HESI PATHOPHYSIOLOGY FNP

2021 HESI PATHOPHYSIOLOGY FNP V2 100 PRACTICE QUESTIONS AND ANSWERS   2021 HESI PATHOPHYSIOLOGY FNP V2 100 PRACTICE QUESTIONS AND ANSWERS 1. Upon admission assessment, the nurse hears a murmur located at the fifth intercostal space, midclavicular line. The client asks, “What does that mean?” The nurse will base her answer on which of the following physiologic principles? A) “You have been exposed to an infection that went into your blood stream.” B) “You have a heart valve that is diseased.” C) “You heart has been pumping your blood so hard, that the pressure has damaged your valves.” D) “Your heart has enlarged, so naturally your valves had to enlarge as well.” Ans: B Feedback: Turbulence is often accompanied by vibrations of the blood and surrounding cardiovascular structures. Some of these vibrations are in the audible range and can be heard using a stethoscope. For example, a heart murmur results from turbulent flow through a diseased heart valve. The other distractors are not feasible. 2. A client is diagnosed with an abdominal aortic aneurysm that the physician just wants to “watch” for now. When teaching the client about signs/symptoms to watch for, the nurse will base the teaching on which of the following physiological principles? A) Small diameter of this vessel will cause it to rupture more readily. B) The larger the aneurysm, the less tension placed on the vessel. C) As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture. D) The primary cause for rupture relates to increase in abdominal pressure such as straining to have a bowel movement. Ans: C Feedback: Because the pressure is equal throughout, the tension in the part of the balloon with the smaller radius is less than the tension in the section with the larger radius. The same holds true for an arterial aneurysm in which the tension and risk of rupture increase as the aneurysm grows in size. Wall tension is inversely related to wall thickness, such that the thicker the vessel wall, the lower the tension, and vice versa. Although arteries have a thicker muscular wall than veins, their distensibility allows them to store some of the blood that is ejected from the heart during systole, providing for continuous flow through the capillaries as the heart relaxes during diastole. 3. A client has entered hypovolemic shock after massive blood loss in a car accident. Many of the client's peripheral blood vessels have consequently collapsed. How does the Laplace law account for this pathophysiologic phenomenon? A) Blood pressure is no longer able to overcome vessel wall tension. B) Decreasing vessel radii has caused a decrease in blood pressure. C) Wall thickness of small vessels has decreased due to hypotension. D) Decreases in wall tension and blood pressure have caused a sudden increase in vessel radii. Ans: A Feedback: In circulatory shock, there is a decrease in blood volume and vessel radii, along with a drop in blood pressure. As a result, many of the small vessels collapse as blood pressure drops to the point where it can no longer overcome the wall tension. Decreases in vessel wall radii do not cause the decrease in blood pressure, and wall thickness generally remains static. 4. Which of the following statements about vascular compliance is accurate? A) Arteries are much more distensible than veins. B) Veins can act as a reservoir for storing large quantities of blood. C) Arteries have thick muscular walls that constrict tightly, thereby ejecting blood without storing it for later use. D) A continuous flow through the capillaries occurs primarily during systole. Ans: B Feedback: The most distensible of all vessels are the veins, which can increase their volume with only slight changes in pressure, allowing them to function as a reservoir for storing large quantities of blood that can be returned to the circulation when it is needed. Although arteries have a thicker muscular wall than veins, their distensibility allows them to store some of the blood that is ejected from the heart during systole, providing for continuous flow through the capillaries as the heart relaxes during diastole. 5. In the days following a tooth cleaning and root canal, a client has developed an infection of the thin, three- layered membrane that lines the heart and covers the valves. What is this client's most likely diagnosis? A) Pericarditis B) Endocarditis C) Myocarditis D) Vasculitis Ans: B Feedback: The endocardium is a thin, three-layered membrane that lines the heart and covers the valves; infection of this part of the heart is consequently referred to as endocarditis. 6. Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the following consequences? A) Backup of blood from the right atrium into the superior vena cava B) Backflow from the right ventricle to the right atrium during systole C) Inhibition of the SA node's normal action potential D) Backflow from the left ventricle to the left atrium Ans: D Feedback: The mitral valve separates the left ventricle from the left atrium; failure of this valve would cause backflow from the former to the latter during systole. Valve function does not directly affect cardiac contractility. 7. Heart muscle differs from skeletal muscle tissue by being able to generate: A) Contractions B) Calcium influx C) Action potentials D) Sarcomere binding Ans: C Feedback: Heart muscle, or the myocardium, is unique among other muscles in that it is capable of generating and rapidly conducting its own electrical impulses or action potentials. These action potentials result in excitation of muscle fibers throughout the myocardium. Similarities to skeletal muscle include contractility, calcium influx, and actin–myosin (sarcomeres) binding. 8. When discussing the AV node's role in the electrical conduction of the heart with a client newly diagnosed with an AV block, which of the following statements are accurate? Select all that apply. A) The AV node offers a two-way conduction area between the atria and the ventricles. B) The velocity of conduction through the AV junctional fibers is very fast, which greatly increases impulse transmission. C) A block at the AV bundle of His interferes with the normal delay of the impulse, thereby interfering with complete ejection of blood from the atria prior to ventricular contraction. D) When there is an AV block, impulses from the atria and ventricles beat independently of each other so, the heart rhythm is usually chaotic and not regular. Ans: C, D Feedback: The AV node connects the atrial and ventricular systems and normally provides for a one-way conduction between the atria and ventricles. The velocity of conduction through the AV junctional fibers is very slow, which greatly delays impulse transmission. A further delay occurs as the impulse travels through the transitional fibers and into the AV bundle, known as the bundle of His. This delay provides a mechanical advantage whereby the atria can complete their ejection of blood before ventricular contraction begins. Under normal circumstances, the AV node provides the only connection between the atrial and ventricular conduction systems. The atria and ventricles would beat independently of each other if the transmission of impulses through the AV node were blocked. 9. If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern? A) Heart rate 150 beats/minute, labeled as supraventricular tachycardia B) Disorganized ventricular fibrillation C) Complete cardiac standstill D) Slowing of heart rate to below 60 beats/minute Ans: D Feedback: Acetylcholine, the parasympathetic neurotransmitter released during vagal stimulation of the heart, slows down the heart rate by decreasing the slope of phase 4. The catecholamines, the sympathetic nervous system neurotransmitters epinephrine and norepinephrine, increase the heart rate by increasing the slope or rate of phase 4 depolarization. Fibrillation is the result of disorganized current flow within the ventricle (ventricular fibrillation). Fibrillation interrupts the normal contraction of the atria or ventricles. In ventricular fibrillation, the ventricles quiver but do not contract. Thus, there is no cardiac output, and there are no palpable or audible pulses (i.e., cardiac standstill). 