D027 ADVANCED PATHOPHARMACOLOGICAL
FOUNDATIONS 150 ACTUAL QUESTIONS AND 100%
CORRECT ANSWERS WITH CORRECT EXPLANATIONS
NEW!!!!!!!!!!!!!!!!!!!!!!!
A patient is brought to the Emergency Department with a gunshot wound to the
chest. The healthcare professional assesses an abnormality involving a pleural
rupture that acts as a one-way valve, permitting air to enter on inspiration but
preventing its escape by closing during expiration. What action by the healthcare
professional is the priority?
Draw arterial blood gasses.
Assist with a chest tube insertion.
Give the patient low-flow oxygen.
Assess for clubbing of fingernails. - ANS... -Assist with a chest tube insertion.
Feedback:In a tension pneumothorax, the site of pleural rupture acts as a one-way
valve, permitting air to enter on inspiration but preventing its escape by closing up
during expiration. As more and more air enters the pleural space, air pressure in the
pneumothorax begins to exceed barometric pressure. Air pressure in the pleural
space pushes against the already recoiled lung, causing compression atelectasis,
and against the mediastinum, compressing and displacing the heart, great vessels,
and trachea. This is an emergency condition requiring chest tube insertion or
immediate needle decompression. Arterial blood gas results will not change the
treatment plan. This patient may need oxygen if definitive treatment is delayed, but
it would need to be high-flow oxygen. Clubbing of fingernails occurs in chronic
hypoxemic conditions. The professional should assist with immediate needle
decompression or chest tube insertion.
A 2-year-old pediatric patient with limited medical history available arrives to an
urgent care with excessive irritability and crying. X-rays were obtained and noted
to have fractures of the metatarsals of the foot and left tibia. On exam, the nurse
notes that the patient seems to have a blue tint to both sclera, and she didn't seem to
react normally when the nurse was talking to her. Which diagnosis is most likely in
this case?
Osteogenesis imperfecta
,Calcium deficiency
Non-accidental trauma (physical abuse)
Osteomyelitis - ANS... -Osteogenesis imperfecta
Osteogenesis imperfecta (OI) is a genetic abnormality with predominant autosomal
dominant inheritance. OI affects bone integrity through a variety of collagen
defects. Depending on the type of OI, various manifestations may be concomitant
such as appearance of blue sclera, hearing deficits, short stature and/or dental
malformations.
A patient who has chronic kidney disease has hemoglobin of 7.2 mg/dL. What
treatment does the healthcare professional prepare the patient for?
Intrinsic factor
Vitamin B12
Vitamin D
Erythropoietin - ANS... -Erythropoietin
Anemia of chronic kidney disease can be successfully treated with erythropoietin.
Reduced erythropoietin secretion and reduced red cell production are evident in
anemia resulting from chronic kidney disease. Intrinsic factor is needed for the
absorption of vitamin B12. Vitamin D is important for calcium absorption.
A healthcare professional is assessing a patient who could have either
pyelonephritis or cystitis. Which differentiating sign would assist the professional
in making this diagnosis?
Difficulty initiating urine stream
Urinalysis confirmation of white blood cell casts
Spasmodic pain that radiates through the groin
Increased GFR - ANS... -Urinalysis confirmation of white blood cell casts
Clinical assessment alone is difficult to differentiate the symptoms of cystitis from
those of pyelonephritis. Urine culture, urinalysis, and clinical signs and symptoms
establish the specific diagnosis. When present, white blood cell casts indicate
pyelonephritis.
,A 23-year-old woman comes in for prenatal counseling. While completing her
family history, she reports her brother has cystic fibrosis. She does not know if she
is a carrier. She asks if her children will be affected by the disease.
What is an accurate way to determine the likelihood of this patient's children being
affected?
A sweat test
A genetic or a carrier test
A history and a physical
A fertility test - ANS... -A genetic or carrier test
The disease occurs when an individual inherits the mutated gene from each parent.
When only one mutated gene is inherited, the individual is labeled a carrier.
chance of the disease.
A 31-year-old man comes into the office for an exam. He is 6' 5 " with a high-
pitched voice, and he has a moderate degree of mental impairment. It is discovered
upon exam that his body hair is sparse, his testes are small, and he has
gynecomastia.
Which genetic disorder should this patient be tested for?
Klinefelter syndrome
Turner syndrome
Partial trisomy
Sex chromosome aneuploidy - ANS... -Klinefelter syndrome: a hereditary disease
also known as 47,XXY or XXY that manifests as the series of symptoms
described.
