Exam 3 - Immunity, Inflammation, and Infection

What is the average daily urinary output in an adult?

1.5 L

Standard Concentration of insulin

100 units/mL

Sodium

136 to 145 mEq/L

When caring for infants and the elderly who are in need of an antimicrobial agent, the nurse is aware that when compared with doses for young and middle-aged adults, these clients may require:

a lower dose.

Hyponatremia

-hypothermia, tachycardia, rapid thready pulse, hypotension, diminished peripheral pulses - headache, lethargy, confusion, muscle weakness, seizures, dizziness

1st line of immunity

-innate/natural immunity - skin, mucous membranes, normal flora -born with, does not need to be developed

2nd line of immunity

-natural immunity - nonspecific body defense

A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what?

"I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours."

The nurse is preparing to administer a sulfonamide to a client when the client states, "I woke up this morning with a lot of sores in my mouth." What is the nurse's next best action?

"I'm going to contact your health care provider before I administer your medication."

A 9-year-old was just diagnosed with type 1 diabetes. The parents state, "We hope our child won't have to take insulin injections." How should the nurse respond?

"The pancreas doesn't produce insulin in Type 1 diabetes, so it is likely that insulin injections will be necessary.

Magnesium

1.3 to 2.1 mEq/L

Diabetic Keto Acidosis (DKA)

- 3 p's - "fruity" breath odor - metabolic or electrolyte imbalances

Diabetes Type I

- 5 to 10% - little to no insulin in the body - destruction of beta cells in the pancreas - < 30 y/o - 3 p's - insulin dependent

Diabetes Type II

- 90- 95% - insulin resistance or impaired insulin secretion

Type II Diabetes

- Most people with type II are obese - Can be treated with oral antidiabetic medications and insulin - insulin resistance - peaks about the age of 50

Dawn Phenomenon

- Rise in BG between 4am-8am. - Treatment- increase the insulin dose or change the injection time of intermediate acting insulin from dinnertime to bedtime

Hypocalcemia

- alkalosis, acute pancreatitis - immobility, hyperproteinemia

Hypokalemia

- decreased blood pressure, thready weak pulse -altered mental status, anxiety, lethargy - shallow breathing

Hyperglycemic Hyperosmolar Syndrome (HHS)

- extremely high blood glucose >600

Somogyi Effect

- morning rise in BG to hyperglycemia levels after an episode of nighttime hypoglycemia - Treatment - increase bedtime snack or decrease evening dose of intermediate insulin

Gestational Diabetes

- onset during pregnancy - risk factors: previous large baby, obesity, >25, hypertension, family history

Hyperkalemia

- slow irregular pulse, hypotension - restlessness, irritability, paresthesia - diarrhea

Hypernatremia

- thirst, hyperthermia, tachycardia - restlessness, irritability, muscle twitching, respiratory compromise, thirst, dry mucous membranes, nausea, vomiting, diarrhea

Hypomagnesemia

- too little magnesium

Leukocytosis

-WBC >10,000 - indicated inflammation, infection, some malignancies, trauma, dehydration, stress, steroid use, thyroid deficiencies

3rd line of immunity

-can distinguish self from non self -heightened response, immunologic memory - natural and artificial, vaccine and exposure -passive immunity, short term

Phosphorus

3.0 to 4.5 mg/dL

Potassium

3.5 to 5.0 mEq/L

Normal WBC count

5,000-10,000

Calcium

9.0 to 10.5 mg/dL

For what client would a broad-spectrum antibiotic be most appropriate?

A client who has symptoms of infection but whose culture and sensitivity results are not yet available

Which of the following statements is true regarding gestational diabetes?

A glucose challenge test should be performed between 24 and 28 weeks

A client has been on an antibiotic for two weeks for treatment of an infection. The client asks the nurse why a superinfection has been caused by this medication. What is the nurse's best response?

Antibiotics can disrupt the normal bacteria in your body, causing another infection to occur."

