NUR 529 EXAM 1, NURS 529 EXAM 1
QUESTIONS WITH SOLVED ANSWERS
Marfans ✅✅ANSW-Marfan syndrome is an autosomal dominant disorder of the connective
tissue, which gives shape and structure to other tissues in the body and holds them in place.
affects fibrillin I (component of microfibrils)
affects eyes, cardiovascular, skeletal system (bones/ joints)
most obvious features of the disorder, include a long, thin body with exceptionally long extremities
and long, tapering fingers,
most life threatening is cardiovascular
dissection of aortia may lead to premature death
Treatment plans include echocardiograms and electrocardiograms to assess the status of the
cardiovascular system, periodic eye examinations, and evaluation of the skeletal system, especially
in children and adolescents.
The stress response Acute effects ✅✅ANSW-The reactions to acute stress are those associated
with the ANS, the fight-or-flight response. The manifestations of the stress response—a pounding
headache; a cold, moist skin; and a stiff neck—are all part of the acute stress response. Centrally,
there is facilitation of neural pathways mediating arousal, alertness, vigilance, cognition, and focused
attention, as well as appropriate aggression. The acute stress response can result from either
psychologically or physiologically threatening events. In situations of life-threatening trauma, these
acute responses may be lifesaving in that they divert blood from less essential to more essential
body functions. Increased alertness and cognitive functioning enable rapid processing of information
and arrival at the most appropriate solution to the threatening situation.
However, for people with limited coping abilities, either because of physical or mental health, the
acute stress response may be detrimental (Chart 7.1). This is true of people with preexisting heart
disease in whom the overwhelming sympathetic behaviors associated with the stress response can
lead to arrhythmias. For people with other chronic health problems, such as headache disorder,
acute stress may precipitate a recurrence. In healthy people, the acute stress response can redirect
,attention from behaviors that promote health, such as attention to proper meals and getting
adequate sleep. For those with health problems, it can interrupt compliance with medication
regimens and exercise programs. In some situations, the acute arousal state actually can be life-
threatening, physically immobilizing the person when movement would avert catastrophe (e.g.,
moving out of the way of a speeding car).
effeects of chronic stress ✅✅ANSW-The stress response is designed to be an acute self-limited
response in which activation of the ANS and the HPA axis is controlled in a negative feedback
manner. As with all negative feedback systems, pathophysiologic changes can occur in the stress
response system. Function can be altered in several ways, including when a component of the
system fails; when the neural and hormonal connections among the components of the system are
dysfunctional; and when the original stimulus for the activation of the system is prolonged or of such
magnitude that it overwhelms the ability of the system to respond appropriately. In these cases, the
system may become overactive or underactive.
Chronicity and excessive activation of the stress response can result from chronic illnesses as well as
contribute to the development of long-term health problems. Chronic activation of the stress
response is an important public health issue from both a health and a cost perspective. Stress is
linked to a myriad of health disorders, such as diseases of the cardiovascular, gastrointestinal,
immune, and neurologic systems, as well as depression, chronic alcoholism and drug abuse, eating
disorders, accidents, and suicide.
edema assessment and tx ✅✅ANSW-The effects of edema are determined largely by its location.
Edema of the brain, larynx, or lungs is an acute, life-threatening condition. Although not life
threatening, edema may interfere with movement, limiting joint motion. Swelling of the ankles and
feet often is insidious in onset and may or may not be associated with disease. At the tissue level,
edema increases the distance for diffusion of O2, nutrients, and wastes. Edematous tissues usually
are more susceptible to injury and development of ischemic tissue damage, including pressure
ulcers. Edema can also compress blood vessels. The skin of a severely swollen finger can act as a
tourniquet, shutting off the blood flow to the finger. Edema can also be disfiguring, causing
psychological effects and disturbances in self-concept. It can also create problems with obtaining
proper-fitting clothing and shoes.
Pitting edema occurs when the accumulation of interstitial fluid exceeds the absorptive capacity of
the tissue gel. In this form of edema, the tissue water becomes mobile and can be translocated with
pressure exerted by a finger. Nonpitting edema usually reflects a condition in which plasma proteins
have accumulated in the tissue spaces and coagulated. It is seen most commonly in areas of
localized infection or trauma. The area often is firm and discolored.
Methods for assessing edema include daily weight, visual assessment, measurement of the affected
part, and application of finger pressure to assess for pitting edema. Daily weight performed at the
same time each day with the same amount of clothing provides a useful index of water gain (1 L of
water weighs 1 kg [2.2 lb]) because of edema.
, Distinguishing lymphedema from other forms of edema can be challenging, especially early in its
course. Papillomatosis, a characteristic honeycomb appearance of the skin b
lungs in acid base regulation ✅✅ANSW-The second line of defense against acid-base
disturbances is the control of extracellular CO2 by the lungs.45,49 Respiratory regulation only comes
into play when the chemical buffers do not minimize H+ changes.45 Increased ventilation decreases
PCO2, whereas decreased ventilation increases PCO2. The blood PCO2 and pH are important
regulators of ventilation.
