Anatomy and Physiology Quiz

I. Fluid and Electrolyte and Acid – Base Balance

1. Approximately 60% of the weight of a typical adult consists of fluid. Body fluid is located in two fluid compartments namely what?
a. Intracellular and intravascular
b. Extracellular and intracellular
c. Intracellular and interstitial
d. Extravascular and intracellular

2. When two different solutions are separated by a membrane that is impermeable to the dissolved substances, fluid shifts through the membrane from the region of low solute concentration to the region of high solute concentration until the solutions are of equal concentration. This diffusion of water caused by a fluid concentration gradient is known as what?
a. Diffusion
b. Filtration
c. Osmosis
d. Active Transportation

3. Hydrostatic pressure in the capillaries tends to filter fluid out of the intravascular compartment into the interstitial fluid. Movement of water and solutes occurs from an area of high hydrostatic pressure to an area of low hydrostatic pressure is known as what?
a. Diffusion
b. Filtration
c. Osmosis
d. Active Transport

4. A patient presented the following signs and symptoms: confusion, muscle cramps and weakness,  dry skin, ↑pulse,  ↓ BP. The patient’s lab result shows ↓ serum and urine sodium and  ↓ urine specific gravity. The doctor told you that the patient is exhibiting hyponatremia. Hyponatremia is having a serum sodium below what? (Smeltzer 2012)
a. 145 mEq/L
b. 108 mEq/L
c. 96.5 mEq/L
d. 135 mEq/L

5. A patient with congestive heart failure is given oral potassium supplements to avoid digoxin toxicity. As a nurse you are aware that the normal serum level for potassium is what? (Smeltzer 2012)
a. 135-145 mEq/L
b. 3.5-5.0 mEq/L
c. 8.5-10.5 mg/dL
d. 1.8-2.7 mg/dL

Evaluate the following arterial blood gas values

6. pH: 7.5   PaCO2: 31   HCO3 : 26

7. pH: 7.38  PaCO2: 32  HCO3: 19

8. pH: 7.24  PaCO2: 60  HCO3: 32

9. pH: 7.41  PaCO2: 30  HCO3 18

10. pH: 7.5  PaCO2: 42  HCO3: 33

II. Respiratory System

11. Resting respiration is the result of cyclic excitation of the respiratory muscles by the phrenic nerve. The rhythm of breathing is controlled by respiratory centers in the brain. The inspiratory and expiratory center is located in the?
a. Medulla Oblongata
b. Hypothalamus
c. Pons
d. Cerebellum

12. The _____ center in the lower pons stimulates the inspiratory medullary center to promote deep, prolonged inspirations.
a. Pneumotaxic
b. Apneustic
c. Chemotaxic
d. Physiotaxic

13. A term that correspond the amount of air inhaled and exhaled with each breath.
a. Residual Volume
b. Inspiratory Reserve Volume
c. Expiratory Reserve Volume
d. Tidal Volume
14. It is the volume of air in the lungs after maximum inhalation
a. Vital Capacity
b. Inspiratory Capacity
c. Functional Residual Capacity
d. Total Lung Capacity

15. The volume of air remaining in the lungs after a normal expiration .
a. Vital Capacity
b. Inspiratory Capacity
c. Functional Residual Capacity
d. Total Lung Capacity

III.  Cardiovascular System

16. It is the ability of the heart to initiate electrical impulse.
a. Excitability
b. Automaticity
c. Conductivity
d. Permeability

17. It is called as the primary pace maker of the heart which fires 60 to 100 impulse per minute
a. SA Node
b. AV Node
c. Bundle of His
d. Purkinje Fibers

18. The ___  coordinates the incoming electrical impulses from the atria and after a slight delay, allowing the atria time to contract and complete ventricular filling then relays the impulse to the ventricles.
a. SA Node
b. AV Node
c. Bundle of His
d. Purkinje Fibers

19. This heart sound is created by the closure of the tricuspid and bicuspid valve
a. S1
b. S2
c. S3
d. S4

20. This heart sound is created b the closure of the pulmonic and aortic valves
a. S1
b. S2
c. S3
d. S4

NCLEX-RN DRILL: MEDICAL SURGICAL CARDIOVASCULAR C

Medical Surgical Nursing is a very broad area in the field of Nursing for it tackles the management of different client condition. Books in Medical Surgical Nursing are usually divided according to the Organ System of the Human Body. The Cardiovascular System is one of the most difficult areas to study and to master since any deviation in this system will affect every organ system. Mastery is needed to be able to answer board type questions pertaining to Cardiovascualr System.



1. A client with no history of cardiovascular disease comes to the ambulatory clinic with flu-like symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse discriminate pain caused by a noncardiac problem?
1. “Can you describe the pain to me?”
2. “Have you ever had this pain before?”
3. “Does the pain get worse when you breathe in?”
4. “Can you rate the pain on a scale of 1 to 10, with 10 being the worst?”

2. A client is admitted to an emergency room with chest pain that is being ruled out for myocardial infarction. Vital signs are as follows: at 11 am, pulse (P), 92 beats/min, respiratory rate (RR), 24 breaths/min, blood pressure (BP), 140/88 mm Hg; 11:15 am, P, 96 beats/min, RR, 26 breaths/min, BP, 128/82 mm Hg; 11:30 am, P, 104 beats/min, RR, 28 breaths/min, BP, 104/68 mm Hg; 11:45 am, P, 118 beats/min, RR, 32 breaths/min, BP, 88/58 mm Hg. The nurse should alert the physician because these changes are most consistent with which of the following complications?
1. Cardiogenic shock
2. Cardiac tamponade
3. Pulmonary embolism
4. Dissecting thoracic aortic aneurysm

3. A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities?
1. Strict bed rest for 24 hours after transfer
2. Bathroom privileges and self-care activities
3. Ad lib activities because the client is monitored
4. Unsupervised hallway ambulation with distances under 200 feet

4. A client admitted to the hospital with chest pain and history of type II diabetes mellitus is scheduled for cardiac catheterization. Which of the following medications would need to be held for 48 hours before and after the procedure?
1. Regular insulin
2. Glipizide (Glucotrol)
3. Repaglinide (Prandin)
4. Metformin (Glucophage)

5. A client is in sinus bradycardia with a heart rate of 45 beats/min, complains of dizziness, and has a blood pressure of 82/60 mmHg. Which of the following should the nurse anticipate will be prescribed?
1. Defibrillate the client.
2. Administer digoxin (Lanoxin).
3. Continue to monitor the client.
4. Prepare for transcutaneous pacing.

6. A nurse notes bilateral 12 edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next?
1. Order daily weights starting on the following morning.
2. Review the intake and output records for the last 2 days.
3. Request a sodium restriction of 1 g/day from the physician
4. Change the time of diuretic administration from morning to evening.

7. A nurse is conducting a health history of a client with a primary diagnosis of heart failure. Which of the following disorders reported by the client is unlikely to play a role in exacerbating the heart failure?
1. Atrial fibrillation
2. Nutritional anemia
3. Peptic ulcer disease
4. Recent upper respiratory infection

8. A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which of the following would the nurse anticipate when auscultating the client's breath sounds?
1. Stridor
2. Crackles
3. Scattered rhonchi
4. Diminished breath sounds

9. A client who has developed severe pulmonary edema would most likely exhibit which of the following?
1. Mild anxiety
2. Slight anxiety
3. Extreme anxiety
4. Moderate anxiety

10. A client with pulmonary edema has been on diuretic therapy. The client has an order for additional furosemide (Lasix) in the amount of 40 mg intravenous push. Knowing that the client will also be started on digoxin (Lanoxin), the nurse should review which laboratory result?
1. Sodium level
2. Digoxin level
3. Creatinine level
4. Potassium level

NCLEX-RN DRILL: MEDICAL SURGICAL CARDIOVASCULAR B

Medical Surgical Nursing is a very broad area in the field of Nursing for it tackles the management of different client condition. Books in Medical Surgical Nursing are usually divided according to the Organ System of the Human Body. The Cardiovascular System is one of the most difficult areas to study and to master since any deviation in this system will affect every organ system. Mastery is needed to be able to answer board type questions pertaining to Cardiovascualr System.

1. The nurse realizes that more teaching is needed when the client on a cardiac low-cholesterol diet makes which choice from the menu?
a. Stewed chicken, green beans, and noodles
b. Liver and onions, salad with ranch dressing, and milk
c. Ham and bean soup, salad with vinaigrette dressing, and cornbread
d. Pork roast, brown rice, and beets

2. When taking a client’s medical history, which are the precipitating factors for myocardial infarction?
(Select all that apply.)
a. Hypothyroidism
b. Cigarette smoking
c. Hyperlipidemia
d. Rheumatic fever
e. Elevated serum iron level
f. High density lipids 40 mg
g. Using oral contraceptives

3. When the nurse performs an admission assessment on a client, the nurse notes that the client has xanthomas present on both eyelids. The laboratory value that the nurse would want to check based on this assessment finding is
a. triglyceride level
b. homocystine level
c. cardiac enzymes—CPK-MB, troponin, and myoglobin
d. cholesterol panel

4. A client presents to the clinic with the following symptoms: a burning sensation in the lower extremities, thickened toe nails, and pain in legs when walking. The nurse would assess the client for which additional factor consistent with Burger’s disease (thromboangitis obliterans)?
a. Bounding peripheral pulses
b. Rubor when the extremities are elevated
c. Intolerance to heat
d. Symptoms triggered by stress

5. A goal for a client with arteriosclerosis obliterans is to increase arterial blood supply to the extremities. Which of the following nursing interventions would be appropriate for this goal?
a. Elevate the extremities above the level of the heart for 15 minutes four times a day.
b. Have client perform Buerger-Allen exercises four times a day.
c. Maintain client on bed rest with legs in a neutral position.
d. Position client in high-Fowler’s position with legs straight.

6. Which of the following assessment findings are consistent with the diagnosis of venous stasis?
a. Absent or diminished peripheral pulses
b. Hair loss on the extremity
c. Moist ulcers around the malleolus
d. Edema of the extremity
e. Coolness of the extremity
f. Leathery quality of the extremity
g. Pallor of the extremity

7. A client is returned to the unit after having a repair of an abdominal aortic aneurysm. The nurse should place the client in which of the following positions?
a. High-Fowler’s
b. Sims
c. Semi-Fowler’s
d. Flat

8. The nurse is giving a client low molecular weight heparin, enoxaparin. The correct nursing interventions when administering this medication include all of the following except
a. using a TB syringe
b. injecting the medicine using Z-track method
c. not rubbing the site postinjection
d. administering the medicine in the anterolateral abdominal wall

9. In order to prevent the postoperative complication of thrombophlebitis in a client who has had mitral valve replacement, the nurse would have the client engage in which of the following activities?
a. Perform dorsiflexion of the feet several times every hour while awake
b. Cough and take deep breaths every hour while awake
c. Sit up in a chair for several hours during the afternoon
d. Eat a high-fiber, high-calorie diet

10. The nurse is caring for a client who has just arrived on the unit following a cardiac catheterization. Which of the following assessments would be most immediate?
a. Heart and lung sounds
b. Pain at the catheter insertion site
c. Pulses distal to the insertion site
d. Urine output

11. A client comes into the ER complaining of “his heart racing.” Cardiac monitor shows atrial tachycardia with a ventricular rate of 190 bpm. The nurse anticipates that the physician will order adenosine (Adenocard) to be given. Prior to giving the medication the nurse should do which of the following?
a. Determine when the client last ate
b. Ask the laboratory to draw serum BUN and creatinine levels
c. Ask the client if he/she has a history of asthma
d. Have the client sign a consent

12. Metoprolol tartrate (Lopressor) is ordered for a client who has had a myocardial infarction. The nurse would expect which therapeutic result from administration of this drug?
a. Increased urinary output
b. Decreased coronary artery spasms
c. Increased cardiac output
d. Decreased resting heart rate

13. A client’s cardiac monitor strip shows the following: HR 42/min, rhythm regular, PRI 0.16 seconds, QRS 0.06 seconds. The client is experiencing dizziness, nausea, and chest pain rated as 3 on a scale of 1–10 with 10 being the worst pain. The drug of choice to treat this dysrhythmia is
a. Lidocaine (Xylocaine)
b. Adenosine (Adenocard)
c. Atropine sulfate
d. Epinephrine (Adrenalin)

14. A client is admitted to the ER with new onset atrial fibrillation with a ventricular response of 110/min. The nurse would anticipate which of the following treatment options to be ordered. (Select all that apply.)
a. Defibrillation
b. Start oxygen at 2–4 lpm
c. Anticoagulant therapy
d. Medicate with beta blocker
e. Start Lidocaine drip
f. Atrial pacing

15. The nurse is assessing a newborn infant who is exhibiting the following signs and symptoms: elevated blood pressure, bounding brachial pulses, diminished pedal pulses, elevated Jugular venous distention (JVD), and cardiac murmur. Based on the assessment, the nurse would suspect that the client may have which of the following conditions?
a. Congestive heart failure
b. Coarctation of the aorta
c. Mitral valve prolapse
d. Transposition of the great vessels

16. The nurse has assessed a client and has determined that the client is exhibiting signs and symptoms of left heart failure. Identify which of the following are indicative of left heart failure.
a. Tachypnea, loss of appetite, ST elevation on the ECG
b. Hemoptysis, cogwheel murmur, midsternal chest pain
c. Ascites, oliguria, fatigue
d. Orthopnea, bibasilar crackles, gallop rhythm

17. The nurse is providing nutritional counseling for a client who is receiving a loop diuretic. Which meal plan would be most appropriate for this client?
a. Raisin bran cereal, tomato juice, whole grain toast
b. Boiled chicken, green beans, tossed salad
c. Vegetable soup, low-salt crackers, skim milk
d. Poached fish, beets, macaroni and cheese

18. The nurse is reading a 6-second cardiac rhythm strip and notes 9 QRS complexes in it. The client’s heart rate is
a. 54
b. 63
c. 81
d. 90

19. A client has been diagnosed with pericardial effusion. The nurse would prepare the client for which of the following procedures?
a. Myotomy
b. Pericardiectomy
c. Pericardiostomy
d. Dynamic cardiomyoplasty

20. Which instruction would be inappropriate to give a client following coronary artery bypass graft surgery?
a. No driving for 6–8 weeks
b. Avoid smoking or tobacco use for 4–6 weeks
c. No heavy lifting for 6–8 weeks
d. Can resume sexual intercourse in 3–4 weeks

NCLEX-RN DRILL: MEDICAL SURGICAL CARDIOVASCULAR A

Medical Surgical Nursing is a very broad area in the field of Nursing for it tackles the management of different client condition. Books in Medical Surgical Nursing are usually divided according to the Organ System of the Human Body. The Cardiovascular System is one of the most difficult areas to study and to master since any deviation in this system will affect every organ system. Mastery is needed to be able to answer board type questions pertaining to Cardiovascualr System.

1. A client with hypertension has an order for furosemide. Which lab finding should be reported to the physician?
A. Phosphorus 2.5 mEq/L
B. Potassium 1.8 mEq/L
C. Calcium 9.4 mg/dl
D. Magnesium 2.4 mEq/L

2. A client is admitted with a diagnosis of heart block. The nurse is aware that the pacemaker of the heart is the:
A. AV node
B. Purkinje fibers
C. SA node
D. Bundle of His

3. A client is being treated with nitroprusside (Nitropress). The nurse is aware that this medication:
A. Should be protected from light
B. Is a non–potassium-sparing diuretic
C. Causes vasoconstriction
D. Decreases circulation to the extremities

4. A client being treated with lisinopril (Zestril) develops a hacking cough. The nurse should tell the client to:
A. Take half the dose to control the problem
B. Take cough medication to control the problem
C. Stop the medication
D. Report the problem to the doctor

5. An elderly client taking digitalis develops constipation. The nurse is aware that constipation in a client taking digitalis might:
A. Develop an elevated digitalis level
B. Have a decrease in the digitalis levels
C. Have alterations in sodium levels
D. Develop tachycardia

6. The client is suspected of having had a myocardium infarction. Which diagnostic finding is most significant?
A. LDH
B. Troponin
C. Creatinine
D. AST

7. A client with an internally implanted defibrillator should be taught to:
A. Avoid driving a car
B. Avoid eating food cooked in a microwave
C. Refrain from using a cellular phone
D. Report swelling at the site

8. A client is scheduled for a cardiac catheterization. Following the procedure, the nurse should:
A. Assess for allergy to iodine
B. Check pulses proximal to the site
C. Assess the urinary output
D. Check to ensure that the client has a consent form signed

9. A client with Buerger’s disease complains of pain in the lower extremities. The nurse is aware that Buerger’s disease is also called:
A. Pheochromocytoma
B. Intermittent claudication
C. Kawasaki disease
D. Thromboangiitis obliterans

10. A client with an abdominal aneurysm frequently complains of:
A. A headache
B. Shortness of breath only during sleep
C. Lower back pain
D. Difficulty voiding

Nursing Theory Lecture 12: Lydia Hall

Lydia Hall

(1964)

Core, Care and Cure Model

Core, Care and Cure Model
• The client is composed of the ff. overlapping parts: person (core), pathologic state and treatment (cure) and body (care).
• Introduced the model of Nursing: What Is It? Focusing on the notion that centers around three components of Care, Core and Cure.
• Care represents nurturance and is exclusive to nursing. Core involves the therapeutic use of self and emphasizes the use of reflection. Cure focuses on nursing related to the physician’s orders. Core and cure are shared with the other health care providers.
• The major purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of the core.

Metaparadigm

Person
• Client is composed of body, pathology, and person. People set their own goals and are capable of learning and growing.

Environment
• Should facilitate achievement of the client’s personal goals.

Health
• Development of a mature self-identity that assists in the conscious selection of actions that facilitate growth.

Nursing
• Caring is the nurse’s primary function. Professional nursing is most important during the recuperative period.

Nursing Theory Lecture 11: Joyce Travelbee

Joyce Travelbee 

(1966, 1971) 

Interpersonal Aspects of Nursing 

 

Interpersonal Aspects of Nursing 

• She postulated the Interpersonal Aspects of Nursing Model. She advocated that the goal of nursing individual or family in preventing or coping with illness, regaining health finding meaning in illness, or maintaining maximal degree of health.

• She further viewed that interpersonal process is a human-to-human relationship formed during illness and “experience of suffering”

• She believed that a person is a unique, irreplaceable individual who is in a continuous process of becoming, evolving and changing.

Metaparadigm 

Person 

• A unique, irreplaceable individual who is in a continuous process of becoming, evolving, and changing.

Environment 

• Not defined

Health 

• Heath includes the individual’s perceptions of health and the absence of disease.

Nursing 

• An interpersonal process whereby the professional nurse practitioner assists an individual, family, or community to prevent or cope with the experience of illness and suffering, and if necessary, to find meaning in these experiences.

Nursing Theory Lecture 6: Faye Glenn Abdellah

Faye Glenn Abdellah 

(1960) 

Twenty One Nursing Problems 

Twenty One Nursing Problems 
• Nursing is broadly grouped into 21 problem areas to guide care and promote the use of nursing judgement.
• Introduced Patient – Centered Approaches to Nursing Model She defined nursing as service to individual and families; therefore the society. Furthermore, she conceptualized nursing as an art and a science that molds the attitudes, intellectual competencies and technical skills of the individual nurse into the desire and ability to help people, sick or well, and cope with their health needs.

21 Nursing Problems 
1. To maintain good hygiene.
2. To promote optimal activity; exercise, rest and sleep.
3. To promote safety.
4. To maintain good body mechanics
5. To facilitate the maintenance of a supply of oxygen
6. To facilitate maintenance of nutrition
7. To facilitate maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiologic response of the body to disease conditions
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory functions
12. To identify and accept positive and negative expressions, feelings and reactions
13. To identify and accept the interrelatedness of emotions and illness.
14. To facilitate the maintenance of effective verbal and non-verbal communication
15. To promote the development of productive interpersonal relationship
16. To facilitate progress toward achievement of personal spiritual goals
17. To create and maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying needs.
19. To accept the optimum possible goals
20. To use community resources as an aid in resolving problems arising from illness.
21. To understand the role of social problems as influencing factors


Metaparadigm 

Person 
• The recipients of nursing care having physical, emotional, and sociologic needs that may be overt or covert.

Environment 
• Not clearly defined. Some discussion indicates that clients interact with their environment, of which nurse is a part.

Health 
• A state when the individual has no unmet needs and no anticipated or actual impairment.

Nursing 
• Broadly grouped in “21 nursing problems,” which center around needs for hygiene, comfort, activity, rest, safety, oxygen, nutrition, elimination, hydration, physical and emotional health promotion, interpersonal relationships, and development of self-awareness. Nursing care is doing something for an individual

Fundamentals of Nursing Drill #3

Test your knowledge on concepts in Fundamentals of Nursing. Get a piece of paper and a pen. Answer the following questions and check your answers. Be sure to read the rationale behind the correct answer. If you find something difficult check out of Fundamentals of Nursing Lecture Notes for quick review or browse your books.

1. The nurse is preparing to move an adult who has right-sided paralysis from the bed to the wheelchair. Which statement describes the best action for the nurse to take?
a. position the wheelchair on the left side of the bed
b. keep the head of the bed elevated at 10o
c. protect the client’s left arm with a sling during the transfer
d. bend at the waist while helping the client into a standing position


2. Which statement by the nurse best indicates a correct understanding of “log rolling” when moving a client?
a. one nurse may perform this task alone
b. pillows are needed for positioning in order to provide support
c. the legs should be moved before the head is moved
d. keeping the neck in a straight position is the primary concern


3. The nurse is caring for a client who has temperature of 105oF (40.50C). The physician orders the application of a cooling blanket. The nurse should know that which of the following statements is true about the use of a cooling blanket?
a. cold application will increase the metabolic rate
b. vital signs should be monitored every 8 hours
c. the client should remain in one position to conserve energy
d. skin hygiene and protection of body surface areas is essential


4. The nurse is preparing to administer a sponge bath to an infant with a high fever. Administration of the bath should include:
a. large amounts of alcohol to increase evaporation of heat
b. adjustment of the water temperature to 60-70 0F
c. wet clothes applied to all areas where blood circulates close to skin surfaces
d. small areas of the body sponged at a time to avoid rapid heat loss


5. The nurse is instructing the family of a homebound bedridden client in the general prevention of pressure sores. Measures to include in the teaching include:
a. promoting lifting rather than dragging when turning the client
b. massaging directly over pressure sites
c. changing the client’s position every 4 hours
d. cleaning soiled areas with hot water


6. Which of the following findings would the nurse note when assessing a client with Stage I pressure ulcer? The ulcer displays:
a. superficial skin breakdown c. subcutaneous damage or necrosis
b. deep pink, red, or mottled skin d. damage to muscle or bone


7. An adult has developed a Stage II pressure ulcer. He is scheduled to receive wet to dry dressings every shift. The nurse realizes that the purpose of receiving this type of dressing is to:
a. draw in wound exudate and decrease bacteria
b. debride slough and eschar
c. promote healing by gas exchange
d. promote a moist environment and soften exudate


8. The nurse is performing a wound irrigation and dressing change. Which action, when taken by the nurse, would be a break in the technique?
a. consistently facing the sterile field
b. washing hands before opening the sterile set
c. opening the bottle of irrigating solution and pouring directly into a container on the sterile field
d. opening the sterile set so that the initial flap is opened away from the nurse


9. Total Parenteral Nutrition (TPN) is ordered for an adult client. The nurse expects the solution will contain all of the following nutrients except:
a. dextrose 10% c. electrolytes
b. trace minerals d. amino acids


10. The nurse caring for an adult client who is receiving TPN will need to monitor him for which of the following metabolic complications:
a. hypocalcemia and hypercalcemia c. hyperglycemia and hyperkalemia
b. hyperglycemia and hypokalemia d. hyperkalemia and hypercalcemia


11. The nurse is caring for a client who is receiving IV fluids. Which observation the nurse makes best indicates the IV has infiltrated?
a. pain at the site
b. a change in flow rate
c. coldness around the insertion site


12. Within 20 minutes of the start of transfusion, the client develops a sudden fever. The most appropriate initial response by the nurse is to:
a. force fluids c. increase the flow rate of IV fluids
b. continue to monitor the vital signs d. stop the transfusion


13. The nurse is caring for a client who has had a chest tube inserted and connected to water seal drainage. The nurse determines the drainage system is functioning correctly when which of the following is observed?
a. continuous bubbling in the water seal chamber
b. fluctuation in the water seal chamber
c. suction tubing attached to a wall unit
d. vesicular breath sounds throughout the lung fields


14. The nurse is caring for a client who has just had a chest tube attached to a water seal drainage system. To ensure that the system is functioning effectively the nurse should:
a. observe for intermittent bubbling in the water seal chamber
b. flush the chest tubes with 30-60 ml of NSS every 4-6 hours
c. maintain the client in an extreme lateral position
d. strip the chest tubes in the direction of the client


15. The nurse enters the room of a client who has a chest tube attached to a water seal drainage system and notices the chest tube is dislodged from the chest. The most appropriate nursing intervention is to:
a. notify the physician
b. insert a new chest tube
c. cover the insertion site with petroleum gauze
d. instruct the client to breathe deeply until help arrives


16. A patient is ordered oxygen via nasal prongs. The nurse administering oxygen via this low-flow system recognizes that this method of delivery:
a. mixes room air with oxygen
b. delivers a precise concentration of oxygen
c. requires humidity during delivery
d. is less traumatic to the respiratory tract


17. An adult is receiving oxygen by nasal prongs. Which statement by the client indicates that the client teaching regarding oxygen therapy has been effective?
a. “I was feeling fine so I removed my nasal prongs.”
b. “I’ve increased my fluids to six glasses of water daily.”
c. “Don’t forget to come back quickly when you get me out of bed; I don’t like to be without my oxygen for too long.”
d. “My family was angry when I told them they could not smoke in my room.”


18. An adult client has a nasogastric tube in place to maintain gastric decompression. Which nursing action will relieve discomfort in the nostril with the NG tube?
a. remove any tape and loosely pin the tube to his gown
b. lubricate the NG tube with viscous xylocaine
c. loop the NG tube to avoid pressure on the nares
d. replace the NG tube with a smaller diameter tube


19. An adult client has just returned to his room following a bowel resection and end-to-end anastomosis. The nurse can expect the drainage from the NG tube in the early post-op period to be:
a. Clear        c. Scant
b. Mucoid    d. Discolored


20. The physician inserts a central venous catheter; the nurse should assist the client to assume which of the following positions?
a. supine                     c. reverse trendelenburg’s
b. trendelenburg’s        d. high fowler’s

Fundamentals Drill #2

Test your knowledge on concepts in Fundamentals of Nursing. Get a piece of paper and a pen. Answer the following questions and check your answers. Be sure to read the rationale behind the correct answer. If you find something difficult check out of Fundamentals of Nursing Lecture Notes for quick review or browse your books.

1. A nurse is reviewing the diagnostic tests prescribed for a client. The nurse notes that a lupus cell preparation (LE cell prep) has been ordered. The nurse determines that this test is used to screen primarily for which of following disorders?
a. Histoplasmosis
b. Systemic lupus erythematosus (SLE)
c. Human immunodeficiency virus (HIV)
d. Progressive systemic sclerosis

2. The nurse is caring for a hospitalized client with acquired immunodeficiency syndrome (AIDS) who is receiving didanosine (Videx). The nurse contacts the physician if which laboratory result is noted that may be an indication of potential pancreatitis?
a. Increased potassium
b. Increased serum triglycerides
c. Increased blood urea nitrogen
d. Increased creatinine

3. A client seeks treatment for a fractured radius. There is an open wound on the arm through which jagged bone edges protrude. The nurse determines that the client has a
a. Greenstick fracture
b. Comminuted fracture
c. Open fracture
d. Simple fracture

4. The client has been admitted to the hospital with a fractured pelvis sustained in a motor vehicle accident. The nurse monitors for complications and assesses the client most closely for which of the following complications in the early post-trauma period?
a. Bradycardia
b. Pain
c. Hematuria
d. Fever

5. The nurse is monitoring a client with a head injury for signs of increased intracranial pressure. Which finding indicates an early sign of increased intracranial pressure?
a. Increase in systolic blood pressure
b. Decreasing level of consciousness
c. Shallow, slow respirations
d. Decrease in pulse rate

6. The nurse is performing an assessment on a client with a diagnosis of Bell’s palsy. The nurse would expect to observe which of the following symptoms in the client?
a. Twitching on the affected side of the face
b. Ptosis of the eyelid and closure of the eye
c. Facial drooping
d. Periorbital edema

7. A client with a diagnosis of multiple myeloma is admitted to the hospital. On assessment, the nurse asks the client which question that specifically relates to a clinical manifestation of this disorder?
a. "Are you having any bone pain?"
b. "Do you have diarrhea?"
c. "Have you noticed an increase in appetite?"
d. "Do you have feelings of anxiety and nervousness, together with difficulty sleeping?"

8. The nurse is preparing to care for a client with a diagnosis of metastatic cancer and notes documentation in the client’s chart that the client is experiencing cachexia. Which of the following would the nurse expect to note on assessment of the client?
a. Sunken eyes and a hollow cheek appearance
b. Periorbital edema and swelling around the ears
c. Generalized edema and the presence of weight gain
d. Increased blood pressure and ascites

9. A nurse is caring for a client receiving hemodialysis who has an internal arteriovenous fistula. The nurse expects to note which finding if the fistula is patent?
a. White fibrin specks noted in the fistula
b. Palpation of a thrill over the site of the fistula
c. Lack of a bruit at the site of the fistula
d. Warmth and redness at the site of the fistula

10. A physician's office nurse is assessing a client who recently had a renal transplant. The nurse monitors for which signs of acute graft rejection?
a. Hypotension, graft tenderness, and anemia
b. Hypertension, oliguria, thirst, and hypothermia
c. Fever, vomiting, hypotension, and copious amounts of dilute urine
d. Fever, hypertension, graft tenderness, and malaise

11. A nurse is caring for a client with a tracheostomy tube who is receiving mechanical ventilation. The nurse is monitoring for complications related to the tracheostomy and suspects tracheoesophageal fistula when
a. Suctioning is required frequently
b. Excessive secretions are suctioned from a tracheostomy
c. The client’s skin and mucous membranes are light pink
d. Aspiration of gastric contents occurs during suctioning

12. A nurse is performing a cardiovascular assessment on a client with heart failure. Which of the following items would the nurse assess to gain the best information about the client’s left-sided heart function?
a. Breath sounds
b. Peripheral edema
c. Jugular vein distention
d. Hepatojugular reflux

13. A nurse suctioning a client through an endotracheal tube monitors the client for complications associated with the procedure. Which of the following indicates a complication?
a. A blood pressure of 138/88 mm Hg
b. An irregular heart rate
c. A reddish coloration in the client's face
d. A pulse oximetry level of 95%

14. An emergency department nurse is assessing a client who sustained a blunt chest injury and suspects the presence of flail chest. Which specific characteristic finding would the nurse note in this condition?
a. Slow deep respirations
b. Asymmetric chest movement
c. Loss of consciousness
d. Anxiety

15. A nurse is caring for a client with a tracheostomy tube and is monitoring the client for subcutaneous emphysema. The nurse identifies this complication by noting which of the following?
a. Crackling sounds heard in the upper lobes bilaterally
b. A puffy and crackling sensation on palpation of the tissues surrounding the tracheostomy site
c. Signs of respiratory distress
d. Dyspnea

16. A nurse is monitoring a client with a tracheostomy tube for complications related to the tube. The nurse suspects tracheoesophageal fistula if which of the following is noted?
a. Abdominal distention
b. Excess mucus production
c. Abnormal skin and mucous membrane color
d. Use of accessory muscles to assist with breathing
.
17. A nurse is assessing a client who was treated for an asthma attack. The nurse determines that the client's respiratory status has worsened if which of the following is noted?
a. Loud wheezing
b. Wheezing during inspiration and expiration
c. Wheezing on expiration only
d. Diminished breath sounds

18. A nurse is reviewing the assessment findings and laboratory results of a child diagnosed with new-onset glomerulonephritis. Which of the following findings would the nurse most likely expect to note?
a. Increased creatinine levels
b. Hypotension
c. Low serum potassium
d. Tea-colored urine

19. A nurse is reviewing the record of an infant admitted to the newborn nursery. The nurse notes that the physician has documented bladder exstrophy. On assessment of the infant, the nurse expects to note which of the following?
a. Undescended or hidden testes
b. The opening of the urethral meatus below the normal placement on the glans penis
c. The opening of the urethral meatus on the ventral side of the glans penis
d. The urinary bladder on the outside of the body


20. A newborn infant with a diagnosis of subdural hematoma is admitted to the newborn nursery. The nurse does which of the following to assess for the major symptom associated with subdural hematoma?
a. Checks for contractures of the extremities
b. Tests for equality of extremities when stimulating reflexes
c. Monitors the urinary output pattern
d. Monitors the urine for blood

Fundamentals of Nursing Drill #1

Test your knowledge on concepts in Fundamentals of Nursing. Get a piece of paper and a pen. Answer the following questions and check your answers. Be sure to read the rationale behind the correct answer. If you find something difficult check out of Fundamentals of Nursing Lecture Notes for quick review or browse your books.

1. A nurse is assessing the extent of pitting edema in a client with congestive heart failure. The nurse gently presses a finger on the client's ankle and notes a barely perceptible pit. The nurse interprets this finding as which measurement of pitting edema?
a. 1+
b. 2+
c. 3+
d. 4+


2. The nurse notes documentation that a client's peripheral pulses are +3. The nurse determines that the pulses are
a. Full and brisk
b. Absent
c. Normal or average
d. Palpable, but diminished


3. A nurse is reviewing a client’s record and notes that the results of the client’s vision test using a Snellen chart is 20/50. The nurse interprets this to mean that the client
a. Has normal vision
b. Has minimal visual
c. Can read at a distance of 20 feet what a client with normal vision can read at 50 feet
d. Can read at a distance of 50 feet what a client with normal vision can read at 20 feet

4. A prenatal client tells the nurse that she is really worried about knowing how to care for her first-born child. The nurse formulates which nursing diagnosis for this client?
a. Ineffective Coping
b. Dysfunctional Grieving
c. Situational Low Self-esteem
d. Deficient Knowledge

5. The nurse notes documentation that a client has the presence of cherry angiomas located on the abdomen. On assessment of the client, the nurse would expect to note which characteristic of this skin lesion?
a. Ruby red papules
b. Thickened skin areas
c. Pinpoint-sized red or purple spots
d. Areas of redness warm to touch

6. A nurse is assessing the risk factors for acquiring pneumonia during hospitalization for a group of clients. The nurse determines that which of the following clients is at lowest risk?
a. An older client with diabetes mellitus
b. A client with human immunodeficiency virus (HIV)
c. A client with a spinal cord injury who is immobile
d. A postoperative client who is ambulating

7. A nurse working in a prenatal clinic is reviewing the records of clients scheduled for prenatal visits. The nurse interprets that the client at greatest risk for abruptio placenta is the one who
a. Is 26 years old and is a primipara
b. Rides an exercise bike for 30 minutes 3 times weekly
c. Has maternal hypertension
d. Takes folic acid supplements daily

8. The nurse teaches a client with gastroesophageal reflux disease (GERD) about the measures to prevent reflux while sleeping. The nurse determines that the client needs additional instructions if the client states
a. "I shouldn't eat anything at bedtime."
b. "I should take an antacid at bedtime."
c. "I should sleep flat on my right side."
d. "Losing weight will decrease some of the stomach pressure."

9. A nurse provides instructions to a client about the measures to treat gout. The nurse determines that the client needs additional instructions if the client states that
a. The intake of red meats needs to be limited.
b. Weight loss can help prevent an attack.
c. Medication can help keep the uric acid level down.
d. Fluid intake needs to be limited.

10. A nurse provides instructions to a client who is being discharged 24 hours after undergoing a percutaneous renal biopsy. Which statement by the client indicates a need to reinforce the instructions?
a. "I need to avoid any strenuous lifting for about two weeks."
b. "I shouldn't work out at the gym for about two weeks."
c. "I will call the physician if my urine becomes bloody."
d. "A fever is normal after this procedure."

11. A clinic nurse has provided instructions to the mother of a child with a urinary tract infection. Which statement by the mother indicates a need for further instructions?
a. "I should wipe my child from front to back after urination or a bowel movement."
b. "I should increase my child's fluid intake."
c. "I should encourage my child to hold the urine and to urinate at least four times a day."
d. "I should avoid the use of bubble baths with my child."

12. A nurse provides dietary instructions to a client with hypertension. The nurse determines that the client understands the instructions if the client states that it is acceptable to eat which of the following food items?
a. Hot dogs
b. Turkey
c. Salad with blue cheese dressing
d. Corned beef hash

13. The nurse is providing dietary instructions to a client with ascites who will be discharged to home from the hospital. The nurse determines that the client understands the instructions if the client states that it is acceptable to eat which food item?
a. Canned green beans
b. Fresh plums
c. Cooked ham
d. Bologna


14. A nurse has provided instructions to a client with chronic obstructive pulmonary disease about the procedure for performing pursed lip breathing. The nurse observes the client perform the procedure and determines that he or she is performing it correctly if the client
a. Takes a deep breath and exhales quickly
b. Monitors inspiration time and ensures that expiration time is less than inspiration time
c. Lies on the side in a supine position to perform the procedure
d. Sits in an upright position, takes a deep breath, and exhales slowly


15. A nurse has completed discharge teaching with the family of a client who requires dressing changes at home. Which method of evaluation would the nurse use to best determine the family’s competence in performing the dressing changes?
a. Asking a family member to perform the dressing change and observing the procedure
b. Asking a family member to identify the supplies needed to perform the dressing change
c. Asking a family member to list the steps of the procedure for performing the dressing change
d. Asking a family member to verbalize the procedure for performing the dressing change


16. A nurse is teaching a client diagnosed with iron deficiency anemia about the foods that are high in iron. The nurse tells the client to consume which high-iron food?
a. Refined white bread
b. Egg whites
c. Mushrooms
d. Spinach

17. A clinic nurse provides instructions to a woman in the second trimester of pregnancy regarding measures to relieve backache. Which statement by the client indicates an understanding of these measures?
a. "I will sleep on a soft mattress."
b. "I will avoid doing those pelvic tilt exercises."
c. "I will avoid getting tired, and I should work at maintaining a good posture."
d. "I will wear shoes with a heel of at least 2 inches."


18. A prenatal client reports heartburn, and the nurse provides instructions to the client regarding measures to alleviate the discomfort. Which statement by the client indicates a need for further instructions?
a. "I need to eat small, frequent meals."
b. "I need to avoid fatty or spicy foods."
c. "I need to lie down after eating."
d. "I need to drink approximately 2000 mL fluid per day."


19. During the administration of a blood transfusion to a client, the nurse notes the presence of crackles in the client’s lung bases. On further assessment, the nurse notes that the client has distended neck veins and an increase in central venous pressure. The nurse suspects that the client is experiencing what complication of the blood transfusion?
a. Transfusion reaction
b. Allergic reaction
c. Sepsis
d. Circulatory overload


20. A client with type 1 diabetes mellitus has a blood glucose level of 554 mg/dL. The nurse calls the physician to report the level and monitors the client closely for which acid-base imbalance?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis

A&P Lecture 4.2: Gas Exchange

ANATOMY AND PHYSIOLOGY LECTURE 4.2

GAS EXCHANGE

The air we breathe is a gaseous mixture consisting mainly of nitrogen (78.62%) and oxygen (20.84%), with traces of carbon dioxide (0.04%), water vapor (0.05%), helium, and argon. The atmospheric pressure at sea level is about 760 mm Hg. Partial pressure is the pressure exerted by each type of gas in a mixture of gases. The partial pressure of a gas is proportional to the concentration of that gas in the mixture. The total pressure exerted by the gaseous mixture is equal to the sum of the partial pressures.

PARTIAL PRESSURE OF GASES

Based on these facts, the partial pressures of nitrogen and oxygen can be calculated. The partial pressure of nitrogen is 79% of 760 (0.79 × 760), or 600 mm Hg; that of oxygen is 21% of 760 (0.21 × 760), or 160 mm Hg. Chart 21-3 spells out terms and abbreviations related to partial pressure of gases.

Once the air enters the trachea, it becomes fully saturated with water vapor, which displaces some of the gases so that the air pressure within the lung remains equal to the air pressure outside (760 mm Hg). Water vapor exerts a pressure of 47 mm Hg when it fully saturates a mixture of gases at the body temperature of

37°C (98.6°F). Nitrogen and oxygen are responsible for the remaining 713 mm Hg (760 − 47) pressure. Once this mixture enters the alveoli, it is further diluted by carbon dioxide. In the alveoli, the water vapor continues to exert a pressure of 47 mm Hg. The remaining 713 mm Hg pressure is now exerted as follows:

nitrogen, 569 mm Hg (74.9%); oxygen, 104 mm Hg (13.6%); and carbon dioxide, 40 mm Hg (5.3%).

PARTIAL PRESSURE IN GAS EXCHANGE

When a gas is exposed to a liquid, the gas dissolves in the liquid until an equilibrium is reached. The dissolved gas also exerts a partial pressure. At equilibrium, the partial pressure of the gas in the liquid is the same as the partial pressure of the gas in the gaseous mixture. Oxygenation of venous blood in the lung illustrates this point. In the lung, venous blood and alveolar oxygen are separated by a very thin alveolar membrane. Oxygen diffuses across this membrane to dissolve in the blood until the partial pressure of oxygen in the blood is the same as that in the alveoli (104 mm Hg). However, because carbon dioxide is a byproduct

of oxidation in the cells, venous blood contains carbon dioxide at a higher partial pressure than that in the alveolar gas. In the lung, carbon dioxide diffuses out of venous blood into the alveolar gas. At equilibrium, the partial pressure of carbon dioxide in the blood and in alveolar gas is the same.

EFFECTS OF PRESSURE ON OXYGEN TRANSPORT

Oxygen and carbon dioxide are transported simultaneously dissolved in blood or combined with some of the elements of blood. Oxygen is carried in the blood in two forms: first as physically dis-olved oxygen in the plasma, and second in combination with the hemoglobin of the red blood cells. Each 100 mL of normal arterial blood carries 0.3 mL of oxygen physically dissolved in the plasma and 20 mL of oxygen in combination with hemoglobin. Large amounts of oxygen can be transported in the blood because it combines easily with hemoglobin to form oxyhemoglobin: O2 + Hgb ↔ HgbO2

The volume of oxygen physically dissolved in the plasma varies directly with the partial pressure of oxygen in the arteries (PaO2). The higher the PaO2, the greater the amount of oxygen dissolved. For example, at a PaO2 of 10 mm Hg, 0.03 mL of oxygen is dissolved in 100 mL of plasma. At 20 mm Hg, twice this amount is dissolved in plasma, and at 100 mm Hg, 10 times this amount is dissolved. Therefore, the amount of dissolved oxygen is directly proportional to the partial pressure, regardless of how high the oxygen pressure rises.

The amount of oxygen that combines with hemoglobin also depends on PaO2, but only up to a PaO2 of about 150 mm Hg. When the PaO2 is 150 mm Hg, hemoglobin is 100% saturated and will not combine with any additional oxygen. When hemoglobin is 100% saturated, 1 g of hemoglobin will combine with 1.34 mL

of oxygen. Therefore, in a person with 14 g/dL of hemoglobin, each 100 mL of blood will contain about 19 mL of oxygen associated with hemoglobin. If the PaO2 is less than 150 mm Hg, the percentage of hemoglobin saturated with oxygen is lower. For example, at a PaO2 of 100 mm Hg (normal value), saturation is 97%; at a PaO2 of 40 mm Hg, saturation is 70%. 

OXYHEMOGLOBIN DISSOCIATION CURVE

The oxyhemoglobin dissociation curve  shows the relationship between the partial pressure of oxygen (PaO2) and the percentage of saturation of oxygen (SaO2). The percentage of saturation can be affected by the following factors: carbon dioxide, hydrogen ion concentration, temperature, and 2,3-diphosphoglycerate.

A rise in these factors shifts the curve to the right so that more oxygen is then released to the tissues at the same PaO2. A reduction in these factors causes the curve to shift to the left, making the bond between oxygen and hemoglobin stronger, so that less oxygen is given up to the tissues at the same PaO2. The unusual shape of the oxyhemoglobin dissociation curve is a distinct advantage to the patient for two reasons:

1. If the arterial PO2 decreases from 100 to 80 mm Hg as a result of lung disease or heart disease, the hemoglobin of the arterial blood remains almost maximally saturated (94%) and the tissues will not suffer from hypoxia.

2. When the arterial blood passes into tissue capillaries and is exposed to the tissue tension of oxygen (about 40 mm Hg), hemoglobin gives up large quantities of oxygen for use by the tissues.

Clinical Significance. 

The normal value of PaO2 is 80 to 100 mm Hg (95% to 98% saturation). With this level of oxygenation,

there is a 15% margin of excess oxygen available to the tissues. With a normal hemoglobin level of 15 mg/dL and a PaO2 level of 40 mm Hg (oxygen saturation 75%), there is adequate oxygen available for the tissues but no reserve for physiologic stresses that increase tissue oxygen demand. When a serious incident occurs

(eg, bronchospasm, aspiration, hypotension, or cardiac dysrhythmias) that reduces the intake of oxygen from the lungs, tissue hypoxia will result.

An important consideration in the transport of oxygen is cardiac output, which determines the amount of oxygen delivered to the body and which affects lung and tissue perfusion. If the cardiac output is normal (5 L/min), the amount of oxygen delivered to the body per minute is normal. If cardiac output falls, the amount ofoxygen delivered to the tissues also falls. Under normal conditions, most of the oxygen delivered to the body is not used. In fact, only 250 mL of oxygen is used per minute. Under normal conditions, this is approximately 25% of available oxygen. The rest of the oxygen returns to the right side of the heart, and the PaO2 of venous blood drops from 80 to 100 mm Hg to about 40 mm Hg.

Carbon Dioxide Transport
At the same time that oxygen diffuses from the blood into the tissues, carbon dioxide diffuses from tissue cells to blood and is transported to the lungs for excretion. The amount of carbon dioxide in transit is one of the major determinants of the acid–base balance of the body. Normally, only 6% of the venous carbon dioxide is removed in the lungs, and  nough remains in the arterial blood to exert a pressure of 40 mm Hg. Most of the carbon dioxide (90%) is carried by red blood cells; the small portion (5%) that remains dissolved in the plasma (partial pressure of carbon dioxide [PCO2]) is the critical factor that determines carbon dioxide movement in or out of the blood. Although the many processes involved in respiratory gas transport seem to occur in intermittent stages, the changes are rapid, simultaneous, and continuous.

 Neurologic Control of Ventilation
Resting respiration is the result of cyclic excitation of the respiratory muscles by the phrenic nerve. The rhythm of breathing is controlled by respiratory centers in the brain. The inspiratory and expiratory centers in the medulla oblongata and pons control the rate and depth of ventilation to meet the body’s metabolic demands.

The apneustic center in the lower pons stimulates the inspiratory medullary center to promote deep, prolonged inspirations. The pneumotaxic center in the upper pons is thought to control the pattern of respirations.

Several groups of receptor sites assist in the brain’s control of respiratory function. The central chemoreceptors, located in the medulla, respond to chemical changes in the cerebrospinal fluid, which result from chemical changes in the blood. These receptors respond to an increase or decrease in the pH and convey a message to the lungs to change the depth and then the rate of ventilation to correct the imbalance. The peripheral chemoreceptors are located in the aortic arch and the carotid arteries and respond first to changes in PaO2, then to partial pressure of carbon dioxide (PaCO2) and pH. The Hering-Breuer reflex is activated by stretch receptors in the alveoli. When the lungs are distended, inspiration is inhibited; as a result, the lungs do not become over distended. In addition, proprioceptors in the muscles and joints respond to body movements, such as exercise, causing an increase in ventilation. Thus, range-of motion exercises in an immobile patient stimulate breathing. Baroreceptors, also located in the aortic and carotid bodies, respond to an increase or decrease in arterial blood pressure and cause reflex hypoventilation or hyperventilation.

A&P Lecture 2: Cell Cycle and Cell Division

ANATOMY AND PHYSIOLOGY LECTURE 2

CELL CYCLE AND CELL DIVISION

The life of a cell is called the cell cycle. It is usually divided into five phases or gaps: G0, G1, S, G2, and M. Some cells may not have a G1 phase, and others may not have a G2 stage. However, all cells must grow, replicate their genetic material if they are to divide, and undergo the process of mitosis if they are to replicate. G0 is the stage during which the cell may leave the cell cycle and either remain in a state of inactivity or reenter the cell cycle at another time. G1 is the stage during which the cell is starting to prepare for mitosis through DNA and protein synthesis and an increase in organelle and cytoskeletal elements. The S phase is the synthesis phase, during which DNA replication occurs and the centrioles are beginning to replicate. G2 is the premitotic phase and is similar to G1 as for RNA and protein synthesis. The M phase is the phase during which cell mitosis occurs. Nondividing cells, such as mature nerve cells and cells not preparing for mitosis, are said to be in the G0 phase of the cell cycle .

Cell Division

Cell division, or mitosis, which was first described in 1875, is the process during which a parent cell divides and each daughter cell receives a chromosomal karyotype identical to the parent cell. Cell division gives the body a means of replacing cells that have a limited life span, such as skin and blood cells; increasing tissue mass during periods of growth; and providing for tissue repair and wound healing. Despite the early cytologic description of the four stages of mitosis, it was not until the early 1950s that the importance of the cell cycle was realized. 

Mitosis, which is a dynamic and continuous process, usually lasts from 1 to 11⁄2 hours. It is divided into four stages: prophase, metaphase, anaphase, and telophase (Fig. 4-13). The phase during which the cell is not undergoing division is called interphase. During prophase, the chromosomes become visible because of increased coiling of the DNA, the two centrioles replicate, and a pair moves to each side of the cell. Simultaneously, the microtubules of the mitotic spindle appear between the two pairs of centrioles. Later in prophase, the nuclear envelope and nucleolus disappear. Metaphase involves the organization of the chromosome pairs in the midline of the cell and the formation of a mitotic spindle composed of the microtubules. Anaphase is the period during which separation of the chromosome pairs occurs, with the microtubules pulling one member of each pair of 46 chromosomes toward the opposite cell pole. Cell division, or cytokinesis, is completed after telophase, the stage during which the mitotic spindle vanishes and a new nuclear membrane develops and encloses each complete set of chromosomes.

Cell division is controlled by changes in the intracellular concentrations and activity of three major groups of

intracellular proteins: (1) cyclins, (2) cyclin-dependent kinases, and (3) the anaphase-promoting complex. The central components of the cell cycle control system are the cyclin-dependent kinases, whose activity depends on association with the regulatory units called cyclins. Oscillations in the activity of the various cyclin-dependent kinases lead to initiation of the different phases of the cell cycle. For example, activation of the S-phase cyclin-dependent kinases initiates the S phase of the cell cycle, whereas activation of the M-phase cyclin-dependent kinases triggers mitosis. The anaphase-promoting complex is responsible for the breakdown of the M cyclins and other regulators of mitosis.

Cell division is also controlled by several external factors, including the presence of cytokines, various growth

factors, or even adhesion factors when the cell is associated with other cells in a tissue. In addition, the cell cycle is regulated by several checkpoints that determine whether DNA replication has occurred with a high degree of fidelity. Two of the better understood are the DNA damage and the spindle formation checkpoints. If these biochemical checkpoints are not faithfully met, the cell may default to programmed

cell death or apoptosis.

Anatomy and Physiology Compiled Lecture Notes: The Cell

THE CELL

• Introduction

• The Cell Membrane

• The Nucleus

• The Cytoplasm

• The Ribosomes

• The Endoplasmic Reticulum

• The Golgi Complex

• The Secretory Vesicles

• The Lysosomes

• The Peroxisomes

• The Proteasomes

• The Mitochondria

• The Accessory Parts

• Cillia
• Flagella
• Microvilli
• Centrioles
• Spindle Fibers

A&P Lecture 1.1: Cell Membrane

This lecture note on Anatomy and Physiology is linked to A&P Lecture 1: The Cell to further explain the physiology of the Cell Membrane. 

ANATOMY AND PHYSIOLOGY LECTURE NOTE 1.1

CELL MEMBRANE

The outermost component of the cell is the plasma membrane. It is a boundary that separates the substances inside the cell, which are intracellular , from substances outside the cell, which are extracellular.It determines what moves into and out of cells. As a result, the intracellular contents of cells is different from the extracellular environment. The membrane encloses and supports the cell contents. It attaches cells to the extracellular environment or to other cells. The cells’ ability to recognize and communicate with each other takes place through the plasma membrane.

The regulation of ion movement by cells results in a charge difference across the plasma membrane called the membrane potential. The outside of the plasma membrane is positively charged, compared with the inside, because there are more positively charged ions immediately on the outside of the plasma membrane and more negatively charged ions and proteins inside. This concept is paramount in understanding the Sodium Potassium Pump that controls the electrophysiology of the heart, transmission of nerve impulses and contraction of muscles.

The plasma membrane consists of 45%–50% lipids, 45%– 50% proteins, and 4%–8% carbohydrates ( figure 3.2 ). The carbohydrates combine with lipids to form glycolipids and with proteins to form glycoproteins. The glycocalyx (glı¯-ko¯-ka¯ liks) is the collection of glycolipids, glycoproteins, and carbohydrates on the outer surface of the plasma membrane. The glycocalyx also contains molecules absorbed from the extracellular environment, so there is often no precise boundary where the plasma membrane ends and the extracellular environment begins.

Indepth Medical Physiology

The membrane that surrounds cells is a notable structure. It is made up of lipids and proteins and is semipermeable meaning- it allows some substances to pass through it and excluding others. However, its permeability can also be varied because it contains numerous regulated ion channels and other transport proteins that can change the amounts of substances moving across it. It is generally referred to as the plasma membrane. The nucleus and other organelles in the cell are bound by similar membranous structures.

Although the chemical structures of membranes and their properties vary considerably from one location to another, they have certain common features. They are generally about 7.5 nm thick. The major lipids are phospholipids such as phosphatidylcholine, phosphotidylserine, and phosphatidylethanolamine. The shape of the phospholipid molecule reflects its solubility properties: the “head” end of the molecule contains the phosphate portion and is relatively soluble in water  and the “tail” ends are relatively insoluble. The possession of both hydrophilic and hydrophobic properties makes the lipid an amphipathic molecule. In the membrane, the hydrophilic ends of the molecules are exposed to the aqueous environment that bathes the exterior of the cells and the aqueous cytoplasm; the hydrophobic ends meet in the water-poor interior of the membrane. In prokaryotes, the membranes are relatively simple, but in eukaryotes, cell membranes contain various glycosphingolipids, sphingomyelin, and cholesterol in addition to phospholipids and phosphatidylcholine.

Many different proteins are embedded in the membrane. They exist as separate globular units and many pass through or are embedded in one leaflet of the membrane- integral proteins, whereas others- peripheral proteins, are associated with the inside or outside of the membrane. The amount of protein varies significantly with the function of the membrane but makes up on average 50% of the mass of the membrane; that is, there is about one protein molecule per 50 of the much smaller phospholipid molecules.

The proteins in the membrane carry out many functions. Some are cell adhesion molecules that anchor cells to their neighbors or to basal laminas. Some proteins function as pumps, actively transporting ions across the membrane. Other proteins function as carriers, transporting substances down electrochemical gradients by facilitated diffusion. Still others are ion channels, which, when activated, permit the passage of ions into or out of the cell. The role of the pumps, carriers, and ion channels in transport across the cell membrane is discussed below. Proteins in another group function as receptors that bind ligands or messenger molecules, initiating physiologic changes inside the cell. Proteins also function as enzymes, catalyzing reactions at the surfaces of the membrane. 

The uncharged, hydrophobic portions of the proteins are usually located in the interior of the membrane, whereas the charged, hydrophilic portions are located on the surfaces. Peripheral proteins are attached to the surfaces of the membrane in various ways. One common way is attachment to glycosylated forms of phosphatidylinositol. Proteins held by these glycosylphosphatidylinositol (GPI) anchors include enzymes such as alkaline phosphatase, various antigens, a number of CAMs, and three proteins that combat cell lysis by complement. Over 45 GPI-linked cell surface proteins have now been described in humans. Other proteins are lipidated, that is, they have specific lipids attached to them. Proteins may be myristoylated, palmitoylated, or prenylated (ie, attached to geranylgeranyl or farnesyl groups).

The protein structure—and particularly the enzyme content—of biologic membranes varies not only from cell to cell, but also within the same cell. For example, some of the enzymes embedded in cell membranes are different from those in mitochondrial membranes. In epithelial cells, the enzymes in the cell membrane on the mucosal surface differ from those in the cell membrane on the basal and lateral margins of the cells; that is, the cells are polarized. Such polarization makes directional transport across epithelia possible. Th e membranes are dynamic structures, and their constituents are being constantly renewed at different rates. Some proteins are anchored to the cytoskeleton, but others move laterally in the membrane.

Underlying most cells is a thin, “fuzzy” layer plus some fibrils that collectively make up the basement membrane or, more properly, the basal lamina. Th e basal lamina and, more generally, the extracellular matrix are made up of many proteins that hold cells together, regulate their development, and determine their growth. These include collagens, laminins, fibronectin, tenascin, and various proteoglycans.

Case Study #0001: Orthostatic Hypotension

The Case Study Series of JQ Nursing Review presents a real life patient situation to encourage you to become an active learner as you read. This will also develop your critical thinking skills. Case Study Questions will challenge you to use your understanding of new concepts and help you integrate your knowledge to solve a clinical problem.

Case Study #0001: 

Orthostatic Hypotension

Scenario
As a nurse, you are assigned at the Emergency Room of the hospital to provide rapid assessment and intervention to various clients.

 In your shift a 72-year old woman was accompanied by her son presented herself at the emergency room. You asked what brings her to the hospital and you've found out that for 3 days, she have had  fever and chills and stayed mostly in bed. On rising to go to the bathroom, she felt dizzy, fainted, and fell to the floor. She regained consciousness immediately and called her son.

Upon further assessment and evaluation by the health team, a diagnosis of Orthostatic Hypotension was made.

Clinical Questions
a. Describe the normal response to a decrease in blood pressure on standing.
b. What happened to the client's heart rate just before she fainted? Why did the client faint?
c. How did the client's fainting and falling to the floor assist in establishing homeostasis (assuming she was not injured)?

A&P Lecture 3: Homeostasis

"You need to know the normal before you can determine the abnormal." 

Knowledge in Anatomy and Physiology is paramount before tackling advance Nursing Courses. It is the reason why Anatomy and Physiology class is taken first before professional courses like Pathophysiology, Medical Surgical Nursing, Maternal and Child Nursing and Psychiatric Nursing.Anatomy and Physiology is a good foundation when you already try to study illnesses. This A&P Lecture Series is designed to help students develop a solid understanding of the concepts of anatomy and physiology and to use this knowledge to solve problems.

ANATOMY AND PHYSIOLOGY LECTURE 2

HOMEOSTASIS

Homeostasis is defined as the body's continuous maintenance of a relatively constant environment within the body. Homeostasis is also defined as the condition of equilibrium or balance in the body’s internal environment beacuse to the constant interaction of the different regulatory processes in the body. Homeostasis is a dynamic condition. In response to changing conditions, the body’s equilibrium can shift among points in a narrow range that is compatible with maintaining life.

Such Homeostatic mechanisms, such as sweating or shivering, normally maintain body temperature near an ideal normal value, or set point. It is important to note that these mechanisms are not able to maintain body temperature precisely at the set point. Instead, body temperature increases and decreases slightly around the set point to produce a normal range of values. As long as body temperature remains within this normal range, homeostasis is maintained.

The organ systems help control the body ’s internal environment so that it remains relatively constant. For  example, the digestive, respiratory, circulatory, and urinary systems function together so that each cell in the body receives adequate oxygen and nutrients and so that waste products do not accumulate to a toxic level. If the fluid surrounding cells deviates from homeostasis, the cells do not function normally and can even die. Disease disrupts homeostasis and sometimes results in death.


Body Fluids and Electrolytes and Acid Base Balance
An integral aspect of homeostasis is maintaining the volume and composition of body fluids, dilute, watery solutions containing dissolved chemicals that are found inside cells as well as surrounding them. This s a pivotal concept in understanding the mechanism of fluid and electrolyte movement inside the body.

A good example s when the inside of a cell has more fluid in it compared to its surrounding environment, the body will activate several mechanism to equalize the pressure gradient between these two compartments.
     ***This concept will be further explained in the upcoming lecture notes on Fluid and Electrolytes and Acid Base Balace.

Control
The body has many regulating systems that can usually bring the internal environment back into balance. Most often, the nervous system and the endocrine system, working together or independently, provide the needed corrective measures. Both means of regulation, however, work toward the same end, usually through negative feedback systems.

Feedback System
A feedback system or feedback loop is a cycle of events in which the status of a body condition is monitored, evaluated, changed, remonitored, reevaluated, and so on.

Parts
1. A receptor is a body structure that monitors changes in a controlled condition and sends input to a control center.
2. A control center in the body, for example, the brain, sets the range of values within which a controlled condition should be maintained, evaluates the input it receives from receptors, and generates output commands when they are needed.
3. An effector is a body structure that receives output from the control center and produces a response or effect that changes the controlled condition.

Negative Feedback
Most systems of the body are regulated by negative-feedback mechanisms, which maintain homeostasis. Negative means that any deviation from the set point is made smaller or is resisted.

Positive Feedback
Positive-feedback responses are not homeostatic and are rare in healthy individuals. Positive implies that, when a deviation from a normal value occurs, the system ’s response is to make the deviation even greater.

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