10. When explaining a new diagnosis of complete heart block to a client/family, the nurse should include which of the following statements? A) “This means that your atria are not contracting normally, they are quivering.” B) “One consequence of this type of block is a very slow heart rate that limits circulation to the brain.” C) “This type of arrhythmia requires defibrillation, which will occur in the cardiac catheter lab later today.” D) “It's pretty common for everyone to experience this arrhythmia, especially during times of stress in their lives.” Ans: B Feedback: In complete heart block, the atria and ventricles beat independently of each other. The most serious effect of some forms of AV block is a slowing of heart rate to the extent that circulation to the brain is compromised. Atria fibrillation is where there is interruption of the normal contraction of the atria, and the atria are quivering rather than contracting. Ventricular fibrillation requires immediate defibrillation for the client to survive. Complete heart block is not common. However, PVCs do occur under times of stress. 11. As a nurse working in the newborn nursery and intensive care unit, when an infant has been diagnosed with failure to thrive, which of the following statements about hormones' effect on the body will the nurse explain to the family? A) The catecholamine norepinephrine is primarily responsible for the failure to thrive. B) CRF increases somatostatin levels, which inhibits secretion of growth hormone. C) ACTH release from the pituitary causes babies to not gain weight. D) Antidiuretic hormone is involved in the stress response and can increase water retention. Ans: B Feedback: Although growth hormone is initially elevated with the onset of stress, prolonged presence of cortisol leads to suppression of growth hormone, insulin-like growth factor 1 (IGF-1), and other growth factors, exerting a chronically inhibitory effect on growth. In addition, CRF directly increases somatostatin, which in turn inhibits growth hormone secretion. Although the connection is speculative, effects of stress on growth hormone may provide one of the vital links to understanding failure to thrive in children. Angiotensin II enhances CRF formation and release, contributes to the release of ACTH from the pituitary, enhances stress-induced release of vasopressin from the posterior pituitary, and stimulates release of norepinephrine from the locus ceruleus. Antidiuretic hormone (ADH) released from the posterior pituitary is also involved in the stress response, particularly in hypotensive stress or stress due to fluid volume loss. 12. A nursing student's current clinical placement has been a source of stress due to high client acuity combined with interpersonal conflict with some of the unit staff. At the same time, the student has been fighting a cold for more than 2 weeks and has been unable to regain a normal feeling of health. How might these two phenomena be related? A) Epinephrine and norepinephrine inhibit the release and action of lymphocytes. B) Stress and illness lack a statistical correlation, though they are often thought to coexist. C) The effects of stress on the cerebellum initiate a decrease in immunity. D) Endocrine–immune interactions may suppress the student's immune response. Ans: D Feedback: Although the exact mechanisms of the effects of stress on immunity are not completely understood, it is generally thought that endocrine–immune interactions suppress immunity. The most significant arguments for interaction between the neuroendocrine and immune systems derive from evidence that the immune and neuroendocrine systems share common signal pathways (i.e., messenger molecules and receptors), that hormones and neuropeptides can alter the function of immune cells, and that the immune system and its mediators can modulate neuroendocrine function. Stress has the capacity to either enhance or suppress immune function. Epinephrine and norepinephrine do not directly inhibit lymphocytes; the cerebellum is not centrally involved in the stress response. 13. A student is participating in an extended fast as part of a charitable fundraising effort. Which of the following is an example of the physiologic reserve that will facilitate the student's adaptation to the stress of this sudden change in diet? A) The student has experience in demonstrating perseverance from previous participation in competitive sports. B) The student's adipose tissue contains large and accessible stores of energy. C) The student is young, is a male, and has no preexisting medical conditions. D) The student is utilizing guided imagery to achieve a sense of “mind over matter.” Ans: B Feedback: The ability of body systems to increase their function given the need to adapt is known as the physiologic reserve, an example of which is the energy stored in fat tissue. Previous experience, health, and relaxation are all likely to foster the student's ability to adapt, but these are not dimensions of physiologic reserve. 14. Which of the following clients will be more able to adapt to a stressor based on an individual's ability to adapt? Select all that apply. A) A Muslim male experiencing abnormal GI bleeding B) An infant with decreased water intake due to diarrhea C) A child living in a crowded apartment with his financially poor, immediate family D) A male client producing increased corticotropin- releasing factor (CRF) E) A client with known CAD, expressing problems affording all his prescribed medication Ans: B, D, E Feedback: An individual's ability to adapt to a stressor is determined by the interplay of numerous variables, including age, gender, and preexisting health status. Ethnicity and socioeconomic status have not been noted to directly influence the adaptation process. 15. A nurse working at nights is constantly complaining of being tired and sick. It seems like she catches every illness that is on the unit. One possible reason for this may relate to: A) She does not contain the “hardiness” gene in her system. B) Alterations in sleep–wake cycle have decreased her immune function. C) She is stressing too much about being tired and sleepy. D) Maybe she should get tested for sleep apnea. Ans: B Feedback: Sleep disorders and alterations in the sleep–wake cycle have been shown to alter immune function, the normal circadian pattern of hormone secretion, and physical and psychological functioning. The concept of hardiness describes a personality characteristic that includes a sense of having control over the environment, a sense of having a purpose in life, and an ability to conceptualize stressors as a challenge rather than a threat. Lower levels of hardiness have been linked with greater reaction to stress. Stress is probably one of the primary factors interfering with sleep. At this time, we do not have enough data to speak to the need for a sleep apnea exam. 16. Although clinical manifestations vary with the type of cancer and organs involved, the oncology nurses have observed that the most frequent side effects clients with cancer experience are: Select all that apply. A) Copious lymph flow B) Sleep disturbances C) Involuntary weight gain D) Visceral organ expansion E) Lack of energy Ans: B, E Feedback: Neoplasia is nearly always accompanied by sleep disturbances and fatigue. Cancer-related fatigue is characterized by feelings of tiredness, weakness, and lack of energy and is distinct from the normal tiredness experienced by healthy individuals in that it is not relieved by rest or sleep. Tissue growth often compresses and obstructs lymph flow and compresses visceral organs and adjacent structures. The cachexia of cancer is associated with unplanned rapid weight loss and wasting of body fat as tumor growth demands more caloric energy than the body can supply. 