d115
1. The most common causes of left-sided heart failure include:: Acute
Myocardial Infarction
Feedback: The most common causes of left-sided heart failure are acute myocardial
infarction and hypertension. Acute or chronic pulmonary disease can cause right
heart failure, referred to as cor pulmonale. The causes of right-sided heart failure
include stenosis or regurgitation of the tricuspid or pulmonic valves, right ventricular
infarction,
and cardiomyopathy. Manifestations (rather than causes) of heart failure reflect the
physiologic effects of the impaired pumping ability of the heart, including decreased
renal blood flow.
2. Assessment of an elderly female client reveals the presence of bilateral
pitting edema of the client's feet and ankles and pedal pulses that are difficult
to palpate. Auscultation of the client's lungs reveals clear air entry to bases,
and the client's oxygen saturation level is 93%, and vital signs are within
reference ranges.
What is this client's most likely health problem?: Right Sided Heart Failure
Feedback: A major effect of right-sided heart failure is the development of periphera
edema. A client who is in shock would not have stable vital signs. Cor pulmonale
would
be accompanied by manifestations of lung disease. Pericarditis is an
inflammation of the pericardium exhibited by fever, precordial pain, dyspnea, and
palpitations.
3. A client has been given the diagnosis of diffuse glomerulonephritis. They
ask the
nurse practitioner what diffuse means. The nurse practitioner responds:: All
glomeruli and all parts of the glomeruli are involved
Feedback: Glomerular changes can be diffuse, involving all glomeruli and all parts
of the
glomeruli; focal, meaning only some of the glomeruli are affected; segmental,
involving only a certain segment of each glomerulus; and mesangial, affecting only
mesangial cells.
4. Which of the following assessment findings would lead the nurse
practitioner to suspect the client has nephrotic syndrome?: Proteinuria and
generalized edema Feedback: The nephrotic syndrome is characterized by massive
proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized
edema, and hyperlipidemia.
, d115
5. A client with a history of chronic pyelonephritis has been admitted
several times
with recurrent bacterial infection of the urinary tract. The nurse practitioner
should anticipate educating this client with regard to which common
treatment
regimen?: Continue taking antibiotics for full 10 to 14 days even if symptoms
disappear
Feedback: Chronic pyelonephritis involves a recurrent or persistent bacterial
infection superimposed on urinary tract obstruction, urine reflux, or both. Chronic
obstructive pyelonephritis can be bilateral, caused by conditions that obstruct
bladder outflow; or
unilateral, such as occurs with ureteral obstruction. Cranberry juice, forced
micturition, and diuretics are not standard treatments for chronic pyelonephritis.
6. The NP suspects that a client with kidney stones has developed magnesium
ammonium phosphate (struvite) stones based on which of the following
urinalysis results? Select all that apply: Alkaline urine pH
High Urine Phosphate Level
High bacterial count
Feedback: Magnesium ammonium phosphate stones, also called struvite stones,
form
only in alkaline urine and in the presence of bacteria that possess an enzyme called
urease, which splits the urea in the urine into ammonia and carbon dioxide. The
ammonia
that is formed takes up a hydrogen ion to become an ammonium ion, increasing the
pH
of the urine so that it becomes more alkaline. Because phosphate levels are
increased in alkaline urine and because magnesium always is present in the urine,
struvite stones form.
Uric acid stones develop in conditions of gout and high concentrations of uric acid
in the
urine. Cystine stones account for less than 1% of kidney stones overall but
represent a
significant proportion of childhood calculi. They are seen in cystinuria, which results
from
a genetic defect in renal transport of cystine
, d115
7. While explaining immunity to a client, the NP responds, "The body's internal
organs are protected from pathogens because: Our mucosal tissue contains all
the necessary cell components to fight a pathogen with an immune response
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.
8. A client has arrived in the emergency department in cardiogenic shock.
Which of
the following assessment findings confirm this diagnosis? Select all that
apply: Less than 5mL dark, concentrated urine in the past hour
BP reading of 80/65
Difficult to arouse with changes in level of consciousness
Feedback: The signs and symptoms of cardiogenic shock are consistent with those
of
end-stage heart failure. The lips, nail beds, and skin may become cyanotic because
of
stagnation of blood flow. Mean arterial and systolic blood pressures decrease due
to poor stroke volume, and there is a narrow pulse pressure because of arterial
vasoconstriction. Urine output decreases because of lower renal perfusion
pressures and
the increased release of aldosterone. Neurologic changes, such as alterations in
cognition
or consciousness, may occur because of low cardiac output and poor cerebral
perfusion.
