Wound Healing & Complications: Oxygen Saturation, Pulmonary Function, Arterial Blood Gases, Exams of Nursing

Download Wound Healing & Complications: Oxygen Saturation, Pulmonary Function, Arterial Blood Gases and more Exams Nursing in PDF only on Docsity! 1 | P a g e NUR 280 EXAM 2 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED RATIONALES ANSWERS BY EXPERTS | FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+ |LATEST UPDATE | GUARANTEED PASS The nurse caring for a patient with a leg ulcer has finished assessing the patient and is developing a problem list prior to writing a plan of care. What major nursing diagnosis might the care plan include? A) Risk for disuse syndrome B) Ineffective health maintenance C) Sedentary lifestyle D) Imbalanced nutrition: less than body requirements D How should the nurse best position a patient who has leg ulcers that are venous in origin? a. keep the patient legs flat and straight b. keep the patients knees bent to 45- degree angle and supported with pillows c. elevate the patients lower extremities d. dangle the patient legs over the side of the bed C A patient with advanced venous insufficiency is confined following orthopedic surgery. How can the nurse best prevent skin breakdown in the patients lower extremities? A) Ensure that the patients heels are protected and supported. B) Closely monitor the patients serum albumin and prealbumin levels. C) Perform gentle massage of the patients lower legs, as tolerated. D) Perform passive range-of-motion exercises once per shift. A The nurse has performed a thorough nursing assessment of the care of a patient with chronic leg ulcers. The nurses assessment should include which of the following components? Select all that apply. A) Location and type of pain B) Apical heart rate C) Bilateral comparison of peripheral pulses D) Comparison of temperature in the patients legs E) Identification of mobility limitations A, C, D, E 2 | P a g e The nurse is evaluating a patients diagnosis of arterial insufficiency with reference to the adequacy of the patients blood flow. On what physiological variables does adequate blood flow depend? Select all that apply. A) Efficiency of heart as a pump B) Adequacy of circulating blood volume C) Ratio of platelets to red blood cells D) Size of red blood cells E) Patency and responsiveness of the blood vessels A, B, E A nurse is assessing a new patient who is diagnosed with PAD. The nurse cannot feel the pulse in the patients left foot. How should the nurse proceed with assessment? A) Have the primary care provider order a CT. B) Apply a tourniquet for 3 to 5 minutes and then reassess. C) Elevate the extremity and attempt to palpate the pulses. D) Use Doppler ultrasound to identify the pulses. D An older adult patient has been treated for a venous ulcer and a plan is in place to prevent the occurrence of future ulcers. What should the nurse include in this plan? A) Use of supplementary oxygen to aid tissue oxygenation B) Daily use of normal saline compresses on the lower limbs C) Daily administration of prophylactic antibiotics D) A high-protein diet that is rich in vitamins D A 79-year-old man is admitted to the medical unit with digital gangrene. The man states that his problems first began when he stubbed his toe going to the bathroom in the dark. In addition to this trauma, the nurse should suspect that the patient has a history of what health problem? A) Raynauds phenomenon b. CAD c. Arterial insufficiency d. Varicose veins c When assessing venous disease in a patients lower extremities, the nurse knows that what test will most likely be ordered? a. Duplex ultrasonography b. Echocardiography c. Positron emission tomography (PET) d. Radiography A 5 | P a g e The nurse is creating a plan of care for a patient who has a recent diagnosis of MS. Which of the following should the nurse include in the patients care plan? A) Encourage patient to void every hour. B) Order a low-residue diet. C) Provide total assistance with all ADLs. d. Instruct the patient on daily muscle stretching. D A middle-aged woman has sought care from her primary care provider and undergone diagnostic testing that has resulted in a diagnosis of MS. What sign or symptom is most likely to have prompted the woman to seek care? A) Cognitive declines B) Personality changes C) Contractures D) Difficulty in coordination D The nurse is caring for a patient who is hospitalized with an exacerbation of MS. To ensure the patients safety, what nursing action should be performed? A) Ensure that suction apparatus is set up at the bedside. B) Pad the patients bed rails. C) Maintain bed rest whenever possible. D) Provide several small meals each day. A A 33-year-old patient presents at the clinic with complaints of weakness, incoordination, dizziness, and loss of balance. The patient is hospitalized and diagnosed with MS. What sign or symptom, revealed during the initial assessment, is typical of MS? A) Diplopia, history of increased fatigue, and decreased or absent deep tendon reflexes B) Flexor spasm, clonus, and negative Babinskis reflex C) Blurred vision, intention tremor, and urinary hesitancy D) Hyperactive abdominal reflexes and history of unsteady gait and episodic paresthesia in both legs c The nurse is caring for a 77-year-old woman with MS. She states that she is very concerned about the progress of her disease and what the future holds. The nurse should know that elderly patients with MS are known to be particularly concerned about what variables? Select all that apply. A) Possible nursing home placement B) Pain associated with physical therapy C) Increasing disability D) Becoming a burden on the family E) Loss of appetite 6 | P a g e A, C, D A patient diagnosed with MS has been admitted to the medical unit for treatment of an MS exacerbation. Included in the admission orders is baclofen (Lioresal). What should the nurse identify as an expected outcome of this treatment? A) Reduction in the appearance of new lesions on the MRI B) Decreased muscle spasms in the lower extremities C) Increased muscle strength in the upper extremities D) Decreased severity and duration of exacerbations B A patient with MS has been admitted to the hospital following an acute exacerbation. When planning the patients care, the nurse addresses the need to enhance the patients bladder control. What aspect of nursing care is most likely to meet this goal? A) Establish a timed voiding schedule. B) Avoid foods that change the pH of urine. C) Perform intermittent catheterization q6h. D) Administer anticholinergic drugs as ordered. A A patient with MS has developed dysphagia as a result of cranial nerve dysfunction. What nursing action should the nurse consequently perform? A) Arrange for the patient to receive a low residue diet. B) Position the patient upright during feeding. C) Suction the patient following each meal. D) Withhold liquids until the patient has finished eating. B A 48-year-old patient has been diagnosed with trigeminal neuralgia following recent episodes of unilateral face pain. The nurse should recognize what implication of this diagnosis? A) The patient will likely require lifelong treatment with anticholinergic medications. B) The patient has a disproportionate risk of developing myasthenia gravis later in life. c. the patient needs to be assessed for MS. D) The disease is self-limiting and the patient will achieve pain relief over time. c The nurse who is a member of the palliative care team is assessing a patient. The patient indicates that he has been saving his PRN analgesics until the pain is intense because his pain control has been inadequate. What teaching should the nurse do with this patient? A) Medication should be taken when pain levels are low so the pain is easier to reduce. B) Pain medication can be increased when the pain becomes intense. C) It is difficult to control chronic pain, so this is an inevitable part of the disease process. D) The patient will likely benefit more from distraction than pharmacologic interventions. A 7 | P a g e Two patients on your unit have recently returned to the postsurgical unit after knee arthroplasty. One patient is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other patient is reporting a pain level of 3 to 4 on the same pain scale. What is the nurses most plausible rationale for understanding the patients different perceptions of pain? A) Endorphin levels may vary between patients, affecting the perception of pain. B) One of the patients is exaggerating his or her sense of pain. C) The patients are likely experiencing a variance in vasoconstriction. D) One of the patients may be experiencing opioid tolerance. A You are frequently assessing an 84-year-old womans pain after she suffered a humeral fracture in a fall. When applying the nursing process in pain management for a patient of this age, what principle should you best apply? A) Monitor for signs of drug toxicity due to a decrease in metabolism. B) Monitor for an increase in absorption of the drug due to age-related changes. C) Monitor for a paradoxical increase in pain with opioid administration. D) Administer analgesics every 4 to 6 hours as ordered to control pain. A The nurse is assessing a patients pain while the patient awaits a cholecystectomy. The patient is tearful, hesitant to move, and grimacing. When asked, the patient rates his pain as a 2 at this time using a 0-to- 10 pain scale. How should the nurse best respond to this assessment finding? A) Remind the patient that he is indeed experiencing pain. B) Reinforce teaching about the pain scale number system. C) Reassess the patients pain in 30 minutes. D) Administer an analgesic and then reassess. B You are creating a nursing care plan for a patient with a primary diagnosis of cellulitis and a secondary diagnosis of chronic pain. What common trait of patients who live with chronic pain should inform your care planning? A) They are typically more comfortable with underlying pain than patients without chronic pain. B) They often have a lower pain threshold than patients without chronic pain. C) They often have an increased tolerance of pain. D) They can experience acute pain in addition to chronic pain. D The nurse is caring for a 51-year-old female patient whose medical history includes chronic fatigue and poorly controlled back pain. These medical diagnoses should alert the nurse to the possibility of what consequent health problem? A) Anxiety B) Skin breakdown C) Depression D) Hallucinations 10 | P a g e A) The dose range is higher with cancer patients, and the medical team will be very careful to prevent addiction. B) Frequently, female patients and younger patients need higher doses of opioids to be comfortable. C) The increased risk of overdose is an inevitable risk of maintaining adequate pain control during cancer treatment. D) There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug. d You have just received report on a 27-year-old woman