exam 2 Flashcards
With the exception of the first two steps, what is required in all steps of the clotting process?
calcium
The first step of hemostasis occurs as a:
vessel spasm
To form a platelet plug, platelets are attracted to the damaged vessel, and then platelet _____ occurs
adhesion
Blood coagulation is initiated by either of two pathways. The intrinsic pathway requires circulating _____ to begin the step-wise coagulation cascade.
factor XII
Increased platelet function, and consequent hypercoagulability, can be caused by:
vascular wall damage
immune thrombocytopenia purpura (ITP) is a/an _____ disorder that destroys _____
autoimmune, platelets
thrombotic thrombocytopenic purpura (TTP) causes which of the following manifestations (select all that apply)
purpura, petechiae, confusion
Hemophilia A is a hereditary blood disorder caused by inadequate activity or absent:
factor VIII
disseminated intravascular coagulation (DIC) is characterized by:
hemorrhage
in persons with a bleeding disorder caused by vascular defects, lab tests will most often reveal:
normal values
removal of a patient’s PIV resulted in brief bleeding and the loss of a small amount of blood. Which of the following processes occurred during the formation of the platelet plug that helped to stop blood flow
release of von Willebrand factor from the epithelium
a 69-year-old patient who is obese and has a diagnosis of angina pectoris has been prescribed clopidogrel (Plavix) by his primary care. The patient’s medication achieves its therapeutic effect in which of the following ways?
prevention of platelet aggregation
a public health nurse is conducting a health promotion campaign under the auspices of the local community center. Which of the following measures that the nurse is promoting are likely to influence the participants risk of hypercoagulability disorders? Select all that apply.
smoking cessation, blood glucose monitoring, weight management, cholesterol screening and management, and b/p screening and management.
during a patient’s admission assessment prior to reduction mammoplasty surgery, the nurse notes a reference to a Leiden mutation in the patient’s history. The nurse would recognize the patients increased risk for:
DVT
the most recent blood work of a patient with a diagnosis of acute myelogenous leukemia (AML) reveals thrombocytopenia. Where is the patient most likely to experience abnormal bleeding due to low platelets?
skin and mucous membranes
a patient was started on a protocol for the prevention of DVT shortly after admission, and has been receiving 5000 units of heparin twice daily for the last 5 days. An immune response to this treatment may increase the patient’s chance of developing which health problem?
thrombocytopenia
in light of the presence of numerous risk factors for CAD, a patient’s primary care has recommended that he take low-dose aspirin once daily. Doing so will reduce the patient’s risk of an MI by altering which of the following stages of hemostasis?
platelet plug formation
a 23-year-old female patient has been diagnosed with von Willebrand disease following a long history of heave periods and occasional nosebleeds. Which of the patients following statements demonstrates a sound understanding of her new diagnosis?
I’ll make sure to take Tylenol instead of aspirin when I get aches and pains.
which of the following patients likely faces the highest risk of an acquired hypocoagulation disorder and vitamin K deficiency?
a patient who has a diagnosis of liver failure secondary to alcohol abuse
a healthy primiparous (first time) mother delivered a healthy infant several hours ago, but the mother experienced post-partum hemorrhage. Which of the following disorders is most likely to underlie the patient’s excessive bleeding after delivery?
disseminated intravascular coagulation
Sue is fatigued and some blood tests are done. Her results include Hct 40%, Hgb 8g/dL, WBC 8000, and platelets 175,000. The nurse should interpret Sue’s blood work as indicative of:
low hemoglobin/anemia
manifestations of anemia that are directly due to the diminished oxygen carrying capacity of hemoglobin include:
bleeding
when an Rh-negative mom has been sensitized and is pregnant with an Rh-positive fetus, what happens to the fetus?
profound red cell hemolysis
the patient is an averaged sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term chronic disease. Which of the following CBC results is characteristic of her type of anemia?
Hgb 8g/dL
megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. This is because both are necessary for _____ synthesis and _____.
