Comprehensive D115 quiz and answers rated A+

Comprehensive D115 quiz and answers rated A+ A child with Down’s syndrome has had frequent respiratory tract infections since birth. What should the APRN tell the parent is the underlying cause of this illness? Gastroesophageal reflux disease causes aspiration of thin fluids. Feedback: Gastroesophageal reflux is commonly seen in children with Down syndrome and can be severe enough to result in aspiration of stomach contents, causing respiratory symptoms such as persistent coughing, wheezing, and pneumonia The FNP understands that a female patient with a complete or partial absence of the second sex chromosome may also display which of the following physical signs? Ovarian failure Feedback: Turner's syndrome occurs in approximately 1 in 2500 live births. It is diagnosed by complete or partial absence of the second sex chromosome (45, X). Patients may also demonstrate congenital lymphedema of hands and feet, webbed neck, high-arched palate, and short fourth metacarpal. Short stature, Ovarian failure, cardiovascular and renal issues, ear malformations, and other health problems, as well as amenorrhea due to premature ovarian failure An example of a disease that is caused by a chromosomal deletion is cri du chat syndrome. Children affected with this disorder commonly display which of the following symptoms? Symptoms associated with cri du chat include low birth weight, severe intellectual disability, microcephaly, and heart defects. What type of immunity is the body's 3rd line of defense and includes the primary characteristics of specificity and memory. Adaptive Feedback: The third line of defense in the human body is adaptive (acquired) immunity. The local manifestations of inflammation result from vascular changes and the circulation of associated components into the tissue. The 4 cardinal signs of inflammation include all of the following: Swelling, pain, heat, and redness are the cardinal signs of inflammation. Patients with trisomy of the 21st chromosome are also predisposed to which of the following diseases, which is also affected by alterations in the 21st chromosome? Alzheimer Disease Which assessment findings are typically associated with a diagnosis of systemic lupus erythematous? Joint pain, malar rash, and photosensitivity Feedback: The symptoms most often experiences with SLE are arthritis, arthralgias, fatigue, Reynaud phenomenon, chronic low-grade fever, sun sensitivity, hair loss, weakness, malar facial rash, and weight loss. The FNP understands the the most common form of facial paralysis is bells palsy. This disorder primarily affects which cranial nerve? Bell palsy may be caused by reactivation of herpesviruses in cranial nerve VII A patient presents with symptoms of fever, tachycardia, chills, throbbing headache, severe photophobia, and nuchal rigidity. Based on the presumed diagnosis, the FNP understands that the following symptoms may also occur in response to irritation and inflammation of the cranial nerves: deafness, tinnitus, and vertigo Feedback: These symptoms can occur due to damage to cranial nerve VIII. The clinical manifestations of myasthenia gravis include diplopia, ptosis, ocular palsies, facial droop, and difficulty swallowing and chewing. The symptoms are a direct result of a defect in nerve impulse transmission at the neuromuscular junction. These symptoms usually have an insidious onset and can commonly occur during which significant life event? Pregnancy When prescribing an antibiotic to treat acute otitis media, the FNP is aware that there are 4 common bacteria that cause AOM. Which of the following is not a common cause? Streptococcus pyogenes - The most common pathogens are Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumonia, and Staphylococcus aureus. During an intake interview with a 26-year-old patient diagnosed with generalized anxiety disorder, the FNP might observe what type of behavior? Inability to concentrate and irritability when questioned When assessing a patient who has a diagnosis of major depressive disorder, which would be considered a cognitive symptom of depression? Cognitive deficits associated with depression include deficits in problem solving, decision making, and impaired judgment, memory loss, and lack of concentration. The FNP would expect which symptoms in a patient with a diagnosis of schizophrenia? Paranoia, delusions, hallucinations, and diminished self-care Feedback: The characteristics of schizophrenia are paranoia, delusions, tangential thought, suspiciousness, disorganized behavior, and hallucinations. You are seeing a 17 year old female, as part of the visit you consider her risk factors for type 2 DM would likely include all of the following except: Family History of type 1 DM - A child or teen is more at risk for type 2 diabetes if he or she has any of these risk factors: Family history of type 2 diabetes Being overweight Not exercising regularly Being African American, Hispanic American, or American Indian A low level HDL cholesterol A high triglyceride level Being female Having slightly high blood sugar levels (prediabetes) Personal history of polycystic ovary syndrome Criteria for diagnosis of type 2 DM include: A plasma glucose level of 126 mg/dL (7 mmol/L) or greater after an 8 hour or greater fast on more than one occasion Feedback: Diagnostic criteria by the American Diabetes Association (ADA) include the following: A fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher, or. A 2- hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during a 75-g oral glucose tolerance test (OGTT) The FNP is seeing a 35-year-old female patient who is brought in by her husband. He tells the FNP that for the last several days his wife has been displaying symptoms of excessive spending, sleeplessness, and a general display of grandiose behavior. He states this is very out of context for her. The FNP understands that these symptoms are all consistent with which of the following? In the manic phase of bipolar disorder the patient often exhibits symptoms of elevated levels of euphoria and self-esteem and feelings of grandiosity. Energy levels are greatly enhanced even after only a few hours of sleep each night. The increased energy, however, does not lead to organized plans and thoughts. The individual may show poor judgment in spending money, may become hypersexual, or may make poor business commitments. Other hallmarks of mania are excessive, rapid, loud, and pressured speech. A patient presents with severe sore throat and pain with swallowing. Upon exam, the FNP notes unilateral swelling of the peritonsillar area and soft palate with deviation of the uvula. The FNP makes the presumptive diagnosis of: Symptoms of peritonsillar abscess include severe sore throat and difficulty swallowing, odynophagia (pain on swallowing), trismus (jaw muscle spasm making it difficult to open mouth), and a “hot potato” voice. Unilateral swelling of the peritonsillar area and soft palate. Affected area is markedly swollen and appears as a bulging red mass with the uvula displaced away from the mass. Accompanied by malaise, fever, and chills. Which female patient is at greatest risk for developing a benign ovarian cyst? 48-year-old who is premenopausal - Benign cysts of the ovaries can occur anytime during the lifespan. They are the most common during the reproductive years, in particular at the extremes of those years. An increase in incidence occurs when hormonal imbalances are more likely, such as in menopause. Which clinical diagnosis is associated with hirsutism, amenorrhea, and infertility? Polycystic ovarian syndrome Feedback: PCOS is defined as having two of the following three features: irregular ovulation, elevated levels of androgens, and the appearance of polycystic ovaries. Which term describes a hypersecretion of mucus and chronic productive cough that continues for at least 3 months of the year for a minimum of 2 consecutive years? Chronic Bronchitis is the term used for the respiratory alteration that causes hypersecretion of mucus and chronic productive cough that continues for at least 3 months of the year for a minimum of 2 consecutive years. The FNP is seeing a 63-year-old female patient who presents with complaints of vaginal bleeding. The patient tells the FNP during the interview that her LMP was more than 2 years ago. The FNP understands that an endometrial biopsy should be performed to rule out what potential diagnosis? If a woman is menopausal and has not had a menstrual period for more than 1 year, all vaginal bleeding should be investigated to rule out uterine and other cancers. Appropriate initial evaluation includes ultrasound and endometrial biopsy to exclude uterine cancer. Which of the following diagnoses is characterized by vascular congestion, painful prolonged erection, and association with cocaine use? Priapism is an uncommon condition of prolonged penile erection, and is defined as a persistent and painful erection lasting longer than 4 hours without sexual stimulation. The vascular congestion is thought to be associated with venous obstruction. Priapism also has been associated with cocaine use. The FNP understand that during follicular or proliferative phase of ovulation: estrogen causes endometrial growth - This occurs in the secretory phase. The treatment for ARDS in children is supportive in nature and similar to that of adults. All of the following factors should be considered in the evaluation and treatment of ARDS in infants except: Higher hematocrit levels Feedback: ARDS in older children and adolescents is similar to that in adults. However, infants have more compliant chest walls, lower hematocrit levels, higher baseline airway resistance, and lower functional residual capacity. Higher baseline airway resistance Lower functional residual capacity The FNP is seeing a 7-year-old child for a follow up of asthma management. A child has asthma. Which pathophysiologic process occurs in this disease? Chronic inflammatory disorder, causing mucosal edema and reversible airflow obstruction. Asthma is a chronic inflammatory disorder of the bronchial mucosa, which causes bronchial hyperresponsiveness, constriction of the airways and variable airflow obstruction that is reversible. All of the following are common infectious respiratory bacteria except: Pseudomonas aeruginosa Haemophilus influenzae Streptococcus pyogenes Escherichia Coli Feedback: Common upper respiratory bacteria include corynebacterium diphtheriae, haemophilus influenzae, streoptococcus pyogenes. Common lower tract respiratory bacteria include bordetella pertussis, escherichia coli, klebsiella pheumoniae, and mycobacterium tuberculosis (for a complete list see table 10.2 in the McCance text) The APN is seeing a 78-year old male with a long standing history of poorly controlled hypertension. When evaluating for hypertensive target organ damage, the APN should look for evidence of: Left ventricular hypertrophy - LVH is a common finding in patients with hypertension. It is defended as an increase in the mass of the left ventricle which can be secondary to an increase in wall thickness, and increase in cavity size or both. The increase in mass predominantly results from a chronic increase in afterload of the LV caused by the hypertension. The heart has to work harder to overcome the increase systemic vascular resistance. The APN is most likely to not find which of the following assessments in a patient with a DVT? Positive obturator sign - DVT should be suspected in patients who present with Unilateral leg edema, leg swelling, pain, warmth, and erythema. Symptoms are usually unilateral. A positive obturator sign is an assessment for appendicitis Heart failure pathophysiology is characterized by: Inadequate cardiac output to meet oxygen and metabolic demands of the body Feedback: Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body's needs for blood and oxygen. Basically, the heart cannot keep up with its workload. Interventions in microalbuminuria for a person with DM includes: Improved glycemic control Strict dyslipidemia control Use of an optimized dose of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) Feedback: Glycemic and lipid control along with Initiation of ACE inhibitor or ARB therapy should be considered in patients with microalbuminuria or overt proteinuria. The level of albuminuria should be followed up during treatment, and doses of the ACE inhibitor or ARB should be titrated upward to maximize the beneficial effect on albuminuria A 10-year-old patient presents with palpable kidney enlargement, chills, fever, and abdominal pain. What is the most likely diagnosis? Acute pyelonephritis is an acute infection of the ureter, reanal pelvis, and/or kidney interstitium. Clinical manifestations include flank or groin pain, fever, chills, costovertebral tenderness and UTI symptoms. Common causes of chronic renal failure include all of the following except: Hypotension The two main causes of chronic renal failure are diabetes and hypertension. Other causes include polycystic kidney disease and glomerulonephritis. Depletion of matrix in articular cartilage-Collagen fibers exposes-Synovial capsule decreases in size, synovial fluid forced into defects and enlarges joint describes which pathophysiological process? Osteoarthritis or degenerative joint disease is a musculoskeletal condition there is inflammation of joints due to loss of articular cartilage, sclerosis of underlying bone, and formation of bone spurs. There are local areas of damage and loss of articular cartilage, new bone formation of joint margins, and thickening of the joint capsule Which of the following is true regarding atopic dermatitis in children? Blood eosinophilia is a common finding - Atopic dermatitis is a chronic, pruritic, inflammatory skin disease occurring most often in children but may also affect adults. It is most often associated with an elevated serum IgE and a personal or family history of atopy. High eosinophil counts are common. Atopic dermatitis affects approximately 5 to over 20 percent of children worldwide. A 70-year-old woman comes to the clinic with a complaint of severe aching of her legs after standing for 10 minutes. What other assessment finding of the lower extremities would support the FNP's diagnosis of chronic venous insufficiency? Pitting edema 3+ and cyanosis on dependency The FNP understands that the pain associated with angina pectoris or myocardial infarction is caused by irritation of the myocardial nerve fibers by the increase in: lactic acid Feedback: Occlusion of the coronary arteries deprives the myocardial cells of glucose needed for aerobic metabolism. Anaerobic metabolism occurs, which causes the accumulations of lactic acid. Lactic acid irritates the myocardial nerve fibers, sending pain messages to the cardiac nerves and upper thoracic posterior roots located in the left shoulder and arm. New York Heart Association Functional Class (NYHA) III for patients with cardiac disease is characterized by: Marked limitation in activity, comfortable at rest, but ordinary activity leads to symptoms is noted as functional class III An older adult who has AML is undergoing cytotoxic chemotherapy treatment and has the following lab values: elevated serum uric acid, serum potassium, and serum phosphate and a low serum calcium level. The WBC count is extremely elevated, and on physical exam, there is noted lymphadenopathy and splenomegaly. What is the most likely cause? Tumor lysis syndrome occurs when a patient has a high WBC count and is undergoing cytotoxic chemotherapy for the treatment of AML. It is characterized by the development of acuter hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, with our without acute renal failure. It is the most common of all the oncologic emergencies. An adult patient with pernicious anemia my present with which signs and symptoms? Peripheral neuropathy, ataxia, lethargy, and fatigue The FNP would suspect DIC if the patient's lab results, including PT, indicated: Increased PT, decreased platelet count, and decreased fibrinogen Feedback: DIC is a complication of infection, malignancy, blood transfusions, liver disease, pregnancy, and sometimes trauma. CID is the inappropriate accelerated systemic activation of the coagulation cascade, resulting in simultaneous hemorrhage and thrombosis. Lab results would show increased PT and decreased platelet count and fibrinogen in response to the hemorrhage and clotting. The definitive test for the diagnosis of sickle cell anemia is: Hemoglobin electrophoresis Feedback: Normal and abnormal hemoglobin can be detected by electrophoresis, which matches hemolyzed RBC material against standard bands for the various known hemoglobins, including hemoglobin S, the abnormal hemoglobin associated with sickle cell anemia. A person develops cardiogenic shock after an acute MI. The nurse understands this will produce a: stimulation of the renin-angiotensin system. Feedback: As cardiac output decreases, compensatory adaptive responses are activated: Renin-angiotensin, neurohormonal, and sympathetic nervous system. Which laboratory result should the FNP evaluate for a person with suspected septic shock? Lactate Feedback: Check lactate level; obtain blood cultures; Endothelial cell dysfunction and mediator release in multiple organ dysfunction syndrome (MODS) produces a net procoagulant state - causes vasodilation with selective vasoconstriction he FNP is caring for a person with a 40% deep partial-thickness injury. Which parameter will need to be closely monitored to best assess adequate fluid resuscitation? Urine output is the most reliable criterion for adequate fluid resuscitation. n regards to shock in children, which parameter is the best indicator of systemic perfusion? Serum lactate is the most sensitive indicator of systemic perfusion in children. Lactic acidosis is an indicator of inadequate systemic perfusion. Clinical manifestations of acute vs. chronic glomerulonephritis include all of the following except: Hypercholesterolemia Hematuria with RBC casts Low serum albumin Feedback: Hypercholesterolemia is seen in chronic glomerulonephritis. Edema Individuals with chronic renal failure often develop hypocalcemia Feedback: normochromic normocytic anemia is common Which of the following is true regarding the RAAS system? In the presence of angiotensin-converting enzyme, angiotensin I is converted to angiotensin II The FNP is aware that one differentiating factor between gastric and duodenal ulcers is: Pain occurs immediately after eating Feedback: This is true for gastric ulcers, in duodenal ulcers the pain occur 30 mins to 2 hours after eating. A patient complains of melena (black, tarry stools). The FNP understands that this: May likely be bleeding from the esophagus or stomach Feedback: Black, tarry stools indicate the passage of blood, usually from the upper GI tract. The FNP is aware that a patient with vitamin D deficiency who exhibits the symptoms of pain, bone fractures, a waddling gait, and facial deformities would have the likely diagnosis of: Osteomalacia Paget disease Paget disease is a state of increased metabolic activity in bone. Clinical manifestations include symmetric skull, impaired motor function, deafness, atrophy of the optic nerve, obstruction of lacrimal duct Risk factors for osteoporosis include all of the following except: Increased levels of estrogen and testosterone Decreased levels of estrogen and testosterone are risk factors for osteoporosis. Decreased activity level Increased age History of smoking The primary defect in osteoarthritis is The primary defect in osteoarthritis is Local areas of damage and loss of articular cartilage, new bone formation of joint margins, and thickening of joint capsule A person has gout. Which typical clinical manifestation may be found upon assessment? Tophi Feedback: Clinical manifestations of gout include: Pain in the great toe (usually, but not always): Worse at night Increase in serum urate concentration: Hyperuricemia Recurrent attacks of monoarticular arthritis: Inflammation of a single joint Deposits of monosodium urate monohydrate (tophi) in and around the joints Renal disease, involving glomerular, tubular, and interstitial tissues and blood vessels Formation of renal stones Allergic contact dermatitis is associated with : delayed hypersensitivity - Allergic contact dermatitis is a common form of T-cell mediated or delayed hypersensitivity (type IV). The FNP is seeing an older adult female patient who complains of a tender area on her torso that extends from her spine around and under her breast to the sternum on the left side. She states the pain has been present for 2 days, and today she has developed clusters of "blisters". What is the diagnostic test that the FNP would perform? Polymerase chain reaction (PCR) Feedback: PCR can be used to detect VZV DNA rapidly and sensitively, and is now widely available. In regards to the case above, what would be your suspected diagnosis? Herpes zoster typically presents with a history of tenderness followed by eruptions and vesicles that follow a dermatome on one side of the body. Which risk factor is associated with gout? Ingestion of salicylate-containing medications Feedback: Gout is associated with use of some medications including salicylates, diuretics, pyrazinamide, and alcohol.