who is coming to your unit from the emergency department with a torn meniscus. You review her PRN medications and see that she has an NSAID (ibuprofen) ordered every 6 hours. If you wanted to implement preventive pain measures when the patient arrives to your unit, what would you do? A) Use a pain scale to assess the patients pain, and let the patient know ibuprofen is available every 6 hours if she needs it. B) Do a complete assessment, and give pain medication based on the patients report of pain. C) Check for allergies, use a pain scale to assess the patients pain, and offer the ibuprofen every 6 hours until the patient is discharged. D) Provide medication as per patient request and offer relaxation techniques to promote comfort. c A 60-year-old patient who has diabetes had a below-knee amputation 1 week ago. The patient asks why does it still feel like my leg is attached, and why does it still hurt? The nurse explains neuropathic pain in terms that are accessible to the patient. The nurse should describe what pathophysiologic process? A) The proliferation of nociceptors during times of stress B) Age-related deterioration of the central nervous system C) Psychosocial dependence on pain medications D) The abnormal reorganization of the nervous system d You are the case manager for a 35-year-old man being seen at a primary care clinic for chronic low back pain. When you meet with the patient, he says that he is having problems at work; in the past year he has been absent from work about once every 2 weeks, is short-tempered with other workers, feels tired all the time, and is worried about losing his job. You are developing this patients plan of care. On what should the goals for the plan of care focus? A) Increase the patients pain tolerance in order to achieve psychosocial benefits. B) Decrease the patients need to work and increase his sleep to 8 hours per night. C) Evaluate other work options to decrease the risk of depression and ineffective coping. D) Decrease the time lost from work to increase the quality of interpersonal relationships and decrease anxiety. d An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical patient is complaining of pain that she rates as 8 on a 0-to-10 point scale. The NA tells the nurse that he thinks the patient is exaggerating and does not need pain medication. What is the nurses best response? 11 | P a g e A) Pain often comes and goes with postsurgical patients. Please ask her about pain again in about 30 minutes. B) We need to provide pain medications because it is the law, and we must always follow the law. C) Unless there is strong evidence to the contrary, we should take the patients report at face value. D) Its not unusual for patients to misreport pain to get our attention when we are busy. c The home health nurse is developing a plan of care for a patient who will be managing his chronic pain at home. Using the nursing process, on which concepts should the nurse focus the patient teaching? A) Self-care and safety B) Autonomy and need C) Health promotion and exercise D) Dependence and health a You are the emergency department (ED) nurse caring for an adult patient who was in a motor vehicle accident. Radiography reveals an ulnar fracture. What type of pain are you addressing when you provide care for this patient? A) Chronic B) Acute C) Intermittent D) Osteopenic b The wife of a patient you are caring for asks to speak with you. She tells you that she is concerned because her husband is requiring increasingly high doses of analgesia. She states, He was in pain long before he got cancer because he broke his back about 20 years ago. For that problem, though, his pain medicine wasnt just raised and raised. What would be the nurses best response? A) I didnt know that. I will speak to the doctor about your husbands pain control. B) Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the patient relief. C) Cancer is a chronic kind of pain so the more it hurts the patient, the more medicine we give the patient until it no longer hurts. D) Does the increasing medication dosage concern you? b You are part of the health care team caring for an 87-year-old woman who has been admitted to your rehabilitation facility after falling and fracturing her left hip. The patient appears to be failing to regain functional ability and may have to be readmitted to an acute-care facility. When planning this patients care, what do you know about the negative effects of the stress associated with pain? A) Stress is less pronounced in older adults because they generally have more sophisticated coping skills than younger adults B) It is particularly harmful in the elderly who have been injured or who are ill. C) It affects only those patients who are already debilitated prior to experiencing pain. 12 | P a g e D) It has no inherent negative effects; it just alerts the person/health care team of an underlying disease process. B You are the nurse caring for the 25-year-old victim of a motor vehicle accident with a fractured pelvis and a ruptured bladder. The nurses aide (NA) tells you that she is concerned because the patients resting heart rate is 110 beats per minute, her respirations are 24 breaths per minute, temperature is 99.1F axillary, and the blood pressure is 125/85 mm Hg. What other information is most important as you assess this patients physiologic status? A) The patients understanding of pain physiology B) The patients serum glucose level C) The patients white blood cell count D) The patients rating of her pain D You are the nurse coming on shift in a rehabilitation unit. You receive information in report about a new patient who has fibromyalgia and has difficulty with her ADLs. The off-going nurse also reports that the patient is withdrawn, refusing visitors, and has been vacillating between tears and anger all afternoon. What do you know about chronic pain syndromes that could account for your new patients behavior? A) Fibromyalgia is not a chronic pain syndrome, so further assessment is necessary. B) The patient is likely frustrated because she has to be in the hospital. C) The patient likely has an underlying psychiatric disorder. D) Chronic pain can cause intense emotional responses. D You are caring for a patient admitted to the medical-surgical unit after falling from a horse. The patient states I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse. When planning the patients care, what variables should you consider? Select all that apply. A) How the presence of pain affects patients and families B) Resources that can assist the patient with pain management C) The influence of the patients cognition on her pain D) The advantages and disadvantages of available pain-relief strategies E) The difference between acute and intermittent pain A, B, D A patient is experiencing severe pain after suffering an electrical burn in a workplace accident. The nurse is applying knowledge of the pathophysiology of pain when planning this patients nursing care. What is the physiologic process by which noxious stimuli, such as burns, activate nociceptors? A) Transduction B) Transmission c. Perception d. Modulation a 15 | P a g e D A nurse on an oncology unit has arranged for an individual to lead meditation exercises for patients who are interested in this nonpharmacological method of pain control. The nurse should recognize the use of what category of nonpharmacological intervention? a. A body-based modality b. A mind-body method c. A biologically based therapy d. An energy therapy b A medical nurse is appraising the effectiveness of a patients current pain control regimen. The nurse is aware that if an intervention is deemed ineffective, goals need to be reassessed and other measures need to be considered. What is the role of the nurse in obtaining additional pain relief for the patient? A) Primary caregiver B) Patient advocate c. Team leader d. Case manager b A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of postsurgical patients pain. What principle should guide the nurses use of placebos in pain management? a. Placebos require a higher level of informed consent than conventional care. b. Placebos are an acceptable, but unconventional, form of nonpharmacological pain management. c. Placebos are never recommended in the treatment of pain. d. Placebos require the active participation of the patients family. c The nurse is accepting care of an adult patient who has been experiencing severe and intractable pain. When reviewing the patients medication administration record, the nurse notes the presence of gabapentin (Neurontin). The nurse is justified in suspecting what phenomenon in the etiology of the patients pain? a. Neuroplasticity b. Misperception c. Psychosomatic processes d.Neuropathy D Upon assessment of a client's wound, the nurse notes the formation of granulation tissue. The tissue easily bleeds when 1. the nurse performs wound care. What is the phase of wound healing characterized by the nurse's assessment? A) Proliferation phase B) Hemostasis 16 | P a g e C) Inflammatory phase D) Maturation phase A Upon responding to the client's call bell, the nurse discovers the client's wound has dehisced. Initial nursing 2. management includes calling the physician and doing which of the following? A) Covering the wound area with sterile towels moistened with sterile 0.9% saline B) Closing the wound area with Steri-Strips C) Pouring sterile hydrogen peroxide into the abdominal cavity and packing with gauze D) Holding the wound together until the physician arrives A The wound care clinical nurse specialist has been consulted to evaluate a wound on the leg of a client with diabetes. The wound care nurse determines that damage has occurred to the subcutaneous tissues; how would she document this 3. wound? A) Stage I pressure ulcer B) Stage II pressure ulcer C) Stage III pressure ulcer D) Stage IV pressure ulcer c When measuring the size, depth, and wound tunneling of a client's stage IV pressure ulcer, what action should the nurse 4. perform first? A) Perform hand hygiene. B) Insert a swab into the wound at 90 degrees. C) Measure the width of the wound with a disposable ruler. D) Assess the condition of the visible wound bed. A The nurse would recognize which of these devices as an open drainage system? A) Penrose drain B) Jackson-Pratt drain C) Hemovac D) Negative pressure dressing a Which is an example of a closed wound? A) Abrasion B) Ecchymosis C) Incision D) Puncture wound b 17 | P a g e What are the two major processes involved in the inflammatory phase of wound healing? A) Bleeding is stimulated, epithelial cells are deposited B) Granulation tissue is formed, collagen is deposited C) Collagen is remodeled, avascular scar forms D) Blood clotting is initiated, WBCs move into the wound d A nurse is caring for a client who is two days postoperative after abdominal surgery. What nursing intervention would 8. be important to promote wound healing at this