A six-month-old female infant with failure to thrive comes in to the office with her
parents. It is noticed upon exam that the patient has facial deformities and is
jaundiced. A complete blood count (CBC) is ordered, which reveals anemia. When
that patient's blood is examined under a microscope, the red blood cells appear
small and abnormally shaped. A mutational analysis is ordered, and alpha
thalassemia is diagnosed.
What is the likelihood of incidence of these parent's future children having alpha
thalassemia?
25%
100%
0%
50% - ANS... -25% or 1/4 chance
, A 64-year-old male truck driver comes in complaining of pain in his lower left
calf. He states he drives eight to ten hours per day. Upon exam, swelling and
mottled coloring are noted in the patient's calf. A D-dimer test is ordered and
comes back positive.
Which additional test should be ordered to confirm a diagnosis in this patient?
A CT scan
A Doppler Ultrasound
The D-dimer test again
A clotting factors test - ANS... -A Doppler Ultrasound is the initial test of choice
for patients who are not initially stratified according to clinical pretest probability
(PTP) as being low, moderate, or high risk for DVT.
A 54-year-old man comes into a clinic for a routine visit. His initial BP is 148/92.
After a recheck 15 minutes later, his BP is 140/90. He states he suffers from "white
coat hypertension." He states he has no history of high blood pressure and no
family history of high blood pressure.
Which nursing intervention would assist this patient in receiving a clinical
diagnosis of hypertension?
Ordering the patient a cholesterol level test
Checking the patient's blood pressure in three months
Completing a biochemical blood profile
Completing an ambulatory blood pressure assessment - ANS... -Completing an
ambulatory BP assessment.
Assessing blood pressure in a location of comfort like the home environment when
no professional is present will enable the ability to determine his blood pressure
under routine circumstances.
A 58-year-old woman comes in complaining of retrosternal chest pain, worsening
with recumbent position. She states she has had a low-grade fever for two days.
Upon exam, the patient has a friction rub. An EKG reveals sinus tachycardia with
inflammatory changes. An ultrasound is performed, and she is diagnosed with an
acute pericarditis.
Which condition would make pericarditis more likely in this patient?
Stroke
Hypertension
Lupus
FOUNDATIONS 150 ACTUAL QUESTIONS AND 100%
CORRECT ANSWERS WITH CORRECT EXPLANATIONS
NEW!!!!!!!!!!!!!!!!!!!!!!!
A patient is brought to the Emergency Department with a gunshot wound to the
chest. The healthcare professional assesses an abnormality involving a pleural
rupture that acts as a one-way valve, permitting air to enter on inspiration but
preventing its escape by closing during expiration. What action by the healthcare
professional is the priority?
Draw arterial blood gasses.
Assist with a chest tube insertion.
Give the patient low-flow oxygen.
Assess for clubbing of fingernails. - ANS... -Assist with a chest tube insertion.
Feedback:In a tension pneumothorax, the site of pleural rupture acts as a one-way
valve, permitting air to enter on inspiration but preventing its escape by closing up
during expiration. As more and more air enters the pleural space, air pressure in the
pneumothorax begins to exceed barometric pressure. Air pressure in the pleural
space pushes against the already recoiled lung, causing compression atelectasis,
and against the mediastinum, compressing and displacing the heart, great vessels,
and trachea. This is an emergency condition requiring chest tube insertion or
immediate needle decompression. Arterial blood gas results will not change the
treatment plan. This patient may need oxygen if definitive treatment is delayed, but
it would need to be high-flow oxygen. Clubbing of fingernails occurs in chronic
hypoxemic conditions. The professional should assist with immediate needle
decompression or chest tube insertion.
A 2-year-old pediatric patient with limited medical history available arrives to an
urgent care with excessive irritability and crying. X-rays were obtained and noted
to have fractures of the metatarsals of the foot and left tibia. On exam, the nurse
notes that the patient seems to have a blue tint to both sclera, and she didn't seem to
react normally when the nurse was talking to her. Which diagnosis is most likely in
this case?
Osteogenesis imperfecta
,Calcium deficiency
Non-accidental trauma (physical abuse)
Osteomyelitis - ANS... -Osteogenesis imperfecta
Osteogenesis imperfecta (OI) is a genetic abnormality with predominant autosomal
dominant inheritance. OI affects bone integrity through a variety of collagen
defects. Depending on the type of OI, various manifestations may be concomitant
such as appearance of blue sclera, hearing deficits, short stature and/or dental
malformations.
