Pathophysiology Exam Update Units 1-5

Pathophysiology Exam Update Units 1-5| Patho Actual Exam 2023-2024|MN 551 Questions and Correct Answers Rated A+ 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) Transports amino acids to the site of protein synthesis B) Acts as an inner nuclear support membrane for a rigid network of protein filaments that bind 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 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 A 14-year-old female has been experiencing severe internal cramps in the region of the pelvis and 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. The nurse will base her response knowing that IBD has been linked to A) liver involvement in faulty glycogen stores. B) endoplasmic reticulum stress in the gastrointestinal system. C) oversecretion of insulin from the beta cells in the pancreas. D) infiltration of the gastrointestinal tract by bacterial toxins. - ANSWER-B A professor is teaching a group of students about the role of mitochondria within the cell. Which of the following statements 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 A patient has been diagnosed with a neurodegenerative disease called multiple sclerosis (MS). The physician explains to the patient that this disease may be caused by dysregulated apoptosis. Later that day, the patient 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 neuropathways." D) "There is an inappropriately low rate of apoptosis occurring within the cells." - ANSWER-C A patient experiencing immotile cilia 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 the sperm to swim downstream D) Inability to hear soft sounds related to kinocilium on the hair cells in the inner ear ANSWER-B A community health care worker is explaining to a group of factory workers the importance of wearing gloves when working with strong chemicals such as turpentine and paint thinner. Which of the following characteristics of cell membranes underlies the nurse's teaching? A) Cell membranes are impermeable to all but lipid-soluble substances. B) Cell membranes have a hydrophilic head and a hydrophobic tail. C) Cell membranes contain receptors for hormones and biologically active substances. D) Transmembrane proteins can pass through the cell membrane into the intracellular environment. - ANSWER-A The nurse is explaining the workings of selective serotonin reuptake inhibitors 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 The nurse is teaching a group of colleagues about the cell division cycle as background to oncology nursing. Which of the following statements is true of the cell cycle? A) Some cells lack a G0 phase. B) Mitosis is a process that occurs in steps over 1 to 2 days. C) The two broad phases of the cell cycle are mitosis and synthesis. D) Nondividing cells such as nerve cells are said to be in the S0 phase. - ANSWER-C A 62-year-old male collapsed while unloading a truck of heavy sacks of feed for his cattle. When he arrived in the emergency department, blood gases reveal a slightly acidic blood sample. The nurse caring for this patient is not surprise with this result based on which of the following pathophysiological rationales? A) The skeletal muscles are producing large amounts of lactic acid and release it into the bloodstream during heavy work/exercise. B) During exercise, catabolism will break down stored nutrients and body tissues to produce energy. C) Large amounts of free energy are released when ATP is hydrolyzed and then converted into adenosine diphosphate. D) Within the mitochondria, energy from reduction of oxygen is used for phosphorylation of ADP to ATP. - ANSWER-A The health caregiver is explaining the rationale for administering a hypotonic intravenous solution (lower concentration of solutes in its surroundings) to a client. Which of the following mechanisms of membrane transport most likely underlies this action? A) Facilitated diffusion B) Active transport C) Diffusion D) Osmosis - ANSWER-D A nurse is teaching a client with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose must enter the body cell in order to provide energy for the client. The nurse knows that which of the following processes allows glucose to enter body cells? A) Osmosis B) Facilitated diffusion C) Active transport D) Diffusion - ANSWER-B An end-stage renal disease patient has been on peritoneal dialysis at home. Based on his lab work, he regulates the type of solution to infuse into his abdomen. When there is a high concentration of potassium inside the cell (hyperkalemia), the solution infused has a lower concentration so that the potassium ions will diffuse outward. At this point, the cellular membrane is said to be A) at equilibrium potential in which no net movement of ions occurs. B) charged with high voltage. C) filled with positive current. D) polarized because of the presence of a negative membrane potential. - ANSWER-D A student asks the instructor about the origins of different tissues and their cellular origins during the process of development. Which of the instructor's following statements 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 A nurse is providing care for a client with a diagnosis of Crohn disease. The nurse recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which of the following types 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 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) 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 contration. - ANSWER-D The homecare nurse is making a home visit to a 51-year-old female client with a long-standing diagnosis of multiple sclerosis. The nurse knows that the muscle wasting and weakness associated with the disease process are 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 An instructor is explaining to a group of students the way in which muscles and their associated tendons can be so strongly attached. The instructor makes references to the role of the basal lamina. Which of the following statements most accurately captures an aspect of the basal lamina? A) It is produced by the connective tissue adjacent to it. B) It is present where connective tissue contacts the tissue it supports. C) It is found solely between connective tissue and muscle fibers. D) It is also known as the basement membrane - ANSWER-B A caregiver is working with a client who is having poorly controlled pain due to shingles. The associate pain travels to the client's nervous system via A) synapses. B) axons. C) afferent neurons. D) efferent neurons. - ANSWER-C A 6-year-old child cuts his leg while playing outside. An inflammatory process begins the healing process by moving leukocytes and platelets through the endothelial lining of blood vessels. This process occurs because of which extracellular tissue component? A) Extracellular matrix B) Glycosaminoglycans C) Selectins D) Cadherins - ANSWER-C Of the following situations, which one would be an example of a maladaptive cellular change? A) An 18-year-old body builder who has developed extremely large pectoral muscles following years of weight lifting B) A 31-year-old marathon runner who has developed hypertrophied myocardial cells C) A 54-year-old female who has developed ovarian atrophy following loss of estrogen stimulation during menopause D) A 44-year-old male with a 60-pack-per year smoking history who was diagnosed with a histological grade 3 lung cancer - ANSWER-D A client is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which of the following factors 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 The nurse is teaching new nursing assistants on the unit about the phenomenon of muscle hypertrophy. Which of the following clients on the unit is most likely to experience muscle hypertrophy? A client with A) urinary incontinence following a cerebral vascular 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 Which of the following clients is at a high risk for developing dilated cardiomyopathy? A) A 17-year-old with a diving injury resulting in paraplegia B) A 4-year-old child born with cerebral palsy and confined to a wheelchair C) A 44-year-old noncompliant female who forgets to take her hypertensive medications D) A 78-year-old patient with Alzheimer disease who received a third-degree burn following an oven fire - ANSWER-C Which of the following statements by a student 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." C) "When male patients experience 'an enlarged prostate,' they are describing a form of hypertrophy." D) "Clients with cardiomyopathy undergo myocardial hypertrophy with proportional increases in cell length and width." - ANSWER-A A community health care nurse is teaching a group of female high school students about the importance of regular Papanicolaou (Pap) smears. The nurse recognizes that what fact underlies the rationale for this teaching? A) The active substitution of normal cells in the cervix correlates to cancer risk. B) Undifferentiated stem cells are an early indicator of cervical cancer. C) Cancer of the uterine cervix develops incrementally at a cellular level. D) Dysplasia in the connective tissue of the cervix is a strong precursor to cancer. - ANSWER-C A home health nurse is making a visit to a family with an 8-month-old infant with severe motor deterioration. The physician has diagnosed the infant with Tay-Sachs disease. The parents are asking the nurse why this happened. The nurse will base her answer knowing the root cause of Tay-Sachs is A) high exposure to lead in the home environment. B) an enzyme defect causing abnormal lipid accumulation in the brain. C) hypoxia caused by placing the infant on their abdomen during sleep. D) an increase in bilirubin retention leading to destruction of RBCs. - ANSWER-B A 68-year-old male client with aortic stenosis secondary to calcification of the aortic valve is receiving care. Which of the following statements best captures an aspect of this client's condition? A) Paget disease, cancer with metastases, or excess vitamin D may have contributed to the problem. B) Increased calcium intake over time may have contributed to the problem. C) The client has possibly undergone damage as a result of calcification following cellular injury. D) The client has possibly exhibited phosphate retention leading to calcium deposits. ANSWER-C A nurse in the emergency department admits a male client who has experienced severe frostbite to his hands and toes after becoming lost on a ski hill. The nurse recognizes that which of the following phenomena has contributed to his tissue damage? A) Decreased blood viscosity has resulted in interstitial bleeding. B) Reactive vasodilation has compromised perfusion. C) Autonomic nervous stimulation has resulted in injury. D) Decreased blood flow has induced hypoxia - ANSWER-D As part of a first aid class, a health care instructor is teaching a group of industrial workers about how electrical injuries can cause cell damage. Which of the statements made by one of the workers indicates that further teaching is necessary? A) "The greater the skin resistance, the greater the amount of deep and systemic damage a victim is likely to incur." B) "The particular pathway that a current takes through the body is very significant." C) "Resistance to flow is the phenomenon that transforms electrical energy into heat." D) "The most severe damage is likely to occur where the current enters and leaves the body." - ANSWER-A A client who has had a diagnosis of lung cancer is scheduled to begin radiation treatment. The nurse knows that which of the following statements listed below 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 A young patient has just been diagnosed with xeroderma pigmentosum. When teaching the family about this disease, the nurse should emphasize which of the following 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 the family to go to the beach is in the fall/winter months." - ANSWER-B D A 7-year-old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which of the following assessment findings is most congruent with the client's diagnosis? A) Decreased deep tendon reflexes B) Hemoglobin 9.9 g/dL C) Diffuse muscle pain D) White blood cells (WBC) 11,000/mm3 - ANSWER-B 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 of the nurse's following responses 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." 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 A nurse is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which of the following statements 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 During a myocardial infarction (MI), a patient with a 97% occlusion of his left descending artery develops ventricular arrhythmias due to the amount of ischemia occurring in the myocardium. While educating the patient about MIs, the nurse will base her teaching on the fact that A) permanent damage will occur in the myocardium if the vessel is not opened within a 1- to 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 through the process of angiogenesis, thereby avoiding any permanent damage to the myocardium. - ANSWER-B Which of the following statements most accurately conveys an aspect of cell injury due to impaired calcium homeostasis? A) Normal intracellular calcium ion levels are higher than extracellular levels. B) Ischemia and certain toxins cause a decrease in cytosolic calcium. C) Injured cells tend to accumulate calcium. D) Low calcium levels cause an activation of damaging enzymes. - ANSWER-C The nurse is providing care for a client with a diagnosis of amyotrophic lateral sclerosis (ALS). The nurse recognizes which of the following mechanisms is suspected to play a role in the cellular death associated with ALS? A) Apoptosis B) Liquefaction necrosis C) Hypoxic cell injury D) Caseous necrosis - ANSWER-A The nurse is providing care for a 21-year-old female client with gas gangrene secondary to her compound fracture in her arm. Which of the following assessment findings would the nurse most reasonably expect to find when caring for a client with a diagnosis of gas gangrene? A) Inflammation of the affected tissue B) A positive culture for Staphylococcus C) Spreading edema D) Impaired alveolar gas exchange - ANSWER-C Which of the following enzymes listed below is responsible for cancer cells' ability to prevent aging of the cells and contributes to cellular immortality that is so characteristic of this disease process? A) Oxidoreductase B) Telomerase C) Hydrolase D) Isomerase - ANSWER-B 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 A student is trying to understand the possible reasons that a genetic abnormality might exist in an individual. Which of the following reasons 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. D) Chromatin has maintained its stable structure during the DNA replication process. ANSWER-D A 45-year-old client who experienced exposure to radiation during an industrial accident several years prior is being assessed. Which of the following phenomena may underlie the genetic changes that have been noted in the client? A) Base pairs may have been rearranged by the radiation in the accident. B) Endonucleases may have influenced the DNA structure following exposure. C) Two paired bases may have exchanged helical position after the accident. D) The radiation may have produced a redundant or degenerate genetic code. - ANSWER-A A researcher is involved in the investigation of an individual's genetic abnormality. Which of the following situations could the researcher most likely rule out as the genetic cause of a mutation? A) Loss of a cytosine-guanine base pair B) Formation of an adenine-uracil base pair C) Substitution of an adenine-thymine base pair for a cytosine-guanine base pair D) Insertion of an extra adenine-thymine base pair - ANSWER-B In the context of an explanation of how human growth occurs, a student is explaining to a colleague the necessity and roles of different types of RNA in protein synthesis. Which of the following types of RNA is a result of the process of transcription? A) Ribosomal RNA B) Messenger RNA C) Translation RNA D) Transfer RNA - ANSWER-B A 31-year-old male has been newly diagnosed with early-onset Parkinson disease. As the nurse is educating the patient and family, they ask how this happened so early in his life. The nurse will base the response on which of the following statements listed below? A) "No one really knows why some patients get this diagnosis in their 30s, while others are in their 50s before they begin to have symptoms." B) "Sometimes exposure to too much ultraviolet radiation causes changes in your gene sequencing and therefore mutations occur." C) "Disruption in some proteins called molecular chaperones causes intracellular molecules to become denatured and insoluble leading to clumping and the development of inclusion bodies." D) "Gene repression is a process by which a regulatory gene acts to reduce or prevent gene expression, thereby confusing the negative feedback mechanisms that could prevent disease formation." - ANSWER-C While discussing embryogenesis to a group of students moving through the maternity ward, the nurse quizzes them to see if they know what is happening during sonic hedgehog signaling. Which of the following answers would be considered accurate? Select all that apply. A) Development of the eyes B) Separation of the brain into two cerebral hemispheres C) A carrier system for delivering the appropriate amino acids to the ribosomes D) Development of the correct number of fingers and toes E) Bone formation leading to macrocephaly - ANSWER-B D A physician is working with a family whose daughter has been recently diagnosed with the chromosomal disorder Turner syndrome. The physician would recognize that which of the following statements about the characteristics of human chromosomes is accurate? A) Individual variations are attributable to differences in appearance in autosomes. B) Chromosomes undergo variations during each episode of cell division. C) Autosomes contain the determination of an individual's sex. D) Each of the 22 pairs of autosomes has a homolog - ANSWER-D A man and woman are eager to determine the sex of their unborn child and have asked the nurse at the fertility clinic how this is possible at an early stage of in vitro development. Which of the nurse's responses best captures the genetic rationale for early sex identification through tissue samples? A) "The inactive X chromosome can be visible in a female." 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 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 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 of the following explanations 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 A health care professional works in a context where there are a large number of clients who live with genetic disorders. Which of the following circumstances would most likely 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 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 Knowing that persons with blonde hair exhibit the phenotype of a recessive gene, which of the following genetic scenarios would most likely underlie such a trait? A) aa B) A heterozygous pairing C) Either AA or Aa D) Different alleles at a gene locus - ANSWER-A A group of researchers have identified that the prevalence of two particular genetic disorders shares a statistical correlation. Which of the following statements 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 When educating the parents of an infant diagnosed with hemochromatosis, the nurse should consider which of the following topics a priority for the parents to know? A) Provide a restricted iron diet to prevent organ damage B) How to check their infants' stools for blood C) Where to look for lesion development on the skin D) How to assess an infant for blood loss and anemia - ANSWER-A A student is explaining to her colleague the different methods that are available for genetic mapping. Which one of the colleague's following 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 A researcher is involved in the production of insulin through recombinant DNA technology. Which of the following statements could the researcher best provide as a rationale for her work? A) The gene fragment responsible for insulin production can be isolated and reproduced. B) Particular bacteria are capable of insulin production. C) It is possible to reproduce the chromosome responsible for insulin production. D) Recombination of DNA base pairs can result in a gene that will produce insulin. - ANSWERA Which of the following patients are receiving treatment that has been developed utilizing recombinant DNA techniques? Select all that apply. A) Patient undergoing detection of gene location by chemically tagging DNA or RNA sequences B) Mother undergoing amniocentesis to diagnose a congenital adrenal hyperplasia C) End-stage renal disease patient receiving erythropoietin to stimulate RBC production D) Stroke victim receiving tissue plasminogen activator (tPA) to dissolve the thrombi E) Couple going to an infertility clinic for diagnostic testing - ANSWER-C D While the nurse is educating a fellow nurse about some new research being developed to treat hepatitis C, specifically to identify disease-related drug targets on the cells, the nurse will be basing these data on which new technology finding? A) Recombinant DNA technology B) Haplotype mapping C) The human genome project D) Interference RNA (RNAi) - ANSWER-D An infant who is 4 days postpartum has been diagnosed with a single-gene disorder. The parents of the child have a number of questions about the etiology of the health problem, which the physician is attempting to address in detail. Which of the following teaching points most accurately captures an aspect of single-gene congenital disorders? A) Affected genes are present on autosomal chromosomes rather than sex chromosomes. B) The majority of single-gene disorders manifest near the time of puberty. C) A particular defect can be caused by mutations at several different loci. D) Single-gene disorders are associated with existing rather than new mutations. - ANSWER-C A male client of a nurse practitioner has an autosomal dominant disorder. The client and his partner are considering starting a family. Which of the following statements indicates the client has an adequate understanding of the genetic basis of this health problem? A) "I know there's no way of accurately determining the chance that my child will inherit the disease." B) "My children who don't have the disease still run the risk of passing it on to their children." C) "I know that new genetic mutations won't occur between generations." D) "I know that a single mutant allele is to blame for the health problem." - ANSWER-D A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community health clinic. Which of the following assessments would be the health care professional's lowest priority? A) A test of the child's visual acuity B) A musculoskeletal assessment C) Tests of kidney function D) Cardiovascular assessment - ANSWER-C A clinician who works on a cardiac care unit of a hospital is providing care for a number of clients. Which client most likely has a genetic disorder arising from inheritance of a single gene? A) A short, thin, 56-year-old woman with hypertension B) A tall, thin, myopic, 28-year-old woman with mitral valve prolapse C) An overweight, middle-aged male smoker with coronary artery disease D) A thin, middle-aged nonsmoking man with a repaired atrial septal defect - ANSWER-B The nurse working in a pediatric office is scheduled to assess a female adolescent diagnosed with neurofibromatosis (NF) type 1. During this assessment, the nurse should be assessing the teenager for which of the following clinical manifestations of NF-1? Select all that apply. A) Irregular menstrual periods B) Severe scoliosis C) Hearing loss D) Complaints of having a hard time concentrating in school E) Speech impediments - ANSWER-B D E A new older female client at a long-term care facility has a diagnosis of type 1 neurofibromatosis. As part of the intake assessment protocol for the facility, the clinical educator is teaching the care staff about the diagnosis. Which of the following statements 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 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 of the following statements is true of autosomal recessive disorders? A) They can manifest when present in one or both gene pairs. B) There is a one in two chance of an affected child in each pregnancy with an affected mother. C) They tend to have a more uniform symptomatology than autosomal dominant disorders. D) The associated disorders are usually attributable to abnormalities in structural proteins. - ANSWER-C A 6-year-old boy who has mental retardation secondary to fragile X syndrome has been admitted to hospital with a mitral valve prolapse. A health care worker who is providing care for the family should have which of the following statements as part of her knowledge base around the disease? A) The common pattern of inheritance is an affected mother who carries one normal and one mutant allele. 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. - ANSWERD Two health care workers are comparing the etiology and incidence of multifactorial inheritance disorders and single-gene disorders. Which of the following statements 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 has a higher risk of having another with the same disorder." - ANSWER-D While taking their daily walk, the nurse is asked by a neighbor what centric fusion (robertsonian) translocation means. She tells you 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 A physician is working with a 30-year-old male client with Down syndrome who has been admitted to hospital with a diagnosis of acute leukemia. Which of the following physical assessment findings would the physician be more likely to find in an examination of this client than in other clients without Down syndrome? A) Hepatomegaly B) Decreased visual acuity C) Congenital heart defects D) Diabetes mellitus - ANSWER-C An 11-year-old girl is suspected of having Turner syndrome. Which of the following diagnostic tests would be the most useful component of screening to confirm or rule out the diagnosis? A) Computed tomography of the head B) Echocardiogram C) Bone scan D) Liver biopsy - ANSWER-B If a male child was born with Klinefelter syndrome, as the child matures and becomes an adolescent, the nurse will assess the child for which of the following clinical manifestations listed below? Select all that apply. A) Enlarged breast tissue B) Sparse facial and pubic hair C) Tall stature out of proportion D) Severe mental retardation E) Higher than average linguistic skills - ANSWER-A B C As part of her prenatal care, a pregnant woman and her partner are being taught by a community health nurse. Which of the following points about the teratogenic effects of different substances should the nurse include in his teaching? A) "Your developing baby is most vulnerable during the first 2 months of your pregnancy." B) "You need to be very careful with vitamin D and its derivatives." C) "Keep in mind that a high percentage of genetic abnormalities are attributable to drug origins." D) "Your best option is to avoid using any drugs during your pregnancy." - ANSWER-A 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 medications prior to finding out that she was pregnant. Select all that apply. A) Warfarin (Coumadin) for chronic atrial fibrillation B) Ethyl alcohol ingestion regularly every weekend and some nights throughout the week C) Isotretinoin (Accutane) for acne D) Over-the-counter cetirizine (Zyrtec) for seasonal allergies E) Tetracycline for acne - ANSWER-A B C D A woman gives birth to a small infant with a malformed skull. The infant grows abnormally slowly and shows signs of substantial cognitive and intellectual deficits. 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 Which of the following pregnant women 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 syndrome and tuberculosis D) A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy - ANSWER-B While traveling throughout Asia, a young couple was exposed to many cultural experiences. One day, they were standing in line, and the person in front of them was clearly displaying signs of illness and had a pink or light red rash on his face with itching. Their guide commented on a recent outbreak of rubella. Upon return to the United States, the couple found out they were pregnant. Upon arrival at the clinic, they are very concerned about their possible exposure to rubella. From this history, the nurse knows that this infant is at high risk for which of the following complications? 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 its eyes and mouth 2 weeks after delivery - ANSWER-A B 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 While preparing a patient about to undergo percutaneous umbilical cord blood sampling, which of the following information should the nurse provide as preprocedure teaching? 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 Which of the following characteristics could apply to healthy somatic cells rather than cancerous cells? A) A high rate of mutation exists in the cells. B) The cells have a reduced tendency to cluster together. C) They remain viable and multiply without attachments to other cells and the extracellular matrix. D) The cells are unable to proliferate except by mitotic division. - ANSWER-D Following a biopsy, a 54-year-old man has been diagnosed as having a benign neoplastic tumor. Which of the following characteristics 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 or 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 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 do not see how he could have developed cancer in his liver. Which of the following facts 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 A 41-year-old female with a family history of breast cancer 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 of the following principles? 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 difficult to feel the hard lumps of a cancer. - ANSWER-A 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 Which of the following patients of a primary care physician would not require extra screening for cancer? A) A 51-year-old woman whose grandmother died of breast cancer B) A 48-year-old man who takes immunosuppressant drugs following a kidney transplant C) A 50-year-old male who is obese and has a low-fiber, high-fat diet D) A 38-year-old female with Down syndrome and congenital scoliosis - ANSWER-D Blood-borne cancerous cells have recently spread from a woman's primary tumor in her pancreas to her bones. Which of the following components of the woman's immune system are likely to be directly involved in the attempt to eradicate the potential metastasis? Select all that apply. A) T lymphocytes B) Macrophages C) Natural killer (NK) cells D) B cells E) Mast cells - ANSWER-A B C D A woman is surprised to read on the Internet that certain infections can cause cancer and has sought clarification from her family physician during an office visit. How can the physician best respond to the woman's query? A) "Though it's not particularly common, it's true that certain bacteria and viruses can lead to cancer." B) "Most cancers that cannot be attributed to family history or lifestyle are in fact associated with viruses." C) "There are many viruses, but only a very few of them have been shown to cause cancer in humans." D) "This is true; for example, HIV has been shown to cause cancer in some patients. ANSWER-C The family of a 68-year-old man who is in the end stages of small cell lung cancer are distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the client's anorexia and cachexia? A) Inadequate cellular metabolism of glucose results from tumor factors. B) High fat losses coupled with preservation of muscle mass exaggerate the appearance of wasting. C) Products of the tumor itself as well as a hypermetabolic state cause cachexia. D) Inadequate food intake due to symptoms and treatment results in loss of both muscle and fat. - ANSWER-C The nurse caring for a lung cancer patient with metastasis to the brain suspects the patient has developed a paraneoplastic syndrome known as syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Which laboratory result in this patient who has gained 3 lb in a day would alert the nurse to the possibility of SIADH? A) Serum potassium of 5.0 mmol/L B) Serum sodium of 115 mmol/L C) BUN of 8 mg/dL D) Hematocrit of 40% - ANSWER-B A 60-year-old man has presented to a clinic and is requesting screening for tumor markers after reading about them in a magazine. What can the clinician most accurately tell the man about the clinical use of tumor markers? A) "Tumor markers are a very useful screening tool, but they only exist for a very few types of cancer." B) "Tests for the presence of tumor markers are limited by the fact that they are only accurate in the very early stages of cancer." C) "Tumor markers are an excellent screening tool, but it's only practical to test for those cancers that you're at risk of." D) "Tumor markers alone aren't enough to confirm whether you have cancer or not, so they're not a very useful screening tool." - ANSWER-D A 51-year-old female has been found to have a metastatic lesion in her lung, and her oncologist is unsure of the site of the primary tumor. Which of the following procedures is most likely to aid in this determination? A) Immunohistochemistry B) Tumor markers C) Microarray technology D) Tissue biopsy - ANSWER-A Which target of both chemotherapy and radiation treatment accounts for adverse as well as therapeutic effects? A) Cell surface receptors B) Circulating hormone levels C) Blood vessels D) Rapidly proliferating cells - ANSWER-D Upon entering the room of a 74-year-old client receiving brachytherapy for cervical cancer, you find the radiation implant and the position-holding device in the client's bed. What is the nurse's first best action? A) Assess the client's mental status. B) Use tongs to place the implant in the radiation container. C) Notify the physician and move the client to a different room. D) Don gloves and attempt to reposition the implant and positioning device. - ANSWER-B A cancer patient has been prescribed 5-fluorouracil, an antimetabolite chemotherapy agent. This medication stops normal development and division by interrupting the S-phase of the cell cycle. When teaching this patient, the nurse explains that during the S-phase of the cell cycle, A) the cell is in a prolonged resting state and only leaves this state when cellular destruction is occurring. B) the DNA synthesis stops, but RNA synthesis continues. C) nuclear division occurs. D) the synthesis of DNA occurs, causing two separate sets of chromosomes to develop. - ANSWER-D A 61-year-old male client is scheduled to begin chemotherapy for the treatment of his bone cancer shortly. Staff at the cancer center have educated the man and his wife about the goals, course, and expectations of his treatment. Which of the following medications and treatments might the man anticipate needing during and after his course of treatment? A) Analgesia and corticosteroids B) Antiemetics and packed red blood cell (PRBC) transfusions C) Whole blood transfusion and antiplatelet aggregators D) Diuretics and selective serotonin reuptake inhibitors (SSRIs) - ANSWER-B A patient 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 he may experience which of the following 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 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 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 The mother of an 18-month-old child is concerned that her child is lethargic and is not eating foods that he normally enjoys. She takes him to the pediatrician for a check-up. Which of the following clinical manifestations would 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 position is changed - ANSWER-A C E A 23-year-old man has received a recent diagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse providing care for the man is explaining that while unpleasant, the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which of the following teaching points should the nurse eliminate from his teaching to the patient? A) "Inflammation can help to remove the body tissue cells that have been damaged by infection." B) "Inflammation will start your body on the path to growing new, healthy tissue at the site of infection." C) "Inflammation helps your body to produce the right antibodies to fight the infection." D) "Inflammation ultimately aids in eliminating the initial cause of the cell injury in your appendix." - ANSWER-C A patient presented to the emergency department of the hospital with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) cellulitis. The patient's physician has ordered a complete blood count and white cell differential. Which