DNA; red blood cell maturation
polycythemia develops in patients with lung disease as a result of:
chronic hypoxia
which of the following types and characteristics of anemias are correctly matched: hemolytic - abnormal iron uptake; iron deficiency - early RBC death; folate - decreased erythropoiesis; bone loss - bone marrow expansion
folate - decreased erythropoiesis
conditions that predispose to sickling of hemoglobin in person’s with sickle cell anemia include:
decreased oxygen saturation
an elevated level of unconjugated bilirubin, due to hemolysis of RBCs results in a high level of iron released and:
jaundice
hemolytic anemia is characterized by excessive red blood cell destruction and compensatory:
increased erythropoiesis
a 48 year old male patient who normally enjoys good health, has been admitted to the hospital for the treatment of polycythemia vera. The nurse who is providing care for the patient should prioritized assessments aimed at the early identification of which of the following health problems:
thromboembolism
which of the following patients is most susceptible to experiencing the inadequate effects of erythropoiesis:
a patient who has developed renal failure as a result of longstanding hypertension
a 72 year old woman with complaints of increased fatigue has completed a series of fecal occult blood tests that indicate the presence of blood in her stool. Which of the following health problems is likely to accompany this patients GI bleed?
iron-deficiency anemia
Hgb solubility results and Hgb electrophoresis have resulted in a diagnosis of sickle cell anemia in an African American infant. The parents of the child should be aware that their child is at a significant risk for which of the following health problems? Select all that apply
acute pain, stroke, respiratory disease
the pathologic effects of thalassemias are primarily due to which of the following pathophysiologic processes?
impaired hemoglobin synthesis
which of the following individuals likely faces the highest risk of megaloblastic anemia?
21 year old college student who lives a vegan lifestyle
for which of the following health problems is a stem cell transplant likely to be of therapeutic benefit:
aplastic anemia
a 68 year old patient with an 80 pack/year of smoking was diagnosed with emphysema 18 months ago. The patients most recent blood work showed RBC indicies, a problems that suggests the need for which of the following interventions:
increased supplementary oxygen therapy
which of the following trends in the hematologic status of a 6 week old infant most clearly warrants medical intervention:
increasing white blood cell counts
a mother has brought her 2 week old infant to the emergency department due to the baby’s persistent and increasing jaundice. Blood testing reveals that the infant’s unconjugated bilirubin level is 28 mg/dL and assessment does not reveal neurological deficits. The infants weight is normal and the mother claims to have had no significant difficulty feeding the infant. The most likely treatment for this infant will be:
phototherapy
smooth muscle relaxation and shunting of blood into the sinusoids is mediated by _____ and results in penile erection
nitric oxide
priapism is a condition that causes ischemia as a result of:
failure of detumescence
common risk factors for erectile dysfunctions due to generalized penile arterial insufficiency include:
cigarette smoking
squamous cell cancer of the penis is more likely to develop in men with chronic:
smegma accumulation
in a hydrocele, excess fluid is present in the:
tunica vaginalis
testicular torsion, a serious disorders affecting young male individuals causes:
loss of testicular perfusion
men older than age 50 are at higher risk for prostatic hypertrophy with complications that include:
urine retention
the major cause of acute prostatitis is:
gram negative
the most important factor in the evolution and treatment of benign prostatic hypertrophy (BPH) is considered to be:
subjective symptoms reported by the patient
cryptorchidism, or undescended testes is a direct cause of:
infertility
which of the following physiologic processes results from the synthesis and release of testosterone:
musculoskeletal growth
a 41 year old patient has undergone a vasectomy. What is the physiologic basis for this contraception technique?
sperm can no longer pass through the ductus deferens
a patient has been diagnosed with an anterior pituitary tumor, and synthesis and release of follicle-stimulating hormone has become deranged. What are the potential consequences of this alteration in endocrine function?
dysfunction of spermatogenesis
which of the following factors constitutes the most significant risk for balanitis xerotica obliterans?
uncircumcised penis
which of the following disorders of the male GI system creates the most urgent need for prompt and aggressive medical treatment?
intravaginal testicular torsion
a 30 year old man has been diagnosed with mumps orchitis, a disease that has the potential to result in:
sterility
after seeking care due to recent history of testicular enlargement and scrotal pain, a 22 year old college student has been diagnosed with testicular cancer. Which of the patients following statements indicates the need for further teaching:
I can’t shake this feeling like I’ve received a death sentence
which of the following assessments is most likely to reveal a potential exacerbation i a 70 year old patient’s diagnosis of BPH:
bladder ultrasound
which of the following statements about screening for prostate cancer is most accurate:
BPH and prostatitis can confound prostate screening results
which of the following diagnoses is most likely to require surgical correction:
hypospadis
acute cervicitis is an inflammation of the cervix characterized by:
mucopurulent drainage
carcinoma of the cervix is often considered to be a sexually transmitted disease associated with the _____ viral infection
human papilloma
pelvic inflammatory disease, an inflammation of the upper reproductive tract is caused by:
STD polymicrobial infection
endometriosis is characterized by painful hemorrhagic lesions in the pelvis and complications that include:
pelvic adhesions
leiomyomas are smooth muscle fibroid tumors that usually develop in:
the corpus of the uterus
symptoms in difficulty of emptying the bladder, frequency, and urgency of urination are common in women with:
cystocele
although there are no effective screening methods for ovarian cancer, and early symptoms are usually absent, there are high-risk indicators that include:
nulliparity
polycystic ovary syndrome (PCOS) is ovarian dysfunction caused by a combination of hormone imbalances that include _____ levels
elevated LH
in the lactating woman, mastitis is usually the result of:
ascending bacterial infection
women are screened regularly for risk factors and manifestations of breast cancer. High-risk women may have a history of:
late menopause
which of the following signs and symptoms is most likely to accompany a diagnosis of vulvodynia?
