Download Porth’s Essentials of Pathophysiology 5th Edition Test bank and more Exams Pathophysiology in PDF only on Docsity! Porth’s Essentials of Pathophysiology 5th Edition Test Bank 1. While attending an international nursing conference, many discussions and break-out sessions focused on the World Health Organization's (WHO) views on health. Of the following comments made by nurses during a discussion session, which statements would be considered a good representation of the WHO definition? Select all that apply. A. Interests in keeping the older adult population engaged in such activities as book reviews and word games during social time B. Increase in the number of chair aerobics classes provided in the skilled care facilities C. Interventions geared toward keeping the older adult population diagnosed with diabetes mellitus under tight blood glucose control by providing in-home cooking classes D. Providing transportation for renal dialysis clients to and from their hemodialysis sessions E. Providing handwashing teaching sessions to a group of young children Answer: A, B, C, E Rationale: WHO definition of health is defined as "a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity." Engaging in book reviews facilitates mental and social well-being; chair aerobics helps facilitate physical well-being; and assisting with tight control of diabetes helps with facilitating physical well-being (even though the person has a chronic disease). Handwashing is vital in the prevention of disease and spread of germs. Question format: Multiple Select CHAPTER 1 Concepts of Health and Disease Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 2 2. A community health nurse is teaching a group of recent graduates about the large variety of factors that influence an individual's health or lack thereof. The nurse is referring to the Healthy People 2020 report from the U.S. Department of Health and Human Services as a teaching example. Of the following aspects discussed, which would be considered a determinant of health that is outside the focus of this report? A. The client has a diverse background by being of Asian and Native American/First Nation descent and practices various alternative therapies to minimize effects of stress. B. The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime. C. The client has a good career with exceptional preventive health care benefits. D. The client lives in an affluent, clean, suburban community with access to many health care facilities. Answer: B surgery. As Parkinson disease progresses, the ability to walk independently is expected to decrease. This is a normal progression for people diagnosed with Parkinson disease. Loss of short-term memory in a client diagnosed with Alzheimer disease is an expected finding. Question format: Multiple Select Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 3 7. Laboratory testing is ordered for a male client during a clinic visit for routine follow-up assessment of hypertension. When interpreting lab values, the nurse knows: A. a normal value represents the test results that fall within the bell curve. B. if the lab result is above the 50% distribution, the result is considered elevated. C. all lab values are adjusted for gender and weight. D. if the result of a very sensitive test is negative, that does not mean the person is disease free. Answer: A Rationale: What is termed a normal value for a laboratory test is established statistically from results obtained from a selected sample of people. A normal value represents the test results that fall within the bell curve or the 95% distribution. Some lab values (like hemoglobin) are adjusted for gender, other comorbidities, or age. If the result of a very sensitive test is negative, it tells us the person does not have the disease and the disease has been ruled out or excluded. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 1 8. The laboratory technologists are a discussing a new blood test that helps establish a differential diagnosis between shortness of breath with a cardiac etiology and shortness of breath with a respiratory/pulmonary etiology. A positive result is purported to indicate a cardiac etiology. The marketers of the test report that 99.8% of clients who have confirmed cardiac etiologies test positive in the test. However, 1.3% of clients who do not have cardiac etiologies for their shortness of breath also test positive. Which statement best characterizes this blood test? A. Low validity; high reliability B. High sensitivity, low specificity C. High specificity; low reliability D. High sensitivity; low reliability Answer: B Rationale: A large number of clients would receive the correct positive diagnosis (high sensitivity), while a significant number would receive a false-positive diagnosis (low specificity). The information given does not indicate low reliability or low validity. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 4 9. As part of a screening program for prostate cancer, men at a senior citizens center are having their blood levels of prostate-specific antigen (PSA) measured. Which statement would best characterize high positive predictive value but low negative predictive value for this screening test? A. All of the men who had high PSA levels developed prostate cancer; several men who had low PSA levels also developed prostate cancer. B. All of the men who had low PSA levels were cancer-free; several men who had high levels also remained free of prostate cancer. C. Men who had low PSA levels also displayed false positive results for prostate cancer; men with high levels were often falsely diagnosed with prostate cancer. D. The test displayed low sensitivity but high specificity. Answer: A Rationale: The test's inability to rule out cancer with a low PSA level indicates low negative predictive value. The answer "All of the men who had low PSA levels were cancer-free; several men who had high levels also remained free of prostate cancer" suggests high negative predictive value. The answer "Men who had low PSA levels also displayed false positive results for prostate cancer; men with high levels were often falsely diagnosed with prostate cancer" indicates low positive predictive value. High positive predictive value is associated with high sensitivity. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 5 10. A male international business traveler has returned from a trip to Indonesia. While there, he hired a prostitute for companionship and engaged in unprotected sex on more than one occasion. Unbeknownst to him, this prostitute harbored the hepatitis C virus. Upon return to the U.S., he exhibited no symptoms and returned to his usual activities. During this period of no outward symptoms, the disease would be classified as being in: A. the preclinical stage of disease. B. remission and unlikely to develop hepatitis C. C. the clinical disease stage of hepatitis C. D. the chronic phase of hepatitis C. Answer: A Rationale: During the preclinical stage, the disease is not clinically evident but is destined to progress to clinical disease. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 5 11. As of Nov. 1, 2012, there were a total of 10 confirmed cases of hantavirus infection in people who were recent visitors (mid-June to end of August, 2012) to Yosemite National Park. Three visitors with confirmed cases died. Health officials believe that 9 out of the 10 cases of hantavirus were exposed while staying in Curry Village in the Signature Tent Cabins. This is an example of: A. what the anticipated mortality rate would be if a family of five were planning to vacation in Yosemite National Park. B. the prevalence of hantavirus one can anticipate if he or she is going to vacation in Yosemite National Park. C. the low rate of morbidity one can expect while traveling to Yosemite National Park. D. the incidence of people who are at risk for developing hantavirus while staying in Yosemite National Park. Answer: D Rationale: The incidence reflects the number of new cases arising in a population at risk during a specified time. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 6 12. A particular disease has a debilitating effect on the ability of sufferers to perform their activities of daily living, and is a significant cause of decreased quality of life. However, few people die as a result of the disease's direct effects. There are hundreds of thousands of Americans living with the disease but relatively few new cases in recent years. Which statement best conveys an accurate epidemiologic characterization of the disease? A. Low mortality; high morbidity; low prevalence; high incidence. B. Low mortality; high morbidity; high incidence; low prevalence. C. High mortality; low morbidity; high incidence; low prevalence. D. High morbidity; low mortality; high prevalence, low incidence. Answer: D individuals to identify potential cases of diabetes. Wound treatment and medication administration would be considered tertiary interventions, and education would be considered primary prevention. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 7 17. An occupational therapist conducts a group therapy program called MindWorks with older adults who have diagnoses of dementia and Alzheimer's disease. The goal of the group is to slow the cognitive decline of clients by engaging them in regular, organized mental activity such as reading maps and solving puzzles. How would the program most likely be characterized? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Prognosis enhancement Answer: C Rationale: Interventions aimed at slowing the course of an already-diagnosed disease characterize tertiary prevention. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 7-8 18. The clinical educator of a hospital medical unit has the mandate of establishing evidence-based practice guidelines for the nursing care on the unit. Which statement most accurately captures a guiding principle of the nurse's task? A. Evidence-based practice guidelines will be rooted in research rather than nurses' subjective practice preferences and experiences. B. Guidelines are synonymous with systematic research reviews. C. The need for continuity and standardization of guidelines will mean that they will be fixed rather than changeable. D. The guidelines will combine individual expertise with external systematic evidence. Answer: D Rationale: Evidence-based guidelines are a result of the combination of empirical, published evidence and the expertise of accomplished practitioners. They are not the same as systematic reviews of the literature and they are fluid and modifiable in the face of new evidence. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 8 19. The neuroscience nursing unit has developed a set of step-by-step directions of what should occur if a nursing assessment reveals the client may be exhibiting clinical manifestations of a cerebrovascular accident (CVA). Which statement about clinical practice guidelines are accurate? Select all that apply. A. Step-by-step guidelines are usually developed and based primarily on "how it has always been done before." B. The development of evidence-based practice guidelines require a research review from different studies to develop the most accurate diagnostic method to implement. C. Once developed, practice guidelines only need to be reviewed if a national committee sends out an update on new research. D. When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test it for further feedback. E. A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method. Answer: B, D, E Rationale: Clinical practice guidelines are systematically developed and intended to inform practitioners in making decisions about health care for CVA clients. They should be developed using research and review by experts in the clinical content. Potential users should also participate and provide feedback prior to implementation. The purpose of the guidelines is to review EBP articles and develop new practice guidelines rather that continuing practicing primarily on "how it has always been done before." Once developed, the guidelines must be continually reviewed and changed to keep pace with new research findings. A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method or the effects of an intervention method. Question format: Multiple Select Chapter 1: Concepts of Health and Disease Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 8 20. A nurse is investigating the epidemiologic factors influencing breast cancer for women in a population. What information should the nurse include? Select all that apply. A. How cancer cells divide and multiply in breast tissue B. The geographic location of women diagnosed with breast cancer C. The currently known incidence and prevalence for this population D. The age of women at the time of diagnosis E. The number of women whose diagnosis was assisted by the use of mammography Answer: B, D Rationale: Epidemiology refers to the study of disease in populations. It looks for patterns such as age, race, geographic location, and dietary habits of people who are affected with a particular disorder. While this data will be compared and reveal patterns of greater or lesser incidence, the focus is on people diagnosed with the condition and should not be influenced by previously calculated statistics. Neither how the condition was diagnosed, nor the pathogenesis of it once present, are part of epidemiology. Question format: Multiple Select Chapter 1: Concepts of Health and Disease Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 6 21. A nurse researcher is interested in the natural history of a disease being studied. What should the nurse focus on to best understand the condition's natural history? A. Following client cases from initial diagnosis and throughout treatment B. Examining outcomes across a wide variety of treatment approaches C. Focusing on clients who did not receive treatment for the condition D. Interviewing clients for their first-hand experience with the condition Answer: C Rationale: The natural history of a disease refers to the progression and projected outcome of the disease without medical intervention. For this reason, following clients who have had any level of treatment will be less valuable at establishing natural history than focusing on only those who have had no treatment. Client experience with the condition will not inform how the disease progresses from a pathogenesis perspective. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 7 22. A clinical nurse specialist is interested in developing a research study focused on clients living with the sequelae of ischemic stroke. Which clients should the nurse include? Select all that apply. The nurse should include clients with: A. aspiration pneumonia. B. unilateral weakness. C. dysphagia (difficulty swallowing). D. falls. E. vision changes. Answer: B, C, E CHAPTER TWO 1. During a discussion on cellular components and their function, a student asked the instructor the purpose of messenger RNA (mRNA). Of the following, which is the most accurate answer? A. To transport amino acids to the site of protein synthesis. B. Acts as an inner nuclear support membranes for a rigid network of protein filaments that binds DNA to the nucleus. C. Performs an active role of protein synthesis, where mRNA molecules direct the assembly of proteins on ribosomes to the cytoplasm. D. Assists cells in forming neoplastic progression by altering the response of chromatin in the nuclear matrix. Answer: C Rationale: The nucleus is the site for the synthesis of 3 types of RNA that move to the cytoplasm and carry out the actual synthesis of proteins. Messenger RNA copies and carries the DNA instructions for protein synthesis to the cytoplasm. Ribosomal RNA is the site of actual protein synthesis; transfer RNA transports amino acids to the site of protein synthesis. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Understand Client Needs: Physiological Integrity: Basic Care and Comfort Reference: p. 12 2. The nurse is providing care for a client with a diagnosis of cirrhosis, and she notes that the client's sclerae are jaundiced. The nurse recalls that jaundice is a pigment that can accumulate in which part of the cell? A. Nucleus B. Cytoplasm C. Golgi apparatus D. Rough endoplasmic reticulum (ER) Answer: B Rationale: Pigments such as bilirubin and melanin can accumulate in the cytoplasm, resulting in the characteristic yellow skin tones associated with jaundice. Pigments do not tend to accumulate in the nucleus, Golgi apparatus, or rough ER. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Remember Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 13 3. A 14-year-old female has been experiencing severe internal cramps in the region of the pelvis along with weight loss. She has been admitted with rectal bleeding. The physician has diagnosed her with inflammatory bowel disease (IBD). She asks the nurse what causes this disease. Which pathophysiologic basis will guide the nurse's response to this adolescent? A. Liver involvement in faulty glycogen stores B. Endoplasmic reticulum stress in the gastrointestinal system C. Over secretion of insulin from the beta cells in the pancreas D. Infiltration of the gastrointestinal track by bacterial toxins Answer: B Rationale: Researchers are determining links between endoplasmic reticulum (ER) and various disease processes. For examples, ER stress in the GI system has been found to be related to intestinal inflammations like the ones that occur with inflammatory bowel disease. Smooth ER of the liver is involved in glycogen stores. Insulin is synthesized as a large, inactive proinsulin molecule cut apart to produce a smaller, active insulin molecule within the Golgi complex of the beta cells. Bacterial toxins have exploited the retrograde transport mechanism. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 13 4. A professor is teaching a group of students about the role of mitochondria within the cell. Which statement is true of mitochondria? A. They are the site of adenosine triphosphate (ATP) production. B. The number of mitochondria in a cell is equal to the number of nuclei. C. They are replicated within the smooth endoplasmic reticulum (ER). D. Mitochondrial DNA is inherited patrilineally. Answer: A Rationale: Consistent with their characterization as the "power plants" of the cell, mitochondria are the site of ATP synthesis for the cell. There are a varying number in each cell, according to the energy demands of the particular cell. They are self- replicating rather than being produced in the smooth ER and they are inherited matrilineally. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 15 5. A client has been diagnosed with a neurodegenerative disease called multiple sclerosis (MS). The physician explains to the client that this disease may be caused by dysregulated apoptosis. Later that day, the client asks the nurse what this means. The nurse should reply: A. The cells around your nerves don't know how to die correctly. B. The cytoplasm should neutralize the various apoptotic inhibitors but isn't working correctly. C. Dysregulated apoptosis has caused an excessive rate of programmed cell death along the neuro-pathways. D. There is an inappropriately low rate of apoptosis occurring within the cells. Answer: C Rationale: Dysregulated apoptosis can mean too little or too much and has been implicated in neurodegenerative disease, in which there is an increased or excessive rate of apoptosis. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 15 6. A client experiencing immotile cilia syndrome (Kartagener syndrome) should be frequently assessed by the nurse for which priority complication? A. Epistaxis resulting from loss of cilia in the nasal passageway. B. Bronchiectasis due to interferences with clearance of inhaled bacteria along the respiratory tract. C. Sterility caused by inability of sperm to swim downstream. D. Inability to hear soft sounds related to kinocilium on the hair cells in the inner ear. Answer: B Rationale: Immotile cilia syndrome immobilizes the cilia of the respiratory tract, thus interfering with clearance of inhaled bacteria, leading to the chronic lung disease called bronchiectasis. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 15 7. The nurse is explaining the workings of selective serotonin reuptake inhibitors (SSRIs) to a client with a diagnosis of depression. Within the teaching, the nurse mentions that in the nervous system, the transmission of information by neurotransmitters is: A. synaptic signaling. B. endocrine signaling. C. autocrine signaling. D. paracrine signaling. Answer: A Rationale: Synaptic signaling occurs in the nervous system, where neurotransmitters act only on adjacent nerve cells through special contact areas protein. Osmosis, active transport, and diffusion do bring about the movement of glucose into body cells. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Remember Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 23 12. A student asks the instructor about the origins of different tissues and their cellular origins during the process of development. Which statement by the instructor best describes the process of cell differentiation? A. "Cells of the hematopoietic system produce the appropriate body cells that are required at each stage of development." B. "A single stem cell differentiates into approximately 200 different types of cells." C. "A fertilized ovum undergoes a series of divisions, yielding many different cell types." D. "Cells differentiate into necessary body cells peaking after conception and ceasing near the time of birth." Answer: C Rationale: Cell differentiation and consequent tissue types are the outcome of the series of cell divisions that occur in the fertilized ovum. It originates neither with a single stem cell nor in the hematopoietic system. Stem cells allow for limited differentiation throughout the lifespan, not only antepartum. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 30 13. A nurse is providing care for a client with a diagnosis of Crohn's disease. The nurse recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which type of tissue is most likely involved in the client's pathology? A. Simple columnar epithelium B. Glandular epithelium C. Simple cuboidal epithelium D. Stratified epithelium Answer: A Rationale: Simple columnar epithelium lines the intestine and its cilia and mucus- secreting goblet cells. The intestinal tract does not consist of glandular epithelium, simple cuboidal epithelium, or stratified epithelium. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 32 14. During a crime scene investigation, the coroner confirms that rigor mortis has set in. This helps to confirm an approximate time of death. The forensic nurse can explain this process (rigor mortis) to a group of students based on the fact that: A. troponin is being prevented from forming a cross-bridge between the actin and myosin. B. when activated by ATP, cross-bridges become attached to the actin filament. C. the myosin head catalyzes the breakdown of ATP to provide the energy need so that a cross-bridge can be formed. D. at death, the body is unable to complete the actin/myosin cycle and release the coupling between the myosin and actin, creating a state of muscular contraction. Answer: D Rationale: As the muscle begins to degenerate after death, the sarcoplasmic cisternae release their calcium ions, which enable the myosin heads to combine with their sites on the actin molecule. As ATP supplies diminish, no energy source is available to start the normal interaction between actin and myosin; therefore, the muscle is in a state of rigor until further degeneration destroys the cross-bridges between actin and myosin. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 35 15. The home care nurse is making a home visit to a 51-year-old female client with a longstanding diagnosis of multiple sclerosis. The nurse knows that the muscle wasting and weakness associated with the disease process is ultimately manifested as a failure of what normal process in muscle tissue? A. The contraction of the epimysium. B. The surrounding of fascicles by perimysium. C. Thick myosin and thin actin filaments sliding over each other. D. The contraction of fascicles within myofibrils. Answer: C Rationale: The contraction of skeletal muscle tissue can be characterized as the sliding action of myosin and actin. Epimysium surrounds and plays a supportive role in skeletal muscle, and perimysium similarly provides support but does not actively produce locomotion. Myofibrils are found within fascicles, not the opposite. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 16 16. A caregiver is working with a client who is having poorly controlled pain due to shingles. The associated pain travels to the client's nervous system via: A. synapses. B. axons. C. afferent neurons. D. efferent neurons. Answer: C Rationale: Afferent or sensory neurons carry information toward the CNS; they are involved in the reception of sensory information from the external environment and from within the body. Efferent or motor neurons carry information away from the CNS; they are needed for control of muscle fibers and endocrine and exocrine glands. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 37 17. The nurse is administering a calcium channel blocker to a client with a cardiac dysrhythmia. For what side effect should the nurse assess? A. Constipation B. Tachycardia C. Hypertension D. Polyuria Answer: A Rationale: Smooth muscle cells in the gastrointestinal tract rely on extracellular calcium entering cells and the release of calcium from the sarcoplasmic reticulum for muscle contraction, or peristalsis. This can contribute to constipation. Calcium- blocking drugs reduce heart rate and vasoconstriction, which will lower blood pressure. These drugs do not increase urine output. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 36-37 18. A client has been told she has elevated levels of low-density lipoproteins (LDL). The client says, "I have always followed a low-cholesterol diet, so how could it be elevated?" How should the nurse respond? A. LDL needs to be taken up into the intracellular space and this process does not work well in some people, causing LDL elevations in the blood. B. We should review your low-cholesterol diet. There are many hidden sources you may not have been aware you were eating. C. Receptors for hormones and biologically active substances are found on cell membranes. D. A disorder within the water channel of the cell membrane can result in cancer formation. Answer: A Rationale: Because cell membranes are soluble to some lipid-soluble substances such as organic solvents, such substances should be kept from direct contact with skin cells. The facts that cell membranes have a hydrophilic head and a hydrophobic tail and contain receptors for hormones and biologically active substances do not have a bearing on the nurse's teaching. While transmembrane proteins can indeed pass into the intracellular environment, the nurse is not referring to proteins in the teaching. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 16 23. The parents of a child newly diagnosed with Tay-Sachs disease asks what signs and symptoms they will see if the disease is progressing. Which response(s) by the nurse is most accurate? Select all that apply. A. hyperactivity in lower limbs B. loss of motor skills like turning over C. chronic constipation D. vision loss E. skin rashes Answer: B, D Rationale: In Tay-Sachs disease, an autosomal recessive disorder, cells do not make a lysosomal enzyme called hexosaminidase A, which is needed to degrade the GM2 ganglioside found in nerve cell membranes. Although GM2 ganglioside builds up in many tissues, such as heart, lver, and spleen, its accumulation in the nervous system and retina of the eye causes the most damage. Therefore, vision loss and loss of motor skills, including turning over, crawling and sitting up are the first signs of Tay-Sachs disease. Question format: Multiple Select Chapter 2: Cell and Tissue Characteristics Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 14 24. When discussing the function of the cell membrane during pathophysiology class, which statement(s) by the faculty is accurate? Select all that apply. A. responsible for helping cytoplasm and cell membrane movement during endocytosis B. helps determine what can and cannot enter and exit cells C. contains receptors for hormones and neurotransmitters D. carry out most of the functions of the cells E. allow ions to cross the membrane during electrical signaling in cells Answer: B, C, E Rationale: The cell membrane acts as a semipermeable structure that helps determine what can and cannot enter and exit cells. The cell membrane contains receptors for hormones and neurotransmitters. The cell membrane also allows ions to cross the membrane during electrical signaling in cells, such as neurons and muscle cells. Contractile activities involving the microfilaments and thick myosin filaments help cytoplasm and cell membrane movement during endocytosis and exocytosis. Proteins carry out most of the functions of the cells. The way proteins are assoicated with the cell membrane often determines their function. Question format: Multiple Select Chapter 2: Cell and Tissue Characteristics Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 16 1. Of the following situations, which one would be an example of a maladaptive cellular change? A. 18-year-old body builder who has developed extremely large pectoral muscles following years of weight lifting. B. 31-year-old marathon runner who has developed hypertrophied myocardial cells C. 54-year-old female who has developed ovarian atrophy following loss of estrogen stimulation during menopause D. 44-year-old male with a 60 pack/year smoking history who was diagnosed with a histological grade-3 lung cancer Answer: D Rationale: In many adaptive cellular responses, the expression of the differentiation genes is altered. When working with cancer clients, histological grade or differentiation refers to how much the tumor cells resemble normal cells of the same tissue type. In body builders and athletes, cells hypertrophy based on the increase in workload placed on the muscle. Reproductive atrophy is expected due to the loss of estrogen stimulation during menopause. Question format: Multiple Choice CHAPTER 3 Cellular Adaptation, Injury, and