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NUR 612 Advanced Health Assessment And Diagnostic Reasoning Exam 5

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NUR 612 Advanced Health Assessment And Diagnostic Reasoning Exam 5

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RN - Registered Nurse
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RN - Registered Nurse

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Page 1 of 36


NUR 612 Advanced Health Assessment And
Diagnostic Reasoning Exam 5



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NUR 612

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Nur 612 Exam 5 PQ


A pt with a diagnosis of end stage liver failure has abg results indicating
altered pH. Which process has most likely caused the acid-base disturbance?


A. Conservation or formation of new HCO3 by kidneys
B. Low albumin and plasma globulin levels
C. Transcompartmental exchange of H and K ions
D. Renal excretion of HCO3 in the presence of excess base
B. Low albumin and plasma globulin levels


Albumin and plasma globulin are key protein buffers in the vascular compartment;
consequently, a low albumin level, as is common in liver failure, is apt to result inf
acid-base imbalances. Answers A, C, and D all convey normal physiological
processes that help to maintain pH
A 77 yo F diagnosed with COPD is experiencing impaired gas exchange and
CO2 retention, despite a rapid respiratory rate. Which pathophysiological
principle would her healthcare team expect if her compensatory mechanisms
are working properly?


A. Abg sampling indicated a pH in the range of 7.45-7.55
B. Her kidneys are likely to reabsorb H and secrete HCO3
C. Her body will produce excess metabolic CO2
D. Her kidneys will adapt with an inc in plasma HCO3 production and her pH
will inc
D. Her kidneys will adapt with an inc in plasma HCO3 production and her pH will inc


Chronic respiratory acidosis is a relatively common disturbance in people w COPD.
In these ppl, the persistent elevation of PCO2 stimulates renal H secretion and

, Page 3 of 36


HCO3 reabsorption. The effectiveness of these compensatory mechanisms can
often return the pH to near normal values as long as O2 lvls are maintained within a
range that does not unduly suppress chemoreceptor control of respirations
a 73 yo man present to his family physician with complaints of recent urinary
hesitation, and is eventually diagnosed with BPH. Which clinical consequence
would his care provider expect prior to the resolution of his health problem?


A. Hydroureter and pain
B. Development of renal calculi and renal cysts
C. Unilateral hydronephrosis and pain
D. Development of GN or nephritic syndrome
A. Hydroureter and pain


Pain and the distention of the distal ureter would be expected manifestations of BPH
A 62 yo F with high bp is to begin long term tx w a thiazide diuretic that she
thinks she'll need to take for some time. What should the APN expect to
happen to pt's K and Ca lvls?


A. Her K and Ca lvl will not change
B. Her K and Ca lvls will both go down
C. Her K lvl will drop and her Ca lvl may rise
D. Her K lvl will rise and her Ca lvl may drop
C. Her K lvl will drop and her Ca lvl may rise


Thiazide diuretics inc the loss of K in the urine. Because Ca is actively reabsorbed in
the distal convoluted tubule, it likely that her Ca level will go up, especially if she
takes the thiazide diuretic for a long time
A 4 you M who has been deaf since birth and has bilateral cataracts has been
brought to the ED by his mother because she noticed blood in the toilet after
he last voided. UA confirms heavy microscopic hematuria as well as
proteiuria. What will the healthcare team's initial differential diagnosis most
likely be?


A. Alport syndrome

, Page 4 of 36


B. Henoch-Schonlein purpura nephritis
C. IgA nephropathy
D. SLE GN
A. Alport Syndrome


Heavy microscpic heamturia, proteinuria, and sensorineural deafness and eye
disorders are characteristic of Alport Syndrome
Which data would a NP consider as most indicative of acute renal failure?


A. Alteration in blood pH, peripheral edema
B. inc nitrogenous waste levels, dec GFR
C. dec serum creatanine and BUN, dec K and Ca lvl
D. Dec urine output, heamturia, inc GFR
B. inc nitrogenous waste levels, dec GFR


The hallmark of acute renal injury is azotemia, an accumulation of nitrogenous
wastes such as creatinine, urea nitrogen, and uric aced plus a dec in GFR of the
kidneys.
A pt has experienced severe hemorrhage and is in prerenal failure. Which lab
results would the NP expect?


A. BUN to creatinine ratio of 20:1
B. Rising creatinine level and dec BUN
C. Rising BUN with dec creatinine
D. A BUN to creatinine ration of 10:1
A. BUN to creatinine ratio of 20:1


Prerenal injury is manifested by a sharp dec in urine output and a disproportionate
elevation of BUN in relation to serum creatinine lvls
Mrs. Williams is 76 years old and comes in to have a wound checked on her
right leg. She fell a month ago and the wound has not healed. She is
concerned that something is wrong. The nurse practitioner examines the
wound and sees that it has been cleaned properly and has no signs of
infection. The edges are approximated, but the skin around the wound is red

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