Renal Function and Acute Kidney Injury: Nursing Perspective, Exams of Nursing

Download Renal Function and Acute Kidney Injury: Nursing Perspective and more Exams Nursing in PDF only on Docsity! 1 [Date] Pathophysiology Exam 3 Practice Questions and Answers Latest 2024 Update Complete test bank The nurse working in an outpatient nephrology clinic knows that which of the following are primary functions of the kidneys? (Select all that apply.) A. Production of clotting factors B. Homeostasis C. Excretion of metabolic wastes D. Regulation of acid-base balance E. Metabolism of fats - Correct answer B, C, D The kidneys do not metabolize fats. Production of clotting factors is a primary function of the liver. The kidneys maintain blood pressure using the RAAS and also produce erythropoietin to stimulate RBC production. In caring for a patient diagnosed with acute kidney injury, the nephrology nurse knows that which of the following tests are specific for renal function? (Select all that apply.) A. Aspartate aminotransferase (AST) B. Blood urea nitrogen C. Creatinine D. Glomerular filtration rate E. White blood cell count - Correct answer B, C, D AST related to LIVER function In caring for a patient with acute kidney injury the nurse knows that the patient's renal function has returned to normal range when the patient's GFR measures: A. 30-40 mL/min 2 [Date] B. 40-50 mL/min C. 70-90 mL/min D. 90-120 mL/min - Correct answer D Normal GFR is 90-120 mL/min Normal Creatinine 0.6-1.1 for females and 0.6-1.2 for males Normal BUN is 10-20 mg/dL *Be sure to know these normal values, you will use them daily as a nurse The nursing working in a geriatric living facility understands that as patients age, which change in glomerular filtration rate is expected? A. Increased GFR B. Decreased GFR C. Same GFR D. No GFR - Correct answer B Aging and renal function: Decrease in renal blood flow and GFR → altered sodium and water balance Number of nephrons decrease due to renal vascular and perfusion changes Response to acid-base changes is delayed Increased risk for drug toxicity Alterations in thirst and water intake Get dehydrated very easily; do not recognize thirst and heat Decreased muscle mass may lead to decreased creatinine values An older patient is experiencing urinary stasis. The registered nurse knows that urinary stasis may lead to which of the following? A. Increased GFR B. Hypocoagulation 5 [Date] Ureterohydronephrosis: dilation of ureter AND renal pelvis and calyces 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? A. Vesicoureteral reflux and pyelonephritis B. Formation of renal calculi C. Glomerulonephritis D. Increased bladder compliance - Correct answer B urine stasis occurs with urinary tract obstruction and can lead to the formation of renal calculi and UTI 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? A. Urge incontinence B. Overflow incontinence C. Stress incontinence D. Functional incontinence - Correct answer C Reduced resistance is associated with the symptom of stress incontinence, which is incontinence with coughing or sneezing. 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? A. Acute cystitis B. Renal calculi C. Chronic renal failure D. Postrenal renal failure - Correct answer A acute cystitis is infection/inflammation of bladder (UTI) 6 [Date] Although renal calculi can cause pain and hematuria, it is not manifested by fever and cloudy urine. 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: A. Cystitis B. Chronic pyelonephritis C. Acute glomerulonephritis D. Renal calculi - Correct answer C Two major symptoms distinctive of more severe glomerulonephritis are: hematuria with red blood cell casts (2) proteinuria exceeding 3 to 5 g/day with albumin (macroalbuminuria) as the major protein A 54-year-old female is diagnosed with nephrotic syndrome. Which of the following is a common symptom of this disease? A. Hematuria B. Dysuria C. Oliguria D. Proteinuria - Correct answer D 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 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? A. Prerenal B. Intrarenal 7 [Date] C. Extrarenal D. Postrenal - Correct answer D the patient will experience postrenal renal failure due to