NURS 611 Advanced Pathophysiology Exam Questions & Answers for: Chapter 36: Alterations of Pulmonary Function; Chapter 37: Alterations of Pulmonary Function in Children; Chapter 38: Structure and Function of the Renal and Urologic Systems; Chapter 39: Alt

a. Normal lung sounds b. Pink, frothy sputum c. Eupnea d. Rhonchi ANS: B Pulmonary edema usually begins to develop at a pulmonary capillary wedge pressure or left atrial pressure of 20 mmHg. Signs of pulmonary edema include dyspnea, hypoxemia, and increased work of breathing. Physical examination may reveal inspiratory crackles (rales), dullness to percussion over the lung bases, and evidence of ventricular dilation (S3 gallop and cardiomegaly). In severe edema, pink, frothy sputum is expectorated, hypoxemia worsens, and hypoventilation with hypercapnia may develop. Eupnea is normal work of breathing. Rhonchi are lowpitched rumbling lung sounds due to turbulent airflow due to obstruction or secretions in the large airways. #13. A patient has a lung problem caused by dysfunction in the pores of Kohn. What action by the healthcare professional is best? a. Have the patient drink plenty of water. b. Give the patient supplemental oxygen. c. Have the patient do breathing exercises. d. Withhold pain medicine so the patient stays awake. ANS: C The pores of Kohn, which open only during deep breathing, allow air to pass from well- ventilated alveoli to obstructed alveoli. A dysfunction in this system would lead to absorption atelectasis, which is the result of gradual absorption of air from obstructed or hypoventilated alveoli. The professional should have the patient do breathing exercises, including using an incentive spirometer. Water will thin any secretions the patient has but will not directly improve ventilation. The patient may need oxygen if the oxygen saturations are low, but this does not address the cause. Withholding pain medication will lead to a patient being unwilling to move about or do breathing exercises. Chapter 36: Alterations of Pulmonary Function #12. A patient has a pulmonary capillary wedge pressure of 30mmHg. What assessment finding by the healthcare professional would be most consistent with this reading? similar similar#14 - Bronchiectasis is persistent abnormal dilation of the bronchi. Bronchial dilation may be cylindrical (cylindrical bronchiectasis), with symmetrically dilated airways, as can be seen after pneumonia and is reversible; saccular (saccular bronchiectasis), in which the bronchi become large and balloon-like; or varicose (varicose bronchiectasis), in which constrictions and dilations deform the bronchi, creating a bulbous appearance. a. Draw arterial blood gasses. b. Assist with a chest tube insertion. c. Give the patient low-flow oxygen. d. Assess for clubbing of fingernails. ANS: B In a tension pneumothorax, the site of pleural rupture acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing up during expiration. As more and more air enters the pleural space, air pressure in the pneumothorax begins to exceed barometric pressure. Air pressure in the pleural space pushes against the already recoiled lung, causing compression atelectasis, and against the mediastinum, compressing and displacing the heart, great vessels, and trachea. This is an emergency condition requiring chest tube insertion or immediate needle decompression. Arterial blood gas results will not change the treatment plan. This patient may need oxygen if definitive treatment is delayed, but it would need to be high- flow oxygen. Clubbing of fingernails occurs in chronic hypoxemic conditions. The professional should assist with immediate needle decompression or chest tube insertion. 15. A patient is brought to the Emergency Department with a gunshot wound to the chest. The healthcare professional assesses an abnormality involving a pleural rupture that acts as a one- way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration. What action by the healthcare professional is the priority? similar16. A patient has a transudative pleural effusion but has minimal symptoms. What action by the healthcare professional is best? a. Prepare for an immediate chest tube insertion. b. Encourage the patient to use the incentive spirometer. c. Facilitate a blood draw to check protein stores. d. Arrange for an oncology consultation. ANS: C In transudative pleural effusion, the fluid, or transudate, is watery and diffuses out of the capillaries as a result of disorders that increase intravascular hydrostatic pressure or decrease capillary oncotic pressure. Examples are congestive heart