Download NURS 5315 Final Exam Questions with Complete Solution and more Exams Nursing in PDF only on Docsity!
1 / 21
NURS 5315 Final Exam Questions with
Complete Solution
1. A patient in respiratory distress and is breathing 33 breaths per minute. Which ABG value is consistent
with the clinical scenario? PCO2 15 pH 7. pH 7. O2 sat 100%: A patient who is breathing 33 breaths per minute is hyperventilating and blowing ott CO2; therefore the PCO2 level will be low. The patient will most likely experience a respiratory alkalosis and the two pH values provided are not consistent with this diagnosis.
2. A patient has a sodium level of 115 mEq/L and is disoriented and lethargic. Which pathological process best
explains this patient's symptoms?
a. The action potential has become hyperpolarized.
b. Water has shifted into the neurons and caused them to swell.
c. Water has shifted into the vascular space and dehydrated the neurons.
d. The action potential has become hypopolarized.: b. The cause of neurologic symptoms associated with a sodium imbalance is directly related
to fluid shifting into or out of the neurons of the brain. With a serum sodium of 115 mEq/L, water shifts into the neurons and causes them to swell. Hypernatremia causes water to shift out of the cell into the intravascular space and causes the neurons to become dehydrated. An alteration in the action potential is not seen with sodium imbalances.
3. A patient experiencing dehydration should be monitored for which elec- trolyte imbalance?
a. Hyperkalemia
2 / 21
b. Hypocalcemia
c. Hypercalcemia
d. Hyponatermia: a. Serum osmolality is increased during times of dehydration. An elevated serum osmolality will pull potassium into the intravascular space
from the intracellular space and cause a rise in serum potassium.
4. A married couple presents to your office for genetic counseling. The husband has an autosomal recessive
disease and his wife has a heterozygous genotype for the disease. They ask you, What is the chance that our baby will have the disease? Which of the following answers is correct? 25% 50% 75% 100%: A chromosome is a package of material located inside the cell nucleus which is made of proteins and a single molecule of DNA. There are 23 pairs of chromosomes in each human cell for a total of 46 chromosomes. Chromosomes are separated into two identical sets during mitosis or meiosis. This provides a set of chromosomes to each daughter cell which results from cell division. This process is responsible for the transfer of genetic information to the daughter cells. The first 22 pairs of chromosomes are known as autosomes. The 23rd pair of chromosomes is the pair which contains the genetic information for gender. This pair contains the genetic information which delineates between the male and female genders. Females have two X chromosomes (XX) and males have an XY chromosome pair. Autosomal chromosomes are said to be autologous. This means they do not carry genetic information pertaining to gender. Autosomal genetic diseases are carried on the first 22 pairs of chromosomes. Sex-linked diseases are only carried on the 23rd pair of chromosomes. The autosomal chromosomes are nearly identical to one another and are considered homologous to one another. Each autosomal chromosome in a pair carries identical genes. These two genes are known as alleles. The alleles occupy the same site on each partner of the chromosome pair and code for the same genetic trait or physiologic function. Alleles can be dominant or recessive. One allele may be dominant and the other recessive, or they both may be dominant or both recessive. The dominant alleles' genetic code will always manifest in the individual's phenotype. The information in the recessive allele is typically not expressed in the phenotype unless both alleles are recessive. For the purpose of
4 / 21 Increased secretion of renin. Increase secretion of natriuretic peptides. Decreased secretion of antidiuretic hormone. Decreased serum osmolality.: Dehydration will trigger the release of renin when renal perfusion is impaired. The other answers are seen during times of fluid volume overload.
7. A patient on hydrochlorothiazide has a pH of 7.49 and a bicarbonate of 30. Which of the following
pathological processes best explains the abnormal lab values?
a. An accumulation of pancreatic bicarbonate secondary to vomiting and loss of hydrochloric acid
b. An increased absorption of Na+ and HCO3- in the proximal renal tubule secondary to increased
aldosterone secretion c Excessive exhalation of CO2 secondary to hyperventilation d. Distal renal tubular dysfunction causing an accumulation of hydrogen ions- : The pH value and bicarbonate value are consistent with a metabolic alkalosis. The most likely cause of the metabolic alkalosis is the use of the hydrochlorothiazide (HCTZ). This is a thiazide diuretic which can cause a metabolic alkalosis. The use of a thiazide diuretic will increase the secretion of aldosterone which stimulates the reabsorption of Na+ and HCO3- in the proximal tubule of the kidney. This is a response directly related to hypovolemia secondary to the diuretic use. Option A occurs as a result of excessive vomiting. Vomiting does cause a metabolic alkalosis but there is nothing in the question to suggest that the patient has been vomiting. Option C would result in a respiratory alkalosis, not a metabolic alkalosis. Option D would cause a metabolic acidosis (not a metabolic alkalosis) secondary to a renal tubular dysfunction known as Renal Tubular Acidosis (RTA).