A nurse is preparing to give a client an initial dose of a penicillin preparation. What should the first action be for the nurse?

Ask the client if there is a history allergy to a penicillin.

When teaching the diabetic client about foot care, what should the nurse instruct the client to do? You Selected:

Avoid going barefoot.

Insulin is secreted by which of the following types of cells?

Beta cells

The nurse is caring for Mr. Jones, who has a diagnosis of heart failure. Today's laboratory results show a serum potassium of 3.2 mEq/L. For what complications should the nurse be aware, related to the potassium level?

Cardiac dysrhythmias

A patient's most recent blood work indicates a K+ level of 7.2 mEq/L, a finding that constitutes hyperkalemia. What signs and symptoms should the nurse vigilantly monitor for?

Cardiac irregularities

An older adult client is treated for pneumonia with clindamycin. One week after the completion of the medication, the client develops diarrhea. What is the most probable cause of the diarrhea

Change in normal flora

Which would be the most significant factor in the selection of an antibiotic drug for treatment of a client's infection?

Culture and susceptibility test results

When an elderly client receiving a blood transfusion presents with an elevated blood pressure, distended neck veins, and shortness of breath, the client is most likely experiencing You Selected:

Fluid overload

The nurse may note the following signs and symptoms: reduced tissue turgor, lowered blood pressure, rapid pulse

Fluid volume deficit

Mr. Smith is admitted to your unit with a diagnosis of heart failure. His heart is not pumping effectively, which is resulting in edema and coarse crackles in his lungs. The term for this condition is which of the following?

Fluid volume excess

The nurse may note the following signs and symptoms: bounding pulse, tachycardia, confusion, shortness of breath

Fluid volume excess

Which of the following should be included in the teaching plan for a patient receiving glargine (Lantus),"peakless" basal insulin?

Do not mix with other insulins

A client loses consciousness after strenuous exercise and needs to be admitted to a health care facility. The client is diagnosed with dehydration. The nurse caring for the client knows that the client needs restoration of which of the following?

Electrolytes

The two major compartments are intravascular and interstitial

Extracellular fluid

Short acting insulin

Humulin R, Novolin R

The nurse may note the following signs and symptoms: thirst, dry, sticky mucous membranes and weakness

Hypernatremia

IV solutions with a greater volume of solutes than plasma

Hypertonic

The nurse may note the following signs and symptoms : tetany, hyperactive DTR's, Trousseau & Chovstek's signs and respiratory depression

Hypocalcemia

The nurse may note the following signs and symptoms with this electrolyte imbalance: cardiac dysrhythmias and reduced deep tendon reflexes

Hypokalemia

When an 80-year-old client who takes diuretics for management of hypertension informs the nurse she take laxatives daily to promote bowel movements, the nurse assesses the client for possible symptoms of

Hypokalemia

These IV solutions have a lower volume of solutes than plasma

Hypotonic

The nurse has educated a client about the risk for kidney damage that accompanies the client's anti-infective regimen. What should the nurse recommend to the client in order to reduce the risk of renal damage?

Increase intake of fluids.

The nurse, along with a nursing student, is caring for Mrs. Roper, who was admitted with dehydration. The student asks the nurse where most of the body fluid is located. The nurse should answer with which of the following fluid compartments?

Intracellular

This fluid constitutes approximately 2/3 of the total body fluid in adults

Intracellular fluid

These IV fluids are often used to restore Vascular volume

Isotonic

Which best explains the role of mucus as a barrier for the body's defense?

It traps the foreign material and thus inactivates it.

The client is taking furosomide. The nurse notes this electrolyte is excreted from the body when administered.

K

An older adult client is prescribed an anti-infective agent. Which would the nurse need to keep in mind?

Liver and kidney function may be reduced, requiring cautious use

A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver?

Metformin

The nurse recognizes a client on intestinal suction or a client with alcohol withdrawal is prone to this electrolyte loss

Mg

Mr. Jones is admitted to your unit from the emergency department with a diagnosis of hypocalcemia. His laboratory results show a serum calcium level of 8.2 mg/dL. For what assessment findings will you be looking?

