Patho-found exam 2

A nurse is reviewing lab reports. The nurse recalls blood plasma is located in which of the following fluid compartments?

Intravascular fluid

A 35-year-old male weighs 70 kg. Approximately how much of this weight is ICF?

42 L- the total volume of body water for a 70 kg person is about 42 L (60%)

While planning care for elderly individuals, the nurse remembers the elderly are at a higher risk for developing dehydration because they have a(n):

decreased muscle mass

Which of the following patients should the nurse assess for a decreased oncotic pressure in the capillaries? A patient with:

liver failure

Water movement between the ICF and ECF compartments is determined by:

osmotic forces

An experiment was designed to test the effects of the Starling forces on fluid movement. Which of the following alterations would result in fluid moving into the interstitial space?

Increased interstitial oncotic pressure

When planning care for a dehydrated patient, the nurse remembers the principle of water balance is closely related to \_____ balance.

Sodium

A 70-year-old male with chronic renal failure presents with edema. Which of the following is the most likely cause of this condition?

Increased capillary hydrostatic pressure

A 10-year-old male is brought to the emergency room (ER) because he is incoherent and semiconscious. CT scan reveals that he is suffering from cerebral edema. This type of edema is referred to as:

localized edema

A nurse is teaching the staff about antidiuretic hormone (ADH). Which information should the nurse include? Secretion of ADH is stimulated by:

increased plasma osmolality

Which statement by the staff indicates teaching was successful concerning aldosterone? Secretion of aldosterone results in:

increased blood volume

A 25-year-old male is diagnosed with a hormone-secreting tumor of the adrenal cortex. Which finding would the nurse expect to see in the lab results?

Decreased blood K+ levels

A patient has been searching on the Internet about natriuretic hormones. When the patient asks the nurse what do these hormones do, how should the nurse respond? Natriuretic hormones affect the balance of:

Sodium

A 5-year-old male presents to the ER with delirium and sunken eyes. After diagnosing him with severe dehydration, the primary care provider orders fluid replacement. The nurse administers a hypertonic intravenous solution. Which of the following would be expected?

Intracellular dehydration

Which of the following patients is the most at risk for developing hypernatremia? A patient with:

dehydration

The most common cause of pure water deficit is:

A. renal water loss

Hyperlipidemia and hyperglycemia are associated with:

Hypertonic hyponatremia

A 52-year-old diabetic male presents to the ER with lethargy, confusion, and depressed reflexes. His wife indicates that he does not follow the prescribed diet and takes his medication sporadically. Lab results indicate hyperglycemia. Which assessment finding is most likely to occur?

decreased sodium

When taking care of a patient with hyperkalemia, which principle is priority? Hyperkalemia causes a(n) \_____ in resting membrane potential with \_____ excitability of cardiac muscle.

increase, increased

Which of the following patients is most prone to hypochloremia? A patient with:

Increased bicarbonate intake

Which of the following conditions would cause the nurse to monitor for hyperkalemia?

Acute acidosis

Which organ system should the nurse monitor when the patient has long-term potassium deficits?

kidneys

A 42-year-old female presents to her primary care provider reporting muscle weakness and cardiac abnormalities. Laboratory tests indicate that she is hypokalemic. Which of the following could be the cause of her condition?

Primary hyperaldosteronism

A 19-year-old male presents to his primary care provider reporting restlessness, muscle cramping, and diarrhea. Lab tests reveal that he is hyperkalemic. Which of the following could have caused his condition?

acidosis

A 60-year-old female is diagnosed with hyperkalemia. Which assessment finding should the nurse expect to observe?

oliguria

Which of the following buffer pairs is considered the major plasma buffering system?

carbonic acid and bicarbonate

A nurse recalls regulation of acid-base balance through removal or retention of volatile acids is accomplished by the:

lungs

Physiologic pH is maintained around 7.4 because carbonic acid and bicarbonate exist in a ratio of:

20:1

Which patient is most prone to metabolic alkalosis? A patient with:

Excessive loss of chloride (Cl)

