NURS 507 ADVANCED PATHOPHYSIOLOGY EXAM LATEST EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS EXAM 2026

NURS 507 ADVANCED PATHOPHYSIOLOGY EXAM LATEST EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS EXAM 2026 Characteristics of Systolic HF: A. Heart failure with ejection fraction ≥ 50% B. Heart failure with ejection fraction ≤ 40% C. Pulmonary congestion without cardiomegaly on chest X-ray D. Pulmonary congestion with cardiomegaly on chest X-ray E. Increased size of left ventricle F. Decreased size of left ventricle G. S3 gallop H. S4 gallop B, D, E, G In a primary care office, a nurse practitioner (NP) assesses a client who reports taking a new medication 30 minutes before arrival. The NP is concerned that the client may be having a hypersensitivity reaction. Which clinical manifestations should the NP expect Hypertension Wheezing Bradycardia Diaphoresis Urticaria Vomiting Urticaria, wheezing, vomiting, and diaphoresis Immediate hypersensitivity is mediated by IgE antibodies, which result in an allergy, anaphylaxis, or atopic disease. The NP should expect the client to have a type 1 MPTC CRIMINAL LAW MPTC CRIMINAL LAW hypersensitivity to recent medication use, which can include these immediate reactions as clinical manifestations: urticaria, wheezing, vomiting, and diaphoresis. Hypertension and bradycardia are not associated with immediate hypersensitivity reactions. ____________ are the primary effector cells and responsible for initiating and mediating _____________ hypersensitivity. Eosinophils, Neutrophils, Mast cells, or T-cells Type 1, 2, 3, or 4 Mast cells are the primary effector cells and responsible for initiating and mediating type 1 hypersensitivity reactions. Characterized by the rapid release of proinflammatory mediators like histamine, leukotrienes, and cytokines in response to allergen exposure, mast cells are the primary effector cells responsible for initiating and mediating type 1 hypersensitivity reactions. ____________ hypersensitivity reactions involve the formation of _____________ that can deposit in tissues, leading to complement activation, inflammation, and tissue destruction. Type 1, 2, 3, or 4 IgE, IgM, IgG, immune complexes Type 3 hypersensitivity reactions involve the formation of immune complexes that can deposit in tissues, leading to complement activation, inflammation, and tissue destruction. Type 3 hypersensitivity reactions involve the formation of immune complexes that can deposit in tissues, leading to complement activation and inflammation. This process can cause tissue damage and is associated with systemic lupus erythematosus (SLE) and serum sickness. Type 1 reactions are mediated by IgE antibodies, and type 2 are mediated by IgG or IgM antibodies. Type 4 reactions are activated by T-helper cells. Highlight the finding(s) the nurse practitioner (NP) recognizes as risk factors that may contribute to the client's new diagnosis of allergic rhinitis. Select all that apply. MPTC CRIMINAL LAW MPTC CRIMINAL LAW Camille Rutherford, 45-years-old Chief Complaint: red, dry, itchy skin on arms and legs, shortness of breath, wheezing, and cough Medical History: presents with a nonproductive cough, expiratory wheezing, and shortness of breath upon exertion; reports a gradual onset of these symptoms and mentioned that they have been progressively worsening when walking their dog outside Past Medical History: eczema, hypertension Social History: lives at home with daughter and their dog cough, wheezing, SOB, gradual onset, outside, eczema, dog Allergic rhinitis attacks are related to ongoing exposure to specific offending agents. The strongest risk factor for developing asthma is a history of atopic disease (the client has eczema, a form of atopic dermatitis). Environmental factors and allergens—such as high humidity, cold, dry weather, house dust mites, pet fur, and pollen—can place a client at risk for a new diagnosis of allergic asthma. With prior exposure to allergens, Camille was sensitized. Chronic exposure to allergens mediated IgE antibodies to attach to sensitized cells, and with further exposure, IgE caused sensitized cells to degranulate. When degranulation occurs, inflammatory mediators like histamine, leukotrienes, and prostaglandins are released to produce several effects on the body, such as shortness of breath and wheezing. Constriction of bronchial smooth muscle also occurs, which explains her respiratory symptoms: shortness of breath, cough, and wheezing. The NP can diagnose the client with a type I hypersensitivity reaction based on localized and systemic symptoms. The client's age and history of hypertension are not risk factors. A 25-year-old presents to the emergency department (ED) with symptoms of ongoing weight loss, rapid heart rate, bilateral neck swelling, and hand tremors. Family medical history reveals a history of thyroid disorders. Physical examination and laboratory tests confirm the diagnosis of Graves' disease. Which mechanism below best explains the pathophysiology of Graves' disease? A. Delayed-type hypersensitivity response in the thyroid gland MPTC CRIMINAL LAW MPTC CRIMINAL LAW B. Activation of complement proteins leading to tissue damage C. Production of autoantibodies targeting the thyroid-stimulating hormone receptor D. Formation of immune complexes in the thyroid tissue C. Graves' disease is an example of a type 2 hypersensitivity reaction in which the immune system produces autoantibodies, particularly IgG antibodies, that bind to and stimulate the thyroid-stimulating hormone (TSH) receptor on thyroid follicular cells. This leads to excessive thyroid hormone production, hyperthyroidism, and the characteristic symptoms observed in the client. Cytotoxic antibodies target specific cell surface antigens (in this case, the TSH receptor), resulting in cellular dysfunction rather than cell destruction. Pathophysiological processes of a type 3 immune complex hypersensitivity into the correct order. 1. Antibodies bind to antigens 2. Immune complexes form 3. Complexes deposit in blood vessels or tissues 4. Activation of complement 5. Inflammatory response at the site of deposit 6. Release of lysosomal enzymes and chemical mediators 7. Tissue damage A client presented to the primary care office with a generalized rash and epidermal blistering from contact exposure to poison ivy two days ago. What clinical manifestations should the NP consider to differentiate a type 1 hypersensitivity rash from a type 4 hypersensitivity rash? A. Type 1 hypersensitivity rash is usually associated with contact dermatitis, while the rash in a type 4 hypersensitivity reaction is commonly seen in allergic reactions. B. Type 1 hypersensitivity rash is often localized and erythematous, whereas the rash in type 4 hypersensitivity is generalized and pruritic. C. Type 1 hypersensitivity rash often involves hives or urticaria, while a delayed onset, epidermal blistering rash characterizes a type 4 reaction. MPTC CRIMINAL LAW MPTC CRIMINAL LAW D. Type 1 hypersensitivity rash results from T-cell-mediated inflammation, whereas the rash in a type 4 hypersensitivity reaction is primarily due to the activation of mast cells C. Type 4 hypersensitivity reactions are T cell-mediated delayed hypersensitivity reactions, have a delayed onset, and the rash is often characterized by epidermal blistering. T cells are central in recruiting other immune cells and causing inflammation in response to an antigen. Type 1 hypersensitivity reactions typically involve activating mast cells and basophils, releasing histamine and other inflammatory mediators. This can result in localized erythema (redness) and the formation of hives or urticaria. Which type of hypersensitivity reaction are Allergic rhinitis, Hay fever, Asthma, Anaphylaxis, Food allergies? Type 1, IgE mediated T