PSYC325 Midterm Exam

PSYC325 Midterm Exam

Answer this test’s questions in a minimum of two substantive paragraphs totaling 300 words, completely and fully for full credit. Source credits and the required Reference list attached at the end of each answer do no count toward its word length.  Answers are to be based on the course textbook and outside academic sources (excluding other course textbooks, encyclopedias such as Encarte and Wikipedia, About.com and Ask.com type websites that synthesize source information for users, magazines, news websites, blogs, etc.). (PSYC325 Midterm Exam)

 

 

Course Materials:

Pinel, J. (2014).  Biopsychology (9th edition). Pearson Publishing.

 

 

Describe the recent finds on the “Nature-Nurture Controversy.” How does evolutionary theory (evolutionary biology and evolutionary psychology) and the study of genetics fit in to this discussion? What are the implications for the biopsychologist? And finally, is there a controversy at all?

 

 

 

 

 

Describe the process of action potential conduction and neurotransmission from one neuron to another, both electrically (including saltatory conduction) and chemically. Describe how a cell fires an action potential and be sure to address which structures are involved in neurotransmission. Discuss reuptake and enzymatic degradation (breakdown) in the context of the appropriate neurotransmitters. (PSYC325 Midterm Exam)

 

 

 

Trace in detail the structure and function of the visual system from the physical stimuli (light waves), to the structure of the eye and through the corresponding brain structures until it is processed as visual information. You will need to compare photoreceptors in darkness to photoreceptors receiving light and describe how light energy is transduced into neural signals. Describe how the trichromatic and opponent-process theory explain how light of different wavelengths is converted into color information.

 

 

 

Discuss some of the methodological approaches that can be used to examine the influence of multiple genes on behavior. Then discuss what transgenic animals are and how they are produced. (PSYC325 Midterm Exam)

 

 

 

What is the medial forebrain bundle? Discuss the evidence for and against its involvement in reward. In addition, review the evidence showing that the brain’s dopamine pathways are critically involved in pleasure and reward.

 

 

 

What is the monoamine theory of depression? What evidence supports this hypothesis as a cause of affective disorder? It generally takes 2-3 weeks of chronic treatment before an antidepressant begins to have a clinical benefit, yet the drug’s pharmacological effect (for example, its inhibition of MOA, or reuptake) is immediate. What synaptic mechanisms may underlie this time lag?

 

Critically evaluate the roles of the lateral hypothalamus and ventromedial hypothalamus in hunger and satiety. What other brain sites are known to be involved in eating behavior? How can this be explained in terms of a homeostatic model? What evidence shows that non- homeostatic mechanisms also contribute to feeding?

 

 

 

How is the brain capable of “seeing” a spectrum of fine color when the eye contains only three different types of color detectors? What evidence supports the existence of dorsal (“where is it?”) and ventral (“what is it?”) visual systems in the cerebral cortex?

 

 

 

Describe the main structures of the brain stem, the midbrain, and forebrain, including the basal ganglia, the limbic system and the cerebral cortex. What functions and behaviors are these regions known to control?

 

 
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FNU Pathophysiology Mid Term Exam

FNU Pathophysiology Mid Term Exam

Question 1 (FNU Pathophysiology Mid Term Exam)

Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node?

Answers:

A. Potassium permeability is allowing the cell membrane to remain depolarized, and Ca2+ channel opens moving Ca2+ back into the cell.

B. The cells are capable of responding to a greater than normal stimulus before the resting membrane potential is reached.

C. A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in, resulting in resting membrane potential.

D. The fast sodium channels in the cellular membranes close, causing an abrupt decrease in intracellular positivity.

Question 2

A 31-year-old woman with a congenital heart defect reports episodes of light-headedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion? (FNU Pathophysiology Mid Term Exam)

Answers:

A. Signal-averaged ECG

B. Holter monitoring

C. Electrophysiologic study

D. Exercise stress testing

Question 3

A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies,

Answers:

A. “They are looking for the presence of antibody or complement on the surface of the RBC.”

B. “They will wash your RBCs and then mix the cells with a reagent to see if they clump together.”

C. “They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis).”

D. “They will be looking to see if you have enough ferritin in your blood.”

Question 4

Of the following list of patients, who would likely benefit the most from hyperbaric oxygen therapy?

Answers:

A. A football player who has torn a meniscus in his knee for the third time this year

B. A patient who developed a fistula between her bowel and vagina following cervical cancer surgery

C. A school-aged child who fell on gravel and has terrible road rash

D. A trauma patient who developed Clostridium spp., an anaerobic bacterial infection in his femur

Question 5

A 71-year-old male patient with a history of myocardial infarction (MI) and peripheral vascular disease (PVD) has been advised by his family physician to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the physician’s suggestion?

Answers:

A. Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation.

B. Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.

C. Aspirin can reduce unwanted platelet adhesion by inhibiting TXA2 synthesis.

D. Aspirin helps to inhibit ADP action and minimizes platelet plug formation.

Question 6 (FNU Pathophysiology Mid Term Exam)

Which of the following assessments and laboratory findings would be most closely associated with acute leukemia?

Answers:

A. Increased serum potassium and sodium levels

B. Increased blood urea nitrogen and bone pain

C. High blast cell counts and fever

D. Decreased oxygen partial pressure and weight loss

Question 7

A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his physician. Which of the following aspects of hyperlipidemia would the physician most likely take into account when teaching the patient?

Answers:

A. Hyperlipidemia is a consequence of diet and lifestyle rather than genetics.

B. The goal of medical treatment is to eliminate cholesterol from the vascular system.

C. Cholesterol is a metabolic waste product that the liver is responsible for clearing.

D. HDL cholesterol is often characterized as being beneficial to health.

Question 8

A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community health clinic. Which of the following assessments would be the health care professional’s lowest priority?

Answers:

A. A musculoskeletal assessment

B. A test of the child’s visual acuity

C. Tests of kidney function

D. Cardiovascular assessment

Question 9

In the ICU setting, a patient transported from surgery following open heart bypass grafting will likely have his core temperature measured by a/an

Answers:

A. esophageal flexible thermometer monitoring aorta distention.

B. rectal tube inserted to prevent evacuation from bowels while recovering from anesthesia.

C. pulmonary artery catheter being used to measure cardiac output.

D. temperature probe taped behind his ear.

Question 10

The son of an 80-year-old man has noticed that in recent weeks his father has become incontinent of urine for the first time in his life. The man is later diagnosed with transient urinary incontinence, a condition that is most often attributable to

Answers:

A. medications.

B. detrusor instability.

C. decrease in bladder and sphincter tone.

D. bladder outlet obstruction.

Question 11

A health educator is teaching a group of colleagues about the physiology of thermoregulation. Which of the following statements is most accurate?

Answers:

A. “Prostaglandin E2 (PGE2) exerts a direct fever-producing effect on the hypothalamus.”

B. “Endogenous pyrogens induce host cells to produce exogenous pyrogens.”

C. “PGE2 induces Kupffer cells to initiate a fever response via hepatic sinusoids.”

D. “Arachidonic acid induces cytokines to act on the temperature regulation center.”

Question 12

A patient experiencing immotile cilia syndrome should be frequently assessed by the nurse for which priority complication? (FNU Pathophysiology Mid Term Exam)

Answers:

A. Epistaxis resulting from loss of cilia in the nasal passageway

B. Sterility caused by inability of the sperm to swim downstream

C. Bronchiectasis due to interferences with clearance of inhaled bacteria along the respiratory tract

D. Inability to hear soft sounds related to kinocilium on the hair cells in the inner ear

Question 13

The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis?

Answers:

A. “Is there any mold in your home that you know of?”

B. “Is there any family history of neuromuscular diseases?”

C. “Has your baby ever been directly exposed to any chemical cleaning products?”

D. “Have you ever given your child any honey or honey-containing products?”

Question 14

In the context of a workshop on rheumatoid arthritis, a clinical educator is teaching a group of nurses about autoimmune diseases. Which of the following statements by an attendee would the educator most likely want to follow up with further teaching?

Answers:

A. “Often the problem can be traced to antigens that sensitize T cells without the need for presentation.”

B. “In some cases, the body attacks its own cells that are chemically similar to those of infectious organisms.”

C. “Introduction of a foreign antigen can sometimes induce a cascade of immune response that is not self-limiting”

D. “Sometimes when the body’s own cells are released after a long time, they are interpreted as being foreign.”

Question 15

Which of the following pregnant women has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly?

Answers:

A. A woman with diagnoses of syphilis and cirrhosis of the liver

B. A woman who has herpes simplex and who has recently recovered from endocarditis

C. A woman with chronic obstructive pulmonary syndrome and tuberculosis

D. A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy

Question 16

In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis?

Answers:

A. A 70-year-old woman whose blood work reveals large numbers of immature granulocytes

B. A 68-year-old former coal miner who has white cell levels exponentially higher than normal ranges

C. A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated

D. An 81-year-old male resident of a long-term care home who has an uncommon bacterial pneumonia and who is unable to produce a fever

Question 17

A group of novice nursing students are learning how to manually measure a client’s blood pressure using a stethoscope and sphygmomanometer. Which of the following statements by students would the instructor most likely need to correct?

Answers:

A. “If my client’s arm is too big for the cuff, I’m going to get a BP reading that’s artificially low.”

B. “I’ll inflate the cuff around 30 mm Hg above the point at which I can’t palpate the client’s pulse.”

C. “The accuracy of the whole process depends on my ability to clearly hear the Korotkoff sounds with the bell of my stethoscope.”

