MN551 Midterm-Advanced Physiology and Pathophysiology Across[ answer to displayed questions ]

1. Which of the following patients who presented to a walk-in
medical clinic is most likely to be diagnosed with a rhinosinusitis rather than
a common cold?
(Points : 3)
A man complaining of general
fatigue, a headache, and facial pain with a temperature of 100.9°F
A woman presenting with
malaise, lethargy, and copious nasal secretions
A man with a dry, stuffy
nasopharynx, a sore throat, and temperature of 98.9°F
A woman complaining of
generalized aches who has a hoarse voice and reddened, painful upper airways
Question 2.2. A 44-year-old
woman developed calf pain during a transatlantic flight followed by acute
shortness of breath upon arrival at her destination. She was subsequently
diagnosed with a pulmonary embolism (PE), which resolved with anticoagulant
therapy. Which of these statements best characterizes the underlying problem of
her PE? (Points : 3)
She was short of breath
because ventilation was occurring but perfusion was inadequate.
The combination of normal
perfusion but compromised ventilation caused hypoxia.
She developed a transient
anatomic shunt resulting in impaired oxygenation.
Impaired gas diffusion across
alveolar membranes resulted in dyspnea and hypoxia.
Question 3.3. A premature
infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD)
and is showing signs and symptoms of hypoxemia, low lung compliance, and
respiratory distress syndrome (RDS). Which of the following is the most likely
contributor to the infant’s present health problem? (Points : 3)
High inspired oxygen
concentration and injury from positive-pressure ventilation
Failure to administer
corticosteroids to the infant in utero
Insufficient surfactant
production and insufficient surfactant therapy
Insufficient supplemental
oxygen therapy
Question 4.4. Which of the
following residents of a long-term care facility is most likely to be
exhibiting the signs and symptoms of chronic obstructive pulmonary disease
(COPD)? (Points : 3)
A 79-year-old lifetime smoker
who is complaining of shortness of breath and pain on deep inspiration
An 81-year-old smoker who has
increased exercise intolerance, a fever, and increased white blood cells
An 81-year-old male who has a
productive cough and recurrent respiratory infections
An 88-year-old female who
experiences acute shortness of breath and airway constriction when exposed to
tobacco smoke
Question 5.5. A 66-year-old
male presents to the emergency department accompanied by his wife who claims
that he has been acting confused. The man is complaining of a sudden onset of
severe weakness and malaise and has a dry cough and diarrhea. His temperature
is 102.8°F and his blood work indicates his sodium level is 126 mEq/L (normal
is 135 to 145 mEq/L). What will be the assessing nurse practitioner’s most
likely suspicion? (Points : 3)
Mycoplasma pneumonia
Legionnaire disease
Pneumococcal pneumonia
Question 6.6. A 51-year-old
female patient who is 2 days postoperative on a surgical unit of a hospital is
at risk for developing atelectasis as a result of being largely immobile. Which
of the following teaching points by her nurse practitioner is most appropriate?
(Points : 3)
“Being in bed increases the
risk of fluid accumulating between your lungs and their lining, so it’s important
for you to change positions often.”
“You should breathe deeply
and cough to help your lungs expand as much as possible while you’re in bed.”
“Make sure that you stay
hydrated and walk as soon as possible to avoid our having to insert a chest
“I’ll prescribe
bronchodilator medications that will help open up your airways and allow more
oxygen in.”
Question 7.7. Due to
complications, a male postoperative patient has been unable to mobilize for
several days following surgery and has developed atelectasis. Which of the
following processes would his care team anticipate with relation to his health
problem? (Points : 3)
Vasodilation in the alveolar
vessels in the affected region of his lung
Increased workload for the
left side of the patient’s heart
Increased blood flow to the
area of atelectasis
Redirection of blood flow
away from the lung regions that are hypoxic
Question 8.8. Which of the
following clinical findings would be most closely associated with a patient who
has interstitial lung disease rather than COPD? (Points : 3)
Audible wheezing on
Diminished expiratory flow
Increased respiratory rate
with decreased tidal volume
Normal compliance of alveolar
Question 9.9. A male lifetime
smoker has died as a result of chronic obstructive pulmonary disease. Which of
the following phenomena regarding his alveoli would his care team have most
reasonably expected in the weeks prior to his death?
