Pathophysiology Final Exam Study Notes, Exams of Nursing

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SCI 225 Week 16: Pathophysiology Final

Exam (Proctored)

A patient with type 1 diabetes asks the nurse what causes polyuria. What is the nurse’s best response? The symptom of polyuria in diabetes mellitus (DM) is caused by: a reduced ADH response caused by insulin deficiency. the loss of protein across the glomerular membrane. the production of ketones. increased glucose in the urine. The presence of glucose in the urine filtrate draws water into the tubules, causing an "osmotic diuresis." If a patient with diabetes has advanced glycosylation end products (AGEs), what does the nurse suspect is happening in the patient's body? Increased ketone formation AGEs cause tissue injury through a variety of mechanisms, including the production of free radicals and the induction of microvascular/macrovascular disease. AGEs do not affect ketone formation.

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Tissue/cellular injury Dawn phenomenon Reduction of chronic complications Which information should the nurse include in a lecture on syndrome of inappropriate antidiuretic hormone (SIADH)? SIADH results in excessive: renal retention of sodium and water. renal excretion of sodium without water retention. renal retention of water without sodium retention. Elevated ADH secretion in SIADH stimulates increased water reabsorption in the distal and collecting tubules. renal excretion of water without sodium retention. A patient has thyroid carcinoma. Which of the following will the nurse find on assessment? Small thyroid nodule Thyroid carcinoma usually presents with small thyroid nodules.

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Elevated T3 and T Large, diffuse goiter Thyroid gland atrophy A patient with Graves disease has subcutaneous swelling of the anterior leg. Which term should the nurse document on the chart? Papilledema Papilledema is swelling of the optic disc in the eye. A patient with Graves disease will develop infiltration of subcutaneous tissues of the anterior lower leg, resulting in a "doughy" edema called pretibial myxedema. Pretibial myxedema Diplopia Acropachy A student nurse asks the nurse what causes acromegaly. The nurse should explain that acromegaly is caused by abnormal increases of: prolactin. growth hormone.

Acromegaly from increased growth hormone secretion results in gigantism, as well as other structural and physiological problems. insulin. glucocorticoids. The pathophysiology of type 1 diabetes mellitus (DM) involves: autoimmune destruction of pancreatic beta cells Type 1 diabetes mellitus is a slowly progressive autoimmune T cell-mediated disease that destroys beta cells of the pancreas. production of antibodies against alpha cells. type I hypersensitivity against pancreatic mast cells. insulin resistance in cellular receptors. Which is the appropriate method for diagnosis of type 1 diabetes? Measuring urine output Evaluating fasting plasma glucose levels Diabetes can be diagnosed by abnormal blood glucose levels either randomly, fasting, glycosylated, or post glucose load. Question 8

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Performing a battery of genetic tests The presence of symptoms is the only definitive method. Which of the following statements indicates that the nurse needs more teaching? Hyperglycemia can lead to chronic complications of diabetes through: activation of protein kinase C. induction of the polyol pathway. Induction of the polyol pathway increases intracellular osmotic pressure, causing cellular edema and tissue dysfunction. However, hyperglycemia can also activate protein kinase C and glycosylation. glycosylation. suppression of oxidative stress. Graves disease is an example of a: type I hypersensitivity. type II hypersensitivity. type III hypersensitivity. IncorrectQuestion 10

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type IV hypersensitivity. Type IV hypersensitivities involve a delayed T-cytotoxic cell response. Graves disease is an example of a tissue-specific (type II) hypersensitivity. A patient asks the nurse about the best treatment for multiple myeloma? How should the nurse respond? Anticoagulants Antibiotics Chemotherapy Although chemotherapy, radiation therapy, and marrow transplant have been used for treatment, the prognosis for persons with MM remains poor. Chelation A patient has acute leukemia. A nurse recalls the cell most affected by this disease is a: mature cell. blast cell. Acute leukemia is characterized by undifferentiated or immature cells, usually a blast cell. differentiated cell. Question 12

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hypochromic cell. Which laboratory result will be elevated in a patient with disseminated intravascular coagulation (DIC)? Platelets Fibrin degradation products In DIC, a sign of fibrinolysis and clot breakdown is the presence of fibrin degradation products. Clotting factors Activated protein C A nurse suspects that the patient is experiencing disseminated intravascular coagulation (DIC). Which laboratory test should the nurse ask the primary care provider to order? Urinalysis D-dimer Arterial blood gases Detection of D-dimers is a widely used test for DIC.