17. Paraneoplastic syndromes are manifestations of cancer that often result from: A) Radiation and chemotherapy B) Compression of area vessels C) Tumor-related tissue necrosis D) Inappropriate hormone release Ans: D Feedback: Paraneoplastic syndromes are manifestations in sites that are not directly affected by the disease; many are caused by excessive or inappropriate peptide hormone synthesis and release by cancer cells. Radiation and chemotherapy are cancer treatments that cause side effects unrelated to the paraneoplastic syndromes. Area vessel compression is a direct result of the tumor's location; area tissue necrosis is a direct result of area tissue destruction and death of healthy cells. 18. A client with nonspecific signs/symptoms has gone to the primary health care provider. The client's chief complaints revolve around extreme fatigue, unplanned weight loss, and being so weak in the muscles. The diagnostic workup included a carcinoembryonic antigen (CEA) tumor marker. The CEA result was elevated. The nurse should anticipate the physician will order which of the following diagnostic tests related to the elevated CEA? Select all that apply. A) Testicular ultrasound B) Colonoscopy C) Mammogram D) Thyroid scan E) Brain CT Ans: B, C Feedback: CEA normally is produced by embryonic tissue in the gut, pancreas, and liver and is elaborated by a number of different cancers, including colorectal carcinomas, pancreatic cancers, and gastric and breast tumors. 19. A client is scheduled for a bronchoscopy related to a history of “bronchitis” for the last 3 months that has been unresponsive to antibiotics. The nurse shares with the client that a primary purpose for this bronchoscopy is to help diagnose the problem by: A) Visualizing airways looking for adhesions B) Opening airways looking for any aspirated food C) Flushing out the airway to remove debris and sputum D) Taking tissue biopsy and looking for abnormal cells Ans: D Feedback: Tissue biopsy involves the removal of a tissue specimen for microscopic study. It is of critical importance in designing the treatment plan should cancer cells be found. Biopsies are obtained in a number of ways, including needle biopsy; endoscopic methods, such as bronchoscopy or cystoscopy, which involve the passage of an endoscope through an orifice and into the involved structure; and laparoscopic methods. 20. A breast cancer client has just learned that her tumor clinical stage is T3, N2, M0. After the physician leaves, the client asks the nurse to explain this to her again. The nurse will use which of the following statements in his or her answer? Your: A) Tumor is very small and has zero number of mitoses. B) Tumor has metastasized to at least three distal sites and you have cancer in your lymph nodes. C) Tumor is large and at least two lymph nodes are positive for cancer cells. D) Extent of disease is unknown, but it looks like your cancer has stayed intact and not spread to the bloodstream. Ans: C Feedback: Tumor staging groups clients according to the extent and spread of the disease, using the TNM (tumor, node, and metastasis) system. In the TNM system, T1, T2, T3, and T4 describe tumor size, N0, N1, N2, and N3, lymph node involvement; and M0 or M1, the absence or presence of metastasis. 21. Which of the following meals would be considered high in folic acid intake? A) Deep-fried mushrooms with creamy horseradish sauce, hot dogs without bun, and potato salad B) Fried chicken, mashed potatoes with gravy, and corn on the cob C) Green leafy salad, beef and bean burrito on whole- wheat shell D) Steak, baked potato with sour cream, and cheesecake Ans: C Feedback: To achieve an adequate intake of folic acid, pregnant women should couple a diet that contains folate-rich foods (e.g., orange juice; dark, leafy green vegetables; and legumes) with sources of synthetic folic acid, such as fortified food products. 22. A first-time pregnant mother asks, “Why do I need an ultrasound? I'm worried that my insurance won't cover it.” The nurse responds that an ultrasonography can diagnose prenatal abnormalities like which of the following? Select all that apply. A) Cytogenic abnormalities B) Skeletal defects like facial structural problems C) Chromosomal deficits D) Abnormal levels of -fetoprotein E) Congenital heart defects Ans: B, E Feedback: Ultrasonography is the primary method for assessing fetal size and screen for structural abnormalities that include the heart, skeleton, face, diaphragm, and gastrointestinal tract. Cytogenic studies and chromosomal analysis require amniocentesis, chorionic villus sampling, or umbilical cord blood. -Fetoprotein (AFP) requires a maternal blood sample that is analyzed for serum markers associated with neural tube defects. 23. A pregnant client's -fetoprotein (AFP) returns elevated. The couple ask the health care worker to explain what this means. Which of the following is the best response? A) “This means you need to decrease your protein intake to prevent renal problems in your baby.” B) “Elevated levels means your baby is at risk of having a neural tube defect like spina bifida (an opening in the spine).” C) “This means your baby has Down syndrome. We won't know how severe until after you give birth.” D) “This is normal. The problem is if it is low, that means your baby will be born with trisomy 18 and will be retarded.” Ans: B Feedback: Maternal and amniotic fluid levels of AFP are elevated in pregnancies where the fetus has a neural tube defect (i.e., anencephaly and open spina bifida) or certain other malformations such as an anterior abdominal wall defect in which the fetal integument is not intact. Screening of maternal blood samples usually is done between weeks 16 and 18 of gestation. Although neural tube defects have been associated with elevated levels of AFP, decreased levels have been associated with Down syndrome. 24. An older mother (age 41) is worried about having a baby with birth defects. She wants to get tested so she can be prepared for the outcome. Which of the following tests should the clinic nurse prepare the client for? Select all that apply. A) A blood test (circulating cell-free DNA) will tell if the baby is mentally retarded. B) Abdominal x-ray can detect skeletal abnormalities. C) Withdrawing a sample of amniotic fluid will reveal any chromosomal defects. D) Ultrasonography will reveal any single-gene disorders like fragile X syndrome. E) PET scanning to see if there are any areas of accelerated growth of tissue. Ans: A, C Feedback: During pregnancy, there are cf-DNA fragments from both the mother and fetus in maternal circulation. It is possible to analyze cf-DNA from maternal blood to detect common fetal trisomies such as Down syndrome as early as 10 weeks. Amniocentesis involves the withdrawal of a sample of amniotic fluid from the pregnant uterus. The procedure is useful in women older than 35 years of age, who have an increased risk of giving birth to an infant with Down syndrome, and in parents who have another child with chromosomal abnormalities. Ultrasonography allows the visualization of body structures, revealing such defects as skeletal malformations. It is only able to identify chromosomal disorders, genetic disorders, and neural tube defects by way of their anatomic effects. PET scanning is used to assess for cancer metastasis or inflammatory diseases. It is not used in pregnancy testing. 