Kaplan Patho Focused Review PDF

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Kaplan Patho Focused Review 1. The nurse provides care for a client diagnosed with Crohn disease (reginal enteritis). Which finding is expected by the nurse as a common complication of Crohn disease  Reflux esophagitis  Chronic constipation  Fistulas o Abnormal tracts between two or more body areas, may involve the GI and the skin, bladder, or vagina.  Hypothermia Rationale: fistulas, abnormal tracts between two or more body areas, may involve the GI tract and the skin, bladder, or vagina 2. The nurse provides care for a client with a 10-year history of osteoarthritis, which assessment by the nurse is expected?  Upper and lower extremity joints warm to touch and reddened in appearance  Increased joint pain and stiffness after periods of activity  Weight loss and decreased appetite  Increased erythrocyte sedimentation rate (ESR) Rationale: joint pain is precipitated by activity and relived by rest. Pain may be due to articular distension or stretching of the joint fibers. It may involve single or multiple joints. 3. The nurse provides care for a client diagnosed with a severe head injury. The client urine output is 150 mL/ hour, blood pressure is 92/68 mm Hg, and increased serum osmolarity is present. The nurse suspects the client has which condition?  Diabetes insipidus o Traumatic brain injury or neurosurgical procedures proximal to the hypothalamus may cause decreased antidiuretic hormone secretion.  Increased intracranial pressure o May be relayed to fluid volume excess or cerebral edema which would not necessarily be exhibited by fluctuations in urine output or serum osmolarity  Pulmonary edema o Is related to significant increase in fluid volume  Acute kidney injury o Oliguria and increased BP are seen with acute kidney injury 4. The nurse cares for the client diagnosed with adrenal hypersecretion (Cushing syndrome) the nurse expects to observe which findings?  Truncal obesity and increased facial fat o Excess amounts of cortisol cause alterations in fat metabolism and accumulatio of adipose tissue in the facial, trunk and cervical areas.  Hypoglycemia and hypertension o Adrenal insufficiency/excess cortisol alters glucose metabolism and increases blood glucose levels  Symptoms of dehydration and hyponatremia

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o Excess of cortisol causes sodium and secondary fluid retention leading to hypernatremia Anorexia and weight loss o More common in adrenal insufficiency

5. The nurse provides care for a client diagnosed with poorly controlled type 1 diabetes mellitus. Which finding is the earliest manifestation of diabetic nephropathy.  Increased urine output o Increased urine output is seen 2-6 weeks after the oliguric stage of acute kidney injury.  Periorbital edema o Due to increased fluid in the interstitial spaces related to fluid volume overloads and is seen during oliguric stage of acute kidney injury.  Increased serum potassium o Hyperkalemia is related to decreased ability of the kidneys to excrete K and is seen during the oliguric stage of acute kidney injury.  Albumin in the urine o Earliest sign of diabetic nephropathy is microalbuminuria, which is protein or albumin in the urine. 6. The nurse provides care for a client diagnosed with severe anemia who exhibits pallor of the skin, conjunctivae, and mucous membranes. Which statement best explains the reason of the pallor?  Increased number of reticulocytes o It is increase when the number of circulating red cells decrease.  Deficient platelet production o Platelets are activated during the first part of the clotting process in response to tissue injury and do not affect skin color.  Decreased in cardiac output o Cardiac output is increased during tissue hypoxia. Tachycardia and palpitations are common symptoms of severe anemia.  Shunting of blood to heart and brain o Pallor is a common symptom of severe anemia due to shunting of the blood from the skin and mucous membranes to the heart and brain. Decreased HGB levels will increase pallor 7. the nurse provides care for a client who has severe decrease in serum albumin levels. Which finding does the nurse expect to observe during assessment of the client?  Bounding pedal pulse strength o Decrease serum albumin will cause a decrease pedal pulse and a decrease plasma osmotic pressure which will cause fluid to move into the interstitial spaces  Bilateral pretibial edema  Weight loss o Edema can cause weight gain not weight loss  Increased BP o BP will be decreased due to diminished blood volume

Rationale: albumin is protein that has strong osmotic effect. It prevents plasma from leaking into interstitial fluid. When serum albumin levels are low interstitial edema and movements of fluid into third space will occur. 8. The nurse provides care for a client who has urticia and swelling of the lips and eyes immediately after a contrast-enhanced computerized tomography procedure. Which statement best explains the reason for these observations?  Increased prostaglandin levels  Release of leukotrienes  Decreased bradykinin levels  Release of histamine Rationale: Histamine is a short acting chemical mediator released during the primary phase of Type 1 hypersensitivity. It is released during degranulation of IgE sentized mast cells and increases capillary permeability, vasodilation, and tissue swelling. The client’s immediate symptoms of urticaria and swelling of the lips and yes indicate release of histamine as the cause of the symptoms, an obvious allergic response.

