A patient presents to an advanced practice registered nurse (APRN) complaining of diarrhea,
rectal bleeding, and right lower quadrant tenderness. Diagnostic tests reveal deficiencies in
folic acid, vitamin D, and calcium. The APRN suspects Crohn disease.
What is the pathological mechanism of this disorder?
Neutrophil infiltration of the crypts, which causes destructive abscess formation
Destruction of mucosal barrier caused by drugs or Helicobacter pylori infection
Acid and pepsin in the duodenum penetrating the mucosal barrier, which causes ulceration
Decreased mucosal blood flow and hypersecretion of acid caused by overstimulation of the
vagal nuclei - ANSWER Crohn disease can involve any part of the gastrointestinal tract
from the oropharynx to the perianal area. Diseased segments frequently are separated by
intervening normal bowel, leading to the term "skip areas." Inflammation can be transmural,
often extending through to the serosa, resulting in sinus tracts or fistula formation.
A patient with a history of prostate cancer is admitted with confusion, thirst, nausea, oligu-
ria, and abdominal cramping. The patient has gained 12 lb in the last two weeks. Diagnostics
include
potassium: 4.1 mEq/L
sodium: 118 mEq/L
serum osmolality: 272 mOsm/kg H2O
increased urine osmolality
Which part of the nephron is affected by this endocrine disorder?
Distal tubule and collecting duct
Proximal tubule and descending loop
Glomerular capsule
Bowman capsule - ANSWER Syndrome of inappropriate secretion of antidiuretic hor-
mone (ADH) is an over secretion of ADH by the posterior pituitary gland due to several
1
, reasons, including prostate or renal cancers. When there is an over-secretion of ADH, it
causes the distal tubules and collecting duct to reabsorb water and hyper-dilute the serum,
causing a decreased serum sodium level, low serum osmolality, and high urine osmolality.
The patient then gains weight from the excess fluid.
An advanced practice registered nurse (APRN) is reviewing orders for a patient who passed a
calculi, which relieved the condition of compensatory hypertrophy. The APRN is aware that
the patient will need to be monitored closely due to a common condition associated with
return to bilateral function.
Which condition should the APRN anticipate?
Apoptosis
Post-obstructive diuresis
Renal colic
Hyperfunction - ANSWER Patients will have marked polyuria (> 4-5 L per day) after the
release of bilateral obstruction. The physiological factors include excess sodium and water
retention and accumulation of urea and other non-reabsorbable solutes, resulting in an os-
motic diuresis.
A patient expresses concern to an advanced practice registered nurse (APRN) about not be-
ing able to complete an entire meal without experiencing acid reflux. The patient also re-
ports new symptoms including chest pain and dysphagia. The APRN suspects that the pa-
tient might have cancer.
Which type of cancer is the APRN concerned about?
Pancreatic
Colorectal
Esophageal
Stomach - ANSWER The most common symptom of esophageal cancer is a problem
swallowing (dysphagia), with a feeling like the food is stuck in the throat or chest or even
choking on food. Some people get a feeling of pressure or burning in the chest.
An advanced practice registered nurse (APRN) is working with a patient who has been diag-
nosed with detrusor hyperreflexia of the bladder without dyssynergia. The APRN is aware
that an underlying neurological disorder led to the patient's condition.
2
rectal bleeding, and right lower quadrant tenderness. Diagnostic tests reveal deficiencies in
folic acid, vitamin D, and calcium. The APRN suspects Crohn disease.
What is the pathological mechanism of this disorder?
Neutrophil infiltration of the crypts, which causes destructive abscess formation
Destruction of mucosal barrier caused by drugs or Helicobacter pylori infection
Acid and pepsin in the duodenum penetrating the mucosal barrier, which causes ulceration
Decreased mucosal blood flow and hypersecretion of acid caused by overstimulation of the
vagal nuclei - ANSWER Crohn disease can involve any part of the gastrointestinal tract
from the oropharynx to the perianal area. Diseased segments frequently are separated by
intervening normal bowel, leading to the term "skip areas." Inflammation can be transmural,
often extending through to the serosa, resulting in sinus tracts or fistula formation.
A patient with a history of prostate cancer is admitted with confusion, thirst, nausea, oligu-
ria, and abdominal cramping. The patient has gained 12 lb in the last two weeks. Diagnostics
include
potassium: 4.1 mEq/L
sodium: 118 mEq/L
serum osmolality: 272 mOsm/kg H2O
increased urine osmolality
Which part of the nephron is affected by this endocrine disorder?
Distal tubule and collecting duct
Proximal tubule and descending loop
Glomerular capsule
Bowman capsule - ANSWER Syndrome of inappropriate secretion of antidiuretic hor-
mone (ADH) is an over secretion of ADH by the posterior pituitary gland due to several
1
, reasons, including prostate or renal cancers. When there is an over-secretion of ADH, it
causes the distal tubules and collecting duct to reabsorb water and hyper-dilute the serum,
causing a decreased serum sodium level, low serum osmolality, and high urine osmolality.
The patient then gains weight from the excess fluid.
An advanced practice registered nurse (APRN) is reviewing orders for a patient who passed a
calculi, which relieved the condition of compensatory hypertrophy. The APRN is aware that
the patient will need to be monitored closely due to a common condition associated with
return to bilateral function.
Which condition should the APRN anticipate?
Apoptosis
Post-obstructive diuresis
Renal colic
Hyperfunction - ANSWER Patients will have marked polyuria (> 4-5 L per day) after the
release of bilateral obstruction. The physiological factors include excess sodium and water
retention and accumulation of urea and other non-reabsorbable solutes, resulting in an os-
motic diuresis.
A patient expresses concern to an advanced practice registered nurse (APRN) about not be-
ing able to complete an entire meal without experiencing acid reflux. The patient also re-
ports new symptoms including chest pain and dysphagia. The APRN suspects that the pa-
tient might have cancer.
Which type of cancer is the APRN concerned about?
Pancreatic
Colorectal
Esophageal
Stomach - ANSWER The most common symptom of esophageal cancer is a problem
swallowing (dysphagia), with a feeling like the food is stuck in the throat or chest or even
choking on food. Some people get a feeling of pressure or burning in the chest.
An advanced practice registered nurse (APRN) is working with a patient who has been diag-
nosed with detrusor hyperreflexia of the bladder without dyssynergia. The APRN is aware
that an underlying neurological disorder led to the patient's condition.
2