(Points : 3)
Proliferation of natural
killer (NK) cells in the alveolar lumen
Large numbers of alveolar
macrophages in septal connective tissue
The presence of tubercles in
the intra-alveolar spaces
Compensatory regeneration of
type I alveolar cells
Question 10.10. A 21-year-old
male patient has suffered a head injury during a crash on his motorcycle, and a
deficit that assessments have revealed is an impaired swallowing mechanism. He
has also developed aspiration pneumonia. Which of the following statements most
accurately capture an aspect of his condition? (Points : 3)
His oropharynx is obstructed.
His epiglottis is covering
his larynx
His vocal folds have been
His tracheobronchial tree is
intermittently obstructed.
Question 11.11. A short,
nonsmoking middle-aged man presents to the emergency department with left-sided
chest pain and a cough. He says that the pain started abruptly, just after
lunch, and that breathing and coughing make it worse. He denies recent injury.
He is breathing shallowly and rapidly and expresses fear that he may be having
a heart attack. Breath sounds are normal, and he is not cyanotic. Which
condition is most likely causing his symptoms? (Points : 3)
Myocardial infarction
Spontaneous pneumothorax
Pleuritis related to
Obstructive atelectasis
Question 12.12. Which of the
following statements best conveys an aspect of the respiratory pressures that
govern ventilation? (Points : 3)
Intrapleural pressure
slightly exceeds that of the inflated lung
The chest wall exerts
positive pressure on the lungs that contributes to expiration
The lungs are prevented from
collapsing by constant positive intrapulmonary pressure
Negative intrapleural
pressure holds the lungs against the chest wall
Question 13.13. The mother of
a 7-year-old boy who has recently been diagnosed with childhood asthma has come
to the education center to learn more about her son’s condition. Which of the
following teaching points is most justifiable? (Points : 3)
“Research has shown that
viruses may actually be a factor in many children’s asthma.”
“The most reliable indicator
that your child is having an asthma attack is audible wheezing.”
“Steroids that your child can
inhale will likely be the first line of defense.
“Your son will likely need to
limit or avoid exercise and sports.”
Question 14.14. Which of the
following phenomena is most likely occurring during a child’s alveolar stage of
lung development? (Points : 3)
Terminal alveolar sacs are
developing and surfactant production is beginning.
A single-capillary network
exists and the lungs are capable of respiration.
The conducting airways are
formed, but respiration is not yet possible.
Primitive alveoli are formed
and the bronchi and bronchioles become much larger.
Question 15.15. A 71-year-old
woman is dependent on oxygen therapy and bronchodilators due to her diagnosis
of emphysema. Which of the following processes would her care team be most
justified in ruling out? (Points : 3)
Decreased elastic recoil due
to alveolar damage
Decreased residual lung
volume due to impaired alveolar ventilation
Increased anatomic dead space
due to reduced tidal volume
Increased alveolar dead space
due to incorrect intrapleural pressure
Question 16.16. A definitive
test for cystic fibrosis is (Points : 3)
The sweat test
A sputum culture
A fecal fat test
A Chymex test for pancreatic
Question 17.17. A patient who
presented with shortness of breath and difficulty climbing stairs has been
diagnosed with pulmonary fibrosis, a disease characterized by scarring of the
alveoli. What would her care team anticipate when observing her breathing?
(Points : 3)
Rapid, deep breaths
Wheezing breaths
Short, shallow breaths
Pursed-lip breaths
Question 18.18. Which of the
following patients are NOT displaying known risk factors for the development of
pulmonary emboli?
(Points : 3)
A patient who is immobilized
following orthopedic surgery
A patient who has impaired
Cl– and Na+ regulation
A patient who is taking
amiodarone for the treatment of a cardiac arrhythmia
A patient who is a smoker and
takes oral contraceptives
A patient who is undergoing
radiation therapy for the treatment of breast cancer
Question 19.19. Following a
winter power outage, a patient who had been using a home gasoline generator
began to experience dizziness and headaches and was diagnosed with carbon
monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon
monoxide poisoning? (Points : 3)
To increase the amount of
oxygen dissolved in plasma
To increase the production of
unbound hemoglobin
To stimulate the release of
oxygen at the capillaries
To remove bound CO from
Question 20.20. A nurse
practitioner is performing patient teaching about the influenza virus with each
patient who has come to the clinic to receive that year’s vaccine. Which of the
following statements by patients best reflects an accurate understanding of the
flu virus? (Points : 3)
“I could come down with viral
or bacterial pneumonia as a result of a bad flu bug.”
“I know my vaccination is especially
important since there aren’t any drugs that can treat the flu once I get sick
with it.”
“The emphasis on bundling up,
staying warm, and drinking lots of fluids is outdated and actually
“Like all vaccines, it is
ideal if everyone in a population gets immunized against the flu.”