8. Which patient may experience a decrease in oncotic pressure?
A patient with cirrhosis.
5 / 21 A patient with dehydration. A patient with heart failure. A patient on dialysis.: Oncotic pressure is a function of plasma proteins. The main plasma protein responsible for oncotic pressure is albumin. In cirrhosis, the liver is unable to produce enough plasma proteins to maintain the oncotic pressure and therefore it decreases. A dehydrated patient may experience a low hydrostatic pressure and the other two patients may experience a high hydrostatic pressure secondary to volume overload.
9. The nurse practitioner notes that a patient has a pH of 7.25 and a bicarbonate of 10. Which of following
laboratory tests is most important for the nurse practitioner to review? sodium magnesium potassium creatinine: The pH and bicarbonate in this question are consistent with a metabolic acidosis. The nurse practitioner should review the potassium level. Hyperkalemia is a common electrolyte imbalance seen in a metabolic acidosis. During a metabolic acidosis, hydrogen (a positive ion) shifts into the intracellular space. In order to maintain the ionic balance, potassium (a positive ion) shifts to the extracellular space and results in a hyperkalemia. None of the other labs are attected by a metabolic acidosis.
10. A patient is noted to have a high anion gap metabolic acidosis. Which of the following is the most
likely etiology of the acidosis? CO2 retention Ethanol ingestion Vomiting Diuretic use: The elevated anion gap in the setting of a metabolic acidosis is consistent with ethanol ingestion. CO2 retention results in an altered mental status and a respiratory acidosis not a metabolic acidosis. Diuretic use and vomiting may cause a metabolic alkalosis.
11. A child is diagnosed with osteogenic sarcoma. From which tissue did the cancer originate?
A connective B epithelial
7 / 21 cells present in the tissue is more than normal. This is seen in benign prostatic hyperplasia. Dysplasia is an erratic arrangement in the cell's organization, sizes, and shape in a tissue. This is a pre-cancerous state seen in cervical dysplasia.
14. A patient with a long-standing history of GERD is at greater risk of which cellular adaptation
pattern?
a. Esophageal hypertrophy
b. Esophageal metaplasia
c. Esophageal atrophy
d. Esophageal dysplasia: ANS: B
Long-standing GERD predisposed the esophageal cells to undergo a metaplasia. In esophageal metaplasia the normal esophageal squamous epithelial cells are replaced by intestinal-like columnar cells under the influence of the refluxed gastric acid. The columnar cells are better equipped to handle the refluxed hydrochloric acid. It is pre-cancerous condition. None of the other adaptation patterns are pertinent.
15. A 50-year-old male is diagnosed with primary lung adenocarcinoma. From which tissue did this
cancer originate?
a. Glandular epithelial
b. Deep Connective Tissue
c. Superficial connective
d. Muscle tissue: ANS: A
The prefix "adeno" refers to epithelial tissue. There is no special designation for cancers which originate in deep or superficial connective tissues. The prefix "myo" is used to denoted cancers which originate from the muscle.
8 / 21
16. Which pathological process is caused by hypoxic cellular injury?
a. Increased anabolism metabolism
b. Increased aerobic metabolism
c. Increased catabolic metabolism
d. Impaired protein synthesis: ANS: D
Impaired protein synthesis is the only correct answer. Anabolic, aerobic, & catabolic metabolism are all decreased by hypoxic injury.
17. A patient with a potassium of 2.0 complains of muscle weakness. Which explanation below best
describes the reason for the complaint?
a. A hyperpolarization of the intracellular environment has made it more diffi- cult for the cell to depolarize.
b. A more positive threshold potential has delayed the action potential.
c. A progressive cellular depolarization has made the cells more excitable.
d. The cells are hyperpolarized and are more excitable.: ANS: A
A hyperpolarization of the intracellular environment has made it more diflcult for the cell to depolarize is the only correct answer. This is what happens in hypokalemia. A more positive threshold potential delays the action potential and is seen on hypercalcemia. A progressive cellular depolarization occurs in hypocalcemia & cells are hypo polarized in hyperkalemia.