Muscle cramping and tetany

Mr. Jones is admitted to your unit from the emergency department with a diagnosis of hypokalemia. His laboratory results show a serum potassium of 3.2 mEq/L. For what manifestations will you be alert?

Muscle weakness, fatigue, and dysrhythmias

Intermediate acting insulin

NPH (Humulin N, Novolin N)

Which intervention is necessary to perform prior to initiating antibiotic therapy?

Obtain a specimen for culture and sensitivity.

When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions?

Ototoxicity and nephrotoxicity

What is the only insulin that can be given intravenously?

Regular

The classic signs of inflammation include:

Rubor, swelling, and pain

client who is 32 weeks pregnant has been diagnosed with a urinary tract infection. The nurse would immediately question any prescription for a sulfonamide based on what risk?

Sulfonamides can cause a life-threatening toxicity for the fetus.

What does the clinical presentation of an inflammatory reaction include?

Swelling Pain Heat Redness

A client is prescribed ciprofloxacin for a urinary tract infection. The nurse is preparing to teach the client about the medication. What must the nurse include in the education plan? You Selected:

Take precautions to prevent photosensitivity.

A 6-year-old client is prescribed a narrow-spectrum antibiotic. What is meant by "narrow-spectrum antibiotic"?

The antibiotic is effective against only a select few pathogens

Based on a physical assessment, the nurse suspects that a client was given tetracycline as a young child. What physical characteristic led the nurse to this conclusion?

Tooth color

An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have?

Type 2 diabetes mellitus

Leukopenia

WBC count <4000

The 80 y/o patient is at risk for FVD. What assessment would be the most reliable indicator of FVD?

Weight

In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history?

abrupt onset of polyuria, nocturia, and polydipsia

A harried mother of four preschoolers voices confusion during their pediatric appointment that three of her immunized children avoided contracting chicken pox but the fourth "had a hard case." After describing the benefits the vaccine provided her children, the nurse explains that her three children avoided infection due to their:

active immunity.

What results indicate hypoglycemia?

blood glucose level below 70 mg/dL

The health care provider is selecting an antibiotic for a client with a known penicillin allergy. The provider knows that cephalosporins are a poor choice for this client because cephalosporins: You Selected:

can cause allergic reactions in clients who are allergic to penicillins

The nurse is caring for a child with type 1 diabetes mellitus. The nurse notes that the child is drowsy, has flushed cheeks and red lips, a fruity smell to the breath, and there has been an increase in the rate and depth of the child's respirations. The nurse recognizes that these symptoms indicate the child has:

diabetic ketoacidosis.

A 29-year-old client has gestational diabetes. The nurse is teaching her about managing her glucose levels. Which therapy would be most appropriate for this client

diet

polyphagia

excessive hunger

polydipsia

excessive thirst

polyuria

excessive urination

Long acting insulin

glargine, detemir, lantas

Rapid acting insulin

lispro, aspart, glulisine

insulin

lowers blood glucose levels

A patient's serum sodium level is 126 mEq/dL. What assessment findings would the nurse expect?

muscle cramps and twitching

Which client has more extracellular fluid?

newborn

A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply.

obesity hypertension previous large-for-gestational-age (LGA) infant

A client has been admitted to the critical care unit with a diagnosis of peritonitis that has necessitated treatment with gentamicin. As a result, the care team should be cautious when concurrently administering other medications that may cause which?

ototoxicity or nephrotoxicity.

A client is receiving aminoglycosides for a severe infection. The client reports an increasing ringing in the ears. The nurse realizes this is indicative of:

ototoxicity.

glucagon

raises blood glucose levels

In the inflammation process, vasodilation of the arterioles and congestion in the capillary beds result in:

redness

Some anti-infective medications are more powerful when given in combination. This means that they are:

synergistic.

An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with

vancomycin.

Cardinal signs of inflammation

warmth, redness, swelling, pain, loss of function