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Free NR283 student Practise Exam Chamberlain University Questions
1.
An increase of which laboratory value is associated with hepatic encephalopathy?
- Bilirubin
- Uric acid
- Ammonia
- Urea
Explanation
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.
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.
2. For each condition, click to specify whether the condition causes a pre-renal, intra-renal, or post-renal acute kidney injury.
- Low blood pressure — Pre-renal.
- Glomerulonephritis — Intra-renal.
- Benign prostatic hypertrophy — Post-renal.
- Fluid volume deficit — Pre-renal.
- Kidney stones — Post-renal.
Explanation
Explanation
Low blood pressure — Pre-renal. Hypotension reduces perfusion to the kidneys, decreasing the glomerular filtration rate without direct kidney damage. This is a classic pre-renal cause of acute kidney injury.
Glomerulonephritis — Intra-renal. Glomerulonephritis involves inflammation within the glomeruli, causing direct structural damage to kidney tissue and classifying it as an intra-renal acute kidney injury.
Benign prostatic hypertrophy — Post-renal. An enlarged prostate obstructs urinary outflow from the bladder, causing back-pressure that impairs kidney function. This is a post-renal cause of acute kidney injury.
Fluid volume deficit — Pre-renal. Reduced circulating fluid volume decreases renal perfusion pressure, impairing kidney function without intrinsic kidney damage, making this a pre-renal cause.
Kidney stones — Post-renal. Stones can obstruct the ureters or renal pelvis, blocking urine flow and causing pressure to build up behind the obstruction, resulting in post-renal acute kidney injury.
Low blood pressure — Pre-renal. Hypotension reduces perfusion to the kidneys, decreasing the glomerular filtration rate without direct kidney damage. This is a classic pre-renal cause of acute kidney injury.
Glomerulonephritis — Intra-renal. Glomerulonephritis involves inflammation within the glomeruli, causing direct structural damage to kidney tissue and classifying it as an intra-renal acute kidney injury.
Benign prostatic hypertrophy — Post-renal. An enlarged prostate obstructs urinary outflow from the bladder, causing back-pressure that impairs kidney function. This is a post-renal cause of acute kidney injury.
Fluid volume deficit — Pre-renal. Reduced circulating fluid volume decreases renal perfusion pressure, impairing kidney function without intrinsic kidney damage, making this a pre-renal cause.
Kidney stones — Post-renal. Stones can obstruct the ureters or renal pelvis, blocking urine flow and causing pressure to build up behind the obstruction, resulting in post-renal acute kidney injury.
3.
What situation may cause hypernatremia?
- Increased thirst
- Decreased aldosterone
- Too much antidiuretic hormone
- Loss of water
Explanation
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.
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.
4.
What person is experiencing referred pain?
- A person with a lower limb amputation feels pain in that limb
- A person with a broken arm experiencing pain at the injury site
- A person with diabetes experiencing shooting pain in the feet
- A person with a myocardial infarction having pain in the jaw
Explanation
Explanation
Correct answer: D. A person with a lower limb amputation feels pain in that limb
Referred pain occurs when pain is felt in a location different from the site of the actual problem. During a myocardial infarction, the heart does not have many localized pain receptors, so the brain interprets the pain as coming from other areas supplied by the same spinal nerves, such as the jaw, shoulder, neck, or left arm.
Correct answer: D. A person with a lower limb amputation feels pain in that limb
Referred pain occurs when pain is felt in a location different from the site of the actual problem. During a myocardial infarction, the heart does not have many localized pain receptors, so the brain interprets the pain as coming from other areas supplied by the same spinal nerves, such as the jaw, shoulder, neck, or left arm.
5.
What condition may cause hypervolemia?
- Renal failure
- Diarrhea
- Extensive burns
- Anaphylaxis
Explanation
Explanation
Correct answer: A. Renal failure
Hypervolemia refers to an excess of fluid in the bloodstream or body. Renal failure can cause hypervolemia because the kidneys cannot effectively excrete sodium and water. This leads to fluid retention and increased blood volume. As fluid accumulates, patients may develop edema, hypertension, and shortness of breath due to fluid overload.
Correct answer: A. Renal failure
Hypervolemia refers to an excess of fluid in the bloodstream or body. Renal failure can cause hypervolemia because the kidneys cannot effectively excrete sodium and water. This leads to fluid retention and increased blood volume. As fluid accumulates, patients may develop edema, hypertension, and shortness of breath due to fluid overload.
6. Complete the following sentence by choosing from the list of options. Manifestations of increased intracranial pressure include (1) ___ and (2) ___.
