WGU D027 Course Material Questions

Which of the following is not a cellular function? - Combustion - All living cells must absorb and metabolize sources of energy, excrete waste and by-products of those processes, and reproduce to continue offspring. Pyrotechnic processes (i.e. combustion) are generally metaphorical. What are mitochondria responsible for? - Energy production - Mitochondria are the energy production organelles of the cell responsible for the major metabolic processes of creating units of energy (e.g., ATP). Which if the following can cause edema? - Increased lymphatic pressure - Decreased vascular and lymphatic pressure does not generally result in the movement and accumulation of fluid into extravascular spaces. Increased plasma pressure in the vascular results in hypertension, while increased lymphatic pressure will readily result in the pooling of lymphatic drainage into third spaces (i.e. edema). Which of the following best describes the result of cellular reproduction? - Two diploid cells, called daughter cells, are produced - The resultant offspring of cellular reproduction is the creation of two daughter cells after the completion of mitosis or meiosis. Interphase is the longest period that a cell spends its life cycle and is the preparatory stage before cellular reproduction. Anaphase is the separation of genetic materials to the opposing centromeres of the cell, followed by telophase. What indicates hypokalemia? - Serum K decreases to less than 3.5 - Normal serum potassium (K), also known as eukalemia, is generally 3.5-5.5 mEq/L, with some variations of +/- 0.1-0.3 mEq/L depending on the laboratory testing, age, and other potential patient-specific conditions and variations. Alterations in fluid volume or the administration of a supplement alone do not necessarily contribute to the development of hypokalemia. What is an example of both hyperplasia and hypertrophy? - Uterine enlargement due to pregnancy - Hyperplasia is the increase in the number of cells of an organ or tissue, while hypertrophy is the enlargement of the cells of a given organ or tissue without a change in the number of cells. Muscle cells grow and enlarge (hypertrophy) in response to increased work or stress from exercise or increased cardiovascular pressures. When a liver is damaged or part of it is removed, it is the one internal solid organ capable of regeneration to repair itself creating more cells (hyperplasia). During pregnancy, the uterus must both grow to create more cells and enlarge those existing cells in preparation for the support of a fetus. What regulates the sodium balance? - Aldosterone - Aldosterone is a regulatory hormone produced by the adrenal glands to affect the kidneys' regulation of sodium, potassium, and water excretion. What is the alteration if the extracellular fluid volume is less than normal? - Hypotonic - In hypotonic states, the cell size is increased as a result of water moving from the extracellular fluid (ECF) into the cell to increase intracellular fluid. Iso- or normotonic states are a balanced state between intra- and extracellular fluid volumes. Hypertonic states cause water to shift out of the cell to increase the ECF above normal. When in excess, what do buffers absorb? - Hydrogen - Excesses of acid or base, H+ or hydroxyl ion (OH−), are absorbed for the purpose of maintaining pH homeostasis (pH of 7.38-7.42) Which of the following would a patient with metabolic acidosis have? - pH below 7.35; Bicarbonate level below 22 mEq/L - The diagnosis of metabolic acidosis requires that the testing of arterial blood finds that the pH is less than 7.35 and the bicarbonate level is less than 22 mEq/L. What is the process by which RNA directs the synthesis of polypeptides? - Translation - Translation refers to this process. Transcription is another process in which RNA is synthesized. Mutation means genetic material has been modified through inheritance. Creation is a term that does not apply in this context. What is the recurrence rate for autosomal dominant disease? - 50% - For a couple in which one or both partners are affected by the disease, the chance of each child being heterozygous affected is 50%. Which of the following statements is true about autosomal recessive disease? - It affects both men and women equally - A criterion for recognizing the inheritance of an autosomal recessive disease is that men and women will be affected by it in equal measure. What is the proportion of the population affected by a disease at the specific point in time? - Prevalence rate - Incidence rate refers to how many new cases there are of a disease within a period of time divided by the number of the population's individuals. The prevalence rate is affected by the incidence rate and how long the affected patients survive. Risk factor is anything that could lead to disease. Relative risk is the measure of a risk factor effect. Which of the following should be completed when a disease is multifactorial but has a larger genetic component? - Get a thorough family history - Environment and lifestyle choices may influence a disease, but diseases such as breast cancer are hereditary, so the family history should be reviewed. Which action is the purpose of the inflammatory process? - To destroy foreign, invasive microorganisms - The general purpose of inflammation is to initiate the destruction of foreign or invasive organisms. As a secondary effect, it increases the healing and immune response processes of the body. What causes edema that occurs during the inflammatory process? - Increased vascular permeability - Increased pressure in the vasculature secondary to the vasodilatory effects of inflammation will result in the leakage of fluid into third spaces (i.e., edema). Previousquestion In what structure do B lymphocytes mature and become B cells? - Bone marrow - The bone marrow is where immature immune cells, such as B and T lymphocytes, reside to mature into B cells. After this maturation process, these cells migrate to other organ sites such as the thyroid, spleen, and thymus to enter their final stages of differentiation and development. Which type of