Pathophysiology Exam 3 Practice | Pediatrics Final Exam Edition | Latest 2024/2025 | 123 Q&A | Graded A | Verified & High-Yield Concepts

This updated Pathophysiology Exam 3 Practice Final (123 Verified Q&A) provides a complete review of the most frequently tested renal, urinary, and gastrointestinal disorders for 2024/2025. Perfect for nursing, medical, and allied health students preparing for major finals, ATI, HESI, or NCLEX-heavy pathophysiology questions. Pathophysiology Exam 3 Practice /123 Questions and Answers Latest 2025/Update. The nurse working in an outpatient nephrology clinic knows that which of the following are primary functions of the kidneys? (Select all that apply.) A. Production of clotting factors B. Homeostasis C. Excretion of metabolic wastes D. Regulation of acid-base balance E. Metabolism of fats Correct ans - B, C, D The kidneys do not metabolize fats. Production of clotting factors is a primary function of the liver. The kidneys maintain blood pressure using the RAAS and also produce erythropoietin to stimulate RBC production. In caring for a patient diagnosed with acute kidney injury, the nephrology nurse knows that which of the following tests are specific for renal function? (Select all that apply.) A. Aspartate aminotransferase (AST) B. Blood urea nitrogen C. Creatinine D. Glomerular filtration rate E. White blood cell count Correct ans - B, C, D AST related to LIVER function In caring for a patient with acute kidney injury the nurse knows that the patient's renal function has returned to normal range when the patient's GFR measures: A. 30-40 mL/min B. 40-50 mL/min C. 70-90 mL/min D. 90-120 mL/min Correct ans - D Normal GFR is 90-120 mL/min Normal Creatinine 0.6-1.1 for females and 0.6-1.2 for males Normal BUN is 10-20 mg/dL *Be sure to know these normal values, you will use them daily as a nurse The nursing working in a geriatric living facility understands that as patients age, which change in glomerular filtration rate is expected? A. Increased GFR B. Decreased GFR C. Same GFR D. No GFR Correct ans - B Aging and renal function: Decrease in renal blood flow and GFR → altered sodium and water balance Number of nephrons decrease due to renal vascular and perfusion changes Response to acid-base changes is delayed Increased risk for drug toxicity Alterations in thirst and water intake Get dehydrated very easily; do not recognize thirst and heat Decreased muscle mass may lead to decreased creatinine values An older patient is experiencing urinary stasis. The registered nurse knows that urinary stasis may lead to which of the following? A. Increased GFR B. Hypocoagulation C. Hypertension D. Infection Correct ans - D Urinary stasis is a risk factor for developing UTI Which of the following is classified as the most common primary mineral salt composition of kidney stones? A. Calcium B. Struvite C. Uric Acid D. Cysteine Correct ans - A A - calcium (i.e. oxalate or phosphate) is most common *Note that a change in urine pH may lead to precipitation of stones Which of the following are risk factors for developing renal tumors? (Select all that apply.) A. Female gender B. Smoking C. Obesity D. Diabetes E. Hypertension Correct ans - B, C, E risk factors are male gender, smoking, obesity, uncontrolled hypertension The registered nurse would expect which of the following lab values for a patient experiencing acute kidney failure? A. Creatinine 3.5 mg/dL B. Sodium 122 mEq/L C. Albumin 3.5 g/dL D. BUN 10 mg/dL Correct ans - A the normal creatinine level is 0.6 - 1.2 This BUN is within normal range (BUN would be elevated in acute kidney failure) In caring for a patient experiencing acute kidney injury who has these lab values: urinary output 15 mL/hr, BUN 30 mg/dL, and creatinine 3.5, the nurse knows that the patient is experiencing which phase of acute kidney injury? A. Initiation phase B. Oliguric phase C. Recovery (polyuric) phase D. I don't remember the normal lab values Correct ans - B Remember that there are phases of acute kidney injury - Initiation phase is when the injury is just beginning and prevention is still possible Next is the oliguric phase where urinary output is decreased and nitrogenous waste products are maintained (BUN and Creatinine) There is also the recovery or polyuric/diuretic phase - diuresis is common and BUN and creatinine decline A 25-year-old female is diagnosed with urinary tract obstruction. While planning care, the nurse realizes that the patient is expected to have hydronephrosis and a decreased glomerular filtration rate caused by: A. Decreased renal blood flow B. Decreased peritubular capillary pressure C. Dilation of renal pelvis and calyces proximal to blockage D. Stimulation of antidiuretic hormone Correct ans - C Hydroureter; dilation of ureter Hydronephrosis: dilation/enlargement of renal pelvis and calyces Ureterohydronephrosis: dilation of ureter AND renal pelvis and calyces A 55-year-old male presents reporting urinary retention. Tests reveal that he has a lower urinary tract obstruction. Which of the following is of most concern to the nurse? A. Vesicoureteral reflux and pyelonephritis B. Formation of renal calculi C. Glomerulonephritis D. Increased bladder compliance Correct ans - B urine stasis occurs with urinary tract obstruction and can lead to the formation of renal calculi and UTI A 75-year-old male reports to his primary care provider loss of urine with cough, sneezing, or laughing. Which of the following is the most likely diagnosis the nurse will observe on the chart? A. Urge incontinence B. Overflow incontinence C. Stress incontinence D. Functional incontinence Correct ans - C Reduced resistance is associated with the symptom of stress incontinence, which is incontinence with coughing or sneezing. A 29-year-old female presents with cloudy urine, flank pain, hematuria, and fever. Which of the following does the nurse suspect the patient is most likely experiencing? A. Acute cystitis B. Renal calculi C. Chronic renal failure D. Postrenal renal failure Correct ans - A acute cystitis is infection/inflammation of bladder (UTI) Although renal calculi can cause pain and hematuria, it is not manifested by fever and cloudy urine. A 30-year-old male is demonstrating hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin being the major protein. The most probable diagnosis the nurse will see documented on the chart is: A. Cystitis B. Chronic pyelonephritis C. Acute glomerulonephritis D. Renal calculi Correct ans - C Two major symptoms distinctive of more severe glomerulonephritis are: hematuria with red blood cell casts (2) proteinuria exceeding 3 to 5 g/day with albumin (macroalbuminuria) as the major protein A 54-year-old female is diagnosed with nephrotic syndrome. Which of the following is a common symptom of this disease? A. Hematuria B. Dysuria C. Oliguria D. Proteinuria Correct ans - D Nephrotic syndrome is manifested by proteinuria Nephrotic syndrome is diagnosed when the protein level in a 24-hour urine collection is greater than 3.5 g A 56-year-old male presents with flank pain and polyuria. Tests reveal that he has an enlarged prostate. Which of the following types of renal failure should the nurse monitor for as it is the most likely to occur? A. Prerenal B. Intrarenal C. Extrarenal D. Postrenal Correct ans - D the patient will experience postrenal renal failure due to obstruction by the prostate. What if the test revealed acute tubular necrosis? intrarenal While turning a patient with chronic renal failure, which principle should the nurse recall? Bone fractures are a risk factor in chronic renal failure because: A. Calcium is lost in the urine B. Osteoblast activity is excessive C. The kidneys fail to activate vitamin D D. Autoantibodies to calcium molecules develop Correct ans - C Hypocalcemia is accelerated by impaired renal synthesis of vitamin D The combined effect of vitamin D deficiency can result in renal osteodystrophies with increased risk for fractures. A man was mildly confused, and his family brought him to adult day care during the week. He was incontinent there every day until a nurse suggested that they put a picture of a toilet on the bathroom door, and he became continent. What incontinence is this? Correct ans - Functional Incontinence A woman has a bladder infection and is distressed to have episodes of sudden strong need to urinate that cause her to become incontinent. What incontinence is this? Correct ans - Urge Incontinence A woman loses a small amount of urine involuntarily every time she sneezes. What incontinence is this? Correct ans - Stress Incontinence A man with a caudal equine involvement in MS became incontinent when his caregiver was late and was not available to assist with the morning catheterization. What incontinence is this? Correct ans - Overflow Incontinence A 50-year-old male is experiencing reflux of chyme from the stomach. He is diagnosed with gastroesophageal reflux. This condition is caused by: A. Fibrosis of lower third of esophagus B. Sympathetic nerve stimulation C. Loss of muscle tone at the lower esophageal sphincter D. Reverse peristalsis of the stomach Correct ans - C GERD is due to a weak esophageal sphincter A 22-year-old male underwent brain surgery to remove a tumor. Following surgery, he experienced a peptic ulcer. His ulcer is referred to as a(n) ulcer. A. Infectious B. Cushing C. Ischemic D. Curling Correct ans - B Cushing ulcer is a stress ulcer associated with severe head trauma or brain surgery. Curling ulcers develop secondary to burns. A 50-year-old male complains of frequently recurring abdominal pain, diarrhea, and bloody stools. A possible diagnosis would be: A. Ulcerative colitis B. Hiatal hernia C. Pyloric obstruction D. Achalasia Correct ans - A Ulcerative colitis is manifested by fever, elevated pulse rate, frequent diarrhea (10 to 20 stools/day), urgency, obviously bloody stools, and continuous lesions present in the colon. Hiatal hernia is most often asymptomatic and would not be manifested by abdominal pain. Pyloric obstruction would be manifested by forceful or projectile vomiting. Achalasia would be manifested by difficulty or uncomfortable swallowing. A 16-year-old female presents with abdominal pain in the right lower quadrant. Physical examination reveals rebound tenderness and a low-grade fever. A possible diagnosis would be: A. Colon cancer B. Pancreatitis C. Appendicitis D. Hepatitis Correct ans - C Appendicitis is manifested by RLQ pain with rebound tenderness. A 54-year-old male complains that he has been vomiting blood. Tests reveal portal hypertension. Which of the following is the most likely cause of his condition? A. Thrombosis in the spleen B. Cirrhosis of the liver C. Left ventricular failure D. Renal stenosis Correct ans - B Portal hypertension occurs secondarily to cirrhosis of the liver. Manifestations associated with hepatic encephalopathy from chronic liver disease are the result of: A. Hyperbilirubinemia and jaundice B. Fluid and electrolyte imbalances C. Impaired ammonia metabolism D. Decreased cerebral blood flow Correct ans - C Impaired ammonia metabolism leads to the symptoms of hepatic encephalopathy. The icteric phase of hepatitis is characterized by which of the following clinical manifestations? A. Fatigue, malaise, vomiting B. Jaundice, dark urine, enlarged liver C. Resolution of jaundice, liver function returns to normal D. Fulminant liver failure, hepatorenal syndrome Correct ans - B The icteric phase is manifested by jaundice, dark urine, and clay-colored stools The liver is enlarged, smooth, and tender, and percussion causes pain; this is the actual phase of illness. A 55-year-old male died in a motor vehicle accident. Autopsy revealed an enlarged liver caused by fatty infiltration, testicular atrophy, and mild jaundice secondary to cirrhosis. The most likely cause of his condition is: A. Bacterial infection B. Viral infection C. Alcoholism D. Drug overdose Correct ans - C The most common cause of cirrhosis is alcoholism. While caring for a patient on a med-surg floor, the nurse notes the presence of bright red stools. How does the nurse document this finding? A. Melena B. Hematochezia C. Hematemesis D. Occult bleeding Correct ans - B Melena is black tarry stools Occult bleeding is where there are broken down products of blood are present in the stool While reading a patient's diagnostic evaluation, the nurse notes that the patient's GI tract has a cobblestone appearance. This is present in