Path Prep U

A client with type 2 diabetes experiences unexplained elevations of fasting blood glucose in the early morning hours. Which conditions can account for this effect?

-Dawn phenomenon- The dawn phenomenon involves increased levels of fasting blood glucose or insulin requirement between the hours of 5 and 9 in the morning. It is not preceded by hypoglycemia. Circadian release of growth hormone and cortisol may be contributing factors. The other answer selections are not characterized by increased early morning levels of blood glucose.

A client in the hospital is frustrated at the inconvenience of having to collect his urine for an entire day and night as part of an ordered 24-hour urine-collection test. The client asks the nurse why the test is necessary since the client provided a single urine sample 2 days prior. How could the nurse best respond?

24-hour urine tests are often used to quantify the amount of substances, such as proteins, that an individual's kidneys are spilling. Single urine samples are able to assess more parameters than just the presence of bacteria, and they are sufficient in quantity to detect numerous substances such as glucose.

The nurse is caring for a client with metabolic alkalosis. Which of these arterial blood gas results supports this diagnosis?

A diagnosis of metabolic acidosis is made on the basis of decreased pH and HCO3 levels. A pH of 7.25 is well below the reference range of 7.35 - 7.45 and an HCO3 level of 18 mEq/L is below the reference range of 22 - 26 mEq/L. A ph level that is above the reference range suggests alkalosis, not acidosis. Similarly, an HCO3 level about the reference range is associated with alkalosis.

Which factor contributes to an infant developing macrosomia (large body size)?

A mother with diabetes during pregnancy is more likely to have a larger fetus, especially if the diabetes is uncontrolled. The other factors may cause the infant to be small for gestational age (SGA).

Which maternal factor contributes to an infant having macrosomia, hypoglycemia, and hyperbilirubinemia?

A mother with diabetes is more likely to have a large body size (macrosomia), especially if the diabetes is uncontrolled. Other fetal abnormalities include hypoglycemia, hypocalcemia, polycythemia, and hyperbilirubinemia. The other factors contribute primarily to the infant being small for gestational age (SGA). The other disorders do not necessarily lead to a high birth weight.

A nurse is caring for a client whose serum potassium level is 2.6 mEq/L (2.6 mmol/L). The nurse anticipates which intervention will be prescribed?

A potassium level of 2.6 mEq/L (2.6 mmol/L) indicates hypokalemia. Potassium may be given intravenously, but the rapid infusion of potassium chloride can cause death from cardiac arrest. Health personnel who assume responsibility for administering intravenous solutions that contain potassium should be fully aware of all the precautions pertaining to their dilution and flow rate. Renal dialysis and treatment with IV infusion of insulin and glucose are treatments for hyperkalemia, not hypokalemia.

An adult client is scheduled for testing of a suspected growth hormone (GH)-secreting tumor. Which result from the glucose suppression test would confirm the condition?

A suppression test is intended to determine if an organ that is oversecreting will respond to feedback to suppress that hormone. The glucose suppression test is used for an adult with acromegaly from excessive GH production. Normally, glucose would cause a decrease in GH secretion, but there is increased production of GH in response to the glucose in the test when the client has acromegaly.

The type of hypersensitivity reaction that is mediated by IgG or IgM antibodies directed against target antigens on specific host cell surfaces or tissues is also known as which type of hypersensitivity reaction?

A type I hypersensitivity reaction is dependent on IgE-mediated activation of mast cells and basophils and the subsequent release of chemical mediators of the inflammatory response. Type II hypersensitivity reactions are mediated by IgG or IgM antibodies directed against target antigens on specific host cell surfaces or tissues and result in complement mediated phagocytosis and cellular injury. Type III hypersensitivity is caused by the formation of antigen-antibody immune complexes in the bloodstream, which are subsequently deposited in vascular epithelium or extravascular tissues and which activate the complement system and induce a massive inflammatory response. Type IV hypersensitivity involves tissue damage in which cell-mediated immune responses with sensitized T lymphocytes cause cell and tissue injury.

A client is admitted with worsening heart failure. The client is reporting frequent urination recently. The nurse knows that the physiology behind the body's response to decreased vascular volume by increasing urine output is due to:

ANP is believed to play an important role in salt and water excretion by the kidney. It is synthesized by muscle cells in the atria of the heart and released when the atria are stretched. Increased levels of this peptide directly inhibit the reabsorption of sodium and water in the renal tubules. ANP also inhibits renin secretion and therefore angiotensin II formation, which in turn reduces reabsorption of sodium. The decrease in sodium reabsorption increases urine output and helps return blood volume to normal. ANP levels, which become elevated when the atria are stretched in HF, help to decrease vascular volume by increasing urine output. Potassium reabsorption is not responsible for water excretion. Aldosterone secretion by the adrenal gland functions in the regulation of sodium and potassium elimination by the principal cells in the distal and collecting tubules.

A man is brought into the emergency department by paramedics who state that the client passed out on the street. The man smells of alcohol, and when roused says he has not eaten since yesterday. He is wearing a medic alert bracelet that says he is a diabetic. What would the nurse suspect as a diagnosis?

Alcohol decreases liver gluconeogenesis, and people with diabetes need to be cautioned about its potential for causing hypoglycemia, especially if alcohol is consumed in large amounts or on an empty stomach.

What is a common source of interleukin-1 (IL-1), interleukin-6 (IL-6), and interleukin-12 (IL-12)?

All of the mentioned interleukins can have macrophages as their source. The other options are sources for only some of these interleukins.

A client presents to the urgent care clinic with erythematous, papular, and vesicular lesions associated with intense pruritus and weeping. The client states he was in the woods and thinks he may have come in contact with poison ivy. The reaction may be classified as:

Allergic contact dermatitis denotes an inflammatory response confined to the skin that is initiated by re-exposure to an allergen to which a person had previously become sensitized. The most common form of this condition is the dermatitis that follows an encounter with poison ivy or poison oak antigens, although many other substances can trigger a reaction. Contact dermatitis is characterized by erythematous, papular, and vesicular lesions associated with intense pruritus and weeping. Allergic rhinitis is characterized by symptoms of sneezing, itching, and watery discharge from the nose and eyes. Allergic rhinitis not only produces nasal symptoms but frequently is associated with other chronic airway disorders, such as sinusitis and bronchial asthma.

A client has been admitted to the hospital for the treatment of HIV infection, which has recently progressed to overt AIDS. Which nursing action should the nurse prioritize when providing care for this client?

Although all of the cited assessments and interventions may be of some value, infection control and the early identification of potential respiratory infections are paramount in the care of clients with AIDS.

When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which organ does the nurse recognize is reliant on glucose as the major energy source?

Although many tissues and organ systems are able to use other forms of fuel, such as fatty acids and ketones, the brain and nervous system rely almost exclusively on glucose as a fuel source. Because the brain can neither synthesize nor store more than a few minutes' supply of glucose, normal cerebral function requires a continuous supply from the circulation.

In which client would the nurse be most likely to assess the signs and symptoms of an acid-base imbalance?

