NURS 5315 Final EXAM WITH ANSWERS |\ |\ |\ |\ |\
A patient in respiratory distress and is breathing 33 breaths per
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
minute. Which ABG value is consistent with the clinical scenario?
|\ |\ |\ |\ |\ |\ |\ |\ |\
PCO2 15 |\
pH 7.30 |\
pH 7.45 |\
O2 sat 100% |\ |\
A patient who is breathing 33 breaths per minute is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
hyperventilating and blowing off CO2; therefore the PCO2 level |\ |\ |\ |\ |\ |\ |\ |\ |\
will be low. The patient will most likely experience a respiratory
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
alkalosis and the two pH values provided are not consistent with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
this diagnosis. |\
A patient has a sodium level of 115 mEq/L and is disoriented and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
lethargic. Which pathological process best explains this patient's
|\ |\ |\ |\ |\ |\ |\ |\ |\
symptoms?
a. The action potential has become hyperpolarized.
|\ |\ |\ |\ |\ |\
b. Water has shifted into the neurons and caused them to swell.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
c. Water has shifted into the vascular space and dehydrated the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
neurons.
d. The action potential has become hypopolarized.
|\ |\ |\ |\ |\ |\
b. The cause of neurologic symptoms associated with a sodium
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
imbalance is directly related to fluid shifting into or out of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
neurons of the brain. With a serum sodium of 115 mEq/L, water
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
,shifts into the neurons and causes them to swell. Hypernatremia
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
causes water to shift out of the cell into the intravascular space
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
and causes the neurons to become dehydrated. An alteration in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the action potential is not seen with sodium imbalances.
|\ |\ |\ |\ |\ |\ |\ |\
A patient experiencing dehydration should be monitored for
|\ |\ |\ |\ |\ |\ |\ |\
which electrolyte imbalance? |\ |\
a. Hyperkalemia
|\
b. Hypocalcemia
|\
c. Hypercalcemia
|\
d. Hyponatermia
|\
a. Serum osmolality is increased during times of dehydration. An
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
elevated serum osmolality will pull potassium into the
|\ |\ |\ |\ |\ |\ |\ |\
intravascular space from the intracellular space and cause a rise |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
in serum potassium.
|\ |\
A married couple presents to your office for genetic counseling.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
The husband has an autosomal recessive disease and his wife
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
has a heterozygous genotype for the disease. They ask you,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
What is the chance that our baby will have the disease? Which of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the following answers is correct?
|\ |\ |\ |\ |\
25%
50%
75%
100%
,A chromosome is a package of material located inside the cell
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
nucleus which is made of proteins and a single molecule of DNA.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
There are 23 pairs of chromosomes in each human cell for a total
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
of 46 chromosomes. Chromosomes are separated into two
|\ |\ |\ |\ |\ |\ |\ |\ |\
identical sets during mitosis or meiosis. This provides a set of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
chromosomes to each daughter cell which results from cell |\ |\ |\ |\ |\ |\ |\ |\ |\
division. This process is responsible for the transfer of genetic
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
information to the daughter cells. The first 22 pairs of |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
chromosomes are known as autosomes. The 23rd pair of |\ |\ |\ |\ |\ |\ |\ |\ |\
chromosomes is the pair which contains the genetic information |\ |\ |\ |\ |\ |\ |\ |\ |\
for gender. This pair contains the genetic information which
|\ |\ |\ |\ |\ |\ |\ |\ |\
delineates between the male and female genders. Females have |\ |\ |\ |\ |\ |\ |\ |\ |\
two X chromosomes (XX) and males have an XY chromosome
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
pair. Autosomal chromosomes are said to be autologous. This
|\ |\ |\ |\ |\ |\ |\ |\ |\
means they do not carry genetic information pertaining to
|\ |\ |\ |\ |\ |\ |\ |\ |\
gender. Autosomal genetic diseases are carried on the first 22
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
pairs of chromosomes. Sex-linked diseases are only carried on
|\ |\ |\ |\ |\ |\ |\ |\ |\
the 23rd pair of chromosomes. The autosomal chromosomes are
|\ |\ |\ |\ |\ |\ |\ |\ |\
nearly identical to one another and are considered homologous
|\ |\ |\ |\ |\ |\ |\ |\ |\
to one another. Each autosomal chromosome in a pair carries
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
identical genes. These two genes are known as alleles. The
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
alleles occupy the same site on each partner of the chromosome
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
pair and code for the same genetic trait or physiologic function.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Alleles can be dominant or recessive. One allele may be
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
dominant and the other recessive, or they both may be dominant|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
or both recessive. The dominant alleles' genetic code will always
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
manifest in the individual's phenotype. The information in the
|\ |\ |\ |\ |\ |\ |\ |\ |\
recessive allele is typically not expressed in the phenotype |\ |\ |\ |\ |\ |\ |\ |\ |\
unless both alleles are recessive. For the purpose of clarity in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
use, the dominant gene is assigned a capital letter and the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
recessive gene is assigned a lower case letter. Any letter is okay
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
to use but make sure you use the same letter for the genotype -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