which disorder? A. Ulcerative colitis B. Irritable bowel disease C. Crohn disease D. Infective enterocolitis Correct ans - C Note also that ulcerative colitis is confined to the colon or rectum Crohn's disease may occur in various sites of GI tract While reading the patient's diagnostic evaluation, the nurse reads that the patient has experienced a twisting of the bowel. This type of obstruction is known as: A. Volvulus B. Intussusception C. Hernia D. Adhesion Correct ans - A In caring for a patient experiencing liver failure, which of the following lab values does the nurse expect to be elevated? (Select all that apply.) A. Aspartate Aminotransferase (AST) B. Alanine Aminotransferase (ALT) C. Albumin D. Ammonia E. Bilirubin Correct ans - A, B, D, E Albumin would be decreased A teenage boy sustains a severe closed head injury following an all-terrain vehicle (ATV) accident. He is in a state of deep sleep that requires vigorous stimulation to elicit eye opening. How should the nurse document this in the chart? A. Confusion B. Coma C. Obtundation D. Stupor Correct ans - D Stupor is a condition of deep sleep or unresponsiveness from which the person may be aroused or caused to open eyes only by vigorous and repeated stimulation. When thought content and arousal level are intact but a patient cannot communicate, the patient has: A. Cerebral death B. Locked-in syndrome C. Dysphagia D. Cerebellar motor syndrome Correct ans - B Locked-in syndrome occurs when the individual cannot communicate through speech or body movement but is fully conscious, with intact cognitive function A 65-year-old male recently suffered a cerebral vascular accident. He is now unable to recognize and identify objects by touch because of injury to the sensory cortex. How should the nurse document this finding? A. Hypomimesis B. Agnosia C. Dysphasia D. Echolalia Correct ans - B Agnosia is the failure to recognize the form and nature of objects A nurse thinks a patient may be experiencing dementia. Which assessment finding will most help support this diagnosis? A. Violent behavior B. Hyperactivity C. Depression D. Loss of recent and remote memory Correct ans - D Dementia is characterized by loss of recent and remote memory. The patient is experiencing an increase in intracranial pressure. This increase results in: A. Brain tissue hypoxia B. Intracranial hypotension C. Ventricular swelling D. Expansion of cranial vault Correct ans - A Brain tissue hypoxia occurs as a result of increased intracranial pressure as it places pressure on the brain A 51-year-old male is admitted to the neuro ICU with a severe closed head injury. All four extremities are in rigid extension, his forearm is hyperpronated, and his legs are in plantar extension. How should the nurse chart this condition? A. Decorticate posturing B. Decerebrate posturing C. Caloric posturing D. Excitation posturing Correct ans - B A 20-year-old male is admitted to the neurological critical care unit with a severe closed head injury. When an intraventricular catheter is inserted, the ICP is recorded at 24 mm Hg. How should the nurse interpret this reading? This reading is: A. Higher than normal B. Lower than normal C. Normal D. Borderline Correct ans - A Normal ICP is 1 to 15 mm Hg A patient has paralysis of both legs. What type of paralysis does the patient have? A. Paraplegia B. Quadriplegia C. Infraparaplegia D. Paresthesia Correct ans - A A patient has excessive movement. What disorder will the nurse see documented on the chart? A. Hypokinesia B. Akinesia C. Hyperkinesia D. Dyskinesia Correct ans - C Which principle should the nurse remember while planning care for a patient with spinal shock? Spinal shock is characterized by: A. Loss of voluntary motor function with preservation of reflexes B. Cessation of spinal cord function below the lesion C. Loss of spinal cord function at the level of the lesion only D. Temporary loss of spinal cord function above the lesion Correct ans - B Spinal shock is the complete cessation of spinal cord function below the lesion A 40-year-old male complains of uncontrolled excessive movement and progressive dysfunction of intellectual and thought processes. He is experiencing movement problems that begin in the face and arms that eventually affect the entire body. The most likely diagnosis is: A. Tardive dyskinesia B. Huntington disease C. Hypokinesia D. Alzheimer disease Correct ans - B Huntington disease is manifested by chorea, abnormal movement that begins in the face and arms, eventually affecting the entire body - Progressive dysfunction of intellectual and thought processes A nurse is preparing to teach staff about the most common type of traumatic brain injury. Which type of traumatic brain injury should the nurse discuss? A. Penetrating trauma B. Diffuse axonal injury C. Focal brain injury D. Concussion Correct ans - D Which assessment finding by the nurse characterizes a mild concussion? A. A brief loss of consciousness B. Significant behavioral change C. Retrograde amnesia D. Permanent confusion Correct ans - C Mild concussion is characterized by immediate but transitory confusion that lasts for one to several minutes, possibly with amnesia for events preceding the trauma. brief loss of consciousness may occur with classic concussion More severe DIAs may induce behavioral changes Confusion will be temporary with mild concussion An initial assessment finding associated with acute spinal cord injury is the injury. A. Pain below the level of B. Loss of autonomic reflexes above C. Loss of voluntary control below D. Hyperactive spinal reflexes below Correct ans - C Six weeks ago a female patient suffered a T6 spinal cord injury. She then developed a blood pressure of 200/120, a severe headache, blurred vision, and bradycardia. What does the nurse suspect the patient is experiencing? A. Extreme spinal shock B. Acute anxiety C. Autonomic hyperreflexia D. Parasympathetic areflexia Correct ans - C A 72-year-old male demonstrates left-sided weakness of upper and lower extremities. The symptoms lasted 4 hours and resolved with no evidence of infarction. The patient most likely experienced a(n): A. Stroke in evolution B. AV malformation C. Transient ischemic attack D. Cerebral hemorrhage