NURS 6501 Advanced Pathophysiology (Walden University) – Exam Practice Questions (2025/2026 Update)

NURS 6501 Advanced Pathophysiology (Walden University) – Exam Practice Questions (2025/2026 Update) q1 A runner has depleted all the oxygen available for muscle energy. Which of the following will facilitate his continued muscle performance? Answer: Anaerobic glycolysis QUESTION What causes the rapid change in the resting membrane potential that initiates an action potential? Answer: Sodium gates open, and sodium rushes into the cell, changing the membrane potential from negative to positive. PG. 2 QUESTION A 12-year-old male is diagnosed with Klinefelter syndrome. His karyotype would reveal which of the following? Answer: XXY QUESTION A nurse is reviewing the pedigree chart. When checking for a proband, what is the nurse looking for? Answer: The person who is first diagnosed with a genetic disease QUESTION PG. 3 An aide asks the nurse why people who have neurofibromatosis will show varying degrees of the disease. Which genetic principle should the nurse explain to the aide? Answer: Expressivity QUESTION In teaching a patient with cirrhosis, which information should the nurse include regarding cholesterol? Answer: Cholesterol decreases the membrane fluidity of the erythrocyte, which reduces its ability to carry oxygen. QUESTION When a patient asks what causes cystic fibrosis, how should the nurse respond? Cystic fibrosis is caused by an _____ gene PG. 4 Answer: Autosomal recessive QUESTION How are potassium and sodium transported across plasma membranes? Answer: By adenosine triphosphate enzyme (ATPase) QUESTION The nurse would be correct in identifying the predominant extracellular cation as: Answer: Sodium PG. 5 QUESTION The early dilation (swelling) of the cell's endoplasmic reticulum results in: Answer: Reduced protein synthesis QUESTION What principle should the nurse remember when trying to distinguish aging from diseases? Answer: It is difficult to tell the difference because both processes are believed to result from cell injury. What is the diagnosis of a 13-year-old female who has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present? Her features include a short stature, widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair. PG. 6 Answer: Turner syndrome A eukaryotic cell is undergoing DNA replication. In which region of the cell would most of the genetic information be contained? Answer: Nucleolus The nurse is teaching staff about the most common cause of Down syndrome. What is the nurse describing? Answer: Maternal nondisjunction A 50-year-old male was recently diagnosed with Huntington disease. Transmission of this disease is associated with: Answer: Delayed age of onset PG. 7 A patient wants to know the risk factors for Down syndrome. What is the nurse's best response? Answer: Pregnancy in women over age 35 What is the role of cytokines in cell reproduction? Answer: Provide growth factor for tissue growth and development A newborn male is diagnosed with albinism based on skin, eye, and hair appearance. Which finding will support this diagnosis? Answer: Inability to convert tyrosine to DOPA (3,4 dihydroxyphenylalanine) Sodium and water accumulation in an injured cell are a direct result of: Answer: Decreased ATP production PG. 8 A nurse is reading a chart and sees the term oncotic pressure. The nurse recalls that oncotic pressure (colloid osmotic pressure) is determined by: Answer: Plasma proteins The ion transporter that moves Na + and Ca 2+ simultaneously in the same direction is an example of which of the following types of transport? Answer: Symport A 20-year-old pregnant female gives birth to a stillborn child. Autopsy reveals that the fetus has 92 chromosomes. What term may be on the autopsy report to describe this condition? Answer: Tetraploidy Why is potassium able to diffuse easily in and out of cells? Answer: Because the resting plasma membrane is more permeable to potassium PG. 9 Hypothyroidism A disorder caused by a thyroid gland that is slower and less productive than normal, does not produce enough T3 and T4 T3, T4, TSH Diagnosing hypo/hyperthyroidism T3/T4 = thyroid. TSH = Pituitary. T3/T4 abnormality = problem with THYROID. T3/T4 normal + TSH abnormal = Secondary thyroid problem If too much T3/T4, then TSH will be down. Vice Versa. calcium parathyroid glands responsible for regulating ___ levels. PG. 10 metabolism, temperature Thyroid produces hormones T3, T4, and plays big role in __, ___ regulation and growth and development iodine Brain cannot make T3 and T4 without ___ slows hypothyroidism everything ___. stimulates sympathetic nervous system, drowsy, lethargic constipated, food move slows, weight gain body temp increases PG. 11 Hyperthyroidism excessive activity of the thyroid gland: increased levels of T3, T4 and TSH loss Hyperthyroidism: burning calories at an excessive rate weight ___ stimulates sympathetic nervous system: alert, quick reflexes, increased HR & BP (fight or flight response_ Heat intolerance: increased body temp Active GI: diarrhea anterior pituitary gland the anterior part of the pituitary gland; an endocrine gland whose secretions are controlled by the hypothalamic hormones produces thyroid stimulating hormone (TSH) PG. 12 Cushing's disease (Remember: UP, UP, UP, DOWN, UP) HYPERnatremia, HYPERtension, INCREASED blood volume, HYPOkalemia, HYPERglycemia adrenal cortex outer section of each adrenal gland; secretes cortisol, aldosterone, and sex hormones Aldosterone Hormone that stimulates the kidney to retain sodium ions and water to regulate BP via angiotensin-aldosterone system, retention of sodium and secretes potassium PG. 13 cortisol stress hormone released by the adrenal cortex helps the body deal with stress such as illness or injury increases blood glucose breaks down fats, proteins, carbs electrolyte regulations Negative feedback Hypothalamus releases CRH corticotropin releasing hormone -- pituitary gland releases ATCH adrenocorticotropic hormone -- adrenal cortex to release cortisol increased Cushings disease has ___ secretion of cortisol PG. 14 decreased Addison's disease has __ secretion of cortisol and aldosterone Need to ADD some steroids syndrome Cushing ___ is when an outside cause results in too much production of cortisol, like treatment with steroids disease Cushings ___ is when an internal issue is causing over production of cortisol PG. 15 autoimmune Addison's disease is typically an ____ disorder where the body is attacking the adrenal cortex on top of the adrenal gland Cushing's ___ symptoms: skin fragile truncal obesity, small extremities with striae on them excessive hair "moon face" buffalo hump females -- no menstruation males-- ED hyperglycemia d/t high cortisol PG. 16 Addison's ___ symptoms: brownish hyperpigmentation of skin diarrhea, nausea hyponatremia d/t low aldosterone levels -- hyperkalemia hypoglycemia d/t low cortisol low bp, risk for vascular collapse going into shock Anti-diuretic hormone aka Vasopressin ADH is a hormone made by the hypothalamus in the brain and stored in the posterior pituitary gland. It tells your kidneys how much water to conserve. PG. 17 ADH constantly regulates and balances the amount of water in your blood. increase SIADH will have ___ in antidiuretic hormone decrease Diabetes insipidus will have a __ in ADH posterior pituitary gland stores and secretes ADH after hypothalamus produces ADH PG. 18 Pheochromocytoma a benign tumor of the adrenal medulla that causes the gland to secrete catecholamines (epinephrine, norpinephrine, dopamine, and dopa) leading to high BP, headache, sweating and symptoms of a panic attack. diabetic ketoacidosis acidity of the blood caused by the presence of ketone bodies produced when the body is unable to burn sugar; thus, it must burn fat (triglycerides and amino acids instead of glucose) for energy hyperglycemia hyperketonemia