immunity occurs when antibodies are transferred from donor to recipient? - Passive acquired immunity - Active immune processes are the self-originating processes of the immune system that occur from (acquired) or without (innate) prior exogenous simulation or exposure to foreign antigens. Passive immunity is stabilized. Existing immune responses that are present with or without simulation can arise or be created from oneself (innate) or acquired from an outside source (e.g. donor antibodies). What does T-cell activity cause in older adults? - Increased susceptibility for infection - As the human body ages, the immune system's effectiveness to coordinate responses to pathogens and other foreign antigens wanes and the risk for disease increases. What is a dermatitis caused by prolonged exposure to chemicals such as acids or soaps also known as? - Irritant contact dermatitis - Prolonged, superficial skin exposure to foreign irritants (e.g., acids or soaps) is a manifestation of an innate, local inflammatory response. The conditions of allergic, stasis, and atopic dermatitis involve more systemic processes of the immune system and vasculature. Which of the following is a self-limiting disease associated with Herpes type viruses and a herald patch? - Pityriasis rosea - Lichen planus, acne vulgaris, and erythema multiforme are conditions generally associated with or caused by autoimmune dysregulation, bacteria, and varieties of foreign antigen (medications, virus, etc.). Pityriasis rosea in particular is associated with and triggered by Herpes viruses, manifesting itself as a herald patch. What is a furuncle? - An infection of the hair follicle that extends to the surrounding tissue - Abscess, dermis, and fungal infections are generally more widespread or larger processes that require broad or systemic treatment. A furuncle, though uncomfortable to painful, is a generally localized infection that is self-resolving or that requires local, minor treatment. What type of lesion may be malignant in the form of squamous cell carcinoma (SCC)? - Actinic keratosis - Actinic keratosis, which is caused by exposure to UV radiation, is a precursor lesion of SCC What type of abnormal cell growth does carcinoma refer to? - Epithelial cells - Carcinoma refers to dysplastic epithelial cells that have penetrated the entire thickness of the epithelium into the basement membrane. What is a characteristic of a malignant tumor? - Absence of normal tissue organization - Healthy tissue is made up of non-cancerous cells that are well-differentiated, connected via a well-organized stroma and that stay put. Malignant tumors lack those characteristics as well as normal tissue organization. Which lifestyle factor has not been linked to the development of cancer? - Extreme exercise - Tobacco use, obesity, and alcohol consumption are causal for numerous cancers, which can be prevented. Exercise helps prevent colon cancer and likely helps prevent endometrial, breast, and other cancers as well. Which pediatric malignancy is linked to the family of origin? - Wilms tumor - Wilms tumor is kidney cancer in childhood caused by inherited genes. The main causes of liver cancer are hepatitis, fatty liver disease, and alcohol use. The main cause of cervical cancer is HPV infection. Leukemia is caused by mutations to hematopoietic stem cells. Which of the following drugs is classified as hormonal treatment for breast cancer? - Tamoxifen - Lapatinib is a tyrosine kinase inhibitor. Paclitaxil is an antimicrotubule agent. Rituximab is a CD20-directed cytolytic monoclonal antibody. Tamoxifen is an anti-estrogen medication used in the treatment of estrogen-linked breast cancer. Where do the cancers treated with glucocorticoids stem from? - Lymphoid tissue - Glucocorticoids, along with other medications, are used to treat cancers of the lymphoid tissue (lymphocytic leukemias, Hodgkin disease, non-Hodgkin lymphomas, and multiple myeloma). A 23-year-old woman comes in for prenatal counseling. While completing her family history, she reports her brother has cystic fibrosis. She does not know if she is a carrier. She asks if her children will be affected by the disease. What is an accurate way to determine the likelihood of this patient's children being affected? - A genetic or a carrier test - Cystic fibrosis is a hereditary disease that impacts the lungs and digestive system. It is the result of the cystic fibrosis transmembrane conductance regulator gene mutation. The disease occurs when an individual inherits the mutated gene from each parent. When only one mutated gene is inherited, the individual is labeled a carrier. A 31-year-old man comes into the office for an exam. He is 6' 5 " with a highpitched voice, and he has a moderate degree of mental impairment. It is discovered upon exam that his body hair is sparse, his testes are small, and he has gynecomastia. Which genetic disorder should this patient be tested for? - Klinefelter syndrome - Klinefelter syndrome is a hereditary disease also known as 47,XXY or XXY that manifests as the series of symptoms described. The symptoms are expressed as a result of the presence of two or more X chromosomes in males. It is often not diagnosed until adulthood. A six-month-old female infant with failure to thrive comes in to the office with her parents. It is noticed upon exam that the patient has facial deformities and is jaundiced. A complete blood count (CBC) is ordered, which reveals anemia. When that patient's blood is examined under a microscope, the red blood cells appear small and abnormally shaped. A mutational analysis is ordered, and alpha thalassemia is diagnosed. What is the likelihood of incidence of these parent's future children having alpha thalassemia? - 25% - Alpha thalassemia is a hereditary blood disorder characterized by reduction in hemaglobin production. Each individual inherits two copies of the HBA1 gene and two copies of the HBA2 gene from each parent. If at least one copy of the four is missing, a variation of alpha thalassemia can result. That means that future offspring have a one in four chance of the disease. Which chamber of the heart has the