clinical pathophysiology questions

The nurse documents the presence of nystagmus when assessing a client. This can be interpreted as:

involuntary eye movements that preserve eye fixation on stable objects in the visual field.

Cortical blindness is the bilateral loss of the primary visual cortex. What is retained in cortical blindness?

Pupillary reflexes

The nurse is conducting a community education class on amblyopia. The nurse determines that the participants understand the concepts when they identify which time period as the time when amblyopia is generally diagnosed?

Infancy

The nurse is teaching parents of a toddler with amblyopia about the treatment plan. Which information does the nurse emphasize as most important?

Limit patching of the good eye to no more than 5 hours a day.

A client has been diagnosed with hemianopia. The client asks the nurse what this is describing concerning the eye?

Loss of half of the visual field in one eye

A client presents with copious amounts of yellow-green drainage, conjunctival redness, and chemosis to the right eye. A culture of the eye drainage reveals S. pneumoniae. The client most likely developed:

Bacterial conjunctivitis

An older adult client comes to the clinic reporting seeing flashing lights and small spots. The client tells the nurse that this has been going on for over 24 hours but now it is as if there is a dark curtain whenever the client opens the eyes. The client asks the nurse if this means that blindness is imminent. What diagnosis should the nurse suspect?

Retinal detachment

The ophthalmologist is performing a client’s annual eye exam and notes an increase in intraocular pressure. The condition most likely is the result of:

imbalance between aqueous production and outflow

The parents of a 6-month-old child who was born with a blocked tear duct are concerned because their child has been waking up the past few mornings with inflammation in the left eye and yellow, dried secretions preventing eye opening in spite of massaging the tear duct. The nurse would anticipate which of the following?

The child has developed dacryocystitis.

For complete function of the eyes, it is necessary that the two eyes point toward the same fixation point and that the retinal and central nervous system visual acuity mechanisms function. How many pairs of extraocular muscles does binocular vision depend on?

Three

Which of these clients' statements would be most suggestive of retinal detachment?

“I feel like there's a shadow that's blocking my vision.”

A client who is being treated in the critical care unit is experiencing a slowing of blood flow to the central retinal artery, ultimately resulting in edema of the client's optic papilla. Which assessment would most likely address the etiology of this health problem?

Monitoring of the client's intracranial pressure

An older adult client is scheduled for outpatient cataract surgery. While taking a presurgery history, which statement by the client correlates to the manifestations of cataracts, thereby verifying the client has received information about the condition?

“I have blurred vision in both my eyes and my vision is distorted.”

Amblyopia, or lazy eye, occurs at a time when visual deprivation or abnormal binocular interactions occur in visual infancy. Whether amblyopia is reversible depends on which factor?

Maturity of the visual system at time of onset.

The nurse is conducting a health promotion class on the prevention of blindness and vision impairment. The nurse determines that participants understand the information when they identify which vision disorder as most likely to have an infectious etiology?

Keratitis

Which visual deficit is a clinician justified in attributing to the normal aging process?

Presbyopia

Open-angle glaucoma is caused by an abnormality in the trabecular meshwork, which controls the flow of aqueous humor. Where is aqueous humor in a normal eye?

Canal of Schlemm

A young child is flying on a plane for the first time. As the plane begins its descent for landing, the child's ears begin to hurt. The flight attendant sees that the child is in pain and tells the child to swallow until the pain goes away. Which structure is the child using to equalize the pressure and relieve the pain?

Swallowing pulls air through the Eustachian tubes, allowing the air pressure to equalize in the inner ear

It is important to differentiate between the kinds of hearing loss so they can be appropriately treated. What is used to test between conductive and sensorineural hearing loss?

Tuning fork

A 72-year-old client admitted with congestive heart failure tells the nurse that lately they have been having difficulty hearing in the left ear. Which intervention should the nurse implement?

Assess for build up of cerumen

The nurse is caring for an older adult client with a suspected diagnosis of presbycusis. Select the most likely manifestation.

Sensorineural hearing loss caused by natural aging

A 38-year-old client who has begun to develop hearing loss is being evaluated by the nurse practitioner. The client tells the nurse that hearing improves when they are on the telephone and that chewing sounds very loud. What does the nurse practitioner suspect?

