Patho Hesi Review Questions

A dissecting aneurysm is dangerous due to the fact that there is a tear in which layer of the vessel wall? Inner, middle, outer.

medial layer- allows blood to seep into the middle layer

A Pulmonary embolus can cause what kind of shock?

obstructive shock

A patient has type II diabetes, what symptoms should he expect? Select all that apply

A. Extreme Hunger

B. Excessive thirst

C. Polyuria

D. Salt craving

E. Quick accumulation of fat

A, B, C

Stenosis of the tricuspid valve would lead to what?

A. left sided heart failure

B. Right sided heart failure

C. Pulmonary regurgitation

D. pulmonary stenosis

B- because the tricuspid valve is located on the right side

#1 sign of right heart failure

peripheral edema and rapid weight gain

A patient comes into the ER and is shaking and states that she has a sharp pain that's in her upper stomach going all the way up into her back. Her labs come back and show she is experiencing hyperglycemia and a high WBC count, what is she most likely experiencing?

A. Diabetes crisis

B. Type II diabetes

C. Cholilithiasis

D. Acute pancreatitis

D. Acute pancreatitis: sharp pain that radiates to the back

Pancreatitis can lead to

Type 1 diabetes

Which part of the ekg corresponds with atrial depolarization?

P wave

It is impossible for ventricular depolarization to occur during which part of the EKG?

S-T segment: ventricles have fully depolarized, absolute refractory period

Heart failure due to the heart muscle being underdeveloped and not strong enough to overcome the afterload would be chronotropic problem, dromotropic problem, or inotropic problem?

Inotropic problem= Strength of contraction

chronotropic

beats per min

dromotropic

rate of electrical conduction through heart

A patient comes in with red lesions on his arms which have a red flare around the border, what is this most likely?

A. Urticaria

B. Impetigo

C. Dermatitis

D. Boils

A. hives= Red flare around the border (#1 symptom)

A pulse pressure that is 78 would most likely indicate?

A. hypotension

B. hypertension

C. shock

D. TBI

D. traumatic brain injury= increased ICP= Cushing's Triad

120-80= what?

pulse pressure

Any pulse pressure over 60 is considered

widened

The diastolic pressure is measured during what on an ekg?

From the T wave (ventricles have stopped beating/contracting) to the beginning of the R wave (ventricles begin to fully contract)

Heart spends more time in diastolic

Does the sympathetic nervous system increase or decrease the peripheral vascular resistance?

increase- because BP increases because of vasoconstriction

A patient is receiving a blood transfusion when he starts stating that he's getting itchy. What is your first intervention?

A. Stop the transfusion

B. Administer Benadryl IM and monitor for worsening of symptoms

C. Check blood pressure

D. Ask the patient if he's short of breath

A. stop the transfusion

An absent P wave could indicate that which part of the heart is not functioning properly?

Atria or SA node

Frank starlings law states that when a heart muscle works hard over a period of time, is it the muscle or contractility that increases?

Muscle increases, Contractility decreases

What is the number one risk factor for dilated ventricular hypertrophy?

Hypertension

who is most likely to have hypertension?

Men, African Americans

A patient comes in with severe burns after being trapped in a building for 2 hours. The patients electrolytes and hemoglobin levels are increased and the patients blood pressure is 80/45 upon arrival heart rate 130 and the patient is not responsive. What is this most likely classified as?

A. Burn injury

B. hyperkalemia

C. hypovolemic Shock

D. hypokalemia

C. When you have a burn injury, you lose a lot of fluids. This is why the BP is so low.

main symptoms of shock

BP is low, severely dehydrated, heart rate increased

What is the primary symptoms associated with an abdominal aneurysm?

A. pulsing area on stomach with upper GI pain

B. Black tarry stools

C. hypertension

D. hypotension

A. pulsing area on stomach with upper GI pain

A patient who has vasospasms of the outer arteries in the extremitites complains of paleness in her finger with pain that comes and goes, these are the symptoms of?

Peripheral vascular disease or Raynaud's phenomenon

what should people with peripheral vascular disease avoid?

touching cold things with their hands

intermittent claudication

pain that comes and goes

What is characterized by a honey colored crust around the mouth?

impetigo

After having Peptic ulcer disease for a month a man comes into the ER complaining of a horrible abdominal pain. The nurse finds his abdomen is hard and rigid. What is it?