25. A pregnant mother (16 weeks' gestation) forgot and emptied her cat's litter box without gloves. She is extremely anxious and wants tested right away. Which test would the nurse prepare her for that would give rapid cytogenic analysis? A) Ultrasonography B) Fetal biopsy C) Chorionic villus sampling D) Percutaneous umbilical cord blood sampling Ans: D Feedback: Percutaneous umbilical cord blood sampling involves the transcutaneous insertion of a needle through the uterine wall and into the umbilical artery. It is used for prenatal diagnosis of hemoglobinopathies, coagulation disorders, metabolic and cytogenetic disorders, and immunodeficiencies. Fetal infections such as rubella and toxoplasmosis can be detected through measurement of immunoglobulin M antibodies or direct blood cultures. Results from cytogenetic studies usually are available within 48 to 72 hours. Fetal biopsy is used to detect certain genetic skin defects that cannot be diagnosed with DNA analysis. The tissue that is obtained following sampling of the chorionic villi can be used for fetal chromosome studies, DNA analysis, and biochemical studies. Ultrasonography makes possible the in utero diagnosis of hydrocephalus, spina bifida, facial defects, congenital heart defects, congenital diaphragmatic hernias, disorders of the gastrointestinal tract, and skeletal anomalies. Cardiovascular abnormalities are the most commonly missed malformation. 26. A premature neonate in the ICU suspected of having an infection has blood drawn for class specific antibodies. Which of the following confirms that the neonate has developed a congenital infection? A) IgG titer is decreased. B) IgM antibodies are elevated. C) IgG antibodies remain elevated throughout entire ICU admission. D) Initial IgM-specific antibodies are negative. Ans: B Feedback: Serology samples are used to identify infectious organisms by measuring the levels of antibodies. The measurement of antibody titers has another advantage in that specific antibody types such as IgM and IgG are produced by the host during different phases of an infectious process. IgM- specific antibodies generally rise and fall during the acute phase of the disease, whereas the synthesis of the IgG class of antibodies increases during the acute phase and remains elevated until or beyond resolution. Measurements of class- specific antibodies are also useful in the diagnosis of congenital infections. IgM antibodies do not cross the placenta, but certain IgG antibodies are transferred passively from mother to child during the final trimester of gestation. Consequently, an elevated level of pathogen- specific IgM antibodies in the serum of a neonate must have originated from the child and therefore indicates congenital infection. A similarly increased IgG titer in the neonate does not differentiate congenital from maternal infection. 27. A client's primary care provider has ordered direct antigen detection in the care of a client with a serious symptomatology of unknown origin. Which of the following processes will be conducted? A) Detecting DNA sequences that are unique to the suspected pathogen B) Growth of biofilms on various media in the laboratory setting C) Quantification of IgG and IgM antibodies in the client's blood D) Introduction of monoclonal antibodies to a blood sample from the client Ans: D Feedback: Direct antigen testing involves the introduction of labeled monoclonal antibodies to a sample of the client's tissue. This method of testing does not rely on detection of specific DNA sequences, growth of biofilms, or quantification of specific antibodies. 28. A client has begun taking acyclovir, an antiviral medication, to control herpes simplex outbreaks. What is this drug's mechanism of action? A) Inhibition of viral adhesion to cells B) Elimination of exotoxin production C) Antagonism of somatic cell–binding sites D) Interference with viral replication processes Ans: D Feedback: Acyclovir, like most antiviral drugs, interferes with normal viral replication. Antiviral drugs do not normally affect adhesion, and viruses are not associated with the production of exotoxins. 29. A client with cancer has been receiving amphotericin B intravenously. The client asks, “How will this help with my fungal disease?” The health care provider responds: A) “This medication inhibits the synthesis of ergosterol.” B) “This drug binds to ergosterol and forms holes in the cell membrane, killing the fungus.” C) “This medication will keep the body from growing any new fungi.” D) “This drug impairs the synthesis of enzymes needed for viral replication.” Ans: B Feedback: The polyene family of antifungal compounds (e.g., amphotericin B, nystatin) preferentially binds to ergosterol and forms holes in the cell membrane, causing leakage of the fungal cell contents and, eventually, lysis of the cell. The imidazole class of drugs (e.g., fluconazole, itraconazole) inhibits the synthesis of ergosterol, thereby damaging the integrity of the fungal cytoplasmic membrane. Zidovudine as well as nonnucleoside inhibitors impair the synthesis of the HIV-specific enzyme reverse transcriptase. This key enzyme is essential for viral replication. 30. Which of the following is an example of how international travel has contributed to increased prevalence and incidence of nonindigenous diseases? A) An airline pilot getting ill after eating pork in a restaurant in Hong Kong B) Outbreak of hemolytic–uremic syndrome related to contaminated salad being shipped to various regions C) Increase in the number of reported Lyme disease cases related to hot summer with local large deer population D) Hepatitis A outbreak when a restaurant worker forgot to wash the hands after using the rest room Ans: B Feedback: Travel results in more sources of infection, but it does not necessarily influence portals of entry, virulence, and the course of diseases. In 2011, one of the largest foodborne outbreaks of E. coli emerged as a global threat. Beginning in May 2011, German public health authorities reported an outbreak of hemolytic–uremic syndrome. Within 3 weeks, German authorities announced the source of the outbreak was cucumbers from Spain, a report later proven incorrect. As the investigation into the source of the outbreak continued, clients in surrounding countries also began to report illness. As the outbreak continued, epidemiologists focused their investigation on bean sprouts from a farm in Lower Saxony, Germany. 31. A 25-year-old cystic fibrosis client presents to the clinic in obvious respiratory distress. Following physical exam, the health care provider suspects bronchiectasis based on which of the following findings? Select all that apply. A) Crushing, substernal chest pain B) Copious amounts of foul-smelling purulent sputum C) Neck vein distention D) Blood-tinged sputum E) Wheezing throughout the lung fields Ans: B, D, E Feedback: Bronchiectasis is usually manifested by a chronic productive cough, often with several 100 mL of foul- smelling, purulent sputum a day. Hemoptysis is common. Dyspnea and wheezing occur in about 75% of clients. Crushing substernal chest pain and next vein distention are more suggestive of pulmonary emboli or myocardial infarction with right-sided heart failure. 32. A teenaged cystic fibrosis client presents to the clinic. The health care provider (HCP) knows that cystic fibrosis (CF) causes severe chronic respiratory disease in children. In addition, the HCP should also focus his or her assessment on which of the other body systems affected by CF? A) Renal B) Pancreatic C) Cardiac D) Central nervous system Ans: B Feedback: Cystic fibrosis (CF) is manifested by pancreatic exocrine deficiency and elevation of sodium chloride in the sweat. Cystic fibrosis (CF) is an inherited disorder involving fluid secretion by the exocrine glands in the epithelial lining of the respiratory, gastrointestinal, and reproductive tracts. Excessive loss of sodium in the sweat predisposes young children to salt depletion episodes. Respiratory manifestations are caused by an accumulation of viscid mucus in the bronchi, impaired mucociliary clearance, lung infections, bronchiectasis, and dilatation. The renal, cardiac, and CNS are usually not involved with CF manifestation. 