Module 1 Pre Assessment

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RATIONALE 1 anatomy CATEGORY Backward effects of left-sided heart failure include: QUESTION A) Pulmonary congestion CORRECT ANSWER A) Pulmonary congestion YOUR ANSWER Deoxygenated blood from the right ventricle flows through the right and left pulmonary arteries to the right and left lung. After entering the lungs, the branches subdivide, finally emerging as capillaries which surround the alveoli and release the carbon dioxide in exchange for oxygen. The capillaries unite gradually and assume the characteristics of veins. These veins join to form the pulmonary veins, which return the oxygenated blood to the left atrium. Backflow of blood through the left atrium result in left-sided heart failure.

RATIONALE 2 anatomy CATEGORY Oxygen saturation is likely to be lowest when an asthmatic with a diagnosis of pneumonia is positioned: QUESTION C) Lying on the right side CORRECT ANSWER C) Lying on the right side YOUR ANSWER Ventilation and perfusion distribute to the dependent lung fields. In a patient with pneumonia in the right lung, positioning with the right lung down would send more blood flow to the consolidated, nonventilated areas of the lung and produce a worse V/Q mismatch, which would decrease oxygen diffusion into the blood and produce a lower arterial oxygen saturation.

RATIONALE 3 anatomy CATEGORY Which of the following is true of the biological functions of testosterone? QUESTION D) Testosterone is needed for development of male secondary sexual characteristics. CORRECT ANSWER D) Testosterone is needed for development of male secondary sexual characteristics. YOUR ANSWER Testosterone is needed for development of male secondary sexual characteristics.

RATIONALE 4 anatomy CATEGORY Which of the following is true of the biological functions of progesterone? QUESTION. A) Progesterone is the most important hormone associated with pregnancy. CORRECT ANSWER A) Progesterone is the most important hormone associated with pregnancy. YOUR ANSWER Progesterone is the most important hormone associated with pregnancy.

RATIONALE 5 anatomy CATEGORY In performing a physical assessment, the nurse notes the patient has a a€? barrela€• configuration to the chest. This is a consequence of: QUESTION D) Increased residual lung volume CORRECT ANSWER D) Increased residual lung volume YOUR ANSWER Emphysema typically produces a barrel a€“shaped chest with an increased anterior-posterior dimension. This is a result of loss of lung parenchyma resulting in reduced elastic recoil and increased residual volume and functional residual capacity.

RATIONALE 6 biology CATEGORY The diet of a patient in end-stage kidney disease is restricted in all of the following except: QUESTION D) Calories CORRECT ANSWER D) Calories YOUR ANSWER Individuals with end-stage renal failure have a low GFR that makes it difficult to rid the body of fluids, potassium and nitrogenous waste products, therefore these substances may be restricted. Nitrogenous wastes are produced by metabolism of proteins. Caloric needs are not reduced as a result of renal failure.

RATIONALE 7 biology CATEGORY What is the function of hemoglobin? QUESTION A) Hemoglobin is the protein in red blood cells that is responsible for carrying oxygen to the cells of the body. CORRECT ANSWER A) Hemoglobin is the protein in red blood cells that is responsible for carrying oxygen to the cells of the body. YOUR ANSWER Hemoglobin is the protein in red blood cells that binds to oxygen and carries oxygen from the respiratory organs to the rest of the body.

RATIONALE 8 biology CATEGORY Common manifestations of bacterial pneumonia include all of the following except: QUESTION. D) Hyperinflation CORRECT ANSWER D) Hyperinflation YOUR ANSWER Hyperinflation occurs with obstructive disorders such as emphysema and asthma, but not with pneumonia, which is an alveolar consolidation and atelectatic problem. Productive cough and fever are commonly associated with pneumonia. Tachypnea is a response to decreased tidal volume or hypoxemia and can occur with pneumonia.

RATIONALE 9 biology CATEGORY Why is heat an effective means of sterilization? QUESTION A) Heat is an effective means of sterilization because it destroys the proteins of microbial life-forms including fungi, bacteria and viruses. CORRECT ANSWER A) Heat is an effective means of sterilization because it destroys the proteins of microbial life-forms including fungi, bacteria and viruses. YOUR ANSWER Heat is an effective means of sterilization because it destroys the proteins of microbial life-forms including fungi, bacteria and viruses.

