While reviewing the role of glucagon in regard to regulation of blood glucose, the nurse knows which of the following situations could lead to an inhibition of glucagon release?
A. A sharp decrease in blood glucose concentration
B. An increase in glucose levels.
C. Recent intake of large amounts of protein-rich food.
D. Recent strenuous physical activity
One of the most reliable predictors for worsening autosomal dominant polycystic kidney disease is
A. serum creatinine levels.
B. urine albumin excretion (UAE).
C. urine specific gravity.
D. blood urea nitrogen (BUN) level.
A speech therapist is performing a swallowing assessment on a 72-year-old man who has suffered a stroke 3 weeks ago. The man has been NPO (nothing by mouth) since his stroke, and the health care team is considering the introduction of oral food. The speech therapist is cueing the client to swallow to preclude either aspiration of food or pocketing of food in the sides of his mouth. The client most likely to have conscious control over which of the following processes listed below involved in swallowing?
A. Moving the epiglottis back to cover the larynx
B. Moving the bolus backward in the esophagus
C. Moving a bolus to the posterior wall of the pharynx
D. Initiation of primary peristalsis
Which of the following data would a clinician consider as most indicative of acute renal failure?
A. Alterations in blood pH; peripheral edema
B. Decreased serum creatinine and blood urea nitrogen (BUN); decreased potassium and calcium levels
C. Decreased urine output; hematuria; increased GFR
D. Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR)
When explaining about the passage of urine to a group of nursing students, the clinic nurse asks them which muscle is primarily responsible for micturition? Their reply is the
B. external sphincter.
C. urinary vesicle.
A 77-year-old woman has been admitted to hospital following several weeks of increasing fatigue. On observation, she is pale, and blood work indicates she has low hemoglobin and red cell counts. Stool tests for occult blood are positive, and following endoscopy, she has been diagnosed with an upper GI bleed that has been shown to originate in her stomach. She admits to regularly exceeding the recommended doses of nonsteroidal anti-inflammatory drugs (NSAIDs) in an effort to control her rheumatoid arthritis. Which of the following phenomena is most likely responsible for her present health problems?
A. NSAIDs increase the gastric production of gastrin, increasing gastric secretions and lowering stomach pH.
B. Drugs such as NSAIDs increase the H+ levels and thus decrease gastric pH, resulting in insult to the stomach lining.
C.NSAIDs can disrupt the permeability of the gastric mucosa, causing hydrogen ions to accumulate in the mucosal cells of the lining.
D.NSAIDs, aspirin, and other drugs increase prostaglandin synthesis, resulting in disruption of cellular structures lining the stomach.
Which of the following statements best describes an aspect of the normal process of glucose metabolism?
A. Glucose that exceeds metabolic needs is converted and stored by the liver.
B. Blood glucose levels are primarily a result of the timing, quantity, and character of food intake.
C. Ingested glucose that is not needed for cellular metabolism circulates in the blood until it is taken up to meet cellular needs.
D. Blood glucose levels are kept in a steady state by selective excretion and reuptake by the kidneys.
Following a 14-day course of broad-spectrum antibiotics for the treatment of sepsis, a 60-year-old woman has developed watery diarrhea. Her care team attributes this to likely elimination of normal intestinal flora by the antibiotics. What other phenomena is most likely accompanying her low levels of normal flora?
A. Proliferation of vitamin K; lower GI bleeding
B. Decreased fermentation of undigestible dietary residue; decreased vitamin absorption
C. Decreased mineral and nutrient absorption; decreased carbohydrate metabolism
D. Decreased pH of the stomach; increased pH of the lower GI tract
A male infant is brought into the clinic because of colic-like symptoms. The mother states he acts like something is hurting. After eating, he vomits most of the feeding and then assumes a fetal position. He is also not gaining weight. The nurse practitioner is thinking that he is displaying clinical manifestations of obstruction and may have which of the following medical diagnoses?
A. Pyloric stenosis
B. Duodenal ulceration
D. Erosive esophagitis
Which of the following medications would the nurse anticipate being prescribed for the renal failure patient who has hyperphosphatemia?