metabolic acidosis occurs mostly in type 1 diabetes mellitus cerebral, coma PG. 19 DKA causes nausea, vomiting, and abd pain and can progress to __ edema, __ and death deficiency DKA: hyperglycemia d/t insulin ___ causes an osmotic diuresis leading to marked urinary losses of water and electrolytes urinary excretion of ketones leads to additional loss of sodium and potassium inflammation Pericarditis is ___ of the pericardium, often with fluid accumulation in the pericardial space (pericardial effusion) cardiac tamponade acute compression of the heart caused by fluid accumulation in the pericardial cavity-- impairs cardiac filling leading to low cardiac output. PG. 20 infective endocarditis inflammation of endothelium that lines heart and cardiac valves. most commonly damages mitral valve, then aortic and tricuspid valves. commonly caused by bacteria that are normally present in the body. can also occur after an invasive medical or dental procedure. symptoms: valvular dysfunction, may affect organ systems, chest pain, CHF, clubbing, meningitis, low back pain, arthralgia, arthritis myocarditis inflammation of the myocardium with necrosis of cardiac myocytes biopsy shows inflammatory infiltrate of the myocardium with lymphocytes, neutrophils, eosinophils, and granulomas direct cardiomyocyte injury cased by an infectious or other cardiotoxic agent OR myocardial injury caused by an autoimmune reaction to an infectious or cardiotoxic agent PG. 21 aortic regurgitation (aortic insufficiency) incompetent aortic valve that allows backward flow of blood from the aorta into left ventricle during diastole aortic stenosis calcification of aortic valve cusps that restricts forward flow of blood during systole narrowing of the aortic valve, obstructing blood flow from the left ventricle to the ascending aorta during systole mitral regurgitation mitral insufficiency; incompetent mitral valve allows regurgitation of blood from the left ventricle back into left atrium during systole mitral stenosis PG. 22 narrowing of the mitral valve orifice that impedes blood flow from the left atrium to the left vetricle mitral valve prolapse Improper closure of the valve between the heart's upper and lower left chambers. billowing of mitral valve leaflets into the left atrium during systole pulmonic regurgitation pulmonic insufficiency; backflow of blood through incompetent pulmonic valve into the right ventricle causes blood from from the pulmonary artery into the right ventricle during diastole pulmonic stenosis PG. 23 narrowing of the opening and valvular area between the pulmonary artery and right ventricle narrowing of the pulmonary outflow tract causing obstruction of blood flow from the right ventricle to the pulmonary artery during systole deep vein thrombosis blood clot forms in a large vein, usually in a lower limb d/t impaired venous return, endothelial injury or hypercoagulability thrombi __ consist of thrombin, fibrin, and red blood cells with few platelets and without treatment can travel to the lungs causing PE Hypertension high blood pressure sustained SBP 130 PG. 24 BP= cardiac output x total peripheral vascular resistance (TPR) HTN leads to ↑ CO, ↑ TPR ADVANCED PATHOPHYSIOLOGY MIDTERM NUR 6501 WALDEN UNIVERSITY| COMPLETE ACTUAL EXAM| 150+ QUESTIONS AND CORRECT DETAILED ANSWERS| 2025/2026 A 4-year-old child appears listless for the last week. He complains of pain when he is picked up by his mother, and he is irritable when touching his arms or legs. Several large ecchymotic lesions have appeared on his right thigh and left shoulder. A complete blood count reveals a HgB=10.2, Hct=30.5%, MCV=96fL, platelet count of 45,000/ML, and WBC count of 13,990/ML. Examination of the peripheral blood smear reveals numerous blasts. The blasts lack peroxidasepositive granules but do contain periodic acid-Schiff (PAS)-positive aggregates and PG. 25 stain positively for TdT. Flow cytometry shows the phenotype of blasts to be CD19+, CD3-, and sIg-. What is the most likely diagnosis? A. Acute lymphoblastic leukemia (ALL) B. Chronic lymphocytic leukemia (CLL) C. Acute myelogenous leukemia (AML) D. Chronic myelogenous leukemia (CML) Acute lymphblastic leukemia A 3-year-old child of Italian ancestry presents with failure to thrive. Physical examination indicates hepatosplenomegaly. His hemoglobin concentration is 6 g/dL, and the peripheral blood smear reveals severely hypochromic microcytic red cells. Total serum iron level is normal. The reticulocyte count is 10%. Hemoglobin electrophoresis shows very little hemoglobin A. A radiograph of the skull shows maxillofacial deformities. What is the principle cause of anemia and other abnormalities in this patient? A. Reduced synthesis of hemoglobin F B. Reduced red blood cell survival from imbalance in the production of alpha and beta globin chains C. Relative deficiency of vitamin B12 D. Increased fragility of the erythrocyte membrane Reduced synthesis of hemoglobin F PG. 26 A 68-year-old previously healthy female has been feeling increasingly tired and weak for several months. She states that she has had black, tarry stools for several weeks. She is found to be anemic with a hemoglobin concentration of 9.3g/dL. The peripheral blood smear reveals microcytic and hypochromic blood cells. Which of the following conditions should be suspected as the most likely of her condition as indicated by the peripheral blood smear? A. Aplastic anemia B. Beta thalassemia C. Gastrointestinal blood loss D. Pernicious anemia Gastrointestinal blood loss A 76-year-old female notices that small, pinpoint to blotchy areas of superficial hemorrhage have appeared on her gums and on the skin of her arms and legs over several weeks. She is found to have a normal prothrombin time(PT) and partial thromboplastin time (PTT). Her CBC shows hemoglobin concentration of 12.7 g/dL, hematocrit of 37.2%. MCV of 80 fL/red cell, platelet count of 276,000/microliter, and WBC of 5600/microliter. Her template bleeding time is 3 minutes. Her fibrinogen level is normal, and there are no fibrin split products detectable. Which of the following conditions best explain these findings? A. Chronic renal failure B. Macronodular cirrhosis C. Vitamin B12 deficiency PG. 27 D. Vitamin C deficiency Vitamin C deficiency A young adult patient has just been diagnosed with Von Willebrand disease. Which of the following statements should you make to advise the patient of potential consequences of this disease? A. You may need an allogeneic bone marrow transplant B. You may have excessive bleeding following tooth extraction C. A splenectomy may be necessary to control the disease D. Expect increasing difficulties with joint mobility You may have excessive bleeding following tooth extraction Low dose aspirin is commonly used to reduce the risk of arterial thrombosis in patients who have suffered a myocardial infarction. Which one of the following steps in homeostasis is inhibited by aspirin? A. Synthesis of von Willebrand factor B. Aggregation of platelets C. Activation of factor Xa D. Synthesis of antithrombin III Aggregation of platelets PG. 28 A 24-year-old presents to the office with fatigue. On physical exam, the NP notices that she ispale with the following vital signs: HR 112, BP 98/64, resp 20, O2 sats 99%. Her CBC shows: WBC6,000, Hemoglobin 9.6, Hematocrit 30.2, MCV is decreased at 76. What is the mostly likely causeof this patient's anemia? A. Iron deficiency anemia caused by menstruation B. Beta Thalassemia of genetic origin C. Pernicious anemia caused by dietary deficiency D. Folate deficiency caused by alcoholism Iron deficiency anemia caused by menstruation A 65-year-old female presents to your office complaining of fatigue. She has a long of rheumatoid arthritis. A CBC reveals the following: Hgb=11.6 g/dL, Hct=34.8%, MCV=87 fL/red cell, platelet count of 268,000/microliter, and WBC count of 6800/microliter. The