An elevated PCO2 is commonly associated with respiratory acidosis because excess CO2 ultimately increases the concentration of H+ ions. Increased intracranial pressure, oxytocin infusion, and the administration of hypotonic fluids are not directly linked to common alterations in acid-base balance.

The nurse is administering a unit of packed red blood cells to a client and piggybacks the unit of blood through a solution of 0.9% NaCl. Blood cells placed in a solution of 0.9% saline will do which of the following?

An example of an isotonic solution is 0.9% NaCl. Cells placed in an isotonic solution, which has the same effective osmolality of the intracellular fluid, neither shrink nor swell.

A student asks the faculty member, "I just do not get how a hormone can be produced within a neuron and then travel via the blood to affect target cells. Can you give me a couple of examples of this phenomenon?" Which faculty response(s) answers this student's question? Select all that apply.

Antidiuretic hormone Epinephrine Neuroendocrine actions are when a hormone produced within a neuron then travels through circulation to exert effects on target cells. Vasopressin (antidiuretic hormone) and epinephrine are examples of hormonal substances with neuroendocrine effects. Sex steroids is a paracrine action. Paracrine action or signaling is a form of cell-to-cell communication in which a cell produces a signal to induce changes in nearby cells, altering the behavior of those cells. Insulin is an autocrine hormone. Autocrine action is a mode of hormone action to which hormones bind to receptors on the cell and affects the cell that produces it, like when growth factors that stimulate cell division. Paracrine describes hormone action where hormones are released from cells and bind to receptor on nearby cells and affects their function. The anterior pituitary gland secretes LH which stimulates secretion of testosterone development of interstitial tissue of testes. There is no neuroendocrine action involved in the secretion of testosterone.

The nurse is explaining to a colleague the basis of a client's allergy to dust. What statement by the nurse most accurately describes antigens in this situation?

Antigens are any molecule that can stimulate an immune response. Antibodies are polypeptides. Cytokines communicate critical information. Interferons disrupt viral multiplication.

The nurse is caring for a client with hyperthyroidism and is preparing to administer the morning medications. Which medication will the nurse administer in order to block the conversion of T4 to T3 in the tissues?

Antithyroid drugs prevent the thyroid gland from converting iodine to its organic form and block the conversion of T4 to T3 in the tissues (PTU only). Aspirin should never be used, especially in clients who have symptoms of thyroid storm. Beta-blockers block the effects of the hyperthyroid state on sympathetic nervous system function. Levothyroxine is a synthetic thyroid hormone and would be used only in hypothyroid states.

When caring for a client with hypomagnesemia, the nurse prioritizes assessment of which body system?

Assessment of the cardiac system is essential as magnesium is needed for proper nervous system function and to maintain the tone of the blood vessels. Low magnesium levels produce an increase in irritability of the heart causing cardiac dysrhythmias. The nurse should assess for tachycardia, hypertension, and cardiac dysrhythmias.

Select the statement that best describes autoimmune disease.

Autoimmune diseases represent a disruption in self-tolerance that results in damage to body tissues by the immune system. Autoimmunity results from a failure of tolerance. Autoimmune disorders may be triggered by environmental stimuli, such as infections, in a genetically predisposed individual. Overuse of antibiotics, however, does not lead to autoimmune diseases.

The cells that mediate humoral immunity do so because they are capable of producing:

B lymphocytes (B cells) are the only cells capable of producing antibodies; therefore, they are the cells that mediate humoral immunity. B lymphocytes (B cells) differentiate into plasma cells that produce the needed immunoglobulins (antibodies) for responding to that particular antigen. Stem cells are undifferentiated cells. T helper cells differentiate into cytotoxic and other T-cell forms.

When providing nutrition education to the client with diabetes, the nurse should include which statement regarding fat intake?

Because diabetes is a risk factor for cardiovascular, cerebrovascular, and peripheral vascular disease, it is recommended that less than 7% of daily calories should be obtained from saturated fat and that dietary cholesterol be limited to 200 mg or less, and intake of trans fats minimized.

The treatment of HIV/AIDS is complicated because different drugs act on different stages of the replication cycle of the virus. Therefore, treatment includes combinations of two, three, or more drugs. What is this treatment called?

Because different drugs act on different stages of the replication cycle, optimal treatment includes a combination of at least two to three drugs, often referred to as HAART [highly active antiretroviral therapy]. The goal of HAART is sustained suppression of HIV replication, resulting in an undetectable viral load and an increasing CD4+ cell count. The other treatments are not used in the treatment of HIV/AIDS.

Which regimen serves as the rationale for AIDS treatment with antiretroviral therapy?

Because different drugs act on various stages of the replication cycle, optimal treatment includes a combination of drugs, including reverse transcriptase inhibitors, protease inhibitors, fusion/entry inhibitors, and integrase inhibitors, and multidrug combination products. Each type of agent attempts to interrupt viral replication at a different point.

Which medication may be responsible for a client developing increased uric acid levels by decreasing ECF volume?

Because of its effect on uric acid secretion, aspirin is not recommended for treatment of gouty arthritis. Thiazide and loop diuretics also can cause hyperuricemia and gouty arthritis, presumably through a decrease in ECF volume and enhanced uric acid reabsorption.

Which treatment regimen is most likely to result in stable blood glucose levels for a client with a diagnosis of type 1 diabetes?

Because of the loss of insulin response, all people with immune-mediated type 1 diabetes require exogenous insulin replacement to reverse the catabolic state, control blood glucose levels, and prevent ketosis.

The pancreas is an endocrine organ that is composed of the acini and the islets of Langerhans. The islets of Langerhans have alpha, beta, and delta cells as well as the PP cell. Which cells secrete insulin?

Beta cells Each islet is composed of beta cells that secrete insulin and amylin, alpha cells that secrete glucagon, and delta cells that secrete somatostatin. In addition, at least one other type of cell, the PP cell, is present in small numbers in the islets and secrets a hormone of uncertain function called pancreatic polypeptide.

The nurse recognizes the role of the lungs in acid-base balance is regulation of which of the following?

Carbon dioxide (CO2) is regulated by the lungs. HCO3 and H+ are regulated by kidneys.

The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding?

Cardiovascular and respiratory functions are strongly affected by thyroid function. With an increase in metabolism, there is a rise in oxygen consumption and production of metabolic end products, with an accompanying increase in vasodilation. Blood volume, cardiac output, and ventilation are all increased. Heart rate and cardiac contractility are enhanced as a means of maintaining the needed cardiac output. Blood pressure is likely to change little because the increase in vasodilation tends to offset the increase in cardiac output.

Potassium is the major cation in the body. It plays many important roles, including the excitability of nerves and muscles. Where is this action particularly important?

Changes in nerve and muscle excitability are particularly important in the heart, where alterations in plasma potassium can produce serious cardiac dysrhythmias and conduction defects.

In both the innate and adaptive immune systems, cells communicate information about invading organisms by the secretion of chemical mediators. Which are these mediators? Select all that apply.

Chemokines Colony-stimulating factors

A client is suffering from the effects of the opportunistic infection, Cryptosporidium parvum. An important nursing intervention would be to encourage which action?

Crytosporidium parvum has clinical features ranging from mild diarrhea to severe, watery diarrhea with a loss of up to several liters per day. Hydration is an important consideration.

