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***Please find attached the assignment if this is not clear enough. Thank you.
Please note that both PART 1 and II are to be submitted together as one assignment.
PART I
Questions 1 & 2 below refer to the following situation:
A 55-year-old man with emphysema (a type of chronic lung disease) who has smoked 2 packs of cigarettes per day for 40 years is hospitalized for acute onset of cough productive of bloody sputum (sputum=secretions from deep in the lungs).After a few days of testing and treatment, the patient? nurse reads a physician? note on the chart: ? have told the patient that the etiologies of his hemoptysis are:1) exacerbation of his chronic emphysema and 2) the new diagnosis of lung cancer.The onsets of both were contributed to by his longstanding smoking.·/p>
1.The patient asks the nurse for more information.Which of the following explanations to the patient best indicates a full understanding of the patient? situation?
a.?ou have a disease process that was iatrogenically caused by cigarette smoking.·
b.?ou have a sudden onset of a chronic lung disease that was brought on by lung cancer.·/p>
c.?he coughing up of blood is caused by a worsening of a disease you?e had for a long time, plus a new problem– lung cancer.·/p>
d.?hese diseases have been creeping up on you for probably 20 years; it just goes to show that you should never have taken up smoking.·/p>
2.Based on all the information you have on the patient, which statement is most likely correct?
a.The patient has a poor prognosis because of the comorbidities of lung cancer and cigarette smoking.
b.Lung cancer was a sequela of the bloody sputum.
c.A precipitating factor for the acute hospitalization was overexertion when the patient started an exercise class.
d.Heavy cigarette smoking was a risk factor in the patient? developing emphysema and lung cancer.
Questions 3 & 4 refer to the following situation: An 80-year-old patient is in shock from loss of blood following an accident.His vital signs are: BP 80/50 (normal ~ 120/80), HR 120 (norm = 60-100), RR 20 (norm = 12 to 20), T 98.6 (norm ~ 98.6).
3.In assessing this patient, the nurse understands that the abnormal HR is
a.probably the etiology for the patient? low BP.
b.due to the patient? heart compensating for low blood volume by pumping faster.
c.the normal compensatory response of shunting blood volume to the periphery.
d.due to multiple risk factors.
4.The patient would also most likely have all of the following EXCEPT
a.S&S of cool feet and hands from the body? compensatory response to shock.
b.S&S of feeling faint and weak from blood loss.
c.a risk factor of shock.
d.a more guarded (ie, ?oorer· prognosis because of his age.
5.A young, otherwise healthy patient is admitted to the hospital with a diagnosis of heart failure of unknown cause.The etiology of the heart failure would be termed
a.iatrogenic.
b.idiopathic.
c.nosocomial.
d.acute.
6.To do well in this course, a student should
a.memorize the notes thoroughly.
b.be able to apply concepts to different situations.
c.begin each assignment at 7am the day it is due.
d.hurriedly take tests one hour before their stop-time.
Questions 7-10 refer to the following situation A 55-year-old male is in the ER having a myocardial infarction (heart attack, AKA ?.I.·, which is caused by coronary arteries that are clogged with fat and narrowed so that not enough oxygen?ich blood is getting to his heart. He admits that his daily nutrition is poor, consisting mainly of high-fat fast food.He has a family history of cardiac disease– his father had a heart attack at age 46. The patient is obese and is a heavy cigarette smoker– 2 PPD (packs per day). The patient said he had decided to take up jogging today and after a few minutes began having chest pain, nausea and shortness of breath. He went to the ER and was noted to have profuse diaphoresis (heavy sweating), tachycardia (rapid heart rate), and significant changes on his electrocardiogram (ECG or EKG). The patient recovers from this acute heart attack but his heart is so damaged that subsequently he has many episodes of congestive heart failure and many hospitalizations.
7.Without even having further knowledge of course material related to MI?, you can tell a lot about the scenario from careful reading and knowledge of basic patho verbiage.Example:The paragraph above suggests that the direct pathophysiologic etiology of the heart attack (MI) is most likely related to
a.not eating green vegetables.
b.congestive heart failure.
c.lack of oxygen that narrows the coronary arteries.
d.oxygen not reaching tissue that is distal to narrowing of the coronary arteries.