A. Sensipar (Cinacalcet)
B. Levothyroxine (Synthroid)
C. Calcium carbonate
D. Vitamin D (calcitriol)
To reduce hepatic blood flow and decrease portal pressures in persons with cirrhosis, the nurse should be prepared to administer which of the following medications?
A. Filgrastim, granulocyte colony-stimulating factor (G-CSF) analog
B. Octreotide, a long-acting synthetic analog of somatostatin
C. Diltiazem (Cardizem), a calcium channel blocker
D. Bevacizumab, an angiogenesis inhibitor
A 30-year-old male who manages his type 1 diabetes with glyburide presents at the emergency room complaining of headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half-marathon. Which of the following is likely to be the cause of his complaints?
A. Somogyi effect
C. Hyperosmolar hyperglycemic state
D. Diabetic ketoacidosis
A 51-year-old male professional is in the habit of consuming six to eight rum and cokes each evening after work. He assures the nurse practitioner who is performing his regular physical exam that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the client's statement?
A.“When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic byproducts.”
B.“You are more than likely inflicting damage on your liver, but this damage would cease as soon as you quit drinking.”
C.“In spite of that, the amount of alcohol you are drinking is likely to result first in cirrhosis and, if you continue, in hepatitis or fatty liver changes.”
D. “That may be the case, but you are still creating a high risk of hepatitis A or B or liver cancer.”
A 55-year-old man has made an appointment to see his family physician because he has been awakening three to four times nightly to void and often has a sudden need to void with little warning during the day. What is the man's most likely diagnosis and possible underlying pathophysiological problem?
A. Stress incontinence due to damage to CNS inhibitory pathways
B. Overactive bladder that may result from both neurogenic and myogenic sources
C. Overflow incontinence that can result from displacement of the angle between the bladder and the posterior proximal urethra
D. Overactive bladder due to intravesical pressure exceeding urethral pressure
Following several days of intermittent upper right quadrant pain, a 29-year-old obese, Native American woman has been diagnosed with cholelithiasis. The nurse at the clinic has taught the client about the pathophysiology and contributing factors to her health problem, as well as some of the likely treatment options. Which of the following statements by the client demonstrates a sound understanding of her diagnosis?
A. “I suppose the fever and vomiting I had this week was probably a sign of my gallstones too.”
B.“Several factors like my genetics and gender may have contributed to this, but I'm glad that medications can cure it.”
C.“This explains why my skin was yellow-tinged lately and why I had those pains that spread to my upper back and right shoulder.”
D. “All in all, I guess this is a result of the fact that I've been eating a diet too high in cholesterol for too long.”
A 42-year-old female client with a long-standing history of chronic nausea and vomiting but a near-insatiable appetite has had her symptoms attributed to an enzyme deficiency. Further diagnostic testing indicates that she has inadequate pancreatic enzyme levels and that her large appetite is due to a lack of enzyme control of food intake inhibition. In which of the following enzymes is the woman most likely deficient?
A nurse educator is performing client education with a 51-year-old man who has been recently diagnosed with chronic kidney disease.Which of the following statements by the client would the nurse most likely want to or clarify?
A.“My heart rate might go up because of my kidney disease, and my blood might be a lot thinner than it should be.”
B. “My kidney problems increase my chance of developing high blood pressure or diabetes.”
C.“I'll be prone to anemia, since I'm not producing as much of the hormone that causes my bones to produce red blood cells.”
D.“I'll have a risk of either bleeding too easily or possibly clotting too quickly, though dialysis can help minimize these effects.”
A 25-year-old Asian American man arrives in the emergency room in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What disease has likely caused of his hematuria and how should it be treated?