serum haptoglobin level is normal, and the serum iron concentration is 20 micrograms/dL. The total iron binding capacity is 195 micrograms/dL, and the percent saturation is 10.2. The serum ferritin concentration is 317 ng/mL. No fibrin split products are detected. The reticulocyte concentration is 1.1%. What is the most likely diagnosis? A. Beta- thalassemia major B. Anemia of chronic disease PG. 29 C. Acute blood loss anemia D. Iron deficiency anemia Anemia of chronic disease A 14-year-old male presents with high fever for ten days. Physical examination reveals scattered petechial hemorrhages but is negative for enlargement of the liver or spleen or lymph nodes. Bone marrow examination does not show any abnormal cells. The complete blood count (CBC) demonstrates a hemoglobin concentration (HgB) of 13.2 g/dL, hematocrit (Hct) of 38.9%, mean cell volume (MCV) of 93 fL, platelet count of 175,000/microliter, and white blood cell (WBC) count of 1850/microliter, with the differential count showing 1 segmented neutrophil, 98 lymphocytes, and 1 monocyte per 100 WBCs. What is the most likely cause of these findings? A. Overwhelming bacterial infection B. Acute lymphocytic (or lymphoblastic) leukemia C. Acute myeloid leukemia D. Aplastic anemia Overwhelming bacterial infection A 31-year-old male has a history of chronic anemia and painful crises with joint and abdominal pain. A head computed tomography (CT) scan reveals several small remote infarctions. During one of these acute crises, he is admitted with PG. 30 severe dyspnea. A CBC is performed. Which of the following morphologic findings for RBCs is most likely to be seen on the peripheral blood smear? A. Tear drop cells B. Schistocytes C. Sickle cells D. Spherocytes Sickle cells A 50-year-old male has a blood pressure of 160/95 mm Hg. If this condition remains untreated for years, which of the following cardiovascular alterations will be seen on a transthoracic echocardiogram and ECG? A. Left Ventricular Hypertrophy B. Left Ventricular Atrophy C. Left Atrial Atrophy D. Right Ventricular Hypertrophy Left ventricular hypertrophy A 65-year-old male with longstanding uncontrolled HTN presents to the office for evaluation of syncope. His vital signs are temperature=98.3, Pulse=85, RR=17, BP=165/85. Physical examination reveals a fourth heart sound and a 4/6 PG. 31 crescendo-decrescendo murmur heard at the right upper sternal border with radiation to the carotid arteries. His ECG reveals enlarged QRS waves, consistent with left ventricular hypertrophy. What is the most likely cause of his syncopal episodes? A. Mitral regurgitation B. Mitral Stenosis C. Aortic regurgitation D. Aortic stenosis Aortic stenosis A 63-year-old female presents to the emergency room with sudden onset of severe chest and back pain. She describes the pain as sharp and different from her anginal pain. Her past medical history is positive for HTN X 20 years. VS: HR 105, BP 160/105, RR 17. On physical examination, the NP notices that her pedal and radial pulses are not equal. What is the most likely cause of her chest pain? A. Unstable angina B. Aortic dissection C. Prinzmetal angina D. Acute myocardial infarction Aortic dissection PG. 32 A 45-year-old male collapsed suddenly while playing basketball. Bystander CPR and defibrillation was performed using an automatic external defibrillator or AED. When EMS arrived, the gentleman was awake and alert. The recorded rhythm strip on the AED shows tachycardia with AV dissociation (rate, approximately 220 bpm). Which arrhythmia induced his arrest? A. Nonsustained supraventricular tachycardia B. Sustained wide complex atrial tachycardia C. Wide complex ventricular tachycardia D. Narrow complex ventricular tachycardia Wide complex tachycardia A 44-year-old previously healthy male presents to the office complaining of increasing dyspnea on exertion and exercise intolerance over the last six months. The NP order a chest XRAY and transthoracic echocardiogram. The chest XRAY shows an enlarged heart and mild pulmonary edema. The echocardiogram reveals four-chamber cardiac dilation with an ejection fraction of 30% and mitral and tricuspid valve regurgitation. The patient is referred to the cardiologist who orders a CAT scan of the coronary arteries which is negative for obstructive coronary artery disease. What is the most likely underlying cause of the dyspnea? A. Idiopathic dilated cardiomyopathy B. Rheumatic heart disease C. Hemochromatosis D. Chagas disease PG. 33 Idiopathic dilated cardiomyopathy A 72-year-old female with a known cardiac history of coronary artery disease presents to the emergency room following a syncopal episode. She received a stent to the right coronary artery in 2017 and was noted to have an ejection fraction of 40% at that time. A 12 lead ECG reveals a regular rhythm with a rate of 35. What is the most likely cause of her bradycardia? A. Blocked pathway at or below the AV node B. Blocked pathway at or below the SA node C. Reentry pathway at or near the SA node D. Reentry pathway at or near the AV node Blocked pathway at or below the AV node A 43-year-old female is ten years post prosthetic aortic valve replacement secondary to infective endocarditis. Which of the following valvular conditions would be an expected finding? A. Paravalvular leak B. Aortic stenosis C. Aortic valve embolization D. Aortic regurgitation PG. 34 Aortic stenosis A 50-year-old male is admitted an acute myocardial infarction. His ejection fraction is noted to be 30%. He develops shortness of breath and his physical exam reveals crackles bilaterally. The bedside CXR indicates pulmonary edema. Which of the following best describes the pathological cause of the edema? A. Increased hydrostatic pressure B. Decreased plasma osmotic pressure C. Increased cardiac output D. Decreased central venous pressure Increased hydrostatic pressure The direction of blood flow and the clinical severity of symptoms in Tetralogy of Fallot is determined primarily by the: A. Presence of an atrial septal defect B. Diameter of the tricuspid valve C. Size of the left ventricle D. Degree of pulmonary stenosis Degree of Pulmonary stenosis PG. 35 A 36-year-old female presents to the ED with the chief complaint of acute SOB and anxiety that started suddenly 2 to 3 hours ago while she was working around the house. She denies chest pain. Her PMH is unremarkable. She takes oral contraceptives, but no other medications. Vital signs are temperature=99.1, RR=34, BP=148/90, pulse=100. Oxygen saturation is 94% on room air. Laboratory tests reveal WBC=7.1, Hgb=12.2, Hct=37.3, Na+=138, K+=4.7, Cl=109, HCO3=25, BUN=14, Cr=0.9, glucose=106. ABGs are obtained and reveal pH=7.52, HCO3=20, PaCO2=26, PaO2=70. CXR and ECG are normal. What type of acid base disorder does the patient suffer from? A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis D. Metabolic acidosis Respiratory alkalosis A 65-year-old male is brought for care by his wife because of headache, nausea, and fatigue. PMH is significant for small cell carcinoma of the lung diagnosed approximately 2 years ago. He also has a history of TIA (6 years ago) and mild CHF. Vital signs are as follow: temperature=99.8F, RR=18, BP=140/88, pulse=76. On examination, he is awake but somewhat lethargic. Physical examination is unremarkable. Laboratory tests reveal the following: WBC=8.3, Hgb/Hct=10.2/30.7, glucose=106, serum Na+=121 mEq/L, K+=4.3, BUN/Cr= 7.0/0.4. What is the most likely diagnosis? PG. 36 A. Syndrome of Inappropriate Anti-diuretic Hormone (SIADH) B. Diabetic ketoacidosis C. Diabetes Insipidus D. Compensated diastolic congestive heart failure SIADH Leo is a 40-year-old male who presents to the clinic with complaints of shortness of breath while doing yard work. He states he has had worsening of the shortness of breath throughout the summer. He states when he was younger, he had shortness of breath and coughed a lot