Death Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 40-41 2. A client is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which factor has most likely contributed to the atrophy of the client's muscle cells? A. High levels of insulin and IGF-1 in the client's blood during immobilization B. Denervation of the affected muscles during the time of traction C. A reduction of skeletal muscle use secondary to the traction treatment D. Reduced oxygen consumption and cellular function that ensures muscle cell survival Answer: C Rationale: Disuse atrophy results from the reduction in skeletal muscle use such as that following encasement in plaster casts or traction. Low levels of insulin and IGF- 1 contribute to atrophy, and denervation only occurs in paralyzed limbs. Reduced oxygen consumption and cellular function are the mechanisms of cell atrophy but not the causes of the process. Question format: Multiple Choice Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 41-42 3. The nurse is teaching new nursing assistants on the unit about the phenomenon of muscle hypertrophy. Which client on the unit is most likely to experience muscle hypertrophy? A client with: A. urinary incontinence following a cerebrovascular accident (CVA). B. hypertension, obesity, and decreased activity tolerance. C. peripheral edema secondary to heart failure (HF). D. possible rejection symptoms following a liver transplant. Answer: B Rationale: Hypertension is a common cause of adaptive hypertrophy, in which cardiac muscle cells increase in size in response to the increased work of circulation over time. The other diagnoses are not associated with muscle hypertrophy. Question format: Multiple Choice Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 42 4. Which client is at high risk for developing dilated cardiomyopathy? A. 17-year-old with a diving injury resulting in paraplegia B. 4-year-old child born with cerebral palsy and confined to a wheelchair C. 44-year-old noncompliant female who forgets to take her hypertensive medications D. 78-year-old Alzheimer client who received a third-degree burn following an oven fire Answer: C Rationale: In hypertension, the increased workload required to pump blood against an elevated arterial pressure in the aorta results in a progressive increase in LV muscle mass and need for coronary blood flow. The pressure overload causes hypertrophied cells to have greater width and length. Paraplegia, cerebral palsy, and Alzheimer disease do not increase the workload of the cardiac muscle per se. Question format: Multiple Choice Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 43 5. Which student statement demonstrates a sound understanding of the cellular processes of hypertrophy and hyperplasia? A. "I know that cells like neurons have little capacity for hyperplastic growth." B. "A remaining kidney can sometimes undergo hyperplasia in response to one that has been removed." CHAPTER 3 Cellular Adaptation, Injury, and Death Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Safety and Infection Control Reference: p. 46 10. A client who has a diagnosis of lung cancer is scheduled to begin radiation treatment. The nurse knows that which statement about potential risks of radiation is most accurate? A. "Some clients experience longer-term irritation of skin adjacent to the treatment site." B. "Sometimes you might find that your blood takes longer to clot than normal." C. "The changes that you might see are normally irreversible." D. "The unwanted effects will be limited to the exposed portions of your skin." Answer: A Rationale: Chronic radiation dermatitis is a consequence of cancer treatment with ionizing radiation. Hypocoagulation is not an identified consequence of radiation exposure, and changes can be both reversible and deeper than the surface of the skin. Question format: Multiple Choice Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 47 11. A young client has just been diagnosed with xeroderma pigmentosum. When teaching this family about this disease, the nurse should emphasize which teaching points? Select all that apply. A. Wash hands thoroughly when working in the garden to prevent infection. B. Wear long sleeves, long pants, gloves, a hat, sunglasses with side shields, and sunscreen while outdoors. C. Apply antibacterial ointment to any break in the skin and cover wounds with bandages. D. The best time to allow the child to play outside is in the evening hours after the sun goes down. E. The best time for this family to go to the beach is in the fall/winter months. Answer: B, D Rationale: Xeroderma pigmentosum is a genetic disorder where the enzyme needed to repair sunlight-induced DNA damage is lacking. While washing hands and applying antibacterial products to open wounds in important teaching for parents with children, they are not specific for this disease diagnosis. Ultraviolet damage still occurs in the fall/winter months at the beach. Question format: Multiple Select Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 47 12. A 7-year-old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which assessment finding is most congruent with the client's diagnosis? A. Decreased deep tendon reflexes B. Hemoglobin 9.9 g/dL (99 g/L) C. Diffuse muscle pain D. White blood cells (WBC) 11,000/mm3 (11.0 x 109/L) Answer: B Rationale: Anemia is the cardinal sign of lead toxicity. Neither muscle pain, decreased deep tendon reflexes nor changes in WBC levels are associated with lead toxicity. Question format: Multiple Choice Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 48 13. The nurse is teaching a group of new mothers about postpartum nutrition, when one of the clients states that she was told to avoid eating fish too often due to the risk of mercury poisoning. Which response by the nurse most accurately addresses the clients concerns? A. "You're right. It's best to avoid eating fish, especially while you are breast- feeding." B. "There are some modest risks, but they are only associated with some long- living fish like tuna." C. "Provided you avoid salmon, you likely won't be putting yourself or your child at risk." D. "The risk of mercury toxicity from eating fish has been shown to be insignificant." Answer: B Rationale: Only long-living fish such as tuna and swordfish concentrate the mercury from sediment in quantities sufficient to pose a risk. It is not necessary to categorically avoid fish, and salmon poses a low risk. Risks are not insignificant, though they are not particularly high. Question format: Multiple Choice Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 49 14. A nurse is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which statement best captures the rationale underlying the nurse's advice? A. Antioxidants inhibit the actions of reactive oxygen species. B. Antioxidants prevent the formation of superoxide dismutase. C. Antioxidants react nonspecifically with molecules. D. Antioxidants prevent the occurrence of cell dysplasia. Answer: A Rationale: Antioxidants inhibit the reactions of reactive oxygen species (ROS) with biological structures. Superoxide dismutase is an antioxidant itself, and ROS, not antioxidants, react nonspecifically with molecules. Antioxidants do not prevent the occurrence of cell dysplasia. Question format: Multiple Choice Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 50 15. During a myocardial infarction (MI), a client with a 97% occlusion of the left descending artery develops ventricular dysrhythmias due to the amount of ischemia occurring in the myocardium. While providing education about MI's, which statement is most accurate to share with this client? A. Permanent damage will occur in the myocardium if the vessel is not opened within a 1-2 minute window following the occlusion. B. Treatment needs to be sought immediately so that the buildup of lactic acid is limited and cellular changes can be reversed. C. Once the oxygen supply has been occluded, cellular changes are irreversible even if oxygenation is restored. D. The body will grow new genes thru the process of angiogenesis, thereby avoiding any permanent damage to the myocardium. Answer: B Rationale: Ischemia is characterized by impaired oxygen delivery and impaired removal of metabolic end products such as lactic acid. Ischemia commonly affects blood flow through limited numbers of vessels and produces local tissue injury. In some instances, the cellular changes due to ischemia are reversible if oxygenation is restored. If not restored, permanent damage can occur. Question format: Multiple Choice Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 50-51 16. Which statement most accurately conveys an aspect of cell injury due to impaired calcium homeostasis? electrolytes. A client taking a loop diuretic is more prone to hypocalcemia as this medication promotes the loss of calcium in urine. Question format: Multiple Select Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 45 21. A nurse is triaging clients at a disaster site. Local facilities have different specialized units. To what facility should the nurse send a client who has sustained an electrical injury to his left thigh? A. Cardiac care unit B. Burn unit C. Surgical intensive care unit D. Neurology unit Answer: B Rationale: An electrical injury to an area containing bone and muscle will have high resistance and create a high degree of local skin burn, so a burn unit is most appropriate. If the injury had been to the torso this may result in more respiratory or cardiac complications. If the client receives surgery, a surgical intensive care unit may be accessed but cardiac care and neurology do not have immediate priority over a burn unit. Question format: Multiple Choice Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 46 22. Parents bring their 18-month-old child to the emergency room exhibiting behavior changes and vomiting. They are concerned the child ingested something in the older home they are renovating. Laboratory findings indicate low hemoglobin and elevated creatinine. Which diagnostic test should the nurse advocate for first? A. Erythrocyte protoporphyrin (EP) level B. Urine test for a mercury level C. Ultrasound of the kidneys D. Erythrocyte sedimentation rate Answer: A Rationale: Anemia is a cardinal sign of lead toxicity, which would be reflected by a low hemoglobin. Lead can also cause diffuse kidney damage, which would be reflected by an elevated creatinine. Behavior changes are also seen with this condition. Screening for lead toxicity involves use of capillary blood obtained from a finger stick to measure free erythrocyte protoporphyrin. Given the history of being exposed to an older home under renovation, this should raise the possibility of lead paint exposure. Combined with the presenting symptoms, this makes ruling out lead poisoning the priority over suspected mercury poisoning, which usually results from ingestion of long-lived fish. Ultrasound of the kidney could be done if the presence of lead is ruled out. An erythrocyte sedimentation rate is a nonspecific test for inflammation and not a priority. Question format: Multiple Choice Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 48 23. The nurse is caring for a 45-year-old client undergoing radiotherapy of the mediastinal nodes due to lymphoma. Which interventions should the nurse prioritize? Select all that apply. A. Assessing for fatigue B. Avoiding invasive procedures C. Performing respiratory assessment D. Performing neurologic assessment E. Assessing for urinary retention Answer: A, B, C Rationale: Radiotherapy on mediastinal lymph nodes would need to be delivered through the sternal area where bone marrow would be affected. This could result in anemia, thrombocytopenia, and neutropenia. This could lead to fatigue, bleeding, and risk for infection, and thus it is important to avoid invasive procedures. As lung tissue could also be affected, respiratory complications are possible, thereby necessitating respiratory assessment. Neither neurologic complications nor urinary retention would be expected for radiotherapy in the mediastinal area. Question format: Multiple Select Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 46 24. A worker in a warehouse is trying to have children but think he or she has handled "mercury" while cleaning equipment. Which statement by the occupational nurse is most appropriate at this time? A. Usually mercury toxicity appears as skin rashes and lesions. B. Most mercury toxicity involves central nervous system changes. C. You should have all the mercury fillings in your teeth changed to newer products. D. Infertility is caused by too much mercury exposure. Answer: B Rationale: Mercury is toxic in four forms: mercury vapor, inorganic divalent mercury, methyl mercury, and ethyl mercury. Depending on the form of mercury exposure, toxicity involving the central nervous system and kidney can occur, not the dermal layers of the skin. In the case of dental fillings, the concern involves mercury vapor being released into the mouth. However, the amount of mercury vapor released from fillings is very small. Question format: Multiple Choice Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 49 25. The health care provider is discussing the treatment protocol using ionizing radiation to treat the client's cancer. The client asks, "What side effects can occur with this treatment?" Which response(s) is accurate? Select all that apply. A. Low blood counts B. New-onset seizures C. Excessive diarrhea D. Photosensitivity E. Kidney stone formation Answer: A, C Rationale: The injurious effects of ionizing radiation vary with the dose, dose rate, and differential sensitivity of the exposed tissue to radiation injury. Because of the effect on DNA synthesis and interfernece with mitosis, rapidly dividing cells of the bone marrow (low blood counts related to hemoglobin, platelets, and white blood cells) and intestine (diarrhea) are much more vulnerable to radiation injury than other tissues such as eyes, brain cells, or the kidney. Question format: Multiple Select Chapter 3: Cellular Adaptation, Injury, and Death Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 46-47 1. How could a health care professional most accurately explain an aspect of the underlying structure of DNA to a colleague who is unfamiliar with genetics? A. "DNA consists of nucleotides plus one of the four nitrogenous bases." B. "In the base pairs, adenine combines with thymine and guanine with cytosine." C. "Thymine and cytosine are considered the purine bases." D. "The backbone of a DNA molecule consists of either deoxyribose or phosphoric acid." Answer: B Rationale: The base pairings of DNA are such that adenine combines with thymine and guanine with cytosine. DNA also includes the sugar deoxyribose, while thymine and cytosine are considered the pyrimidine bases. The backbone of DNA includes both deoxyribose and phosphoric acid. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 58 2. A student is trying to understand the possible reasons that a genetic abnormality might exist in an individual. Which reason is most plausible? A. DNA has combined with several types of protein and a small amount of RNA. B. Histones have exerted control on the folding of DNA strands. C. DNA has blocked genetic transcription by preventing access of nucleotides to the DNA surface. B. "The cells of a male contain a Barr body that can be visualized." C. "A normal female lacks Barr bodies." D. "The number of visible Y chromosomes indicates the sex." Answer: A Rationale: The fact that the inactive X chromosome can be visible as a Barr body in a female allows for the extrapolation of the number of X chromosomes, and thus the sex associated with the cells. Normal male cells lack Barr bodies, but they are present in females. The number of X chromosomes ultimately determines sex. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 63 8. A health care researcher has identified the gene of interest in a particular genetic disorder as well as the gene's location, Xq97. Where would one find a gene named Xq97? A. Band q, region 97 of the Y chromosome B. Band 7, region 9 of the short arm of the X chromosome C. Band 9, region 7 of the long arm of the X chromosome D. Band 9, region 7 of the short arm of the Y chromosome Answer: C Rationale: In gene names, the first letter stands for the chromosome. The second indicates the arm of the chromosome, p (short) or q (long). The first numeral indicates the band, and the second one indicates the region within that band. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 67 9. A child possesses a trait that is the result of the interaction of two different genes, neither of which could have produced the trait independently. Which explanation best captures the genetic explanation for this? A. The trait is an expression of multiple alleles. B. Epistasis has dictated the phenotypic outcome. C. The phenomenon is an example of polygenic inheritance. D. The outcome is the result of the interaction between collaborative genes. Answer: D Rationale: The expression of two genes influencing the same phenotype, neither of which could have produced it alone, is an example of collaborative genes. Multiple alleles involve more than one gene at a particular locus affecting the same trait, and in epistasis a gene masks the phenotypic effects of another nonallelic gene. Polygenic inheritance involves multiple genes each affecting a small influence on a genetic outcome. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 68 10. A health care professional works in a context where there are a large number of clients who live with genetic disorders. Which circumstance would be most likely to involve an individual who has a genetic disorder? A. The primordial germ cells of both of the individual's parents have undergone meiosis. B. Two chromosomes of the same number have been inherited from one parent. C. The individual possesses 22 pairs of autosomes. D. The individual's karyotype indicates separate X and Y chromosomes at chromosome 23. Answer: B Rationale: When two chromosomes are inherited from one parent, the result can be the disorder of uniparental disomy. The other answers all relate normal genetic processes. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 68 11. Mary is heterozygous for blue eyes, a recessive trait. John is homozygous for brown eyes, a dominant trait. What color eyes will their four children have? A. Brown B. Blue C. Some will have blue, and some will have brown D. Impossible to tell Answer: A Rationale: A heterozygote with a dominant and a recessive allele will have the dominant phenotype. In Mary's case, this will manifest itself in her brown eyes. A homozygote with two dominant alleles will have the dominant phenotype, so John also has brown eyes. To have blue eyes, the children would have to inherit two alleles for blue eyes. Because they will inherit, at most, one recessive allele for blue eyes, the children's eyes will be brown. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 69 12. Knowing that persons with blonde hair exhibit the phenotype of a recessive gene, which genetic scenario would be most likely to underlie such a trait? A. AA B. A heterozygous pairing. C. Either AA or Aa. D. Different alleles at a gene locus. Answer: A Rationale: A recessive trait is expressed solely in a homozygous pairing, such as AA. A heterozygous pairing, in which there are different alleles at a gene locus, will not express a recessive trait. Aa is an example of a heterozygous pairing. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 69 13. A group of researchers has identified that the prevalence of two particular genetic disorders share a statistical correlation. Which statement best conveys the genetic rationale for this situation? A. There is likely a cause and effect relationship between the two genes responsible. B. The chromosomes containing each gene are likely closely situated. C. The genes causing each disorder are likely in the same section of the same chromosome. D. The disorders likely share the same locus. Answer: C Rationale: The genes causing these problems are likely proximate in the same chromosome. They would not likely be correlated if they were in different chromosomes, and the situation is not indicative of a cause and effect relationship. The genes are likely closely situated, but they could not share the same locus. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 71 14. A student is explaining to her colleague the different methods that are available for genetic mapping. Which of the colleague's statements indicates a need for further teaching? A. "I know that linkage studies are rooted in the exchange of genes that occurs during meiosis." B. "Gene dosage studies involve the measurement of enzyme activity as a reflection of genetic activity." C. "If hybrid cells were stable, somatic cell hybridization would not be viable." D. "In situ hybridization focuses on genes that can express themselves in cell culture." Answer: D 19. A couple is undergoing cytogenetic testing due to a familial disorder. What information should the nurse offer the couple about what type of sample is required for this testing? A. A sample of your blood will be collected so the plasma can be used for testing. B. Various samples can be used as long as the cells will grow in the culture used. C. Bone marrow samples for stem cells will offer the most accurate results. D. Saliva collected in a sterile container is used due to the ease of collection. Answer: B Rationale: Cytogenetics, or chromosome studies, can be done on any tissue or cell that grows and divides in culture. Rather than plasma, a sample containing white blood cells is often used. Buccal samples are also used, but saliva contains only a few of these cells compared to buccal scrapings, making it a difficult sample to collect due to the volume needed. Bone marrow is not required. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 67 20. A nurse is working with a researcher examining the variation of medication response in differing populations. What topic is the nurse most likely focusing on for this research? A. Haplotypes B. Phenotypes C. DNA ligases D. RNA interference Answer: A Rationale: A haplotype consists of the many closely linked single nucleotide polymorphisms (SNPs) on a single chromosome that generally are passed as a block from one generation to another in a particular population. Using haplotypes can determine appropriate medications and therapies based upon genotype. Phenotype refers to recognizable traits that are associated with a specific genotype. A DNA ligase is a special enzyme used to join a bacterial vector and DNA fragment during gene cloning. RNA interference is a technique developed to stop genes from making unwanted disease proteins. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Remember Client Needs: Health Promotion and Maintenance Reference: p. 71 21. A female client who is a carrier of a genetic illness asks the nurse if she should have her partner tested for the condition prior to starting a family. What is the nurse's best response? A. If there is no incidence of this condition in his family, testing is not likely needed. B. Since this is a condition that is linked to a recessive gene, testing may be advised. C. If your partner does not have the illness, it is highly unlikely to pass on the condition. D. You will pass this condition on to your child regardless of your partner's genetic status. Answer: B Rationale: If the client is a carrier for this condition, then the condition is recessive. If her partner also has the recessive gene, the risks of their children inheriting both recessive alleles and developing the condition increases (but is not guaranteed). Genetic testing would be needed to know if this were the case. While family history is helpful, the fact the condition is recessive means it may be carried without the affected members knowing. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 69 22. A forensic nurse is working with a client who was sexually assaulted. As part of court proceedings an image of the suspected assailant's DNA fingerprint is being entered into evidence. The client asks the nurse how it is possible to know the DNA from such a small sample. What is the nurse's best response? A. There is a procedure used to amplify the DNA gathered to create a whole image of the DNA. B. We combine the sample collected after the crime with additional body fluids from the suspect. C. From the existing DNA in the sample, clones are made to create a full picture of the genotype. D. DNA is a very small molecule, so we only need a small sample to create a full profile. Answer: A Rationale: Although it is true that only a small sample is needed, the procedure of creating a DNA fingerprint does involve using amplification by polymerase chain reaction (PCR); therefore, mentioning this amplification is the most accurate response. Samples would not be combined as this would contaminate the original. The process is not the same as cloning. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 72 23. A nurse is working with a 40-year-old pregnant woman. The physician has recommended karyotyping for this client. How should the nurse best explain what this test examines? A. It is recommended because chromosomal abnormalities increase with maternal age. B. This is a test that examines your baby's chromosomes for any abnormalities. C. The test looks at your DNA for any genetic abnormalities you may pass onto your baby. D. This test will measure a specific protein that is associated with congenital disorders. Answer: B Rationale: While it is true that chromosomal abnormalities increase with age, this does not tell the client what the test examines. Karyotyping involves a process by which chromosomes are photographed—the completed picture is called a karyotype—and this would be performed on the fetus's sample since the disorders associated with maternal age are not inherited but often occur due to nondisjunction. This test does not examine the mother's DNA or screen for specific proteins. Question format: Multiple Choice Chapter 4: Genetic Control of Cell Function and Inheritance Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 67 24. The nursing student is surprised to learn that bacteria are used when creating medications using recombinant DNA. How should the nursing instructor explain the connection? A. Because genes of all organisms are similar, we can manipulate the bacteria to produce specific proteins. B. Bacteria produce enzymes that are used to manipulate the human cells, which then produce the medication. C. Bacteria are injected into human DNA proteins so that the bacteria now act like cells in the human body. D. It is not really the bacteria that is used for this process but a substance in the bacteria called DNA ligase. Answer: A Rationale: The gene isolation and cloning methods used in recombinant DNA technology rely on the fact that the genes of all organisms, from bacteria through mammals, are based on a similar molecular organization. If this were not the case, the process would not be possible. The bacteria are not creating enzymes for this purpose nor can bacteria be injected "into" DNA. DNA ligase is only an enzyme used in the process of joining the DNA fragment to the bacterial vector when performing the procedure; the bacteria is what is used in recombinant technology. Question format: Multiple Choice Rationale: NF-1 children have many problems, often not apparent until puberty. They tend to have large tumors that cause facial disfigurement, skeletal deformities such as scoliosis, and neurologic complications like learning disabilities, attention deficit disorders, and speech abnormalities. Question format: Multiple Select Chapter 5: Genetic and Congenital Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 77-78 5. A new older female client at a long term care facility has a diagnosis of neurofibromatosis type 1. As part of the intake assessment protocol for the facility, the clinical educator is teaching the care staff about the diagnosis. Which statement most accurately conveys an aspect of neurofibromatosis? A. "The neurofibroma lesions are unsightly for the client, but they are not painful." B. "Her diagnosis puts her at higher risk of developing a malignant neoplasm." C. "She is living with an example of an autosomal recessive disorder." D. "The client is likely to be photosensitive as a result of the disease." Answer: B Rationale: NF-1 is associated with increased risk of malignant neoplasm. The lesions may be painful to the client and the disease is an autosomal dominant disorder. Photosensitivity is not noted as a complication of neurofibromatosis type 1. Question format: Multiple Choice Chapter 5: Genetic and Congenital Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 78 6. As part of an orientation to a genetic counseling practice, a group of medical students are differentiating between autosomal recessive disorders and autosomal dominant disorders. Which statement is true of autosomal recessive disorders? A. They can manifest when present in one or both gene pairs. B. There is a 1 in 2 chance of an affected child in each pregnancy with an affected mother. C. They tend to have a more uniform symptomology than autosomal dominant disorders. D. The associated disorders are usually attributable to abnormalities in structural proteins. Answer: C Rationale: Autosomal recessive disorders tend to have a more uniform symptomology than autosomal dominant disorders. Their incidence is dependent on both members of the gene pair being affected, and there is a 1 in 4 risk of an affected child with each pregnancy. The associated disorders are usually attributable to enzyme deficiencies. Question format: Multiple Choice Chapter 5: Genetic and Congenital Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 78 7. A 6-year-old boy with intellectual disability secondary to fragile X syndrome has been admitted to the hospital with a mitral valve prolapse. The health care worker caring for the child should have which concepts as part of her knowledge base regarding fragile X syndrome? A. An affected mother who carries one normal and one mutant allele has a 75% chance of transmitting the gene to her daughters. B. The boy's mother had a 100% chance of transmitting the defective gene to her son. C. Genes of the boy's Y chromosome can be affected in addition to the X chromosome. D. The boy