D. “With practice, my measurement of clients’ blood pressures with this method will be more accurate than with automated machines.”

Question 18

A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician’s explanation?

Answers:

A. Tissue destruction results from neutrophil deactivation.

B. Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas.

C. Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.

D. Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis.

Question 19

0 out of 1 points

A student makes the statement to a colleague, “Blood plasma is essentially just a carrier for the formed elements like red blood cells and white blood cells.”What would be the most accurate response to this statement?

Answers:

A. “Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis.”

B. “Actually, plasma is integral to the proper function of the liver and maintenance of acid–base balance.”

C. “Actually, plasma plays a significant role in nutrient and waste transport.”

D. “That’s not really true. Plasma is crucial in the immune and inflammatory responses.”

Question 20 (FNU Pathophysiology Mid Term Exam)

A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)?

Answers:

A. A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort

B. A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin

C. A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

D. A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw

Question 21

In which of the following situations would blood most likely rapidly relocate from central circulation to the lower extremities?

Answers:

A. A client does isotonic exercises in a wheelchair.

B. A client reclines from a sitting to supine position.

C. A client is helped out of bed and stands up.

D. A client undergoes a stress test on a treadmill.

Question 22

When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant?

Answers:

A. Lymphocytes

B. Neutrophils

C. Eosinophils

D. Basophils

Question 23

A nurse is providing care for a 44-year-old male client who is admitted with a diagnosis of fever of unknown origin (FUO). Which of the following characteristics of the client’s history is most likely to have a bearing on his current diagnosis?

Answers:

A. The client is cachexic and an African American.

B. The client is malnourished, hypomagnesemic, and hypocalcemic.

C. The client is HIV positive and homeless.

D. The client is receiving intravenous normal saline with 20 mEq KCl.

Question 24

As part of a screening program for prostate cancer, men at a senior citizens’ center are having their blood levels of prostate-specific antigen (PSA) measured.Which of the following statements would best characterize a high positive predictive value but a low negative predictive value for this screening test?

Answers:

A. All of the men who had low PSA levels were cancer-free; several men who had high levels also remained free of prostate cancer.

B.Men who had low PSA levels also displayed false-positive results for prostate cancer; men with high levels were often falsely diagnosed with prostate cancer.

C. The test displayed low sensitivity but high specificity.

D. All of the men who had high PSA levels developed prostate cancer; several men who had low PSA levels also developed prostate cancer.

Question 25

When looking at a granulocyte under a microscope, the anatomy student would describe it as a cell

Answers:

A. having a kidney-shaped nucleus.

B. having no nuclei.

C. lacking granules.

D. shaped like a sphere with multilobar nuclei.

Question 26

The cardiologist just informed a patient that he has a reentry circuit in the electrical conduction system in his heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to him. Which of the following statements most accurately describes what is happening?

Answers:

A. “You must have a large clot in one of your arteries that supply oxygenated blood to the special conduction cells in your heart.”

B.“There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast.”

C. “This means that the SA node (which is the beginning of your heart’s electrical system) has been damaged and is no longer functioning normal.”

D. “For some reason, your electrical system is not on full charge, so they will have to put in new leads and a pacemaker to make it work better.”

Question 27

In the ED, a homeless patient is brought in with severe hypothermia. The police officers also state that they found a “bottle of booze” on the sidewalk next to him. This puts the nurse on high alert since alcohol contributes to hypothermia by

Answers:

A. causing the person to have less fat on his body.

B. interfering with the appetite center in the brain causing the person to not respond to hunger pains.

C. increasing his basal metabolic rate, so he will run out of ATP faster than expected.

D. dulling the mental awareness that impairs judgment to seek shelter.

Question 28

Which of the following glycoproteins is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia? (FNU Pathophysiology Mid Term Exam)

Answers:

A. Growth factors and cytokines

B. Natural killer cells and granulocytes

C. Neutrophils and eosinophils

D. T lymphocytes and natural killer cells

Question 29

A professor is teaching a group of students about the role of mitochondria within the cell. Which of the following statements is true of mitochondria? (FNU Pathophysiology Mid Term Exam)

Answers:

A. They are the site of adenosine triphosphate (ATP) production.

B. Mitochondrial DNA is inherited patrilineally.

C. The number of mitochondria in a cell is equal to the number of nuclei.

D. They are replicated within the smooth endoplasmic reticulum (ER).

Question 30

A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems?

Answers:

A. Infections

B. Jaundice

C. Blood clots

D. Anemia

Question 31 (FNU Pathophysiology Mid Term Exam)

A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her body. What physiological processes could best underlie her care provider’s teaching about her new diet?

Answers:

A. Free radicals increase cytokine expression and adhesion molecule levels, resulting in increased inflammation.

B. Free radicals contribute to atherosclerosis and decreased immune response.

C. Free radicals act as direct mediators in the inflammatory process.

D. Free radicals inhibit the inflammatory response, limiting preadaptive response to infection.

Question 32

A male client of a nurse practitioner has an autosomal dominant disorder. The client and his partner are considering starting a family. Which of the following statements indicates the client has an adequate understanding of the genetic basis of this health problem?

Answers:

A. “I know that a single mutant allele is to blame for the health problem.”

B. “I know that new genetic mutations won’t occur between generations.”

C. “I know there’s no way of accurately determining the chance that my child will inherit the disease.”

D. “My children who don’t have the disease still run the risk of passing it on to their children.”

Question 33

In which of the following hospital patients would the care team most realistically anticipate finding normal cholesterol levels?

Answers:

A. A 44-year-old male admitted for hyperglycemia and with a history of diabetic neuropathy

B. A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness

C. A 77-year-old female admitted for rheumatoid arthritis exacerbation who is receiving hormone replacement therapy and with a history of hypothyroidism

D. A morbidly obese 50-year-old female who is taking diuretics and a beta-blocker to treat her hypertension

Question 34

As of November 1, 2012, there were a total of 10 confirmed cases of Hantavirus infection in people who were recent visitors (mid-June to end of August, 2012) to Yosemite National Park. Three visitors with confirmed cases died. Health officials believe that 9 out of the 10 people with Hantavirus were exposed while staying in Curry Village in the Signature Tent Cabins. This is an example of

Answers:

A. the low rate of morbidity one can expect while traveling to Yosemite National Park.

B. the prevalence of Hantavirus one can anticipate if he or she is going to vacation in Yosemite National Park.

C. what the anticipated mortality rate would be if a family of five were planning to vacation in Yosemite National Park.

D. the incidence of people who are at risk for developing Hantavirus while staying in Yosemite National Park.

Question 35

A 1-year-old child who has experienced low platelet counts and bacterial susceptibility has been admitted to a pediatric medical unit of a hospital for treatment of Wiskott-Aldrich syndrome. The nurse who has admitted the child to the unit would anticipate which of the following short-term and longer-term treatment plans?

Answers: (FNU Pathophysiology Mid Term Exam)

A. Neutropenic precautions; fresh frozen plasma transfusions; treatment of gastrointestinal symptoms

B. Transfusion of clotting factors XII and XIII and serum albumin; splenectomy

C. Intravenous immunoglobulin (IVIG) treatment; thyroidectomy

D. Treatment of eczema; management of bleeding; bone marrow transplant

Question 36

A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma?

Answers:

A. The lymph nodes involved are located in a large number of locations in the lymphatic system.

B. The woman complains of recent debilitating fatigue.

C. Her neoplasm originates in secondary lymphoid structures.

D. The presence of Reed-Sternberg cells has been confirmed.

Question 37

An 81-year-old female client of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client’s condition?

Answers:

A. Peripheral dilation is associated with decreased stroke volume and ejection fraction.

B. Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest.

C. Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.

D. Heart valves are not capable of preventing backflow in cases of atrial congestion.

Question 38

A nurse who works on a pediatric cardiology unit of a hospital is providing care for an infant with a diagnosis of tetralogy of Fallot. Which of the following pathophysiologic results should the nurse anticipate?

Answers: (FNU Pathophysiology Mid Term Exam)

A. Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.

B. There is a break in the normal wall between the right and left atria that results in compromised oxygenation.

C. The aortic valve is stenotic, resulting in increased afterload.

D. The right ventricle is atrophic as a consequence of impaired myocardial blood supply.

Question 39

Which of the following hypertensive individuals is most likely to have his or her high blood pressure diagnosed as secondary rather than essential?

Answers:

A. A 40-year-old smoker who eats excessive amounts of salt and saturated fats

B. A 69-year-old woman with a diagnosis of cardiometabolic syndrome

C. An African American man who leads a sedentary lifestyle

D. A 51-year-old male who has been diagnosed with glomerulonephritis

Question 40 (FNU Pathophysiology Mid Term Exam)

A 72-year-old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, “What caused this [aortic stenosis] to happen now?” The clinic nurse responds,

Answers:

A.“Aortic stenosis is commonly seen in elderly patients.Basically, there is a blockage in the valve that is causing blood to pool, causing decreased velocity of flow.”

B.“Because of the high amount of energy it takes to push blood through the aortic valve to the body, your valve is just had to work too hard and it is weakening.”

C.“This is caused by a tear in one of the papillary muscles attached to the valve. They can do a procedure where they thread a catheter into the heart and reattach the muscle ends.”