helper 2 cells produce high levels of interleukin-4, leading to B-cell activation and subsequent plasma cell production of IgE antibody. IgE binds to mast cell receptors resulting in their immediate degranulation and release of histamine, leukotrienes, and other inflammatory mediators. Which type of hypersensitivity reaction are Autoimmune hemolytic anemia, HIT, Graves' disease, Myasthenia gravis, blood transfusion and Rh factor incompatibility, blood transfusion? Type 2, Tissue-specific reaction Altered self-antigens on tissues are bound by autoantibodies resulting in tissue destruction by complement, macrophages, neutrophils, or natural killer cells. Some autoantibodies bind to hormone or neurotransmitter receptors causing decreased or increased receptor activation. Which type of hypersensitivity reaction are SLE, glomerulonephritis, Arthus reaction, RA, serum sickness, Raynaud phenomenon? Type 3, Immune complex MPTC CRIMINAL LAW MPTC CRIMINAL LAW Antibodies are formed to circulating antigens resulting in the formation of immune complexes that deposit in tissues. These immune complexes activate complement and neutrophils resulting in tissue destruction. Which type of hypersensitivity reaction are Contact sensitivity to poison ivy and latex, Mycobacterial infection, organ transplant rejection, contact dermatitis, positive tuberculin skin test, DM1, latex? Type 4, cell-mediated T helper 1 cells produce interferon gamma resulting in the activation of macrophages and T cytotoxic cells that attack the target cell through the release of destructive enzymes. In some cases, destruction of an invader is not possible, and granuloma formation walls it off from the rest of the body. The chronological order of the stages of human immunodeficiency virus (HIV) infection is 1. Acute HIV infection: After initial infection, the acute HIV infection stage occurs first, typically 2-3 weeks after infection, characterized by high viral replication and dissemination throughout the body with the client potentially experiencing nonspecific flu-like symptoms as the immune system begins to respond to the virus. 2. Clinical latency: Clinical latency is the second stage of HIV infection, which can last for a year or more. This stage is characterized by low levels of HIV replication and persistent immune activation, with CD4+ helper T cell counts gradually declining. The client may not experience symptoms during this stage. 3. AIDS: AIDS is the final and most severe stage of infection, where the immune system is badly damaged. AIDS is characterized by a CD4+ T cell count below 200 cells/mm3 with the body becoming vulnerable to opportunistic infections, opportunistic malignancies, and neurological complications. Without treatment, survival time averages 3 years. A nurse practitioner (NP) is evaluating a 45-year-old male named Clarence Goff (pronouns he/him/his). Clarence has a history of human immunodeficiency virus (HIV) MPTC CRIMINAL LAW MPTC CRIMINAL LAW and is presenting to the office with a recent onset of oral candidiasis and a CD4 lab result of 180 cells/mm3 from yesterday. Which of the following pathophysiological processes should the NP consider as contributing factors to the client's current immunodeficient state? Select all that apply. A. HIV-associated disruption of mucosal barriers B. Increased destruction of CD8+ T helper lymphocytes by the HIV virus C. Direct HIV infection of neutrophils leading to neutropenia D. Increased destruction of CD4+ T helper lymphocytes by the HIV virus E. HIV-associated immune suppression, leading to the presence of opportunistic infection A, D, E A. HIV-associated immune suppression, leading to the presence of opportunistic infection is a correct answer. The client is presenting with candidiasis, an opportunistic infection. Opportunistic infections become more common as the client's immune system function declines. D. Increased destruction of CD4+ T helper lymphocytes by the HIV virus is a correct answer. The hallmark of HIV pathophysiology is the destruction of CD4+ T helper lymphocytes, which are critical for orchestrating the immune response. This client has a low CD4 lab result demonstrating a decline in immune competence. E. HIV-associated disruption of mucosal barriers is a correct answer. The disruption of mucosal barriers is a consequence of direct HIV effects and the loss of local immune protection, making mucosal surfaces like the oral cavity more susceptible to opportunistic infections such as candidiasis. While HIV can affect the bone marrow's ability to produce various blood cells, it does not directly infect neutrophils. Yenesi has a history of breast cancer and is currently undergoing chemotherapy. Yenesi presents to the office complaining of a fever of 101.5 °F, chills, and a productive cough with green sputum. The NP notes that the client has a neutrophil count of 500 cells/mm3 on her routine lab work from this morning. Which of the following is the most MPTC CRIMINAL LAW MPTC CRIMINAL LAW appropriate step in initial management for the client's suspected condition? A. Prescribe a course of oral antibiotics and arrange daily follow-up calls to monitor the client's status. B. Advise the client to take over-the-counter antipyretics and increase fluid intake, then reassess in 24 hours. C. Place the client on neutropenic precautions and instruct them to go to the nearest Emergency Department for evaluation and treatment of potential neutropenic fever. D. Order a sputum culture before initiating antibiotics. C. A client with cancer who is receiving chemotherapy and presenting with neutropenia, a fever, and signs of infection should be considered a medical emergency due to the high risk of severe complications. The client requires prompt evaluation and treatment at the Emergency Department, including administration of broad-spectrum intravenous antibiotics after obtaining the necessary cultures. _________ Produce autoantibodies A. B-cells B. T-cells C. Autoantibodies D. Immune complexes E. Complement system A. B cells produce autoantibodies when activated by T cells that do not recognize "self" cells and instead activate an immune response. _________ Modulate immune activity and may be involved in the breakdown of self tolerance, leading to autoimmune reactions A. B-cells B. T-cells C. Autoantibodies D. Immune complexes E. Complement system MPTC CRIMINAL LAW MPTC CRIMINAL LAW B. T cells modulate the immune response. Due to a breakdown in "self" versus "non-self" recognition, T cells mount an immune response to self-antigens, producing cytokines and activating B cells. _________ Bind to self-antigens, forming complexes that precipitate in tissues A. B-cells B. T-cells C. Autoantibodies D. Immune complexes E. Complement system C. Autoantibodies, made by B cells, bind to self-antigens, forming immune complexes that precipitate in tissues and cause inflammation. _________ Precipitate in tissues, leading to inflammation and tissue damage A. B-cells B. T-cells C. Autoantibodies D. Immune complexes E. Complement system D. Immune complexes precipitate in tissues, leading to inflammation and tissue damage. They are made from autoantibodies that bind to self-antigens. _________ A group of proteins that, when activated, can cause cell lysis and inflammation A. B-cells B. T-cells C. Autoantibodies D. Immune complexes E. Complement system MPTC CRIMINAL LAW MPTC CRIMINAL LAW E. The complement system is a group of proteins that, when activated, can cause cell lysis and inflammation. While reviewing the chart of a client with systemic lupus erythematosus (SLE) and lupus nephritis, a nurse practitioner (NP) prioritizes monitoring __________ and confirming ___________ to assess current disease activity and guide treatment adjustments. liver functionrenal or renal function mean corpuscular volume (MCV) or serum autoantibodies Renal; Serum autoantibodies While reviewing the chart of a client with SLE and lupus nephritis, a nurse practitioner prioritizes monitoring renal function and confirming serum autoantibodies to assess current disease activity and guide treatment adjustments. The client is diagnosed with lupus nephritis, a disorder in which immune complexes have triggered inflammation in the kidneys. This inflammation may lead to kidney dysfunction, requiring ongoing monitoring of renal function. Which diagnostics should the nurse practitioner (NP) order to confirm a systemic lupus erythematosus (SLE) diagnosis based on the information provided? Select all that apply. A. Urinalysis B. Tissue biopsy: skin rash C. Computed tomography (CT) scan of the brain D. Complete metabolic panel (CMP) A, B, D The NP should order the complete metabolic panel (CMP), a tissue biopsy, and urinalysis to confirm an SLE diagnosis. - A complete metabolic panel (CMP) would provide information on kidney function, fluid and electrolyte balance, liver function, and albumin levels. Since the client had a positive ANA and SLE is suspected, the information from these diagnostic labs can be helpful in assessing the involvement of other organ systems. - SLE can cause malar rashes, similar to the one Amelia presents with; therefore, histopathology from a biopsy can be helpful in determining immune activity in the tissue MPTC CRIMINAL LAW MPTC CRIMINAL LAW from the rash, potentially contributing to SLE diagnosis. - SLE can frequently involve the kidneys; therefore, it is important to gather information about kidney function, including a CMP and urinalysis. Graves' disease clinical manifestations: C/O periodic palpitations, unexplained weight loss, and increased anxiety over the past 2 weeks. 4 months postpartum following an uncomplicated, full-term, vaginal birth and has completed all postpartum follow-up appointments with her OB. Feling "hot flashes" and excessively sweating with an increased appetite. No PMH, no allergies, and does not smoke. A/Ox4, denies N/V/D, headache. Client denies pain but describes a feeling of "fullness" in her throat. Thyroid gland enlarged on palpitation of neck. Fine tremor noted in fingers. Skin warm and moist. Lungs clear to auscultation bilaterally. Sinus tachycardia with no rubs, murmurs, or gallops. Abdomen soft, nontender, nondistended with bowel sounds auscultated in all four quadrants. No edema, full ROM. Difficulty sleeping but has attributed that to having a newborn. The data within the electronic health record that indicates clinical manifestations potentially related to Graves' disease include the following: - weight loss despite increased appetite, anxiety, and insomnia - palpitations, tremor, and sinus tachycardia - feeling hot, sweating, warm and moist skin - enlarged thyroid gland with a feeling of "fullness" in the throat - postpartum period Which of the following diagnostics should the nurse practitioner (NP) order to confirm a Graves' disease diagnosis based on the information provided? Select all that apply. A. Radioactive iodine therapy (RAI) with I-131 B. Thyroid-stimulating hormone (TSH) blood level C. Thyroid hormone blood levels D. Thyroid-stimulating hormone (TSH) receptor antibody blood levels E. Thyroid ultrasonogram with Doppler B, C, D, E The initial assessment of suspected thyroid disorders includes obtaining a TSH blood level. If TSH is decreased, measurement of thyroid hormones (T3 and T4) is performed. MPTC CRIMINAL LAW MPTC CRIMINAL LAW A diagnosis of hyperthyroidism is confirmed with decreased TSH and high levels of T3 and T4. Then, providers must determine the cause of hyperthyroidism. If TSH is decreased, measurement of thyroid hormones (T3 and T4) is performed. A diagnosis of hyperthyroidism is confirmed with decreased TSH and high levels of T3 and T4. Then, providers must determine the cause of hyperthyroidism. To differentiate Graves' disease from other causes of hyperthyroidism, the provider can assess TSH receptor antibody (TRAb) assays, including thyroid-stimulating immunoglobulin (TSI) and thyrotropin binding inhibitory immunoglobulin (TBII). A thyroid ultrasonogram with Doppler can assess for a thyroid gland hypervascularization. While radioactive iodine uptake scans are used to diagnose Graves' disease, they use I 123 as it emits less radiation than I-131. Radioactive iodine I-131 is only used for treatment. Which lab results indicate the client is experiencing primary hyperthyroidism? A. Decreased thyroid-stimulating hormone (TSH) with increased thyroid hormone levels B. Decreased thyroid-stimulating hormone (TSH) with decreased thyroid hormone levels C. Increased thyroid-stimulating hormone (TSH) with decreased thyroid hormone levels D. Increased thyroid-stimulating hormone (TSH) with increased thyroid hormone levels A. The pathophysiological alteration in Graves' disease is ___________ thyroid hormone production, which is ____________ in nature. decreased or increased autoimmune or infectious Graves' disease is an autoimmune disorder characterized by the production of thyroid antibodies that cause increased production of thyroid hormones. Which of the following treatments may be appropriate for Graves' disease? Select all that apply. A. Beta blocker medications B. Methimazole for pregnant clients C. Radioactive iodine therapy (RAI) MPTC CRIMINAL LAW MPTC CRIMINAL LAW D. Thyroidectomy E. Propylthiouracil (PTU) for non-pregnant clients A, C, D. Radioactive iodine therapy (RAI) I-131 can be used to destroy thyroid cells in radioactive iodine therapy. Beta adrenergic blocking medications can be used to control symptoms of Graves' disease in clients experiencing tachycardia with heart rates over 90 beats per minute, those with cardiovascular disease, or older adults. Thyroidectomy is indicated for large goiters, neck compression symptoms, co-existing thyroid cancer, or severe orbitopathy. Methimazole is preferred in the treatment of non-pregnant clients. PTU is preferred in the treatment of pregnant clients in the first trimester. After confirming the diagnosis of Graves' disease with labs, ultrasound, and a radioactive iodine uptake scan, the nurse practitioner (NP) confirms that Chandra has a negative pregnancy test and initiates medication therapy using methimazole. The client returns for a follow-up appointment and reports an improvement in her symptoms but complains of feeling fatigued and has a heart rate of 55. Which of the following should the NP assess to evaluate the outcome of therapy? A. Thyroid antibodies B. Thyroid-stimulating hormone (TSH) C. Sleep habits D. Thyroid ultrasonogram with Doppler B. Monitoring the TSH will help determine if methimazole has helped the client become euthyroid. The client's symptoms of fatigue and bradycardia indicate that her hyperthyroid has potentially been overtreated and that medication might need to be adjusted to bring TSH within the normal range (as opposed to having a low TSH in hyperthyroidism and a high TSH in hypothyroidism). It would not be helpful to assess thyroid antibodies, thyroid ultrasound, or sleep habits to determine the outcome of therapy as those were all part of the initial diagnosis. Assessing TSH levels is helpful to evaluate the outcome of therapy. MPTC CRIMINAL LAW MPTC CRIMINAL LAW Which of the following is not associated with Graves' Disease? Enlarged thyroid Unintentional weight loss Increased appetite Racing heart Rash Rash The nurse practitioner (NP) is assessing a client with a hemoglobin of 8.3 g/dL. Which signs and symptoms the NP should expect? And what else? A. Fatigue - B. HTN - C. Dizziness - D. Exertional dyspnea - E. Bradycardia - F. Pallor A, C, D, F Anemia is a reduction in the oxygen-carrying capacity of blood due to a lack of circulating red blood cells or