obstruction by the prostate. What if the test revealed acute tubular necrosis? intrarenal 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: A. Calcium is lost in the urine B. Osteoblast activity is excessive C. The kidneys fail to activate vitamin D D. Autoantibodies to calcium molecules develop - Correct answer C Hypocalcemia is accelerated by impaired renal synthesis of vitamin D The combined effect of vitamin D deficiency can result in renal osteodystrophies with increased risk for fractures. A man was mildly confused, and his family brought him to adult day care during the week. He was incontinent there every day until a nurse suggested that they put a picture of a toilet on the bathroom door, and he became continent. What incontinence is this? - Correct answer Functional Incontinence A woman has a bladder infection and is distressed to have episodes of sudden strong need to urinate that cause her to become incontinent. What incontinence is this? - Correct answer Urge Incontinence 10 [Date] Manifestations associated with hepatic encephalopathy from chronic liver disease are the result of: A. Hyperbilirubinemia and jaundice B. Fluid and electrolyte imbalances C. Impaired ammonia metabolism D. Decreased cerebral blood flow - Correct answer C Impaired ammonia metabolism leads to the symptoms of hepatic encephalopathy. The icteric phase of hepatitis is characterized by which of the following clinical manifestations? A. Fatigue, malaise, vomiting B. Jaundice, dark urine, enlarged liver C. Resolution of jaundice, liver function returns to normal D. Fulminant liver failure, hepatorenal syndrome - Correct answer B 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: A. Bacterial infection B. Viral infection C. Alcoholism D. Drug overdose - Correct answer C The most common cause of cirrhosis is alcoholism. 11 [Date] While caring for a patient on a med-surg floor, the nurse notes the presence of bright red stools. How does the nurse document this finding? A. Melena B. Hematochezia C. Hematemesis D. Occult bleeding - Correct answer B Melena is black tarry stools Occult bleeding is where there are broken down products of blood are present in the stool While reading a patient's diagnostic evaluation, the nurse notes that the patient's GI tract has a cobblestone appearance. This is present in which disorder? A. Ulcerative colitis B. Irritable bowel disease C. Crohn disease D. Infective enterocolitis - Correct answer C Note also that ulcerative colitis is confined to the colon or rectum Crohn's disease may occur in various sites of GI tract While reading the patient's diagnostic evaluation, the nurse reads that the patient has experienced a twisting of the bowel. This type of obstruction is known as: A. Volvulus B. Intussusception C. Hernia D. Adhesion - Correct answer A In caring for a patient experiencing liver failure, which of the following lab values does the nurse expect to be elevated? (Select all that apply.) A. Aspartate Aminotransferase (AST) 12 [Date] B. Alanine Aminotransferase (ALT) C. Albumin D. Ammonia E. Bilirubin - Correct answer A, B, D, E Albumin would be decreased A teenage boy sustains a severe closed head injury following an all-terrain vehicle (ATV) accident. He is in a state of deep sleep that requires vigorous stimulation to elicit eye opening. How should the nurse document this in the chart? A. Confusion B. Coma C. Obtundation D. Stupor - Correct answer D Stupor is a condition of deep sleep or unresponsiveness from which the person may be aroused or caused to open eyes only by vigorous and repeated stimulation. When thought content and arousal level are intact but a patient cannot communicate, the patient has: A. Cerebral death B. Locked-in syndrome C. Dysphagia D. Cerebellar motor syndrome - Correct answer B Locked-in syndrome occurs when the individual cannot communicate through speech or body movement but is fully conscious, with intact cognitive function A 65-year-old male recently suffered a cerebral vascular accident. He is now unable to recognize and identify objects by touch because of injury to the sensory cortex. How should the nurse document this finding? 