Question 21.21. A 77-year-old
lifetime smoker has been diagnosed with a tumor in his lung at the site of an
old tubercle scarring site, located in a peripheral area of his bronchiolar
tissue. What is this patient’s most likely diagnosis? (Points : 3)
Squamous cell carcinoma
Small cell lung cancer
Large cell carcinoma
Question 22.22. As a result
of dehydration, a patient’s epithelial cells are producing insufficient amounts
of mucus. Consequently, the patient’s mucociliary blanket is compromised. Which
of the following changes would a care provider most reasonably anticipate as a
direct result of this change? (Points : 3)
Impaired function of the
patient’s cilia
Decreased levels of oxygen
Increased amounts of bacteria
in the lungs
Increased carbon dioxide
Question 23.23. Which of the
following statements best captures the etiology of the acute response phase of
extrinsic (atopic) asthma? (Points : 3)
IgG production is heightened
as a consequence of exposure to an allergen.
Airway remodeling results in
airflow limitations.
Epithelial injury and edema
occur along with changes in mucociliary function.
Chemical mediators are
released from presensitized mast cells.
Question 24.24. A 62-year-old
female smoker is distraught at her recent diagnosis of small cell lung cancer
(SCLC). How can her nurse practitioner most appropriately respond to her?
(Points : 3)
“I’m sure this is very hard
news to hear, but be aware that with aggressive treatment your chances of
beating this are quite good.”
“This is very difficult to
hear, I’m sure, and we have to observe to see if it spreads because that often
“I’m very sorry to have to
give you this news; I’d like to talk to you about surgical options, however.”
“This is a difficult
diagnosis to receive, but there is a chance that the cancer may go into
Question 25.25. About 3 weeks
after razing an old chicken house, a 71-year-old retired farmer has developed a
fever, nausea, and vomiting. After ruling out more common health problems, his
care provider eventually makes a diagnosis of histoplasmosis. Which of the
following processes is most likely taking place? (Points : 3)
Toxin production by Histoplasma
capsulatum is triggering an immune response.
Antibody production against
the offending fungi is delayed by the patient’s age and the virulence of the
Spore inhalation initiates an
autoimmune response that produces the associated symptoms.
Macrophages are able to
remove the offending fungi from the bloodstream but can’t destroy them.
1. A 60-year-old man has been
diagnosed with renal calculi after repeated episodes of excruciating flank pain
in recent weeks. The man states, “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? (Points : 3)
“Your diet may have played a
part in this, but in fact genetics is likely primarily to blame.”
“What you eat can influence
your risk of stone formation, but many other factors like hormones and your
metabolism are involved.”
“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.”
“Your diet might be normally
healthy, but high intake of normally beneficial minerals like calcium and
magnesium can lead to stones.”
Question 2.2. An 87-year-old
male resident of an assisted living facility has been consistently continent of
urine until the last several weeks. Which of the following actions by the care
providers at the facility is the most likely priority? (Points : 3)
Performing a physical
examination and history to determine the exact cause and character of the incontinence
Providing patient education
focusing on the fact that occasional incontinence is a normal, age-related
Teaching the resident about
protective pads, collection devices, and medications that may be effective
Showing the resident the
correct technique for exercises to improve bladder, sphincter, and pelvic floor
Question 3.3. A 34-year-old
male patient has diagnoses of liver failure, ascites, and hepatic
encephalopathy secondary to alcohol abuse. The patient’s family is questioning
the care team about why his abdomen is so large even though he is
undernourished and emaciated. Which of the following statements most accurately
underlies the explanation that a member of the care team would provide to the
family? (Points : 3)
An inordinate amount of
interstitial fluid is accumulating in the patient’s abdomen.
The transcellular component
of the intracellular fluid compartment contains far more fluid than normal.
The normally small
transcellular fluid compartment, or third space, is becoming enlarged.
Gravity-dependent plasma is
accumulating in the patient’s peritoneal cavity.
Question 4.4. A patient is
brought to the emergency department with complaints of shortness of breath.
Assessment reveals a full, bounding pulse, severe edema, and audible crackles
in the lower lung fields bilaterally. What is the patient’s most likely
diagnosis? (Points : 3)
Fluid volume excess
Question 5.5. Following
several days in an acidotic state, a hospital patient has returned to the
desired pH. Which of the following processes could have contributed to the
resolution of the patient’s health problem?(Points : 3)
Exchange of Na+ and H+ ions
Selective renal secretion and
reabsorption of CO2
Phosphate and ammonia buffer
systems in the renal tubules
Excretion of HCO3– by the
Question 6.6. Which of the
following patients would be considered to have a significant risk of developing
the prerenal form of acute renal failure?
