NUR 507 midterm exam 4 Chamberlain University
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Free NUR 507 midterm exam 4 Chamberlain University Questions
What is the primary purpose of high-density lipoprotein (HDL) cholesterol in the body?
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Transporting cholesterol from peripheral tissues to the liver
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Providing a structural component for cell membranes
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Facilitating the formation of atherosclerotic plaques
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Transporting cholesterol to peripheral tissues
Explanation
Explanation:
Correct Answer: (A) Transporting cholesterol from peripheral tissues to the liver HDL cholesterol performs reverse cholesterol transport, picking up excess cholesterol from peripheral tissues and blood vessels and carrying it back to the liver for processing and excretion. This function helps protect against atherosclerosis, earning HDL its designation as "good" cholesterol.
Why Other Options are Incorrect:
B. Providing a structural component for cell membranes — While cholesterol in general contributes to cell membrane structure, this is not the primary or defining function of HDL specifically.
C. Facilitating the formation of atherosclerotic plaques — This is the opposite of HDL's function; HDL actually helps protect against plaque formation, while LDL contributes to it.
D. Transporting cholesterol to peripheral tissues — This describes the function of LDL cholesterol, not HDL, which works in the reverse direction.
Which of the following individuals is most at-risk for developing intrinsic renal failure?
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A 70-year-old male who is septic
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A 60-year-old male with diabetes mellitus
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A 25-year-old female with a recent urinary tract infection
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A 45-year-old male with a history of hypertension
Explanation
Explanation:
Correct Answer: (A) A 70-year-old male who is septic
Sepsis can lead to significant hypotension and systemic inflammation, which can cause direct damage to the renal parenchyma through ischemia and inflammatory injury, resulting in intrinsic renal failure. This combination of factors places a septic patient at high risk for developing acute tubular necrosis or other forms of direct kidney tissue damage.
Why Other Options are Incorrect:
B. A 60-year-old male with diabetes mellitus While diabetes is a risk factor for chronic kidney disease over time, it does not represent the same acute, direct risk for intrinsic renal failure as sepsis.
C. A 25-year-old female with a recent urinary tract infection An uncomplicated UTI is generally a lower urinary tract issue and does not typically cause direct intrinsic kidney damage unless it progresses to pyelonephritis or sepsis.
D. A 45-year-old male with a history of hypertension While chronic hypertension can contribute to kidney damage over time, it does not pose the same immediate risk for intrinsic renal failure as an acute septic process.
In chronic kidney disease (CKD), the presence of proteinuria is primarily attributed to:
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Impaired reabsorption of proteins in the renal tubules
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Glomerular hyperfiltration and increased glomerular capillary permeability
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Increased glomerular filtration rate (GFR)
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Decreased filtration of proteins in the renal tubules
Explanation
Explanation:
Correct Answer: (B) Glomerular hyperfiltration and increased glomerular capillary permeability
In CKD, remaining functional nephrons undergo compensatory hyperfiltration, which increases the pressure within the glomerular capillaries. This elevated pressure damages the glomerular filtration barrier, increasing its permeability and allowing excess protein to leak into the urine.
Why Other Options are Incorrect:
A. Impaired reabsorption of proteins in the renal tubules While tubular reabsorption plays a role in protein handling, the primary driver of proteinuria in CKD is increased glomerular permeability rather than impaired tubular reabsorption alone.
C. Increased glomerular filtration rate (GFR) Overall GFR actually declines as CKD progresses, even though localized hyperfiltration occurs in remaining nephrons.
D. Decreased filtration of proteins in the renal tubules This is inaccurate, as proteinuria results from increased, not decreased, filtration of proteins across the glomerular barrier.
A patient undergoes pulmonary function tests (PFTs) due to suspected restrictive lung disease. The PFT results demonstrate a decreased forced vital capacity (FVC) and a decreased total lung capacity (TLC). Which of the following patterns is consistent with a restrictive pulmonary disorder?