15 [Date] A 40-year-old male complains of uncontrolled excessive movement and progressive dysfunction of intellectual and thought processes. He is experiencing movement problems that begin in the face and arms that eventually affect the entire body. The most likely diagnosis is: A. Tardive dyskinesia B. Huntington disease C. Hypokinesia D. Alzheimer disease - Correct answer B Huntington disease is manifested by chorea, abnormal movement that begins in the face and arms, eventually affecting the entire body - Progressive dysfunction of intellectual and thought processes A nurse is preparing to teach staff about the most common type of traumatic brain injury. Which type of traumatic brain injury should the nurse discuss? A. Penetrating trauma B. Diffuse axonal injury C. Focal brain injury D. Concussion - Correct answer D Which assessment finding by the nurse characterizes a mild concussion? A. A brief loss of consciousness B. Significant behavioral change C. Retrograde amnesia D. Permanent confusion - Correct answer C Mild concussion is characterized by immediate but transitory confusion that lasts for one to several minutes, possibly with amnesia for events preceding the trauma. 16 [Date] brief loss of consciousness may occur with classic concussion More severe DIAs may induce behavioral changes Confusion will be temporary with mild concussion An initial assessment finding associated with acute spinal cord injury is _____ the injury. A. Pain below the level of B. Loss of autonomic reflexes above C. Loss of voluntary control below D. Hyperactive spinal reflexes below - Correct answer C Six weeks ago a female patient suffered a T6 spinal cord injury. She then developed a blood pressure of 200/120, a severe headache, blurred vision, and bradycardia. What does the nurse suspect the patient is experiencing? A. Extreme spinal shock B. Acute anxiety C. Autonomic hyperreflexia D. Parasympathetic areflexia - Correct answer C A 72-year-old male demonstrates left-sided weakness of upper and lower extremities. The symptoms lasted 4 hours and resolved with no evidence of infarction. The patient most likely experienced a(n): A. Stroke in evolution B. AV malformation C. Transient ischemic attack D. Cerebral hemorrhage - Correct answer C When symptoms resolve with complete recovery, it is a transient ischemic attack A 60-year-old female with a recent history of head trauma and a long-term history of hypertension presents to the ER for changes 17 [Date] in mental status. MRI reveals that she had a hemorrhagic stroke. What does the nurse suspect caused this type of stroke? A. Rheumatic heart disease B. Thrombi C. Hypotension D. Aneurysm - Correct answer D The primary causative factor of a hemorrhagic stroke is an aneurysm. A 25-year-old female presents to her primary care provider reporting fever, headache, nuchal rigidity, and decreased consciousness. She was previously treated for sinusitis. Which of the following is the most likely diagnosis? A. Aseptic meningitis B. Bacterial meningitis C. Fungal meningitis D. Nonpurulent meningitis - Correct answer B bacterial meningitis can occur secondary to sinusitis and is manifested by fever, tachycardia, chills, and a petechial rash with a severe throbbing headache, severe photophobia, and nuchal rigidity A 23 y/o female begins having problems with tiredness, weakness, and visual changes. Her diagnosis is multiple sclerosis (MS). What is occurring in the patient's body? A. Demyelination of nerve fibers in the CNS B. Depletion of dopamine in the central nervous system (CNS) C. The development of neurofibril webs in the CNS D. Reduced amounts of acetylcholine at the neuromuscular junction - Correct answer A The pathophysiology of MS includes demyelination of nerve fibers 20 [Date] In patients with acute diarrhea, many require no treatment. However, the nurse knows the priority assessment in all patients with diarrhea is which of the following? A. Fluid and electrolyte status B. Skin integrity C. Dietary intake D. Stool specimen - Correct answer A. Although most acute forms of diarrhea are self-limited and require no treatment, diarrhea can be particularly serious in infants and small children, persons with other illnesses, elderly persons, and even previously healthy persons if it continues