Chemoreceptors in the brain stem and peripheral chemoreceptors in the carotid and aortic bodies
sense changes in PCO2 and pH and alter the ventilation rate.
When the H+ concentration is above normal, the respiratory system is stimulated resulting in
increased ventilation. This control of pH is rapid, occurring within minutes, and is maximal within 12
to 24 hours. Although the respiratory response is rapid, it does not completely return the pH to
normal. It is only about 50% to 75% effective as a buffer system.44,45 This means that if the pH falls
from 7.4 to 7.0, the respiratory system can return the pH to a value of about 7.2 to 7.3.44 In acting
rapidly, however, it prevents large changes in pH from occurring while waiting for the much more
slowly reacting kidneys to respond.
Although CO2 readily crosses the blood-brain barrier, there is a lag for entry of HCO3−. Thus, blood
levels of HCO3− change more rapidly than CSF levels. In metabolic acidosis, for example, there is
often a primary decrease in pH of the cerebral fluids and a slower decrease in HCO3−. When
metabolic acid-base disorders are corrected rapidly, the respiratory response may persist because of
a delay in adjustment of CSF HCO3− levels.
kidney is acid base regulation ✅✅ANSW-The kidneys are the third line of defense in acid-base
disturbances and play three major roles in regulating acid-base balance.45,46 The first is through the
excretion of H+ from fixed acids that result from protein and lipid metabolism. The second is
accomplished through the reabsorption of the HCO3− that is filtered in the glomerulus, so this
important buffer is not lost in the urine. The third is the production of new HCO3− that is released
back into the blood.44-46 The kidneys also play a role in controlling pH: in conditions of acid load,
ammonium (NH4+) production and excretion allows for acid secretion and pH normalization.45 The
renal mechanisms for regulating acid-base balance cannot adjust the pH within minutes, as
respiratory mechanisms can, but they begin to adjust the pH in hours and continue to function for
days until the pH has returned to normal or near-normal range.
acid base balance- compensatpru mechanisms ✅✅ANSW-Acidosis and alkalosis typically involve
a primary or initiating event and a compensatory or adaptive state that results from homeostatic
mechanisms that attempt to correct or prevent large changes in pH. For example, a person may have
QUESTIONS WITH SOLVED ANSWERS
Marfans ✅✅ANSW-Marfan syndrome is an autosomal dominant disorder of the connective
tissue, which gives shape and structure to other tissues in the body and holds them in place.
affects fibrillin I (component of microfibrils)
affects eyes, cardiovascular, skeletal system (bones/ joints)
most obvious features of the disorder, include a long, thin body with exceptionally long extremities
and long, tapering fingers,
most life threatening is cardiovascular
dissection of aortia may lead to premature death
Treatment plans include echocardiograms and electrocardiograms to assess the status of the
cardiovascular system, periodic eye examinations, and evaluation of the skeletal system, especially
in children and adolescents.
The stress response Acute effects ✅✅ANSW-The reactions to acute stress are those associated
with the ANS, the fight-or-flight response. The manifestations of the stress response—a pounding
headache; a cold, moist skin; and a stiff neck—are all part of the acute stress response. Centrally,
there is facilitation of neural pathways mediating arousal, alertness, vigilance, cognition, and focused
attention, as well as appropriate aggression. The acute stress response can result from either
psychologically or physiologically threatening events. In situations of life-threatening trauma, these
acute responses may be lifesaving in that they divert blood from less essential to more essential
body functions. Increased alertness and cognitive functioning enable rapid processing of information
and arrival at the most appropriate solution to the threatening situation.
However, for people with limited coping abilities, either because of physical or mental health, the
acute stress response may be detrimental (Chart 7.1). This is true of people with preexisting heart
disease in whom the overwhelming sympathetic behaviors associated with the stress response can
lead to arrhythmias. For people with other chronic health problems, such as headache disorder,
acute stress may precipitate a recurrence. In healthy people, the acute stress response can redirect
,attention from behaviors that promote health, such as attention to proper meals and getting
adequate sleep. For those with health problems, it can interrupt compliance with medication
regimens and exercise programs. In some situations, the acute arousal state actually can be life-
threatening, physically immobilizing the person when movement would avert catastrophe (e.g.,
moving out of the way of a speeding car).
effeects of chronic stress ✅✅ANSW-The stress response is designed to be an acute self-limited
response in which activation of the ANS and the HPA axis is controlled in a negative feedback
manner. As with all negative feedback systems, pathophysiologic changes can occur in the stress
response system. Function can be altered in several ways, including when a component of the
system fails; when the neural and hormonal connections among the components of the system are
dysfunctional; and when the original stimulus for the activation of the system is prolonged or of such
magnitude that it overwhelms the ability of the system to respond appropriately. In these cases, the
system may become overactive or underactive.
