NR 507 Midterm Practice Questions & Answers (View Questions

NR 507 Midterm Practice Questions & Answers (View Questions) Epigenetics Defects in the encoding of histone-modifying proteins  Housekeeping Genes are vital to the function and maintenance of all the body’s cells. What characteristic is associated with these genes? They lack encoding histones  Mutations in the encoding of histone modifying proteins have been shown to influence the development of what congenital condition? Acephalous  Epigenetics refers to chemical modification that are made to what? Both the DNA and the histones  Signals to change or modify epigenetic tags are received from where? Contact with other cells, hormones and environmental factors.  What sort of molecule is responsible for transferring signals into cells to gen regulatory proteins? Proteins  Mutations in the encoding of histone-modification proteins have been shown to influence the development of what congenial condition? Heart Disease Epigenetics and its role on human development  Research has provided support for the theory that epigenetic modification can result from deficient in utero nutrition causing? Obesity, cardiovascular disease, and diabetes  During which stage of human development does the role of epigenetics have the greatest impact on the development of epigenetic abnormalities? In utero  The difference between DNA sequence mutations and epigenetic modifications is? Epigenetic modification can be reversed.  Research has provided support for the theory that epigenetic modification can result from deficient in utero nutrition causing which chronic disease? Obesity, cardiovascular disease and diabetes Totipotent cells and its ability to differentiate into any type of cell  Which embryonic stem cell characteristic is referred to as a totipotent? Ability to differentiate into any type of somatic cell  Examples of two totipotent cells are? A zygote and Cells in the early embryo up to 5 days  What is a Totipotent cell? Totipotent cells are cells that are able to develop into any type of cell found in the body.  Are all cells Totipotent cells?  No. Only the fertilized egg and the cells produced by the first few cell divisions (in the Embryonic Development phase) are Totipotent cells. Prader-Willi syndrome and Angelman syndrome?  What characteristic of Prader-Willi syndrome is not a characteristic of Angelman syndrome? it is inherited from the father  A child with Prader-Willi syndrome has been hospitalized. Which assessment findings does the nurse expect with this syndrome? Insatiable hunger  The nurse is examining an 8-year-old boy with chromosomal abnormalities. Which sign or symptom suggests the boy has Angelman syndrome?  Observation shows jerky ataxic movement similar to a puppet's gait. Cellular Proliferation 5-Azacytidine and the treatment of cancer  What is 5-azacytidine? Nucleoside analog able to be incorporated into RNA & DNA  5- Azactytide has demonstrated promise in the treatment of which form of cancer? Pancreatic the role of inactive MLH1 in the development of some forms of inherited colon cancer  What is the role of inactive MLH1 in the development of some forms of inherited colon cancer? DNA damage is left unrepaired Effects of ethanol on neural stem cells ability to differentiate into functional neurons-  Research has demonstrated that neural stem cells have an impaired ability to differentiate into functional neurons when subjected to? Ethanol Inflammation as an etiology for cancer-note conditions in which this may occur  What chronic inflammatory conditions can increase risk for cancer? HIV, hepatitis, h-pylori, bronchitis, pancreatitis Cancer In terms of epigenetic modifications, the role of environmental stressors associated with development of cancer  When considering abnormal epigenetics modifications, what factor is currently being viewed as strongly associated with the development of some cancers? Environmental stressors Defects in Mechanism of Defense Hemolytic defects in the newborn  To explain hemolytic disorders in the new born to new parents, the nurse who cares for the new born population must be aware of the physiologic characteristics related to these conditions. What is the most common cause of pathologic hyperbilirubinemia? Hemolytic disorders  Which infant is most likely to express Rh incompatibility? Infant of an Rh- negative mother and a father who is Rh Positive and homozygous for the Rh factor  Rh hemolytic disease is suspected in a mother's second baby, a son. Which factor is important in understanding how this could develop? The first child was Rh positive  The nurse is caring for an infant with hemolytic disease. Which medication should the nurse anticipate to be prescribed to decrease the bilirubin level? Phenobarbital  A newborn is found to have hemolytic disease. Which combination would be found related to the blood types of this newborn and the parents of the newborn? Newborn who is Type A, mother who is type O  The nurse is caring for a newborn with hemolytic disease of the newborn who is receiving phototherapy. Which nursing intervention would be the most appropriate for the nurse to do? The nurse turns the newborn every 3 to 4 hours Understand the meaning of infectivity Most effective treatment for HIV  A patient diagnosed with acute primary HIV infection is in the clinic. What treatment