Page 1 of 39 1 NURS 5315 ADV ANCED PATHOPHYSIOLOGY Final EXAM Questions and Answers Latest ( 2024) (Verified Answers) complete solutions NURS 5315 Final A patient in respiratory distress and is breathing 33 breaths per minute. Which ABG value is consistent with the clinical scenario? PCO2 15 pH 7.30 pH 7.45 O2 sat 100% A patient who is breathing 33 breaths per minute is hyperventilating and blowing off CO2; therefore the PCO2 level will be low. The patient will most likely experience a respiratory alkalosis and the two pH values provided are not consistent with this diag nosis. A patient has a sodium level of 115 mEq/L and is disoriented and lethargic. Which pathological process best explains this patient's symptoms? a. The action potential has become hyperpolarized. b. Water has shifted into the neurons and caused them to swell. c. Water has shifted into the vascular space and dehydrated the neurons. d. The action potential has become hypopolarized. b. The cause of neurologic symptoms associated with a sodium imbalance is directly related to fluid shifting into or out of t he neurons of the brain. With a serum sodium of 115 mEq/L, water shifts into the neurons and causes them to swell. Hypernatremia causes water to shift out of the cell into the intravascular space and causes the neurons to become dehydrated. An alteration i n the action potential is not seen with sodium imbalances. Page 2 of 39 2 A patient experiencing dehydration should be monitored for which electrolyte imbalance? a. Hyperkalemia b. Hypocalcemia c. Hypercalcemia d. Hyponatermia a. Serum osmolality is increased during time s of dehydration. An elevated serum osmolality will pull potassium into the intravascular space from the intracellular space and cause a rise in serum potassium. A married couple presents to your office for genetic counseling. The husband has an autosomal recessive disease and his wife has a heterozygous genotype for the disease. They ask you, What is the chance that our baby will have the disease? Which of the following answers is correct? 25% 50% 75% 100% A chromosome is a package of material located insi de the cell nucleus which is made of proteins and a single molecule of DNA. There are 23 pairs of chromosomes in each human cell for a total of 46 chromosomes. Chromosomes are separated into two identical sets during mitosis or meiosis. This provides a set of chromosomes to each daughter cell which results from cell division. This process is responsible for the transfer of genetic information to the daughter cells. The first 22 pairs of chromosomes are known as autosomes. The 23rd pair of chromosomes is the pair which contains the genetic information for gender. This pair contains the genetic information which delineates between the male and female genders. Females have two X chromosomes (XX) and males have an XY chromosome pair. Autosomal chromosomes are said to be autologous. This means they do not carry genetic information pertaining to gender. Autosomal genetic diseases are carried on the first 22 pairs of chromosomes. Sex -linked diseases are only carried on the 23rd pair of chromosomes. The autosomal chr omosomes are Page 3 of 39 3 nearly identical to one another and are considered homologous to one another. Each autosomal chromosome in a pair carries identical genes. These two genes are known as alleles. The alleles occupy the same site on each partner of the chromosome pair and code for the same genetic trait or physiologic function. Alleles can be dominant or recessive. One allele may be dominant and the other recessive, or they both may be dominant or both recessive. The dominant alleles' genetic code will always mani fest in the individual's phenotype. The information in the recessive allele is typically not expressed in the phenotype unless both alleles are recessive. For the purpose of clarity in use, the dominant gene is assigned a capital letter and the recessive g ene is assigned a lower case letter. Any letter is okay to use but make sure you use the same letter for the genotype - for example, "Bb or aa." The term homozygous refers to a pair of alleles which are either both dominant or recessive. For example, "BB o r bb" are said to be homozygous because the alleles are either both dominant or recessive. An allele pair in which one is dominant and one is recessive is said to be heterozygous. In autosomal recessive disorders both alleles on the chromosome are affected by the genetic aberration. If only one recessive gene is affected by the genetic aberration then the person is said to be a carrier and will not have the phenotypic expression of the disease. The healthy, recessive allele will compensate for the allele wh ich is affected by the genetic aberration. The carrier can pass the trait but does not have the genetic disease. In an autosomal dominant disorder the dominant gene is the only gene that has to be affected by the genetic aberration in order to have the phe notypic expression of the disease. A healthy recessive allele cannot compensate for a diseased dominant allele. In order to answer this question one must understand the above information and draw a Punnett Square. The husband has an autosomal recessive di sease which means his genotype must be aa. The wife has a heterozygous genotype for the disease which means her genotype is Aa. The capital A reflects a healthy gene so she is merely a carrier and does not express the disease phenotype. The father's genoty pe is written across the top line and the mother's genotype is written in the boxes to the left. The four boxes in the middle are the possible genotypes of their offspring. Each box represents a 25% chance for the offspring to have that particular genotype . The Page 4 of 39 4 question asks you to determine the chances the offspring will have the autosomal recessive disease or in other words, express the phenotype for the disease. The genotype which will result in the disease is "aa." Therefore, there is a 50% chance that their offspring will have the autosomal recessive disease. A child is diagnosed with hemophilia. This is an example of which genetic concept? Phenotype Genotype Autosomal transmission of the disease Transcription The expression of a genetic disease is an e xample of a phenotype. A genotype is a gene's programming. Hemophilia is transmitted on the x -chromosome and is not transmitted via the autosomes. This is not an example of transcription . Dehydration triggers which physiologic response? Increased secretio n of renin. Increase secretion of natriuretic peptides. Decreased secretion of antidiuretic hormone. Decreased serum osmolality. Dehydration will trigger the release of renin when renal perfusion is impaired. The other answers are seen during times of flui d volume overload. A patient on hydrochlorothiazide has a pH of 7.49 and a bicarbonate of 30. Which of the following pathological processes best explains the abnormal lab values? a. An accumulation of pancreatic bicarbonate secondary to vomiting and loss of hydrochloric acid b. An increased absorption of Na+ and HCO3 - in the proximal renal tubule secondary to increased aldosterone secretion
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