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NURS 611 Study guide questions and
answers for exam 3
Pathophysiology associated with Type 1 & 2 DM - correct answer -autoimmune loss of B cells in the pancreatic islet Development of insulin resistance in a characteristic of: - correct answer -Type 2 DM Lack of all anterior pituitary hormones is called? - correct answer -panhypopituitarism Clinical manifestations of hypothyroidism - correct answer -low basal metabolic rate, cold intolerance, lethargy, tiredness, and slightly lower basal body temperature Characteristics of diabetes insipidus - correct answer -an insufficiency of ADH, leading to polyuria and polydipsia Characteristics of diabetes mellitus - correct answer -not a single disease but a group of clinical heterogeneous disorders that have glucose intolerance in common Characteristics of SIADH - correct answer -by high levels of ADH in the absence of normal physiologic stimuli for its release Common symptom of DM, DI, and SIADH - correct answer -thrist What causes the microvascular complications of DM - correct answer -results from capillary basement membranes thickening and endothelial cell hyperplasia What is the cause of diabetes insipidus - correct answer -inability of kidney to increase permeability of water - resulting in large excretions of large volume of dilute urine and increased plasma osmolality
Describe the pathophysiological changes associated with Addison's Disease - correct answer -results from hyposecretion of adrenal cortex hormones Describe the pathophysiological changes associated with hypoparathyroidism - correct answer -damages caused during thyroid surgery- What are the causes of ketoacidosis - correct answer -develops when there is an absolute or relative deficiency of insulin and an increase in insulin counterregulatory hormones. What are the pathophysiological changes associated with ketoacidosis - correct answer -dry mouth, HA, polyuria, polylipsia, wt loss, N/V, fruity breath, kussmaul resp., lethargy, SOB, abd pain What is acromegaly - correct answer -a term for adults who have been exposed to continuously high levels of growth hormone. What is gigantism - correct answer -term for children and adolescents who have been exposed to an increase amount of growth hormone One of the cause's of __________ is a deficiency of endemic iodine - correct answer -hypothyroidism Manifestations of hypothyroidism - correct answer -lower levels of thyroid hormone w/o negative feedback of TH in the pituitary, increase secretion of TSH that may lead to a goiter Microvascular complications related to chronic diabetes mellitus - correct answer -retinopathy, nephropathy, and neuropathy Macrovascular complications related to chronic diabetes mellitus - correct answer -CAD, CVA, PVD, disease and infection What happens during hypoglycemia? - correct answer -hunger, lightheadedness, tachycardia, pallor, HA, and confusion
tissues resulting in monocyte and vascular hypertrophy and progression of HTN; causes structural changes in blood vessels that contribute to permanent increase in peripheral resistance and make vessels more vulnerable to endothelial dysfunction and platelet aggregation Discuss the neural effects of angiotensin II - correct answer -stimulation of thirst, release of ADH, and increases in sympathetic nervous system output. Define pulsus paradoxus - correct answer -is when the arterial blood pressure during expiration exceeds arterial pressure during inspiration by >10 mmHg What is pulsus paradoxus mean clinically - correct answer -it reflects impairment of diastolic filling of the left ventricle plus reduction of blood volume within all 4 cardiac chambers Clinic indicator for a coronary thrombus - correct answer -usually have marked elevations in the ST segments on ECG and are categorized as having a STEMI Define pericarditis - correct answer -inflammation of pericardium S/SX of pericarditis - correct answer -several days of fever, myalgias, and malaise followed by sudden onset of CP that increases with breathing or lying down. What is the most common cardiovascular complication of HIV - correct answer -pericarditis What are some other reported s/sx of pericarditis - correct answer -dyphagia, restlessness, irritability, anxiety, and weakness Types of cardiomyopathies - correct answer -Dilated and hypertrophic and restrictive What is dilated cardiomyopathy - correct answer -characterized by ventricular dilation and grossly impaired systolic function - leading to dilated heart failure