33. Which of the following individuals is experiencing an immunologic lung disorder affecting ventilation that has caused the formation of a granuloma on chest x-ray? A) A 30-year-old African American man who has been diagnosed with sarcoidosis B) An infant whose routine screening is suggestive of cystic fibrosis C) An elderly, lifelong smoker who has been admitted to hospital with emphysema exacerbation D) A 16-year-old girl who must limit her physical activity to prevent the onset of acute asthmatic attacks Ans: A Feedback: Sarcoidosis is an example of restrictive lung disease, whereas cystic fibrosis (CF), emphysema, and asthma are considered obstructive. 34. Soon after delivery, the mother grabs the nurses arm and states, “Something's wrong…I can't get my breath.” Which of the following assessments lead the nurse to suspect the client has had an amniotic emboli travel to the lungs? Select all that apply. A) BP 90/65; pulse 130, irregular; respiratory rate 35, shallow. B) Intercostal traction noted on inspiration. C) +3 pitting edema in lower extremities. D) Trachea has shifted and is no longer midline. E) Productive cough with blood-streaked sputum. Ans: A, E Feedback: The embolism may consist of amniotic fluid that has entered the maternal circulation during childbirth. Persons with moderate-sized emboli often present with breathlessness accompanied by pleuritic pain, apprehension, slight fever, and cough productive of blood- streaked sputum. Tachycardia often occurs to compensate for decreased oxygenation, and the breathing pattern is rapid and shallow. Intercostal traction is usually associated with atelectasis; pitting edema is a sign of right-sided heart failure; trachea shift is a classic sign of a tension pneumothorax. 35. Which of the following clients is at risk for developing a preventable disorder related to prolonged immobility? A) A middle-aged adult male diagnosed with bronchitis related to chronic smoking B) A young adult female diagnosed with sarcoidosis requiring corticosteroids to return her to remission C) A postsurgical client who is refusing to get out of bed and walk and will not wear those “uncomfortable elastic stocking” D) A sleep apnea client related to a history of smoking who utilizes a C-PAP machine every night at bedtime to maintain airway Ans: C Feedback: A lack of mobility can result in secondary atelectasis (through incomplete lung expansion) and pulmonary embolism (from deep vein thrombosis). This is not the case with the other listed disorders of ventilation and gas exchange. 36. If a client with a kidney stone has the “classic” ureteral colic, the client will describe his pain as: Select all that apply. A) Acute, intermittent B) Diffuse over the entire lower back and legs C) Excruciating D) In the flank and upper outer quadrant of the abdomen Ans: A, C, D Feedback: The symptoms of renal colic are caused by stones 1 to 5 mm in diameter that can move into the ureter and obstruct flow. Classic ureteral colic is manifested by acute, intermittent, and excruciating pain in the flank and upper outer quadrant of the abdomen on the affected side. The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in the man. The pain is usually not described as diffuse and over the entire low back and legs. 37. A client has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which of the following measures should the client integrate into his lifestyle to reduce the risk of recurrence? A) Increased fluid intake and dietary changes B) Weight loss and blood pressure control C) Regular random blood glucose testing D) Increased physical activity and use of over-the- counter diuretics Ans: A Feedback: Depending on the type of stone that was present, many clients benefit from increased fluid intake and changes in diet. Weight loss, blood sugar and pressure control, and exercise are not central preventative measures. It would likely be inappropriate to recommend the use of over-the- counter diuretics as a preventative measure. 38. A young child has been diagnosed with Wilms tumor after his mother discovered an unusual mass, prompting a diagnostic workup. Which of the following characteristics is typical of Wilms tumor? The tumor is usually: A) Asymptomatic B) Self-limiting C) A secondary neoplasm D) Encapsulated Ans: D Feedback: Wilms tumor usually is a solitary mass that occurs in any part of the kidney. It usually is sharply demarcated and variably encapsulated. It is not a self-limiting health problem, and chemotherapy, radiotherapy, and/or surgery may be utilized. Symptoms include hypertension, abdominal pain, and vomiting. 39. While taking a history from an adult client newly diagnosed with renal cell cancer, the nurse can associate which of the following high-risk factors with the development of this cancer? A) Heavy smoking B) Inherited renal disease C) Adrenal medulla tumors D) Anorexia/bulimia disorder Ans: A Feedback: Epidemiologic evidence suggests a correlation between heavy smoking and kidney cancer. Obesity also is a risk factor; particularly in women. The risk of renal cell carcinoma also is increased in persons with acquired cystic kidney disease associated with chronic renal insufficiency. Although the adrenal gland is adjacent to the kidney, primary adrenal tumors are unrelated to renal cell disease. 40. Which of the following client clinical manifestations most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma? A) Urinary urgency B) Hematuria C) Oliguria D) Cloudy urine Ans: B Feedback: Presenting features of renal cancer include hematuria, flank pain, and presence of a palpable flank mass. Gross or microscopic hematuria, which occurs in more than 50% of cases, is an important clinical clue. Urgency, oliguria, and cloudy urine are not as closely associated with renal carcinoma. 41. A pregnant woman who is beginning her third trimester has been diagnosed with a urinary tract infection (UTI). Which of the following factors most likely predisposed this client to the development of a UTI? A) Increased urine alkalinity during pregnancy B) Hypertrophy of the bladder wall C) Dilation of the upper urinary structures D) Spastic peristalsis of the ureters Ans: C Feedback: Normal changes in the functioning of the urinary tract that occur during pregnancy predispose to UTIs. These changes involve the collecting system of the kidneys and include dilation of the renal calyces, pelves, and ureters that begins during the first trimester and becomes most pronounced during the third trimester. Bladder hypertrophy, spastic peristalsis, and increased urine pH are not phenomena that are common accompaniments to pregnancy. 42. Which of the following signs and symptoms in a 2- year-old child should prompt assessment for a urinary tract infection? A) Unexplained fever and anorexia B) Decreased urine output and irritability C) Production of concentrated urine and recurrent nausea D) Frank hematuria Ans: A Feedback: Although all of the cited symptoms warrant further assessment and follow-up, the presence of fever and anorexia is typical of UTIs in toddlers. 43. A public health nurse is conducting a health promotion class for a group of older adults. Which of the participants' following statements demonstrates an accurate understanding of the risk factors for bladder cancer? A) “I suppose I should listen to my doctor and drink more cranberry juice.” B) “More than ever, I guess it would worthwhile for me to quit smoking.” C) “I can see that preventing bladder cancer is one more benefit of a healthy diet.” D) “I think I should be okay because there's no history of bladder cancer in my family that I'm aware of.” Ans: B Feedback: Smoking is implicated in 30% to 50% of all bladder cancers among males who are current or past smokers. Cranberry juice may be of benefit in the prevention of UTIs, not cancer, and neither poor diet nor family history is as significant as cigarette smoking in the etiology of bladder cancer. 