-Advanced Physiology and Pathophysiology Across

1. Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold?

(Points : 3)

A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F

A woman presenting with malaise, lethargy, and copious nasal secretions

A man with a dry, stuffy nasopharynx, a sore throat, and temperature of 98.9°F

A woman complaining of generalized aches who has a hoarse voice and reddened, painful upper airways

Question 2.2. A 44-year-old woman developed calf pain during a transatlantic flight followed by acute shortness of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE), which resolved with anticoagulant therapy. Which of these statements best characterizes the underlying problem of her PE? (Points : 3)

She was short of breath because ventilation was occurring but perfusion was inadequate.

The combination of normal perfusion but compromised ventilation caused hypoxia.

She developed a transient anatomic shunt resulting in impaired oxygenation.

Impaired gas diffusion across alveolar membranes resulted in dyspnea and hypoxia.

Question 3.3. A premature infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD) and is showing signs and symptoms of hypoxemia, low lung compliance, and respiratory distress syndrome (RDS). Which of the following is the most likely contributor to the infant’s present health problem? (Points : 3)

High inspired oxygen concentration and injury from positive-pressure ventilation

Failure to administer corticosteroids to the infant in utero

Insufficient surfactant production and insufficient surfactant therapy

Insufficient supplemental oxygen therapy

Question 4.4. Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)? (Points : 3)

A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration

An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells

An 81-year-old male who has a productive cough and recurrent respiratory infections

An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke

Question 5.5. A 66-year-old male presents to the emergency department accompanied by his wife who claims that he has been acting confused. The man is complaining of a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F and his blood work indicates his sodium level is 126 mEq/L (normal is 135 to 145 mEq/L). What will be the assessing nurse practitioner’s most likely suspicion? (Points : 3)

Bronchopneumonia

Mycoplasma pneumonia

Legionnaire disease

Pneumococcal pneumonia

Question 6.6. A 51-year-old female patient who is 2 days postoperative on a surgical unit of a hospital is at risk for developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse practitioner is most appropriate? (Points : 3)

“Being in bed increases the risk of fluid accumulating between your lungs and their lining, so it’s important for you to change positions often.”

“You should breathe deeply and cough to help your lungs expand as much as possible while you’re in bed.”

“Make sure that you stay hydrated and walk as soon as possible to avoid our having to insert a chest tube.”

“I’ll prescribe bronchodilator medications that will help open up your airways and allow more oxygen in.”

Question 7.7. Due to complications, a male postoperative patient has been unable to mobilize for several days following surgery and has developed atelectasis. Which of the following processes would his care team anticipate with relation to his health problem? (Points : 3)

Vasodilation in the alveolar vessels in the affected region of his lung

Increased workload for the left side of the patient’s heart

Increased blood flow to the area of atelectasis

Redirection of blood flow away from the lung regions that are hypoxic

Question 8.8. Which of the following clinical findings would be most closely associated with a patient who has interstitial lung disease rather than COPD? (Points : 3)

Audible wheezing on expiration

Diminished expiratory flow rates

Increased respiratory rate with decreased tidal volume

Normal compliance of alveolar tissue

Question 9.9. A male lifetime smoker has died as a result of chronic obstructive pulmonary disease. Which of the following phenomena regarding his alveoli would his care team have most reasonably expected in the weeks prior to his death?

(Points : 3)

Proliferation of natural killer (NK) cells in the alveolar lumen

Large numbers of alveolar macrophages in septal connective tissue

The presence of tubercles in the intra-alveolar spaces

Compensatory regeneration of type I alveolar cells

Question 10.10. A 21-year-old male patient has suffered a head injury during a crash on his motorcycle, and a deficit that assessments have revealed is an impaired swallowing mechanism. He has also developed aspiration pneumonia. Which of the following statements most accurately capture an aspect of his condition? (Points : 3)

His oropharynx is obstructed.

His epiglottis is covering his larynx

His vocal folds have been compromised.

