A patient's anemia is described as having erythrocytes that demonstrate anisocytosis. The nurse would recognize the erythrocytes would be:
Correct Answer: Able to assume various shapes
Response Feedback: Anisocytosis means the erythrocytes are able to assume various shapes.
A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following types of anemia will the nurse see documented on the chart?
Correct Answer: Pernicious anemia
Response Feedback: A lack of the intrinsic factor leads to pernicious anemia
When a nurse is reviewing lab results and notices that the erythrocytes contain an abnormally low concentration of hemoglobin, the nurse calls these erythrocytes:
Correct Answer: Hypochromic
Response Feedback: Hypochromic erythrocytes have low concentrations of hemoglobin.
A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has?
Correct Answer: Hemolytic anemia
Response Feedback: Hemolytic anemia is an example of normocytic-normochromic anemia. Sideroblastic anemia is an example of microcytic hypochromic anemia. Pernicious anemia is an example of a macrocytic anemia. Iron deficiency anemia is an example of microcytic hypochromic anemia.
After initial compensation, what hemodynamic change should the nurse monitor for in a patient who has a reduction in the number of circulating erythrocytes?
Correct Answer: Hyperdynamic circulatory state
Response Feedback: After initial compensation, the blood flows faster and more turbulently than normal blood, causing a hyperdynamic circulatory state.
A 25-year-old female has a heavy menses during which she loses a profuse amount of blood. Which of the following adaptations should the nurse expect?
Correct Answer: Peripheral vasoconstriction
Response Feedback: When the anemia is severe or acute in onset (e.g., hemorrhage), the initial compensatory mechanism is peripheral blood vessel constriction, diverting blood flow to essential vital organs.
A 60-year-old female emphysema patient experiences a rapid and pounding heart, dizziness, and fatigue with exertion. Which of the following respiratory assessment findings indicate the respiratory system is compensating for the increased oxygen demand?
Correct Answer: Increased rate and depth of breathing
Response Feedback: The rate and depth of breathing increase in an effort to increase oxygen availability accompanied by an increase in the release of oxygen from hemoglobin.
A 2-year-old malnourished child has vitamin B12 and folate deficiencies. A blood smear suggests the deficiency is macrocytic and normochromic. The nurse would expect the hemoglobin to be:
Correct Answer: Normal
Response Feedback: The macrocytic (megaloblastic) anemias are characterized by unusually large stem cells (megaloblasts) in the marrow that mature into erythrocytes that are unusually large in size (macrocytic), thickness, and volume. The hemoglobin content is normal, thus allowing them to be classified as normochromic.
A 45-year-old male is diagnosed with macrocytic, normochromic anemia. The nurse suspects the most likely cause of this condition is:
Correct Answer: Defective DNA synthesis
Response Feedback: These anemias are the result of ineffective erythrocyte deoxyribonucleic acid (DNA) synthesis.
When a patient wants to know why vitamin B12 and folate deficiencies cause anemia, how should the nurse respond?
Correct Answer: Red blood cells have a shorter life span.
Response Feedback: These deficiencies lead to defective erythrocytes that die prematurely, which decreases their numbers in the circulation, causing anemia.
A 20-year-old female undergoes lab testing for anemia. Results show high iron, bilirubin, and transferrin and low hemoglobin and hematocrit. Which of the following is the most likely diagnosis to be documented on the chart?
Correct Answer: Sideroblastic anemia
Response Feedback: Individuals with sideroblastic anemia may show signs of iron overload (hemosiderosis), including mild to moderate enlargement of the liver (hepatomegaly) and spleen (splenomegaly).
A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia). How should the nurse respond when the patient asks what causes pernicious anemia? A decrease in ______ is the most likely cause.
Correct Answer: Intrinsic factor
Response Feedback: The underlying alteration in pernicious anemia (PA) is the absence of intrinsic factor (IF), an enzyme required for gastric absorption of dietary vitamin B12, a vitamin essential for nuclear maturation and DNA synthesis in red blood cells.
Which of the following individuals should the nurse assess first for a vitamin B12 deficiency anemia?
Correct Answer: 47-year-old male who had a gastrectomy procedure (removal of the stomach)
Response Feedback: With removal of the stomach, the intrinsic factor is also removed, leading to an inability to absorb B12; thus, the person with removal of the stomach is at greatest risk
A 65-year-old male experienced loss of appetite, weight loss, lemon-yellow skin, liver enlargement, and a beefy red tongue shortly before his death. Autopsy suggested pernicious anemia, and the cause of death would most likely reveal:
Correct Answer: Heart failure
Response Feedback: When the hemoglobin has decreased to 7 to 8 g/dL, the individual experiences the classic symptoms of anemia: weakness, fatigue, paresthesias of feet and fingers, difficulty walking, loss of appetite, abdominal pain, weight loss, and a sore tongue that is smooth and beefy red. The skin may become "lemon yellow" (sallow), caused by a combination of pallor and jaundice. Hepatomegaly, indicating right-sided heart failure, may be present in the elderly.
A 40-year-old male vegetarian is diagnosed with folate deficiency anemia. He reports that he is an alcoholic. Which of the following factors put him at greatest risk for developing his disease?
Correct Answer: Being alcoholic
Response Feedback: Folate deficiency occurs more often in alcoholics and individuals who are malnourished because of fad diets or diets low in vegetables. A diet high in vegetables would help prevent folate deficiency.
How should the nurse prepare a patient who is to receive a Schilling test for pernicious anemia?
Correct Answer: Administer radioactive cobalamin and measure its excretion in the urine.
Response Feedback: The Schilling test is performed by administering radioactive cobalamin and then measuring its excretion in the urine. Low urinary excretion is significant for pernicious anemia (PA).
A 67-year-old female has chronic gastrointestinal bleeding. A nurse recalls the primary cause of her anemia is:
Correct Answer: Iron deficiency
Response Feedback: A continuous loss of blood is one of the most common causes of iron deficiency anemia (IDA)
A 34-year-old male presents in the emergency room with extreme fatigue and shortness of breath. His skin and sclera appear to have a yellowish discoloration. These assessment findings are consistent with which type of anemia?
Correct Answer: Hemolytic anemia
Response Feedback: A yellow appearance to the skin and sclera are consistent with hemolytic anemia.
A 58-year-old female presents in the clinic presenting with fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit, a high mean corpuscular volume, and normal plasma iron. These assessment findings are consistent with which type of anemia?
Correct Answer: Pernicious anemia
Response Feedback: Pernicious anemia is manifested by tingling paresthesias of feet and fingers.
The nurse will check which of the following tests to directly measure iron stores?
Correct Answer: Bone marrow biopsy
Response Feedback: Iron stores are measured directly by bone marrow biopsy.
A 21-year-old female was recently diagnosed with iron deficiency anemia. In addition to fatigue and weakness, which of the following clinical signs and symptoms would she most likely exhibit?
Correct Answer: Spoon-shaped nails
Response Feedback: Iron deficiency anemia is manifested by fingernails that become brittle and "spoon shaped" or concave.
A 21-year-old woman was recently diagnosed with iron deficiency anemia. Her hematocrit is 32%. Which of the following treatments would the nurse expect to be prescribed for her?
Correct Answer: Iron replacement
Response Feedback: Iron replacement therapy is required and very effective. Initial doses are 150 mg to 200 mg/day and are continued until the serum ferritin level reaches 50 mg/L.
A 45-year-old male is diagnosed with sideroblastic anemia. When he asks what the most likely cause of this disease is, what is the nurse's best response?
Correct Answer: Ineffective iron uptake and abnormal hemoglobin production
Response Feedback: Sideroblastic anemia is due to ineffective iron uptake and hemoglobin production.
A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following assessment findings would most likely occur?
Correct Answer: Bronze colored skin
Response Feedback: The skin of the patient with sideroblastic anemia is bronze in color. The patient with sideroblastic anemia shows signs of iron overload.
A nurse is preparing to teach the staff about aplastic anemia. Which information should the nurse include? Aplastic anemia is caused by:
Correct Answer: Stem cell deficiency
Response Feedback: In aplastic anemia, erythrocyte stem cells are underdeveloped, defective, or absent.
A nurse recalls posthemorrhagic anemia can result in death when a patient's blood loss is in excess of:
Correct Answer: 40% to 49%
Response Feedback: Death can occur if blood loss exceeds 40% to 49% of plasma volume.
A 57-year-old male presents to his primary care provider for red face, hands, feet, ears, and headache and drowsiness. A blood smear reveals an increased number of erythrocytes, indicating:
Correct Answer: Polycythemia vera (PV)
Response Feedback: PV is manifested by increased numbers of erythrocytes. PV is characterized by excessive proliferation of erythrocyte precursors in the bone marrow.
A 67-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera. Upon taking the history, the patient will most likely report:
Correct Answer: Chest pain
Response Feedback: Coronary blood flow may be affected, precipitating angina. The patient will experience signs of interrupted blood flow due to increased blood viscosity. They will not experience hyperactivity. Blood pressure will be increased, not decreased. The skin will be red over the face hands, feet, and ears.
A 68-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera (PV). A nurse realizes the patient's symptoms are mainly the result of:
Correct Answer: Increased blood viscosity
Response Feedback: The symptoms of PV are due to increased blood viscosity.
A 67-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera (PV). Which treatment should the nurse discuss with the patient?
Correct Answer: Therapeutic phlebotomy
Response Feedback: Treatment of PV is phlebotomy to reduce red cell mass and blood volume.
A 70-year-old male is brought to the emergency department, where he dies shortly thereafter. Autopsy reveals polycythemia vera (PV). His death was most likely the result of:
Correct Answer: Cerebral thrombosis
Response Feedback: 50% of individuals with PV die within 18 months of the onset of initial symptoms because of thrombosis or hemorrhage.
A 67-year-old male was diagnosed with polycythemia vera (PV) but refused treatment. His condition is at risk for converting to:
Correct Answer: Acute myeloid leukemia
Response Feedback: A significant potential outcome of PV is the conversion to acute myeloid leukemia (AML), occurring spontaneously in 10% of individuals and generally being resistant to conventional therapy.
A staff member asks what leukocytosis means. How should the nurse respond? Leukocytosis can be defined as:
Correct Answer: A high leukocyte count
Response Feedback: Leukocytosis is present when the count is higher than normal.
A 20-year-old female has an increase in eosinophils. When the patient wants to know the most likely cause of the eosinophilia. What is the nurse's best response?
Correct Answer: Parasitic invasion and allergic reactions
Response Feedback: Parasitic invasion can lead to eosinophilia.
A 15-year-old female presents with splenomegaly, hepatomegaly, and lymph node enlargement. She is diagnosed with infectious mononucleosis. What should the nurse tell the patient about the recovery time?
Correct Answer: A few weeks
Response Feedback: Infectious mononucleosis (IM) is usually self-limiting, and recovery occurs in a few weeks; severe clinical complications are rare (5%). Fatigue may last for 1 to 2 months after resolution of other symptoms.
A 35-year-old male with hyperthyroidism begins treatment to decrease thyroid activity. A nurse monitors for which of the following conditions that could result secondary to the treatment?
Correct Answer: Basophilia
Response Feedback: Basophilia results from antithyroid therapy.
A 15-year-old male is diagnosed with infectious mononucleosis. When the patient asks how he got this disease, how should the nurse respond? The most likely cause is:
Correct Answer: Epstein-Barr virus (EBV)
Response Feedback: Infectious mononucleosis (IM) is an acute infection of B lymphocytes (B cells) with EBV.
A 15-year-old male with infectious mononucleosis is being given instructions on how to prevent the spread of this infection to others. Which statement represents a correct instruction?
Correct Answer: Do not share drinking glasses or eating utensils.
Response Feedback: Transmission of mononucleosis is usually through saliva from close personal contact. The virus also may be secreted in other mucosal secretions of the genital, rectal, and respiratory tract, as well as blood.
A 10-year-old male is diagnosed with leukemia. The nurse assesses for which other condition that could be associated with his disease?
Correct Answer: Down syndrome
Response Feedback: There is also an increased incidence of leukemia in association with other hereditary abnormalities such as Down syndrome.
A 5-year-old female is diagnosed with acute leukemia. The nurse will most likely treat this patient with:
Correct Answer: Chemotherapy
Response Feedback: Chemotherapy, used in various combinations, is the treatment of choice for leukemia.
An oncologist is discussing multiple myeloma. Which information should the oncologist include? Multiple myeloma can be defined as a neoplasm of:
Correct Answer: B cells
Response Feedback: Multiple myeloma is a B cell cancer.
A 65-year-old male is diagnosed with multiple myeloma. He reports severe pain. This pain can be attributed to:
Correct Answer: Destruction of bone tissue
Response Feedback: Multiple myeloma is a B cell cancer characterized by the proliferation of malignant plasma cells that infiltrate the bone marrow and aggregate into tumor masses throughout the skeletal system; thus, the pain is related to bone destruction.
A 35-year-old female is diagnosed with lymphadenopathy. Which assessment finding will help confirm this diagnosis?
Correct Answer: Enlarged lymph nodes
Response Feedback: Lymphadenopathy is evidenced by enlarged lymph nodes.
A 35-year-old male has enlarged lymph nodes in the neck and a mediastinal mass. He was diagnosed with Hodgkin lymphoma. Which of the following abnormal cells would the nurse expect to find with this disease?
Correct Answer: Reed-Sternberg cell
Response Feedback: Hodgkin lymphoma is manifested by Reed-Sternberg cells.
The people from which country have the lowest risk for Hodgkin lymphoma?
Correct Answer: Japan
Response Feedback: Japan has the lowest rate of Hodgkin lymphoma.
A 62-year-old female tells her health care provider she has been experiencing regular night sweats that cause her to wake up drenched. She also remarks that she has been unintentionally losing weight. Physical exam reveals enlarged lymph nodes on her neck that do not appear to be painful. She should be screened for which of the following cancers?
Correct Answer: Hodgkin lymphoma
Response Feedback: The patient has symptoms of Hodgkin lymphoma. About a third of individuals will have some degree of systemic symptoms. Intermittent fever, without other symptoms of infection, drenching night sweats, itchy skin (pruritus), and fatigue are relatively common.
A 10-year-old male presents with abdominal swelling, night sweats, fever, and weight loss. He is diagnosed with Burkitt lymphoma. Upon obtaining the history, which of the following is the most likely cause?
Correct Answer: Epstein-Barr virus (EBV)
Response Feedback: EBV is associated with almost all cases of Burkitt lymphoma.
For a patient experiencing hypersplenism, the nurse expects the erythrocytes to be:
Correct Answer: Sequestered
Response Feedback: Hypersplenism results in sequestering of the blood cells.
Thrombocytopenia may be:
Correct Answer: Congenital or acquired
Response Feedback: The condition may also be either congenital or acquired and may be either primary or secondary to other conditions.
A 30-year-old female presents with hematuria, menorrhagia, and bleeding gums. She is diagnosed with immune thrombocytic purpura (ITP). A nurse realizes the most likely cause is:
Correct Answer: Antibody destruction of platelets
Response Feedback: The majority of cases of ITP are due to immune driven destruction of platelets.