8.In reading the scenario, it is easy to find 4 risk factors?hings that ?et the stage·for this patient to have a heart attack.They include all the following EXCEPT
a.being a heavy cigarette smoker.
b.having profuse diaphoresis.
c.a parent with heart disease.
d.high-fat diet.
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9.Which mini-concept map do you think best describes accurate linkage between underlying pathophysiology and signs and symptoms (S&S) described in this scenario?
a.Jogging increased heart rate?lood pumped throughout body faster?issues
(including lungs and stomach) receive too much blood?atient complains of shortness of breath and nausea.
b.History of heart disease in family?atient worries about it constantly?ecomes
anxious?mokes too much?icotine causes narrowing of all arteries in body, including coronaries?eart attack from narrowed coronaries.
c.High levels of fat in the blood from high-fat diet?logs in coronary arteries develop over time ?xygenated blood cannot get to distal tissues of heart?noxygenated tissues ?ry out·(send pain messages to brain) ·patient complains of chest pain.
d.Obesity·increased pressure on diaphragm?reathing becomes more
difficult?hortness of breath?ess oxygen·EKG changes.
10.A sequela of the MI was
a.having to be hospitalized frequently because of problems associated with the damaged heart.
b.having to be hospitalized frequently with repeat heart attacks.
c.needing to jog more often.
d.continuing to smoke 2 PPD.
11.The most likely sequela of not submitting an assignment by the deadline is
a.being allowed to submit the assignment later because you had a bad cold during the
days leading up to the assignment due date.
b.getting a zero on that assignment.
c.instructor? lack of concern, because you will be able to drop the lowest assignment
grade.
d.being allowed to submit the assignment later because you thought it wasn? due till the next day.
12.
13.
14.After not eating since breakfast 6 hours ago, a student taking a test notices a period of hunger and fatigue.He doesn? have access to food because he is taking the test.About 10 minutes later, though, he begins to feel ok again and finishes the test with flying colors.What has happened in his body?
a.A compensatory response called glycogenolysis allowed him to access stored glucose for energy.
b.A decompensatory response occurred, in which adrenalin increased and caused more blood flow to the brain.
c.Since his blood sugar was likely low, the heart underwent a compensatory response
known as hypertrophy in order to increase blood flow to central organs.
d.Using a control mechanism known as hyperventilation, the student was able to
?low off·excess CO2 and thus have a clearer thinking process.
15.Which sets of sentences match each other correctly?(Read very carefully.)
a.After several days of little sleep and very stressful life events a student? cold evolves into pneumonia.Insomnia and stress are precipitating factors for the pneumonia.
b.A person with a chronic lung disease gets pneumonia.The pneumonia is considered an acute illness.
c.Freshly oxygenated blood flows from the aorta through coronary arteries to distal parts of the heart muscle.Blockage in the coronaries would cause decreased oxygenation in the cardiac muscle tissue that is proximal to the blockage.
d.A and B.
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Genetic Influence in Disease
16.A child is born to a couple, one of whom is heterozygous for an autosomal dominant disease. The other parent is homozygous normal.What would be the child? chances of having the disease? (Use a Punnett square to figure this out).
a.0%
b.25%
c.50%
d.75%
17.A child is born to a couple, one of whom is a carrier for a sex-linked recessive disease. The other parent has the disease (?aving·the disease means the phenotype is seen?e, S&S).What would be the chances that the couple has a child with the disease? (Use a Punnett square to figure this out.)
a.0%
b.25%
c.50%
d.75%
18.In the question above, what are the chances that a child will be a carrier?
a.0%
b.25%
c.50%
d.75%
19.An RN is taking care of a cocaine addict who has just given birth to a baby with a teratogenic defect.A student nurse asks him what the probable etiology was.The RN shows understanding of genetic disorders when he says
a.?t? hard to know the exact cause, but it? likely that fetal chromosomal development was impaired by the mom? intra-pregnancy cocaine ingestion.·/strong>
b.?he baby inherited a structural chromosomal defect that resulted in a problem called aneuploidy.·/strong>
c.?he baby inherited a gene that caused a defect called trisomy 21.·/strong>
d.?ince the little guy was born with the Philadelphia chromosome, he will be a life-long Phillies fan.·/strong>
20.A child with sickle cell anemia presents with pain all over, especially the joints.Which of the following best links the patho with S&S?