As part of maintaining homeostasis, why are hormones, secreted by endocrine cells, continuously inactivated?

Continuous inactivation of secreted hormones is necessary to prevent accumulation that could disrupt the feedback mechanism. Increased secretion stimulates production of more receptor sites. Metabolic waste absorption is not a function of the endocrine system.

A client is diagnosed with adrenocorticotropic hormone deficiency (ACTH) and is to begin replacement therapy. Regarding which type of replacement will the nurse educate the client?

Cortisol replacement is started when ACTH deficiency is present; thyroid replacement when TSH deficiency is detected; and sex hormone replacement when LH and FSH are deficient. GH replacement is indicated for pediatric GH deficiency, and is increasingly being used to treat GH deficiency in adults.

A nurse is teaching a client scheduled for a cystoscopy about the procedure. Which statement made by the client verifies that the teaching has been successful?

Cystoscopy provides a means for direct visualization of the urethra, bladder, and ureteral orifices. It relies on the use of a cystoscope, an instrument with a lighted lens. The cystoscope is inserted through the urethra into the bladder. Biopsy specimens, lesions, small stones, and foreign bodies can be removed from the bladder.

Once T helper cells are activated, they secrete which substance that activates and influences nearly all of the other cells of the immune system?

Cytokines activate and regulate B cells, cytotoxic T cells, natural killer (NK) cells, macrophages, and other immune cells. The ability of the cells of both the innate and adaptive immune systems to communicate critical information with each other and initiate effector cell responses is dependent upon the secretion of short-acting, biologically active, soluble substances called cytokines. Complement is activated in the inflammatory response. Leukotrienes and bradykinin are also a part of the inflammatory response.

A clinical research study is evaluating cells that bridge both the innate and adaptive immune systems. A nurse has identified the dendritic cells (DCs) as a key component. Which statement validates this finding?

Dendritic cells (DCs) are specialized, bone marrow-derived leukocytes found in lymphoid tissue and are the bridge between the innate and adaptive immune systems. They are present primarily in an immature form that is available to directly sense pathogens, capture foreign agents, and transport them to secondary lymphoid tissues. Once activated, DCs undergo a complex maturation process in order to function as key antigen-presenting cells (APCs) capable of initiating adaptive immunity. They are responsible for the processing and presentation of foreign antigens to the lymphocytes.

The nurse is caring for a client who receives hemodialysis. The nurse knows that hemodialysis involves movement of charged or uncharged particles along a concentration gradient. Which function best describes this process?

Diffusion is movement of charged or uncharged particles along a concentration gradient. Osmosis is the movement of water across a semipermeable membrane.

When caring for a client with dehydration, the nurse anticipates the client will have an alteration in which substance in the blood?

During periods of dehydration, the blood volume and GFR drop, and BUN levels increase. The renal tubules are permeable to urea, which means that the longer the tubular fluid remains in the kidneys, the greater the reabsorption of urea into the blood.

Infants are born with a passive immunity that occurs when immunoglobulin antibodies cross the placenta from the maternal circulation prior to birth. Which immunoglobulin is capable of crossing the placenta?

During the first few months of life, infants are protected from infection by IgG antibodies that have been transferred from the maternal circulation during fetal life. IgA, IgM, IgD, and IgE do not normally cross the placenta.

Which cellular mediator is involved in the development of type I hypersensitivity reactions?

Early in the immediate response to allergen exposure, mast cells degranulate and release mediators that include histamine and heparin. Plasma cells and monocytes respond as part of the acute immune response. Arachidonic acid is part of the late-phase response to the allergen.

The nurse is assessing a male client and finds abnormally large hands and feet, a bulbous nose, and a broad face with a protruding jaw. Based on these findings, which endocrine abnormality is most likely the cause for these physical changes?

Enlargement of the small bones of the hands and feet and of the membranous bones of the face and skull results in a pronounced enlargement of the hands and feet, a broad and bulbous nose, a protruding jaw, and a slanting forehead. Bone overgrowth often leads to arthralgias and degenerative arthritis of the spine, hips, and knees. Virtually every organ of the body is increased in size. Enlargement of the heart and accelerated atherosclerosis may lead to an early death. Hyperthyroidism results from excess thyroid hormone. Myxedema and Cushing syndrome are the result of adrenal abnormalities and do not cause these bone changes.

Which complications may be experienced by a client with diabetic neuropathies? Select all that apply.

Foot ulcers Gastroparesis Erectile dysfunction Urinary retention Neuropathies may be distal or autonomic. People with peripheral neuropathies lose perception of pain, vibration, and temperature usually in the distal extremities. This leads to injuries and foot ulcers. Autonomic neuropathies lead to gastroparesis, urinary retention, altered bowel patterns, and orthostatic hypotension.

After having a very stressful day in pathophysiology class, the student knows that which hormone (secreted by the adrenal cortex) will help decrease the effects of stress?

Glucocorticoids, mainly cortisol, affect metabolism of all nutrients; regulate blood glucose levels; affect growth; have anti-inflammatory action; and decrease effects of stress. The other hormones do not affect stress levels.

The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL (48.67 mmol/L). The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time?

Goals of care for clients with DKA include administration of insulin and intravenous fluid and electrolyte replacement solutions. A common reason for development of DKA is an infection; monitoring for a fever should not take priority over administration of insulin and fluid replacement.

Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of:

Graves disease is an autoimmune disorder characterized by abnormal stimulation of the thyroid gland by thyroid-stimulating antibodies (TSH-receptor antibodies) that act through the normal TSH receptors.

A client asks the nurse what causes the secretion of growth hormone (GH) and adrenocorticotrophic hormone (ACTH) to fluctuate. The best response by the nurse would be:

Growth hormone (GH) and adrenocorticotropic hormone (ACTH) have diurnal fluctuations that vary with the sleep-wake cycles. Others, such as the female sex hormones, are secreted in a complicated cyclic manner. The levels of hormones such as insulin and antidiuretic hormone (ADH) are regulated by feedback mechanisms that monitor substances such as glucose (insulin) and water (ADH) in the body.

What is the main effect of HIV infection?

HIV infects a limited number of cell types in the body, including a subset of lymphocytes called CD4+T lymphocytes (also known as T-helper cells or CD4+T cells). The CD4+T cells are necessary for normal immune function. Among other functions, the CD4+T cell recognizes foreign antigens and helps activate antibody-producing B lymphocytes. The phagocytic function of monocytes and macrophages is also influenced by CD4+T cells.

Which is least likely to contribute to the spread of HIV infection?

HIV is not spread through mosquitoes or other vectors. All the other options are known methods of spreading HIV.

Type 1A diabetes

autoimmune destruction of pancreatic beta cells

Hormones are chemical messengers that provide which function in the body?

Hormones regulate and integrate body functions. Hormones act on specific target cells, but they cause a variety of effects on tissues. Hormones do not transport other substances; hormones are transported and present in body fluids at all times.

A nurse suspects that a client with a plasma magnesium level of 1.2 mg/dL (0.60 mmol/L) may have which condition in his or her history?

Hypomagnesemia commonly occurs from excess alcohol use. None of the other options would result in low magnesium.

