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NURS 5315 FINAL QUESTIONS AND ANSWERS
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NURS 5315 FINAL QUESTIONS AND ANSWERS
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Name: Score:50 Multiple choice questions
Term 1 of 50
The nurse practitioner notes that a patient has a pH of 7.25 and a bicarbonate of 10. Which of
following laboratory tests is most important for the nurse practitioner to review?
sodium
magnesium
potassium
creatinine
The best fluid to order in a patient with sickle cell disease who is experiencing an acute
vaso-occlusive crisis is a hypotonic solution. Hypotonic solutions will cause fluid to
move into the intracellular space i.e. the red blood cell. This will cause the red blood
cells to swell and thereby reverse the sickling. Option B is an isotonic fluid which will
remain mainly in the intravascular space. Options C and D are both hypertonic solutions
which will draw fluid out of the cells into the intravascular space.
ANS: A
Patients who abuse ETOH have many nutritional deficiencies, some of which include B
vitamins, folic acid, and phosphate. Therefore they should receive thiamine
supplementation.
The pH and bicarbonate in this question are consistent with a metabolic acidosis. The
nurse practitioner should review the potassium level. Hyperkalemia is a common
electrolyte imbalance seen in a metabolic acidosis. During a metabolic acidosis,
hydrogen (a positive ion) shifts into the intracellular space. In order to maintain the ionic
balance, potassium (a positive ion) shifts to the extracellular space and results in a
hyperkalemia. None of the other labs are affected by a metabolic acidosis.
The most appropriate diagnosis is AIDS. AIDS is defined by the presence of HIV and
either a history of an opportunistic infection or the presence of a current opportunistic
infection. PCP is an opportunistic infection and a history of it changes the diagnosis from
HIV positive to AIDS. An individual with HIV infection can also meet the criteria for an
AIDS diagnosis if their CD4 count drops below 200 even if it is a temporary drop. The
patient is not currently experiencing PCP so this is not an appropriate diagnosis. If the
patient did not have a history of PCP then HIV infection would be an appropriate
diagnosis. HIV related syndrome is a false diagnosis.
,Term 2 of 50
A 40-year-old African American female presents with a complaint of a discoid, malar rash,
photosensitivity, and oral ulcers. Which of the following pathological processes best explains
the patient s symptoms?
A T-cell mediated immune response has been initiated secondary to the presence of an
antigen.
A deficiency in complement proteins has resulted in a streptococcal skin infection.
A foreign antigen has triggered an immediate IgE immune response.
Antibody nucleic acid immune complexes are deposited throughout the body and trigger an
immune response.
The clinical manifestations are consistent with an acute coronary syndrome which has
resulted in a papillary muscle rupture. The papillary muscle rupture presents with an
acute onset of a holosystolic murmur and S3 sound.
The clinical scenario is consistent with a pernicious anemia which is secondary to a B12
deficiency. The human body stores approximately 10 years of vitamin B12 and therefore
this anemia tends to present more commonly in the elderly. Other individuals at risk for
B12 deficiency include alcoholics, vegans, those with a gastrectomy, inflammatory bowel
disease, and persons who have had a surgical resection of the ileum. The ileum is the site
of absorption of B12. Vitamin K is used to reverse the effects of warfarin and not to treat
anemia. Iron is used to treat iron deficiency anemia. Folic acid is used to treat an anemia
secondary to folic acid deficiency.
The clinical scenario is consistent with Hodgkin's Lymphoma. Option A is the only answer
which describes the pathological process of the Hodgkin's Lymphoma. Option B
describes the pathological process for multiple myeloma. Option C is the pathological
basis of leukemias. Option D describes the pathological process for immune
thrombocytopenic purpura (ITP).
The clinical scenario is consistent with systemic lupus erythematosus (SLE). The
pathophysiology of SLE is characterized by the formation of autoantibodies to cellular
nucleic acids. Option A is an example of solid organ transplant rejection. Option B is an
example of an immune deficiency. Option C is an example of an allergic reaction.
,Term 3 of 50
A 74-year-old female presents to the emergency department after having a syncopal episode.
On examination the patient is noted to have a systolic murmur at the second intercostal space,
right of the sternal border which radiates to the neck. Which of the following is the most likely
cause of the syncope?