vulvar pain
a 21 year old college student has sought care because of the vaginal burning, itching, and redness that have become worse in recent weeks. Which of the clinicians assessment questions is most likely to apply to a diagnosis of vaginitis:
have you ever had a sexually transmitted infection
a 29 year old patient had a Papanicolaou smear performed during her most recent visit to her primary care provider. This diagnostic procedure aims to identify:
dysplastic cervical cells
which of the following physiologic processes is caused by estrogens:
promotion of ovarian follicle growth
which of the following disorders of the female GI system is most likely to result from a disruption in normal endocrine function:
polycystic ovary syndrome (PCOS)
which of the following complaints by middle-aged women should prompt a care provider to rule out the possibility of ovarian cancer:
I’m having a lot of indigestion and bloating, which are both new to me
a nurse is conducting a healthy living workshop to a group of younger women. Which of the following screening recommendations should the nurse provide to the participants:
mammography and clinical breast exams every 3 years until the age of 40
which of the following processes is a component of the pathogenesis of proliferative breast lesions without atypia:
growth of ductal or lobular epithelial cells
which of the following physiologic changes results in menopause:
cessation of ovarian function and decreased estrogen levels
a 59 year old woman with a recent diagnosis of breast cancer has begun a course of hormone therapy. What is the goal of this pharmacologic treatment?
blocking receptors on the surface of malignant cells
a predominant effect of a prolonged excessive growth hormone is:
increased blood glucose levels
the most common cause of hypothyroidism is:
autoimmune thyroiditis
thyroid hormone deficit _____ which alters the function of all major organs in the body
decreases metabolism
the most common cause of thyrotoxicosis is Grave’s disease, which has the distinguishing characteristic of _____ in addition of a diffuse goiter
opthalmopathy
the major adrenal cortical hormones are steroids and are synthesized from acetate and:
cholesterol
primary adrenal insufficiency is manifested by:
hyponatremia and hypoglycemia
one of the earliest signs of Cushing’s syndrome is the loss of variable diurnal secretion of cortisol-releasing hormone and:
ACTH
the iatrogenic form of Cushing’s syndrome is caused by:
long-term cortisol therapy
major manifestations of Cushing syndrome include:
overt diabetes mellitus
the immunosuppressive and anti-inflammatory effects of cortisol cause:
inhibition of prostaglandin synthesis
which of the following individuals is experiencing the effects of a primary endocrine disorder:
a patient who has low calcium levels because of the loss of his parathyroid gland
which of the following physiologic processes is a direct effect of release of growth hormone by the anterior pituitary:
production of insulin like growth factors (IGFs) by the liver
which of the following individuals displays the precursors to acromegaly:
an adult with an excess of growth hormone due to adenoma
which of the following residents of a long-term care facility is exhibiting signs and symptoms that are indicative of hypothyroidism:
an 80 year old woman who has uncharacteristically lost her appetite and often complains of feeling old
abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of:
Graves disease
a patient has developed the facial appearance that is characteristic of myxedema along with an enlarged tongue, bradycardia, and voice changes. Which of the following treatment modalities is most likely to benefit this patient:
synthetic preparations of T3 or T4
a 33 year old patient has been admitted to the hospital for the treatment of Graves disease. Which of the following assessments should the patient’s care team prioritize:
vision and oculomotor function
a patient who has been taking 80 mg of prednisone, a glucocorticoid each day has been warned by his PCP to follow a plan for the gradual reduction of dose rather than stopping suddenly. What is the rationale:
stopping suddenly may cause adrenal insufficiency
the signs and symptoms of abrupt cessation of pharmacologic glucocorticoids closely resemble those of:
Addison disease
which of the following pathophysiologic phenomena may result in a diagnosis of Cushing disease: excess ACTH
excess ACTH production by a pituitary tumor
the basal lamina between the epidermis and the dermis is involved in skin disorders that cause:
blister formation
cells that form a network to bind and process antigens in the epidermis are known as:
Langerhans cells
the pilosebaceous unit of the skin consists of:
sebaceous glands
the ____ are the skin structures that become inflamed in acne