time? A) Administer pain medications on a p.r.n. and regular basis. B) Assist in moving to prevent strain on the suture line. C) Tell the client that a mild fever is a normal response. D) If a scar forms over a joint, it may limit movement. b A home health nurse has a caseload of several postoperative clients. Which one would be most likely to require a longer 9. period of care? A) An infant B) A young adult C) A middle adult D) An older adult d A nurse is educating a postoperative client on essential nutrition for healing. What statement by the client would indicate 10. a need for more information? A) "I will drink a lot of orange juice and drink milk, too." B) "I will take the zinc supplement the doctor recommended." C) "I will restrict my diet to fats and carbohydrates." D) "I will drink 8 to 10 glasses of water every day." c What nursing diagnosis would be a priority for a client who has a large wound from colon surgery, is obese, and is 11. taking corticosteroid medications? A) Self-care Deficit B) Risk for Imbalanced Nutrition C) Anxiety D) Risk for Infection d A nurse working in long-term care is assessing residents at risk for the development of a decubitus ulcer. Which one 12. would be most at risk? A) A client 83 years of age who is mobile B) A client 92 years of age who uses a walker 20 | P a g e which of the following? A) Serous B) Sanguineous C) Serosanguineous D) Purulent c An older adult client has edema of the right lower extremity with redness and clear drainage. This is most likely related 24. to what? A) Beta-hemolytic streptococcus B) Age C) V enous insufficiency D) Hemangioma c Which of the following clients would be considered at risk for skin alterations? Select all that apply. A) A teenager with multiple body piercings B) A homosexual in a monogamous relationship C) A client receiving radiation therapy D) A client undergoing cardiac monitoring E) A client with diabetes a, c, e A nurse is applying cold therapy to a client with a contusion of the arm. Which of the following is an effect of cold 26. therapy? Select all that apply. A) Constricts peripheral blood vessels B) Reduces muscle spasms C) Increases blood flow to tissues D) Increases the local release of pain-producing substances E) Reduces the formation of edema and inflammation a, b, e Which of the following are functions of the skin? Select all that apply. A) Protection B) Temperature regulation C) Sensation D) Vitamin C production E) Immunological a, b, c, e While performing a bed bath, the nurse notes an area of tissue injury on the client's sacral area. The wound presents as a shallow open ulcer with a red-pink wound bed and partial thickness loss of dermis. Which of the following is the 28. correct name of this wound? 21 | P a g e A) Stage II pressure ulcer B) Stage I pressure ulcer C) Stage III pressure ulcer D) Stage IV pressure ulcer a A nurse is treating the pressure ulcer of an African American client. How would the nurse assess for deep tissue injury in 29. this client? A) Upon inspection the nurse would notice a purple or maroon localized area of discolored, intact skin. Upon inspection, the nurse would see a blood-filled blister due to damage of underlying soft tissue from pressure and/or B) shear. Upon palpation, the nurse determines that the area preceded by deep tissue injury is painful, firm, boggy, warmer or C) cooler as compared with adjacent tissue. Upon inspection the nurse notes partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink D) wound bed, without slough. c A nurse inspecting a client's pressure ulcer documents the following: full-thickness tissue loss; visible subcutaneous fat; 30. bone, tendon, and muscle are not exposed. This pressure ulcer is categorized to be at which of the following stages? A) Stage I B) Stage II C) Stage III D) Stage IV c Which of the following is an accurate step when applying a saline-moistened dressing on a client's wound? A) Do not use irrigation to clean the wound before changing the dressing. B) Hold the fine-mesh gauze over the basin and pour the ordered solution over the mesh to saturate it. C) Exert light pressure to pack the wound tightly with moistened dressing. D) Apply several dry, sterile gauze pads over the wet gauze and place the ABD pad over the gauze. d A physician orders a dressing to cover a wound that is shallow with minimal drainage. What would be the best type of 32. dressing for this wound? A) Saline-moistened dressing B) Dressing secured with Montgomery straps C) Hydrocolloid dressing D) Foam dressing 22 | P a g e c Which of the following is an indication for the use of negative pressure wound therapy? A) Bone infections B) Malignant wounds C) Wounds with fistulas to body cavities D) Pressure ulcers d A student has been assigned to provide morning care to a client. The plan of care includes the information that the client 34. requires partial care. What will the student do? A) Provide total physical hygiene, including perineal care. B) Provide total physical hygiene, excluding hair care. C) Provide supplies and orient to the bathroom D) Provide supplies and assist with hard-to-reach areas d A cyclist reports to the nurse that he is experiencing pain in the tendons and ligaments of his left leg, and the pain is 1. worse with ambulation. The nurse will document this type of pain as which of the following? A) Somatic pain B) Cutaneous pain C) Visceral pain D) Phantom pain a Which statement accurately describes pain experienced by the older adult? A) Boredom and depression may affect an older person's perception of pain. B) Residents in long-term care facilities have a minimal level of pain. C) The older client has decreased sensitivity to pain. d. a heightned pain tolerance occurs in the older adult a Pet therapy is commonly used in long-term facilities for distraction. If a client is experiencing pain and the pain is 3. temporarily decreased while petting a visiting dog or cat, this is an example of which type of distraction technique? A) Tactile kinesthetic distraction B) Visual distraction C) Auditory distraction D) Project distraction a Of the following individuals, who can best determine the experience of pain? A) The person who has the pain 25 | P a g e What is the term used to describe a pharmaceutical agent that relieves pain? A) Antacid B) Antihistamine C) Analgesic D) Antibiotic c A client with cancer pain is taking morphine for pain relief. Knowing constipation is a common side effect, what would 17. the nurse recommend to the client? A) "Only take morphine when you have the most severe pain." B) "Increase fluids and high-fiber foods, and use a mild laxative." C) "Administer an enema to yourself every third day." D) "Constipation is nothing to worry about; take your medicine." b Which client would benefit from a p.r.n. drug regimen? A) One who had thoracic surgery 12 hours ago B) One who had thoracic surgery four days ago C) One who has intractable pain D) One who has chronic pain b A nurse is teaching an alert client how to use a PCA system in the home. How will she explain to the client what he must 19. do to self-manage pain? A) "You don't have to do anything. The machine does it all." B) "I will teach your family what they need to do." C) "When you push the button, you will get the medicine." D) "The medicine is going into your body all the time." c A middle-age client is complaining of acute joint pain to a nurse who is assessing the client's pain in a clinic. Which of 20. the following questions related to pain assessment should the nurse ask the client? A) Does your diet include red meat and poultry products? B) Does your pain level change after taking medications? C) Are your family members aware of your pain? D) Have you thought of the effects of your condition on your family? b A client having acute pain tells the nurse that her pain has gradually reduced, but that she fears it could recur and 21. become chronic. What is a characteristic of chronic pain? A) Chronic pain will lead to psychological imbalance. B) Chronic pain has far-reaching effects on the client. C) Chronic pain can be severe in its initial stages. D) Chronic pain eases with healing and eventually disappears. 26 | P a g e b A nurse is assessing a client with arthritis. Which of the following should the nurse consider in the initial assessment of 22. the client? A) Blood group B) Anxiety level C) Pain level D) Glucose level c A nurse is caring for a client with acute back pain. When should the nurse assess the client's pain? A) Six hours after administering a prescribed analgesic B) After the client is discharged from the health care facility C) Once per day when the pain is a potential problem D) Whenever the vital signs are measured and documented d A client has an order for a narcotic analgesic every three to four hours and he received his last dose three hours earlier. Which of the following actions is most appropriate for the nurse to take in response to the client's request for pain 24. medication on his first postoperative day? A) Provide the client with pain medication B) Tell the client that the pain cannot be severe C) Document and ask the client to wait one hour D) Contact the physician for a change in medication a Besides controlling pain of the post-abdominal surgery client with narcotics, the nurse suggests to the client that he ... A) focus on pain relief B) use distraction C) describe the pain D) think about the next dose b The Joint Commission supports the client's right to pain management, and published standards for assessment and management of pain in hospitals, ambulatory care settings, and home care settings (Joint Commission, 2008b). Which of 26. the following are recommended guidelines for pain management? Select all that apply. A) Teach all clients to use a pain rating scale. B) Determine a pain-rating goal with each client. C) Use pharmacologic pain relief measures first. 27 | P a g e D) Manipulate factors that affect the pain experience. E) Keep the primary care provider in charge of all pain relief measures. a, b, d The nurse talks with a client who states, "My primary care provider wants me to try a TENS unit for my pain. How can 27. electricity decrease my pain?" Which of the following responses is most appropriate? A) "The mild electrical impulses block the pain signal before it can reach the brain." B) "The electrode patches generate heat and decrease muscle tension." C) "The machine tricks the mind into believing the pain does not exist." D) "The electricity produces numbness and alters tissue sensitivity." a The nurse has just completed programming of a patient-controlled analgesia (PCA) pump using prescribed parameters. 