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Decreased FVC with a decreased FEV1/FVC ratio
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Decreased FVC with a normal or increased FEV1/FVC ratio
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Decreased FVC with a normal TLC
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Decreased FVC with a decreased residual volume (RV)
Explanation
Explanation:
Correct Answer: (B) Decreased FVC with a normal or increased FEV1/FVC ratio
Restrictive lung disease is characterized by reduced lung volumes, including decreased FVC and TLC, due to limited lung expansion. Since both FEV1 and FVC decrease proportionally in restrictive disease, the FEV1/FVC ratio remains normal or may even increase, distinguishing it from obstructive patterns where this ratio is reduced.
Why Other Options are Incorrect:
A. Decreased FVC with a decreased FEV1/FVC ratio A decreased FEV1/FVC ratio is characteristic of obstructive lung disease, not restrictive disease.
C. Decreased FVC with a normal TLC This is inconsistent with restrictive lung disease, which by definition involves a decreased TLC along with decreased FVC.
D. Decreased FVC with a decreased residual volume (RV) While RV may decrease in some restrictive diseases, this is not the defining or most consistent pattern used to characterize restrictive pulmonary disorders; the FEV1/FVC ratio is the key distinguishing feature.
Which of the following eGFR values reflects Stage 2 chronic kidney disease (CKD)?
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60-89 mL/min
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≥90 mL/min
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30-59 mL/min
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15-29 mL/min
Explanation
Explanation:
Correct Answer: (A) 60-89 mL/min Stage 2 CKD is defined by a mildly decreased glomerular filtration rate of 60-89 mL/min, typically accompanied by evidence of kidney damage such as proteinuria, indicating early kidney dysfunction with largely preserved filtration capacity.
Why Other Options are Incorrect:
B. ≥90 mL/min — This range reflects normal or Stage 1 CKD (with evidence of kidney damage but normal GFR), not Stage 2.
C. 30-59 mL/min — This range corresponds to Stage 3 CKD, reflecting a moderate decrease in kidney function.
D. 15-29 mL/min — This range corresponds to Stage 4 CKD, indicating severe reduction in kidney function.
A client with mixed incontinence will exhibit which symptoms?
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Involuntary loss of urine associated with neurologic lesions
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Continuous loss of urine related to vesicovaginal fistula
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A combination of stress and urge incontinence
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Involuntary loss of urine caused by dementia or immobility
Explanation
Explanation:
Correct Answer: (C) A combination of stress and urge incontinence Mixed incontinence is defined as the presence of both stress incontinence, involving urine leakage with increased abdominal pressure such as coughing or sneezing, and urge incontinence, involving a sudden, strong need to urinate with involuntary leakage, occurring together in the same client.
Why Other Options are Incorrect:
A. Involuntary loss of urine associated with neurologic lesions describes reflex incontinence, not mixed incontinence.
B. Continuous loss of urine related to a vesicovaginal fistula describes a specific structural cause of continuous incontinence, not mixed incontinence.
D. Involuntary urine loss caused by dementia or immobility describes functional incontinence, which is related to cognitive or physical barriers to toileting, not mixed incontinence.
What is the consequence of decreased renal production of vitamin D on the body?
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Impaired bone mineralization and increased risk of fractures
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Elevated levels of parathyroid hormone (PTH)
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Increased absorption of calcium from the intestine
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Enhanced excretion of phosphate by the kidneys
Explanation
Explanation:
Correct Answer: (B) Elevated levels of parathyroid hormone (PTH)
Decreased renal production of active vitamin D leads to reduced intestinal calcium absorption, resulting in lower serum calcium levels. This drop in calcium stimulates the parathyroid glands to secrete more parathyroid hormone in an attempt to compensate, leading to secondary hyperparathyroidism.
Why Other Options are Incorrect:
A. Impaired bone mineralization and increased risk of fractures While this is a downstream consequence of chronic vitamin D deficiency and secondary hyperparathyroidism, it is a later complication rather than the immediate consequence of decreased vitamin D production.