Which patient should the nurse assess for both hyperkalemia and metabolic acidosis? A patient diagnosed with:

renal failure

For a patient experiencing metabolic acidosis, the body will compensate by:

hyperventilating

Which finding would support the diagnosis of respiratory acidosis?

pneumonia

A 54-year-old male with a long history of smoking complains of excessive tiredness, shortness of breath, and overall ill feelings. Lab results reveal decreased pH, increased CO2, and normal bicarbonate ion. These findings help to confirm the diagnosis of:

respiratory acidosis

For a patient with respiratory acidosis, chronic compensation by the body will include:

Kidney excretion of H+

A 55-year-old female presents to her primary care provider and reports dizziness, confusion, and tingling in the extremities. Blood tests reveal an elevated pH, decreased PCO2, and slightly decreased HCO3. Which of the following is the most likely diagnosis?

Respiratory alkalosis with renal compensation

Outcomes of laboratory tests include an elevated level of natriuretic peptides. Which organ is the priority assessment?

heart

A 60-year-old male with a 30-year history of smoking is diagnosed with a hormone-secreting lung tumor. Further testing indicates that the tumor secretes ADH. Which of the following assessment findings should the nurse expect? (Select all that apply.)

-Confusion
-Weakness
-Nausea
-Muscle twitching

The nurse would anticipate the patient with syndrome of inappropriate ADH (SIADH) to demonstrate which of the following symptoms? (Select all that apply.)

-Weakness
-Nausea
-Headache
-Muscle twitching

A primary care provider is talking about plasma proteins synthesized by lymphocytes in the lymph nodes. What is the primary care provider describing?

antibodies

While reviewing lab results, the nurse recalls the most abundant cells in the blood are:

erythrocytes

An adult patients blood sample is analyzed in a laboratory. Assuming a normal sample, which type of white blood cell accounts for the highest percentage?

neutrophils

A group of cells isolated in the laboratory have membrane-bound granules in their cytoplasm and they show phagocytic activity. Which of the following cells is most similar?
A) Monocyte
B) Macrophage
C) Lymphocyte
D) Eosinophils

eosinophils

While planning care for a patient with inflammation, which principle will the nurse remember? The predominant phagocyte of early inflammation is the:

neutrophil

A patient has researched white blood cells on the Internet. Which statement indicates the patient has a good understanding? \_______________ contain preformed granules of vasoactive amines.
A) Neutrophils
B) Eosinophils
C) Monocytes
D) Basophils

basophils

A nurse recalls that monocytes are blood cells that mature (differentiate) into:
a. Macrophages
b. Neutrophils
c. Eosinophils
d. Mast cells

macrophages

A nurse is teaching the staff about platelets. Which information should the nurse include? In addition to playing a role in hemostasis, platelets have the ability to:

release biochemical mediators of inflammation

While planning care for a newborn, the pediatric nurse recalls the main site of hematopoiesis in the fetus is the:

spleen

A 45-year-old female undergoes a splenectomy to remove a tumor. Which of the following assessment finding is most likely to occur following surgery?

leukocytosis

During an infection, the nurse assesses the lymph nodes. Lymph nodes enlarge and become tender because:

Lymphocytes are rapidly dividing

After birth, red blood cells are normally made only in the:

bone marrow

A nurse is discussing a cell that can differentiate into any tissue type. Which term is the nurse describing?

pluripotent

A hematologist is discussing hematopoiesis. Which information should be included? \________ participate in hematopoiesis.
a. Colony-stimulating factors (CSFs)
b. Eosinophils
c. Basophils
d. Neutrophils

Colony-stimulating factors or CSF

An unstable type of hemoglobin that cannot bind with oxygen is termed:
A) Deoxyhemoglobin
B) Oxyhemoglobin
C) Methemoglobin
D) Glycosylated hemoglobin

methemoglobin

A staff member wants to know where the greatest proportion of iron is located. How should the nurse respond? The greatest proportion of total body iron is located in the:
a. Erythrocytes
b. Spleen pulp
c. Bone marrow
d. Liver tissue

erythrocytes

A student asks the instructor about recycled iron. What information should the instructor share? Recycled iron from macrophages is delivered to the bone marrow bound to:
A) Ferritin
B) Hemoglobin
C) Hemosiderin
D) Transferrin

transferrin

A nurse is preparing to teach about erythropoietin. Which information should the nurse include? Erythropoietin is produced in the:

kidneys

Which condition will cause a patient to secrete erythropoietin?

hypoxia

After erythrocytes have circulated for about 120 days, they are removed by macrophages, which are mainly in the:

spleen

Which electrolyte will the nurse check to ensure normal platelet functioning?