a decrease in the quality or quantity of hemoglobin. A normal hemoglobin level is 12.0-17.0 g/dL. The client has a low hemoglobin level; therefore, the NP should expect the client to exhibit clinical manifestations of anemia such as weakness, fatigue, pallor, muscle pain, increased respiratory rate, exertional dyspnea, dizziness, and fainting. Considering the pathophysiology of anemia, when arterial oxygen levels are _________, the kidneys increase production and excretion of ___________ to stimulate the _________ to increase red blood cell production. low, high, or normal; erythropoietin, erythropoiesis, or oxygen bone marrow, liver, or kidneys low; erythropoietin; bone marrow Red blood cells are produced within the bone marrow through the process of erythropoiesis: Decreased arterial oxygen levels results in tissue hypoxia. Tissue hypoxia stimulates the kidneys to increase production and excretion of erythropoietin. Erythropoietin binds to erythropoietin receptors in the bone marrow, resulting in MPTC CRIMINAL LAW MPTC CRIMINAL LAW increased production of red blood cells. An increase in red blood cells often corrects tissue hypoxia. Improved tissue hypoxia signals the kidneys to reduce production and excretion of erythropoietin to a normal level. When the serum erythropoietin level is high, it is anticipated that the hematocrit will be _________ , and when the serum erythropoietin level is low, it is anticipated that the hematocrit will be ________. low or high low or high When the serum erythropoietin level is high, it is anticipated that the hematocrit will be low, and when the serum erythropoietin level is low, it is anticipated that the hematocrit will be high. Increased production and excretion of erythropoietin is stimulated by tissue hypoxia, associated with low hemoglobin and hematocrit levels. When hemoglobin and hematocrit levels are normal, the production and excretion of erythropoietin returns to normal levels. When hemoglobin and hematocrit levels are high, the production and excretion of erythropoietin is low. Which items should the nurse practitioner (NP) recognize as potential causes of anemia? Select all that apply. A. Esophageal varices B. Polycythemia C. Sickle cell disease D. Anorexia E. Strict vegan diet A, C, D, E Anemia can be caused by acute or chronic blood loss, impaired erythrocyte production, increased erythrocyte destruction, or a combination of these factors. Gastrointestinal tract lesions such as esophageal varices can cause anemia. Nutritional deficiencies from following a strict vegan diet or anorexia can cause anemia. Inherited genetic defects like sickle cell disease can cause anemia. MPTC CRIMINAL LAW MPTC CRIMINAL LAW The nurse practitioner (NP) reviews a client's laboratory report. The mean corpuscular volume (MCV) is 110 fL, and the mean corpuscular hemoglobin concentration (MCHC) is 40 g/dL. The NP should classify the client's anemia as _________ and ______________ microcytic, normocytic, or macrocytic hypochromic, normochromic, or hyperchromic. macrocytic and hyperchromic MCV: normal value is 80 to 100 fL. MCHC: normal value is 32 g/dL to 36 g/dL Which of the following indicates microcytic anemia? SATA A. Vitamin B-12 deficiency B. Chronic kidney disease C. Cancer D. Iron deficiency E. Folate deficiency F. Blood loss due to trauma G. Thalassemia H. Gastric bypass D, G Common causes of microcytic anemia include iron deficiency or thalassemia. Which of the following indicates macrocytic anemia? SATA A. Vitamin B-12 deficiency B. Chronic kidney disease C. Cancer D. Iron deficiency E. Folate deficiency F. Blood loss due to trauma G. Thalassemia H. Gastric bypass MPTC CRIMINAL LAW MPTC CRIMINAL LAW A. E Common causes of macrocytic anemia include vitamin B-12 deficiency or folate deficiency. Which of the following indicates normocytic anemia? SATA A. Vitamin B-12 deficiency B. Chronic kidney disease C. Cancer D. Iron deficiency E. Folate deficiency F. Blood loss due to trauma G. Thalassemia H. Gastric bypass B, C, F, H Causes of normocytic anemia may include acute blood loss, chronic diseases (such as cancer), kidney failure, hereditary spherocytosis, G6PD deficiency, and paroxysmal nocturnal hemoglobinuria. Gastric bypass surgery places the client at risk for anemia due to loss of the gastric mucosa, which aids in the absorption of iron and other nutrients necessary for red blood cell production. Which finding(s) should the nurse practitioner (NP) recognize as risk factors that may contribute to the client's new diagnosis of anemia? Select all that apply. A. Vitamin B-12 supplements B. Vegetarian diet C. Heavy menstrual bleeding D. Ulcerative colitis E. Exercise habits B, C, D Heavy menstrual bleeding can lead to iron deficiency anemia. Chronic blood loss during menstruation may deplete iron stores over time, affecting hemoglobin levels. A vegetarian diet, especially if not well-balanced, can be associated with nutritional deficiencies, including iron and vitamin B-12. Iron deficiency anemia is a common consequence of inadequate dietary iron intake, and vitamin B-12 deficiency can MPTC CRIMINAL LAW MPTC CRIMINAL LAW contribute to a different type of anemia (pernicious anemia). Ulcerative colitis, an inflammatory bowel disease, can contribute to anemia. Inflammation in the gastrointestinal tract may interfere with nutrient absorption, leading to deficiencies in iron and other essential nutrients, contributing to anemia. Ulcerative colitis can also cause increased erythrocyte destruction or blood loss from an exacerbation. The client is preparing for discharge. Which of the following statements made by the client indicate they understand the discharge education? Select all that apply. A. "Citrus fruits can be added to meals to help me absorb more iron." B. "I may experience diarrhea from taking the iron supplement." C. "I should eat plenty of dark, leafy green vegetables." D. "I should start being a vegetarian." E. "I will continue taking an iron supplement." A, C, E Clients with iron-deficiency anemia must increase their intake of iron by eating foods like dark, leafy green vegetables, nuts, and dried fruit. Iron supplements may also be needed to replenish iron stores. Vitamin C helps the absorption of non-heme iron (whereas calcium carbonate block iron absorption). The most frequent side effects of iron supplementation include nausea and constipation, not diarrhea. Vegetarians must be purposeful about food choices to ensure an adequate intake of iron. Clinical manifestations of Iron deficiency anemia (in addition to fatigue, weakness, SOB, pallor). STAT A. Coarsely ridged fingernails B. Glossitis C. Pica. D. Burning mouth All Clinical manifestations of Thalassemia anemia A. Hydrops fetalis B. Jaundice C. Bone deformities MPTC CRIMINAL LAW MPTC CRIMINAL LAW D. Elevated iron levels. E. Splenomegaly and hepatomegaly F. CHF c G. Impaired growth and development All Clinical manifestations of VB12 deficiency anemia: A. Fatigue B. SOB C. Nausea D. Constipation E. Diarrhea F. Weight loss G. Neuro: difficulty walking, peripheral neuropathy, memory loss All except constipation. Also pallor, jaundice, glossitis, mouth ulcer, depression, cognitive change Risk factos for VB12 deficiency anemia A. Diet: vegan or vegetarian B. Absorption problem: pernicious anemia, gastrectomy, ileal resection C. Meds: PPI, anti-histamine, metformin D: Aging All. Advanced age is a risk factor for vitamin B-12 deficiency. As individuals age, there may be a decline in stomach acid production and intrinsic factor secretion, both of which are essential for vitamin B-12 absorption. Omeprazole, a proton pump inhibitor (PPI), can reduce stomach acid production. Adequate stomach acid is necessary for the release of vitamin B-12 from food, and its reduction can impair B-12 absorption. The ileum is the