PATHO HESI Flashcards [4th set]

FINALIZED VERSION lmk if theres duplicates

What are clinical signs of hypocalcemia vs hypercalcemia?

a. Hypercalcemia exhibits s/sx of decreased neuromuscular irritability, such as

lethargy, shortened ST segment, and diminished reflexes

b. Hypocalcemia exhibits s/sx of increased neuromuscular irritability such as

headache, renal calculi, and fatigue

c. Hypocalcemia exhibits s/sx of increase neuromuscular irritability such as (+)

Trousseau sign, (+) Chvoskek sign, paresthesia, muscle twitching and cramping

d. Hypercalcemia exhibits s/sx of decreased neuromuscular irritability such as

seizures, lethargy, nausea, vomiting, diarrhea, dizziness, disorientation and

muscle twitching

c. Hypocalcemia exhibits s/sx of increase neuromuscular irritability such as (+)

Trousseau sign, (+) Chvoskek sign, paresthesia, muscle twitching and cramping

What will happen to the patient if too much carbonic acid accumulates in the blood?

a. Respirations will increase and the depth will decrease

b. Respirations will decrease, and the depth will increase

c. Respirations will decrease and the depth will decrease

d. Respirations will increase and the depth will increase

d. Respirations will increase and the depth will increase

Which is true about the kidneys?

a. The kidneys are responsible for maintaining fluid and electrolyte homeostasis

b. The kidneys filter more than 70 ml of fluid an hour

c. The kidneys activate vitamin C

d. The kidneys contain 100,000 nephrons

a. The kidneys are responsible for maintaining fluid and electrolyte homeostasis

What happens to calcium in chronic renal failure?

a. Increased absorption from the GI tract

b. High serum calcium

c. Low serum levels.

d. Normal parathyroid activity

c. Low serum levels

Which is normal for urine?

a. pH is acidic

b. Protein

c. Specific gravity of 1.03- 1.3

d. Basic pH

a. pH is acidic

Predisposing factors for pyelonephritis include:

a. Pregnancy, neurogenic bladder, catheterization and urinary obstruction.

b. Viral infection, sexual trauma, and sepsis

c. Diabetes, polycystic kidney disease and cystoscopy

d. Irradiation, diabetes and trauma

a. Pregnancy, neurogenic bladder, catheterization and urinary obstruction

What effect does urinary obstruction have on glomerular filtration, urinary stasis,

and infection risk?

a. Decreased hydrostatic pressure, decreased filtration and anuria

b. Decreased glomerular filtration, urinary stasis, and predisposition to infection

c. Increased glomerular filtration rate, diuresis and infectious process

d. No effect on glomerular filtration, increase urinary stasis and infection

b. Decreased glomerular filtration, urinary stasis, and predisposition to infection

Glomerulonephritis results from:

a. Trauma to the kidney

b. Infection caused by staphylococci

c. Obstructive pathology

d. Antigen-antibody complexes

b. Infection caused by staphylococci

Which clinical findings suggest nephritic syndrome?

a. Hypoproteinemia, hypoalbuminemia, edema, hyperlipidemia and

hypercoagulability

b. Proteinuria, hypolipidemia, hypotension, and presence of WBCs

c. Hyperproteinmia, proteinuria, hematuria, and decreased coagulability

d. Hyperalbuminemia, lipiduria, presence of RBCs and casts

a. Hypoproteinemia, hypoalbuminemia, edema, hyperlipidemia and hypercoagulability

Which is NOT a risk factor for acute renal failure?

a. Atherosclerosis

b. Hypertension

c. Diabetes mellitus

d. Youth

d. Youth

Which is a classic finding in renal failure?

a. Crystals in the urine

b. Increased phosphorus

c. Increased calcium

d. Protein in the urine

b. Increased phosphorous

A patient presents with jugular venous distention, bounding pulses, rales in the

lungs, and peripheral edema. What causes these symptoms in chronic renal failure?