thinnest muscle in the heart? - Right atrium - The ventricles possess cardiac muscles that are the thickest lined chambers of the heart because their blood volume burden must be pumped to the lungs and the rest of the body, which are areas of high resistance. The atria receive blood from either the rest of the body via the vena cava (right) or lungs (left). They must only pump the volume directly to the ventricles. The coronary arteries encircle the chambers of the heart to supply the nutrients needed to keep the tissue alive. During diastole, which part of the heart is filling with blood? - Both ventricles - Systole reflects the perfusing pressure of the cardiovascular system where the ventricles eject blood from the heart. Once complete, a resting period—diastole— follows, where blood must refill the ventricles directly from the collection that occurred in the atria. Oxygenated blood flows through which vessel? - Pulmonary vein - The superior vena cava carries all the deoxygenated blood from peripheral circulation back to the heart where it enters the right atrium to be pumped into the right ventricle. The right ventricle pumps to the lungs for oxygenation via the pulmonary artery. After pulmonary circulation, the oxygenated blood is carried back to the heart via the pulmonary vein. Which complex (wave) represents the sum of all ventricular muscle cell depolarizations? - QRS - The QRS wave of an electrocardiogram (ECG or EKG) represents the largest spike in electrical activity of the heart, as ventricular muscle cells perform the highest burden of work to pump blood volume out of the heart in that instance. What effect does atherosclerosis have on the development of an aneurysm? - Erodes the vessel wall - Atherosclerosis, also known as the process of "hardening of the arteries" and secondary to plaque formation, weakens the flexibility of a blood vessel wall. Without vascular compliance, the vessel wall becomes more rigid and susceptible to rupture (i.e., an aneurysm). What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis? - LDLs cause smooth muscle proliferation - Within the arterial wall subintima, oxidized LDLs stimulate macrophage foam cell formation and proinflammatory pathways, which lead to smooth muscle proliferation, fatty streak creation, and eventual fibrous plaque overlays (McCance, p. 699 & 1072). Which factor is responsible for the hypertrophy of the myocardium associated with hypertension? - Angiotensin II - Angiotensin II leads to myocardial hypertrophy, poor myocardial compliance, and ventricular dilation through stimulating increased cardiac preload and afterload and direct toxicity to myocardial cells. It causes sarcomere death, abnormal collagen matrices, and interstitial fibrosis (McCance, p. 1099). Most cardiovascular developments occur between which weeks of gestation? - Fourth and seventh weeks - During weeks four to seven, the primitive heart tube progresses through numerous stages of development leading to a developed heart with distinct atria, ventricles, and cardiac vessels. Which compensatory mechanism is spontaneously used by children diagnosed with tetralogy of Fallot (TOF) to relieve hypoxic spells? - Squatting - Spontaneous squatting helps relieve hypercyanotic events in older children through increasing systemic vascular resistance, decreasing venous blood return. This provides a larger amount of oxygenated blood for the body and leads to the temporary reversal of blood through the ventricular septal defect (VSD), which results in increased pulmonary flow. Squatting is rarely seen clinically because most TOF defects are diagnosed and surgically repaired in infancy (McCance, p. 1127). Which condition is consistent with the cardiac defect of transposition of the great vessels? - The aorta arises from the right ventricle - In transposition of the great vessels, opposite of a normal heart, the aorta arises from the right ventricle, and the pulmonary artery arises from the left ventricle. What produces ADH? - Posterior pituitary - The anterior pituitary gland produces a wide variety of hormones such as the adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), luteinising hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), growth hormone (GH), and melanocyte-stimulating hormone (MSH). The hypothalamus also produces a number of hormones such as the thyrotropinreleasing hormone (TRH), growth hormone-releasing and growth inhibiting hormones (GHRH and GHIH), gonadotropin-releasing hormone (GnRH), corticotropin-releasing hormone (CRH), and oxytocin. The posterior pituitary stores oxytocin and the antidiuretic hormone (ADH) from the hypothalamus for later use. The complex interaction of feedback and influence that the hypothalamus and pituitary glands have on each other is generally referred to as the hypothalamus-pituitary axis. The thyroid gland hormones (T3 and T4) are regulated by __________. - TSH - The thyroid-stimulating hormone directly regulates the release and the resulting levels of circulating T3 and T4. Growth, adrenocorticotropic, and folliclestimulating hormones have no direct effects on the thyroid. What do the pancreas beta cells produce? - Insulin - The pancreas is a very delicate and complex endo- and exocrine gland comprised of different cells and structures designed for different functions. The beta cells are responsible for the endocrinologic function and production of insulin. Alpha cells produce glucagon while P cells produce pancreatic polypeptide. Lipase is produced by many different organs of the gastrointestinal (GI) tract, though the pancreas supplies the main source. What do high levels of ADH cause? - SIADH - The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by increasing intravascular volume, decreased urine production, electrolyte disturbances, etc. It leads to acute medical complications requiring treatment. Which condition is indicated by a high level of TSH and low T4? - Hypothyroidism - Hypothyroidism is a condition in which there is a dysregulation in the thyroid performing its normal endocrine functions. The anterior pituitary senses low circulating T4; this causes a feedback response