Correct ans - C When symptoms resolve with complete recovery, it is a transient ischemic attack A 60-year-old female with a recent history of head trauma and a long-term history of hypertension presents to the ER for changes in mental status. MRI reveals that she had a hemorrhagic stroke. What does the nurse suspect caused this type of stroke? A. Rheumatic heart disease B. Thrombi C. Hypotension D. Aneurysm Correct ans - D The primary causative factor of a hemorrhagic stroke is an aneurysm. A 25-year-old female presents to her primary care provider reporting fever, headache, nuchal rigidity, and decreased consciousness. She was previously treated for sinusitis. Which of the following is the most likely diagnosis? A. Aseptic meningitis B. Bacterial meningitis C. Fungal meningitis D. Nonpurulent meningitis Correct ans - B bacterial meningitis can occur secondary to sinusitis and is manifested by fever, tachycardia, chills, and a petechial rash with a severe throbbing headache, severe photophobia, and nuchal rigidity A 23 y/o female begins having problems with tiredness, weakness, and visual changes. Her diagnosis is multiple sclerosis (MS). What is occurring in the patient's body? A. Demyelination of nerve fibers in the CNS B. Depletion of dopamine in the central nervous system (CNS) C. The development of neurofibril webs in the CNS D. Reduced amounts of acetylcholine at the neuromuscular junction Correct ans - A The pathophysiology of MS includes demyelination of nerve fibers A young woman presents with signs and symptoms of urinary tract infection (UTI). The nurse notes that this is the fifth UTI in as many months. What would this information lead the nurse to believe? A. There is possible obstruction in the urinary tract. B. The woman has multiple sexual partners. C. The woman takes too many bubble baths. D. The woman does not clean herself properly. Correct ans - A. Urinary tract obstruction encourages the growth of microorganisms and should be suspected in persons with recurrent UTIs. The other answers can cause lower UTIs, but an obstruction would be considered because of the frequency of the infections. The nurse is reviewing the lab results of a patient with suspected nephrotic syndrome. The nurse anticipates that the results to include: A. Protein in the urine B. Decreased triglycerides C. Abnormal blood clotting factors D. Decreased low-density lipoproteins E. Serum hyperalbuminemia Correct ans - A. In a person with nephrotic syndrome there is massive proteinuria (protein in the urine), serum hypoalbuminemia, generalized edema and hyperlipidemia. An 86-year-old female has been admitted to the hospital for the treatment of dehydration and hyponatremia after she decreased her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which of the following early signs of prerenal injury? A. Sharp decrease in urine output B. Excessive voiding of clear urine C. Acute hypertensive crisis D. Intermittent periods of confusion Correct ans - A. Dehydration and its consequent hypovolemia can result in acute renal failure that is prerenal in etiology. The kidney normally responds to a decrease in GFR with a decrease in urine output. Thus, an early sign of prerenal injury is a sharp decrease in urine output. Post-renal failure is obstructive in etiology, and intrinsic (or intrarenal) renal failure is reflective of deficits in the function of the kidneys themselves. A nurse is assessing a client for *early* manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display? A. Hypertension B. Impotence C. Terry nails D. Asterixis Correct ans - A. Hypertension is commonly an early manifestation of CKD. The mechanisms that cause the hypertension are multifactorial; they include increased vascular volume, increased peripheral vascular resistance, decreased levels of renal vasodilator prostaglandins, and increase activity of the renin-angiotensin-aldosterone system. Impotence occurs in as many as 56% of males on dialysis. Terry nails are dark band just behind the leading edge of a fingernail followed by a white band that occur in the late stages. Asterixis, a sign of hepatic encephalopathy, is due to the inability of the liver to metabolize ammonia to urea. The GFR is considered to be the best measure of renal function. What is used to estimate the GFR? A. BUN B. Serum creatinine C. Albumin level D. Serum protein Correct ans - B. In clinical practice, GFR is usually estimated using the serum creatinine concentration. The other answers are not used to estimate the GFR. In patients with acute diarrhea, many require no treatment. However, the nurse knows the priority assessment in all patients with diarrhea is which of the following? A. Fluid and electrolyte status B. Skin integrity C. Dietary intake D. Stool specimen Correct ans - A. Although most acute forms of diarrhea are self-limited and require no treatment, diarrhea can be particularly serious in infants and small children, persons with other illnesses, elderly persons, and even previously healthy persons if it continues for any length of time. Thus, the replacement of fluids and electrolytes is considered to be a primary therapeutic goal in the treatment of diarrhea. Crohn's disease is recognized by sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. The nurse recognizes these lesions to be defined by which of the following descriptions? A. Mosaic B. Pyramidal C. Cobblestone D. Triangular Correct ans - C. A characteristic feature of Crohn disease is the sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. When there are multiple lesions, they are often referred to as skip lesions because they are interspersed between what appear to be normal segments of the bowel. The surface of the inflamed bowel usually has a characteristic "cobblestone" appearance resulting from the fissures and crevices that develop, surrounded by areas of submucosal edema. Symptoms of hepatic encephalopathy are thought to be related to increased serum levels of neurotoxins such as: A. ammonia B. potassium. C. urea. D. creatinine. Correct ans - A. Hepatic encephalopathy is characterized by neural disturbances ranging from lack of mental alertness to confusion to coma and convulsions. An early sign is asterixis, the flapping