primary site of vitamin B-12 absorption. Any surgical removal or resection of the ileum can significantly reduce the absorption of vitamin B-12, leading to a risk of deficiency over time. Manifestation of folate deficiency: A. angular cheilitis (fissure or cracks at the corner of the mouth) MPTC CRIMINAL LAW MPTC CRIMINAL LAW B. diarrhea, flatulence C. Burning mouth syndrome D. malnutrition E. Dysphagia All. Angular cheilitis is characterized by the formation of painful fissures or cracks at the corners of the mouth and is specifically associated with folate deficiency. Folate deficiency can disrupt the normal processes of tissue repair, leading to delayed healing and compromised tissue integrity. Risk factors of folate deficiency: A. Not eating green leafy veggies, legumes, fruits, fortified cereals, bread, grains B. Increased requirement: pregnancy, breastfeeding, infants, children C. Meds: anticonvulsant, methotrexate D. Impaired absorption: celiac disease, IBD, ETOH All Subjective: Steven reports fatigue, weakness, and difficulty concentrating. History reveals chronic alcohol use, approximately 10 standard drinks per day. Consumes low carbohydrate, high protein diet. Reports having knee replacement 3 years ago. Reports experiencing flatulence and diarrhea. Objective: Vital Signs: Blood pressure 128/78 mmHg, heart rate 90 bpm, respiratory rate 16 bpm, temperature 98.6 °F (37 °C) oral General Appearance: Client appears fatigued, with pallor. Immediate follow up: A. fatigue B. Diet C. Surgical history D. Pallor E. Alcohol use F. VS G. difficulty concentrating MPTC CRIMINAL LAW MPTC CRIMINAL LAW Fatigue, diet, alcohol, difficulty concentrating Fatigue is a non-specific symptom that can have various underlying causes, including anemia, nutritional deficiencies, or systemic illnesses. Pallor is often indicative of anemia, and the combination of fatigue and pallor raises concerns about the client's hematological status. Difficulty concentrating is a neurological symptom that warrants follow-up. The nurse practitioner should ask when the client has last had a drink and be aware the client is at risk for experiencing withdrawal. Which of the following client(s) should the nurse practitioner (NP) recognize as being at risk for developing folate deficiency? Select all that apply. A. 40-year-old client with celiac disease B. 30-year-old client with severe anorexia nervosa C. 27-year-old client who is newly pregnant and breastfeeding their toddler D. 32-year-old client who had a gastrectomy one year ago E. 19-year-old client with sickle cell disease A, B, C Celiac disease is an autoimmune disorder characterized by an immune reaction to gluten. Chronic inflammation in the small intestine can lead to malabsorption of nutrients, including folate. Individuals with severe anorexia nervosa are at risk for folate deficiency due to inadequate dietary intake. Clients with eating disorders, particularly severe anorexia nervosa, often have restricted diets, putting them at risk for nutritional deficiencies. A client who is both newly pregnant and breastfeeding has increased folate requirements, so may be at risk for folate deficiency. Clients who undergo gastrectomy may have impaired absorption of certain nutrients, but folate deficiency is not the primary concern. Vitamin B-12 deficiency is more common in individuals who have had a gastrectomy. Sickle cell disease can lead to increased nutrient needs, but folate deficiency is typically not a direct result of the disease. Review the electronic health record below and click to select the client's risk factors for vitamin B-12 deficiency anemia. 32 yo. complaints of persistent fatigue and weakness with a gradual onset of symptoms over the past few months. She is seeking medical attention due to concerns about the impact of these symptoms on daily functioning. Follows strict vegan diet. Reports MPTC CRIMINAL LAW MPTC CRIMINAL LAW intermittent diarrhea and has type 2 diabetes diagnosed 2 years ago. Takes metformin for diabetes management and takes ibuprofen for management of arthritis. Reports family history of thalassemia. A. age B. strick vegan C. metformin D. NSAIDs E. Family hx of thalassemia B, C Vitamin B-12 is primarily found in animal products. Individuals who follow strict vegetarian or vegan diets without consuming adequate fortified foods are at risk for vitamin B-12 deficiency. Metformin is also associated with reduced vitamin B-12 absorption. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can cause gastrointestinal bleeding and irritation, but do not constitute a risk factor for vitamin B-12 deficiency. Advanced age is a risk factor for vitamin B-12 deficiency, but this client is not advanced in age. A family history of thalassemia would not be a risk factor for vitamin B 12 deficiency. A nurse practitioner (NP) evaluates a 45-year-old client who presents with fatigue and weakness. The NP diagnoses the client with anemia of chronic disease. What is the primary pathophysiological mechanism causing this normocytic anemia? A. Defective erythropoiesis B. Impaired iron absorption C. Delayed maturation of erythrocyte precursors D. Excessive blood loss A. The primary pathophysiological mechanism underlying normocytic anemias such as anemia of chronic disease is defective erythropoiesis. Chronic inflammation affects the bone marrow, leading to impaired production of red blood cells despite adequate iron availability. Impaired iron absorption is more relevant to microcytic anemias, where the size of red MPTC CRIMINAL LAW MPTC CRIMINAL LAW blood cells is reduced due to insufficient iron for hemoglobin synthesis. Excessive blood loss typically results in hypovolemic anemia and can lead to microcytic or normocytic anemia, depending on the rate of blood loss. However, normocytic anemias are not primarily characterized by excessive blood loss. Delayed maturation of erythrocyte precursors is a characteristic feature of macrocytic anemias, not normocytic anemias. A nurse practitioner (NP) evaluates a 28-year-old client who presents with fatigue, jaundice, and dark-colored urine. The NP diagnoses the client with hemolytic anemia. What is the most likely pathophysiological mechanism causing this normocytic anemia? A. Excessive blood loss B. Defective erythropoiesis C. Impaired iron absorption D. Increased red blood cell destruction D. Hemolytic anemia is characterized by the premature destruction of red blood cells, leading to the release of hemoglobin. The symptoms of fatigue, jaundice, and dark colored urine are classic manifestations of hemolysis. Impaired iron absorption is more relevant to microcytic anemias, where the size of red blood cells is reduced due to insufficient iron for hemoglobin synthesis. Defective erythropoiesis involves abnormalities in the production of red blood cells. While it can contribute to certain types of anemias, hemolytic anemia is primarily characterized by the accelerated destruction of mature red blood cells. Excessive blood loss, while a cause of anemia, typically leads to hypovolemic anemia rather than hemolytic anemia. Which client should the nurse practitioner (NP) recognize as most at risk for developing hemolytic anemia? A. 50-year-old who experienced a transfusion reaction after a blood transfusion B. 28-year-old with a family history of thalassemia C. 35-year-old who recently underwent surgery for a bleeding ulcer D. 60-year-old with a history of iron-deficiency anemia A. A client who experienced a transfusion reaction after a blood transfusion is at significant risk for developing hemolytic anemia. Transfusion reactions can involve the MPTC CRIMINAL LAW MPTC CRIMINAL LAW destruction of donor red blood cells, leading to hemolysis and associated symptoms such as fever, chills, and jaundice. Iron-deficiency anemia is characterized by