A 50-year-old female is diagnosed with primary thrombocythemia. A nurse would expect the blood smear to reveal _____ platelets.
Correct Answer: Overproduced
Response Feedback: Thrombocythemia is characterized by a platelet count more than 400,000 platelets/mm3 of blood and is symptomatic when the count exceeds 1,000,000/ mm3, at which time the risk for intravascular clotting (thrombosis) is high
A 52-year-old male IV drug user was diagnosed with hepatitis C 5 years ago. He is now experiencing impaired blood clotting. The nurse suspects a decrease in which of the following vitamins?
Correct Answer: K
Response Feedback: Lack of vitamin K interferes with clotting.
A nurse checks individuals with liver disease for clotting problems because:
Correct Answer: Clotting factors are produced in the liver.
Response Feedback: Clotting factors are produced by the liver.
A 40-year-old female develops disseminated intravascular coagulation (DIC). Upon obtaining the history, which finding is the most likely cause of this condition?
Correct Answer: Sepsis
Response Feedback: Sepsis is one of the most common conditions associated with DIC.
A nurse is teaching the staff about disseminated intravascular coagulation (DIC). Which information should the nurse include? The sequence of events in DIC is initiated by the release of:
Correct Answer: Clotting factors are depleted.
Response Feedback: Intravascular clotting leads to depletion of clotting factors.
A 22-year-old female just delivered a healthy baby girl. She suffered from eclampsia during her pregnancy, and on the second postpartum day she complained of bleeding gums and bruising on her arms and legs. Hematology lab tests indicate that she had disseminated intravascular coagulation (DIC). Further review of lab tests by the nurse revealed an increase in:
Correct Answer: Fibrin degradation products (FDPs)
Response Feedback: Patients with DIC have high levels of FDPs.
When the nurse sees a diagnosis of hereditary hemochromatosis on the chart, the nurse knows this is a disorder of:
Correct Answer: Iron overload
Response Feedback: Iron overload can be primary, as in hereditary hemochromatosis.
A patient has microcytic hypochromic anemia. Which of the following pathogenic mechanisms may cause anemia in this patient? (Select all that apply.)
Correct Answers: Decreased erythrocyte life span, Failure of mechanisms of compensatory erythropoiesis, Disturbances of the iron cycle
Response Feedback: Causes of microcytic hypochromic anemia are decreased erythrocyte life span, failure of mechanisms of compensatory erythropoiesis, or disturbance of the iron cycle. Increased metabolic rate and swelling of tissues does not lead to anemia.
A 22-year-old female just delivered a healthy baby girl. She suffered from eclampsia during her pregnancy, and on the second postpartum day she complained of bleeding gums and bruising on her arms and legs. Hematology lab tests indicate that she had disseminated intravascular coagulation (DIC). Further review of lab tests by the nurse revealed an increase in:
Correct Answer: Fibrin degradation products (FDPs)
Response Feedback: Patients with DIC have high levels of FDPs.
A 15-year-old male is diagnosed with infectious mononucleosis. Which of the following assessment findings would he most likely demonstrate? (Select all that apply.)
Correct Answers: Lymph node enlargement, Fever and sore throat, Fatigue, Enlargement of liver and spleen
Response Feedback: At the time of diagnosis, the individual commonly presents with the classic group of symptoms: fever, sore throat, cervical lymph node enlargement, and fatigue; generalized lymph node enlargement also may develop, as well as enlargement of the spleen and liver.
A patient wants to know about risk factors for acute leukemia. Which of the following should the nurse include? (Select all that apply.)
Correct Answers: Chemotherapy treatment for other cancers, Excessive ultraviolet radiation exposure, Ovarian cancer
Response Feedback: Hepatitis C or HIV can predispose the patient to leukemia, not CMV. Drugs that cause bone marrow depression, such as chemotherapeutic agents, predispose an individual to leukemia; eating genetically modified food is not a predisposing factor. Excessive ultraviolet radiation exposure can predispose an individual to myelogenous leukemia. Acute leukemia also may develop secondary to certain acquired disorders, including ovarian cancer.
A 35-year-old male was diagnosed with hepatitis B. Further tests revealed neutropenia characterized by a neutrophil count less than _____ per milliliter.
Correct Answer: 2000
A nurse realizes a patient has thrombocytopenia when the platelet count is below _____ platelets per cubic millimeter.
Correct Answer: 100,000
A 1-year-old female is diagnosed with anemia secondary to insufficient erythropoiesis. When the parents asked what caused this, how should the nurse respond? The most likely cause(s) is (are):
Correct Answer: An iron deficiency
Response Feedback: The most common cause of insufficient erythropoiesis is iron deficiency.
A 12-month-old toddler weighing 18 pounds is brought to the clinic because of weakness, slow physical growth, and developmental delays. His mother reports that the only food he will consume is cow's milk. Considering this information, the nurse decides that the child probably has _____ anemia.
Correct Answer: Iron deficiency
Response Feedback: As many as one-third of infants with severe iron deficiency anemia have chronic intestinal blood loss induced by exposure to a heat-labile protein in cow's milk. Such exposure causes an inflammatory gastrointestinal reaction that damages the mucosa and results in diffuse hemorrhage.
A 16-month-old female presents with tachycardia, pallor, anorexia, and systolic murmur. The nurse is checking the lab results, and the hemoglobin determination indicates a level below _____ g/dL.
Correct Answer: 5
Response Feedback: When hemoglobin levels fall below 5 g/dL, pallor, anorexia, tachycardia, and systolic murmurs may occur.
Which mother is at most risk for a maternal-fetal blood incompatibility?
Correct Answer: Mother is Rh-negative, and fetus is Rh-positive.
Response Feedback: Maternal-fetal incompatibility exists if mother and fetus differ in ABO blood type or if the fetus is Rh-positive and the mother is Rh-negative.
A 22-year-old female gives birth at 20 weeks' gestation to a stillborn fetus. Physical exam of the fetus by the nurse reveals gross edema of the entire body and anemia. This condition is referred to as:
Correct Answer: Hydrops fetalis.
Response Feedback: Fetuses that do not survive anemia in utero usually are stillborn, with gross edema in the entire body, a condition called hydrops fetalis.
Sickle cell disease is characterized by the presence of Hb S. A nurse is trying to differentiate between Hb S and normal Hb. Which of the following amino acids is present in Hb S and not present in normal Hb?
Correct Answer: Valine
Response Feedback: Hb S is formed by a genetic mutation in which one amino acid (valine) replaces another (glutamic acid).
A 10-year-old male is diagnosed with sickle cell anemia. When the parents ask who is responsible for this disease, what is the nurse's best response? He most likely inherited it from:
Correct Answer: Both his mother and father
Response Feedback: Sickle cell is a recessive disorder inherited from both parents.
In the United States, which group of people should be assessed first for sickle cell disease?
Correct Answer: African-Americans
Response Feedback: In the United States, sickle cell disease is most common in African-Americans.
A 25-year-old female has a child that is diagnosed with sickle cell anemia. She does not have the disease. Which of the following characterizes the genetic makeup of the parents with regard to this trait?
Correct Answer: Hb S and Hb A
Response Feedback: In this instance the child inherits Hb S from one parent and normal hemoglobin (Hb A), not Hb S, for both.
When should the nurse start closely monitoring the patient with sickle cell anemia? If:
Correct Answer: Oxygen tension is low
A 12-year-old male is diagnosed with sickle cell anemia. A blood smear reveals severely sickled cells. A nurse recalls the sickled cells will be removed from circulation mostly by the:
Correct Answer: Spleen
Response Feedback: Sickled cells undergo hemolysis in the spleen or become sequestered there, causing blood pooling and infarction of splenic vessels.
Which major symptom in a patient with sickle cell anemia indicates to the nurse, the patient is experiencing a vaso-occlusive crisis?
Correct Answer: Pain
Response Feedback: Vaso-occlusive crisis is extremely painful and may last for days or even weeks, with an average duration of 4 to 6 days.
For which type of sickle cell crisis should the nurse assess for in young children?
Correct Answer: Sequestration crisis
Response Feedback: Sequestration occurs when large amounts of blood become acutely pooled in the liver and spleen. This type of crisis is seen only in a young child.
A 6-year-old male presents with fatigue, jaundice, and irritability. A blood smear shows the presence of sickled cells. Erythropoiesis is compromised in this child; which crisis should the nurse monitor the patient for?
Correct Answer: Aplastic crisis
Response Feedback: Aplastic anemia is caused by diminished erythropoiesis despite an increased need for new erythrocytes.
A 5-year-old female dies from sickle cell disease. The pediatrician will document the most likely cause of death is:
Correct Answer: Infection
Response Feedback: Infection is the most common cause of death related to sickle cell disease.
A geneticist is discussing thalassemias. Which information should be included? The alpha and beta thalassemias are inherited in an _____ fashion.
Correct Answer: Autosomal recessive
Response Feedback: The alpha and beta thalassemias are inherited autosomal recessive disorders.
A 2-year-old male presented with growth and maturation retardation and splenomegaly. He died shortly after arriving at the ER. Autopsy revealed thalassemia secondary to defective:
Correct Answer: Hemoglobin synthesis
Response Feedback: Thalassemia would be secondary to defective hemoglobin synthesis.
A 38-year-old female gives birth to a stillborn fetus. Autopsy reveals cardiomegaly, hepatomegaly, edema, and ascites. Which of the following does the nurse suspect caused the death?
Correct Answer: Alpha thalassemia major
Response Feedback: Alpha thalassemia major causes hydrops fetalis and fulminant intrauterine congestive heart failure. In addition to edema and massive ascites, the fetus has a grossly enlarged heart and liver.
If an infant has hydrops fetalis, which type of thalassemia does the nurse suspect?
Correct Answer: Alpha major
Response Feedback: Hydrops fetalis is due to alpha thalassemia major.
The mother of a 3-year-old child speaks to the pediatrician because the child took several hours to stop bleeding following a minor scrape. Testing reveals that the child has hemophilia A resulting from a deficiency in factor:
Correct Answer: VIII
Response Feedback: Hemophilia A is a deficiency in factor VIII.
A nurse wants to chart the other name for hemophilia B. Which term should the nurse write?
Correct Answer: Christmas disease
Response Feedback: Hemophilia B is also known as Christmas disease.
A 3-year-old child presents with bruising on the legs and trunk and a petechial rash. The mother also reports frequent nosebleeds. Lab tests reveal a decreased platelet count. Which is the most likely diagnosis the nurse will see documented on the chart?
Correct Answer: Idiopathic thrombocytopenic purpura (ITP)
Response Feedback: A decreased platelet count is the cause of ITP.
A 5-year-old male is diagnosed with idiopathic thrombocytic purpura (ITP). Which information should the nurse give the staff regarding the cause of this condition?
Correct Answer: Virally induced antibody destruction of platelets
Response Feedback: In approximately 70% of cases of ITP, there is an antecedent viral disease.
Which of the following clusters of symptoms would lead the nurse to suspect a child has idiopathic thrombocytopenic purpura (ITP)?
Correct Answer: Spontaneous nosebleeds, bruising, petechiae
Response Feedback: Nosebleeds, bruising, and petechiae are signs of a lack of clotting due to low platelets and ITP.
A 1-year-old is diagnosed with idiopathic thrombocytopenic purpura (ITP). The nurse assesses for the most serious concern, which is development of:
Correct Answer: Intracranial bleeding
Response Feedback: Although the incidence is less than 1%, intracranial hemorrhage is the most serious complication of ITP.
A nurse monitors for the most common childhood cancer, which is:
Correct Answer: Acute lymphoblastic leukemia (ALL)
Response Feedback: Approximately 80% to 85% of leukemias in children are ALL.
A 10-year-old male with Down syndrome undergoes chemotherapy for cancer. Following treatment, monitoring for which condition is priority?
Correct Answer: Acute myelogenous leukemia (AML)
Response Feedback: AML is attributable to prior chemotherapy.
A 10-year-old female is diagnosed with a malignancy in the brain and lung. DNA analysis reveals translocation at chromosome 7 and 14. The most likely medical diagnosis the primary care provider will make is:
Correct Answer: Lymphoblastic non-Hodgkin lymphoma (NHL)
Response Feedback: Lymphoblastic NHL shows chromosomal translocations, particularly chromosomes 7 and 14.
Which condition makes the patient most prone for developing non-Hodgkin lymphoma (NHL)?
Correct Answer: AIDS
Response Feedback: Children with AIDS have an increased risk of developing NHL.
What is a priority assessment for Hodgkin lymphoma in children?
Correct Answer: Painless adenopathy in cervical nodes
Response Feedback: Painless adenopathy in the lower cervical chain, with or without fever, is the most common symptom in children with Hodgkin lymphoma.
Which laboratory test will assist the nurse in identifying infants who are prone to develop hemolytic disease of the newborn (HDN)?
Correct Answer: Coombs
Response Feedback: Routine evaluation of fetuses at risk for HDN includes the Coombs test.
A nurse is planning care for a child with iron deficiency anemia. Characteristics of iron deficiency anemia include which of the following? (Select all that apply.)
Correct Answers: It is most common between the ages of 6 months and 2 years, It may be related to socioeconomic factors, It is difficult to diagnose in early stages.
Iron deficiency anemia is the most common blood disorder of infancy and childhood, with the highest incidence occurring between 6 months and 2 years of age. Incidence is not related to gender or race, but socioeconomic factors are important because they affect nutrition. The symptoms of mild anemia—listlessness and fatigue—usually are not present or are undetectable in infants and young children who are unable to describe these symptoms. Therefore, parents generally do not note any change in the child's behavior or appearance until moderate anemia has developed.
A 5-year-old male is diagnosed with leukemia. Which of the following symptoms would the nurse expect? (Select all that apply.)
Correct Answers: Fatigue, Pallor, Petechiae
Response Feedback: Pallor, fatigue, petechiae, purpura, bleeding, and fever generally are present. Jaundice is not.
A 60-year-old male presents to his primary care provider reporting chest pain. He is diagnosed with atherosclerosis. This disease is caused by:
Correct Answer: Abnormal thickening and hardening of vessel walls
Response Feedback: Atherosclerosis is a form of arteriosclerosis characterized by thickening and hardening of the vessel wall.
A patient wants to know what causes atherosclerosis. How should the nurse respond? In general, atherosclerosis is caused by:
Correct Answer: Endothelial injury and inflammation
Response Feedback: Atherosclerosis begins with injury to the endothelial cells that line artery walls.
A staff member asks a nurse what foam cells are. What is the nurse's best response? Foam cells in a fatty streak are:
Correct Answer: Macrophages that engulf low-density lipoprotein (LDL)
Response Feedback: Foam cells are lipid-laden macrophages that engulf LDL.
A nurse takes an adult patient's blood pressure and determines it to be normal. What reading did the nurse obtain?
Correct Answer: Systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg
Response Feedback: Normal blood pressure has a systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg. A systolic pressure of 140 mm Hg or more would indicate stage I hypertension. A systolic pressure of less than 100 mm Hg would indicate low blood pressure. A diastolic pressure greater than 90 mm Hg would indicate hypertension.
