A 40-year-old male who has been HIV positive for 6 years is experiencing a new increase in his viral load along with a corresponding decrease in his CD4+ count. Which of the following aspects of his immune system is likely to remain most intact?
A. Activation of B lymphocytes
B. Phagocytic function of monocytes and macrophages
C. Orchestration of natural killer cells as part of cell-mediated immunity
D. Presentation of major histocompatibility molecules on body cells
The nurse practitioner working in an overnight sleep lab is assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient’s blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles?
A. When airways are obstructed, the body will retain extracellular fluid so that this fluid can be shifted to intravascular space to increase volume.
B. During apneic periods, the patient experiences hypoxemia that stimulates chemoreceptors to induce vasoconstriction.
C. When the patient starts to snore, his epiglottis is closed over the trachea.
D. When the airway is obstructed, specialized cells located in the back of the throat send signals to the kidney to increase pulse rate.
A female dental assistant has developed signs and symptoms of a latex sensitivity and is undergoing allergy testing as well as blood work. Which of the following components of the assistant’s blood work would most likely be the focus of her health care provider’s analysis?
A. Analysis of class II MHC antigens
B. Serum IgE immunoassays
C. Serum CD8+ levels
D. Serum B-lymphocyte levels
Which of the following clients’ signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult
A. has vomited and complained of a severe headache.
B. states that his left arm and leg are numb, and gait is consequently unsteady.
C. has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days.
D. has experienced a sudden loss of balance and slurred speech.
As part of the diagnostic workup for a male client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care?
A. Cardiac catheterization, cardiac CT, exercise stress testing
B. Ambulatory ECG, cardiac MRI, echocardiogram
C. Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy
D. Echocardiogram, PET scan, ECG
Which of the following statements best captures an aspect of the process of hematopoiesis?
A. Colony-stimulating factors (CSFs) produce cytokines that activate progenitor cells.
B. Various subtypes of pluripotent stem cells eventually differentiate into the cellular components of blood.
C. Progenitor cells differentiate into precursor cells.
D. Self-replicating precursor cells differentiate into specific CSFs.
A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The patient’s physician would anticipate that which of the following phenomena is most likely occurring?
A. Epinephrine from his adrenal gland is initiating the renin–angiotensin–aldosterone system.
B. Vasopressin is exerting an effect on his chemoreceptors and baroreceptors resulting in vasoconstriction.
C. The patient’s juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation.
D. The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.
A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease.Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient’s bleeding?
A. Hemophilia B
B. Vitamin K deficiency
C. Idiopathic immune thrombocytopenic purpura (ITP)
D. Excess calcium
Members of an AIDS support group who have more advanced cases are sharing some of their recent health problems with a member who has just been diagnosed. Which of the member’s statements is most accurate?
A. “The eradication of Pneumocystis jiroveci pneumonia (PCP) has helped extend the life expectancy of a lot of persons living with AIDS.”
B. “As people with HIV live longer, most of us are eventually succumbing to the cancers that are associated with HIV.”
C. “One of the scariest things out there now is the huge increase in drug-resistant tuberculosis.”
D. “Those of us with HIV are so much more prone to loss of vision and hearing.”
A hospital laboratory technologist is analyzing the complete blood count (CBC) of a patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC?
A. The α-granules of platelets contribute primarily to vasoconstriction.
B. New platelets are released from the bone marrow into circulation.
C. Platelets originate with granulocyte colony–forming units (CFU).
D. The half-life of a platelet is typically around 8 to 12 days.
Which of the following patients has an absolute neutrophil count that is critically low and that the standard of care would recommend they be placed on neutropenic precautions?
A. A 75-year-old renal failure patient receiving Epogen for anemia with hemoglobin level of 9.7.
B. A 37-year-old patient with leukemia being treated with chemotherapy with ANC of 400
C. A patient on long-term steroids for rheumatoid arthritis with WBC of 7000
D. A 65-year-old prostate cancer patient receiving radiation therapy with neutrophil count of 2000
A medical student is working with a 61-year-old male client in the hospital who has presented with a new onset of atrial fibrillation. Which of the following courses of treatment will the student most likely expect the attending physician to initiate?
A. Diuretics, total bed rest, and cardioversion if necessary
B. Anticoagulants and beta-blockers to control rate
C. Immediate cardioversion followed by surgery to correct the atrial defect
D. Antihypertensives and constant cardiac monitoring in a high acuity unit
A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relates to these health problems?
A. The patient has a history of acute and chronic renal failure.
B. The patient’s cardiac ejection fraction was 40% during his last echocardiogram.
C. The patient is male and has a history of hypertension.
D. The client is 89 years old and takes a diuretic medication for his congestive heart failure.
Which of the following procedures reduces the potential for infection primarily by addressing the portal of entry?
A. Wearing gloves when contact with blood or body fluids is anticipated
B. Wiping down common areas with buffered bleach on a regular basis
C. Isolating patients who have antibiotic-resistant infections
D. Disposing of soiled clothing and bed linens in a dedicated receptacle
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A 70-year-old woman with ongoing severe atrial fibrillation is scheduled for defibrillation. What is an aspect of the rationale and physiology of defibrillation treatment?
A. Defibrillation can be achieved using either a transcutaneous or transvenous pacemaker.
B. Interruption of disorganized impulses by the current allows the AV node to readopt its normal pacemaker role.
C. Defibrillation must be coincided with the R wave of the ECG in order to be successful.
D. The goal is to depolarize the entire heart during the passage of current.
In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the patient has gone into ventricular tachycardia.The nurse will likely assess for signs/symptoms of
A. increasing cardiac index by correlating the volume of blood pumped by the heart with an individual’s body surface area.