A. Appendix rupture

B. Peritonitis

C. Gallbladder rupture

D. Intestinal blockage

B. peritonitis

#1 sign of peritonitis

Abdomen hard and rigid

A patient presents with fluid around his heart, chest pain, and a friction rub.

A. pericardial effusion

B. cardiac tamponade

C. pericarditis

D. Ineffective endocarditis

C. pericarditis

#1 sign of pericarditis

friction rubs

A patient comes in with osteomyelitis, which of the risk factors was the primary cause for his disease?

A. Immunosupressive drugs

B. compound fracture

C. HIV

D. comminuted fracture

B. Compound fraction

A patient is diagnosed with albinism at birth. What defects will he most likely deal with through his life?

Vision problems

High risk for skin cancer

A patient comes into the ER complaining of feeling light headed all day and collapses in front of you, its found the patient has a BP of 98/42, pulse of 50 bpm, and a decreased cardiac output. What is the patient most likely experiencing?

A. pericarditis

B. cardiac tamponade

C. Cardiogenic Shock

D. Right sided Heart failure

C. Cardiogenic shock

What is the term used to describe the eye bouncing back and forth?

nystagmus

Acne vulgaris is caused by an inflammation of what specific part of the skin?

Sebaceous follicle

A patient comes in with scaly, white patches on his elbow and a high WBC count?

Psoriasis

How to treat psoriasis?

Steroid cream to put over infected area

Athletes foot is treated using what?

A. antibiotics

B. warm compresses

C. antifungal agent

D. ablative agent to affected area

C. antifungal agent

Cardiac output is calculated using what two factors?

Stroke volume and heart rate

A patient asks you how the heart is always beating in a person, which of the following is the most accurate description?

A. the brain sends an impulse to the SA node in your heart which makes it beat

B. The brain sends an impulse to the AV node which makes it beat

C. the heart just beats because that's what its meant to do

D. the heart makes itself beat by the SA node stimulating the heart

D. Heart makes its own electrical impulses

A patient comes in with a skin abscess full of pus deep in the skin. What is the name of this and how is it treated primarily?

It's a carbuncle, treat it by lancing and draining it

What virus causes warts?

HPV

A patient who contracts chickenpox as a child is at risk for what disease later in life?

Shingles (pain, rash that follows course of a nerve)

A burn puts a patient at most risk for what electrolyte imbalance?

Risk due to cellular damage- potassium (hyperkalemia)

Cells die and rupture causing massive release of K

Blistering is an example of what degree of burn?

2nd degree burn

A small bump on the skin that has a pearly sheen along with vessels on the surface matches the description of?

Basal cell carcinoma

Melanoma usually begins in what?

a mole

What are the four criteria used to help diagnose melanoma?

Asymmetrical

Border (uneven)

Color

Diameter greater than 2mm

A patient can be considered immunocompromised if what cell is absent?

A. erythrocytes

B. eosinophils

C. thrombocytes

D. Neutrophils

D. neutrophils are the main WBC in your body. If they are absent you will be immunocompromised.

A patient undergoes a kidney transplant and during patient teaching which response from the patient alerts you that further teaching is necessary?

A. I will have to take immunosuppressants for the rest of my life

B. I will have to take immunosuppressants until my body adjusts to the new kidney and my WBC count goes down

C. I will always be at a higher risk than other people for infection now

D. This kidney will work fine in my body.

B is false so it requires further teaching

The presence of reed Sternberg cells is diagnostic criteria for what lymphoma?

Hodgkin's Lymphoma

What is the normal count for platelets?

150,000-400,000

What is the factor which begins the coagulation process?

von Willebrand factor (Makes platelets adhere to the vessel wall)

What is the term for having an overproduction of red blood cells?

Polycythemia

What two factors needed for blood coagulation are obtained through dietary sources?