tremor (see your module). The liver loses it's ability to detoxify and this leads to an accumulation of ammonia. The other responses are not neruotoxins. The nurse is caring for a client with an elevated serum bilirubin level. The nurse recognizes a high bilirubin level may result in which of these? A. Jaundice B. Cholestasis C. Xanthomas D. Biliary cirrhosis Correct ans - A. Jaundice, or icterus, results from an abnormally high accumulation of bilirubin in the blood, causing a yellowish discoloration to the skin, sclera, and deep tissues. Skin xanthomas (focal accumulations of cholesterol) may occur with cholestasis, the result of hyperlipidemia and impaired excretion of cholesterol. Intrahepatic cholestasis, rather than hyperbilirubinemia, causes primary biliary cirrhosis. What laboratory markers are most commonly used to diagnose acute pancreatitis? A. Amylase and cholesterol B. Lipase and amylase C. Lipase and triglycerides D. Cholesterol and triglycerides Correct ans - B. Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis. Cholesterol and triglycerides are not used as laboratory markers for acute pancreatitis. Which of the following disorders is associated with demyelination of the optic nerve? A. Parkinson's disease. B. Myasthenia Gravis. C. Multiple Sclerosis D. Amyotrophic Lateral Sclerosis. Correct ans - C. Multiple Sclerosis is an autoimmune disorder. It is characterized by a progressive, inflammatory, demyelination of the CNS. Loss of myelin disrupts nerve conduction leading to paresthesia, weakness, impaired gait, visual disturbances, and/or urinary incontinence. Parkinson's is a degeneration of the basal ganglia involving dopaminergic nigrostriatal pathway. ALS is a disorder of the upper and lower motor neurons. Myasthenia Gravis is an autoimmune disorder characterized by IgG antibodies formed against acetylcholine receptors. The sudden loss of spinal reflexes, sensation, and visceral function below the level of the lesion that immediately follows a spinal cord injury is called: A. accumulation of toxic metabolites B. spinal shock C. autonomic dysfunction D. hemiplegia Correct ans - B. This occurs in spinal shock. Autonomic dysfunction occurs when there is damage to the autonomic nervous system and effects the cardiac, urinary, and visual systems. Hemiplegia refers to paralysis of one side that occurs in a stroke. Excess cerebrospinal fluid (CSF) accumulation in the ventricles is a condition called A. cerebral edema B. CSF shunting C. Cheyne-Stokes condition. D. hydrocephalus Correct ans - D. Hyrdocephalus is caused by an accumulation of excess CSF in the ventricles. Shunting of CSF fluid helps to remove accumulation of excess CSF. Cheyne-Stokes refers to an abnormal breathing pattern that can occur in the setting of increased ICP. Cerebral edema refers to brain edema. Which of the following are manifestations following a stroke? A. Dysphagia B. Slurred speech C. Facial drooping on one side D. Weakness of both upper extremities. Correct ans - A,B,&C are manifestations. The is generally hemiparesis in the setting of a stroke. Which of the following is not true in Amyotrophic lateral sclerosis (ALS)? A. Rapidly progressive muscle weakness and atrophy B. Slowly progressive muscle weakness and atrophy C. Preserved cognitive function D. Leads to respiratory failure Correct ans - A. ALS is not a rapidly progressive. It is a disease of the upper and lower motor neurons. Symptoms progress over one to two years. There is no association with symptoms of decreased mental function. ALS is usually fatal in a few years from respiratory failure. A nurse is preparing for a course in cardiopulmonary resuscitation (CPR) and realizes that ventricular fibrillation quickly disrupts blood flow to the brain that causes which of the following in a matter of seconds? A. Regional ischemia B. Global hypoxemia C. Global ischemia D. Global hypoxia Correct ans - C. Ischemia includes an interruption in blood flow; hypoxia is a decrease in oxygen without interruption in blood flow. With ventricular fibrillation, there is no effective contraction of the ventricles and therefore no cardiac output that would cause global ischemia of the brain due to the lack of perfusion. Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury? A. Altered level of consciousness B. Change in behavior C. Respiratory instability D. Loss of eye movement reflexes Correct ans - A. In contrast to focal injury, which causes focal neurologic deficits without altered consciousness, global injury nearly always results in altered levels of consciousness ranging from inattention to stupor or coma. The other answers are manifestations of different types of brain injury, not a global injury. The trauma nurse is caring for a patient who sustained a closed head injury. The nurse is aware of the dangers of elevated ICP and risk of brain herniation. Which of the following will the nurse monitor to evaluate for signs of herniation related to intercranial hypertension? (select all that apply) A. Breathing pattern B. Level of consciousness C. Urine output D. Pupillary response Correct ans - A, B, D. Changes in the breathing pattern (e.g. slowing with progression to Cheyne-Stokes), pupils may become unequal prior to becoming fixed and dilated, and level of consciousness will decreased when the brain is no longer able to compensate for intercranial hypertension. Urine output is monitored but is not a sign of intercranial hypertension. Which of the following are risk factors for stroke? (select all that apply) A. Atrial fibrillation B. Cigarette smoking C. Use of oral contraceptives D. Use of aspirin E. Elevated blood cholesterol Correct ans - A, B, C, &E are all risk factors for stroke. Use of aspirin is not a risk factor for stroke. Note that these are also modifiable risk factors. The tonic phase of an epileptic seizure is characterized by? A. involuntary muscle contraction and loss of consciousness. B. cessation of seizure activity. C. aura and prodromal signs. D. Alternating muscle contraction and relaxation. Correct ans - A. The tonic phase of a seizure is characterized by involuntary muscle contraction and loss of consciousness. The post-ictal phase is the period immediately following cessation of seizure activity. The aura and prodromal signs occure prior to seizure ativity. The clonic phase involves alternative muscle contraction and relaxation. A client is admitted to the emergency department and diagnosed with diabetic ketoacidosis (DKA). The client would most likely manifest: A. Ketosis B. Hypoglycemia C. Respiratory alkalosis D. Hypervolemia Correct ans - A. Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketosis, osmotic diuresis, dehydration, and metabolic acidosis. It is an acute life-threatening complication of uncontrolled diabetes. Which urinalysis lab values would the nurse expect to see elevated in a patient diagnosed with a urinary tract infection? (Select all that apply.) A. Leukocyte esterase B. Nitrites C. WBC D. BUN E. Glucose Correct ans - A B C Which of the following clinical manifestations would a nurse expect of a patient diagnosed with advanced bladder cancer? (Select all that apply.) A. Painful urination B. Hematuria C. Bone pain D. Fatigue E. Lower back pain Correct ans - B C D E Expect PAINLESS hematuria Which of the following is a risk factor for the development of renal calculi? A. Hypoparathyroidism B. Hypocalcemia C. Gout D. Low protein diet Correct ans - C Increased uric acid levels -- > stone formation Hypoparathyroidism -- > decreased Ca (less risk for stone formation) Changes in pH (higher or lower), hypercalcemia, and high protein diet are other risk factors Family hx of calculi and personal hx of UTI are also risk factors Which of the following is a clinical manifestation of nephrotic syndrome? A. Proteinuria B. Hypervitaminosis of vitamin D C. Hyperalbuminemia D. Muscular atrophy Correct ans - A Massive proteinuria. Also expect hypoalbuminemia, edema, hyperlipidemia, vitamin D deficiency. Which of the following may cause post-renal acute kidney injury? A. Hypotension B. Glomerulonephritis C. Heart failure D. Benign prostatic hyperplasia Correct ans - D Outflow obstruction = post-renal AKI Which of the following lab values does the nurse expect of a patient diagnosed with chronic kidney disease? (Select all that apply.) A. BUN: 18 mg/dL B. Creatinine: 2.4 mg/dL C. Calcium: 11.0 mg/dL D. Potassium: 5.5 mEq/L E. Serum pH: 7.55 Correct ans - B D BUN will be >20 Creatinine > 1.2 Calcium usually < 9.0 Potassium > 5 Serum pH < 7.35 if uncompensated metabolic acidosis Also expect anemia, GFR <60 *Table 30-12 on p. 763 of Huether Note that Calcium has an inverse relationship with phosphorous, so the patient with CKD will likely have elevated phosphorous levels and decreased calcium levels Which of the following does the nurse expect of a patient diagnosed with ulcerative colitis? A. Cobblestone appearance of the GI tract B. Skip lesions of normal areas on an X-ray C. Alternating periods of diarrhea and constipation D. Inflammation of the entire mucosal layer of the GI tract Correct ans - D Note that this refers to the thickness of the mucosal layer, not the length of the GI tract. It is true however that ulcerative colitis more commonly affects the rectosigmoid colon area, as compared to Crohn's dz that may affect the entire GI tract. The orthopedic nurse recognizes that the patient whose bone fracture creates a V-like appearance on an x-ray and does not extend completely through the bone is referred to as: A. Comminuted fracture B. Greenstick fracture C. Impacted Fracture D. Spiral fracture Correct ans - B Called a greenstick bc it is similar to bending an immature branch - the break does not extend through the bone completely. Figure 39-1 p 991. for pictures of different types of fractures Which of the following injuries is defined as a tear or rupture of a tendon? A. Sprain B. Strain C. Avulsion D. Subluxation Correct ans - B sTrain = Tendon (T in both). Sprain is ligament. Avulsion is complete separation of ligament or tendon from bone. Subluxation is incomplete separation of joint. Which of the following does the nurse expect of a patient experiencing compartment syndrome? (Select all that apply.) A. Pain B. Weakness C. Bounding pulses D. Dark urine E. Decreased BUN Correct ans - A B D Expect pulselessness and increased BUN (secondary to AKI from myoglobinuria) 6 P's: pain (disproportionate to injury), pressure, pallor, parasthesia (neuropathy), paresis (partial paralysis), and pulselessness Which of the following are risk factors for osteoporosis? (Select all that apply.) A. Advanced age B. Increased weight C. High-impact exercises D. Hypoparathyroidism E. Corticosteroid use Correct ans - A E Decreased weight, sedentary lifestyle, and hyperparathyroidism are risk factors for osteoporosis. Check out the risk factor chart on p. 1002 * *How do we diagnose osteoporosis? DXA scan Pt teaching? Regular weight bearing exercises, take vitamin D and Calcium along with estrogen and testosterone Which of the following characterizes osteomalacia? A. Pediatric disorder of compact and spongy bone B. Common in the United States C. Osteoclast activity overrides osteoblast activity D. Soft osteoid takes the place of rigid bone Correct ans - D Expect pain and tenderness, bowed legs or "knock-knees", pathological fractures. A describes Ricket's Which of the following are characteristic of osteoarthritis? (Select all that apply.) A. Formation of osteophytes B. History of undernutrition C. Autoimmune origin D. Pain that is exacerbated by movement E. Joint stiffness Correct ans - A D E History of obesity, not undernutrition. Age-related, not autoimmune origin. Be sure to know the difference between Rheumatoid arthritis and osteoarthritis. Be sure to differentiate btw Heberden's and Bouchard's nodes. Which of these disorders is characterized by systemic autoimmune response that is characterized by stiffening and fusion of the sacroiliac and spinal joints? A. Rheumatoid arthritis B. Gout C. Osgood-Schlatter disease D. Ankylosing spondylitis Correct ans - D Rounded thoracic spine, head and neck held forward on shoulders, and hips flexed In caring for a patient with acute kidney injury the nurse knows that the patient's renal function has returned to normal range when the patient's glomerular filtration rate measures: A. 30-40 mL/min B. 40-50 mL/min C. 70-90 mL/min D. 90-120 mL/min Correct ans - D Normal GFR is 90-120 