His tracheobronchial tree is intermittently obstructed.

Question 11.11. A short, nonsmoking middle-aged man presents to the emergency department with left-sided chest pain and a cough. He says that the pain started abruptly, just after lunch, and that breathing and coughing make it worse. He denies recent injury. He is breathing shallowly and rapidly and expresses fear that he may be having a heart attack. Breath sounds are normal, and he is not cyanotic. Which condition is most likely causing his symptoms? (Points : 3)

Myocardial infarction

Spontaneous pneumothorax

Pleuritis related to infection

Obstructive atelectasis

Question 12.12. Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation? (Points : 3)

Intrapleural pressure slightly exceeds that of the inflated lung

The chest wall exerts positive pressure on the lungs that contributes to expiration

The lungs are prevented from collapsing by constant positive intrapulmonary pressure

Negative intrapleural pressure holds the lungs against the chest wall

Question 13.13. The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son’s condition. Which of the following teaching points is most justifiable? (Points : 3)

“Research has shown that viruses may actually be a factor in many children’s asthma.”

“The most reliable indicator that your child is having an asthma attack is audible wheezing.”

“Steroids that your child can inhale will likely be the first line of defense.

“Your son will likely need to limit or avoid exercise and sports.”

Question 14.14. Which of the following phenomena is most likely occurring during a child’s alveolar stage of lung development? (Points : 3)

Terminal alveolar sacs are developing and surfactant production is beginning.

A single-capillary network exists and the lungs are capable of respiration.

The conducting airways are formed, but respiration is not yet possible.

Primitive alveoli are formed and the bronchi and bronchioles become much larger.

Question 15.15. A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her diagnosis of emphysema. Which of the following processes would her care team be most justified in ruling out? (Points : 3)

Decreased elastic recoil due to alveolar damage

Decreased residual lung volume due to impaired alveolar ventilation

Increased anatomic dead space due to reduced tidal volume

Increased alveolar dead space due to incorrect intrapleural pressure

Question 16.16. A definitive test for cystic fibrosis is (Points : 3)

The sweat test

A sputum culture

A fecal fat test

A Chymex test for pancreatic insufficiency

Question 17.17. A patient who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. What would her care team anticipate when observing her breathing? (Points : 3)

Rapid, deep breaths

Wheezing breaths

Short, shallow breaths

Pursed-lip breaths

Question 18.18. Which of the following patients are NOT displaying known risk factors for the development of pulmonary emboli?

(Points : 3)

A patient who is immobilized following orthopedic surgery

A patient who has impaired Cl– and Na+ regulation

A patient who is taking amiodarone for the treatment of a cardiac arrhythmia

A patient who is a smoker and takes oral contraceptives

A patient who is undergoing radiation therapy for the treatment of breast cancer

Question 19.19. Following a winter power outage, a patient who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning? (Points : 3)

To increase the amount of oxygen dissolved in plasma

To increase the production of unbound hemoglobin

To stimulate the release of oxygen at the capillaries

To remove bound CO from hemoglobin

Question 20.20. A nurse practitioner is performing patient teaching about the influenza virus with each patient who has come to the clinic to receive that year’s vaccine. Which of the following statements by patients best reflects an accurate understanding of the flu virus? (Points : 3)

“I could come down with viral or bacterial pneumonia as a result of a bad flu bug.”

“I know my vaccination is especially important since there aren’t any drugs that can treat the flu once I get sick with it.”

“The emphasis on bundling up, staying warm, and drinking lots of fluids is outdated and actually ineffective.”

“Like all vaccines, it is ideal if everyone in a population gets immunized against the flu.”