9. The nurse provides care for a client with HTN and notes the client’s serum renin levels are increased. Which finding best describes the affect of increased renin levels on BP?  Decrease serum angiotensin II levels  Increase reabsorption of NA in kidneys o High renin levels will increase BP and will activate the RAAS.  Increases myocardial contractility  Activates the sympathetic nervous system Rationale: high renin levels will increase BP and will activate the RAAS. Angiotensin I will convert to angiotensin II, which has a potent vasoconstricted effect. Renin increases Na aldosterone levels, kidney reabsorption of NA, H20, and increase BV and BP 10. The nurse provides care for a client who has been involved in a motor vehicle accident. The client is diagnosed with an epidural hematoma. Epidural hematoma is most commonly associated with which condition?  Thrombosis of the internal carotid artery  Damage to the middle meningeal artery  Rupture of the bridging veins  Fracture of the base of the skull Rationale: the middle meningeal artery lies in a groove in the temporal bone. The interior surface of temporal bone. The interior surface of temporal bone fracture increases risk of meningeal artery tear, neurologic changes may be rapid due to accumulation of arterial blood in the epidural space.

11. The nurse is providing care for a client admitted with the diagnosis of small bowel obstruction and has severe abdominal distension. Which finding best describes the reason for the distension?

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Increase gastric acid pH level Vagal nerve stimulation Accumulation of fluid in intestine o Decreased perfusion of intestine

12. The nurse provides care for a client diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). The nurse expects to observe which during the review of the client’s laboratory results?  Decreased serum NA levels o  Increased serum K levels  Decreased serum Ca levels  Increased serum Mg levels 13. The nurse provides care for a client with acquired immunodeficiency syndrome (AIDS). The nurse knows the client is at high risk to develop which disease?  Glioblastoma Multiforme  Kaposi sarcoma o  Hepatocarcinoma  Melanoma 14. The nurse provides care for a client with a history of Type 1 diabetes mellitus and admitted in a severe drowsy state. The client’s arterial blood gas values: pH – 7.26, pcO2 – 37 mm hg, HC0 12 mEq/L. the nurse expects which finding during a review of the client’s history.  Reduced fluid intake  History of visual problems  History of recent infection  Decreased urine output Rationale: the client is exhibiting metabolic acidosis. 15. The nurse provides care for a client diagnosed with alcoholic cirrhosis. The client is at high risk to develop which complication?  Hep B  Pancreatic cancer  Weight gain  Epistaxis Rationale: epistaxis is an acute hemorrhage from the nostril, nasal cavity, or nasopharynx. Bleeding is a common risk factor of cirrhosis due to decreased formation of coagulation factors. 16. Which statement best describes the event leading to death of neurons after an ischemic stroke?

 Increased metabolic activity the neurons surrounding the affected area  Movement of K ions into the cells from the extracellular area  Accumulation of NA and H20 inside the neurons in the affected area  Increased formation of ATP in the neurons in the affected area Rationale: the decrease formation of ATP is due to ischemia of the neuros and a failure of the Na/K pump. Na, H20, and Ca accumulate inside the neurons with ischemia. Destruction of cell membrane and decreased mitochondrial function cause death of neurons. 17. The nurse provides care for a client diagnosed with subarachnoid hemorrhage 48 hrs. ago. The client reports a severe headache, increased sensitivity to light, and neck stiffness. The nurse knows which explanation is best to provide the basis for the symptoms.  Dilation of the cerebral blood vessels  Increased amounts of endorphins in the brain tissue  Irritation of the meninges of the CNS  Increased metabolic activity of the brain Rationale: meninges covering the CNS have nociceptors. Pressure or stretch of meninges causes headache, photophobia, and neck stiffness. Manifestations will decrease as blood is reabsorbed and vasospasm decreases. 18. The nurse provides care for a client with a two-year history of sickle cell disease. Which factor increases the risk of vasoocclusive crisis?  Fluid volume overload  Influenza infection  Decreased protein intake  Low serum Hgb 19. An older adult client initial assessment revels: BP 88/55 mm Hg, apical 110 BPM, and poor skin turgor. Which laboratory test result does the nurse expect?  Increased serum Hct o  Decreased serum Na  Decreased serum osmolality  Decreased serum K 20. A client is admitted with an exacerbation of multiple sclerosis. Which observation does the nurse the nurse expect to assess?  Bradycardia and decreased BP  Ascending paralysis of skeletal muscle  Enlarged pupils and facials paralysis  Numbness of extremities and difficulty walking Rationale: it is a progressive neuromuscular tissue that is caused by an immune-mediated destruction of the myelin sheath that covers the nerve fibers in the brain and the spinal cord.