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a.Cyst formation in the kidneys leads to blood spillage from the circulation into the
urine, thus causing anemia.
b.A single-gene mutation causes malfunction of genetic coding for clotting properties, leading
to bleeding and ischemic pain of the joints.
c.Chromosomal aberrancy causes malformation of RBCs in the blood supply to the joints and subsequent pain due to lack of oxygen.
d.A single-gene mutation causes malfunction in RBC O2-carrying capacity, leading to ischemic pain in the joint tissues.
Questions 21-25 are based on this scenario:A 25-year old pregnant women voices concerns about the genetic health of her fetus because she has sickle cell disease.Her husband has been genetically tested and has a heterozygous genotype.
Tips:The questions assume that you are taking the following critical thinking steps:
- You read the question and by knowing (from your readings) that sickle cell disease is an autosomal recessive disease and thus has a certain pattern of inheritance (do your Punnett square work below)
- You know that in most genetic diseases, the gene that has been mutated will not code properly for certain proteins that are important for certain normal functions.You will ask yourself, in sickle cell, how does the mutation lead to the phenotype, ie, the signs and symptoms?
First figure out the Punnett square for this couple (blue highlight) & then the possible kids·genotypes (yellow) ·(use the letter ·strong>s·for the parents·genotypes?tands for sickle cell; see pgs. 50-51 as needed):
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_____ |
_____ |
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_____ |
_____ |
_____ |
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_____ |
_____ |
_____ |
21.Mom? genotype is
a.ss
b.Ss
c.SS
d.none of the above.
22.Which is true about the dad?
a.His genotype is ss.
b.He is a carrier of sickle cell.
c.He likely has the typical S&S of sickle cell.
d.All of the above.
23.What is the percent possibility of this couple? child having a completely normal genotype?
a.0%
b.25%
c.50%
d.100%
24.What is the percent possibility of this couple? child having sickle cell trait?
a.0%
b.25%
c.50%
d.75%
25.What is the percent possibility of this couple? child having the disease, sickle cell anemia?
a.0%
b.25%
c.50%
d.75%
26.The parents of a new baby with Down? syndrome ask their nurse what to expect.She bases her answer on her understanding that the child will have
a.developmental problems brought on by a sex-linked monosomy.
b.developmental problems brought on by the pathologic interaction of 3 chromosomes where there should be only two.
c.a phenotype based on defective mitochondrial protein synthesis that created aneuploidy.
d.the phenotype of diminished IQ and physical differences that are caused by a single-gene disorder.
27.A person has hemophilia.Which is the correct genotype?
a.HH
b.XHY
c.XhY
d.hh
28.The phenotype of the person in question 27 includes having ________ because __________.
a.joint pain: the gene that codes for coagulation factors is defective, causing easy bleeding into the joints.
b.joint pain: the joint tissue is oxygen-starved due to deformed hemoglobin in the RBCs.
c.simian facial features: hemophilia is a teratogenic disorder caused by maternal alcohol
abuse.
d.severely shortened arms and legs: a drug called thalidomide caused the mutated genotype.
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Intracellular Function and Disorders
Questions 29-31 apply to this scenario: The parents of a five-year-old girl complain anxiously to
her pediatrician that in the last couple of weeks, no matter how much she eats, she keeps losing weight.
She appears quite thin, well below her normal weight.Her blood sugar is 300 (normal range 75-110).
She is diagnosed with Type I diabetes mellitus (DM 1).
29.In this scenario, the explanation that bests links pathophysiology with S&S in this child is that in DM1, the pancreas
a.quits producing glucagon so that glycogen stores are inaccessible, thus causing weight loss.
b.increases insulin production so that glucose stays in the blood, causing hyperglycemia.
c.quits producing insulin so that glycogenolysis is stimulated and too much glucose enters the blood.
d.quits producing insulin so that glucose cannot be used as energy in the cells, thus causing the body to burn up fat and protein for energy.