A nurse is caring for a client with hypoparathyroidism. Which imbalance is a major concern for the client?

Hypoparathyroidism reflects deficient parathyroid hormone (PTH) secretion, resulting in hypocalcemia. The main function of PTH is to maintain the calcium concentration of the extracellular fluid.

A community health nurse who is attending a marathon recognizes that which types of hypotonic hyponatremia is likely when a client reports muscle weakness, cramping, and general fatigue in spite of adequate water hydration during the run?

Hypovolemic hypotonic hyponatremia develops when water, rather than electrolyte-containing liquids, is used to replace fluids lost in sweating. This may also be caused by gastrointestinal sodium loss caused by frequent irrigations with distilled water as well as by adrenal insufficiency. Hypervolemic problems are caused by excess water. The terms "euvolemic" and "normovolemic" are synonymous.

The nurse is assisting a new mother with breastfeeding. What does the nurse understand is a primary secretory immunoglobulin (Ig) that is found in the colostrum?

IgA is primarily a secretory Ig that is found in saliva, tears, colostrum, and bronchial, gastrointestinal, prostatic, and vaginal secretions. Because it is found in secretions, its primary function is in local immunity on mucosal surfaces. IgA prevents the attachment of viruses and bacteria to epithelial cells.

Which immunoglobulin (Ig) is released in response to allergy or parasitic infections?

IgE is secreted in response to inflammation and allergy and is released in the presence of parasitic infection. IgG is responsible for antiviral, antitoxin, and antibacterial responses. IgA is found in body secretions and helps with local immunity on mucosal surfaces. IgM is the first antibody developed by an infant. IgD helps B cells mature.

The nurse is aware that the only class of immunoglobulins to cross the placenta is:

IgG is the only class of immunoglobulins to cross the placenta. Levels of maternal IgG decrease significantly during the first 3 to 6 months of life, while infant synthesis of immunoglobulins increases.

A newborn has been lethargic, is not nursing well, and is basically looking ill. Following lab tests, it has been found that the newborn has IgM present in his blood. How should the nurse interpret this finding?

IgM is the first immunoglobulin to appear in response to antigen and is the first antibody type made by a newborn. This is diagnostically useful because the presence of IgM suggests a current infection in the infant by a specific pathogen. IgE is involved in inflammation, allergic responses, and combating parasitic infections. It binds to mast cells and basophils. The binding of antigen to mast cell- or basophil-bound IgE triggers these cells to release histamine and other mediators important in inflammation and allergies. IgA is found in saliva and tears, and is a primary defense against infections in mucosal tissues.

A 30-year-old client who manages type 2 diabetes with glyburide presents at the emergency room reporting headache, confusion, and tachycardia. The client has come from a party at which the client drank two beers to celebrate running a half-marathon. Which is likely to be the cause of this client's?

In hypoglycemia, headache, difficulty in problem solving, disturbed or altered behavior, coma, and seizures may occur. At the onset, activation of the parasympathetic nervous system often causes hunger, and the initial parasympathetic response is followed by activation of the sympathetic nervous system; this causes anxiety, tachycardia, sweating, and constriction of the skin vessels (i.e., the skin is cool and clammy). In diabetic ketoacidosis, the client typically has a history of one or two days of polyuria, polydipsia, nausea, vomiting, and marked fatigue. Abdominal pain and tenderness may be experienced without abdominal disease, and the breath has a characteristic fruity smell. The most prominent manifestations of hyperosmolar hyperglycemic state are dehydration and neurologic signs including grand mal seizures, hemiparesis, Babinski reflexes, aphasia, muscle fasciculations, hyperthermia, hemianopia, nystagmus, and visual hallucinations; the client will also experience excessive thirst. The Somogyi effect describes a cycle of insulin-induced posthypoglycemic hyperglycemic episodes.

The nurse caring for a client with metabolic acidosis examines arterial blood gas (ABG) results. Which change from the initial value indicates the client's metabolic acidosis is improving?

In metabolic acidosis, the client has a net loss of bicarbonate (HCO3-), which creates a drop in pH. The pH needs to move away from acidosis, which is the low end of the pH scale, for the client's condition to demonstrate improvement. To raise the pH, either the bicarbonate level needs to increase or the carbon dioxide (CO2) level needs to decrease. Oxygen (O2) concentration is reported on ABG results, but does not indicate acid-base balance.

A client has recently received a pneumococcal vaccine and the client's B cells are consequently producing antibodies. Which cells may enhance this production of antibodies?

In order for B lymphocytes to produce antibodies, they require the help of specific T lymphocytes, called helper T cells, which help B lymphocytes produce antibodies. Natural killer cells as well as regulatory and cytotoxic T cells do not perform this function.

During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur?

In predisposed persons, the prolonged elevation of glucocorticoid hormones can lead to hyperglycemia and the development of diabetes mellitus and starvation. They stimulate gluconeogenesis by the liver, sometimes producing a 6- to 10-fold increase in hepatic glucose production. A prolonged increase in glucocorticoid hormones does not cause hepatomegaly, portal hypertension, or adrenal hyperplasia.

The nurse is educating a client about renal disease. Which percentage of cardiac output perfuses the kidneys?

In the adult, the kidneys are perfused with 1000 to 1300 mL of blood per minute, or 22% to 25% of the cardiac output; 10% to 15% and 15% to 20% represent a decreased percentage; 27% to 30% is an increased percentage.

The nurse is reviewing the laboratory work of several medical clients. Which laboratory result is most suggestive of abnormalities in kidney function?

Increased creatinine and BUN is associated with abnormalities in renal function, as is the presence of glucose in a urine sample. Urine samples normally lack protein and have a specific gravity of 1.030 to 1.040. An elevated BUN coupled with normal creatinine is likely not attributable to impaired kidney function.

The nurse is caring for an infant wih DiGeorge syndrome. Which organ does the nurse know will be underdeveloped or absent?

Infants born with DiGeorge syndrome usually have partial or complete failure of development of the thymus and parathyroid glands and have congenital defects of the head, neck, palate, and heart. In some children, the thymus is not absent but is extremely small and located outside of the mediastinum.

Which metabolic abnormality can lead to the development of type 2 diabetes?

Insulin Resistance The metabolic abnormalities that lead to type 2 diabetes include (1) peripheral insulin resistance, (2) deranged secretion of insulin by the pancreatic beta cells, and (3) increased glucose production by the liver. Obese people have increased resistance to the action of insulin and impaired suppression of glucose production by the liver, resulting in both hyperglycemia and hyperinsulinemia. Lifestyle and overeating seem to be the triggering events (rather than metabolic abnormalities). Acute pancreatitis is a reversible impairment of alpha and beta cell function, with hypoinsulinemia as a complication.

Which are examples of a negative feedback system? Select all that apply.

Insulin and glucagon Cortisol and adrenocorticotropic hormone Somatostatin and thyroid-stimulating hormone (TSH) Calcium and parathyroid hormone In negative feedback, sensors detect a change in hormone levels and adjust hormone secretion to maintain optimal levels. In positive feedback control, rising levels of a hormone cause another gland to release a hormone that stimulates the first. Release of the female hormone estradiol during the follicular stage of the menstrual cycle causes increased release of gonadotropin (FSH), which further increases release of estradiol until the follicle dies and ceases production.