will pass the gene to all his future daughters, who will become carriers. Answer: D Rationale: When the affected son procreates, he transmits the defective gene to all of his daughters, who become carriers of the mutant gene. The most common pattern of inheritance for fragile X syndrome is an unaffected mother carrying one normal and one mutant allele. The Y chromosome is not affected. An unaffected mother has a 50% chance of transmitting the defective gene to her sons. Question format: Multiple Choice Chapter 5: Genetic and Congenital Disorders Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 79-80 8. Two health care workers are comparing the etiology and incidence of multifactorial inheritance disorders and single-gene disorders. Which statement best captures the relationship between the two types of genetic disorders? A. "Multifactorial disorders and single-gene disorders can both be predicted quite accurately." B. "Multifactorial disorders are more likely to involve multiple organs." C. "Multifactorial disorders manifest themselves at birth." D. "A couple with a child with a multifactorial disorder have a higher risk of having another with the same disorder." Answer: D Rationale: Parents of a child with a multifactorial disorder have a higher chance of having the disorder recur with another child. Multifactorial disorders are less predictable than single-gene disorders and usually involve single organs. They can manifest themselves at any point in the lifespan. Question format: Multiple Choice Chapter 5: Genetic and Congenital Disorders Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 80-81 9. While taking a daily walk, the nurse is asked by a neighbor what centric fusion (Robertsonian) translocation means. The neighbor tells the nurse that a family member has been diagnosed with this and is now afraid to have children. Given this diagnosis, what may be potential risks for her offspring? A. If chromosome 21 is involved, there is a high risk for producing a child with Down syndrome. B. Since the extremely short fragment only contains a small amount of genetic material, there should be no additional risk than the normal population. C. This translocation of genetic material places the child at high risk for having multiple limb abnormalities. D. Cleft lip with cleft palate is frequently associated with this translocation of genetic material. Answer: A Rationale: In centric fusion or Robertsonian translocation, the break occurs near the centromere affecting the short arm in one chromosome (13 and 14, or 14 and 21 The child also has facial abnormalities that become more striking as it develops. What might you expect to find in the mother's pregnancy history? A. Folic acid deficiency B. Chronic alcohol use C. Chronic cocaine use D. Active herpes simplex infection Answer: B Rationale: The infant's signs and symptoms are characteristic of fetal alcohol syndrome. Folic acid deficiency is associated with neural tube defects, such as anencephaly and spina bifida. Cocaine use is associated with some of the same signs and symptoms as alcohol use but does not produce the characteristic facial abnormalities of fetal alcohol syndrome. Herpes simplex infection, although it is associated with microcephaly, hydrocephalus, defects of the eye, and hearing problems, also does not produce characteristic facial abnormalities. Question format: Multiple Choice Chapter 5: Genetic and Congenital Disorders Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 88-89 15. Which pregnant woman has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly? A. A woman with diagnoses of syphilis and cirrhosis of the liver. B. A woman who has herpes simplex and who has recently recovered from endocarditis. C. A woman with chronic obstructive pulmonary disease (COPD) and tuberculosis. D. A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy. Answer: B Rationale: Herpes is among the microorganisms most commonly responsible for fetal anomalies. Syphilis and tuberculosis infections are also implicated but to a lesser degree. The other listed diagnoses are not noted to be associated with fetal anomalies. Question format: Multiple Choice Chapter 5: Genetic and Congenital Disorders Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 89 16. A couple who are pregnant with their first child have made an appointment with a clinical geneticist to discuss prenatal screening. The man states that they, "just want to make sure that there is nothing wrong with our baby." How could the clinician best respond to this statement? A. "We can't rule out all abnormalities, but a routine fetal tissue biopsy can yield useful information." B. "Testing the umbilical blood and performing amniocentesis can give us some information, but not a guarantee." C. "Prenatal screening is not usually necessary unless you are among a high-risk group." D. "You need to be aware that if abnormalities are detected, termination is normally required." Answer: B Rationale: Prenatal screening provides a useful, but incomplete, picture of fetal health; umbilical sampling and amniocentesis are common methods of screening. Fetal tissue biopsy is a rarely-used screening method, and a couple need not belong to a high-risk group to benefit from prenatal screening. Abnormalities do not usually necessitate termination. Question format: Multiple Choice Chapter 5: Genetic and Congenital Disorders Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 90 17. While preparing a client about to undergo percutaneous umbilical cord blood sampling (PUBS), which educational information should the nurse provide prior to the procedure? Select all that apply. A. Once the procedure is begun, you must lie very still since they will be inserting a needle through the uterine wall. B. We will put you into the stirrups and dilate your cervix with a small catheter so that we can obtain a cord sample. C. During the procedure, an ultrasound will be utilized to guide the catheter into the correct position. D. We will send a sample of amniotic fluid to a regional medical center to have DNA tests performed for any genetic abnormality. Answer: A, C Rationale: PUBS is an invasive diagnostic procedure that involves the transcutaneous insertion of a needle through the uterine wall and into the umbilical artery. It is performed under ultrasound guidance and can be done any time after 16 weeks of gestation. Amniocentesis is the withdrawal of a sample of amniotic fluid for abnormal fetal screening as well as for chromosomal analysis. In chorionic villus sampling, the transcervical approach may be used. Question format: Multiple Select Chapter 5: Genetic and Congenital Disorders Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 91-92 18. While taking a prenatal history, the nurse would be most concerned about severe teratogenic effects on the fetus if the mother admits to taking which medication prior to finding out that she was pregnant? Select all that apply. A. Warfarin for chronic atrial fibrillation B. Ethyl alcohol ingestion regularly several times per week C. Isotretinoin for acne D. Over-the-counter cetirizine for seasonal allergies E. Tetracycline for acne Answer: A, B, C, E Rationale: Several medications have been considered teratogenic. They include thalidomide, antimetabolites, warfarin, anticonvulsants, ethyl alcohol, cocaine, propylthiouracil, tetracycline, and isotretinoin. Question format: Multiple Select Chapter 5: Genetic and Congenital Disorders Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 87-88 19. The nurse is caring for a client with Marfan syndrome. Which assessment finding should the nurse prioritize as requiring the most emergent intervention? A sudden: A. drop in blood pressure from 130/90 to 95/50 mm Hg. B. complete loss of vision in a single eye. C. drop in heart rate from 80 to 60 beats per minute. D. onset of confusion and altered level of consciousness. Answer: A Rationale: All the listed findings require urgent attention and investigation. However, the nurse should associate the drop in blood pressure with the most life- threatening aspect of Marfan syndrome, which is dissection and rupture of the aorta. Without immediate action, this client could die from blood loss and hypovolemic shock. Retinal detachment could result in unilateral vision loss and should be addressed immediately but is not life-threatening. A drop in heart rate should be investigated but a heart rate of 60 is not associated with a life- threatening condition such as ruptured aortic aneurysm. Finally, any sudden onset of confusion requires urgent investigation but is not as emergent as the possibility of the ruptured aortic aneurysm. Question format: Multiple Choice Chapter 5: Genetic and Congenital Disorders Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 77 Question format: Multiple Choice Chapter 5: Genetic and Congenital Disorders Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 81 24. A pregnant client is exploring options related to prenatal testing due to a history of inherited disorders. What information should the nurse include when informing the client about various prenatal tests? Select all that apply. A. The type of test used is determined by your preference and level of invasiveness. B. If genetic disorders are being investigated, chorionic villus sampling will be required. C. Percutaneous umbilical cord blood sampling is needed for a truly accurate result. D. An ultrasound will be required for either amniocentesis or chorionic villus sampling. E. All of the tests used to examine fetal DNA are invasive and carry associated risks. Answer: D, E Rationale: The type of test to be used will be determined in consultation with the health care provider, who will consider the condition being investigated, the number of weeks gestation, and degree of risk to the pregnancy. The test will not be based on client preference and level of invasiveness alone. Amniocentesis is used to identify genetic disorders. Percutaneous umbilical cord sampling is used when this is the only method that can diagnosis a particular condition (not because it is more accurate than other methods for all conditions). All the tests are invasive and require ultrasound guidance to perform. Question format: Multiple Select Chapter 5: Genetic and Congenital Disorders Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 92 25. While traveling throughout Asia, a young couple was exposed to rubella. During their first clinic visit, the couple found out they were pregnant and express concern about their possible exposure to rubella. The nurse knows that this infant is at high risk for which possible complications related to rubella exposure? Select all that apply. A. Blindness or cataracts B. Deafness C. Facial deformities like small palpebral fissures or thin vermillion border D. Short, flipper-like appendages E. Small outbreak of blisters around the eyes and mouth 2 weeks after delivery Answer: A, B Rationale: Rubella remains endemic in many developing countries, where it is the major preventable cause of hearing impairment, blindness, and adverse neurodevelopmental outcomes. Facial deformities are common with fetal alcohol exposure. Short, flipper-like appendages are usually a result of thalidomide. A small outbreak of blisters around the eyes and mouth may be related to early development of herpes simplex. Question format: Multiple Select Chapter 5: Genetic and Congenital Disorders Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 89 1. Following a biopsy, a 54-year-old man has been diagnosed as having a benign neoplastic tumor. Which characteristic most likely applies to his tumor? A. The tumor is poorly approximated and has the potential to break loose. B. The tumor may secrete hormones, cytokines. C. The well-differentiated, neoplastic cells are clustered together in a single mass. D. It has a rapid rate of growth and can induce ischemia. Answer: C Rationale: Benign tumors are composed of well-differentiated cells that resemble the cells of the tissues of origin and are characterized by a slow, progressive rate of growth that may come to a standstill or regress. They tend to exist in a single mass. Malignant tumors tend to be poorly differentiated, grow rapidly, secrete hormones or cytokines, and have the potential to break loose. Question format: Multiple Choice CHAPTER 6 Neoplasia Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 96 2. A 77-year-old male client with a diagnosis of stomach cancer has been found to have metastases in his liver. The client and his family are surprised at this turn of events, stating that they don't see how he could have developed cancer in his liver. Which fact would underlie the reply that the care team provides? A. The parenchymal tissue of the liver is particularly susceptible to secondary malignancies. B. The portal circulatory system brings venous blood from the GI tract into the liver. C. Hepatic stromal tissue shares characteristics with cancerous cells, including lack of anchorage dependence. D. The proximity of the liver to the stomach allows for direct spread of cancerous cells due to a lack of contact inhibition. Answer: B Rationale: Portal circulation brings venous blood into the portal vein of the liver, facilitating hematologic spread. The parenchyma of the liver possesses no particular susceptibility to cancer. Hepatic tissue does not share traits of cancerous cells such as low contact inhibition or lack of anchorage dependence. Question format: Multiple Choice Chapter 6: Neoplasia Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 99 3. A 41-year-old female with a family history has had a baseline mammogram. She states that she performs monthly self breast exams but really has a hard time evaluating her lumps since she has numerous cysts. At her annual mammogram, the technician views a suspicious area and refers her to the radiologist. She asks the nurse in the office, "How can a lump appear so quickly?" The nurse's response is based on which principle? A. A tumor is undetectable until it has doubled 30 times and contains at least 1 billion cells. B. Many tumor cells never leave the M phase of the cell cycle. C. Cancer cells are undifferentiated and come in various shapes and sizes. D. If the breast has a lot of cysts, then the fluid within those sacs makes it hard to feel the hard lumps of a cancer. Answer: A Rationale: The ratio of dividing cells to resting cells in a tissue mass is called the growth fraction. The doubling time is the length of time it takes for the total mass of cells in a tumor to double. Tumors do no stay in the M phase of the cell cycle. Undifferentiated cancer cells do come in various shapes/sizes but this has nothing to do with the detection of the tumor by palpation. Breast cysts are fluid filled sacs but are usually not cancerous. Question format: Multiple Choice Chapter 6: Neoplasia Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 100 4. Unbeknownst to her or her care team, a 51-year-old woman's breast cancer has an etiology rooted in the fact that tumor suppressing genes are present but have been silenced. Consequently, she has not synthesized normal cancer-suppressing proteins and neoplasia has resulted. What process has accounted for the woman's cancer? A. Chromosomal translocation