level up
Which labs will determine function of the Pancreas?
amylase and lipase
Which of the following physiologic principles would be considered a function of the somatic nervous system?
A) The act of typing a report using a computer keyboard
B) Withdrawing the hand after touching a hot surface
C) The patellar reflex "knee jerk" activated by tapping the patellar tendon abdominal viscera
D) The beginning of depolarization in the cardiac conduction of impulses
Ans: A
The somatic nervous system provides sensory and motor innervation for all parts of the central nervous system (CNS) and peripheral nervous system (PNS) except viscera, smooth muscle, and glands. The autonomic nervous system (ANS) provides efferent motor innervation to smooth muscle, the conducting system of the heart, and glands.
A client presents to the clinic complaining, “I have something in my eye.” When questioned, the client admits to a scratching and burning sensation and light sensitivity. The health care provider suspects the client has developed:
A) Conjunctivitis
B) Retinal detachment
C) Acute glaucoma
D) Corneal edema
Ans: A
Conjunctivitis causes bilateral tearing, itching, burning, foreign body sensation, and morning eyelash crusting and eye redness. The primary symptom of retinal detachment is painless changes in vision. Commonly, flashing lights or sparks, followed by small floaters or spots in the field of vision, are early symptoms. Attacks of glaucoma (increased intraocular pressure) are manifested by ocular pain, excruciating headache, blurred or iridescent vision, and corneal edema with hazy cornea, dilated (mydriasis), and fixed pupil; with repeated or prolonged attacks, the eye becomes reddened. With corneal edema, the cornea appears dull, uneven, and hazy; visual acuity decreases; and iridescent vision (i.e., rainbows around lights) occurs.
A client with a diagnosis of myasthenia gravis has required a mastectomy for the treatment of breast cancer. The surgery has been deemed a success, but the client has gone into a myasthenic crisis on postoperative day 1. Which of the following measures should the care team prioritize in this client's immediate care?
A) Positioning the client to minimize hypertonia and muscle rigidity
B) Seizure precautions with padded side rails and bed in lowest height
C) Respiratory support and protection of the client's airway
D) Monitoring the client for painful dyskinesias
Ans: C
Myasthenic crisis occurs when muscle weakness becomes severe enough to compromise ventilation to the extent that ventilatory support and airway protection are needed. Seizures, dyskinesias, hypertonia, and muscle rigidity are not associated with myasthenia gravis in general or myasthenic crisis in particular.
A teenager has been in a car accident and experienced acceleration–deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication?
A) Brain contusions and hematomas
B) TIAs and cerebrovascular infarction
C) Momentary unconsciousness
D) Status epilepticus
Ans: A
Contusions (focal brain injury) cause permanent damage to brain tissue. The bruised, necrotic tissue is phagocytized by macrophages, and scar tissue formed by astrocyte proliferation persists as a crater. The direct contusion of the brain at the site of external force is referred to as a acceleration injury, whereas the opposite side of the brain receives the deceleration injury from rebound against the inner skull surfaces. As the brain strikes the rough surface of the cranial vault, brain tissue, blood vessels, nerve tracts, and other structures are bruised and torn, resulting in contusions and hematomas. TIAs and cerebral vascular infarction (stroke) are often caused by atherosclerotic brain vessel occlusions that cause ischemic injuries. In mild concussion head injury, there may be momentary loss of consciousness without demonstrable neurologic symptoms or residual damage, except for possible residual amnesia. Status epilepticus is not related to this situation.
Which labs will indicate function of the liver?
ALT and AST
An otherwise healthy client has been referred to a pain clinic because she claims to experience exquisite pain from the friction of her clothes on her torso. This client is likely to be diagnosed with which of the following health problems?
A) Visceral pain
B) Hypoalgesia
C) Allodynia
D) Primary hyperalgesia
Ans: C
Allodynia is pain that follows a nonnoxious stimulus to apparently normal skin. Visceral pain is a deep, nonspecific pain that results from disruption of organs or deep tissues. Hypoalgesia is an abnormal decrease in pain sensitivity, whereas primary hyperalgesia describes pain sensitivity that occurs directly in damaged tissues.
Which of the following vision deficits is a clinician justified in attributing to the normal aging process?
A) Conjunctivitis
B) Presbyopia
C) Strabismus
D) Angle-closure glaucoma
Ans: B
The term presbyopia refers to a decrease in accommodation that occurs because of aging. Conjunctivitis, strabismus, and angle-closure glaucoma are considered abnormal and pathologic in clients of all ages.
A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which of the following abnormalities in the client's gait?