A client with hereditary angioneurotic edema (HAE) is experiencing an attack. Which priority intervention should the nurse be prepared to administer?

Laryngeal edema is a life-threatening manifestation that can lead to complete airway obstruction and death without intervention. Although vomiting may occur due to the swelling of the structures of the gastrointestinal mucosa, the priority intervention would be maintaining a patent airway.

Which statement explains how T lymphocytes and B lymphocytes differ?

T lymphocytes mature in the thymus gland; B lymphocytes mature in the bone marrow.

The nurse is teaching a client with diabetes about medications that will increase the blood glucose level. Which information would be most important for the nurse to provide? Select all that apply.

Loop diuretics Oral contraceptives Total parenteral nutrition Antipsychotics Several diuretics—thiazide and loop diuretics—can elevate blood glucose. Other drugs and therapies known to cause hyperglycemia include diazoxide, glucocorticoids, oral contraceptives, antipsychotic agents, and total parenteral nutrition. Insulin would cause a decrease in blood glucose. Vitamins will not alter the levels.

A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37 mEq/L (37 mmol/L). The nurse suspects the client may be experiencing:

Metabolic alkalosis is characterized by a serum pH greater than 7.45; serum HCO3− greater than 29 mEq/L (29 mmol/L); and a base excess greater than 3.0. Transient or acute alkalosis is common during or immediately following excess oral ingestion of bicarbonate antacids. Respiratory acidosis as well as metabolic acidosis would have a decrease in pH. Respiratory alkalosis would have an increase in pH and a HCO3− less than 24 mEq/L (24 mmol/L).

The nurse is teaching a group of nursing students about the mechanism of action of common diuretics. What best reflects the mechanism of these drugs?

Most diuretics share the same mechanism of action—blockade of sodium and chloride reabsorption. By blocking the reabsorption of these solutes, diuretics create an osmotic pressure gradient within the nephron that prevents the passive reabsorption of water. Thus, diuretics cause water and sodium to be retained in the nephron, promoting the excretion of both.

A client experiences an increase in thyroid hormone as a result of a thyroid tumor. Which hormonal response demonstrates the negative feedback mechanism?

Negative feedback occurs when secretion of one hormone causes a reduction in the secretion of the hormone that stimulates production of the first hormone. In this case, TSH, which is manufactured by the anterior pituitary gland, would normally stimulate release of thyroid hormones, but with the increase of those hormones by the secreting tumor, enough thyroid hormones flood the system that there should be a reduction in TSH levels.

When caring for clients with disorders of sodium balance, the nurse know that which finding is consistent with hypernatremia?

Normal serum sodium is between 135 mEq/L and 145 mEq/L. Hypernatremia-elevated sodium level-implies a plasma sodium level above 145 mEq/L. Because of extra particles in the bloodstream, serum osmolality is greater than 295 mOsm/kg.

Select the statement that best describes the effectiveness of vaccination in the older adult population.

Older adults tend to be more susceptible to infections, have more evidence of autoimmune and immune complex disorders than younger persons, and have a higher incidence of cancer. Experimental evidence suggests that vaccination is less successful in inducing immunization in older persons than in younger adults. However, the effect of altered immune function on the health of older adults is clouded by the fact that age-related changes or disease may affect the immune response.

Water movement from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water is termed:

Osmosis is the force that moves water from the side of the membrane having a lesser number of particles and greater concentration of water to the side having a greater number of particles and lesser concentration of water. Active transport is the movement of ions against an electrical or chemical gradient. Diffusion is the process by which particles in solution move from an area of higher concentration to lower, resulting in equal distribution. Filtration is the process of passing a liquid through a filter that is accomplished by gravity, vacuum, or pressure.

A client comes into a clinic complaining of cough, fever, shortness of breath. The client informs the health care provider he is HIV positive. Upon physical exam, the family nurse practitioner (FNP) may note which clinical manifestations of suspected Pneumocystic jiroveci pneumonia (PCP)? Select all that apply.

PCP is a common presenting manifestation of AIDS or people with compromised immune systems. The symptoms include cough, fever, shortness of breath, and weight loss. Physical exam demonstrates only fever and tachypnea [elevated respiratory rate], and normal breath sounds. Chest x-ray shows interstitial infiltrates. Night sweats are usually associated with tuberculosis infection.

A woman experiences a viral infection while pregnant. Which type of immunity does an infant have at birth against this infection?

Passive immunity is when the antibodies against an antigen are transferred directly to the host, such as when a fetus gains from the mother's immune system. Active immunity is acquired through exposure to antigens, and having the B and T lymphocytes develop a response. Tolerance is the ability of the immune system to react to foreign substances but not the body cells. Adaptive immunity is when the immune system responds to antigens and is moderated by B and T lymphocytes.

An obese adult has recently been diagnosed with type 2 diabetes. The nurse knows that the most likely treatment plan for this client will include which topics?

Persons with type 2 diabetes would be unlikely to require insulin initially and oral medications are likely to be of benefit as an addition to weight loss and glucose monitoring.

The nurse is administering the medications to a client on the cardiac unit. Giving which medication causes the nurse to be alert for hypokalemia?

Potassium is typically lost with the use of thiazide or loop diuretics. The other groups of medications may cause an increase in potassium levels.

A client with schizophrenia is admitted to the behavioral health department and is observed drinking copious amounts of water and voiding large amounts of dilute urine. The nurse recognizes this behavior is consistent with which problem?

Psychogenic polydipsia involves compulsive water drinking and is usually seen in people with psychiatric disorders, most commonly schizophrenia. People with the disorder drink large amounts of water and excrete large amounts of urine. The cause of excessive water drinking in these people is uncertain. The condition may be compounded by antipsychotic medications that increase ADH levels and interfere with water excretion by the kidneys. Cigarette smoking, which is common among people with psychiatric disorders, also stimulates ADH secretion.

The renal control mechanism of restoring the acid-base balance is accomplished through which process?

Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms. Respiratory control mechanisms of restoring acid-base balance are done via regulation of production of carbonic acid and stimulation of the chemoreceptors in the brain.

The nurse is caring for a client who complains of headache and blurred vision. The nurse recognizes that these symptoms, accompanied by increased plasma partial pressure carbon dioxide (PCO2) level and decreased pH level, are consistent with which diagnosis?

Respiratory acidosis is reflected in the ABG as an increased PCO2 and decreased pH level as well as headache, blurred vision, irritability, muscle twitching, and psychological disturbances.

A client develops an immunodeficiency disorder after receiving chemotherapy for the treatment of lung cancer. The client asks the nurse if he was born with this deficiency. What is the nurse's best response?

Secondary immunodeficiency disorders develop later in life as a result of other pathophysiologic states such as malnutrition, disseminated cancers; infection of the cells of the immune system, most notably with human immunodeficiency virus, and treatment with immunosuppressant drugs, such as chemotherapeutic agents, corticosteroids, or transplant rejection medications.

Which statement from a group of young adults demonstrates the need for further teaching related to HIV and prevention of the spread of HIV?