21. The nurse provides care for a client with chronic kidney disease, during review of laboratory results, the nurse note the client’s serum Mg is increased. Which question is priority for the nurse to ask the client?  Are you drinking many beverages that contain caffeine?  Do you notice any tremors of your hands and fingers?  How many dairy products do you consume daily?  What OTC do you take? Rationale: Mg excretion is reduced in clients with chronic kidney disease. Antacids and laxatives may contain high levels of mg and should be avoided by clients with chronic kidney disease. 22. A client reports removing a deer tick with a pair of tweezers from the arms one week ago. Which question is most important for the nurse to ask?  Do you have a flu like symptoms to report at this time?  Have you noticed any numbness and tingling in your feet recently?  Do your joints feel hot and swollen?  Does your heart seem to be beating harder? Rationale: symptoms of the early of Lyme disease begins 3 to 30 days after the bite from an infected tick. 23. The nurse understands that which client is most at risk to develop urinary tract calculi?  Client who is a vegetarian  Client who consumes a low Na diet  Client with polycystic kidney disease  Client with diabetic nephropathy Rationale: consumption of foods high in calcium or oxalate rich foods increase urine alkalinity and increase urine alkalinity and the risk of calculi. 24. The nurse provides care for a client who has 15-year history of SLE. The client blood pressure is 158/94 and 2+ pretibial edema is present. The nurse notes an elevated serum K level and decreased serum Hbg level. Which process best describes the reason for these findings?  Degranulation of mast cells and release of histamine and serotine  Formation of antigen-antibody complexes that lodge in small blood vessels o  Release of massive amounts of igE and leukotrienes  Lysis of the antibody molecules and release of sensitized T cells. 25. The nurse provides care for an older adult client with systolic (left-sided) heart failure. The nurse is to administer a medication that decreases afterload, which best describes the desrices effect of the medication for this client?  Decrease the pressure the heart must work again to eject blood  Increase coronary blood flow for easier to contractility  Decreased myocardial contractility to relieve aortic pressure  Increase systemic BP to improve contractility

26. The nurse provides care for an older adult client. The client is diagnosed with pathological fracture of the 9th thoracic vertebra. What is the most likely cause of the fracture for this client?  Osteogenesis imperfecta  Osteogenic sarcoma  Osteoporosis o  Osteochondroma 27. A nurse provides care for a client diagnosed with a group A beta-hemolytic streptococcal bacterial infection. The nurse knows the client is at high risk to develop which condition?  Myoglobinuria  Acute glomerulonephritis o  Renal calculi  Uremic encephalopathy 28. A client is diagnosed with type 2 diabetes mellitus. Which factor contributes to the insulin resistance seen in type 2 diabetes?  Autoimmune destruction of beta cells in the pancreas  History of mumps infection as a child  Increased waist circumference size o  Increased glucagon secretion from the alpha cells in the pancreas 29. Which client is at highest risk to develop iron deficiency anemia?  A middle age client diagnosed with a gastric ulcer o  A middle age client who avoids meat products  An older adult client who received chemotherapy for 6 months  An adult client who lost 30 pounds over the two months 30. The nurse provides care for a client with AIDS who has a CD4 T cell count of 120. The nurse knows the client is at risk to develop which infection?  Beta-hemolytic streptococcal infection  H.plyori infection  Hep A infection  Pneumocytis pneumonia (PCP) Rationale: person in stage 3 HIV with a CD4 T cell count less are at high risk for the development of PCP...