Aortic Stenosis
Aortic Regurgitation
Mitral Regurgitation
Angina
Aortic stenosis is a narrowing of the aortic valve. Blood from the left ventricle passes
through the aortic valve into the aorta to perfuse the body. Understanding this anatomy
is essential to answering the question correctly. In an aortic stenosis the valve is
narrowed. The more severe the narrowing of the aortic valve, the less blood moves
through the valve to perfuse the body. As a result blood backs up in the left ventricle
and over time causes left ventricular hypertrophy. The backup of blood will also
eventually cause left atrial hypertrophy, left-sided heart failure, pulmonary HTN, right
ventricular hypertrophy and right-sided heart failure. As a result an individual with
severe aortic stenosis is at an increased risk for pulmonary edema post-operatively
because they are unable to appropriately compensate for the IV fluids given during
surgery. Ventricular hypertrophy may happen as a result of the stenosis but it is not an
acute complication. Pulmonary fibrosis is a chronic condition in the lungs which results in
the scarring of the lung tissue and it is not related to aortic stenosis.
The clinical scenario is consistent with an aortic stenosis. Aortic stenosis is more
common in females and the elderly. An aortic stenosis causes a decrease in cerebral
perfusion which may result in syncope. Systolic murmurs, heard at the second intercostal
space right of the sternal border which radiate to the neck originate from the aortic
valve. Systolic murmurs which radiate to the axilla originate from the mitral valve. A valve
which has regurgitation allows some blood to flow back through the valve during the
cardiac cycle. Perfusion is not typically an issue with valvular regurgitation. There is no
mention of chest pain; therefore, the syncope is not related to angina.
Atrial fibrillation results in a loss of the atrial kick which supplies 20% of the cardiac
output. There was indeed decreased perfusion to the brain but it was due to a low
cardiac output secondary to the atrial fibrillation. The question does not give any
information in it to suggest that the patient experienced an orthostatic hypotensive
episode.
The clinical manifestations are consistent with an acute coronary syndrome which has
resulted in a papillary muscle rupture. The papillary muscle rupture presents with an
acute onset of a holosystolic murmur and S3 sound.
, Term 4 of 50
A patient with a cough, fever and fatigue is diagnosed with influenza. Which of the following is
the best explanation for the patient s symptoms?
A systemic viremia
Release of cytokines
Release of acute phase reactants
Release of bradykinin
The patient's symptoms are directly related to the inflammatory response which has
been triggered by the influenza infection. The release of cytokines are responsible for
the symptoms experienced by patients infected with influenza. Influenza is not a
systemic infection and remains isolated to the pulmonary cells; therefore, a viremia does
not occur when a person has influenza. Acute phase reactants include ferritin, platelets,
coagulation proteins, c-reactive protein, complement proteins and are released during
times of inflammation but are not responsible for the symptoms. Bradykinin is released
during times of inflammation and causes pain. The patient is not experiencing any pain.
ANS: A
A hyperpolarization of the intracellular environment has made it more difficult for the
cell to depolarize is the only correct answer. This is what happens in hypokalemia. A
more positive threshold potential delays the action potential and is seen on
hypercalcemia. A progressive cellular depolarization occurs in hypocalcemia & cells are
hypo polarized in hyperkalemia.
ANS: B
Long-standing GERD predisposed the esophageal cells to undergo a metaplasia. In
esophageal metaplasia the normal esophageal squamous epithelial cells are replaced
by intestinal-like columnar cells under the influence of the refluxed gastric acid. The
columnar cells are better equipped to handle the refluxed hydrochloric acid. It is pre-
cancerous condition. None of the other adaptation patterns are pertinent.
The pH value and bicarbonate value are consistent with a metabolic alkalosis. The most
likely cause of the metabolic alkalosis is the use of the hydrochlorothiazide (HCTZ). This
is a thiazide diuretic which can cause a metabolic alkalosis. The use of a thiazide diuretic
will increase the secretion of aldosterone which stimulates the reabsorption of Na+ and
HCO3- in the proximal tubule of the kidney. This is a response directly related to
hypovolemia secondary to the diuretic use. Option A occurs as a result of excessive
vomiting. Vomiting does cause a metabolic alkalosis but there is nothing in the question
to suggest that the patient has been vomiting. Option C would result in a respiratory
alkalosis, not a metabolic alkalosis. Option D would cause a metabolic acidosis (not a
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