mL/min. Normal Creatinine 0.6-1.2 Normal BUN is 7.0-18.0 mg/dL. (or 10-20 depending on your source) **Be sure to know these** In caring for a patient diagnosed with acute pancreatitis, which lab values does the nurse expect to be elevated? (Select all that apply.) A. Amylase B. Lipase C. LDL D. HDL E. Triglycerides Correct ans - A B Amylase and lipase are the pancreatic enzymes When caring for a patient experiencing increased intracranial pressure, which of the following clinical manifestations should the nurse expect? A. Hypotension B. Agitation C. Unilateral dilated pupil D. Cheyne-Stokes respirations Correct ans - D Expect arterial BP within normal limits or higher, decreased LOC, fixed and dilated pupils if they are involved (later), and Cheyne-Stokes (Crescendo- Decrescendo) respirations. The neuro stepdown nurse knows that the patient diagnosed with trauma to Broca's area may have which alteration in communication? A. Intact comprehension with difficulty expressing language B. Difficulty expressing language and altered comprehension C. Altered comprehension and intact language expression D. No alteration of communication Correct ans - A Expressive dysphasia. Damage to Wernicke's area may produce receptive dysphagia which manifests as difficulty understanding language so return communication is meaningless. Which of the following does the nurse expect when caring for a patient suffering from dementia? (Select all that apply.) A. Sudden onset B. Altered sleep-wake cycle C. Memory loss D. Progressive failure of many cerebral functions E. Altered decision-making Correct ans - C D E Be able to compare/contrast dementia vs delirium! The nurse on a neuro ICU knows that the patient experiencing locked in syndrome: (Select all that apply.) A. Can respond to questions by wiggling her toes B. Can understand the speech of those around her C. Is generally paralyzed except for eye movement D. May persist in this state for decades E. Is unable to think logically Correct ans - B C D A seven year old boy was struck with a baseball while practicing for his tournament. After the incident, he had difficulty recalling facts that happened before the incident. This is referred to as: A. Retrograde amnesia B. Anterograde amnesia C. Posterior amnesia D. Attention deficit disorder Correct ans - A Retrograde amnesia - trouble with memory before incident. Anterograde amnesia - loss of ability to form new memories after the event. When assessing the patient's level of consciousness, the nurse notes that the patient falls asleep unless stimulated verbally or tactilely and answers questions with minimal response. This level of altered consciousness is referred to as: A. Lethargy B. Obtundation C. Stupor D. Light coma Correct ans - B. Check Table 15-3 on p.360. Be sure to know these - they are frequently presented and very important. While assessing a patient's respiratory pattern, the nurse notes that the patient is exhibiting completely irregular breathing and the rate is slow. This abnormal pattern of breathing is referred to as: A. Posthyperventilation apnea B. Cheyne-Stokes C. Apneusis D. Ataxic breathing Correct ans - D These are listed on Table 15-4 on p. 361. Be sure to know these, too. After a stroke, a patient has difficulty understanding what the nurse is saying and speaks nonsensical sentences. The neuro nurse understands that ischemia has occurred in which area of the brain? A. Wernicke's area B. Broca's area C. The pons D. The medulla Correct ans - A - Wernicke's for receptive dysphagia (difficulty understanding language) When caring for a patient experiencing delirium, which of the following does the nurse expect? (Select all that apply.) A. Insidious onset B. Reversible course C. Disrupted sleep-wake cycle D. Impaired orientation E. Hallucinations Correct ans - B C D E Expect abrupt onset for this acute deterioration Check out Table 15-10 on p.370 to compare delirium and dementia This particular disease is characterized by neurotic plaques of amyloid beta protein, neurofibrillary tangles, and degeneration of basal forebrain cholinergic neurons with loss of acetylcholine: A. Alzheimer's disease B. Huntington disease C. Creutzfeldt-Jakob disease D. Parkinson's disease Correct ans - A This describes Alzheimer's Note that Huntington disease aka chorea is genetic and onsets btw 25 and 45 y.o. when the gene has likely already been passed to offspring. There is an abnormally long polyglutamine tract in the huntingtin (htt) protein that is toxic to neurons caused by a CAG repeat of 40-70 times rather than the normal 9-34 with abnormal protein folding. There is a degeneration of the basal ganglia, particularly the caudate nucleus, tangles of protein, and DEPLETION OF GABA, the primary inhibitory neurotransmitter (this is the principal biochemical alteration of the disease). As a nurse is caring for an infant suffering from shaken baby syndrome, the nurse understands that which of these brain injuries is most common? A. Mild concussion B. Epidural Hematoma C. Subdural Hematoma D. Diffuse axonal injury Correct ans - D Occurs from high levels of acceleration and deceleration, such as whiplash, or rotational forces that cause shearing of axonal fibers and white matter tracts. Immediately after a spinal injury, a patient develops spinal shock. Which of the following are associated with spinal shock? (Select all that apply.) A. Loss of function at and above the level of spinal cord injury B. Drop in blood pressure C. Hyperextension of the legs D. Loss of bowel and bladder control E. Loss of thermoregulation Correct ans - B D E Function is lost below the level of injury Expect flaccid paralysis, loss of sensation, poor venous circulation, loss of thermoregulation s/t inability to regulate body heat through vasoconstriction and increased metabolism (sympathetic nervous system damaged) May last 7-20 days up to 3 mo Which of the following are risk factors for stroke? (Select all that apply.) A. Increased age B. Caucasian ethnicity C. Hypertension D. Type I Diabetes E. Smoking cigarettes Correct ans - A C E Increased age, AA ethnicity, HTN, type II DM, hypercholesterolemia, smoking, obesity, birth control medication, atrial fibrillation, history of stroke or TIA *Note that