C. Increased absorption of calcium from the intestine Decreased vitamin D actually leads to decreased, not increased, calcium absorption from the intestine.
D. Enhanced excretion of phosphate by the kidneys In kidney disease with decreased vitamin D, phosphate excretion is typically impaired, contributing to hyperphosphatemia rather than enhanced excretion.
Which of the following individuals is most at-risk for developing prerenal failure?
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An elderly individual with heart failure
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A healthy young adult with normal fluid intake
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A pregnant woman in the third trimester
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A marathon runner in peak physical condition
Explanation
Correct Answer: A) An elderly individual with heart failure
Prerenal failure results from any condition that significantly reduces renal perfusion pressure, causing the kidneys to receive insufficient blood flow to maintain filtration. Heart failure is a leading cause of prerenal acute kidney injury because the failing heart produces reduced cardiac output, leading to decreased arterial blood pressure and renal perfusion. In response, the kidneys activate the renin-angiotensin-aldosterone system and retain sodium and water, but if perfusion remains critically low, glomerular filtration rate drops and prerenal azotemia develops. Elderly patients with heart failure are particularly vulnerable due to age-related declines in baseline renal reserve and the frequent use of diuretics and ACE inhibitors that further reduce renal perfusion.
What does the term azotemia denote in the context of kidney function?
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Insufficient production of red blood cells
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Impaired glucose metabolism
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Excessive sodium retention
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Elevated levels of nitrogen-containing compounds in the blood
Explanation
Explanation:
Correct Answer: (D) Elevated levels of nitrogen-containing compounds in the blood
Azotemia refers to the accumulation of nitrogenous waste products, such as urea and creatinine, in the bloodstream due to impaired kidney filtration function. This elevation reflects the kidneys' reduced ability to clear these metabolic byproducts from the blood.
Why Other Options are Incorrect:
A. Insufficient production of red blood cells This describes anemia, which can be a complication of kidney disease but is not what the term azotemia refers to.
B. Impaired glucose metabolism This is not related to the definition of azotemia, which specifically concerns nitrogenous waste accumulation.
C. Excessive sodium retention This describes a fluid and electrolyte imbalance rather than the nitrogen waste accumulation defined by azotemia.
Which of the following test results are diagnostic of appendicitis?
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Increased neutrophils and C-reactive protein
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Positive RBCs in the urine
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Decreased hemoglobin and hematocrit
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White blood cell count less than 10,000 cells/mm3
Explanation
Explanation:
Correct Answer: (A) Increased neutrophils and C-reactive protein
Appendicitis is an acute inflammatory condition, and laboratory findings reflect this systemic inflammatory response. Elevated neutrophil count (neutrophilia) indicates bacterial infection and acute inflammation, while elevated C-reactive protein (CRP) is a sensitive marker of inflammation that rises rapidly in response to tissue injury and infection. Together, leukocytosis with a neutrophilic predominance and elevated CRP are the most characteristic and diagnostically supportive laboratory findings in appendicitis.
Why Other Options Are Incorrect:
B. Positive RBCs in the urine Hematuria suggests urinary tract pathology such as kidney stones, urinary tract infection, or bladder injury. While an inflamed appendix lying near the ureter may occasionally cause microscopic hematuria, it is not a diagnostic finding for appendicitis and should prompt investigation of urological causes.
C. Decreased hemoglobin and hematocrit Anemia indicated by reduced hemoglobin and hematocrit is not a characteristic finding in uncomplicated appendicitis. These values may decrease in cases of hemorrhagic complications but are not diagnostically associated with the acute inflammatory process of appendicitis.
D. White blood cell count less than 10,000 cells/mm3 A WBC below 10,000 cells/mm3 is within or near normal limits and would not support a diagnosis of appendicitis. Appendicitis typically produces leukocytosis with WBC counts elevated above 10,000 to 18,000 cells/mm3, reflecting the acute infectious and inflammatory process.
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