PRN 1520 -PATHOPHYSIOLOGY COMPREHENSIVE FINAL EXAM SOUTH COLLEGE
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Free PRN 1520 -PATHOPHYSIOLOGY COMPREHENSIVE FINAL EXAM SOUTH COLLEGE Questions
A client presents with symptoms of progressive demyelination affecting neurons. The nurse observes muscle weakness and coordination difficulties. What condition is most likely responsible for these symptoms?
- Parkinson's disease
- Multiple sclerosis
- Myasthenia gravis
- Guillain-Barré syndrome
Explanation
Correct Answer: B) Multiple sclerosis
Multiple sclerosis (MS) is a chronic autoimmune disease characterized by progressive demyelination of neurons in the central nervous system. The destruction of the myelin sheath disrupts nerve impulse conduction, resulting in the hallmark symptoms of muscle weakness, coordination difficulties (ataxia), visual disturbances, fatigue, and spasticity. The progressive nature of demyelination directly matches the clinical presentation described.
Parkinson's disease involves the degeneration of dopaminergic neurons in the substantia nigra, causing tremors, rigidity, and bradykinesia — not primarily demyelination. Myasthenia gravis is a neuromuscular junction disorder caused by autoantibodies against acetylcholine receptors, leading to muscle weakness without demyelination. Guillain-Barré syndrome involves demyelination of the peripheral nervous system and presents with ascending paralysis, but it is acute rather than progressive.
Which of the following findings suggests the development of pulmonary edema?
- Bounding peripheral pulses
- Constipation and dry mucous membranes
- Increased urinary output at night
- Productive cough with frothy sputum
Explanation
Correct Answer: D) Productive cough with frothy sputum
Pulmonary edema occurs when excess fluid accumulates in the alveoli and lung interstitium, impairing gas exchange. A productive cough with frothy, pink-tinged sputum is a hallmark clinical sign, resulting from fluid being forced into the airways as pressure builds in the pulmonary vasculature. This finding, along with dyspnea, orthopnea, and crackles on auscultation, is a key indicator of acute pulmonary edema requiring immediate intervention.
Bounding peripheral pulses are associated with fluid overload or conditions like sepsis but are not specific to pulmonary edema. Constipation and dry mucous membranes are signs of dehydration or fluid deficit — the opposite of fluid accumulation. Increased urinary output at night (nocturia) can occur with heart failure as the body redistributes fluid when recumbent, but it is not a direct sign of pulmonary edema developing acutely.
A mole that is the most concerning for malignant melanoma is one that:
- Is larger than 6 mm in diameter.
- Looks like all other moles on the body.
- Is flat with a uniform tan color.
- Has symmetric borders.
Explanation
Correct Answer: A) Is larger than 6 mm in diameter.
Malignant melanoma is assessed using the ABCDE criteria — Asymmetry, Border irregularity, Color variation, Diameter, and Evolution. A mole larger than 6 mm in diameter (approximately the size of a pencil eraser) is a significant warning sign for melanoma. Combined with other ABCDE features, increasing size is a key indicator that prompts urgent dermatological evaluation and possible biopsy.
Which finding should the nurse expect in a client with Addison's disease?
- Rapid heart rate
- Increased appetite
- Fatigue
- Weight gain
Explanation
Correct Answer: C) Fatigue
Addison's disease is primary adrenal insufficiency characterized by deficient cortisol and aldosterone production. Profound, chronic fatigue is the most common and consistent symptom, resulting from inadequate cortisol levels that impair the body's ability to maintain energy and respond to stress. Other classic features include weight loss, hypotension, hyperpigmentation, and anorexia — making increased appetite and weight gain inconsistent with this diagnosis.