B. The "two-hit" hypothesis of carcinogenesis C. Epigenetic mechanisms D. A DNA repair defect. Answer: C Rationale: Epigenetic mechanisms may "silence" genes, such as tumor suppressor genes, so that even though the gene is present, it is not expressed and a cancer- suppressing protein is not made. This process does not involve defects in DNA repair or chromosomal translocation and while it may form a half of the "two-hit" hypothesis, this is not synonymous with epigenetic mechanisms. Question format: Multiple Choice Chapter 6: Neoplasia Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 103 10. A 51-year-old female has been found to have metastatic lesions in her lung but her oncologist is unsure of the primary tumor site. Which procedure is most likely to aid in this determination? A. Immunohistochemistry B. Tumor markers C. Microarray technology D. Tissue biopsy Answer: A Rationale: Immunohistochemistry can be used to determine the site of origin of metastatic tumors. In cases in which the origin of the metastasis is obscure, immunochemical detection of tissue-specific or organ-specific antigens can often help to identify the tumor source. Tumor markers, microarray technology, and biopsy are less likely to aid in identifying the primary source. Question format: Multiple Choice Chapter 6: Neoplasia Cognitive Level: Understand Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 113 11. A client with malignant melanoma has been prescribed alpha interferon, a biologic response modifier. Since this drug prolongs the cell cycle, increasing the percentage of cells in the G0 phase, and stimulates NK cells and T-lymphocyte killer cells, the nurse can anticipate that they may experience which common side effects? A. Fever, chills, and fatigue B. Nausea, vomiting, and diarrhea C. Opportunistic infections like Candida D. Renal damage with an increased creatinine level Answer: A Rationale: Interferon is a biologic response modifier that changes a person's own immune response to cancer. This medication is given by injection, usually every other day. Because of stimulation of the body's natural immune response, the client experiences extreme flu-like symptoms. Question format: Multiple Choice Chapter 6: Neoplasia Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 116 12. An oncology nurse who has worked for many years providing care for children with cancer has taken a job on an adult oncology unit of a hospital. What differences might the nurse anticipate in this new job? A. There will be a greater number of cancers that are epithelial in origin. B. A greater proportion of the clients will have cancer that involves the hematopoietic system. C. The nurse will be working with more clients who have blastomas. D. More clients will be receiving treatment for leukemia. Answer: A Rationale: Epithelial cancers are more common in adults, while "blastomas" and cancers of the hematopoietic system such as leukemia are more common in children. Question format: Multiple Choice Chapter 6: Neoplasia Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 117 13. A 26-year-old man who survived childhood acute lymphocytic leukemia (ALL), one of the most common childhood cancers, now complains of weakness, fatigue, and shortness of breath. His treatment for ALL likely included anthracyclines. What is the most likely cause of his symptoms? A. Recurrence of ALL B. CNS problems resulting from childhood chemotherapy C. Heart failure resulting from childhood chemotherapy D. Hormonal dysfunction resulting from childhood chemotherapy Answer: C Rationale: The client's symptoms resemble those of congestive heart failure. The anthracyclines, such as doxorubicin and daunorubicin, are associated with risk for developing cardiomyopathy and heart failure. Question format: Multiple Choice Chapter 6: Neoplasia Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 118 14. The mother of an 18-month-old child is concerned that her child is lethargic and not eating foods that he normally enjoys. She takes him to the pediatrician for a check-up. Which clinical manifestations lead the health care provider to suspect the child may have a neuroblastoma? Select all that apply. A. Large, protruding abdomen B. Excessive burping C. Weight loss D. Large amount of pale urine E. Crying when joints/position changed Answer: A, C, E Rationale: Neuroblastomas are the second most common solid malignancy in childhood after brain tumors. Clinical manifestations vary with the primary site. The majority of neuroblastomas occur in the adrenal glands with large abdominal masses, fever, and possibly weight loss. Bone pain suggests metastatic disease. Question format: Multiple Select Chapter 6: Neoplasia Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 117 15. The nurse is planning care for a client who is receiving antimetabolite chemotherapy. What should the nurse include in the plan of care? Select all that apply. A. Falls prevention protocol B. Daily weights C. Encourage intake of a soft diet with fresh fruits and vegetables. D. Monitor bowel movements closely. E. Indwelling urinary catheter for accurate output record Answer: A, B, D Rationale: Common side effects when taking an antimetabolite include stomatitis, diarrhea, and myelosuppression. The nurse should monitor bowel movements due to the risk for diarrhea and for possible gastrointestinal blood loss related to thrombocytopenia and mucosal injury, which affect the S phase of the cell cycle. Due to this increased risk for bleeding, falls prevention is also important. While stomatitis would make a soft diet appropriate, fresh fruits and vegetables can introduce microbes that could be harmful for the immunocompromised client. Due to this increased risk for infection, an indwelling catheter is not recommended. Daily weight can help determine total body water and is recommended due to the risk for decreased intake and increased losses for these clients, placing them at risk for fluid volume deficit. Question format: Multiple Select 20. A client overheard the provider discussing the case and mentioning a "mutation in the TP53 gene." The client asks the nurse, "What does that mean?" Which response is the most appropriate for this client? A. "The TP53 gene is a group of tumor suppressor genes associated with lung, breast and colon cancer." B. "The TP53 gene was likely damaged when you were in utero and exposed to a toxin." C. "All cancers result from an abnormality in some gene or chromosome." D. "This means that they are looking for a monoclonal antibody that will selectively kill your tumor." Answer: A Rationale: Multiple tumore suppressor genes have been found that connect with various types of cancer. Of particular interest in this group is the TP53 gene, which is on the short arm of chromosome 17 and codes for the p53 protein. Mutations in the TP53 gene have been associated with lung, breast, and colon cancer. The TP53 gene also appears to initiate apoptosis in radiation- and chemotherapy-damaged tumor cells. The statment does not mean the gene was damaged in embryo and exposed to a toxin. Not all cancers result from an abnormality in some gene or chromosome. A monoclonal antibody is an antibody produced by a single clone of cells or cell line and consisting of identical antibody molecules. It is different from a mutation in a certain gene pool. Question format: Multiple Choice Chapter 6: Neoplasia Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 103 21. Which breakfast diet contains chemicals that likely can contribute to a higher rate of cancer risk? A. Sausage fried in reused grease and biscuits and gravy. B. Pancakes made with buttermilk and warm maple syrup. C. English muffin with jelly and scrampled eggs. D. Tofu stir-fried with peppers and onions and topped with cheddar cheese. Answer: A Rationale: There is strong evidence that certain elements in the diet contain chemicals that contribute to cancer risk. Many dietary carcinogens like benzo[a]pyrene and other polycyclic hydrocarbons are converted to carcinogens when foods are fried in fat that has been reused multiple times. The other breakfast items are no greater risk for causing cancer. Question format: Multiple Choice Chapter 6: Neoplasia Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 107 22. When educating a client who has tested positive for human T-cell leukemia virus-1 (HTLV-1), what mode(s) of transmission should the nurse discuss to prevent the spread? Select all tht apply. A. sexual intercourse B. blood by sharing needles C. infants through breast milk D. sneezing (releasing droplets) E. kissing a person on the forehead Answer: A, B, C Rationale: Human T-cell leukemia virus-1 (HTLV-1) is the only known retrovirus to cause cancer in humans. Similar to HIV, HTLV-1 is attracted to CD4+ T cells, and this subset of T cells is therefore the major target for cancerous transformation. The virus requires transmission of infected T cells through sexual intercourse, infected blood, or breast milk. Kissing a person on the forehead will not spread this virus, assuming all skin is intact. Question format: Multiple Select Chapter 6: Neoplasia Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Reference: p. 109 23. A client has stage IV cancer but further testing is needed to determine the site of origin of this metastatic tumor. Which form of testing will the health care provider be discussing with this client? A. Papanicolaou test B. sentinal node recovery C. immunohistochemistry D. microarray technology Answer: C Rationale: Immunohistochemistry involves the use of antibodies to facilitate the identification of cell products or susrface markers. It can also be used to determine the site or origin of metastatic tumors. Many people with cancer present with metastasis. In cases in which the origin of the metastasis is obscure, immunochemical detection of tissue-specific or organ-specific antigens can often help to identify the tumor's source. Papanicolaou test is a cytologic method used for detecting cancer cells and widely used as a screening test for cervical cancer. Sentinal lymph node is defined as the first lymph node to which cancer cells are most likely to spread from a primary tumor. This test is primarily done for breast cancer. Microarray technology uses "gene chips" to perform miniature assays to detect and quantify the expression of large numbrs of genes. Question format: Multiple Choice Chapter 6: Neoplasia Cognitive Level: Understand Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 113 24. The nurse is educating a client who is undergoing gamma knife radiosurgery for a brain metastasis. What advantage to this procedure should the nurse share when comparing it to other conventional treatments? A. less cognitive dysfunction B. less chance of developing focal seizures C. less explosive vomiting D. lessen the number of migraine headaches per day Answer: A Rationale: Gamma knife radiosurgery allows the application of focuesed radiation for limited brain metastasis and is associated with fewer long-term complications, such as cognitive dysfunction, compared to whole-brain radiation. Seizure activity, migraine headaches, and vomiting all can be related to the primary tumor in the brain. Question format: Multiple Choice Chapter 6: Neoplasia Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 114 25. A community health nurse is discussing preventative vaccines with a group of primigravda women. Which cancer-causing virus(es) should the nurse discuss that have a vaccine to prevent developing the disease? Select all that apply, A. hepatitis B B. chlamydia C. human papillomavirus (HPV) D. meningitis E. zika virus Answer: A, C Rationale: Cancer vaccines are one of the latest biologic response modifiers that act by stimulating the immune system to fight a specific infection or disease, most often cancer-causing viruses such as hepatitis B and human papillomavirus (HPV). Chlamydia is a common bacterial infection that is can be transmitted through sexual contact with another person. Viral meningitis is an infection of the meninges (a thin lining covering the brain and spinal cord) by any one of a number of different viruses. Acyclovir can be used to treat herpes simplex virus infection. Zika virus is a mosquito-borne flavivirus that was first identified in Uganda in 1947 in monkeys. Zika virus infections during pregnancy have been linked to miscarriage and can cause microcephaly, a potentially fatal congenital brain defects. Question format: Multiple Select Chapter 6: Neoplasia Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 116 1. An 81-year-old male client who has a diagnosis of orthostatic hypotension is experiencing an episode of particularly low blood pressure. The man's body has responded by increasing levels of angiotensin II in the bloodstream, a hormone which decreases glomerular filtration rate in the kidneys and contributes to an increase in blood pressure. Which phenomena best describes what has occurred? A. Positive feedback B. Adaptation C. Negative feedback D. Homeostasis Answer: C Rationale: This regulation and attempt to normalize blood pressure is an example of a negative feedback mechanism, in which physiologic processes result in the maintenance of homeostasis. This process of normalization is not an example of positive feedback, and homeostasis is the goal rather than the process. This process involves adaptation, but negative feedback is a more precise characterization of the process. Question format: Multiple Choice Chapter 7: Stress and Adaptation Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 123 Rationale: The locus caeruleus (LC) produces norepinephrine (NE), which initiates the autonomic syndrome known as "fight-or-flight." The LC-NE system is connected to the hypothalamus, the limbic system, the hippocampus, and the cerebral cortex, which carry out the specific functions of the stress response. Question format: Multiple Choice Chapter 7: Stress and Adaptation Cognitive Level: Remember Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 126 8. The nurse is caring for a client with left-sided heart failure causing chronic activation of the renin-angiotensin-aldosterone system (RAAS). What is the nurse's priority assessment? A. Fluid volume excess B. Decreased blood pressure when standing C. Hyperkalemia D. Increased urine output Answer: A Rationale: Activation of the RAAS results in an increase in vascular tone (elevation of BP) and renal retention of sodium and water, which will reduce urine output and contribute to the loss of potassium. Question format: Multiple Choice Chapter 7: Stress and Adaptation Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 126 9. A client who has been awaiting the results of a bone marrow biopsy for several days is experiencing stress as a result of uncertainty and the possibility that abnormal cell growth may be detected. A physical examination and blood work would most likely yield which result? A. Increased respiratory rate; increased levels of testosterone B. Increased blood pressure and heart rate; increased antidiuretic hormone (ADH). C. Pupil dilation; increased somatomedin C D. Increased gastrointestinal motility; decreased thyroid-stimulating hormone Answer: B Rationale: Increases in ADH, blood pressure, and heart rate are all associated with the stress response. Testosterone and somatomedin C are decreased in prolonged stress exposure. Gastrointestinal motility is decreased, not increased, during stress. Question format: Multiple Choice Chapter 7: Stress and Adaptation Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 127 10. A female client with a new diagnosis of systemic lupus erythematosus (SLE) has been told that this is an autoimmune disease whereby the immune system is attacking the body's cells and tissue. She knows that she has inflammation and tissue damage. She asks her nurse to explain "What cells in the body are triggering this inflammation?" The nurse responds: A. "Mainly the adrenocorticoids like cortisone are responsible for all your inflammation." B. "Mineralocorticoids like aldosterone usually begin the process of inflammation." C. "The lymphocytes that migrate to the brain where they secrete cytokines, which trigger inflammation." D. "Primarily, this acute stress reaction is associated with stimulation of the autonomic nervous system, which causes stiffness in the joints." Answer: C Rationale: Immune cells such as monocytes and lymphocytes can penetrate the blood-brain barrier and take up residence in the brain, where they secrete chemical messengers called cytokines that influence the stress response. This triggers inflammation. Question format: Multiple Choice Chapter 7: Stress and Adaptation Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 127 11. An electrician who has been working 14- to 16-hour days for several weeks to ensure the financial survival of his business presents to his family physician with a report of persistent headaches and insomnia. His family physician attributes the physical symptoms to the ongoing stress likely caused by which component of the stress response? A. The fact that he has previously had difficulty coping with stress B. The fact that he is not physically active on a regular basis C. The fact that his company is heavily in debt D. The fact that he takes diuretic medication for his hypertension Answer: A Rationale: An individual's subjective response to stress is closely linked to previous experiences in dealing with stress and the presence or absence of coping mechanisms. Physical activity, subjective financial status, and diuretic medications would be less likely to have as great an effect. Question format: Multiple Choice Chapter 7: Stress and Adaptation Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 128 12. A widow who lost her husband a few weeks ago is having trouble with insomnia. When visiting with her health care provider, the provider suggests a prescription to help her regain a normal circadian pattern. This is based on the fact that interruption of sleep–wake cycles can cause which problems? Select all that apply. A. Hallucinations that may result in harm to the individual B. Alterations in immune function that can result in an infection C. Excess of non-rapid eye movement (NREM) sleep, which affects the creativity process D. An increased risk in accidents when sleep deprived, similar to those under the influence of alcohol E. Restless leg syndrome due to inability to find a comfortable sleeping position Answer: B, D Rationale: Sleep disorders and alterations in the sleep–wake cycle have been shown to alter immune function, normal hormone secretion, and physical and psychological functioning. However, hallucinations are not associated with sleep deprivations. With sleep disorders, the REM sleep cycle will decrease, affecting creativity and forming associations. Restless leg syndrome is not associated with insomnia. Question format: Multiple Select Chapter 7: Stress and Adaptation Cognitive Level: Analyze Client Needs: Physiological Integrity: Basic Care and Comfort Reference: p. 130 13. A client with Parkinson disease has challenged himself to maintain mobility for longer than the physician predicts. He strives every day to walk 5 to 10 steps farther than the day before. This phenomenon, being researched by social psychologists, is known as: A. stubbornness. B. assertiveness. C. hardiness. D. positivism. Answer: C Rationale: Hardiness describes a personality characteristic that includes a sense of having control over the environment, a sense of having a purpose in life, and an ability to conceptualize stressors as a challenge rather than a threat. Question format: Multiple Choice Chapter 7: Stress and Adaptation Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 130 14. Which clent, when faced with acute stressful situations, would be considered highest risk for becoming noncompliant with his/her medication regimen? A. Client with end-stage renal failure experiencing electrolyte imbalances related to having trouble sticking to the prescribed diet B. Teenager whose period is late by 2 weeks and afraid to tell her parents C. Paraplegic client who forgot his pressure control device and has a small decubitus on the coccyx D. New mother who is breast-feeding every 2 to 3 hours throughout the day and night Answer: A Rationale: For people with health problems (like ESRD clients), acute stress can interrupt compliance with medication regimens and exercise programs. Question format: Multiple Choice Chapter 7: Stress and Adaptation Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 126 20. A nurse is developing a program to help clients reduce the impact of chronic stress on their health. Which clients should the nurse prioritize as being able to most benefit from the program? Select all that apply. A. A 15-year-old with mononucleosis B. A 45-year-old with inflammatory bowel disease C. A 75-year-old with pneumonia D. A 30-year-old with substance use E. A 22-year-old with an eating disorder Answer: B, D, E Rationale: Chronic stress is linked to chronic illnesses such as gastrointestinal disorders (inflammatory bowel disease), chronic alcoholism or drug use, and eating disorders. The 15-year-old client and the 75-year-old both have self-limiting conditions that, though stressful, would benefit less from a program focused on chronic stress management than those clients with the listed chronic conditions. Question format: Multiple Select CHAPTER 7 Stress and Adaptation Cognitive Level: Analyze Client Needs: Psychosocial Integrity Reference: p. 131 21. A 12-year-old client who experienced trauma is now having trouble dealing with many forms of conflict in the home and becomes distraught. What is the best approach for the nurse to recommend to the parents? A. Avoid having disagreements in the home until the child is well enough to cope with the discord. B. Request a mild sedative that the parents can administer to the child if becoming distraught. C. Talk about the past trauma often and encourage the child to think positively about the future. D. Place the child in a quiet space away from any disruptions when there are disagreements. Answer: C Rationale: The parents should encourage talking about the past trauma, as adverse physical and psychological experiences early in life (prenatal and childhood periods) can impact one's adult health. Studies suggest that assisting people in trying to remember previous experiences (and taking time to imagine positive future scenarios) better prepares them to manage future stressful experiences and lessens the impact of the past trauma. It would not be feasible to sequester the child or avoid disagreements altogether. Sedatives should not be used for this scenario. Question format: Multiple Choice Chapter 7: Stress and Adaptation Cognitive Level: Analyze Client Needs: Psychosocial Integrity Reference: p. 131-132 22. The nurse is caring for a client hospitalized yesterday with acute coronary syndrome. The client also has difficulty dealing with life stressors. On what should the nurse focus as the priority of care? A. Counseling the client on how to reduce life stressors to decrease the impact on overall health B. Assessing heart rate and blood pressure and interviewing the client about chest pain C. Teaching the client stress management techniques such as guided imagery and journaling D. Encouraging physical activity along with a healthy diet to slow the progression of heart disease Answer: B Rationale: In this moment, the priority is keeping the client hemodynamically stable and angina-free. Learning how to reduce life stressors or the reaction to them takes time; other approaches will need to be used in the short term based on the client's cardiovascular status. While suffering from an acute illness, the nurse will need to determine how the stress response may be affecting the client's myocardial health; medications and nonpharmacologic interventions could be applied in response. Once stable, long-term goals such as increasing physical activity or learning stress management techniques can be addressed. Question format: Multiple Choice Chapter 7: Stress and Adaptation Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 133 23. A single mother who was raised in a traumatic environment is very protective of her child. She expresses a desire to keep her child from experiencing stressful situations in hopes of promoting healthy development. What response by the nurse is most helpful? A. "You are creating more stress for yourself while protecting your child and this is not healthy." B. "It is normal to experience stressors periodically and this can enhance healthy development." C. "I think it is admirable that you are protecting your child from negative life experiences." D. "You can never prevent all stressful situations; they are a reality of growing into adulthood." Answer: B Rationale: Stressors that are considered within normal ranges of intensity and duration have been described as "eustress" by theorist Hans Selye. These are considered positive stimuli for emotional and intellectual growth. Informing the mother of the benefits of eustress could help frame stress differently for her. Simply telling the mother she is causing stress for herself does not address the misconception. The approach should not be simply praised or criticized by the nurse as pointless. Question format: Multiple Choice Chapter 7: Stress and Adaptation Cognitive Level: Analyze Client Needs: Psychosocial Integrity Reference: p. 123-124 24. The nurse is caring for a client who has a tumor that results in excess levels of catecholamines being released. Which assessments will the nurse prioritize in this client's plan of care? Select all that apply. A. Blood glucose B. Oxygen saturation C. Blood pressure D. Heart rate and rhythm E. Level of consciousness Answer: A, C, D Rationale: Excess catecholamines such as epinephrine and norepinephrine produce a decrease in insulin release and an increase in glucagon release. This results in increased glycogenolysis as well as an increase in insulin resistance, which warrants monitoring blood glucose levels. There will also be an increase in heart rate, cardiac contractility, and vascular smooth muscle contraction, which could lead to severe hypertension and myocardial oxygen consumption; thus, the nurse should prioritize monitoring both heart rate and blood pressure. Because there is relaxation of bronchial smooth muscle, the nurse would not expect any adverse effects on oxygen saturation. Catecholamines are not associated with an altered level of consciousness. Question format: Multiple Select Chapter 7: Stress and Adaptation Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 124 25. A nurse is caring for a client with posttraumatic stress distress disorder (PTSD). Which behaviors would the nurse expect the client to manifest? Select all that apply. A. Sleep disturbance with vivid nightmares B. Reluctance to participate in group discussions C. Difficulty concentrating on tasks D. Disregard for personal safety E. Inability to recall the traumatic events Answer: A, B, C Rationale: Posttraumatic stress disorder (PTSD) is characterized by intrusion that involves the reliving of the traumatic events and often manifests as nightmares. Therefore, the client does not have an inability to recall the events. The client would also likely display avoidance, which could make the client reluctant to share feelings in group discussions. Hyperarousal in PTSD often leads to difficulty concentrating, increased vigilance, and concern over safety rather than disregard for personal safety. Question format: Multiple Select Chapter 7: Stress and Adaptation Cognitive Level: Understand Client Needs: Psychosocial Integrity Reference: p. 131-132 D. Give him an electrolyte solution by mouth. Answer: D Rationale: Fluid volume deficit results in postural hypotension (dizziness while upright) due to decreased blood volume. Sunken eyes and elevated temperature also point to a fluid volume deficit. The most important action to take is to replace fluid; however, pure water without accompanying electrolytes, such as sodium, may cause hyponatremia (water retention and a decrease in serum osmolality). Thus, an oral electrolyte solution is recommended; in more severe cases an IV would be appropriate. Question format: Multiple Choice Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 150 6. A client is brought to the emergency department with reports of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. The nurse notifies the physician to obtain orders for which of these problems? A. Hyponatremia B. Fluid volume excess C. Hypocalcemia D. Hyperkalemia Answer: B Rationale: Peripheral and pulmonary edema as well as a bounding pulse and dyspnea are indicators of fluid volume overload. Question format: Multiple Choice Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 150 7. A client with a diagnosis of schizophrenia has been admitted with suspected hyponatremia after consuming copious quantities of tap water. Which finding does the nurse anticipate uncovering related to this problem? A. High urine specific gravity, tachycardia and a weak, thready pulse. B. Low blood pressure, dry mouth and increased urine osmolality C. Increased hematocrit and blood urea nitrogen; seizures D. Muscle weakness, lethargy and headaches. Answer: D Rationale: Weakness, lethargy, and nausea are noted manifestations of hyponatremia, which may occur with psychogenic polydipsia. High urine specific gravity; tachycardia; and a weak, thready pulse are associated with hypernatremia, while low blood pressure, fever, and increased urine osmolality are manifestations of fluid volume deficit. Increased hematocrit and blood urea nitrogen and seizures are also associated with hypernatremia. Question format: Multiple Choice Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 147 8. The nurse evaluates the ECG of a client who has developed hypokalemia secondary to diuretic use. Which manifestation of hypokalemia does the nurse anticipate on the ECG? A. Irregular heart rate and a peaked T wave. B. A low T wave and an absent P wave. C. A prominent U wave and a flattened T wave. D. A narrow QRS complex and an absent U wave. Answer: C Rationale: ECG changes associated with hypokalemia include a prominent u wave and a flattening of the T wave. Atrial fibrillation, a low P wave, and the absence of a U wave are not associated with hypokalemia. Question format: Multiple Choice Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 