D115 master set-Advanced Pathophysiology for the
Advanced Practice Nurse
A 27-year-old nulligravid female and her 25-year-old male partner present to your office for
family planning.
How does your reproductive knowledge guide your intake with this couple? - ANS-An
understanding of reproductive pathophysiology is necessary to recognize deviations from the
norm. Age of onset of menarche can provide valuable information about how the hormones are
functioning in the body. A previous pregnancy is an indicator of future fertility.
A 47-year-old, overweight woman has gradually increasing dyspnea, mild chest discomfort upon
exertion, fatigue, and weight gain. She has no children and is not pregnant. Further history
reveals a family history of diabetes.
Describe and justify other assessment questions, beyond questions about chest discomfort, that
you should ask the patient. - ANS-With the woman's overweight condition and family history of
diabetes, she may have type 2 diabetes mellitus.
You should ask her about polyuria, polydipsia, changes in vision, itching skin rash or ulcers,
vaginal discharge, recent history of frequent urinary tract infections, paresthesias, and
intermittent claudication.
These questions address manifestations of hyperglycemia and of complications of long-term
diabetes, which may be present by the time type 2 diabetes is diagnosed.
A 56-year-old female came to the nurse practitioner with fatigue, pallor, dyspnea on exertion,
and palpitations. Her laboratory report indicates that her hematocrit, hemoglobin, and
reticulocyte count are low, that her MCV is high, and that her MCH and MCHC are normal. Her
diagnosis is pernicious anemia.
Briefly explain why the nurse practitioner should ask the patient about her paresthesias and
ataxia. - ANS-Without the presence of intrinsic factor, vitamin B12 will not be absorbed
effectively from the gastrointestinal tract.
A 62-year-old female comes to the emergency department with mild respiratory distress,
increasing dyspnea, orthopnea, bilateral ankle edema, and sudden weight gain. She states that
she has had severe hypertension for many years and that she has been unable to afford her
antihypertensive medication for the past several months.
Explain why you should ask the patient if she has had any recent episodes of chest pain or any
history of angina or heart attack. - ANS-Hypertension is a risk factor for coronary
atherosclerosis. It also increases afterload and causes ventricular hypertrophy, both of which
increase myocardial oxygen demand.
,A family is concerned that their elderly family member is not eating.
Which three education topics should be addressed with the family regarding anorexia of the
elderly? - ANS-With aging, decreased saliva affects both taste and swallowing, often leading to
anorexia. Additionally, anorexia of aging is common, and family members need to understand
this. Offering oral care guidance and suggesting foods that taste good to the patient and are
easy to chew with the teeth or dentures may be effective interventions. Furthermore, social
stimulation has been shown to be effective in elderly patients with anorexia, providing relaxation
and enjoyment during food intake.
A female patient has been diagnosed with an uncomplicated urinary tract infection (UTI).
Which self-care measure that is specific to this type of infection should the healthcare provider
teach the patient? - ANS-Wiping front to back helps prevent the spread of e. coli into the urinary
meatus. E. coli is normally colonized in the bowel and is the most common pathogen in UTIs.
A healthcare professional is assessing a patient who could have either pyelonephritis or cystitis.
Which differentiating sign would assist the professional in making this diagnosis? -
ANS-Urinalysis confirmation of white blood cell casts
When the kidney is inflamed, it causes damage that results in the production of white blood cell
(WBC) casts.
A healthcare professional is conducting community education on vaccinations.
Which statement about vaccines should the professional include in the presentation? -
ANS-Vaccines require booster injections to maintain life-long protection.
Most vaccines require a booster to increase immunity. The initial effects of a vaccine may
diminish over time, and boosters improve protection against disease.
A healthcare professional is educating a community men's group on symptoms of benign
prostatic hyperplasia (BPH).
Which pathophysiological condition causes most of the symptoms of BPH? - ANS-Compression
of the urethra- The prostate grows and compresses the urethra, causing most of the symptoms
of BPH.
A healthcare professional is educating a community men's group on symptoms of benign
prostatic hyperplasia (BPH).
Which pathophysiological condition causes most of the symptoms of BPH? - ANS-The prostate
grows and compresses the urethra, causing most of the symptoms of BPH.
A male infant has been diagnosed with intussusception, and the student asks the healthcare
professional to explain the condition.
Which explanation by the professional is most accurate? - ANS-An intussusception is where
one part of the intestine telescopes into another section of the intestine. Intussusception's cause
is typically idiopathic but can be linked to some viruses that cause swelling in the intestines and
is often seen in the fall and winter. Intussusception most commonly affects male children from
3-36 months of age.
,A male patient presents with sinus congestion, clear nasal discharge, and a cough that is worse
when he is reclined.
What is the probable condition causing these symptoms? - ANS-Allergic rhinitis is marked by
sinus congestion, clear nasal discharge, post nasal drip that causes a sore throat, and cough
that is worse when supine.
