Advanced Pathophysiology Exam, Exams of Nursing

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NURSING 2450

Advanced

Pathophysiology

COMPLETED EXAM

1. A patient with chronic obstructive pulmonary disease (COPD) presents with dyspnea, wheezes, and productive cough. The nurse suspects that the patient has developed a respiratory infection. Which of the following laboratory tests would be most useful to confirm the diagnosis? A) Arterial blood gas (ABG) analysis B) Sputum culture and sensitivity C) Chest x-ray D) Pulmonary function tests (PFTs) Answer: B) Sputum culture and sensitivity Rationale: Sputum culture and sensitivity can identify the causative organism and the appropriate antibiotic therapy for a respiratory infection. ABG analysis can assess the gas exchange and acid-base balance, but it does not indicate the presence of infection. Chest x- ray can show the extent of lung damage, but it cannot differentiate between infection and other causes of inflammation. PFTs can measure the airflow and lung volumes, but they are not specific for infection.
2. A patient with type 1 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse monitors the patient's fluid and electrolyte status closely. Which of the following findings would indicate a complication of DKA? A) Serum sodium level of 140 mEq/L B) Serum potassium level of 3.2 mEq/L C) Serum bicarbonate level of 18 mEq/L D) Serum glucose level of 250 mg/dL Answer: B) Serum potassium level of 3.2 mEq/L Rationale: Serum potassium level of 3.2 mEq/L indicates hypokalemia, which is a common complication of DKA due to osmotic diuresis, insulin therapy, and metabolic acidosis. Serum sodium level of 140 mEq/L is within the normal range (135- 145 mEq/L). Serum bicarbonate level of 18 mEq/L is low, but it is expected in DKA due to metabolic acidosis. Serum glucose level of

hemoglobin (HbA) because it has two gamma chains instead of two beta chains. This allows HbF to bind oxygen more tightly and extract it from maternal blood in the placenta. HbF also has a lower affinity for 2,3- bisphosphoglycerate (2,3-BPG), a molecule that reduces oxygen affinity in HbA. Therefore, HbF can maintain a high oxygen saturation even at low partial pressures of oxygen.

1. What are the main factors that influence growth hormone secretion throughout the life span? How do they affect growth and metabolism?

• Growth hormone (GH) secretion is influenced by several factors, such as age, sex, circadian rhythm, stress, exercise, nutrition, and feedback from insulin-like growth factor 1 (IGF-1). GH secretion is highest during childhood and puberty, when it stimulates linear growth and bone development. GH secretion declines with age, leading to reduced muscle mass, bone density, and metabolic rate. GH secretion is also higher in males than females, and follows a diurnal pattern with a peak during deep sleep. Stress, exercise, and fasting can increase GH secretion, while obesity, hyperglycemia, and aging can decrease it.

2. What are the main changes in cardiovascular function that occur during aging? How do they affect blood pressure, cardiac output, and oxygen delivery?

• Aging causes several changes in cardiovascular function, such as increased arterial stiffness, reduced compliance, increased peripheral resistance, reduced baroreceptor sensitivity, reduced cardiac reserve, and impaired endothelial function. These changes can lead to increased systolic blood pressure, decreased diastolic blood pressure, increased pulse pressure, reduced stroke volume, reduced cardiac output, reduced coronary blood flow, and reduced oxygen delivery to the tissues. These changes can also increase the risk of hypertension, atherosclerosis, ischemic heart disease, heart failure, and arrhythmias.

3. What are the main changes in respiratory function that occur during aging? How do they affect lung volumes, gas exchange, and ventilation-perfusion ratio?

• Aging causes several changes in respiratory function, such as decreased lung elasticity, increased chest wall rigidity, decreased alveolar surface area, decreased ciliary function, decreased cough reflex, and decreased immune response. These changes can lead to decreased vital capacity, increased residual volume, increased functional residual capacity, decreased forced expiratory volume in one second (FEV1), decreased forced vital capacity (FVC), decreased FEV1/FVC ratio, decreased diffusing capacity for carbon monoxide (DLCO), decreased arterial oxygen tension (PaO2), increased arterial carbon dioxide tension (PaCO2), increased alveolar-arterial gradient (A-a gradient), and increased ventilation-perfusion mismatch. These changes can also increase the risk of respiratory infections, chronic obstructive pulmonary disease (COPD), pulmonary embolism (PE), and hypoxemia.

4. What are the main changes in renal function that occur during aging? How do they affect glomerular filtration rate (GFR), tubular function, and electrolyte balance?

• Aging causes several changes in renal function, such as decreased renal mass, decreased renal blood flow,

5. What are the main changes in endocrine function that occur during aging? How do they affect hormone levels, feedback mechanisms, and target tissue responses?