(Points : 3)
A 22-year-old male who has
lost a large amount of blood following a workplace injury
A 41-year-old female who is
admitted for intravenous antibiotic treatment of pyelonephritis
A 79-year-old male with
diagnoses of poorly controlled diabetes mellitus and congestive heart failure
A 20-year-old male who is
admitted for treatment of an overdose of a nephrotoxic drug
A 68-year-old male with a
diagnosis of benign prostatic hyperplasia (BPH)
An 80-year-old female who has
been admitted for treatment of dehydration, hyponatremia, and malnutrition
Question 7.7. An 81-year-old
female has long-standing hypocalcemia secondary to kidney disease and will
shortly be moving into an assisted living facility from her own apartment.
Which of the following findings should staff at the facility be instructed to
observe for? (Points : 3)
Loss of appetite and
complaints of nausea
Muscular spasms and
complaints of cramps
High fluid intake and urine
Lethargy and stupor
Question 8.8. A 55-year-old
man has made an appointment to see his nurse practitioner 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 pathophysiologic problem? (Points : 3)
Stress incontinence due to
damage to CNS inhibitory pathways
Overactive bladder that may
result from both neurogenic and myogenic sources
Overactive bladder due to
intravesical pressure exceeding urethral pressure
Overflow incontinence that
can result from displacement of the angle between the bladder and the posterior
proximal urethra
Question 9.9. A 68-year-old
woman with a new onset of vascular dementia has recently begun retaining urine.
Which of the following physiological phenomena would her care providers most realistically
expect to be currently occurring as a result of her urinary retention? (Points
: 3)
Hypertrophy of the bladder
muscle and increased bladder wall thickness
Decreased urine production
and nitrogenous wasted excretion by the kidneys
Decompensation, bladder
stretching, and high residual urine volume
Overflow incontinence and
loss of contraction power
Question 10.10. Which of the
following individuals is at the highest risk for developing a urinary tract
infection (UTI)? (Points : 3)
A 60-year-old man with a
history of cardiovascular disease who is recovering in the hospital from a
coronary artery bypass graft
A 66-year-old man undergoing
dialysis for the treatment of chronic renal failure secondary to hypertension
A 38-year-old man with high
urine output due to antidiuretic hormone insufficiency
A 30-year-old obese woman
with poorly controlled diabetes mellitus
Question 11.11. A nurse
educator is orientating new nurses to a renal unit of a hospital. Which of the
following teaching points should the nurse include as part of a review of
normal glomerular function? (Points : 3)
“Nephrons are delicate
structures that cannot endure the high pressure that exists in capillary beds
elsewhere in the body.”
“Glomerular filtrate is very
similar in composition to blood plasma found elsewhere in circulation.”
“Dilation of the afferent
arteriole allows more blood into the nephron and increases the glomerular
filtration rate.”
“The glomerulus is located
between an arteriole and a venule that work together to regulate blood flow.”
Question 12.12. A 51-year-old
woman diagnosed with multiple sclerosis (MS) five months prior is distressed
that she has had several recent episodes of urinary incontinence. She has asked
her nurse practitioner why this is the case. Which of the following statements
best captures the facts that would underlie the nurse’s response to the
patient? (Points : 3)
Neurologic diseases like MS
often result in flaccid bladder dysfunction.
She may be unable to sense
her bladder filling as a result of her MS.
Lesions of the basal ganglia
or extrapyramidal tract associated with MS inhibit detrusor contraction.
Pathologic reductions in
bladder volume brought on by MS necessitate frequent micturition.
Question 13.13. A patient
with poorly controlled diabetes mellitus presents to the emergency department
with suspected ketoacidosis. Which of the following diagnostic results would be
most likely to confirm this diagnosis? (Points : 3)
Low O2 levels, increased
anion gap, base excess
High ammonia levels,
decreased anion gap, high potassium
Increased CO2, increased
anion gap, base deficit
Decreased CO2, decreased
anion gap
Question 14.14. A pediatric
unit will be receiving from a rural medical outpost a patient transfer of an
8-day-old infant with a suspected congenital renal disorder. Which of the
following possibilities is the care team most likely to be able to rule out
early? (Points : 3)
One of the infant’s kidneys
may have failed to develop to a normal size.
The kidneys may be misshapen
and have cysts.
The upper or lower poles of
the two kidneys may be fused.