44. A neighbor is complaining to a friend (who happens to be a nurse) about several changes in their body. Which of the following complaints raises a “red flag” because it could be a sign of epithelial cell bladder cancer? A) “Seems like I'm holding onto more water these days.” B) “Every now and then, I have urine leak when I cough.” C) “Sometimes I get a sharp pain in my side while exercising.” D) “I noticed my urine is pinkish red, but I'm not having any pain when I pee.” Ans: D Feedback: The most common sign of bladder cancer is intermittent painless hematuria. Fluid retention, stress incontinence, and pain with exercise are not usual signs of cancer. 45. A bladder cancer client asks the nurse, “What did the doctor mean by intravesicular chemotherapy? Am I going to lose all my hair and have to do for treatments over months and months?” The best response would be: A) “This is when they put the chemotherapy directly into the bladder to kill any cancer cells.” B) “They will take you to radiology and inject some chemotherapy through your abdomen into your bladder.” C) “The doctor will place a scope up your urethra, into the bladder, and burn the lining of the bladder with a laser and then inject some tuberculosis bacillus into the lining.” D) “This is when they use a CyberKnife to cut off any lesions and then inject chemotherapy into the remaining portion of the bladder.” Ans: A Feedback: Surgical treatment of superficial bladder cancer is often followed by intravesicular chemotherapy or immunotherapy, a procedure in which the therapeutic agent is directly instilled into the bladder. None of the other responses describe this procedure. The chemotherapy drug is not injected through the abdomen into the bladder. BCG is instilled into the bladder to elicit an inflammatory response that can kill the tumor. A CyberKnife is used with the brain, not the bladder. 46. Which of the following individuals is experiencing the effects of a primary endocrine disorder? A client: A) With adrenal cortical insufficiency due to pituitary hyposecretion of ACTH B) Who has hypothyroidism as a result of low TSH production C) Whose dysfunctional hypothalamus has resulted in endocrine imbalances D) Who has low calcium levels because of the loss of his parathyroid gland Ans: D Feedback: The loss of a gland, and the subsequent absence of the hormone that it normally produces, results in a primary endocrine disorder. The lack of a stimulating hormone such as ACTH or TSH results in a secondary disorder, whereas hypothalamic dysfunction causes tertiary endocrine disorders. 47. A woman who is exhibiting clinical manifestations of a pituitary adenoma will likely complain of: Select all that apply. A) Cessation of menses B) Unusual milk secretion unrelated to pregnancy C) Enlargement of the abdomen D) Pelvic pain E) Infertility Ans: A, B, E Feedback: The signs and symptoms of pituitary adenomas include endocrine abnormalities related specifically to functional hormone-secreting adenomas and to the local mass effects from the expanding tumor. Lactotrophic adenomas are the most frequent type of hyperfunctioning pituitary adenoma. Hyperprolactinemia inhibits the pulsatile secretion of LH, which is essential for normal ovulation in women. Thus, manifestations of hyperprolactinemia are easily recognized to include amenorrhea (lack of menses), galactorrhea (spontaneous milk secretion unrelated to pregnancy), and infertility. 48. Loss of pituitary function can result in deficiencies/loss of which of the following hormones' secretions? Select all that apply. A) Growth hormone B) Luteinizing hormone C) Follicle stimulating hormone D) Corticotropin-releasing hormone E) Prolactin Ans: A, B, C, E Feedback: Anterior pituitary hormone loss is usually gradual, especially with progressive loss of pituitary reserve due to tumors or previous pituitary radiation therapy (which may take 10 to 20 years to produce hypopituitarism). The loss of pituitary function tends to follow a classic course beginning with the loss of GH, LH, and FSH secretion followed by deficiencies in TSH, then ACTH, and finally prolactin. 49. Which of the following physiologic processes is a direct effect of the release of growth hormone by the anterior pituitary? A) Development of cartilage and bone B) Production of insulin-like growth factors (IGFs) by the liver C) Increase in overall metabolic rate and cardiovascular function D) Positive feedback of the hypothalamic–pituitary– thyroid feedback system Ans: B Feedback: GH cannot directly produce bone growth; instead, it acts indirectly by causing the liver to produce IGFs. It affects neither metabolic rate nor the function of the hypothalamic–pituitary–thyroid feedback system. 50. Which of the following individuals displays the precursors to acromegaly? A) An adult with an excess of growth hormone due to an adenoma B) A girl who has been diagnosed with precocious puberty C) An adult who has a diagnosis of Cushing syndrome D) A client who has recently developed primary adrenal carcinoma Ans: A Feedback: When growth hormone (GH) excess occurs in adulthood or after the epiphyses of the long bones have fused, it causes a condition called acromegaly, which represents an exaggerated growth of the ends of the extremities. 51. The cells that mediate humoral immunity do so because they are capable of producing: A) Platelets B) Antibodies C) Stem cells D) Helper T cells Ans: B Feedback: B lymphocytes (B cells) are the only cells capable of producing antibodies; therefore, they are the cells that mediate humoral immunity. B lymphocytes (B cells) differentiate into plasma cells that produce the needed immunoglobulins (antibodies) for responding to that particular antigen. Stem cells are undifferentiated cells. T helper cells differentiate into cytotoxic and other T-cell forms. 52. A client has recently received a pneumococcal vaccine and the client's B cells are consequently producing antibodies. Which of the following cells may enhance this production of antibodies? A) Helper T cells B) Regulatory T cells C) Cytotoxic T cells D) Natural killer cells Ans: A Feedback: Among T lymphocytes are a subset of T cells called helper T cells, which help B lymphocytes produce antibodies. Natural killer cells as well as regulatory and cytotoxic T cells do not perform this function. 53. While caring for a pediatric client admitted with a viral infection, the nurse knows that which type of cell will be the child's primary defense against the virus? A) Complement B) Bradykinin C) Leukotrienes D) Natural killer (NK) cells Ans: D Feedback: The third type of lymphocyte, the natural killer (NK) cell is part of the innate immune system and may be the first line of defense against viral infections. The NK cell also has the ability to recognize and kill tumor cells, abnormal body cells, and cells infected with intracellular pathogens, such as viruses and intracellular bacteria. Complement is activated in the inflammatory response. Leukotrienes and bradykinin are also a part of the inflammatory response. 54. A child's thymus gland is fully formed and proportionately larger than an adult's. Which of the following processes that contributes to immunity takes place in the thymus gland? A) Differentiation of B cells B) Production of natural killer (NK) cells C) Proliferation of T cells D) Filtration of antigens from the blood Ans: C Feedback: Phenotypically immature T cells enter the thymus from the bone marrow and undergo maturation and thymic selection. B cells are not differentiated in the thymus, and NK cells result from the common lymphoid progenitor. The spleen filters antigens from the blood. 