30.If ABGs were done on this patient, you would expect all the following EXCEPT:
a.a blood pH of 7.32 because sustained gluconeogenesis causes acidic byproducts to
accumulate.
b.a HCO3 of 20 because the high numbers of acids in her body ?ake over·and ?vercome·/p>
the HCO3, which then diminishes in number.
c.a HCO3 of 30 because the low numbers of acids in her body stimulate increase in HCO3.
d.this acid/base imbalance to be called metabolic acidosis because it is an acidotic state
caused by a metabolic disorder.
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31.This girl? body needs to compensate for the acid/base imbalance noted above.Knowing that the lungs will compensate when the ?etabolic·side is ?ick·and the kidneys will compensate when the lungs are ?ick,·which compensatory response would you expect?
a.Hyperventilation –increased respiratory rate (RR)– to ?low off·CO2; this is the lungs·way to get rid of acids.
b.Hypoventilation?ecreased RR– to ?old onto·CO2, since CO2 is an alkali that will counteract the acidosis.
c.Kidneys will excrete more HCO3 into the urine to get rid of acidic byproducts.
d.By hyperventilating and blowing off CO2, the body will bring the pH down to normal range.
32.A child accidentally ingests an insecticide with the ingredient cyanide.Knowing that cyanide suppresses the actions of cytochrome oxidase in the electron transport chain, what is a likely sign or symptom you would expect and why? (see page 2 of metabolic pathway concept map and use your critical thinking skills)
a.Ketonuria due to increased glycogenesis.
b.Confusion due to glycolysis.
c.Mild euphoria due to enhanced production of ATP.
d.Shortness of breath due to decreased ATP to use for the work of breathing.
33.A patient with a serum calcium of 6.0 (norm = 8.5- 10.5) is most likely to______ because_______.
a.be lethargic: the cells are hypopolarized.
b.have muscle spasms: more Na+ has entered the cells.
c.be weak: more Na+ has left the cells.
d.have hyperirritable muscles: the cells are hyperpolarized.
34.A patient has been vomiting copiously for 3 days.He is probably in ___ because _____.
a.metabolic acidosis: vomiting often leads to hyperventilation.
b.respiratory alkalosis: vomiting often leads to hyperventilation
c.metabolic alkalosis: vomiting of the normal acidic digestive secretions of the stomach eventually depletes the body? acids.
d.metabolic acidosis: vomiting of the normal acidic digestive secretions of the stomach eventually depletes the body? acids.
Questions 35-36 apply to this scenario: A 78-year-old patient with cancer of the esophagus has not been able to eat, has lost 80 pounds and appears cachectic (extremely thin & wasted; the noun is cachexia).His breath smells fruity, like acetone.His pH is 7.14 and HCO3 18.
(normal HCO3 is 24-28)
35.Looking at his pH and HCO3, plus the corroborating patient picture, what acid/base imbalance is he in?
a.respiratory alkalosis.
b.metabolic alkalosis.
c.metabolic acidosis.
d.respiratory acidosis.
36.Link aspects of his clinical presentation to the pathophysiology underlying them.
a.Patient can? eat·hypoglycemia?nsulin secreted from pancreas·triggers glycogenolysis as a back-up plan ·raises blood sugar but byproducts include ketones.
b.Difficulty breathing·increased metabolic needs?ses up all energy sources·body begins
to use HCO3 as source of energy?CO3 depleted·HCO3 decreases to 18, causing pH to increase from normal to 7.14.
c.Chronic illness?ncreased stress?ncrease in counterregulatory hormones?lycogenesis triggered?oo much glucose being stored rather than being readily available?achexia.
d.Given the description of the patient’s debilitated state, he is probably in sustained gluconeogenesis?ives energy but also increases accumulation of ketones ·body tries to get rid of them via many ways, including as acetone in the breath.