at night. He was given an inhaler for a few years, but he hasn't had any trouble since he was about nine years old. Which findings are most suggestive of a diagnosis of asthma? A. Dry cough during exam, respiratory rate of 20 breaths/minute, and wheezing upon auscultation of posterior lower lung lobes. B. Dry cough noted during the exam, Sp02=96%, FEV1 80% predicted, and FEV1 increased 15% after administration of a short-acting bronchodilator. C. Bilateral wheezing noted on auscultation, Sp02=95%, and heart rate of 86 D. Pale, boggy nasal turbinates, dry cough, FEV1 80% predicted and FEV1 increased 5% after administration of a short-acting broncho Dry cough noted during exam, Sp02=96%, FEV1 80% predicted, and FEV1 increased 15% after administration of short acting bronchodilator. PG. 37 Which of the following symptoms is generally NOT considered a typical finding in someone with active tuberculosis infection? A. Weight loss B. Fever in the morning C. Night sweats D. Hemoptysis Fever in the morning A 43-year-old female presents to the clinic with a 2-day history of cough and fever. She states that she has felt tired for the past couple of weeks. Past medical history is unremarkable. On physical examination, she appears ill and has a persistent cough, productive of purulent sputum. She has crackles in her right posterior chest. BP=126/74, pulse=80, RR=24, temperature 102.2. WBC count is 14,000/mm3. What diagnostic test should be done first? A. Sputum culture B. CT chest C. Bronchoscopy D. Chest Xray Chest X-RAY PG. 38 Which of the following findings is expected with restrictive lung disease? A. Decreased expansion of the lung B. Increased lung tissue compliance C. Over inflation of the lung alveoli D. Increased lung volumes Decreased expansion of the lung A 55-year-old female presents to the clinic because she is "sick and tired" of this cough she has had for 5 years, and it is getting worse. The cough is often productive of watery mucus. She complains of worsening dyspnea on exertion and cannot climb a flight of stairs without taking a rest. She denies chest pain, paroxysmal nocturnal dyspnea, fevers, chills, and weight loss. PMH is significant for HTN and a 35 pack-year history of cigarette smoking. Vital signs are as follow: temperature=99.0, pulse=75, RR=21, BP=158/82. Physical examination reveals an obese woman in no acute distress. On lung auscultation, there are coarse breath sounds bilaterally, but no wheezes or crackles. Chest radiograph is significant for a flattened diaphragm. What is the most likely diagnosis? A. COPD B. Asthma C. Cor Pulmonale D. Bronchitis COPD PG. 39 Two weeks after an 80-year-old female with Staphylococcus aureus pneumonia received a course of antibiotic therapy she returns to the clinic complaining of ongoing fever. She states the productive cough has resolved. A chest radiograph reveals a 3 cm, rounded density in the right lower lobe whose liquefied contents form a central air-fluid level. There are no surrounding infiltrates. What is the most likely cause of the chest Xray results ? A. Abscess formation B. Recurrent pneumonia C. Pulmonary fibrosis D. Development of COPD Abscess formation A 66-year-old male is brought to the clinic with complaining of productive cough, fever, and chills for the past 2 days. The patient lives with his wife and is retired. PMH is significant for DM, for which he takes insulin; CHF, with an ejection fraction of 40%; and a history of renal insufficiency. He is alert and oriented. There is no history of smoking or alcohol use. On physical examination, he has crackles in the left lower lung. Cardiovascular examination is normal. Vital signs are temperature=103.3, BP=130/64, Pulse=128, RR=24. Oxygen saturation on room air is 97%. CXR shows infiltrates and consolidation in the left lower lobe of the lung. Laboratory test results show WBC=15, Hct=36, Na=142, glucose=167, BUN=36, Cr=1.5. What is the most likely diagnosis? A. Asthma PG. 40 B. Bronchitis C. Hospital acquired pneumonia D. Community acquired pneumonia Community acquired pneumonia A 70-year-old male has undergone an open cholecystectomy. Aggressive pulmonary toileting is necessary in the post-operative period because older adults have: A. Decreased residual capacity B. Increased vital capacity C. Increased alveolar surface area D. Decreased chest wall compliance Decreased chest wall compliance Which of the following elevated lab values on a CBC would indicate Macrocytosis? A. Mean corpuscular volume B. Mean corpuscular hemoglobin concentration C. Mean corpuscular hemoglobin D. red cell distribution width PG. 41 Mean corpuscular volume Which guidelines address the diagnosis and TX for COPD? A. GINA B. GOLD C. NHLBI D. JNCC VIII GOLD When working up your pt for suspected restrictive lung disease, the most important part of the workup is what? A. Complete H&P B. IMAGING C. LABS Complete H&P PG. 42 ABG: pH 7.34, PCO2 59, PO2 86, HCO3 28, what is the likely diagnosis? A. Acute metabolic alkalosis B. Acute respiratory acidosis C. Chronic respiratory alkalosis D. Chronic respiratory acidosis Chronic respiratory acidosis A 40 yo pt presents with watery diarrhea and abdominal cramps, she took antibiotics for a UTI. What is the likely diagnosis? A. C-Diff B. Helicobacter pylori C. Escherichia coli D. Bacillus cereus C-diff Pulmonary fibrosis, aspiration, and bronchiostasis are examples of restrictive lung disease, which statement is true? A. prohibits air from flowing out of alveoli, trapping air in the lungs PG. 43 B. Prohibits air from flowing into the alveoli by not allowing chest expansion C. There is an increase in the compliance of lung tissue D. Lung volumes are increased Prohibits air from flowing into the alveoli by not allowing chest expansion Which of the following signs are associated with hypocalcemia? A. Obturator signs B. Chandelier sign C. Chvostek sign D. Homans sign Chvostek sign The most common infection in persons with AIDS? (80% Occurrence) A. pneumocystic pneumonia B. Mycobaterium tuberculosis C. Legionnaires D. Cytomegalovirus Pneumocystic pneumonia PG. 44 How low must the CD4+ count be before a patient can be considered as having AIDS? A. 20,000 B. 200 C. 2,000 D. 2,500 200 The NP has learned that her patient's tumor is benign, what characteristics will the benign tumor have? A. Well differentiated B. High mitotic index C. not encapsulated D. Grow rapidly Well differentiated PG. 45 An echo indicated greatly hypertrophied left ventricular wall, what is most likely the cause? A. Chronic alcoholism B. Emphysema C. Acute AMI D. Hypertension Hypertension Pt with fatigue, pruritus, enlarged cervical lymph nodes. Biopsy reveals lymphohistiocytic cells A. non-classic hodgkin's lymphoma B. Classic hodgkin's lymphoma lymphadenopathy non-hodgkin's lymphoma Non-classic hodgkin's lymphoma Which of the following steps in homeostasis is inhibited by aspirin? A. synthesis of von willebrand factor PG. 46 B. Activation of factor XA C. Aggregation of platelets D. Synthesis of antithrombin III Aggregation of platelets An elderly pt with a productive cough and fever is diagnosed with PNA, All of the organisms are capable of causing PNA except? A. Treponema pallidum B. Mycoplasma pneumonia C. Haemophlilus Influenza D. Streptococcus penumonia Treponema pallidum Acute bronchitis can usually be diagnosed by which of the following? A. White blood cell count B. Clinical presentation C. sputum culture D. Chest X-ray Clinical Presentation PG. 47 NP suspects Systemic lupus, which lab result would you expect to see? A. Hemoglobin 12.2 B. Leukocyte count of 8,100 C. Proteinurea and hematuria on UA D. Serum creatinine of 1.2 Proteinurea and hematuria on UA A 52 yo WM with hx of alcohol abuse presents to ED for hemataemesis. 