Options for (1): decreased heart rate, decreased blood pressure, decreased pain
Options for (2): vomiting, diarrhea, constipation
- decreased heart rate
- decreased blood pressure
- decreased pain
- vomiting
- diarrhea
- constipation
Explanation
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.
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.
7. What arterial blood gas result is expected in a person experiencing a panic attack?
-
pH 7.32, PaCO2 49 mm Hg, HCO3 26 mEq/L
-
pH 7.46, PaCO2 42 mm Hg, HCO3 28 mEq/L
-
pH 7.49, PaCO2 28 mm Hg, HCO3 24 mEq/L
-
pH 7.34, PaCO2 45 mm Hg, HCO3 21 mEq/L
Explanation
Explanation
Correct Answer: (C) pH 7.49, PaCO2 28 mm Hg, HCO3 24 mEq/L
During a panic attack, the person hyperventilates, breathing rapidly and deeply. This causes excessive elimination of carbon dioxide from the body, leading to a decrease in PaCO2. As CO2 drops, carbonic acid in the blood decreases, causing the blood pH to rise above 7.45, resulting in respiratory alkalosis. The HCO3 remains normal or near normal in the acute phase because the kidneys have not yet had time to compensate. A pH of 7.49 (alkalotic), PaCO2 of 28 mm Hg (low), and HCO3 of 24 mEq/L (normal) is the classic ABG pattern of uncompensated respiratory alkalosis caused by hyperventilation during a panic attack.
Why Other Options are Incorrect:
A. pH 7.32, PaCO2 49 mm Hg, HCO3 26 mEq/L represents respiratory acidosis with a low pH, elevated PaCO2, and normal to slightly elevated HCO3. This pattern is seen in hypoventilation states such as COPD exacerbation or respiratory depression, not hyperventilation from a panic attack.
B. pH 7.46, PaCO2 42 mm Hg, HCO3 28 mEq/L represents metabolic alkalosis with a normal to slightly elevated pH, normal PaCO2, and elevated HCO3. This pattern is associated with excessive vomiting, nasogastric suctioning, or diuretic use, not a panic attack.
D. pH 7.34, PaCO2 45 mm Hg, HCO3 21 mEq/L represents metabolic acidosis with a low pH, normal PaCO2, and low HCO3. This pattern is seen in conditions such as diabetic ketoacidosis or diarrhea, not a panic attack.
Correct Answer: (C) pH 7.49, PaCO2 28 mm Hg, HCO3 24 mEq/L
During a panic attack, the person hyperventilates, breathing rapidly and deeply. This causes excessive elimination of carbon dioxide from the body, leading to a decrease in PaCO2. As CO2 drops, carbonic acid in the blood decreases, causing the blood pH to rise above 7.45, resulting in respiratory alkalosis. The HCO3 remains normal or near normal in the acute phase because the kidneys have not yet had time to compensate. A pH of 7.49 (alkalotic), PaCO2 of 28 mm Hg (low), and HCO3 of 24 mEq/L (normal) is the classic ABG pattern of uncompensated respiratory alkalosis caused by hyperventilation during a panic attack.
Why Other Options are Incorrect:
A. pH 7.32, PaCO2 49 mm Hg, HCO3 26 mEq/L represents respiratory acidosis with a low pH, elevated PaCO2, and normal to slightly elevated HCO3. This pattern is seen in hypoventilation states such as COPD exacerbation or respiratory depression, not hyperventilation from a panic attack.
B. pH 7.46, PaCO2 42 mm Hg, HCO3 28 mEq/L represents metabolic alkalosis with a normal to slightly elevated pH, normal PaCO2, and elevated HCO3. This pattern is associated with excessive vomiting, nasogastric suctioning, or diuretic use, not a panic attack.
D. pH 7.34, PaCO2 45 mm Hg, HCO3 21 mEq/L represents metabolic acidosis with a low pH, normal PaCO2, and low HCO3. This pattern is seen in conditions such as diabetic ketoacidosis or diarrhea, not a panic attack.
8.
Abnormal excitation of sensory nerves results in what condition?
- Loss of smell or taste
- Sensorineural hearing loss
- Photophobia
- Neuropathy
Explanation
Explanation:
Correct Answer: D) Neuropathy
Neuropathy refers to damage or dysfunction of peripheral nerves that results in abnormal nerve signaling. When sensory nerves become abnormally excited or irritated, they may produce unusual sensations such as tingling, burning, numbness, hypersensitivity, or pain without a clear external stimulus.
This abnormal excitation disrupts normal sensory transmission and leads to sensory disturbances commonly associated with peripheral neuropathy. Conditions such as diabetes, infections, trauma, or exposure to toxins can damage sensory nerves and cause these abnormal nerve impulses. Therefore, abnormal excitation of sensory nerves is most closely associated with neuropathy.