for additional stimulation resulting in the production of more thyroid stimulating hormone (TSH), without the expected effects of raising T4. What diagnosis results if a patient's anterior pituitary produces none of the normal pituitary hormones? - Panhypopituitarism - In panhypopituitarism, all hormones of the anterior pituitary are deficient: ACTH, TSH, FSH, LH, GH, and prolactin. Which of the following symptoms is not indicative of metabolic syndrome? - Cachexia - Metabolic syndrome is diagnosed when three of the five metabolic findings are present: increased waist circumference or central obesity (males > 40 inches, females > 35 inches); triglycerides ≥150 mg/dl; HDL < 40 mg/dl (males) or < 50 mg/dl (females); BP ≥ 130/85 mmHg; or fasting BG ≥ 100 mg/dl (McCance, p. 688). What is occlusion of the capillaries due to diabetes called? - Microvascular disease - Microvascular disease is primarily due to a long duration (10 or more years) of poorly controlled DM, leading to capillary occlusion and resultant tissue ischemia (retinal, renal, and neurological) (McCance, p. 695). Which of the following is anorexia of aging associated with? - Poor dentition, decreased gastric emptying, and the effects of medication - Anorexia of aging is associated with decreased orexigenic signals, increased anorexigenic signals, decreased gastric emptying, poor dentition, loneliness, and functional impairments (McCance, p. 721). A BMI greater than what indicates obesity? - 30 kg/m2 - Underweight is < 18.5 kg/m2. Normal weight is 18.5-24.9 kg/m2. Overweight is 25-29.9 kg/m2. Obesity is ≥ 30 kg/m2. See "About Adult BMI" for more information. Which term identifies the movement of blood into and out of the capillary beds of the lungs to body organs and tissues? - Perfusion - The actual delivery of blood with oxygen and nutrients around the body is perfusion. What is the mechanism of defense for the alveolar macrophages? - To ingest and remove bacteria from the alveoli by phagocytosis - Pulmonary cilia are responsible for the entrapment and movement of large, foreign particles from the air. The action of coughing propels collected particles while alveolar macrophages work on the microscopic level to eliminate bacteria from lung alveoli. If an individual aspirates, where would a nurse expect abnormal breath sounds? - Right lung - In the anatomy of the lung, the right bronchus is at more of a vertical angle than the left main stem bronchus. Therefore, when food or other foreign bodies are inhaled or aspirated, the more likely path of travel is down towards the right lung, resulting in abnormal breath sounds in that lobe upon auscultation. Besides a cough, the most common symptom of pulmonary disease is __________. - dyspnea - Patients with pulmonary pathology may not always have production or sputum or any upper respiratory signs, especially if the etiology is of a noninfectious nature or source. The rate of respiration could be either increased or decreased once again depending on the etiology of the pulmonary issue. However, labored or any irregularity in breathing, dyspnea, will be a common finding. A condition caused by postoperative patients' reluctance to change position or breathe deeply is _____________. - pulmonary atelectasis - Pulmonary atelectasis is an acute process and the result of the alveoli collapsing in patients postoperatively if the patient does not change position or breathe deeply to keep the delicate lung structures inflated. There is no effect on bones (compression fractures) or function of surfactant. Bronchiectasis is a chronic condition of lung bronchial wall thickening. What is an abnormal permanent enlargement of gas-exchange airways accompanied by destruction of alveolar wall without obvious fibrosis? - Emphysema - Emphysema is caused by lung cell alveolar apoptosis caused by neutrophil mediated destruction of collagen by elastase and proteases, as well as macrophage action and proinflammatory mediators (McCance, p. 1183). Which type of pneumonia is acquired by infection from inhaling microorganisms in a shopping mall? - CAP - Community-acquired pneumonia (CAP) is caused by microorganism exposure in the general community setting. Hospital-acquired pneumonia (HAP), healthcareassociated pneumonia (HCAP), and ventilator-associated pneumonia (VAP) are all associated with exposure to a healthcare setting or intervention (McCance, p. 1188). Which type of croup is most common? - Laryngotracheitis - Viral croup (laryngotracheitis) and recurrent croup (spasmodic croup) are the most common forms of croup (McCance, p. 1208). How is asthma confirmed in children over the age of six? - Pulmonary function testing - Allergies, family history of asthma, and frequent cough all suggest the risk of asthma. However, confirmation of airway narrowing is provided through pulmonary function testing (McCance, p. 1179). What are most cases of acute bronchitis are caused by? - Viruses - Ninety percent of all cases of acute bronchitis are viral in nature and self-limiting (McCance, p. 1185). Where is the region responsible for the motor aspects of speech located? - The Broca area in the frontal lobe - The Brodmann areas in the parietal lobe are responsible for vision-motor coordination after getting visual processing signals from the occipital lobe. The temporal lobe processes auditory and language, while the Broca area in the frontal lobe functions to produce speech. Which area of the brain controls reflex activities concerned with heart rate, blood pressure, respirations, sneezing, swallowing, and coughing? - Medulla oblongata - The medulla oblongata, a major part of the brainstem, is the oldest part of the brain and is responsible for the most basic and reflexive functions of the central nervous system (e.g., pulse rate, blood pressure, respiratory drive). The pons, which is Latin for bridge, connects the medulla oblongata to thalamus and subsequently other, higher parts of the brain such as the midbrain and forebrain. A failure to recognize the form and nature of objects is __________. - agnosia - Agnosia is defined as the inability to interpret sensations and thus recognize visualized