A) Slow to start walking and has difficulty when asked to “stop” suddenly
B) Difficulty putting weight on soles of feet and tends to walk on tiptoes
C) Hyperactive leg motions like he just can't stand still
D) Takes large, exaggerated strides and swings arms/hands wildly
Ans: A
The cardinal symptoms of Parkinson disease (PD) are tremor, rigidity (hypertonicity), and bradykinesia or slowness of movement. Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Persons with the disease have difficulty initiating walking and difficulty turning. While walking, they may freeze in place and feel as if their feet are glued to the floor, especially when moving through a doorway or preparing to turn. When they walk, they lean forward to maintain their center of gravity and take small, shuffling steps without swinging their arms.
A family brings their elderly mom to the emergency department. The client had a short period of time where she was confused, had slurred speech and appeared to have a weak arm. Now she is back to her normal self. Suspecting a transient ischemic attacks (TIAs), the health care provider will order diagnostic testing looking for:
A) Aneurysm leakage
B) Cause of minor residual deficits
C) Diffuse cerebral electrical malfunctions
D) Atherosclerotic lesions in cerebral vessels
Ans: D
The traditional definition of TIAs as a neurologic deficit resolving within 24 hours was developed before the mechanisms of ischemic cell damage and the penumbra were known and before the newer, more advanced methods of neuroimaging became available. A more accurate definition now is a transient deficit without time limits, best described as a zone of penumbra without central infarction. TIAs are important because they may provide warning of impending stroke. The causes of TIAs are the same as those of ischemic stroke, and include atherosclerotic disease of cerebral vessels and emboli. The most common predisposing factors for cerebral hemorrhage are advancing age and hypertension; other causes include aneurysm rupture. Cerebral electrical malfunctions usually occur with seizure activity.
What lab value will be elevated in cases of cholestasis?
Alkaline Phosphatase (ALP)
Which of the following characteristics differentiates a migraine with aura from a migraine without aura?
A) Gastrointestinal involvement in the hours leading up to the headache
B) A decrease in mood and affect prior to the headache
C) Lack of response to nonpharmacologic treatments
D) Visual symptoms that precede the headache
Ans: D
An aura is visual (flickering lights, spots, or loss of vision), sensory (feeling of pins and needles, or numbness), and/or speech disturbance that precedes a migraine. Nonpharmacologic treatments may be used with varying success in both types of migraine, and nausea and vomiting may precede or accompany each. Changes in mood and affect are not central to an aura.
A client has been diagnosed with open-angle glaucoma during routine eye exam. The client has been prescribed a topical b-adrenergic antagonist. Client teaching about how this drug works should include which of the following statements? b-adrenergic antagonists:
A) Cause an early decrease in production of aqueous humor by constricting the vessels supplying the ciliary body.
B) Lower intraocular pressure by decreasing aqueous humor production
C) Reduce the secretion of aqueous humor
D) Exert their effects by increasing the effects of acetylcholine, thereby increase aqueous outflow through contraction of the ciliary muscle and pupillary constriction
Ans: B
Topical b-adrenergic antagonists, which are thought to lower intraocular pressure by decreasing aqueous humor production, are usually the drugs of first choice. The a-adrenergic agonists cause an early decrease in production of aqueous humor by constricting the vessels supplying the ciliary body. Carbonic anhydrase inhibitors reduce the secretion of aqueous humor. Cholinergic drugs exert their effects by increasing the effects of acetylcholine (a postganglionic neurotransmitter in the parasympathetic nervous system) and increase aqueous outflow through contraction of the ciliary muscle and pupillary constriction.
A client's recent diagnosis of Parkinson disease has prompted his care provider to promptly begin pharmacologic therapy. The drugs that are selected will likely influence the client's levels of:
A) Dopamine
B) Acetylcholine
C) Serotonin
D) Adenosine
Ans: A
Although some antiparkinsonian drugs act by reducing the excessive influence of excitatory cholinergic neurons, most act by improving the function of the dopaminergic system. Serotonin and adenosine are not known to participate directly in the pathophysiology of Parkinson disease.
A family brings a client to the emergency department with increasing lethargy and disorientation. They think the client had a seizure on the drive over to the hospital. The client has been sick with a “cold virus” for the last few days. On admission, the clients' temperature is 102°F. Which other clinical manifestations may lead to the diagnosis of encephalitis?
A) Petechia over entire body
B) BP 100/72
C) Impaired neck flexion resulting from muscle spasm
D) Appearance of red-purple discolorations on the skin that do not blanch on applying pressure
Ans:C
Like meningitis, encephalitis is characterized by fever, headache, and nuchal rigidity (impaired neck flexion resulting from muscle spasm), but more often clients also experience neurologic disturbances, such as lethargy, disorientation, seizures, focal paralysis, delirium, and coma. Meningococcal meningitis is characterized by a petechial (petite hemorrhagic spots) rash with palpable purpura (red-purple discolorations on the skin that do not blanch on applying pressure) in most people. This BP is within normal range.