a. Azotemia

b. Hypocalcemia

c. Inability to excrete fluid

d. Hypertension

c. Inability to excrete fluid

Which of these is NOT restricted in nutrition when in renal failure?

a. Protein

b. Carbohydrates

c. Sodium

d. Fluid

b. Carbohydrates

Incontinence manifested by constant or intermittent dribbling is called:

a. Urge incontinence

b. Overflow incontinence

c. Mixed incontinence

d. Stress incontinence

b. Overflow incontinence

What predisposes an elderly person to cystitis?

a. Obesity, chronic illness such as diabetes, and sexual relations

b. Lack of exercise, arthritis, and decreased estrogen in women

c. Benign prostatic hypertrophy, diabetes mellitus and bowel incontinence.

d. Urinary incontinence, neurologic illness and thirst

c. Benign prostatic hypertrophy, diabetes mellitus and bowel incontinence

Normal cells commit suicide. Which of the following is the term for this cellular

suicide?

a. Apoptosis

b. Anaplasia

c. Proto-oncogene

d. Suppressor genes

a. Apoptosis

Odansetron* is a common anti-emetic drug. What imbalance may it prevent?

(remember drug name)

a. Hypoxia

b. Hypokalemia

c. Mixed acidosis

d. Metabolic alkalosis

d. Metabolic alkalosis

What is expected when a client experiences chronic stress?

a. Increased energy

b. Reduced urine output

c. Reduced productivity

d. Heightened awareness

c. Reduced productivity

Which of the following could produce conductive hearing loss?

a. Bug in ear

b. Removal of dry cerumen

c. Disease of cochlear system

d. Listening to iPod set at '10'

a. Bug in ear

Which of the following may result in a sensorineural hearing loss?

a. Congenital absence of outer ear

b. Cochlear damage

c. Impacted cerumen in ears

d. Bean inserted into external auditory canal

b. Cochlear damage

A patient with diabetic ketonuria develops hypokalemia during treatment. What

mechanism is responsible for this finding?

a. Decrease in serum pH

b. Activation of active transport mechanism in kidneys

c. K+ follows glucose into cells

d. Increase in cardiac output

c. K+ follows glucose into cells

when maintained well, maintains skin and mucous membranes and is also essential in reducing host susceptibility

nutrition

pts with advanced cancer are often ____

malnourished

involves the administration of a nutrient mixture directly into a peripheral vein

total parenteral nutrition

asymptomatic disease with mild discomfort, diarrhea, or constipation and flatulence which can be excused for other reasons

diverticulosis

• includes the pituitary gland, the two adrenal glands, the thyroid gland, the four parathyroid glands, the endocrine portion of the pancreas, the gonads, the pineal gland, and the thymus

• secrete hormones directly into the blood, in contrast to exocrine glands that secrete into a duct

endocrine glands

chemical messengers that affect blood glucose levels, including insulin, glucagon, epinephrine, cortisol, and growth hormone

hormones

• develops more frequently in patients with Type 2 diabetes; often the patient is an older person with an infection or one who has overindulged in carbs, thereby using more insulin than anticipated

• condition may be difficult to diagnose initially; severe cellular dehydration results in neurologic deficits, muscle weakness, difficulties with speech, and abnormal reflexes

• #1 nursing intervention with a patient who has HHNC is:

  maintain a patent airway!