of the following blood components would the physician most likely anticipate to be elevated? A) Basophils B) Eosinophils C) Platelets D) Neutrophils - ANSWER-d A 16-year-old girl has broken her arm while snowboarding. When she arrives at hospital, she is shocked at the amount of swelling at the injury site. Which of the following statements best explains the physiological 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 Which of the following 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 When explaining the final stages of the inflammatory response to pathogens, the nurse will educate the patient about 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 A deficiency in which of the following would result in an inhibition of the inflammatory response? A) Histamine B) Helper T cells C) B cells D) Vitamin K - ANSWER-A When educating a patient with a wound that is not healing, the nurse should stress which of the following 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 Tumor necrosis factor-a and IL-1 are major cytokines that mediate inflammation. If the patient is developing a systemic response to an infection, the nurse will likely assess which of the following clinical manifestations? Select all that apply. A) Elevated temperature B) Hypertension C) Tachycardia D) Decrease in urine output E) Anorexia - ANSWER-A C E A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her body. What physiological processes 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 preadaptive 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. - ANSWER-C A nurse is changing the wound dressing on the coccyx-region pressure ulcer of an immobilized patient. The existing dressing is saturated with both watery, clear discharge and foul, graycolored liquid. Which of the following entries in the patient's chart best captures this? A) "Large amounts of suppurative and serous exudates noted" B) "Purulent discharge and fibrinous exudates noted on existing dressing" C) "Abscess activity noted to coccyx wound" D) "Plasma proteins and membranous exudates present on existing dressing" - ANSWER-A Which of the following aspects of a patient's site of inflammation would help the care provider rule out chronic inflammation? A) High levels of macrophages B) Increased neutrophils C) Proliferation of fibroblasts D) Infiltration of lymphocytes - ANSWER-B In the ICU, a patient has been diagnosed with sepsis due to a bacterial invasion. The human body usually responds to infections by developing an uncontrolled inflammatory response with large production and release of inflammatory cytokines such as IL-1 and TNF-a. The nurse will note which of the following clinical manifestations in this septic patient as a result of the activation of these cytokines? Select all that apply. A) Excessive interstitial edema related to increased vascular permeability B) Decreased cardiac output resulting from myocardial depression C) Increased respiratory rate with crackles heard throughout all lung fields D) Excessive bleeding from bowels and bladder E) Lower blood pressure due to intravascular fluid loss - ANSWER-A B E A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has A) a mild parasitic infection. B) a severe bacterial infection. C) a mild viral infection. D) a severe fungal infection. - ANSWER-B Which of the following patients would have a very poor response related to tissue regeneration of his or her injured area? A) A 21-day-old infant undergoing a diaphragmatic hernia repair B) A 54-year-old male who had a massive MI 4 days ago and came to the ED today for treatment C) A 73-year-old female who is undergoing lithotripsy for kidney stones D) A 33-year-old athlete undergoing surgery to repair a torn MCL in his right knee - ANSWERB A hospital patient has a large, superficial wound on her elbow that was the result of shearing action when she was moved up in her bed. The patient's husband mentions that the wound looks infected and irritated because the wound bed is completely red. Which of the following responses would be inappropriate? A) "Even though it is red, it doesn't mean that the wound is infected." B) "The red areas show that there is enough circulation to facilitate healing." C) "Those are fresh blood vessels that are a sign of healthy healing." D) "A thin sheet of blood clotting is actually desirable and not a sign that your wife's wound is infected." - ANSWER-D Which of the following processes would most likely be considered an anomaly during the cellular phase of inflammation? A) Platelet aggregation B) Vasoconstriction C) Migration of phagocytic white cells D) Macrophage activity - ANSWER-B A patient who is recovering from burn injuries is discussing his prognosis with a physician. Which of the following teaching points about expectations for healing should the physician include? A) "Once your healing is complete, your skin will be just as strong as before your accident." B) "You may find that the scar is a bit smaller than the area of the wound." C) "You'll find that your new tissue is more elastic and fragile than the rest of your skin." D) "The final remodeling phase of healing may last up to 3 months in your case." - ANSWER-B Of the following list of patients, who would likely benefit the most from hyperbaric oxygen therapy? A) A trauma patient who developed Clostridium spp., an anaerobic bacterial infection in his femur B) A patient who developed a fistula between her bowel and vagina following cervical cancer surgery C) A school-aged child who fell on gravel and has terrible road rash D) A football player who has torn a meniscus in his knee for the third time this year - ANSWERA Which of the following patients is most likely to have impairments to the wound-healing process? A patient with A) chronic obstructive pulmonary disease. B) a diagnosis of multiple sclerosis and consequent impaired mobility. C) poorly controlled blood sugars with small blood vessel disease. D) congenital heart defects and anemia. - ANSWER-C A 79-year-old female resident of an assisted living facility receives care from a community nurse on a regular basis for treatment of a chronic venous leg ulcer. Which of the following factors would the nurse be most justified in ruling out as a contributing factor to the client's impaired wound healing? A) A lower skin collagen content than in younger adults B) Decreased fibroblast synthesis C) Slow reepithelialization D) Decreased antibody levels - ANSWER-D Staphylococcus aureus commonly found in the skin, nares, and other body sites of patients without any signs and symptoms of infection is known as which of the following conditions listed below? A) An opportunistic infection B) A parasitic infestation C) Bacterial colonization D) A saprophytic infection - ANSWER-C Which of the following statements is an accurate descriptor of the role of viruses in human infections? A) Viruses have no genetic material of their own. B) Some viruses are capable of transforming normal host cells into malignant cells. C) Viruses are often implicated in cases of transmissible neurodegenerative diseases. D) Viruses require stimulation after a latent period before they are able to produce symptoms. - ANSWER-B Which of the following types of pneumonia listed below is best characterized by an infective agent that produces sputum samples with a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet? A) Chlamydial B) Viral C) Mycoplasmal D) Bacterial - ANSWER-D The nurse will most likely assess which of the following clinical manifestations in a client who was diagnosed with Creutzfeldt-Jakob disease? A) Change in behavior and memory and loss of coordination leading to encephalopathy B) Gastrointestinal problems like vomiting and diarrhea C) Muscle inflammation and edema, making movements very painful D) Projectile vomiting, hypertension, and drowsiness caused by elevated ICP - ANSWER-A The spirochete leptospires is primarily transmitted to farmers by A) an airborne mechanism. B) exposure to spores in the environment. C) direct contact with infected animals. D) a mosquito bite. - ANSWER-C The nurse knows which of the following statements best describes the characteristic trait of risckettsiae related to Rocky Mountain spotted fever? Rickettsiae A) are eukaryotic. B) have both RNA and DNA. C) have a distinct spiral-shaped morphology. D) are neither gram negative nor gram positive - ANSWER-B An 81-year-old female patient in a subacute medical unit of a hospital has developed an oral Candida albicans infection. Which of the following phenomena would the patient's nurse suspect as a key contributing factor to her infection? A) The moist and temperature-suited oral environment of the client's mouth B) The ability of fungi to remain latent until the host reaches an immunocompromised state C) Antibiotic therapy that eliminated normal bacterial flora D) The airborne communicability of yeast and molds and subsequent inhalation - ANSWER-C The nurse knows which of the following statements below is appropriate to be included in an education session for a 21-year-old male with a diagnosis of malaria? A) "Your infection likely began with the introduction of fertilized protozoal ova from a mosquito." B) "The protozoa responsible have hijacked the genetic material of your cells in order to reproduce." C) "You are very tired because the pathogens are utilizing the ATP that your own cells need." D) "The infectious organisms are considered tiny, single-celled animals, given their complete eukaryotic machinery." - ANSWER-D The physician knows the client G1P0 has correctly understood the prenatal education regarding sexually transmitted infection as evidenced by which of the following statements listed below? A) "Gonorrhea and chlamydia out of the various infectious agents pose the greatest risks of transmission from mother to child." B) "I know that my baby will need observation for HIV signs and symptoms in the weeks following my delivery." C) "My baby could become infected either across the placenta or during the birth itself." D) "If I receive prophylactic immunization, I will reduce my baby's chance of being born with an illness." - ANSWER-C Which of the following procedures reduces the potential for infection primarily by addressing the portal of entry? A) Wiping down common areas with buffered bleach on a regular basis B) Wearing gloves when contact with blood or body fluids is anticipated C) Disposing of soiled clothing and bed linens in a dedicated receptacle D) Isolating patients who have antibiotic-resistant infections - ANSWER-B A school-age child with a history of asthma has brought a note home from school stating that there has been one case of meningitis (Neisseria meningitides) in the school. Since the mother is a nurse, she is very concerned since she knows the portal of entry of this pathogen is A) by inhalation via the respiratory tract such as through breathing or yawning. B) by direct contact with a contaminated object such as a pencil. C) by ingestion such as when children share their drink with their friends. D) through a cut or abrasion that may occur on the playground. - ANSWER-A Which of the following scenarios best describes an example of infection originating with a fomite? A) A client who contracted hepatitis C through sharing a contaminated syringe with an infected person B) A nurse with a positive tuberculin screening test (PPD) after admitting a patient diagnosed with tuberculosis (TB) C) A woman who contracted Lyme disease after a tick bite D) A man who has been diagnosed with trichinosis after eating undercooked pork - ANSWER-A The nurse knows which of the following statements listed below best matches the phase of the infectious process of food poisoning with a client with sudden, violent diarrhea and vomiting after consuming chicken and potato salad 8 hours ago at the beach on a hot day? A) Maximum impact of infectious process B) Insidious prodromal phase C) Sudden incubation of active replication D) Subacute prodromal phase - ANSWER-A Which of the following infectious agents listed below would be a site-specific pathogen and not spread throughout the body via the circulatory system? A patient diagnosed with A) B. burgdorferi caused by a tick bite. B) Salmonella typhi related to ingestion of contaminated food or water. C) Helicobacter pylori diagnosed after an endoscopic procedure. D) N. meningitidis infection in a child in a daycare setting. - ANSWER-C A family consumed some undercooked hamburger at a picnic and has since developed bloody diarrhea. The nurse knows which of the following statements listed below is correct regarding the infectious process? A) Evasive factors that become more virulent by evading parts of the host's immune system B) Exotoxins that damage vascular endothelium causing bleeding and low platelet counts C) Adhesion factors that can anchor a pathogen firmly to the host tissue surfaces D) Invasive factors capable of destroying the cell membrane by utilization of enzymes - ANSWER-A A patient diagnosed with H pylori asks the nurse, "How an infection can occur in the stomach since it is an acid environment?" The nurse responds, A) "We have many infectious agents that can live in an acidic environment with a pH more than 8.0." B) "H. pylori is a virus and is still being researched as to how it is able to survive in the stomach acids." C) "H. pylori produces an enzyme called urease that converts gastric juices into ammonia, which neutralizes the acidic stomach environment." D) "This parasite secretes an enzyme called coagulase, which protects the pathogen from the antibodies." - ANSWER-C A client has a suspected infection by a particular microorganism in question that cannot be cultured. Which of the following processes listed below is most likely to result in an accurate diagnosis for the client? A) Observe directly for the presence or absence of specific antigens in the client's blood serum sample. B) Introduce cultured, marked antibodies to the client, and observe for a reaction with antigens in the client. C) Observe for a cytopathic effect on biopsy tissue samples from the client's mucosa. D) Release purified antigens into the client's circulation to observe whether the client has produced the relevant antibodies. - ANSWER-B A client has been diagnosed with herpes simplex virus. The client states that, "modern medicine produces more and more antivirals every year, and so the treatment should be simple." Which of the following statements listed below is the best response? A) "The recent rise of drug resistance has significantly hampered the elimination of viruses." B) "The cell coat of viruses is particularly resilient to the available synthetic antivirals." C) "The use of antivirals is severely limited by the unwanted adverse effects that they cause." D) "Treatment options for viruses are often limited because what destroys viruses often damages your own body cells." - ANSWER-D A client with a diagnosis of sepsis has received intravenous immune globulin (IVIG) as a partial treatment. The nurse knows which of the following client responses listed below would best suggest an accurate understanding of IVIG treatment? A) "These antibodies in the solution have been collected from individuals who have successfully fought off the same infection." B) "The IVIG should help stimulate fever, inflammation, and tissue repair in the fight against the infection." C) "A big part of my IVIG treatment is actually stimulating and supplementing my immune system to do the work itself." D) "The main effect of IVIG is to cause my body to produce more white blood cells to fight infection." - ANSWER-C The nurse in the emergency department knows that clients exposed to Clostridium botulinum, an agent of bioterrorism, would likely be exhibiting which of the following clinical manifestations listed below? A) Blindness and respiratory distress B) Hemorrhage from all orifices resulting in signs of shock and coma C) Frothy, odiferous diarrhea and dehydration D) Muscle weakness in extremities eventually leading to paralysis of respiratory muscles - ANSWER-D Health care team members know recently that an increased incidence of infections such as West Nile virus and SARS does not match with previously established patterns. Which of the following phenomena constitutes the most significant contributor to the spread of new diseases in the United States? A) Drug resistance by bacterial and protozoal infections B) Increased ease and frequency of individual and group international travel C) Genetic variation and mutation by microorganisms D) Decreased living standards and public health standards in urban areas - ANSWER-B The medical team is assessing a newly admitted patient who is hypothermic following a night spent lost on a ski slope. The health care professionals would recognize that which of the following phenomena most likely contributed to minimizing the client's heat loss in a cold environment? A) The high heat conductivity of subcutaneous tissue protected against core heat loss. B) Increased blood flow to the outer shell prevented superficial freezing and loss of heat. C) The tissue thickness of the outer shell increased and preserved heat. D) Shell temperature dropped, minimizing the temperature variance between the core temperature and environmental temperature. - ANSWER-c In the ICU setting, a patient transported from surgery following open heart bypass grafting will likely have his core temperature measured by a/an A) rectal tube inserted to prevent evacuation from bowels while recovering from anesthesia. B) temperature probe taped behind his ear. C) esophageal flexible thermometer monitoring aorta distention. D) pulmonary artery catheter being used to measure cardiac output. - ANSWER-D A nurse is providing care for several clients on a neurological unit of a hospital. In which of the following clients would the nurse be justified in predicting a problem with thermoregulation? A) A 66-year-old male with damage to his thalamus secondary to a cerebral vascular accident B) A 22-year-old male with damage to his cerebellum secondary to a motorcycle accident C) A 68-year-old male with end-stage neurosyphilis D) A 45-year-old female with a T8 fracture secondary to a diving accident - ANSWER-A An 8-year-old boy has fallen through the ice while skating on a frozen pond. By the time paramedics arrive, the boy has been removed from the water by his friends, but his core body temperature is 31.1°C (88.0°F). The responders would recognize that which of the following physiological processes would have been active during the boy's accident? A) Production and release of cortisol as a heat generation process B) Stimulation of the thyroid gland in order to increase cellular activity C) Heat production through increased body metabolism D) Energy generation through the release of epinephrine and norepinephrine - ANSWER-C An agricultural worker is picking fruit on a day when the air temperature is 106°F. Which of the following processes will most likely be occurring while he works? A) Conduction of heat from the air will be heating his skin surface and raising his core temperature. B) Blood volume at his skin surface will be increasing to dissipate heat. C) His autonomic nervous system will be stimulating him to sweat. D) Radiation from his skin surfaces will be dissipating heat into the environment. - ANSWER-B A health educator is teaching a group of colleagues about the physiology of thermoregulation. Which of the following statements is most accurate? A) "Endogenous pyrogens induce host cells to produce exogenous pyrogens." B) "Prostaglandin E2 (PGE2) exerts a direct fever-producing effect on the hypothalamus." C) "PGE2 induces Kupffer cells to initiate a fever response via hepatic sinusoids." D) "Arachidonic acid induces cytokines to act on the temperature regulation center." ANSWER-B A physician is noting the recent vital signs for several patients on an acute medical ward of a hospital. Which of the following hospital patients with noninfectious diagnoses would most likely have a fever? A) A 71-year-old female with limited mobility, chronic obstructive pulmonary disease, and vascular dementia B) A 33-year-old female with a postoperative deep vein thrombosis and pulmonary embolism C) A 51-year-old obese male with hepatic encephalopathy secondary to alcohol abuse D) A 71-year-old male with congestive heart failure and peripheral edema - ANSWER-B A 54-year-old man presents with a temperature of 38.8°C (101.8°F), a racing heart, fatigue, and an upset stomach after spending an afternoon building a deck on a very hot, humid day. The physician assessing the man is performing a differential diagnosis as part of her assessment. Which of the following findings would suggest fever rather than hyperthermia as a cause of the elevation in the man's temperature? A) Moist skin B) Dizziness C) Shivering D) Cognitive changes - ANSWER-C A nurse is providing care for a 44-year-old male client who is admitted with a diagnosis of fever of unknown origin (FUO). Which of the following characteristics of the client's history is most likely to have a bearing on his current diagnosis? A) The client is cachexic and an African American. B) The client is HIV positive and homeless. C) The client is malnourished, hypomagnesemic, and hypocalcemic. D) The client is receiving intravenous normal saline with 20 mEq KCl. - ANSWER-B In the hospital setting, one of the best ways to lower a hyperthermic patient's fever would be to facilitate conduction of heat from the body by A) providing frequent sponge baths with cool water. B) taking all covers/clothing off and pouring alcohol on the skin. C) placing him or her on a cooling mattress that circulates a coolant solution through the mattress. D) placing IV solutions into the freezer for 30 minutes prior to hanging them. - ANSWER-C A child aged 33 days is presented to the emergency department of a hospital by her parents following a 2-day fever. Her temperature is 38°C (100.4°F) tympanically. Which of the following diagnostic tests is most clearly indicated? A) Electrolytes, blood urea nitrogen (BUN), and creatinine levels B) Abdominal ultrasound C) Computed tomography (CT) of the head D) Urine for culture and sensitivity - ANSWER-D An 88-year-old resident of a long-term care home has been suffering from a 3-day onset of increased shortness of breath and decreased oxygen saturation. At the hospital, an anterior-posterior chest x-ray and sputum culture and sensitivity have confirmed a diagnosis of bacterial pneumonia, yet the client's tympanic temperature has not exceeded 37.3°C (99.2°F). The health care team would recognize that which of the following phenomena likely underlies this situation? A) An older adult is often insensitive to exogenous pyrogens. B) An older adult is sometimes incapable of vasodilation. C) An older adult's hypothalamus has diminished thermoregulatory ability. D) Infections manifest by cognitive changes in older adults. - ANSWER-C A 14-year-old boy is participating in his school's track meet; the outdoor temperature is 99°F, and a teacher has found the boy sitting restless in the shade and disoriented to time. The teacher notes that the student has dry skin in spite of the high temperature and the fact that he has recently completed a running event. The teacher calls for the school nurse, who will recognize which of the following potential diagnoses and anticipated hospital treatments? A) Heat exhaustion, likely treated with rest, shelter from the sun, and salt tablets B) Heat stroke, likely treated with submersion in cold water C) Heat stroke, likely treated with rehydration by intravenous hypotonic solution D) Heat exhaustion, likely treated with oral rehydration with cool water - ANSWER-B About 30 minutes following the morning medication pass, the nurse's aide informs the nurse that one of the patients on their team is complaining of "hot sweats." The aide also states that his temperature is now 101.5°F. Knowing that some medications can cause hyperthermia, the nurse reviews his medications. From the following patient list, which patient is at high risk for developing an elevated temperature? A) Patient with hypertension being treated with Prinivil (Lisinopril). B) Suicidal patient who overdosed on his monoamine oxidase (MOA) inhibitor. C) Postoperative patient receiving Oxycodone (OxyContin) for his pain. D) Patient with C. difficile receiving Vancocin (Vancomycin) IV every 6 hours. - ANSWER-B A 20-year-old female has been brought to the emergency department from a rave party where she collapsed on the dance floor. Her accompanying friends acknowledge that the woman took ecstasy early in the evening. Her heart rate is regular at 89 beats/minute and temperature 39.8°C (103.6°F) orally. The emergency team would recognize that which of the following phenomena, related to the drug, is a likely contributor to the woman's status? A) Increased peripheral vasoconstriction B) The direct pyrogenic effect of ecstasy C) The initiation of an inappropriate immune response D) Impaired temperature regulation by the hypothalamus - ANSWER-A During surgery, the anesthesia personnel noticed the patient is having a steady rise in his end-tidal carbon dioxide level. At this time, the nurse anesthetist begins to assess the patient for malignant hyperthermia. The initial (priority) assessment for this disorder may include A) hypotension. B) acute renal failure. C) skeletal muscle rigidity. D) sudden cardiac arrest. - ANSWER-C In the ED, a homeless patient is brought in with severe hypothermia. The police officers also state that they found a "bottle of booze" on the sidewalk next to him. This puts the nurse on high alert since alcohol contributes to hypothermia by A) interfering with the appetite center in the brain causing the person to not respond to hunger pains. B) causing the person to have less fat on his body. C) dulling the mental awareness that impairs judgment to seek shelter. D) increasing his basal metabolic rate, so he will run out of ATP faster than expected. ANSWER-C An 80-year-old woman is undergoing total hip replacement surgery as treatment for severe osteoarthritis. During the procedure, the patient's core temperature falls to 31.6°C (88.9°F), necessitating interventions to address her hypothermia. The surgical team recognizes that there are likely multiple causes of patient's hypothermia. Which of the following factors would the team be most justified in ruling out as a contributor? A) The cold environment in most operating theaters B) Decreased vasoconstriction as a result of anesthetic C) Decreased temperature adaptation due to her unconscious state D) Impaired thermoregulatory mechanisms due to anesthetic - ANSWER-C A 38-year-old male client with mild hypothermia following a prolonged hike in the rain is brought to hospital by ambulance. Which of the following sets of vital signs would be the most characteristic of the client's diagnosis? A) BP 178/102; RR 12; HR 58 B) BP 109/68; RR 9; HR 130 C) BP 160/99; RR 30; HR 66 D) BP 138/84; RR 28; HR 111 - ANSWER-D Following a cardiothoracic surgery, where controlled therapeutic hypothermia was utilized to decrease metabolic demands, the nurse responsible for recovering this patient should be assessing for which of the following potential complications to cold cardioplegia? A) Development of a first-degree AV block B) Vasoconstriction resulting in weak pedal pulses, requiring the use of a Doppler C) Frequent premature ventricular contractions (PVCs) on the telemetry monitor D) Cyanosis in lower extremities with no blanching in the toes - ANSWER-C The nurse knows which of the following statements listed below relative to a client with malignant melanoma treated with alpha interferon (IFN-a) is accurate? Alpha interferon (IFN-a) A) will kill certain microorganisms that may help spread the cancer. B) plays an important role in the modulation of the inflammatory response. C) helps keep all the blood levels at a higher level. D) controls the migration of leukocytes to their primary site. - ANSWER-B The nurse knows which of the following statements listed below is accurate regarding the functions and nature of cytokines relative to a variety of pathologies? A) "A particular cytokine can have varied effects on different systems, a fact that limits their therapeutic use." B) "Cytokine production is constant over time, but effects are noted when serum levels cross a particular threshold." C) "Most cytokines are produced by granular leukocytes, and different cells are capable of producing the same cytokine." D) "Cytokine actions are self-limiting, in that activation of one precludes activation of other cytokines with similar actions." - ANSWER-A The nurse knows that a drug in a category identified as a colony-stimulating factor (CSF) helps A) cells engulf and digest microbes that want to attach to cell membranes and destroy normal cell function. B) produce cells that will be the first responder cells to protect against cancer formation. C) stimulate the person's immune system so that he or she can kill his or her own cancer cells. D) stimulate bone marrow to produce large numbers of mature cells such as platelets and erythrocytes. - ANSWER-D Which of the following individual situations listed below best exemplifies the processes of innate immunity? A) A child who has experienced heat and swelling of his skinned knuckle B) An adult who complains of itching and is sneezing because he is allergic to pollen C) A client whose blood work indicates increased antibody titers during an acute illness D) A client who has experienced rejection of a donor liver after transplantation - ANSWER-A The nurse knows which of the following components listed below is needed for long-lasting immunity in a client with a diagnosis of sepsis without the causative agent identified? A) Neutrophils B) Lymphocytes C) Colony-stimulating factors D) Natural killer cells - ANSWER-B A client has been identified as having an excess of macrophage inhibitory factor, causing the client to have inhibited movement and activity of macrophages. Which of the following processes listed below would the health care team member expect to remain unaffected? A) Amplification of the immune response B) Destruction of virus-infected or tumor cells C) Initiation of adaptive immunity D) Specificity and memory of the immune response - ANSWER-D A client who has a diagnosis of an autoimmune disease asks his nurse why it is that his immune system does not attack all of the cells that make up his body. Which of the following aspects of pathogen recognition in the innate immune system listed below would underlie the nurse's response? A) Normal host cells excrete inhibitory proteins that are detected by natural killer cells. B) Intraepithelial lymphocytes and natural killer cells possess specific, highly diverse receptors. C) Pattern recognition receptors (PRRs) ensure that cells are correctly identified. D) Leukocytes possess pathogen-associated molecular patterns (PAMPs) - ANSWER-C A 60-year-old male client with an acute viral infection is receiving interferon therapy. The physician is teaching the family of the client about the diverse actions of the treatment and the ways that it differs from other anti-infective therapies. Which of the following teaching points listed below should the physician least likely include? A) "Interferon can help your father's unaffected cells adjacent to his infected cells produce antiviral proteins that can stop the spread of the infection." B) "Interferon can help limit the replication of the virus that's affecting your father." C) "Interferon helps your father's body recognize infected cells more quickly." D) "Interferon can bolster your father's immune system through the stimulation of natural killer cells that attack viruses." - ANSWER-D Which of the following phenomena would be least likely to result in activation of the complement system? A) Recognition of an antibody bound to the surface of a microbe B) Increase in tissue blood flow and capillary permeability, so fluids/proteins can leak into the area C) Activation of toll-like receptors (TLRs) on complement proteins D) Direct recognition of microbial proteins - ANSWER-C A nurse is providing care for a client who is immunocompromised following chemotherapy. The nurse knows which of the following characterizations of the adaptive immune system listed below is responsible for the client's disruption in his normal immune function? A) Epitopes on antigens are recognized by immunoglobulin receptors following presentation by accessory cells. B) Haptens combine to form epitopes that stimulate the response of regulatory and effector cells. C) Effector cells orchestrate the immune response of regulatory cells toward an antigen. D) Accessory cells such as macrophages are engulfed by regulatory cells, stimulating effector cells. - ANSWER-A The nurse knows the cells primarily programmed to remove the invading organisms and remember the antigen to respond rapidly during the next exposure are A) CD4 and CD8 cells. B) natural killer (NK) cells and macrophages. C) T and B lymphocytes. D) white blood cells and platelets. - ANSWER-C A 53-year-old female hospital patient has received a kidney transplant following renal failure secondary to hypertension. As part of the teaching while she was on the organ wait list, she was made aware that she would need to take antirejection drugs for the rest of her life. Which aspect of the immune system underlies this necessity? A) The lack of identifiable major histocompatibility complex (MHC) molecules will stimulate the innate immune response. B) Donor organ antibodies will be identified as foreign and stimulate an immune response. C) Antirejection drugs will stimulate the production of familiar MHC molecules. D) MHC molecules will never develop in the cells of the donor organ, and effector cells will be continually stimulated. - ANSWER-D A client has been inhaling viruses periodically while on a cross-country flight. Which of the following situations listed below would most likely result in the stimulation of the client's T lymphocytes and adaptive immune system? A) Presentation of a foreign antigen by a familiar immunoglobulin B) Recognition of a foreign major histocompatibility complex (MHC) molecule C) Recognition of a foreign peptide bound to a self-major histocompatibility complex (MHC) molecule D) Cytokine stimulation of a T lymphocyte with macrophage or dendritic cell mediation - ANSWER-C Three days ago, a mother delivered her full-term infant who had been identified as having an in utero infection. The infant is receiving antibiotic and phototherapy, and the mother is breast-feeding. Which of the following types of immunoglobulins could most reasonably be expected to predominate in the infant's immune system? A) IgA, IgM, IgD B) IgG, IgA, IgM C) IgE, IgG, IgD D) IgM, IgD, Igm - ANSWER-B A middle school student is scheduled to receive booster immunizations, and the father asks the nurse why the booster is necessary. What characteristic of the adaptive immune system listed below would provide the rationale for the nurse's response? A) Some antibodies require a repeat of the primary immune response. B) Some antibodies have a duration measured in months rather than years. C) A secondary response causes a sharp rise in antibody levels. D) Antigen receptors on CD4+ cells require multiple exposures separated by time. - ANSWER-C A student states, "It seems like helper T cells do a lot more than just 'help' the cellular immunity process." Which of the following responses listed below best conveys an aspect of the role of CD4+ helper T cells in immunity? A) "Without helper T cells, no antigens would be presented." B) "Helper T cells play a major role in stimulating and regulating the whole process." C) "Without helper T cells, the wrong antibodies would end up being produced." D) "Helper T cells are key to the hematopoiesis that produces all the components of the immune system." - ANSWER-B A newly diagnosed HIV-positive adolescent has blood work drawn, which includes a CD8 T-cell count. The nurse knows which of the following functions of CD8 T cells listed below will assist the adolescent's immune system in fighting off the viral attack? Select all that apply. A) Release destructive enzymes B) Trigger intracellular programmed death C) Cause allergens to surround the virus D) Boost antigen-antibody response E) Remove foreign material from lymph before it enters the blood - ANSWER-A B A 10-year-old child with strep throat asks the nurse, "why there are large bumps [lymph nodes] on my neck when my throat gets sore?" The nurse replies lymph nodes A) help your body fight off infections by allowing special cells (lymphocytes and macrophages) move through the lymph chain and engulf and destroy germs. B) bring in cells into the lymph node (your bump) to stop the germs from going anywhere else in the body. C) bring all kind of good cells to your throat so that they can wall the strep off and keep the germs from getting any food or water." D) help your tonsils