A.Immunoglobulin A nephropathy and may be advised to use omega-3 fatty acids to delay progression of disease
B. Kimmelstiel-Wilson syndrome and should be treated with medication to control high blood pressure
C. Membranous glomerulonephritis and should be treated with corticosteroids
D. Goodpasture syndrome and will be treated with plasmapheresis and immunosuppressive therapy
Which of the following clients in a hospital medical unit is most clearly demonstrating the signs and symptoms of liver failure? An adult with
A. sudden onset of confusion, a history of alcohol abuse, and low levels of serum AST and ALT.
B. blood pressure of 189/103, jaundice, and multiple thromboses.
C. low hemoglobin levels, low platelet levels, and spider angiomas present.
D. ascites, fever, and recent onset of atrial fibrillation.
Which of the following clients is most clearly displaying the signs and symptoms of irritable bowel disease (IBD)?
A.A 24-year-old man who has a stressful job but whose diarrhea and cramping do not worsen during periods of high stress
B. A 32-year-old mother who complains of intermittent abdominal pain that is worse during her menstrual period
C.A 44-year-old man who works the evening shift at a factory and who states that his lower abdominal pain is much worse at night than during the day
D.A 51-year-old male who states that his stomach pain is in his lower abdomen, “comes and goes,” and “feels more like a cramp than a dull ache”
A 40-year-old man who uses heroin intravenously was diagnosed with hepatitis C (HCV) 1 year ago and is now considered to have chronic viral hepatitis. Which of the following statements by the client to his care provider would warrant ion?
A.“I'm not looking forward to all the side effects of the drug treatments for my HCV, but I hope I don't end up needing a liver transplant.”
B. “Even though I'm sick, at least I won't feel sick most of the time.”
C. “It's at least a bit reassuring that my liver isn't undergoing damage when I'm not experiencing symptoms.”
D.“I know the medications to treat this aren't fantastic, but at least there are some options for controlling the virus.”
A 42-year-old male has been diagnosed with renal failure secondary to diabetes mellitus and is scheduled to begin dialysis soon. Which of the following statements by the client reflects an accurate understanding of the process of hemodialysis?
A. “I know I'll have to go to a hospital or dialysis center for treatment.”
B. “It's stressful knowing that committing to dialysis means I can't qualify for a kidney transplant.”
C. “I won't be able to go about my normal routine during treatment.”
D. “Changing my schedule to accommodate 3 or 4 hours of hemodialysis each day will be difficult.”
Chronic anxiety and stress contribute to ulcers. Which of the following effects of the sympathetic nervous system is most responsible for this effect?
A. Inhibition of the actions of Brunner glands
B. Overstimulation of the oxyntic glands
C. Inflammation of the parotid glands
D. Suppression of cholecystokinin
When educating a patient about glargine (Lantus), the nurse should explain that this medication
A. will have a peak effect within 30 minutes, so it can be taken after a meal.
B.has a rapid onset and peaks in about 5 minutes after injection, so he will need to eat food immediately after injection.
C.is a combination with short-acting and intermediate-acting insulin, so it is safe to take anytime throughout the day.
D. has a prolonged absorption rate and provides a relatively constant concentration for 12 to 24 hours.
A 60-year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states that, “I don't know how this could happen to me, since I'm so careful about eating a healthy diet.” What is the most appropriate response to the man's statement?
A.“You likely don't need to change your diet, but now that you have stones in one kidney, you're at very high risk of growing them in the other kidney.”
B. “Your diet may have played a part in this, but in fact, genetics are likely primarily to blame.”
C.“Your diet might be normally healthy, but high intake of normally beneficial minerals like calcium and magnesium can lead to stones.”
D.“What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved.”
A 46-year-old man who is obese has received news that he has type 2 diabetes. He is in the process of determining a plan of care with an interdisciplinary team at a hospital-based diabetes clinic. The nurse knows that the most likely treatment plan for the man will include
A. injectable insulin and nutrition management.
B. continuous subcutaneous insulin infusion (CSII) and nutrition management.
C. oral antihyperglycemic medications and weight loss measures.
D. weight loss, glucose monitoring, and lifestyle modification.
A nurse in an acute medical unit of a hospital has admitted a 62-year-old female from the emergency department who has been diagnosed with acute pyelonephritis. Which of the following statements most accurately conveys an aspect of the knowledge base that the nurse needs to perform adequate care and teaching?