Most cases of combined systolic and diastolic hypertension have no known cause and are documented on the chart as _____ hypertension.
Correct Answer: Primary
Response Feedback: Most cases of hypertension are diagnosed as primary hypertension.
A 30-year-old Caucasian female was recently diagnosed with primary hypertension. She reports that she eats fairly well, usually having red meat and potatoes daily. She also reports that her father has hypertension as well. A nurse determines which of the following risk factors is most likely associated with this diagnosis?
Correct Answer: Genes
Response Feedback: Genetic factors, such as family history of hypertension, are the number one factor in the development of hypertension.
A 65-year-old male presents for a routine checkup. A blood pressure check reveals a systolic pressure of 160 mm Hg and a diastolic pressure of 70 mm Hg. Which of the following is the most likely cause of this type of pressure elevation?
Correct Answer: Rigidity of the aorta
Response Feedback: Older adults experience stiffening of the arteries, which could lead to hypertension. A vasospasm could lead to chest pain, not hypertension. Increased sodium intake, not decreased, could lead to increased blood volume and hypertension. Lung disease would not lead to hypertension.
A 52-year-old male is diagnosed with primary hypertension. He has no other health problems. Present treatment would cause the nurse to anticipate administering which drug to the patient?
Correct Answer: A diuretic
Response Feedback: Diuretics have been shown to be the safest and most effective medications for lowering blood pressure and preventing the cardiovascular complications of hypertension.
A 55-year-old female has undiagnosed hypertension. She presents to her primary care provider reporting impaired vision and chronic edema. Lab tests reveal that she also has renal insufficiency. While planning care, the nurse realizes the most likely cause for these findings is:
Correct Answer: End-organ damage
Response Feedback: The patient is experiencing end-organ damage, as indicated by renal insufficiency.
A nurse monitors the patient for _____ when rapid onset of malignant hypertension results.
Correct Answer: Encephalopathy
Response Feedback: Malignant hypertension leads to cerebral edema and cerebral dysfunction (encephalopathy) and even death.
When a nurse checks the patient for orthostatic hypotension, what did the nurse have the patient do?
Correct Answer: Stand up
Response Feedback: Orthostatic hypotension refers to a drop in blood pressure when standing up.
A 50-year-old male is diagnosed with orthostatic hypotension. Which of the following symptoms would he most likely experience?
Correct Answer: Syncope and fainting
Response Feedback: Orthostatic hypotension is often accompanied by dizziness, blurring or loss of vision, and syncope or fainting.
A 65-year-old female presents to the emergency department reporting difficulty swallowing and shortness of breath. A CT scan would most likely reveal an aneurysm in the:
Correct Answer: Thoracic aorta
Response Feedback: Thoracic aortic aneurysms can cause dysphagia (difficulty swallowing) and dyspnea (breathlessness).
A 60-year-old male is diagnosed with cerebral aneurysm. Where does the nurse suspect the cerebral aneurysm is located?
Correct Answer: Circle of Willis
Response Feedback: Cerebral aneurysms often occur in the circle of Willis.
What term should the nurse document for a detached blood clot?
Correct Answer: Thromboembolus
Response Feedback: A detached thrombus is a thromboembolus.
A 32-year-old female presents with lower leg pain, with swelling and redness. While obtaining the patient's history, which finding could have caused her condition?
Correct Answer: Venous thrombus
Response Feedback: A thrombus formation in the vein leads to inflammation that may cause pain and redness with obstruction. Increased pressure in the vein behind the clot may lead to edema of the extremity.
A 28-year-old female presents with severe chest pain and shortness of breath. She is diagnosed with pulmonary embolism, which most likely originated from the:
Correct Answer: Deep veins of the leg
Response Feedback: The most likely origin of the embolism is from the deep veins of the legs.
Individuals with Raynaud disease need to be counseled to avoid which of the following conditions to prevent severe symptoms?
Correct Answer: Cold exposure
Response Feedback: Raynaud disease consists of vasospastic attacks triggered by brief exposure to cold.
A 75-year-old obese female presents to her primary care provider reporting edema in the lower extremities. Physical exam reveals that she has varicose veins. Upon performing the history, which of the following is a possible cause for the varicose veins?
Correct Answer: Long periods of standing
Response Feedback: The probable cause of the patient's varicose veins is gradual venous distention caused by the action of gravity on blood in the legs due to long periods of standing. Varicose veins are most likely due to long periods of standing leading to the action of gravity promoting venous distention. Exercise would help prevent this. Trauma can occur, but usually this affects the more superficial veins. Ischemia affects arteries not veins.
A 52-year-old male presents with pooling of blood in the veins of the lower extremities and edema. The diagnosis is chronic venous insufficiency, and an expected assessment finding of this disorder is:
Correct Answer: Skin hyperpigmentation
Response Feedback: Symptoms include edema of the lower extremities and hyperpigmentation of the skin of the feet and ankles. Edema in these areas may extend to the knees. Symptoms include edema and hyperpigmentation of the skin, but deep vein thrombi do not form.Gangrene does not occur in veins, but in arteries. Edema does not occur above the knee.
While planning care for a patient with superior vena cava syndrome (SVCS), which principle should the nurse remember? SVCS is a progressive _____ of the superior vena cava (SVC) that leads to venous distention of the upper extremities and head.
Correct Answer: Occlusion
Response Feedback: SVCS is a progressive occlusion of the SVC that leads to venous distention in the upper extremities and head.
A 50-year-old male with a 30-year history of smoking was diagnosed with bronchogenic cancer. He developed edema and venous distention in the upper extremities and face. Which of the following diagnosis will the nurse observe on the chart?
Correct Answer: Superior vena cava syndrome (SVCS)
Response Feedback: SVCS is a progressive occlusion of the superior vena cava that leads to venous distention in the upper extremities and head.
A 52-year-old female is diagnosed with coronary artery disease. The nurse assesses for myocardial:
Correct Answer: Ischemia
Response Feedback: Coronary artery disease leads to myocardial ischemia.
A 56-year-old male is diagnosed with coronary artery disease. Which of the following modifiable risk factors would the nurse suggest the patient change?
Correct Answer: Smoking cigarettes
Response Feedback: Cigarette smoking leads to vasoconstriction and should be the first behavior the patient changes.
A 50-year-old obese male with hypertension and coronary artery disease visits a nutritionist for food counseling. He has an elevated level of low-density lipoprotein (LDL) and a low level of high-density lipoprotein (HDL). Which of the following should the nurse advise him to avoid?
Correct Answer: Trans fats
Response Feedback: Trans fats are primarily found in artificially solidified (hydrogenated) oils (e.g., margarine and vegetable shortening). By becoming more solid, they lose essential fatty acids (EFAs). They can raise LDL and lower HDL levels.
When a patient asks the nurse what is the most common cause of myocardial ischemia, which statement is the correct response? The most common cause of myocardial ischemia is:
Correct Answer: Atherosclerosis
Response Feedback: The most common cause of myocardial ischemia is atherosclerosis.
A 51-year-old male presents with recurrent chest pain on exertion. He is diagnosed with angina pectoris. When he asks what causes the pain, how should the nurse respond? The pain occurs when:
Correct Answer: The myocardial oxygen supply has fallen below demand.
Response Feedback: Angina is chest pain caused by myocardial ischemia, which develops if the flow or oxygen content of coronary blood is insufficient to meet the metabolic demands of myocardial cells.
A 62-year-old male presents to his primary care provider reporting chest pain at rest and with exertion. He does not have a history of coronary artery disease and reports that the pain often occurs at night. He is most likely experiencing which type of angina?
Correct Answer: Prinzmetal
Response Feedback: Chest pain that occurs at rest and at night is descriptive of Prinzmetal angina. Unstable angina is a form of acute coronary syndrome that results from reversible myocardial ischemia. Stable angina is predictable and occurs with activity. Silent angina has few, if any, symptoms.
A 51-year-old male is at the health clinic for an annual physical exam. After walking from the car to the clinic, he developed substernal pain. He also reported discomfort in his left shoulder and his jaw, lasting 2 to 3 minutes and then subsiding with rest. He indicates that this has occurred frequently over the past few months with similar exertion. The nurse suspects he is most likely experiencing:
Correct Answer: Stable angina
Response Feedback: Stable angina is associated with activity and subsides with rest.
A 49-year-old male presents to his primary care provider reporting chest pain. EKG reveals ST elevation. He is diagnosed with myocardial ischemia. Which of the following interventions would be most beneficial?
Correct Answer: Apply oxygen to increase myocardial oxygen supply.
Response Feedback: Increase myocardial oxygen supply is indicated to treat ischemia.
A 68-year-old male presents to the ER reporting chest pain. He has a history of stable angina that now appears to be unstable. He most likely has:
Correct Answer: Impending myocardial infarction (MI)
Response Feedback: Unstable angina is an indication of impending MI.
A 55-year-old male died of a myocardial infarction. Autopsy would most likely reveal:
Correct Answer: Platelet aggregation within the atherosclerotic coronary artery
A 60-year-old female had a myocardial infarction. She was brought to the hospital 30 minutes later. She survived, but now the nurse is providing care for impaired ventricular function because:
Correct Answer: The resulting ischemia leads to hypoxic injury and myocardial cell death.
Response Feedback: The patient has impaired ventricular functioning because a portion of the myocardium has died due to ischemia.
A 75-year-old male has severe chest pain and dials 911. Lab tests at the hospital reveal elevated levels of cardiac troponins I and T. Based upon the lab findings, the nurse suspects which of the following has occurred?
Correct Answer: Myocardial infarction (MI)
Response Feedback: The diagnosis of acute MI is made on the basis of serial cardiac biomarker alterations. The cardiac troponins (troponins I and T) are the most specific indicators of MI.
A 28-year-old female presents to the ER reporting severe chest pain that worsens with respirations or lying down. She has a fever, tachycardia, and a friction rub. Based upon the assessment findings, the nurse determines the patient is experiencing:
Correct Answer: Acute pericarditis
Response Feedback: Severe chest pain that worsens with respirations or lying down in a patient with fever, tachycardia, and a friction rub is characteristic of acute pericarditis.
A 56-year-old male presents to his primary care provider for a checkup. Physical exam reveals edema, hepatomegaly, and muffled heart sounds. Which of the following is of greatest concern to the nurse?
Correct Answer: Tamponade
Response Feedback: Muffled heart sounds is an indication of tamponade, and with tamponade the blood backs up into the venous system, leading to hepatomegaly.
A 42-year-old female is diagnosed with constrictive pericarditis. The nurse assesses the blood pressure for decreased cardiac output because of:
Correct Answer: Fibrosis and calcification of the pericardial layers
Response Feedback: In constrictive pericarditis, fibrous scarring compresses the heart and eventually reduces cardiac output.
Many valvular stenosis and regurgitation disorders in adults have a common etiology. Which of the following conditions should alert the nurse that the patient may have both types of valve dysfunction?
Correct Answer: Rheumatic fever or heart disease
Response Feedback: Valvular dysfunction is often related to rheumatic fever.
While planning care, the nurse remembers which principle? In valvular _____, the valve opening is constricted and narrowed because the valve leaflets, or cusps, fail to open completely.
Correct Answer: Stenosis
Response Feedback: Valvular stenosis occurs when the valve opening is constricted and narrowed.
A 67-year-old female was previously diagnosed with rheumatic heart disease. Tests reveal lipoprotein deposition with chronic inflammation that impairs blood flow from the left ventricle into the aorta. Which of the following is the most likely diagnosis recorded on the chart?
Correct Answer: Aortic stenosis
Response Feedback: Aortic stenosis would impair blood flow from the left ventricle to the aorta.
A 60-year-old female was diagnosed with mitral stenosis. As a result, the nurse realizes the patient has incomplete emptying of the:
Correct Answer: Left atrium
Response Feedback: Mitral stenosis would result in incomplete emptying of the left atrium, as the mitral valve is located between the left atrium and left ventricle.
A 72-year-old female has a history of hypertension and atherosclerosis. An echocardiogram reveals backflow of blood into the left ventricle. Which of the following is the most likely diagnosis documented on the chart?
Correct Answer: Aortic regurgitation
Response Feedback: Aortic regurgitation would allow backward flow of blood into the left ventricle.
Upon assessment of the patient, the nurse finds a widened pulse pressure and throbbing peripheral pulses. Which valve disorder does the nurse suspect?
Correct Answer: Aortic regurgitation
Response Feedback: Aortic regurgitation is manifested by widened pulse pressure resulting from increased stroke volume and diastolic backflow.
A 35-year-old male presents with pulmonary hypertension. Testing reveals he is in right heart failure. Which of the following is the most likely diagnosis the nurse will see listed on the chart?
Correct Answer: Tricuspid regurgitation
Response Feedback: Tricuspid regurgitation leads to volume overload in the right atrium and ventricle, increased systemic venous blood pressure, and right heart failure.
A nurse recalls the most common cardiac valve disease in the United States, which tends to be most prevalent in young women, is:
Correct Answer: Mitral valve prolapse
Response Feedback: Mitral valve prolapse is the most common valve disorder in the United States.
A 10-year-old male presents with fever, lymphadenopathy, arthralgia, and nose bleeds. He is diagnosed with rheumatic heart disease. When a staff member asks what caused the disease, what is the nurse's most correct response? The most likely cause of this disease is:
Correct Answer: Group A β-hemolytic streptococcus infections
Response Feedback: Rheumatic fever is a systemic, inflammatory disease caused by a delayed exaggerated immune response to infection by the group A β-hemolytic streptococcus.
A 10-year-old male presents with fever, lymphadenopathy, arthralgia, and nose bleeds. He is diagnosed with rheumatic heart disease. While planning care, which characteristic changes should the nurse remember?
Correct Answer: Antigens that bind to the valvular lining, triggering an autoimmune response
Response Feedback: The immune response cross-reacts with molecularly similar self-antigens in heart, muscle, joints, and the brain, causing an autoimmune response resulting in diffuse, proliferative, and exudative inflammatory lesions in these tissues.
A 30-year-old female presents to her primary care provider with fever, cardiac murmur, and petechial skin lesions. She is diagnosed with infective endocarditis. When the patient wants to know what caused the disease, what is the nurse's best response? The most likely cause of the disease is:
Correct Answer: Bacteria
Response Feedback: Infective carditis is due to a bacterial infection
A nurse is teaching staff about endocarditis. Which information should the nurse include? Inflammatory cells have difficulty limiting the colonization of microorganisms in infective endocarditis because the:
Correct Answer: Microorganisms are sequestered in a fibrin clot.
Response Feedback: In endocarditis, bacterial colonies are inaccessible to host defenses because they are embedded in the protective fibrin clots.
A 50-year-old male visits the cardiologist for an EKG. Results indicate that he has no PR interval and a variable QRS rate with rhythm irregularity. Which of the following is the most likely diagnosis to be recorded on the chart?
Correct Answer: Atrial fibrillation
Response Feedback: Atrial fibrillation is characterized by no PR interval and a variable QRS response.
Which characteristic changes should the nurse keep in mind while caring for a patient with left heart failure? As left heart failure progresses:
Correct Answer: Left ventricular preload increases.