B. decreasing cardiac output due to less ventricular filling time.
C. development of hypertension with BP 190/98.
D. oxygen deprivation with O2 saturation decreasing to approximately 90%.
An agricultural worker is picking fruit on a day when the air temperature is 106°F. Which of the following processes will most likely be occurring while he works?
A. Conduction of heat from the air will be heating his skin surface and raising his core temperature.
B. His autonomic nervous system will be stimulating him to sweat.
C. Blood volume at his skin surface will be increasing to dissipate heat.
D. Radiation from his skin surfaces will be dissipating heat into the environment.
A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem?
A. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins
B. Cerebellar lesions; surgical and immunosuppressive treatment
C. Excess acetylcholinesterase production; treatment with thymectomy
D. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids
A student asks the instructor about the origins of different tissues and their cellular origins during the process of development. Which of the instructor’s following statements best describes the process of cell differentiation?
A. “A fertilized ovum undergoes a series of divisions, yielding many different cell types.”
B. “A single stem cell differentiates into approximately 200 different types of cells.”
C. “Cells differentiate into necessary body cells peaking after conception and ceasing near the time of birth.”
D. “Cells of the hematopoietic system produce the appropriate body cells that are required at each stage of development.”
A physician is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the physician most likelyrule out hypertension as a contributing factor?
A. A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance
B. A 61-year-old man who has a heart valve infection and recurrent fever
C. An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness
D. A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week
A geriatric clinical nurse educator is teaching the other members of the health care team about the incidence, prevalence, and course of depression among older adults. Which of the following statements is most likely to appear in the physician’s teaching?
A. “Bronchodilators and antiplatelet medications have been correlated with depression in the elderly.”
B. “Many older adults lack the symptoms of sleep disturbances and lack of concentration that suggest depression in younger adults.”
C. “Even though suicide rates are lower among older adults than younger adults, depression needs to be diagnosed and treated early.”
D. “Though they are certainly not synonymous, depression can be an indicator of dementia.”
The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations?
A. Petechia and spontaneous bleeding
B. Dyspnea and crackles in bilateral lung bases
C. Muscle cramping and cyanosis in the feet
D. Chest pain and intermittent ventricular tachycardia
A 51-year-old patient with a history of alcohol abuse and liver disease has low serum levels of albumin and presents with ascites (excess fluid in his peritoneal space) and jaundice. A health care professional would recognize that which of the following processes is most likely underlying his health problems?
A. Insufficient albumin is causing insufficient absorption of fluid into the capillaries.
B. Low albumin contributing to an inability to counter gravitational effects.
C. Low albumin is contributing to excess hydrostatic pressure and inappropriate fluid distribution.
D. Low albumin is inducing hypertension and increased filtration of fluid into interstitial spaces.
A community health nurse is teaching a group of recent graduates about the large variety of factors that influence an individual’s health or lack thereof. The nurse is referring to the Healthy People 2020 report from the U.S. Department of Health and Human Services as a teaching example. Of the following aspects discussed, which would be considered a determinant of health that is outside the focus of this report?
A.The client has a diverse background by being of Asian and Native American descent and practices various alternative therapies to minimize effects of stress.
B. The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime.
C. The client lives in an affluent, clean, suburban community with access to many health care facilities.
D. The client has a good career with exceptional preventative health care benefits.
The clinical educator of a hospital medical unit has the mandate of establishing evidence-based practice guidelines for the nursing care on the unit. Which of the following statements most accurately captures a guiding principle of the nurse’s task?
A. Evidence-based practice guidelines will be rooted in research rather than nurses’ subjective practice preferences and experiences.
B. Guidelines are synonymous with systematic research reviews.
C. The need for continuity and standardization of guidelines will mean that they will be fixed rather than changeable.
D. The guidelines will combine individual expertise with external systematic evidence.
A nurse who provides care in a geriatric subacute medicine unit of a hospital has noted that a large number of patients receive ?-adrenergic blocking medications such as metoprolol. Which of the following statements best conveys an aspect of the use of beta-blockers?
A. They counteract arrhythmias and tachycardias by increasing vagal stimulation.
B. They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential.
C. They decrease myocardial oxygen demand by blocking the release of intracellular calcium ions.
D. They inhibit the potassium current and repolarization, extending the action potential and refractoriness.
Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?
A. “The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel.”
B. “Infections of any sort are often a signal that plaque disruption is in danger of occurring.”
C. “The impaired function of the lungs that accompanies pneumonia or chronic obstructive pulmonary disease is a precursor to plaque disruption.”
D. “People with plaque in their arteries experience attacks of blood flow disruption at seemingly random times.”
A 40-year-old male client is shocked to receive a diagnosis of mature B-cell lymphoma and is doing research on his diagnosis on the Internet. Which of the following statements that he reads on various Web sites is most reliable?
A. “Like most forms of Hodgkin lymphoma, mature B-cell lymphoma often requires radiation treatment.”
B. “Doctors are able to diagnose mature B-cell lymphoma by the presence of Reed-Sternberg cells.”
C. “The lymph nodes are usually affected, and often the spleen and bone marrow.”
D. “Unlike many other lymphomas, mature B-cell lymphoma is often self-limiting, and treatment is focused on symptoms.”
Which of the following processes would most likely be considered an anomaly during the cellular phase of inflammation?
A. Platelet aggregation
C. Migration of phagocytic white cells
D. Macrophage activity
A geriatrician has ordered an echocardiogram and stress test for an 80-year-old male client in an effort to gauge the client’s cardiovascular health status.Which of the following changes would the physician most likely identify as an anomaly that is not an expected age-related change?
A. Increased resting, supine heart rate
B. Low maximal heart rate and cardiac output
C. Increased left ventricular wall thickness
D. Delayed left ventricular filling
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