Chronicity and excessive activation of the stress response can result from chronic illnesses as well as
contribute to the development of long-term health problems. Chronic activation of the stress
response is an important public health issue from both a health and a cost perspective. Stress is
linked to a myriad of health disorders, such as diseases of the cardiovascular, gastrointestinal,
immune, and neurologic systems, as well as depression, chronic alcoholism and drug abuse, eating
disorders, accidents, and suicide.
edema assessment and tx ✅✅ANSW-The effects of edema are determined largely by its location.
Edema of the brain, larynx, or lungs is an acute, life-threatening condition. Although not life
threatening, edema may interfere with movement, limiting joint motion. Swelling of the ankles and
feet often is insidious in onset and may or may not be associated with disease. At the tissue level,
edema increases the distance for diffusion of O2, nutrients, and wastes. Edematous tissues usually
are more susceptible to injury and development of ischemic tissue damage, including pressure
ulcers. Edema can also compress blood vessels. The skin of a severely swollen finger can act as a
tourniquet, shutting off the blood flow to the finger. Edema can also be disfiguring, causing
psychological effects and disturbances in self-concept. It can also create problems with obtaining
proper-fitting clothing and shoes.
Pitting edema occurs when the accumulation of interstitial fluid exceeds the absorptive capacity of
the tissue gel. In this form of edema, the tissue water becomes mobile and can be translocated with
pressure exerted by a finger. Nonpitting edema usually reflects a condition in which plasma proteins
have accumulated in the tissue spaces and coagulated. It is seen most commonly in areas of
localized infection or trauma. The area often is firm and discolored.
Methods for assessing edema include daily weight, visual assessment, measurement of the affected
part, and application of finger pressure to assess for pitting edema. Daily weight performed at the
same time each day with the same amount of clothing provides a useful index of water gain (1 L of
water weighs 1 kg [2.2 lb]) because of edema.
, Distinguishing lymphedema from other forms of edema can be challenging, especially early in its
course. Papillomatosis, a characteristic honeycomb appearance of the skin b
lungs in acid base regulation ✅✅ANSW-The second line of defense against acid-base
disturbances is the control of extracellular CO2 by the lungs.45,49 Respiratory regulation only comes
into play when the chemical buffers do not minimize H+ changes.45 Increased ventilation decreases
PCO2, whereas decreased ventilation increases PCO2. The blood PCO2 and pH are important
regulators of ventilation.
Chemoreceptors in the brain stem and peripheral chemoreceptors in the carotid and aortic bodies
sense changes in PCO2 and pH and alter the ventilation rate.
When the H+ concentration is above normal, the respiratory system is stimulated resulting in
increased ventilation. This control of pH is rapid, occurring within minutes, and is maximal within 12
to 24 hours. Although the respiratory response is rapid, it does not completely return the pH to
normal. It is only about 50% to 75% effective as a buffer system.44,45 This means that if the pH falls
from 7.4 to 7.0, the respiratory system can return the pH to a value of about 7.2 to 7.3.44 In acting
rapidly, however, it prevents large changes in pH from occurring while waiting for the much more
slowly reacting kidneys to respond.
Although CO2 readily crosses the blood-brain barrier, there is a lag for entry of HCO3−. Thus, blood
levels of HCO3− change more rapidly than CSF levels. In metabolic acidosis, for example, there is
often a primary decrease in pH of the cerebral fluids and a slower decrease in HCO3−. When
metabolic acid-base disorders are corrected rapidly, the respiratory response may persist because of
a delay in adjustment of CSF HCO3− levels.
kidney is acid base regulation ✅✅ANSW-The kidneys are the third line of defense in acid-base
disturbances and play three major roles in regulating acid-base balance.45,46 The first is through the
excretion of H+ from fixed acids that result from protein and lipid metabolism. The second is
accomplished through the reabsorption of the HCO3− that is filtered in the glomerulus, so this
important buffer is not lost in the urine. The third is the production of new HCO3− that is released
back into the blood.44-46 The kidneys also play a role in controlling pH: in conditions of acid load,
ammonium (NH4+) production and excretion allows for acid secretion and pH normalization.45 The
renal mechanisms for regulating acid-base balance cannot adjust the pH within minutes, as
respiratory mechanisms can, but they begin to adjust the pH in hours and continue to function for
days until the pH has returned to normal or near-normal range.
acid base balance- compensatpru mechanisms ✅✅ANSW-Acidosis and alkalosis typically involve
a primary or initiating event and a compensatory or adaptive state that results from homeostatic
mechanisms that attempt to correct or prevent large changes in pH. For example, a person may have