Otosclerosis

The nurse is caring for a pediatric client who has a diagnosis of acute otitis media (AOM). Which option for pain management should the nurse educate the family about related to AOM?

Incision of the tympanic membrane

The nurse is caring for a client diagnosed with labyrinthitis. The nurse explains that manifestations of this disorder are generally expected:

to resolve in 10 to 14 days.

The nurse is teaching a client who has tinnitus about suggested dietary modifications. What information is most important for the nurse to include?

“Try cutting down on foods high in monosodium glutamate.”

The nurse is preparing a client for a surgical procedure to create an endolymphatic shunt. The nurse understands that this procedure aims to relieve which symptom?

Vertigo

The nurse is conducting the Rinne test. What is included in this test?

Placing a vibrating tuning fork on the client's mastoid bone and in front of the ear in an alternating fashion

The educator of a geriatric unit is orienting new staff and is teaching strategies on communicating with older adults with impaired hearing. Which teaching point is most appropriate?

“Ensure that the hearing aid is in place, turned on, and properly functioning.”

A client, who travels frequently for work, reports intense ear pain during ascent from and descent into airports. The health care provider will recommend which category of medications to help alleviate this symptom?

decongestant nasal spray such as phenylephrine

A client with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from their health care provider about their diagnosis. The client is eager to avoid future episodes of vertigo and has asked the health care provider what they can do to prevent future episodes. How can the health care provider best respond?

“There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo.”

What is the nursing focus when the nurse performs a hearing test on a newborn infant?

Preventing developmental delays

The nurse is conducting a community education class on acute otitis media. Which statement by the participants indicates to the nurse that they understand the education?

It can be caused by a bacterial infection.

Presbycusis is degenerative hearing loss associated with aging. What is the first symptom of this disorder?

Reduction in ability to understand speech

The nurse is treating a client with a history of alcohol use disorder. The client's spouse tells the nurse that the client has no difficulty speaking and responds when spoken to but is having difficulty understanding what is being said. The spouse asks if the nurse believes the client needs a hearing aid. The nurse explains to the spouse that the client probably does not require a hearing aid but may be suffering from:

Receptive aphasia

A client is having difficulty with balance. The nurse understands that the area of the ear that impacts balance is:

Vestibular apparatus

A client's chart documents the finding of cholesteatoma. The nurse interprets this to mean that the client has:

cystlike mass in the middle ear

A nurse is interpreting the test results of  client’s screening test for cancer. If the client’s result is negative and the test has a 95% specificity, the nurse should conclude that theres a 95% chance of which outcome?

client does not have cancer 

A disease agent can affect more than one organ of the body, and more than one disease agent can affect the same organ of the body. Which term best describes this aspect of disease etiology?

multifactorial in origin

The nurse is performing an assessment on a newly admitted client with asthma and hears wheezes in the upper lobes of the lungs. When the nurse documents this finding , the nurse recognizes this to be:

a sign

The nurse documents which assessment data as a symptom?

report of pain

Which science is called on to study the risk factors in multifactorial diseases?

epidemiology

A client state, “I do not know why the health care provider (HCP) bothered discussing the prognosis for my illness with me since the outcome is not certain.” How will the nurse respond?

“Being aware of the prognosis helps you make decisions about treatment options”

A newly introduced diagnostic test has been found to produce unacceptably low levels of reliability. The nurse should recognize that the test:

yields inconsistent results when repeated

A client with hypertension is given an IV medication and has an anaphylactic reaction. This is considered to be:

a complication

The nurse is providing a prenatal class for a group of clients at the local community center. The nurse informs the group about the importance of taking their folic acid supplements for the prevention of neural tube defects. What type of prevention is the nurse providing?

primary prevention

Researchers have designed a study where the health of a large group of recent newborns will be followed for several years. What type of study is this?

cohort

Which attribute is a benefit of health care providers using an evidence-based practice guideline?

It directs research into forming a diagnosis and treatment for a certain condition

Which statement is an example of a prognosis?