2 L of blood loss 6 hours. A. Variceal bleeding from cirrhosis B. Bleeding peptic ulcer C. Bleeding duodenal ulcer D. Mallory-weis tears Variceal bleeding from cirrhosis Pt has an MCV of 75. What type of anemia do they have? PG. 48 A. pernicious anemia B. Microcytic anemia C. Normocytic anemia D. Macrocytic anemia Microcytic anemia Pt presents with MCV of 86. What type of anemia do they have? A. Microcytic anemia B. Macrocytic anemia C. Normocytic anemia D. Pernicious Anemia Normocytic anemia Pt presents with an MCV of 106. What type of anemia do they have? A. Microcytic anemia B. Macrocytic anemia C. Pernicious anemia PG. 49 D. Normocytic anemia Mactocytic anemia What kind of patients are high risk for DIC? A. post-surgical patients B. Post bariatric surgery patients C. Post partum women D. All the Above All the above What are typical diagnostics used to diagnose an MI? EKG, Troponins and CPK True or False: Pt with unstable angina will have EKG changes false PG. 50 After further evaluation, you diagnose Alex with systemic lupus erythematosus. Which instruction would be included in the teaching plan for the patient? A. "Wear sunscreen and large brimmed hats when exposed to the sun." B. "Carry injectable epinephrine at all times in case of a flare-up." C. " Remove rugs, curtains, and other dust-collecting items from your home." D. "Tanning beds are safe to use, but avoid direct sunlight." Wear sunscreen and large brimmed hats when exposed to the sun Alex is a 25-year-old African American woman has presented to your clinic with complaints of increased fatigue, an unexplained 8 pound weight loss, and diffuse joint pain in her hips and knees for the past several months. She has also noticed a rash on her nose and cheeks that she says gets worse after being in the sun. Her past medical history is unremarkable, and she denies any allergies. You suspect systemic lupus erythematosus and order a full lab panel. Which of the following lab results would you most likely expect to see at this time? A. Hemoglobin of 12.2 g/dL B. Leukocyte count of 8,100 C. Proteinuria and hematuria on UA D. Serum creatinine of 1.2 mg/dL Proteinurea and hematuria on UA PG. 51 Mr. Cantorelli, a 38 year old personal trainer, comes in to the ER with complaints of shortness of breath and chest pain that feels like "someone pushing on my heart". His life partner, Mr. Gustafson, tells nursing staff that Mr. Cantorelli was diagnosed with HIV six months ago, right after the patient's brother died suddenly of "a massive heart attack." 12 lead EKG is unremarkable. Cardiac enzymes and troponin are negative. Physical exam reveals 3 enlarged lymph nodes in the neck and mild splenomegaly. What would you expect to see on the chest X-ray? A. Enlarged heart due to congestive heart failure B. Bilateral pneumothorax C. Multiple rib fractures D. Mediastinal mass Mediastinal mass Question 2: What chambers of the heart are affected with Dilated Cardiomyopathy? A. All 4 chambers will be enlarged and dilated B. Only the lower chambers (ventricles) are enlarged. C. No chambers are affected in Cardiomyopathies. D. Only the upper chambers will enlarged. All 4 chambers will be enlarged and dilated PG. 52 A 59 y/o white male is seen at the ER. He presents with shortness of breath. Upon examination, the nurse practitioner notes crackles in lungs, a systolic murmur at the midclavicular 5th intercostal space, irregular heart rate, and decreased distal pulses. ECHO is performed, but appears normal. LVH is noted on EKG. What is the most likely diagnosis for this patient? A. Restrictive Cardiomyopathy B. Hypertrophic Cardiomyopathy C. pneumonia D. Dilated Cardiomyopathy Hypertrophic cardiomyopathy Which of the following predisposing risk factors are NOT associated with the formation of atrial fibrillation? A.Valvular heart disease B.Asian descent C.Mitral valve prolapse D. Hypertension Asian descent PG. 53 A patient presents to the emergency department complaining of chest pain, lightheadedness, and palpitations. After obtaining an EKG, it is discovered that the patient is in a rhythm known as atrial fibrillation. We know this is caused from... A.The upper chambers of the heart beating too quickly B.Abnormal electrical signals in the lower chambers of the heart C.Rapid chaotic atrial impulse formation causing ineffective quivering of the atria Quivering of the ventricles Rapid chaotic atrial impulse formation causing ineffective quivering of the atria A 12-year-old boy is brought to the emergency room due to dyspnea. He has a known history of cystic fibrosis. What would be an expected finding in a person with this diagnosis on a chest x-ray? A. Hyperinflated lungs with bronchiectasis B. 3 cm cavity with an air-fluid level C. Bilateral infiltrates D. Pulmonary interstitial edema Hyperinflated lungs with bronchiectasis PG. 54 A sweat chloride test is ordered on a patient suspected of having cystic fibrosis. The result comes back as 21 mmol/L. What do these results indicate? A. The patient is positive for cystic fibrosis. B. The patient is positive for a CF metabolic syndrome. C. The patient is negative for cystic fibrosis. D. Further testing is needed to evaluate for cystic fibrosis. The patient is negative for cystic fibrosis Which of the following findings are NOT associated with cystic fibrosis? A. Meconium ileus B. Vitamin D deficiency C. Infertility D. Weight gain weight gain What is seen when diagnosing thrombolytic thrombocytopenia purpura? A. Headaches B. Neuro problems PG. 55 C. Schistocytes D. All of the above All of the above Mr. Wayne is a 42-year-old male who has hypertension and was recently diagnosed with mixed hyperlipidemia. He has been trying lifestyle changes for three months and his medications include lisinopril 10mg daily and one multivitamin daily. He comes into the office today to review his labs. His BP is 130/80, HR 90, BMI 34.8. His exam is unremarkable except for mild non-pitting edema to the ankles bilaterally. The nurse practitioner knows that, as part of the metabolic derangement, which of the following conditions is often observed in the early stages of development of Type 2 Diabetes Mellitus and often before abnormalities in the blood glucose are seen? A. Hyperlipidemia B. Retinopathy C. Atherosclerosis D. Hyperthyroidism Hyperlipidemia A 36 year old female presents to the clinic with a history of fatigue for the past few months. She admits to mild constipation that is not troublesome for her. She reports a 5 lb weight gain over the past 6 months, which she attributes to living a more sedentary life due to her fatigue. Her thyroid does not seem enlarged, although her face is slightly puffy. The remainder of her exam is unremarkable. PG. 56 The nurse practitioner orders thyroid function studies, which show an elevated Thyroid Stimulating Hormone (TSH). What is the most likely diagnosis? A. Grave's disease B. Addison's disease C. Hyperthyroidism D. Hypothyroidism Hypothyroidism Mrs. Patterson, a 62-year-old female, presents to the clinic to review lab results. Her only complaint is fatigue. Which two laboratory results would lead the Nurse Practitioner to suspect primary hyperparathyroidism? A. Hypercalcemia and hypophosphatemia B. Elevated Vitamin D level and Hypocalcemia C. Hypocalcemia and Hypophosphatemia D. Hyperkalemia and hypophosphatemia A. Hypercalcemia and hypophosphetemia A 55-year-old male had a fasting blood glucose level of 160 mg/dL 1 month ago. Today, his fasting glucose level is 140 mg/dL. He has a history of HTN that is controlled with an ACE inhibitor. He has no other medical problems. He is 5'11" and weighs 215 lbs. His father had DM, but the family history is otherwise noncontributory. This patient is asymptomatic, and his physical examination is unremarkable. What is the most likely diagnosis? PG. 57 A. Maturity Onset Diabetes of the Young (MODY) B. Addison's disease C. Type 2 Diabetes D. Cushing's syndrome C. type 2 diabetes A 13-year-old male has been drinking large quantities of fluids and has an insatiable appetite, even for a teenager. However, he