Exam (elaborations)
NR 507 PATHO FINAL QUESTIONS AND ANSWERS
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NR 507 PATHO FINAL QUESTIONS AND ANSWERS
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NR 507 PATHO FINAL QUESTIONS AND ANSWERS1. 99% of T4 is bound to protein and inactive. The amount of unbound T4, known as
2. The production, storage, and release of T4 (and FT4) are under control of
1. free T4 (FT4), is the amount of freely circulating hormone which can affect the body
tissues
2. TSH, it is released from the anterior pituitary gland and travels in the blood stream
to bind with a receptor on the thyroid epithelial cells
1. A diagnosis of GERD can often be made on patient history alone. Explain
2. List other dx tests that can be done
1. explore if the patient smokes or drinks alcohol, ingests foods that triggers reflux (i.e.
peppermint and chocolate) or takes medications which may be predispose the patient to
GERD by relaxing the LES
2. Upper GI series
Endoscopy
Esophageal manometry
Esophageal pH
1. An infection of the lower urinary tract can progress to an upper urinary tract infection
if the bacteria ascends from the bladder to the kidney. The condition is
2. The signs and symptoms of pyelonephritis include
3. Think of the symptoms of pyelonephritis in a classic triad:
4. if the infection has entered the circulation from the kidney via the renal vein
5. For the patient with pyelonephritis, the urine will present with
1. pyelonephritis.
2. all the symptoms associated with cystitis plus fever, flank pain, costovertebral angle
(CVA) tenderness, nausea, and vomiting. Malaise is also a common complaint
3. vomiting, flank pain and fever
4. there can also be signs of shock
5. WBC casts
1. Another issue that contributes to UI is
2. any of the normal nerve innervations that occur during micturition that are impeded
can cause UI due to weakening of the detrusor muscle or lead to over-contraction,
causing weakening of the internal and external sphincters List some transient causes
1. weakness in the internal or external sphincters
,2a. Delirium: the individual may be unaware of the need to urinate
2b. (UTI): A UTI can result in frequency and urgency.
2c. Atrophic vaginitis: this is atrophy of the vaginal walls, bladder and urethra r/t
estrogen deficiency
2d. Drugs:
anticholinergics-prevent relaxation of bladder,
Anti-Parkinson drugs: alpha-agonist, and antagonist drugs-An alpha-agonist will cause
bladder over-contraction of the bladder leading to overflow incontinence; an alpha-
antagonist will prevent the bladder from contracting that will lead to stress
incontinence.
Diuretics and ACE inhibitors increase the amount and frequency of urination that results
in urge incontinence, Calcium channel blockers can prevent the internal and external
sphincters from contracting
sedatives and hypnotics may inhibit the individual’s need to urinate.
1. Bipolar I involves a
2. A Bipolar II disorder involves at least
1. full manic or mixed episode. Manic episodes include major highs that can last at least
a week; there is always manic episodes that can be accompanied by psychosis or
delusions
2. one major depressive episode and at least one hypomanic episode, but no full mixed
or manic episode.
Hypomania involves less severe manic episodes than seen in Bipolar I
1. (blank) is a gram-negative bacterium that is associated with GERD. Complications
include
1. H. pylori; dyspepsia and adenocarcinoma
1. Chronic kidney disease (CKD) is characterized by a long-term
2. (blank) is used to determine the significance and stage of the CKD
3. Why is Stage III a significant stage
,1. permanent decline in renal function
2. (GFR)
3. The significance is that there is still an opportunity to improve the patient's kidney
function to keep them between stages I-III. If this can be achieved, then the patient will
not need long term dialysis.
1. Despite the different classifications, all antidepressant medications are
2. So what influences the ARNPs drug of choice?
1. equally effective in reducing the major symptoms of MDD2.
2a the side effects of the medication, especially if the 2b. drug aggravates an existing
medical condition interactions with other medications and diagnoses
2c. Cost may also be a factor in adherence to treatment
1. Escherichia coli can bind to cells in the lower urinary tract and hide from the immune
cells. The bacteria can form biofilms-what is this?
2. Describe the pathophysiology of a UTI that can lead to septic shock or bacterimia
Note the diagram btw a male & female urinary tracts (who's is much shorter)
1. A biofilm is any group of microorganisms that allow them to stick to one another and
adhere to surfaces that help them survive.
2. First, bacteria enter and contaminate the lower urinary tract. This causes the
colonization of bacteria in the urethra and the bladder. If the UTI progresses the
bacteria can ascend to the kidneys and colonize there. At this point, the infection
becomes an upper UTI. From there, if left untreated, the bacteria can spread into the
circulation via the renal veins causing bacteremia
1. Generally, liver function tests, aspartate aminotransferase (AST) and alkaline
phosphatase (ALP) indicate what?
2. Treatment for this patient involves what?
1. these do not signify cirrhosis specifically, but rather, demonstrate liver injury.
2. Liver damage is irreversible.
, The goal is to treat the complications that result from cirrhosis. The patient will be
encouraged to rest.
He may be prescribed corticosteroids to help decrease inflammation.
The NP should encourage the patient to stop alcohol consumption to slow cirrhosis
progression to improve symptoms and increase his quality of life.
A liver transplant is the only treatment for liver failure.
1. GFR determines the stage of kidney failure. However, when determining the need for
dialysis, it is based on
2. Patients will need dialysis when the following symptoms are present:
1. the patient's symptoms rather than the GFR
2. Metabolic acidosis.
Hyperkalemia: leading to EKG changes (peaked T-waves) is an indication for dialysis.
Drug toxicity: including salicylates, Lithium, Isopropanol, Methanol and Ethylene glycol).
Fluid volume overload- not responsive to diuretics. Uremic symptoms due to
nitrogenous wastes in the blood stream
1. goals of treatment for ulcerative colitis are
2. Pharmacological management may include
1. to alleviate acute symptoms and prevent their reoccurrence
2. aminosalicylic acid (5-ASA), corticosteroids, immunomodulating drugs, biologic
therapies, and Janus kinase inhibitors.
1. In summary, it is important to recognize that
2. Give two examples of somatic or voluntary innervation in bladder control
1. sympathetic, parasympathetic, and somatic actions work together to either fill or
empty the bladder.
2. The pudendal nerve which involves voluntary control over the pelvic floor and
external sphincter
1. NSAIDS suppress mucosal prostaglandin synthesis which
2. H. pylori is a gram-negative bacterium that actually. It produces NH3 (urease) to
actually decrease acid production. its production of urease neutralizes stomach acid. H.
pylori then moves into the gastric mucosa causing
1. results in decreased bicarbonate and mucin secretion and the production
and increased secretion of hydrochloric acid.
2. The movement into the gastric mucosa damages the mucosal cells as seen below:
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