Response Feedback: Left ventricular preload increases in left heart failure because less blood is ejected from the left ventricle.
A 65-year-old male with a history of untreated hypertension is now experiencing left heart failure. A nurse recalls his untreated hypertension led to:
Correct Answer: Myocardial hypertrophy and ventricular remodeling
Response Feedback: With hypertension comes increased afterload and resistance to ventricular emptying and more workload for the ventricle, which responds with hypertrophy of the myocardium and ventricular remodeling.
A 59-year-old female is diagnosed with left ventricular failure. If a decrease in kidney perfusion occurs, the nurse knows this would ultimately cause:
Correct Answer: Increased systemic vascular resistance
Response Feedback: With a decrease in kidney perfusion, renin is released with the ultimate outcome of increased systemic vascular resistance to raise blood pressure to increase blood flow to the kidney.
A 68-year-old female is experiencing left heart failure. Physical exam reveals elevated blood pressure. The nurse understands this is most likely caused by:
Correct Answer: Sympathetic nervous system compensation for decreased cardiac output
Response Feedback: The sympathetic nervous system increases peripheral vascular resistance (PVR) and leads to hypertension.
When a patient with left heart failure starts to have a cough and dyspnea, which principle should the nurse remember? Pulmonary symptoms, common to left heart failure, are a result of:
Correct Answer: Pulmonary vascular congestion
Response Feedback: The clinical manifestations of left heart failure are the result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation.
A 73-year-old female has increased pulmonary pressure resulting in right heart failure. The nurse should monitor for a possible complication because a potential cause for her heart to fail is:
Correct Answer: Left heart failure
Response Feedback: Right-sided failure often follows left-sided failure when pulmonary congestion forces backward flow of blood into the left ventricle.
65-year-old male is diagnosed with chronic pulmonary disease and elevated pulmonary vascular resistance. Which of the following heart failures should the nurse assess for in this patient?
Correct Answer: Right heart failure
Response Feedback: Right-sided failure occurs when the patient experiences chronic pulmonary disease and elevated pulmonary vascular resistance because the blood has difficulty overcoming the pressure and blood builds up in the right side of the heart.
A 72-year-old female has a history of right heart failure caused by a right ventricular myocardial infarction. Which of the following symptoms are specifically related to her right heart failure?
Correct Answer: Significant edema to both lower legs and feet
Response Feedback: Right-sided failure allows blood to back up into the systemic circulation, leading to peripheral edema.
Which condition should cause the nurse to assess for high-output failure in a patient?
Correct Answer: Anemia
Response Feedback: Common causes of high-output failure include anemia.
When a person is in shock, a nurse remembers impairment in cellular metabolism is caused by:
Correct Answer: Inadequate tissue perfusion
Response Feedback: In shock, impaired cellular metabolism is caused by inadequate tissue perfusion.
One consequence of switching from aerobic to anaerobic cellular metabolism during shock states is:
Correct Answer: Decreased adenosine triphosphate (ATP) production
Response Feedback: Anaerobic metabolism leads to decreased ATP production.
A nurse is planning care for a patient in shock. Which principle should the nurse remember? During shock states, glucose uptake is usually:
Correct Answer: Impaired
Response Feedback: Some compensatory mechanisms activated by shock contribute to decreased glucose uptake by the cells.
A 50-year-old male was admitted to the intensive care unit with a diagnosis of acute myocardial infarction (MI). He is being treated for shock. His cardiopulmonary symptoms include low blood pressure, tachycardia, and tachypnea. His skin is pale and cool. The primary cause of his shock is most likely:
Correct Answer: Decreased cardiac contractility
Response Feedback: MI leads to decreased cardiac contractility due to a damaged myocardium and would lead to shock.
An 82-year-old female was admitted to the hospital with confusion and severe hypotension. Her body's compensatory mechanisms are increased heart rate, vasoconstriction, and movement of large volumes of interstitial fluid to the vascular compartment. What kind of shock does the nurse suspect the patient is experiencing?
Correct Answer: Hypovolemic
Response Feedback: In hypovolemic shock, heart rate and SVR increase, boosting both cardiac output and tissue perfusion pressures. Interstitial fluid moves into the vascular compartment.
A 27-year-old male is admitted to a neurologic unit with a complete C-5 spinal cord transection. On initial assessment, he is bradycardic, hypotensive, and hyperventilating. He appears to be going into shock. The most likely mechanism of his shock is:
Correct Answer: Vasodilation caused by a decrease in sympathetic stimulation
Response Feedback: The patient is experiencing neurogenic shock in which blood volume has not changed, but SVR decreases drastically so that the amount of space containing the blood has increased, leading to hypotension.
What factors make a patient prone to neurogenic shock? Neurogenic shock can be caused by any factor that inhibits the:
Correct Answer: Sympathetic nervous system
Response Feedback: Neurogenic shock is caused by any factor that inhibits the sympathetic nervous system.
A 15-year-old male who is allergic to peanuts eats a peanut butter cup. He then goes into anaphylactic shock. Which assessment findings will the nurse assess for?
Correct Answer: Bronchoconstriction, hives or edema, and hypotension
Response Feedback: Anaphylactic shock is characterized by bronchoconstriction, hives, and hypotension.
A nurse is teaching a patient about anaphylactic shock. Which information should the nurse include? The onset of anaphylactic shock is usually:
Correct Answer: Immediate and life threatening
Response Feedback: The onset of anaphylactic shock is usually immediate and life threatening.
For an infection to progress to septic shock, which of the following factors should the nurse determine occurred?
Correct Answer: Bacteria must enter the bloodstream.
Response Feedback: For septic shock to occur, bacteria must enter the bloodstream.
Septic shock can occur in individuals who are not immunosuppressed.
A 20-year-old female is being admitted to the hospital with fever and septic shock. Which set of assessment findings would the nurse expect the patient to exhibit?
Correct Answer: Low blood pressure, tachycardia, generalized edema
Response Feedback: Clinical manifestations of shock will include a low blood pressure and tachycardia.
The hypotensive state seen in septic shock can lead to:
Correct Answer: Gut lining disruption and the translocation of bacteria into the bloodstream
Response Feedback: Gastrointestinal mucosa changes cause the translocation of bacteria from the gut into the bloodstream.
Which patient is most prone to multiple organ dysfunction syndrome (MODS)? In a patient with:
Correct Answer: Septic shock
Response Feedback: The most common cause of MODS is septic shock.
A 75-year-old female has been critically ill with multiple organ dysfunction syndrome (MODS) for longer than a week and has developed a severe oxygen supply and demand imbalance. The statement that best describes this imbalance is which of the following?
Correct Answer: The reserve has been exhausted, and the amount of oxygen consumed depends on the amount the circulation is able to deliver.
Response Feedback: In MODS, the reserve has been exhausted and the body cannot meet the oxygenation demands.
Which organ should the nurse monitor closely since it is often the first to fail in patients with multiple organ dysfunction syndrome (MODS)?
Correct Answer: Lungs
Response Feedback: The lungs are the first to fail in MODS.
Which of the following findings in the patient with Raynaud disease would indicate a need for further teaching?
Correct Answer: The patient smokes cigarettes.
Response Feedback: Cigarette smoking should be stopped to eliminate the vasoconstricting effects of nicotine.
Which of the following lab tests will the nurse check to help diagnose heart failure and provide insight into its severity?
Correct Answer: Brain natriuretic
Response Feedback: The level of serum brain natriuretic peptide (BNP) can also help make the diagnosis of heart failure and give some insight into its severity.
A nurse recalls acute orthostatic hypotension can be caused by (select all that apply):
Correct Answers: Prolonged immobility, Drug action, Starvation, Volume depletion
Response Feedback: Acute orthostatic hypotension occurs as a result of drug action, prolonged immobility, starvation, and volume depletion. Physical exhaustion, rather than exercise, could cause orthostatic hypotension
A patient has been researching cardiac cells on the internet. Which information indicates the patient has a good understanding? Cardiac cells can withstand ischemic conditions for _____ minutes before irreversible cell injury occurs.
Correct Answer: 20
An 8-week-old infant presents to his pediatrician for a well-baby checkup. Physical exam reveals a murmur and an echocardiogram confirms a ventricular septal defect. Which of the following genetic factors should the nurse assess for as it would most likely accompany this diagnosis?
Correct Answer: Down syndrome
Response Feedback: Down syndrome is the genetic factor that would most likely accompany the diagnosis of a congenital heart defect.
A newborn child is diagnosed with tetralogy of Fallot. What symptoms would the nurse expect to observe in the child?
Correct Answer: Cyanosis and hypoxia
Response Feedback: The child will experience cyanosis and hypoxia. This type of shunt decreases flow through the pulmonary system, causing less than normal oxygen delivery to the tissues and resultant cyanosis. It will not cause a high-pitched cry.
A newborn is diagnosed with congenital heart disease. Which of the following intrauterine factors should the nurse focus on during the history that could have caused this disorder?
Correct Answer: Viral infection
Response Feedback: One of the identified causes of cardiac defects, such as pulmonic stenosis, is maternal conditions, such as intrauterine viral infections, especially rubella. Diabetes contributes to large babies; maternal infection contributes to cardiac abnormalities. Alcohol exposure contributes to abnormalities such as facial changes; maternal conditions, such as intrauterine viral infections, especially rubella, lead to congenital abnormalities. Medications such as dextroamphetamines lead to other abnormalities.
When a staff member asks what coarctation of the aorta is, how should the nurse respond? Coarctation of the aorta is the local narrowing of the aorta near the:
Correct Answer: Ductus arteriosus
Response Feedback: Coarctation of the aorta is narrowing of the aorta near the ductus arteriosus.
A newborn is suspected of having coarctation of the aorta. Which of the following assessments would aid in diagnosis?
Correct Answer: Weak or absent femoral pulses
Response Feedback: The newborn will have weak or absent femoral pulses because blood flow is obstructed near the lower extremities.
A 1-month-old infant visits his primary care provider for a well-baby check. Physical exam reveals decreased cardiac output, hypotension, tachycardia, and a loud murmur suggestive of aortic stenosis. Which of the following would be expected with this diagnosis?
Correct Answer: Ventricular hypertrophy
Response Feedback: The infant with aortic stenosis will also be experiencing ventricular hypertrophy because of the resistance of blood flow from the left ventricle into the aorta.
A newborn develops a murmur and cyanosis shortly after birth. She is diagnosed with pulmonic stenosis (PS) after an echocardiogram revealed narrowing of the pulmonary:
Correct Answer: Valve orifice
Response Feedback: PS is a narrowing or stricture of the pulmonary valve causing resistance to blood flow from the right ventricle to the pulmonary artery.
When a staff member asks what the patent opening between the aorta and pulmonary artery in a fetus is called, how should the nurse reply? It is the:
Correct Answer: Ductus arteriosus
Response Feedback: In the fetal circulation, the ductus arteriosus is an opening between the aorta and the pulmonary artery.
A 2-week-old infant presents with poor feeding, fatigue, dyspnea, and a murmur. She is diagnosed with a patent ductus arteriosus (PDA). A nurse recalls this condition results in a(n):
Correct Answer: Left-to-right shunt
Response Feedback: PDA is failure of the fetal ductus arteriosus to close. The continued patency of this vessel allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a left-to-right shunt. It could decrease systemic blood flow, not increase it.
An infant undergoes an echocardiogram for a suspected heart defect. Tests reveal an opening in the middle of the atrial septum. What term would the nurse use to describe this defect?
Correct Answer: Ostium secundum ASD
Response Feedback: An opening in the middle of the atrial septum is referred to as an ostium secundum ASD.
Which is the most common type of congenital heart defect the nurse should assess for in infants?
Correct Answer: Ventricular septal defect (VSD)
Response Feedback: The most common type of congenital heart defect is a VSD.
An 8-week-old infant presents to her primary care provider for a well-baby check. Physical exam reveals a murmur, and an echocardiogram shows a large ventricular septal defect. If left untreated, what condition should the nurse discuss with the parents?
Correct Answer: Pulmonary hypertension
Response Feedback: If the degree of shunting is significant and not corrected, the child is at risk for developing pulmonary hypertension. Cyanosis is not present at first if the shift is left to right.
The defect does not lead to valve damage.
A 22-year-old pregnant woman presents to her OB/GYN for a prenatal checkup. The heartbeat sounds irregular, and a fetal echocardiogram reveals an atrioventricular canal (AVC) defect. This defect is the result of:
Correct Answer: Fusion of the endocardial cushions
Response Feedback: AVC defect is the result of incomplete fusion of endocardial cushions.
A newborn experiences frequent periods of cyanosis, usually occurring during crying or after feeding. Which of the following is the most likely diagnosis the nurse will observe on the chart?
Correct Answer: Tetralogy of Fallot
Infants with tetralogy of Fallot experience cyanosis after crying or during feeding.
A newborn child has a murmur and cyanosis. An echocardiogram reveals that the tricuspid valve failed to develop and no blood flows between the right atrium and ventricle. What term will the nurse use to describe this condition? Tricuspid:
Correct Answer: Atresia
Response Feedback: Tricuspid atresia is failure of the tricuspid valve to develop; consequently, there is no communication from the right atrium to the right ventricle. In regurgitation, blood moves backwards, but is not obstructed. In stenosis, blood flow is narrowed, but not totally obstructed. In transposition, the two great vessels are on opposite sides.
When the pediatrician cardiologist discusses total anomalous pulmonary venous connection, which of the following statements BEST describes this condition?
Correct Answer: Pulmonary venous return is to the right atrium.
The pulmonary venous return is connected to the right side of the circulation, rather than to the left atrium.
A newborn baby is severely cyanotic. An echocardiogram reveals transposition of the great arteries. A nurse assesses for which of the following, as it usually occurs with this defect?
Correct Answer: The aorta leaving the right ventricle
Response Feedback: In transposition of the great arteries, the pulmonary artery leaves the left ventricle and the aorta exits from the right ventricle.
A 1-month-old infant was diagnosed with truncus arteriosus (TA) with a ventricular septal defect. Which of the following would the nurse also expect?
Correct Answer: Blood from both ventricles mixing in a common vessel
Response Feedback: TA is failure of normal separation and division of the embryonic outflow track into a pulmonary artery and an aorta, resulting in a single vessel that exits the heart.
A 22-year-old pregnant female presents for a fetal echocardiogram. Tests reveal small left atrium and mitral valve and an absent left ventricle and aortic valve. The diagnosis is hypoplastic left heart syndrome (HLHS). The nurse will anticipate that the treatment for this defect is:
Correct Answer: An indication for neonatal heart transplant
Response Feedback: Treatment of HLHS is heart surgery and the possibility of a heart transplant. The disorder is often fatal. Repair of the disorder requires multiple progressive surgeries. Symptoms of the disorder includes mild cyanosis, tachypnea, and low cardiac output.
A 1-year-old female with a ventricular septal defect is experiencing left-sided heart failure. Which of the following symptoms will most likely occur?
Correct Answer: Failure to thrive and periorbital edema
Response Feedback: Left heart failure in infants is manifested as poor feeding and sucking, often leading to failure to thrive and periorbital edema.