D. “Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur.” (FNU Pathophysiology Mid Term Exam)

Question 41

Which of the following patients is most likely to have impairments to the wound-healing process? A patient with

Answers:

A. chronic obstructive pulmonary disease.

B. congenital heart defects and anemia.

C. poorly controlled blood sugars with small blood vessel disease.

D. a diagnosis of multiple sclerosis and consequent impaired mobility.

Question 42 (FNU Pathophysiology Mid Term Exam)

The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client’s medication regimen. What is the most likely focus of the pharmacologic treatment of the man’s health problem?

Answers:

A. Increasing the functional ability of the underactive dopaminergic system

B. Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions

C. Preventing axonal degradation of motor neurons

D. Preventing demyelination of the efferent cerebellar pathways

Question 43

A 4-year-old boy presents with a chronic cough and swollen lymph nodes. His records show that he has been given antibiotics several times in the past year with limited success, most recently for a liver abscess, and that he also has a recurring fungal skin condition. Which of the following is his most likely diagnosis?

Answers:

A. Selective IgA deficiency

B. Ataxia–telangiectasia

C. A deficiency in IgG2 subclass antibodies

D. Chronic granulomatous disease

Question 44

A nurse is teaching a client with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose must enter the body cell in order to provide energy for the client. The nurse knows that which of the following processes allows glucose to enter body cells?

Answers: (FNU Pathophysiology Mid Term Exam)

A. Active transport

B. Diffusion

C. Osmosis

D. Facilitated diffusion

Question 45

Two health care workers are comparing the etiology and incidence of multifactorial inheritance disorders and single-gene disorders. Which of the following statements best captures the relationship between the two types of genetic disorders?

Answers:

A. “A couple with a child with a multifactorial disorder has a higher risk of having another with the same disorder.”

B. “Multifactorial disorders are more likely to involve multiple organs.”

C. “Multifactorial disorders and single-gene disorders can both be predicted quite accurately.”

D. “Multifactorial disorders manifest themselves at birth.”

Question 46

A 44-year-old female who is on her feet for the duration of her entire work week has developed varicose veins in her legs. What teaching point would her care provider be most justified in emphasizing to the woman?

Answers:

A. “Your varicose veins are likely a consequence of an existing cardiac problem.”

B. “Once you have varicose veins, there’s little that can be done to reverse them.”

C. “The use of blood thinner medications will likely relieve the backflow that is causing your varicose veins.”

D. “If you’re able to stay off your feet and wear tight stockings, normal vein tone can be reestablished.”

Question 47

At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client’s mean arterial pressure is at the low end of the normal range; at 6 AM, the client’s MAP has fallen definitively below normal. The client is at risk for

Answers:

A. left ventricular hypertrophy.

B. pulmonary hypertension.

C. organ damage and hypovolemic shock.

D. orthostatic hypotension.

Question 48

A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a “coup”injury. How will the nurse explain this to the family so they can understand?

Answers:

A. “It’s like squeezing an orange so tight that the juice runs out of the top.”

B. “Your son has a huge laceration inside his brain where the bat hit his skull.”

C. “Your son has a contusion of the brain at the site where the bat hit his head.”

D. “When the bat hit his head, his neck jerked backward causing injury to the spine.”

Question 49

Which of the following individuals is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system? An adult

Answers:

A. who had nerves transected during surgery to remove a tumor from the mandible.

B. who developed rhabdomyolysis and ischemic injury after a tourniquet application.

C. who suffered a bone-depth laceration to the shoulder during a knife attack.

D. who had his forearm partially crushed by gears during an industrial accident.

Question 50

A woman gives birth to a small infant with a malformed skull. The infant grows abnormally slowly and shows signs of substantial cognitive and intellectual deficits. The child also has facial abnormalities that become more striking as it develops. What might you expect to find in the mother’s pregnancy history?

Answers:

A. Active herpes simplex infection

B. Chronic alcohol use

C. Chronic cocaine use

D. Folic acid deficiency

Question 51

A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations?

Answers:

A. Spinal infection

B. Encephalitis

C. Lyme disease

D. Rocky Mountain spotted fever

Question 52

The homecare nurse is making a home visit to a 51-year-old female client with a long-standing diagnosis of multiple sclerosis. The nurse knows that the muscle wasting and weakness associated with the disease process are ultimately manifested as a failure of what normal process in muscle tissue?

Answers:

A. The contraction of fascicles within myofibrils

B. The contraction of the epimysium

C. The surrounding of fascicles by perimysium

D. Thick myosin and thin actin filaments sliding over each other

Question 53

A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has

Answers:

A. a mild viral infection.

B. a severe fungal infection.

C. a mild parasitic infection.

D. a severe bacterial infection.

Question 54

The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computed tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage?

Answers:

A. Monitoring in the ICU for signs and symptoms of cerebral insult

B. Stat administration of tissue plasminogen activator (tPA)

C. Administration of a diuretic such as mannitol to reduce cerebral edema and ICP

D. Craniotomy and clipping of the affected vessel

Question 55

A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy?

Answers:

A. Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies.

B. Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response.

C. Allergens in large, regular quantities overwhelm the IgE antibodies that mediate the allergic response.

D. Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response.

Question 56

Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students’ following statements best captures an aspect of the two health problems?

Answers:

A. “Both diseases can result from inadequate production of thrombopoietin by megakaryocytes.”

B. “Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis.

C. “TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma.”

D. “ITP can be either inherited or acquired, and if it’s acquired, it involves an enzyme deficiency.”

Question 57

A 37-year-old male with HIV who has recently become symptomatic has begun highly active antiretroviral therapy (HAART). Among the numerous medications that the man now regularly takes are several that inhibit the change of HIV RNA to DNA in a CD4+ cell. Which of the following classes of medications addresses this component of the HIV replication cycle?

Answers:

A. Protease inhibitors

B. Entry inhibitors

C. Non-nucleoside reverse transcriptase inhibitors

D. Integrase inhibitors

Question 58

A male international business traveler has returned from a trip to Indonesia. While there, he hired a prostitute for companionship and engaged in unprotected sex on more than one occasion. Unbeknownst to him, this prostitute harbored the hepatitis C virus. Upon return to the United States, he exhibited no symptoms and returned to his usual activities. During this period of no outward symptoms, the man would be classified as being in

Answers:

A. the clinical disease stage of hepatitis C.

B. the preclinical stage of disease.

C. the chronic phase of hepatitis C.

D. remission and unlikely to develop hepatitis C.

Question 59

A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked what the first chromosomal abnormality that identified cancer was, one student correctly answered

Answers:

A. Philadelphia.

B. interleukin cells.

C. BRCA-1.

D. PSA.

Question 60

A school nurse is teaching high school students about HIV and AIDS in the context of the school’s sexual health curriculum. Which of the students’ following statements would the nurse most likely want to correct or clarify?

Answers:

A. “Lots more heterosexual people get HIV these days than they used to.”

B. “Drugs for AIDS reduce the virus in your body, but they don’t get rid of it.”

C. “They have to take a blood sample from you in order to test you for AIDS.”

D. “Condoms provide really good protection from AIDS.”

Question 61

A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light.She is breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment?

Answers:

A. Delirium

B. Coma

C. Vegetative state

D. Brain death

Question 62

Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents?

Answers:

A. “Your daughter has lost all her cognitive functions as well as all her basic reflexes.”

B. “Your daughter’s condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions.”

C. “Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.”

D. “If you or the care team notices any spontaneous eye opening, then we will change our treatment plan.”

Question 63

Which of the following patients would be considered to be in the latent period of HIV infection?

Answers:

A. A 33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his axilla and cervical neck region for the past 4 months

B. A 24-year-old college student who has developed a chronic cough that will not go away, even after taking two courses of antibiotics.

C. A 45-year-old alcohol abuser who is complaining of excessive vomiting of blood that started 2 weeks ago

D. A 16-year-old prostitute who has open sores on her labia that drain purulent secretions

Question 64

When discussing the sequence of clot dissolution, the science instructor will talk about which item that begins the process?

Answers:

A. Plasminogen

B. α-plasmin inhibitor

C. Dabigatran

D. Platelets

Question 65

A 30-year-old male’s blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the man’s most likely diagnosis?

Answers:

A. Multiple myeloma

B. Acute lymphocytic leukemia

C. Hodgkin lymphoma

D. Acute myelogenous leukemia

Question 66

A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level of 5.8 g/dL has been ordered a transfusion of packed red blood cells. The client possesses type B antibodies but lacks type D antigens on his red cells. Transfusion of which of the following blood types would be least likely to produce a transfusion reaction?

Answers:

A. A+

B. B–

C. A–

D. B+

Question 67

A nurse is providing care for a 17-year-old boy who has experienced recurrent sinus and chest infections throughout his life and presently has enlarged tonsils and lymph nodes. Blood work indicated normal levels of B cells and free immunoglobulins but a lack of differentiation into normal plasma cells. The boy is currently receiving intravenous immunoglobulin (IVIG) therapy. What is the boy’s most likely diagnosis?

Answers:

A. X-linked hypogammaglobulinemia

B. Transient hypoglobulinemia

C. Common variable immunodeficiency

D. IgG subclass deficiency

Question 68

A patient diagnosed with H pylori asks the nurse, “How an infection can occur in the stomach since it is an acid environment?” The nurse responds,

Answers:

A. “This parasite secretes an enzyme called coagulase, which protects the pathogen from the antibodies.”

B. “H. pylori produces an enzyme called urease that converts gastric juices into ammonia, which neutralizes the acidic stomach environment.”