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Potassium A patient has heparin-induced thrombocytopenia (HIT). Which condition is a priority to assess? Pulmonary infarction Pulmonary hypertension Pulmonary edema Pulmonary embolism Venous thrombosis is more common and results in deep venous thrombosis and pulmonary emboli. A patient has non-Hodgkin’s lymphoma (NHL). When the nurse is reviewing the history, which finding is a risk factor for NHL? Appendectomy 1 year ago Bacterial infection Heart disease Organ transplant 2 years ago

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Causes of NHL include immunosuppression following organ transplantation, viral infection, and chemical exposure. Which concept should the nurse include when describing the pathophysiology of thrombotic thrombocytopenic purpura? Lytic lesions Schizocytes/Schistocytes A routine blood smear usually shows fragmented red cells (schizocytes) produced by shear forces when red cells are in contact with the fibrin mesh in clots that form in the vessels. Macrocytic Hyperchromic A patient has multiple myeloma. Which area in the body does the nurse closely monitor for the tumor masses? Lung Brain Bones Multiple myeloma (MM) is a B cell cancer characterized by the proliferation of malignant plasma cells that infiltrate the bone marrow and aggregate into tumor masses throughout the skeletal system.

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Liver A patient has acquired immunodeficiency syndrome (AIDS). Which laboratory report should the nurse monitor closely in this patient? Sodium levels Urine analysis Lymphocyte counts Lymphocytopenia is a major problem in acquired immunodeficiency syndrome (AIDS). Schilling test A patient has a "shift to the left" or "left shift." Which other term can the nurse use to describe this finding? Burkitt lymphoma Disseminated intravascular coagulation Anemia Leukemoid reaction Premature release of the immature cells is responsible for the phenomenon known as "a shift to the left" or leukemoid reaction.

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If a patient has secondary hypertension, the nurse realizes that the patient has an abnormal blood pressure caused by: elevated levels of LDL. high sodium intake. genetics. an underlying disease. Secondary hypertension is caused by an underlying disease process or medication that raises peripheral vascular resistance or cardiac output. A patient has atherosclerosis. Which factor associated with endothelial injury will the nurse observe written in the history? Anemia Autoimmunity Autoimmune factors, infectious microorganisms, and smoking are among the possible causes of endothelial injury. BP 110/ Nonsmoker Question 21

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A nurse is asked what causes Prinzmetal angina. How should the nurse respond? Prinzmetal angina is caused by: blood clots in the coronary artery. hypoxemia from respiratory disease. vasospasm. Prinzmetal angina is a special type of chest pain that occurs transiently at rest because of vasospasm. deep vein thromboses. Mitogens, such as angiotensin II, and growth factors stimulate: smooth muscle proliferation. In atherosclerosis, mitogens and growth factors stimulate smooth muscle proliferation around the fatty streak. endothelial injury. cardiac muscle toxicity. activation of phagocytes. Question 25 Question 24

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The nurse recalls risk factors that are associated with atherosclerosis. These include primary hypertension and: a high-sodium diet. advanced age. Older adults are more likely than younger individuals to develop atherosclerosis and primary hypertension. hyperhomocysteinemia. a low-potassium diet. When conducting a physical assessment of a patient during an acute asthma episode, the nurse would expect to observe: paralysis of accessory breathing muscles. bradypnea. pulsus paradoxus. During an acute asthma episode, pulsus paradoxus may be noted. eupnea.

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A patient asks the nurse what is most closely associated with the development of lung cancer? How should the nurse respond? Excessive alcohol drinking Chronic obstructive pulmonary disease Cigarette smoking The most common cause of lung cancer is tobacco smoking. Endocrine disorders A patient has pleuritic chest pain, shortness of breath, and hemoptysis. The primary care provider suspects a pulmonary embolus. Which laboratory test should the nurse check to help confirm this diagnosis? D-dimer levels The diagnosis is made by measuring elevated levels of D-dimer in the blood in combination with scanning using spiral computed tomography (CT). Red blood cell count Potassium levels IgE count Underlying the pathophysiology of ARDS is massive pulmonary:

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hyperventilation. inflammation. All disorders causing ARDS cause massive pulmonary inflammation that injures the alveolocapillary membrane and produces severe pulmonary edema, V/Q mismatch (shunting), and hypoxemia. high V/Q ratio. alveolar dead space. A patient in the emergency room reports coughing up blood, night sweats, and recently "feeling tired all of the time." The patient is feverish. Which medical condition does the nurse suspect the patient is experiencing? Viral pneumonia A pulmonary embolus Tuberculosis All of these symptoms are typical of tuberculosis (TB) infection. Being homeless and living in a shelter are risk factors for TB since the bacteria is easily transmitted from person to person. Aspiration pneumonia

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A patient with HIV has painful burning dysesthesias and paresthesias, especially in the extremities. What condition will the nurse see documented in the chart? CNS neoplasms HIV neuropathy Painful, burning dysesthesias and paresthesias, typically in the extremities, are present in individuals with HIV neuropathy. HIV-associated dementia/cognitive disorders Opportunistic infections A patient has a recent spinal cord injury. Which term should the nurse use to describe the loss of reflex function below the level of injury/lesion? Autonomic hyperreflexia Spinal shock In spinal shock, reflex function is completely lost in all segments below the lesion. Degenerative disk disease Low back pain

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A patient with a spinal cord injury (T6 level) reports a headache. The patient's blood pressure is 296 systolic, and the patient is sweating. Which intervention is most appropriate? Prepare the patient for surgery. Administer pain medication for headache. Start CPR. Check the patient's bladder. The most common cause is a distended bladder or rectum, but any sensory stimulation can elicit autonomic hyperreflexia. Which of the following may cause an attack or an exacerbation of symptoms for a patient with multiple sclerosis? Cool environment Administration of corticosteroids Increased calcium levels Conditions that cause short-lived attacks include minor increases in body temperature or serum calcium (Ca++) concentration. Decreased stress levels

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While reviewing a patient’s health history, which finding will most alert the nurse to the possible development of a chronic subdural hematoma? Peripheral nerve trauma Brain cancer Prior brain atrophy Prior brain atrophy is a major risk factor in the development of chronic subdural hematomas. Meningitis Dermoid cysts are tumors that contain elements of skin, hair, glands, muscle, cartilage, and bone that can eventually develop into: ovarian cancer. Dermoid cysts are ovarian tumors that are generally asymptomatic but must be removed to prevent the development of ovarian cancer. uterine fibroids. benign breast tumors. follicular cysts.

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A patient has dysmenorrhea and the primary care provider prescribes a nonsteroidal anti-inflammatory medication. When should the nurse advise the patient to take this drug? At or before the onset of menses Management of dysmenorrhea is usually successful with nonsteroidal antiinflammatory drugs (which block prostaglandin production), but these medications must be started at, or even before, the onset of menses. At or after the onset of menses On the last day of menses During the middle of menses Benign ovarian cysts are classified as: subserous, submucous, or intramural. follicular, corpus luteum/luteal, or dermoid. Benign ovarian cysts are classified as follicular, corpus luteum/luteal, and dermoid. hyperplastic, atrophic, or functional. stage I, II, III or IV. The most important risk factor in the development of prostate cancer is: Question 38

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older age. By age 85, 1 in 6 American men will develop prostate cancer and about 3% will die from it. smoking. low-fat diet. urethral stricture. A patient has a cystocele. What other condition should the nurse assess for in this patient? Stress incontinence A cystocele occurs when the bladder descends into the anterior aspect of the vaginal canal and usually results in bladder control problems such as stress incontinence. Significant problems defecating The descent of the rectum into the vaginal canal Infertility A nurse is describing the pathophysiology of duodenal ulcers. Which information should the nurse include?

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Chronic inflammation inhibits the proton pumps in the gastric lining to decreased acid levels. The presence of bacteria in the stomach causes the pyloric sphincter to open slowly. H. pylori H. pylori releases toxins and enzymes that promote inflammation. The nurse is caring for a variety of patients. Which patient is most at risk for a paralytic ileus? A patient in which gastroesphageal reflux has resolved Paralytic ileus is a functional bowel obstruction caused by failure of motility and often occurs after abdominal surgery. A patient with postoperative abdominal surgery A patient who is pregnant A patient who is vomiting Which of the following complications will cause the most concern for a nurse who is caring for a patient with a paraesophageal hiatal hernia? Ulcers Gastroesophageal reflux

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Gastritis Strangulation Strangulation of the hernia is a major complication. A patient has gallbladder pain that is felt in the right shoulder. The nurse explains to the patient that the issue is the gallbladder, and that the pain in the shoulder is the result of which type of pain? Parietal Visceral Referred Referred pain is visceral pain felt at some distance from a diseased or affected organ. For example, acute cholecystitis may have pain referred to the right shoulder or scapula. Somatic A characteristic of ulcerative colitis is: the disease has “skip” lesions. the disease begins in the rectum and may advance back through the colon in a continuous manner. Question 45

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Ulcerative colitis begins in the rectum and advances up through the colon in a continuous manner and does not "skip" parts of the mucosa. it has a cobblestone appearance that increases the risk for colon cancer. it has a beginning in the small intestines and advances to the large intestines. A patient has a fracture that broke into several fragments. Which type of fracture did the patient sustain? Comminuted A fracture in which the bone breaks into two or more fragments is called a comminuted fracture. Open Greenstick Occult A patient fractures a bone in a place where there was a pre-existing disease. Which type of fracture is being described? Transchondral fracture Pathological fracture A pathologic fracture occurs in a place where there was pre-existing disease that weakened the area.

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Stress fracture Fatigue fracture A middle-aged patient has a tumor that infiltrates trabeculae in spongy bone. Which diagnosis will the nurse observe documented on the chart? Chondrosarcoma Leukemia Lymphoma Osteosarcoma Osteosarcoma is a cancer of the osteogenic (bone-forming) cells. Chondrosarcoma is a tumor of middle-aged and older adults that infiltrates trabeculae in spongy bone. Which of the following assessment symptoms are typical in a patient who has just sustained a femoral fracture? Chest pain and shortness of breath Low blood glucose and seizures Pain and swelling in the thigh

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Because of inflammation, a fracture generally manifests with pain and swelling at the site of injury. Limb paralysis and referred pain Which of the following is a characteristic assessment finding in a patient with fibromyalgia? Trigger/tender point pain Fibromyalgia specifically manifests with trigger/tender point pain. Leg cramps Permanent shortening of muscles Muscle atrophy