NURSE Final Exam with complete Question and Answers

NURSE Final Exam with complete Question and Answers A patient on hydrochlorothiazide has a pH of 7.49 and a bicarbonate of 30. Which of the following pathological processes best explains the abnormal lab values? a. An accumulation of pancreatic bicarbonate secondary to vomiting and loss of hydrochloric acid b. An increased absorption of Na+ and HCO3- in the proximal renal tubule secondary to increased aldosterone secretion c Excessive exhalation of CO2 secondary to hyperventilation d. Distal renal tubular dysfunction causing an accumulation of hydrogen ions The pH value and bicarbonate value are consistent with a metabolic alkalosis. The most likely cause of the metabolic alkalosis is the use of the hydrochlorothiazide (HCTZ). This is a thiazide diuretic which can cause a metabolic alkalosis. The use of a thiazide diuretic will increase the secretion of aldosterone which stimulates the reabsorption of Na+ and HCO3- in the proximal tubule of the kidney. This is a response directly related to hypovolemia secondary to the diuretic use. Option A occurs as a result of excessive vomiting. Vomiting does cause a metabolic alkalosis but there is nothing in the question to suggest that the patient has been vomiting. Option C would result in a respiratory alkalosis, not a metabolic alkalosis. Option D would cause a metabolic acidosis (not a metabolic alkalosis) secondary to a renal tubular dysfunction known as Renal Tubular Acidosis (RTA). Which patient may experience a decrease in oncotic pressure? A patient with cirrhosis. A patient with dehydration. A patient with heart failure. A patient on dialysis. Oncotic pressure is a function of plasma proteins. The main plasma protein responsible for oncotic pressure is albumin. In cirrhosis, the liver is unable to produce enough plasma proteins to maintain the oncotic pressure and therefore it decreases. A dehydrated patient may experience a low hydrostatic pressure and the other two patients may experience a high hydrostatic pressure secondary to volume overload. The nurse practitioner notes that a patient has a pH of 7.25 and a bicarbonate of 10. Which of following laboratory tests is most important for the nurse practitioner to review? sodium magnesium potassium creatinine The pH and bicarbonate in this question are consistent with a metabolic acidosis. The nurse practitioner should review the potassium level. Hyperkalemia is a common electrolyte imbalance seen in a metabolic acidosis. During a metabolic acidosis, hydrogen (a positive ion) shifts into the intracellular space. In order to maintain the ionic balance, potassium (a positive ion) shifts to the extracellular space and results in a hyperkalemia. None of the other labs are affected by a metabolic acidosis. A patient is noted to have a high anion gap metabolic acidosis. Which of the following is the most likely etiology of the acidosis? CO2 retention Ethanol ingestion Vomiting Diuretic use The elevated anion gap in the setting of a metabolic acidosis is consistent with ethanol ingestion. CO2 retention results in an altered mental status and a respiratory acidosis not a metabolic acidosis. Diuretic use and vomiting may cause a metabolic alkalosis. A child is diagnosed with osteogenic sarcoma. From which tissue did the cancer originate? A connective B epithelial C liver D nerve tissue A. Cancers arising from connective tissue, usually have the suffix "sarcoma". Epithelial cancers typically have the prefix "adeno". The liver is considered epithelial tissue. Cancerous which originate from nervous tissue have the suffix "balstoma". Upon examining a paraplegic patient, the nurse practitioner notes that the patient's lower extremities are thin and wasted. This is an example of which cellular adaptation pattern? A. Atrophy B Hypertrophy C hyperplasia D dysplasia Upon examining a paraplegic patient the nurse practitioner notes that the patient's lower extremities are thin and wasted. This is an example of which cellular adaptation pattern? a. Atrophy b. Hypertrophy c. Hyperplasia d. Dysplasia ANS: A The patient in this scenario has experienced muscle wasting (atrophy) secondary to the loss of use of their lower extremities. Hypertrophy is an enlargement of th