A 3-year-old male is diagnosed with Kawasaki disease. Which of the following does the nurse suspect is the most likely cause?
Correct Answer: Inflammation of the small capillaries, arteries, and veins
A 5-year-old female is found to have hypertension during three separate visits to her primary care provider. The nurse would expect tests to suggest that the hypertension is secondary to:
Correct Answer: Renal disease
Response Feedback: Hypertension in a 5-year-old is related to renal disease.
A 40-year-old pregnant woman is concerned about the health of her unborn child. She has phenylketonuria (PKU) and recently had a viral infection. If the child is born with a congenital heart defect, which of the following is the most likely based on the mother's history? (Select all that apply.)
Correct Answers: Coarctation of aorta, Patent ductus arteriosus
Response Feedback: Coarctation of the aorta and patent ductus arteriosus are the disorders found in infants of mothers with PKU.
A newborn child is diagnosed with trisomy 18. Which of the following congenital heart defects should the nurse assess for in the infant? (Select all that apply.)
Correct Answers: Patent ductus, Ventricular septal defect, Pulmonary stenosis
Response Feedback: The infant with trisomy 18 could present with a ventricular septal defect, a patent ductus, or pulmonary stenosis.
A 25-year-old female is diagnosed with urinary tract obstruction. While planning care, the nurse realizes that the patient is expected to have hydronephrosis and a decreased glomerular filtration rate caused by:
Correct Answer: dilation of the renal pelvis and calyces proximal to a blockage.
Response Feedback: Hydronephrosis occurs due to dilation of the renal pelvis and calyces proximal to a blockage.
A 27-year-old male has a severe kidney obstruction leading to removal of the affected kidney. Which of the following would the nurse expect to occur?
Correct Answer: Compensatory hypertrophy of the remaining kidney
Response Feedback: The remaining kidney would hypertrophy to compensate for the increased workload of the loss of the affected kidney.
A 55-year-old male presents reporting urinary retention. Tests reveal that he has a lower urinary tract obstruction. Which of the following is of most concern to the nurse?
Correct Answer: Formation of renal calculi
Response Feedback: Urine stasis occurs with urinary tract obstruction and can lead to the formation of renal calculi.
When a patient asks what the most common type of renal stones is composed of, how should the nurse respond? The most common type of renal stone is composed of:
Correct Answer: calcium.
Response Feedback: The most common composition of a renal stone is calcium, accounting for 70% to 80%.
While planning care for a patient with renal calculi, the nurse remembers the most important factor in renal calculus formation is:
Correct Answer: urine pH.
Response Feedback: The most important factor in renal calculus formation is urine pH.
A 24-year-old female is diagnosed with renal calculus that is causing obstruction. Which of the following symptoms would she most likely experience?
Correct Answer: Flank pain
Response Feedback: Significant flank pain is the most common manifestation.
A 25-year-old female presents with burning urination. She was diagnosed with a urinary tract infection. When the nurse checks the culture results, which of the following organisms is most likely infecting her urinary tract?
Correct Answer: Escherichia coli
A 35-year-old male received a traumatic brain injury in a motor vehicle accident. CT scan revealed a lesion above the pontine micturition center. Which of the following would the nurse expect?
Correct Answer: Detrusor hyperreflexia
Response Feedback: Neurologic disorders that develop above the pontine micturition center result in detrusor hyperreflexia, also known as an uninhibited or reflex bladder.
A 75-year-old male reports to his primary care provider loss of urine with cough, sneezing, or laughing. Which of the following is the most likely diagnosis the nurse will observe on the chart?
Correct Answer: Stress incontinence
Response Feedback: Reduced resistance is associated with the symptom of stress incontinence, which is incontinence with coughing or sneezing.
A 19-year-old female was involved in a motor vehicle accident during which she sustained a closed head injury. She is now experiencing detrusor sphincter dyssynergia. Which of the following is the most beneficial medication treatment?
Correct Answer: Alpha blocker
Response Feedback: Because the bladder neck consists of circular smooth muscle with adrenergic innervation, detrusor sphincter dyssynergia may be managed by alpha-adrenergic blocking (antimuscarinic) medications.
A nurse assesses a patient with a complicated urinary tract infection (UTI) for:
Correct Answer: Other health problems
Response Feedback: A complicated UTI develops when there is an abnormality in the urinary system or a health problem that compromises host defenses or response to treatment. UTI may occur alone or in association with pyelonephritis, prostatitis, or kidney stones.
A 28-year-old female presents with fever, chills, and flank pain. She is diagnosed with pyelonephritis. A nurse recalls the patient's infection is located in the:
Correct Answer: Renal pelvis
Response Feedback: Pyelonephritis is an infection of one or both upper urinary tracts (ureter, renal pelvis, and interstitium).
While planning care for a patient who has acute pyelonephritis. A nurse recalls the most common condition associated with the development of acute pyelonephritis is:
Correct Answer: Urinary tract obstruction
Response Feedback: Urinary obstruction and reflux of urine from the bladder are the most common underlying risk factors.
A 29-year-old female presents with cloudy urine, flank pain, hematuria, and fever. Which of the following does the nurse suspect the patient is most likely experiencing
Correct Answer: Acute cystitis
Response Feedback: The patient is demonstrating symptoms of acute cystitis.
A 15-year-old male was diagnosed with pharyngitis. Eight days later he developed acute glomerulonephritis. While reviewing the culture results, which of the following is the most likely cause of this disease?
Correct Answer: Group A ß-hemolytic streptococcus
Response Feedback: Group A ß-hemolytic streptococcus is the primary cause of glomerulonephritis associated with a pharyngeal infection.
A 25-year-old male was diagnosed with Goodpasture syndrome. While planning care for this patient, which of the following mechanisms would cause tissue injury?
Correct Answer: Production of antibodies against the glomerular basement membrane
Response Feedback: Antiglomerular basement membrane disease (Goodpasture syndrome) is associated with antibody formation against both pulmonary capillary and glomerular basement membranes.
When a nurse observes poststreptococcal glomerulonephritis as a diagnosis on a patient, which principle will the nurse remember? Acute poststreptococcal glomerulonephritis is primarily caused by:
Correct Answer: Antigen-antibody complex deposition in the glomerular capillaries and inflammatory damage
Response Feedback: Acute poststreptococcal glomerulonephritis is caused by an antigen-antibody complex.
A 30-year-old male is demonstrating hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin being the major protein. The most probable diagnosis the nurse will see documented on the chart is:
Correct Answer: Acute glomerulonephritis
Response Feedback: Two major symptoms distinctive of more severe glomerulonephritis are: (1) hematuria with red blood cell casts and (2) proteinuria exceeding 3 to 5 g/day with albumin (macroalbuminuria) as the major protein.
A 45-year-old male presents with oliguria. He is diagnosed with chronic glomerulonephritis. The nurse knows oliguria is related to:
Correct Answer: Thickening of the glomerular membrane and decreased renal blood flow
Response Feedback: Changes in the glomerulus are characterized by progressive thickening and fibrosis of the glomerular basement membrane.
A 54-year-old female is diagnosed with nephrotic syndrome. Which of the following is a common symptom of this disease?
Correct Answer: Proteinuria
Response Feedback: Nephrotic syndrome is manifested by proteinuria. Nephrotic syndrome is diagnosed when the protein level in a 24-hour urine collection is greater than 3.5 g.
A 42-year-old male is involved in a motor vehicle accident during which he loses a lot of blood. The nurse realizes he is in acute renal failure caused by:
Correct Answer: Inadequate renal blood flow
Response Feedback: With blood loss, renal failure is due to inadequate blood flow.
A 35-year-old female was severely burned and is hospitalized. She is now suffering from acute tubular necrosis (ATN). Which of the following is the most likely diagnosis the nurse will observe on the chart?
Correct Answer: Intrarenal
Response Feedback: Intrarenal acute kidney failure is associated with several systemic diseases but is commonly related to ATN.
A 56-year-old male presents with flank pain and polyuria. Tests reveal that he has an enlarged prostate. Which of the following types of renal failure should the nurse monitor for as it is the most likely to occur?
Correct Answer: Postrenal
Response Feedback: The patient will experience postrenal renal failure due to obstruction by the prostate.
A 60-year-old male is diagnosed with renal failure. While the nurse is reviewing lab results, which of the following lab values would be most consistent with this diagnosis?
Correct Answer: Elevated plasma creatinine level
Response Feedback: Creatinine is constantly released from muscle and excreted primarily by glomerular filtration. In chronic kidney disease (CKD), as glomerular filtration rate (GFR) declines, the plasma creatinine level increases by a reciprocal amount to maintain a constant rate of excretion. As GFR continues to decline, plasma creatinine concentration increases. Creatinine is elevated; potassium is also elevated.Metabolic acidosis develops. Decreased urea clearance occurs.
A 45-year-old female presents with hypertension, anorexia, nausea and vomiting, and anemia. She is diagnosed with chronic renal failure. When the patient asks what caused this anemia, how should the nurse respond? Your anemia is caused by:
Correct Answer: Inadequate production of erythropoietin
Response Feedback: The kidneys are inadequate in their production of erythropoietin.
A 42-year-old female is diagnosed with chronic renal failure, and the nurse is discussing dietary treatment. Which information indicates the nurse understands dietary regimen? Treatment includes restricting:
Correct Answer: Proteins
Response Feedback: Low-protein diets are recommended.
While turning a patient with chronic renal failure, which principle should the nurse recall? Bone fractures are a risk factor in chronic renal failure because:
Correct Answer: The kidneys fail to activate vitamin D.
Response Feedback: Hypocalcemia is accelerated by impaired renal synthesis of 1,25-vitamin D. The combined effect of vitamin D deficiency can result in renal osteodystrophies with increased risk for fractures.
Anemia accompanies chronic renal failure because of:
Correct Answer: Inadequate production of erythropoietin
Response Feedback: Chronic renal failure leads to anemia because of declining erythropoietin production.
A patient with end-stage renal disease has pruritus. When the patient asks what causes this, what is the nurse's best response? Pruritus, seen in patients with end-stage renal disease, is caused by high levels of:
Correct Answer: Calcium
Response Feedback: Pruritus is related to high levels of calcium.
When a nurse is teaching about urinary pathogens in men. Which information should the nurse include? Mechanisms for defense against urinary pathogens in men include (select all that apply):
Correct Answers: The long length of the urethra, Antimicrobial secretions from the prostate
Response Feedback: Both the longer urethra and prostatic secretions decrease the risk of infection in men. The urine is not more alkaline, and they do not secrete mucus that traps bacteria. The ureters in men and women are implanted in similar positions and in their normal position; it is not a factor in the development of cystitis.
Upon examination of a male infant, it is determined that the urethral meatus is located on the undersurface of the penis. The nurse will document this condition as:
Correct Answer: Hypospadias
Response Feedback: When the urethral meatus is located on the undersurface of the penis, it is referred to as hypospadias.
A newborn female has chronic renal failure caused by a lack of development of one of the kidneys. When a staff member asks what this condition is called, how should the nurse respond? This condition is called:
Correct Answer: Renal aplasia
Response Feedback: During embryologic development, the ureteric duct grows into the metanephric tissue, triggering the formation of the kidneys. If this growth does not occur, the kidney is absent, a condition called renal aplasia.
A nurse is preparing to teach about renal agenesis. Which information should the nurse include? Infants who have bilateral renal agenesis:
Correct Answer: Are stillborn or die within a few hours of birth
Response Feedback: Bilateral renal agenesis is a rare disorder incompatible with extrauterine life.
An infant male experiences a constant dribbling of urine. His urethral opening is located behind the glans. Which of the following is the most likely diagnosis the nurse will observe on the chart?
Correct Answer: Anterior epispadias
Response Feedback: Anterior epispadias occurs when the urethral opening is small and situated behind the glans.
Extrophy of the Posterior epispadias occurs when a fissure extends the entire length of the penis and into the bladder neck.
A newborn male dies shortly after birth. Physical examination reveals wide-set eyes, parrot-beak nose, low-set ears, and receding chin. The most likely diagnosis the nurse will see on the chart is:
Correct Answer: Potter syndrome
Response Feedback: Potter syndrome is manifested by wide-set eyes, parrot-beak nose, low-set ears, and receding chin.
A 15-year-old female presents with flank pain, irritability, malaise, and fever. Tests reveal glomerulonephritis. When the parents ask what could have caused this, how should the nurse respond?
Correct Answer: Poststreptococcal infection
Response Feedback: Glomerulonephritis is most likely related to a post-strep infection
A urologist is discussing nephrotic syndrome. Which information should be included? If nephrotic syndrome is not caused initially by kidney disease, it is termed _____ nephrotic syndrome.
Correct Answer: Secondary
Response Feedback: Secondary nephrotic syndrome is not caused initially by kidney disease
A 4-year-old male is diagnosed with nephrotic syndrome. Which of the following assessment findings accompanies this condition?
Correct Answer: Proteinuria
Response Feedback: Proteinuria accompanies nephrotic syndrome.
A 7-year-old female is diagnosed with nephrotic syndrome. Which of the following should the nurse ask the parents if they or the child has noticed recently?
Correct Answer: Frothy urine
Response Feedback: In the child with nephrotic syndrome, the parents may notice diminished, frothy, or foamy urine output.
Which of the following clusters of symptoms would make a clinician suspect a child has developed glomerulonephritis?
Correct Answer: Gross hematuria, flank pain, and hypertension
Response Feedback: The child with glomerulonephritis typically experiences gross or microscopic hematuria, proteinuria, edema, renal insufficiency, flank pain, and hypertension.
A 5-year-old male was diagnosed with glomerulonephritis. History reveals that he had an infection 3 weeks before the onset of this condition. The infection was most likely located in the:
Correct Answer: Respiratory tract
Response Feedback: The location of the infection leading to glomerulonephritis is the respiratory tract.
When a child is admitted with acute renal failure, a clinician realizes the most common cause of acute renal failure is:
Correct Answer: Hemolytic uremic syndrome (HUS)
Response Feedback: HUS is the most common cause of acute renal failure in children.
A 10-year-old male is diagnosed with glomerulonephritis. Tests reveal the deposition of immunoglobulin IgA in the glomerular capillaries. The nurse will monitor for recurrent:
Correct Answer: Hematuria
Response Feedback: The child with immunoglobulin associated with glomerulonephritis will have recurrent hematuria.
When a newborn is admitted with urinary tract infections (UTIs), which type of infection will the nurse look for in the newborn?
Correct Answer: Blood-borne infections
Response Feedback: UTIs are rare in newborns, and when they do occur, they are usually caused by bacteria from the bloodstream that have settled in the urinary tract.
A 3-year-old female presents with recurrent urinary tract infections (UTIs), fever, poor growth and development, and feeding problems. Tests reveal a retrograde flow of urine from the urinary bladder into the ureters. When giving report to the oncoming shift, the nurse will call this condition:
Correct Answer: Vesicoureteral reflux (VUR)
Response Feedback: VUR is the retrograde flow of urine from the bladder into the kidney or ureters, or both.
A nurse observes on the chart that a patient is admitted with Wilms tumors. A nurse knows the tumors are found in the:
Correct Answer: Kidneys
Response Feedback: Wilms tumor is found in the kidneys.