failure, in which venous and left atrial pressures are increased, and liver or kidney disorders that cause hypoproteinemia. Hypoproteinemia decreases capillary oncotic pressure, which promotes diffusion of water out of the capillaries. The best action for the professional is to assess the patient’s protein stores through blood analysis. The patient does not need a chest tube since the symptoms are minimal. An incentive spirometer will not provide definitive information to treat the problem. Exudative effusions are caused by inflammation, infection, or malignancy, so this patient does not need an oncology consult. #17 - Emphysema is abnormal permanent enlargement of gas-exchange airways (acini) accompanied by the destruction of alveolar walls without obvious fibrosis. An effusion is the presence of fluid in the pleural space that can be caused by hypoproteinemia (transudative) or malignancy, infection, or inflammation (exudative). An abscess is a collection of pus. similar19. A patient has been diagnosed with acute respiratory distress syndrome (ARDS). For what other health condition should the healthcare professional assess this patient for as the priority? a. Heart failure b. Pneumonia c. Pulmonary emboli d. Acute pulmonary edema ANS: B ARDS is a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury not attributed to heart failure or fluid overload. All disorders causing ARDS cause acute immune cell-mediated injury to the alveolocapillary membrane producing massive inflammation, increased capillary permeability, and alveolar flooding with protein-rich fluid that overwhelms ion channels and lymphatic removal of fluid. The most common predisposing factors for ARDS are genetic factors, sepsis, and multiple trauma (especially when multiple transfusions are received). However, there are many other causes, including pneumonia, burns, aspiration, cardiopulmonary bypass surgery, pancreatitis, drug overdose, smoke or noxious gas inhalation, oxygen toxicity, radiation therapy, and disseminated intravascular coagulation. Alcohol abuse and smoking are preventable environmental risk factors. 25. A healthcare professional is educating a patient about asthma. The professional states that good control is necessary due to which pathophysiologic process? b. Uncontrolled inflammation leads to increased bronchial hyperresponsiveness and eventual scarring. ANS - The late asthmatic response begins 4 to 8 hours after the early response when the release of toxic neuropeptides contributes to increased bronchial hyperresponsiveness. Untreated inflammation leads to increased scarring and remodeling of pulmonary tissue, so good control of asthma is necessary to prevent that complication. Poor asthma control does not specifically lead to hypertension or dysrhythmias, nor will it permanently weaken respiratory muscles. similar similar26. A patient comes to the Emergency Department with inspiratory and expiratory wheezing, dyspnea, nonproductive cough, and tachypnea. What treatment does the healthcare professional anticipate for this patient as the priority? d. Inhaled bronchodilator ANS - Asthma is characterized by expiratory wheezing, dyspnea, nonproductive coughing, prolonged expiration, tachycardia, and tachypnea. Severe attacks involve the use of accessory muscles of respiration, and wheezing is heard during both inspiration and expiration. The treatment consists of inhaled -agonist bronchodilators, oxygen if needed, and corticosteroids. After the patient has been stabilized, the healthcare professional attempts to determine the cause of the attack, which would include a possible sputum culture and getting a history of any recent exposures to illness. Antibiotics will be given for a bacterial infection, such as pneumonia or pharyngitis, that led to the attack. 29. A patient with emphysema comes to the clinic and reports increased, productive cough. What diagnostic test should the healthcare professional facilitate as the priority? a. Chest x-ray b. Peak expiratory flow c. Pulmonary function tests d. Sputum culture ANS: A The cough in emphysema is generally not productive, unless the patient has an acute exacerbation, which can be caused by a pulmonary infection. The best way to diagnose an infection such as pneumonia is with a chest x-ray. A sputum culture would be helpful to specify the organism for tailored treatment, but is not required for the diagnosis. Pulmonary function studies might be ordered later to see if the patient’s disease has progressed, but would not be ordered during an acute illness. Peak expiratory flow is usually used to monitor