objects. It is typically a result of brain damage. Amnesia is the loss of memory while aphasia is the loss of speech functions. Locked-in syndrome (LIS), also known as pseudocoma, is a conscious state where a person is aware but cannot move or communicate due to paralysis of nearly all voluntary skeletal muscles. What are transient disorders of awareness that may have an either sudden or gradual onset? - Acute confusional states - Dementia, Creutzfeldt-Jakob disease, and Huntington disease are all insidious and progressive neurodegenerative diseases. Acute confusional states are transient and commonly caused by autonomic nervous system hyperactivity or hypoactivity, metabolic disorders, or drugs or toxins directly interfering with synaptic neurotransmission (McCance, p. 518). A traumatic brain injury that results in bleeding between the dura mater and the skull is called ____________. - an epidural hematoma - The epidural space resides between the dura mater and skull. Subdural hematomas occur in the subdural space found between the dura and arachnoid. Intracerebral hematoma is bleeding within the brain tissue. A concussion is a traumatic brain injury (TBI) marked by diffuse axonal injury due to mechanical stretching and shearing of axonal fibers caused by acceleration and deceleration injuries (e.g., whiplash) (McCance, p. 555-556). A stroke that is caused by fragments that break off from a thrombus in the heart is called _____________. - an embolic stroke - An embolic stroke occurs when portions of a clot detach, travel to the brain, and cause ischemia. Thrombotic stroke is caused by thrombi that develop in the brain causing ischemia as they grow. Lacunar strokes are caused by lacunar ischemic lesions of deeply penetrating arteries within the brain. Hemodynamic stroke is caused by hypoperfusion of the brain (e.g., cardiac failure, pulmonary embolism, massive bleeding) (McCance, p. 566). A tear in a tendon is __________. - a strain - A torn tendon is a strained tendon. Bursitis is inflammation of a bursa. Epicondylitis is inflammation or degeneration of a tendon in the elbow. A torn ligament is a sprain. The condition when blood flows to an affected area is compromised because of increased venous pressure is called what? - Compartment syndrome - Malignant hyperthermia—which is rare and often fatal—is triggered by inhaled anesthetics or succinylcholine and leads to high body temperature, changes in muscle metabolism and function, rhabdomyolysis, systemic acidosis, cardiac dysfunction. Compartment syndrome refers to the process of decreased blood flow to a specific area due to increased venous pressure in that area. DIC is a clinical syndrome of systemic coagulation and clotting, which often blocks blood flow to organs leading to organ failure. Crush syndrome refers to the effects of rhabdomyolysis on the kidneys. A chronic, systemic inflammatory autoimmune disorder that affects the joints is called what? - Rheumatoid arthritis - Rheumatoid arthritis is a chronic, systemic autoimmune disease that affects tissues, organs, and joints (McCance, p. 1450). A type of dystrophy caused by a deletion of one or more exons of the DMD gene on the X chromosome is what? - Duchenne muscular dystrophy - Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder that affects 1 out of 3500 males and leads to the inability to walk by 10-12 years of age and death due to respiratory and cardiac failure by age 20 (McCance, p. 154). How is Crohn disease (CD) different from ulcerative colitis (UC)? - CD affects any part of the GI tract and involves skip lesions - While these two diseases are similar, CD impacts all of the GI tract and includes skip lesions. Ulcerative colitis affects the rectum and the sigmoid colon. In addition, CD affects women more often than men, and it increases cancer risk. What is the most common type of peptic ulcer? - Duodenal ulcer - A duodenal ulcer is more prevalent since ulceration tends to happen in many places in the stomach or duodenum. It is usually caused by using NSAIDs and an infection from H. pylori. Patients with celiac disease must avoid foods with what? - Gluten - Celiac disease is also known as gluten-sensitive enteropathy. When these patients consume gluten, typically from wheat products, the gluten acts as an antigen that leads to gastrointestinal reactions A GFR of 20 mL/min would be what stage of chronic kidney disease? - Stage 4 - GFR is rated as severe when it is in the range of 15 to 29. This is stage 4 What is the most common infecting microorganism that causes urinary tract infections (UTIs)? - Escherichia coli - A major cause of UTIs is the presence of uropathic strains of E. coli, which is 80- 85% of cases. E. coli is a major, endogenous bacteria that resides in the lower gastrointestinal tract. Cross contamination into the urinary tract is common in children and incontinent adult patients. What is condition in which a child has never been continent? - Primary incontinence - Primary incontinence refers to a child never being continent. Secondary incontinence relates to a child who has gone through toilet training and is dry for half a year before reverting to incontinence. Stress incontinence means urine may leak due to pressure or exertion from the abdomen. What is a symptom of PCOS? - Obesity - Patients with this syndrome tend to be obese and have high androgen levels. Losing weight can increase insulin sensitivity, and treatments can lead to regular menses. HPV testing is recommended at the same time as a pap test in women at which ages? - 30-65 - While the pap test is considered one of the best ways to check for cancer, it is necessary to have extra testing for cells in the cervix being infected through HPV. What does the treatment of a torsion of the testis require? - Surgical intervetion - Testicular torsion that is not surgically reversed within six hours leads to testicular damage and tissue necrosis (McCance, p. 843) The incubation period for primary syphilis ranges from how many days? - 10-90 days - The incubation period of primary syphilis ranges from 10 to 90 days with an average of 12 weeks, following which an eroded-painless