A 6-year-old male is experiencing urine reflux from the urinary bladder into a grossly dilated ureter and calyces. He was diagnosed with vesicoureteral reflux. This condition would be graded:
Correct Answer: IV
Response Feedback: The patient has symptoms of grade IV reflux.
A 2-year-old male is diagnosed with Wilms tumor. Which of the following clinical conditions is often associated with this disease?
Correct Answer: Aniridia
Response Feedback: Children with Wilms tumor often have other congenital anomalies, including aniridia, a lack of an iris in the eye.
A 7-year-old male presents to his primary care provider for incontinence. His mother indicates that he has never been continent. Which of the following is the most likely diagnosis the nurse will observe on the chart?
Correct Answer: Primary enuresis
Response Feedback: Primary incontinence (enuresis) means the child has never been continent.
Nocturnal enuresis is nighttime incontinence.
In addition to a mass, the child with Wilms tumor may also exhibit which assessment finding? (Select all that apply.)
Correct Answers: Abdominal pain, Hematuria, Fever
In addition to an abdominal mass, other presenting complaints include vague abdominal pain (37%), hematuria (18%), and fever (22%). Enuresis and weight gain do not occur.
A 34-year-old male was diagnosed with a bacterial GI infection. Which of the following types of diarrhea would most likely occur with his condition?
Correct Answer: Secretory
Response Feedback: Infections lead to secretory diarrhea.
A 20-year-old male was recently diagnosed with lactose intolerance. He eats an ice cream cone and develops diarrhea. His diarrhea can be classified as _____ diarrhea.
Correct Answer: Osmotic
Response Feedback: A nonabsorbable substance in the intestine leads to osmotic diarrhea.
A 40-year-old female presents complaining of pain near the midline in the epigastrium. Assuming the pain is caused by a stimulus acting on an abdominal organ, the pain felt is classified as:
Correct Answer: Visceral
Response Feedback: Visceral pain arises from a stimulus (distention, inflammation, ischemia) acting on an abdominal organ.
The most common disorder associated with upper GI bleeding is:
Correct Answer: Esophageal varices
Response Feedback: Esophageal varices is the most common disorder associated with upper GI bleeding.
A 52-year-old presents with bleeding from the rectum. This condition is referred to as:
Correct Answer: Hematochezia
Response Feedback: Hematochezia is bleeding from the rectum.
A 50-year-old male is experiencing reflux of chyme from the stomach. He is diagnosed with gastroesophageal reflux. This condition is caused by:
Correct Answer: Loss of muscle tone at the lower esophageal sphincter
Response Feedback: Gastroesophageal reflux is due to loss of muscle tone at the lower esophageal sphincter.
Reflux esophagitis is defined as a(n):
Correct Answer: Inflammatory response to gastroesophageal reflux
Response Feedback: When gastroesophageal reflux leads to an inflammatory response, it is termed reflux esophagitis.
A 45-year-old male complains of heartburn after eating and difficulty swallowing. He probably has:
Correct Answer: Hiatal hernia
Response Feedback: Regurgitation, dysphagia, and substernal discomfort after eating are common in individuals with hiatal hernia
A serious complication of paraesophageal hiatal hernia is:
Correct Answer: Strangulation
Response Feedback: Strangulation of the hernia is a major complication.
A 38-year-old female complains of epigastric fullness following a meal, nausea, and epigastric pain. Tests reveal narrowing of the opening between the stomach and the duodenum. This condition is referred to as:
Correct Answer: Pyloric obstruction
Response Feedback: The pylorus is the opening between the esophagus and the duodenum; the obstruction is pyloric.
The cardinal sign of pyloric stenosis caused by ulceration or tumors is:
Correct Answer: Vomiting
Response Feedback: The cardinal sign of pyloric stenosis is vomiting.
A 10-month-old is brought to the pediatrician by the mother who states the baby has been experiencing colicky pain followed by vomiting, sweating, nausea, and irritability. Testing reveals a condition in which one part of the intestine telescopes into another. From which type of intestinal obstruction is he suffering?
Correct Answer: Intussusception
Response Feedback: Telescoping of one part of the intestine into another; this usually causes strangulation of the blood supply and is more common in infants 10 to 15 months of age than in adults.
A 40-year-old male develops an intestinal obstruction related to protrusion of the intestine through the inguinal ring. This condition is referred to as:
Correct Answer: A hernia
Response Feedback: A hernia is a protrusion of the intestine through a weakness in the abdominal muscles or through the inguinal ring.
Chronic gastritis is classified according to the:
Correct Answer: Location of lesions
Response Feedback: Chronic gastritis is classified as type A (fundal) or type B (antral), depending on the pathogenesis and location of the lesions.
A 42-year-old female presents with abdominal discomfort, epigastric tenderness, and bleeding. Gastroscopy reveals degeneration of the gastric mucosa in the body and fundus of the stomach. Which of the following would most likely follow?
Correct Answer: Pernicious anemia
Response Feedback: Pernicious anemia can develop because the damage to the mucosa makes the intrinsic factor less available to facilitate vitamin B12 absorption in the ileum.
A 54-year-old male is diagnosed with peptic ulcer disease. This condition is most likely caused by:
Correct Answer: Breaks in the mucosa and presence of corrosive secretions
Response Feedback: Peptic ulcer disease is caused by breaks in the mucosa and the presence of corrosive substances.
A 60-year-old male presents with GI bleeding and abdominal pain. He reports that he takes NSAIDs daily to prevent heart attack. Tests reveal that he has a peptic ulcer. The most likely cause of this disease is:
Correct Answer: Inhibiting mucosal prostaglandin synthesis
Response Feedback: Use of NSAIDs inhibit prostaglandins and maintenance of the mucosal barrier and decrease bicarbonate secretion.
A 39-year-old female with chronic intermittent pain in the epigastric area 2 to 3 hours after eating is diagnosed with a duodenal ulcer. Which of the following behaviors may have contributed to the development of the ulcer?
Correct Answer: Cigarette smoking
Response Feedback: Acid production is stimulated by cigarette smoking.
A 22-year-old male underwent brain surgery to remove a tumor. Following surgery, he experienced a peptic ulcer. His ulcer is referred to as a(n) _____ ulcer.
Correct Answer: Cushing
Response Feedback: A Cushing ulcer is a stress ulcer associated with severe head trauma or brain surgery that results from decreased mucosal blood flow and hypersecretion of acid caused by overstimulation of the vagal nerve.
A 24-year-old male who sustained a head injury and fractured femur develops a stress ulcer. A common clinical manifestation of this ulcer is:
Correct Answer: Bleeding
Response Feedback: The most common clinical manifestation is bleeding.
A 3-month-old female develops colicky pain, abdominal distention, and diarrhea after drinking cow's milk. The best explanation for her symptoms is:
Correct Answer: Excess of undigested lactose in her digestive tract, resulting in increased fluid movement into the digestive lumen and increased bowel motility
Response Feedback: Undigested lactose increases the osmotic gradient in the intestine, causing irritation and osmotic diarrhea.
Clinical manifestations of bile salt deficiencies are related to poor absorption of:
Correct Answer: Fats and fat-soluble vitamins
Response Feedback: Clinical manifestations of bile salt deficiency are related to poor intestinal absorption of fat and fat-soluble vitamins (A, D, E, K).
A 30-year-old obese female underwent gastric resection in an attempt to lose weight. Which of the following complications could the surgery cause?
Correct Answer: Anemia
Response Feedback: One of the complications is anemia due to iron malabsorption, which may result from decreased acid secretion.
A 50-year-old male complains of frequently recurring abdominal pain, diarrhea, and bloody stools. A possible diagnosis would be:
Correct Answer: Ulcerative colitis
Response Feedback: Ulcerative colitis is manifested by fever, elevated pulse rate, frequent diarrhea (10 to 20 stools/day), urgency, obviously bloody stools, and continuous lesions present in the colon.
Which of the following symptoms would help a health care provider distinguish between ulcerative colitis and Crohn disease?
Correct Answer: Malabsorption
Response Feedback: Malabsorption is common in Crohn disease and is rare in ulcerative colitis. Both disorders can lead to abdominal pain. Both disorders have a clinical course of remissions and exacerbations. Both disorders lead to diarrhea.
A 16-year-old female presents with abdominal pain in the right lower quadrant. Physical examination reveals rebound tenderness and a low-grade fever. A possible diagnosis would be:
Correct Answer: Appendicitis
Response Feedback: Appendicitis is manifested by right lower quadrant pain with rebound tenderness.
The most common cause of chronic vascular insufficiency among the elderly is:
Correct Answer: Atherosclerosis
Response Feedback: The most common cause of chronic vascular insufficiency is atherosclerosis, especially in the elderly
Which of the following characteristics is associated with an acute occlusion of mesenteric blood flow to the small intestine?
Correct Answer: Often precipitated by an embolism
Response Feedback: Occlusion of blood flow is often precipitated by embolism.
The risk of hypovolemic shock is high with acute mesenteric arterial insufficiency because:
Correct Answer: Ischemia alters mucosal membrane permeability, and fluid is shifted to the bowel wall and peritoneum.
Response Feedback: Fluid shifts lead to hypovolemia.
Which of the following conditions is thought to contribute to the development of obesity?
Correct Answer: Leptin resistance
Response Feedback: Leptin resistance disrupts hypothalamic satiety signaling and promotes overeating and excessive weight gain and is a factor in the development of obesity.
A 13-year-old female confides to her mother that she binge eats and induces vomiting to prevent weight gain. This disease is referred to as:
Correct Answer: Bulimia nervosa
Response Feedback: Binge eating and vomiting is characteristic of bulimia nervosa.
A 54-year-old male complains that he has been vomiting blood. Tests reveal portal hypertension. Which of the following is the most likely cause of his condition?
Correct Answer: Cirrhosis of the liver
Response Feedback: Portal hypertension occurs secondarily to cirrhosis of the liver.
The most common clinical manifestation of portal hypertension is _____ bleeding.
Correct Answer: Esophageal
Response Feedback: Vomiting of blood from bleeding esophageal varices is the most common clinical manifestation of portal hypertension.
A 60-year-old female with a history of alcoholism complains of recent weight gain and right flank pain. Physical examination reveals severe ascites. This condition is caused by decreased:
Correct Answer: Albumin and lack of cellular integrity
Response Feedback: Ascites is due to decreased albumin and lack of cellular integrity.
Manifestations associated with hepatic encephalopathy from chronic liver disease are the result of:
Correct Answer: Impaired ammonia metabolism
Response Feedback: Impaired ammonia metabolism leads to the symptoms of hepatic encephalopathy.
An increase in the rate of red blood cell breakdown causes which form of jaundice?
Correct Answer: Hemolytic
Response Feedback: Excessive hemolysis (breakdown) of red blood cells can cause hemolytic jaundice (prehepatic jaundice).
Complete obstruction of bile flow to the liver would be manifested by:
Correct Answer: Clay-colored stools
Response Feedback: Complete obstruction of bile flow leads to clay-colored stools.
The icteric phase of hepatitis is characterized by which of the following clinical manifestations?
Correct Answer: Jaundice, dark urine, enlarged liver
Response Feedback: The icteric phase is manifested by jaundice, dark urine, and clay-colored stools. The liver is enlarged, smooth, and tender, and percussion causes pain; this is the actual phase of illness.
A 55-year-old male died in a motor vehicle accident. Autopsy revealed an enlarged liver caused by fatty infiltration, testicular atrophy, and mild jaundice secondary to cirrhosis. The most likely cause of his condition is:
Correct Answer: Alcoholism
Response Feedback: The most common cause of cirrhosis is alcoholism
In alcoholic cirrhosis, hepatocellular damage is caused by:
Correct Answer: Acetaldehyde accumulation
Response Feedback: Alcoholic cirrhosis is caused by the toxic effects of alcohol metabolism on the liver. Alcohol is transformed to acetaldehyde, and excessive amounts significantly alter hepatocyte function and activate hepatic stellate cells, a primary cell involved in liver fibrosis.
A 39-year-old female presents with abdominal pain and jaundice. She is diagnosed with gallstones and undergoes cholecystectomy. An analysis of her gallstones would most likely reveal a high concentration of:
Correct Answer: Cholesterol
Response Feedback: The majority of gallstones are composed of cholesterol.
A 55-year-old female has general symptoms of gallstones but is also jaundiced. IV cholangiography would most likely reveal that the gallstones are obstructing the:
Correct Answer: Common bile duct
Response Feedback: Jaundice is due to obstruction of the common bile duct
Cholecystitis is inflammation of the gallbladder wall usually caused by:
Correct Answer: Obstruction of the cystic duct by a gallstone
Response Feedback: Cholecystitis can be acute or chronic, but both forms are almost always caused by a gallstone lodged in the cystic duct.
Tissue damage in pancreatitis is caused by:
Correct Answer: Leakage of pancreatic enzymes
Response Feedback: Leaked enzymes become activated, initiating autodigestion, inflammation, oxidative stress, and acute pancreatitis.
A 40-year-old male presents with epigastric pain. Tests reveal acute pancreatitis. The most likely cause of his condition is:
Correct Answer: Obstruction of the biliary tract by a gallstone
Response Feedback: Biliary tract obstruction by gallstones is one of the known causes of pancreatitis.
Acute pancreatitis often manifests with pain to which of the following regions?
Correct Answer: Epigastric
Response Feedback: Epigastric or midabdominal pain ranging from mild abdominal discomfort to severe, incapacitating pain is one of the manifestations of pancreatitis.
Pancreatic insufficiency is manifested by deficient production of:
Correct Answer: Lipase
Response Feedback: Pancreatic insufficiency is the deficient production of lipase by the pancreas.
A 60-year-old male is diagnosed with cancer of the esophagus. Which of the following factors most likely contributed to his disease?
Correct Answer: Reflux esophagitis
Response Feedback: Reflux is a factor in the development of esophageal cancer.
Which of the GI cancers has the highest rate of incidence and is responsible for the highest number of deaths?
Correct Answer: Colorectal
Colorectal cancer (CRC) is the third most common cause of cancer and cancer death in the United States for both men and women.
A 40-year-old male who consumes a diet high in fat and low in fiber is at risk for:
Correct Answer: CRC
Response Feedback: CRC is associated with dietary intake, primarily lack of fiber and high fat content.
The cardinal signs of small bowel obstruction are:
Correct Answer: Vomiting and distention
Response Feedback: Colicky pains followed by vomiting and distention are the cardinal symptoms of small bowel obstruction.
Which of the following gastrointestinal (GI) clinical manifestations is subjective? (Select all that apply.)
Correct Answers: Anorexia, Nausea
Response Feedback: Anorexia is lack of the desire for food intake and is a subjective experience. Nausea is a subjective experience. Retching is a forceful form of vomiting and is observable. Vomiting and diarrhea are observable.
A patient presents to the physician with complaints of constipation. Which of the following could be the cause? (Select all that apply.)