Sexual contact is the most frequent mode of HIV transmission. There is a risk of transmitting HIV when semen or vaginal fluids come in contact with a part of the body that lets them enter the bloodstream. This can include the vaginal mucosa, anal mucosa, and wounds or sores on the skin. Condoms are highly effective in preventing the transmission of HIV. Unprotected sex between men is still the main mode of transmission. During the window period, a person's HIV antibody test result will be negative, but he or she can still transmit the virus.

A female client with a history of chronic renal failure has a total serum calcium level of 7.9 mg/dL (1.98 mmol/L). While performing an assessment, the nurse should focus on which clinical manifestation associated with this calcium level?

Spasms and numbness are characteristic of hypocalcemia. Respiratory effects, tachycardia, and diaphoresis are not associated with low calcium levels, whereas decreased level of consciousness can be indicative of hypercalcemia.

A client has been identified as having an excess of macrophage inhibitory factor, causing the client to have inhibited movement and activity of macrophages. Which process should the health care team expect to remain unaffected?

Specificity and memory are the defining characteristics of the adaptive immune system, and macrophages do not perform this particular role. Amplification of the immune response, destruction of virus-infected or tumor cells, and initiation of adaptive immunity are all components of macrophage activity.

The physician suspects a client may be experiencing hypofunction of an endocrine organ. Select the most appropriate test to determine organ function.

Stimulation tests are used when hypofunction of an endocrine organ is suspected. Suppression tests are used when hyperfunction of an endocrine organ is suspected. Genetic testing is used for DNA analysis, and imaging may be used as a follow-up after the diagnosis.

A 20-year-old male presents at the clinic complaining of severe fatigue, night sweats, and fever. While taking the client's history, he reports having multiple sexual partners and unprotected sex. HIV/AIDS is suspected. What diagnostic test would be ordered to confirm the diagnosis?

The HIV antibody test procedure consists of screening with an enzyme immunoassay (EIA), also known as enzyme-linked immunosorbent assay (ELISA), followed by a confirmatory test, the Western blot assay, which is performed if the EIA is positive. The complete metabolic panel cannot diagnose HIV/AIDS. The diagnostic test for HIV/AIDS is the ELISA, not the ALEA. The confirmatory test for HIV/AIDS is not the Eastern blot test.

The nurse is caring for a client who has just learned that he is HIV positive. The client asks the nurse how long he has been able to infect others. Select the best response by the nurse.

The HIV-infected person is infectious even when no symptoms are present. The point at which an infected person converts from being negative for presence of HIV antibodies in the blood to being positive is called seroconversion. The time after infection and before seroconversion is known as the window period. During the window period, a person's HIV antibody test result will be negative, but the infected person may still transmit the virus.

The initial management of anaphylaxis focuses on the establishment of a stable airway and intravenous access and the administration of epinephrine. Epinephrine produces relaxation of bronchial smooth muscle and inhibits the immediate life-threatening cardiovascular effects of anaphylaxis. All the other assessments (pulse rate, skin, and breath sounds) can be done after the airway is assessed and managed.

The Western blot is a more sensitive assay than the EIA that looks for the presence of antibodies to specific viral antigens. In the case of a false-positive EIA result, the Western blot test can identify the person as uninfected. Technologic advances have led to new forms of testing, such as the oral test, home testing kits, and the new rapid blood test. Oral fluids contain antibodies to HIV. In the late 1990s, the FDA approved the OraSure test. The OraSure uses a cotton swab, which is inserted into the mouth for 2 minutes, placed in a transport container with preservative, and then sent to a laboratory for EIA and Western blot testing.

A client has been diagnosed with an intestinal parasite. The nurse monitors laboratory test levels for which cells necessary for the activation of eosinophils that, along with IgE, functions in the control of helminths?

The activated CD4+ helper T cell can differentiate into two distinct subpopulations of helper T cells (i.e., T1H or T2H) based on the cytokines secreted by the APCs at the site of activation. T2H cells produce IL-4 and IL-5. IL-5 is an activator of eosinophils that, along with IgE, functions in the control of helminth (intestinal parasite) infections.

Hormones regulate and integrate body functions. Hormones act on specific target cells, but they cause a variety of effects on tissues. Hormones do not transport other substances; hormones are transported and present in body fluids at all times.

The activity of the hypothalamus is regulated by both hormonally mediated signals (e.g., negative feedback signals) and by neuronal input from a number of sources. Neuronal signals are mediated by neurotransmitters such as acetylcholine, dopamine, norepinephrine, serotonin, gamma-aminobutyric acid (GABA), and opioids. Cytokines that are involved in immune and inflammatory responses, such as the interleukins, also are involved in the regulation of hypothalamic function. This is particularly true of the hormones involved in the hypothalamic-pituitary-adrenal axis. Thus, the hypothalamus can be viewed as a bridge by which signals from multiple systems are relayed to the pituitary gland. This cannot be said of the other options.

The nurse is planning to collect a 24-hour urine sample for hormone assay. In which situation does the nurse collaborate with the health care provider to find an alternate type of testing?

The advantages of a urine test include the relative ease of obtaining urine samples and the fact that blood sampling is not required. The disadvantage is that reliably timed urine collections often are difficult to obtain and rely on adequate renal function. Anuria refers to the absence of urine output.

Which unit of measure best describes the concentration of solute in a particular volume of fluid based on electrolyte equivalency?

The amount of electrolytes and solutes in body fluids is expressed as a concentration or amount of solute in a given volume of fluid, such as milligrams per deciliter (mg/dL). The millequivalent is used to express the charge equivalency for a given weight of an electrolyte and is expressed as milliequivalents per liter (mEq/L).

A client with a history of brain tumors that resulted in partial removal of the pituitary gland years ago expresses concern to the health care provider about whether she will be able to breast-feed her infant. Which physiologic function of the pituitary gland facilitates breast milk production?

The anterior pituitary gland or adenohypophysis contains five cell types: (1) thyrotrophs, which produce thyrotropin, also called TSH; (2) corticotrophs, which produce corticotropin, also called ACTH; (3) gonadotrophs, which produce the gonadotropins, LH and FSH; (4) somatotrophs, which produce GH; and (5) lactotrophs, which produce prolactin that is involved with breast growth and milk production.

The nurse has just administered a Mantoux test to a client. Select the reaction that best describes the anticipated response.

The best-known DTH response is the reaction to the tuberculin test, in which inactivated tuberculin or purified protein derivative is injected under the skin. In a person who has been sensitized by previous infection, a local area of redness and induration develops within 8 to 12 hours, reaching a peak in 24 to 72 hours. The other options do not apply.

The nurse is planning care for a client with a diagnosis of primary immunodeficiency. What is a priority intervention to incorporate into the plan?

The client with immunodeficiency has an absent or inadequate immune response. Cell-mediated, or cellular, immunity is mediated by the cytotoxic T lymphocytes (T cells) and functions in the elimination of intracellular pathogens. A lack of this response increases the client's risk of infection.