Which of the following would the nurse expect to find with right-sided heart failure (Select all that apply)
- Cyanosis of fingertips
- Pulmonary crackles
- Jugular vein distention
- Splenomegaly
- Peripheral edema
Explanation
Correct Answer: Jugular vein distention, Splenomegaly, Peripheral edema
Right-sided heart failure leads to increased pressure in the veins, causing jugular vein distention, peripheral edema, and congestion in the abdominal organs, such as the spleen (splenomegaly). Cyanosis and pulmonary crackles are more common with left-sided heart failure, as they result from fluid accumulation in the lungs.
Which physiological changes contribute to a higher risk of infection in older adults?
- More exposure to viruses
- Increased blood flow
- Increased T-cell production
- Decreased immune response
Explanation
Correct Answer: D) Decreased immune response
As part of the normal aging process, the immune system undergoes a progressive decline known as immunosenescence. Older adults experience reduced production and function of T-cells and B-cells, decreased antibody response to vaccines and infections, impaired phagocytic activity, and slower inflammatory responses. These changes collectively weaken the body's ability to detect, respond to, and eliminate pathogens, making older adults significantly more vulnerable to infections such as pneumonia, urinary tract infections, and influenza — and more likely to experience severe complications.
More exposure to viruses is a behavioral or environmental factor, not a physiological change. Increased blood flow and increased T-cell production would actually enhance immune defense — they are therefore protective factors, not contributors to infection risk in aging.
Which of the following conditions is most likely associated with black, tarry stools?
- Appendicitis
- Gastrointestinal reflux
- Ulcerative colitis
- Upper gastrointestinal bleeding
Explanation
Correct Answer: D) Upper gastrointestinal bleeding
Black, tarry stools — known as melena — result from the digestion of blood as it travels through the gastrointestinal tract. When bleeding occurs in the upper GI tract (esophagus, stomach, or proximal small intestine), digestive enzymes and bacterial action break down hemoglobin, producing the characteristic black, tarry, foul-smelling appearance. Common causes include peptic ulcers, esophageal varices, and Mallory-Weiss tears.
Appendicitis causes right lower quadrant pain and does not typically produce stool changes. Gastrointestinal reflux involves stomach acid backing into the esophagus and is not associated with melena. Ulcerative colitis is a lower GI condition that more commonly produces bloody diarrhea with bright red blood or mucus, not black tarry stools.
Which of the following symptoms suggests diabetic ketoacidosis (DKA)?
- Low heart rate
- Severe hypertension
- Fruity breath
- Shallow respirations
Explanation
Correct Answer: C) Fruity breath
Fruity breath is a hallmark sign of DKA, caused by the exhalation of acetone — a byproduct of ketone production. When the body lacks insulin, it breaks down fat for energy, producing ketones including acetoacetate and acetone. The accumulation of ketones gives the breath a characteristic sweet, fruity odor that is distinctly recognizable and a key clinical indicator of DKA.
Osteomyelitis is best described as:
- Autoimmune destruction of the joints.
- Decreased bone density caused by calcium loss.
- Degeneration of joint cartilage due to aging.
- Infection and inflammation of bone tissue.
Explanation
Correct Answer: D) Infection and inflammation of bone tissue.
Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus, that leads to inflammation, bone destruction, and potential abscess formation. It can occur through direct inoculation (trauma, surgery), spread from adjacent tissue, or hematogenous (bloodborne) spread from another infection site.
A patient with chronic obstructive pulmonary disease (COPD) is experiencing difficulty breathing and has elevated blood CO2 levels. Which condition is the patient most likely developing?
- Metabolic alkalosis
- Respiratory alkalosis
- Respiratory acidosis
- Metabolic acidosis
Explanation
Correct Answer: C) Respiratory acidosis
In COPD, airflow obstruction impairs the patient's ability to exhale adequately, causing CO2 to accumulate in the blood. Since CO2 combines with water to form carbonic acid, elevated CO2 directly lowers blood pH, resulting in respiratory acidosis. This is the expected acid-base imbalance in any condition where ventilation is insufficient to clear CO2.
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