Neurogenic disorder of the large intestine, Sedentary lifestyle, Low residue diet, Aging, Use of antacids
Constipation can be caused by neurogenic disorders of the large intestine in which neural pathways or neurotransmitters are altered and colon transit time delayed. A low-residue diet (the habitual consumption of highly refined foods) decreases the volume and number of stools and causes constipation. A sedentary lifestyle and lack of regular exercise are other common causes of constipation. Lack of access to toilet facilities and consistent suppression of the urge to empty the bowel are other causes. Excessive use of antacids containing calcium carbonate or aluminum hydroxide often results in constipation. Opiates, particularly codeine, tend to inhibit bowel motility. Conditions associated with constipation include congenital megacolon, hypothyroidism, pelvic hiatal hernia, multiple sclerosis, spinal cord trauma, cancer, cerebrovascular disease, and irritable bowel syndrome-constipation predominant. Aging may result in changes in neuromuscular function, causing constipation.
A 62-year-old male presents with difficulty swallowing. Tests reveal a loss of esophageal peristalsis and failure of the lower esophageal sphincter to relax. Functional dysphasia is the diagnosis. A history of which of the following could be the most likely cause? (Select all that apply.)
Correct Answers: Parkinson disease, Cerebrovascular accident, Achalasia
Response Feedback: Functional dysphasia is caused by neural or muscular disorders that interfere with voluntary swallowing or peristalsis. Disorders that affect the striated muscles of the upper esophagus interfere with the oropharyngeal (voluntary) phase of swallowing. Typical causes are dermatomyositis (a muscle disease) and neurologic impairments caused by cerebrovascular accidents, Parkinson disease, or achalasia. Peptic ulcer disease or pyloric stenosis would not cause functional dysphasia.
Complications obstruction in the lower bowel include (select all that apply):
Correct Answers: Metabolic acidosis, Tachycardia, Hypovolemia, Peritonitis
With obstruction lower in the intestine, metabolic acidosis is more likely to occur because bicarbonate from pancreatic secretions and bile cannot be reabsorbed. Hypokalemia can be extreme. Continued intestinal secretion and decreased absorption lead to decreased blood volume and elevates hematocrit, decreases central venous pressure, and causes tachycardia. Severe dehydration leads to hypovolemic shock. Bacteria also proliferate and may cross the mucosal barrier and cause peritonitis or sepsis.
The primary causes of duodenal ulcers include (select all that apply):
Correct Answers: Nonsteroidal anti-inflammatory drugs (NSAIDs), H. pylori infection
Response Feedback: Infection with H. pylori and chronic use of NSAIDs are the major causes of duodenal ulcer. Consuming spicy foods, trauma, and antibiotics do not lead to duodenal ulcer disease.
A 46-year-old female is diagnosed with gastric ulcers. Which of the following characterizes the disorder?
Correct Answers: Pain occurs immediately after eating, Duration of treatment is extended.
The pattern of pain is different from that of duodenal ulcers as it frequently occurs immediately after eating. Gastric ulcers cause more anorexia, vomiting, and weight loss than duodenal ulcers. Gastric ulcers also tend to be chronic rather than alternating between periods of remission and exacerbation. The evaluation and treatment of gastric ulcers are similar to the evaluation and treatment of duodenal ulcers, although duration of treatment is longer than with duodenal ulcers.
A 55-year-old male intravenous (IV) drug user with a history of advanced liver disease is diagnosed with hepatorenal syndrome. Which of the following clinical manifestations would be expected? (Select all that apply.)
Correct Answers: Oliguria, Jaundice, Ascites, Anorexia
Oliguria and complications of advanced liver disease, including jaundice, ascites, and GI bleeding, are usually present. Systolic blood pressure is usually below 100 mm Hg. Nonspecific symptoms of hepatorenal syndrome include anorexia, weakness, and fatigue.
Which of the following type(s) of hepatitis has an incubation period of up to 180 days? (Select al that apply.)
Correct Answers: A, D
Response Feedback: Both hepatitis A and D have incubation periods of up to 180 days.
A 31-year-old female presents with midabdominal pain. She is expected to have acute pancreatitis. Which of the will be part of the treatment plan? (Select all that apply.)
Correct Answers: Narcotic analgesics, Restriction of food intake, Nasogastric suctioning, Antibiotics, IV fluids
Narcotic medications may be needed to relieve pain. To decrease pancreatic secretions and "rest the gland," oral food and fluids may be withheld, and continuous gastric suction is instituted. Nasogastric suction may not be necessary with mild pancreatitis, but it helps to relieve pain and prevent paralytic ileus in individuals who are nauseated and vomiting. Parenteral fluids are essential to restore blood volume and prevent hypotension and shock. Antibiotics may control infection. The risk of mortality increases significantly with the development of infection or pulmonary, cardiac, and renal complications.
A 52-year-old female presents with continuous abdominal pain that intensifies after eating. She is diagnosed with chronic pancreatitis. Contributing factors include: (Select all that apply.)
Correct Answers: Peptic ulcer disease, Trauma, Smoking
Pancreatitis can be acute or chronic, and risk factors include alcoholism, obstructive biliary tract disease (particularly cholelithiasis), peptic ulcers, trauma, hyperlipidemia, and smoking, as well as certain drugs.
The adult intestine processes approximately _____ liters of luminal content per day, of which 99% of the fluid is normally reabsorbed.
Correct Answer: 9
A 16-year-old female is diagnosed with anorexia nervosa. By definition, the patient would weigh ____% less than normal for age and height:
Correct Answer: 15
The definition of anorexia is body weight 15% less than normal for age and height because of refusal to eat.
The family learns that a 3D ultrasound of a 9-week fetus shows incomplete fusion of the nasomedial or intermaxillary process. The family will be told that the child will be born with:
Correct Answer: Cleft lip
Response Feedback: Cleft lip is caused by the incomplete fusion of the nasomedial or intermaxillary process beginning the fourth week of embryonic development, a period of rapid development.
Examination of a newborn female revealed that the esophagus ends in a blind pouch. This condition is referred to on the chart as:
Correct Answer: Esophageal atresia
Response Feedback: When the esophagus ends in a blind pouch, the condition is referred to as esophageal atresia
Which condition should the nurse assess for in mothers carrying fetuses affected by esophageal malformations?
Correct Answer: Excessive amniotic fluid
Response Feedback: Polyhydramnios (excessive amniotic fluid) is reported to occur in 14% to 90% of mothers of affected infants because of alterations in fetal swallowing.
A mother brings her 2-week-old infant to the pediatrician because he vomits forcefully for no apparent reason and food sometimes is regurgitated as though undigested. The infant is most likely suffering from:
Correct Answer: Pyloric stenosis
Response Feedback: Pyloric stenosis is manifested by forceful vomiting.
A sign that a newborn infant may have pyloric stenosis is:
Correct Answer: Olive-sized mass in the upper abdomen
Response Feedback: A firm, small, movable mass, approximately the size of an olive, is felt in the right upper quadrant in 70% to 90% of infants with pyloric stenosis.
A 2-month-old female is brought to the emergency room (ER) for persistent bile-stained vomiting after feeding. Physical examination reveals dehydration, and x-ray reveals that the colon is located in the upper right quadrant. What is the most likely cause of this condition?
Correct Answer: Malrotation
Response Feedback: In infants, malrotation obstruction causes intermittent or persistent bile-stained vomiting after feedings.
Meconium ileus is associated with which of the following disorders?
Correct Answer: Cystic fibrosis
Response Feedback: Meconium ileus is associated with cystic fibrosis.
Intussusception is treated initially by:
Correct Answer: An air enema
Response Feedback: Reduction is an emergency procedure using an air enema.
A 2-month-old female with Down syndrome is diagnosed with Hirschsprung disease following family complaints of chronic constipation. The most likely cause of these symptoms is:
Correct Answer: Absence of ganglia along the length of the colon
Response Feedback: Congenital aganglionic megacolon is caused by the absence of the enteric ganglia (Meissner and Auerbach plexuses) along a variable length of the colon, resulting in inadequate motility.
The primary complication of enterocolitis associated with Hirschsprung disease is related to which finding?
Correct Answer: Fecal impaction
Response Feedback: The most serious complication in the neonatal period is enterocolitis related to fecal impaction.
A 6-month-old male infant is brought to the ER after the sudden development of abdominal pain, irritability, and vomiting followed by passing of "currant jelly" stool. Ultrasound reveals intestinal obstruction in which the ileum collapsed through the ileocecal valve and invaginated into the large intestine. This type of obstruction is referred to as:
Correct Answer: Intussusception
An 8-week-old female is diagnosed with a congenital heart disease and Down syndrome. Her parents report that she has difficulty defecating. X-ray reveals anorectal malformation that causes complete obstruction often referred to as:
Correct Answer: Imperforate anus
Response Feedback: Deformities that cause complete obstruction are known collectively as imperforate anus.
Occurrence of gastroesophageal reflux is highest in which pediatric population?
Correct Answer: Premature infants
Response Feedback: The frequency of reflux is highest in premature infants and decreases during the first 6 to 12 months of life
An 8-week-old male was recently diagnosed with cystic fibrosis. Which of the following digestive alterations would be expected?
Correct Answer: Malabsorption
Response Feedback: Cystic fibrosis results in malabsorption.
A 13-month-old infant presents with vomiting; abdominal pain; and pale, bulky, greasy, and foul-smelling stools. A possible diagnosis the clinician would document on the chart might be:
Correct Answer: Gluten-sensitive enteropathy
Response Feedback: Infants with gluten-sensitive enteropathy experience greasy stools.
Celiac disease, or sprue, is caused by alterations of the intestinal:
Correct Answer: Villi
Response Feedback: Gluten-sensitive enteropathy, formerly called celiac sprue or celiac disease, is an autoimmune disease that damages small intestinal villous epithelium.
Marasmus is most common in children of which age group?
Correct Answer: Younger than one
Response Feedback: Marasmus is most common in children younger than one
A 1-week-old female is brought to her pediatrician for abdominal distention and unstable temperature. Physical examination reveals bradycardia and apnea. Tests reveal hypoxic injury to the bowel resulting in bacterial invasion and perforation. This condition is referred to as:
Correct Answer: Necrotizing enterocolitis (NEC)
Response Feedback: NEC is an ischemic, inflammatory condition of the bowel that causes necrosis, perforation, and death, if untreated.
Prolonged diarrhea is more serious in children than adults because:
Correct Answer: Fluid reserves are lower in children.
Response Feedback: Prolonged diarrhea is more dangerous in children because they have much smaller fluid reserves than adults.
When an infant has increased bilirubin production and impaired hepatic excretion of bilirubin, what does the nurse suspect is occurring in the patient?
Correct Answer: Physiologic jaundice
Response Feedback: Impaired excretion of bilirubin can lead to physiologic jaundice.
A 7-month-old female presents with jaundice, clay-colored stool, and failure to gain weight. Testing reveals the absence of intrahepatic bile ducts. This condition is referred to as _____ atresia.
Correct Answer: Biliary
Response Feedback: Jaundice is the primary clinical manifestation of biliary atresia, along with hepatomegaly and acholic (clay-colored) stools.
A 7-month-old female presents with jaundice, clay-colored stool, and failure to gain weight. She is diagnosed with biliary atresia. The nurse realizes the treatment for this disorder will most likely be:
Correct Answer: Liver transplant
Response Feedback: The treatment for biliary atresia is liver transplant.
The nurse assessing the patient with biliary atresia would expect to find which primary clinical manifestation?
Correct Answer: Jaundice
Response Feedback: The primary clinical manifestation is jaundice.
Outbreaks of hepatitis _____ often occur in young children attending day care centers and can be attributed to poor hand washing.
Correct Answer: A
Response Feedback: Outbreaks of hepatitis A occur in condition where poor hand washing occurs.
Where does the nurse expect the obstruction to be in a patient with extrahepatic portal hypertension?
Correct Answer: Hepatic portal vein
Response Feedback: Extrahepatic (prehepatic) portal venous obstruction causes 50% to 70% of extrahepatic portal hypertension in children.
Early identification and treatment for metabolic disorders is important because:
Correct Answer: Permanent damage to vital organs can be prevented.
Response Feedback: The earliest possible identification of metabolic disorders is essential because early treatment may prevent permanent damage to vital organs, such as the liver or brain.
A 3-month-old female presents with intention tremors, dystonia, greenish-yellow rings in the cornea, and hepatomegaly. Tests reveal a defect on chromosome 13. Which of the following is the most likely diagnosis?
Correct Answer: Wilson disease
Response Feedback: Wilson disease is manifested by dystonia and greenish-yellow rings in the cornea.
A 27-year-old male presents with fever, GI bleeding, hepatomegaly, and transient joint pain. He reports that as a child he received blood transfusions following a motor vehicle accident. He also indicates he was vaccinated against hepatitis B. Which of the following types of hepatitis does the clinician think he most likely has?
Correct Answer: C
Response Feedback: Hepatitis C virus is transmitted with blood transfusions
The nurse would correctly identify the most common symptom of Meckel diverticulum as:
Correct Answer: Rectal bleeding
Response Feedback: Although most Meckel diverticuli are asymptomatic, the most common symptom is painless rectal bleeding.
A newborn male is diagnosed with cleft palate. The pediatrician counsels the parents that complications of cleft palate include (select all that apply):
Correct Answers: Tonsil hypertrophy, Recurrent paranasal infections, Excessive dental decay, Hearing loss
Response Feedback: Children with cleft palate tend to have tonsil hypertrophy, tend to have repeated infections of the paranasal sinuses, do not experience difficulty breathing, experience excessive dental decay, and experience hearing loss.
Which of the following are complications of gastroesophageal reflux? (Select all that apply.)
Correct Answers: Aspiration pneumonia, Anemia, Weight loss, Delayed growth
Aspiration pneumonia develops in one-third of infants with gastroesophageal reflux. In cases that persist into childhood, chronic cough, wheezing, and recurrent pneumonia are common. Inadequate retention of nutrients can adversely impact growth and weight gain. Esophagitis resulting from exposure of the esophageal mucosa to acidic gastric contents is manifested by pain, bleeding, and eventually stricture formation and abnormal motility. Approximately 25% have iron deficiency anemia caused by frank or occult blood loss. Hepatomegaly is not a complication of gastroesophageal reflux.
A nurse is discussing endocrine system dysfunction with a patient. Which statement indicates the patient understood? Endocrine system dysfunction can result from hyposecretion, hypersecretion, or from:
Correct Answer: Abnormal receptor activity
Response Feedback: Dysfunction may result from abnormal cell receptor function or from altered intracellular response to the hormone-receptor complex.
An aide asks the nurse what is the most common cause of elevated levels of antidiuretic hormone (ADH) secretion. How should the nurse respond?
Correct Answer: Cancer
Response Feedback: The most common cause of elevated levels of ADH is cancer.
A 54-year-old patient with pulmonary tuberculosis (lung infection) is evaluated for syndrome of inappropriate ADH secretion (SIADH). Which of the following electrolyte imbalances would be expected in this patient?
Correct Answer: Hyponatremia
Response Feedback: Hyponatremia occurs due to increased water reabsorption by kidneys.
A 44-year-old patient with pulmonary tuberculosis (lung infection) is evaluated for SIADH. Which of the following assessment findings would be expected in this patient?