The nurse understands that a positive ELISA test reported in a baby born to a woman who is HIV positive indicates:

The diagnosis of HIV infection in children born to HIV-infected mothers is complicated by the fact that infants have the maternal anti-HIV IgG antibody for approximately 6 months. Consequently, infants born to HIV-infected women can be HIV-antibody-positive by ELISA for up to 18 months of age even though they are not infected with HIV.

The nurse would be most concerned when the glomerular filtrate contains:

The glomerular filtrate has a chemical composition similar to plasma, but it contains almost no proteins because large molecules do not readily cross the glomerular wall. Potassium, sodium, and water would be filtered.

A woman in her 28th week of pregnancy tests positive for gestational diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?

The goals of the nutritional plan for gestational diabetes mellitus (GDM) include normal glucose levels, no ketosis, proper weight gain for the pregnancy, and adequate nutrition for fetal health.

A client is diagnosed with type 2 diabetes mellitus and begins to follow a nutritional plan at home. What result at the follow-up visit indicates a successful outcome?

The goals of the nutritional plan for type 2 diabetes mellitus include normal glucose levels, normal lipid levels, weight loss to ideal body weight (or at least 5% to 10% of total body weight) and regulating blood pressure. High-density cholesterol should be above 60 mg/dL (1.55 mmol/L).

A mother brings her 5-month-old infant to the pediatrician for recurrent colds. The mother has never breast-fed and the infant is fed iron-fortified formula. The mother asks, "My baby has been perfectly healthy up until last month—now it seems like she has been sick constantly. Why?" How should the physician respond?

The infant's immune system is not yet mature. Passive immunity is immunity transferred from mother to fetus before birth. After birth, the neonate receives IgG antibodies from the mother in breast milk or colostrum. Therefore, infants are provided with some degree of protection from infection for approximately 3 to 6 months, giving their own immune systems time to mature.

A child has experienced a bee-sting while at the park. The health care provider is walking by and notices the child has swelling around the eyes, lips, and face in general. What priority assessment should the nurse make at this time?

The initial management of anaphylaxis focuses on the establishment of a stable airway and intravenous access and the administration of epinephrine. Epinephrine produces relaxation of bronchial smooth muscle and inhibits the immediate life-threatening cardiovascular effects of anaphylaxis. All the other assessments (pulse rate, skin, and breath sounds) can be done after the airway is assessed and managed.

Select the most important intervention in the management of anaphylaxis.

The initial management of anaphylaxis focuses on the establishment of a stable airway and intravenous access and the administration of epinephrine. Epinephrine produces relaxation of bronchial smooth muscle and inhibits the immediate life-threatening cardiovascular effects of anaphylaxis. The other options may be done after the initial management is completed.

In an attempt to best explain the innate immune system to a class of first-year nursing students, the instructor should describe what characteristic?

The innate immune system is the first line of defense. The adaptive immune system is composed of lymphocytes and their products. Antibodies comprise humoral immunity and T-cells provide cellular immunity.

in an attempt to best explain the innate immune system to a class of first-year nursing students, the instructor should describe what characteristic?

The innate immune system is the first line of defense. The adaptive immune system is composed of lymphocytes and their products. Antibodies comprise humoral immunity and T-cells provide cellular immunity.

Which aspect of kidney function is performed by the juxtaglomerular apparatus?

The juxtaglomerular apparatus is thought to represent a feedback control system that links changes in the glomerular filtration rate (GFR) with renal blood flow.

A nursing student studying pharmacology is learning how angiotensin converting enzyme inhibitors (ACE) work. The student is correct when stating that the mechanism of action of ACE inhibitors is to:

The juxtaglomerular cells of the kidney contain granules of inactive renin, an enzyme that functions in the conversion of angiotensinogen to angiotensin. Angiotensin I is converted to angiotensin II in the presence of converting enzyme. By blocking converting enzyme, angiotensin II, a potent vasoconstrictor, is not produced, thus lowering blood pressure.

While discussing the regulation of hormone levels, the instructor gives an example of hormones regulated by feedback mechanisms. Which example of this regulation is best?

The levels of hormones such as insulin and antidiuretic hormone (ADH) are regulated by feedback mechanisms that monitor substances such as glucose (insulin) and water (ADH) in the body. None of the other examples are accurate examples of this feedback mechanism.

Lymph fluid arises directly from which space?

The lymphatic system represents an accessory route whereby fluid from the interstitial spaces can return to circulation. More important, the lymphatic system provides a means for removing plasma proteins and osmotically active particulate matter from the tissue spaces, neither of which can be reabsorbed into the capillaries.

The effective circulating volume is the major regulator of water balance in the body. What else does it regulate?

The major regulator of sodium and water balance is the maintenance of the effective circulating volume. Magnesium, calcium, and potassium are not regulated by the effective circulating volume.

When caring for a client with hyperkalemia, the nurse prioritizes assessment of which body system?

The most serious effect of hyperkalemia is disturbances in cardiac conduction. Peaked, narrow T waves and widening of the QRS complex occur first, followed by prolongation of the PR interval and disappearance of P waves with bradycardia. Ventricular fibrillation and cardiac arrest are terminal events.

The nurse has just received the lab results of a client's calcium level. The nurse identifies a normal calcium level as:

The normal range for calcium is 9.0 to 10.5 mg/dL. A decreased level of calcium is 3.5 to 5.3 mg/dL. Elevated levels of calcium include 12.0 to 15.0 mg/dL and 13.5 to 14.5 mg/dL.

The nurse is caring for a client with a tumor obstructing the lymphatic system. For which consequence does the nurse assess?

The normally small amount of fluid remaining in the interstitium is removed by the lymphatic system and returned to the systemic circulation. Any excess fluids and osmotically active plasma proteins that may have leaked into the interstitium are picked up by vessels of the lymphatic system and returned to circulation.

A pregnant client is having premature labor cramps and is diagnosed with preeclampsia. The admitting prescriptions include starting an IV infusion of magnesium sulfate. What intervention will the nurse provide this client?

The nurse should assess carefully for signs of hypermagnesemia when administering IV magnesium sulfate. Changes in neuromuscular status like lethargy, confusion, or hyporeflexia are manifestations of hypermagnesemia, which could happen when a client is receiving IV magnesium sulfate. Prolonged PR interval and wide QRS complex are signs of hyperkalemia, not hypermagnesemia. Prolongation of QT interval predisposes to ventricular dysrhythmias and is associated with hypocalcemia. Diagnosis of osteoporosis requires a bone density scan and is not the priority for this client.

Which structure controls the functions of the greatest number of target glands and cells?

The pituitary gland has been called the master gland because its hormones control the functions of many target glands and cells. It supersedes the importance of the thyroid, adrenal cortex, or pancreas in this regulatory role.

Antinuclear antibodies are characteristic of:

The presence of antinuclear antibodies is most commonly assoicated with systemic lupus erythematosus.

Which of the following is a secondary lymphoid structure located high in the left abdominal cavity?

The spleen is a large, ovoid secondary lymphoid organ located high in the left upper quadrant of the abdominal cavity between the diaphragm and the stomach. The thymus is an elongated, bilobed structure located in the mediastinum above the heart. Lymph nodes are small aggregates of lymphoid tissue located along lymphatic vessels throughout the body. Peyer patches are peripheral lymphoid tissue found in the intestine.