A. The infection in the kidney is most likely a manifestation of a systemic infection.
B. Imaging tests are likely to reveal scarring and deformation of the renal calices and pelvis.
C. Most cases of acute pyelonephritis are attributable to poorly controlled hypertension.
D. Flank pain, dysuria, and nausea and vomiting are likely assessment findings.
A number of clients on a geriatric subacute medical floor of a hospital have developed foul-smelling diarrhea over the last several days, and subsequent culture of stool samples has confirmed the presence of Clostridium difficile in each case. The care team in the unit would recognize that which of the following factors likely contributed to the health problem and would anticipate which of the following treatments?
A.The use of broad-spectrum antibiotics likely played a role in the development of infections, and most clients would likely receive metronidazole as a treatment.
B.Poor hand washing practice on the part of care providers led to the outbreak, and treatment will consist of hydration and nutritional support.
C.Ingestion of contaminated food probably contributed to the infections, and corticosteroids will be needed to treat them.
D.Genetic predisposition and the presence of the bacterium in clients' normal flora likely contributed, and treatment would consist of broad-spectrum antibiotics.
A male patient comes to the clinic asking to speak to a health care provider privately. He reveals that he had shared a needle/syringe with a prostitute (shooting up cocaine) and then had unprotected sex. Upon questioning, it was revealed that the patient had not had any immunization for hepatitis B. Which of the following medications would the nurse anticipate administering today to this patient?
A. Hepatitis A vaccine
B. Hepatitis B immunoglobulin (HBIG)
C. Hepatitis C immunoglobulin (HCIG)
D. Tenofovir disoproxil fumarate plus emtricitabine
A family physician is providing care for a 61-year-old obese male who has a history of diabetes and hypertension. Blood work has indicated that the man has a GFR of 51 mL/minute with elevated serum creatinine levels.Which of the following statements will the physician most likely provide the client in light of these results?
A.“We will regularly monitor your kidney function, but most likely your kidneys will be able to compensate on their own and intervention is not required.”
B. “You're in kidney failure, and I'll be starting dialysis treatment immediately.”
C. “Your chronic kidney disease has likely been caused by your diabetes and high blood pressure.”
D. “You likely have chronic kidney disease, and there may be urine in your blood until it is controlled.”
A 15-year-old boy with type 1 diabetes is exasperated by his regimen of blood sugar monitoring and insulin administration and has told his mother that he wants to scale both back. Which of the following responses by his mother is most accurate?
A. “You need to be vigilant now if you want to be free of diabetes when you grow up.”
B.“I know it's not fun, but you're even more susceptible to complications when you're young if you don't stay on top of your diabetes.”
C.“Even though you might save some time and energy by doing this, remember that high blood sugars cause a lot of pain and will cause you to gain weight.”
D.“Even though it's hard to do, you need to continue, so you don't go blind or need a kidney transplant down the road.”
A 51-year-old male has been diagnosed with alcohol-induced liver disease. He admits to the nurse providing his care that, “I know what the lungs do, and I know what the heart does, but honestly I have no idea what the liver does in the body.” Which of the following statements would best underlie the explanation that the nurse provides?
A. The liver contributes to the metabolism of ingested food and provides the fluids that the GI tract requires.
B.The liver is responsible for the absorption of most dietary nutrients as well as the production of growth hormones.
C. The liver metabolizes most components of food and also cleans the blood of bacteria and drugs.
D.The liver maintains a balanced level of electrolytes and pH in the body and stores glucose, minerals, and vitamins.
A mom asks her neighbor, a nurse, why every time she takes her daughter (10 years old) out for ice cream she comes home with a stomachache and then experiences a bout of diarrhea. The nurse is thinking that this girl is experiencing
A. premature peptic ulcer formation.
B. gallbladder disease.
C. anxiety about increasing too many calories.
D. a deficiency of lactase.
Which of the following medications used in the treatment of peptic ulcers and gastroesophageal reflux binds to H2 receptors and blocks the action of histamine on parietal cells?