is losing weight and has become more tired and listless over the past month. A complete blood count is normal, but he is found to have a fasting serum glucose of 175 mg/dL. A diagnosis of type 1 diabetes is made. What is the probable inheritance pattern of his underlying disease? A. Autosomal dominant B. Multi-factorial C. X-linked recessive D. Autosomal recessive B. Multifactorial Ms. Jackson, a 45 y/o female, complains of fatigue, weight gain, lack of concentration, and swelling for almost one year. The Nurse Practitioner thinks the patient could have hypothyroidism based on her clinical presentation. Which lab values would help to confirm Ms. Jackson's diagnosis of hypothyroidism? A. Increased TSH and decreased free T4 PG. 58 B. Increased TSH and increased T3 C. Decreased TSH and increased total T4 D. Decreased TSH and decreased free T4 A. increased tsh and decreased free t4 Mr. Mann, age 50, presents to the Emergency Department with his wife for complaints of palpitations, feeling of panic with shakiness, headache, nausea for the past two hours. Upon arrival BP is 210/105. His medical history is significant for GERD and HTN. He takes Prilosec OTC daily and lisinopril 10mg daily. He has no known medication allergies. His family history includes HTN and cardiovascular disease in father, osteoporosis, anxiety, and HTN in mother, and breast cancer in only sister. His wife states the patient did this a couple of weeks ago on two different occasions, but the symptoms went away in just one or two minutes. His physical exam reveals mild diaphoresis, epigastric tenderness, and generalized trembling. What diagnosis does this patient's presentation most closely represent? A. Myxedema Coma B. Addison's Disease C. Thyrotoxicosis D. Pheochromocytoma D. pheochromocytoma A 72-year-old male is brought to the ED in a coma. He was delivered to the ED from a nursing home and was reported by the nursing home staff to have had a PG. 59 seizure that lasted less than 1 minute. He was subsequently confused and soon thereafter entered a comatose state. His medical history is significant for Type II DM requiring insulin, HTN, and mild CHF. In the ED, the patient is very lethargic and responds only to painful stimuli. His vital signs are stable. The list of differential diagnoses that can cause seizure and coma. What is the most important diagnostic study to do immediately? A. Serum toxicology B. CT head without contrast C. CT head with contrast D. Serum glucose D. serum glucose A 2-year-old child who recently immigrated to the United States has failure to thrive. The child is short, with course facial features, a protruding tongue, and an umbilical hernia. Profound mental retardation is apparent as the child matures. These findings are best explained by a lack of: A. Somatostatin B. Cortisol C. Thyroxine (T4) D. Norepinephrine C. thyroxine PG. 60 A 36-year-old female presents to the clinic with a history of fatigue for the past few months. She does not have any other complaints. After a thorough medical history, she admits to mild constipation that is not troublesome for her. She reports a 5 lb weight gain over the past 6 months, which she attributes to living a more sedentary life of late due to her fatigue and lethargy. Her physical examination is unremarkable; her thyroid does not seem enlarged, although her face is slightly puffy. You order thyroid function studies, which show an elevated Thyroid Stimulating Hormone (TSH). What is the diagnosis? A. Hashimoto's thyroiditis B. Grave's disease C. Addison's Disease D. Cushing's syndrome A. Hashimoto's thyroiditis A 35-year-old female brings her 13-year-old son to the clinic reporting that he has developed some strange behaviors. She reports he cannot leave the house to go to school each morning without reorganizing his bookshelf and brushes his teeth 3 times before bed. She also expresses frustration that if daily plans change, he becomes tearful and hostile. You suspect that this child may have: A. post-traumatic stress disorder B. obsessive compulsive disorder C. depression D. social anxiety disorder B. OCD PG. 61 A 45-year-old male presents to the clinic with a chief complaint of a daily chronic, episodic headache for the past 7 weeks. He reports that he has been experiencing insomnia due to the symptoms which are waking him up at night. He reports that they last anywhere from 15 minutes to 3 hours. What is the most likely diagnosis? A. brain tumor B. migraine headache C. tension headache D. cluster headache D A 44-year-old male injection drug user is admitted with a 1 day history of increasing headache and high fever. Head computed tomography (CT) does not reveal a mass lesion or midline shift. A lumbar puncture is performed; the cerebral spinal fluid (CSF) protein concentration is increased, but the glucose level is decreased. Which of the following infectious agents is most likely to account for these findings? A. Mycobacterium B. Staphylococcus aureus C. Toxoplasma gondii D. Herpes simplex virus B PG. 62 A 66-year-old female presents after a transient episode of visual loss in her right eye. She reports that she had right sided headaches for several months, for which she takes ibuprofen, with some relief. On physical examination, she has tenderness over her scalp in the left temporal region and complains that her jaw "get tired with chewing." Neurological examination is normal with no focal deficits. Vital signs are as follows: temperature=101.1, pulse=72, RR=16, BP=140/82. What is the most likely diagnosis? A. Temporal arteritis B. Migraine headache C. Tension headache D. Cluster headache A A 4-year-old girl has been irritable for the past 2 days. She has not received her vaccinations. She has a temperature of 39.1 C. A lumbar puncture is performed, and the CSF shows numerous neutrophils, a slightly increased protein level, and a decreased glucose concentration. A gram stain of the CSF is most likely to show: A. L. Monocytogenes B. N. meningitis C. H. influenzae D. S. pyogenes C PG. 63 A 26-year-old woman is examined by a neurologist for decreased vision in her left eye. Clinical history reveals an episode of weakness several months earlier, which she attributed to job stress and fatigue. The neurological examination reveals mild residual weakness in her right lower extremity. The spinal fluid tap reveals increased IgG levels with prominent oligoclonal bands in the CSF. A brain MRI scan reveal small, scattered, o.5 cm areas consistent with demyelination, mostly located in periventricular white matter. What should the nurse practitioner tell the patient? A. Relapses and remissions will occur over many years B. No further neurological problems will be experienced C. This disease can be passed on to children D. Further debilitation and death will occur within 5 years A A previously healthy nurse practitioner student has headaches for several weeks. She has increasing malaise. A head CT scan shows no abnormalities. A lumbar puncture yields clear, colorless CSF with normal glucose and minimally elevated protein levels. A few lymphocytes are present, but no neutrophils. A CSF gram stain is negative as is the India ink preparation. Her condition gradually improves over the next several months. Serum serologic test are most likely to reveal an elevated titer of antibodies to: A. Toxoplasma gondii B. Echo virus C. Listeria monocytogenes D. Neisseria meningitis B PG. 64 A 35-year-old female has been experiencing muscular weakness for several weeks. When she drives her automobile for long distances, she notices difficulty keeping her eyes open because her eyelids droop, and she experiences double vision. While working at her job as a secretary, these problems get worse as the day progresses. Which of the following laboratory test findings is most likely to be present in this patient? A. Increased serum creatine kinase level B. Elevated serum