asthma. The professional should expedite a chest x-ray. similar similar30. A patient has been diagnosed with primary emphysema but claims there is no history of smoking. What action by the healthcare professional is most appropriate? a. Facilitate genetic testing on the patient. b. Ask the family if the patient smokes. c. Schedule pulmonary function studies. d. Get baseline arterial blood gasses. ANS: A Although emphysema is usually caused by smoking, a mutation in the alpha1- antitrypsin gene results in the development of the disease in younger, nonsmokers. The healthcare professional would facilitate this test. There is no reason to ask the family of a patient about the patient’s smoking history unless the patient was unable to answer questions on his or her own. Pulmonary function studies will be done at some time, but does not help determine the etiology of the disease. 33. The student asks a professor to explain how tuberculosis (TB) can remain dormant in some people. What explanation by the professor is best? a. It does not remain dormant but some host defenses can kill the bacteria. b. The bacilli can become isolated within tubercles in the lungs. c. Macrophages attack and phagocytize new areas of infection. d. Virulence factors in the bacilli weaken over time leading to apoptosis. ANS: B Neutrophils, lymphocytes, and macrophages seal off colonies of the TB bacilli, forming granulomatous tubercles of scar tissue that isolates them. In this manner, and with developing immunity, TB can remain dormant sometimes for years or for life. Some bacilli are killed by host defenses but not enough to rid to body of the disease. Macrophages do phagocytize some of the bacilli. Virulence factors do not weaken over time. 37. A patient has been diagnosed with an empyema. What does the healthcare professional tell the patient about this condition? a. We will have to drain the pus out of your pleural space. Empyema is the presence of pus in the pleural space. The usual treatment is drainage of the pleural space with a chest tube and administration of antibiotics (not antivirals). Blebs are the cause of some cases of spontaneous pneumothorax and they can rupture with exercise. Respiratory muscle fatigue may develop with empyema, but this is a vague finding not directly related to empyema. similar6. A patient has been diagnosed with tuberculosis (TB). What does the student know about this condition? (Select all that apply.) a. Foreign-born people have the highest rate in the United States. b. TB is rapidly becoming resistant to many different antibiotics. c. It is transmitted through contact with patient secretions. d. A positive skin test is the only reliable way to diagnose TB. e. Treatment consists of a combination of antibiotics. ANS: A, B, E TB is a common worldwide health problem, but in the United States, most cases of TB are seen in foreign-born individuals. TB is rapidly developing multi-drug resistance. It is transmitted through inhaling infectious droplets. A positive skin test demonstrates exposure to TB, not specifically active disease; a chest x-ray is needed for confirmation. Treatment does consist of a multiple antibiotic regime. 7. A patient has pneumonia. For which clinical manifestations should the healthcare professional assess for? (Select all that apply.) a. Inspiratory crackles b. Fremitus c. Egophony d. Whispered pectoriloquy e. Absence of breath sounds ANS: A, B, C, D Pneumonia is characterized by inspiratory crackles, increased tactile fremitus (palpable chest vibrations), egophony (a voice sound heard on auscultation as a prolonged “a” over consolidated lung tissue when a person says “e”), and whispered pectoriloquy (the sound of whispering heard on auscultation over consolidated lung tissue which are normally not heard). An absence of breath sounds would not be consistent with this disease process.Chapter 37: Alterations of Pulmonary Function in Children 17. What abnormalities lead to the mucus plugging seen in children with cystic fibrosis (CF)? a. Excess mucus plugs the gut and keeps it from absorbing water effectively. b. A weak inflammatory response allows bacterial to colonize the mucus. c. Defective chloride secretion and excess sodium absorption thicken the mucus. d. Pulmonary vascular remodeling occurs that leads to chronic hypoxia. ANS: C Respiratory mucus in CF is dehydrated and viscous because of impaired chloride secretion and excess sodium absorption. The gut’s ability to absorb water is not affected. The inflammatory response is active in this disease process. Pulmonary remodeling does lead to chronic hypoxia, but this is not related to mucus plugging. 