NR283 student Practise Exam Chamberlain University
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Free NR283 student Practise Exam Chamberlain University Questions
An increase of which laboratory value is associated with hepatic encephalopathy?
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Bilirubin
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Uric acid
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Ammonia
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Urea
Explanation
Correct Answer: C) Ammonia
Hepatic encephalopathy occurs when the liver cannot effectively detoxify substances that accumulate in the bloodstream, particularly ammonia. Ammonia is produced in the intestines during the breakdown of proteins and is normally converted by the liver into urea for safe excretion by the kidneys.
When liver function is impaired, ammonia builds up in the blood and crosses the blood–brain barrier, affecting brain function. Elevated ammonia levels lead to neurological symptoms such as confusion, altered level of consciousness, disorientation, asterixis (flapping tremor), and in severe cases coma. Therefore, increased blood ammonia levels are strongly associated with hepatic encephalopathy.
Which chemical is involved in the inflammatory response, regulation of body temperature, and regulation of water balance?
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Acetylcholine
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Dopamine
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Histamine
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Serotonin
Explanation
Correct answer: C. Histamine
Histamine is an important chemical mediator released by mast cells and basophils during inflammatory and allergic reactions. It contributes to the inflammatory response by causing vasodilation and increasing capillary permeability. Histamine also plays a role in several physiological processes including regulation of body temperature and fluid balance through its actions in the hypothalamus and other body systems.
Which will typically start the clotting process?
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Decreased vitamin K
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Blood vessel damage
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Fibrinolysis
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Hypocoagulation
Explanation
Correct answer: B. Blood vessel damage
The clotting process, also called hemostasis, typically begins when a blood vessel is damaged. Injury to the vessel wall exposes collagen and tissue factors beneath the endothelium. This exposure triggers platelet adhesion and activation, which leads to platelet aggregation and formation of a temporary platelet plug.
At the same time, the coagulation cascade is activated, resulting in the conversion of fibrinogen to fibrin. Fibrin forms a stable mesh that strengthens the clot and stops bleeding.
Decreased vitamin K impairs clotting factor production and slows clot formation, fibrinolysis refers to the breakdown of clots after healing begins, and hypocoagulation refers to reduced clotting ability rather than initiation of clotting.
How does increased capillary hydrostatic pressure result in edema?
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It decreases blood volume which leads to fluid in the tissues
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It causes vasoconstriction of the capillaries to limit fluid leakage
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It increases the synthesis of plasma proteins to retain fluid
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It forces fluid out of the capillaries into the interstitial space
Explanation
Capillary hydrostatic pressure is the outward force exerted by blood against capillary walls. When this pressure is elevated — as in venous obstruction, heart failure, or fluid overload — it overcomes the opposing oncotic pressure that normally keeps fluid in the vessels. As a result, fluid is pushed out of the capillaries and accumulates in the surrounding interstitial tissue, causing edema.
Why the other options are incorrect:
A. It decreases blood volume which leads to fluid in the tissues — Increased hydrostatic pressure does not primarily decrease blood volume; it shifts fluid outward due to increased outward force, not volume reduction.
B. It causes vasoconstriction of the capillaries to limit fluid leakage — Vasoconstriction is not a consequence of increased hydrostatic pressure. In fact, elevated pressure promotes fluid leakage rather than limiting it.
C. It increases the synthesis of plasma proteins to retain fluid — Plasma protein synthesis is a liver function unrelated to capillary hydrostatic pressure changes. Low oncotic pressure from reduced proteins is a separate mechanism of edema.
Options for (1): decreased heart rate, decreased blood pressure, decreased pain
Options for (2): vomiting, diarrhea, constipation
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decreased heart rate
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decreased blood pressure
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decreased pain
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vomiting
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diarrhea
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constipation
Explanation
Increased intracranial pressure (ICP) classically presents with the Cushing's triad: bradycardia (decreased heart rate), hypertension, and irregular respirations. The bradycardia results from vagal activation triggered by brainstem compression. Vomiting is also a hallmark manifestation of raised ICP, occurring due to direct pressure on the vomiting center located in the medulla oblongata, and is often sudden and projectile in nature.
Why the other options are incorrect:
Decreased blood pressure — Raised ICP causes hypertension as part of the Cushing's reflex, not hypotension. The body elevates systemic blood pressure to maintain cerebral perfusion pressure against the rising intracranial pressure.
Decreased pain — Severe headache is one of the most common manifestations of increased ICP, caused by pressure on pain-sensitive intracranial structures. A decrease in pain is not expected.
Diarrhea — Diarrhea is not a recognized manifestation of increased ICP. The gastrointestinal effect associated with raised ICP is vomiting due to medullary compression, not changes in bowel motility.
Constipation — Constipation has no pathophysiologic link to increased intracranial pressure and is not an expected manifestation of this condition.
What situation may cause hypernatremia?