antinuclear antibody level C. Increased serum level of acetylcholine receptor antibody D. Increased cerebrospinal fluid IgG protein concentration C A 40-year-old man complains to the nurse practitioner of severe stabbing pains behind his left eye for the past two days. They are accompanied by some nasal congestion and rhinorrhea, which is clear in color. The patient denies pharyngitis and fever. Which of the following conditions is most likely? A. Migraine headache with aura B. Cranial neuralgia C. Tic douloureux D. Cluster headache D PG. 65 After falling in the bathtub and striking her head, a 78-year-old female becomes increasingly somnolent. A day later, a head computed tomography (CT) scan demonstrates an accumulation of fluid beneath the dura, compressing the left cerebral hemisphere. What is the best term for this fluid collection? A. Hematoma B. Petechia C. Hematuria D. Ecchymosis A A 35 year old American Indian male presents to the clinic today complaining of abdominal pain in the RUQ that has persisted for over 24 hours. After running some tests, the patient is diagnosed with cholelithiasis. Based on what you know about the formation of gallstones, what would you expect to be the pathology behind this diagnosis? A.Decreased muscular wall motility B.Chronic inflammation of the gallbladder C.Presence of a foreign body D.Excessive bile that is saturated with cholesterol D. PG. 66 A 40 year old female presents to the ED with symptoms of cholelithiasis. After completing a comprehensive history and physical examination you decided to complete diagnostic testing to verify your diagnosis of cholelithiasis. Which of the following diagnostic test is the most sensitive in detecting gallstones. Abdominal Computed Tomography (CT) Abdominal X-ray Abdominal Ultrasound Magnetic Resonance Cholangiopancreatography C. A 43 y/o white male presents to the emergency room complaining of acute flank pain that radiates to the left groin, costovertebral tenderness, and nausea/vomiting. Vitals: BP 89/67, HR 110bpm, Temp 101.2, and RR 22per minute. Labs: WBC 14000. What is the appropriate treatment for this patient? A. Hydration therapy and CT Scan B. MET therapy and pain relief C. Urologic consultation for antibiotic therapy and renal decompression D. Antibiotic therapy and conservative therapy with analgesics and antiemetics C. PG. 67 You're providing education to a patient recently diagnosed with renal stones about the most common types of stones. You explain that the most common type of kidney stone is made of: A.Cholesterol B.Calcium and Oxalate C.Calcium and Phosphate Uric Acid B. The best diagnostic test to utilize for diagnosis of Polycystic Kidney Disease is... MRI/MRA Ultrasound 24 Hour Urine CT B. The "adult type" of Polycystic Kidney Disease has a mean age of diagnosis around 30-40yo. This type of Polycystic Disease is called PG. 68 Acquired Polycystic Kidney Disease Autosomal Recessive Kidney Disease Autosomal Dominant Kidney Disease Adult Onset Polycystic Kidney Disease C. According to the DSM-5, a diagnosis of schizophrenia is made if a person has two or more core symptoms. Which of the following are core symptoms of schizophrenia? Hallucinations and disorganized speech Distrust of others and Paranoia Grandiosity and inability to handle criticism Seeks attention and has strong opinions A. A 62 year old male diagnosed with schizophrenia presents to the clinic with disorganized speech and auditory hallucinations. The patient has been taking Aripiprazole (Abilify). The patient appears to be non compliant with the prescription medication. What would be another treatment option for this patient? Group therapy B. Haloperidol PG. 69 C. Electroconvulsive Therapy C. A 35 year old woman is considered infertile after _____ of trying to conceive. 1 year 4 months 6 months 3 months C. Which of the following are causes of male infertility? Genetic Disorders Hormonal Disruption Varicoceles All of the above D. What are three subjective symptoms of Type 1 Diabetes Mellitus? PG. 70 A. Dysuria, weight gain, dysphagia B. Polydispia, polyuria, polyphagia C. Fever, pruritus, fatigue D. Anorexia, nausea, weakness B. •A twenty-year-old is diagnosed with ALS and asks if he will very quickly lose his ability to swallow and talk. The most appropriate answer is: •A) Yes, you need to prepare for that because the kind of ALS that you have progresses very rapidly. •B) Because you are a male and not a female you are not likely to have juvenile ALS so that is an immediate concern •C) Because you are younger than 25, you are less likely to develop those bulbar symptoms rapidly although you may still develop them later. •D) ALS does not ever affect ones ability to swallow or talk. C. •What is the cure for ALS? •A) intravenous immunoglobulin (IVIG). •B) Neurontin and physical therapy •C) chelation therapy •D) None of the above. There is no cure. PG. 71 D. What 2 common bacteria cause the red hot painful swelling you see with cellulitis? Neisseria Meningitidis & Clostridium tetani B. Legionella micdadei & Mycoplasmas C. Staphylococcus & streptococcus D. Shigella typhi & Yersinia pestis C. The most commonly prescribed class of antibiotics for outpatient treatment of mild cellulitis caused by Group A Streptococci is: Penicillins Macrolides Fluoroquinolones Aminoglycosides A. All of the following are presenting symptoms of Parkinson's disease, EXCEPT: PG. 72 A. Unilateral symptom presentation B. Bradykinesia C. Tremor that occurs with activity and improves with rest D. Muscle pain and rigidity, often occurring in the shoulder C. A primary pathologic hallmark of Parkinson's disease is the deficiency of which neurotransmitter? A. Serotonin B. Dopamine C. Acetylcholine D. Norepinephrine B. ill was admitted to the hospital with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis? A. Progressive weakness that is worse at the end of the day B. Ascending paralysis and loss of motor function C. Visual disturbances, including diplopia D. Cogwheel rigidity and loss of coordination A. PG. 73 Your patient presents with weakness in his arms and legs that is worse after he has done any type of physical activity. This weakness is relieved by rest. What specific tests would you want to order? TSH, Free T4 CT of the mediastinum AChR antibodies and MuSK receptor antibodies Electrocardiogram C. What are early signs and symptoms of Rheumatoid Arthritis (RA)? Joint pain tenderness and swelling Loss of joint range of motion Limping All of the above D. Rheumatoid Arthritis is a disease process that causes abnormalities in which system of the body? PG. 74 Cardiovascular Integumentary Immune Digestive C. •A 35-year-old female comes into the clinic with complaints of a mole that has changed over the last several months. What findings would lead the nurse practitioners to think the patient may have melanoma? •A) The mole is symmetrical and 4 mm in diameter. •B) The mole has ragged borders and bleeds frequently. •C) The mole is uniform in color. •D) The mole has even borders and does not itch. B. •When providing patient education regarding the prevention of melanoma, what information should the nurse practitioner include? •A) Apply sunscreen with SPF 15 every 4 hours while outside. •B) It is okay to use a tanning bed for less than 10 minutes at a time. •C) Avoid direct sunlight exposure between 1000 and 1600. •D) It is unnecessary to perform self-examinations of your skin. PG. 75 C. Which of the following would confirm myasthenia gravis? a. increased levels of anticholinesterases b. presence of achr antibodies and musk receptor antibodies c. elevated levels of igG antibodies D. Increased levels of protein in the CSF with NL blood counts B. BRCA-1 Mutation is associated with A. Breast Cancer B. Colon Cancer C. Lung Cancer D. Pancreatic cancer A. PG. 76 treatment of acute prostatitis would include coverage of which organism? a. Staph aurues b. Enterobacter