for any length of time. Thus, the replacement of fluids and electrolytes is considered to be a primary therapeutic goal in the treatment of diarrhea. Crohn's disease is recognized by sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. The nurse recognizes these lesions to be defined by which of the following descriptions? A. Mosaic B. Pyramidal C. Cobblestone D. Triangular - Correct answer C. A characteristic feature of Crohn disease is the sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. When there are multiple lesions, they are often referred to as skip lesions because they are interspersed between what appear to be normal segments of the bowel. The surface of the inflamed bowel usually has a characteristic "cobblestone" appearance resulting from the fissures and crevices that develop, surrounded by areas of submucosal edema. Symptoms of hepatic encephalopathy are thought to be related to increased serum levels of neurotoxins such as: A. ammonia 21 [Date] B. potassium. C. urea. D. creatinine. - Correct answer A. Hepatic encephalopathy is characterized by neural disturbances ranging from lack of mental alertness to confusion to coma and convulsions. An early sign is asterixis, the flapping tremor (see your module). The liver loses it's ability to detoxify and this leads to an accumulation of ammonia. The other responses are not neruotoxins. The nurse is caring for a client with an elevated serum bilirubin level. The nurse recognizes a high bilirubin level may result in which of these? A. Jaundice B. Cholestasis C. Xanthomas D. Biliary cirrhosis - Correct answer A. Jaundice, or icterus, results from an abnormally high accumulation of bilirubin in the blood, causing a yellowish discoloration to the skin, sclera, and deep tissues. Skin xanthomas (focal accumulations of cholesterol) may occur with cholestasis, the result of hyperlipidemia and impaired excretion of cholesterol. Intrahepatic cholestasis, rather than hyperbilirubinemia, causes primary biliary cirrhosis. What laboratory markers are most commonly used to diagnose acute pancreatitis? A. Amylase and cholesterol B. Lipase and amylase C. Lipase and triglycerides D. Cholesterol and triglycerides - Correct answer B. Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis. Cholesterol and triglycerides are not used as laboratory markers for acute pancreatitis. 22 [Date] Which of the following disorders is associated with demyelination of the optic nerve? A. Parkinson's disease. B. Myasthenia Gravis. C. Multiple Sclerosis D. Amyotrophic Lateral Sclerosis. - Correct answer C. Multiple Sclerosis is an autoimmune disorder. It is characterized by a progressive, inflammatory, demyelination of the CNS. Loss of myelin disrupts nerve conduction leading to paresthesia, weakness, impaired gait, visual disturbances, and/or urinary incontinence. Parkinson's is a degeneration of the basal ganglia involving dopaminergic nigrostriatal pathway. ALS is a disorder of the upper and lower motor neurons. Myasthenia Gravis is an autoimmune disorder characterized by IgG antibodies formed against acetylcholine receptors. The sudden loss of spinal reflexes, sensation, and visceral function below the level of the lesion that immediately follows a spinal cord injury is called: A. accumulation of toxic metabolites B. spinal shock C. autonomic dysfunction D. hemiplegia - Correct answer B. This occurs in spinal shock. Autonomic dysfunction occurs when there is damage to the autonomic nervous system and effects the cardiac, urinary, and visual systems. Hemiplegia refers to paralysis of one side that occurs in a stroke. Excess cerebrospinal fluid (CSF) accumulation in the ventricles is a condition called A. cerebral edema B. CSF shunting C. Cheyne-Stokes condition. D. hydrocephalus - Correct answer D. Hyrdocephalus is caused by an accumulation of excess CSF in the ventricles. Shunting of 25 [Date] B. Cigarette smoking C. Use of oral contraceptives D. Use of aspirin E. Elevated blood cholesterol - Correct answer A, B, C, &E are all risk factors for stroke. Use of aspirin is not a risk factor for stroke. Note that these are also modifiable risk factors. The tonic phase of an epileptic seizure is characterized by? A. involuntary