29. Which of the following actions should you take next? A) V erify the settings with another nurse. B) Document implementation of the PCA on the client's chart. C) Attach the PCA pump tubing to the client's intravenous access device. D) Check the pump's electrical cords for cracks, splits, or fraying. a A nurse is ordered to apply a transcutaneous electrical nerve stimulation (TENS) unit to a client recovering from 30. abdominal surgery. Which of the following is a consideration when using this device? A) TENS is an invasive technique for providing pain relief. TENS involves the electrical stimulation of large-diameter fibers to inhibit the transmission of painful impulses carried B) over small-diameter fibers. C) TENS is most beneficial when used to treat pain that is generalized. D) A TENS unit is applied intermittently throughout the day and should not be worn for extended periods of time. b A nurse is assessing the vital signs of a client who is moaning due to the acute onset of pain. What would be the 31. expected objective findings? A) Decreased pulse and respirations B) Increased pulse and blood pressure C) Increased temperature d. no change from client's norms b A nurse is assessing a mentally challenged, adult client who is in pain after a fall. Which of the following scales should 32. the nurse use to assess the client's pain? A) Pain Assessment in Advanced Dementia (PAINAD) B) Wong-Baker Faces scale 30 | P a g e d A client with bipolar disorder begins taking lithium carbonate (lithium) 300 mg four times a day. After 3 days of therapy, the client says, "My hands are shaking." Which is the best response by the nurse? a."Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks." b."It is nothing to worry about unless it continues for the next month." c."Tremors can be an early sign of toxicity, but we'll keep monitoring your lithium level to make sure you're OK." d."You can expect tremors with lithium. You seem very concerned about such a small tremor." a What are the most common types of side effects from SSRIs? a.Dizziness, drowsiness, and dry mouth b.Convulsions and respiratory difficulties c.Diarrhea and weight gain d.Jaundice and agranulocytosis a The nurse observes that a client with depression sat at a table with two other clients during lunch. Which is the best feedback the nurse could give the client? a."Do you feel better after talking with others during lunch?" b."I'm so happy to see you interacting with other clients." c."I see you were sitting with others at lunch today." d."You must feel much better than you were a few days ago." c Which term typifies the speech of a person in the acute phase of mania? a.Flight of ideas b.Psychomotor retardation c.Hesitant d.Mutism a What is the rationale for a person taking lithium to have enough water and salt in his or her diet? a.Salt and water are necessary to dilute lithium to avoid toxicity. b.Water and salt convert lithium into a usable solute. c.Lithium is metabolized in the liver, necessitating increased water and salt. d.Lithium is a salt that has greater affinity for receptor sites than sodium chloride. d A client says to the nurse, "You are the best nurse I've ever met. I want you to remember me." What is an appropriate response by the nurse? a."Thank you. I think you are special too." b."I suspect you want something from me. What is it?" 31 | P a g e c."You probably say that to all your nurses." d."Are you thinking of suicide?" d A client with mania begins dancing around the day room. When she twirled her skirt in front of the male clients, it was obvious she had no underwear on. The nurse distracts her and takes her to her room to put on underwear. The nurse acted as she did to a.minimize the client's embarrassment about her present behavior. b.keep her from dancing with other clients. c.avoid embarrassing the male clients who are watching. d.teach her about proper attire and hygiene. a Which actions would indicate an increased suicidal risk? Select all that apply. a.An abrupt improvement in mood b.Calling family members to make amends c.Crying when discussing sadness d.Feeling overwhelmed by simple daily tasks e.Statements such as "I'm such a burden for everyone" f.Statements such as "Everything will be better soon" a, b, f Which activities would be appropriate for a client with mania? Select all that apply. a.Drawing a picture b.Modeling clay c.Playing bingo d.Playing table tennis e.Stretching exercises f.Stringing beads a, b, e Which statement would indicate that teaching about naltrexone (ReVia) has been effective? a."I'll get sick if I use heroin while taking this medication." b."This medication will block the effects of any opioid substance I take." c."If I use opioids while taking naltrexone, I'll become extremely ill." d."Using naltrexone may make me dizzy." b Clonidine (Catapres) is prescribed for symptoms of opioid withdrawal. Which nursing assessment is essential before giving a dose of this medication? a.Assessing the client's blood pressure b.Determining when the client last used an opiate c.Monitoring the client for tremors d.Completing a thorough physical assessment 32 | P a g e a Which behaviors would indicate stimulant intoxication? a.Slurred speech, unsteady gait, impaired concentration b.Hyperactivity, talkativeness, euphoria c.Relaxed inhibitions, increased appetite, distorted perceptions d.Depersonalization, dilated pupils, visual hallucinations b The 12 steps of AA teach that a.acceptance of being an alcoholic will prevent urges to drink. b.a higher power will protect individuals if they feel like drinking. c.once a person has learned to be sober, he or she can graduate and leave AA. d.once a person is sober, he or she remains at risk for drinking. d The nurse has provided an in-service program on impaired professionals. She knows that teaching has been effective when staff identify which as the highest risk for substance abuse among professionals? a.Most nurses are codependent in their personal and professional relationships. b.Most nurses come from dysfunctional families and are at risk for developing addiction. c.Most nurses are exposed to various substances and believe they are not at risk of developing the disease. d.Most nurses have preconceived ideas about what kind of people become addicted. c A client comes to day treatment intoxicated but says he is not. The nurse identifies that the client is exhibiting symptoms of a.denial. b.reaction formation. c.projection. d.transference. a The client tells the nurse that she has a drink every morning to calm her nerves and stop her tremors. The nurse realizes the client is at risk for a.an anxiety disorder. b.a neurologic disorder. c.physical dependence. d.psychological addiction. c Which conditions would the nurse recognize as signs of alcohol withdrawal? Select all that apply. a.Blackouts b.Diaphoresis 35 | P a g e C) Visible clubbing of the fingers and toes D) Reddened extremities with muscle atrophy B A nurse is creating an education plan for a patient with venous insufficiency. What measure should the nurse include in the plan? A) Avoiding tight-fitting socks. B) Limit activity whenever possible. C) Sleep with legs in a dependent position. D) Avoid the use of pressure stockings. A The nurse is caring for a patient with a large venous leg ulcer. What intervention should the nurse implement to promote healing and prevent infection? A) Provide a high-calorie, high-protein diet. B) Apply a clean occlusive dressing once daily and whenever soiled. C) Irrigate the wound with hydrogen peroxide once daily. D) Apply an antibiotic ointment on the surrounding skin with each dressing change. A An occupational health nurse is providing an educational event and has been asked by an administrative worker about the risk of varicose veins. What should the nurse suggest as a proactive preventative measure for varicose veins? a. Sit with crossed legs for a few minutes each hour to promote relaxation. b. Walk for several minutes every hour to promote circulation. c. Elevate the legs when tired. d. Wear snug-fitting ankle socks to decrease edema. B A nurse in a long-term care facility is caring for an 83-year-old woman who has a history of HF and peripheral arterial disease (PAD). At present the patient is unable to stand or ambulate. The nurse should implement measures to prevent what complication? A. Aoritis B. Deep vein thrombosis C. Thoracic aortic aneurysm D. Raynauds disease B A nurse is admitting a 45-year-old man to the medical unit who has a history of PAD. While providing his health history, the patient reveals that he smokes about two packs of cigarettes a day, has a history of alcohol abuse, and does not exercise. What would be the priority health education for this patient? a. The lack of exercise, which is the main cause of PAD. b. The likelihood that heavy alcohol intake is a significant risk factor for PAD. 36 | P a g e c. Cigarettes contain nicotine, which is a powerful vasoconstrictor and may cause or aggravate PAD. d. Alcohol suppresses the immune system, creates high glucose levels, and may cause PAD. c A nurse has written a plan of care for a man diagnosed with peripheral arterial insufficiency. One of the nursing diagnoses in the care plan is altered peripheral tissue perfusion related to compromised circulation. What is the most appropriate intervention for this diagnosis? a. Elevate his legs and arms above his heart when resting. b. Encourage the patient to engage in a moderate amount of exercise. c. Encourage extended periods of sitting or standing. d. Discourage walking in order to limit pain. b The nurse is caring for a patient who is admitted to the medical unit for the treatment of a venous ulcer in the area of her lateral malleolus that has been unresponsive to treatment. What is the nurse most likely to find during an assessment of this patients wound? a. Hemorrhage b. Heavy exudate c. Deep wound bed d. Pale-colored wound bed B You are caring for a patient who is diagnosed with Raynauds phenomenon. The nurse should plan interventions to address what nursing diagnosis? a. Chronic pain b. Ineffective tissue perfusion c. Impaired skin integrity d. Risk for injury B A nurse working in a long-term care facility is performing the admission assessment of a newly admitted, 85-year-old resident. During inspection of the residents feet, the nurse notes that she appears to have early evidence of gangrene on one of her great toes. The nurse knows that gangrene in the elderly is often the first sign of what? a. Chronic venous insufficiency b. Raynauds phenomenon c. VTE d. PAD D Graduated compression stockings have been prescribed to treat a patients venous insufficiency. What education should the nurse prioritize when introducing this intervention to the patient? A) The need to take anticoagulants concurrent with using compression stockings B) The need to wear the stockings on a one day on, one day off schedule 37 | P a g e C) The importance of wearing the stockings around the clock to ensure maximum benefit D) The importance of ensuring the stockings are applied evenly with no pressure points D While assessing a client, a nurse find that the client has superficial burns. Which treatment does the nurse anticipate to be beneficial for this