ischemic strokes can be embolic or thrombotic This particular type of headache is the most common and pain is similar to the sensation of a tight band around the patient's head with a gradual onset of pain. A. Cluster headache B. Migraine headache C. Tension headache D. Subarachnoid hemorrhage Correct ans - C Table 16-7 is an excellent table describing these headaches. This demyelinating disorder characteristically presents with ascending paralysis: A. Amyotrophic Lateral Sclerosis B. Multiple Sclerosis C. Myasthenia Gravis D. Guillain-Barre Syndrome Correct ans - D Guillain-Barre may advance from paresis of legs to complete quadriplegia, respiratory insufficiency, and autonomic nervous system instability Multiple sclerosis is a scarring and loss of axons from an autoimmune response Parasthesias of face, trunk, or limbs are common with weakness, impaired gait, etc. Which of the following is a sign of myasthenia gravis? A. Antibodies against acetylcholine receptors B. Excessive acetylcholine activity C. Depletion of Dopamine D. Ascending paralysis Correct ans - A Also expect ocular manifestations. Insidious onset. While caring for a patient on the med-surg floor, the nurse notes the presence of bright red stools. How does the nurse document this finding? A. Melena B. Hematochezia C. Hematemesis D. Occult bleeding Correct ans - B Melena is black tarry stools. Occult bleeding is where there are broken down products of blood are present in the stool. A 25-year-old female presents with amenorrhea and hirsutism. She is diagnosed with PCOS. Lab testing will most likely reveal: A. Estrogen deficit B. Genetic cancerous mutations C. Cortisol excess D. Hyperinsulinemia Correct ans - D Glucose intolerance/insulin resistance (IR) and hyperinsulinemia often run parallel and markedly aggravate the hyperandrogenic state, thus contributing to the severity of signs and symptoms of PCOS. A 40-year-old female presents with cramping and excessive vaginal bleeding. Ultrasound reveals benign uterine tumors in the smooth muscle cells of the myometrium. These tumors are commonly called: A. Adenomyosis B. Endometriosis C. Leiomyomas D. Adenomas Correct ans - C A 21-year-old female is infected with human papillomavirus (HPV) following unprotected sexual intercourse with a male she recently met. She is now at higher risk of developing which of the following cancers? A. Cervical B. Ovarian C. Endometrial D. Vulvar Correct ans - A HPV is associated with cervical cancer. A 30-year-old male presents with penile tenderness and discharge. Physical examination reveals that his foreskin cannot be retracted back over the glans penis. He is suffering from: A. Paraphimosis B. Phimosis C. Peyronie disease D. Priapism Correct ans - B A 68-year-old male presents complaining of difficulty having sexual intercourse. He reports that his penis curves during erection. This condition is referred to as: A. Phimosis B. Cryptochordism C. Paraphimosis D. Peyronie disease Correct ans - D A 21-year-old male presents with inflammation of the testes. He has a high fever and edema and redness of the testes. Which organism is the most likely the cause of his symptoms? A. Herpes virus B. Escherichia coli C. Mumps D. Cytomegalovirus Correct ans - C A middle-aged male speaks to his physician about benign BPH. He reveals that his father was recently diagnosed with this condition, and he wants to know if he could have it. The physician tells him that a common complaint from men with mild to moderate BPH is: A. Decreased urinary stream B. Infertility C. Sexual dysfunction D. Prostatodynia Correct ans - A (may also see hesitancy) 35-year-old nonpregnant female presents complaining of breast discharge. She is diagnosed with galactorrhea. The condition is most likely caused by: A. Infection B. Hormone imbalances C. Tissue injury D. Cancer Correct ans - B A 25-year-old sexually active female presents with urethritis, dysuria, and cervical discharge. She is diagnosed with the most common bacteria STI in the United States. The student would identify this infection is due to: A. Gonorrhea B. Syphilis C. Chlamydia D. Herpes Correct ans - C A major complication of persistent gastroesophageal reflux is: A. Barrett esophagus B. Heartburn C. Chest pain D. Hoarseness Correct ans - A The others may be clinical manifestations, but would not be considered complications (let alone a major complication) Acute gastritis refers to a transient inflammation of the gastric mucosa that is most commonly associated with: A. Diarrhea B. Food allergies C. Gastric reflux D. Long-term use of NSAIDs Correct ans - D Which of the following characteristics differentiates inflammatory diarrhea from the noninflammatory type? A. Larger volume of diarrhea B. Electrolyte imbalance C. Absence of blood in stool D. Infection of intestinal cells Correct ans - D Both have very have larger volumes and will affect electrolyte balance Inflammatory diarrhea WILL have blood in the stool Both prehepatic and posthepatic causes of portal hypertension include the formation of: A. Fibrous nodules B. Venous thrombosis C. Collateral circulation D. Portosystemic shunts Correct ans - B Can occlude blood getting to the liver (prehepatic) as well as leaving the liver (posthepatic) A 35-year-old female suffers a broken clavicle following a motor vehicle accident. X-ray reveals that the bone surfaces in the joint partially lost contact with each other. This condition is called: A. Dislocation B. Subluxation C. Distortion D. Nonunion Correct ans - B Which of the following clinical findings would be expected in the patient with rhabdomyolysis? A. Sweating B. Dark urine C. Yellow color to the skin D. Lower extremity swelling Correct ans - B (due to myoglobinuria) A 70-year-old female presents with a hip fracture. She is diagnosed with osteoporosis. One factor that most likely contributed to her condition is: A. Increased androgen levels B. Decreased estrogen levels C. Strenuous exercise D. Excessive dietary calcium Correct ans - B A 25-year-old male was in an automobile accident. At impact, his forehead struck the windshield. In this situation, a nurse recalls the coup injury would occur in the region. A. Frontal B. Temporal C. Parietal D. Occipital Correct ans - A