NRS 410V Pathophysiology and Nursing Management of Clients Health

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1 CATEGORY anatomy QUESTION Backward effects of left-sided heart failure include: CORRECT ANSWER A) Pulmonary congestion YOUR ANSWER A) Pulmonary congestion Deoxygenated blood from the ... right ventricle flows through the right and left pulmonary arteries to the right and left lung. After entering the lungs, the branches subdivide, finally emerging as capillaries which surround the alveoli and release the carbon dioxide in exchange for oxygen. RATIONALE The capillaries unite gradually and assume the characteristics of veins. These veins join to form the pulmonary veins, which return the oxygenated blood to the left atrium. Backflow of blood through the left atrium result in left-sided heart failure. 2 CATEGORY anatomy Oxygen saturation is likely to be lowest when an asthmatic with a diagnosis of pneumonia is QUESTION positioned: CORRECT ANSWER C) Lying on the right side YOUR ANSWER C) Lying on the right side Ventilation and perfusion distribute to the dependent lung fields. In a patient with pneumonia in the right lung, positioning with the right lung down would send more blood flow to the RATIONALE consolidated, nonventilated areas of the lung and produce a worse V/Q mismatch, which would decrease oxygen diffusion into the blood and produce a lower arterial oxygen saturation. 3 CATEGORY anatomy In performing a physical assessment, the nurse notes the patient has a “barrel― QUESTION configuration to the chest. This is a consequence of: CORRECT ANSWER D) Increased residual lung volume YOUR ANSWER D) Increased residual lung volume Emphysema typically produces a barrel –shaped chest with an increased anterior-posterior RATIONALE dimension. This is a result of loss of lung parenchyma resulting in reduced elastic recoil and increased residual volume and functional residual capacity. 4 CATEGORY anatomy QUESTION Which of the following is true of the biological functions of testosterone? CORRECT ANSWER D) Testosterone is needed for development of male secondary sexual characteristics. YOUR ANSWER D) Testosterone is needed for development of male secondary sexual characteristics. Testosterone is needed for development of male secondary sexual RATIONALE characteristics. 5 CATEGORY anatomy QUESTION Which of the following is true of the biological functions of estrone? CORRECT ANSWER C) Estrone is required for proper development of female secondary sexual characteristics. YOUR ANSWER C) Estrone is required for proper development of female secondary sexual characteristics. RATIONALE Estrone is required for proper development of female secondary sexual characteristics. 6 CATEGORY biology QUESTION Closed drainage systems work to re-expand a lung after pneumothorax by: CORRECT ANSWER A) Re-establishing the normal negative intrapleural pressure. YOUR ANSWER A) Re-establishing the normal negative intrapleural pressure. The effect of closed chest drainage is to re-establish negative pressure within the pleural RATIONALE space to encourage re-expansion of the affected lung alveoli. 7 CATEGORY biology QUESTION Patients with chronic renal failure usually exhibit: CORRECT ANSWER C) Hypocalcemia YOUR ANSWER C) Hypocalcemia Hypocalcemia is a common feature in renal failure because the kidneys fail to produce activated vitamin D, which then interferes with the absorption of calcium from the diet. In RATIONALE addition, the kidneys are unable to efficiently rid the body of phosphate because a low GFR, which contributes to hormonal dysregulation associated with hypocalcemia. 8 CATEGORY biology QUESTION The diet of a patient in end-stage kidney disease is restricted in all of the following except: CORRECT ANSWER D) Calories YOUR ANSWER D) Calories Individuals with end-stage renal failure have a low GFR that makes it difficult to rid the body of fluids, potassium and nitrogenous waste products, therefore these substances may be RATIONALE restricted. Nitrogenous wastes are produced by metabolism of proteins. Caloric needs are not reduced as a result of renal failure. 9 CATEGORY biology QUESTION In addition to hypertension, pre-eclampsia is characterized by: CORRECT ANSWER C) Protein in the urine and edema YOUR ANSWER C) Protein in the urine and edema In addition to elevated blood pressure, retention of fluid leading to edema and leakage of RATIONALE protein into the urine are usually found in pregnancy induced hypertension (pre-eclampsia). Nausea, vomiting, fatigue and back pain are common findings of normal pregnancy. 