Calcium

Which of the following nutritional components will the nurse encourage a patient to consume as it is needed for erythropoiesis?

Cobalamin

A newborn baby is diagnosed with a blood disorder in which her platelet count is low. Which of the following does the nurse suspect could be the reason?

Decreased thrombopoietin

A nurse is caring for a patient who cannot clot. Which end product of the clotting cascade is this patient unable to make?

fibrin

A nurse is discussing fibrinolysis. Which information should the nurse share? Fibrinolysis is mediated by:

plasmin

A newborn baby has a clotting disorder that results in her body being unable to produce thrombin. Which of the following phases of platelet degranulation would be impossible?
A. Subendothelial exposure
B. Adhesion
C. Activation
D. Aggregation

aggregation

While checking lab results, the nurse remembers the normal leukocyte count is:

5,000-10,000/mm3

When a staff member asks how erythrocytes can carry oxygen, which of the following properties should the nurse describe that allow erythrocytes to function as gas carriers? (Select all that apply.)

- Biconcavity
- Reversible deformability

A nurse is caring for an elderly patient. Which of the following are true regarding the hematological system and aging? (Select all that apply.)

Total serum iron is decreased
Total iron-binding capacity is decreased
Intestinal iron absorption is decreased

When an aide asks a nurse how many oxygen molecules can hemoglobin carry, what is the nurse's best response? Hemoglobin molecules carry \_____ oxygen molecules.

4 (four)

A patient's anemia is described as having erythrocytes that demonstrate anisocytosis. The nurse would recognize the erythrocytes would be:

Able to assume various shapes

A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following types of anemia will the nurse see documented on the chart?

pernicious anemia

When a nurse is reviewing lab results and notices that the erythrocytes contain an abnormally low concentration of hemoglobin, the nurse calls these erythrocytes:

hypochromic

A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has?

hemolytic anemia

After initial compensation, what hemodynamic change should the nurse monitor for in a patient who has a reduction in the number of circulating erythrocytes?

Hyperdynamic circulatory state

A 25-year-old female has a heavy menses during which she loses a profuse amount of blood. Which of the following adaptations should the nurse expect?

peripheral vasoconstriction

A 60-year-old female emphysema patient experiences a rapid and pounding heart, dizziness, and fatigue with exertion. Which of the following respiratory assessment findings indicate the respiratory system is compensating for the increased oxygen demand?

increased rate and depth of breathing

A 2-year-old malnourished child has vitamin B12 and folate deficiencies. A blood smear suggests the deficiency is macrocytic and normochromic. The nurse would expect the hemoglobin to be:

normal

A 45-year-old male is diagnosed with macrocytic, normochromic anemia. The nurse suspects the most likely cause of this condition is:

Defective DNA synthesis

These anemias are the result of ineffective erythrocyte deoxyribonucleic acid (DNA) synthesis.

When a patient wants to know why vitamin B12 and folate deficiencies cause anemia, how should the nurse respond?

Red blood cells have a shorter life span

These deficiencies lead to defective erythrocytes that die prematurely, which decreases their numbers in the circulation, causing anemia

A 20-year-old female undergoes lab testing for anemia. Results show high iron, bilirubin, and transferrin and low hemoglobin and hematocrit. Which of the following is the most likely diagnosis to be documented on the chart?

Sideroblastic anemia

Individuals with sideroblastic anemia may show signs of iron overload (hemosiderosis), including mild to moderate enlargement of the liver (hepatomegaly) and spleen (splenomegaly).

A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia). How should the nurse respond when the patient asks what causes pernicious anemia? A decrease in \______ is the most likely cause.