• hyperglycemia and dehydration develop because of the relative insulin deficit, but sufficient insulin is available to prevent ketoacidosis

HHNC

• women have higher risk for osteoporosis

• low bone mass

• children & elderly: 2 most critical stages of life in which osteoporosis can develop

• common in older individuals, especially postmenopausal women with estrogen deficiency

• osteoblastic activity is less effective with advancing age

• decreased mobility, hormonal factors, calcium D deficits, low vitamin D, and low protein= factors of osteoporosis

risks of osteoporosis

positive results of a pregnancy test are based on the presence of this

hCG

some pregnancy tests can detect pregnancy as early as:

the first day following a missed period

a second pregnancy test is recommended within a ___ if the first test is negative

week

this kind of pregnancy test should be performed if it is ectopic

serum pregnancy test

this level is expected to double about every 48 hours in a normal pregnancy; if failed to double, the pregnancy may be ectopic

beta- hCG

• the sterile gut of a newborn lacks intestinal bacteria necessary for the synthesis of this vitamin

• required for the production of clotting factors such as prothrombin and fibrinogen

• administered to newborns to prevent hemorrhagic disorders

vitamin K

manifestations include heavy feelings over the chest, shortness of breath, tachycardia, cough, dysphagia, hiccups, hoarseness, nausea, vomiting, excessive perspiration, decreased level of consciousness, pulses paradoxes, distant or muted heart sounds, and extreme anxiety, neck vein distension

or medical emergency; pericardiocentesis with surgical repair as appropriate is needed (16-18 gauge needle inserted into pericardial space to relieve pressure and analyze fluid)

results from fluid accumulation in the pericardial sac, constriction of the pericardium by tumor, or pericarditis secondary to radiation therapy to the chest

cardiac tamponade

POTENTIAL QUESTIONS

-is increased with exercise.

-the "good" lipoprotein; has a low lipid content and is used to transport cholesterol AWAY from the peripheral cells to the liver, where it undergoes catabolism and excretion

-protects women until after menopause

-smoking decreases these levels

HDL levels

can lead to ventricular hypertrophy;

afterload, hypertension

• will lead to an increase in CO and maintenance of tissue perfusion

• indicative of angina pectoris; condition in which the heart has outgrown its blood supply

• an increase in the muscle mass and cardiac wall thickness in response to overwork and strain; occurs slowly because it takes time for increased muscle tissues to develop; generally follows persistent or chronic dilation and thus further increases the contractile power of the muscle fibers

hypertrophy

necessary when drugs have failed; is a short term bridge to cardiac transplantation; needed if acute myocardial infarction occurs with ventricular aneurysm accompanied by ventricular dysrhythmias, acute ventricular septal defect, acute mitral valve dysfunction, cardiogenic shock, or refractory chest pain with or without ventricular dysrhythmias

used when heart failure occurs

intraaortic balloon pump therapy

-dislodging of plaque, aortic dissection, and compromised distal circulation are common complications

-patients with this in place are prone to infection

IABP

-a "clot-busting agent" used to reduce the effects of CVA in some individuals

-contraindicated for anticoagulant drugs

tissue plasminogen activator (tPA)

-a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney

-the leading cause of end-stage renal disease in the US; about the same in patients with either type 1 or type 2 diabetes

-risk factors include hypertension, genetic predisposition, smoking, and chronic hyperglycemia

what characteristics does this describe

diabetic nephropathy

-if a diabetic patient is alert, they may develop this

-nonspecific S/S include: tachycardia, palpitations, fatigue, or altered mood

-most common nonspecific symptoms include: fatigue and depression, accompanied by other manifestations such as changes in energy level, alertness, sleep patterns, mood, affect, weight, skin, hair, personal appearance, and sexual function

diabetic polydipsia

a nonspecific response of the body to any demand made on it

stress

three stages of the general adaptation syndrome to stress

alarm reaction, stage of resistance, stage of exhaustion

activated in the endocrine system in response to stress

hypothalamus

prepare the body for flight-or-flight response

epinephrine and norepinephrine

the hypothalamus releases this in response to stress

CRH(corticotropin releasing hormone)

Essential for the stress response and play an important role in "turning off" or blunting aspects of the stress response

• stress= factors affecting this among individuals include external and internal influence; a nonspecific response of the body to any demand made on it

corticosteroids

• initiates starch digestion

• splits starch and glycogen into disaccharides

salivary amylase

-involves a progressive demyelination of the neurons in the brain, spinal cord, and cranial nerves