client? a. intravenous fluids b. analgesics c. topical antibiotics d. tetanus booster While assessing a client, a nurse finds that the skin on the wrist appears pearl-pink, wet, and blistered. On further assessment, the nurse finds that the client's dermis is exposed, extremely tender, and painful due to scalds. What does the nurse infer from these findings? a. the client has full thickness burns b. the client has superficial burns c. the client has deep partial thickness burns d. the client has superficial partial thickness burns d. the client has superficial partial thickness burns While assessing a child, a nurse finds a characteristic gray coloring on 30% of the total body surface area (TBSA). On communicating with the parent, the nurse finds that the child has ingested toilet bowl cleaner accidentally. Which condition does the nurse expect in the child? a. electrical burns b. thermal burns c. chemical burns d. radiation burns c. chemical burns which zone exhibits the greatest degree of thermal injury within the skin? a. zone of coagulation b. zone of stasis c. all of the above d. zone of hyperemia a. zone of coagulation while caring for a client after a thermal injury a nurse finds that the client is showing signs and symptoms of hyperkalemia. which is the most important nursing intervention for this client? a. elevating the head of the clients bed immediately b. monoriting continuously through electrocardiogm c. administrating oral fluids to the client frequently d. applying a topic antibiotic on the burn b. monitoring continuously through electrocardiogm 40 | P a g e genetic screening may be indicated for individuals who have a family history of which of the following neoplasms? a.liver cancer b. breast cancer c. multiple myeloma d. leukemia b. breast cancer Which of the following dietary guidelines should a nurse provide to a group of older adults to possibly decrease their risks of developing colon cancer? A. "As much as possible, try to eat organic foods." B. "Regular vitamin supplements and a low-carbohydrate diet are beneficial." C. "Try to minimize fat and maximize fiber when you're planning your meals." D. Eat enough fiber in your diet that you have bowel movement at least once daily. C. "Try to minimize fat and maximize fiber when you're planning your meals." A 5-year-old girl's diagnosis of bone cancer required an aggressive treatment regimen. Which of the following considerations forms the most significant threat to her future health? a. Unwanted effects of chemotherapy and radiation therapy b. Retention of chemotherapeutic drugs in the healthy bone matrix c. resistance to chemotherapy and radiation if required later in life d. risk for recurrence of the primary neoplasm after puberty a. Unwanted effects of chemotherapy and radiation therapy The patient is diagnosed with Hodgkin type of lymphoma based on the results of laboratory tests and study of the tumor cells. A distinct characteristic of Hodgkin lymphoma is the presence of a. M-type protein antibodies b. Reed-Sternberg cells c. Bence Jones proteins d. Philadelphia chromosome b. Reed-Sternberg cells Manifestations of Hodgkin lymphoma that distinguish it from non-Hodgkin lymphoma include: a. superficial hymphadenopathy b. poor humoral antibody response c. nonogontiguious nodal spread d. pruritus and night fevers. d. pruritus and night fevers. In contrast to acute leukemias, chronic leukemias are malignant involving abnormal __________________ blood cells in the marrow. proliferation of well-differentiated 41 | P a g e a. proliferation of well-differentiated b. uncontrolled growth of immature c. production of undifferentiated d. replication of pluripotent percusor a. proliferation of well-differentiated Which of the following factors differentiates chronic leukemias from acute leukemias? a. the prevalence among individuals with down syndrome is high b. leukemic cells are disseminated throughout the body by the circulatory system c. the leukemic cells are more fully differentiated than in acute leukemias d. they are cancers of the hematopeitic proenitor cells c. the leukemic cells are more fully differentiated than in acute leukemias Hemophilia A is a hereditary blood disorder caused by inadequate activity or absence of which of the following? a. prothrombin b. vWF complex c. factor VIII d. intrinsic factor c. factor VIII A 69-year-old patient who is obese and has a diagnosis of angina pectoris has been prescribed aspirin by his primary care provider. The patient's medication achieves its therapeutic effect in which of the following ways? a. deactivation of factor X b. inhibition of the clotting pathway c. activation of plasminogen d. prevention of platelet aggregation d. prevention of platelet aggregation Which of the following patients likely faces the highest risk of an acquired hypocoagulation disorder and vitamin K deficiency? a. a patient who has chronic renal failure as a result from type 1 diabetes b. a patient who is immunocomprimised as a result of radiation therapy c. a patient with dehydration and hypokalemia as resulted from c-diff d. a patient who has diagnosed of liver failure secondary to alcohol abuse d. a patient who has diagnosed of liver failure secondary to alcohol abuse Sue is fatigued and some blood tests are done. Her results include Hct 40%; Hgb 8g/dL; WBC 8,000; platelets 175,000. The nurse should interpret Sue's blood work as indicative of: a. low WBC count/ granluocytopenia b. high platlets/ thrombocytosis c. low hemoglobin/anemia. d. high hematocrit/polyenima 42 | P a g e c. low hemoglobin/anemia. megloblastic anemias caused by follic acid or vitamin B12 deficiencies can seriously affect RBC production. This is because both are necessary for ____ synthesis and ______. a. DNA: red blood cell maturation b. thrombin: platelet aggregation c. iron: hemoglobin adhesion d. protein: reticulocyte maturation a. DNA: red blood cell maturation Conditions that predispose to sickling of hemoglobin in persons with sickle cell anemia include a. impaired red blood cell maturation b. decreased oxygen saturation c. increased intravascular volume d. increased iron content of blood b. decreased oxygen saturation while caring for a client after a thermal injury a nurse finds that the client is showing signs and symptoms of hyperkalemia. which is the most important nursing intervention for this client? a. administering IV fluids b. incubating the patient c. elevating the affected extremities of the client d. beginning cardiopulmonary resuscitation b. incubating the patient The parasympathetic nervous system causes a slowing of the heart rate by increasing: a. vessel constriction. b. vagus nerve activity. c. smooth muscle tone. d. norepinephrine. b. vagus nerve activity. Following several weeks of increasing fatigue and a subsequent diagnostic work-up, a patient has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the following consequences? a. Inhibition of the SA node's normal action potential b. Backup of blood from the right atrium into the superior vena cava c. Backflow from the right ventricle to the right atrium during systole d. Backflow from the left ventricle to left atrium d. Backflow from the left ventricle to left atrium Disseminated intravascular coagulation (DIC) can be initiated by an external event like trauma. Once that event happens, what is the first pathological body change that would indicate the presence of DIC? a. clots form throughout the body, especially in small vessels 45 | P a g e Platelet count, serum creatinine, and liver enzymes The nurse is hearing diminished breath sounds and a "grating" sound during respirations. This is consistent with excess collection of fluid in the pleural cavity. The medical term for this is pneumothorax. poor lung compliance. pleural effusion. pleurisy. pleural effusion. A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man? Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility Infusion of normal saline or Ringer lactate to maintain the vascular space Resolution of compensatory pulmonary edema and heart arrhythmias Administration of oxygen and epinephrine to promote perfusion Infusion of normal saline or Ringer lactate to maintain the vascular space A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice? Measurement of urine output and mental status assessment Pupil response and counting the patient's apical heart rate Palpation of pedal (foot) pulses and pain assessment Activity tolerance and integumentary inspection Measurement of urine output and mental status assessment Harmful effects on cardiac action potential are most likely to result from a deficit of which of the following electrolytes? Hydrogen carbonate (HCO3-) Potassium (K+) Magnesium (Mg2+) Chloride (Cl-) Potassium (K+) A male patient with a history of angina has presented to the emergency department with uncharacteristic chest pain and his subsequent ECG reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle? Depolarization of the AV node, bundle branches, and Purkinje system Atrial depolarization Ventricular repolarization Ventricular depolarization Ventricular repolarization 46 | P a g e Release of which of the following humoral factors will result in vasodilation? Serotonin Angiotensin II Norepinephrine Histamine Histamine Which of the following factors is the primary governor of the local control of blood flow? Action potential Feedback from arterial baroreceptors and chemoreceptors The nutritional needs of the tissue involved Cardiac contractility and preload The nutritional needs of the tissue involved A patient's primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen to treat his primary hypertension. How does this diuretic achieve its therapeutic effect? By decreasing vascular volume by increasing sodium and water excretion By inhibiting the movement of calcium into arterial smooth muscle cells By inhibiting the conversion of angiotensin I to angiotensin II. By blocking the release of antidiuretic hormone from the posterior pituitary By decreasing vascular volume by increasing sodium and water excretion A patient with persistent, primary hypertension remains apathetic about his high blood pressure, stating, "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How could a clinician best respond to this patient's statement? "You may not sense any problems, but it really increases your risk of heart disease and stroke." "That's true, but it's an indicator that you're not taking very good care of yourself." "You're right, but it's still worthwhile to monitor it in case you do develop problems." "Actually, high blood pressure makes you very susceptible to getting diabetes in the future." "You may not sense any problems, but it really increases your risk of heart disease and stroke." Which of the following is a nonmodifiable risk factor for the development of primary hypertension? High salt intake African American race Male gender Obesity African American race A patient with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the patient's increased blood pressure? Increased sympathetic stimulation by the autonomic nervous system (ANS) Coarctation of the patient's aorta 47 | P a g e Activation of the renin-angiotensin-aldosterone mechanism Increased levels of adrenocortical hormones Activation of the renin-angiotensin-aldosterone mechanism The patient is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the mid-calf area. He has many of the manifestations of: arterial insufficiency. stasis ulcerations. primary varicose veins. deep vein thrombosis. deep vein thrombosis. By definition, hypertension is systolic blood pressure of ____ mm Hg or higher or diastolic blood pressure of ____ mm Hg or higher. 