Renal cell carcinoma may be
Question 15.15. 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 care team’s initial differential diagnosis
most likely be? (Points : 3)
Alport syndrome
Systemic lupus erythematosus
Henoch-Schonlein purpura
Immunoglobulin A nephropathy
Question 16.16. Which of the
following individuals would be considered to be at risk for the development of
(Points : 3)
An 81-year-old man with
right-sided heart failure and hypothyroidism
A 60-year-old obese female
with a diagnosis of poorly controlled diabetes mellitus
A 34-year-old industrial
worker who has suffered extensive burns in a job-related accident
A 77-year-old woman who has
an active gastrointestinal bleed and consequent anemia
A 22-year-old female with
hypoalbuminemia secondary to malnutrition and anorexia nervosa
Question 17.17. A 22-year-old
female with a history of intermittent flank pain, repeated UTIs, and hematuria
has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD).
Which of the following phenomena has most likely contributed to the development
of her health problem? (Points : 3)
UTIs coupled with an impaired
immune response have caused her ADPKD.
She has inherited a tendency
for epithelial cell in her tubules to proliferate inappropriately.
Severe hypertension and
portal hypertension are likely precursors.
She has inherited undersized
kidneys that are prone to calculi formation.
Question 18.18. A 31-year-old
patient with a diagnosis of end-stage liver failure has been admitted to the
intensive care unit of a hospital. Arterial blood gas sampling indicates that
the man has an acid-base imbalance. Which of the following situations is most
likely to result in an inappropriate pH? (Points : 3)
Conservation or formation of
new HCO3– by the kidneys
Low albumin and plasma
globulin levels
Transcompartmental exchange
of H+ and potassium ions
Renal excretion of HCO3– in
the presence of excess base
Question 19.19. Which of the
following data would a clinician consider to be most indicative of acute renal
failure? (Points : 3)
Alterations in blood pH,
peripheral edema
Increased nitrogenous waste
levels, decreased glomerular filtration rate (GFR)
Decreased serum creatinine
and blood urea nitrogen (BUN), decreased potassium and calcium levels
Decreased urine output,
hematuria, increased GFR
Question 20.20. A 61-year-old
woman who has had an upper respiratory infection for several weeks has
presented to her nurse practitioner with complaints of a recent onset of
urinary retention. She reveals to her nurse practitioner that she has been
taking over-the-counter cold medications at higher than the suggested dose for
the past two weeks. Which of the following phenomena will her nurse
practitioner most likely suspect is contributing to her urinary retention?
(Points : 3)
Cholinergic actions of the
cold medicine are triggering internal and external sphincter contraction.
Antihistamine effects inhibit
communication between the pons and the thoracolumbar cord.
The anticholinergic effects
of the medication are impairing normal bladder function.
Over-the-counter medications
such as cold medicine stimulate the parasympathetic nervous system and inhibit
bladder emptying.
Question 21.21. Which of the
following patients on a medical unit of a hospital is most likely to be
experiencing health problems that may be attributable to kidney disease?
(Points : 3)
An 81-year-old female patient
with osteoporosis and anemia
A 77-year-old patient with
urinary retention due to benign prostatic hyperplasia (BPH)
A 55-year-old woman with a
recent stroke secondary to long-standing hypertension
A 60-year-old man with a
systemic fungal infection requiring intravenous antibiotics
Question 22.22. Which of the
following substances is most likely to be reabsorbed in the tubular segments of
the nephron using passive transport mechanisms?
(Points : 3)
Question 23.23. A 77-year-old
female hospital patient has contracted Clostridium difficile during her stay
and is experiencing severe diarrhea. Which of the following statements best
conveys a risk that this woman faces?(Points : 3)
She is susceptible to isotonic
fluid volume deficit and hypernatremia as a result of water losses.
She is prone to isotonic
fluid volume excess due to impaired osmolality from sodium losses.
She could develop
third-spacing edema as a result of plasma protein losses.
She is at risk of
compensatory fluid volume overload secondary to gastrointestinal water and
electrolyte losses.
Question 24.24. At which of
the following locations in the nephron would a nurse practitioner first expect
blood to be largely free of plasma proteins? (Points : 3)
Proximal convoluted tubule
Bowman space
Loop of Henle
Afferent arteriole
Question 25.25. Which
diuretic acts by inhibiting sodium chloride reabsorption in the thick ascending
limb of the loop of Henle? (Points : 3)
Bumetanide (Bumex)
Mannitol (Osmitrol)
Acetazolamide (Diamox)

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