The client’s chance of a full recovery is 50%

The Framingham cohort study examined characteristics of people who would later develop which disease?

coronary disease

The nurse notes a client’s sodium level is 147 mEq/L (147 mmol/L). The nurse uses this result to reach which conclusion?

the result is more than two standard deviations different from the majority of people

An infant has a difficult time passing through the birth canal and the health care provider uses forceps to deliver the child. In the process the facial nerve was damaged, resulting in a facial droop. Which condition does the nurse recognize this to be?

acquired defect

The nurse observes that blood pressure readings taken by a new licensed assistive personnel (UAP) are very different from what other nurses obtain. What does the nurse understand is occurring with these readings?

a lack of reliability of the readings of the UAP

A client has been admitted to the ICU with a myocardial infarction. After the client recovers from the acute course of the event and ready for discharge, the nurse provides information about the beta adrenergic blocker, atenolol, that the client will take to prevent complications after the MI. What type of prevention is the nurse providing?

tertiary prevention

Why are some diseases termed syndromes?

they are a compilation of signs and symptoms, characteristics of a specific disease state

The nurse is caring for clients with chronic illnesses. Which characteristics of chronic illness will the nurse apply when developing plans of care?

chronic illnesses may have periods of stability and acute exacerbations

A health care provider is examining a college student  who is exhibiting the classic symptoms of schizophrenia. In the course of the evaluation, the health care provider begins developing a treatment strategy based on what they know about the disease, available therapies, medications, and consequences of not following the treatment regimen. What aspect of the disease is the healthcare provider using?

natural history

A client develops an infection with a resistant organism while hospitalized for surgery. After treatment, there are no obvious signs of infection, but a culture shows that the organism is present. Which term describes the client’s status?

carrier status

Facility policies on wound dressing selection refer to a nurse to a dressing algorithm. The nurse anticipates that the algorithm will include:

A step-by-step decision-making tree for dressing selection

During an assessment, a client tells the nurse that they have suffered from asthma since childhood. They are not experiencing any symptoms at this time but takes an inhaled steroid medication daily. The nurse should document the asthma as being which type of condition?

chronic 

A nurse researcher is collecting data on the number of people who have current diagnosis of diabetes in a local population. Which term categorizes the aspect the nurse is collecting?

prevalence

A school nurse compares the number of cases of measles in one elementary classroom to the number of students in the school. Which term describes this type of comparison?

prevalence

Pathogenesis is the term used to describe the sequence of cellular and tissue events that occur from the time of first contact with an etiologic agent until the disease becomes evident. What is another way of defining pathogenesis?

how the disease process evolves

 The nurse is caring for clients with chronic illnesses which characteristic of chronic illness will the nurse apply when developing plans of care?

chronic illnesses may have periods of stability and acute exacerbations

A client has been taking a corticosteroid for the treatment of asthma for several months. The client has now developed manifestations of cortisol excess. The client has been informed that with the gradual weaning of the steroid, the signs and symptoms will abate. Which medical term best describes this process related to a specific disease state like asthma?

a syndrome

 A healthcare provider is providing care for a number of clients on a medical unit of a large, university hospital. The health care provider is discussing with a colleague the differentiation between diseases that are caused by abnormal molecules and molecules that cause disease. Which client most clearly demonstrates the consequences of molecules that cause disease?

a 30-year-old homeless client who has pneumocystis carinii pneumonia (PCP) and is HIV positive

A client is taking a synthetic thyroid hormone for the treatment of hypothyroidism. The client develops signs and symptoms of hyperthyroidism. The nurse refers to this adverse extension of disease development as:

complications

In 2014, an outbreak of Ebola virus disease began in west Africa in which there was a sharp increase in the number of people being diagnosed with this disease. At the same time, a very high proportion of those who were diagnosed died from the disease. The epidemiologic characteristics of this disease include:

increased incidence and high mortality

A nurse is conducting a staff development program on the determinants of health highlighted in Healthy People 2030. The nurse notes that the participants need additional education based on which statement?

Nursing practice should focus solely on the management of chronic disease

The nurse is counseling a group of clients about screening and diagnosing colon cancer. Place in order from least to most specific for colon cancer,the diagnostic procedures involved.

• gathering a list of risk factors such as age and family history 

• performing a stool for occult blood test 

• performing a colonoscopy to observe for polyps

• performing a tissue biopsy for cell morphology

The nurse is evaluating the results of a study where the rates of cardiovascular disease were compared in tobacco smokers versus nonsmokers. The nurse interprets the results for which type of study?

cross-sectional

The nurse is conducting a staff educational program on screening tests. The nurse determines that the participants understand the information when they identify the proportion of true positive test results in a given population as being:

positive predictive value

The nurse is aware that the major role of the kidneys in regular acid-base balance is to increase the production of which chemical component?