129; 85 140; 90 138; 89 155; 95 140; 90 Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by: intermittent vessel vasospasms. excessive endothelial relaxing factors. increased collateral circulation. fixed coronary obstruction. fixed coronary obstruction. Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a: red thrombus. vessel wall injury. calcified lesion. large lipid core. large lipid core. In adults, sudden death from an acute myocardial infarction is usually caused by: high troponin levels. hypertrophic cardiomyopathy. acute ventricular arrhythmia. acute myocarditis. acute ventricular arrhythmia. 50 | P a g e type I hypersensitivity response. Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by: hyperinflated alveolar sacs. excessive surfactant. hyperventilation. ventilation-perfusion mismatch. ventilation-perfusion mismatch. A common cause of bacterial pneumonia in both community and hospital setting is: E. coli S. aureus. Enterobacter. S. pneumoniae. S. aureus. The pathogenic capacity of the tubercle bacillus is related to: formation of a Ghon's focus lesion. its inherent destructive capabilities. rapid viral replication in host cells. the initiation of a cell-mediated immune response. the initiation of a cell-mediated immune response. The "cold viruses" are rapidly spread from person to person. The greatest source of spread is: fingers. sneezing. plastic toys. eye mucosa. fingers. A college student is lamenting the fact that she has developed a cold on the weekend prior to exam week. Which of the following statements shows that the student has an accurate understanding of her upper respiratory infection? "I'm just going to try to rest as much as I can until these bacteria clear up." "I think I'll go to the campus clinic and see if I can get a prescription for antibiotics." "I suppose I should have been washing my hands more in the past few days." "If I can just start some antihistamines as soon as possible I bet I'll get over this faster." "I suppose I should have been washing my hands more in the past few days." Which of the following individuals should be prioritized for receiving a seasonal influenza vaccination? An 81-year-old resident of a long-term care facility A 19-year-old man who was admitted to a hospital for an appendectomy 51 | P a g e A neonate who was born in a busy, inner-city hospital in late October An 86-year-old patient whose flu symptoms have required hospitalization An 81-year-old resident of a long-term care facility A patient has been admitted to a medical unit of a hospital for the treatment of pneumonia that is attributable to S. pneumonia. Which of the following considerations is the priority in this patient's treatment? Maintaining the patient's activities of daily living Maintaining the patient's airway Monitoring and treating the patient's pain Preventing and treating the patient's fever Maintaining the patient's airway A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis bacteria and has subsequently developed latent tuberculosis infection. Which of the following is true of this nurse? The nurse is likely asymptomatic. The nurse is now immune to more severe tuberculosis infection. The nurse can spread tuberculosis to others. The nurse has active tuberculosis infection. The nurse is likely asymptomatic. A patient with a diagnosis of community-acquired pneumonia is producing copious secretions that are physically obstructing her airway. Which of the following pathophysiologic processes will result from this condition? Compensatory vasoconstriction Ventilation without perfusion Dead air space Perfusion without ventilation Perfusion without ventilation A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a life-threatening condition because: expired air exits the bleeding wound. trapped, inspired air collapses the lung. the opposite lung hyperinflates. blebs on the lung surface rupture. trapped, inspired air collapses the lung. Atelectasis is most commonly caused by: airway obstruction. pulmonary embolism. 52 | P a g e inflammation of the pleura. chronic forceful coughing. airway obstruction. Acute onset bronchial asthma causes wheezing and breathlessness as a result of: airway inflammation. alveolar collapse. compression atelectasis. pulmonary hypertension. airway inflammation. The common results of respiratory failure are hypoxemia and: hypercapnia. bradycardia. vasoconstriction. pulmonary emboli. hypercapnia A patient with a history of emphysema is experiencing hypoxemia after a taxing physical therapy appointment. Which of the following physiologic phenomena will occur as a consequence of hypoxemia? Peripheral vasodilation Necrosis Hypoventilation Increased heart rate Increased heart rate A motor vehicle accident has resulted in a tension pneumothorax for the driver of the car. Which of the following manifestations is associated with tension pneumothorax? Audible friction rub over the affected lung Mediastinal shift Metabolic alkalosis Atrial fibrillation Mediastinal shift A patient has just been admitted to the postsurgical unit following a below-the-knee amputation. Which of the following measures should her care team prioritize to prevent atelectasis during the patient's immediate recovery? Bedrest and supplementary oxygen by nasal cannula Administration of bronchodilators by nebulizer Deep-breathing exercises and early mobilization Adequate hydration and a high-humidity environment 55 | P a g e lethargy coma restlessness How would you know if you had hypoxemia or hypercapnia? measure oxygen saturations perform pulmonary function testing measure arterial blood gases observe for signs and symptoms measure arterial blood gases Your patient describes a sensation of shortness of breath and the inability to get enough air. This is documented as: dyspnea orthopnea hemoptysis aspiration dyspnea You notice that your patient has a barrel chest. This is most likely a result of: smoking chronic costochondritis chronic alveolar distention hypoxia chronic alveolar distention Upon auscultation of your patient's lung sounds, you notice a high-pitched wheezing sound. This is due to: airway constriction bronchodilation fluid accumulation in the lungs asthma airway constriction Your 4-month old cousin is diagnosed with gastroesophageal reflux. She spits up frequently after feedings and is irritable for about 1 hour after eating. At her last health check up, the practitioner mentioned that she is at risk for pneumonia. What would be the most likely cause for this? prematurity ineffective cough reflex probably exposure to the influenza virus aspiration 56 | P a g e aspiration Which of the following diagnostic findings is related to the accumulation of the products of inflammation during typical pneumonia? pneumothorax consolidation hemoptysis exudation consolidation What is the route of transmission for tuberculosis? airborne droplet nuclei respiratory droplet transmission direct contact vector transmission airborne droplet nuclei Which of the following is not characteristic of infection with tuberculosis? The tuberculosis bacillus is slow growing A humoral-mediated immune response is critical for destruction of the bacillus The tuberculosis bacilli do not produce toxins The infection can be found in any organ in the body A humoral-mediated immune response is critical for destruction of the bacillus Which of the following is not a change in the bronchi and bronchioles related to chronic bronchitis? chronic inflammation in the airways hypertrophy of bronchial mucous glands fibrosis squamous cell metaplasia hypertrophy of bronchial mucous glands Which of the following manifestations are more commonly found in chronic bronchitis as compared to emphysema? lymphadenopathy cough dyspnea cyanosis cyanosis Bronchial circulation differs from the pulmonary circulation by providing blood for the: Conducting airways Alveolar gas exchange 57 | P a g e Mediastinal and pleural space Intrapulmonary pressure balance Conducting airways When a client with a history of asthma takes a walk outside on a windy day with high pollen counts, she may experience an asthma attack, resulting in an increase in respiration rate and wheezing. The body's response is likely related to which pathophysiological principle? Parasympathetic nervous system stimulation resulting in airway constriction Release of catecholamines causing blood vessel constriction Influx of macrophages to wall of the pollen, thereby stopping the attack Inhibition of glandular secretions, which causes build up of mucus in the lungs Parasympathetic nervous system stimulation resulting in airway constriction A client who is in a room at 1 atmosphere (760 mm Hg) is receiving supplemental oxygen therapy that is being delivered at a concentration of 50%. What is the consequent PO2? 38,000 mm Hg. More data are needed. 