RATIONALE 10 biology CATEGORY In addition to hypertension, pre-eclampsia is characterized by: QUESTION C) Protein in the urine and edema CORRECT ANSWER C) Protein in the urine and edema YOUR ANSWER In addition to elevated blood pressure, retention of fluid leading to edema and leakage of protein into the urine are usually found in pregnancy induced hypertension (pre-eclampsia). Nausea, vomiting, fatigue and back pain are common findings of normal pregnancy.

RATIONALE 11 chemistry CATEGORY The solution that would be most alkalotic would be the one with a pH of: QUESTION D) Fourteen CORRECT ANSWER D) Fourteen YOUR ANSWER The normal blood pH range is 7. 35 to 7. 45.

RATIONALE 12 chemistry CATEGORY A calculated ABG value that indicates excess or insufficiency of sodium bicarbonate in the system is: QUESTION B) Base excess CORRECT ANSWER B) Base excess YOUR ANSWER. The base excess indicates the amount of excess or insufficient level of bicarbonate in the system.

RATIONALE 13 chemistry CATEGORY List the enzymes whose levels are elevated in the blood serum following an MI. QUESTION A) CPK, LDH, AST, and SGOT CORRECT ANSWER A) CPK, LDH, AST, and SGOT YOUR ANSWER CPK, LDH, AST and SGOT are primary cardiac enzymes released with cardiac tissue necrosis. The enzymes show elevation 8-12 hours after infarction and therefore, are diagnostic indicators of MI.

RATIONALE 14 chemistry CATEGORY The oxyhemoglobin dissociation curve represents the relationship between the: QUESTION B) Oa‚‚ saturation and PaOa‚‚ CORRECT ANSWER B) Oa‚‚ saturation and PaOa‚‚ YOUR ANSWER The oxyhemoglobin dissociation curve is a tool used to show the relationship between oxygen saturation and the PaO2.

RATIONALE 15 chemistry CATEGORY What effect does glycogen metabolism have on glucose levels? QUESTION A) Glycogen metabolism traps glucose within liver cells and increases storage of glucose in the form of glycogen. These processes decrease blood glucose levels. CORRECT ANSWER A) Glycogen metabolism traps glucose within liver cells and increases storage of glucose in the form of glycogen. These processes decrease blood glucose levels. YOUR ANSWER Glycogen metabolism increases the glucose levels within cells, while decreasing glucose levels in blood. Insulin stimulates uptake of glucose from the bloodstream into cells and phosphorylation of glucose by the enzyme glucokinase as well as glycogen synthase, the first enzyme in glycogen synthesis. Glucose is trapped within the liver cells, resulting in increased glucose storage, in the form of glycogen. In turn, glucose levels in blood is decreased.

RATIONALE 16 pathophysiology CATEGORY Which of the following may be a reason to order an ABG on a patient? QUESTION D) All of the above CORRECT ANSWER D) All of the above YOUR ANSWER ABGs are ordered in most instances in which a patient experiences dyspnea or signs of respiratory distress.

RATIONALE 17 pathophysiology CATEGORY Interpret the following ABG results. pH 7. 21 pCOa‚‚ 60 HCOa‚? 24 QUESTION B) Respiratory acidosis without compensation CORRECT ANSWER B) Respiratory acidosis without compensation YOUR ANSWER pH 7. 21 (acid), pCO2 60 (acid), HCO3 24 (normal). Step one of arterial blood gas interpretation requires that you identify whether the pH, pCO2 and HCO3 are abnormal. The two matching values determine what the problem is. When an acid-base disorder is either uncompensated or partially compensated, the pH remains outside the normal range.

RATIONALE 18 pathophysiology CATEGORY The respiratory system compensates for changes in the pH level by responding to changes in the levels of: QUESTION A) COa‚‚ CORRECT ANSWER A) COa‚‚ YOUR ANSWER The blood pH will change according to the level of carbonic acid present. This triggers the lungs to either increase or decrease the rate and depth of ventilation until the appropriate amount of CO2 has been re-established.