What does dilated cardiomyopathy cause - correct answer -decreased ejection fraction, increased end diastolic and residual volumes, decreased ventricular stroke volume, and biventricular failure What are cardiomyopathies - correct answer -diverse group of disease that primarily affects the myocardium What causes cardiomyopathies - correct answer -underlying cardiovascular disorders (HTN and ischemic heart disease), possibly from infectious disease, exposure to toxins, systemic connective tissues disease, infiltrative and proliferative disorders or nutrional deficiencies Characteristic of hypertrophic cardiomyopathy - correct answer -thickening of the septal wall - leading to outflow obstruction to the left ventricular outflow tract What causes restrictive cardiomyopathy - correct answer -may occur idopathically or as a cardiac manifestation of systemic disease What systemic diseases can cause restrictive cardiomyopathy - correct answer -scleroderma, anylodosis, sarcoidosis, lympoma, and hemochromatosis, or a # of inherited storage diseases Discuss the effect of HTN on the kidneys - correct answer -In the kidney vasoconstriction and resultant renal perfusion cause tubular ischemia and preglomerular arteriopathy Describe the blood flow through the heart - correct answer -during relaxation (diastole) blood fills the ventricles, then the contraction (systole) propels the blood out of the ventricles into the vascular system. What is considered a complete cardiac cycle - correct answer -a set of both relaxation and contraction of the myocardial layer of the heart What are B1 receptors in the heart - correct answer -found mostly in the heart, specifically the conduction system (AV and SA nodes, purkinje fibers) and the atrial and ventricular myocardium
What is Zone 2 of the pulmonary anatomy - correct answer -is the portion where alveolar pressure is greater than venous pressure but not greater than arterial pressure - blood flows thru Zone 2, but it's impeded to a certain extent by alveolar pressure. Its normally above the level of the left atrium What is Zone 3 of the pulmonary anatomy - correct answer -arterial and venous pressures are greater than alveolar pressure and blood flow is not affected by alveolar pressure - its in the base of the lungs. Blood flow thru pulmonary capillary bed increases in regular increments from the apex to the base What part of the brainstem is responsible for automatic rhythm of respiration? - correct answer - composed of several groups of neurons located bilaterally in the brainstem, the dorsal resp. group, ventral resp. group, pneumotaxic center, and the apneustic center. Describe how to effectively monitor a person's alveolar ventilation - correct answer -to determine the adequacy of ventilation - an ABG to monitor PaCO2. What is dyspnea - correct answer -often described as breathless, air hunger, SOB, labored breathing, and preoccupation with breathing When is dyspnea seen - correct answer -common symptom of respiratory disease. Dyspnea is a result of___: - correct answer -decrease pH, increase PaCO2, and decreased PaO2, stimulation of stretcher or J-receptor, and fatigue of teh intercostal muscle and diaphragm What is promixmal nocturnal dyspnea (PND) - correct answer -its a dyspnea that occurs when an pt lies flat and is common with heart failure. What causes PND - correct answer -from redistributes body water - fluid accumulates in the lung. How is PND relieved - correct answer -repositioning such as sitting up or standing to relieve the pressure put on the respiratory muscles by the abdominal contents How is oxygen transported in the blood - correct answer -in 2 forms - small amt dissolves in plasma and bound to HgB molecules
How is respiration stimulated - correct answer -from impulses from the brainstem to the resp muscles causing them to contract and relax. How is the basic automatic rhythm of respiration set - correct answer -by the DRG - a cluster of insp nerve cells located in the medulla that sends efferent impulses to the diaphragm and insp intercostals muscles What does the beta 2 adrenergic receptors stimulation - correct answer -bronchodilation - which decreases resistances to airflow and vasodilation of the bronchial smooth muscles What substances can cause bronchoconstriction? - correct answer -occurs if the irritant receptors in the airway epithelium are stimulated by irritants in inspired air; by endogenous substances (histamines, serotonin, prostaglandins), by many drugs and humoral substances What causes pulmonary artery constriction - correct answer -Low alveolar partial pressure of oxygen (PAO2) What are the risk factors for pulmonary emboli? - correct answer -many conditions and disorders that promote blood cloting What are the 3 categories that make the Virchow triad - correct answer -venous stasis, hypercoagulability, and injuries to the endothelial cells that line the vessels. What consequences of a PE - correct answer -impairs blood flow to a segment of the lung Define alveolar dead space - correct answer -the area where alveoli are ventilated but not perfused Lung changes that occur with aging - correct answer -loss of elastic recoil, stiffening of the chest wall, alterations in gas exchange, and increase if flow resistance What anemia is classified as a macrocytic-normochromic anemia - correct answer -Pernicious anemia has large abnormally shaped erythrocytes but normal HgB concentrations - due to lack of vitamin B-