a lack of iron to produce hemoglobin. It does not inherently predispose individuals to hemolytic anemia. Thalassemia is a genetic disorder affecting the production of hemoglobin but does not directly lead to hemolysis of red blood cells, a key feature of hemolytic anemia. Excessive blood loss from surgery can lead to hypovolemic anemia but does not inherently cause hemolysis. The nurse practitioner (NP) evaluates a 30-year-old client with chronic kidney disease who presents with fatigue, weakness, and pallor. The laboratory results reveal a low hemoglobin, increased c-reactive protein, and increased erythrocyte sedimentation rate. The NP anticipates which additional laboratory finding? A. Reticulocyte count is not relevant to anemia assessment B. Increased reticulocytes C. Decreased reticulocytes D. Normal reticulocyte count C. Given the clinical and laboratory findings in a client with chronic kidney disease and suspected anemia of chronic disease, the NP should anticipate a decreased reticulocyte count as an additional relevant laboratory finding. This aligns with the impaired bone marrow response characteristic of anemia in the context of chronic inflammation. Risk factors of normocytic anemia: A. Chronic conditions: Chrone's, IBD, CKD, cancer, CHF B. Autoimmune: RA, SLE, vasculitis, sarcoidosis C. Infection D. organ transplant E. Age (elderly) F. Nutritional status All MPTC CRIMINAL LAW MPTC CRIMINAL LAW Newborn with jaundice and Rh+ blood and the mother has Rh- blood is: A. Congenital inherited disorder B. Acquired factor B. A newborn with jaundice and Rh+ blood, and the mother has Rh- blood is an acquired factor. This scenario suggests Rh incompatibility between the newborn and the mother, leading to hemolytic disease of the newborn (HDN). The mother's immune system produces antibodies against the Rh-positive blood cells of the newborn, causing hemolysis. Which of the following are associated with hemolytic anemia? A. Splenomegaly B. Cognitive impairment C. Dark-colored urine D. Scleral icterus A, C, D Cognitive impairment is more commonly associated with anemia of chronic disease. In conditions with chronic inflammation, such as autoimmune disorders or chronic infections, the inflammatory mediators may affect the central nervous system, leading to cognitive symptoms. Dark-colored urine is a classic symptom of hemolytic anemia. The breakdown of red blood cells releases hemoglobin, which is further metabolized into bilirubin. Elevated levels of bilirubin can cause the urine to appear dark or tea-colored. Splenomegaly is more commonly associated with hemolytic anemias. In hemolytic processes, the spleen often becomes enlarged as it works to remove and process the damaged red blood cells. Scleral icterus, or yellowing of the eyes, is a sign of elevated bilirubin levels in the blood. In hemolytic anemia, the increased breakdown of red blood cells releases hemoglobin, which is metabolized into bilirubin. The most important diagnostic test for a delayed hemolytic transfusion reaction is a _________, and the nurse practitioner (NP) should anticipate that it will be ________________. MPTC CRIMINAL LAW MPTC CRIMINAL LAW blood culture, Coombs test, or c-reactive protein positive, negative, or inconclusive The most important diagnostic test for a delayed hemolytic reaction is a Coombs test, and the NP should anticipate that it will be positive. The Coombs test, also known as the Direct Antiglobulin Test (DAT), is crucial in diagnosing hemolytic reactions, including delayed hemolytic transfusion reactions. In this test, antibodies or complement components that may be coating the client's red blood cells are detected. A positive Coombs test indicates the presence of antibodies or complement on the surface of red blood cells, confirming immune-mediated hemolysis. To evaluate the effectiveness of treatment for hemolytic anemia, Which 3 laboratory results should the nurse practitioner (NP) continue to monitor to evaluate if the client is improving? A. Hgb B. Hct C. WBC D. Reticulocyte count E. Coombs test F. MCV A, B, D Stabilization and normalization of hemoglobin and hematocrit levels in the laboratory results indicate that the red blood cell status is improving. This is a key marker for resolving the hemolytic reaction and improving the overall oxygen-carrying capacity of the blood. A decreasing reticulocyte count suggests that the bone marrow's response to red blood cell production is becoming more regulated and returning to normal. This is indicative of a positive response to treatment and resolution of the hemolytic process. A nurse practitioner (NP) is evaluating a client with a history of chronic kidney disease who reports symptoms of fatigue, weakness, and occasional shortness of breath. The client notes a gradual onset of these symptoms over the past few months. Which laboratory test(s) should the NP order? Select all that apply. A. Erythrocyte sedimentation rate B. C-reactive protein MPTC CRIMINAL LAW MPTC CRIMINAL LAW C. Ferritin level D. Basic metabolic panel E. Complete blood count A, B, C, E. A complete blood count is essential to assess the levels of red blood cells, hemoglobin, and hematocrit when anemia is suspected. An elevated c-reactive protein level and erythrocyte sedimentation rate indicate inflammation and can support the diagnosis of anemia of chronic disease. Ferritin is a key marker for iron storage in the body. In chronic kidney disease, impaired iron utilization is common, and assessing ferritin levels helps determine the iron status. A low ferritin level may suggest iron deficiency, contributing to anemia. A basic metabolic panel helps evaluate kidney function, electrolyte levels, and overall metabolic status, but is not used to diagnose anemia of chronic disease. Which of the following best describes the primary pathophysiological mechanism underlying sickle cell disease? A. Impaired immune response leading to frequent infections B. Abnormal clotting leading to vascular occlusion C. Altered synthesis of hemoglobin due to a mutation in the beta-globin gene D. Dysregulated iron metabolism causing excessive iron deposition C. The primary pathophysiological mechanism in sickle cell disease involves a mutation in the beta-globin gene (HBB), where adenine is substituted with thymine. This genetic change leads to the synthesis of abnormal hemoglobin, known as hemoglobin S (HbS), causing red blood cells to assume a sickle shape under certain conditions. Abnormal clotting is a consequence of the sickle-shaped red blood cells leading to vascular occlusion. Sickle cell disease can impair the immune response, but the main pathophysiological process is related to the abnormal hemoglobin structure. Iron overload from altered iron metabolism is associated with conditions such as thalassemia. A nurse practitioner (NP) is assessing a client who presents with complaints of severe pain and swelling, particularly in the extremities. The pain is described as sharp and MPTC CRIMINAL LAW MPTC CRIMINAL LAW intermittent, and swelling is evident in the joints. The client reports that the symptoms have been progressively worsening over the past 24 hours. The client has a history of sickle cell disease. The NP should recognize the client's pain is primarily caused by which pathophysiological process? A. Abnormal immune response causing inflammation B. Excessive production of hemoglobin C. Occlusion of blood vessels by sickled cells D. Impaired blood clotting mechanisms C. In sickle cell disease, the characteristic sickle-shaped red blood cells tend to obstruct small blood vessels, causing reduced blood flow and subsequent pain and swelling. Excessive production of hemoglobin is not the primary cause of pain and swelling in sickle cell disease. Impaired blood clotting mechanisms are not the primary contributors