A patient who has chronic kidney disease has hemoglobin of 7.2 mg/dL. What
treatment does the healthcare professional prepare the patient for?
Intrinsic factor
Vitamin B12
Vitamin D
Erythropoietin - ANS... -Erythropoietin
Anemia of chronic kidney disease can be successfully treated with erythropoietin.
Reduced erythropoietin secretion and reduced red cell production are evident in
anemia resulting from chronic kidney disease. Intrinsic factor is needed for the
absorption of vitamin B12. Vitamin D is important for calcium absorption.
A healthcare professional is assessing a patient who could have either
pyelonephritis or cystitis. Which differentiating sign would assist the professional
in making this diagnosis?
Difficulty initiating urine stream
Urinalysis confirmation of white blood cell casts
Spasmodic pain that radiates through the groin
Increased GFR - ANS... -Urinalysis confirmation of white blood cell casts
Clinical assessment alone is difficult to differentiate the symptoms of cystitis from
those of pyelonephritis. Urine culture, urinalysis, and clinical signs and symptoms
establish the specific diagnosis. When present, white blood cell casts indicate
pyelonephritis.
,A 23-year-old woman comes in for prenatal counseling. While completing her
family history, she reports her brother has cystic fibrosis. She does not know if she
is a carrier. She asks if her children will be affected by the disease.
What is an accurate way to determine the likelihood of this patient's children being
affected?
A sweat test
A genetic or a carrier test
A history and a physical
A fertility test - ANS... -A genetic or carrier test
The disease occurs when an individual inherits the mutated gene from each parent.
When only one mutated gene is inherited, the individual is labeled a carrier.
chance of the disease.
A 31-year-old man comes into the office for an exam. He is 6' 5 " with a high-
pitched voice, and he has a moderate degree of mental impairment. It is discovered
upon exam that his body hair is sparse, his testes are small, and he has
gynecomastia.
Which genetic disorder should this patient be tested for?
Klinefelter syndrome
Turner syndrome
Partial trisomy
Sex chromosome aneuploidy - ANS... -Klinefelter syndrome: a hereditary disease
also known as 47,XXY or XXY that manifests as the series of symptoms
described.
A six-month-old female infant with failure to thrive comes in to the office with her
parents. It is noticed upon exam that the patient has facial deformities and is
jaundiced. A complete blood count (CBC) is ordered, which reveals anemia. When
that patient's blood is examined under a microscope, the red blood cells appear
small and abnormally shaped. A mutational analysis is ordered, and alpha
thalassemia is diagnosed.
What is the likelihood of incidence of these parent's future children having alpha
thalassemia?
25%
100%
0%
50% - ANS... -25% or 1/4 chance
, A 64-year-old male truck driver comes in complaining of pain in his lower left
calf. He states he drives eight to ten hours per day. Upon exam, swelling and
mottled coloring are noted in the patient's calf. A D-dimer test is ordered and
comes back positive.
Which additional test should be ordered to confirm a diagnosis in this patient?
A CT scan
A Doppler Ultrasound
The D-dimer test again
A clotting factors test - ANS... -A Doppler Ultrasound is the initial test of choice
for patients who are not initially stratified according to clinical pretest probability
(PTP) as being low, moderate, or high risk for DVT.
A 54-year-old man comes into a clinic for a routine visit. His initial BP is 148/92.
After a recheck 15 minutes later, his BP is 140/90. He states he suffers from "white
coat hypertension." He states he has no history of high blood pressure and no
family history of high blood pressure.
Which nursing intervention would assist this patient in receiving a clinical
diagnosis of hypertension?
Ordering the patient a cholesterol level test
Checking the patient's blood pressure in three months
Completing a biochemical blood profile
Completing an ambulatory blood pressure assessment - ANS... -Completing an
ambulatory BP assessment.
Assessing blood pressure in a location of comfort like the home environment when
no professional is present will enable the ability to determine his blood pressure
under routine circumstances.
A 58-year-old woman comes in complaining of retrosternal chest pain, worsening
with recumbent position. She states she has had a low-grade fever for two days.
Upon exam, the patient has a friction rub. An EKG reveals sinus tachycardia with
inflammatory changes. An ultrasound is performed, and she is diagnosed with an
acute pericarditis.
Which condition would make pericarditis more likely in this patient?
Stroke
Hypertension
Lupus