get bigger with cells that will bring immune cells into your throat to prevent any other infections. - ANSWER-A Which of the following situations can best be characterized as an example of passive immunity? A) A 6-month-old infant receives his scheduled immunization against measles, mumps, and rubella. B) A 9-year-old boy is immune to chicken pox after enduring the infection before 1 year. C) An 8-year-old girl recovers from a respiratory infection after intravenous antibiotic treatment. D) A 6-week-old infant receives antibodies from his mother's breast milk. - ANSWER-D The nurse knows high incidences of infectious illnesses among the older adults who reside in a long-term care facility are most likely to have diminished immune capacity because of A) decreased numbers and responsiveness of T lymphocytes. B) decreased antigen recognition by B lymphocytes. C) overexpression of cytokines and receptors. D) altered function in peripheral lymphocytes. - ANSWER-A After years of going to different physicians with vague symptoms, a 55-year-old client with a history of Hodgkin disease has been diagnosed with a secondary immunodeficiency syndrome. The client asks the nurse what this means. The nurse knows from the following list of characteristics that secondary immunodeficiency disorders: Select all that apply. A) may be inherited as a sex-linked trait. B) usually develop later in life. C) may be a result of chemotherapy being used to treat a cancer. D) can result from frequent recurring Staphylococcus aureus infections. E) can occur in a chronic obstructive pulmonary disease patient taking corticosteroids daily. - ANSWER-B C E A 2-year-old girl has had repeated ear and upper respiratory infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiological origin of the child's recurrent infections? A) The child's immune system is unable to synthesize adequate immunoglobulin on its own. B) The child had a congenital absence of IgG antibodies that her body is only slowly beginning to produce independently. C) The child was born with IgA and IgM antibodies, suggesting intrauterine infection. D) The child lacks the antigen-presenting cells integral to normal B-cell antibody production. - ANSWER-A A nurse is providing care for a 17-year-old boy who has experienced recurrent sinus and chest infections throughout his life and presently has enlarged tonsils and lymph nodes. Blood work indicated normal levels of B cells and free immunoglobulins but a lack of differentiation into normal plasma cells. The boy is currently receiving intravenous immunoglobulin (IVIG) therapy. What is the boy's most likely diagnosis? A) X-linked hypogammaglobulinemia B) Transient hypoglobulinemia C) Common variable immunodeficiency D) IgG subclass deficiency - ANSWER-C Which of the following patients is most likely to benefit from transplantation of thymic tissue or major histocompatibility complex (MHC)-compatible bone marrow? A) A 12-year-old girl with a history of epilepsy and low IgG levels secondary to phenytoin use B) A 7-year-old boy whose blood work indicates decreased IgA and IgG with increased IgM C) A 6-year-old boy whose pre-B cells are incapable of translation to normal B cells D) A 9-year-old girl who has a diagnosis of IgA deficiency - ANSWER-B An 8-week-old boy has been recently diagnosed with a severe combined immunodeficiency (SCID). His parents have performed a significant amount of research on the Internet and have brought a large amount of material to discuss with their care provider. Which of the following statements best reflects an accurate understanding of their son's health situation? A) "We read that gene therapy could cure our son; we'd like you to look into that option." B) "Our son likely has a deficiency of B lymphocytes and can't produce antibodies." C) "We feel guilty, because dietary and environmental factors have been shown to contribute to SCID" D) "The antibodies that our son produces are mismatched to the infections that he was born with and encounters." - ANSWER-B A 1-year-old child who has experienced low platelet counts and bacterial susceptibility has been admitted to a pediatric medical unit of a hospital for treatment of Wiskott-Aldrich syndrome. The nurse who has admitted the child to the unit would anticipate which of the following short-term and longer-term treatment plans? A) Transfusion of clotting factors XII and XIII and serum albumin; splenectomy B) Neutropenic precautions; fresh frozen plasma transfusions; treatment of gastrointestinal symptoms C) Intravenous immunoglobulin (IVIG) treatment; thyroidectomy D) Treatment of eczema; management of bleeding; bone marrow transplant - ANSWER-D A nurse has just learned that her child has a life-threatening complement disorder known as hereditary angioneurotic edema (HAE). Due to deficiency in C1-INH, the nurse needs to be prepared for which possible life-threatening clinical manifestation? A) Bulging eyeballs B) Swelling of the airway C) Compressed carotid arteries D) Compression of brachial nerves - ANSWER-B A 4-year-old boy presents with a chronic cough and swollen lymph nodes. His records show that he has been given antibiotics several times in the past year with limited success, most recently for a liver abscess, and that he also has a recurring fungal skin condition. Which of the following is his most likely diagnosis? A) Selective IgA deficiency B) A deficiency in IgG2 subclass antibodies C) Chronic granulomatous disease D) Ataxia-telangiectasia - ANSWER-C A patient diagnosed with a primary immunodeficiency disorder has asked his siblings to be tested as possible stem cell donors. When discussing this procedure with his family, the nurse emphasizes that stem cells can be harvested from: Select all that apply. A) bone marrow. B) peripheral blood. C) skin tissue harvesting. D) mouth swabs. E) tears. - ANSWER-A B When explaining what is occurring when their child has an acute bronchial asthma attack, the nurse will emphasize that which mediator is primarily responsible for the bronchial constriction? A) Tree pollen B) Mold dust C) Histamine D) T-lymphocyte proliferation - ANSWER-C A male elementary school student has a severe allergy to peanuts and is displaying the signs of anaphylactic shock after inadvertently eating a peanut-containing candy bar. Which of the following statements best captures the boy's current status and preferred treatment? A) He is experiencing shortness of breath caused by potent vasoconstriction that can be relieved by epinephrine injection. B) He is approaching vascular shock and developing edema due to actions of IgE antibodies, situations that can be reversed by administration of epinephrine. C) His mast cells and basophils have been sensitized, but systemic effects can be mitigated by administration of bronchodilators. D) He is likely in a primary- or initial-stage allergic response that can be relieved by antihistamine administration. - ANSWER-B A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? A) Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response. B) Allergens in large, regular quantities overwhelm the IgE antibodies that mediate the allergic response. C) Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response. D) Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies. - ANSWER-D A 24-year-old woman has gone to the OB-GYN clinic for her first visit since she found out she was pregnant. The clinician tested her blood type along with the usual prenatal testing. On a follow-up visit, the woman was told that she is Rh negative. When asked what that means for her baby, the nurse explains that Rh-negative women lack RhD antigens on their erythrocytes but produce anti-D antibodies. As a result of this blood type, A) "If you and your baby have mismatched blood, it can invoke anaphylaxis in the baby." B) "If the types are incompatible, severe antibody-mediated inflammation occurs." C) "If blood types do not match, the baby's liver will produce extra cells to replace RBCs needed to oxygenate organs." D) "If the fetus is Rh positive, maternal anti-D antibodies can coat fetal RBCs resulting in severe anemia." - ANSWER-D A 67-year-old patient diagnosed with myasthenia gravis will likely display which clinical manifestations as a result of autoantibodies ultimately blocking the action of acetylcholine, resulting in destruction of the receptors? A) Weakness of the eye muscles; difficulty in swallowing and slurred speech; impaired gait B) Tremor of hands/arms; rigidity of the arms; shuffling gait C) Short-term memory lapses; problems with orientation; a lack of drive or initiative D) Facial droop; slurred speech; weakness on one side of the body - ANSWER-A Following a spider bite she received while camping, a 20-year-old female presented to the emergency department with rash, edema, and fever and was subsequently diagnosed with serum sickness. Which of the following statements best conveys the physiological rationale for the broad systemic effects of this event? A) The woman is experiencing diffuse tissue necrosis as a consequence of an Arthus reaction. B) Antigen-antibody complexes have been deposited in a variety of locations throughout the body. C) Antibody binding to specific target cell receptors is bringing about a change in cell function. D) Deposited antibodies are activating her complement system. - ANSWER-B A new nursing student is taking a tuberculin (TB) skin test as part of her preparation for beginning clinical placement in the hospital. The student is unclear of the rationale or physiology involved in this test. Which of the following is the correct explanation? A) The cell-mediated hypersensitivity associated with Mycobacterium tuberculosis remains detectable for several years. B) Formation of contact dermatitis lesions confirms prior TB contact. C) Previous TB exposure forms sensitized Th1 cells that are long-lived. D) This type of delayed-type hypersensitivity (DTH) is a response to latent Mycobacterium tuberculosis bacteria. - ANSWER-C A female dental assistant has developed signs and symptoms of a latex sensitivity and is undergoing allergy testing as well as blood work. Which of the following components of the assistant's blood work would most likely be the focus of her health care provider's analysis? A) Analysis of class II MHC antigens B) Serum IgE immunoassays C) Serum B-lymphocyte levels D) Serum CD8+ levels - ANSWER-B While undergoing a kidney transplant from a nonfamily member, the patient's transplanted kidney has just had the arterial clamps removed. The OR staff notice that the organ is turning purple with no urine output. When explaining to the family why they had to remove the donor kidney, the nurse will anticipate that the surgeon would likely include which statement? A) Obviously, there has been a mismatch during the human leukocyte antigen (HLA) testing. B) The circulating B and T lymphocytes are just doing their job. C) Hyperacute rejection occurs because antibodies against HLA antigens are deposited in vessels causing necrosis. D) Previous exposure to the HLA antigens is responsible for the high titers of complement fixing antibodies that cause the rejection. - ANSWER-C After several months on a waiting list, a 44-year-old male received a liver transplant 5 days ago. In the last 36 hours, he has developed a rash beginning on his palms and soles, along with abdominal pain and nausea. It has been determined by his care team that the immune response that is causing his symptoms originates not with his own compromised immune components but with those introduced with his new organ. This man's most likely medical diagnosis is A) graft versus host disease (GVHD). B) acute transplant rejection. C) hyperacute organ rejection. D) T-cell-mediated graft rejection - ANSWER-A group of nurses about autoimmune diseases. Which of the following statements by an attendee would the educator most likely want to follow up with further teaching? A) "Introduction of a foreign antigen can sometimes induce a cascade of immune response that is not self-limiting" B) "Often the problem can be traced to antigens that sensitize T cells without the need for presentation." C) "In some cases, the body attacks its own cells that are chemically similar to those of infectious organisms." D) "Sometimes when the body's own cells are released after a long time, they are interpreted as being foreign." - ANSWER-A While teaching about HIV/AIDS to a group of high school seniors, the school health nurse will begin by explaining the basic facts that will likely include which of the following information? A) Like all viruses, HIV is a genetic material made from DNA with long molecules that carry genetic information. B) HIV is different from other viruses since it is a retrovirus that selectively attacks the body's immune cells. C) There are two types of HIV, but the one that is endemic to the United States is HIV type 2. D) HIV type 1 for some reason rarely develops into full-blown AIDS. - ANSWER-B As part of her prenatal education, a 29-year-old woman who is pregnant with her first child is receiving teaching from her primary care provider. Which of the following statements by the woman reflects an accurate understanding of HIV transmission? A) "I know my baby is safe from HIV while in the womb, but the delivery will place him or her at real risk." B) "It's discouraging to know that my breast milk can pass on HIV to my baby." C) "I know it's possible, but it's comforting that the chances of my child contracting my HIV are actually very low." D) "I'm relieved to learn that a caesarean delivery will protect my baby from being born HIV positive." - ANSWER-B A potential donor is angry at the personal nature of the questions about HIV risk factors that he is required to answer at a blood collection center and states that simple blood testing should suffice. How can the nurse at the center best respond? A) "There are some very uncommon subtypes of the HIV virus that are not detectable by current testing methods." B) "There's a chance that persons who are asymptomatic, but HIV positive can have their antibodies missed by serum testing." C) "There's a period shortly after someone is infected with HIV when blood tests might still be negative." D) "Even though blood tests are completely accurate, the high stakes of blood donation and transfusion mean that double measures are appropriate." - ANSWER-C A 40-year-old male who has been HIV positive for 6 years is experiencing a new increase in his viral load along with a corresponding decrease in his CD4+ count. Which of the following aspects of his immune system is likely to remain most intact? A) Presentation of major histocompatibility molecules on body cells B) Orchestration of natural killer cells as part of cell-mediated immunity C) Activation of B lymphocytes D) Phagocytic function of monocytes and macrophages - ANSWER-A A 19-year-old intravenous drug user was exposed to the HIV 3 weeks ago and is experiencing a rapid proliferation in viral load. Which of the following statements best captures an aspect of the process of HIV replication that underlies this proliferation? A) Free HIV RNA is able to attach to the cell coat of CD4+ cells. B) The cytoplasm of CD4+ cells provides a protected environment for the replication of RNA by HIV. C) Expression of reverse transcriptase by CD4+ cells allows replication of HIV cells rather than new lymphocytes. D) HIV is able to change its RNA into DNA to allow for replication by CD4+ cells. - ANSWERD Utilizing the World Health Organization (WHO) framework of clinical categories for persons with acquired immunodeficiency syndrome (AIDS) over 15 years of age, a visitor to the United States goes to a city clinic complaining of diarrhea, weight loss of 20 lb, and feeling like he is running a temperature. These manifestations have been occurring for the past 5 weeks. The nurse would identify this patient to be in which clinical stage? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4 - ANSWER-C Which of the following patients would be considered to be in the latent period of HIV infection? A) A 16-year-old prostitute who has open sores on her labia that drain purulent secretions B) A 33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his axilla and cervical neck region for the past 4 months C) A 45-year-old alcohol abuser who is complaining of excessive vomiting of blood that started 2 weeks ago D) A 24-year-old college student who has developed a chronic cough that will not go away, even after taking two courses of antibiotics. - ANSWER-B A person who has been diagnosed with HIV infection 12 years ago and still has a CD4+ cell count of 800 cells/μL and a low viral load is considered clinical to be a A) rapid progressor. B) typical progressor. C) slow progressor. D) long-term nonprogressor - ANSWER-D A 39-year-old female with HIV infection has been characterized as a typical progressor by her care team and is experiencing an increase in her manifestations and health complaints as her CD4+ count declines. Which of the following health problems would her care team most likely attribute to a cause other than her HIV? A) Her recent diagnosis of bacterial pneumonia B) Her esophagitis that has been linked to herpes simplex infection C) Her decreased bone density and recent fractures D) Her increasing confusion and disorientation - ANSWER-C A patient comes into a clinic complaining of cough, fever, and shortness of breath. The patient informs the health care provider that he is HIV positive. Upon physical exam, the family nurse practitioner (FNP) may note which of the following clinical manifestations of suspected Pneumocystis jiroveci pneumonia (PCP)? Select all that apply. A) Interstitial infiltrates on chest x-ray B) Respiratory rate of 32 with normal breath sounds C) Stridor when taking a deep breath D) Use of abdominal muscles to breathe while sitting on the exam table E) Night sweats that require clothing changes frequently throughout the night - ANSWER-A B Members of an AIDS support group who have more advanced cases are sharing some of their recent health problems with a member who has just been diagnosed. Which of the member's statements is most accurate? A) "One of the scariest things out there now is the huge increase in drug-resistant tuberculosis." B) "The eradication of Pneumocystis jiroveci pneumonia (PCP) has helped extend the life expectancy of a lot of persons living with AIDS." C) "Those of us with HIV are so much more prone to loss of vision and hearing." D) "As people with HIV live longer, most of us are eventually succumbing to the cancers that are associated with HIV." - ANSWER-D A 48-year-old man who has been HIV positive for 6 years has just learned that he has been diagnosed with Kaposi sarcoma (KS). Which of the following facts most accurately conveys an aspect of his diagnosis? A) An opportunistic Epstein-Barr virus underlies the man's KS. B) He is likely to have lesions on his skin, mouth, or GI tract. C) Intense pain was probably his first manifestation of KS. D) Heterosexual contact most likely underlies his HIV and subsequent KS. - ANSWER-B Which of the following signs and diagnostic findings are recognized components of the metabolic and morphologic changes that occur with HIV infection accompanied with lipodystrophy? Select all that apply. A) Hyperlipidemia B) Insulin resistance C) Deficiencies of anterior pituitary hormones D) Increased abdominal girth E) Breast enlargement - ANSWER-A B D E When counseling a male patient with suspected HIV, the nurse informs him that if the enzyme-linked immunosorbent assay (ELISA) comes back positive, then A) no further testing is required since this confirms HIV infection. B) a second test known as the Western blot assay will be ordered to confirm positive HIV status. C) he will be sent to an infectious disease physician for a tissue biopsy to confirm infection. D) if the second test, the Western blot, returns negative, he has not developed a case of full-blown AIDS. - ANSWER-B A school nurse is teaching high school students about HIV and AIDS in the context of the school's sexual health curriculum. Which of the students' following statements would the nurse most likely want to correct or clarify? A) "They have to take a blood sample from you in order to test you for AIDS." B) "Drugs for AIDS reduce the virus in your body, but they don't get rid of it." C) "Lots more heterosexual people get HIV these days than they used to." D) "Condoms provide really good protection from AIDS." - ANSWER-A Which of the following individuals would most likely be placed on highly active antiretroviral therapy (HAART) if he or she were not yet receiving the treatment? Select all that apply. A) A 35-year-old female sex trade worker who is HIV negative but who has a documented history of sharing needles for heroin use B) A 46-year-old male with long-standing HIV and a CD4+ count of 125 cells/mL C) A 16-year-old female who was diagnosed with HIV 2 days prior and is asymptomatic with normal CD4+ levels D) A 38-year-old woman who has a CD4+ count of 250 cells/mL and is keen to begin HAART E) Prophylactically to a health care worker who incurred a laceration from a scalpel used in surgery but has no abnormal lab results - ANSWER-B D A 37-year-old male with HIV who has recently become symptomatic has begun highly active antiretroviral therapy (HAART). Among the numerous medications that the man now regularly takes are several that inhibit the change of HIV RNA to DNA in a CD4+ cell. Which of the following classes of medications addresses this component of the HIV replication cycle? A) Entry inhibitors B) Protease inhibitors C) Integrase inhibitors D) Non-nucleoside reverse transcriptase inhibitors - ANSWER-D All antiretroviral medications interfere with some stage of the HIV life cycle. What stage do protease inhibitors prevent? A) Cleavage of the polyprotein chain into the individual proteins that will be used to make new virus B) Addition of more nucleosides to the DNA chain C) Killing of the CD4+ T cell to release virions into the bloodstream D) Attachment of the virus to CD4+ cell receptors - ANSWER-A A 23-year-old HIV-positive woman in the United States with routinely low viral loads and robust CD4+ cell counts is planning to get pregnant. Which precaution would her care giver eliminate from her care? A) Offer her HAART that includes zidovudine B) Counsel her not to breast-feed C) Give her single-dose perinatal nevirapine D) Give the infant trimethoprim-sulfamethoxazole, starting at 4 to 6 weeks of age - ANSWER-C While volunteering in an HIV clinic in a big city, the nurse notices a new mom and her baby (a 6-month-old male) in the waiting room. Upon assessing the infant for possible HIV infection, the nurse will be assessing for which of the following clinical manifestations of HIV infection? Select all that apply. A) Weighing him to determine if he is gaining 1.5 to 2 lb/month B) Observing to see if he can roll over from back to stomach C) Lack of coordination to play with toys/stuffed animals D) History of repeated episodes of bacterial pneumonia and ear infections E) Listlessness and poor eye contact - ANSWER-C D E 5th grade elementary student asks the school nurse how much blood is in an entire body. The nurse should respond that the average grown-up adult has A) 2 to 4 cups of blood in his or her body. B) 3 pints of blood in total. C) 3 to 4 quarts of blood in his or her body. D) 5 to 6 L of blood throughout his or her body. - ANSWER-D A hospital laboratory technician is performing routine blood analysis as part of an inpatient's assessment and is examining the sample in a test tube following processing in a centrifuge and the addition of an anticoagulant. Which of the following observations would the technician most likely interpret as an anomaly? A) The bottom layer of blood in the tube accounts for around one third of the total volume. B) The middle layer of cells appears white to gray in color. C) The top layer of cells is too thin to visualize without microscopy. D) The yellowish fluid on the top of the sample appears to constitute around one half of the total volume. - ANSWER-A During science class, a student asks, "What's the difference between plasma and serum in the blood?" The nurse responds that the primary difference between plasma and serum is that plasma contains A) fibrinogen. B) heparin. C) white blood cells. D) hydrogen ions. - ANSWER-A A student makes the statement to a colleague, "Blood plasma is essentially just a carrier for the formed elements like red blood cells and white blood cells." What would be the most accurate response to this statement? A) "That's not really true. Plasma is crucial in the immune and inflammatory responses." B) "Actually, plasma plays a significant role in nutrient and waste transport." C) "Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis." D) "Actually, plasma is integral to the proper function of the liver and maintenance of acid-base balance." - ANSWER-B The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating? A) Impaired immune function B) Acid-base imbalances C) Impaired thermoregulation D) Fluid imbalances - ANSWER-D A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems? A) Jaundice B) Anemia C) Infections D) Blood clots - ANSWER-C Which of the following statements best conveys a characteristic of red blood cells? A) They lack organelles and soluble enzymes. B) They contribute to the maintenance of blood pH. C) They help maintain the body's fluid balance. D) They are self-replicating. - ANSWER-B When looking at a granulocyte under a microscope, the anatomy student would describe it as a cell A) lacking granules. B) having a kidney-shaped nucleus. C) having no nuclei. D) shaped like a sphere with multilobar nuclei. - ANSWER-D Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the A) neutrophils. B) erythrocytes. C) albumin. D) basophils. - ANSWER-A A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to touch. Which of the following hematological processes is most likely occurring in the bone marrow in response to the infection? A) Proliferation of immature neutrophils B) High circulatory levels of myeloblasts C) Increased segmented neutrophil production D) Phagocytosis by myelocytes - ANSWER-A When talking about the lifespan of various blood components, the students should know that once a neutrophil moves into tissue, it lives approximately for how long? A) 12 hours B) 24 hours C) 2 days D) 4 days - ANSWER-D When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant? A) Neutrophils B) Eosinophils C) Basophils D) Lymphocytes - ANSWER-C course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician's explanation? A) Tissue destruction results from neutrophil deactivation. B) Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis. C) Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas. D) Neutrophils are ineffective against the Mycobacterium tuberculosis antigens. - ANSWER-C A couple who is expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting it. How can their caregiver best respond to the couple's enquiry? Stem cells can A) "help correct autoimmune diseases and some congenital defects." B) "be used to regenerate damaged organs should the need ever arise." C) "be used as source of reserve cells for the entire blood production system." D) "help treat some cancers and anemias, but they must come from your child himself or herself." - ANSWER-C Which of the following statements best captures an aspect of the process of hematopoiesis? A) Colony-stimulating factors (CSFs) produce cytokines that activate progenitor cells. B) Progenitor cells differentiate into precursor cells. C) Various subtypes of pluripotent stem cells eventually differentiate into the cellular components of blood. D) Self-replicating precursor cells differentiate into specific CSFs. - ANSWER-B Which of the following colony-stimulating factors (CSFs) is given to ESRD patients to help with their chronic anemia? A) Erythropoietin (EPO) B) Thrombopoietin (TPO) C) Neupogen D) Interleukin - ANSWER-A A nurse is providing care for several patients on an acute medical unit of a hospital. Which of the following patients would be most likely to benefit from hematopoietic growth factors? A) A 51-year-old female patient with liver failure secondary to hepatitis B) A 61-year-old female patient with end-stage renal cancer C) A 55-year-old obese male patient with peripheral neuropathy secondary to diabetes D) A 44-year-old man with a newly diagnosed brain tumor - ANSWER-B A geriatrician is following a number of clients on a subacute geriatric medical unit, some of whom require diagnostic blood work. Which of the following clients would be most likely to have an erythrocyte sedimentation rate (ESR) screening test ordered? An adult with A) a diagnosis of Alzheimer disease and depression. B) orthostatic hypotension and syncopal episodes. C) congestive heart failure. D) systemic lupus erythematosus. - ANSWER-D An oncologist has ordered a bone marrow biopsy for a client and is explaining the reasons for the test and what the client might expect during the test. Which of the following explanations best reflects an aspect of a bone marrow biopsy? A) "I'll take a sample of your bone marrow from your breastbone or your spine." B) "I will be harvesting a sample of your stem cells for examination." C) "I need a more accurate count of your blood components than normal blood work is able to provide." D) "I need to get samples of the types of blood cells that your body is producing." - ANSWER-D Following a bone marrow biopsy, which of the following assessments would indicate the patient is experiencing a complication as a result of this diagnostic procedure? A) BP 90/60, heart rate 132, excess bleeding, and hematoma noted at the insertion site B) BP 130/80, oxygen saturation 95%, and crackles heard on inspiration C) Respiratory rate 24 and complaining of pain at insertion site D) Heart rate regular 64 beats/minute and temperature 99.6°F orally - ANSWER-A A hospital laboratory technologist is analyzing the complete blood count (CBC) of a patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC? A) Platelets originate with granulocyte colony-forming units (CFU). B) The half-life of a platelet is typically around 8 to 12 days. C) The -granules of platelets contribute primarily to vasoconstriction. D) New platelets are released from the bone marrow into circulation - ANSWER-B A 71-year-old male patient with a history of myocardial infarction (MI) and peripheral vascular disease (PVD) has been advised by his family physician to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the physician's suggestion? A) Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin. B) Aspirin helps to inhibit ADP action and minimizes platelet plug formation. C) Aspirin can reduce unwanted platelet adhesion by inhibiting TXA2 synthesis. D) Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation - ANSWER-A A hospital client is receiving intravenous infusion of heparin for treatment of a pulmonary embolus. Which of the following phenomena is most likely to occur, resulting in the drug's therapeutic effect? A) Inhibition of vitamin K synthesis in the liver B) Suppression of fibrin formation C) Deactivation of the intrinsic clotting pathway D) Inhibition of ADP-induced platelet aggregation - ANSWER-B When discussing the sequence of clot dissolution, the science instructor will talk about which item that begins the process? A) Plasminogen B) Dabigatran C) Platelets D) 2-plasmin inhibitor - ANSWER-A In which of the following patients, would diagnostic investigations least likely reveal increased thrombopoietin production? A) An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive B) A 55-year-old man with dehydration secondary to Crohn disease C) A 66-year-old woman with a diagnosis of lung cancer with bone metastases D) A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia - ANSWER-D A 44-year-old Caucasian woman is being treated in an airport infirmary after she developed a painful, swollen leg during a transatlantic flight in economy class. The woman is suspected of having deep vein thrombosis (DVT) and is questioning the paramedics about why this might be the case, given that she has twice previously had similar experiences. Which of the following teaching points by the airport medical staff would be most appropriate? A) "A lot of Caucasian people have a genetic mutation that causes platelets to stick to their blood vessel walls." B) "There is a genetic disorder that causes many Caucasians to form more clots in their blood vessels." C) "A lot of Caucasians have an inherited inability to dissolve clots that form in their bodies." D) "Your doctor might be able to tell you if you've inherited a predisposition to bleeding in your veins." - ANSWER-C A medical student is familiarizing herself with recent overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history? A) A 66-year-old obese male with left-sided hemiplegia secondary to a cerebrovascular accident B) A 90-year-old female resident of a long-term care facility who has been experiencing transient ischemic attacks C) A 30-year-old female with a diagnosis of left leg deep vein thrombosis and a pulmonary embolism D) A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use - ANSWER-D A 36-year-old woman with a diagnosis of antiphospholipid syndrome is receiving a scheduled checkup from her nurse practitioner. Which of the following teaching points would the nurse most likely prioritize? A) "It's important for you to do regular physical activity and maintain a healthy body weight." B) "Good nutrition and blood sugar control are important in your case." C) "You'll need to avoid taking nonsteroidal anti-inflammatory drugs when you have menstrual cramps." D) "You need to ensure your birth control pills don't contain estrogen." - ANSWER-D A patient asks the health care provider why his lower legs look purple. The health care provider will base her response on which pathophysiological principle? A) Too much trauma breaks capillaries, and they bleed into the tissue. B) The bruising around the ankles is due to the fact that it is a dependent area where the capillary pressure is higher. C) There is a problem with his plasminogen levels. D) Morbid obesity causes veins to enlarge and bleed into tissues due to stress the abdomen is placing on the vascular system. - ANSWER-B A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy's spleen. Which of the following teaching points would be most accurate? A) "We believe that your son's spleen is causing the destruction of many of his blood platelets, putting him at a bleeding risk." B) "Your son's spleen is inappropriately filtering out the platelets from his blood and keeping them from normal circulation." C) "Your son's spleen is holding on to too many of his platelets, so they're not available for clotting." D) "We think that his spleen is inhibiting the production of platelets by his bone marrow." - ANSWER-C While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB-GYN physician has called in a specialist who thinks that the patient is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which of the following orders? A) Decrease the dose of heparin from 5000 units b.i.d to 3000 units b.i.d B) Immediately discontinue the heparin therapy C) Switch to Coumadin 2.5 mg once/day D) Infuse FFP stat - ANSWER-B Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which of the following results is most likely to be considered unexpected by the health care team? A) Increased thrombopoietin levels B) Decreased platelet count C) Normal vitamin K levels D) Normal leukocyte levels - ANSWER-A Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students' following statements best captures an aspect of the two health problems? A) "Both diseases can result from inadequate production of thrombopoietin by megakaryocytes." B) "ITP can be either inherited or acquired, and if it's acquired, it involves an enzyme deficiency." C) "Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis. D) "TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma." - ANSWER-C Misinterpreting her physician's instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status? A) Irreversible acetylation of platelet cyclooxygenase activity has occurred. B) The patient's prostaglandin (TXA2) levels are abnormally high. C) She is at risk of developing secondary immune thrombocytopenic purpura (ITP). D) The binding of an antibody to platelet factor IV produces immune complexes. - ANSWER-A Which of the following teaching points would be most appropriate with a client who has a recent diagnosis of von Willebrand disease? A) "It's important that you avoid trauma." B) "Your disease affects your platelet function rather than clot formation." C) "Make sure that you avoid taking aspirin." D) "Clotting factor VIII can help your body compensate for the difficulty in clotting." - ANSWER-C The school nurse knows several children with hemophilia A. After recess, one student with hemophilia comes