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NURS 5315 FinalA patient in respiratory distress and is breathing 33 breaths per minute. Which ABG value is
consistent with the clinical scenario?
PCO2 15
pH 7.30
pH 7.45
O2 sat 100%
A patient who is breathing 33 breaths per minute is hyperventilating and blowing off CO2;
therefore the PCO2 level will be low. The patient will most likely experience a respiratory
alkalosis and the two pH values provided are not consistent with this diagnosis.
A patient has a sodium level of 115 mEq/L and is disoriented and lethargic. Which pathological
process best explains this patient's symptoms?
a. The action potential has become hyperpolarized.
b. Water has shifted into the neurons and caused them to swell.
c. Water has shifted into the vascular space and dehydrated the neurons.
d. The action potential has become hypopolarized.
b. The cause of neurologic symptoms associated with a sodium imbalance is directly related to
fluid shifting into or out of the neurons of the brain. With a serum sodium of 115 mEq/L, water
shifts into the neurons and causes them to swell. Hypernatremia causes water to shift out of the
cell into the intravascular space and causes the neurons to become dehydrated. An alteration in
the action potential is not seen with sodium imbalances.
Brainpower
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A patient experiencing dehydration should be monitored for which electrolyte imbalance?
a. Hyperkalemia
b. Hypocalcemia
c. Hypercalcemia
d. Hyponatermia
a. Serum osmolality is increased during times of dehydration. An elevated serum osmolality will
pull potassium into the intravascular space from the intracellular space and cause a rise in
serum potassium.
A married couple presents to your office for genetic counseling. The husband has an autosomal
recessive disease and his wife has a heterozygous genotype for the disease. They ask you,
,What is the chance that our baby will have the disease? Which of the following answers is
correct?
25%
50%
75%
100%
A chromosome is a package of material located inside the cell nucleus which is made of
proteins and a single molecule of DNA. There are 23 pairs of chromosomes in each human cell
for a total of 46 chromosomes. Chromosomes are separated into two identical sets during
mitosis or meiosis. This provides a set of chromosomes to each daughter cell which results from
cell division. This process is responsible for the transfer of genetic information to the daughter
cells. The first 22 pairs of chromosomes are known as autosomes. The 23rd pair of
chromosomes is the pair which contains the genetic information for gender. This pair contains
the genetic information which delineates between the male and female genders. Females have
two X chromosomes (XX) and males have an XY chromosome pair. Autosomal chromosomes
are said to be autologous. This means they do not carry genetic information pertaining to
gender. Autosomal genetic diseases are carried on the first 22 pairs of chromosomes.
Sex-linked diseases are only carried on the 23rd pair of chromosomes. The autosomal
chromosomes are nearly identical to one another and are considered homologous to one
another. Each autosomal chromosome in a pair carries identical genes. These two genes are
known as alleles. The alleles occupy the same site on each partner of the chromosome pair and
code for the same genetic trait or physiologic function. Alleles can be dominant or recessive.
One allele may be dominant and the other recessive, or they both may be dominant or both
recessive. The dominant alleles' genetic code will always manifest in the individual's phenotype.
The information in the recessive allele is typically not expressed in the phenotype unless both
alleles are recessive. For the purpose of clarity in use, the dominant gene is assigned a capital
letter and the recessive gene is assigned a lower case letter. Any letter is okay to use but make
sure you use the same letter for the genotype - for example, "Bb or aa." The term homozygous
refers to a pair of alleles which are either both dominant or recessive. For example, "BB or bb"
are said to be homozygous because the alleles are either both dominant or recessive. An allele
pair in which one is dominant and one is recessive is said to be heterozygous. In autosomal
recessive disorders both alleles on the chromosome are affected by the genetic aberration. If
only one recessive gene is affected by the genetic aberration then the person is said to be a
carrier and will not have the phenotypic expression of the disease. The healthy, recessive allele
will compensate for the allele which is affected by the genetic aberration. The carrier can pass
the trait but does not have the genetic disease. In an autosomal dominant disorder the dominant
gene is the only gene that has to be affected by the genetic aberration in order to have the
phenotypic expression of the disease. A healthy recessive allele cannot compensate for a
diseased dominant allele. In order to answer this question one must understand the above
information and draw a Punnett Square.
The husband has an autosomal recessive disease which means his genotype must be aa. The
wife has a heterozygous genotype for the disease which means her genotype is Aa. The capital
A reflects a healthy gene so she is merely a carrier and does not express the disease
, phenotype. The father's genotype is written across the top line and the mother's genotype is
written in the boxes to the left. The four boxes in the middle are the possible genotypes of their
offspring. Each box represents a 25% chance for the offspring to have that particular genotype.
The question asks you to determine the chances the offspring will have the autosomal recessive
disease or in other words, express the phenotype for the disease. The genotype which will
result in the disease is "aa." Therefore, there is a 50% chance that their offspring will have the
autosomal recessive disease.
A child is diagnosed with hemophilia. This is an example of which genetic concept?
Phenotype
Genotype
Autosomal transmission of the disease
Transcription
The expression of a genetic disease is an example of a phenotype. A genotype is a gene's
programming. Hemophilia is transmitted on the x-chromosome and is not transmitted via the
autosomes. This is not an example of transcription.
Dehydration triggers which physiologic response?
Increased secretion of renin.
Increase secretion of natriuretic peptides.
Decreased secretion of antidiuretic hormone.
Decreased serum osmolality.
Dehydration will trigger the release of renin when renal perfusion is impaired. The other answers
are seen during times of fluid volume overload.
A patient on hydrochlorothiazide has a pH of 7.49 and a bicarbonate of 30. Which of the
following pathological processes best explains the abnormal lab values?
a. An accumulation of pancreatic bicarbonate secondary to vomiting and loss of hydrochloric
acid
b. An increased absorption of Na+ and HCO3- in the proximal renal tubule secondary to
increased aldosterone secretion
c Excessive exhalation of CO2 secondary to hyperventilation
d. Distal renal tubular dysfunction causing an accumulation of hydrogen ions
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
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