18. A female patient with a new diagnosis of ovarian cancer should be evaluated for metastasis to which
organ?
10 / 21 Patients who abuse ETOH have many nutritional deficiencies, some of which include B vitamins, folic acid, and phosphate. Therefore they should receive thiamine supplementation.
21. 1. A patient with chronically uncontrolled hypertension should be screened for which cellular
adaptative pattern?
a. Ventricular hypertrophy
b. Renal dysplasia
c. Ventricular hyperplasia
d. Cardiac Atrophy: ANS: A
Left ventricular hypertrophy occurs secondary to hypertension cardiac cells do not undergo hyperplasia or atrophy. Renal dysplasia does not occur.
22. Which disorder results from an anamnestic immune response? Hemolytic Anemia of
the New Born Measles Mumps Rheumatoid Arthritis: Hemolytic anemia of the newborn results from an secondary immune response mounted by the mother. An infection with measles or mumps triggers a primary immune response and RA is an autoimmune condition.
23. The nurse practitioner is seeing a new patient with a history of HIV for three years. The patient reports
a history of pneumocystis jiroveci pneumonia (PCP) three years ago. His labs show a CD4 count of 500 and a viral load of 25,000. Which of the following diagnoses should the NP assign the patient? AIDS HIV infection PCP HIV related syndrome: The most appropriate diagnosis is AIDS. AIDS is defined by the presence of HIV and either a history of an opportunistic infection or the presence of
11 / 21 a current opportunistic infection. PCP is an opportunistic infection and a history of it changes the diagnosis from HIV positive to AIDS. An individual with HIV infection can also meet the criteria for an AIDS diagnosis if their CD4 count drops below 200 even if it is a temporary drop. The patient is not currently experiencing PCP so this is not an appropriate diagnosis. If the patient did not have a history of PCP then HIV infection would be an appropriate diagnosis. HIV related syndrome is a false diagnosis.
24. A patient in the ED is given an IV antibiotic to treat an acute infection. Fifteen minutes after receiving
the antibiotic the patient is short of breath, has hives and swollen eyes. Which process best describes the immune response in this scenario? An IgE mediated immune reaction. An immune response is trigged by an antigen/antibody complex made of IgM and IgG antibodies. Autoantibodies attack cellular nuclear material. A T-cell mediated immune response.: The condition this patient is experiencing is an acute allergic reaction which is an IgE mediated response.
25. A patient with a cough, fever and fatigue is diagnosed with influenza. Which of the following is the
best explanation for the patient s symptoms? A systemic viremia Release of cytokines Release of acute phase reactants Release of bradykinin: The patient's symptoms are directly related to the inflammatory response which has been triggered by the influenza infection. The release of cytokines are responsible for the symptoms experienced by patients infected with influenza. Influenza is not a systemic infection and remains isolated to the pulmonary cells; therefore, a viremia does not occur when a person has influenza. Acute phase reactants include ferritin, platelets, coagulation proteins, c-reactive protein, complement proteins and are released during times of inflammation but are not responsible for the symptoms. Bradykinin is released during times of inflammation and causes pain. The patient is not experiencing any pain.
13 / 21 Cytomegalovirus infection: Pneumocystis Jiroveci Pneumonia is the most common OI to occurs in AIDS patients with a CD4 count less than 200. CAP is not an opportunistic infection.
29. A patient has had active Crohn disease for 1 month. Which abnormality is most consistent with
this scenario? Increased IL-13 levels Decreased IL- levels Activation of H2 receptors Decreased platelet counts: IL-4 is released in acute inflammation and IL-13 is released later in the inflammatory process. Platelets are increased during inflammatory episodes and the activation of H2 receptors has anti-inflammatory properties.
30. Which patient requires treatment with antibiotics for a prolonged period of time?
A patient with mycobacterium avium complex. A patient with community acquired MRSA. A patient with oral candidiasis. A patient with measles.: Mycobacterium avium complex is caused by an acid fast bacilli. These bacteria have extremely thick cell walls which inhibits nutrients or antibiotics from entering the cell easily; therefore, this patient requires a prolonged course of antibiotics to ettectively treat this condition. Oral candidiasis is a fungal infection, measles is a viral infection and neither are treated with antibiotics. MRSA does not necessary require long term treatment with antibiotics.