to the school nurse complaining of pain in his knee from falling on the playground. The nurse notes there is swelling in the knee and pain on palpation. The nurse should A) administer some NSAIDs to relieve the pain. B) wrap the knee in an ace bandage for compression. C) apply some warm compresses to the knee. D) notify parents to pick up the child and possibly administer factor VIII. - ANSWER-D A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient's bleeding? A) Excess calcium B) Vitamin K deficiency C) Hemophilia B D) Idiopathic immune thrombocytopenic purpura (ITP) - ANSWER-B Which of the following patients would be at risk for developing nonthrombocytopenic purpura? Select all that apply. A) A child adopted from India and displaying malaise, lethargy, and petechiae all over the body B) A 73-year-old patient admitted with concussion that resulted from a fall C) A 55-year-old patient diagnosed with Cushing disease displaying bruises, weight gain with a buffalo hump, and moon face D) A 15-year-old insulin-dependent diabetic with hypoglycemia displaying irritability with headaches and tachycardia E) A pregnant mother experiencing headaches and proteinuria - ANSWER-A C A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client's husband is confused as to why a disease of coagulation can result in bleeding. Which of the nurse's following statements best characterizes DIC? A) "So much clotting takes place that there are no available clotting components left, and bleeding ensues." B) "Massive clotting causes irritation, friction, and bleeding in the small blood vessels." C) "Excessive activation of clotting causes an overload of vital organs, resulting in bleeding." D) "The same hormones and bacteria that cause clotting also cause bleeding." - ANSWER-A A newly diagnosed leukemia patient begins hemorrhaging from every orifice. The physician is concerned that the patient has developed disseminated intravascular coagulation (DIC). The nurse should anticipate which of the following orders to be prescribed for this patient? Select all that apply. A) Transfuse 2 units of platelets. B) Transfuse fresh frozen plasma. C) Give aspirin twice per day. D) Administer IV Toradol stat. E) Place in reverse isolation. - ANSWER-A B A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy's spleen. Which of the following teaching points would be most accurate? A) "Ferritin is the activated and usable form of iron that your red blood cells can use to transport oxygen." B) "Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills." C) "Ferritin is a protein-iron complex that allows your red blood cells to make use of the iron that you consume in your diet." D) "Ferritin is the form of iron that is transported in your blood plasma to red blood cells that need it." - ANSWER-B A 62-year-old female with a diagnosis of acute and chronic renal failure secondary to diabetes mellitus is receiving her weekly injection of epoetin, a supplementary form of erythropoietin. Which of the following statements best captures the necessity of this medication? A) Erythropoietin is needed in order for stem cells to proliferate into committed erythroid precursors. B) Erythropoietin is necessary for the accurate sensation of hypoxia that stimulates erythropoiesis. C) Erythropoietin causes the erythrocyte colony-forming units to proliferate and mature. D) Erythropoietin facilitates the extrusion of the reticulocyte nucleus and the formation of true erythrocytes - ANSWER-C A client with a diagnosis of hemolytic anemia has gone to a community-based laboratory for follow-up blood work. The lab technician confirms with the client that hematocrit is one of the components of the blood work. The client replies, "I thought the point of the blood work was to see how many red blood cells I have today." How could the technician best respond to the client's statement? A) "This result will tell your care provider about the number of red blood cells in a given quantity of your blood plasma." B) "Your hematocrit measures the average size of your red blood cells and indirectly measures your oxygen-carrying capacity." C) "The result will indicate how many of your red blood cells are new and young and will indicate your body's production rate of red cells." D) "The hematocrit measures the mass that your red blood cells account for in a quantity of your blood." - ANSWER-D A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level of 5.8 g/dL has been ordered a transfusion of packed red blood cells. The client possesses type B antibodies but lacks type D antigens on his red cells. Transfusion of which of the following blood types would be least likely to produce a transfusion reaction? A) BB) B+ C) A+ D) A- - ANSWER-D Your ESRD patient is receiving 2 units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56. What is the nurse's priority action? A) Slow the rate of the blood infusion to 50 mL/hour. B) Document the assessment as the only action. C) Discontinue the transfusion and begin an infusion of normal saline. D) Recheck the type of blood infusing with the chart documentation of patient's blood type. - ANSWER-C A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stool that has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely to occur? A) The woman has depleted blood volume due to her ongoing blood loss. B) She will have iron deficiency anemia due to depletion of iron stores. C) The patient will be at risk for cardiovascular collapse or shock. D) She will have delayed reticulocyte release. - ANSWER-B Amniocentesis has suggested that a couple's first child will be born with sickle cell disease. The parents are unfamiliar with the health problem, and their caregiver is explaining the complexities. Which of the following statements by the parents would suggest a need for further teaching or clarification? A) "Our baby's red cells are prone to early destruction because of his or her weak membranes." B) "Not all of his or her red cells will be sickled, but low oxygen levels can cause them to become so." C) "Sickled cells can block his or her blood vessels, especially in the abdomen, chest, and bones." D) "Our son or daughter likely won't show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies." - ANSWER-D A child has been diagnosed with thalassemia. Which of the following comorbidities may occur as a result of having thalassemia? A) Hypocoagulation B) Iron deficiency C) Splenomegaly D) Neutropeniabb - ANSWER-C A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies, A) "They will wash your RBCs and then mix the cells with a reagent to see if they clump together." B) "They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis)." C) "They will be looking to see if you have enough ferritin in your blood." D) "They are looking for the presence of antibody or complement on the surface of the RBC." - ANSWER-D A 13-year-old African American boy comes to the ER complaining of fatigue and a rapid heartbeat. In conversation with the father, it becomes apparent to you that the boy has grown 2 inches in the previous 5 months. What is the first problem the health care team would attempt to rule out? A) Sickle cell anemia B) Iron deficiency anemia C) Thalassemia D) Aplastic anemia - ANSWER-B A 22-year-old female who adheres to a vegan diet has been diagnosed with iron deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation? A) Decreased mean corpuscular volume (MCV) B) Decreased hemoglobin and hematocrit C) Microcytic, hypochromic red cells D) Decreased erythropoietin levels - ANSWER-D A community health nurse is conducting a class on the nutritional component for new mothers. Which of the following teaching points would be most justified? A) "Iron supplementation is not necessary provided you are breast-feeding your infant." B) "Be aware that cow's milk depletes your baby's supply of iron." C) "Your infant needs the same amount of iron as you but has far fewer sources for obtaining it." D) "If you choose to feed your baby with formula, ensure that it is iron fortified." - ANSWER-D A client with a diagnosis of atrophic gastritis and consequent pernicious anemia is receiving high oral doses of vitamin B12. Which of the following changes would be most likely expected by his care provider at the completion of his treatment? A) Decreased mean corpuscular volume B) Increased serum bilirubin C) Increased folic acid levels D) Decreased free heme levels - ANSWER-A Two years after chemotherapy and radiation therapy for lung cancer, a 72-year-old patient notices that he seems to be extremely tired all the time. The physician suspects the patient may have developed aplastic anemia. The nurse assessing the patient will likely find which of the following clinical manifestations of aplastic anemia? Select all that apply. A) Complaints of weakness and fatigue B) Small spots of skin hemorrhages over the entire body C) Excess bleeding from gums and nose D) Spoon-shaped deformity of the fingernails E) Hemolysis from renal dialysis treatments. - ANSWER-A B C Which of the following patients would be most likely to be experiencing an increase in renal erythropoietin production? A) A 71-year-old smoker admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD) B) A 70-year-old woman admitted with dehydration secondary to an overdose of her potassium-wasting diuretic C) A 68-year-old man with a long-standing diagnosis of polycythemia vera D) A 21-year-old man with acute blood loss secondary to a motor vehicle accident 3 hours prior - ANSWER-A A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. What will be the primary goal of his treatment? A) To control his hypertension B) To increase the amount of oxygen distributed by his red blood cells C) To reduce the mean size of his red cells D) To reduce the viscosity of his blood - ANSWER-D A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor? A) The fact that the infant is being breast-fed B) Hypoxia C) Hepatic immaturity of the infant D) Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA) - ANSWER-D Which of the following nursing interventions would be a priority when caring for a newborn who is receiving phototherapy for high bilirubin levels? Select all that apply. A) Frequent monitoring of temperature B) Keeping diapers dry and clean C) Maintaining oral intake to prevent dehydration D) Putting lotion on his skin frequently to prevent drying/cracking of skin E) Applying sunscreen to prevent ultraviolet radiation - ANSWER-A C If an Rh-negative mother is giving birth to an Rh-positive infant, the nurse should be prepared to administer A) antihistamines like Benadryl. B) alpha interferon. C) Rh immune globulin. D) a monoclonal antibody like infliximab - ANSWER-C The family members of an elderly patient are wondering why his "blood counts" are not rising after his last GI bleed. They state, "He has always bounced back after one of these episodes, but this time it isn't happening. Do you know why?" The nurse will respond based on which of the following pathophysiological principles? A) "Everything slows down when you get older. You just have to wait and see what happens." B) "Due to stress, the red blood cells of older adults are not replaced as promptly as younger people." C) "The doctor may start looking for another cause of his anemia, maybe cancer of the bone." D) "Don't worry about it. We can always give him more blood." - ANSWER-B Which of the following glycoproteins is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia? A) Growth factors and cytokines B) Neutrophils and eosinophils C) T lymphocytes and natural killer cells D) Natural killer cells and granulocytes - ANSWER-A A 12-year-old boy has contracted a bacterial infection at school, and his body has responded by increasing leukocyte production. Place the following components of white blood cell production in the correct chronological order. Use all the options. A) Myeloblast B) Promyelocyte C) Myeloid stem cell D) Metamyelocyte E) Neutrophil - ANSWER-C A B D E Which of the following statements most accurately conveys an aspect of lymphatic system activity? A) B- and T-lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures. B) B cells and macrophages are released from the bone marrow in their completed state. C) Stem cells in the lymphterm-19 nodes initiate and regulate the process of white cell synthesis. D) Leukocytes bypass vascular circulation and are distributed instead by the lymphatic system - ANSWER-A A 44-year-old male hospital client with a diagnosis of end-stage acquired immunodeficiency syndrome (AIDS) has been placed on neutropenic precautions that limit his interaction with visitors, staff, and other clients. What is the underlying rationale for these precautions? A) His antibody-mediated immunity is compromised by his low production of neutrophils. B) Neutropenia limits the ability of his CD4 helper cells to present antigens. C) Insufficient levels of neutrophils make him particularly susceptible to infections. D) Cyclic neutropenia limits his body's ability to fight various infections. - ANSWER-C Which of the following patients has an absolute neutrophil count that is critically low and that the standard of care would recommend they be placed on neutropenic precautions? A) A patient on long-term steroids for rheumatoid arthritis with WBC of 7000 B) A 37-year-old patient with leukemia being treated with chemotherapy with ANC of 400 C) A 65-year-old prostate cancer patient receiving radiation therapy with neutrophil count of 2000 D) A 75-year-old renal failure patient receiving Epogen for anemia with hemoglobin level of 9.7. - ANSWER-B A patient with rheumatoid arthritis has been diagnosed with a secondary immune-associated neutropenia called Felty syndrome. The nurse has had to research this and found that she should be assessing this patient for which of the following manifestations of Felty syndrome. Select all that apply. A) Upper left quadrant pain on palpation B) An area of diminished breath sounds related to pneumonia C) Intermittent pain that radiates from the flank to the groin D) Swelling and pain in all joints when put through full range of motion E) Headache that worsens when exposed to bright lights - ANSWER-A B A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms? A) The Epstein-Barr virus (EBV) is lysing many of the boy's neutrophils. B) Viruses are killing some of his B cells and becoming incorporated into the genome of others. C) The EBV inhibits the maturation of white cells within his peripheral lymph nodes. D) The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes. - ANSWER-B A 16-year-old female has been brought to her primary care physician by her mother due to the girl's persistent sore throat and malaise. Which of the following facts revealed in the girl's history and examination would lead the physician to rule out infectious mononucleosis? A) The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes. B) Her liver and spleen are both enlarged. C) Blood work reveals an increased white blood cell count. D) Chest auscultation reveals crackles in her lower lung fields bilaterally - ANSWER-D A 40-year-old male client is shocked to receive a diagnosis of mature B-cell lymphoma and is doing research on his diagnosis on the Internet. Which of the following statements that he reads on various Web sites is most reliable? A) "Like most forms of Hodgkin lymphoma, mature B-cell lymphoma often requires radiation treatment." B) "Doctors are able to diagnose mature B-cell lymphoma by the presence of Reed-Sternberg cells." C) "Unlike many other lymphomas, mature B-cell lymphoma is often self-limiting, and treatment is focused on symptoms." D) "The lymph nodes are usually affected, and often the spleen and bone marrow." - ANSWERD Which of the following statements by a client of a cancer center who has a new diagnosis of non-Hodgkin lymphoma (NHL) demonstrates a sound understanding of the diagnosis and treatment of the health problem? A) "They confirmed my diagnosis with a lymph node biopsy, and I'll get radiation treatment soon because it's fairly early stage." B) "They took a sample of my lymph nodes, and I'll be having surgery soon that will hopefully cure my lymphoma." C) "My blood work came back positive for NHL, and I'm meeting with my oncologist to discuss chemotherapy soon." D) "Since the tests show NHL, I'm going to pursue my options for palliative care because I'm committed to dying with dignity." - ANSWER-A A patient has visited his physician because he found an enlarged lymph node along the mediastinal border. When questioned, the physician may be alerted to a possible diagnosis of Hodgkin lymphoma (HL) if the patient also displays: Select all that apply. A) yeast infection in the mouth. B) night sweats. C) unexplained pruritus. D) joint swelling. E) sore throat with pustules on tonsils - ANSWER-B C A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma? A) Her neoplasm originates in secondary lymphoid structures. B) The lymph nodes involved are located in a large number of locations in the lymphatic system. C) The presence of Reed-Sternberg cells has been confirmed. D) The woman complains of recent debilitating fatigue. - ANSWER-B A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked what the first chromosomal abnormality that identified cancer was, one student correctly answered A) interleukin cells. B) BRCA-1. C) Philadelphia. D) PSA. - ANSWER-C Which of the following assessments and laboratory findings would be most closely associated with acute leukemia? A) High blast cell counts and fever B) Decreased oxygen partial pressure and weight loss C) Increased serum potassium and sodium levels D) Increased blood urea nitrogen and bone pain - ANSWER-A Which of the following individuals would most likely possess normal plasma cell synthesis and fully differentiated myeloid and lymphoid cells? A) A 7-year-old boy with a diagnosis of acute lymphocytic leukemia (ALL) B) A 70-year-old male who has acute myelogenous leukemia (AML) C) A 58-year-old female with HIV and multiple myeloma D) A 78-year-old male who has been diagnosed with chronic lymphocytic leukemia (CLL) - ANSWER-D A patient diagnosed with low-risk chronic lymphocytic leukemia (CLL) has recently developed thrombocytopenia. One of the medications utilized to treat this would be A) dexamethasone, a corticosteroid. B) cisplatin, a chemotherapeutic. C) vincristine, a Vinca alkaloid. D) doxorubicin, a cytotoxic antibiotic. - ANSWER-A A 70-year-old woman has received a diagnosis of chronic myelogenous leukemia (CML) after a clinical investigation sparked by the presence of leukocytosis in her routine blood work. What clinical course should her care provider tell her to expect? A) "You can expect your blood results, fatigue, and susceptibility to infection to gradually worsen over a few years." B) "You could remain the chronic stage of CML for several years before it accelerates and culminates in a crisis." C) "It's likely that this will give you chronic fatigue and malaise for the rest of your life, but that will probably be the extent of your symptoms." D) "Unfortunately, your leukemia will likely enter a crisis mode within a few weeks if we don't treat it immediately." - ANSWER-B A 32-year-old woman presents at her neighborhood health clinic complaining of weakness and a feeling of abdominal fullness. She reports that 6 months earlier she noticed that she had difficulty in maintaining the high level of energy she has relied on during her aerobic workouts over the past few years. Because she felt that she was in overall good health, but knew that women often need additional iron, she added a multiple vitamin with iron and some meat and leafy greens to her diet. She followed her plan carefully but had no increase in energy. Upon examination, her spleen is noted to be enlarged. Which of the following is most likely to be the cause? A) Accelerated CML B) Stage A Hodgkin disease C) Infectious mononucleosis D) CLL - ANSWER-A In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis? A) A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated B) A 68-year-old former coal miner who has white cell levels exponentially higher than normal ranges C) An 81-year-old male resident of a long-term care home who has an uncommon bacterial pneumonia and who is unable to produce a fever D) A 70-year-old woman whose blood work reveals large numbers of immature granulocytes - ANSWER-A A 30-year-old male's blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the man's most likely diagnosis? A) Acute myelogenous leukemia B) Multiple myeloma C) Acute lymphocytic leukemia D) Hodgkin lymphoma - ANSWER-B As part of presurgical teaching for patients who are about to undergo a coronary artery bypass graft, a nurse is performing an education session with a group of surgical candidates. Which of the following teaching points best conveys an aspect of the human circulatory system? A) "The blood pressure varies widely between arteries and veins and between pulmonary and systemic circulation." B) "Only around one quarter of your blood is in your heart at any given time." C) "Blood pressure and blood volume roughly mimic one another at any given location in the circulatory system." D) "Left-sided and right-sided pumping action on each beat of the heart must equal each other to ensure adequate blood distribution." - ANSWER-A In which of the following situations would blood most likely rapidly relocate from central circulation to the lower extremities? A) A client undergoes a stress test on a treadmill. B) A client does isotonic exercises in a wheelchair. C) A client is helped out of bed and stands up. D) A client reclines from a sitting to supine position. - ANSWER-C Which of the following statements most accurately captures a principle of blood flow? A) With constant pressure, a small increase in vessel radius results in an exponential increase in blood flow. B) Blood flow is primarily determined by blood viscosity and temperature. C) Blood flows most quickly in the small diameter peripheral capillaries. D) Smaller cross-sectional vessel area is associated with lower flow velocity. - ANSWER-A A 72-year-old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds, A) "Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur." B) "Aortic stenosis is commonly seen in elderly patients. Basically, there is a blockage in the valve that is causing blood to pool, causing decreased velocity of flow." C) "This is caused by a tear in one of the papillary muscles attached to the valve. They can do a procedure where they thread a catheter into the heart and reattach the muscle ends." D) "Because of the high amount of energy it takes to push blood through the aortic valve to the body, your valve is just had to work too hard and it is weakening." - ANSWER-A A physician is teaching a group of medical students about the physiological basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by a student would warrant correction by the physician? A) "As vessel wall thickness increases, tension decreases." B) "Smaller blood vessels require more pressure to overcome wall tension." C) "The smaller the vessel radius, the greater the pressure needed to keep it open." D) "Tension and vessel thickness increase proportionately." - ANSWER-D During an automobile accident where the patient is bleeding heavily, which vascular component is the most distensible and can store large quantities of blood that can be returned to the circulation at this time of need? A) Liver and pancreas B) Kidneys C) Veins D) Aorta - ANSWER-C A client has suffered damage to his pericardium following a motor vehicle accident. Which consequence could be a possible complication of damaged pericardium that his care providers should assess for? A) Impaired physical restraint of the left ventricle B) Increased friction during the contraction/relaxation cycle C) Reduced protection from infectious organisms D) Impaired regulation of myocardial contraction - ANSWER-D A pathologist is examining histological (tissue) samples from a client with an autoimmune disease. Which of the following characteristics of muscle samples would signal the pathologist that the samples are cardiac rather than skeletal muscle? A) The cell samples lack intercalated disks. B) The muscle cells have small and a few mitochondria. C) The cells have a poorly defined sarcoplasmic reticulum. D) The muscles are striated and composed of sarcomeres. - ANSWER-C An 81-year-old female client of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client's condition? A) Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest. B) Blood backs up into the jugular vein because there are no valves at the point of entry into the heart. C) Peripheral dilation is associated with decreased stroke volume and ejection fraction. D) Heart valves are not capable of preventing backflow in cases of atrial congestion - ANSWERB As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which of the following teaching points best captures a component of cardiac function? A) "Efficient heart function requires that the ventricles do not retain any blood at the end of the cardiac cycle." B) "Recall that the heart sounds that we listen to as part of our assessments are the sounds of the myocardium contracting." C) "The diastolic phase is characterized by relaxation of ventricles and their filling with blood." D) "Aortic pressure will exceed ventricular pressure during systole." - ANSWER-C A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon? A) Increased preload due to vascular resistance B) High afterload because of backpressure against the left ventricle C) Impaired contractility due to aortic resistance D) Systolic impairment because of arterial stenosis - ANSWER-B In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the patient has gone into ventricular tachycardia. The nurse will likely assess for signs/symptoms of A) development of hypertension with BP 190/98. B) oxygen deprivation with O2 saturation decreasing to approximately 90%. C) decreasing cardiac output due to less ventricular filling time. D) increasing cardiac index by correlating the volume of blood pumped by the heart with an individual's body surface area. - ANSWER-C A nurse is using a stethoscope and blood pressure cuff to manually measure a client's blood pressure. The nurse knows that which of the following facts related to blood flow underlies the ability to hear blood pressure by auscultation (listening)? A) The force of blood with each cardiac contraction produces friction on vessel walls that can be heard and felt. B) The movement of smooth muscle surrounding vessels produces noise that is audible by a stethoscope. C) Turbulent flow of blood during systole produces sound while laminar flow during diastole is silent. D) Pressure pulsation that exceeds the velocity of blood flow is audible and coincides with systolic BP. - ANSWER-D Analysis has shown that a client's right atrial pressure is 30 mm Hg. What is the most likely conclusion that the client's care team will draw from this piece of data? A) The result is likely normal and gravity dependent given the lack of valves in thoracic and central veins. B) The pressure is insufficient to provide adequate stroke volume and cardiac output. C) The pressure is excessive given that the right atrium should be at atmospheric pressure. D) Pressure pulsations are likely to be undetectable given the low atrial pressure - ANSWER-C A patient arrived at the emergency department 2 days after the development of "chest pressure" and "tightness" was treated with antacids thinking it was indigestion. His enzymes show a massive myocardial infarction (MI). Following angioplasty, the patient asks why so much muscle was damaged if only one vessel was blocked, the left circumflex. The nurse responds, A) "With any blockage in the heart, muscle damage always occurs." B) "If a major artery like the circumflex is occluded, the smaller vessels supplied by that vessel cannot restore the blood flow." C) "Since the circumflex artery supplies oxygenated blood flow to the posterior surface of the left ventricle, any amount of blockage will result in vital muscle tissue being lost." D) "When it comes to arteries in the heart, all vessels are equal, and any blockage causes a massive amount of damage that will not be restored." - ANSWER-B When explaining to a patient why he only had minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain this is primarily due to A) the possibility that the person has elevated INR levels that prevent blood from backlogging in the vessel. B) development of collateral circulation that builds channels between some of the smaller arteries usually when the flow is decreased gradually. C) good genetic makeup that allows occluded arteries to keep vasodilating to meet metabolic needs. D) the release of substances formed by special glands that transport the blood cell-by-cell through smaller spaces. - ANSWER-B Which of the following individuals is most likely to be experiencing vasodilation? A) A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin-angiotensin-aldosterone system B) A 9-year-old boy who has been given an injection of epinephrine to preclude an anaphylactic reaction to a bee sting C) A 30-year-old woman who takes antihistamines to treat her seasonal allergies D) A 32-year-old man who takes a selective serotonin reuptake inhibitor for the treatment of depression - ANSWER-A When trying to explain to a new dialysis patient the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have A) no capillary openings since this would lead to extensive hemorrhage. B) small openings that allow large amounts of smaller molecular substances to filter through the glomeruli. C) large pores so that substances can pass easily through the capillary wall. D) endothelial cells that are joined by tight junctions that form a barrier to medication filtration. - ANSWER-B A 51-year-old patient with a history of alcohol abuse and liver disease has low serum levels of albumin and presents with ascites (excess fluid in his peritoneal space) and jaundice. A health care professional would recognize that which of the following processes is most likely underlying his health problems? A) Low albumin is contributing to excess hydrostatic pressure and inappropriate fluid distribution. B) Low albumin is inducing hypertension and increased filtration of fluid into interstitial spaces. C) Insufficient albumin is causing insufficient absorption of fluid into the capillaries. D) Low albumin contributing to an inability to counter gravitational effects. - ANSWER-C While intubated for surgery, a patient has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe? A) Decreased vascular perfusion due to parasympathetic stimulation B) Decreased heart rate, contractility, and afterload C) Decreased heart rate as a result of parasympathetic innervation of the heart D) Decreased heart rate as a result of impaired acetylcholine reuptake - ANSWER-C If a virus has caused inflammation resulting in endothelial dysfunction, an excessive amount of endothelins in the blood can result in A) arterial wall weakening resulting in aneurysm formation. B) release of excess fatty plaque causing numerous pulmonary emboli. C) contraction of the underlying smooth muscles within the vessels. D) overproduction of growth factors resulting in new vessel production. - ANSWER-C A nursing instructor is explaining the role of vascular smooth muscle cells in relation to increases in systemic circulation. During discussion, which neurotransmitter is primarily responsible for contraction of the entire muscle cell layer thus resulting in decreased vessel lumen radius? A) Nitric oxide B) Adrenal glands C) Fibroblast growth factor D) Norepinephrine - ANSWER-D A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his physician. Which of the following aspects of hyperlipidemia would the physician most likely take into account when teaching the patient? A) Hyperlipidemia is a consequence of diet and lifestyle rather than genetics. B) HDL cholesterol is often characterized as being beneficial to health. C) Cholesterol is a metabolic waste product that the liver is responsible for clearing. D) The goal of medical treatment is to eliminate cholesterol from the vascular system. - ANSWER-B Which of the following patients will likely experience difficulty in maintaining lipoprotein synthesis resulting in elevated LDL levels? A) A 55-year-old male admitted for exacerbation of chronic obstructive pulmonary disease (COPD) B) A 44-year-old female admitted for hysterectomy due to cervical cancer with metastasis C) A 35-year-old patient with a history of hepatitis C and B with end-stage liver disease D) A 27-year-old patient with pancreatitis related to alcohol abuse - ANSWER-C In which of the following hospital patients would the care team most realistically anticipate finding normal cholesterol levels? A) A 44-year-old male admitted for hyperglycemia and with a history of diabetic neuropathy B) A 77-year-old female admitted for rheumatoid arthritis exacerbation who is receiving hormone replacement therapy and with a history of hypothyroidism C) A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness D) A morbidly obese 50-year-old female who is taking diuretics and a beta-blocker to treat her hypertension - ANSWER-C A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session? A) "Remember the 'H' in HDL and the 'L' in LDL correspond to high danger and low danger to your health." B) "Having high cholesterol increases your risk of developing diabetes and irregular heart rate." C) "Smoking and being overweight increases your risk of primary hypercholesterolemia." D) "Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk." - ANSWER-D Which of the following medications will likely be prescribed for a patient with elevated LDL and triglyceride levels? A) Zocor (simvastatin), an HMG-CoA reductase inhibitor or "statin" B) Cholestyramine (Questran), a bile acid sequestrant C) Nicotinic acid (Niacin), a B vitamin D) Fenofibrate (Tricor), a fibric acid - ANSWER-A When a 55-year-old patient's routine blood work returns, the nurse notes that his C-reactive protein (CRP) is elevated. The patient asks what that means. The nurse responds, A) "You must eat a lot of red meat since this means you have a lot of fat floating in your vessels." B) "You are consuming high levels of folate, which works with the B vitamins and riboflavin to metabolize animal protein." C) "This means you have high levels of HDL to balance the LDL found in animal proteins." D) "This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease - ANSWER-D A patient is reading a brochure on atherosclerosis while in the waiting room of medical clinic. Which of the following excerpts from the educational brochure warrants correction? A) "Because smoking causes a permanent increase in your risk of heart disease, it's best not to start." B) "All things being equal, men have a higher risk of coronary heart disease than perimenopausal women." C) "High blood pressure often accompanies, or even causes, clogging of the arteries." D) "Every bit that you can lower your cholesterol means that you'll have a lower risk of developing heart disease." - ANSWER-A When trying to educate a patient about the release of free radicals and the role they play in formation of atherosclerosis, which of the following statements is most accurate? A) The end result of oxidation is rupture of the plaque resulting in hemorrhage. B) Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. C) Oxidized free radicals produce toxic metabolic waste that can kill liver cells. D) Activated cells roam in the vascular system looking for inflammatory cells to engulf. - ANSWER-B A nurse is providing care for a client who has a history of severe atherosclerosis. Which of the following clinical manifestations of the client's illness should the nurse anticipate and assess in the client? A) Motor deficits in muscles distal to plaque formation B) Peripheral vasodilation to compensate for ischemia C) Cognitive deficits due to ischemia or thrombosis D) Aneurysm formation due to weakening of blood vessel walls E) Necrosis of the vessel wall - ANSWER-D Which of the following assessment findings of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa? A) The man's blood work indicates polycythemia (elevated red cell levels) and leukocytosis (elevated white cells). B) The man's blood pressure is 178/102, and he has abnormal liver function tests. C) The man is acutely short of breath, and his oxygen saturation is 87%. D) The man's temperature is 101.9°F, and he is diaphoretic (heavily sweating). - ANSWER-B A patient arrives at the ED complaining of numbness in the left lower leg. Upon assessment, the nurse finds the lower left leg to be cold to touch, pedal and posterior tibial pulses nonpalpable, and a sharp line of paralysis/paresthesia. The nurse's next action is based on the fact that A) acute arterial occlusion is a medical emergency requiring immediate intervention to restore blood flow. B) submersion in a whirlpool with warm water will improve the venous blood flow And restore pulses. C) the immediate infusion of tissue plasminogen activator (tPA) will not correct the problem and should only be used for CVAs. D) administration of an aspirin and sublingual nitroglycerin will vasodilate the artery to restore perfusion. - ANSWER-A A 70-year-old male client presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable, and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which of the following medical diagnosis/possible treatment plans listed below? A) Acute arterial occlusion that will be treated with angioplasty B) Raynaud disease that will require antiplatelet medications C) Atherosclerotic occlusive disease necessitating thrombolytic therapy D) Giant cell temporal arteritis that will be treated with corticosteroids - ANSWER-C A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught stating, "I've always been healthy, and I can't believe I have a disease now." What would be her physician's most appropriate response? A) "This likely won't have a huge effect on your quality of life, and I'll prescribe anticlotting drugs to prevent attacks." B) "I'll teach you some strategies to minimize its effect on your life, and minor surgery to open up your blood vessels will help too." C) "You need to make sure you never start smoking, and most of the symptoms can be alleviated by regular physical activity." D) "If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation." - ANSWER-D During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the client, who is unfamiliar with aneurysms. Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? A) Aneurysms are commonly a result of poorly controlled diabetes mellitus. B) Hypertension is a frequent modifiable contributor to aneurysms. C) Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures. D) Aneurysms can normally be resolved with lifestyle and diet modifications. - ANSWER-B In which of the following patients is the emergency department staff most likely to suspect an abdominal aortic aneurysm? A) A 60-year-old client with diminished oxygen saturation, low red blood cell levels, and pallor B) A 70-year-old woman with jugular venous distention, shortness of breath, and pulmonary edema C) A 66-year-old client with facial edema, cough, and neck vein distention D) An 81-year-old man with acute cognitive changes as well as difficulty in speaking and swallowing - ANSWER-C A 44-year-old female who is on her feet for the duration of her entire work week has developed varicose veins in her legs. What teaching point would her care provider be most justified in emphasizing to the woman? A) "Once you have varicose veins, there's little that can be done to reverse them." B) "Your varicose veins are likely a consequence of an existing cardiac problem." C) "If you're able to stay off your feet and wear tight stockings, normal vein tone can be reestablished." D) "The use of blood thinner medications will likely relieve the backflow that is causing your varicose veins." - ANSWER-A An elderly patient arrives to the health care provider's office complaining of a "sore" that would not heal on his lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the patient that the usual treatment is A) hydrotherapy to facilitate improvement in circulation. B) compression therapy to help facilitate blood flow back to the vena cava. C) initiation of Coumadin therapy to maintain an INR of 2 to 3 above norm. D) long-term antibiotic therapy to facilitate healing of the wound. - ANSWER-B A physician is explaining to a group of medical students the concept of Virchow triad as it applies to venous thrombosis. Which of the following clinical observations of a 50-year-old male client is most likely unrelated to a component of Virchow triad? A) The man has decreased cardiac output and an ejection fraction of 30%. B) The man's prothrombin time and international normalized ratio (INR) are both low. C) The man has a previous history of a dissecting aneurysm. D) There is bilateral, brown pigmentation of his lower legs. - ANSWER-A A 74-year-old man is being assessed by a nurse as part of a weekly, basic health assessment at the long-term care facility where he resides. His blood pressure at the time is 148/97 mm Hg, with a consequent pulse pressure of 51 mm Hg. The nurse would recognize that which of the following is the most significant determinant of the resident's pulse pressure? A) Blood volume, resistance, and flow B) The cardiac reserve or possible increase in cardiac output over normal resting level C) The amount of blood that his heart ejects from the left ventricle during each beat D) The relationship between total blood volume and resting heart rate - ANSWER-C At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure is at the low end of the normal range; at 6 AM, the client's MAP has fallen definitively below normal. The client is at risk for A) pulmonary hypertension. B) left ventricular hypertrophy. C) organ damage and hypovolemic shock. D) orthostatic hypotension - ANSWER-C The nurse practitioner working in an overnight sleep lab is assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient's blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles? A) During apneic periods, the patient experiences hypoxemia that stimulates chemoreceptors to induce vasoconstriction. B) When the patient starts to snore, his epiglottis is closed over the trachea. C) When the airway is obstructed, specialized cells located in the back of the throat send signals to the kidney to increase pulse rate. D) When airways are obstructed, the body will retain extracellular fluid so that this fluid can be shifted to intravascular space to increase volume. - ANSWER-A A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The patient's physician would anticipate that which of the following phenomena is most likely occurring? A) The patient's juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation. B) Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system. C) Vasopressin is exerting an effect on his chemoreceptors and baroreceptors resulting in vasoconstriction. D) The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption. - ANSWER-D A group of novice nursing students are learning how to manually measure a client's blood pressure using a stethoscope and sphygmomanometer. Which of the following statements by students would the instructor most likely need to correct? A) "I'll inflate the cuff around 30 mm Hg above the point at which I can't palpate the client's pulse." B) "If my client's arm is too big for the cuff, I'm going to get a BP reading that's artificially low." C) "The accuracy of the whole process depends on my ability to clearly hear the Korotkoff sounds with the bell of my stethoscope." D) "With practice, my measurement of clients' blood pressures with this method will be more accurate than with automated machines." - ANSWER-B A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which of the leader's following teaching points is most accurate? A) "It's important to minimize the amount of potassium and, especially, sodium in your diet." B) "High blood pressure is largely controllable, except for those with a significant family history or African Americans." C) "Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure." D) "Hypertension puts you at a significant risk of developing type 2 diabetes later in life." - ANSWER-C When advising a morbidly obese patient about the benefits of weight reduction, which of the following statements would be most accurate to share? A) "All you need to do is stop drinking sodas and sugary drinks." B) "A 10 lb loss of weight can produce a decrease in blood pressure." C) "An increased 'waist-to-hip' ratio can lead to too much pressure on the liver and intestines." D) "If your leptin (hormone) level is too low, you are at increased risk for developing high BP." - ANSWER-B A physician is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the physician most likelyrule out hypertension as a contributing factor? A) A 61-year-old man who has a heart valve infection and recurrent fever B) An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness C) A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week D) A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance - ANSWER-A An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which of the following components of the pathologist's report is most suggestive of a possible history of poorly controlled blood pressure? A) "Scarring of the urethra suggestive of recurrent urinary tract infections is evident." B) "Bilateral renal hypertrophy is noted." C) "Vessel wall changes suggestive of venous stasis are evident." D) "Arterial sclerosis of subcortical brain regions is noted." - ANSWER-D During a routine physical exam for a patient diagnosed with hypertension, the nurse practitioner will be most concerned if which of the following assessments are found? A) Noted hemorrhages and microaneurysms during evaluation of the internal eye B) Unable to feel vibrations when a tuning fork is placed on the skull C) Inability to locate the kidneys with deep palpation to the abdomen D) Slight increase in the number of varicose veins noted bilaterally - ANSWER-A A nurse is providing care for a number of older clients on a restorative care unit of a hospital. Many of the clients have diagnoses or histories of hypertension, and the nurse is responsible for administering a number of medications relevant to blood pressure control. Which of the following assessments would the nurse be most justified in eliminating during a busy morning on the unit? A) Checking the recent potassium levels of a client receiving an ACE inhibitor B) Measuring the heart rate of a client who takes a beta-adrenergic blocker C) Measuring the pulse of a client taking an ACE inhibitor D) Noting the sodium and potassium levels of a client who is receiving a diuretic - ANSWER-C Which of the following hypertensive individuals is most likely to have his or her high blood pressure diagnosed as secondary rather than essential? A) A 51-year-old male who has been diagnosed with glomerulonephritis B) An African American man who leads a sedentary lifestyle C) A 69-year-old woman with a diagnosis of cardiometabolic syndrome D) A 40-year-old smoker who eats excessive amounts of salt and saturated fats - ANSWER-A A patient is admitted to the outpatient diagnostic unit for further testing to identify the cause of the uncontrolled secondary hypertension. In preparation, the nurse should anticipate that which of the following diagnostic procedures will provide the most definitive diagnosis? A) Routine ultrasound of kidney B) Renal arteriography C) Echocardiography D) Serum creatinine level - ANSWER-B A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider most likelysuspect? A) Pheochromocytoma B) Essential hypertension C) Coarctation of the aorta D) An adrenocortical disorder - ANSWER-C During a prenatal education class, an expectant mother tells the group about a friend whose blood pressure became so high during pregnancy that she had to be admitted to hospital. Which of the following statements should the nurse include in response to this? A) "A large increase in blood pressure is a normal part of the changes in blood circulation that accompany pregnancy." B) "By avoiding salt, staying active, and minimizing weight gain, you can prevent this during your pregnancy." C) "Essentially, experts don't really know why so many pregnant women develop high blood pressure." D) "I'm sure this was hard for your friend, but rest assured that it won't affect your baby even if it affects you." - ANSWER-C A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg, and she has proteinuria. What other lab tests should be ordered for her? A) Plasma angiotensin I and II and renin B) Urinary sodium and potassium C) Platelet count, serum creatinine, and liver enzymes D) Urinary catecholamines and metabolites - ANSWER-C A 16-year-old adolescent who received a kidney transplant at the age of 10 has recently developed a trend of increasing BP readings. Of the following list of medications, which may be the primary cause for the development of hypertension? A) Furosemide (Lasix) B) Cyclosporine (Sandimmune) C) Isotretinoin (Accutane) D) Hydrochlorothiazide (Hydrodiuril) - ANSWER-B A nurse working on a gerontology unit notes that the majority of the clients on the unit are prescribed antihypertensive medications. When it comes to the aging process, which of the following phenomena are primarily the contributing factors to hypertension in the elderly population? Select all that apply. A) Stiffening of large arteries like the aorta B) Increased sensitivity of the renin-angiotensin-aldosterone system C) Decreased baroreceptor sensitivity and renal blood flow D) Increased peripheral vascular resistance E) Increase in renal perfusion - ANSWER-A C D A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relates to these health problems? A) The patient is male and has a history of hypertension. B) The patient's cardiac ejection fraction was 40% during his last echocardiogram. C) The patient has a history of acute and chronic renal failure. D) The client is 89 years old and takes a diuretic medication for his congestive heart failure. - ANSWER-D A 78-year-old male patient has undergone a total knee replacement. He just does not feel like getting out of bed and moving around. After 3 days of staying in bed, the physical therapist encourages him to get out of bed to the chair for meals. He starts to complain of dizziness and light-headedness. These symptoms are primarily caused by which of the following pathophysiological principles? Select all that apply. The patient('s) A) is experiencing a reduction in plasma volume. B) peripheral vasoconstriction mechanism has failed. C) is so stressed that he is releasing too many endorphins. D) is still bleeding from the surgical procedure. E) has lost all of his muscle tone. - ANSWER-A B In which of the following patient situations would a physician be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient's health problems? A) A 61-year-old man whose ECG was characterized by widespread T-wave inversions on admission but whose T waves have recently normalized B) A 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and a history of atrial fibrillation C) A 56-year-old obese man who is complaining of chest pain that is exacerbated by deep inspiration and is radiating to his neck and scapular ridge D) A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels - ANSWER-B Following cardiac surgery, the nurse suspects the patient may be developing a cardiac tamponade. Which of the following clinical manifestations would support this diagnosis? Select all that apply. A) Muffled heart tones B) Narrowed pulse pressure C) Low BP—84/60 D) Heart rate 78 E) Bounding femoral pulse - ANSWER-A B C Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)? A) Inadequate ventricular end-diastolic pressure B) Use of calcium channel blocker medications C) Increased aortic pressure D) Ventricular atrophy - ANSWER-C As part of the diagnostic workup for a male client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? A) Echocardiogram, PET scan, ECG B) Ambulatory ECG, cardiac MRI, echocardiogram C) Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy D) Cardiac catheterization, cardiac CT, exercise stress testing - ANSWER-A Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health? A) "People with plaque in their arteries experience attacks of blood flow disruption at seemingly random times." B) "The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel." C) "Infections of any sort are often a signal that plaque disruption is in danger of occurring." D) "The impaired function of the lungs that accompanies pneumonia or chronic obstructive pulmonary disease is a precursor to plaque disruption." - ANSWER-B Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction? A) A 33-year-old male whose pain started at 7 AM during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable. B) A 67-year-old female whose pain started at 2 AM while she was asleep and responded to nitrates; the ECG showed arrhythmias and ST-segment elevation; cardiac markers remained stable. C) An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose. D) A 61-year-old man whose pain started at 9 AM during a short walk and responded to nitrates, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened. - ANSWER-C Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome? A) Increased serum creatinine and troponin I as a result of enzyme release from damaged cells B) Increased serum potassium and decreased sodium as a result of myocardial cell lysis, release of normally intracellular potassium, and disruption of the sodium-potassium pump C) Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation D) Low circulatory levels of myoglobin and creatine kinase as a result of the inflammatory response - ANSWER-C A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)? A) A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort B) A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin C) A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw D) A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest - ANSWER-D Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications? Select all that apply. A) Large amount of pink, frothy sputum and new onset of murmur B) Tachypnea with respiratory distress C) Frequent ventricular arrhythmia unrelieved with amiodarone drip D) Complaints of facial numbness and tingling E) Enhanced renal perfusion as seen as an increase in urine output - ANSWER-A B C D A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points should the physician include in his explanation of the man's new diagnosis? A) "I'll be able to help track the course of your angina through regular blood work that we will schedule at a lab in the community." B) "With some simple lifestyle modifications and taking your heparin regularly, we can realistically cure you of this." C) "I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising." D) "There are things you can do to reduce the chance that you will need a heart bypass, including limiting physical activity as much as possible." - ANSWER-C Which of the following ECG patterns would the nurse observe in a patient admitted for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)? Select all that apply. A) Atrial flutter B) Ventricular tachycardia with left bundle branch block pattern C) T-wave inversion in the right precordial leads D) Sinus arrhythmia with a first-degree AV block E) Development of a "U" wave following a normal T wave - ANSWER-B C The initial medical management for a symptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications? A) Lisinopril, an ACE inhibitor B) Lasix, a diuretic C) Propranolol, a -adrenergic blocker D) Lanoxin, an inotropic - ANSWER-C A 31-year-old African American female who is in her 30th week of pregnancy has been diagnosed with peripartum cardiomyopathy. Which of the following statements best captures an aspect of peripartum cardiomyopathy? A) Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes. B) Treatment is possible in postpartum women, but antepartum women are dependent on spontaneous resolution of the problem. C) Mortality exceeds 50%, and very few surviving women regain normal heart function. D) Symptomatology mimics that of stable angina and is diagnosed and treated similarly. - ANSWER-A An IV drug abuser walks into the ED telling the nurse that, "he is sick." He looks feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The assessment reveals a loud murmur. An echocardiogram was ordered that shows a large vegetation growing on his mitral valve. The patient is admitted to the ICU. The nurse will be assessing this patient for which possible life-threatening complications? A) Systemic emboli, especially to the brain B) Petechial hemorrhages under the skin and nail beds C) GI upset from the massive amount of antibiotics required to kill the bacteria D) Pancreas enlargement due to increased need for insulin secretion - ANSWER-A A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics? A) CT of the heart, chest x-ray, and ECG B) Echocardiogram, blood cultures, and temperature C) ECG, blood pressure, and stress test D) Cardiac catheterization, chest x-ray, electrolyte measurement, and white cell count ANSWER-B A 13-year-old boy has had a sore throat for at least a week and has been vomiting for 2 days. His glands are swollen, and he moves stiffly because his joints hurt. His parents, who believe in "natural remedies," have been treating him with various herbal preparations without success and are now seeking antibiotic treatment. Throat cultures show infection with group A streptococci. This child is at high risk for A) myocarditis. B) mitral valve stenosis. C) infective endocarditis. D) vasculitis. - ANSWER-B On a routine physical exam visit, the physician mentions that he hears a new murmur. The patient gets worried and asks, "What does this mean?" The physician responds, A) "It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit." B) "This could be caused by an infection. Have you been feeling well the past few weeks?" C) "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problem." D) "This may make you a little more fatigued than usual. Let me know if you start getting dizzy or light-headed." - ANSWER-C A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to the client? A) "The normal tissue that makes up the valve between the right sides of your heart has stiffened." B) "Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation." C) "Your heart's mitral valve isn't closing properly so blood is flowing backward in your heart and eventually into your lungs." D) "The valve between your left ventricle and left atria is infected and isn't allowing enough blood through." - ANSWER-B A 66-year-old client's echocardiogram report reveals a hypertrophied left ventricle. The health care provider suspects the client has aortic stenosis. Which of the following clinical manifestations would be observed if this client has aortic stenosis? Select all that apply. A) Decrease in exercise tolerance B) Exertional dyspnea C) Palpitations D) Syncope E) Heartburn - ANSWER-A B D Which of the following situations related to transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? A) Pressure in pulmonary circulation and the right side of the infant's heart fall markedly. B) Alveolar oxygen tension increases causing reversal of pulmonary vasoconstriction of the fetal arteries. C) Systemic vascular resistance and left ventricular pressure are both increasing. D) Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week. - ANSWER-D A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? A) His resting blood pressure is normally in the range of 150/90, and an echocardiogram indicates his ejection fraction is 30%. B) His end-diastolic volume is higher than normal, and his resting heart rate is regular and 82 beats/minute. C) He is presently volume overloaded following several days of intravenous fluid replacement. D) Ventricular dilation and wall tension are significantly lower than normal. - ANSWER-D A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client A) has a distended bladder, facial edema, and nighttime difficulty breathing. B) complains of dyspnea and has adventitious breath sounds on auscultation (listening). C) has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. D) has cyanotic lips and extremities, low urine output, and low blood pressure - ANSWER-C An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms are least likely to decrease the symptoms of his heart failure? A) An increase in preload via the Frank-Starling mechanism B) Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine C) Activation of the renin-angiotensin-aldosterone system and secretion of brain natriuretic peptide (BNP) D) AV node pacemaking activity and vagal nerve suppression - ANSWER-D The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations? A) Chest pain and intermittent ventricular tachycardia B) Dyspnea and crackles in bilateral lung bases C) Petechia and spontaneous bleeding D) Muscle cramping and cyanosis in the feet - ANSWER-B A 77-year-old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could A) decrease renal perfusion and result in the development of ascites. B) be a result of catecholamines released from SNS that could increase the myocardial oxygen demand. C) desensitize the -adrenergic receptors leading to increase in norepinephrine levels. D) prolong the electrical firing from the SA node resulting in the development of a heart block. - ANSWER-B A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice? A) Measurement of urine output and mental status assessment B) Pupil response and counting the patient's apical heart rate C) Palpation of pedal (foot) pulses and pain assessment D) Activity tolerance and integumentary inspection - ANSWER-A Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate of 112, respiratory rate of 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is to A) have medical supply department bring up suction equipment. B) apply oxygen via nasal cannula at 3 lpm. C) page the respiratory therapist to come give him a breathing treatment. D) call for emergency assistance utilizing hospital protocol. - ANSWER-D A female older adult client has presented with a new onset of shortness of breath, and her physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the most accurate rationale for the physician's choice of blood work? A) BNP is released as a compensatory mechanism during heart failure, and measuring it can help differentiate the client's dyspnea from a respiratory pathology. B) BNP is an indirect indicator of the effectiveness of the renin-angiotensin-aldosterone (RAA) system in compensating for heart failure. C) BNP levels correlate with the client's risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia. D) BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects. - ANSWER-A A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure? A) Antihypertensive, diuretic, antiplatelet aggregator B) Diuretic, ACE inhibitor, beta-blocker C) Anticoagulant, antihypertensive, calcium supplement D) Beta-blocker, potassium supplement, anticoagulant - ANSWER-B Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place? A) The man's - and -adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate. B) Hemolysis and blood pooling are taking place in the man's peripheral circulation. C) Bronchoconstriction and hyperventilation are initiated as a compensatory mechanism. D) Intracellular potassium and extracellular sodium levels are rising as a result of sodium-potassium pump failure - ANSWER-A Following coronary bypass graft (CABG) surgery for a massive myocardial infarction (MI) located on his left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which of the following assessment findings would confirm that the client may be in the early stages of cardiogenic shock? Select all that apply. A) Decreasing mean arterial pressure (MAP) B) Low BP reading of 86/60 C) Urine output of 15 mL last hour D) Low pulmonary capillary wedge pressure (PCWP) E) Periods of confusion - ANSWER-A B C E A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man? A) Resolution of compensatory pulmonary edema and heart arrhythmias B) Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility C) Infusion of normal saline or Ringer lactate to maintain the vascular space D) Administration of oxygen and epinephrine to promote perfusion - ANSWER-C A 30-year-old woman presents at a hospital after fainting at a memorial service, and she is diagnosed as being in neurogenic shock. Which of the following signs and symptoms is she most likely to display? A) Faster than normal heart rate B) Pain C) Dry and warm skin D) Increased thirst - ANSWER-C All of the following interventions are ordered stat. for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first? A) Epinephrine (Adrenalin) B) Normal saline infusion C) Dexamethasone (Decadron) D) Diphenhydramine (Benadryl) - ANSWER-A A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis? A) Hypovolemic shock B) Septic shock C) Neurogenic shock D) Obstructive shock - ANSWER-B A client has many residual health problems related to compromised circulation following recovery from septic shock. The nurse knows that which of the following complications listed below are a result of being diagnosed with septic shock and therefore should be assessed frequently? Select all that apply. A) Profound dyspnea due to acute respiratory distress syndrome B) Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces C) Formation of plaque within vessels supplying blood to the heart causing muscle damage and chest pain D) Acute renal failure due to decreased/impaired renal perfusion as a result of low BP E) Flushed skin and pounding headache that coincides with each heart beat - ANSWER-A B D A 3-year-old child with right-sided heart failure has been admitted for worsening of his condition. Which of the following assessments would be considered one of the earliest signs of systemic venous congestion in this toddler? A) Breathlessness with activity B) Excessive crying C) Enlargement of the liver D) Increased urine output - ANSWER-C A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which of the physician's following statements best captures an aspect of these differences? A) "You'll find that in pediatric patients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles." B) "Because of their higher relative blood volume, jugular venous distention is a better assessment technique for suspected heart failure in young patients." C) "Signs and symptoms in children may sometimes mimic those of shock, with a low blood pressure and high heart rate." D) "Fever is a sign of heart failure in children that you are unlikely to see in older adults." - ANSWER-A Which of the following changes associated with aging contributes to heart failure development in older adults? Select all that apply. A) Increased incidence of mitral stenosis B) Sludge buildup in the kidneys C) Elevated diastolic BP D) Increased vascular stiffness E) Inflammation in the joints due to arthritis - ANSWER-C D Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long-term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points is most accurate? A) "Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure." B) "Heart failure will often first show up with persistent coughing and lung crackles." C) "Residents in early heart failure will often be flushed and have warm skin and a fever." D) "Complaints of chest pain are actually more often related to heart failure than to myocardial infarction." - ANSWER-A A physician has ordered the measurement of a cardiac patient's electrolyte levels as part of the client's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart? A) Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation. B) Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells. C) The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions. D) The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential. - ANSWER-B Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node? A) A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in, resulting in resting membrane potential. B) The cells are capable of responding to a greater than normal stimulus before the resting membrane potential is reached. C) The fast sodium channels in the cellular membranes close, causing an abrupt decrease in intracellular positivity. D) Potassium permeability is allowing the cell membrane to remain depolarized, and Ca2+ channel opens moving Ca2+ back into the cell. - ANSWER-A An ECG technician is placing leads on a patient who has presented to the emergency department with a sudden onset of chest pain. The technician would recognize which of the following facts about the placement of leads and the achievement of a clinically accurate ECG? A) The electrical potential recorded by a lead on an extremity will vary significantly depending on where the lead is placed on the extremity. B) The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane. C) Limb leads measure the electrical activity of the heart indirectly through the activity of adjacent skeletal muscle. D) A total of 12 chest leads are necessary to attain the most accurate ECG. - ANSWER-B The cardiologist just informed a patient that he has a reentry circuit in the electrical conduction system in his heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to him. Which of the following statements most accurately describes what is happening? A) "This means that the SA node (which is the beginning of your heart's electrical system) has been damaged and is no longer functioning normal." B) "You must have a large clot in one of your arteries that supply oxygenated blood to the special conduction cells in your heart." C) "There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast." D) "For some reason, your electrical system is not on full charge, so they will have to put in new leads and a pacemaker to make it work better." - ANSWER-C A 68-year-old male complains to his family physician that when he tests his blood pressure using a machine at his pharmacy, his heart rate is nearly always very low. At other times, he feels that his heart is racing, and it also seems to pause at times. The man has also had occasionally light-headedness and a recent syncopal episode. What is this client's most likely diagnosis and the phenomenon underlying it? A) Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias B) Ventricular arrhythmia as a result of alternating vagal and sympathetic stimulation C) Torsade de pointes as a result of disease of the bundle of His D) Premature atrial contractions that vacillate between tachycardic and bradycardic episodes as a consequence of an infectious process - ANSWER-A A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was "so fast I couldn't even count it." The child was determined to be in atrial flutter, and his mother is seeking an explanation from the health care team. Which of the following points should underlie an explanation to the mother? A) The child is experiencing a reentry rhythm in his right atrium. B) The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions. C) The child is likely to have a normal ECG apart from the rapid heart rate. D) The boy's atria are experiencing abnormal sympathetic stimulation. - ANSWER-A A nurse educator is teaching a group of nurses at a long-term care facility about atrial fibrillation in light of its prevalence in older adults. Which of the following statements by the nurses would the educator most want to correct? A) "The electrical impulses go in chaotic directions, and so the atria can't contract properly." B) "An ECG of someone in atrial fibrillation would be almost random in appearance." C) "The contraction of the ventricles and the atria can range from 400 to 600 beats/minute." D) "It can be hard to measure at the bedside because not all ventricular beats make a palpable pulse." - ANSWER-C A medical student is working with a 61-year-old male client in the hospital who has presented with a new onset of atrial fibrillation. Which of the following courses of treatment will the student most likely expect the attending physician to initiate? A) Immediate cardioversion followed by surgery to correct the atrial defect B) Anticoagulants and beta-blockers to control rate C) Antihypertensives and constant cardiac monitoring in a high acuity unit D) Diuretics, total bed rest, and cardioversion if necessary - ANSWER-B A 63-year-old male client has been diagnosed with a bundle branch block. How will this client's care team most likely expect his condition to be expressed diagnostically? A) His AV node will be performing the primary pacemaker role due to inadequacy of the SA node. B) His ECG will show a flattened P wave as a result of impaired atrial depolarization. C) Conduction from the Purkinje fibers to the bundle branches is compromised by inadequate conduction. D) His ECG will show an inordinately wide QRS complex because impulses are bypassing the normal conduction tissue. - ANSWER-D Which of the following patients should the nurse be assessing for long QT syndrome? A) A 95-year-old patient with Alzheimer's who is having periods of apnea B) A 32-year-old male admitted for cocaine overdose with long history of illicit drug abuse C) A 56-year-old female admitted for total hysterectomy due to excessive bleeding and clotting D) A 68-year-old male who was in a car accident with sternal bruising and fractured femur - ANSWER-B A number of patients in an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention? A) A 46-year-old man whose cardiac telemetry shows him to be in ventricular tachycardia B) A 69-year-old woman who has entered ventricular fibrillation C) A 60-year-old man with premature ventricular