55. While explaining immunity to a client, the nurse responds, “The body's internal organs are protected from pathogens because: A) Our mucosal tissue contains all the necessary cell components to fight a pathogen with an immune response.” B) The tonsils store a large amount of natural killer cells at that location.” C) We have special glands that can secrete cytokines on a moment's notice.” D) The actions of the cytokines in the mouth can act on different cell types at the same time it is fighting pathogens.” Ans: A Feedback: Secondary lymphoid tissues contain all the necessary cell components (i.e., T cells, B cells, macrophages, and dendritic cells) for an immune response. Because of the continuous stimulation of the lymphocytes in these tissues by microorganisms constantly entering the body, large numbers of plasma cells are evident. Immunity at the mucosal layers helps to exclude many pathogens and thus protects the vulnerable internal organs. Although cells of both the innate and adaptive immune systems communicate critical information by cell-to-cell contact, many interactions and effector responses depend on the secretion of short- acting soluble molecules called cytokines. The actions of cytokines are often pleiotropic and redundant. Pleiotrophism refers to the ability of a cytokine to act on different cell types. 56. Which of the following characteristics differentiates a migraine with aura from a migraine without aura? A) Gastrointestinal involvement in the hours leading up to the headache B) A decrease in mood and affect prior to the headache C) Lack of response to nonpharmacologic treatments D) Visual symptoms that precede the headache Ans: D Feedback: An aura is visual (flickering lights, spots, or loss of vision), sensory (feeling of pins and needles, or numbness), and/or speech disturbance that precedes a migraine. Nonpharmacologic treatments may be used with varying success in both types of migraine, and nausea and vomiting may precede or accompany each. Changes in mood and affect are not central to an aura. 57. While talking about their migraine headaches, two women have found that they have some common triggers for their migraines, which may include: Select all that apply. A) Nonpharmacologic treatments like yoga B) Piercings of their nose and cheeks C) At the time of their menstrual cycle D) When drinking white wine E) Consuming chocolate Ans: C, E Feedback: Although the pathophysiology of migraines is not well understood, it is thought that hormone levels, particularly estrogen levels, may underlie their increased prevalence in women. Fluctuations in hormone levels, particularly in estrogen levels, are thought to play a role in the pattern of migraine attacks. For many women, migraine headaches coincide with their menstrual periods. The greater predominance of migraine headaches in women is thought to be related to the aggravating effect of estrogen on the migraine mechanism. Dietary substances, such as monosodium glutamate, aged cheese, and chocolate, also may precipitate migraine headaches. Yoga, piercings, and drinking white wine are not known to be triggers for migraines. 58. A 44-year-old woman has sought care for the treatment of headaches that have been increasing in severity and frequency and has been subsequently diagnosed with migraines. Which of the following teaching points should her care provider emphasize? A) “Weight loss and exercise are very important components of your treatment.” B) “Stopping all of your current medications, even temporarily, should provide some relief.” C) “It would be helpful for you to take control of your diet, sleep schedule, and stress levels.” D) “Your headaches are likely a result of a nerve disorder and, unfortunately, cannot be treated successfully.” Ans: C Feedback: Migraines may be precipitated by certain foods as well as stress and lack of sleep. Obesity and sedentary lifestyle are not thought to be risk factors. Migraines are not believed to result from a nerve disorder, and treatment is often difficult, but positive. It would be inappropriate and ineffective to recommend the cessation of all the client's drugs. 59. Which of the following principles should underlie the pain control strategy in the care of a child with a diagnosis of cancer? A) Opioids should be avoided in order to prevent liver and kidney insult. B) Dosing and timing should aim for a steady serum level of the prescribed drug. C) Doses of analgesia should be given only when the client's pain becomes severe. D) Drugs from numerous classifications should be used to maximize pain control. Ans: B Feedback: Pain control can be maximized and side effects minimized by timing the administration of analgesia so that a steady blood level is achieved and, as much as possible, pain is prevented. Opioids can be safely used in children, and analgesia should not be withheld until pain is severe. Using drugs from numerous classifications will not necessarily increase pain control. 60. Pain assessment is likely to be most challenging when providing care for which of the following older adult clients? A) A 90-year-old client who takes multiple medications for cardiac and respiratory conditions B) A 77-year-old man who has sustained burns on the lower part of his body C) An 82-year-old woman who has been diagnosed with diabetes and an anxiety disorder D) An 87-year-old man with vascular dementia and other health problems like heart failure Ans: D Feedback: Pain in the elderly has been associated with impaired appetite, increased sleep disturbances, and in some cases a decrease in cognitive functions. Anxiety, polypharmacy, and the presence of acute pain are factors that may also influence the assessment process, but these are more likely to have a bearing on pain treatment and management than on pain assessment. 61. A client with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the client appears confused but is oriented to person and place but not time. What type of seizure did this client most likely experience? A) Tonic–clonic seizure B) Atonic seizure C) Myoclonic seizure D) Focal seizure with impairment to consciousness Ans: D Feedback: Focal seizures with impairment of consciousness, sometimes referred to as psychomotor seizures, are often accompanied by automatisms or repetitive nonpurposeful activities such as lip smacking, grimacing, patting, or rubbing clothing. Confusion during the postictal period (after a seizure) is common. Atonic seizures are characterized by loss of muscle tone, and myoclonic seizures involve brief involuntary muscle contractions induced by stimuli of cerebral origin. With tonic–clonic seizures, formerly called grand mal seizures, a person has a vague warning (probably a simple focal seizure) and experiences a sharp tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness. 62. A client has started having uncontrolled seizures that are not responding to usual medications. Nursing working with the client must pay special attention to which of the following priority aspects of this clients care? Assessment of: A) ECG for arrhythmias B) Urine output and continence C) Ability to grasp hands and squeeze on command D) Respiratory status and oxygen saturation Ans: D Feedback: Tonic–clonic status epilepticus is a medical emergency and, if not promptly treated, may lead to respiratory failure and death. Treatment consists of appropriate life support measures. Airway/breathing is always the priority in this emergency situation. 