chancre emerges. A 64-year-old male truck driver comes in complaining of pain in his lower left calf. He states he drives eight to ten hours per day. Upon exam, swelling and mottled coloring are noted in the patient's calf. A D-dimer test is ordered and comes back positive. Which additional test should be ordered to confirm a diagnosis in this patient? - An MRI - D-dimer is not a conclusive assessment of a deep vein thrombosis (DVT), as it can be elevated for a variety of reasons including stress, recent surgery, inflammation, trauma, liver disease, or malignancy. The test does not identify the location of a clot or the cause. An MRI will provide visualization of the causative agent and the precise location. A 54-year-old man comes into a clinic for a routine visit. His initial BP is 148/92. After a recheck 15 minutes later, his BP is 140/90. He states he suffers from "white coat hypertension." He states he has no history of high blood pressure and no family history of high blood pressure. Which nursing intervention would assist this patient in receiving a clinical diagnosis of hypertension? - Completing an ambulatory blood pressure assessment - For someone with "white coat hypertension," the best option is to eliminate the situation in which the trigger is present. Assessing blood pressure in a location of comfort like the home environment when no professional is present will enable the ability to determine his blood pressure under routine circumstances. A 58-year-old woman comes in complaining of retrosternal chest pain, worsening with recumbent position. She states she has had a low-grade fever for two days. Upon exam, the patient has a friction rub. An EKG reveals sinus tachycardia with inflammatory changes. An ultrasound is performed, and she is diagnosed with an acute pericarditis. Which condition would make pericarditis more likely in this patient? - Lupus - Lupus is an autoimmune disorder that is often responsible for causing an inflammatory response in the pericardial sac. Autoimmune disorders are known to cause chronic pericarditis. A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse correctly tell the patient about this symptom? - This symptom is common. If it does not stop, then your medication can be changed - Coughing is the most common side effect associated with all ACE inhibitors. About 10% of those taking an ACE inhibitor will experience a dry, nonproductive cough that can range from very mild to severe and hacking. Persistent dry cough is the most common reason for discontinuing ACE inhibitors (Burchum & Rosenthal, p. 357). A patient has a chronic congestive heart failure. The prescriber has ordered spironolactone to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching? - "I need to stop taking my potassium supplement." - Spironolactone is a potassium-sparing diuretic and therefore the most common side effect of spironolactone is hyperkalemia. Potassium supplements should be discontinued to avoid hyperkalemia (Burchum & Rosenthal, p. 392). A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient? - The patient should stop taking the medication and contact her provider immediately - ACE inhibitors are contraindicated in pregnancy because of their teratogenicity and should be avoided. Harm to the developing fetus includes major congenital malformations (e.g., hypotension, skull hypoplasia, pulmonary hypoplasia, renal failure) and death (Burchum & Rosenthal, p. 357). A patient begins taking nifedipine along with metoprolol to treat hypertension. The nurse understands that metoprolol is used to ______________. - prevent reflex tachycardia - Reflex tachycardia is a side effect of taking nifedipine, exacerbating angina due to a higher cardiac oxygen demand. When combined with a beta blocker like metoprolol, this side effect can be avoided. A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse caring for this patient will ______________. - caution the patient not to get up abruptly - Orthostatic hypotension is a common risk factor associated with taking vasodilators, and it places the individual at risk for falls. The individual should pause before moving from laying to sitting and sitting to standing. If dizziness or other signs of orthostatic hypotension are felt, the individual should lay down until symptoms resolve (Burchum & Rosenthal, p. 371). A 60-year-old African-American patient has a blood pressure of 120/80 mm Hg and reports a family history of hypertension. The patient has a body mass index of 22.3. The patient reports consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse expect to teach this patient? - Sodium restriction - Genetics account for 20-40% of the variation in blood pressure. Environmental factors play a large role in the development of HTN (high sodium intake, insufficient physical activity, stress, and obesity) (McCance, p. 169). A patient is recovering from a myocardial infarction (MI) but does not have symptoms of heart failure. The nurse will expect to teach this patient about what? - CE inhibitors and beta blockers - ACE inhibitors and beta blockers improve post-MI outcomes and reduce post-MI mortality. Which two classes of antidysrhythmic drugs have nearly identical cardiac effects? - Beta blockers and calcium channel blockers - Both beta blockers and calcium channel blockers reduce heart rate, suppress AV conduction, and reduce myocardial contractility. A patient who is taking simvastatin develops an infection, and the provider orders azithromycin to treat the infection. The nurse should be concerned if the patient complains of what? - Muscle pain - Muscle pain may be a sign of myopathy and rhabdomyolysis, which, while rare (less than 0.15 out of 1 million patients), may cause kidney failure and death. Any patient with new onset muscle pain while taking a statin drug should undergo careful evaluation. A patient who is taking warfarin has just vomited blood. The nurse notifies the provider, who orders laboratory work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer __________. - phytonadione (vitamin K) 1 mg IV over 1 hour - Generally, when INR is in the supratherapeutic range, 1 to 2.5 mg of oral vitamin K is preferred. Because this patient is at risk of vomiting again, the nurse would expect to administer 1-10 mg of vitamin K intravenously over one hour. Subcutaneous administration of vitamin K is no better than a placebo at reducing INR below supratherapeutic levels. The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include? - Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis - Hyperglycemia, hypoglycemia, and ketoacidosis are short-term complications of diabetes, while peripheral neuropathy, arterial insufficiency, and carotid stenosis are long-term complications of diabetes. A patient with type 1 diabetes is eating breakfast at 7:30 a.m. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? - Lispro - The patient has preprandial hyperglycemia, which should be treated, and needs an insulin that will quickly lower blood sugar (quick onset) with a short duration of action. NPH has an onset of 60-120 minutes and a duration of 16-24 hours. A 70/30 mix has an onset of 30-60 minutes and a duration of 10-16 hours. Lispro has an onset of 15-30 minutes and a duration of 3-6 hours. A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included? - "You should use a carbohydrate counting approach to maintain glycemic control." - The goal in type 1 diabetes is to maintain glycemic control, which counting carbohydrates will accomplish. Eating any foods that one desires will lead to hyperglycemia. Eating protein to promote fat breakdown as well as restricting calories may lead to ketosis and potential ketoacidosis. What is the most reliable measure for assessing diabetes control over the preceding three-month period? - Glycosylated hemoglobin level - Self-monitoring and the patient's own reporting allow for error and subjectivity in reporting diabetes control. Fasting blood glucose is a snapshot in time and does not provide detail about the past three months. Glycosylated hemoglobin (HgbA1c) provides a reliable assessment of average blood glucose over the past three months. Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug? - Once daily at bedtime - Insulin glargine (Lantus) is a peakless long acting (18-24 hour) insulin that should be administered once daily at bedtime. A patient arrives in the emergency department with a heart rate of 128 beats/minute and a temperature of 105°F. The patient's skin feels hot and moist. The free T4 level is 4 ng/dL. The free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer ______________. - propylthiouracil (PTU) - This patient is experiencing thyrotoxic crisis, or thyroid storm. PTU is the preferred medication for treatment of thyroid storm. Methimazole is preferred in reducing hyperthyroidism in stable patients. Iodine-131 is used to treat Graves disease by destroying a portion of the thyroid gland. IV levothyroxine would not be appropriate since TSH is depressed and both free T4 and free T3 are elevated. A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats per minute, a blood pressure of 105/62 mm Hg, and a temperature of 96.2°F. The patient appears pale and complains of always feeling cold and tired. The nurse will contact the provider to discuss tests for which condition? - Hypothyroidism - The subjective and objective findings suggest possible hypothyroidism in an adult. Cretinism is congenital hypothyroidism and diagnosed at a young age. Graves and Plummer disease cause hyperthyroidism. The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient? - Neuropsychological deficits in the fetus can occur if the condition is not treated - The fetus does not produce its own thyroid hormone until week 20 of development and relies on maternal thyroid hormone production. The thyroid hormone is needed for neural and physical development. The nurse prepares a patient with Graves disease for radioactive iodine (I131) therapy. Which statement made by the patient best demonstrates understanding of radioactive iodine (I131) therapy? - "This drug will be taken up by the thyroid gland and will destroy the cells to reduce my hyperthyroidism." - I131 therapy for Graves' disease is achieved in one dose, ranging from 4-10 millicuries. No isolation from family is required since the drug only affects the thyroid gland, destroying a portion of the gland to reduce hyperthyroidism. Cold intolerance and weight gain are related to hypothyroidism. A nurse caring for a patient, notes that the patient has a temperature of 40°C (104°F) and a heart rate of 110 beats per minute. The patient's skin is warm and moist, and the patient complains that the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will contact the provider to discuss _________. - Graves disease - Hyperpyrexia, tachycardia, and increased sweating are signs of the hyperthyroidism associated with Graves disease. Cretinism is congenital hypothyroidism. Myxedema is puffy skin caused by long-standing hypothyroidism. Plummer disease is hyperthyroidism due to a cancerous thyroid tumor. A nurse is teaching a group of nursing students about antihistamines. Which statement by a student indicates an understanding of the mechanism of action of the antihistamines? - "Antihistamines block H1 receptors to prevent actions of histamine at these sites." - H1 antihistamines block the action of histamine at H1 receptor sites. They do not block the release of histamine and may block muscarinic receptors in addition to H1 receptors. First-generation antihistamines are less selective than secondgeneration antihistamines and are more likely to cause drowsiness. A prescriber orders hydroxyzine for a patient with acute urticaria. The nurse will include what information when teaching the patient about this drug? - The patient should avoid drinking alcohol while taking the drug - Vistaril is a first-generation antihistamine that reduces the redness and itching associated with urticaria. As a first-generation antihistamine, Vistaril causes sedation, which will worsen with other CNS depressants like alcohol (which should be avoided). Shortness of breath is not a side effect of antihistamine use, rather is often caused by histamine action in the bronchioles. A patient with asthma will be using