10 CATEGORY biology QUESTION Why is heat an effective means of sterilization? A) Heat is an effective means of sterilization because it destroys the proteins of microbial CORRECT ANSWER life-forms including fungi, bacteria and viruses. A) Heat is an effective means of sterilization because it destroys the proteins of microbial YOUR ANSWER life-forms including fungi, bacteria and viruses. Heat is an effective means of sterilization because it destroys the proteins of microbial RATIONALE life-forms including fungi, bacteria and viruses. 11 CATEGORY chemistry Laboratory test results indicative of thrombocytopenia, in addition to a low platelet count, would QUESTION be: CORRECT ANSWER A) Increased PT YOUR ANSWER A) Increased PT Prolonged bleeding time with normal clotting cascade tests (PT and aPTT) is indicative of a platelet disorder. If the PT or aPTT is prolonged, then another etiology such as clotting factor RATIONALE deficiencies must be considered. Decreased RBC count is a feature of aplastic anemia, but it rarely occurs with thromobocytopenia unless there is hemorrhage. 12 CATEGORY chemistry QUESTION The oxyhemoglobin dissociation curve represents the relationship between the: CORRECT ANSWER B) O₂ saturation and PaO₂ The oxyhemoglobin dissociation curve is a tool used to show the relationship between oxygen RATIONALE saturation and the PaO2. 13 CATEGORY chemistry Carbon monoxide binds tightly to the heme groups of hemoglobin and myoglobin. How does QUESTION this affinity reflect the toxicity of carbon monoxide? C) Because carbon monoxide binds tightly to the heme groups of hemoglobin, it is not easily CORRECT ANSWER removed or replaced by oxygen. As a result, the effects of oxygen deprivation result in suffocation. C) Because carbon monoxide binds tightly to the heme groups of hemoglobin, it is not easily YOUR ANSWER removed or replaced by oxygen. As a result, the effects of oxygen deprivation result in suffocation. Since carbon monoxide binds more tightly to heme groups than does oxygen, carbon RATIONALE monoxide, rather than oxygen is circulated to organs, depriving the system of oxygen which results in suffocation and organ failure. 14 CATEGORY chemistry QUESTION List the enzymes whose levels are elevated in the blood serum following an MI. CORRECT ANSWER A) CPK, LDH, AST, and SGOT YOUR ANSWER A) CPK, LDH, AST, and SGOT CPK, LDH, AST and SGOT are primary cardiac enzymes released with cardiac tissue RATIONALE necrosis. The enzymes show elevation 8-12 hours after infarction and therefore, are diagnostic indicators of MI. 15 CATEGORY chemistry On the normal oxyhemoglobin curve, if the O₂ saturation is 88%, it would correlate with a QUESTION PaO₂ of approximately: CORRECT ANSWER C) 60 mm Hg YOUR ANSWER C) 60 mm Hg The illustration demonstrates that if the curve is not shifted, an oxygen saturation of 88% is RATIONALE equivalent to a PaO2 of about 60 mmHg. 16 CATEGORY pathophysiology You are reviewing the results of an ABG. Both the pH and the HCO³ values are abnormal QUESTION and match. The primary problem is: CORRECT ANSWER B) Renal YOUR ANSWER B) Renal Step one of arterial blood gas interpretation requires that you identify whether the pH, pCO2 RATIONALE and HCO3 are abnormal. The two matching values determine what the problem is. 17 CATEGORY pathophysiology Interpret the following ABG results. QUESTION pH 7.45 pCO₂ 26 HCO₃ 16 CORRECT ANSWER C) Respiratory alkalosis fully compensated YOUR ANSWER C) Respiratory alkalosis fully compensated pH 7.45 (normal), pCO2 26 (alkaline), HCO3 16 (acid). Step one of arterial blood gas interpretation requires that you identify whether the pH, pCO2 and HCO3 are abnormal. The RATIONALE two matching values determine what the problem is. In fully compensated states, the pH has returned to within the normal range, although the other values may still be abnormal. 18 CATEGORY pathophysiology QUESTION Which of the following may be a reason to order an ABG on a patient? CORRECT ANSWER D) All of the above YOUR ANSWER D) All of the above ABGs are ordered in most instances in which a patient experiences dyspnea or signs of RATIONALE respiratory distress. 19 CATEGORY pathophysiology A patient with a prolonged episode of nausea, vomiting and diarrhea has an ABG ordered on QUESTION admission. You might expect the results to show: CORRECT ANSWER A) Metabolic acidosis YOUR ANSWER A) Metabolic acidosis Diarrhea and intestinal fistulas may cause decreased levels of base. Signs and symptoms of RATIONALE metabolic acidosis include nausea and vomiting and diarrhea. 20 CATEGORY pathophysiology Interpret the following ABG results. QUESTION pH 7.33 pCO₂ 60 HCO₃ 34 CORRECT ANSWER C) Respiratory acidosis with partial compensation YOUR ANSWER C) Respiratory acidosis with partial compensation pH 7.33 (acid), pCO2 60 (acid), HCO3 34 (alkaline). Step one of arterial blood gas interpretation requires that you identify whether the pH, pCO2 and HCO3 are abnormal. The RATIONALE two matching values determine what the problem is. When an acid-base disorder is either uncompensated or partially compensated, the pH remains outside the normal range. 21 CATEGORY pharmacology QUESTION The purposes of epinephrine injection include all of the following except: CORRECT ANSWER D) Blocking histamine receptors. YOUR ANSWER D) Blocking histamine receptors. Epinephrine is effective as an acute treatment for type I hypersensitivity reactions to bee stings because it binds to B2 receptors in bronchioles and may inhibit bronchoconstriction. It also RATIONALE stimulates the heart to help maintain blood pressure, which may fall because of vasodilatory effects of histamine. Epinephrine also helps reduce further release of inflammatory mediators from mast cells. Epinephrine does not bind to or block histamine receptors. 22 CATEGORY pharmacology QUESTION What is the medical application of cortisone? Cortisone is used to treat: CORRECT ANSWER A) Rheumatoid arthritis, asthma, gastrointestinal disorders, and a variety of skin conditions. YOUR ANSWER A) Rheumatoid arthritis, asthma, gastrointestinal disorders, and a variety of skin conditions. Cortisone is a steroid hormone that prevents the release of substances in the body that cause RATIONALE inflammation. 23 CATEGORY pharmacology QUESTION How do sulfa drugs selectively kill bacteria while causing no harm to humans? C) Humans are not harmed because we do not synthesize our own folic acid. It is obtained in CORRECT ANSWER the diet. C) Humans are not harmed because we do not synthesize our own folic acid. It is obtained in YOUR ANSWER the diet. The vitamin, Folic acid, is needed for the synthesis of a coenzyme, responsible for producing the amino acid methionine and the purine and pyrimidine nitrogenious bases for DNA and RNA. Sulfa drug binds to the enzyme, prohibiting the production of folic acid, and leading to RATIONALE the cessation of biosynthesis of methionine and nitrogenous bases. These changes destroy microorganism. As we obtain folic acid through our diet, rather than creating it ourselves, there 24 CATEGORY pharmacology QUESTION What occurs when glycogen metabolism is stimulated by insulin? B) Insulin stimulates glycogen synthase, the first enzyme in glycogen synthesis. It also CORRECT ANSWER stimulates removal of glucose from the bloodstream into cells and phosphorylation of glucose by the enzyme glucokinase. B) Insulin stimulates glycogen synthase, the first enzyme in glycogen synthesis. It also YOUR ANSWER stimulates removal of glucose from the bloodstream into cells and phosphorylation of glucose by the enzyme glucokinase. Glycogen metabolism increases the glucose levels within cells, while decreasing glucose levels in blood. Insulin stimulates uptake of glucose from the bloodstream into cells and RATIONALE phosphorylation of glucose by the enzyme glucokinase as well as glycogen synthase, the first enzyme in glycogen synthesis. Glucose is trapped within the liver cells, resulting in increased glucose storage, in the form of glycogen. In turn, glucose levels in blood is decreased. 25 CATEGORY pharmacology Therapeutic interventions focused on increasing the oxygen supplied to the heart and QUESTION decreasing the heart’s demand for oxygen include: CORRECT ANSWER C) Morphine sulphate YOUR ANSWER C) Morphine sulphate Morphine can reduce myocardial oxygen consumption by reducing the preload of the heart. It does this by causing venodilation and pooling of blood in the periphery. If the person is RATIONALE experiencing pain or anxiety, morphine can reduce the sympathetic activation of the heart caused by these symptoms. The other drugs might be expected to improve oxygen delivery to the heart but would not decrease oxygen utilization by the heart. Page 6 [Show More]

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