should be initiated for this patient? Combination antiretroviral therapy Defected cells of HIV  A patient has human immunodeficiency virus (HIV). A nurse realizes the HIV will attack: Helper T cells  The nursing instructor is discussing the development of human immunodeficiency disease (HIV) with the students. What should the instructor inform the class about helper T cells? They are activated on recognition of antigens and stimulate the rest of the immune system. Signs of T-Lymphocyte deficiency-  T-cell defects Present early -Failure to thrive -Opportunistic (viral & often bacterial)  A patient has DiGeorge syndrome. Which assessment findings should the nurse monitor for in this patient? Low calcium levels and tetany  A nurse is caring for a client who is deficient in T cells. Which result of this T cell deficiency does the nurse anticipate? Decrease in leukocytes and impaired cellular immunity Pulmonary Alterations Pulmonary function tests  Identify purposes for preforming PFT’s? to identify and measure pulmonary disease  What is the role of pulmonary function testing? It serves both a diagnostic and therapeutic role, determines how well the lungs work.  What do PFT screening do? It may detect pulmonary abnormalities caused by disease or environmental factors in general populations, occupational settings, smokers or other high-risk groups.  A 15-year-old female is diagnosed with restrictive lung disease caused by fibrosis. The patient had a pulmonary functions test. Which of the following findings is expected? Decreased functional residual capacity Relationship of lung compliance and residual volume  A nurse is teaching about the functions of the pulmonary system. Which information should the nurse include? One of the functions of the pulmonary system is the: Exchange of gases between the environment and blood  An 80-year-old male presents to his primary care provider reporting difficulty breathing. Pulmonary function tests reveal that he has increased residual volume. A nurse suspects the most likely cause of this disorder is _____in lung compliance? Increase Shifts in the oxyhemoglobin dissociation  In a patient with acidosis or a fever, the nurse would expect the oxyhemoglobin dissociation curve to shift: To the right, causing more o2 to be released to the cells  What factors affect oxyhemoglobin dissociation? Acidity, PCO2 and Temperature  In a normal person, as PaO2 drops from 100 to 80 to 60, there is __almost no change_ in how tightly Hgb is holding onto its 02 (90-100% saturation). But when the PaO2 approaches 50, the s-curve begins to __drop sharply_, and as it does it means that _HGB will be to release its O2 and more freely into tissue_.  For a right shifted curve, for the same PaO2 there will be a lower __% of O2 still bound to HGB_ when compared to a normal curve  What causes a R shift? Exercise and Pathological conditions of body tem (wound healing or infection)  In both healthy and pathological conditions, the signs of a R shift are? Increased temp/hyperthermia/febrile condition, increased PaCo2, decreased PH  What causes a L shift? Hyperventilation (high altitude)/hyporcapnia, hypothermia, HGB want to hold onto its O2 more tightly so the PaO2 must drop very low before the HGB begins to release its O2 more freely CO2 transport in the blood  Most carbon dioxide in the blood is transported? In the form of bicarbonate  If an individual with respiratory difficulty were retaining too much carbon dioxide, which of the following compensatory responses would the nurse expect to be initiated? Increased in respiratory rate  A patient wants to know how carbon dioxide is transported in the body. How should the nurse respond? Carbon dioxide (CO2) is mainly transported in the blood: In the form of bicarbonate Characteristics of alveoli  Air passage between alveoli is collateral and evenly distributed because of? Pores of Kohn  Changes in the alveoli that cause an increase in alveolar surface tension, alveolar collapse and decreased lung expansion are a result of? Decreased surfactant production  Students in a histology class are assigned to identify regions of the lung. The slide shows a basement membrane, capillary lumen, and macrophages. The students are looking at the: Alveoli  While auscultating a patient's lungs, a nurse recalls the alveoli in the apexes of the lungs are _____ than alveoli in the bases. Larger  The nurse is caring for a client who is now 2 days post near-drowning. The focused assessment would involve which of the following areas of the lung involved in gas exchange? Alveoli Arterial perfusion pressure and alveolar gas pressure in the lung base  A consequence of alveolar hypoxia is: Pulmonary artery vasoconstriction  The pressure required to inflate an alveolus is inversely related to: Alveolus radius  The nurse is describing the movement of blood into and out of the capillary beds of the lungs to the body organs and tissues. What term should the nurse use to describe this process? Perfusion  A pulmonologist is discussing the base of the lungs with staff. Which information should be included? At the base of the lungs: Arterial perfusion pressure exceeds alveolar gas pressure  When the pulmonologist discusses the condition in which a series of alveoli in the left lower lobe receive adequate ventilation but do not have adequate perfusion, which statement indicates