for example, "Bb or aa." The term homozygous refers to a pair of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
alleles which are either both dominant or recessive. For example,
|\ |\ |\ |\ |\ |\ |\ |\ |\
, "BB or bb" are said to be homozygous because the alleles are
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
either both dominant or recessive. An allele pair in which one is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
dominant and one is recessive is said to be heterozygous. In |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
autosomal recessive disorders both alleles on the chromosome |\ |\ |\ |\ |\ |\ |\ |\
are affected by the genetic aberration. If only one recessive gene
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
is affected by the genetic aberration then the person is said to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
be a carrier and will not have the phenotypic expression of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
disease. The healthy, recessive allele will compensate for the
|\ |\ |\ |\ |\ |\ |\ |\ |\
allele which is affected by the genetic aberration. The carrier can
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
pass the trait but does not have the genetic disease. In an
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
autosomal dominant disorder the dominant gene is the only gene |\ |\ |\ |\ |\ |\ |\ |\ |\
that has to be affected by the genetic aberration in order to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
have the phenotypic expression of the disease. A healthy
|\ |\ |\ |\ |\ |\ |\ |\ |\
recessive allele cannot compensate for a diseased dominant |\ |\ |\ |\ |\ |\ |\ |\
allele. In order to answer this question one must understand the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
above information and draw a Punnett Square.
|\ |\ |\ |\ |\ |\
The husband has an autosomal recessive disease which means
|\ |\ |\ |\ |\ |\ |\ |\ |\
his genotype must be aa. The wife has a heterozygous genotype
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
for the disease which means her genotype is Aa. The capital A
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
reflects a healthy gene so she is merely a carrier and does not
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
express the disease phenotype. The father's genotype is written
|\ |\ |\ |\ |\ |\ |\ |\ |\
across the top line and the mother's genotype is written in the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
boxes to the left. The four boxes in the middle are the possible
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
genotypes of their offspring. Each box represents a 25% chance |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
for the offspring to have that particular genotype. The question
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
asks you to determine the chances the offspring will have the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
autosomal recessive disease or in other words, express the |\ |\ |\ |\ |\ |\ |\ |\ |\
phenotype for the disease. The genotype which will result in the |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
disease is "aa." Therefore, there is a 50% chance that their
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
offspring will have the autosomal recessive disease. |\ |\ |\ |\ |\ |\
A patient in respiratory distress and is breathing 33 breaths per
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
minute. Which ABG value is consistent with the clinical scenario?
|\ |\ |\ |\ |\ |\ |\ |\ |\
PCO2 15 |\
pH 7.30 |\
pH 7.45 |\
O2 sat 100% |\ |\
A patient who is breathing 33 breaths per minute is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
hyperventilating and blowing off CO2; therefore the PCO2 level |\ |\ |\ |\ |\ |\ |\ |\ |\
will be low. The patient will most likely experience a respiratory
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
alkalosis and the two pH values provided are not consistent with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
this diagnosis. |\
A patient has a sodium level of 115 mEq/L and is disoriented and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
lethargic. Which pathological process best explains this patient's
|\ |\ |\ |\ |\ |\ |\ |\ |\
symptoms?
a. The action potential has become hyperpolarized.
|\ |\ |\ |\ |\ |\
b. Water has shifted into the neurons and caused them to swell.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
c. Water has shifted into the vascular space and dehydrated the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
neurons.
d. The action potential has become hypopolarized.
|\ |\ |\ |\ |\ |\
b. The cause of neurologic symptoms associated with a sodium
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
imbalance is directly related to fluid shifting into or out of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
neurons of the brain. With a serum sodium of 115 mEq/L, water
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
,shifts into the neurons and causes them to swell. Hypernatremia
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
causes water to shift out of the cell into the intravascular space
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
and causes the neurons to become dehydrated. An alteration in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the action potential is not seen with sodium imbalances.
|\ |\ |\ |\ |\ |\ |\ |\
A patient experiencing dehydration should be monitored for
|\ |\ |\ |\ |\ |\ |\ |\
which electrolyte imbalance? |\ |\
a. Hyperkalemia
|\
b. Hypocalcemia
|\
c. Hypercalcemia
|\
d. Hyponatermia
|\
a. Serum osmolality is increased during times of dehydration. An
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
elevated serum osmolality will pull potassium into the
|\ |\ |\ |\ |\ |\ |\ |\
intravascular space from the intracellular space and cause a rise |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
in serum potassium.
|\ |\
A married couple presents to your office for genetic counseling.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
The husband has an autosomal recessive disease and his wife
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
has a heterozygous genotype for the disease. They ask you,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
What is the chance that our baby will have the disease? Which of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the following answers is correct?