37.A scene in the ER:A CIA operative who has had no previous medical history presents with initial complaints of nausea, vomiting, severe weakness.Now he is also short of breath.His pH is 7.20 and his HCO3 is 17.What is most likely going on in his body?
a.Poisoning (by an enemy spy)·cellular hypoxia?ells must repeatedly go through
anaerobic glycolysis to gain some ATPS?ncreases pyruvate?actic acidosis·metabolic acidosis.
b.Poisoning (by an enemy spy)·hypoxia?ells must continuously go through aerobic
glycolysis instead of continuing down normal metabolic pathway·low ATPS?espiratory
acidosis.
c.Gastrointestinal flu·can? eat·low blood sugar?lucagon secreted?riggers glycogenolysis·glucose released into blood, but also there are acidotic byproducts that must be countered by more HCO3?ncreased alkalinity?etabolic alkalosis.
d.Job stress?ow oxygenation·body compensates by increasing respiratory rate (hyperventilation)·too much CO2 blown off·respiratory alkalosis.
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38.A patient in the ER is about to get a laceration stitched up.First the ER nurse practitioner (NP) will infiltrate the area with Lidocaine, a drug that will prevent the patient from feeling pain as the stitches go in.The medication? mechanism of action is to change the permeability of nerve cell membranes so that they decrease the number of Na+ ions that are allowed to come into the cell.Using critical thinking and knowledge of RMP issues, what do you think is the next step?
a.The nerve cells in the area become filled with anions and the RMP is reset from -90mV
to -60mV.
b.Because of the increased influx of cations, the local nerve cell membranes become more positively charged.
c.Because of the decreased influx of cations, the local nerve cell RMPs will be reset from
-90mV to -120mV.
d.The sodium/potassium pump of the cell membranes will cease to work properly, and the
cells will become incapable of holding their normal RMP charge.
39.Link the correct answer in question 38 with the effect of numbing the skin in the area to be stitched.
a.Since the RMPs of the area nerve cells are now more positively charged, they are hypopolarized and therefore will conduct pain sensations very slowly or not at all.
b.Since the RMPs of the area nerve cells are now more negatively charged, they are hyperpolarized and therefore will conduct pain sensations very slowly or not at all.
c.Since the RMPs of the area nerve cells are now more negatively charged, they are hypopolarized and therefore will be so hyperactive that pain sensation will be negligible.
d.Since the RMPs of the area nerve cells are now more positively charged, they are hyperpolarized and therefore will conduct pain sensations very slowly or not at all.
40.Patho student Haymitch Abernathy spent 2 days in the hospital with mild pancreatitis.He gets out on a Monday evening feeling much better but knows he missed the 8am deadline for an assignment submission.What should he do, according to course policy?
a.Send an email to his instructor right away to explain about his hospitalization, understanding that excuses must be offered within 24 hours after the deadline.
b.Scan his doctor note and email the copy to his instructor.
c.Opt to use this assignment zero score as the one grade he can drop at the end of the semester.
d.A and B.
PART II
1.Remember the patient in PART I, with cancer who can? eat and has lost 80 pounds?Let? add to his
assessment findings:let? say he has generalized edema and a serum protein of4gm/dl (normal = 6.0 to 8.3 gm/dl ).Which is the most accurate mini-concept map linking his blood protein level with edema?
a.hypoproteinemia·concentration in blood is now lower than the normal concentration of fluids inside cells·fluid goes from blood to tissue (B to T).
b.hypoproteinemia·concentration in blood is now higher than the normal concentration of fluids inside cells·fluid goes from B to T
c.hypoproteinemia·blood is now hyperosmolar compared to the cells ·fluid goes from T to B
d.hyperproteinemia?lood now has lower oncotic pressure than normal·fluid goes from T to B
2.All of the following are accurate possible findings in the patient above EXCEPT that
a.he has confusion due swollen brain cells.
b.he has crackles in his lungs from fluid in the alveoli (lung tissue).
c.his serum osmolality is 302 (norm = 280- 295).
d.he will need a hypertonic IV solution to return fluid status to normal.
3.A 28-year-old man presents with a low blood pressure due to blood loss from a gunshot wound.The regulatory
action that will best compensate for this patient? fluid volume deficit is:
a.increased action of the natriuretic peptide system.
b.increased action of the RAAS.
c.inhibition of renin secretion.
d.conversion of aldosterone into angiotensin II.
4.As a result of the action in the previous question, all the following will occur EXCEPT:
a.the patient? body will ?ang on·to fluids.
b.Na+ will be retained by the kidneys.
c.water excretion into the urine will increase.
d.blood pressure will increase.