63. The health care provider for a client with degenerative Alzheimer-type dementia recognizes the client has moved from the initial stage to the moderate stage based on which of the following clinical manifestations? Select all that apply. A) Extreme confusion and disorientation B) Incontinence of urine and bowel C) Need for direct supervision for ADLs D) Social withdrawal from all family and friends E) Inability to problem solve simple tasks Ans: A, C, E Feedback: Although different staging schemas exist, three broad stages of Alzheimer dementia have been identified, each of which is characterized by progressive degenerative changes. The early stage is characterized by short-term memory loss, lack of spontaneity, and social withdrawal. The moderate stage of dementia is marked by extreme confusion, disorientation, and personal hygiene (ADLs) is neglected. During this stage, there are also changes in higher cortical functioning needed for language, spatial relationships, and problem solving. In severe Alzheimer disease, in the terminal stage, the person typically becomes incontinent. 64. Which of the following statements by the husband of a client with Alzheimer disease demonstrates an accurate understanding of his wife's medication regimen? A) “I'm really hoping these medications will slow down her mental losses.” B) “We're both holding out hope that this medication will cure her Alzheimer's.” C) “I know that this won't cure her, but we learned that it might prevent a bodily decline while she declines mentally.” D) “I learned that if we are vigilant about her medication schedule, she may not experience the physical effects of her disease.” Ans: A Feedback: There is presently no cure for Alzheimer disease. Medications do not directly address the physical manifestations of Alzheimer disease. Rather, drugs are used primarily to slow the progression and to control depression, agitation, or sleep disorders. 65. A client with a long history of cigarette smoking and poorly controlled hypertension has experienced recent psychomotor deficits as a result of hemorrhagic brain damage. The client's psychomotor deficits are likely the result of: A) Alzheimer disease B) Frontotemporal dementia (FTD) C) Vascular dementia D) Wernicke-Korsakoff syndrome Ans: C Feedback: Vascular dementia is caused by brain injury resulting from ischemic or hemorrhagic damage. Smoking and hypertension are contributing factors, and slowness in psychomotor functioning is a main clinical feature of vascular dementia. The client's history and symptomatology are not characteristic of Alzheimer disease, FTD, or Wernicke-Korsakoff syndrome. 66. Which of the following clients is at high risk for developing acute bacterial prostatitis? A) A middle-aged male with prostate hyperplasia B) A fifth grade male diagnosed with acute pyelonephritis C) An elderly male diagnosed with frequent UTIs testing positive for gram-negative rods D) A sickle cell anemia client complaining of prolonged erection lasting less than 4 hours Ans: C Feedback: The most likely etiology of acute bacterial prostatitis is an ascending urethral infection or reflux of infected urine into the prostatic ducts. E. coli, other gram-negative rods, and enterococci, organisms known to cause urethritis are the most common infectious agents, rather than a descending bacterial infection from the kidneys (as in pyelonephritis). Benign prostatic hyperplasia (BPH) is an age-related, nonmalignant enlargement of the prostate gland caused by overgrowth of the prostate mucosal glands. Prolonged erection does not increase the probability of developing acute bacteria prostatitis. 67. Men older than age 50 are at high risk for prostatic hypertrophy with complications that include: A) Hypospadias B) Scrotal edema C) Urine retention D) Testicular cancer Ans: C Feedback: Benign prostatic hypertrophy (BPH) is a common disorder in men over 50; because the prostate encircles the urethra, BPH exerts its effect through obstruction of urinary outflow from the bladder. Hypospadias is a congenital condition in which the termination of the urethra is on the ventral surface of the penis. Scrotal edema is often the result of testicular disease or inflammation rather than prostate enlargement. Often the first sign of testicular cancer is a slight enlargement of the testicle that may be accompanied by some degree of discomfort. 68. When evaluating a client with suspected benign prostatic hypertrophy (BPH), the health care worker should collect data related to which of the following signs/symptoms? Select all that apply. A) Frequency of erectile dysfunction B) Enlarged inguinal lymph nodes C) Urinary frequency issues D) Weak urine stream E) Straining to empty the bladder Ans: C, D, E Feedback: It is now thought that the single most important factor in the evaluation and treatment of BPH is the man's own personal experiences related to the disorder. The American Urological Association Symptom Index consists of seven questions about symptoms regarding incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia. Erectile dysfunction may develop secondary to the androgen hormone imbalances associated with BPH. Enlarged lymph nodes usually relates to a regional infection. 69. Which of the following assessments is most likely to reveal a potential exacerbation in a 70-year-old client's diagnosis of benign prostatic hyperplasia (BPH)? A) Urine testing for microalbuminuria B) Blood test for white blood cells and differential C) Digital rectal examination D) Sperm morphology testing Ans: C Feedback: The diagnosis of BPH is based on history, physical examination, digital rectal examination, urinalysis, blood tests for serum creatinine and prostate-specific antigen (PSA), and urine flow rate. The digital rectal examination is used to examine the external surface and size of the prostate. An enlarged prostate found during a digital rectal examination does not always correlate with the degree of urinary obstruction. Some men can have greatly enlarged prostate glands with no urinary obstruction, but others may have severe symptoms without a palpable enlargement of the prostate. Proteinuria, increased WBCs, and changes in sperm morphology are not associated with BPH. 70. An elderly male client has been diagnosed with prostate cancer. However, because he has a history of heart failure with an ejection fraction of 20% and chronic obstructive pulmonary disease due to many years of smoking, the client is not a candidate for major surgery. Which of the following treatments should the nurse anticipate being utilized for this client? A) Transurethral prostatectomy (TURP) that only utilizes epidural blocks and small amounts of Versed and Fentanyl B) Stent placed to widen and maintain the patency of the urethra C) Teaching the client how to perform a straight catheterization every time they feel the need to empty their bladder D) Brachytherapy inserted into the penis and instilled into the prostate tissue Ans: B Feedback: The surgical removal of an enlarged prostate can be accomplished by the transurethral, suprapubic, or perineal approach. Currently, transurethral prostatectomy (TURP) is the most commonly used technique. For men who have heart or lung disease or a condition that precludes major surgery, a stent may be used to widen and maintain the patency of the urethra. A stent is a device made of tubular mesh that is inserted under local or regional anesthesia. Within several months, the lining of the urethra grows to cover the inside of the stent. It would be highly unlikely for the client to be asked to straight cath for urination. Brachytherapy would not be a treatment of choice since it would block the passage of urine from the bladder. 71. A child in gymnastics class has fallen off the balance beam and hurt her ankle. X-rays are negative for fracture, so the health care provider has diagnosed a severe sprain. Which of the following treatment measures should be taught to the family and child? Select all that apply. A) Immobilization for several weeks B) Elevate the ankle on pillows C) Apply ice packs to the ankle D) P