-characterized by remissions and exacerbations, but nevertheless is marked by progressive degeneration; second most common cause of disability in the US

-considered a disease of young to middle-aged adults with the onset usually being between 20 and 50 years of age

-related to infectious, immunologic, and genetic factors and is perpetuated as a result on intrinsic factors

-onset is often insidious and gradual with vague symptoms occurring intermittently over months or years

multiple sclerosis

very common disorder in older men, with an estimated 50% of men over 65 years experiencing some form varying from mild to severe

change is actually hyperplasia of the prostatic tissue with formation of nodules surrounding the urethra leading to compression of the urethra and variable degrees of urinary obstruction

occurs in older men, causing urinary obstruction, but is not associated with malignancy

BPH

-common occurrence when the contractility of the ventricle is reduced and stroke volume declines and may occur a few days after an MI or much later as activity is resumed

-occurs when the heart is unable to pump sufficient blood to meet the metabolic needs of the body; usually occurs secondary

-may present as an acute episode but usually is a chronic condition; may result from an infarction or a valve defects may arise from increased demands on the heart, such as those imposed by hypertension or lung disease

CHF

infarction of right ventricle,pulmonary valve stenosis, pulmonary disease

right-sided CHF

• the release of insulin antagonists by adipose tissue; an increased proportion of body fat results in insulin resistance and changes in metabolism

• changes in metabolism of lipids and glucose eventually leading to cardiovascular disease and Type 2 diabetes

metabolic syndrome

tachycardia can cause ___ cardiac output

reduced

• occurs perhaps when there is an abnormal decrease in systolic pressure during inspiration when the pulse differs on inspiration and expiration

• occurs with panic, infection, respiratory failure

tachycardia

the volume of blood ejected by a ventricle in one minute and depends on heart rate and stroke volume, the volume pumped from one ventricle in one contraction

cardiac output

-refers to a deficiency of adrenocortical secretions, the glucocorticoids, mineralocorticoids, and androgens; an autoimmune reaction is the common cause

-high risk of infection, poor stress response, weight loss, fatigue, anorexia, nausea, diarrhea, hypotension, syncope, hyperpigmentation

-affects blood glucose levels, fluid and electrolyte balance, and the stress response

Addison's disease

most common leukocyte, comprising 50% to 60% of WBCs, but survive only 4 days and are the first to respond to any tissue damage and commence phagocytosis

neutrophils

• will stimulate an increase in neutrophils, whereas allergic reactions or parasitic infections increase the eosinophil count

• as WBCs and platelets decrease this is likely

• (tetanus or osteomyelitis) are a threat in persons with compound fractures or when surgical intervention is required; precautions include wound debridement, application of a windowed cast, tetanus booster shots, and prophylactic antimicrobial therapy

infection

an increase in WBCs in the circulation often associated with inflammation or infection

leukocytosis

a specific defense responding to particular substances, cells, toxins, or proteins, which are perceived as foreign to the body and therefore unwanted or potentially dangerous

immune response

can distinguish self from non-self and can thus detect and destroy unknown material

immune system

all immune cells originate here

bone marrow

activate the immune system to produce matching antibodies

antigens

the first line of defense that blocks entry of materials or harmful substances

skin/mucous membranes

a fracture complication that may occur as local pain and irritation cause strong muscle contractions at the fracture site; pulls the bone fragments further out of position, causing angulation, rotation of a bone, or overriding of the bone pieces

muscle spasm

a complication that develops in a limb following treatment as edema increases during the first 48 hours after the trauma and casting; if peripheral area becomes pale or cold and numb or pulse decreases or is absent, it is likely that the cast has become too tight and is compromising the circulation in the limb

ischemia

may develop shortly after the fracture occurs when there is more extensive inflammation, such as with crash injuries; increase pressure of fluid within the fascia, (non-elastic covering of the muscle) compresses nerves and vessels, causing severe pain and ischemia or necrosis of the muscle; pressure effects may be aggravated by a cast

compartment syndrome

are a risk when fatty marrow escapes from the bone marrow into a vein within the first week after injury. More common in patients with fractures of the pelvis of long bones such as the femur, particularly when the fracture site has not been well immobilized during transportation immediately after the injury

fat emboli

one side of the body is paralyzed usually as a result from cerebral infarctions

hemiplegia

• occurs in people who experience a left-brain stroke; commonly slower in organization and performance of tasks and tend to have impaired spatial discrimination; behaviors are slow and cautious