HCO3-

A client with ethylene glycol toxicity is restless, stating they have flank pain. What intervention should the nurse perform to minimize complications?

Increase IV fluids

Of the following clients, who would be at highest risk for developing hyperkalemia?

Client admitted for acute kidney injury following a drug overdose

The nurse is caring for the following group of clients. Which client is most likely to be diagnosed with respiratory alkalosis?

26-year-old client with anxiety who has been hyperventilating

In which client would the nurse be most likely to assess the signs and symptoms of an acid-base imbalance?

A client with chronic obstructive pulmonary disease (COPD) whose most recent arterial blood gases reveal a PCO2 of 51 mm Hg

Body weight consists of which percentage of body water?

60%

In which client would the nurse be most likely to assess the signs and symptoms of an acid-base imbalance?

a client with chronic obstructive pulmonary disease (COPD) whose most arterial blood gases reveal a PCO2 of 51 mm Hg

When caring for a client with hypomagnesemia, the nurse prioritizes assessment of which body system?

cardiac

A client has been diagnosed with metabolic acidosis. What assessment finding does the nurse expect?

decreased pH below 7.35

The nurse is aware that the major role of kidneys in regulating acid-base balance is to increase the production of:

HCO3-

The renal control mechanism of restoring the acid-base balance is accomplished through which process?

reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms

The nurse is caring for a client with a tumor obstructing the lymphatic system. For which consequence does the nurse assess?

fluid accumulating in the interstitial spaces distal to the tumor

Which clinical manifestation would lead the nurse to suspect a client has developed fluid volume excess?

weight gain

A nurse is caring for a client with severe liver failure. Knowing that the client’s condition has resulted in impaired synthesis of albumin, the nurse understands that the client’s generalized edema is resulted to which of the following?

decreased colloidal osmotic pressure

A client with a history of chronic kidney disease has a total serum calcium level of 7.9 mg/dL (1.98 mmol/L). While performing an assessment the nurse should focus on which clinical manifestation associated with this calcium level?

intermittent muscle spasms and reports of numbness around the mouth

The nurse is teaching an older adult about adapting to age-related physiologic changes. Which statement by the client prompts the nurse to provide additional teaching?

“I will reduce my total daily fluid intake.”

The nurse is caring for the following group of clients. Which client is most likely to be diagnosed with respiratory alkalosis?

26-year-old client with anxiety who has been hyperventilating

The nurse is caring for a client who has developed hypoxemia and tissue hypoxia. Which of these interventions does the nurse set as a priority intervention?

administration of supplemental oxygen

A client is admitted after losing 44 lbs over the past 3 months, largely due to frequent vomiting. What interventions should the nurse anticipate in the treatment of the client’s resulting acid-base imbalance?

fluid replacement with an intravenous solution containing electrolytes as prescribed

The nurse just received the laboratory results of a client’s calcium level. The nurse identifies a normal calcium level as:

8.5-10.5 mg/dl

A client has these ABG values: anion gap 20 mEq/L (20 mmol/L), pH 7.29, PCO2 37 mm Hg (4.92 mmol/L), HCO3- 11 mEq/L (11 mmol/L), base excess (-6 mmol/L). With what condition do these values correspond?

Lactic acidosis

A client with a blood glucose reading of 673 mg/dl (37.4 mmol/l) is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29; HCO3- level 19 mEq/L (19 mmol/l); PCO2 level 32 mm Hg. The nurse should prepare for which initial treatment orders?

initiation of an insulin IV infusion along with fluid replacement

Respiratory alkalosis can be caused by a respiratory rate in excess of that which maintains normal plasma PCO2 levels. What is a common cause of respiratory alkalosis?

hyperventilation 

Which buffer system acts immediately?

chemical buffer system

Which type of oxygen mask may be indicated for the patient in respiratory alkalosis?

Rebreather mask

What are signs of metabolic alkalosis?

Chvostek sign

Which is not a cause of metabolic acidosis?

vomiting

Which are treatments for respiratory acidosis?

Reversing sedative medication, intubation or BiPAP, hydration

Why does knowing what causes acid-base imbalances and what is happening in the body is important?

To guide treatment and prevention efforts