contractions (PVC) and a history of atrial fibrillation D) A 60-year-old woman who has just been diagnosed with a first-degree AV block - ANSWERB A 71-year-old man is slated for pacemaker insertion for treatment of a third-degree AV block. The man's nurse has been educating him about his diagnosis and treatment and answering the numerous questions he has about his health problem. Which of the following teaching points should the nurse include in this patient teaching? A) "This is almost certainly a condition that you were actually born with, but that is just now becoming a serious problem." B) "Because the normal electrical communication in lacking, the bottom parts of your heart are beating especially fast to compensate for inefficiency." C) "The root problem is that the top chambers of your heart and the bottom chambers of your heart aren't coordinating to pump blood efficiently." D) "If left untreated, this would have put you at great risk of stroke or heart attack." - ANSWERC A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiologist by her family physician. As part of the client's diagnostic workup, the cardiologist has ordered her to wear a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring? A) A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity. B) The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies. C) Accurate interpretation of the results requires correlating the findings with activity that the woman was doing at the time of recording. D) Holter monitors are normally set to record electrical activity of the heart at least once per hour. - ANSWER-C A 31-year-old woman with a congenital heart defect reports episodes of light-headedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion? A) Signal-averaged ECG B) Exercise stress testing C) Electrophysiologic study D) Holter monitoring - ANSWER-D Following electrophysiological testing that included ablation therapy, the nurse should be assessing the patient for which complication that may occur postprocedure? A) Complaints of nausea and spitting up bile-looking secretions along with stomach cramps B) Sudden onset of dysonea, tachypnea, and chest pain of a "pleuritic" nature (worsened by breathing) C) Bleeding from the nose that requires packing, excessive swallowing of mucus, and coughing D) Complaints of heart palpitations, frequent PVCs noted on monitor, and substernal chest pain - ANSWER-B A nurse who provides care in a geriatric subacute medicine unit of a hospital has noted that a large number of patients receive -adrenergic blocking medications such as metoprolol. Which of the following statements best conveys an aspect of the use of beta-blockers? A) They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential. B) They inhibit the potassium current and repolarization, extending the action potential and refractoriness. C) They counteract arrhythmias and tachycardias by increasing vagal stimulation. D) They decrease myocardial oxygen demand by blocking the release of intracellular calcium ions. - ANSWER-A A patient, who is experiencing some angina associated with atrial tachycardia, has been placed on verapamil (Calan), a calcium channel blocker. Knowing that this medication blocks the slow calcium channels, thereby depressing phase 4 and lengthening phases 1 and 2 action potential, the nurse should assess this patient for which of the following adverse reactions? A) Bradycardia B) Ventricular tachycardia C) Sudden cardiac death D) Increased cardiac output - ANSWER-A A 70-year-old woman with ongoing severe atrial fibrillation is scheduled for defibrillation. What is an aspect of the rationale and physiology of defibrillation treatment? A) Interruption of disorganized impulses by the current allows the AV node to readopt its normal pacemaker role. B) Defibrillation can be achieved using either a transcutaneous or transvenous pacemaker. C) Defibrillation must be coincided with the R wave of the ECG in order to be successful. D) The goal is to depolarize the entire heart during the passage of current. - ANSWER-D A patient with a new automatic implantable cardioverter-defibrillator (AICD) asks the nurse what happens if he goes into that deadly heart rhythm again. The nurse will base her response knowing that the AICD will A) periodically fire just to test for lead placement and battery life. B) respond to ventricular tachyarrhythmia by delivering a shock within 10 to 20 seconds of its onset. C) use radiofrequency energy to deliver an electrical shock through the site where the lethal rhythm originates. D) remove scar tissue and aneurysm during placement of electrodes and then will shock if paradoxical ventricular movement is located. - ANSWER-B Assuming that they have not responded to drug therapy, which of the following clients is likely to be the best candidate for surgical cardiac ablation? A) A 62-year-old woman with peripheral vascular disease who has experienced multiple episodes of torsade des pointes B) A 75-year-old man with diabetes but no previous heart disease that suddenly develops syncope due to sick sinus syndrome C) A 46-year-old man with unstable angina and a history of myocardial infarction who is found to have long QT syndrome and episodes of frequent ventricular arrhythmias D) A 22-year-old woman with an atrial septal defect who has recurrent paroxysmal atrial flutter with rapid ventricular rate associated with her caffeine intake. - ANSWER-C As a result of dehydration, a client's epithelial cells are producing insufficient amounts of mucus. Consequently, the client's mucociliary blanket is compromised. Which of the following changes would the care provider anticipate as a direct result of this change? A) Impaired function of the client's cilia B) Decreased levels of oxygen saturation C) Increased amounts of bacteria in the lungs D) Increased carbon dioxide levels - ANSWER-C A 21-year-old male client has suffered a head injury during a crash on his motorcycle, and a deficit that assessments have revealed is an impaired swallowing mechanism. He has also developed aspiration pneumonia. Which of the following statements most accurately captures an aspect of his condition? A) His vocal folds are likely not performing their normal function. B) His epiglottis is covering his larynx. C) His vocal folds have been compromised. D) His tracheobronchial tree is intermittently obstructed. - ANSWER-A A male, lifetime smoker has died because of chronic obstructive pulmonary disease. Which of the following phenomena regarding his alveoli would his care team expect in the weeks prior to his death? A) Proliferation of natural killer (NK) cells in the alveolar lumen B) Large numbers of alveolar macrophages in septal connective tissue C) The presence of tubercles in the interalveolar spaces D) Compensatory regeneration of type I alveolar cells - ANSWER-B Reviewing pathology for an exam on pulmonary vasculature, the nursing student states that blood enters the right side of the heart via the vena cavae, then to the right atrium, right ventricle, and then which vessel carries the deoxygenated blood into the pulmonary system? A) Pulmonary capillaries B) Pulmonary artery C) Pulmonary vein D) Ductus arteriosus - ANSWER-B The nurse is hearing diminished breath sounds and a "grating" sound during respirations. This is consistent with excess collection of fluid in the pleural cavity. The medical term for this is A) pleurisy. B) pleural effusion. C) pneumothorax. D) poor lung compliance. - ANSWER-B Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation? A) Intrapleural pressure slightly exceeds that of the inflated lung. B) The chest wall exerts positive pressure on the lungs that contributes to expiration. C) The lungs are prevented from collapsing by constant positive intrapulmonary pressure. D) Negative intrapleural pressure holds the lungs against the chest wall. - ANSWER-D The emergency department is awaiting the arrival of a spinal cord-injured patient. Knowing the innervation of the diaphragm, a patient with which type of injury may be in need of immediate mechanical ventilation? Injury to the A) C4 area. B) C7 area. C) T1 area. D) T4 area. - ANSWER-A A client who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. Upon assessment of the lungs, what clinical manifestations should the nurse expect? A) Rapid, deep breaths B) Wheezing throughout lung fields C) Short, shallow breaths D) Pursed-lip breaths with slow, steady breaths - ANSWER-C A female patient is requiring supplementary oxygen by face mask due to her reduced lung compliance. Which of the following pathophysiological processes is most likely a contributor to her low lung compliance? A) The woman's lungs have more recoil than a healthy person's. B) Her type II alveolar cells are producing a slight excess of surfactant. C) Turbulent airflow is taking place in the patient's large airways. D) Her thoracic cage is less flexible than when she was healthy. - ANSWER-D While working in the newborn ICU, the nurses receive a call that an infant, gestational age of 23 weeks, is being air flighted to the level 3 trauma nursery. The priority intervention for this infant would be A) insertion of an umbilical line for fluids. B) intubation and mechanical ventilation. C) insertion of a feeding tube. D) insertion of an intraventricular catheter. - ANSWER-B A 60-year-old male hospital patient with a diagnosis of chronic obstructive pulmonary disease (COPD) is undergoing lung function tests to gauge the progression of his disease. Which of the following aspects of the lung volumes will the respiratory therapist be most justified in using to guide interpretation of the test results? A) Vital capacity will equal the patient's combined inspiratory reserve, expiratory reserve, and tidal volume. B) Vital capacity will equal the total lung capacity. C) Resting tidal volume will exceed that of tidal volume during activity. D) Expiratory reserve will equal residual lung volume - ANSWER-A A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her diagnosis of emphysema. Which of the following pathological processes occur as a result of her emphysema? Select all that apply. A) Decreased elastic recoil due to alveolar damage B) Decreased residual lung volume due to impaired alveolar ventilation C) Increased anatomical dead space due to reduced tidal volume D) Increased alveolar dead space due to incorrect intrapleural pressure - ANSWER-A C D The physician mentions the patient has developed alveolar dead space. The nurse recognizes that this means A) air that is moved in and out of the lungs with each breath. B) air that cannot participate in gas exchange and remains in the main bronchus. C) air is trapped in the conducting airways. D) alveoli are ventilated but not perfused. - ANSWER-D Due to complications, a male postoperative patient has been unable to mobilize secretions for several days following surgery and develops atelectasis. Which of the following processes would his care team anticipate with relation to his health problem? A) Vasodilation in the alveolar vessels in the affected region of his lung B) Increased workload for the left side of the patient's heart C) Increased blood flow to the area of atelectasis D) Directing blood flow away from the lung regions that are hypoxic - ANSWER-D A 44-year-old woman has developed calf pain during a transatlantic flight. She is extremely short of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE) that resolved with anticoagulant therapy. Which of these statements best characterizes the underlying problem of her PE? A) Ventilation was occurring, but perfusion was inadequate causing shortness of breath. B) The combination of normal perfusion but compromised ventilation caused hypoxia. C) She developed a transient anatomic shunt resulting in impaired oxygenation. D) Impaired gas diffusion across alveolar membranes resulted in dyspnea and hypoxia. - ANSWER-A Following a winter power outage, a client who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning? A) To increase the amount of oxygen carried in the dissolved state B) To increase the production of unbound hemoglobin C) To stimulate the release of oxygen at the capillaries D) To remove bound CO from hemoglobin - ANSWER-A Which of the following situations is most likely to result in an increased binding affinity of hemoglobin for oxygen? A) A client is in respiratory acidosis, with a low pH. B) Three of four binding sites on a client's hemoglobin molecule are occupied by oxygen. C) A client's body temperature is elevated as a result of an infectious process. D) An increase in 2,3-diphosphoglycerate enhances the loading of oxygen. - ANSWER-B A nurse in a respiratory unit of a hospital is providing care for a client with end-stage lung disease. Consequently, measurement of the client's arterial blood gases indicates increased PCO2. Which of the following associated consequences would the nurse anticipate? A) A shift to the left of the oxygen-hemoglobin dissociation curve B) Lower than normal production of HCO3 C) Higher than normal production of H+ D) An absence of carbaminohemoglobin - ANSWER-C Which of the following neurological patients is most likely to have abnormalities in breathing regulation? A) A 23-year-old male who has an injury to his frontal lobe following a sports injury B) A 45-year-old female with a spinal cord injury at C7 following a motor vehicle accident C) A 34-year-old male with damage to his upper and lower pons following a blow to the back of the head D) A 66-year-old male with temporal lobe infarcts secondary to a stroke - ANSWER-C A nurse in an acute medical unit is providing care for a number of patients with a variety of diagnoses. Which of the following patients most likely exhibits risk factors for impaired coughing? A patient with A) an injury to her cerebellum. B) a nasogastric (NG) tube attached to suction. C) a diagnosis of viral pneumonia. D) diagnosis of diabetes mellitus and morbid obese. - ANSWER-B As part of a public health initiative, a nurse is teaching a group of older adults about ways to promote and maintain their health. Recognizing that the common cold is a frequent source of ailment, the nurse is addressing this health problem. Which of the following teaching points about the common cold is most accurate? A) "You shouldn't be taking antibiotics for a cold until your doctor has confirmed exactly which bug is causing your cold." B) "It's important to both cover your mouth when you cough or sneeze and encourage others to do so, since most colds are spread by inhaling the germs." C) "Scientists don't yet know exactly what virus causes the cold, and there is not likely to be a vaccine until this is known." D) "Use caution when choosing over-the-counter drugs for your cold; most people do best with rest and antifever medications." - ANSWER-D Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold? A) A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F B) A woman presenting with malaise, lethargy, and copious nasal secretions C) A man with a dry, stuffy nasopharynx, a sore throat, and temperature of 98.9°F D) A woman complaining of generalized aches and who has a hoarse voice and reddened, painful upper airways - ANSWER-A A child with rhinosinusitis should be monitored for complications. Which of the following assessment findings would alert the nurse that a complication is developing? A) Purulent nasal discharge B) Temperature of 100.8°F C) Periorbital edema D) Complaints of headache - ANSWER-C A family physician is performing patient teaching about the influenza virus with each patient who has come to the clinic to receive that year's vaccine. Which of the following statements by the patient best reflects an accurate understanding of the flu virus? A) "I could come down with viral or bacterial pneumonia as a result of a bad flu bug." B) "I know my vaccination is especially important since there aren't any drugs that can treat the flu once I get sick with it." C) "The emphasis on bundling up, staying warm, and drinking lots of fluids is outdated and actually ineffective." D) "Like all vaccines, it is ideal if everyone in a population gets immunized against the flu." - ANSWER-A A pneumonia that occurs 48 hours or more after admission to the hospital is considered A) community-acquired pneumonia. B) hospital-acquired pneumonia. C) viral pneumonia. D) immunocompromised pneumonia. - ANSWER-B A nurse is providing care for an older, previously healthy adult male who has been diagnosed today with pneumococcal pneumonia. Which of the following signs and symptoms is the nurse most likely to encounter? A) The man will be hypotensive and febrile and may manifest cognitive changes. B) The patient will have a cough producing clear sputum, and he will have faint breath sounds and fine crackles. C) The patient will have copious bloody sputum and diffuse chest pain and may lose his cough reflex. D) The patient will lack lung consolidation and will have little, if any, sputum production. - ANSWER-B A client with a newborn infant is also the caregiver for her 75-year-old mother, who lives with them and who has diabetes. The client requests pneumonia vaccinations for her entire household. Which vaccine is most likely to be effective for the baby? A) Since the baby's immune system is mature at birth, regular vaccine is appropriate. B) There is no effective vaccine for newborn infants. C) The 23-valent vaccine will be effective. D) No vaccine is necessary for the baby if the nursing mother is immunized - ANSWER-B A 66-year-old male presents to the emergency room accompanied by his wife who claims that he has been acting confused. The man is complaining of a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F, and his blood work indicates his sodium level at 126 mEq/L (normal 135 to 145 mEq/L). Based on this assessment, the nurse suspects the patient has A) bronchopneumonia. B) Mycoplasma pneumonia. C) Legionella pneumonia. D) pneumococcal pneumonia. - ANSWER-C A health educator is performing a health promotion workshop with the staff of a large, urban homeless shelter, and a component of the teaching centers around tuberculosis. One of the staff members comments, "Anyone who's had contact with tuberculosis in the past can give it to any of the other residents of the shelter, even if they didn't get sick themselves." How could the educator best respond to this comment? A) "Many people do manage to fight off the infection, but you're right: they can still spread it by coughing or sneezing." B) "If someone has been previously exposed to tuberculosis, they are particularly infectious because they are often unaware of the disease." C) "Actually, people who have the latent form of the disease won't be sick and can't spread it either." D) "There isn't any real risk of them spreading it, but we would like to vaccinate everyone who's had any contact with it in the past." - ANSWER-C When educating a student who lives in a crowded apartment and diagnosed with tuberculosis, the college school nurse will emphasize, A) "Once your fever goes away, you can stop taking the streptomycin injection." B) "If isoniazid makes you nauseous, we can substitute something milder." C) "To destroy this bacterium, you must strictly adhere to a long-term drug regimen." D) "You will have to wear an N95 mask while on campus at all times." - ANSWER-C Around 3 weeks after razing an old chicken house, a 71-year-old retired farmer has developed a fever, nausea, and vomiting. After ruling out more common health problems, his care provider eventually made a diagnosis of histoplasmosis. Which of the following processes is most likely taking place? A) Toxin production by Histoplasma capsulatum is triggering an immune response. B) Antibody production against the offending fungi is delayed by the patient's age and the virulence of the organism. C) Spore inhalation initiates an autoimmune response that produces the associated symptoms. D) Macrophages are able to remove the offending fungi from the bloodstream but can't destroy them. - ANSWER-D A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung cancer (SCLC). How can her physician most appropriately respond to her? A) "I'm sure this is very hard news to hear, but be aware that with aggressive treatment, your chances of beating this are quite good." B) "This is very difficult to hear, I'm sure, and we have to observe to see if it spreads because that often happens." C) "I'm very sorry to have to give you this news; I'd like to talk to you about surgical options, however." D) "This is a difficult diagnosis to receive, but there is a chance that the cancer may go into remission." - ANSWER-B A patient with small cell lung cancer (SCLC) has developed a paraneoplastic syndrome called Cushing syndrome. Based on this new complication, the nurse will likely assess which of the following clinical manifestations of Cushing syndrome? A) Weight gain, moon face, buffalo hump, and purple striae on the abdomen B) Bilateral edema in the arms, swollen face, and protruding eyes C) Severe bone/joint pain, nausea/vomiting, and polyuria D) Tetany, new-onset seizure activity, emotional lability, and extrapyramidal symptoms - ANSWER-A A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercle scarring site, located in a peripheral area of his bronchiolar tissue. What is this client's most likely diagnosis? A) Squamous cell carcinoma B) Small cell lung cancer C) Large cell carcinoma D) Adenocarcinoma - ANSWER-D The neonatal ICU nurse is aware that type II alveolar cells produce surfactant, and they usually develop at how many weeks of gestation? A) 17 to 18 weeks B) 19 to 20 weeks C) 24 to 28 weeks D) 34 to 38 weeks - ANSWER-C Which of the following phenomena is most likely occurring during a child's alveolar stage of lung development? A) Terminal alveolar sacs are developing, and surfactant production is beginning. B) A single capillary network exists, and the lungs are capable of respiration. C) The conducting airways are formed, but respiration is not yet possible. D) Primitive alveoli are formed, and the bronchi and bronchioles become much larger. - ANSWER-B Which of the following situations would be most deserving of a pediatrician's attention? A) The mother of an infant 2 days postpartum notes that her baby has intermittent periods of hyperventilation followed by slow respirations or even brief periods of apnea. B) A volunteer in the nursery notes that one of the infants, aged 2 weeks, appears unable to breathe through his mouth, even when his nose is congested. C) A neonate is visibly flaring her nostrils on inspiration. D) A midwife notes that a newborn infant's chest is retracting on inspiration and that the child is grunting. - ANSWER-D A premature infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD) and is showing signs and symptoms of hypoxemia, low lung compliance, and respiratory distress. Which of the following is the most likely contributor to the infant's present health problem? A) High-inspired oxygen concentration and injury from positive-pressure ventilation B) Failure to administer corticosteroids to the infant in utero C) Insufficient surfactant production and insufficient surfactant therapy D) Insufficient supplemental oxygen therapy - ANSWER-A A 3-year-old boy has developed croup following a winter cold. His care provider would recognize that which of the following microorganisms and treatments is most likely to be effective? A) Respiratory syncytial virus treated with intubation B) Parainfluenza virus treated with a mist tent and oxygen therapy C) Haemophilus influenza treated with appropriate antibiotics D) Staphylococcus aureus treated with bronchodilators and mist tent - ANSWER-B The nurse caring for a male child with respiratory problems is concerned he may be developing respiratory failure. Upon assessment, the nurse knows that which of the following are clinical manifestations of respiratory failure? Select all that apply. A) Severe accessory muscle retractions B) Nasal flaring C) Grunting on expiration D) Inspiratory wheezes heard E) Swollen glottis - ANSWER-A B C New parents were just told by their physician that their son is two standard deviations above the mean. The parents later asked the nurse what that means. The nurse will explain by stating, A) "If your child is one standard deviation from the norm that translates to mean, he will be taller than 50% of his peers." B) "This is great news since it means you will have a larger baby than most." C) "Being two standard deviations above the mean translates into that your child will likely be taller than 95% of children in the population." D) "With the mean being average at 50%, two standard deviations means that your child will be at least 99.7% taller than his brother." - ANSWER-C A woman has recently determined that she is pregnant, and her clinician believes that the conception occurred around 8 weeks prior. Since the embryo is in the third stage of embryonic development, which of the following events and processes in growth and development would be expected to be taking place? A) Transition from a morula to a blastocyst B) Ossification of the skeleton and acceleration of body length growth C) Rapid eye movement and early support of respiration D) Formation of upper limbs and opening of the eyes - ANSWER-D A midwife who is providing care for a woman during her first pregnancy is assessing for intrauterine growth retardation (IUGR) during an early prenatal checkup. Which of the following questions best addresses the risks for IUGR? A) "What does your typical diet look like over the course of a day?" B) "What is the highest level of education that you've finished?" C) "Are there many people in your life that you can count on for help and support?" D) "How would you describe your mood since you've been pregnant?" - ANSWER-A Which of the following assessment findings of a male infant 14 hours postpartum would be considered abnormal and would require further assessment and possible intervention? A) The baby's first stool appears to contain blood. B) The child is unable to breathe through his mouth. C) The baby's skin has a yellowish orange hue. D) The child's suck is weak when placed at his mother's breast. - ANSWER-C A nurse is performing a 5-minute Apgar score on a newborn female. Which of the following characteristics of the infant's current condition would not be reflected in the child's Apgar score? A) The baby's heart rate is 122 beats/minute. B) The infant displays a startle reflex when the crib is accidentally kicked. C) The child's temperature is 35.0°C (95°F) by axilla. D) The infant's skin is pink in color. - ANSWER-C The nursery has just admitted a new infant born 1 hour ago. While performing an assessment, the nurse suspects the infant may have hypoglycemia based on which of the following assessment data? Select all that apply. A) Heel stick glucose value of 50 mg/dL B) Infant having periods of apnea requiring physical stimulation C) Muscle twitching noted while lying in crib undisturbed by nurses D) Hyperactive reflexes noted especially when crying E) Poor suck reflex resulting in an inability to feed properly - ANSWER-B C E The first-time parents of an infant girl 2 days postpartum are distressed at the jaundiced appearance of her skin and are eager for both an explanation and treatment for the problem. Which of the following responses by their physician is most accurate? A) "Your daughter's young liver is unable to get rid of the waste products from old red blood cells." B) "Because your daughter's kidneys are so small, they have a hard time getting rid of the wastes that are always accumulating in her blood." C) "Nearly half of all infants have this problem, and while it is distressing to look at, it is largely harmless and will resolve in time." D) "This is a sign that your baby needs more milk than she is currently getting, and increased breast-feeding will act to flush these pigments out of her system." - ANSWER-A Which of the following infants most likely requires medical intervention? A) A 2-day-old baby boy who has caput succedaneum B) An infant 4 hours postpartum who has visible coning of his head following vaginal delivery C) A girl 3 days postpartum with noticeable unilateral cephalhematoma D) A male infant whose vertex delivery resulted in a brachial plexus injury - ANSWER-D A nurse who works in a neonatal intensive care unit is providing care for an infant born at 26 weeks' gestation. Which of the following assessments would lead the nurse to suspect that the infant has developed respiratory distress syndrome (RDS)? A) The infant's blood pressure and temperature are normal measurements as expected. B) Infant is grunting and has notable intercostal retractions with respirations. C) Infant has poor motor skills and limited limb range of motion. D) Infant has apnea lasting 5 to 10 seconds with a decrease in heart rate, which reverses with tactile stimulation. - ANSWER-B While assessing a premature infant born at 25 weeks' gestation, the neonatal intensive care unit (NICU) nurse would suspect which diagnosis when the infant displays poor muscle tone, apnea, and a new onset of somnolence? A) Hydrocephalus B) Airway obstruction C) Intraventricular hemorrhage D) Sepsis - ANSWER-C A premature infant who is receiving care in a neonatal intensive care unit (NICU) has just been identified as having necrotizing enterocolitis (NEC). Of the following clinical manifestations, identify those most likely to contribute to the diagnosis of NEC. Select all that apply. A) Feeding intolerance B) Inability to pass stool within the first 10 days of life C) Hard, taut abdomen with increasing distention D) Blood noted in stools E) Hypoactive bowel sounds on right lower quadrant - ANSWER-A C D The neonatologist suspects an infant has developed sepsis with multiorgan system illness. The nurse caring for this infant will note which of the assessment findings support this diagnosis. Select all that apply. A) Decreasing BP with increase in heart rate indicative of shock B) Prolonged PT and PTT and decrease in platelet count C) Frequent voiding of a small amount of light-colored urine D) Bilateral warm feet but pedal pulses hard to palpate E) Positive Moro reflex when loud noise made at crib side - ANSWER-A B The exasperated parents of a 4-month-old infant with colic have asked their health care provider what they can do to alleviate their child's persistent crying. Based on their concerns, the nurse should educate/discuss with the parents which of the following? A) Encouraging them to walk away from the infant when they can no longer tolerate it B) Recommending them to reduce the amount of commercial formula and increase breast-feeding C) Discussing the use of prescribed antiflatulent medication that will help more than changing the formula D) Demonstrating how to use a soothing voice and slow rocking back and forth as a way to calm the infant - ANSWER-D During a prenatal education class, a participant has related a story about how her friend's infant died of sudden infant death syndrome (SIDS). What can the educator tell the group about how they can prevent SIDS when they have their babies? Select all that apply. A) "The best sleeping position for your baby is on his back." B) "Children are at particular risk of SIDS when they have a cold or flu, so these times require extra vigilance." C) "Using drugs during pregnancy has been shown to be associated with SIDS after birth, which is one more reason for mothers to avoid them." D) "It's important if anyone in your home smokes to make sure they only do it outside." E) "The exact cause of SIDS still isn't known, so there's little that you can do to prevent this tragic event." - ANSWER-A C D Due to rapid neural growth, a child can begin to control the bowel and bladder sphincters by what age? A) 12 months B) 18 months C) 2 years D) 4 years - ANSWER-C What topic should health promotion initiatives emphasize if the target audience is parents of preschoolers and the goal is to minimize mortality? A) Handwashing as an infection control measure B) Injury prevention especially when the child is near water C) Identifying signs of child abuse and neglect D) The importance of good nutrition - ANSWER-B In the grocery store, a nurse overhears a teenage mother intentionally shaming and verbally reprimanding a child in public. The mother also grabbed the child's stuffed animal and tore the limbs off. From what the nurse remembers about abuse, this would be classified as a form of A) physical abuse. B) emotional abuse. C) sexual abuse. D) neglect. - ANSWER-B A 10-year-old boy has a body mass index that places him in the 96th percentile for his age and gender. While educating the parents about obesity, the nurse should emphasize that his weight may predispose him to the development of A) scoliosis. B) respiratory infections. C) gastrointestinal disorders. D) type 2 diabetes. - ANSWER-D A 14-year-old boy has experienced a pronounced growth spurt over the last several months. While discussing this with his parents, the nurse educates what normal male growth patterns contain. Of the following, which are accurate statements to relay to the parents? Select all that apply. A) Most males will complete their growth spurt by age 16. B) It is not usual for their son to gain up to 30 kg in weight. C) With parathyroid hormone involvement, your son may be at risk for fractures. D) Expect the thorax to become broader and for the pelvis to remain narrow. E) Some children have stunted growth in their arms or legs. - ANSWER-B D Which of the following statements made by parents of high schoolers would be a cause for the concern the child may be thinking about suicide? A) "My child seems to eat all the time. He tells me that all of his friends are eating a lot as well." B) "My child seems to go shopping at the mall every day after school with her friends. I think they hang out at the mall." C) "My child has never had problems in school until now. He is failing classes and getting in trouble." D) "My child used to talk to me about anything. Now she spends most of her time in her room texting friends." - ANSWER-C As a consequence of a long-standing lung disease, a client is in a chronic state of hypoxia. Which of the following phenomena would the client's care team be most justified in anticipating? Select all that apply. A) Metabolic alkalosis B) Increased erythropoietin production C) Pulmonary vasodilation D) Hyperventilation E) Personality changes - ANSWER-B D E A patient who has been on a high-protein diet comes to the emergency department with respiratory symptoms. Upon analysis of arterial blood gases (ABGs), the patient is diagnosed with hypercapnia. The nurse will note the ABG results that confirm this diagnosis include: Select all that apply. A) pH 7.31 (normal 7.35 to 7.45). B) PO2 of 97%. C) PCO2 of 58 mm Hg (normal 38 to 42). D) Serum HCO3of -33 mEq/L (normal 22 to 28). E) Serum K+ (potassium)of 3.6 mmol/L (normal 3.5 to 5.0). - ANSWER-A C D A nurse is providing care for a patient who has been admitted with a newly diagnosed bilateral pleural effusion. Which of the following findings from the nurse's initial assessment of the patient is incongruent with the patient's diagnosis and would require further investigation? A) The client complains of sharp pain exacerbated by deep inspiration. B) The client's breath sounds are diminished on auscultation. C) Pulse oximetry indicates that the client is hypoxemic. D) The client complains of dyspnea and increased work of breathing. - ANSWER-A A patient arrives in the ED after an automobile accident. Which of the following clinical manifestations lead the nurse to suspect a pneumothorax? Select all that apply. A) Respiratory rate 34 B) Asymmetrical chest movements, especially on inspiration C) Diminished breath sounds over the painful chest area D) Pulse oximetry 98% E) ABG pH level of 7.38 - ANSWER-A B C A short, nonsmoking 44-year-old male presents to the emergency room with left-sided chest pain and a cough. He states that the pain started abruptly and worsens with deep breathing and coughing. He denies recent injury. Assessment includes shallow respirations with a rate of 36, normal breath sounds, and no cyanosis. Which condition is most likely causing his symptoms? A) Myocardial infarction B) Spontaneous pneumothorax C) Pleuritis related to infection D) Obstructive atelectasis - ANSWER-C A 51-year-old female client who is 2 days postoperative in a surgical unit of a hospital is at risk of developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse is most appropriate? A) "Being in bed increases the risk of fluid accumulating between your lungs and their lining, so it's important for you to change positions often." B) "You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed." C) "Make sure that you stay hydrated and walk as soon as possible to avoid us having to insert a chest tube." D) "I'll proscribe bronchodilator medications that will help open up your airways and allow more oxygen in." - ANSWER-B Which of the following statements best captures the