• person may suddenly burst into tears of laughter

right hemiplegia

-leakage of protein and large numbers of erythrocytes into the filtrate; specific mechanisms of damage are not totally clear, but immunoglobulin G and C3 (complement) are present in glomerular tissue and serum C3 is reduced

-usually originate as upper respiratory infections, middle ear infections, or "strep throat", certain strains of staph are occasionally responsible for initiating the immune disorder in the kidney

-usually develops 10 days to 2 weeks after the antecedent infection; usually affects children between ages of 3 and 7, especially boys

-facial and periorbital edema occur initially, followed by generalized edema as colloid osmotic pressure of blood drops and sodium and water are retained

-leads to elevated blood pressure and edema

-antistreptococcal antibodies create an antigen-antibody complex that lodges in the glomerular capillaries, activates the compliment system to cause an inflammatory response in the glomeruli of both kidneys

glomerulonephritis

-filtrate travels through this and electrolytes and water are adjusted to the body's current needs

-furosemide acts on this to decrease reabsorption of sodium and water

-reabsorption of Na+ and Cl- in ascending limb; reabsorption of water in descending loop; concentration of filtrate

Loop of Henle

-can be acute or chronic, acute referring to a single episode, chronic referring to the long-term condition

-onset commonly occurs in children and some patients are no longer subject to attacks after adolescence

-bronchi and bronchioles respond to the stimuli with three changes, inflammation of the mucosa with edema, contraction of smooth muscle, and increased secretion of thick mucus in the passages

asthma

-involves acute episodes triggered by a Type 1 hypersensitivity reaction to an inhaled antigen

-in patients with this, the antigen reacts with immunoglobulin E on the previously sensitized mast cells in the respiratory mucosa, releasing histamine, kinins, prostaglandins, and other chemical mediators, which cause inflammation, bronchospasm, edema, and increased mucus secretion; also stimulates branches of the vagus nerve, causing reflex bronchoconstriction

extrinsic asthma

onset occurs during adulthood; in this disease other types of stimuli target hyper-responsive tissues in the airway, initiating the acute attack (respiratory infections, exposure to cold, exercise, drugs such as aspirin, stress, and inhalation or irritants such as cigarette smoke)

intrinsic asthma

occurs a few hours later after an asthma attack in which leukocytes are increased, particularly eosinophils, releasing additional chemical mediators such as leukotrienes, resulting in prolonged inflammation, bronchoconstriction and epithelial damage

second stage

• the destruction of the alveolar walls and septae, which leads to large, permanently inflated alveolar air spaces

• in some, there is a genetic deficiency of alpha1- antitrypsin, a protein that normally presents in tissues and body fluids that inhibits the activity of proteases, which are destructive enzymes released by neutrophils during an inflammatory response

• lungs appear to have many large holes in them (blebs or bullae)

• onset is insidious and dyspnea occurs first on exertion and then progresses until it is marked even at rest; hyperventilation with a prolonged expiratory phase, use of accessory muscles, and hyperinflation leading to development of a "barrel chest"; anorexia and fatigue contributing to weight loss; clubbed fingers and secondary polycythemia may develop as compensations

Which of the following increase lung compliance?

a. Pneumonia

b. Emphysema.

c. ARDS

d. Pulmonary edema

emphysema

deep vein thrombosis

• pulmonary embolus due to this is the leading cause of death in hospitals

• the formation of a thrombus in association with inflammation in the vein; the most common disorder of the veins