31. Diapedesis is an essential function of which cell?
White Blood Cells Platelets
14 / 21 Red Blood Cells Epithelial cells: Diapedesis is the term used to describe the adherence of white blood cells to the vascular wall and their crossing over to the site of injury.
32. A 64-year-old male patient presents to your office with a complaint of in- termittent fevers, weight
loss, and profuse night sweats. On examination he has an enlarged mass on the right side of his neck. Which of the following pathological processes best explains the clinical manifestations? Malignant transformation of lymphocytes to Reed Sternberg cells Malignant transformation of B-cells which infiltrate the bone marrow, bone and other soft tissues Uncontrolled proliferation of malignant leukocytes which blocks the growth of healthy blood cells Antigen antibody complexes bind to the Fc receptors on platelets which leads to their destruction in the spleen.: The clinical scenario is consistent with Hodgkin's Lymphoma. Option A is the only answer which describes the pathological process of the Hodgkin's Lymphoma. Option B describes the pathological process for multiple myeloma. Option C is the pathological basis of leukemias. Option D describes the pathological process for immune thrombocytopenic purpura (ITP).
33. Which of the following intravenous fluids would be best to order to help reverse the sickling process
associated with sickle cell anemia during an acute vaso-occlusive crisis? 0.45% normal saline 0.9% normal saline 3% normal saline D5 normal saline (D5NS): The best fluid to order in a patient with sickle cell disease who is experiencing an acute vaso-occlusive crisis is a hypotonic solution. Hypotonic solutions will cause fluid to move into the intracellular space i.e. the red blood cell. This will cause the red blood cells to swell and thereby reverse the sickling. Option B is an isotonic fluid which will remain mainly in the intravascular space. Options C and D are both hypertonic solutions which will draw fluid out of the cells into the
16 / 21 coagulopathy. A protein C deficiency causes a hypercoagulable state.
38. A male patient presents to the emergency department with a complaint of acute, left elbow
progressive pain and swelling. An x-ray completed of the elbow was concerning for hemarthrosis. Which of the following lab values would be the most important for the nurse practitioner to order? Platelet count White blood count Prothrombin time Hemoglobin: A coagulopathy is a dysfunction in either the intrinsic or extrinsic clotting cascade which prevents hemostasis. The clotting cascade is independent of the platelet plug formation and individuals with a coagulopathy may have normal platelet production and function. The clinical picture is consistent with a coagulopathy and not a platelet disorder. Individuals with a coagulopathy tend to bleed into the joints and persons with thrombocytopenia or platelet dysfunction tend to experience mucosal bleeds. While a platelet count is reasonable the question ask which lab would be the most important to order. In this instance the prothrombin time is the most important to order. The prothrombin time will identify a disorder in the clotting cascade and the clinical scenario is consistent with a coagulopathy. A white blood cell count may be helpful to rule out an infected joint but given the clinical scenario it is not the most important lab to order. Again a hemoglobin will be helpful to determine the extent of the bleeding but what is most important at this point is to determine the etiology. The prothrombin time will help isolate the etiology which will help the nurse practitioner determine the appropriate treatment.
39. A 70-year-old female client presents to your office with a three week history of numbness and tingling
in her bilateral, lower extremities. The sensation has progressively gotten worse and she complains of fatigue. The CBC shows a hemoglobin of 8mg/dl and a hematocrit of 24%. Which of the following findings would the nurse practitioner likely observe when examining the patient? Koilonychia Positive stool guaiac Jaundice Smooth, beefy, red tongue: The clinical scenario is consistent with a pernicious anemia which is secondary to a B12 deficiency. The only clinical manifestation listed in the choices that is consistent with a B12 deficiency is option D. Koilonychia is a spooning of the nail beds and is seen in iron deficiency anemia. A positive stool for guaiac may be present in an iron deficiency anemia and could be a sign of
17 / 21 colon cancer. Jaundice would be present in a hemolytic anemia such as sickle cell anemia.
40. A 70-year-old female patient presents to your office with a three week history of numbness and
tingling in her bilateral, lower extremities. The sensation has progressively gotten worse and she complains of fatigue. The CBC shows a hemoglobin of 8mg/dl and a hematocrit of 24%. Which of the following treatments will the nurse practitioner likely order? Vitamin K Vitamin B12 Iron Folic Acid: The clinical scenario is consistent with a pernicious anemia which is secondary to a B12 deficiency. The human body stores approximately 10 years of vitamin B12 and therefore this anemia tends to present more commonly in the elderly. Other individuals at risk for B12 deficiency include alcoholics, vegans, those with a gastrectomy, inflammatory bowel disease, and persons who have had a surgical resection of the ileum. The ileum is the site of absorption of B12. Vitamin K is used to reverse the ettects of warfarin and not to treat anemia. Iron is used to treat iron deficiency anemia. Folic acid is used to treat an anemia secondary to folic acid deficiency.