• Aging causes several changes in endocrine function, such as decreased hormone synthesis and secretion, decreased hormone transport and binding, decreased hormone receptor number and affinity, decreased signal transduction and gene expression, and altered feedback mechanisms. These changes can lead to reduced levels of thyroid hormones, growth hormone, sex hormones , and melatonin ; increased levels of cortisol and

parathyroid hormone;

and vaccines, and increased production of pro-inflammatory cytokines. These changes can lead to reduced innate and adaptive immunity, reduced ability to fight infections and tumors, reduced ability to mount an effective immune response, increased susceptibility to autoimmune diseases and chronic inflammation, and increased risk of infection-related morbidity and mortality.

7. What are the main changes in nervous system function that occur during aging? How do they affect brain structure and function, cognitive function, and sensory and motor function?

• Aging causes several changes in nervous system function, such as decreased brain weight and volume, decreased number and size of neurons and synapses,

decreased neurotransmitter synthesis and release, decreased blood flow and oxygen delivery to the brain, increased accumulation of amyloid plaques and neurofibrillary tangles, and increased oxidative stress and inflammation. These changes can lead to reduced brain structure and function, reduced cognitive function and memory, reduced attention and processing speed, reduced executive function and problem-solving skills, reduced learning and plasticity, and increased risk of neurodegenerative diseases such

Hypersensitivity is best defined as a(n): altered immunologic response to an antigen that results in disease. The hypersensitivity reaction that occurs after a person who is allergic to bee stings is stung by a bee is called: anaphylaxis Common hay fever allergy is expressed through a reaction that is mediated by: IgE The class of antibody involved in type I hypersensitivity reactions is: IgE Blood transfusion reactions are an example of: alloimmunity During an IgE-mediated hypersensitivity reaction, which leukocyte is activated? Eosinophils During an IgE-mediated hypersensitivity reaction, what causes bronchospasm? Smooth muscle contraction caused by histamine bound to H1 receptors What is a characteristic of atopic individuals who are genetically predisposed to develop allergies? They produce greater quantities of IgE than other individuals. What is the mechanism in type II hypersensitivity reactions?

Antibodies bind to the antigens on the cell surface. In a type II hypersensitivity reaction, when antibodies are formed against red blood cell antigens of the Rh system, the blood vessels are destroyed by: phagocytosis in the spleen What is the mechanism in type III hypersensitivity reactions?

When histamine binds the histamine- 2 (H2) receptor, inflammation is: inhibited Frequently H1 and H2 receptors are located on the same cells and act in a(n) fashion. antagonistic Which chemical mediators induce pain during an inflammatory response? Prostaglandins and bradykinin Which chemical mediator derived from mast cells retracts endothelial cells to increase vascular permeability and causes leukocyte adhesion to endothelial cells? platelet-activating factor (PAF) What are the inflammatory effects of nitric oxide (NO)?

It decreases mast cell function and decreases platelet aggregation. Which of the following indicates a correct sequence in phagocytosis? Recognition, engulfment, fusion, destruction When looking at white blood cell differentials, PAs know that individuals have early, acute inflammatory reactions when they notice elevations of which leukocyte? neutrophils The predominant phagocytic cells in the later stages of an inflammatory response are: monocytes What is the role of eosinophils in regulating vascular mediators released from mast cells? Eosinophils release histaminase that limits the effects of histamine during acute inflammation A role of NK cells is to: eliminate malignant cells Which manifestation of inflammation is systemic? Fever and leukocytosis One systemic manifestation of the acute inflammatory response is fever that is produced by o n the hypothalamus. endogenous pyrogens acting Which solution is best to use when cleaning a wound that is healing by epithelialization?

The adequacy of a person's alveolar ventilation is assessed best by monitoring: arterial blood gas. Normal physiologic changes in the aging pulmonary system include: stiffening of the chest wall. How is most of the oxygen in the blood transported? bound to hemoglobin Which endogenous substances cause bronchoconstriction? Histamine and prostaglandin If a patient develops acidosis, the nurse would expect the oxyhemoglobin dissociation curve to: shif t to the right, causing more O2 to be released to the cells. Most carbon dioxide in the blood is transported: in the form of bicarbonate. The sternocleidomastoid and scalene muscles are referred to as: diaphragmatic muscles Decreased lung compliance means that the lungs are: stiff The lung is innervated by the parasympathetic nervous system via the nerve. vagus Hypoventilation that results in the retention carbon dioxide will stimulate which of the following receptors in an attempt to maintain a normal homeostatic state?

Central chemoreceptors Which of the following is the most important cause of pulmonary artery constriction? Low alveolar PO The PA who is auscultating the lungs of a child who has aspirated a piece of hot dog, would expect decreased or absent breath sound over the: right lung secrete surfactant, a lipoprotein that coats the inner surface of the alveoli. Type II alveolar cells The adequacy of a person's alveolar ventilation is assessed best by monitoring: