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PATHOPHYSIOLOGY
(NURS231) FINAL EXAM PREP
2025 COMPREHENSIVE
QUESTIONS WITH 100%
VERIFIED SOLUTIONS- GRADED
A+
Under what circumstances do cells in the kidneys secrete renin?
- Serum osmotic pressure increases.
- Serum potassium levels are high 3. The urine pH decreases.
- Blood flow in the afferent arteriole decreases.
- blood flow in the afferent arteriole decreases At change-of-shift report, the nurse learns the medical diagnoses for four patients. Which patient should the nurse assess MOST carefully for development of hyponatremia? Select one:
- Vomiting all day and not replacing any fluid
- Tumor that secretes excessive antidiuretic hormone (ADH)
- Tumor that secretes excessive aldosterone
- Tumor that destroyed the posterior pituitary gland
- tumour that secretes excessive antidiuretic hormone (ADH) Compensation mechanisms in the body for dehydration would include: Select one:
- Increased antidiuretic hormone (ADH) 2. Decreased aldosterone.
- Slow, strong heart contraction
- Peripheral vasodilation.
- increased antidiuretic hormone Which of the following would result from a deficit of plasma proteins? Select one:
- Increased osmotic pressure
- Increased hydrostatic pressure
- Decreased osmotic pressure
- Decreased hydrostatic pressure
- decreased osmotic pressure Which substance directly controls the reabsorption of water from the collecting ducts? Select one:
- Renin
- Aldosterone
- Angiotensin
- Antidiuretic hormone
- antidiuretic hormone When a patient is receiving diuretic therapy, what best reflects the patient's fluid volume status? Select one:
- Blood pressure and pulse
- Intake, output, and daily weight
- Abdominal girth and calf circumference
- Serum potassium and sodium levels
- Intake, Output and Daily Weight When is the best time for a patient to receive antidiuretics to reduce the amount of disruption of their daily routine? In the morning Fatigue is characterized by what 3 things?
- perception of generalized weakness
- mental fatigue
- decreased ability to complete activities Fatigue is classified as a health problem if it persists for... a. 1+ week b. 2+ weeks c. 3+ weeks d. one month+
Balancing sleep and wakefulness, getting adequate exercise, having a healthy diet, providing patient education for patients at particular risk for fatigue disorder What are some interventions a patient can perform to manage fatigue? exercise 30 minutes a day, eat a balanced diet, get adequate sleep, manage any underlying conditions that can cause fatigue, manage stress with relaxation techniques, have planned rest/nap breaks, use CNS stimulants if needed, consider CBT psychotherapy, stretch/yoga regularly, and go for walks. What is the difference between hypnotics and sedatives? Sedatives reduce excitability but don't cause sleep unless given in high doses. Hypnotics cause sleep. What is a long-term side effect of prolonged sedative/hypnotic drug therapy? Interference with REM sleep, daytime drowsiness and fatigue, interruptions of sleep cycles What is the mechanism of action for benzodiazepines? Bind to cell receptors enhancing the effect of GABA (inhibitory neurotransmitter), which slows the activity of nerves in the brain What are the indications for benzodiazepines? Commonly used for sedation, relief of agitation or anxiety, treatment of anxiety-related depression or bipolar disorder, sleep induction for sleep disorders, skeletal muscle relaxation for muscle spasms, treatment of acute seizure disorders, treatment and prevention of the symptoms of alcohol withdrawal, and used as an adjuncts in anaesthesia. What are the contraindications of benzodiazepines? pregnancy, known drug allergy, open-angle glaucoma, elderly (increases risk of falls and dementia), impaired kidney or liver function What can happen if a pregnant woman takes benzodiazepines? Increases the risk of low birth weight babies and preterm delivery What are the adverse effects of taking benzodiazepines?
- ataxia (balance, coordination and speech disturbances)
- confusion, amnesia
- fatigue/lethargy/drowsiness
- lightheadedness, dizziness, vertigo
- headaches
- feeling "hungover", dry mouth, and GI upset
- visual disturbances
- restlessness and/or irritability. What are some nursing considerations to help with the adverse drug reactions of benzodiazepines?
Dizziness/vertigo: have patient rise slowly, avoid driving heavy machinery, and take drug in the evening GI upset: take meds with food, regular water and fibre intake, and exercise What happens if a person overdoses on benzodiazepines? Luckily, the worst that can happen is coma. This is why benzo's are preferred to barbiturates because they have lower toxicities and risks associated with an overdose. What is flumazenil? Benzodiazepine antagonist; an antidote to reverse sedative effects in the case of an OD What are drug interactions for benzodiazepines? Do not take with other CNS depressants to avoid risking respiratory depression, hypotension, toxicities, sedation and confusion. Which natural health products should be avoided with benzodiazepines? Kava, valerian and grapefruit Which of the following is a benzodiazepine?: a. buspirone (Buspar) b. hydroxyzine (Vistaril) c. phenobarbital d. lorazepam (Ativan) d. lorazepam is a benzodiazepine. Benzodiazepines have "-zepam" or "-zolam" suffixes!! Which of the following is a benzodiazepine?: a. zoplicone (Rhovane) b. zolpidem tartrate (Ambien) c. diazepam (Valium) d. flumazenil c. diazepam (Valium) is a benzodiazepine. Benzodiazepines have "-zepam" or "-zolam" suffixes!! Which of the following is NOT a benzodiazepine?: a. alprazolam (Xanax) b. clonazepam (Klonopin) c. chlordiazepoxide (Librium) d. cyclobenzaprine d. cyclobenzaprine cyclobenzaprine is a muscle relaxant. alprazolam, clonazepam, and chlordiazepoxide are all benzodiazepines Which of the following is a long-acting and an intermediate-acting benzodiazepine? lorazepam (Ativan) and diazepam (Valium)
What are the negative outcomes of an overdose on barbiturates? respiratory depression, coma, and/or death How would you treat an overdose of barbiturates? activated charcoal, O2 ventilation, maintain airways and give diuretics to increase excretion of the drug What are drug interactions of barbiturates? -antihistamines
- CNS depressants (benzodiazepines, alcohol, opioids, etc.)
- monoamine oxidase inhibitors (MAOI's)
- tricyclic antidepressants
- anti-coagulants, oral contraceptives, glucocorticoids (because barbiturates increase liver metabolism, it can reduce the effectiveness of other drugs causing health problems in some conditions) What is the most commonly prescribed barbiturate, and what is it indicated for? Phenobarbital; used for seizure disorders Which of the following is NOT a barbiturate?: a. fluoxetine b. phenobarbital c. amobarbital d. secobarbital a. fluoxetine. fluoxetine is a SSRI (anti-depressant) What is the site of action for muscle relaxants? Either the CNS (centrally acting) or the skeletal muscle (direct acting) How do direct acting muscle relaxants work in the body (physiological mechanism)? By reducing the excitability and response to stimuli in the muscle fibres by reducing calcium released What are the indications for muscle relaxants? Cerebral palsy, multiple sclerosis, cerebral lesions, Parkinsons, Huntingtons, or muscle injury What are the side effects of muscle relaxants?
- lightheadedness, dizziness
- euphoria, confusion
- fatigue, drowsiness
- muscle weakness, muscle stiffness -GI upset, diarrhea, constipation
- headache
- slurred speech
- erectile dysfunction - weight gain What are nursing interventions for an overdose on muscle relaxants?
No pharmaceutical antidote; maintain airway, ECG monitoring, IV fluids to reduce risk of crystalluria What is the indication for baclofen (Lioresal)? muscle relaxant indicated for chronic spasticity what is the indication for cyclobenzaprine hydrochloride? muscle relaxant indicated for muscle spasms related to muscle injury Which of the following is a muscle relaxant?: a. baclofen (Lioresal) b. fluconazole c. lidocaine d. amobarbital a. baclofen (Lioresal) fluconazole is an antifungal, lidocaine is an anaesthetic, and amobarbital is a barbiturate (CNS depressant) During sleep, the body releases hormones that regulate what functions? Growth and recovery, energy, metabolism, and endocrine function What are the health outcomes of adequate, healthy sleep? reduced BP, HR, RR, O2 consumption, anxiety, and arousal What are the health outcomes of irregular, inadequate sleep?
- increased risk of developing a chronic disease
- reduced cognitive function, memory and thought processing
- increased irritability, impaired emotional regulation
- decreased job performance
- impaired endocrine and immune function What is sleep hygiene? habits that affect sleep quality and quantity What habits can impair sleep quality?
- naps in the late afternoon
- screen time before bed
- eating high sugar, fat, or spicy foods before bed
- engaging in stressful activities before bed
- alcohol use 4 hours before bed
- certain medications/stimulants before bed (ie. nictoine, caffeine, asthma medications, amphetamines, thyroid medications, anti-arthythmics, anti-depressants, steroids, alpha or beta blockers and diuretics) What habits can improve sleep quality?
- 30 minutes of exercise per day
What is insomnia? Difficulty in falling asleep or staying asleep What is obstructive sleep apnea? intermittent airflow blockage during sleep What are the risk factors of sleep apnea? obesity, male, old age What are the long terms consequences of sleep apnea? hypercapnia, reduced O2 saturation, REM-sleep deprivation, polycythemia (increased RBC count), pulmonary or systemic hypertension, stroke, right sided heart failure, dysrrhythmias, liver congestion, cyanosis and peripheral edema What is hypersomnia? Excessive sleep, especially during the day What are circadian rhythm sleep disorders? disordered circadian rhythms, often seen in shift workers. What are the long term side effects of circadian rhythym disruption? Increased risk of depression and anxiety, increased risk for cardiovascular disease, and increased risk of multiple cause-mortality What is parasomnia? What are some examples? Undesirable behavior or experience related to sleep. Examples include sleep talking, somnambulism, sleepwalking, night terrors, and R.E.M. behavior disorder. What parts of the brain are involved in sleep and wakefulness? hypothalamus, thalamus, cerebral cortex and brainstem Acetylcholine, hypocretins (orexins) and glutamate are neurotransmitters/chemicals involved in... wakefulness Prostaglandin D, adenosine, melatonin, serotonin, GABA, 1-tryptophan, and growth factor are neurotransmitters involved in.... sleepiness Why is REM sleep also called "paradoxical sleep"? because one's heart rate, breathing patterns, and EEG mimic wakefulness, but the individual is still asleep
How many cycles of REM and Non-REM does the average person cycle through per night?: a. 1- b. 10- c. 4- d. 7- c. there are 4-6 cycles of REM and non-REM sleep per night As the night continues, REM intervals ______ and non-REM intervals _____ in number. lengthen, decrease When heat production occurs during ingestion and metabolism of food, which of the following mechanisms is this called? A. Convection B. Skeletal muscle contraction C. Chemical reactions of metabolism D. Chemical thermogenesis C. Chemical reactions of metabolism cause heat production in the body core What is the difference between pyrexia and hyperthermia? Pyrexia (fever) is when your hypothalamus temporarily increases your body's thermal set point (intentional). Hyperthermia is when the body's internal temperature rises without an increase in the hypothalamic set point. List some of the benefits of a fever -kills many pathogens
- enhances phagocytosis
- enhances transformation and motility of neutrophils
- causes lysosomal breakdown and cell self-destruction
- reduces levels of iron, zinc and copper in the body (minerals that bacteria benefit from) What induces fever? endogenous pyrogens released from phagocytic cells When the hypothalamus is triggered by endogenous pyrogens, what substance does it create to cause a fever? Prostaglandin E If a person has a temperature of 43 degrees celcius, what is expected? Death occurs at 43 degrees " x results from prolonged sweating and electrolyte loss that is not replenished." a. malignant hyperthermia
c. 37 degrees celcius d. 41 degrees celcius a. a core body temperature of 35 degrees celcius or less is classified as hypothermia What is a central fever? What induces it? A sustained, noninfectious fever caused by trauma such as damage to the CNS, inflammation, increased intracranial pressure or bleeding, injuries, hemorrhagic shock, major surgery or thermal burns. What is the normal body temperature range? 36.2-37. What numerical difference would you expect between oral temperature and rectal temperature? 0.5 degrees celcius What temperature assessment method is the most expressive of the body's core temperature? rectal temperature unmyelinated C fibres and myelinated alpha-delta fibres are involved in which process? C fibres and alpha-delta fibres are peripheral thermoreceptors in the skin and abdominal organs that provide the hypothalamus with information about temperature of the core and skin. What body processes produce heat? Metabolism, skeletal muscle contraction and tone. What is the process of TSH-RH? thyrotropin-stimulating-hormone-release-hormone (TSH-RH) released by the hypothalamus --> triggers the anterior pituitary gland to release thyroid-stimulating hormone (TSH) --> TSH triggers thyroid gland to secrete thyroxin --> thyroxin acts on the adrenal medulla to produce epinephrine --> epinephrine causes shivering, increases the metabolic rate, stimulates glycolysis, causes vasoconstriction --> body temperature increases Why does vasoconstriction help preserve body heat? By shrinking the peripheral vessels, it keeps blood localized to the body's core, keeping the core temperature warm, while also reducing the amount of heat lost at the skin surface. Heat loss is achieved through which 9 mechanisms?
- radiation
- conduction
- convection
- vasodilation
- evaporation of sweat
- decreased muscle tone
- increased respiration
- adaptation
- voluntary measures Why does a person's breathing slow down when they are hypothermic? Body heat is lost by breathing, because warm air is leaving the body and colder air is being inhaled. What are some reasons infants are vulnerable to thermoregulatory problems? lack of shivering response, greater body surface to body weight ratio, small body size, inability to sweat, inability to independently accommodate their temperature, thin layer of subcutaneous fat, blood vessels closer to the skin surface What are some reasons older adults are vulnerable to thermoregulatory problems? decreased vasoconstrictor abilities, decreased or absent sweating, decreased ability to recognize changes in environmental temperature, decreased peripheral sensation, slower circulation, decreased shivering response, reduced heat production, structural and functional changes to the skin, decreased perfusion, slower metabolic rate, desynchronized circadian rhythm, decreased nnutritional reserves, decreased thirst, and lack of brown adipose tissue. Which cytokines released by phagocytes act as endogenous pyrogens? Interleukins 1 and 6, and TNF A patient who lies on a cold examination table without sufficient padding will lose body heat to the table by ... conduction Non-shivering or chemical thermogenesis occurs when --- acts on -- fat. epinephrine, brown Fever --- many immune defenses against bacteria and viruses increases Children develop (lower or higher) fevers than do adults for minor infections; older adults often have (lower or higher) fevers during infection. higher, lower Heat stroke is characterized by very high body temperature, ---- of sweat, and --- heart rate. absence, rapid Pain (transmission or transduction) is conversion of chemical or other stimuli into electrical impulses in axons of nociceptors transduction Normally, REM sleep occurs --- non-REM sleep in a cycle, but in neonates, REM sleep begins ----. after; immediately after falling asleep Obese man snores and gasps at night and often falls asleep at his computer at work. What is occurring?: a. dyssomnia, insomnia
The --- is responsible for thermoregulation and modifies heat production, heat --- , or heat loss mechanisms, based on input from thermoreceptors. hypothalamus; conservation Which sleep stage does dreaming occur? REM sleep Papilledema is edema of the --- nerve where it enters the eyeball and is associated with --- intracranial pressure optic; increased Pain that is felt in an area remote from its point of origin is called ---- pain. referred Your patient states: "When I started exercising at the gym, the trainer told me not to wipe off my sweat but let it stay on my skin so I would not get heat illness. Why should I do that? Being sweaty is not ladylike!". What is an appropriate response? When you exercise, your body generates more heat. Leaving the sweat on your skin while you are exercising is beneficial because it evaporates, removing excessive heat from your body. That is a protection against heat illness. Think of being sweaty during exercise as a sign that you are taking steps to be stronger and healthier. A nurse colleague says: "I understand why my patients get fevers from exogenous pyrogens when they have bacterial infections, but how can a patient who does not have an infection get a mild fever after surgery?". What is an appropriate response? When our immune cells respond to the tissue injury of surgery, they secrete chemicals that we call endogenous pyrogens. These chemicals circulate to the hypothalamus and trigger fever, just like the exogenous pyrogens that you mentioned. Mr. Smith is receiving therapeutic hypothermia after a brain injury. His wife says, "I understand why his hand feels so cold, but should I worry because his skin is so pale?" What is an appropriate response? Do not worry because he is pale; that is a normal response to a cold body temperature. The body directs blood away from the skin to keep heat from leaving the body. That makes the skin look pale. Mr. Redd does physical labor in a factory near large furnaces. After several hours of work, during which his clothes became soaked with sweat, Mr. Redd began to feel weak. He kept working without drinking water. Near the end of his shift, Mr. Redd became lightheaded and nauseated, and then fainted. He was taken to the employee health office with the following results: low BP, tachycardia, no dysrhythmias, increased body temperature and respiratory rate, warm and damp skin, and functioning reflexes.
- What is the most likely condition Mr. Redd is experiencing?
- Explain the physiological reasons why he is experiencing these symptoms.
Heat exhaustion. He developed heat exhaustion from the interplay of several factors. He was producing heat with physical labor in a hot environment; thermoregulatory mechanisms caused him to sweat profusely, but he was not able to replace the water and salt loss from the sweat, so he became dehydrated. As Mr. Redd's body temperature began to rise, his hypothalamus triggered widespread cutaneous vasodilation. The combination of decreased circulating blood volume and widespread cutaneous vasodilation caused his blood pressure to decrease so that he was not able to perfuse his brain. Tachycardia arose because Mr. Redd's arterial baroreceptors sensed his decreased blood pressure and stimulated his sympathetic cardioaccelerator nerves. Mr. Boult, age 61, reports "awful burning pain" in his feet and calves for the past 4 months. He was diagnosed with type 2 diabetes 24 years ago. He manages his diabetes with oral antidiabetic medications. All of his vital signs and lab tests are within normal ranges. However, upon physical assessment he has a lack of touch sensation in feet and to the midpoint of calves bilaterally, and dry skin. What type of condition does Mr. Boult most likely have? diabetic neuropathy Why would someone with diabetic neuropathy not have physiologic manifestations of pain such as tachycardia and elevated blood pressure? The body will physiologically adapt to persistent/chronic pain, so the sympathetic nervous system is not activated as it would be in acute pain. What is the difference between neuropathic pain and nociceptive pain? Neuropathic pain occurs when nerves are damaged. The injured nerves become hyperexcitable and fire in the absence of pain signals from the tissues. On the other hand, nociceptive pain occurs when the free nerve endings of primary pain afferents respond to stimuli from the tissues. Nociceptive pain occurs when the nerves are intact. What is unique about the neurotransmitters serotonin and norepinephrine as they relate to pain? Serotonin and norepinephrine are inhibitory in the medulla and pons of the brain, but excitatory in peripheral nerves. ______ pain is caused by lesions in the nerves, excitability/sensitivity of primary sensory neurons, or a dysfunction in pain processing centres in the brain or spinal cord. Neuropathic pain Acute/nociceptive pain can be classified in which 3 categories?
- visceral (pain in internal organs, transmitted by C fibres)
- somatic (pain in muscles, joints and skin, trasmitted by a-delta fibres)
- referred (pain is felt in an area distant from the point of origin) What are the body's heat production methods? Heat loss methods? Heat production: shivering/muscle contraction, vasoconstriction, slowed breathing rate, metabolism.
chronic pain kidney stones, appendicitis and myocardial infarction are examples of (acute or chronic) pain? acute pain what is vascular pain? pain from vascular or perivascular tissues contributing to headaches or migraines Visceral nerve fibres synapse in the spinal cord, close to fibres that supply subcutaneous tissues, causing pain that is felt a distance away from the site of pain. What kind of pain is this? Referred pain. People with cancer have chronic pain that can be caused by many different reasons. List some reasons cancer could cause chronic pain. Pain from surgical, radition, chemo, or pharmacological therapies; tumour/mass presses on nerve fibres; hypoxia from blocked blood supply to tissue; muscle spams; metasteses. Pain resulting from damage or inflammation to CNS tissues (ex. stroke, trauma, tumour) is what kind of pain? Central pain. Explain the step of pain transduction.
- mechanical, chemical or thermal stimuli create electrochemical energy
- pain mediating chemicals (prostaglandin, histamine, bradykinin) are released and initiate action potentials at the nociceptors
- the pain signal travels to the dorsal horn of the spinal cord Explain the steps of pain transmission.
- the action potential is propagated along the nerve fibres (C fibres, A-delta fibres) and travel to the thalamus Explain pain perception, including which parts of the brain are involved in it. Pain perception is subjective and unique to each person depending on many factors (age, culture, gender, genetics, amount of mu receptors). The brain stem, midbrain, diancephalon and the cerebral cortex are involved in perception and processing of pain. explain pain modulation
descending neurons from the brain go to the spinal cord. GABA, neurotensin, norepinephrine, serotonin, and endogenous opioids are involved in fighting pain by binding to endogenous opioid receptors. Which of the following is not preferred for treating neuropathic pain?: a. gabapentin b. anticonvulsants c. opioids d. amitrityline hydrochloride c. opioids. (gabapentin, anticonvulsants and amitriptyline hydrochloride are preferred over opioids when treating neuropathic pain) Opioids can be mild or strong agonists, or agonist-antagonists. Which of the following are MILD opioid agonists? (select all that apply): a. codeine b. morphine c. hydrocordone bitartrate d. oxycodone e. methadone a & c. Opioids can be mild or strong agonists, or agonist-antagonists. Which of the following are STRONG opioid agonists? (select all that apply): a. morphine b. codeine c. hydromorphone hydrochloride d. oxycodone e. hydrocodone bitartrate f. fentanyl g. methadone a, c, d, f, g Pentazocine (Talwin) is a... opioid agonist-antagonist What are the 3 classes of opioids? morphine-like, meperidine-like, methadone-like What is the major difference between opioid antagonist-agonists, and opioid agonists? agonist-antagonists bind to receptors and cause DIMINISHED pain sensations; agonists bind to receptors and block ALL pain sensation Opioid agonist-antagonists bind to which receptors? (select all that apply): a. mu receptors b. kappa receptors c. delta receptors a & b