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Increased thirst
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Decreased aldosterone
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Too much antidiuretic hormone
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Loss of water
Explanation
Correct Answer: D) Loss of water
Hypernatremia occurs when the concentration of sodium in the blood becomes elevated, most commonly due to a deficit of water rather than an excess of sodium. When the body loses more water than sodium, the sodium that remains in the bloodstream becomes more concentrated, leading to hypernatremia.
Water loss can occur through conditions such as excessive sweating, diarrhea, fever, burns, diabetes insipidus, or inadequate fluid intake. These situations reduce total body water while sodium levels remain relatively unchanged, resulting in increased serum sodium concentration. Therefore, loss of water is a primary cause of hypernatremia.
What action should a person prioritize when experiencing diarrhea, excessive sweating, and lightheadedness?
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Eat a potassium-rich food such as a banana
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Rest in a cool environment with legs elevated
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Wear loose-fitting and breathable clothing
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Drink a solution of water and electrolytes
Explanation
Correct Answer: (D) Drink a solution of water and electrolytes
Diarrhea, excessive sweating, and lightheadedness are classic signs of dehydration and electrolyte loss. The priority action is to replace lost fluids and electrolytes by drinking an oral rehydration solution containing water and electrolytes such as sodium, potassium, and glucose. This directly addresses the underlying cause of all three symptoms by restoring fluid volume, correcting electrolyte imbalances, and improving cerebral perfusion to relieve lightheadedness.
Why the other options are incorrect:
A. Eating a potassium-rich food such as a banana may help replace some electrolytes but is not the priority action. The most urgent need is fluid and electrolyte replacement through an oral rehydration solution, which addresses dehydration more comprehensively and rapidly than food alone, especially when diarrhea is ongoing.
B. Resting in a cool environment with legs elevated is a helpful measure to manage lightheadedness by improving venous return to the brain, but it does not address the underlying cause of fluid and electrolyte depletion. It is a supportive measure rather than the priority intervention.
C. Wearing loose-fitting and breathable clothing may provide comfort but does not address the dehydration and electrolyte loss causing the symptoms. It has no direct therapeutic effect on diarrhea, excessive sweating, or lightheadedness.
What can cause a functional bowel obstruction?
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Inguinal hernia
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Intestinal tumor
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Paralytic ileus
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Surgical adhesion
Explanation
Correct Answer: (C) Paralytic ileus
A functional bowel obstruction, also called a paralytic ileus or pseudo-obstruction, occurs when the bowel stops moving contents forward despite there being no physical blockage. Paralytic ileus results from failure of peristalsis — the muscular contractions that propel intestinal contents — commonly following abdominal surgery, electrolyte imbalances, or severe illness. The obstruction is functional, not mechanical.
Why the other options are incorrect:
A. Inguinal hernia — An inguinal hernia can trap a loop of bowel, causing a mechanical obstruction by physically blocking the intestinal lumen. This is a structural, not functional, cause of obstruction.
B. Intestinal tumor — A tumor can physically narrow or block the intestinal lumen, creating a mechanical obstruction. This is not a functional cause as it involves an actual physical barrier.
D. Surgical adhesion — Adhesions are bands of scar tissue that form after surgery and can physically compress or kink the bowel, causing a mechanical obstruction. They are not a functional cause of bowel obstruction.
What action should an older adult take to improve safety and prevent increased intracranial pressure?
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Discontinue blood thinning medications.
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Monitor blood glucose levels several times a day.
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Use an assistive device if experiencing problems with balance.
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Take all medications at the same time every day.
Explanation
Correct Answer: C) Use an assistive device if experiencing problems with balance.
Older adults are at increased risk for falls due to changes in balance, vision, muscle strength, and coordination. Falls can lead to head injuries, which may result in bleeding within the skull and increased intracranial pressure. Preventing falls is therefore an important safety measure.
Using an assistive device such as a cane or walker helps improve stability and balance while walking. This reduces the risk of falling and decreases the likelihood of head trauma that could cause increased intracranial pressure. Therefore, using an assistive device when balance problems occur is an important preventive action.
What manifestation is expected with an obstruction of the small intestine?
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Increased passage of gas
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Severe diarrhea
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Abdominal distension
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Decreased heart rate
Explanation
When the small intestine is obstructed, gas and fluid accumulate proximal to the blockage because they cannot pass through. This buildup causes the abdomen to visibly swell and feel tight, resulting in abdominal distension. It is one of the cardinal signs of bowel obstruction along with nausea, vomiting, and absent bowel sounds.
Why the other options are incorrect:
A. Increased passage of gas — Obstruction prevents the normal movement of gas through and out of the bowel. Gas passage would be reduced or absent, not increased.
B. Severe diarrhea — Diarrhea implies increased motility and transit, which is the opposite of what occurs in obstruction. Constipation and absence of stool are expected instead.
D. Decreased heart rate — Bowel obstruction typically triggers a sympathetic stress response, leading to tachycardia, not bradycardia, especially as the condition progresses and fluid shifts occur.
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