Vitamin K (made by bacteria in stomach, babies given vit. K shot)

calcium (need to make clotting factors)

A patient tells you the doctor told her that her son is diagnosed with Christmas disease. You answer knowing this disease will cause her son to

A. eventually go into hypovolemic shock

B. will cause his WBC count to be elevated

C. will lead to left sided heart failure

D. will have to take a medication for the rest of his life

D. Christmas disease= hemophilia B- lack of factor IX

A patient is going through childbirth when she suddenly screams in pain and her placenta ruptures. Later on you notice her platelet count is at 65000 and she has petechiae on her lower extremities, your action as a nurse is based on the knowledge that?

A. This is a normal finding for childbirth and post-hemorrhage

B. This is a medical emergency that needs immediate intervention

C. She will need post-op checks every 15 minutes until her platelets begin to rise

D. She will need synthetic erythopoetin (epogen) immediately

B. This is DIC (placental emboli)

A patient comes in with a rbc count of 4.4 million, wbc- 4.8 thousand, and platelets- 150,100. this patient is diagnosed with? Pancytopenia, anemia, neutropenia, thrombocytopenia.

Neutropenia- because the WBC count is low

A patient comes in with acute gastritis. He complains for the past week he hasn't been able to exercise properly because he runs out of breath so easily. Your first intervention would be to?

A. Get chest x-ray stat to check for pleural effusion

B. Check WBC count

C. Check amounts of pepsin being secreted

D. Check amounts of intrinsic factor being secreted

D. Acute gastritis- can get pernicious anemia b/c he doesn't have enough intrinsic factor

The part of the EKG which corresponds with ventricular repolarization is?

T wave

A patients RBC count is 4.8 million and his hemoglobin count is 8.3 this is consistent with what disease?

Thalassemia (Lack of normal hemoglobin)

Normal RBC count, with abnormal hemoglobin

A patients RBC count is at 7.2 million, hemoglobin is 17, and his hematocrit is at 65. these are consistent with?

A. Polycythemia

B. Thalassemia

C. Anemia

D. Aplastic anemia

A. Super elevated lab values

Universal blood donor?

O-

Universal blood recipient?

AB+

Can rh positive receive rh negative blood?

yes

What are the four mechanisms used to treat an injury to the ACL?

Rest, ice, compression, elevation (RICE)

A patient is infected with an oppurtunistic infection 10 years after he was diagnosed with HIV, which of the following describes this individual?

A. Has become hypersensitive to the antigens of viruses

B. Is now classified as an autoimmune individual

C. Most likely has a WBC count of 5,000

D. Can be classified as immunodeficient

D.

What cell is the primary cell affected by HIV?

A. T8 cell

B. T4 Cell

C. NK cells

D. Neutrophils

B

A patient comes into the physician's office complaining of feeling as if she has no energy, has gained 20 pounds in the last two months and feels as if she's "always cold" which of these hormones would you suspect the patient is lacking?

A. Epinephrine

B. T2

C. T3&T4

D. ACTH

C. T3 & T4 (hypothyroidism)

A patient comes into the ER complaining of trouble breathing and enlargement of the neck which began occurring a month after she stopped eating iodized salt due to an allergy. Her symptoms describe what pathophysiology?

A. Hyperplasia of the jugular ligaments

B. Cushings syndrome

C. Thyroid storm

D. Goiter

D

A patient who has been taking T3 and T4 supplements due to hypothyroidism comes into the ER complaining of "a Feeling of doom for the last couple hours" his B/P is 170/110 and his pulse is 145 BPM suddenly the patient starts panting and asking where he is before collapsing to the ground. What is happening?

A. Myasthenia Crisis

B. Thyroid storm

C. Myxedema coma

D. Hyperthyroidism

B

The number one risk factor for atherosclerosis?

dyslipidemia

This is a buildup of high density or low density cholesterol?

low density

A patient asks what it means that he was just diagnosed with diabetes mellitus type II. What is the best explanation?

A. Your body is not producing the ADH it needs

B. Your alpha cells in the pancreas is producing insulin that is no longer effective

C. You have an autoimmune disease what has destroyed your insulin secreting cells

D. Your cells are becoming immune to insulin

D- cells are becoming immune to insulin

A patient comes in and its noticed that his face is very round and large, his BMI is 30, and a fat pad has developed between his shoulder blades. He also states that he has a cut on his arm from a week ago that has barely healed? You suspect which of the following.