5. A health professions student learns which facts about the pediatric differences in the respiratory system? (Select all that apply.) a. An adult’s chest wall compliance is lower than an infant’s. b. Increased resiliency makes infants more tolerant to respiratory problems. c. Infants are obligatory nose breathers. d. A baby is born with all the alveoli he or she will ever have. e. Airway obstruction occurs sooner in infants than in older children. ANS: A, C, E There are several age-related differences to consider when working with children. Chest wall compliance is higher in infants than it is in adults, particularly in premature infants. Immunological immaturity makes infants and small children more susceptible to infection. Until 2 to 3 months of age, infants are obligatory nose breathers which increases their risk for obstruction and poor gas exchange. A child grows and develops more alveoli until between 5 to 8 years of age. Airway obstruction does occur sooner in infants because an infant’s airway is smaller in general and in any airway; resistance is proportional to the inverse of the fourth power of the radius; thus a decrease to half the original diameter increases resistance by 16-fold. similarChapter 38: Structure and Function of the Renal and Urologic Systems #1 - The cortex contains all the glomeruli and portions of the tubules of the kidneys. The medulla forms the inner part of the kidney and consists of regions called pyramids. The apices of the pyramids project into minor calyces (cup-shaped cavities) that unite to form major calyces. Renal columns are an extension of the cortex and lie between the pyramids and extend to the renal pelvis. #2 - The nephron is the functional unit of the kidney. The glomerulus is a tuft of capillaries that loop into the circular Bowman glomerular capsule (Bowman space), like fingers pushed into bread dough and is the site of filtration. Final adjustments in urine composition are made by the distal tubule and collecting duct according to body needs. The apices of the pyramids project into minor calyces (cup-shaped cavities) that unite to form major calyces. #5 - Control of renal blood flow, glomerular filtration, and renin secretion occurs at the JGA. Together, the juxtaglomerular cells and macula densa cells form the JGA. The macula densa prevent large fluctuations in body water and salt. The visceral epithelium becomes the parietal epithelium. The filtration slits are intercellular clefts that modulate filtration. #17 - Tubular reabsorption is the movement of fluids and solutes from the tubular lumen to the peritubular capillary plasma. Tubular secretion is the transfer of substances from the plasma of the peritubular capillary to the tubular lumen. Ultrafiltration causes small molecules to move from the blood across the Bowman capsule into the renal tubule. Excretion is the elimination of a substance in the final urine. #20 - Tamm–Horsfall glycoprotein, also known as uromodulin, is the most abundant urinary protein, protects against bacterial adhesion and urolithiasis, and is a ligand for lymphokines. Urodilatin is a natriuretic hormone. Nephrin is a protein needed for a stable renal filtration barrier. Cystatin C is a stable protein in serum filtered at the glomerulus and metabolized in the tubules. Serum levels of cystatin C also are a marker for estimating GFR, particularly for mild to moderate impaired renal function.Chapter 39: Alterations of Renal and Urinary Tract Function #1 - Angiotensin II activity is elevated with progressive nephron injury. Angiotensin II promotes glomerular hypertension and hyperfiltration caused by efferent arteriolar vasoconstriction and also promotes systemic hypertension. The chronically high intraglomerular pressure increases glomerular capillary permeability, contributing to proteinuria. Angiotensin II also may promote the activity of inflammatory cells and growth factors that participate in tubulointerstitial fibrosis and scarring. 2. A patient has been diagnosed with a renal stone. Based on knowledge of common stone types, what self-care measure does the healthcare professional plan to teach the patient when stone analysis has returned? a. Increase water intake. b. Decrease soda intake. c. Restrict animal protein in the diet. d. Ingest 1000 mg of calcium a day. ANS: D Calcium stones (calcium phosphate or calcium oxalate) account for 70% to 80% of all stones requiring treatment. While all choices are appropriate for self-care in the patient with kidney stones, maintaining a calcium intake of 1000 to 1200 mg/day is a specific preventative measure for calcium stones. 