• a disorder involving a thrombus in a deep vein, most commonly the iliac and femoral veins

occurs when the valves are dysfunctional or the muscles of the extremities are inactive; occurs more frequently in people who are obese or pregnant, have chronic heart failure or atrial fibrillation, have been traveling on long trips without regular exercise, have a prolonged surgical procedure, or are immobile for long periods

venous stasis

• occurs because of glucose intolerance and increased gluconeogenesis by the liver; high glucose levels due to lack of insulin

• deficit of insulin

What may unusual thirst in diabetic patient indicate?

a. Nephropathy

b. Hyperglycemia

c. Polyuria

d. Fluid overload

When experiencing stress, the effects of the epinephrine circulating in body will result in:

A. bradycardia.

B. decreased heart contractility.

C. increased skeletal muscle blood supply.

D. hyperglycemia.

D. hyperglycemia.

It will cause transient hyperglycemia. The epinephrine will increase heart rate and contractility. There will be increased venous return to the heart and, thus, increased cardiac output and blood pressure. Epinephrine dilates blood vessels of the muscles.

hyperglycemia

a process of wound healing that occurs when there is minimal tissue damage, damaged cells recover, and the tissues return to normal within a short period of time (ex: after a mild sunburn)

resolution

wound healing that occurs in damaged tissue in which the cells are capable of mitosis; some types of cells are constantly replicating, here as other cells such as hepatocytes in the liver are able to undergo mitosis when necessary; damaged tissue is thus replaced by identical tissue from the proliferation of nearby cells

regeneration

refers to the process involved when the would is clean, free of foreign material and necrotic tissue, and the edges of it are held close together, creating a minimal gap between the edges; seen in some surgical incisions

first intention healing

refers to a situation in which there is a large break in the tissue and consequently more inflammation, a longer healing period, and formation of more scar tissue; a compound fracture would heal in this manner

second intention

exophthalmos

• occurs in hyperthyroidism and with Grave's disease

• evident by the presence of protruding, staring eyes and decreased blink and eye movements; results from increased tissue mass in the orbit pushing the eyeball forward and from increased sympathetic stimulation affecting the eyelids; if untreated, visual impairment may result from optic nerve damage or corneal ulceration

• type of infiltrative ophthalmopathy that is due to impaired venous drainage from the orbit, which causes increased fat deposits and edema in the retroorbital tissues; forcing the eyeballs outward

exophthalmos occurs in hyperthyroidism as a result of ____ accumulation in eye and ____ tissue

fluid/retroorbital tissue

first and most important step in stopping Laennec's syndrome

stop drinking!

goal treatment is to correct the underlying cause and to replace both water and any needed electrolytes

volume deficit

balanced IV solutions such as lactated ringer's solution are usually given and isotonic sodium chloride is used when rapid replacement is needed

fluid volume deficit

results from a loss of function, partial or total, of one or more components of the immune system leading to increased risk of infection and cancer

immunodeficiency

involve a basic developmental failure somewhere in the system (Ex: in the bone marrow's production of stem cells) the thymus, or the synthesis of antibodies

primary deficiencies

refers to loss of immune response resulting from specific causes and may occur at any time during the lifespan

secondary immunodeficiency (acquired)

patients on dialysis have an increased risk of infection by this

HIV

used to treat HIV

antiretroviral agents

releases ammonia

urease

ammonia

• an end product of protein metabolism in the liver or intestine, and then is converted by liver cells into urea for excretion by the kidneys

• a nitrogen waste resulting from protein metabolism in the intestine or liver, is removed from the blood and converted to urea, enabling it to be excreted by the kidneys

• correlates well with the signs of hepatic encephalopathy

• used to check kidney and liver functions

• conversion of ammonia typically occurs here

• elevation of this can result in hepatic encephalopathy secondary to liver cirrhosis