Cells that destroy some types of tumor cells and some virus-infected cells without prior exposure are: - correct answer -Natural Killer (NK) Cells. Mature erythrocytes are removed from the bloodstream by the: - correct answer -Spleen In aplastic anemia, pancytopenia develops as a result of the: - correct answer -Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes What are clinical manifestations of hypothyroidism? - correct answer -Constipation, decreased heat rate, and lethargy Diagnosing a thyroid carcinoma is best done with: - correct answer -fine-needle aspiration biopsy. The term used to describe a person who experiences a lack of all hormones associated with the anterior pituitary is: - correct answer -panhypopituitarism. The mitral and tricuspid valves close after the ventricles are filled with blood because the: - correct answer -Increased pressure in the ventricles pushes the valves to close. The significance of the "atrial kick" is that it is the contraction of the: - correct answer -left atria that increases the blood volume into the ventricle Depolarization of a cardiac muscle cell occurs as the result of a: - correct answer -Rapid movement of sodium into the cell. The ___________ period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated. - correct answer -refractory What, if any, is the effect of epinephrine on ß2-receptors of the heart? - correct answer -Dilate coronary arterioles
Where are the receptors for neurotransmitters located in the heart? - correct answer -Myocardium and coronary vessels Stretch receptors as well as peripheral chemoreceptors send afferent impulses regarding ventilation to the: - correct answer -Dorsal respiratory group in the medulla oblongata. Which endogenous substances cause bronchoconstriction? - correct answer -Histamine and prostaglandin Changes in the alveoli that cause an increase in alveolar surface tension, alveolar collapse, and decreased lung expansion are a result of: - correct answer -Decreased surfactant production. The relationship between arterial perfusion and alveolar gas pressure at the base of the lungs is best described as: - correct answer -Arterial perfusion pressure exceeds alveolar gas pressure. Which of the following is the most important cause of pulmonary artery constriction? - correct answer - Low alveolar PO Insulin counterregularlatory hormones - correct answer -catecholamines, cortisol, glucagon, and growth hormone How do counterregularlatory hormones work - correct answer -antagonize insulin by increasing glucose production and decrease use of glucose What is the result of a compensatory mechanism directed at eliminating metabolic acidosis - correct answer -Hyperkalemia Graves disease definition - correct answer -an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Symptoms of Graves disease - correct answer -Anxiety and irritability, tremors, heat sensitivity, wt loss, goiter, changes in menses, bulging eyes, palpitations, diarrhea, reduced libido
What are the parameters in diagnosising DM - correct answer -Fast BS of >126 mg/dl, > 200 mg/dl 2 hours after eating, random glucose level > 200 mg/dl with symptoms of polydipsia, polyphagia and polyuria A person develops severe dehydration and hyperglycemia. An absence of ketosis has occurred. What condition does this person have. - correct answer -Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) What occurs when hypoglycemia stimulates glucose counterregulation hormones, which causes a rebound hyperglycemia - correct answer -Somogui effect What occurs with diminished level of consciousness, which is an emergency associated with severe hypothyroidisms with symptoms such as hypothermia, hypoventilation, hypotension, hypoglycemia, and lactic acidosis - correct answer -Myxedema coma The classic symptoms of ______ include unexplained weight gain and anuria - correct answer -diabetes What disease is associated with symptoms including polyuria, polydipsia, polyphagia, and unexplained weight loss - correct answer -diabetes What is anuria - correct answer -the abesence of urine production or a urinary output of less than 100 ml/day What is the term for higher than normal WBC count - correct answer -leukocytosis What is the term for lower than normal WBC count - correct answer -leukopenia What are neutrophils, eosinophils and basophils considered - correct answer -granulocytes What is the term for an increase in the number of granulocytes - correct answer -granulocytosis What is the most numerous of the granulocytes - correct answer -neutrophil
Which form of leukemia is the most commonly observed in children - correct answer -Acute lymphoblastic leukemia (ALL) Which molecular anomaly with acute lymphoblastic leukemia carries the worst prognosis - correct answer -Philadelphia chromosome Where do lymphomas usually start - correct answer -lymphatic tissue of the stomach or colon. What is the term for malignancy within the lymphatic tissue in the bone marrow - correct answer - lymphocytic leukemia When is Hodgkin lymphoma's peak incidence - correct answer -in the 20-30's and then later in life What is the lymphoma associated with the jaw and facial bones and with the Epstein-Barr virus and with children from east-central Africa and New Guinea - correct answer -Burkitt lymphoma Spontaneous bleeding without trauma can occur between what counts of platelets - correct answer - between 10,000 and 15,000 mm What are s/sx of spontaneous bleeding - correct answer -petechiae, ecchymoses, larger purpuric spots or frank bleeding from mucous membranes Where is severe spontaneus bleeding fatal - correct answer -GI tract, respiratory system, or CNS What is immune thrombocytopenic purpura - correct answer -a process that involves autoantibodies What are the initial manifestations of ITP - correct answer -petechiae that progress to major hemorrhage from mucosal sites. Who and when is ITP frequently seen - correct answer -children and typically last 1-2 months with a complete remission