a metered dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered two puffs to be given twice daily. It is important for the nurse to teach this patient that ___________________. - the patient should wait one minute between puffs - Patients should wait one minute between puffs for inhaled medications. Sudden, rapid inhalation of medication may cause bronchospasm. Activation of the MDI should occur after inhalation begins. A patient with persistent, frequent asthma exacerbations asks a nurse about a longacting beta2 agonist (LABA) medication. What will the nurse tell this patient? - LABAs should be combined with an inhaled glucocorticoid - LABAs are reserved for patients for whom first-line treatments of asthma have failed and should be combined with an inhaled glucocorticoid. A nurse is teaching a group of nursing students about the different formulations of beta2-adrenergic agonist medications. Which statement by a student indicates an understanding of the teaching? - "Oral beta2 agonists are not useful for short-term treatment." - Inhaled beta2 agonists provide the fastest (immediate) effect. All oral beta2 agonists are long-acting and not useful for short-term or PRN treatment. Which medication should be used for asthma patients as part of step 1 management? - Short-acting beta2 agonists - The step 1 treatment recommendation for intermittent asthma is a short-acting beta2 agonist for PRN use. A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates an understanding of this medication regimen? - "The glucocorticoid is used as prophylaxis to prevent exacerbations." - Glucocorticoid use in stable COPD is preventive in nature through suppressing inflammation and should not be used as a PRN rescue medication for exacerbations. Beta2-adrenergic agonists should be used PRN and may not be needed daily. A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient? - A long-acting inhaled beta2 agonist - LABAs are preferred over SABAs for those with stable COPD. A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin _________. - helps stimulate the flow of secretions to increase cough productivity - Guaifenesin is an expectorant that increases the flow of respiratory tract secretions to increase the productivity of coughing. A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct? - "You should take oral antihistamines daily during each allergy season to get maximum effects." - To maximize the effects of antihistamine use (blocking histamine from coupling with H1 receptors), these medications should be taken daily during allergy season. The H1 receptor blocking of antihistamines is not as effective once histamine has already triggered a full allergic response. A nursing student asks the nurse why epinephrine and not other adrenergic agonists is used to treat anaphylactic shock. What will the nurse tell the student? - "Epinephrine has the ability to activate multiple types of adrenergic receptors." - Epinephrine activates the four types of adrenergic receptors and is the drug of choice for anaphylaxis. The nurse is discussing home management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates an understanding of the teaching? - "I should take the first dose at bedtime." - The first dose's effect leading to orthostatic hypotension is the reason patients should take the first dose of alpha-adrenergic antagonists at bedtime so the period of lowest blood pressure is when the person is supine and sleeping. A nurse is discussing motor symptoms with a patient with Parkinson disease who has been taking levodopa or carbidopa (Sinemet) for nine months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom? - "I may need to try a lower dose of Sinemet to reduce my tics." - Tics, or dyskinesias, are a possible side effect of Sinemet, which may resolve with a lower dose. A nurse is caring for an older adult man who has Alzheimer disease (AD). The patient's daughter wants to know if testing can be done to determine her risk for developing the disease. What will the nurse tell her? - Advancing age and family history are known risk factors - The cause of AD is not currently known, but the most important risk factors are age and family history. A patient is going to begin taking phenytoin (Dilantin) for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient? - She should consider a different form of birth control while taking phenytoin - Phenytoin is designated as pregnancy category D and interferes with the efficacy of oral birth control pills leading to the potential for unplanned pregnancy. A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do? - Contact the provider to request an order for serum drug levels - Plasma drug levels are the gold standard for determining the dosing of antiepileptic drugs. A patient who takes daily doses of aspirin is scheduled for surgery next week. The nurse should advise the patient to do what? - Stop using aspirin immediately - Aspirin at therapeutic levels may double bleeding time for up to one week and should be discontinued at least one week prior to any surgery. A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the following will be important for minimizing the risk of osteoporosis? - Calcium and vitamin D supplements - Glucocorticoids suppress bone creation, accelerate bone loss, and decrease absorption of dietary calcium. Vitamin D and calcium supplementation should be prescribed for all individuals on long-term glucocorticoid treatment to prevent bone loss and facilitate sufficient serum calcium and vitamin D levels. A patient who has been diagnosed with rheumatoid arthritis (RA) for one month and who has generalized symptoms is taking high-dose nonsteroidal antiinflammatory drugs (NSAIDs) and an oral glucocorticoid. The provider has ordered methotrexate (Rheumatrex). The patient asks the nurse why methotrexate is necessary since pain and swelling have been well controlled with the other medications. The nurse will tell the patient that _____________. - starting methotrexate early can help delay joint degeneration - Methotrexate helps delay B and T lymphocytic joint destruction caused by RA in 80% of patients taking the drug.