380 mm Hg. 15.2 mm Hg 380 mm Hg. A college student is training for a marathon in the mountains. One day, she experiences a sharp pain and suddenly becomes short of breath. At the emergency room, chest x-ray reveals a spontaneous pneumothorax. The client asks the nurse to explain why this happened. The nurse states, "For unknown reasons, you lose intrapleural negative pressure. You must have experienced a forced expiration against a closed glottis to cause the lung to deflate." This means your lungs collapsed and expelled its air when you lose negative pressure." You must have coughed too forcibly and your air sacs burst." You must have a genetic anomaly causing weakened alveolar sacs to rupture. This means your lungs collapsed and expelled its air when you lose negative pressure." Clients who have been bed-ridden for a long time likely will experience: An inability to produce sufficient amounts of surfactant and may require recombinant forms Shallow, quiet breathing, which impairs the spreading of surfactant A sharp increase in surfactant levels that will require frequent suctioning Increase in their depth of breathing, which increases lung volumes causing more surfactant to spread out over the alveolar surfaces Shallow, quiet breathing, which impairs the spreading of surfactant Clients with chronic obstructive lung disease (COPD) may experience airway closure at the end of normal instead of low lung volumes, which result in: Airway constriction of the main bronchus Release of epinephrine, a catecholamine, which causes airway dilation 60 | P a g e Swelling of extremity due to obstructed lymph channel, nonpitting Vasculitis An inflammation of the blood vessels that causes changes in the blood vessel walls Malignant Spreads Surgical dehiscence Wound ruptures open along incision Arterial insufficiency Slow or stop of blood flow through the arteries Pressure ulcers occur on: Bony areas due to pressure, friction, or shear Arterial ulcer A wound that won't heal due to decreased blood flow Claudication Limping Wet gangrene Tissue necrosis associated with infection requires emergent debridement and drainage, followed by revascularization Dry gangrene Necrosis not invasive; doesn't produce sepsis unless infected; revascularization performed first before amputating Dual venous system 61 | P a g e Superficial saphrenous system and deep venous system Venous ulcers caused by: Failure of calf muscle to pump or valve incompetence Venous Leg Ulcer Veins dilate and leak blood and serum into interstitial tissue; ulcers always associated with edema Sensory neuropathy Lack of sensation Motor neuropathy Wasting of foot muscles; structural deformity Autonomic neuropathy Loss of autonomic system function; Absence of sweat and oil production leads to dry scaly skin and development of cracks and fissures Necrotizing fasciitis Rapid spreading inflammation and necrosis of skin, subQ fat and fascia Fournier's Gangrene Type of necrotizing fasciitis or gangrene affecting the external genitalia and/or perineum What are the different types of necrotizing fasciitis? Type 1- Clostridium and bactericides species Type 2- Streptococcus A Type 3- Vibrio infection Superficial fungal infections Attack keratinized (dead) cells; inflammatory reaction to toxins *Ex: Ringworm, athletes foot Deep fungal infections Attack living tissue; may attack other organs *Ex: Candidiasis, sporotrichosis Burns 62 | P a g e Destruction of skin and/or mucous membrane due to heat, chemicals, or radiation What are the burn phases? 1. Emergent- Pain response; catecholomine release (adrenaline) 2. Fluid Shift- Fluid and proteins shift; lasts 18-24hrs (reaches peak 6-8hrs) 3. Hypermetabolic- Lasts days to weeks; increased nutrients needed; influx of vascular space fluid=sweating 4. Resolution- Scarring Jackson's Theory of Thermal Wounds includes: 1. Zone of coagulation 2. Zone of stasis 3. Zone of hyperemia Zone of Coagulation Area in a burn nearest the heat source that suffers the most damage (as evidenced by clotted blood and thrombosed blood vessels); irreversible tissue loss Zone of Stasis Area surrounding zone of coagulation characterized by decreased blood flow; decrease tissue perfusion; potentially salvageable Zone of Hyperemia Peripheral area around burn that has increased blood flow Thermal injuries include: Scalds, flames, contact First degree burn Superficial; redness; epidermis in tact Second degree burn (superficial partial thickness) Blistering, wet, shiny 65 | P a g e Pemphoid Bullous Chronic, inflammatory blistering disease. Is cellulitis bilateral? No Periorbital cellulitis Special form of cellulitis that usually occurs in children; unilateral swelling and redness of the eyelid and orbital area Marjolin ulcer Non healing ulcer after a burn Melanoma Skin cancer Basal cell carcinoma Slow growing lesions arise from basal cells; most common cancer Squamous cell carcinoma Cancer caused by an uncontrolled growth of abnormal squamous cells. Diapedesis Cells leave the veins to wound site Anemia Reduction in the total # of RBCs (erythrocytes) or hemoglobin What is one of the most common anemic pts? Renal failure (kidneys produce erythropoietin) What is the most common type of anemia world wide? Iron deficiency Anemia is becoming common in people who have had: Post-gastic bypass surgery 66 | P a g e A CBC will give you White blood cell count, red blood cell count, hemoglobin levels, size of RBCs, mean corpuscular volume. MCH (mean corpuscular hemoglobin) Amount of hemoglobin in each cell (hypchromatic= not a lot of color/pale) MCHC (mean corpuscular hemoglobin concentration) Mean hemoglobin concentration in relation to total volume of cell Red Blood Cell Distribution Width (RBDW) Types of RBCs and how many MCV (mean corpuscular volume) Mean corpuscular volume size (Large= macrocytic, small= microcytic) Corpuscular Cell suspended in fluid (usually blood) The clotting cascade is common in: Women who have just given birth DVTs travel to where The lungs Pulmonary embolism Blood clot in the pulmonary artery DVT Deep vein thrombosis (blood clot in leg) CRF Chronic renal failure; *MCV, MCH, and MCHC levels all normal Iron deficiency anemia Low MCV, MCH, and MCHC levels *microcytic Heparin Anticoagulant B12/Folate deficiency anemia 67 | P a g e High MCV levels, normal MCH and MCHC levels *macrocytic BRCA1 and BRCA2 Indicate breast cancer and ovarian cancer (always) Disseminated Intravascular Coagulopathy (DIC) Excessive bleeding and clotting; clotting cascade Cervical cancer is a: Virus Malignant cells lack: Apoptosis Anaplastic Abnormal tissue; undifferentiated Pancreatic cancer spreads quickly because: It has a lot of veins/arteries circulating from entire body What type of cell has the highest risk of cancer? Epithelial Direct cancer spread Cancer not removed completely during surgery Proto-oncogenes Genetic cancer genes A defect in the P53 gene is indicative of: Cancer Anaplasia Lack of differentiation Cancer gets both: Graded (based on anaplasia) and staged (based on location/spread) Cachexia Anorexia/wasting of the body due to severe chronic illness and increased metabolic rate (common in cancer) 70 | P a g e Inhibits vasoconstriction, is anti-thromboic (lowers platelet adhesion), Anti-inlammatory (lowers leukocyte adhesion), Anti-proliferative (lowers smooth muscle growth) Hyperkalemia High peak T waves Arterialsclerosis Inflammatory disease Plaque build up is due to Fibroblasts laying down collagen Most effected arteries by atherosclerosis #1. Aorta 2. Coronary 3. Carotid 4. Legs 5. Circle of Willis (brain) Left anterior descending artery Feeds left side of heart Circumflex artery Feeds back of heart Right anterior descending artery Feeds right side of heart Aspirin Stops coagulation of platelets Factor's affecting blood flow: Pressure, resistance, and Poiseuille's Law Aneurysm Arteries weaken and blow up like a balloon AAA Abdominal Aortic Aneurysms (between kidneys); most susceptible to aneurysm Ischemic Coronary Artery Disease (CAD) Results in angina and MI 71 | P a g e Collateral circulation Over time, alternate route taken by blood Angiogram X-ray of blood vessels Types of hypertension 1. Complicated 2. Malignant- Life threatening organ damage 3. Orthostatic PTCA percutaneous transluminal coronary angioplasty (balloon angioplasty) CABG coronary artery bypass graft Fusiform and saccular aneurysms True aneurysms Off-pump Pt heart gets stitched between beats During diastole Ventricles relaxed, Blood enters atria, Blood flows through AV valves into ventricles, Semilunar valves are closed During systole Ventricles contract, AV valves shut, Blood pushes through semilunar valves into aorta and pulmonary trunk Baroreceptors 72 | P a g e Cells that are sensitive to blood pressure changes. Dysrhythmias are the number one cause of Heart attacks that result in death Stemi MI Whole thickness of the heart muscle has been destroyed; more scar tissue Non-stemi MI Destruction of heart muscle, but not whole thickness Sympathetic NS kicks in when Someone is having a MI *anxious, high HR, sweating, vasodilation Morphine Vasodilates When someone is having an MI, you're going to give them: 1. Morphine 2. Oxygen 3. Nitroglycerin 4. Aspirin Men are at higher risk for MI Normal return blood amount from pulmonary vein: 100cc Ejection fraction EF = (stroke volume / end diastolic volume) x 100 *Want it to be over 60% An ejection fraction lower than 50% Pushes blood back into the lungs and causes pink brothy sputum and S3 sounds; increased pulmonary tension S3 sounds are indicative of Congestive heart failure (left sided); most pts have left sided heart failure Betablockers Reduce HR 75 | P a g e prerenal aki Most common cause of ARF Caused by impaired renal blood flow GFR declines because of the decrease in filtration pressure intrarenal aki acute tubular necrosis is most common cause postischemic or nephrotoxic oliguria Acute Tubular Necrosis (ATN) damage to renal tubules due to toxins in the urine; results in oliguria post renal aki occurs with urinary tract obstructions that affect the kidneys bilaterally GFR (glomerular filtration rate) the total amount of filtrate formed by the kidneys per minute oliguria Decreased urine output aki phases Initiation maintenance recovery initiation phase of aki Kidney injury is evolving Prevention of injury is possible maintenance phase of aki Established kidney injury and dysfunction Urine output is lowest during this phase serum creatinine and blood urea nitrogen both increase recovery phase of aki Injury repaired and normal renal function reestablished Diuresis common Decline in serum creatinine and urea Increase in creatinine clearance lowest urine output during AKI 76 | P a g e maintenance phase Chronic Kidney Disease (CKD) the progressive loss of renal function over months or years that affects nearly all organ systems associated with CKD HTN diabetes intrinsic kidney disease stages of CKD 1 Normal: GFR >90 2 Mild: GFR 60-89 3 Moderate: GFR 30-59 4 Severe: GFR 15-29 5 End Stage: GFR <15 chronic kidney disease manifestations proteinura uremia creatinine and urea clearance fluid and electrolyte balance potassium balance acid base balance proteinuria (albuminuria) protein in the urine uremia urine in the blood proteinuria and uremia in CKD Due to glomerular hyperfiltration Damages interstitial tissue of kidney via inflammation creatinine nitrogenous waste excreted in the urine urea major nitrogenous waste excreted in urine creatinine and urea clearance in CKD 77 | P a g e GFR falls Plasma creatinine increases fluid and electrolyte balance in CKD sodium excretion increases with obligatory water excretion leading to sodium deficit and volume loss concentration and dilution ability diminishes potassium balance in CKD Tubular secretion increases early Once oliguria sets in, potassium retained acid base balance in CKD Metabolic acidosis when GFR 30%-40% metabolic acidosis decreased pH in blood and body tissues as a result of an upset in metabolism calcium & phospate in CKD reduced renal phosphate excretion, decreased renal synthesis of Vit D and hypocalcemia increased risk for fractures nephrotic syndrome (nephrosis) glomerular basement membrane injury leads to increase permeability to protein Nephrosis Manifestations excretion of 3.5 g or more protein in urine per day hypoalbuminemia edema hyperlipidemia and lipiduria