sebaceous glands
unlike hair, nails grow:
continuously
Lichenification is caused by:
repeated scratching
in addition to keratinocytes, the epidermis has _____ cells that protect against damage from UV rays
melanocyte
sebaceous glands secrete sebum which is a:
skin lubricant
the basement membrane between the epidermis and the dermis provides for adhesion and serves as a:
selective filter
pruritis, a symptom of many common skin disorders is an:
itching sensation
mitosis that results in the production of new epidermal cells occurs in which of the following layers of the epidermis:
stratum germinativum
which of the following statements about the structure of the skin are correct:
all 5 layers of the epidermis lack a blood supply
what is physiologic basis for albinism:
lack of tyrosinase
which of the following skin disorders is likely to result from the localized lack of melanin production by melanocytes:
vitiligo
due to the increasing dryness of her skin in recent years, a 70-year-old woman has had to reduce the number of baths she takes. Which of the following factors has resulted in this age-related change in skin function:
changes in sebaceous secretions
dark skin tone is genetically determined and is primarily the result of:
high production of melanin
which of the following skin lesions is categorized as a type of blister:
bulla
a 22-year-old male college student has presented to his campus medical center distraught at the emergence of numerous small blisters at the shaft of his penis. On examination the clinician notes that the lesions are between 2 and 4 mm in diameter and filled with serous fluid. The clinician would document the presence of:
vesicles
which of the following characteristics differentiates apocrine sweat glands from eccrine sweat glands:
apocrine secretions contain oil
most of the body’s hair follicles are paired with:
a sebaceous gland
manifestations of superficial dermatophytosis of the skin include:
scaling
onychomycosis initially causes the toenail to appear _____ as the fungus digests the nail keratin
opaque
a yeast-like Candida albicans fungal infection can be differentiated from a tinea fungal infection in the presence of:
satellite lesions
warts develop when _____ are invaded by HPV:
keratinocytes
allergic and hypersensitivity dermatoses are characterized by:
epidermal edema
papulosquamous dermatoses such as psoriasis are a group of skin disorders characterized by:
scaling papules
a thermal burn described as involving the entire epidermis and dermis is classified as:
full thickness second degree
the main cause of decubitus ulcers (bed sores) is _____ that impairs the flow of blood and lymph:
external pressure
dysplastic nevi are precursors of malignant melanoma that are:
larger than other nevi
which one of the following skin disorders seen in elderly persons is considered a premalignant lesion:
actinic keratosis
which of the following disorders of the skin is most likely to respond to treatment with systemic antibiotics:
acne vulgaris
dry itchy plaques on her elbows and knees have prompted a 23-year-old female to seek care. The clinician has diagnosed the patient with psoriasis a disorder that results from:
increased epidermal cell turnover
a patient has been admitted to the ICU after developing toxic epidermal necrolysis (TEN) consequent to the administration of a sulfonamide antibiotic. What pathophysiologic phenomenon is likely the greatest immediate threat to this patients health:
the presence of diffuse lesions and skin sloughing on the patients mucous membranes
a man’s winter vacation to a tropical destination has been accompanied by repeated sunburns. What process accounts for the damaging effects of the suns radiation:
damage to the epidermal cell DNA and free radical production
a 45-year-old man has been brought to the ER by EMS with severe electrical burns resulting from a work accident. The most immediate threat to this patient’s survival at this time is:
hemodynamic instability
a 79-year-old patient has been confined to bed after a severe hemorrhagic stroke that has caused hemiplegia. Which of the following measures should his care team prioritize in the prevention of pressure ulcers?
reposition on a scheduled basis
which of the following actions involves the greatest risks of skin shearing:
pulling the patient up in bed
what neoplasm of the skin is associated with the poorest prognosis:
malignant melanoma
the transition from melanoma to radical growth to vertical growth is associated with:
an increased risk of metastasis
a 5-year-old girl has been presented for care by her father due to her recent development of macules on her trunk, extremities, and mucous membranes. The child is mildly febrile, but her primary symptom is extreme pruritus. What disorder should the clinician suspect:
varicella