A. Nexium (esomeprazole)
B. Cimetidine (Tagamet)
C. Lotronex (alosetron)
D. Levbid (hyoscyamine)
A frantic mother brings her young child into the emergency department. She states that during the evening bath, she noticed a large mass in her child's abdomen. After diagnostic testing, the pediatrician tells the parents that their child has Wilms tumor, stage IV. After the doctor leaves the room, the parents ask the nurse, “What does this mean?” The nurse will respond, “Your child ('s)
A. “has cancer in the kidney that has spread most likely to his lungs.”
B. “will need to undergo surgery to remove both kidneys and then go on dialysis.”
C. “tumor can be easily treated with chemotherapy. We will start this soon.”
D. “has cancer in his stomach.”
Which of the following clinical findings among older adults is most unlikely to warrant further investigation and possible treatment?
A. A 78-year-old female's GFR has been steadily declining over several years.
B. An 80-year-old male whose urine dipstick reveals protein is present.
C. An 81-year-old male's serum creatinine level has increased sharply since his last blood work.
D. A 90-year-old female's blood urea nitrogen (BUN) is rising.
When the sympathetic nervous system is stimulated, the interstitial cells of Cajal, pacemaker cells of the GI tract, react by
A. signaling the vagus nerve to slow down motility and increase absorption of water from the large intestine.
B. increasing the peristaltic motion of the GI tract, thereby causing explosive diarrhea.
C. increasing the amount of secretions being entered into each segment of the intestinal tract.
D.decreasing amplitude or abolishing the slow waves that control the spontaneous oscillations in membrane potentials.
A patient who has suffered a spinal cord injury at C4 is experiencing a sudden change in condition. His BP is 186/101; heart rate is 45; and he is profusely sweating and complaining of “not feeling right.” The nurse should
A. call a “Code Blue.”
B. palpate his bladder for overdistention.
C. page physician stat. and ask for an antihypertensive medication.
D. place his bed flat and elevate the foot of the bed.
A 24-year-old man is currently in a rehabilitation facility following a spinal cord injury at level T2. He is discussing his long-term options for continence management. Which of the following statements by the client demonstrates he has a clear understanding of the issue?
A. “It's critical that intermittent catheterization be performed using sterile technique.”
B. “An indwelling urethral catheter is the option that best minimizes my chance of a urinary tract infection.”
C. “Self-catheterization can limit the recovery of my neural pathways that control my voiding if I do it too often.”
D.“An indwelling catheter certainly would work well, but it comes with a number of risks and possible complications.”
A 4-year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the health care team's initial differential diagnosis most likely be?
A. Henoch-Schönlein purpura nephritis
B. Alport syndrome
C. Systemic lupus erythematosus glomerulonephritis
D. Immunoglobulin A nephropathy
A 22-year-old student has developed a fever and diarrhea while on a backpacking trip in Southeast Asia. His oral temperature is 101.4°F.The diarrhea is bloody, frequent, and small in volume. These clinical manifestations are sufficiently distressing that he is visiting a local medical clinic in the area. Which of the following diagnoses best characterizes this health problem?
A. Secretory diarrhea
B. Factitious diarrhea
C. Inflammatory diarrhea
D. Noninflammatory diarrhea
The mother of a 19-week-old infant has brought her baby in for assessment to a pediatrician because of the baby's persistent weight loss and diarrhea. An intestinal biopsy has confirmed a diagnosis of celiac disease, and the child's mother is anxious to know what caused the disease. Which of the following aspects of the etiology of celiac disease would underlie the explanation that the physician provides?
A. Bacterial or chemical invasion of the peritoneum leads to decreased nutrient absorption and transport.
B.Neurogenic or muscular inhibition of peristalsis results in inappropriate motility of ingested food in the lower small intestine and the colon.
C.An inappropriate T-cell–mediated response results in increased levels of antibodies and an inflammatory response.