41. A woman of childbearing age is most likely to experience which type of anemia?
Iron Deficiency Anemia Pernicious Anemia Anemia of Chronic Disease Folate Deficiency Anemia: A women of childbearing age often has iron deficiency anemia secondary to their menses. Remember blood loss is the most common reason for iron deficiency anemia.
42. A 72-year-old male patient with a history of diabetes mellitus type 2 and systolic heart failure. He
has never been diagnosed with hypertension and his physical exam is normal. What is the most likely cause of his heart failure? Infiltrative Coronary Artery Disease Valvular Disease Infectious The most likely cause of this patient's heart failure is chronic ischemic changes secondary to coronary artery
19 / 21
46. A 74-year-old female presents to the emergency department after having a syncopal episode. On
examination the patient is noted to have a systolic murmur at the second intercostal space, right of the sternal border which radiates to the neck. Which of the following is the most likely cause of the syncope? Aortic Stenosis Aortic Regurgitation Mitral Regurgitation Angina: The clinical scenario is consistent with an aortic stenosis. Aortic stenosis is more common in females and the elderly. An aortic stenosis causes a decrease in cerebral perfusion which may result in syncope. Systolic murmurs, heard at the second intercostal space right of the sternal border which radiate to the neck originate from the aortic valve. Systolic murmurs which radiate to the axilla originate from the mitral valve. A valve which has regurgitation allows some blood to flow back through the valve during the cardiac cycle. Perfusion is not typically an issue with valvular regurgitation. There is no mention of chest pain; therefore, the syncope is not related to angina.
47. A 56-year-old male presents to the ED with a complaint of chest pain. He has no prior medical history.
One exam he has a holosystolic murmur with an S3 heart sound. Troponin levels are elevated. Which pathological condition best explains the clinical manifestations? Papillary muscle rupture secondary to cardiac infarction. Growth of vegetation on the aortic valve. Myocardial injury from the immune/inflammatory response associated with rheumatic fever. A connective tissue disorder has progressed to cause an aortic regurgitation.- : The clinical manifestations are consistent with an acute coronary syndrome which has resulted in a papillary muscle rupture. The papillary muscle rupture presents with an acute onset of a holosystolic murmur and S3 sound.
48. A patient presents to the emergency department with shortness of breath. An echocardiogram shows
a restrictive filling pattern of the left ventricle. Which of the following diagnoses is correct?
20 / 21 Coronary Artery Disease Diastolic Heart Failure Acute Respiratory Failure Dilated Cardiomyopathy: An echocardiogram is only used to diagnose structural defects of the heart. A restrictive filling pattern or impaired relaxation of a ventricle is consistent with a diastolic heart failure. Coronary artery disease is not diagnosed using an echocardiogram; however, visible structural changes may suggest acute or chronic ischemia, but further testing is warranted to make the diagnosis. A dilated ventricle is visible on an echocardiogram in a dilated cardiomyopathy.
49. At which age, after birth, is pulmonary resistance equal to that of an adult? 4 weeks
8 weeks 6 months 1.5 years: At 2 months of age pulmonary resistance is equal to that of an adult.
50. A 76-year-old female is admitted to the hospital with a complaint of syncope. Diagnostic evaluation
reveals that she has an atrial fibrillation with a heart rate of 160. Which statement below best explains the reason why this patient had a syncopal episode. A decrease in cardiac output caused a decrease in cerebral perfusion. A cardiac embolus temporarily blocked cerebral perfusion. A stenotic aortic valve resulted in a decrease in cerebral perfusion. She stood up to fast and experienced an orthostatic hypotensive episode.: Atrial fibrillation results in a loss of the atrial kick which supplies 20% of the cardiac output. There was indeed decreased perfusion to the brain but it was due to a low cardiac output secondary to the atrial fibrillation. The question does not give any information in it to suggest that the patient experienced an orthostatic hypotensive episode.
51. An 84-year-old female patient with a history of severe aortic stenosis is going to surgery tomorrow for a