15. A patient exhibits symptoms including hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin as the major protein. What diagnostic test or treatment regime does the healthcare professional educate the patient on? a. Intravenous pyelogram b. Oral antibiotics c. Renal biopsy d. Cyclophosphamide ANS: C The data suggest the patient has glomerulonephritis. Two major changes distinctive of more severe glomerulonephritis are (1) hematuria with red blood cell casts and (2) proteinuria exceeding 3 to 5 g/day with albumin as the major protein. There are several types of this disorder and treatment is specific to individual types. The patient needs a renal biopsy to determine appropriate treatment. A pyelogram would help identify kidney stones. Oral antibiotics would be used if there is an infection. Cyclophosphamide can be used in glomerulonephritis that is unresponsive to corticosteroids.17. A patient who has a history of mildly decreased renal function is admitted to the hospital for IV antibiotics. Which antibiotics would the healthcare professional avoid in this patient? a. Penicillin and ampicillin b. Vancomycin and bacitracin c. Gentamicin and tobramycin d. Cefazolin and cefepime ANS: C Although numerous antibiotics can produce nephrotoxic ATN, the aminoglycosides (gentamicin, tobramycin) are the major culprits. The healthcare professional would avoid their use in this patient if at all possible. Chapter 40: Alterations of Renal and Urinary Tract Function in Children #4 - Hypospadias is a congenital condition in which the urethral meatus is located on the ventral side or undersurface of the penis. In epispadias, the dorsal urethra is not fused and has failed to form into a tube. Epispadias can be seen in both boys and girls. In chordee a shortage of skin on the ventral surface causes the penis to bend or to “bow” ventrally. Hyperspadias is not a condition. #14 - Aniridia (lack of an iris in the eye) is an anomaly often associated with Wilms tumor. Approximately 10% of children who have Wilms tumor also have a loss of other important genes and therefore have a number of congenital anomalies, including hemihypertrophy (an asymmetry of the body), and genitourinary malformations (i.e., horseshoe kidneys, hypospadias, ureteral duplication, Chapter 24: Structure and Function of the Reproductive Systems #12 - Having ejected a mature ovum, the ovarian follicle develops into the corpus luteum. The remaining follicles either fail to develop at all or degenerate without maturing completely and are known as atretic follicles. Theca cells produce androgens that migrate to granulosa cells. Scar tissue serves no reproductive purpose.Chapter 25: Alterations of the Female Reproductive System #3 - Mixed precocious puberty, which is virilization of a girl or feminization of a boy, causes the child to develop some secondary sex characteristics of the opposite sex. Partial precocious puberty is the partial early development of appropriate secondary sex characteristics alone or in combination. Central precocious puberty is GnRH dependent and occurs when the HPG axis is working normally but prematurely. Central precocious puberty results from failure of central inhibition of the GnRH pulse generator (the gonadostat), often because of CNS abnormality. “Isosexual” is not a description of a type of precocious puberty. 4. A person has been diagnosed with primary dysmenorrhea and wants to know why ibuprofen is a good choice for pain control. What response by the health care professional is best? a. “It inhibits the release of leukotrienes in your system.” b. “It reduces the production of prostaglandins in your body.” c. “It enhances the effects of bradykinin release.” d. “It contributes to a higher C reactive protein in your blood.” ANS: B Primary dysmenorrhea is painful menstruation associated with the release of prostaglandins in ovulatory cycles. Nonsteroidal antiinflammatory medications like ibuprofen reduce the activity of the COX enzyme, which in turn inhibits prostaglandin production. Leukotrienes are part of the inflammatory process. Bradykinin is a vasodilator and also has a role in pain, but is not related to dysmenorrhea. C reactive protein is part of the innate immune system. 