A. Cushings syndrome

B. Addisons disease

C. Hypothyroidism

D. Low ACTH levels

A

Fat pad between shoulder blades could mean?

cushing's

down syndrome

too much steroid intake

A patient with emphysema comes in with a weight gain of 10 pounds in the last month, edema in the lower extremities, and poor activity intolerance the most likely cause of this is?

A. Left sided heart failure

B. Right sided heart failure

C. Cor Pulmonale

D. Empysema attack

C

A patient comes in and explains that he has been experiencing abdominal pain along with black tarry stools which began occurring about a week after a family vacation to his lake house. The doctor finds he has Peptic ulcer disease. What is the most likely cause of this?

A. High stress

B. Gastric cancer

C. GERD

D. Heliobacter pylori

D

A small boy comes into the ER vomiting and crying with pain that is radiating from his lower right side. Five minutes later he states that the pain has suddenly dissapeared and he feels fine. Ten minutes after that he suddenly begins screaming again stating the pain is worse than before. What has happened?

A. Appendix has ruptured

B. Peritonitis

C. Gallbladder rupture

D. Pancreatitis

A. Rebound tenderness and McBurney's Point= appendicitis

A man comes into the doctors office complaining of his stomach being in terrible pain for the last month and that he has had bloody diarrhea nine different times already today, these symptoms point towards?

A.Crohns disease- bad stomach cramping and malabsoprtion

B.Ulcerative colitis

C.Diverticulitis

D.Irritable bowel syndrome

B. Frequent bloody diarrhea= main symptom

Where in the body are glucocorticoids and aldosterone made?

A. Adrenal cortex

B. Adrenal medulla

C. Medulla Oblongota

D. Pancreas

A

The osmolarity of the extracellular fluid (ECF) is almost entirely due to __________.

sodium

The osmolarity of intracellular fluid (ICF) is related to many particles, with ____ being the primary electrolyte

potassium

______ is a hormone causes sodium retention (resulting in water retention) and potassium excretion.

aldosterone

__________ _______ is the gland that regulates calcium and phosphorus balance

parathyroid gland

Ca & phosphorous= inverse relationship

Urine osmolality and specific gravity increase indicates:

Overhydration or dehydration

dehydration

Specific gravity

how much stuff is in your urine

Increase= more stuff in urine aka dehydrated, concentrated

Decrease= less stuff in urine aka overhydrated, dilute

GFR: always above 60

A depressed, non compliant diabetic, alcoholic presents to the ER with disorientation and spasms. You should suspect which irregular lab value?

A. hypomagnesemia

B. hyperkalemia

C. hyponatremia

D. hypocalcemia

A. hypomagnesemia goes with alcoholism

A man just stopped drinking alcohol after 20 years of abuse present to the ER with a blood glucose of 280 mg/dl, fruity smelling breath, and an altered mental status. You should anticipate he will be treated with?

Insulin

He is in diabetic ketoacidosis (fruity smelling breath)

0.5% normal saline (HNS or 0.45% NS) & 2.5% dextrose in 0.45% saline (D2.5 45% NS) Are examples of what type of solutions?

Hypotonic solution- anything below 0.9%

Lactated Ringer's solution (LR) & 5% dextrose in water Are examples of what types of solutions?

isotonic solution

What three systems help maintain acid base balance? Select all that apply

A. respiratory system

B. Lymph system

C. Renal system

D. Buffer system

E. Muscoskeletal system

A, C, D

Patient on continuous NG suctioning is at risk for which acid base imbalance?

Metabolic alkalosis- Because you are taking the stomach acid out

Patient with diarrhea at risk for which acid base imbalance?

metabolic acidosis

Which of the following is the number one cause of cardiogenic shock?

A. Left sided heart failure

B. Right sided heart failure

C. myocardial infarction

D. Hypertrophic ventricular myopathy

C

In a patient with decreased breath sounds on the right side, tracheal deviation, and decreased oxygen saturation, what is likely to be the priority treatment?

Thoracentesis- inserting a needle and chest tube to relieve the pneumothorax (insert high)

Air floats (high), water sinks (low)