C. “H. pylori is a virus and is still being researched as to how it is able to survive in the stomach acids.”

D. “We have many infectious agents that can live in an acidic environment with a pH more than 8.0.”

Question 69

The family members of an elderly patient are wondering why his “blood counts” are not rising after his last GI bleed. They state, “He has always bounced back after one of these episodes, but this time it isn’t happening. Do you know why?”The nurse will respond based on which of the following pathophysiological principles?

Answers:

A. “Everything slows down when you get older. You just have to wait and see what happens.”

B. “Due to stress, the red blood cells of older adults are not replaced as promptly as younger people.”

C. “Don’t worry about it. We can always give him more blood.”

D. “The doctor may start looking for another cause of his anemia, maybe cancer of the bone.”

Question 70 (FNU Pathophysiology Mid Term Exam)

A 14-year-old boy is participating in his school’s track meet; the outdoor temperature is 99°F, and a teacher has found the boy sitting restless in the shade and disoriented to time. The teacher notes that the student has dry skin in spite of the high temperature and the fact that he has recently completed a running event. The teacher calls for the school nurse, who will recognize which of the following potential diagnoses and anticipated hospital treatments?

Answers:

A. Heat exhaustion, likely treated with oral rehydration with cool water

B. Heat stroke, likely treated with rehydration by intravenous hypotonic solution

C. Heat stroke, likely treated with submersion in cold water

D. Heat exhaustion, likely treated with rest, shelter from the sun, and salt tablets

Question 71

A 40-year-old male who has been HIV positive for 6 years is experiencing a new increase in his viral load along with a corresponding decrease in his CD4+ count. Which of the following aspects of his immune system is likely to remain most intact?

Answers:

A. Activation of B lymphocytes

B. Phagocytic function of monocytes and macrophages

C. Orchestration of natural killer cells as part of cell-mediated immunity

D. Presentation of major histocompatibility molecules on body cells

Question 72

The nurse practitioner working in an overnight sleep lab is assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient’s blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles?

Answers:

A. When airways are obstructed, the body will retain extracellular fluid so that this fluid can be shifted to intravascular space to increase volume.

B. During apneic periods, the patient experiences hypoxemia that stimulates chemoreceptors to induce vasoconstriction.

C. When the patient starts to snore, his epiglottis is closed over the trachea.

D. When the airway is obstructed, specialized cells located in the back of the throat send signals to the kidney to increase pulse rate. (FNU Pathophysiology Mid Term Exam)

Question 73

A female dental assistant has developed signs and symptoms of a latex sensitivity and is undergoing allergy testing as well as blood work. Which of the following components of the assistant’s blood work would most likely be the focus of her health care provider’s analysis? (FNU Pathophysiology Mid Term Exam)

Answers:

A. Analysis of class II MHC antigens

B. Serum IgE immunoassays

C. Serum CD8+ levels

D. Serum B-lymphocyte levels

Question 74

Which of the following clients’ signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult

Answers:

A. has vomited and complained of a severe headache.

B. states that his left arm and leg are numb, and gait is consequently unsteady.

C. has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days.

D. has experienced a sudden loss of balance and slurred speech.

Question 75

As part of the diagnostic workup for a male client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care?

Answers:

A. Cardiac catheterization, cardiac CT, exercise stress testing

B. Ambulatory ECG, cardiac MRI, echocardiogram

C. Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy

D. Echocardiogram, PET scan, ECG

Question 76

Which of the following statements best captures an aspect of the process of hematopoiesis?

Answers:

A. Colony-stimulating factors (CSFs) produce cytokines that activate progenitor cells.

B. Various subtypes of pluripotent stem cells eventually differentiate into the cellular components of blood.

C. Progenitor cells differentiate into precursor cells.

D. Self-replicating precursor cells differentiate into specific CSFs.

Question 77

A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The patient’s physician would anticipate that which of the following phenomena is most likely occurring? (FNU Pathophysiology Mid Term Exam)

Answers:

A. Epinephrine from his adrenal gland is initiating the renin–angiotensin–aldosterone system.

B. Vasopressin is exerting an effect on his chemoreceptors and baroreceptors resulting in vasoconstriction.

C. The patient’s juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation.

D. The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.

Question 78

A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease.Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient’s bleeding?

Answers:

A. Hemophilia B

B. Vitamin K deficiency

C. Idiopathic immune thrombocytopenic purpura (ITP)

D. Excess calcium

Question 79

Members of an AIDS support group who have more advanced cases are sharing some of their recent health problems with a member who has just been diagnosed. Which of the member’s statements is most accurate?

Answers: (FNU Pathophysiology Mid Term Exam)

A. “The eradication of Pneumocystis jiroveci pneumonia (PCP) has helped extend the life expectancy of a lot of persons living with AIDS.”

B. “As people with HIV live longer, most of us are eventually succumbing to the cancers that are associated with HIV.”

C. “One of the scariest things out there now is the huge increase in drug-resistant tuberculosis.”

D. “Those of us with HIV are so much more prone to loss of vision and hearing.”

Question 80

A hospital laboratory technologist is analyzing the complete blood count (CBC) of a patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC?

Answers:

A. The α-granules of platelets contribute primarily to vasoconstriction.

B. New platelets are released from the bone marrow into circulation.

C. Platelets originate with granulocyte colony–forming units (CFU).

D. The half-life of a platelet is typically around 8 to 12 days.

Question 81

Which of the following patients has an absolute neutrophil count that is critically low and that the standard of care would recommend they be placed on neutropenic precautions?

Answers:

A. A 75-year-old renal failure patient receiving Epogen for anemia with hemoglobin level of 9.7.

B. A 37-year-old patient with leukemia being treated with chemotherapy with ANC of 400

C. A patient on long-term steroids for rheumatoid arthritis with WBC of 7000

D. A 65-year-old prostate cancer patient receiving radiation therapy with neutrophil count of 2000

Question 82

A medical student is working with a 61-year-old male client in the hospital who has presented with a new onset of atrial fibrillation. Which of the following courses of treatment will the student most likely expect the attending physician to initiate?

Answers:

A. Diuretics, total bed rest, and cardioversion if necessary

B. Anticoagulants and beta-blockers to control rate

C. Immediate cardioversion followed by surgery to correct the atrial defect

D. Antihypertensives and constant cardiac monitoring in a high acuity unit

Question 83

A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relates to these health problems?

Answers:

A. The patient has a history of acute and chronic renal failure.

B. The patient’s cardiac ejection fraction was 40% during his last echocardiogram.

C. The patient is male and has a history of hypertension.

D. The client is 89 years old and takes a diuretic medication for his congestive heart failure.

Question 84

Which of the following procedures reduces the potential for infection primarily by addressing the portal of entry?

Answers:

A. Wearing gloves when contact with blood or body fluids is anticipated

B. Wiping down common areas with buffered bleach on a regular basis

C. Isolating patients who have antibiotic-resistant infections

D. Disposing of soiled clothing and bed linens in a dedicated receptacle

Question 85

0 out of 1 points

A 70-year-old woman with ongoing severe atrial fibrillation is scheduled for defibrillation. What is an aspect of the rationale and physiology of defibrillation treatment?

Answers:

A. Defibrillation can be achieved using either a transcutaneous or transvenous pacemaker.

B. Interruption of disorganized impulses by the current allows the AV node to readopt its normal pacemaker role.

C. Defibrillation must be coincided with the R wave of the ECG in order to be successful.

D. The goal is to depolarize the entire heart during the passage of current.

Question 86

In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the patient has gone into ventricular tachycardia.The nurse will likely assess for signs/symptoms of

Answers:

A. increasing cardiac index by correlating the volume of blood pumped by the heart with an individual’s body surface area.

B. decreasing cardiac output due to less ventricular filling time.

C. development of hypertension with BP 190/98.

D. oxygen deprivation with O2 saturation decreasing to approximately 90%.

Question 87

An agricultural worker is picking fruit on a day when the air temperature is 106°F. Which of the following processes will most likely be occurring while he works?

Answers:

A. Conduction of heat from the air will be heating his skin surface and raising his core temperature.

B. His autonomic nervous system will be stimulating him to sweat.

C. Blood volume at his skin surface will be increasing to dissipate heat.

D. Radiation from his skin surfaces will be dissipating heat into the environment.

Question 88 (FNU Pathophysiology Mid Term Exam)

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem?

Answers:

A. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins

B. Cerebellar lesions; surgical and immunosuppressive treatment

C. Excess acetylcholinesterase production; treatment with thymectomy

D. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids

Question 89

A student asks the instructor about the origins of different tissues and their cellular origins during the process of development. Which of the instructor’s following statements best describes the process of cell differentiation?

Answers:

A. “A fertilized ovum undergoes a series of divisions, yielding many different cell types.”

B. “A single stem cell differentiates into approximately 200 different types of cells.”

C. “Cells differentiate into necessary body cells peaking after conception and ceasing near the time of birth.”

D. “Cells of the hematopoietic system produce the appropriate body cells that are required at each stage of development.”

Question 90

A physician is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the physician most likelyrule out hypertension as a contributing factor? (FNU Pathophysiology Mid Term Exam)

Answers:

A. A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

B. A 61-year-old man who has a heart valve infection and recurrent fever

C. An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness

D. A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week

Question 91

A geriatric clinical nurse educator is teaching the other members of the health care team about the incidence, prevalence, and course of depression among older adults. Which of the following statements is most likely to appear in the physician’s teaching?