muscle contraction and loss of consciousness. B. cessation of seizure activity. C. aura and prodromal signs. D. Alternating muscle contraction and relaxation. - Correct answer A. The tonic phase of a seizure is characterized by involuntary muscle contraction and loss of consciousness. The post-ictal phase is the period immediately following cessation of seizure activity. The aura and prodromal signs occure prior to seizure ativity. The clonic phase involves alternative muscle contraction and relaxation. A client is admitted to the emergency department and diagnosed with diabetic ketoacidosis (DKA). The client would most likely manifest: A. Ketosis B. Hypoglycemia C. Respiratory alkalosis D. Hypervolemia - Correct answer A. Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketosis, osmotic diuresis, dehydration, and metabolic acidosis. It is an acute life- threatening complication of uncontrolled diabetes. Which urinalysis lab values would the nurse expect to see elevated in a patient diagnosed with a urinary tract infection? (Select all that apply.) A. Leukocyte esterase B. Nitrites 26 [Date] C. WBC D. BUN E. Glucose - Correct answer A B C Which of the following clinical manifestations would a nurse expect of a patient diagnosed with advanced bladder cancer? (Select all that apply.) A. Painful urination B. Hematuria C. Bone pain D. Fatigue E. Lower back pain - Correct answer B C D E Expect PAINLESS hematuria Which of the following is a risk factor for the development of renal calculi? A. Hypoparathyroidism B. Hypocalcemia C. Gout D. Low protein diet - Correct answer C Increased uric acid levels -- > stone formation Hypoparathyroidism -- > decreased Ca (less risk for stone formation) Changes in pH (higher or lower), hypercalcemia, and high protein diet are other risk factors Family hx of calculi and personal hx of UTI are also risk factors Which of the following is a clinical manifestation of nephrotic syndrome? A. Proteinuria B. Hypervitaminosis of vitamin D C. Hyperalbuminemia 27 [Date] D. Muscular atrophy - Correct answer A Massive proteinuria. Also expect hypoalbuminemia, edema, hyperlipidemia, vitamin D deficiency. Which of the following may cause post-renal acute kidney injury? A. Hypotension B. Glomerulonephritis C. Heart failure D. Benign prostatic hyperplasia - Correct answer D Outflow obstruction = post-renal AKI Which of the following lab values does the nurse expect of a patient diagnosed with chronic kidney disease? (Select all that apply.) A. BUN: 18 mg/dL B. Creatinine: 2.4 mg/dL C. Calcium: 11.0 mg/dL D. Potassium: 5.5 mEq/L E. Serum pH: 7.55 - Correct answer B D BUN will be >20 Creatinine > 1.2 Calcium usually < 9.0 Potassium > 5 Serum pH < 7.35 if uncompensated metabolic acidosis Also expect anemia, GFR <60 *Table 30-12 on p. 763 of Huether Note that Calcium has an inverse relationship with phosphorous, so the patient with CKD will likely have elevated phosphorous levels and decreased calcium levels 30 [Date] Which of the following characterizes osteomalacia? A. Pediatric disorder of compact and spongy bone B. Common in the United States C. Osteoclast activity overrides osteoblast activity D. Soft osteoid takes the place of rigid bone - Correct answer D Expect pain and tenderness, bowed legs or "knock-knees", pathological fractures. A describes Ricket's Which of the following are characteristic of osteoarthritis? (Select all that apply.) A. Formation of osteophytes B. History of undernutrition C. Autoimmune origin D. Pain that is exacerbated by movement E. Joint stiffness - Correct answer A D E History of obesity, not undernutrition. Age-related, not autoimmune origin. Be sure to know the difference between Rheumatoid arthritis and osteoarthritis. Be sure to differentiate btw Heberden's and Bouchard's nodes. Which of these disorders is characterized by systemic autoimmune response that is characterized by stiffening and fusion of the sacroiliac and spinal joints? A. Rheumatoid arthritis B. Gout C. Osgood-Schlatter disease D. Ankylosing spondylitis - Correct answer D 31 [Date] Rounded thoracic spine, head and neck held forward on shoulders, and hips flexed In caring for a patient with acute kidney injury the nurse knows that