cloacae c. Steptococcus pyognese d. E.coli D. Very painful HA mostly affecting middle aged white males, associated with periorbital pain and occurs daily for weeks a. tension HA b. Migraine c. Cluster HA d. brain tumor C. Acute vesicular eruption due to infection with varicella-zoster virus a. stevens-johnson syndrome b. molluscum contagiosum PG. 77 c. herpes zoster d. rubella c. the pneumonic ABCDEE is used to diagnose... a. malignant melanoma b. basal cell carcinoma c. seborrheic keratoses d. squamous cell carcinoma a. which disorder is not an example of an x-linked recessive disorder? a. duchenne muscular dystrophy b. hemophilia c. color vision deficiency d. cystic fibrosis d. PG. 78 nocturnal hypoglycemia develops a stimulating surge of counter regulatory hormones is known as a. somogyi effect b. dawn phenomenon c. raynaud's phenomenon d. morgellon's disease a. state of intracellular dehydration as a result of elevated blood glucose levels a. HHNK b. DKA B. primary disease of the thyroid gland associated with high TSH low or normal T4 and hyponatremia and hypoglycemia. a. hyperthyroidism PG. 79 b. hyperaldosteronism c. hypothyroidism d. hypoaldosteronism c. acth hypersecretion by the pituitary gland leads too a. addison's disease b. grave's disease c. hashimotos thyroiditis d. cushing's syndrome D. Excessive urination and extreme thirst from inadequate output of pituitary hormone adh causes a. DI b. SIADH c. DMI d. DMII A. PG. 80 rare but serious disease resulting from catecholamine release a. essential htn b. adrenal hemorrhage c. pheochromocytoma d. sympathomimetic toxicity c. left knee pain for last 2 months, worse with climbing stairs. Which diagnostic test is most appropriate a. Xray b. CT c. MRI d. Pet A. PG. 81 An inflammatory arthritis affecting the spine and large joints that is diagnosed PE exam and Xray a. Rheumatoid b. Ankylosing spondylitis c. psoriatic d. osteoarthritis B. Which condition usually presents with an acute onset of focal neurological deficits a. hemorrhagic CVA b. CVA infarct c. TIA d. Status epilepticus A. Autoimmune disease marked by numbness, weakness, loss of muscle coordination, disturbances of vision, speech and bladder a. Gullian-barre PG. 82 b. myasthenia gravis c. ALS d. MS D. Benign, painless lesion. Looks stuck on. brown black or beige a. Actinic keratosis b. seborrheic keratoses c. seborrheic dermatitis d. pigmented nevi B. Numbness and tingling in hand and arm caused by pinched nerve a. MS b. ALS c. Carpal Tunnel d. Brown sequard syndrome C. PG. 83 Renal blood flow diminishes up to 10% per decade after the ages of 30-40 a. TRUE b. FALSE A. Quiz 1: NURS 6501 Advanced Pathophysiology Walden University 0 out of 1 points QUESTION A patient has severe mental retardation caused by a deletion of part of chromosome 5. What genetic disorder will the nurse see documented in the chart? Answer: Cri du chat syndrome PG. 84 QUESTION A 12-year-old male is diagnosed with Klinefelter syndrome. His karyotype would reveal which of the following? Answer: XXY QUESTION A 15-year-old female is diagnosed with Prader-Willi syndrome. This condition is an example of: Answer: Gene imprinting QUESTION A 20-year-old pregnant female gives birth to a stillborn child. Autopsy reveals that the fetus has 92 chromosomes. What term may be on the autopsy report to describe this condition? PG. 85 Answer: Tetraploidy QUESTION A 50-year-old male was recently diagnosed with Huntington disease. Transmission of this disease is associated with: Answer: Delayed age of onset QUESTION A eukaryotic cell is undergoing DNA replication. In which region of the cell would most of the genetic information be contained? Answer: Nucleolus QUESTION PG. 86 A newborn male is diagnosed with albinism based on skin, eye, and hair appearance. Which finding will support this diagnosis? Answer: Inability to convert tyrosine to DOPA (3,4 dihydroxyphenylalanine) QUESTION A nurse is reading a chart and sees the term oncotic pressure. The nurse recalls that oncotic pressure (colloid osmotic pressure) is determined by: Answer: Plasma proteins QUESTION A nurse is reviewing the pedigree chart. When checking for a proband, what is the nurse looking for? Answer: The person who is first diagnosed with a genetic disease PG. 87 QUESTION A patient wants to know the risk factors for Down syndrome. What is the nurse's best response? Answer: Pregnancy in women over age 35 QUESTION A runner has depleted all the oxygen available for muscle energy. Which of the following will facilitate his continued muscle performance? Answer: Anaerobic glycolysis QUESTION An aide asks the nurse why people who have neurofibromatosis will show varying degrees of the disease. Which genetic principle should the nurse explain to the aide? Answer: PG. 88 Expressivity QUESTION How are potassium and sodium transported across plasma membranes? Answer: By adenosine triphosphate enzyme (ATPase) QUESTION In teaching a patient with cirrhosis, which information should the nurse include regarding cholesterol? Answer: Cholesterol decreases the membrane fluidity of the erythrocyte, which reduces its ability to carry oxygen. Sodium and water accumulation in an injured cell are a direct result of: - Answer: Decreased ATP production PG. 89 The early dilation (swelling) of the cell's endoplasmic reticulum results in: - Answer: Reduced protein synthesis The ion transporter that moves Na + and Ca 2+ simultaneously in the same direction is an example of which of the following types of transport? - Answer: Symport The nurse is teaching staff about the most common cause of Down syndrome. What is the nurse describing? - Answer: Maternal nondisjunction The nurse would be correct in identifying the predominant extracellular cation as: - Answer: Sodium What causes the rapid change in the resting membrane potential that initiates an action potential? - Answer: Sodium gates open, and sodium rushes into the cell, changing the membrane potential from negative to positive. What is the diagnosis of a 13-year-old female who has a karyotype that reveals an absent homologous X chromosome with only a single X PG. 90 chromosome present? Her features include a short stature, widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair. - Answer: Turner syndrome What is the role of cytokines in cell reproduction? - Answer: Provide growth factor for tissue growth and development What principle should the nurse remember when trying to distinguish aging from diseases? - Answer: It is difficult to tell the difference because both processes are believed to result from cell injury. When a patient asks what causes cystic fibrosis, how should the nurse respond? Cystic fibrosis is caused by an _____ gene - Answer: Autosomal recessive Why is potassium able to diffuse easily in and out of cells? - Answer: Because the resting plasma membrane is more permeable to potassium PG. 91 Final Exam: NURS 6501 Advanced Pathophysiology Walden University What is the link between major depression and cortisol secretion? Individuals with depression show that persistently elevated plasma cortisol levels can result in inflammation that is believed to trigger depression A patient has chronic anemia associated with chronic renal failure. What substance does the healthcare professional tell the patient is needed to treat this anemia? Erythropoietin What is the first indication of nephrotic syndrome in children? Periorbital edema A patient is in the Emergency Department with heat stroke. What finding does the healthcare provider associate with this condition? Absence of sweating despite a high core temperature PG. 92 Clinical manifestations that include irregular or heavy bleeding, the passage of large clots, and the depletion of iron stores support which diagnosis? Abnormal uterine bleeding The health care professional is caring for a person who has a pathologic fracture. The patient asks the professio