(Normal labs:Na+ = 135 to 145; K+ = 3.5 ·5.0;serum osmolality (?smo· = 280- 295;HCO3 = 22-28).
5.A patient is hospitalized in renal failure.Because of her kidneys·inability to excrete water, she has generalized edema & a serum sodium of 129. Because the kidneys have also lost the ability to appropriately regulate potassium, she also has a serum potassium of 5.9.These lab results show:
a.hypernatremia & hypokalemia.
b.hyperkalemia & hyponatremia.
c.hyperosmolality & hypernatremia.
d.hypoosmolality & hypocalcemia.
6.In the previous question, the edema is most likely due to fluid shifting from the intravascular space into interstitial spaces secondary to all the following EXCEPT:
a.hypertonicity of the plasma space.
b.hypotonicity of the plasma space.
c.hypoosmolality of the blood.
d.diminished osmotic pressure of the blood.
7.A patient has advanced liver disease.Blood tests reveal that his serum albumin (albumin is one of
the protein molecules found in the blood) level is very low. What eventually happens in this patient situation?
a.Water would shift from blood (B) to tissue (T) because of decreased plasma oncotic pressure.
b.There would be an increased intravascular volume due to increased plasma oncotic pressure.
c.There would be dehydrated brain cells due to fluid shifting from T to B.
d.Water would shift from T to B because of increased osmolality of the vascular space.
8The physiologic process underlying fluid shifts in the patient situation above is that
a.·i>concentration calls·fluid into hypoosmolar compartments from hyperosmolar ones.
b.the principle of diffusion results in albumin molecules going from lower to higher concentration.
c.·i>concentration calls·fluid into compartments with higher oncotic pressure from compartments with lower
oncotic pressure.
d.the proteinemia means that protein molecules will diffuse throughout the blood and tissue.
9.A patient who just came out of general anesthesia has lab work done.The serum osmo is 165.The nurse taking care of this patient suspects that the _____ is due to _________.
a.hyperosmolality: dehydration.
b.hypoosmolality: syndrome of inappropriate ADH (SIADH).
c.hypertonicity: SIADH.
d.high oncotic pressure: a state of hyperpolarization inside the cells.
10.The nurse in the previous question (9) would expect all the following S&S EXCEPT:
a.signs of cerebral edema such as irritability.
b.signs of cerebral cell dehydration such as headache.
c.pitting edema
d.crackles in the lungs upon auscultation.
11.Re: the patient in the previous two questions (9 & 10):As an intervention to return the patient to normal serum osmolality, the nurse is likely to be ordered to hang an IV bag of _______ because once the fluid is distributed in the blood it will __________ and help return fluid compartment status to homeostasis.
a.0.45 NaCl: cause water to shift from tissue (T) to blood (B).
b.3% NaCl : cause water to shift from T to B.
c.0.25 NaCl: shift water from B to T.
d.NS: shift water from B to T.
12.A patient who is having hyposecretion of ADH (antidiuretic hormone) would MOST LIKELY have the following sign:
a.serum osmolality of 270.
b.oliguria (low urine output).
c.serum osmolality of 300.
d.edema.
13.If you had a patient whose lab work showed that he was hyperproteinemic, what would you know about that patient?
a.He has a low osmotic pressure.
b.He has a low blood oncotic pressure.
c.His blood is more concentrated than usual.
d.You may need to hang an IV bottle of albumin.
14.You have two patients whose serum osmolality results are as follows:Albus Dumbledore (Mr. D.) has a serum osmolality of 263.Minerva McGonagall (Ms. M) has a serum osmolality of 326. (normal serum osmo = 280- 295).
Based on understanding the links between fluid imbalances, lab results, and S&S, you will expect that
a.Ms. M. will have an overall puffy appearance.
b.Mr. D will have poor skin turgor and dry mucus membranes.
c.Ms. M. will need a hypertonic IV to get her fluid status back to normal.
d.Mr. D will have generalized pitting edema.
15.On a more cellular level, which is true regarding the two patients in question 14?
a.Mr. D? tissue cells are likely shrunken from fluid being pulled from tissue to blood.
b.Ms. M?
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