to the vaso-occlusive crises in sickle cell disease. Inflammation may contribute to pain and swelling associated with sickle cell disease but is secondary to the vaso-occlusion caused by sickle-shpaed red blood cells. A 28-year-old client with a history of sickle cell anemia presents to the emergency department with severe pain in the joints and abdomen, decreased range of motion in extremities, and decreased oxygen saturation levels. The client denies recent infections. The nurse practitioner (NP) should recognize the client is most likely experiencing which type of sickle cell crisis? A. Aplastic crisis B. Vaso-occlusive crisis C. Hyperhemolytic crisis D. Sequestration crisis B. A vaso-occlusive crisis, also known as a painful crisis, is characterized by the occlusion of small blood vessels by sickled red blood cells, leading to ischemia and severe pain. Symptoms include joint and abdominal pain, decreased range of motion, and compromised oxygen saturation due to impaired blood flow. Aplastic crisis is characterized by a sudden drop in red blood cell production, often MPTC CRIMINAL LAW MPTC CRIMINAL LAW triggered by infections, but this client denies recent infections. Hyperhemolytic crisis involves the accelerated destruction of red blood cells, leading to anemia, jaundice, and splenomegaly. Sequestration crisis is characterized by the pooling of blood in the spleen and liver, leading to sudden splenomegaly and potential hypovolemic shock. The nurse practitioner (NP) is counseling the parents of a child with sickle cell disease. Which of the following topics should the NP plan to include when educating the parents? Select all that apply. A. Homeopathic remedies for a cure B. Hydroxyurea therapy C. Pain management strategies D. Blood transfusion schedule E. Vaccination schedule B, C, D, E Hydroxyurea is a medication commonly used in sickle cell disease to reduce the frequency of vaso-occlusive crises. The NP should educate parents about the potential benefits, risks, and monitoring associated with hydroxyurea therapy. Maintaining an up-to-date vaccination schedule is crucial for preventing infections, which can trigger vaso-occlusive crises in individuals with sickle cell disease. Parents should be educated about effective pain management strategies to alleviate the discomfort associated with vaso-occlusive crises. This may include the use of medications, heat application, and other supportive measures. Some children with sickle cell disease may require regular blood transfusions to manage complications. The NP should educate parents about the indications, benefits, and potential risks associated with blood transfusion therapy. 13 yo patient diagnosed with sequestration crisis secondary to sickle cell disease. Chief complaint: severe abd pain and weakness. Which of the following findings is the best indicator of an improved outcome? A. Pulse oximetry 98% on room air B. Resolution of abdominal pain C. Normal skin color D. Hemoglobin level 12 g/dL MPTC CRIMINAL LAW MPTC CRIMINAL LAW B. While all outcomes are important, the best indicator of improvement in this scenario is resolution of abdominal pain. This directly addresses the client's chief complaint, aligns with the goals of pain management, and provides a tangible measure of the client's comfort and response to treatment. Continuous monitoring of hemoglobin, pulse oximetry, and skin color are essential for a comprehensive assessment. An increase in hemoglobin suggests improved oxygen-carrying capacity and may indicate a positive response to treatment. Stabilization or improvement in pulse oximetry readings, specifically an increase to 95% or above, is essential for assessing enhanced oxygen saturation. Improved skin color, returning to a normal or healthier hue, reflects enhanced perfusion and oxygenation, contributing to overall improvement Which of the following pathophysiological condition(s) can lead to coronary artery disease (CAD)? Select all that apply. A. DM B. HF C. HTN D. PNA E. A. fib F. Gastroenteritis A. C. Modifiable: HLD, sedentary lifestyle, smoking, obesity, HTN Non-modifiable: age, family hx, menopause, genetics Which of the following statements best describes the cause of coronary artery disease (CAD)? A. A heart arrhythmia or disturbance slows the pumping of the heart, impairing coronary circulation and reducing oxygenated blood. B. A clot in the coronary circulation blocks blood movement beyond a specific point. C. Higher than normal blood pressure injures the inside of the coronary artery, causing leakage of blood into the heart muscle. D. A buildup of plaque inside a coronary artery leads to reduced circulation to the heart. D MPTC CRIMINAL LAW MPTC CRIMINAL LAW Coronary artery disease (CAD) can lead to which of the following pathophysiological conditions? Select all that apply. A. Vasoconstriction B. Weakened cardiac muscle C. Inadequate ventilation and perfusion D. Thrombus formation E. Inflammation and plaque accumulation A, B, D, E Which of the following diagnostic tests are used to confirm coronary artery disease (CAD)? Select all that apply. A. Chest radiograph B. Cardiac catheterization C. Treadmill exercise stress test D. ST elevation on an electrocardiogram E. Orthostatic blood pressures B, C Of the options provided, the treadmill stress test can confirm the presence of CAD based on how the client responds to the increased demand exercise places on the heart, which may include ECG changes. Cardiac catheterization is an invasive procedure in which contrast dye is used to detect blockages in the coronary arteries indicative of CAD. A chest radiograph, or X-ray, provides an image of the heart size, not the coronary arteries. It is used to evaluate for other conditions that can contribute to cardiovascular disease risk. Blood pressure can confirm hypertension, which is a nonspecific finding. It can occur in the absence of CAD but is a risk factor for CAD. An ST elevation on an electrocardiogram (ECG) confirms a myocardial infarction, which can occur in the absence of CAD. Which diagnostic tests can the nurse practitioner (NP) order to establish a baseline for cardiovascular health risk or determine the extent of coronary artery disease (CAD)? Select all that apply. MPTC CRIMINAL LAW MPTC CRIMINAL LAW A. Exercise stress test B. Comprehensive metabolic panel C. Arterial blood gas D. Serum triglyceride level E. Electrocardiogram F. Erythrocyte sediment rate A, B, D, E Diagnostic tests may be ordered and performed for a client at risk for or symptomatic of CAD. These tests establish a baseline for the individual's cardiovascular health risk or help determine the extent of the disease, if present. Tests include an electrocardiogram, echocardiogram, lipid profile (includes triglycerides), exercise stress test, cardiac catheterization, coronary angiogram, coronary artery calcium scan, and a comprehensive metabolic panel to evaluate glucose levels, electrolytes, kidney, and liver function. An erythrocyte sedimentation rate (ESR) test is a non-specific test for inflammation in the body and is not diagnostic for CAD. An arterial blood gas is not indicated as the lungs are clear to auscultation, and there is no history to suspect acid-base imbalance or inadequate ventilation. Patient's lab results show elevated sodium, triglycerides, and (HgbA1C) Patient expressed a sedentary work environment, weight (125 kg), eat fast food 2-3 times per week, and a history of diabetes mellitus. Which client referral should the nurse practitioner (NP) prioritize? A. Cardiothoracic surgeon B. Registered dietitian C. Social services D. Exercise physiologist E. Hematologist B When a client is admitted for symptomatic heart failure, which of the following is the priority medication the nurse practitioner (NP) should administer? A. Furosemide