9. A 51-year-old man has been diagnosed with chronic bronchitis after a
long history of recurrent coughing. Which of the man's following statements
1. The most common causes of left-sided heart failure include:: Acute
Myocardial Infarction
Feedback: The most common causes of left-sided heart failure are acute myocardial
infarction and hypertension. Acute or chronic pulmonary disease can cause right
heart failure, referred to as cor pulmonale. The causes of right-sided heart failure
include stenosis or regurgitation of the tricuspid or pulmonic valves, right ventricular
infarction,
and cardiomyopathy. Manifestations (rather than causes) of heart failure reflect the
physiologic effects of the impaired pumping ability of the heart, including decreased
renal blood flow.
2. Assessment of an elderly female client reveals the presence of bilateral
pitting edema of the client's feet and ankles and pedal pulses that are difficult
to palpate. Auscultation of the client's lungs reveals clear air entry to bases,
and the client's oxygen saturation level is 93%, and vital signs are within
reference ranges.
What is this client's most likely health problem?: Right Sided Heart Failure
Feedback: A major effect of right-sided heart failure is the development of periphera
edema. A client who is in shock would not have stable vital signs. Cor pulmonale
would
be accompanied by manifestations of lung disease. Pericarditis is an
inflammation of the pericardium exhibited by fever, precordial pain, dyspnea, and
palpitations.
3. A client has been given the diagnosis of diffuse glomerulonephritis. They
ask the
nurse practitioner what diffuse means. The nurse practitioner responds:: All
glomeruli and all parts of the glomeruli are involved
Feedback: Glomerular changes can be diffuse, involving all glomeruli and all parts
of the
glomeruli; focal, meaning only some of the glomeruli are affected; segmental,
involving only a certain segment of each glomerulus; and mesangial, affecting only
mesangial cells.
4. Which of the following assessment findings would lead the nurse
practitioner to suspect the client has nephrotic syndrome?: Proteinuria and
generalized edema Feedback: The nephrotic syndrome is characterized by massive
proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized
edema, and hyperlipidemia.
, d115
5. A client with a history of chronic pyelonephritis has been admitted
several times
with recurrent bacterial infection of the urinary tract. The nurse practitioner
should anticipate educating this client with regard to which common
treatment
regimen?: Continue taking antibiotics for full 10 to 14 days even if symptoms
disappear
Feedback: Chronic pyelonephritis involves a recurrent or persistent bacterial
infection superimposed on urinary tract obstruction, urine reflux, or both. Chronic
obstructive pyelonephritis can be bilateral, caused by conditions that obstruct
bladder outflow; or
unilateral, such as occurs with ureteral obstruction. Cranberry juice, forced
micturition, and diuretics are not standard treatments for chronic pyelonephritis.
6. The NP suspects that a client with kidney stones has developed magnesium
ammonium phosphate (struvite) stones based on which of the following
urinalysis results? Select all that apply: Alkaline urine pH
High Urine Phosphate Level
High bacterial count
Feedback: Magnesium ammonium phosphate stones, also called struvite stones,
form
only in alkaline urine and in the presence of bacteria that possess an enzyme called
urease, which splits the urea in the urine into ammonia and carbon dioxide. The
ammonia
that is formed takes up a hydrogen ion to become an ammonium ion, increasing the
pH
of the urine so that it becomes more alkaline. Because phosphate levels are
increased in alkaline urine and because magnesium always is present in the urine,
struvite stones form.
Uric acid stones develop in conditions of gout and high concentrations of uric acid
in the
urine. Cystine stones account for less than 1% of kidney stones overall but
represent a
significant proportion of childhood calculi. They are seen in cystinuria, which results
from
a genetic defect in renal transport of cystine
, d115
7. While explaining immunity to a client, the NP responds, "The body's internal
organs are protected from pathogens because: Our mucosal tissue contains all
the necessary cell components to fight a pathogen with an immune response
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.
8. A client has arrived in the emergency department in cardiogenic shock.
Which of
the following assessment findings confirm this diagnosis? Select all that
apply: Less than 5mL dark, concentrated urine in the past hour
BP reading of 80/65
Difficult to arouse with changes in level of consciousness
Feedback: The signs and symptoms of cardiogenic shock are consistent with those
of
end-stage heart failure. The lips, nail beds, and skin may become cyanotic because
of
stagnation of blood flow. Mean arterial and systolic blood pressures decrease due
to poor stroke volume, and there is a narrow pulse pressure because of arterial
vasoconstriction. Urine output decreases because of lower renal perfusion
pressures and
the increased release of aldosterone. Neurologic changes, such as alterations in
cognition
or consciousness, may occur because of low cardiac output and poor cerebral
perfusion.
9. A 51-year-old man has been diagnosed with chronic bronchitis after a
long history of recurrent coughing. Which of the man's following statements