the patient's renal function has returned to normal range when the patient's glomerular filtration rate measures: A. 30-40 mL/min B. 40-50 mL/min C. 70-90 mL/min D. 90-120 mL/min - Correct answer D Normal GFR is 90-120 mL/min. Normal Creatinine 0.6-1.2 Normal BUN is 7.0-18.0 mg/dL. (or 10-20 depending on your source) **Be sure to know these** In caring for a patient diagnosed with acute pancreatitis, which lab values does the nurse expect to be elevated? (Select all that apply.) A. Amylase B. Lipase C. LDL D. HDL E. Triglycerides - Correct answer A B Amylase and lipase are the pancreatic enzymes When caring for a patient experiencing increased intracranial pressure, which of the following clinical manifestations should the nurse expect? A. Hypotension B. Agitation C. Unilateral dilated pupil 32 [Date] D. Cheyne-Stokes respirations - Correct answer D Expect arterial BP within normal limits or higher, decreased LOC, fixed and dilated pupils if they are involved (later), and Cheyne- Stokes (Crescendo-Decrescendo) respirations. The neuro stepdown nurse knows that the patient diagnosed with trauma to Broca's area may have which alteration in communication? A. Intact comprehension with difficulty expressing language B. Difficulty expressing language and altered comprehension C. Altered comprehension and intact language expression D. No alteration of communication - Correct answer A Expressive dysphasia. Damage to Wernicke's area may produce receptive dysphagia which manifests as difficulty understanding language so return communication is meaningless. Which of the following does the nurse expect when caring for a patient suffering from dementia? (Select all that apply.) A. Sudden onset B. Altered sleep-wake cycle C. Memory loss D. Progressive failure of many cerebral functions E. Altered decision-making - Correct answer C D E Be able to compare/contrast dementia vs delirium! The nurse on a neuro ICU knows that the patient experiencing locked in syndrome: (Select all that apply.) A. Can respond to questions by wiggling her toes B. Can understand the speech of those around her C. Is generally paralyzed except for eye movement D. May persist in this state for decades E. Is unable to think logically - Correct answer B C D 35 [Date] Note that Huntington disease aka chorea is genetic and onsets btw 25 and 45 y.o. when the gene has likely already been passed to offspring. There is an abnormally long polyglutamine tract in the huntingtin (htt) protein that is toxic to neurons caused by a CAG repeat of 40-70 times rather than the normal 9-34 with abnormal protein folding. There is a degeneration of the basal ganglia, particularly the caudate nucleus, tangles of protein, and DEPLETION OF GABA, the primary inhibitory neurotransmitter (this is the principal biochemical alteration of the disease). As a nurse is caring for an infant suffering from shaken baby syndrome, the nurse understands that which of these brain injuries is most common? A. Mild concussion B. Epidural Hematoma C. Subdural Hematoma D. Diffuse axonal injury - Correct answer D Occurs from high levels of acceleration and deceleration, such as whiplash, or rotational forces that cause shearing of axonal fibers and white matter tracts. Immediately after a spinal injury, a patient develops spinal shock. Which of the following are associated with spinal shock? (Select all that apply.) A. Loss of function at and above the level of spinal cord injury B. Drop in blood pressure C. Hyperextension of the legs D. Loss of bowel and bladder control E. Loss of thermoregulation - Correct answer B D E Function is lost below the level of injury Expect flaccid paralysis, loss of sensation, poor venous circulation, loss of thermoregulation s/t inability to regulate body 36 [Date] heat through vasoconstriction and increased metabolism (sympathetic nervous system damaged) May last 7-20 days up to 3 mo Which of the following are risk factors for stroke? (Select all that apply.) A. Increased age B. Caucasian ethnicity C. Hypertension D. Type I Diabetes E. Smoking cigarettes - Correct answer A C E Increased age, AA ethnicity, HTN, type II DM, hypercholesterolemia, smoking, obesity, birth control medication, atrial