Correct Answer: D) Neuropathy
Neuropathy refers to damage or dysfunction of peripheral nerves that results in abnormal nerve signaling. When sensory nerves become abnormally excited or irritated, they may produce unusual sensations such as tingling, burning, numbness, hypersensitivity, or pain without a clear external stimulus.
This abnormal excitation disrupts normal sensory transmission and leads to sensory disturbances commonly associated with peripheral neuropathy. Conditions such as diabetes, infections, trauma, or exposure to toxins can damage sensory nerves and cause these abnormal nerve impulses. Therefore, abnormal excitation of sensory nerves is most closely associated with neuropathy.
9. What is the definition of hypoxia?
-
Poor perfusion to tissues and organs in the body.
-
A lack of oxygen able to be exchanged in the body.
-
An area of dead tissue related to poor perfusion.
-
Increased carbon dioxide (CO2) in the bloodstream.
Explanation
Explanation
Correct Answer: (B) A lack of oxygen able to be exchanged in the body.
Hypoxia is defined as a deficiency of oxygen reaching the tissues and cells of the body. It occurs when there is an insufficient amount of oxygen available for exchange and utilization at the cellular level, impairing cellular metabolism and function. Hypoxia can result from reduced oxygen in the inspired air, impaired gas exchange in the lungs, reduced oxygen-carrying capacity of the blood, or impaired oxygen delivery to the tissues.
Why the other options are incorrect:
A. Poor perfusion to tissues and organs describes ischemia rather than hypoxia. While ischemia can lead to hypoxia, the two terms are distinct. Ischemia refers specifically to inadequate blood flow, whereas hypoxia refers specifically to inadequate oxygen availability regardless of the cause.
C. An area of dead tissue related to poor perfusion describes necrosis or infarction, which is the end result of prolonged ischemia or hypoxia rather than a definition of hypoxia itself.
D. Increased carbon dioxide in the bloodstream describes hypercapnia, which is a separate condition from hypoxia. While hypoxia and hypercapnia can occur together in respiratory failure, they are distinct clinical entities with different definitions and mechanisms.
Correct Answer: (B) A lack of oxygen able to be exchanged in the body.
Hypoxia is defined as a deficiency of oxygen reaching the tissues and cells of the body. It occurs when there is an insufficient amount of oxygen available for exchange and utilization at the cellular level, impairing cellular metabolism and function. Hypoxia can result from reduced oxygen in the inspired air, impaired gas exchange in the lungs, reduced oxygen-carrying capacity of the blood, or impaired oxygen delivery to the tissues.
Why the other options are incorrect:
A. Poor perfusion to tissues and organs describes ischemia rather than hypoxia. While ischemia can lead to hypoxia, the two terms are distinct. Ischemia refers specifically to inadequate blood flow, whereas hypoxia refers specifically to inadequate oxygen availability regardless of the cause.
C. An area of dead tissue related to poor perfusion describes necrosis or infarction, which is the end result of prolonged ischemia or hypoxia rather than a definition of hypoxia itself.
D. Increased carbon dioxide in the bloodstream describes hypercapnia, which is a separate condition from hypoxia. While hypoxia and hypercapnia can occur together in respiratory failure, they are distinct clinical entities with different definitions and mechanisms.
10.
What factor increases a person's risk for developing peripheral neuropathy?
- Eating spicy food
- High water intake
- Atherosclerosis
- Low blood sugar
Explanation
Explanation
Correct Answer: C) Atherosclerosis
Peripheral neuropathy occurs when peripheral nerves are damaged due to reduced blood supply, metabolic disorders, toxins, or chronic disease. Atherosclerosis causes narrowing and hardening of the arteries, which reduces blood flow to tissues, including the nerves. When nerves receive insufficient oxygen and nutrients, they can become damaged over time.
Reduced circulation caused by atherosclerosis can therefore contribute to nerve degeneration and dysfunction. This may lead to symptoms such as numbness, tingling, burning sensations, and weakness in the extremities. For this reason, atherosclerosis is considered a risk factor for developing peripheral neuropathy.
Correct Answer: C) Atherosclerosis
Peripheral neuropathy occurs when peripheral nerves are damaged due to reduced blood supply, metabolic disorders, toxins, or chronic disease. Atherosclerosis causes narrowing and hardening of the arteries, which reduces blood flow to tissues, including the nerves. When nerves receive insufficient oxygen and nutrients, they can become damaged over time.
Reduced circulation caused by atherosclerosis can therefore contribute to nerve degeneration and dysfunction. This may lead to symptoms such as numbness, tingling, burning sensations, and weakness in the extremities. For this reason, atherosclerosis is considered a risk factor for developing peripheral neuropathy.
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