157 9. The nurse on the cardiac unit has noted that the client's potassium level is 6.1 mEq/L (6.1 mmol/L). The nurse has notified the physician and removed the banana from the client's meal tray. When explaining the nursing actions to the client, which statement is appropriate? A. "Your potassium level is high so I need you let me know if you feel numbness, tingling or weakness." B. "Your potassium levels in your blood are higher than they should be, which brings a risk of changes in kidney function." C. I need to monitor you for signs of high potassium; tell me if you feel as if your heart is beating quickly." D. "The amount of potassium in your blood is too high, but I will change your intravenous fluids." Answer: A Rationale: Paresthesia (tingling) and muscle weakness are the first manifestations of hyperkalemia along with slow heart rate. Tachycardia and tachydysrhythmias are more commonly associated with hypokalemia, and the greatest risks associated with potassium imbalances are cardiac rather than renal (although kidney failure may cause hyperkalemia). Hyperkalemia may not be resolved changing IV fluids. Question format: Multiple Choice Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 158-159 10. A client with hypercalcemia and hypercalciuria has just passed a kidney stone. The nurse recognizes which of these laboratory studies should also be assessed? A. Parathyroid hormone level B. Bone scan C. Plasma phosphate levels D. Serum magnesium level Answer: A Rationale: Hyperparathyroidism, in which parathyroid hormone is secreted to excess, may be caused by a parathyroid adenoma. Since parathyroid hormone mobilizes calcium from bone and promotes its transfer to the extracellular fluid, excess calcium is excreted in the urine (promoting the development of kidney stones) and is evident in the plasma. In primary hyperparathyroidism, antibody binding assays of intact PTH would reveal either normal or elevated parathyroid hormone in the face of hypercalcemia. Question format: Multiple Choice Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 160-161 11. The nurse is caring for a client with a longstanding diagnosis of hypocalcemia secondary to kidney disease. The nurse observes which clinical manifestations in this client? A. Loss of appetite and reports of nausea B. Muscular spasms and reports of tingling in hands/feet C. High fluid intake and copious amounts of dilute urine output D. Lethargy and change in level of consciousness Answer: B Rationale: Paresthesias, muscle spasms, and cramping are common manifestations of low serum calcium. Polydipsia, polyuria, anorexia, and lethargy and stupor are associated with hypercalcemia. Question format: Multiple Choice Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 163-164 Rationale: Increased CO2 levels, an increased anion gap, and a base deficit are all associated with an acidotic state. Base excess, low oxygen, high potassium, high ammonia, and decreased anion gap would not suggest acidosis. Question format: Multiple Choice Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 177 17. A 14-year-old boy, appearing to be intoxicated, arrives in the emergency department where the EMTs report the boy denies consuming anything out of the ordinary. However, an open antifreeze container was found in the boy's room. Which intervention is likely to be prescribed to treat the client's symptoms? A. Gastric lavage B. Syrup of ipecac C. Fomepizole D. Sodium bicarbonate Answer: C Rationale: Ethylene glycol is found in products ranging from antifreeze and de-icing solutions to carpet and fabric cleaners. It tastes sweet and is intoxicating, factors that contribute to its abuse potential. A lethal dose is approximately 100 mL. It is rapidly absorbed from the intestine, making treatment with either gastric lavage or syrup of ipecac ineffective. Fomepizole, with specific indications for ethylene glycol poisoning, was recently approved by the U.S. Food and Drug Administration. Sodium bicarbonate is not a treatment for this condition. Question format: Multiple Choice Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 181 18. A client is brought to the emergency department for an overdose of aspirin. The nurse caring for this client should anticipate which clinical manifestations? Select all that apply. A. Respiratory rate of 40 B. BP 100/72 mmHg C. ABG report: pH 7.50, PCO2 31 mmHg (4.12 kPa), HCO3 level 19 mmol/L D. Urine output ~100 mL/hr. E. Bilateral crackles (fluid) in the lungs Answer: A, C Rationale: The salicylates cross the blood-brain barrier and directly stimulate the respiratory center, causing hyperventilation and respiratory alkalosis. The blood pressure is a normal range and the urine output is normal or excessive depending on fluid intake. Bilateral crackles (fluid) in the lungs are usually a sign of heart failure. Question format: Multiple Select Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 181 19. A nurse is providing care for a client who has been diagnosed with metabolic alkalosis after several days of antacid use. Which treatment should the nurse prepare to give? A. Intravenous or oral administration of free hydrogen ions B. Intravenous administration of a KCl solution C. Administration of oxygen and NaHCO3 solution D. Supplementary oxygen and possible mechanical ventilation Answer: B Rationale: KCl administration facilitates the renal retention of hydrogen ions, resulting in lowering of pH. It is not possible to administer free H+ ions, and sodium bicarbonate would exacerbate her condition. Mechanical ventilation is indicated in cases of respiratory acidosis. Question format: Multiple Choice Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 184 20. A client's arterial blood gases reveal normal oxygen level, pH 7.50, PCO2 level of 50 mmHg (6.65 kPa) and HCO3 level of 30 (30 mmol/L). The client's respiratory rate is 12 breaths/min and all other vital signs are within normal range. What is this client's most likely diagnosis? A. Respiratory alkalosis B. Metabolic acidosis C. Respiratory acidosis D. Metabolic alkalosis Answer: D Rationale: In response to increased bicarbonate, the client is hypoventilating to increase carbon dioxide partial pressure. As well, renal compensation is aimed at lowering pH by both reducing H+ excretion and HCO3 – reabsorption. Metabolic alkalosis is manifested with increased pH, increased HCO3, and increased PCO2 levels. The given data are incongruent with the other major acid–base imbalances. Question format: Multiple Choice Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 183-184 21. The ICU nurse is concerned with her client's arterial blood gas (ABG) results— especially the pH 7.30; and PCO2 49 mmHg (6.52 kPa). The nurse interprets these ABG results and assesses her client for which clinical manifestations of respiratory acidosis? Select all that apply. A. Headache with complaints of blurred vision B. Muscle twitching C. Hyperactive deep tendon reflexes D. Complaints of paresthesia sensations around lips/mouth E. Numbness in fingers and toes Answer: A, B Rationale: Carbon dioxide readily crosses the blood-brain barrier, exerting its effects by changing the pH of brain fluids. Elevated levels of CO2 produce vasodilation of cerebral blood vessels, causing headache, blurred vision, irritability, muscle twitching, and psychological disturbances. Hyperactive deep tendon reflexes and reports of paresthesia sensations around lips/mouth are related to hypocalcemia. Numbness in fingers and toes correlates with respiratory alkalosis. Question format: Multiple Select Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 185 22. In the neurotrauma unit, a teenager with a closed head injury related to an automobile accident is experiencing high intracranial pressure (ICP). He is intubated and on a ventilator. One treatment for this is to allow him to progress into which acid-base imbalance in an attempt to lower ICP? A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis. Answer: D Rationale: Respiratory alkalosis is seen as a treatment with the ventilator with intubated people experiencing high intracranial pressure (ICP) in order to attempt to lower the ICP. Question format: Multiple Choice Chapter 8: Disorders of Fluid and Electrolyte and Acid Base Balance Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 186-187 23. A 77-year-old client diagnosed with chronic obstructive pulmonary disease (COPD) is experiencing impaired gas exchange and CO2 retention, despite a rapid C. Platelets D. Neutrophils Answer: D Rationale: Increased neutrophils are associated with inflammation, in general, and bacterial infections in particular. Platelets play a role in inflammation but their levels would not rise to the same extent as would neutrophils. Eosinophils are not strongly associated with bacterial infection and basophils would not increase to the same degree as neutrophils. Question format: Multiple Choice Chapter 9: Inflammation, Tissue Repair, and Wound Healing Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 192 3. A 16-year-old girl has broken her arm while snowboarding and is shocked at the amount of swelling at the injury site. Which statement best explains the physiologic rationale for her swelling? A. Migration and proliferation of mast cells, neutrophils, and platelets to the injury site occupy an increased volume of tissue. B. Potent vasodilation increases the total volume of vascular space at the site of inflammation. C. Osmotic flow of plasma into the intravascular space causes increased blood volume and interstitial fluid. D. Loss of plasma proteins causes an increase in interstitial osmotic pressure. Answer: D Rationale: Swelling is the result of plasma proteins leaving the interstitial space, resulting in increased osmotic pressure of interstitial fluid and movement of fluid into tissues. Neither blood components, vasodilation, nor increased intravascular volume account for swelling. Question format: Multiple Choice Chapter 9: Inflammation, Tissue Repair, and Wound Healing Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 196 4. Which phenomena best accounts for the increased presence of leukocytes at the site of inflammation? A. Existing leukocytes stick to the epithelial cells and move along blood vessel walls. B. Increased numbers of leukocytes are released into circulation via cytokine stimulation. C. Leukocytes are osmotically drawn from circulation into the interstitial space as a result of swelling. D. Epithelium expresses leukocyte stimulation factors in response to cell injury. Answer: A Rationale: During inflammation, leukocytes accumulate at the point of epithelial contact in the processes of margination, adhesion, and transmigration. This is not directly achieved by way of increased leukocyte production or release, nor by osmotic pressure. The epithelium does not produce leukocyte stimulation factors. Question format: Multiple Choice Chapter 9: Inflammation, Tissue Repair, and Wound Healing Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 192 5. When explaining the final stages of the inflammatory response to pathogens, the nurse should include which educational topics? A. How the body can kill the pathogen by generating toxic oxygen and nitrogen products, producing such things as nitric oxide and hydrogen peroxide B. Margination, which is a process whereby white cells (leukocytes) stick to the endothelium and accumulate along the blood vessel C. The increase in vascular permeability, which lets fluids leak into the extravascular tissues D. The promotion of tissue regeneration, whereby monocytes and macrophages produce potent prostaglandins and leukotrienes Answer: A Rationale: The latter stages of phagocytosis result in intracellular killing of pathogens, accomplished by several mechanisms, including toxic oxygen and nitrogen products, lysozymes, proteases, and defensins. The metabolic burst pathways generate toxic oxygen and nitrogen products (e.g., nitric oxide, hydrogen peroxide, and hypochlorous acid). Margination is the early stages of the inflammatory response. Vascular changes occur with inflammation but are prior to the final stage. Macrophages arrive within hours at the inflammation site. Question format: Multiple Choice Chapter 9: Inflammation, Tissue Repair, and Wound Healing Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 197 6. A deficiency in which of these would result in an inhibition of the inflammatory response? A. Histamine B. Helper T cells C. B cells D. Vitamin K Answer: A Rationale: Histamine is a key mediator in the inflammatory system, unlike helper T cells, B cells, or vitamin K. Question format: Multiple Choice Chapter 9: Inflammation, Tissue Repair, and Wound Healing Cognitive Level: Remember Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 198-199 7. When educating a client with a wound that is not healing, the nurse should stress which dietary modifications to ward off some of the negative manifestations that can occur with inflammation? A. Increase the amount of calcium in the diet, especially drinking milk and eating cheese. B. This is the one time whereby you should eat more fat (both polyunsaturated and saturated) so you can absorb more fat-soluble vitamins. C. Since there is a loss of plasma proteins, you should increase your intake of organ meats like liver. D. Increase your intake of oily fish and fish oil so that you will increase absorption of omega-3 polyunsaturated fatty acids. Answer: D Rationale: Dietary modification of the inflammatory response through the use of omega-3 polyunsaturated fatty acids, specifically eicosatetraenoic acid and docosahexaenoic acid, which are present in oily fish and fish oil, may be effective in preventing some negative manifestations of inflammation. Question format: Multiple Choice Chapter 9: Inflammation, Tissue Repair, and Wound Healing Cognitive Level: Apply Client Needs: Physiological Integrity: Basic Care and Comfort Reference: p. 199 8. Tumor necrosis factor-α and IL-1 are major cytokines that mediate inflammation. If the client is developing a systemic response to an infection, the nurse will likely assess which clinical manifestations? Select all that apply. A. Elevated temperature B. Hypertension C. Tachycardia D. Decrease in urine output E. Anorexia Answer: A, C, E Rationale: IL-1 and TNF-α are mediators of the acute-phase responses associated with infection or injury. Features of these systemic responses include fever [elevated temperature], hypotension, tachycardia [increased heart rate], anorexia, increase in neutrophil count, and increased levels of corticosteroid hormones. Question format: Multiple Select Chapter 9: Inflammation, Tissue Repair, and Wound Healing Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 200 9. A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her body. Which physiologic process could best underlie her care provider's teaching about her new diet? A. Free radicals act as direct mediators in the inflammatory process. B. Free radicals inhibit the inflammatory response, limiting pre-adaptive response to infection. C. Free radicals increase cytokine expression and adhesion molecule levels, resulting in increased inflammation. D. Free radicals contribute to atherosclerosis and decreased immune response.