiber confers which of the following benefits? A: Lowering cholesterol and blood glucose Q: Of the following clients, which would be at highest risk for developing hyperkalemia? 27 A: A male admitted for acute renal failure following a drug overdose Q: Which of the following scenarios place the client at a high risk for developing hypoparathyroidism and require close supervision for assessing for development of muscle cramps, carpopedal spasm, convulsions, and paresthesia in the hands and feet? Select all that apply. A: A neck cancer client returning from OR after having a radical neck dissection A: hyperthyroid client experiencing a “thyroid storm” requiring urgent thyroidectomy Q: As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased: A: Bicarbonate/carbonic acid regulation Q: From the following list of physical assessment results, which would be interpreted as the client has developed obesity? A: Body mass index (BMI) of 40 Q: A client is experiencing significant stress while awaiting the results of her recent lymph node biopsy. Among the hormonal contributors to this response is a release of aldosterone, resulting in which of the following physiologic effects? A: Increased sodium absorption Q: The most reliable method for measuring body water or fluid volume increase is by assessing: A: Body weight change Q: When educating students about the differences between brown fat versus white fat, the instructor will share that brown fat has iron in its mitochondria that will facilitate: A: Production of a protein that releases the energy generated from metabolism as heat Q:A female client experienced a random assault several months earlier, and her recent vigilance around her own safety is described as “obsessive” by her friends and family. Which of the following aspects of posttraumatic stress disorder (PTSD) characterizes the client's behavior? A: Hyperarousal Q: The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by: A: Low serum sodium level of 122 mEq/L Q: A female client with a history of chronic renal failure has a total serum calcium level of 7.9 mg/dL. While performing an assessment, the nurse should focus on which of the following clinical manifestations associated with this calcium level? A: Intermittent muscle spasms and complaints of numbness around her mouth 30 Q: The 16-year-old boy has enlarged lymph nodes and a sore throat. His girlfriend was recently diagnosed with infectious mononucleosis. While educating this teenager, the nurse emphasizes that infectious mononucleosis is caused by which pathogen and usually transmitted via: A: Epstein-Barr virus; saliva Q: During a client's admission assessment prior to reduction mammoplasty surgery, the nurse notes a reference to a Leiden mutation in the client's history. The nurse assesses this client for an increased risk of developing which of the following postsurgical complications? A: Deep vein thrombosis Q: A 23-year-old female client has been diagnosed with von Willebrand disease following a long history of “heavy periods” and occasional nosebleeds. Which of the client's following statements demonstrates a sound understanding of her new diagnosis? A: “I'll make sure to take Tylenol instead of aspirin when I get aches and pains.” Q: The client is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which of the following complete blood count (CBC) results is characteristic of her type of anemia? A: Hemoglobin 8 g/dL Q: When an Rh-negative mother has been sensitized and is pregnant with an Rh-positive fetus, what happens to the fetus? A: Profound red cell hemolysis Q: The client is undergoing diagnostic workup for possible Hodgkin type of lymphoma. Which of the following laboratory results would confirm the diagnosis of Hodgkin lymphoma? A: Reed-Sternberg cells Q:A 48-year-old male client, who normally enjoys good health, has been admitted to the hospital for the treatment of polycythemia vera. The nurse who is providing care for the client should prioritize assessments aimed at the early identification of which of the following health problems? A: Thromboembolism Q:A client has been diagnosed with non-Hodgkin lymphoma (NHL), a form of malignancy that most likely originated in which of the following sites? A: Lymph nodes Q: Hemolytic anemia is characterized by excessive red blood cell destruction and compensatory: A: Increased erythropoiesis Q: The pathologic effects of the thalassemias are primarily due to which of the following pathophysiologic processes? 31 A: Impaired hemoglobin synthesis Q:A 72-year-old woman with complaints of increasing fatigue has completed a series of fecal occult blood tests that indicate the presence of blood in her stool. Which of the following health problems is likely to accompany this client's gastrointestinal bleed? A: Iron deficiency anemia Q: In immune thrombocytopenia purpura (ITP), the client has what type of disorder that primarily destroys which blood component? A: Autoimmune; platelets EXAM 2 QUIZZES Q: A heart failure client has an echocardiogram performed revealing an ejection fraction (EF) of 40%. The nurse knows this EF is below normal and explains to the client: A: “This means your heart is not pumping as much blood out of the heart with each beat.” Q: Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to “an enlarged heart.” Which of the following disorders was the player's most likely cause of death? A: Hypertrophic cardiomyopathy (HCM) Q: Which of the following clients should most likely be assessed for orthostatic hypotension? A: An 80-year-old elderly client who has experienced two falls since admission while attempting to ambulate to the bathroom Q: Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the following consequences? A: Backflow from the left ventricle to the left atrium Q: Which of the following is a non-modifiable risk factor for the development of primary hypertension? A: African American race Q: Which of the following clients would be at high risk for developing primary varicose veins? Select all that apply. A: A 47-year-old waitress who works 12-hour shifts three or four times/week A: A morbidly obese (>100 pounds overweight) male who works behind the counter of a convenience store 10 hours/day, 5 days/week 32 Q: Upon admission assessment, the nurse hears a murmur located at the fifth intercostal space, midclavicular line. The client asks, “What does that mean?” The nurse will base her answer on which of the following physiologic principles? A: “You have a heart valve that is diseased.” Q: While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes? A: Peripheral vascular resistance Q: The most important complication of atherosclerosis that may cause occlusion of small heart vessels is: A: Thrombosis Q: When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents: A: The amount of blood the heart pumps each minute Q: If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern? A: Slowing of heart rate to below 60 beats/minute Q: The most common causes of left-sided heart failure include: A: Acute myocardial infarction Q: The client is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the mid calf area. He has many of the manifestations of: A: Deep vein thrombosis Q: One of the principal mechanisms by which the heart compensates for increased workload is: A: Myocardial hypertrophy Q: A father experienced the onset of chest pain and dies suddenly. The family asks, “What caused him to die so suddenly?” The health care provider's reply that is most appropriate would be, “There's a high probability that your loved one developed an acute heart attack and experienced: A: Acute ventricular arrhythmia. Q: A male client with a history of angina has presented to the emergency department with uncharacteristic chest pain, and his subsequent ECG reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle? 35 - Perfusion without ventilation Q: The pathogenic capacity of the tubercle bacillus is related to: A: The initiation of a cell-mediated immune response Q: As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to: A: Pulmonary hypertension Q: A mother rushes her toddler into the emergency department stating, “My baby can't breathe.” Initial assessment reveals the child is struggling to breathe in an upright position. He has both inspiratory and expiratory stridor and is using his chest muscles to breathe. The nurse suspects the child has which of the following acute respiratory infections? A: Epiglottitis Q: The respiratory drive in patients with chronic obstructive pulmonary disease can be diminished when administering oxygen to them. A: True Q: Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma? A. Pet dander Blue Bloaters is an acronym for patients with emphysema. False Difficulty breathing is dyspnea True While taking a history from an adult client newly diagnosed with renal cell cancer, the nurse can associate which of the following high-risk factors with development of this cancer? A: Heavy smoking If a CKD client is developing uremic encephalopathy, the earliest manifestations may include: Select all that apply. A: Decreased alertness A: Decreased awareness A drug abuser was found unconscious after shooting up heroin 2 days prior. Because of the pressure placed on the hip and arm, the client has developed rhabdomyolysis. The nurse knows this can: 36 A: Obstruct the renal tubules with myoglobin and damage tubular cells An adult client has been diagnosed with polycystic kidney disease. Which of the following statements demonstrates an accurate understanding of this diagnosis? A: “I suppose I should be tested to see if my children might inherit this.” A female teenager has experienced three uncomplicated urinary tract infections in the last 3 months. Knowing the anatomical location of the urethra, the nurse should educate this teenager about: A: Wiping from front to back to prevent Escherichia coli contamination of the urethra Which of the following assessment findings would lead the nurse to suspect the client has nephrotic syndrome? A: Proteinuria and generalized edema The nurse is providing care for a client who has a diagnosis of kidney failure. Which of the following laboratory findings is consistent with this client's diagnosis? A: Hypocalcemia A child is recovering from a bout with group A β-hemolytic Streptococcus infection. They return to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed: A: Acute postinfectious glomerulonephritis A neighbor is complaining to a friend (who happens to be a nurse) about several changes in their body. Which of the following complaints raises a “red flag” because it could be a sign of epithelial cell bladder cancer? A: “I noticed my urine is pinkish red, but I'm not having any pain when I pee.” Many factors contribute to the incontinence that is common among the elderly. A major factor is increased: A: Use of multiple medications A female client asks, “Why do I leak urine every time I cough or sneeze?” The health care worker's response is based on which physiologic principle? A: When intravesical pressure exceeds maximal urethral closure pressure A client is beginning to recover from acute tubular necrosis. The nurse would likely be assessing which of the following manifestations of the recovery phase of ATN? A: Diuresis 37 A client has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which of the following measures should the client integrate into his lifestyle to reduce the risk of recurrence? A: Increased fluid intake and dietary changes The most recent assessment of a client with a diagnosis of type 1 diabetes indicates a heightened risk of diabetic nephropathy. Which of the following assessment findings is most suggestive of this increased risk? A: Microalbuminuria In anatomy class, the instructor asks, “Explain how urine is expelled from the bladder during voiding.” The student with the most accurate response would be: A: “The detrusor muscle contract down on the urine and the ureteral orifices are forced shut. The external sphincter relaxes as urine moves out of the bladder.” A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse what diffuse means. The nurse responds: A: All glomeruli and all parts of the glomeruli are involved. Glomerulonephritis is usually caused by: A: Antigen–antibody complexes Which of the following individuals likely faces the greatest risk for the development of chronic kidney disease? A: A client with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet A public health nurse is conducting a health promotion class for a group of older adults. Which of the participants' following statements demonstrates an accurate understanding of the risk factors for bladder cancer? A: “More than ever, I guess it would worthwhile for me to quit smoking.” A client had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased, and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute: A: Tubular necrosis EXAM 3 QUIZZES Q: The immunosuppressive and anti-inflammatory effects of cortisol cause: A: Inhibition of prostaglandin synthesis