Vit D deficiency Nephritic Syndrome immune complex deposits in glomerular membrane causes increased permeability that allows RBCs and protein to move into filtrate Nephritic Syndrome Manifestations hematuria mild proteinuria immune injury Renal stones masses of crystals, protein, or other substances that form within and may obstruct the urinary tract risk factors for kidney stones 80 | P a g e systemic diseases (secondary) (lupus, inflammatory conditions) IgA nephropathy primarily immune related glomerulonephritis glomerulonephritis manifestations hematuria w RBC casts (nephritic sediment) proteinuria exceeding 3-5 g/d w albumin as major protein (nephrotic sediment) oliguria hypertension edema renal insufficiency usually self limiting IgA nephropathy characterized by the deposition of deposition of mostly IgA but some IgM antibodies and complement in the mesangium of the glomerular capillaries manifested by recurrent hematuria concurrent w resp. tract infection polycystic kidney disease a genetic, autosomal disorder characterized by the growth of numerous fluid-filled cysts in the kidneys urinary tract infection (UTI) inflammation of the urinary epithelium caused by bacteria types of UTI acute cystitis painful bladder syndrome/interstitial cystitis - nonbacterial infectious - noninfectious acute and chronic pyelonephritis nonbacterial infectious cystitis most commonly seen in immunocompromised pts Noninfectious cystitis assoc. w chemo or radiation cystisis inflammation of the bladder UTI manifestations 81 | P a g e frequency of urination lower abdominal and/or suprapubic pain dysuria urgency dysuria painful urination UTI treatments antimicrobial therapy increased fluid intake avoidance of bladder irritants urinary analgesics analgesics pain relievers renal agenesis absence of one or both kidneys aplasia the defective development, or the congenital absence, of an organ or tissue unilateral kidney agenesis congenital absence of 1 kidney asymptomatic more often affects males bilateral kidney agenesis rare in conjunction w low amounts of amniotic fluid and Potter syndrome 40% are stillborn- rarely survive for more than 24 hrs. VUR (vesicoureteral reflux) retrograde flow of urine from the bladder into the ureters leads to frequent pyelonephritis reflex encourages infected urine from the bladder to be swept up into the kidneys caused by congenital abnormality or ectopic insertion of the ureter into the bladder diagnosis of VUR a voiding cystourethrogram (VCUG) and an intravenous pyelogram (IVP) Hemolytic Uremic Syndrome (HUS) 82 | P a g e Characterized by hemolytic anemia, thrombocytopenia, acute renal failure most common cause of ARF in children hemolytic uremic syndrome HUS manifestations sudden onset of pallor, bruising or purport, irritability and oligura slight fever, anorexia, vomiting, diarrhea, abdominal pain, mild jaundice, circulatory overload seizures and lethargy indicate CNS involvement hemolytic anemia reduction in red cells due to excessive destruction Thrombocytopenia low platelet count neurogenic bladder damage to the nerve that controls the bladder dyssynergia loss of coordinated neuromuscular contraction/ lack of bladder control common in MS/Parkinson's pts detrusor hyperreflexia increased detrusor muscle contractility that occurs even though there is no sensation to void (overactive) detrusor areflexia the absence of detrusor contractions (underactive) OBS overactive bladder syndrome (frequency, urgency, nocturia) urinary obstruction urethral stricture, prostate enlargement, pelvic organ prolapse partial obstruction of bladder outlet or urethra low bladder wall compliance hematomas masses of clotted blood in the tissues subdural hematoma 85 | P a g e Fragments that break from a thrombus formed outside the brain hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed assoc. w HTN, aneurysms, tumors, anticoagulation Cerebral death (irreversible coma) death of the cerebral hemispheres exclusive of the brain stem and cerebellum body can maintain homeostasis Brain Death (Total Brain Death) brain can no longer maintain internal homeostasis Brudzinski's sign Sign of meningitis; positive when a patient's legs lift involuntarily when lifting a patient's head Kernig's sign Sign of meningitis; positive when the leg is fully bent at the hip and knee, and subsequent extension of the knee leads to pain hydrocephalus abnormal accumulation of fluid (CSF) in the brain - decreased reabsorption (more common in adults) - increased fluid production - obstruction within the ventricular system (more common in children) hydrocephalus manifestations basilar skull fracture fracture at the base of the skull raccoons eyes Bilateral bruising around the eyes; often associated with a basilar skull fracture (frontal fossa) Battle's sign Bruising behind the ears, indicative of a basilar skull fracture (middle fossa) arteriovenous malformation tangled mass of dilated blood vessels subarachnoid hemorrhage 86 | P a g e Blood escapes from defective or injured vasculature into the subarachnoid space exerts pressure on brain, irritates meninges, destroys brain cells commonly w skull fracture and cerebral contusion glioma a tumor of neuroglial cells astrocytoma most malignant tumor of astrocytes (glial brain cells) Oligodendroglioma cancerous tumor composed chiefly of neuroglial cells and located in the cerebrum meningioma benign tumor of the meninges neurofibromas A tumor of peripheral nerves caused by abnormal proliferation of Schwann cells encephalitis Acute febrile illness, usually of viral origin with nervous system involvement often caused by arthropod- borne viruses and herpes simplex virus Brain or spinal cord abscess localized collection of pus within parenchyma causes of abscess open trauma and during neurosurgery middle ear or sinus infection metastatic spread from other infected sites cryptogenically cryptogenic unknown origin brain trauma Injury to the brain capable of producing physical, intellectual, emotional, social and vocational changes Closed (blunt, non-missile) trauma Head strikes hard surface or a rapidly moving object strikes the head The dura remains intact and brain tissues are not exposed to the environment Causes focal (local) or diffuse (general) brain injuries Open (penetrating, missile) trauma 87 | P a g e Injury breaks the dura and exposes the cranial contents to the environment Causes primarily focal injuries coup injury Injury directly below the point of impact contre-coup injuries injury to the surface of the brain on the opposite side from the blow that first started the head moving Diffuse Axonal Injury (DAI) Diffuse brain injury that is caused by stretching, shearing, or tearing of nerve fibers with subsequent axonal damage loss of elasticity and impaired impulse transmission- axons swell diffuse brain injury concussion mild concussion Immediate but transitory clinical manifestations Confusion lasts for 1 to several minutes, possibly with amnesia classic concussion consciousness is lost for up to 6 hours loss of reflexes transient apnea, bradycardia, hypotension but vital signs stabilize amnesia exists post concussion syndrome lingering symptoms from a concussion that last for an extended period of time blood-brain barrier Blood vessels (capillaries) that selectively let certain substances enter the brain tissue and keep other substances out chemo drugs can pass BBB seizure sudden, transient alteration of brain function caused by an abrupt explosive, disorderly discharge of cerebral neurons transient temporary Causes of seizures 90 | P a g e Traumatic injury of vertebral and neural tissues as a result of compressing, pulling, or shearing forces most commonly occurs due to vertebral injuries spinal cord trauma at and above C4 affect resp ability spinal cord trauma C4-C7 severe arm weakness w no LE motor or sensory fx Autonomic hyperreflexia (dysreflexia) Stimulation of sensory receptors below the level of cord lesion massive, uncompensated cardiovascular response to stimulation of the sympathetic nervous system multiple sclerosis a progressive disease of the nervous system that involves a degeneration of the myelin that surrounds nerve fibers in the brain and spinal cord myasthenia gravis a chronic autoimmune disease that affects the neuromuscular junction and produces serious weakness of voluntary muscles causing diplopia and difficulty talking, chewing, swallowing. IgG antibodies produced against Ach receptors. Acetylcholine deficit Alzheimer's & Myasthenia Garvis Myasthenia Crisis vs. Cholinergic Crisis myasthenia crisis: low dose of meds = RESP. EMERGENCY increased RR/pulse rise in BP Cholinergic crisis: too much Ach parasympathetic drive excessive lose resp. drive Encephalopathies fixed lesions wo active ongoing disease spastic cerebral palsy increased muscle tone, extremity rigidity, hyperactive deep tendon reflexes dystonic cerebral palsy difficulty in fine motor coordination and purposeful mvmt Ataxic Cerebral Palsy 91 | P a g e gait disturbances and instability amyotrophic lateral sclerosis (ALS) diffusely affects motor neurons of cerebral cortex, brain stem, and spinal cord wo inflammation leads to progressive weakness, resp. failure and death normal intellectual and sensory fx til death gullian-barre syndrome inflammatory disease that causes demyelination of axons in peripheral nerves often preceded by resp or GI viral infection may lead to quadriplegia or resp insufficiency hyperkinesia excessive movement Paroxysmal dyskinesias abnormal, involuntary movements that occur as spasms tardive dyskinesia involuntary movements of the face, trunk and extremities usually a side effect of phenothiazine drugs paresis weakness paralysis inability to move hemi- one half di- both sides para- lower half of the body quad- all extremeties myelomeningocele most severe form of spina bifida in which the spinal cord and meninges protrude through the spine siadh 92 | P a g e disease of posterior pituitary hypersecretion of ADH antidiuretic hormone (ADH) promotes retention of water by kidneys hyperparathyroidism manifestations hypercalcemia hypophosphatemia hypercalciuria: kidney stones pathologic fractures hypopituitary disease disease of anterior pituitary gland damage to pituitary stalk due to lack of O2 or infection Grave's Disease/ hyperthyroidism most common cause from Type II hypersensitivity w autoantibodies pretibial myxedema dry, waxy swelling of the front surfaces of the lower legs (graves disease) exophthalmos bulging eyes (graves disease) primary hypothyroidism Autoimmune thyroiditis (Hashimoto disease) most common congenital hypothyroidism condition present at birth that results in lack of thyroid hormones; results in poor physical and mental development; formerly called cretinism myxedema coma severe hypothyroidism medical emergency thyroid toxic crisis hyperthermia, tachycardia, heart failure, agitation, nausea/vomiting complication of hyperthyroidism diabetes insipidus