D.Inability to process or absorb the fat content of breast milk results in malnutrition and deficiency of fat-soluble vitamins.
A stroke patient is having difficulty swallowing food and beverages. The patient complains that he feels like “the food is sticking to the back of his throat.” Given this information, the priority nursing interventions would be to
A. add a thickening agent to all of the patient's beverages.
B. feed the patient while he is sitting in an upright position.
C. make the patient “nothing per os” (NPO) and call the physician.
D. warrant no action since this is a normal occurrence after a stroke.
A 29-year-old female has been admitted to the emergency department following a suicide attempt by overdose of acetaminophen. What changes in the client's liver and diagnostic results would the care team most likely anticipate?
A. Rapid onset of hepatitis and increased GGT, ALT, and bilirubin
B. Cholestatic reaction with increased bilirubin count
C. Allergic inflammation accompanied by an increase in serum IgE and basophils
D. Hepatocellular necrosis evidenced by increased ALT and AST levels
Which of the following individuals is at the highest risk of developing a urinary tract infection (UTI)?
A. A 66-year-old man undergoing dialysis for the treatment of chronic renal failure secondary to hypertension
B.A 60-year-old man with a history of cardiovascular disease who is recovering in hospital from a coronary artery bypass graft
C. A 30-year-old woman with poorly controlled diabetes mellitus
D. A 38-year-old man with high urine output due to antidiuretic hormone insufficiency
A 60-year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration, and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode.Which of the following actions should be the wife's first choice?
A. IV infusion of 50% dextrose and water solution
B. Administration of subcutaneous glucagon
C. Careful monitoring for level of consciousness and resolution of hypoglycemia
D. Administration of 15 to 20 g of glucose in a concentrated carbohydrate source
When explaining a cystometry test to measure bladder pressure during filling and voiding in a normal adult, the nurse informs the nursing students that the normal capacity when adults have a desire to void is
A. 400 to 500 mL.
B. 100 to 150 mL.
C. 200 to 250 mL.
D. 300 to 399 mL.
A 15-year-old who has just been diagnosed with type 1 diabetes says she read on the Internet that diabetes is the leading cause of acquired blindness among Americans. She asks you if she will lose her sight. In addition to explaining that new treatment technologies are being worked on every day, which of the following would be the most appropriate response?
A. Reassure her that only type 2 diabetes is a risk factor for blindness.
B. Tell her to expect that she will begin to lose her eyesight by the time she is 25.
C. Explain that almost all people with type 1 diabetes do experience some degree of vision loss.
D.Tell her there is about a 50%chance that she will suffer some diabetes-related sight loss by the time she is 50.
Response Feedback: Nearly all people with type 1 diabetes and more than 60% of people with type 2 diabetes have some degree of retinopathy. Pregnancy, puberty, and cataract surgery can accelerate these changes.
A patient has been admitted with diabetic ketoacidosis. The emergency department starts an IV to improve circulatory volume. If there is a sudden change in extracellular fluid osmolality that results in a too rapid blood glucose lowering, the nurse will likely observe which of the followingclinical manifestations?
A. Rapid, deep respirations, palpitations, low BP
B. Chills, profuse sweating, weakness
C. Increase urine output, thirst, vomiting
D. Headaches, dizziness, change in level of consciousness
A 24-year-old college student has presented to the campus medical clinic with complaints of frequent, burning urination and has, subsequent to urinalysis, been diagnosed with an acute lower urinary tract infection (UTI) caused by E. coli. What teaching will the clinician most likely provide to the student?
A.“This likely shows that you have some sort of obstruction in your urinary system, so when that is treated your UTI will likely resolve as well.”
B.“Many of these bacteria are now resistant to some antibiotics, but I will take that into account when I choose which antibiotic to prescribe.”
C.“Unfortunately, the bacteria causing your infection is no longer responsive to antibiotics, but there are alternative treatments that we can use.”
D. “This should likely resolve itself if you drink a lot of water and especially cranberry or blueberry juice.”