What blood cell has no nucleus or mitochondria but carries oxygen to the tissue - correct answer - hemoglobin Which cells are the predominant cells of early inflammation - correct answer -neutrophil What other cells are part of the inflammatory response but aren't the earliest cells activitated - correct answer -Monocytes, basophils, and eosinophils What do monocytes mature into - correct answer -macrophages What are often increased at sites of allergic inflammatory reactions and parasitic infection - correct answer -basophils what contains a variety of enzymes that help control the inflammatory processes - correct answer - eosinophil granules What are fragments of cytoplasmic components - correct answer -platelets What shape are plateltes - correct answer -disc-shaped formed from megakaryocytes What is following is responsible for lysis or the breakdown of blood clots - correct answer -fibrinolytic system What does nitric oxide cause - correct answer -vasodilation What is a circulating plasma protease inhibitor that inhibits thrombin and factro Xa - correct answer - Antithrombin III What are agranulocytes include - correct answer -monocytes and macrophages
What collects interstital fluid and eventually returns it to circulation via the superior vena cava - correct answer -lymphnodes Lymph nodes are part of what - correct answer -hematologic and immune systems What does infection do to the lymph nodes - correct answer -enlargement and tenderness Platelet activation involves which processess - correct answer -adhesion, aggregation, activation What stimulates platelet activation - correct answer -epi, thrombin, collagen Inhibition of platelets is associate with - correct answer -tissue factor inhibitor and inhibits factor Xa of the clotting cascade, inactivation of COX-1(which decreases production of thromboxane A2 (TXA2) What is anemia - correct answer -reduction in erythrocytes or a decrease in the quality or quantity of hemoglobin Characteristics of macrocytic anemia - correct answer -unusally large stem cells (megaloblasts) in the marrow Macrocytic anemias result from - correct answer -defective erythrocyte DNA synthesis - caused by deficiencies of Vit B12 or folate or defective coenzymes required for nuclear maturation and DNA synthesis What is the most common of the megaloblastic anemias and is caused by Vit B12 deficiency, which is associated with the end stage type A chronic atrophic gastritis - correct answer -pernicious anemia A defect in mitochondrial heme synthesis causes which form of anemia - correct answer -Sideroblastic What is a heterogeneous group of disorders characterized by varying severity because of a deviation of mitochodrial heme synthesis - correct answer -Sideroblastic
What is a rare disorder involving IgG and can result in massive intravascular hemolysis - correct answer - cold hemolysin What is another name for the cold hemolysis type of anemia - correct answer -Paroxysmal cold hemoglobinuria What is a form of immune hemolytic anemia from an allergic reaction against foreign antigens (antibiotics) - correct answer -drug-induced hemolytic anemia What is the most common cause of aplastic crisis - correct answer -human parvovirus B What is the most common cause of anemia - correct answer -Impaired production of erythrocytes, blood loss, increased red cell destruction, or any combination of these What connects the upper and lower airways - correct answer -larynx What contains the heart, great vessels, and esophagus and is located between the two lungs - correct answer -mediastinum Which lung has three lobes - correct answer -Right What lung has two lobes - correct answer -Left How are the lungs divided - correct answer -segments and lobules What enters the lungs at the hila - correct answer -the right and left main bronchi What bifurcates at the carina - correct answer -trachea
what do goblet cells secrete - correct answer -mucus What is made with u-shaped cartilaginous rings - correct answer -trachea What process describes the exchange of CO2 for O2 - correct answer -Respiration What is the mechanical movement of gas or air into and out of the lungs - correct answer -Ventilation What refers to the actual blood flow and O2 delivery - correct answer -circulation What refers to the amount of air delivered to the alveoli - correct answer -alveolar ventilation Which receptors monitors the pH, PaCO2, PaO2 in arterial blood - correct answer -Central chemoreceptors Which receptors are located in smooth muscle and are sensitive to increases in the size or volume of the lungs - correct answer -Stretch receptors What receptors are found in the epithelium of conducting airways and are sensitive to noxious aerosis, gases, and particles - correct answer -irritant receptors What receptors are located near the capillaries in the alveolar septa and are sensitive to increased capillary pressure - correct answer -J-receptors What is associated with increased lung compliance and decreased elastic recoil - correct answer - emphysema What refers to the opposition to airflow and is determined by the length, radius, and cross-sectional area of the airways - correct answer -airway resistence What affects the surface tension and alveolar ventilation - correct answer -surfactant