Answers:

A. “Bronchodilators and antiplatelet medications have been correlated with depression in the elderly.”

B. “Many older adults lack the symptoms of sleep disturbances and lack of concentration that suggest depression in younger adults.”

C. “Even though suicide rates are lower among older adults than younger adults, depression needs to be diagnosed and treated early.”

D. “Though they are certainly not synonymous, depression can be an indicator of dementia.”

Question 92

The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations?

Answers:

A. Petechia and spontaneous bleeding

B. Dyspnea and crackles in bilateral lung bases

C. Muscle cramping and cyanosis in the feet

D. Chest pain and intermittent ventricular tachycardia

Question 93

A 51-year-old patient with a history of alcohol abuse and liver disease has low serum levels of albumin and presents with ascites (excess fluid in his peritoneal space) and jaundice. A health care professional would recognize that which of the following processes is most likely underlying his health problems?

Answers:

A. Insufficient albumin is causing insufficient absorption of fluid into the capillaries.

B. Low albumin contributing to an inability to counter gravitational effects.

C. Low albumin is contributing to excess hydrostatic pressure and inappropriate fluid distribution.

D. Low albumin is inducing hypertension and increased filtration of fluid into interstitial spaces.

Question 94 (FNU Pathophysiology Mid Term Exam)

A community health nurse is teaching a group of recent graduates about the large variety of factors that influence an individual’s health or lack thereof. The nurse is referring to the Healthy People 2020 report from the U.S. Department of Health and Human Services as a teaching example. Of the following aspects discussed, which would be considered a determinant of health that is outside the focus of this report?

Answers:

A.The client has a diverse background by being of Asian and Native American descent and practices various alternative therapies to minimize effects of stress.

B. The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime.

C. The client lives in an affluent, clean, suburban community with access to many health care facilities.

D. The client has a good career with exceptional preventative health care benefits.

Question 95

The clinical educator of a hospital medical unit has the mandate of establishing evidence-based practice guidelines for the nursing care on the unit. Which of the following statements most accurately captures a guiding principle of the nurse’s task?

Answers: (FNU Pathophysiology Mid Term Exam)

A. Evidence-based practice guidelines will be rooted in research rather than nurses’ subjective practice preferences and experiences.

B. Guidelines are synonymous with systematic research reviews.

C. The need for continuity and standardization of guidelines will mean that they will be fixed rather than changeable.

D. The guidelines will combine individual expertise with external systematic evidence.

Question 96

A nurse who provides care in a geriatric subacute medicine unit of a hospital has noted that a large number of patients receive ?-adrenergic blocking medications such as metoprolol. Which of the following statements best conveys an aspect of the use of beta-blockers? (FNU Pathophysiology Mid Term Exam)

Answers:

A. They counteract arrhythmias and tachycardias by increasing vagal stimulation.

B. They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential.

C. They decrease myocardial oxygen demand by blocking the release of intracellular calcium ions.

D. They inhibit the potassium current and repolarization, extending the action potential and refractoriness. (FNU Pathophysiology Mid Term Exam)

Question 97

Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?

Answers:

A. “The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel.”

B. “Infections of any sort are often a signal that plaque disruption is in danger of occurring.”

C. “The impaired function of the lungs that accompanies pneumonia or chronic obstructive pulmonary disease is a precursor to plaque disruption.”

D. “People with plaque in their arteries experience attacks of blood flow disruption at seemingly random times.” (FNU Pathophysiology Mid Term Exam)

Question 98

A 40-year-old male client is shocked to receive a diagnosis of mature B-cell lymphoma and is doing research on his diagnosis on the Internet. Which of the following statements that he reads on various Web sites is most reliable?

Answers:

A. “Like most forms of Hodgkin lymphoma, mature B-cell lymphoma often requires radiation treatment.”

B. “Doctors are able to diagnose mature B-cell lymphoma by the presence of Reed-Sternberg cells.”

C. “The lymph nodes are usually affected, and often the spleen and bone marrow.”

D. “Unlike many other lymphomas, mature B-cell lymphoma is often self-limiting, and treatment is focused on symptoms.”

Question 99

Which of the following processes would most likely be considered an anomaly during the cellular phase of inflammation?

Answers: (FNU Pathophysiology Mid Term Exam)

A. Platelet aggregation

B. Vasoconstriction

C. Migration of phagocytic white cells

D. Macrophage activity

Question 100

A geriatrician has ordered an echocardiogram and stress test for an 80-year-old male client in an effort to gauge the client’s cardiovascular health status.Which of the following changes would the physician most likely identify as an anomaly that is not an expected age-related change?

Answers:

A. Increased resting, supine heart rate

B. Low maximal heart rate and cardiac output

C. Increased left ventricular wall thickness

D. Delayed left ventricular filling (FNU Pathophysiology Mid Term Exam)

 
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Assignment 1: Personal Reflection Journal Entry

Assignment 1: Personal Reflection Journal Entry

Due in Week 4 and worth 175 points  (Assignment 1: Personal Reflection Journal Entry)

In this assignment, you will review your current level of adjustment.

Write a one to two (1-2) page paper in which you:

  1. Reflect on how well you are:
    1. adjusting to your life in terms of subjective well-being, diversity, contexts, and / or thinking critically.
    2. balancing your priorities, specifically with home, work, school, recreation, and / or family.
    3. developing your identity, specifically self-esteem, self-concept, ethnicity, and / or gender.
    4. coping with stress, specifically social support, multiple coping strategies, and / or self-control.

Your assignment must follow these formatting requirements:

  • Be typed, double-spaced, using Times New Roman font (size 12), with one-inch margins on all sides; Since the only resources you will be using for this assignment are the article and your textbook, you need not include a reference page. Check with your professor for any additional instructions.
  • Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page is not included in the required assignment page length.

The specific course learning outcomes associated with this assignment are:

  • Define psychology and psychological adjustment.
  • Identify contextual variables (e.g., culture) that impact psychological adjustment.
  • Describe self-concept, self-esteem, and identity.
  • Define stress, stressors, and coping strategies, and contemplate their relationship to health and wellness.
  • Use critical thinking skills to reflect on personal experiences with adjustment and identify new strategies for personal growth.
  • Use technology and information resources to research issues in psychology.
  • Write clearly and concisely about psychology using proper writing mechanics. (Assignment 1: Personal Reflection Journal Entry)

Resources

https://www.sciencedirect.com/topics/medicine-and-dentistry/psychological-adjustment

 
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Power Politics and Collective Bargaining on Organizational Climate

Power Politics and Collective Bargaining on Organizational Climate

Submit Assignment (Power Politics and Collective Bargaining on Organizational Climate)

Due Feb 20 by 11:59pm  Points 10  Submitting a file upload

Power, politics, and Collective Bargaining on Organizational Climate

List and support your reasons for or against striking.

You are a staff nurse in the ICU in one of your city’s two hospitals. You have worked at this hospital for 5 years and transferred to the ICU 2 years ago. You love nursing but are sometimes frustrated in your job due to a short supply of nurses, excessive overtime demands, and the stress of working with such critically ill patients.

The hospital has a closed shop, so union dues are deducted from your pay even though you are not actively involved in the union. The present union contract is up for renegotiation, and union and management have been unable to agree on many issues. When management made its last offer, the new contract was rejected by the nurses. Now that the old contract has expired, nurses are free to strike if they vote to do so. (Power Politics and Collective Bargaining on Organizational Climate)

You had voted for accepting the management offer; you have two children to support, and it would be devastating to be without work for a long time. Last night, the nurses voted on whether to return to the bargaining table and try to renegotiate with management or to go out on strike. Again, you voted for no strike. You have just heard from your friend that the strike vote won. Now, you must decide if you are going to support your striking colleagues or cross the picket line and return to work tomorrow. Your friends are pressuring you to support their cause. You know that the union will provide some financial compensation during the strike but believe that it will not be adequate for you to support yourself and your children. Yo agree with union assertions that the organization has overworked and underpaid you and that it has been generally unresponsive to nursing needs. On the other hand, you believe that your first obligation is your children.

 

Using a problem-solving and decision making skills model discussed in class outline how you would approach solving this difficult decision. Describe how you arrived at your decision. How many alternatives did you generate? If you were financially stable without a family would your decision have been the same?

Resources

 
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Nursing Leadership Experience

Nursing Leadership Experience

For 6 years I worked with whom I consider the best nurse leader I could ever had. Participative (Democratic) style describes exactly how she was. She always took into consideration the staff’s opinions before making any decision, she was humble enough to tell us “hey, great idea! thanks for helping me with your opinion to get to a final determination”. On this theory, everyone is given the opportunity to participate, ideas are exchanged freely, and discussion is encouraged. While the democratic process tends to focus on group equality and the free flow of ideas, the leader of the group is still there to offer guidance and control. The democratic leader is charged with deciding who is in the group and who gets to contribute to the decisions that are made (Kendra Cherry, 2014) (Nursing Leadership Experience)

How has your experience been with the nurse leader? Provide a description of your interactions with him or her?