RATIONALE 19 pathophysiology CATEGORY Interpret the following ABG results. pH 7. 33 pCOa‚‚ 60 HCOa‚? 34 QUESTION C) Respiratory acidosis with partial compensation CORRECT ANSWER C) Respiratory acidosis with partial compensation YOUR ANSWER pH 7. 33 (acid), pCO2 60 (acid), HCO3 34 (alkaline). Step one of arterial blood gas interpretation requires that you identify whether the pH, pCO2 and HCO3 are abnormal. The two matching values determine what the problem is. When an acid-base disorder is either uncompensated or partially compensated, the pH remains outside the normal range.

RATIONALE 20 pathophysiology CATEGORY All of the following might be a cause of respiratory acidosis except: QUESTION D) Hyperventilation CORRECT ANSWER D) Hyperventilation YOUR ANSWER Answers A-C might be a cause of respiratory acidosis.

RATIONALE 21 pharmacology CATEGORY What is the medical application of cortisone? Cortisone is used to treat: QUESTION A) Rheumatoid arthritis, asthma, gastrointestinal disorders, and a variety of skin conditions. CORRECT ANSWER A) Rheumatoid arthritis, asthma, gastrointestinal disorders, and a variety of skin conditions. YOUR ANSWER. Cortisone is a steroid hormone that prevents the release of substances in the body that cause inflammation.

RATIONALE 22 pharmacology CATEGORY What occurs when glycogen metabolism is stimulated by insulin? QUESTION B) Insulin stimulates glycogen synthase, the first enzyme in glycogen synthesis. It also stimulates removal of glucose from the bloodstream into cells and phosphorylation of glucose by the enzyme glucokinase. CORRECT ANSWER B) Insulin stimulates glycogen synthase, the first enzyme in glycogen synthesis. It also stimulates removal of glucose from the bloodstream into cells and phosphorylation of glucose by the enzyme glucokinase. YOUR ANSWER Glycogen metabolism increases the glucose levels within cells, while decreasing glucose levels in blood. Insulin stimulates uptake of glucose from the bloodstream into cells and phosphorylation of glucose by the enzyme glucokinase as well as glycogen synthase, the first enzyme in glycogen synthesis. Glucose is trapped within the liver cells, resulting in increased glucose storage, in the form of glycogen. In turn, glucose levels in blood is decreased.

RATIONALE 23 pharmacology CATEGORY The purposes of epinephrine injection include all of the following except: QUESTION D) Blocking histamine receptors. CORRECT ANSWER D) Blocking histamine receptors. YOUR ANSWER Epinephrine is effective as an acute treatment for type I hypersensitivity reactions to bee stings because it binds to B2 receptors in bronchioles and may inhibit bronchoconstriction. It also stimulates the heart to help maintain blood pressure, which may fall because of vasodilatory effects of histamine. Epinephrine also helps reduce further release of inflammatory mediators from mast cells. Epinephrine does not bind to or block histamine receptors.

RATIONALE 24 pharmacology CATEGORY. Therapeutic interventions focused on increasing the oxygen supplied to the heart and decreasing the hearta€™s demand for oxygen include: QUESTION C) Morphine sulphate CORRECT ANSWER C) Morphine sulphate YOUR ANSWER Morphine can reduce myocardial oxygen consumption by reducing the preload of the heart. It does this by causing venodilation and pooling of blood in the periphery. If the person is experiencing pain or anxiety, morphine can reduce the sympathetic activation of the heart caused by these symptoms. The other drugs might be expected to improve oxygen delivery to the heart but would not decrease oxygen utilization by the heart.

RATIONALE 25 pharmacology CATEGORY An intervention that would contribute toward the healing of a peptic ulcer is: QUESTION B) Blocking or neutralizing of acid secretion CORRECT ANSWER B) Blocking or neutralizing of acid secretion YOUR ANSWER Blocking acid secretion into the lumen of the stomach or neutralizing the secreted acid with ingested antacids are standard therapies for peptic ulcers. These measures will reduce the proteolytic activity of pepsin in the stomach, which is inactivated at less acidic pH as well as reduce the damage from the acid itself.

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