etiology of the acute response phase of extrinsic (atopic) asthma? A) IgG production is heightened as a consequence of exposure to an allergen. B) Airway remodeling results in airflow limitations. C) Epithelial injury and edema occur along with changes in mucociliary function. D) Chemical mediators are released from presensitized mast cells. - ANSWER-D The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son's condition. Which of the following teaching points is most justifiable? A) "Research has shown that viruses may actually be a factor in many children's asthma." B) "The most reliable indicator that your child is having an asthma attack is audible wheezing." C) "Steroids that your child can inhale will likely be the first line of defense." D) "Your son will likely need to limit or avoid exercise and sports." - ANSWER-A In the early morning, an African American woman brings her 5-year-old son to the emergency room. The boy is wheezing, is short of breath, and has a dry cough. The mother states that he has always been very healthy. He went to bed with only a slight cold and a runny nose but woke her with his coughing shortly after 4 AM. His symptoms worsened so dramatically that she brought him to the hospital. The care team would most likely suspect that he has A) respiratory syncytial virus. B) influenza. C) asthma. D) pneumonia. - ANSWER-C Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)? A) A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration B) An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells C) An 81-year-old male who has a productive cough and recurrent respiratory infections D) An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke - ANSWER-C A COPD patient asks the nurse what medications are prescribed to help his breathing. The nurse, looking at the list of medications, will educate the patient about which of the following medications to help his COPD in the long term? Select all that apply. A) Salmeterol (Serevent), a bronchodilator B) Tiotropium (Spiriva), anticholinergic C) Alprazolam (Xanax), a benzodiazepine D) Sildenafil (Viagra), a vasodilator E) Ketorolac (Toradol), an NSAID - ANSWER-A B A nurse is providing care for a client who has been admitted to a medical unit with a diagnosis of bronchiectasis. Which of the following signs and symptoms should the nurse expect to find during physical assessment of the client and the review of the client's history? Select all that apply. A) Recurrent chest infections B) Production of purulent sputum C) A barrel chest D) Low hemoglobin levels E) Recent surgery - ANSWER-A B D A physician is providing care for a child who has a diagnosis of cystic fibrosis (CF). Place the following events in the etiology of CF in ascending chronological order. Use all the options. A) Airway obstruction B) Recurrent pulmonary infections C) Impaired Cl- transport D) Decreased water content of mucociliary blanket E) Increased Na+ absorption - ANSWER-C E D A B Which of the following clinical findings would be most closely associated with a client who has interstitial lung disease in comparison to chronic obstructive pulmonary disease (COPD)? A) Audible wheezing on expiration B) Reduced expiratory flow rates C) Decreased tidal volume D) Normal forced expiratory volume - ANSWER-C A patient is admitted for a relapse for sarcoidosis. Knowing this is usually caused by an inflammatory process, the nurse can anticipate administering A) a bronchodilator. B) a corticosteroid. C) aspirin. D) an albuterol inhaler - ANSWER-B Which of the following clients are displaying known risk factors for the development of pulmonary emboli? Select all that apply. A client who is: A) immobilized following orthopedic surgery. B) experiencing impaired Cl- and Na+ regulation. C) taking amiodarone for the treatment of premature ventricular contractions. D) a smoker and who takes oral contraceptives. E) undergoing radiation therapy for the treatment of breast cancer. - ANSWER-A D A patient with pulmonary hypertension may display which of the following clinical manifestations? Select all that apply. A) Shortness of breath B) Decreased exercise tolerance C) Nasal flaring D) Grunting on expiration E) Swelling (edema) of the legs and feet - ANSWER-A B E Upon admission to the ICU, a patient with a history of cor pulmonale will likely be exhibiting which of the following clinical manifestations of right heart failure? Select all that apply. A) Fine crackles throughout both lung fields B) +4 pitting edema in lower extremities C) Expectorating copious amounts of frothy, pink sputum D) Jugular vein distension E) Altered level of consciousness - ANSWER-B D E A 41-year-old male client has presented to the emergency department with an acute onset of increased respiratory rate and difficulty breathing. STAT chest x-ray indicates diffuse bilateral infiltrates of his lung tissue, and ECG displays no cardiac dysfunction. What is this client's most likely diagnosis? A) Cor pulmonale B) Acute lung injury C) Pulmonary hypertension D) Sarcoidosis - ANSWER-B While rock climbing, a 22-year-old male has endured a severe head injury. Which of the following statements best captures expected clinical manifestations and treatments for his immediate condition? A) Oxygen therapy is likely to decrease his respiratory drive and produce an increase in PCO2. B) Cheyne-Stokes breathing is likely but will respond to bronchodilators. C) The client is unlikely to respond to supplementary oxygen therapy due to impaired diffusion. D) Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation - ANSWER-D At an international nursing conference, many discussions and breakout sessions focused on the World Health Organization (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 elderly 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 elderly population diagnosed with diabetes mellitus under tight blood glucose control by providing in-home cooking classes D) Providing transportation for renal dialysis patients to and from their hemodialysis sessions E) Providing handwashing teaching sessions to a group of young children - ANSWER-A B C E 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 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 preventative health care benefits. D) The client lives in an affluent, clean, suburban community with access to many health care facilities. - ANSWER-B A physician is providing care for a number of patients on a medical unit of a large, university hospital. The physician is discussing with a colleague the differentiation between diseases that are caused by abnormal molecules and diseases that cause disease. Which of the following patients most clearly demonstrates the consequences of molecules that cause disease? A) A 31-year-old woman with sickle cell anemia who is receiving a transfusion of packed red blood cells B) A 91-year-old woman who has experienced an ischemic stroke resulting from familial hypercholesterolemia C) A 19-year-old man with exacerbation of his cystic fibrosis requiring oxygen therapy and chest physiotherapy D) A 30-year-old homeless man who has Pneumocystis carinii pneumonia (PCP) and is HIV positive. - ANSWER-D A member of the health care team is researching the etiology and pathogenesis of a number of clients who are under his care in a hospital context. Which of the following aspects of clients' situations best characterizes pathogenesis rather than etiology? A) A client who has been exposed to the Mycobacterium tuberculosis bacterium B) A client who has increasing serum ammonia levels due to liver cirrhosis C) A client who was admitted with the effects of methyl alcohol poisoning D) A client with multiple skeletal injuries secondary to a motor vehicle accident - ANSWER-B A new myocardial infarction patient requiring angioplasty and stent placement has arrived to his first cardiac rehabilitation appointment. In this first session, a review of the pathogenesis of coronary artery disease is addressed. Which statement by the patient verifies to the nurse that he has understood the nurse's teachings about coronary artery disease? A) "All I have to do is stop smoking, and then I won't have any more heart attacks." B) "My artery was clogged by fat, so I will need to stop eating fatty foods like French fries every day." C) "Sounds like this began because of inflammation inside my artery that made it easy to form fatty streaks, which lead to my clogged artery." D) "If I do not exercise regularly to get my heart rate up, blood pools in the veins causing a clot that stops blood flow to the muscle, and I will have a heart attack." - ANSWER-C A 77-year-old man is a hospital inpatient admitted for exacerbation of his chronic obstructive pulmonary disease (COPD), and a respiratory therapist (RT) is assessing the client for the first time. Which of the following aspects of the patient's current state of health would be best characterized as a symptom rather than a sign? A) The patient's oxygen saturation is 83% by pulse oxymetry. B) The patient notes that he has increased work of breathing when lying supine. C) The RT hears diminished breath sounds to the patient's lower lung fields bilaterally. D) The patient's respiratory rate is 31 breaths/minute. - ANSWER-B Which of the following situations would be classified as a complication of a disease or outcome from the treatment regimen? Select all that apply. A) Massive pulmonary emboli following diagnosis of new-onset atrial fibrillation B) Burning, intense incision pain following surgery to remove a portion of colon due to intestinal aganglionosis C) Development of pulmonary fibrosis following treatment with bleomycin, an antibiotic chemotherapy agent used in treatment of lymphoma D) Gradual deterioration in ability to walk unassisted for a patient diagnosed with Parkinson disease E) Loss of short-term memory in a patient diagnosed with Alzheimer disease - ANSWER-A C Laboratory testing is ordered for a male patient during a clinic visit for a routine follow-up assessment of hypertension. When interpreting lab values, the nurse knows that 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 The laboratory technologists are 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 patients who have confirmed cardiac etiologies test positive in the test. However, 1.3% of patients who do not have cardiac etiologies for their shortness of breath also test positive. Which of the following statements 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 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 of the following statements would best characterize a high positive predictive value but a 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 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 United States, he exhibited no symptoms and returned to his usual activities. During this period of no outward symptoms, the man 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 As of November 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 people with 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 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 of the following statements best conveys an accurate epidemiological 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 An epidemiologist is conducting a program of research aimed at identifying factors associated with incidence and prevalence of congenital cardiac defects in infants. The researcher has recruited a large number of mothers whose infants were born with cardiac defects as well as mothers whose infants were born with healthy hearts. The researcher is comparing the nutritional habits of all the mothers while their babies were in utero. Which of the following types of study is the epidemiologist most likely conducting? A) Cohort study B) Cross-sectional study C) Case-control study D) Risk factor study - ANSWER-C A nurse practitioner is working in a crowded neighborhood where the population is primarily immigrants from China. The nurse has designed a research study to follow children from kindergarten to the age of 25. She is going to be looking at their diet, successful progression in school, health practices, and development of disease, to name a few items. This type of research is known as A) cohort study. B) cross-sectional study. C) case-control study. D) epidemiological study. - ANSWER-A As part of a community class, student nurses are developing a class to teach expectant parents the importance of having their child properly secured in a child safety seat. During the class, the students are going to have a safety officer examine the car seats that the parents have installed in their vehicles. This is an example of which type of prevention? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Prognosis enhancement - ANSWER-A A multidisciplinary health care team operates a program aimed at the prevention, identification, and treatment of diabetes on a large Indian reservation. Which of the following aspects of the program would be most likely to be classified as secondary prevention? A) Regularly scheduled wound dressing changes for clients who have foot ulcers secondary to peripheral neuropathy and impaired wound healing B) Teaching school children how a nutritious, traditional diet can lessen their chances of developing adult-onset diabetes C) Staffing a booth where community residents who are attending a baseball tournament can have their blood glucose levels checked D) Administering oral antihyperglycemic medications to clients who have a diagnosis of diabetes - ANSWER-C An occupational therapist conducts a group therapy program called MindWorks with older adults who have diagnoses of dementia and Alzheimer 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 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 of the following statements 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 The neuroscience nursing unit has developed a set of step-by-step directions of what should occur if a nursing assessment reveals that the patient may be exhibiting clinical manifestations of a cerebrovascular accident (CVA). Which of the following statements 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 requires 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 During a period of extreme excess fluid volume, a renal dialysis patient may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell? A) 0.9% sodium chloride B) 5% dextrose and water C) 3% sodium chloride D) Lactated Ringer solution - ANSWER-C A 34-year-old male client has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The client's family is questioning the care team as to why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide the family? A) An inordinate amount of interstitial fluid is accumulating his abdomen. B) The transcellular component of the intracellular fluid compartment contains far more fluid than normal. C) Normally small transcellular fluid compartment, or third space, is becoming enlarged. D) Gravity-dependent plasma is accumulating in his peritoneal cavity. - ANSWER-C Which of the following individuals would be considered to be at risk for the development of edema? Select all that apply. A) An 81-year-old man with right-sided heart failure and hypothyroidism B) A 60-year-old obese female with a diagnosis of poorly controlled diabetes mellitus C) A 34-year-old industrial worker who has suffered extensive burns in a job-related accident D) A 77-year-old woman who has an active gastrointestinal bleed and consequent anemia E) A 22-year-old female with hypoalbuminemia secondary to malnutrition and anorexia nervosa - ANSWER-A C E Recognizing the prevalence and incidence of dehydration among older adults, a care aide at a long-term care facility is in the habit of encouraging residents to drink even though they may not feel thirsty at the time. Which of the following facts underlies the care aide's advice? A) Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high. B) The metabolic needs for both fluid and sodium in older adults differ from those of younger individuals. C) Regulation and maintenance of effective circulating volume by the kidneys is less effective in the elderly. D) The renin-angiotensin-aldosterone system (RAAS) is less able to facilitate sodium clearance in older adults. - ANSWER-A The nurse is providing teaching to a student nurse about how antidiuretic hormone (ADH) plays a central role in the reabsorption of water by the kidneys. The nursing student is correct to place the following components of the homeostatic action of ADH in the correct sequence. Use all the options. A) Stored ADH is released into circulation. B) ADH is transported along a neural pathway to the posterior pituitary gland. C) Aquaporins are inserted into tubular cell membranes. D) ADH is synthesized by cells in the supraoptic and paraventricular nuclei of the hypothalamus. E) Serum osmolality increases. - ANSWER-D B E A C A patient arrives in the ED very hypovolemic related to excretion of "at least 3 gallon jugs of urine in the past 24 hours." He describes the urine as being clear-like water. The physician suspects diabetes insipidus. The nurse should be prepared to administer which of the following medications? A) Desmopressin acetate (DDAVP) B) Benadryl, an anticholinergic C) Calcium gluconate D) Prednisone - ANSWER-A A patient has been diagnosed with a brain tumor that cannot be removed surgically. During each office visit, the nurse will be assessing the patient for syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following assessments would alert the clinic nurse that the patient may be developing this complication? A) Complaints that his urine output is decreased, no edema noted in ankles, and increasing headache B) Elevated blood glucose levels, dry mucous membranes, and severe projectile vomiting C) Fever, diarrhea, and nausea D) Muscle cramps, pins and needle sensation around the mouth/lips, and unexplained bruising - ANSWER-A A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces? A) She is susceptible to isotonic fluid volume deficit. B) She is prone to isotonic fluid volume excess. C) She could develop third-spacing edema as a result of plasma protein losses. D) She is at risk of compensatory fluid volume overload secondary to gastrointestinal water and electrolyte losses. - ANSWER-A You are volunteering in the medical tent of a road race on a hot, humid day. A runner who has collapsed on the road is brought in with the following symptoms: sunken eyes, a body temperature of 100°F, and a complaint of dizziness while sitting to have his blood pressure taken (which subsides upon his lying down). These are signs of a fluid volume deficit. Which of the following treatments should be carried out first? A) Offer water by mouth. B) Begin cooling of his body by ice packs. C) Give him a transfusion of FFP. D) Give him an electrolyte solution by mouth. - ANSWER-D A client is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. What is the client's most likely diagnosis? A) Hyponatremia B) Fluid volume excess C) Electrolyte imbalance: hypocalcemia D) Hyperkalemia - ANSWER-B A 26-year-old male patient with a diagnosis of schizophrenia has been admitted with suspected hyponatremia after consuming copious quantities of tap water. Given this diagnosis, what clinical manifestations and lab results should the nurse anticipate the patient will exhibit? 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 and seizures D) Muscle weakness, lethargy, and headaches. - ANSWER-D An ECG technician is performing an ECG on a hospital patient who has developed hypokalemia secondary to diuretic use. Which of the following manifestations of the client's health problem will the technician 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 A nurse in a medical unit has noted that a client's potassium level is elevated at 6.1 mEq/L. The nurse has notified the physician, removed the banana from the client's lunch tray, and is performing a focused assessment. When questioned by the client for the rationale for these actions, which of the following explanations is most appropriate? A) "Your potassium level is high, and so I need you let me know if you feel numbness, tingling, or weakness." B) "Your potassium levels in the blood are higher than they should be, which brings a risk of changes in the brain function." C) "I'll need to monitor you today for signs of high potassium; tell me if you feel as if your heart is beating quickly or irregularly." D) "The amount of potassium in your blood is too high, but this can be resolved by changing the intravenous fluid you are receiving." - ANSWER-A A renal failure patient with severe hyperkalemia (K+ level 7.2 mEq/L) has just been admitted to the nursing unit. Given the severity of this situation, the nurse should be prepared to administer which intravenous infusion stat? A) Lactated Ringer solution at 150 mL/hour to maintain blood glucose levels B) Regular insulin infusion, rate dependent on lab values C) Infusion of Solu-Medrol to decrease irritation to the intravascular system D) Dilaudid via patient-controlled device (PCA) to control pain - ANSWER-B Vitamin D is integral to the regulation of calcium and phosphate levels. Put the following steps in the action of vitamin D into the correct sequence. Use all the options. A) Vitamin D is present in the skin or intestine. B) Vitamin D is concentrated in the liver. C) Absorption of calcium from the intestine increases. D) Vitamin D is transported to the kidneys. E) Calcitriol is produced. - ANSWER-A B D E C A 52-year-old patient has just passed a kidney stone and has high levels of calcium in her urine. Blood tests show high levels of calcium in her blood as well. What subsequent lab results would be most likely to distinguish between primary hyperparathyroidism and hypercalcemia of malignancy? A) Parathyroid hormone level B) Bone scan C) Plasma phosphate levels D) Serum magnesium level - ANSWER-A An 81-year-old female has a long-standing diagnosis of hypocalcemia secondary to kidney disease. She will be moving into an assisted living facility shortly. Which of the following clinical manifestations would the nursing staff at the facility likely observe in this patient? A) Loss of appetite and complaints of nausea B) Muscular spasms and complaints of tingling in the hands/feet C) High fluid intake and copious amounts of dilute urine output D) Lethargy and change in level of consciousness - ANSWER-B A terminally ill cancer patient with metastasis to the bone has been admitted with elevated calcium levels (hypercalcemic crisis). The patient is very lethargic and exhibiting muscle flaccidity. The nurse should be prepared to administer (Select all that apply.) A) pamidronate, a bisphosphonate. B) intravenous drip of insulin. C) furosemide, a loop diuretic. D) gallium nitrate, a gallium salt of nitric acid. E) prednisone, a corticosteroid. - ANSWER-A D E A 56-year-old female hospital patient with a history of alcohol abuse is receiving intravenous (IV) phosphate replacement. Which of the following health problems will this IV therapy most likely resolve? A) The client has an accumulation of fluid in her peritoneal cavity. B) The client is acidotic and has impaired platelet function. C) The client has an irregular heart rate and a thread pulse. D) The client has abdominal spasms and hyperactive reflexes. - ANSWER-B A patient who has had a prolonged period of nasogastric (NG) suctioning following colon surgery is experiencing electrolyte imbalances. The magnesium level is low (1.2 mg/dL). Knowing that magnesium deficiency occurs in conjunction with low calcium levels, the nurse should assess the patient for which of the following clinical manifestations of hypocalcaemia? Select all that apply. A) Personality changes B) Hyperactive reflexes C) Increase in ventricular arrhythmias D) Increase in bouts of atrial fibrillation E) Symptomatic hypotension - ANSWER-A B C A male patient with a history of heavy alcohol use has been admitted to hospital for malnutrition and suspected pancreatitis. The patient's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him? A) "The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough. B) "The multitude of chemical reactions that take place in your body depend on your body fluids being slightly acidic." C) "The healthy function of your kidneys and your lungs requires a specific level of pH in your body." D) "Your body is highly dependent on what food and fluid you consume to keep itself at a functioning level of slight nonacidity." - ANSWER-A When explaining how carbon dioxide combines with water to form carbonic acid as part of acid-base lecture, the faculty instructor emphasized that which enzyme is needed as a catalyst for this reaction? A) Carbonic anhydrase B) Phenylalanie hdroxylase C) Hydrolases D) Trypsin - ANSWER-A A 31-year-old client with a diagnosis of end-stage liver failure has been admitted to the intensive care unit of a hospital. Arterial blood sampling indicates that the man has an acid-base imbalance. Which of the following situations is most likely to result in an inappropriate pH? A) Conservation or formation of new HCO3 - by the kidneys B) Low albumin and plasma globulin levels C) Transcompartmental exchange of H+ and potassium ions D) Renal excretion of HCO3 - in the presence of excess base - ANSWER-B A patient with ESRD comes into the emergency department in severe acidosis. The nurse notes that the respiratory rate is 36 breaths/minute. The nurse understands the pathophysiology of this response and explains to the student nurse that the patient's A) anxiety level is high, and the body is trying to release endorphins. B) chemoreceptors in the carotid and aortic bodies have noticed the pH change and altered the ventilator rate. C) kidneys are not able to buffer the acid and require the help from the lungs. D) lungs are trying to excrete excess hydrogen. - ANSWER-B Place the following stages of the hydrogen ion elimination and bicarbonate conservation in the proximal tubules of the nephrons in the ascending chronological order. Use all the options. A) CO2 and H2O are produced. B) H+ is secreting into the tubular fluid. C) Carbonic acid is produced. D) H+ combines with filtered HCO3 -. - ANSWER-B D C A Following several days in an acidotic state, a hospital patient has returned to desired pH. Which of the following processes could have contributed to the resolution of the patient's health problem? A) Exchange of Na+ and H+ ions B) Selective renal secretion and reabsorption of CO2 C) The phosphate and ammonia buffer systems in the renal tubules D) Excretion of HCO3 - by the kidneys - ANSWER-C When trying to explain the role of potassium and hydrogen related to acid-base balance, which of the following statements is accurate? A) Hypokalemia stimulates H+ secretion. B) Hyperkalemia will cause the reabsorption of HCO3. C) Acidosis causes an increase in K+ elimination. D) Alkalosis tends to increase H+ elimination. - ANSWER-A A client with poorly controlled diabetes mellitus presents to the emergency department with suspected ketoacidosis. Which of the following diagnostic results would most likely confirm this diagnosis? A) Low O2 levels, increased anion gap, base excess B) High ammonia levels, decreased anion gap, high potassium C) Increased anion gap, base deficit D) Decreased anion gap, decreased urine ammonium level - ANSWER-C A patient who has just had her first postoperative dinner out to celebrate her recovery from an intestinal bypass is brought to the emergency room by her spouse. He reports that the patient seems disoriented and is slurring her words. The patient did not have any alcohol with her pasta dinner. Which of the following might be the cause of her symptoms? A) Ketoacidosis B) Lactic acidosis C) Hypercapnia D) Hypothalemia - ANSWER-B The nurse is caring for a patient with ketoacidosis, who is complaining of increasing lethargy and occasional confusion following several weeks of rigid adherence to a carbohydrate-free diet. The nurse understands which of the following phenomena is most likely occurring? A) High-fat, low-carbohydrate dietary intake is associated with respiratory acidosis. B) In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids. C) Metabolism of dietary fats without the buffer action of carbohydrates results in the catabolism of ketoacids. D) Decreased carbohydrate intake induces insulin deficiency and consequent ketoacidosis. - ANSWER-B A 14-year-old boy, appearing to be intoxicated, is brought to the emergency room by ambulance. The EMTs report that the boy has denied consuming anything out of the ordinary, but an open antifreeze container was found in the boy's room. Which of the following is likely to be used to treat the patient's symptoms? A) Gastric lavage B) Syrup of ipecac C) Fomepizole D) Sodium bicarbonate - ANSWER-C A patient who overdosed on aspirin is brought to the emergency department. The nurse caring for this patient should anticipate which of the following clinical manifestations? Select all that apply. A) Respiratory rate of 40 B) BP 100/72 C) ABG report: pH 7.50, PCO2 31 mm Hg, and HCO3 level 19 mmol/L. D) Urine output approximately 100 mL/hour E) Bilateral crackles (fluid) in the lungs - ANSWER-A C Which of the following individuals are at risk of developing metabolic alkalosis? Select all that apply. A) A 70-year-old woman who has taken two tablespoons of baking soda to settle her "sour stomach" B) A hospital patient who is on nasogastric suction following gastric surgery C) A 20-year-old male who has been regularly inducing himself to vomit following binge eating D) A 33-year-old male patient who is on mechanical ventilation in the intensive care unit following a head injury E) A 58-year-old alcoholic male who has been foregoing food for several weeks while drinking heavily F) A 60-year-old female who has chronic renal failure secondary to hypertension - ANSWER-A BC A 55-year-old male client with a history of cardiovascular disease has been admitted to the intensive care unit after recovering from cardiogenic shock. In the hours since admission, the client's arterial blood gases indicate acidosis, most likely acute lactic acidosis. Which of the following signs, symptoms, and diagnostic findings might his care team anticipate before the acid-base balance is restored? Select all that apply. A) Decreased pH B) Cardiac dysrhythmias C) Decreased alertness and cognition D) Hypoventilation E) Nausea and vomiting - ANSWER-A B C E A nurse is providing care for a client who has been diagnosed with metabolic alkalosis after several days of antacid use. Which of the following treatments should the nurse prepare to give? A) Intravenous or oral administration of free hydrogen ions B) Intravenous administration of KCl solution C) Administration of oxygen and NaHCO3 solution D) Supplementary oxygen and possible mechanical ventilation - ANSWER-B A hospital patient's arterial blood gases indicate normal levels of oxygen and increased carbon dioxide. The patient's respiratory rate is 12 breaths/minute (normal 14 to 20 breaths/minute) with all other vital signs within normal range. While not evident from assessment and diagnostics, the patient's kidneys are minimizing both H+ excretion and HCO3 - reabsorption. What is this client's most likely diagnosis? A) Respiratory alkalosis B) Metabolic acidosis C) Respiratory acidosis D) Metabolic alkalosis - ANSWER-D A 77-year-old female diagnosed with chronic obstructive pulmonary disease (COPD) is experiencing impaired gas exchange and CO2 retention, despite a rapid respiratory rate. Which of the following pathophysiological principles would her health care team expect if her compensatory mechanisms are working? A) Arterial blood gas sampling indicates a pH in the range of 7.45 to 7.55. B) Her kidneys are likely to reabsorb H+ and secrete HCO3 C) Her body will produce excess metabolic CO2. D) Her kidneys will adapt with an increase in plasma HCO3 - and her pH will decrease. - ANSWER-D The ICU nurse is concerned with her patient's arterial blood gas (ABG) results—especially the pH 7.30; and PCO2 49 mm Hg. The nurse interprets these ABG results to mean respiratory acidosis. The nurse knows which of the following are 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 the lips/mouth E) Numbness in the fingers and toes - ANSWER-A B A 55-year-old woman has presented to the emergency department following a panic attack. Her blood pressure, respiratory rate, and heart rate are all highly elevated, while her temperature and oxygen saturation are within normal ranges. What is the woman's body most likely doing to address the changes in pH associated with her situation? A) Her kidneys will limit the amount of bicarbonate that they reabsorb. B) She will be retaining Cl- ions in an effort to lower pH. C) Her respiratory center will attempt to lower her CO2 levels. D) The patient's kidneys will excrete more hydrogen ions than they normally do. - ANSWER-A 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 is 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 A dialysis technician is providing care for a client with chronic renal failure. The technician would recognize which of the following characteristics of healthy kidneys? Select all that apply. A) The kidneys are contained within the peritoneal cavity. B) Blood vessels, nerves, and ureters all connect with the kidney at the hilus. C) The medulla of the kidney contains the glomeruli. D) Each kidney consists of lobes, with each lobe comprised of nephrons. E) Each nephron contains several hundred glomeruli that perform filtration. - ANSWER-B D A patient in the ICU has been diagnosed with hypovolemic shock. His BP is 88/53, heart rate 122, and respiratory rate 26. Given these vital signs, the nurse should expect the urine output to be A) maintained between 30 and 50 mL/hour with no sediment in the bag. B) increased to 60+ mL/hour with dilute urine. C) decreased below 30 mL/hour with decreased GFR. D) the patient's normal amount with dark, concentrated urine. - ANSWER-C At which of the following locations in the nephron would a health care professional first expect blood to be largely free of plasma proteins? A) Proximal convoluted tubule B) Bowman space C) Loop of Henle D) Afferent arteriole - ANSWER-B Which of the following statements about mesangial cells within the glomerulus is accurate? Select all that apply. Mesangial cells A) cover the entire amount of endothelial cells contained within the capillaries. B) have phagocytic properties that remove macromolecular materials. C) exhibit vasodilator properties to assist with increase in blood flow in times of stress. D) enlarge (hyperplasia) in response to glomerular diseases. E) are coiled and drain Bowman capsule. - ANSWER-B D A nurse educator is orientating new nurses to a renal unit of the hospital. Which of the following teaching points should the nurse include as part of a review of normal glomerular function? A) "Nephrons are delicate structures that cannot endure the high pressure that exists in capillary beds elsewhere in the body." B) "Glomerular filtrate is very similar in composition to blood plasma found elsewhere in circulation." C) "Dilation of the afferent arteriole allows more blood into the nephron and increases the glomerular filtration rate." D) "The glomerulus is located between an arteriole and a venule that work together to regulate blood flow." - ANSWER-B While assessing a patient with urosepsis, the ICU nurse notes the patient's BP is 80/54; HR 132; RR 24; and pulse oximetry 89% on 6 lpm O2. Over the last hour, the patient's urine output is 15 mL. When explaining to a new graduate nurse, the nurse will emphasize that the patient's status may relate to that A) the infection is deep inside the kidney, and it will take a long time for the antibiotics to kill the bacteria. B) the patient's sympathetic nervous system has been stimulated that has resulted in vasoconstriction of the afferent arteriole, which causes a decrease in renal blood flow. C) the glomerular filtration system gets overwhelmed in times of stress (like infections) and can become clogged with waste material from the bacteria. D) the ability to transport substances from the tubular fluid into the peritubular capillaries becomes impaired, which results in fluid being forced out of capillaries into the glomerulus. - ANSWER-B Which of the following substances is most likely to be reabsorbed in the tubular segments of the nephron using passive transport mechanisms? A) Water B) Sodium C) Phosphate D) Calcium - ANSWER-A When explaining to a class of nursing students enrolled in pathophysiology, the instructor states, "the majority of energy used by the kidney is for A) filtration of drugs out of the body." B) secretion of erythropoietin for production of RBCs." C) active sodium transport mechanisms." D) removal of excess glucose from the blood." - ANSWER-C Damage to which of the following areas of a nephron would most likely result in impaired secretion and reabsorption? A) Distal tubule B) Loop of Henle C) Proximal tubule