As I mention in the question above, I consider this nurse the best nurse leader I could ever had, besides being an excellent leader she was a great mentor for my professional growth, when I moved from Colombia as a Paramedic to Miami I met her at the first job I had for 6 years, it was a clinical research company and I had no idea this even existed, I just wanted a job, I was recently married and this job was looking for people with experience in the medical field to draw blood, admit patients, etc. I got my EMT but I wanted more, I wanted to go to school for something else, but I was kind of lost in regards to which school should I go? can I rollover some classes from Paramedic school? how can I start?  and this great nurse leader had faith on me, she DROVE me to Miami Dade College, she stayed there for almost 3 hours with me waiting for an advisor to help me get the information needed and during the entire program she never let me drop out even though sometimes that’s all I wanted to do, I started nursing school with a 3 month old and it was extremely hard to keep up with home, baby, full time job and school; but this leader was always there. She thought me throughout those years that being a great leader is not synonym of being a selfish leader, work wise she always had the best from me, and research have found that the democratic leadership style is one of the most effective types and leads to higher productivity, better contributions from group members, and increased group morale and this is EXACTLY what she obtained from me. Now, I’m the charge nurse at the GI center where I work and I consider myself to be a democratic leader as well since I totally understood this was the best way to get the whole team involved and to receive their best production. (Nursing Leadership Experience)

Resources

 
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Project Management- Planning_ Scheduling_ Scope and Strategy

Project Management- Planning_ Scheduling_ Scope and Strategy

Question description Project Management- Planning Scheduling Scope and Strategy

(WBS AND Gantt Chart (BOTH attached), Critical Path for the project- 2 pages long, Project Quality Plan- (you can search for template), Scope Statement- 1 page- (Project Scope and Business Objective Worksheet ATTACHED), Failure Mode and Effects Analysis (FEMA)- you can search for a template, and minimum of 2 pages long summary of the action items identified through the FMEA that will increase the probability of the project being considered a success with the customers.) (Project Management- Planning_ Scheduling_ Scope and Strategy)

I have attached the first part of the project which is what this project is a continuation from.

Part 1

1. Complete a WBS for your project. (Work Breakdown Structure ATTACHED)

This list of activities needs to contain enough detail so you can effectively plan and schedule your event.

2. Using the completed WBS as a reference, next complete a Gantt chart of your project using the template provided. If you discover in the process you overlooked activities make sure to include them in the WBS. (Gantt Chart ATTACHED)

3. In a paper that is a minimum of 2 pages longidentify the Critical Path for your project. Using the WBS and the Gantt chart you constructed for this project analyze how much longer you will need to start planning in advance of your event in order to complete the project?

Your submission should follow the essentials of APA (i.e., cover page, double-spaced, 12 pt. font, reference section at the end, in-text citations, etc.). (Project Management- Planning_ Scheduling_ Scope and Strategy)

Part 2

4. For this part of the Course Project, you will put together a Project Quality Plan.In order to provide the highest quality experience possible, attendees of the event were surveyed to determine what was most important to them when attending such an event. The result of this survey is listed below:

 90% of those completing the survey felt that having engaging and dynamic speakers is key to a successful event

– 90% felt that it was important that the accommodations were physically located where the convention is being held; they didn’t want to have to take a bus or a shuttle from their hotel to the convention.

– 85% stated the food provided should be wonderful and meet any dietary restrictions, such as vegetarian or gluten-free.

For your assignment, you will need to do the following:

4. Complete a Project Scope Statement for your project (Use the templates for Project Scope and Business Objective Worksheet provided). Your project Scope should be at one page in length. (Project Scope and Business Objective Worksheet ATTACHED)

Using the WBS for your project, identify which of the Work Activities listed could potentially impact those items identified by attendees as critical for the success of the project.

5. Complete a Failure Mode and Effects Analysis (FMEA)Only include those activities that impact the four issues identified by your customers as critical to producing a quality event. For each of the activities listed:

– Based on your knowledge of the activity analyze the severity of the impact on the project if the activity failed to produce a quality result as Low, Medium, or High

– Also based on your knowledge of the activity analyze the probability of the poor quality result occurring as (Project Management- Planning_ Scheduling_ Scope and Strategy)

– For the three activities that were evaluated as having the most severe quality consequences AND having the highest impact generate an action plan to reduce or eliminate these failures from occurring

6. In a paper that is a minimum of 2 pages long, clearly and concisely summarize the action items identified through the FMEA that will increase the probability of your project being considered a success with your customers.

Your submission should follow the essentials of APA(i.e., cover page, double-spaced, 12 pt. font, reference section at theend, in-text citations, etc.).

Save Part 1 of your assignment as a Microsoft Excel document. And the paper as a Microsoft Word document.

Save Part 2 of your assignment as a Microsoft Word document.

Resources

https://www.projectmanager.com/guides/work-breakdown-structure

 
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CEU program for Family Nurse practitioner

CEU program for Family Nurse practitioner

Question description (CEU program for Family Nurse practitioner)

  • Write substantive response of 200 words to the question below and include in-text citation. APA format.
  • References and citations should conform to the APA 6th edition.

The FNP must maintain his or her license to practice. In order to obtain and maintain your license, you must be certified. An important requirement for maintaining your license and certification is obtaining the specified ANCC Continuing Education Units (CEU). It is important for FNPs to keep up with continuing education. They must maintain at least 75 CEUs. Identify at least two approved ANCC CEU providers. Give an example of each CEU program. Discuss at least one other method of obtaining CEU credits than attending workshops, seminars, and conventions.

Part B.

Respond to other student’s responses with substantive comments. Substantive comments add to the discussion and provide your fellow students with information that will enhance the learning environment.The postings should be at least one paragraph (approximately 100 words) and include references. (CEU program for Family Nurse practitioner)

Sandra’s Response

There is general agreement that nurses must acquire and maintain the specialized knowledge needed to provide highly skilled care and to demonstrate their competence to the public, their employers, their profession, and patients on an ongoing basis throughout their work lives. Nurses report that continuing nursing education is the third most vital component of nursing skill building. Nurses from states that mandate continuing nursing education, as well as those from states that do not, rank continuing nursing education just after their workplace experience and their basic nursing education in importance. Continuing education units are required by different professions as well as nursing to keep up with updated information regarding practice guidelines, laws, and research among other valuable pearls of knowledge that help the profession distinguish itself from others. Two approved ANCC CEU programs that I found are the AANP and NPACE.

  • The American Association of Nurse Practitioners (AANP)- The CE Opportunities Calendar provided on the website features hundreds of current AANP-accredited programs, listed by date, with city, state and contact information for each activity. It also includes an updated listing of AANP-Approved Providers of continuing education for NPs.
  • The Nurse Practitioner Associates for Continuing Education (NPACE)– Founded in 1980, Is a non-profit organization based in the United States that provides continuing education to Nurse Practitioners and Advanced Practice Clinicians. This organization puts together seminars annually around the United States with qualified guest speakers that have been in the field for numerous years and that have experience in public speaking, research, and a multitude of specialties.

For those seeking CEU credits but are limited in traveling there are online webinars available, audiovisual programs, and monographs. In addition, online CE courses in a variety of specialty focuses and topics are available through the AACN. Moreover, there are always many opportunities to obtaining CE through publications and Journals as well. (CEU program for Family Nurse practitioner)

References

The American Association of Nurse Practitioners (2018) Retrieved from https://www.aanp.org/education/continuing-education-ce/ce-opportunities

The Nurse Practitioner Association for Continuing Education (2018) Retrieved from http://npace.org/online-ce/

Whitehead, T. D., & Lacey-Haun, L. (2008). Evolution of accreditation in continuing nursing education in america. The Journal of Continuing Education in Nursing, 39(11), 493-9; quiz 500-1, 516. Retrieved from https://prx-herzing.lirn.net/login?url=https://sea…

Stephen’s Response

The American Nurses Credentialing Center approves CE providers to issue continuing education to nurse practitioners in order for them to meet the 75 CE requirement of their license. The ANCC website makes finding approved providers easy. Two providers of CE that were generated by the website were The American Academy of CME and the American Association of Heart Failure Nurses (ANCC, 2018). The first one is a not for profit medical education company and offers CE classes like “CME Challenge An Interactive Session to Test Your Compliance Radar” and “Survey Says…Making Wise Choices About Compliance Today to Avoid Accreditor’s Regret Tomorrow (AACME, 2018).” The second is a professional nurses education that has multiple programs in research and patient education as well as CE offerings. An example of a course from this group is “pulmonary Hypertension Management (AAHFN, 2018). Other then workshops, seminars, and conventions, the NP can earn CE from the comfort of their own home. A number of organizations offer online multimedia CE that is text or video based. Examples of these organizations are the American Association of Nurse Practitioners, Advanced Practice Education Associates, and the Nurse Practitioner Association for Continuing Education (Decapua, 2016). (CEU program for Family Nurse practitioner)

References

AACME. (2018, January 4). AACME partners in education. Retrieved from https://www.academycme.org/

AAHFN. (2018, February 17). American Association of Heart Failure Nurses. Retrieved from https://www.aahfn.org/default.aspx.

ANCC. (2018, January 1). Find an accredited organization or program. Retrieved from https://www.nursingworld.org/organizational-programs/accreditation/find-an-accredited-organization/.

Decapua, M. (206, February 15). 6 great sources for NP continuing education. Retrieved from https://www.healthecareers.com/article/education/6…

 
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Integrating Theories

Integrating Theories

(Integrating Theories)

In this course, we have studied various approaches to therapy and explored the utility of each orientation with reference to the client.  For this assignment, take the perspective of a therapist working with clients. This will help you honestly assess your own development and more objectively evaluate the advantages and disadvantages of using an integrative approach to counseling. Answer each of the following questions thoroughly and provide examples where requested to substantiate your points.