fibrillation, history of stroke or TIA *Note that ischemic strokes can be embolic or thrombotic This particular type of headache is the most common and pain is similar to the sensation of a tight band around the patient's head with a gradual onset of pain. A. Cluster headache B. Migraine headache C. Tension headache D. Subarachnoid hemorrhage - Correct answer C Table 16-7 is an excellent table describing these headaches. This demyelinating disorder characteristically presents with ascending paralysis: A. Amyotrophic Lateral Sclerosis B. Multiple Sclerosis C. Myasthenia Gravis D. Guillain-Barre Syndrome - Correct answer D 37 [Date] Guillain-Barre may advance from paresis of legs to complete quadriplegia, respiratory insufficiency, and autonomic nervous system instability Multiple sclerosis is a scarring and loss of axons from an autoimmune response Parasthesias of face, trunk, or limbs are common with weakness, impaired gait, etc. Which of the following is a sign of myasthenia gravis? A. Antibodies against acetylcholine receptors B. Excessive acetylcholine activity C. Depletion of Dopamine D. Ascending paralysis - Correct answer A Also expect ocular manifestations. Insidious onset. While caring for a patient on the med-surg floor, the nurse notes the presence of bright red stools. How does the nurse document this finding? A. Melena B. Hematochezia C. Hematemesis D. Occult bleeding - Correct answer B Melena is black tarry stools. Occult bleeding is where there are broken down products of blood are present in the stool. A 25-year-old female presents with amenorrhea and hirsutism. She is diagnosed with PCOS. Lab testing will most likely reveal: A. Estrogen deficit B. Genetic cancerous mutations C. Cortisol excess D. Hyperinsulinemia - Correct answer D 40 [Date] A 25-year-old sexually active female presents with urethritis, dysuria, and cervical discharge. She is diagnosed with the most common bacteria STI in the United States. The student would identify this infection is due to: A. Gonorrhea B. Syphilis C. Chlamydia D. Herpes - Correct answer C A major complication of persistent gastroesophageal reflux is: A. Barrett esophagus B. Heartburn C. Chest pain D. Hoarseness - Correct answer A The others may be clinical manifestations, but would not be considered complications (let alone a major complication) Acute gastritis refers to a transient inflammation of the gastric mucosa that is most commonly associated with: A. Diarrhea B. Food allergies C. Gastric reflux D. Long-term use of NSAIDs - Correct answer D Which of the following characteristics differentiates inflammatory diarrhea from the noninflammatory type? A. Larger volume of diarrhea B. Electrolyte imbalance C. Absence of blood in stool D. Infection of intestinal cells - Correct answer D Both have very have larger volumes and will affect electrolyte balance 41 [Date] Inflammatory diarrhea WILL have blood in the stool Both prehepatic and posthepatic causes of portal hypertension include the formation of: A. Fibrous nodules B. Venous thrombosis C. Collateral circulation D. Portosystemic shunts - Correct answer B Can occlude blood getting to the liver (prehepatic) as well as leaving the liver (posthepatic) A 35-year-old female suffers a broken clavicle following a motor vehicle accident. X-ray reveals that the bone surfaces in the joint partially lost contact with each other. This condition is called: A. Dislocation B. Subluxation C. Distortion D. Nonunion - Correct answer B Which of the following clinical findings would be expected in the patient with rhabdomyolysis? A. Sweating B. Dark urine C. Yellow color to the skin D. Lower extremity swelling - Correct answer B (due to myoglobinuria) A 70-year-old female presents with a hip fracture. She is diagnosed with osteoporosis. One factor that most likely contributed to her condition is: A. Increased androgen levels B. Decreased estrogen levels C. Strenuous exercise 42 [Date] D. Excessive dietary calcium - Correct answer B A 25-year-old male was in an automobile accident. At impact, his forehead struck the windshield. In this situation, a nurse recalls the coup injury would occur in the _____ region. A. Frontal B. Temporal C. Parietal D. Occipital - Correct answer A