D) Collecting tubule - ANSWER-C When explaining the role of the proximal tubule in terms of medication administration, the nursing instructor will emphasize that which of the following medications are bound to plasma proteins and require the proximal tubule secretion of exogenous organic compounds to help with filtration? Select all that apply. A) Penicillin B) Aspirin C) Morphine sulfate D) Potassium chloride E) Sodium chloride - ANSWER-A B C Which of the following statements most accurately captures the function of the ascending loop of Henle? A) Urine is concentrated by the selective absorption of free water in the ascending limb. B) Sodium and water are reabsorbed in equal amounts, reducing filtrate quantity but maintaining osmolality. C) The majority of solute and water reabsorption occurs in the ascending loop of Henle. D) Impermeability to water and absorption of solutes yields a highly dilute filtrate. - ANSWERD To treat enuresis in a young girl, her pediatrician prescribes desmopressin, an antidiuretic hormone (ADH) nasal spray, before bedtime. What is the most likely rationale for this treatment? A) It removes water from the filtrate and returns it to the vascular compartment. B) It lessens the amount of fluid entering the glomerulus. C) It leads to the production of dilute urine. D) It causes tubular cells to lose their water permeability. - ANSWER-A Following an automobile accident where the patient had a traumatic amputation of his lower leg and lost greater than 40% of his blood volume, he is currently not producing any urine output. The nurse bases this phenomena on which of the following humoral substances responsible for causing severe vasoconstriction of the renal vessels? A) Aquaproin-2 channels B) Angiotensin II and ADH C) Renin and potassium ions D) Albumin and norepinephrine - ANSWER-B A physician who is providing care for a 71-year-old male client with a recent diagnosis of renal failure and an acid-base imbalance is explaining some of the underlying etiology of the man's diagnoses to him and his family. Which of the following phenomena would most accurately underlie the teaching that the physician provides? A) The kidneys are integral to the reabsorption of hydrogen ions and maintenance of a low pH. B) Blood buffer systems and respiratory control can compensate for inadequate renal control of pH. C) The kidneys have the primary responsibility for eliminating excess hydrogen ions from the body. D) pH is kept at an optimal level through the renal secretion of bicarbonate ions in blood filtrate. - ANSWER-C Which of the following clients on a medical unit of a hospital is most likely to be experiencing health problems that may be attributable to kidney disease? A) An 81-year-old female client with osteoporosis and anemia B) A 77-year-old client with urinary retention due to benign prostatic hyperplasia (BPH) C) A 55-year-old woman with a recent stroke secondary to long-standing hypertension D) A 60-year-old man with a systemic fungal infection requiring intravenous antibiotics. - ANSWER-A While living and hiking in the Rocky Mountains, a gentleman slipped and fell. He goes to an urgent care where an x-ray was done, and some blood was drawn for a CBC. The clinic informs him that he is anemic. What may contribute to this person's anemia? Select all that apply. A) Living in a high altitude B) Tissue hypoxia C) Inability to manufacture erythropoietin D) Destruction of RBCs caused by natural killer cells E) Dehydration - ANSWER-A B C Which of the following patients on a geriatric medical unit is most likely to require slow-release potassium supplements on a regular basis? A) A 90-year-old female who is taking an aldosterone antagonist to treat pulmonary edema B) An 81-year-old male who takes a thiazide diuretic to control his hypertension C) A 79-year-old male with heart failure who is receiving a loop diuretic D) An 83-year-old female who is taking an osmotic diuretic to address severe peripheral edema - ANSWER-B A 62-year-old woman with high blood pressure is to begin long-term treatment with a thiazide diuretic that she thinks she will need to take for some time. What should the nurse expect to happen to her potassium and calcium levels? A) Her potassium and calcium levels will not change. B) Her potassium and calcium levels will both go down. C) Her potassium level will drop, but her calcium level may rise. D) Her potassium level will rise, but her calcium level may drop. - ANSWER-C A patient in a hospital is frustrated at the inconvenience of having to collect his urine for an entire day and night as part of an ordered 24-hour urine collection test. He asks the nurse why the test is necessary since he provided a single urine sample 2 days ago. How could the nurse best respond to the patient's question? A) "A single urine sample lets your care team determine if there are bacteria in your urine, but other tests of urine chemistry need a longer-term view." B) "Current lab tests aren't able to detect the small quantities of most substances contained in a single urine sample. C) "Only a longer-term test is able to show whether your kidneys are letting sugar spill out into your urine." D) "Often why an abnormal substance shows up in urine test, a 24-hour urine collection is needed to determine exactly how much it is present in your urine." - ANSWER-D Which of the following lab results would be associated with abnormalities in kidney function? Select all that apply. A) An absence of protein in a urine sample B) Increased creatinine levels C) Urine gravity of 1.038 and normal serum creatinine levels D) Decreased blood urea nitrogen (BUN) level E) Detectable levels of glucose in a urine sample F) Elevated cystatin-C level. - ANSWER-B E F A pediatric unit will be receiving an 8-day-old infant with a suspected congenital renal disorder. Which of the following renal abnormalities could be the possible cause? Select all that apply. A) One of the infant's kidneys may have failed to develop normally. B) The kidneys may be misshapen and have cysts present. C) The upper or lower poles of the two kidneys may be fused. D) Renal cell carcinoma may be present. E) Urine-filled dilation of renal pelvis associated with atrophy of the kidney may be present. - ANSWER-A B C A 22-year-old female with a history of intermittent flank pain, repeated UTIs, and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of this diagnosis? A) UTIs coupled with an impaired immune response have caused her ADPKD. B) She has inherited a tendency for epithelial cells in her tubules to proliferate inappropriately. C) Severe hypertension and portal hypertension are likely precursors. D) She has inherited undersized kidneys that are prone to calculi formation. - ANSWER-B One of the most reliable predictors for worsening autosomal dominant polycystic kidney disease is A) serum creatinine levels. B) blood urea nitrogen (BUN) level. C) urine albumin excretion (UAE). D) urine specific gravity. - ANSWER-C A nurse has noted the high incidence of urinary tract obstructions of a variety of etiologies. Which of the following individuals are at risk of developing urinary obstructions? Select all that apply. A) A 43-year-old male with an acid-base imbalance secondary to malnutrition B) A 29-year-old female, pregnant for the first time C) A 69-year-old female with anemia secondary to insufficient erythropoietin production D) A 70-year-old male with benign prostatic hyperplasia (BPH) E) A 58-year-old male with renal calculi F) A 28-year-old male with a neurogenic bladder secondary to spinal cord injury - ANSWER-B DEF A 73-year-old man presents to his family physician with complaints of recent urinary hesitation and is eventually diagnosed with benign prostatic hyperplasia (BPH). Which of the following clinical consequences would his care provider expect prior to the resolution of his health problem? A) Hydroureter and pain B) Development of renal calculi and renal cysts C) Unilateral hydronephrosis and pain D) Development of glomerulonephritis or nephrotic syndrome - ANSWER-A A 60-year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states that, "I don't know how this could happen to me, since I'm so careful about eating a healthy diet." What is the most appropriate response to the man's statement? A) "Your diet may have played a part in this, but in fact, genetics are likely primarily to blame." B) "What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved." C) "You likely don't need to change your diet, but now that you have stones in one kidney, you're at very high risk of growing them in the other kidney." D) "Your diet might be normally healthy, but high intake of normally beneficial minerals like calcium and magnesium can lead to stones." - ANSWER-B Which of the following pain descriptions would lead the nurse to suspect the client is experiencing ureteral colic? A) Right upper quadrant pain that worsens with deep breaths and palpation B) Excruciating pain in the flank and upper outer quadrant of the abdomen that radiates to the bladder area C) Pain described as "fire poking in their side," pulsating with every heart beat but decreases when in fetal position D) Perineal pain that increases when urinating and then lessens until the time to urinate again - ANSWER-B A client has been diagnosed with having calcium oxalate kidney stones following intravenous pyelography. Which of the following teaching points about the treatment of the health problem are justifiable? Select all that apply. A) "You may need to cut out cocoa, chocolate, and some nuts from your diet." B) "It's important that you avoid high-calcium foods like milk, cheese, and yogurt." C) "We will come up with a plan to safely limit your fluid intake over the next few weeks." D) "Extracorporeal shock-wave lithotripsy treatment may be used to fragment larger stones." E) "Most likely your stones can be dissolved by medications over the next several days." - ANSWER-A D Which of the following individuals is at the highest risk of developing a urinary tract infection (UTI)? A) A 60-year-old man with a history of cardiovascular disease who is recovering in hospital from a coronary artery bypass graft B) A 66-year-old man undergoing dialysis for the treatment of chronic renal failure secondary to hypertension C) A 38-year-old man with high urine output due to antidiuretic hormone insufficiency D) A 30-year-old woman with poorly controlled diabetes mellitus - ANSWER-D A 24-year-old college student has presented to the campus medical clinic with complaints of frequent, burning urination and has, subsequent to urinalysis, been diagnosed with an acute lower urinary tract infection (UTI) caused by E. coli. What teaching will the clinician most likely provide to the student? A) "This should likely resolve itself if you drink a lot of water and especially cranberry or blueberry juice." B) "Unfortunately, the bacteria causing your infection is no longer responsive to antibiotics, but there are alternative treatments that we can use." C) "Many of these bacteria are now resistant to some antibiotics, but I will take that into account when I choose which antibiotic to prescribe." D) "This likely shows that you have some sort of obstruction in your urinary system, so when that is treated your UTI will likely resolve as well." - ANSWER-C Because the associated nephropathy is an important cause of end-stage renal failure in children and adolescents, a toddler who has had an uncomplicated bout of urinary tract infection (UTI) should still be evaluated for A) urethrovesical reflux. B) vesicoureteral reflux. C) neurogenic bladder. D) detrusor muscle instability - ANSWER-B A female client with suspected glomerular disease has been referred to a nephrologist. The nurse knows that which of the following clinical manifestations may be present with the diagnosis of acute nephritic syndrome? Select all that apply. A) Sudden onset of hematuria B) Proteinuria C) Flank pain D) Excess urine output E) Edema - ANSWER-A B E A patient has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause? A) "Do you have a history of heart failure?" B) "Have you recently had kidney stones?" C) "Have you ever been diagnosed with diabetes?" D) "Have you had any type of infection within the last 2 weeks?" - ANSWER-D A 9-year-old boy has been diagnosed with the nephrotic syndrome. Place the following stages in the development of his health problem in ascending order. Use all the options. A) Hypoalbuminemia B) Increased glomerular membrane permeability C) Decreased colloidal osmotic pressure D) Proteins escape from the plasma to the glomerular filtrate E) Accumulation of fluid in the interstitial tissue (edema) - ANSWER-B D A C E A 25-year-old Asian American man arrives in the emergency room in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What disease has likely caused of his hematuria and how should it be treated? A) Goodpasture syndrome and will be treated with plasmapheresis and immunosuppressive therapy B) Membranous glomerulonephritis and should be treated with corticosteroids C) Immunoglobulin A nephropathy and may be advised to use omega-3 fatty acids to delay progression of disease D) Kimmelstiel-Wilson syndrome and should be treated with medication to control high blood pressure - ANSWER-C A 4-year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the health care team's initial differential diagnosis most likely be? A) Alport syndrome B) Systemic lupus erythematosus glomerulonephritis C) Henoch-Schönlein purpura nephritis D) Immunoglobulin A nephropathy - ANSWER-A A nurse in an acute medical unit of a hospital has admitted a 62-year-old female from the emergency department who has been diagnosed with acute pyelonephritis. Which of the following statements most accurately conveys an aspect of the knowledge base that the nurse needs to perform adequate care and teaching? A) Most cases of acute pyelonephritis are attributable to poorly controlled hypertension. B) Flank pain, dysuria, and nausea and vomiting are likely assessment findings. C) The infection in the kidney is most likely a manifestation of a systemic infection. D) Imaging tests are likely to reveal scarring and deformation of the renal calices and pelvis. - ANSWER-B A 34-year-old man has been taking up to 2400 mg of ibuprofen per day following a motor vehicle accident several months ago and consequent chronic pain. He has recently been diagnosed with chronic analgesic nephritis as a result of his high analgesic intake. The man is surprised at the diagnosis stating, "I thought that taking too many drugs hurts your liver if anything, not your kidneys." What is the most appropriate response to the man's statement? A) "Your liver does perform most of the detoxification in your body, but your kidneys can perform this role if the liver is unable to." B) "High drug intake can cause your kidneys to be very vulnerable to infections, which is likely what happened in your case." C) "Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs." D) "It is very rare for someone as young as yourself to have kidney damage like this; usually only older people are vulnerable to kidney damage from drugs." - ANSWER-C A frantic mother brings her young child into the emergency department. She states that during the evening bath, she noticed a large mass in her child's abdomen. After diagnostic testing, the pediatrician tells the parents that their child has Wilms tumor, stage IV. After the doctor leaves the room, the parents ask the nurse, "What does this mean?" The nurse will respond, "Your child ('s) A) "has cancer in his stomach." B) "has cancer in the kidney that has spread most likely to his lungs." C) "will need to undergo surgery to remove both kidneys and then go on dialysis." D) "tumor can be easily treated with chemotherapy. We will start this soon." - ANSWER-B During a family picnic, a relative of a nurse asks what he should do if there is blood in his urine and some pain in his lower abdomen. The best advice the nurse could give this family member would be for him to A) go to the emergency room right away. B) get an appointment with his family doctor. C) wait and see if it goes away without treatment. D) increase his intake of cranberry juice and other fluids. - ANSWER-B Which of the following data would a clinician consider as most indicative of acute renal failure? A) Alterations in blood pH; peripheral edema B) Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR) C) Decreased serum creatinine and blood urea nitrogen (BUN); decreased potassium and calcium levels D) Decreased urine output; hematuria; increased GFR - ANSWER-B Which of the following clients would be considered to have a significant risk of developing the prerenal form of acute renal failure? Select all that apply. A) A 22-year-old male who has lost large amounts of blood following a workplace injury B) A 41-year-old female who is admitted for intravenous antibiotic treatment of pyelonephritis C) A 79-year-old male with diagnoses of poorly controlled diabetes mellitus and heart failure D) A 20-year-old male who is admitted for treatment of an overdose of a nephrotoxic drug E) A 68-year-old male with a diagnosis of benign prostatic hyperplasia (BPH) F) An 80-year-old female who has been admitted for the treatment of dehydration and malnutrition - ANSWER-A C F The clinical nurse educator on a nephrology unit of a large, urban hospital is orientating recent nursing graduates to the unit. Which of the following teaching points about acute tubular necrosis (ATN) should the educator include in the orientation session? A) "The cardinal signs of ATN are oliguria and retention of potassium, creatinine, and sulfates." B) "Ureteral and bladder outlet obstructions are often contributors to ATN." C) "Trauma, burns, and major surgery are common precursors to ATN." D) "Tubular epithelial cells are sensitive to ischemia and toxins, and damage is irreversible." - ANSWER-C Which of the following patients scheduled for an interventional radiology procedure requiring administration of radiocontrast dye would be considered at high risk for nephrotoxicity? Select all that apply. A) A 14-year-old with severe abdominal pain B) A 25-year-old with a history of glomerular nephritis who is complaining of severe flank pain C) A 67-year-old diabetic undergoing diagnostic testing for new-onset proteinuria D) A 45-year-old with elevated liver enzymes possibly due to fatty liver cirrhosis E) A 53-year-old male undergoing biopsy for a suspicious "spot" on his chest x-ray - ANSWERBC A 35-year-old female ultramarathon runner is admitted to the hospital following a day-long, 50-mile race because her urinary volume is drastically decreased and her urine is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis. Why is her urine red? A) Hematuria B) Hemoglobinuria C) Myoglobinuria D) Kidney bleeding - ANSWER-C Following the diagnosis of acute renal failure, the nurse knows that one of the earliest manifestations of residual tubular damage is which of the following lab/diagnostic results? A) Elevated blood urea nitrogen (BUN) B) Serum creatinine elevation C) Inability to concentrate urine D) Reduced glomerular filtration rate - ANSWER-A A family physician is providing care for a 61-year-old obese male who has a history of diabetes and hypertension. Blood work has indicated that the man has a GFR of 51 mL/minute with elevated serum creatinine levels. Which of the following statements will the physician most likely provide the client in light of these results? A) "We will regularly monitor your kidney function, but most likely your kidneys will be able to compensate on their own and intervention is not required." B) "You likely have chronic kidney disease, and there may be urine in your blood until it is controlled." C) "Your chronic kidney disease has likely been caused by your diabetes and high blood pressure." D) "You're in kidney failure, and I'll be starting dialysis treatment immediately." - ANSWER-C A nurse is collecting a urine specimen prior to measuring the albumin level in a client's urine. A colleague questions the rationale for the test, stating, "I thought albumin was related to liver function, not kidney function." How can the nurse best respond to this statement? A) "Urine should normally be free of any proteins, and albumin is one of the more common proteins to be excreted in chronic renal failure." B) "Urine albumin levels are useful for diagnosing diabetic kidney disease." C) "A urine dipstick test will tell us exactly how much albumin is being spilled by the client's kidneys." D) "A urine test for albumin allows us to estimate the client's GFR quite accurately." ANSWER-B Which of the following clinical manifestations would lead the nurse to suspect the renal failure patient is developing uremia? Select all that apply. A) Weakness and fatigue B) Lethargy and confusion C) Extreme itching D) Blood in urine E) Urine smell in the stool - ANSWER-A B C A hospital client with a diagnosis of chronic renal failure has orders for measurement of her serum electrolyte levels three times per week. Which of the following statements best captures the relationship between renal failure and sodium regulation? A) Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption. B) Renal clients often require a sodium-restricted diet to minimize the excretion load on remaining nephrons. C) Clients with renal failure often maintain high sodium levels because of decreased excretion. D) Restricting sodium intake helps to preserve nephron function and has the additional benefit of lowering blood pressure - ANSWER-A Which of the following clients' diagnostic blood work is most suggestive of chronic kidney disease (CKD)? A) A client with high pH; low levels of calcium; and low levels of phosphate B) A client with low vitamin D levels; low calcitriol levels; and elevated parathyroid hormone (PTH) levels C) A client with low bone density; low levels of calcium; and low levels of phosphate D) A client with low potassium levels; low calcitriol levels; and increased PTH levels ANSWER-B Which of the following medications would the nurse anticipate being prescribed for the renal failure patient who has hyperphosphatemia? A) Vitamin D (calcitriol) B) Calcium carbonate C) Levothyroxine (Synthroid) D) Sensipar (Cinacalcet) - ANSWER-B To maintain hematocrit levels in people with kidney failure, the nurse should be prepared to A) arrange for frequent blood transfusions in an outpatient clinic. B) administer iron dextran intravenously. C) administer a subcutaneous injection of recombinant human erythropoietin (rhEPO). D) administer prenatal vitamins twice a day. - ANSWER-C A nurse educator is performing client education with a 51-year-old man who has been recently diagnosed with chronic kidney disease. Which of the following statements by the client would the nurse most likely want to correct or clarify? A) "I'll be prone to anemia, since I'm not producing as much of the hormone that causes my bones to produce red blood cells." B) "My heart rate might go up because of my kidney disease, and my blood might be a lot thinner than it should be." C) "My kidney problems increase my chance of developing high blood pressure or diabetes." D) "I'll have a risk of either bleeding too easily or possibly clotting too quickly, though dialysis can help minimize these effects." - ANSWER-C The nurse assessing a renal failure patient for encephalopathy caused by high uremic levels may observe which of the following clinical manifestations? A) Severe chest pain with pericardial friction rub on auscultation B) Stiff immobile joints and contractures C) Loss of recent memory and inattention D) Pruritus with yellow hue to skin tone - ANSWER-C Which of the following phenomena contributes to the difficulties with absorption, distribution, and elimination of drugs that are associated with kidney disease? A) Reductions in plasma proteins increase the amount of free drug and decrease the amount of protein-bound drug. B) Acute tubular necrosis is associated with impaired drug reabsorption through the tubular epithelium. C) Decreased retention by the kidneys often renders normal drug dosages ineffective. D) Dialysis removes active metabolites from circulation minimizing therapeutic effect. - ANSWER-A A 42-year-old male has been diagnosed with renal failure secondary to diabetes mellitus and is scheduled to begin dialysis soon. Which of the following statements by the client reflects an accurate understanding of the process of hemodialysis? A) "It's stressful knowing that committing to dialysis means I can't qualify for a kidney transplant." B) "I know I'll have to go to a hospital or dialysis center for treatment." C) "Changing my schedule to accommodate 3 or 4 hours of hemodialysis each day will be difficult." D) "I won't be able to go about my normal routine during treatment." - ANSWER-D Following kidney transplantation, the patient is prescribed maintenance immunosuppressive therapy consisting of prednisone, azathioprine, and cyclosporine. Educating the patient about long-term maintenance on immunosuppressive therapy should include discussion of side effects that may include: (Select all that apply). A) cardiovascular complications. B) increased risk of developing cancer. C) nephrotoxicity of a newly transplanted kidney. D) development of moon face and buffalo hump. E) ringing or buzzing of the ears. - ANSWER-A B A 1-year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which of the following treatment options is his care team most likely to reject? A) Dietary restriction plus erythropoietin B) Continuous cyclic peritoneal dialysis C) Renal transplantation D) Continuous ambulatory peritoneal dialysis - ANSWER-A Which of the following clinical findings among older adults is most unlikely to warrant further investigation and possible treatment? A) An 81-year-old male's serum creatinine level has increased sharply since his last blood work. B) A 78-year-old female's GFR has been steadily declining over several years. C) A 90-year-old female's blood urea nitrogen (BUN) is rising. D) An 80-year-old male whose urine dipstick reveals protein is present. - ANSWER-B When explaining about the passage of urine to a group of nursing students, the clinic nurse asks them which muscle is primarily responsible for micturition? Their correct reply is the A) urinary vesicle. B) trigone. C) detrusor. D) external sphincter. - ANSWER-C During male ejaculation, which of the following statements addresses why sperm is not normally seen inside the bladder? A) The parasympathetic nervous system keeps the seminal fluid inside the urethra. B) The musculature of the trigone area, bladder neck, and prostatic urethra contract at the same time. C) With ejaculation, the male expels some urine along with the seminal fluid to wash any extra sperm out of the bladder. D) The detrusor muscle relaxes allowing for the closing of the sphincter at the base of the bladder. - ANSWER-B A 61-year-old woman who has had an upper respiratory infection for several weeks has presented to her family physician with complaints of a recent onset of urinary retention. She reveals to her physician that she has been taking nonprescription cold medications over and above the suggested dose for the past 2 weeks. Which of the following phenomena will her physician most likely suspect is contributing to her urinary retention? A) Cholinergic actions of the cold medicine are triggering internal and external sphincter contraction. B) Antihistamine effects inhibit communication between the pons and the thoracolumbar cord. C) The anticholinergic effects of the medication are impairing normal bladder function. D) Over-the-counter medications such as cold medicine stimulate the parasympathetic nervous system and inhibit bladder emptying. - ANSWER-C An 82-year-old resident of a long-term care facility with a recent history of repeated urinary tract infections and restlessness is suspected of having urinary retention. Which of the following actions by the care team is most appropriate? A) Uroflowmetry to determine the rate of the client's urine flow B) Ultrasound bladder scanning to determine the residual volume of urine after voiding C) Renal ultrasound aimed at identifying acute or chronic kidney disease D) Urinalysis focusing on the presence of or absence of microorganisms, blood, or white cells in the man's urine - ANSWER-B When explaining a cystometry test to measure bladder pressure during filling and voiding in a normal adult, the nurse informs the nursing students that the normal capacity when adults have a desire to void is A) 100 to 150 mL. B) 200 to 250 mL. C) 300 to 399 mL. D) 400 to 500 mL. - ANSWER-D Which of the following individuals are likely to display identified risk factors for the development of lower urinary tract obstruction? Select all that apply. A) A 32-year-old woman who had a healthy delivery of her third child 4 months ago B) A 68-year-old man who has been diagnosed with benign prostatic hyperplasia (BPH) C) A 55-year-old man with diabetes who is receiving diuretic medications for the treatment of hypertension D) A 30-year-old woman who has been diagnosed with gonorrhea E) A 74-year-old woman who has developed a lower bowel obstruction following several weeks of chronic constipation F) A 20-year-old man who has spina bifida and consequent impaired mobility. - ANSWER-B D EF A 68-year-old woman with a new onset of vascular dementia has recently begun retaining urine. Which of the following physiological phenomena would her care providers most realistically expect to currently occur as a result of her urinary retention? A) Hypertrophy of the bladder muscle and increased bladder wall thickness B) Decreased urine production and nitrogenous waste excretion by the kidneys C) Decompensation, bladder stretching, and high residual urine volume D) Overflow incontinence and loss of contraction power - ANSWER-A A 51-year-old woman diagnosed with a cerebrovascular accident (CVA) 5 months prior is distressed that she has had several recent episodes of urinary incontinence. She has asked her nurse practitioner why this is the case. Which of the following statements best captures the fact that would underlie the nurse's response to the client? A) Neurological diseases like MS often result in flaccid bladder dysfunction. B) She may be unable to sense her bladder filling as a result of her MS. C) Lesions to the basal ganglia or extrapyramidal tract associated with MS inhibit detrusor contraction. D) Pathological reductions in bladder volume brought on my MS necessitate frequent micturition. - ANSWER-B A patient who has suffered a spinal cord injury at C4 is experiencing a sudden change in condition. His BP is 186/101; heart rate is 45; and he is profusely sweating and complaining of "not feeling right." The nurse should A) call a "Code Blue." B) page physician stat. and ask for an antihypertensive medication. C) palpate his bladder for overdistention. D) place his bed flat and elevate the foot of the bed. - ANSWER-C A middle-aged man with diabetes reports that he must strain to urinate and that his urine stream is weak and dribbling. He also reports feeling that his bladder never really empties. The nurse knows that all of his complaints are likely caused by which of the following medical diagnoses? A) Detrusor muscle areflexia B) Detrusor-sphincter dyssynergia C) Uninhibited neurogenic bladder D) Bladder atony with dysfunction - ANSWER-D A diabetes education nurse is teaching a group of recently diagnosed diabetics about the potential genitourinary complications of diabetes and the consequent importance of vigilant blood glucose control. Which of the following teaching points best conveys an aspect of bladder dysfunction and diabetes mellitus? A) "People with diabetes are highly susceptible to urethral obstructions, and these can heal more slowly and cause more damage than in people without diabetes." B) "High blood sugar results in a high glucose level in your urine, and this can make your bladder muscle less able to fully empty the bladder." C) "Many people with diabetes find it necessary to live with an indwelling catheter to ensure their bladders do not become too full." D) "It's important for you to empty your bladder frequently because diabetes carries risks of kidney damage that can be exacerbated by incomplete bladder emptying." - ANSWER-D A 24-year-old man is currently in a rehabilitation facility following a spinal cord injury at level T2. He is discussing his long-term options for continence management. Which of the following statements by the client demonstrates he has a clear understanding of the issue? A) "Self-catheterization can limit the recovery of my neural pathways that control my voiding if I do it too often." B) "It's critical that intermittent catheterization be performed using sterile technique." C) "An indwelling catheter certainly would work well, but it comes with a number of risks and possible complications." D) "An indwelling urethral catheter is the option that best minimizes my chance of a urinary tract infection." - ANSWER-C The nurse should anticipate that a patient diagnosed with spastic bladder dysfunction may be prescribed which of the following medications that will help decrease detrusor muscle tone and increase bladder capacity? Select all that apply. A) Ditropan (Oxybutynin), an antimuscarinic drug B) Detrol LA (tolterodine tartrate), an antimuscarinic drug C) Uroxatral (alfuzosin), an -adrenergic antagonist D) Flomax (tamsulosin), an -blocker E) Bactrim (sulfamethoxazole and trimethoprim), antibiotics - ANSWER-A B A 55-year-old man has made an appointment to see his family physician because he has been awakening three to four times nightly to void and often has a sudden need to void with little warning during the day. What is the man's most likely diagnosis and possible underlying pathophysiological problem? A) Stress incontinence due to damage to CNS inhibitory pathways B) Overactive bladder that may result from both neurogenic and myogenic sources C) Overactive bladder due to intravesical pressure exceeding urethral pressure D) Overflow incontinence that can result from displacement of the angle between the bladder and the posterior proximal urethra - ANSWER-B Because they strengthen the pelvic floor muscles, Kegel exercises are most likely to help A) overflow incontinence. B) urge incontinence. C) stress incontinence. D) mixed incontinence. - ANSWER-C An 87-year-old male resident of an assisted living facility has been consistently continent of urine until the last several weeks. Which of the following actions by the care providers at the facility is the most likely priority? A) Performing a physical examination and history to determine the exact cause and character of the incontinence B) Providing client education focusing on the fact that occasional incontinence is a normal, age-related change C) Teaching the resident about protective pads, collection devices, and medications that may be effective D) Showing the resident the correct technique for exercises to improve bladder, sphincter, and pelvic floor tone - ANSWER-A A patient asks the nurse what it means when the doctor said that he had adenocarcinoma of the bladder. Reviewing the pathophysiologic principles behind this type of cancer, the nurse knows A) it is a low-grade tumor that is readily cured with bladder surgery. B) after resection of the cancer, the prognosis is excellent with this type of cancer cell. C) that these types of cancer cells are very invasive to the tissue; therefore, the entire bladder must be removed. D) this is a rare but highly metastatic tumor that has a very poor prognosis. - ANSWER-D When teaching a community education class about the seven warning signs of cancer, the nurse will note that the most common sign of bladder cancer is A) inability to empty the bladder fully. B) colic spasms of the ureters. C) painless bloody urine. D) passage of large clots after voiding. - ANSWER-C A 63-year-old woman has visited a physician because she has been intermittently passing blood-tinged urine over the last several weeks, and cytology has confirmed a diagnosis of invasive bladder cancer. Which of the following statements by the physician is most accurate? A) "There are new and highly effective chemotherapy regimens that we will investigate." B) "Fortunately, bladder cancer has a very low mortality rate, and successful treatment is nearly always possible." C) "It's likely that you'll need surgery, possibly a procedure called a cystectomy." D) "Unfortunately, there are nearly no treatment options for this type of cancer, but we will focus on addressing your symptoms." - ANSWER-C When educating the patient about possible treatments following surgery for bladder cancer, the nurse might include which of the following chemotherapy options? Select all that apply. A) Intravesical chemotherapy with doxorubicin (Adriamycin) B) Intravenous chemotherapy with at least three agents C) Bacillus Calmette-Guérin (BCG) vaccine D) Endocan, a tumor angiogenesis inhibitor - ANSWER-A C D