|\ |\ |\ |\ |\
25%
50%
75%
100%
,A chromosome is a package of material located inside the cell
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
nucleus which is made of proteins and a single molecule of DNA.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
There are 23 pairs of chromosomes in each human cell for a total
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
of 46 chromosomes. Chromosomes are separated into two
|\ |\ |\ |\ |\ |\ |\ |\ |\
identical sets during mitosis or meiosis. This provides a set of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
chromosomes to each daughter cell which results from cell |\ |\ |\ |\ |\ |\ |\ |\ |\
division. This process is responsible for the transfer of genetic
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
information to the daughter cells. The first 22 pairs of |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
chromosomes are known as autosomes. The 23rd pair of |\ |\ |\ |\ |\ |\ |\ |\ |\
chromosomes is the pair which contains the genetic information |\ |\ |\ |\ |\ |\ |\ |\ |\
for gender. This pair contains the genetic information which
|\ |\ |\ |\ |\ |\ |\ |\ |\
delineates between the male and female genders. Females have |\ |\ |\ |\ |\ |\ |\ |\ |\
two X chromosomes (XX) and males have an XY chromosome
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
pair. Autosomal chromosomes are said to be autologous. This
|\ |\ |\ |\ |\ |\ |\ |\ |\
means they do not carry genetic information pertaining to
|\ |\ |\ |\ |\ |\ |\ |\ |\
gender. Autosomal genetic diseases are carried on the first 22
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
pairs of chromosomes. Sex-linked diseases are only carried on
|\ |\ |\ |\ |\ |\ |\ |\ |\
the 23rd pair of chromosomes. The autosomal chromosomes are
|\ |\ |\ |\ |\ |\ |\ |\ |\
nearly identical to one another and are considered homologous
|\ |\ |\ |\ |\ |\ |\ |\ |\
to one another. Each autosomal chromosome in a pair carries
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
identical genes. These two genes are known as alleles. The
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
alleles occupy the same site on each partner of the chromosome
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
pair and code for the same genetic trait or physiologic function.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Alleles can be dominant or recessive. One allele may be
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
dominant and the other recessive, or they both may be dominant|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
or both recessive. The dominant alleles' genetic code will always
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
manifest in the individual's phenotype. The information in the
|\ |\ |\ |\ |\ |\ |\ |\ |\
recessive allele is typically not expressed in the phenotype |\ |\ |\ |\ |\ |\ |\ |\ |\
unless both alleles are recessive. For the purpose of clarity in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
use, the dominant gene is assigned a capital letter and the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
recessive gene is assigned a lower case letter. Any letter is okay
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
to use but make sure you use the same letter for the genotype -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
for example, "Bb or aa." The term homozygous refers to a pair of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
alleles which are either both dominant or recessive. For example,
|\ |\ |\ |\ |\ |\ |\ |\ |\
, "BB or bb" are said to be homozygous because the alleles are
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
either both dominant or recessive. An allele pair in which one is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
dominant and one is recessive is said to be heterozygous. In |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
autosomal recessive disorders both alleles on the chromosome |\ |\ |\ |\ |\ |\ |\ |\
are affected by the genetic aberration. If only one recessive gene
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
is affected by the genetic aberration then the person is said to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
be a carrier and will not have the phenotypic expression of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
disease. The healthy, recessive allele will compensate for the
|\ |\ |\ |\ |\ |\ |\ |\ |\
allele which is affected by the genetic aberration. The carrier can
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
pass the trait but does not have the genetic disease. In an
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
autosomal dominant disorder the dominant gene is the only gene |\ |\ |\ |\ |\ |\ |\ |\ |\
that has to be affected by the genetic aberration in order to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
have the phenotypic expression of the disease. A healthy
|\ |\ |\ |\ |\ |\ |\ |\ |\
recessive allele cannot compensate for a diseased dominant |\ |\ |\ |\ |\ |\ |\ |\
allele. In order to answer this question one must understand the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
above information and draw a Punnett Square.
|\ |\ |\ |\ |\ |\
The husband has an autosomal recessive disease which means
|\ |\ |\ |\ |\ |\ |\ |\ |\
his genotype must be aa. The wife has a heterozygous genotype
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
for the disease which means her genotype is Aa. The capital A
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
reflects a healthy gene so she is merely a carrier and does not
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
express the disease phenotype. The father's genotype is written
|\ |\ |\ |\ |\ |\ |\ |\ |\
across the top line and the mother's genotype is written in the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
boxes to the left. The four boxes in the middle are the possible
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
genotypes of their offspring. Each box represents a 25% chance |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
for the offspring to have that particular genotype. The question
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
asks you to determine the chances the offspring will have the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
autosomal recessive disease or in other words, express the |\ |\ |\ |\ |\ |\ |\ |\ |\
phenotype for the disease. The genotype which will result in the |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
disease is "aa." Therefore, there is a 50% chance that their
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
offspring will have the autosomal recessive disease. |\ |\ |\ |\ |\ |\