  1. Do you think therapists should focus on becoming an expert in one particular counseling approach or should they try to become proficient in more than one approach? Provide an explanation for your answer and illustrate them with examples.
  2. Identify what the three most important characteristics of a successful counselor you consider to be. Describe how these characteristics can be developed or strengthened?
  3. Identify and describe some of the characteristics (from question 2) that are best developed in the counseling process with clients?  Support your points with examples? Identify and describe some areas of personal or professional development that would potentially be unethical for the counselor to develop in the counseling process with clients? Explain your rationale in detail and give examples.
  4. What are some of your own personal motivations and characteristics that may help or hinder you as a counselor (identify at least two)?
  5. What areas of your own personal and professional development need the most development before you will feel prepared to be an effective counselor (identify at least three)?
  6. What are two advantages and two disadvantages of practicing within the framework of one specific theory as opposed to developing a more integrative approach consisting of several therapies? Give a detailed description and rationale for both sides.
  7. What are the advantages and disadvantages of practicing within an integrated framework?
  8. Explain at least two techniques you would use in your treatment and describe how you would integrate these techniques in a therapy session.(Integrating Theories)

Your paper should be double-spaced and in 12 point, Times New Roman font with normal one-inch margins, written in APA style, and free of typographical and grammatical errors. It should include a title page with a running head, an abstract and a reference page. The body of the paper should be no less than 5 and no longer than 8 pages in length.

 
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Maintaining Confidentiality in the Age of Public Access

Assignment 1: Maintaining Confidentiality in the Age of Public Access

(Maintaining Confidentiality in the Age of Public Access)

In the digital age, where technology is more of a requirement than an option, counselors are often faced with the challenge of knowing how to effectively manage boundaries. The following case study will help students understand real-life challenges that counselors often face regarding boundaries and technologies.

Case Study:

Latisha is a 32-year-old African American doctoral student in a small, rural university. As part of her doctoral studies, she serves as a supervisor for students doing their master’s in counseling internship. One of her supervisees, Emma, is working with adolescent girls during her internship and has been assigned four clients she sees twice a week. Latisha is Facebook friends with several classmates and former supervisees but has avoided friending current supervisees, explaining this policy in her professional disclosure statement.

One weekend, she notices a Facebook exchange between a classmate and Emma whose page is public and visible. Latisha views Emma’s Facebook page where she discovers Emma has friended the mother of a client and the two have discussed the client through various posts. Emma’s client Jenn is a 15-year-old female who is the subject of a bitter custody dispute. Latisha is aware that Jenn has a 19-year-old African American boyfriend, and the two are sexually active, which conflicts with the mother’s fundamental Christian values. Latisha now realizes the mother is a member of her own church.

The next day, while attending church, Latisha is approached by the mother who states that she knows Latisha is Emma’s internship supervisor and proceeds to lay out the details of her pending divorce and custody issues. The parent mentions she intends to subpoena Emma and her records as part of the divorce litigation and wants her to testify to Jenn’s placement and well-being.

Tasks:

Using an ethical decision-making model, outline your response to this situation. Outline the proposed action(s) you would take in this case, providing justification for the proposed action(s) and a description of the decision-making model used to arrive at that decision. Your decision-making model should be one that has been discussed in the professional literature, and after explaining the model, you will need to offer a rationale regarding why you chose to apply that particular model to the case study. Remember:

  • You should be sure to cite appropriate literature and must give proper credit to authors of any decision-making models used to analyze the case.
  • Do not simply list the steps of the model; apply the steps and be sure to document and defend your courses of action and your final decision.
  • Cite all appropriate professional standards and relevant laws. Regardless of the model chosen, you need to clearly identify, describe, and evaluate what ethical codes and laws were violated. Be specific—use mental health statutes and specific ethical codes that apply.(Maintaining Confidentiality in the Age of Public Access)

Discuss in detail what actions you would take as you proceed through the steps of your chosen ethical decision-making model, each of the steps should take at least a paragraph (or more) to address. You may (and are encouraged to) respond in an outline form (i.e., develop a response to each ethical decision-making step); however, do not simply list the steps of the model but integrate them into a complete answer.

Your answer should be at a minimum approximately 250 words.

 
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Nursing Questions & case study

Nursing Questions & case study

(Nursing Questions & case study)

Complete each case study utilizing collegiate formatting (MLA or APA); typed in Cambria or New Times Roman 12 point font in ONE document.  Citations required.

Case studies are case specific. Your answers should reflect the assessment and your analysis of the information in the case study… no generalized answers of all matter regarding the content.

QUESTION 1: Healthcare Delivery and Evidenced –Based Nursing Practice

The registered nurse working in the cardiac care clinic is tasked with implementing quality improvement measures. To educate the clinic staff, the nurse plans an in-service program to introduce concepts of quality improvement and evidence-based practice. Additionally, the role of the case manager will be included in the presentation. The nurse plans on using care of the patient with Congestive Heart Failure as a template, and prepares sample clinical pathways, care maps, and multidisciplinary action plans. (Learning Objective 3)

a. Describe how clinical pathways are used to coordinate care of caseloads of patients.

b. What is the role of the case manager in evaluating a patient’s progress?

c. What are examples of evidence-based practice tools used for planning patient care?

QUESTION 2: Community-Based Nursing Practice(Nursing Questions & case study)

Mrs. Johnson, a 67-year-old female patient, has recently been discharged from the hospital following an admission for COPD. She has a past medical history of a colon resection related to acute diverticulitis. She developed a surgical wound infection that requires daily wet to dry wound packing and IV Zosyn. Mrs. Johnson was discharged with home oxygen. To manage her care at home, home care visits were ordered. (Learning Objective 5). 

a. What would be involved in setting up the first home care visit?

b. Describe the nursing assessments and management that would occur during the visit.

QUESTION 3: Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing Process

1. Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of the small intestine. She is currently receiving comfort measures only in hospice. She has gangrene of her right foot and has a history of diabetes controlled with oral agents. She is confused and the physician has determined that she is unable to make her own informed decisions. The hospice nurse, not realizing that the weekly order for CBC and renal profile had been discontinued, obtained the labs and sent them to the nearby laboratory for processing. The abnormal lab results obtained later that day revealed that the patient needed a blood transfusion. The hospice nurse updated the patient’s medical power of attorney who was distressed at the report. The patient’s wishes were to die peacefully and to not have to undergo an amputation of her right foot. But if the patient receives the blood transfusion, she may live long enough to need the amputation. The patient’s physician had previously informed the medical power of attorney that the patient would most likely not be able to survive the amputation. The patient’s medical power of attorney had made the request to cease all labs so that the patient would receive comfort measures until she died. The patient has no complaint of shortness of breath or discomfort. (Learning Objective 4)

What ethical dilemma exists?

Who are the stakeholders and what gains or losses do each have?

What strategies should the hospice nurse take to resolve the ethical dilemma?

QUESTION 4:

Chapter 4, Health Education and Health Promotion(Nursing Questions & case study)

he community health nurse is planning a health promotion workshop for a high school PTSO (Parent-Teacher-Student Organization). The choice of topics was suggested by the high school’s registered nurse who has observed a gradual increase in student obesity. The two nurses have collaborated to develop this workshop to provide parents, students, and teachers with information about the importance of health promotion. (Learning Objectives 6, 8, and 9)

a. Describe the importance of a focus on health promotion.

b. According to the health promotion model developed by Becker (1993), what four variables influence the selection and use of health promotion behaviors?

c.       Describe four components of health promotion.

QUESTION 5: Chapter 5, Adult Health and Nutritional Assessment

The registered nurse prepares to conduct a nutritional assessment on Mrs. Varner, a 52-year-old Caucasian female who describes herself as “overweight most of my adult life.” The client states that her health is good. She works part time as a receptionist and volunteers about 10 hours per week in her church. The nurse obtains Mrs. Varner’s height as 64 inches and her weight as 165 pounds. (Learning Objective 8)

a. What is the rationale for computing body mass index? What is Mrs. Varner’s BMI?

b. Calculate her ideal body weight. What is your assessment of her BMI and weight?

c. Based on Mrs. Varner’s BMI and weight, the nurse measures her waist circumference. Describe the proper procedure for this assessment.

d. Mrs. Varner’s waist circumference is 38 inches. What is your assessment?

e. What laboratory values would the nurse review to evaluate Mrs. Varner’s protein levels?(Nursing Questions & case study)

QUESTION 6: Chapter 6, Individual and Family Homeostasis, Stress, and Adaptation

Mary Turner stepped on a nail 5 days ago and sustained a puncture about 1 inch deep. She immediately cleaned the area with soap and water and hydrogen peroxide, and applied triple antibiotic ointment to the site. Today she comes to the clinic with complaints of increased pain and swelling in her foot. On assessment, the nurse notes that the puncture site is red and edematous, and has a moderate amount of yellowish drainage. (Learning Objective 9)

a. Describe the sequence of events that caused the local inflammation seen in Mary’s foot.

b. What is the role of histamine and kinins in the inflammatory process?

c. Which of the five cardinal signs of inflammation does Mary exhibit?

d. Because Mary’s injury occurred 5 days ago, the nurse should assess for what systemic effects?