Which lab may be recommended in a patient with hepatic encephalopathy?
Ammonium
Following his annual influenza vaccination, a client begins to feel achy, like he has developed the flu. An hour later, the client is rushed to the emergency department. Diagnosis of Guillain-Barré syndrome was made based on which of the following assessment findings? Select all that apply. (3)
A) Rapid deterioration of respiratory status
B) Lack of any physical pain
C) Flaccid paralysis of limbs
D) BP 90/62
E) Pale, cool, dry skin
Ans: A, C, D
Guillain-Barré syndrome usually is a medical emergency. There may be a rapid development of ventilatory failure and autonomic disturbances that threaten circulatory function. The disorder is characterized by progressive ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. Paralysis may progress to involve the respiratory muscles. Autonomic nervous system involvement that causes postural hypotension, arrhythmias, facial flushing, abnormalities of sweating, and urinary retention is common. Pain is another common feature of Guillain-Barré syndrome
In comparison to children with acute otitis media (AOM), those with otitis media with effusion (OME) have:
A) Systemic infection
B) Earache and fever
C) Excess middle ear fluid
D) Sensorineural hearing loss
Ans:C
Otitis media with effusion (OME) is a condition in which the tympanic membrane is intact and there is an accumulation of fluid in the middle ear without fever or other signs or symptoms of infection. Acute otitis media (AOM) is characterized by otalgia (earache), fever, temporary conductive hearing loss, and excess middle ear fluid in combination with signs and symptoms of an acute or systemic infection.
A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on upper and lower motor neurons. The health care provider caring for this client will focus on which priority intervention for this client?
A) Ability to turn from side to side, thereby preventing skin breakdown
B) Ability to empty bladder completely, thereby preventing autonomic dysreflexia
C) Respiratory ventilation assessment and prevention of aspiration pneumonia
D) Assessment of lower extremities to prevent deep vein thrombosis
Ans: C
Amyotrophic lateral sclerosis is a mixed upper motor neuron (UMN) and lower motor neuron (LMN) disorder. In the more advanced stages of ALS, muscles of the palate, pharynx, tongue, neck, and shoulders become involved, causing impairment of chewing, swallowing (dysphagia), and speech. Dysphagia with recurrent aspiration and weakness of the respiratory muscles produces the most significant acute complications of the disease. Airway/breathing is always the priority over bladder emptying; skin breakdown, and assessing for DVT.
A client with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the client appears confused but is oriented to person and place but not time. What type of seizure did this client most likely experience?
A) Tonic–clonic seizure
B) Atonic seizure
C) Myoclonic seizure
D) Focal seizure with impairment to consciousness
Ans: D
Focal seizures with impairment of consciousness, sometimes referred to as psychomotor seizures, are often accompanied by automatisms or repetitive nonpurposeful activities such as lip smacking, grimacing, patting, or rubbing clothing. Confusion during the postictal period (after a seizure) is common. Atonic seizures are characterized by loss of muscle tone, and myoclonic seizures involve brief involuntary muscle contractions induced by stimuli of cerebral origin. With tonic–clonic seizures, formerly called grand mal seizures, a person has a vague warning (probably a simple focal seizure) and experiences a sharp tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness.
These levels will be elevated with Diabetic Ketoacidosis and Hyperglycemic hyperosmolar state
Both: Blood Glucose Levels
DKA: ketones
HHS:osmolarity
define:
Paralysis
Paresis
hemi-
di/para-
loss of movement
weakness
both limbs one side
both upper or both lower limbs
Will a cochlear implant be effective in someone with a damaged auditory nerve?
no
A client's recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which of the following treatment measures is most likely to resolve this health problem?
A) Aggressive diuresis
B) Placement of a shunt
C) Administration of hypertonic intravenous solution
D) Lumbar puncture
Ans: B
Hydrocephalus represents a progressive enlargement of the ventricular system due to an abnormal increase in cerebrospinal fluid (CSF) volume. This increase in CSF volume can be resolved by the placement of a shunt to drain the offending fluid volume. Diuresis, hypertonic solution administration, and lumbar puncture are not usual treatment modalities.
A client with a long history of cigarette smoking and poorly controlled hypertension has experienced recent psychomotor deficits as a result of hemorrhagic brain damage. The client's psychomotor deficits are likely the result of:
A) Alzheimer disease
B) Frontotemporal dementia (FTD)
C) Vascular dementia
D) Wernicke-Korsakoff syndrome
Ans: C
Vascular dementia is caused by brain injury resulting from ischemic or hemorrhagic damage. Smoking and hypertension are contributing factors, and slowness in psychomotor functioning is a main clinical feature of vascular dementia. The client's history and symptomatology are not characteristic of Alzheimer disease, FTD, or Wernicke-Korsakoff syndrome.