Intrinsic factor

The underlying alteration in pernicious anemia (PA) is the absence of intrinsic factor (IF), an enzyme required for gastric absorption of dietary vitamin B12, a vitamin essential for nuclear maturation and DNA synthesis in red blood cells.

Which of the following individuals should the nurse assess first for a vitamin B12 deficiency anemia?

47-year-old male who had a gastrectomy procedure (removal of the stomach)

A 65-year-old male experienced loss of appetite, weight loss, lemon-yellow skin, liver enlargement, and a beefy red tongue shortly before his death. Autopsy suggested pernicious anemia, and the cause of death would most likely reveal:

heart failure

A 40-year-old male vegetarian is diagnosed with folate deficiency anemia. He reports that he is an alcoholic. Which of the following factors put him at greatest risk for developing his disease?

Being alcoholic

Folate deficiency occurs more often in alcoholics and individuals who are malnourished because of fad diets or diets low in vegetables.

How should the nurse prepare a patient who is to receive a Schilling test for pernicious anemia?

Administer radioactive cobalamin and measure its excretion in the urine.

A 67-year-old female has chronic gastrointestinal bleeding. A nurse recalls the primary cause of her anemia is:

iron deficiency anemia

A 34-year-old male presents in the emergency room with extreme fatigue and shortness of breath. His skin and sclera appear to have a yellowish discoloration. These assessment findings are consistent with which type of anemia?

Hemolytic anemia

A yellow appearance to the skin and sclera are consistent with hemolytic anemia.

A 58-year-old female presents in the clinic presenting with fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit, a high mean corpuscular volume, and normal plasma iron. These assessment findings are consistent with which type of anemia?

Pernicious anemia

Pernicious anemia is manifested by tingling paresthesias of feet and fingers.

The nurse will check which of the following tests to directly measure iron stores?

Bone marrow biopsy

Iron stores are measured directly by bone marrow biopsy.

A 21-year-old female was recently diagnosed with iron deficiency anemia. In addition to fatigue and weakness, which of the following clinical signs and symptoms would she most likely exhibit?

spoon shaped nails

A 21-year-old woman was recently diagnosed with iron deficiency anemia. Her hematocrit is 32%. Which of the following treatments would the nurse expect to be prescribed for her?

Iron replacement

Iron replacement therapy is required and very effective. Initial doses are 150 mg to 200 mg/day and are continued until the serum ferritin level reaches 50 mg/L.

A 45-year-old male is diagnosed with sideroblastic anemia. When he asks what the most likely cause of this disease is, what is the nurses best response?

Ineffective iron uptake and abnormal hemoglobin production

A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following assessment findings would most likely occur?

Bronze colored skin

A nurse is preparing to teach the staff about aplastic anemia. Which information should the nurse include? Aplastic anemia is caused by:

Stem cell deficiency

In aplastic anemia, erythrocyte stem cells are underdeveloped, defective, or absent.

A nurse recalls posthemorrhagic anemia can result in death when a patient's blood loss is in excess of:

40% to 49%

A 57-year-old male presents to his primary care provider for red face, hands, feet, ears, and headache and drowsiness. A blood smear reveals an increased number of erythrocytes, indicating:

Polycythemia vera (PV)

PV is manifested by increased numbers of erythrocytes.

A 67-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera. Upon taking the history, the patient will most likely report:

Chest pain

Coronary blood flow may be affected, precipitating angina.

A 68-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera (PV). A nurse realizes the patient's symptoms are mainly the result of:

increased blood viscosity

A 67-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera (PV). Which treatment should the nurse discuss with the patient?

Therapeutic phlebotomy

Treatment of PV is phlebotomy to reduce red cell mass and blood volume.

A 70-year-old male is brought to the emergency department, where he dies shortly thereafter. Autopsy reveals polycythemia vera (PV). His death was most likely the result of:

Cerebral thrombosis

50% of individuals with PV die within 18 months of the onset of initial symptoms because of thrombosis or hemorrhage.

A 67-year-old male was diagnosed with polycythemia vera (PV) but refused treatment. His condition is at risk for converting to:

acute myeloid leukemia