QUESTION 7:

Chapter 7, Overview of Transcultural Nursing

The nurse manager of an ambulatory care clinic has noted an increased number of visits by patients from different countries and cultures, including patients from Mexico and other Latin American countries. Concerned about meeting the needs of this culturally diverse population, the nurse manager convenes a staff meeting to discuss this change in patient demographics, and to query the staff about any learning needs they have related to the care of these patients. (Learning Objective 3)

a. What strategy to avoid stereotyping clients from other cultures should the nurse include in this meeting?

b. Identify culturally sensitive issues to be discussed in the staff meeting.

c. One technician on the staff complains that some patients never make eye contact, and this makes it difficult for him to complete his work. How should the nurse respond?

QUESTION 8: Chapter 8, Overview of Genetics and Genomics in Nursing(Nursing Questions & case study)

Mr. Wayne is a 38-year-old man with a significant family history of elevated cholesterol levels. His father died at age 42 from a massive heart attack secondary to elevated cholesterol and triglycerides, and two of his older siblings are currently taking medications to lower their cholesterol levels. Mr. Wayne makes an appointment to discuss his risk for hypercholesterolemia. The nurse recognizes that Mr. Wayne is at risk for familial hypercholesterolemia because this is an autosomal dominant inherited condition. (Learning Objective 2)

a. Describe the pattern of autosomal dominant inheritance.

b. Mr. Wayne asks what chance his children have of developing familial hypercholesterolemia. How should the nurse respond?

c. Explain the phenomenon of penetrance observed in autosomal dominant inheritance.

QUESTION 9: Chapter 9, Chronic Illness and Disability

Mr. Edwards is 20-year-old male patient who is admitted for treatment of recurring pyelonephritis (kidney infection) and surgical treatment of a urinary stricture, which has decreased the urinary stream. Mr. Edwards has paraplegia; he is paralyzed from the waist down secondary to an automobile accident when he was 16. He came by ambulance to the hospital, leaving his wheelchair and wheelchair pressure-relieving cushion at home. According to the nursing history, the patient is a nonsmoker and he does not drink alcohol or take any illegal drugs. (Learning Objective 5)

a. What nursing considerations should be made for Mr. Edwards related to his disability?

b. What health promotion and prevention education does Mr. Edwards need?(Nursing Questions & case study)

QUESTION 10: Chapter 10, Principles and Practices of Rehabilitation

You are assigned to care for David Ramsey, a 22-year-old male patient who sustained a back injury secondary to being thrown from a motorcycle. He did not damage the spinal cord, but the computed tomography revealed a compression fracture at L-2 (lumbar area). David complains of severe lower back pain with numbness and tingling in the lower extremities. You identify the following nursing diagnosis: Impaired Physical Mobility.

(Learning Objective 4)

a. What assessments are indicated based on this nursing diagnosis?

b. List other major nursing diagnoses based on David’s clinical presentation.

QUESTION 11:

Chapter 11, Health Care of the Older Adult

The nurse working at the senior center notices Mrs. Jones, a 78-year-old, crying. The nurse approaches Mrs. Jones and asks if she needs help. Mrs. Jones states “I am so embarrassed. I had another accident and my pants are all wet. It’s like I’m a baby. I never should have come to the senior center.” (Learning Objectives 3 and 4)

a. What factors may be contributing to the urinary incontinence?

b. How should the nurse respond to Mrs. Jones?

QUESTION 12:

Chapter 12, Pain Management

Mr. Rogers is 2 days postoperative of a thoracotomy for removal of a malignant mass in his left chest. His pain is being managed via an epidural catheter with morphine (an opioid analgesic). As the nurse assumes care of Mr. Rogers, he is alert and fully oriented, and states that his current pain is 2 on a 1-to-10 scale. His vital signs are 37.8 – 92 – 12, 138/82. (Learning Objective 6)

What are benefits of epidural versus systemic administration of opioids?

b. The nurse monitors Mr. Rogers’ respiratory status and vital signs every 2 hours. What is the rationale for these frequent assessments?

c. The nurse monitors Mr. Rogers for what other complications of epidural analgesia?

d. Mr. Rogers complains of a severe headache. What should the nurse do?

e. Mr. Rogers’ epidural morphine and decreased mobility increase his chances of constipation. What interventions should be included in his plan of care to minimize constipation?

QUESTION 13:(Nursing Questions & case study)

Chapter 13, Fluid and Electrolytes: Balance and Disturbance

Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L. (Learning Objective 4)

a. What are possible causes of a low potassium level?

b. What action should the nurse take in relation to the serum potassium level?

c. What clinical manifestations might the nurse assess in Mrs. Dean?

Question 14:

Chapter 14, Shock and Multiple Organ Dysfunction Syndrome

Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 of 92%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000 and the C-reactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient’s blood pressure during the usage of the vasopressor therapy. (Learning Objectives 6 and 7)

a. What predisposed the patient to develop septic shock?

b. What potential findings would suggest that the patient’s septic shock is worsening from the point of admission?

c. The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication?

d. Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient?

QUESTION 15:(Nursing Questions & case study)

Chapter 15, Oncology: Nursing Management in Cancer Care

The oncology clinical nurse specialist (CNS) is asked to develop a staff development program for registered nurses who will be administering chemotherapeutic agents. Because the nurses will be administering a variety of chemotherapeutic drugs to oncology patients, the CNS plans on presenting an overview of agents, classifications, and special precautions related to the safe handling and administration of these drugs. (Learning Objectives 6 and 8)

a. What does the CNS describe as the goals of chemotherapy?

b. How should the CNS respond to the following question: “Why do patients require rounds of chemotherapeutic drugs, including different drugs and varying intervals?”

c. In teaching about the administration of chemotherapeutic agents, what signs of extravasation should the nurse include?

d. What clinical manifestations of myelosuppression, secondary to chemotherapy administration, should the CNS include in this program?

QUESTION 16:

Chapter 16, End-of-Life Care

Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung), which has compromised his lung expansion. He states that he is short of breath and feels anxious that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an invasive procedure used to drain the fluid from the pleural space so the lung can expand). The thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing. Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal cannula as needed for comfort. (Learning Objective 9)

a.       What nursing measures should the nurse use to manage the patient’s dyspnea?

b. The patient complains that he has no appetite and struggles to eat and breathe. What nursing measures should the nurse implement to manage this physiologic response to the terminal illnesses?

QUESTION 17:

Chapter 17, Preoperative Nursing Management

The nurse in a gynecology clinic is completing preoperative teaching for a patient scheduled for an abdominal hysterectomy next week. The patient states that she is currently taking 325 mg of aspirin daily for chronic joint pain, along with a multivitamin. The patient has type 2 diabetes; she closely monitors her blood glucose levels. Currently, she is taking an oral hypoglycemic agent. The nurse advises her to ask the anesthesiologist whether she should take this medication the morning of surgery. (Learning Objectives 2 and 4)

a. The nurse instructs the patient to stop taking the aspirin. What is the rationale for this action?

b. Why is it important to assess the patient for use of herbal products prior to surgery?

c.       The patient asks how surgery could affect her blood glucose; how should the nurse respond?

QUESTION 18: Chapter 18, Intraoperative Nursing Management

Pearl Richards, 69 years of age, is a female patient who is in the operating room for a repair of an abdominal aortic aneurysm. The patient has a history of hypertension controlled with medications, osteoporosis, chronic obstructive pulmonary disease, and has smoked two packs of cigarettes per day for 40 years. (Learning Objectives 2, 6, and 9)        

a. What nursing interventions are instituted to reduce the surgical risk factors related to the patient’s age?

b. Explain the role of the nurse in providing patient safety measures during the intraoperative period.(Nursing Questions & case study)

QUESTION 19: Chapter 19, Postoperative Nursing Management

1. Rita Schmidt, 74 years of age, is a female patient who was admitted to the surgical unit after undergoing removal of a section of the colon for colorectal cancer. The patient does not have a colostomy. The patient has several small abdominal incisions and a clear dressing over each site. The incisions are well approximated and the staples are dry and intact. There is a Jackson-Pratt drain intact with minimal serous sanguineous drainage present. The patient has a Salem sump tube connected to low continuous wall suction that is draining a small amount of brown liquid. The patient has no bowel sounds. The Foley catheter has a small amount of dark amber-colored urine without sediments. The patient has sequential compression device (SCD) in place. The nurse performs an assessment and notes that the patient’s breath sounds are decreased bilaterally in the bases and the patient has inspiratory crackles. The patient’s cardiac assessment is within normal limits. The patient is receiving O2 at 2 L per nasal cannula with a pulse oximetry reading of 95%. The vital signs include: blood pressure, 100/50 mm Hg; heart rate 110 bpm; respiratory rate 16 breaths/min; and the patient is afebrile. The patient is confused as to place and time. (Learning Objectives 4 and 7)

a. Explain the assessment parameters used to provide clues to detect postoperative problems early and the interventions needed.

b. What gerontological postoperative considerations should the nurse make?

2. Mr. John Smith is admitted to the hospital for surgical incision and drainage (I&D) of an abscess on his right calf, which resulted from a farm machinery accident. The right calf has an area 3 cm × 2.5 cm, which is red, warm and hard to touch, and edematous. (Learning Objective 5)

a. Explain the wound healing process according to the phase of Mr. Smith’s wound?

b. The surgeon orders for wet-to-dry sterile saline dressing twice a day with iodoform gauze to the wound, covered with the wet-to-dry dressing. Explain how to perform this dressing change

 
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