5. A woman has been diagnosed with compartment II primary amenorrhea. The healthcare professional helps prepare the woman for what type of diagnostic testing? a. Genetic testing b. CT scan of the anterior pituitary c. Blood work for hypothalamic function d. Vaginal speculum exam ANS: A Compartment II disorders involve the ovary and are often linked to genetic disorders. The professional would help prepare the woman for genetic testing. Compartment III disorders result from dysfunction of the anterior pituitary gland. Hypothalamic disorders often cause compartment IV primary amenorrhea. Compartment I disorders are anatomic defects of the outflow tract associated with primary amenorrhea and include congenital absence of the vagina.#8 - Unpredictable and variable bleeding, in terms of amount and duration, characterize abnormal uterine bleeding. Especially during perimenopause, dysfunctional bleeding also may involve flooding and the passage of large clots, which often indicate excessive blood loss. Excessive bleeding can lead to irondeficiency anemia. Premenstrual syndrome involves distressing physical, emotional, or behavioral symptoms. Over 300 symptoms have been ascribed to this condition, but heavy bleeding, passing clots, and iron deficiency anemia are not characteristics of PMS. Polycystic ovary syndrome can include dysfunctional bleeding or amenorrhea. Primary dysmenorrhea is lack of the menstrual period, so heavy bleeding would not be a manifestation of this disorder. #14 - Cystocele is the only term used to identify the descent of a portion of the posterior bladder wall and trigone into the vaginal canal. A rectocele is the bulging of the rectum and posterior vaginal wall into the vaginal canal. “Vaginocele” is not a term used to describe relaxation of pelvic structure support. An enterocele is the herniation of the peritoneal sac between the vagina and rectum. 22. A woman has been diagnosed with a simple fibroadenoma. What treatment does the healthcare provider educate the woman about? a. A repeat biopsy in 6 months b. More frequent mammograms c. Nothing; no treatment is needed. d. Rapid surgical excision and chemotherapy ANS: C Simple fibroadenomas are benign, and if asymptomatic, do not require treatment. A complex fibroadenoma with surrounding proliferative changes needs further treatment. If the woman has a family history of breast cancer, she may wish to have it removed to decrease worry.4. A woman has been diagnosed with compartment IV primary amenorrhea. What assessments would the healthcare professional perform as priorities? (Select all that apply.) a. Weight and body mass index b. Signs of systemic infection c. Stress self-assessment questionnaire d. Genetic family history e. Presence of secondary sex characteristics ANS: A, B, C, E? Compartment IV primary amenorrhea is due to CNS dysfunction, specifically of the hypothalamus. The hypothalamus is unable to synthesize GnRH, so the pituitary fails to secrete LH and FSH. Therefore, the ovary does not receive the hormonal signals required to stimulate estrogen production, and ovulation and menstruation do not occur. Because the ovarian hormones are absent, estrogendependent sex characteristics do not develop. Other possible causes of this condition include starvation or malnutrition, infections, and stress. The healthcare professional would assess for these contributing factors. Genetic testing/screening would be more appropriate for compartment II primary amenorrhea, which involves the ovaries and is often linked to genetic disorders. Chapter 26: Alterations of the Male Reproductive System #13 - Bacterial prostatitis can exhibit common manifestations that include a sudden onset of malaise, low back and perineal pain, high fever (up to 40 C [104 F]), and chills, as well as dysuria, inability to empty the bladder, nocturia, and urinary retention. Since it is most often associated with a urinary tract infection (UTI), the specific causative organism can usually be identified from a urinalysis. The professional should assist and educate the man on obtaining the appropriate specimen. While possible that prostatitis could be sexually transmitted, that is not as common as developing the infection secondary to a UTI. Heat and mild analgesics are helpful, but do nothing to identify the causative organism for appropriate treatment. A sample of fluid may be obtained for culture by prostatic massage, but this is very painful and would most likely not be done if other diagnostic tools are available.33. NURS 611 Advanced Pathophysiology Exam Questions & Answers for: Chapter 36: Alterations of Pulmonary Function; Chapter 37: Alterations of Pulmonary Function in Children; Chapter 38: Structure and Function of the Renal and Urologic Systems; Chapter 39: Alterations of Renal and Urinary Tract Function; Chapter 25: Alterations of the Female Reproductive System