Question 21.21. A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercle scarring site, located in a peripheral area of his bronchiolar tissue. What is this patient’s most likely diagnosis? (Points : 3)

Squamous cell carcinoma

Small cell lung cancer

Large cell carcinoma

Adenocarcinoma

Question 22.22. As a result of dehydration, a patient’s epithelial cells are producing insufficient amounts of mucus. Consequently, the patient’s mucociliary blanket is compromised. Which of the following changes would a care provider most reasonably anticipate as a direct result of this change? (Points : 3)

Impaired function of the patient’s cilia

Decreased levels of oxygen saturation

Increased amounts of bacteria in the lungs

Increased carbon dioxide levels

Question 23.23. Which of the following statements best captures the etiology of the acute response phase of extrinsic (atopic) asthma? (Points : 3)

IgG production is heightened as a consequence of exposure to an allergen.

Airway remodeling results in airflow limitations.

Epithelial injury and edema occur along with changes in mucociliary function.

Chemical mediators are released from presensitized mast cells.

Question 24.24. A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung cancer (SCLC). How can her nurse practitioner most appropriately respond to her? (Points : 3)

“I’m sure this is very hard news to hear, but be aware that with aggressive treatment your chances of beating this are quite good.”

“This is very difficult to hear, I’m sure, and we have to observe to see if it spreads because that often happens.”

“I’m very sorry to have to give you this news; I’d like to talk to you about surgical options, however.”

“This is a difficult diagnosis to receive, but there is a chance that the cancer may go into remission.”

Question 25.25. About 3 weeks after razing an old chicken house, a 71-year-old retired farmer has developed a fever, nausea, and vomiting. After ruling out more common health problems, his care provider eventually makes a diagnosis of histoplasmosis. Which of the following processes is most likely taking place? (Points : 3)

Toxin production by Histoplasma capsulatum is triggering an immune response.

Antibody production against the offending fungi is delayed by the patient’s age and the virulence of the organism.

Spore inhalation initiates an autoimmune response that produces the associated symptoms.

Macrophages are able to remove the offending fungi from the bloodstream but can’t destroy them.

1. A 60-year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states, “I don’t know how this could happen to me, since I’m so careful about eating a healthy diet.” What is the most appropriate response to the man’s statement? (Points : 3)

“Your diet may have played a part in this, but in fact genetics is likely primarily to blame.”

“What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved.”

“You likely don’t need to change your diet, but now that you have stones in one kidney, you’re at very high risk of growing them in the other kidney.”

“Your diet might be normally healthy, but high intake of normally beneficial minerals like calcium and magnesium can lead to stones.”

Question 2.2. An 87-year-old male resident of an assisted living facility has been consistently continent of urine until the last several weeks. Which of the following actions by the care providers at the facility is the most likely priority? (Points : 3)

Performing a physical examination and history to determine the exact cause and character of the incontinence

Providing patient education focusing on the fact that occasional incontinence is a normal, age-related change

Teaching the resident about protective pads, collection devices, and medications that may be effective

Showing the resident the correct technique for exercises to improve bladder, sphincter, and pelvic floor tone

Question 3.3. A 34-year-old male patient has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The patient’s family is questioning the care team about why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide to the family? (Points : 3)

An inordinate amount of interstitial fluid is accumulating in the patient’s abdomen.

The transcellular component of the intracellular fluid compartment contains far more fluid than normal.

The normally small transcellular fluid compartment, or third space, is becoming enlarged.

Gravity-dependent plasma is accumulating in the patient’s peritoneal cavity.

Question 4.4. A patient is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in the lower lung fields bilaterally. What is the patient’s most likely diagnosis? (Points : 3)

Hyponatremia

Fluid volume excess

Hypocalcemia

Hyperkalemia

Question 5.5. Following several days in an acidotic state, a hospital patient has returned to the desired pH. Which of the following processes could have contributed to the resolution of the patient’s health problem?(Points : 3)

Exchange of Na+ and H+ ions

Selective renal secretion and reabsorption of CO2

Phosphate and ammonia buffer systems in the renal tubules

Excretion of HCO3– by the kidneys

Question 6.6. Which of the following patients would be considered to have a significant risk of developing the prerenal form of acute renal failure?