MPTC CRIMINAL LAW MPTC CRIMINAL LAW B. Metoprolol C. Acetylsalicylic acid D. Digitalis E. Lisinopril A. Acute symptomatic heart failure is initially treated with diuretics like furosemide. While beta-blockers (e.g., metoprolol) and angiotensin-converting enzyme (ACE) inhibitors (e.g., lisinopril) are also used, they are started after removing extra fluid. Acetylsalicylic acid is administered for the prevention of myocardial infarction. Digitalis can be used to strengthen the heart's contraction, but it is usually a third-line treatment if used. Characteristics of systolic HF: A. Heart failure with ejection fraction ≤ 40% B. Heart failure with ejection fraction ≥ 50% C. Increased size of left ventricle D. Decreased size of left ventricle E. Pulmonary congestion with cardiomegaly on chest X-ray F. Pulmonary congestion without cardiomegaly on chest X-ray G. S3 gallop H. S4 gallop A, C, E, G. Characteristics of diastolic HF: A. Heart failure with ejection fraction ≤ 40% B. Heart failure with ejection fraction ≥ 50% C. Increased size of left ventricle D. Decreased size of left ventricle E. Pulmonary congestion with cardiomegaly on chest X-ray F. Pulmonary congestion without cardiomegaly on chest X-ray G. S3 gallop H. S4 gallop B, D, F, H MPTC CRIMINAL LAW MPTC CRIMINAL LAW Which of the following best describes mitral regurgitation? A. Narrowing of the valve limiting forward flow B. Uneven closure of the valve flaps C. Calcification of the leaflet edges D. Retrograde flow through the valve D. Mitral valve regurgitation is best described as a retrograde flow through the mitral valve. Narrowing of the valve is mitral stenosis. Uneven closure of the mitral valve is a prolapse. Calcification of the leaflet edges can lead to mitral stenosis. A client with aortic stenosis will most likely present with _____________ A. a diastolic murmuran B. S3 gallop C. a mid-systolic murmur D. right ventricular hypertrophy. C. A client with aortic stenosis will most likely present with a mid-systolic murmur. Diastolic murmurs are associated with mitral stenosis or aortic regurgitation. An S3 gallop suggests heart failure. Aortic stenosis causes left ventricular hypertrophy, not right ventricular hypertrophy. Which of the following is the most common cause of mitral stenosis? A. Untreated streptococcal infection B. Calcification of the leaflets C. Congenital bicuspid valve D. Chordae tendineae damage after myocardial infarction A. Untreated streptococcal infection Calcification of the leaflets can happen to any valve, but it is not the most common cause of mitral stenosis. The mitral valve is normally bicuspid; a congenital abnormality is seen in aortic stenosis. Chordae tendineae damage causes mitral regurgitation. Which of the following are the most common causes of aortic stenosis? Select all that apply. MPTC CRIMINAL LAW MPTC CRIMINAL LAW A. Scar tissue caused by rheumatic fever B. Calcification of the leaflets C. Insulin resistance D. Congenital bicuspid valve E. Dyslipidemia F. Hypertension A, B, D The most common causes of aortic stenosis include a congenital bicuspid valve, calcification of the valve leaflets, and damage caused by rheumatic fever. Dyslipidemia, hypertension, and insulin resistance are causes of atherosclerotic heart disease. Which of the following are expected findings associated with mitral stenosis? Select all that apply. A. Systolic murmur B. Syncope C. Atrial fibrillation D. Dependent edema E. Chest pain F. Diastolic murmur G. Left atrial enlargement H. Orthopenia I. Pulmonary edema C, F, G, H, I Expected findings associated with mitral stenosis include diastolic murmur, atrial fibrillation, left atrial enlargement, orthopnia, and pul. edema (Orthopnea is associated with mitral stenosis due to pulmonary venous hypertension, leading to fluid accumulation in the lungs when lying down) (Pulmonary edema is a direct consequence of increased pressure in the left atrium and pulmonary veins due to mitral stenosis, leading to fluid transudation into the lung interstitial tissue.) Dependent edema can be found in tricuspid regurgitation. Chest pain, systolic murmur, and syncope are usually found in aortic stenosis. MPTC CRIMINAL LAW MPTC CRIMINAL LAW Which of the following may cause syncope in a client with aortic stenosis? A. Peripheral blood vessel vasoconstriction B. Increased cardiac output with peripheral vasodilation C. Inability to increase cardiac output during exertion D. Decreased oxygen saturation with increased myocardial oxygen demand C. The inability to increase cardiac output during exertion causes syncope in a client with aortic stenosis. The narrow valve limits the amount of blood through the aortic valve with each cycle, causing a fixed cardiac output. Decreased oxygen saturation with increased myocardial oxygen demand may cause angina (not syncope) in a client with aortic stenosis. Increased cardiac output with peripheral vasodilation is normal physiology with exertion. Peripheral vasoconstriction limits syncopal events. After confirming a diagnosis of aortic stenosis, which of the following is the most appropriate management strategy? A. Start calcium channel blockers B. Refer for potential aortic valve replacement C. Monitor echocardiograms annually D. Start beta-blocker therapy B. Immediate referral for valve replacement surgery is essential in a client with symptoms of syncope due to a high mortality rate. Beta-blockers and calcium channel blockers are avoided in aortic stenosis due to a negative inotropic (reduced contractility) effect. Regular monitoring should only be done in a client who has not been syncopal and with mild symptoms. The nurse practitioner (NP) is seeing a client with chronic bronchitis that needs spirometry on today's visit. What pulmonary function test (PFT) findings are anticipated based on the diagnosis of chronic bronchitis? A. Decreased lung compliance B. Decreased forced expiratory flow (FEV1) C. Decreased total lung capacity (TLC) D. Decreased diffusing capacity MPTC CRIMINAL LAW MPTC CRIMINAL LAW B. Chronic bronchitis is an obstructive disease. Therefore, the client will have decreased expiratory flow rates. The FEV1 will be decreased. Air trapping is also common in obstructive disease which will cause an increased TLC. A decreased diffusing capacity typically only occurs in emphysema, not chronic bronchitis. In chronic bronchitis, lung compliance is increased slightly, not decreased. The nurse practitioner (NP) must prescribe additional orders due to the client's confirmed diagnosis of bacterial pneumonia. Which two (2) actions should the nurse prioritize? Select 2. A. Repeat arterial blood gas (ABG) - call results B. Increase intravenous (IV) 0.9% normal saline (NS) infusion to 250 mL/hour C. Albuterol 2.5 mg/kg per nebulizer every 1-4 hours, PRN D. Albuterol 2.5 mg/kg per nebulizer every 20 minutes for 3 doses E. Azithromycin 500 mg IV x 2 days, then 500 mg orally (to complete a 7- to 10-day course of therapy) F. Methylprednisolone sodium succinate 30 mg/kg intravenous (IV) every 6 hours D, F Bronchodilators (rapid-acting beta 2 agonists), such as albuterol, administered via inhalation nebulizer treatments are used in acute airway management and facilitate gas exchange. The client has dyspnea and increased respiratory efforts. Acute administration of corticosteroids decreases the inflammatory response. Follow-up administration with IV steroids is required to reduce inflammation and open the airways, but steroid medications are not rapid-acting like the beta 2 agonists. Increasing IV and oral fluid intake is essential for management due to the inflammatory response. Data from an ABG will assist in managing the client, but treatment should be completed on time, especially when all other clinical findings reflect respiratory distress in a client experiencing pn