A newborn child has a solitary purplish lesion on the head that looks like a spongy mass.
Which diagnosis is supported by this type of lesion? - ANS-A cavernous hemangioma is a
benign purple vascular tumor consisting of a collection of blood vessels that form a lesion.
A patient expresses concern to an advanced practice registered nurse (APRN) about not being
able to complete an entire meal without experiencing acid reflux. The patient also reports new
symptoms including chest pain and dysphagia. The APRN suspects that the patient might have
cancer.
Which type of cancer is the APRN concerned about? - ANS-The most common symptom of
esophageal cancer is a problem swallowing (dysphagia), with a feeling like the food is stuck in
the throat or chest or even choking on food. Some people get a feeling of pressure or burning in
the chest.
A patient has a hernial protrusion of a sac-like cyst containing meninges, spinal fluid, and a
portion of the spinal cord through a deficit in the spinal column.
Which condition does this describe? - ANS-Myelomeningocele is a type of spina bifida, a neural
tube defect, which is rarely covered by skin and protrudes from the back exposing spinal cord
tissue.
A patient has localized and has intense abdominal pain that lateralizes. In order to move
forward with your assessment, you consider the types of pain.
Which type of pain is this patient most likely experiencing? - ANS-Parietal pain is caused by a
stimulus in the parietal peritoneum. The nerves in the parietal peritoneum are made up of
A-delta fibers. These fibers travel to the spinal cord and correspond with the skin dermatomes
T6 and L1. This produces localized and intense pain that lateralizes because the parietal
peritoneum is innervated from only one side of the nervous system at a time.
A patient has pulmonary edema.
Which condition should the healthcare professional assess the patient for as the priority? -
ANS-Left-sided heart failure is most important to determine because it dictates diagnosis and
treatment of pulmonary edema.
A patient is being monitored in an ICU after a head injury of unknown origin. Initially, the patient
is awake and alert but cannot remember what happened. The patient begins to show signs of
increased intracranial pressure with episodes of confusion, restlessness, and lethargy.
, Which stage of intracranial hypertension should be diagnosed by an advanced practice
registered nurse (APRN)? - ANS-In stage 2, compensatory mechanisms are exhausted, and
there is a slow rise in ICP. Clinical signs and symptoms include drowsiness and headache.
A patient is in a hospital diagnosed with leukemia and has been receiving chemotherapy
treatments. An advanced practice registered nurse (APRN) assesses petechiae, ecchymoses,
large purpuric spots, and bleeding from the mucous membranes.
Which lab finding should the APRN expect for this patient? - ANS-Spontaneous bleeding
without apparent trauma can occur with platelet counts between 10,000 and 15,000/mm3,
resulting in petechiae, ecchymoses, larger purpuric spots, or frank bleeding from mucous
membranes. These symptoms are typical in a patient with leukemia being treated with
chemotherapy.
A patient is seen by an advanced practice registered nurse (APRN) for chronic venous
insufficiency. The patient has a leg wound that is red, warm, swollen, draining, and painful.
Which treatment should the APRN provide for this patient? - ANS-Cellulitis is an infection of the
dermis and subcutaneous tissue that causes redness, warmth, edema, and pain. Initial
treatment is with systemic antibiotics. Bacterial cellulitis is a common complication of chronic
venous disease (CVD) when dermatitis or open ulcers are present. The treatment is antibiotics.
A patient of child-bearing age reports not being recently sexually active but is complaining of
lactating without breast pain or bleeding. A serum pregnancy test performed by an advanced
practice registered nurse (APRN) was negative. The patient is concerned about the possibility of
breast cancer.
Which problem should the APRN suspect? - ANS-Complaints of lactation with a negative blood
pregnancy test is generally due to galactorrhea. Galactorrhea often results from having too
much prolactin—the hormone responsible for milk production after childbirth. It can be caused
by some medications, hypothyroid disease, chronic kidney disease, opioid use, spinal cord
injury, or even stress.
A patient presents to a hospital complaining of coughing, dyspnea, fatigue, weight loss, chills,
and fever. The patient has been working as a painter for 25 years. An advanced practice
registered nurse (APRN) performs several diagnostic tests, which reveal a diagnosis of
hypersensitivity pneumonitis.
Which statement describes the mechanism of this condition? - ANS-Hypersensitivity
pneumonitis is an autoimmune reaction initiated by alveolar macrophages and IgG antibody
production. Symptoms include cough, dyspnea, fatigue, weight loss, chills, and fever.
A patient presents to a mental health facility with complaints of hallucinations, disorganized
thoughts, decreased intimacy, and a flat affect. An advanced practice registered nurse (APRN)
orders neuroimaging.
Which pathologic change should the APRN expect to find? - ANS-There is third ventricle
enlargement and neuropsychological deficits in schizophrenia.