Correct Answer: Concentrated urine
Response Feedback: Clinical manifestations of SIADH include urine that is inappropriately concentrated with respect to serum osmolarity
A nurse is caring for a patient with SIADH. What severe complication should the nurse assess for?
Correct Answer: Neurologic damage
Response Feedback: When the hyponatremia of SIADH becomes severe, 110 mEq/L to 115 mEq/L, confusion, lethargy, muscle twitching, convulsions, and severe and sometimes irreversible neurologic damage may occur
A 22-year-old male is admitted to the intensive care unit with a closed head injury sustained in a motorcycle accident. The injury has caused severe damage to the posterior pituitary. Which of the following complications should the nurse anticipate?
Correct Answer: Dehydration from polyuria
Response Feedback: Diabetes insipidus is a well-recognized complication of closed head injury and is manifested by polyuria leading to dehydration.
While planning care for a patient from general anesthesia, which principle should the nurse remember? A side effect of some general anesthetic agents is _____ diabetes insipidus
Correct Answer: Nephrogenic
Response Feedback: General anesthetics can lead to nephrogenic diabetes insipidus.
Diabetes insipidus, diabetes mellitus (DM), and SIADH share which of the following assessment manifestations?
Correct Answer: Thirst
Response Feedback: All three share thirst as a common clinical manifestation.
A 50-year-old male patient presents with polyuria and extreme thirst. He was given exogenous ADH. For which of the following conditions would this treatment be effective?
Correct Answer: Neurogenic diabetes insipidus
Response Feedback: Neurogenic diabetes insipidus is caused by the insufficient secretion of ADH; thus, exogenous ADH would be useful in the treatment of this disorder.
A 25-year-old male presents with fatigue, constipation, and sexual dysfunction. Tests reveal all pituitary hormones are normal and no masses are present. The nurse suspects the most likely cause of his symptoms is a dysfunction in the:
Correct Answer: Pituitary stalk
Response Feedback: When pituitary hormones are normal, dysfunction in the action of hypothalamic hormones are most commonly related to interruption of the connection between the hypothalamus and pituitary, the pituitary stalk.
A 15-year-old female presents with breast discharge, dysmenorrhea, and excessive excitability. Tests reveal that all her pituitary hormones are elevated. What does the nurse suspect as the most likely cause for these assessment findings?
Correct Answer: A pituitary adenoma
Response Feedback: Hormonal effects of pituitary adenomas include hypersecretion from the adenoma, itself, and hyposecretion from surrounding pituitary cells; in this case prolactin would be elevated with the manifestation of menstrual irregularities and secretion from the breast.
What common neurologic disturbances should the nurse assess for in a patient with a pituitary adenoma?
Correct Answer: Visual disturbances
Response Feedback: The clinical manifestations of pituitary adenomas are visual changes including visual field impairments (often beginning in one eye and progressing to the other) and temporary blindness.
A 35-year-old female with Graves disease is admitted to a medical-surgical unit. While the nurse is reviewing the lab tests, which results would the nurse expect to find?
Correct Answer: High levels of circulating thyroid-stimulating antibodies
Response Feedback: Graves disease results from a form of Type II hypersensitivity in which there is stimulation of the thyroid by autoantibodies directed against the TSH receptor.
While checking the lab results for a patient with Graves disease, the nurse would check the T3 level to be abnormally:
Correct Answer: High
Response Feedback: T3 levels are elevated in Graves disease.
A 35-year-old female with Graves disease is admitted to a medical-surgical unit. Which of the following symptoms would the nurse expect to find before treatment?
Correct Answer: Skin hot and moist, rapid heart rate
Response Feedback: Symptoms of Graves disease include heat intolerance and increased tissue sensitivity to stimulation by the sympathetic division of the autonomic nervous system.
Visual disturbances are a common occurrence in patients with untreated Graves disease. The endocrinologist explains to the patient that the main cause of these complications is:
Correct Answer: Orbital edema and protrusion of the eyeball
Response Feedback: Visual disturbances with Graves disease include orbital fat accumulation, inflammation, and edema of the orbital contents resulting in exophthalmos (protrusion of the eyeball), periorbital edema, and extraocular muscle weakness leading to diplopia (double vision).
A 25-year-old female with Graves disease is admitted to a medical-surgical unit. Palpation of her neck would most likely reveal:
Correct Answer: Diffuse thyroid enlargement
A 22-year-old female has a low level of TSH. What condition does the nurse expect the patient is experiencing?
Correct Answer: Secondary hypothyroidism
Response Feedback: Causes of secondary hypothyroidism are related to either pituitary or hypothalamic failure, which would be evident by low levels of TSH.
While planning care for a patient with hypothyroidism, which principle should the nurse remember? The basal metabolic rate is unusually _____ with hypothyroidism.
Correct Answer: Low
A 3-year-old male was diagnosed with congenital hypothyroidism. The parents ask the nurse if left untreated what will happen. What is the nurse's best response? If left untreated, the child would have:
Correct Answer: Mental retardation and stunted growth
Response Feedback: Cognitive disability varies with the severity of congenital hypothyroidism and the length of delay before treatment is initiated
A 30-year-old male was diagnosed with thyroid carcinoma. The lab tests the nurse would most likely find are _____ T3 and T4 levels.
Correct Answer: Normal
Response Feedback: Most individuals with thyroid carcinoma have normal T3 and T4 levels and are therefore euthyroid.
What problem should the nurse assess for in a patient with chronic hyperparathyroidism?
Correct Answer: Osteoporosis and pathologic fractures
Response Feedback: Excessive osteoclastic and osteocytic activity resulting in bone resorption may cause pathologic fractures, kyphosis of the dorsal spine, and compression fractures of the vertebral bodies.
A 45-year-old female with Graves disease underwent surgical removal of her thyroid gland. During the postoperative period, her serum calcium was low. The most probable reason for her low serum calcium is:
Correct Answer: Hypoparathyroidism caused by surgical injury to the parathyroid glands
Response Feedback: Hypoparathyroidism is most commonly caused by damage to the parathyroid glands during thyroid surgery.
A 30-year-old female with Graves disease is admitted to a hospital unit for the surgical removal of her thyroid gland. During the postoperative period, the nurse notes that the patient's serum calcium is low. The nurse should observe the patient for which of the following signs/symptoms?
Correct Answer: Laryngeal spasms and hyperreflexia
Response Feedback: Symptoms of low calcium are associated with tetany, a condition characterized by muscle spasms, hyperreflexia, clonic-tonic convulsions, and laryngeal spasms.
When a patient wants to know what most commonly causes hypoparathyroidism, how should the nurse reply? It is most commonly caused by:
Correct Answer: Parathyroid gland injury
Response Feedback: Hypoparathyroidism is most commonly caused by damage to the parathyroid glands.
A 25-year-old male presents to his primary care provider reporting changes in facial features. CT scan reveals a mass on the anterior pituitary, and lab tests reveal severely elevated growth hormone (GH). Which of the following would the nurse also expect to find?
Correct Answer: Sexual dysfunction
Response Feedback: In addition to elevated levels of GH, sexual dysfunction in men can occur.
A 30-year-old male presents to his primary care provider reporting visual disturbances. CT reveals a pituitary tumor and lab tests reveal elevated prolactin. He is diagnosed with prolactinoma. Which of the following treatments would the nurse help implement? Administering:
Correct Answer: Dopaminergic agonists
Response Feedback: Dopaminergic agonists (bromocriptine and cabergoline) are the treatment of choice for prolactinomas
A 12-year-old female is newly diagnosed with type 1 DM. When the parents ask what causes this, what is the nurse's best response?
Correct Answer: Immune destruction of the pancreas
Response Feedback: The most common cause of type 1 DM is a slowly progressive autoimmune T cell-mediated disease that destroys the beta cells of the pancreas.
A 12-year-old male is newly diagnosed with type 1 DM. Which of the following tests should the nurse prepare the patient to best confirm the diagnosis?
Correct Answer: Fasting plasma glucose levels
Response Feedback: Fasting blood glucose levels are most beneficial in confirming the diagnosis of diabetes.
An 11-year-old male is newly diagnosed with type 1 DM. Which classic symptoms should the nurse assess the patient for?
Correct Answer: Polydipsia, polyuria, polyphagia, and weight loss
Response Feedback: Classic symptoms of type 1 DM include polydipsia, polyuria, polyphagia, and weight loss.
A 19-year-old female with type 1 DM was admitted to the hospital with altered consciousness and the following lab values: serum glucose 500 mg/dl (high) and serum K+ 2 (low). Her parents state that she has been sick with the "flu" for a week. The diagnosis is hyperosmolar hyperglycemia nonketotic syndrome (HHNKS). What relationship do these values have with her insulin deficiency?
Correct Answer: Decreased insulin causes hyperglycemia and osmotic diuresis.
Response Feedback: Because the amount of insulin required to inhibit fat breakdown is less than that needed for effective glucose transport, insulin levels are sufficient to prevent excessive lipolysis and ketosis.
A nurse is reviewing lab results for glycosylated hemoglobin (hemoglobin A1c) levels. A nurse recalls the purpose of this test is to:
Correct Answer: Monitor long-term serum glucose control.
Response Feedback: Glycosylated hemoglobin refers to the permanent attachment of glucose to hemoglobin molecules and reflects the average plasma glucose exposure over the life of a red blood cell (approximately 120 days).
When a patient asks what causes hyperglycemia in type 2 DM, how should the nurse respond? Hyperglycemia is a result of:
Correct Answer: Hyperinsulinemia
Response Feedback: Type 2 diabetes is due to hyperinsulinemia and insulin resistance.
A 19-year-old female with type 1 DM was admitted to the hospital with the following lab values: serum glucose 500 mg/dl (high), urine glucose and ketones 4+ (high), and arterial pH 7.20 (low). Her parents state that she has been sick with the "flu" for a week. Which of the following statements best explains her acidotic state?
Correct Answer: Insulin deficiency promotes lipid metabolism and ketone formation.
Response Feedback: With insulin deficiency, lipolysis is enhanced, and there is an increase in the amount of nonesterified fatty acids delivered to the liver. The consequence is increased glyconeogenesis contributing to hyperglycemia and production of ketone bodies (acetoacetate, hydroxybutyrate, and acetone) by the mitochondria of the liver at a rate that exceeds peripheral use.
A 13-year-old male who uses insulin to control his type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion during gym class. The most probable cause of these symptoms is:
Correct Answer: Hypoglycemia caused by increased exercise
Response Feedback: The boy is experiencing hypoglycemia due to increased glucose utilization with exercise.
A 55-year-old female is admitted to the medical unit for complications of long-term, poorly controlled type 2 DM. Which of the following would the nurse expect to find in addition to elevated glucose?
Correct Answer: Atherosclerosis
Response Feedback: Macrovascular disease (lesions in large and medium sized arteries) increases morbidity and mortality and increases risk for accelerated atherosclerosis.
When a staff member asks the nurse what causes the chronic complications of DM such as microvascular and macrovascular disease, how should the nurse respond? These complications are primarily related to:
Correct Answer: Hyperglycemia
Response Feedback: The underlying cause of the micro and macro diseases associated with diabetes is due to hyperglycemia
A nurse checks lab results as both Cushing syndrome and Addison disease can manifest with elevated levels of:
Correct Answer: Adrenocorticotropic hormone (ACTH)
Response Feedback: Cushing syndrome and Addison are related to elevated levels of ACTH.
Which of the following alterations would the nurse expect to find in a patient with untreated Cushing disease or syndrome?
Correct Answer: Hypertension
Response Feedback: With elevated cortisol levels, vascular sensitivity to catecholamines increases significantly, leading to vasoconstriction and hypertension
When a nurse is assessing the physical features of individuals with Cushing syndrome, these findings will include:
Correct Answer: Truncal obesity and moon face
Response Feedback: Weight gain is the most common feature and results from the accumulation of adipose tissue in the trunk, facial, and cervical areas. These characteristic patterns of fat deposition have been described as "truncal obesity," "moon face," and "buffalo hump."
A 35-year-old female took corticosteroid therapy for several months. Which of the following would the nurse expect to find?
Correct Answer: Type 2 DM
Response Feedback: Overt DM develops in approximately 20% of individuals with hypercortisolism.
A nurse is preparing to teach a patient about Addison disease. Which information should the nurse include? The most common cause of Addison disease is:
Correct Answer: An autoimmune reaction
Response Feedback: Addison disease is caused by autoimmune mechanisms that destroy adrenal cortical cells and is more common in women.
A 50-year-old female presents with lightheadedness and overall abnormal feelings. Hyperaldosteronism is diagnosed. Which of the following symptoms would the nurse expect?
Correct Answer: Hypokalemia
Response Feedback: Hypokalemia occurs due to increased renal secretion of potassium.
A 49-year-old female is diagnosed with hypercortisolism. Which of the following would the nurse expect?
Correct Answer: Osteoporosis
Response Feedback: The effects of hypercortisolism in bone cause loss of the protein matrix leading to osteoporosis, with pathologic fractures, vertebral compression fractures, bone and back pain, kyphosis, and reduced height
The body's inability to conserve water and sodium when affected by Addison disease is explained by which of the following conditions?
Correct Answer: Aldosterone deficiency
Response Feedback: The symptoms of Addison disease are primarily a result of hypocortisolism and hypoaldosteronism.
A patient with Addison disease has weakness and easy fatigability. A nurse recalls this is due to:
Correct Answer: Hypocortisolism
Response Feedback: With mild to moderate hypocortisolism, symptoms usually begin with weakness and easy fatigability.
What is the cause of the hyperpigmentation seen in people with Cushing syndrome?
Correct Answer: Elevated levels of ACTH
Response Feedback: Bronze or brownish hyperpigmentation of the skin, mucous membranes, and hair occurs when there are very high levels of ACTH.
A 30-year-old female presents with hypertension, headache, tachycardia, impaired glucose tolerance, and weight loss. Which of the following diagnosis will the nurse see documented on the chart?
Correct Answer: Pheochromocytoma
Response Feedback: Symptoms of pheochromocytoma include hypertension, palpitations, tachycardia, glucose intolerance, excessive sweating, and constipation.
A nurse wants to determine if there is kidney dysfunction in a patient with diabetes. Which of the following is the earliest manifestation?
Correct Answer: Microalbuminuria
Response Feedback: Microalbuminuria is the first manifestation of kidney dysfunction. Polyuria occurs due to increased fluid in the vascular space, and microalbuminuria is the earliest manifestation.
Which of the following diseases should the nurse teach the patient to prevent as it is the ultimate cause of death in the patient with diabetes?
Correct Answer: Cardiovascular disease
Response Feedback: Cardiovascular disease is the ultimate cause of death in up to 75% of people with diabetes.
A nurse is assessing a patient with hypoparathyroidism. Clinical manifestations of hypoparathyroidism include (select all that apply):
Correct Answers: Tetany, Chvostek sign, Trousseau sign, Hair loss
Response Feedback: Symptoms of hypoparathyroidism includes tetany, Chvostek and Trousseau signs, dry (not oily) skin, and loss of body and scalp hair.