the nurse understands this condition? When this occurs in a patient it is called:  Alveolar dead space How do determine the partial pressure of oxygen given the percentage of oxygen in the air and the barometric pressure  What is the partial pressure of oxygen in the lung given the following conditions? Percentage of oxygen in air: 20 Barometric pressure: 700 mm Hg 140mmhg  What would the partial pressure of oxygen equal if the barometric pressure was 600 mm Hg? If the barometric pressure is 600 mmHg, the PO2 would equal 125 mm Hg. Results of increased work of breathing  An 80-year-old male presents to his primary care provider reporting difficulty breathing. Pulmonary function tests reveal that he has increased residual volume. A nurse suspects the most likely cause of this disorder is _____ in lung compliance. An increase Know terms: Vital capacity (VC),  While reviewing the results of the pulmonary functions test, the nurse is aware that the maximum amount of gas that can be displaced (expired) from the lung is called: Vital Capacity Total lung capacity  What would happen to TLC and VC of your lungs become stiff and less elasticity Can't take in as much air because elasticity is reduced Functional capacity Residual volume,- Functional residual capacity (FRC)  Which of the following terms should the nurse use when there is a balance between outward recoil of the chest wall and inward recoil of the lungs at rest? Functional residual capacity (FRC) is reached Renal Alterations Types of nephrons and their functions  The nephrons that determine the concentration of the urine are _____ nephrons. Juxtamedullary  Which of the following renal structures is not a component of the nephron? Renal capsule  At which of the following locations in the nephron would a nurse practitioner first expect blood to be largely free of plasma proteins? Bowman space  Which of the following substances is most likely to be reabsorbed in the tubular segments of the nephron using passive transport mechanisms? Water  What is the function of nephron? Filtration of blood plasma, reabsorption of water, amino acids, sugars, and salts, secretion of H+, K+, ions . All of these functions allow urine concentration and Acidification  The nephrons are the functional units of the kidney, responsible for the initial formation of urine. The nurse knows that damage to the area of the kidney where the nephrons are located will affect urine formation. Identify that area. Renal cortex Overall renal physiology Substances that are actively secreted by the renal tubules  Which of the following substances are actively secreted by the renal tubules? Hydrogen and potassium  Which of the following comprises the kidney's transport system? Tubules and pelvis Activation of the renin-angiotensin system  Which of the following statements correctly describes a direct end-effect of the renin-angiotensin-aldosterone system? Angiotensin II causes systemic vasoconstriction.  What does the reduced perfusion of the kidney activate that causes constriction of peripheral arterioles? Renin-angiotensin system Glomerular filtration rate  The glomerular filtration rate (GFR) is directly related to the Perfusion pressure in the glomerular capillaries  A nurse educator is orientating anew nurses to a renal unit of a hospital. Which of the follow teaching points should the nurse include as a part of a review of normal glomerular function? Glomerular filtrate is very similar in composition to blood plasma found else ware in circulation. Mesangial cells  A urologist is discussing the phagocytic cells that lie between the layers of the renal corpuscle Mesangial cells  Lying between the layers of the renal corpuscle is a population of phagocytic cells called? Mesangial cells Renal system anatomy  When the renal system secretes rennin, it causes the direct activation of? Angiotensin 1 Why plasma proteins should be absent from the urine  The fluid formed in the capillary cluster of the nephron is the same as blood plasma except for the absence of? Larger molecules of plasma protein  Which of the following substances does not normally get filtered in the kidneys? Plasma proteins Effects of urinary tract obstruction- hydronephrosis and a decreased glomerular filtration rate  A 25-year-old female is diagnosed with urinary tract obstruction. while planning care, the nurse realizes that the patient is expected to have hydronephrosis and a decreased glomerular filtration rate caused by? Dilatation of the renal pelvis and calyces proximal to a blockage.  Which of the following changes will result in a decreased glomerular filtration rate? Increased hydrostatic pressure in Bowman’s capsule Effect of urinary retention  A 55-year-old male presents reporting urinary retention. Tests reveal that he has a lower urinary tract obstruction. Which of the following is of most concern to the nurse? Formation of renal calculi  A group of students are reviewing information about disorders of the bladder and urethra. The students demonstrate understanding of the material when they identify which of the following as a voiding dysfunction? Urinary retention  A client presents at the clinic with complaints of urinary retention. What question should the nurse ask to obtain additional information about the client's complaint? When did you last urinate  The nurse is teaching a group of nursing students about acute glomerulonephritis genitourinary conditions. A student asks the about a condition that occurs when there is a decreased volume of urine output. The condition the student is referring to is which of the following? Oliguria is a subnormal volume of urine Most common type of renal stone  When a patient asks what the most common type of renal stones is composed of, how should the nurse respond? The most common type of renal stone is composed of Calcium  The nurse recognizes that a referral for genetic counseling is inappropriate for the client with: Renal calculi  Because a client's renal stone was found to be composed of uric acid, a low-purine, alkaline-ash diet was ordered. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications? Milk, apples, tomatoes, and corn Epispadias  The optimal time for surgical repair of the Hypospadias and epispadias is 18 mths  What gender has predominance for exstrophy-epispadias complex? Males (by factor of 2.5)  What 4 considerations must be addressed when performing the epispadias repair? 1) Correction of dorsal chordee 2) Urethra recon 3) Glanular recon 4) Penile skin closure  What are 2 anomalies noted with epispadias? Along with bladder and cloacal exstrophy, you can have: 1) VUR 2) inguinal hernias  List 3 goals of surgical treatment of epispadias 1) Urinary continence 2) Upper tract preservation 3) Cosmetic penis  What is the most important indicator of successful continence with epispadias repair? Good bladder capacity  What are the 3 types of female epispadias? 1) Patulous urethra 2) Dorsally split along most of urethra 3) Complete urethral cleft with incontinence PIC: A=normal, B=clitoris altered, C and D=varying degree of urethral defect  Error! Filename not specified.  What are other aspects of female epispadias?  - Bifid clitoris - Poorly developed labia minora - glabrous mons pubis skin Glomerulonephritis  A 15-year-old male was diagnosed with pharyngitis. Eight days later he developed acute glomerulonephritis. While reviewing the culture results, which of the following is the most likely cause of this disease? Group A B-hemolytic streptococcus  When a nurse observes post-streptococcal glomerulonephritis as a diagnosis on a patient, which principle will the nurse remember? Acute post-streptococcal glomerulonephritis is primarily caused by? antigen –antibody complex deposition in the glomerular capillaries and inflammatory damage  A 30-year-old male is demonstrating hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin being the major protein. The most probable diagnosis the nurse will see documented on the chart is? Acute glomerulonephritis  A 15-year-old female presents with flank pain, irritability, malaise, and fever. Tests reveal glomerulonephritis. When the parents ask what could have caused this, how should the nurse respond? Post streptococcal infection  Which of the following clusters of symptoms would make a clinician suspect a child has developed glomerulonephritis? Gross hematuria, flank pain and hypertension  A 5-year-old male was diagnosed with glomerulonephritis. History reveals that he had an infection 3 weeks before the onset of this condition. The infection was most likely located in the Pharynx  A 30-year-old male is demonstrating hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin being the major protein. The most probable diagnosis the nurse will see documented on the chart is? acute glomerulonephritis  A 45-year-old male presents with oliguria. He is diagnosed with chronic glomerulonephritis. The nurse knows oliguria is related to? thickening of the glomerular membrane and decreased renal blood flow  Which assessment finding is most important in determining nursing care for a client with acute glomerulonephritis? Blurred vision. Visual disturbances can be indicative of rising blood pressure in a client with acute glomerulonephritis.  The nurse is assessing a child with acute poststreptococcal glomerulonephritis. Which of the following would the nurse expect to assess? fatigue, lethargy, abdominal pain, hypertension, crackles, and anorexia. Nephrotic syndrome  A urologist is discussing nephritic syndrome. Which information should be included? If nephrotic syndrome is not caused initially by kidney disease, it is termed ____ nephrotic syndrome? Secondary  A 4-year-old male is diagnosed with nephrotic syndrome. Which of the following assessment findings accompanies this condition? Proteinuria  A 7-year-old female is diagnosed with nephrotic syndrome. Which of the following should the nurse ask the parents if they or the child has noticed recently? Frothy urine  Nephrotic syndrome occurs when there is loss of _____ in the urine. Protein  Secondary forms of nephrotic syndrome are associated with all of the following conditions except: Hyperthyroidism  Which of the following diseases is a glomerular disorder? Nephrotic syndrome  Which assessment finding is common in children diagnosed with nephrotic syndrome? Periorbital edema  A child is getting a diagnostic work-up for nephrotic syndrome. Which of the following lab results would the nurse expect to see? Proteinuria, hypoalbuminemia, and hypercholesterolemia are diagnostic of a child with nephritic syndrome. The child will also present symptomatically with a sudden onset of edema. Hematuria is typically seen with glomerulonephritis.