A nurse is caring for a client with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is high, and serum osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which problem could the client be diagnosed with?

The syndrome of inappropriate ADH (SIADH) results from a failure of the negative feedback system that regulates the release and inhibition of ADH. In people with this syndrome, ADH secretion continues even when serum osmolality is decreased, causing marked water retention and dilutional hyponatremia. SIADH may occur as a transient condition, as in a stress situation, or, more commonly, as a chronic condition, resulting from disorders such as lung or brain tumors. Tumors, particularly bronchogenic carcinomas and cancers of the lymphoid tissue, prostate, and pancreas, are known to produce and release ADH independent of normal hypothalamic control mechanisms. The manifestations of SIADH are those of dilutional hyponatremia. Urine osmolality is high and serum osmolality is low. Urine output decreases despite adequate or increased fluid intake. Hematocrit and the plasma sodium and blood urea nitrogen levels are all decreased because of the expansion of the extracellular fluid volume.

While caring for a pediatric client admitted with a viral infection, the nurse knows that which type of cell will be the child's primary defense against the virus?

The third type of lymphocyte, the natural killer (NK) cell is part of the innate immune system and may be the first line of defense against viral infections. The NK cell also has the ability to recognize and kill tumor cells, abnormal body cells, and cells infected with intracellular pathogens, such as viruses and intracellular bacteria. Complement is activated in the inflammatory response. Leukotrienes and bradykinin are also a part of the inflammatory response.

What is a characteristic indicator that an individual is in the latent phase of HIV?

The three phases experienced are primary infection phase, chronic asymptomatic or latency phase, and overt AIDS phase. Mononucleosis-like symptoms and high viral loads are seen in the primary infection phase, whereas the AIDS phase is characterized with opportunistic infections.

A nurse is caring for a child diagnosed with DiGeorge syndrome with thymic hypoplasia. Which immune response would the nurse anticipate in this child?

The thymus is essential to the development of the immune system because it is responsible for the production of mature, immunocompetent T lymphocytes. Mature, immunocompetent T-helper and T-cytotoxic cells leave the thymus in 2 to 3 days and enter the peripheral lymphoid tissues through the bloodstream. Without a thymus, infections would occur frequently. These T cells recognize foreign antigens and build an immune response. Therefore, with thymic hypoplasia, there is a risk for increased infection (not reduced infection or no change). Obviously, there is an antigen response.

A client is brought to the emergency department semicomatose and a blood glucose reading of 673. He is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29; HCO3− level 19 mEq/dL (19 mmol/L); PCO2 level 32 mm Hg. The nurse should anticipate that which order may correct this diabetic ketosis?

The treatment of metabolic acidosis focuses on correcting the condition that is causing the disorder and restoring the fluids and electrolytes that have been lost from the body. For example, insulin administration and fluid replacement are frequently sufficient to correct a low pH in persons with diabetic ketosis. Administration of potassium chloride is used as a treatment of metabolic alkalosis. Administering supplemental oxygen and rebreathing from a paper bag are usual treatment of respiratory alkalosis. Instituting a cough-and-deep breathing schedule for every hour while awake to improve ventilation is usual treatment of respiratory acidosis.

Which pathophysiologic phenomenon may result in a diagnosis of Cushing disease?

Three important forms of Cushing syndrome result from excess glucocorticoid production by the body. One is a pituitary form, which results from excessive production of ACTH by a tumor of the pituitary gland. Hypopituitarism and destruction of the adrenal cortex are associated with Addison disease. Disruption of the HPA system is not implicated in the etiology of Cushing disease.

Which client is at the greatest risk for developing an intracellular pathogen infection?

Thus, the CD4+ TH1 cell controls and coordinates host defenses against certain intracellular pathogens, a function that helps to explain why a decreased CD4+ TH1 count in persons with acquired immunodeficiency syndrome (AIDS) places them at high risk for intracellular pathogen infections. If the teenager has a healthy immune system, high school should not place him or her at high risk for infection. A WBC of 8000 is normal. Radioactive iodine attacks the thyroid gland and does not usually interfere with immunity.

Which effect of thyroid hormone deficit alters the function of all major organs in the body?

Thyroid hormone has two major functions: it increases metabolism and protein synthesis, and it is necessary for growth and development in children, including mental development and attainment of sexual maturity. Altered levels of thyroid hormone affect all the major organs in the body; hypothyroidism decreases metabolism and protein synthesis. Thyroid hormone deficit decreases the absorption of glucose from the gastrointestinal tract. Because vitamins are essential parts of metabolic enzymes and coenzymes, an increase (rather than decrease) in metabolic rate causes the use of vitamins and tends to cause vitamin deficiency.

An infant whose mother had myxedema during the pregnancy has failed to meet standards for growth and is developmentally delayed. Which hormonal imbalance is this child exhibiting?

Thyroid hormone is necessary for metabolism at all ages, as well as growth and development during childhood. Uncorrected thyroid insufficiency in childhood leads to cretinism, a condition with marked physical and intellectual disability. Myxedema is the term used for thyroid insufficiency in adults.

A client is diagnosed with a mild case of an autoimmune disorder and is beginning a treatment regimen. What is the mainstay of treatment with an autoimmune disorder?

Treatment of autoimmune disorders is dependent on the magnitude of the presenting manifestations and underlying mechanisms of the disease process. Because in many cases the pathophysiologic mechanisms are not always known, treatment may be purely symptomatic. Corticosteroids and immunosuppressive drugs are the mainstay of therapy directed at arresting or reversing the cellular damage caused by the autoimmune response. Plasmapheresis has been used in severe cases to remove autoreactive cells from circulation.

The diagnosis of type 1 diabetes would be confirmed by which principle?

Type 1 diabetes is a catabolic disorder characterized by an absolute lack of insulin. In type 2 diabetes, some insulin is produced.

The nurse is caring for a critically ill client who requires measurement of hourly urine output. When assessing the urine output of the previous shift, the nurse recognizes that which volume reflects a minimum, normal urinary output?

Under normal conditions, only approximately 1 mL of the 125 mL of glomerular filtrate that is formed each minute is excreted in the urine. The other 124 mL is reabsorbed in the tubules. This means that the average output of urine is approximately 60 mL/hour.

The nurse is caring for a client who is diagnosed with gout. Which laboratory study does the nurse monitor to monitor this condition?

Uric acid is a product of purine metabolism. Excessively high blood levels (i.e., hyperuricemia) can cause gout, and excessive urine levels can cause kidney stones.

A client is diagnosed with gout in the right foot and a kidney stone in the left ureter. The nurse recognizes these conditions may have resulted from accumulation of which chemical in the body?

Uric acid is a product of purine metabolism. Excessively high blood levels (i.e., hyperuricemia) can cause gout, and excessive urine levels can cause kidney stones. Albumin, protein, and urea do not contribute to kidney stone or gout formation.

Urine is an amber, light-yellow fluid that is 5% dissolved solid. What percent of it is water?

Urine is 95% water and 5% dissolved solids.

A client is admitted after losing 44 lb (20 kg) over the past 3 months, largely due to frequent vomiting. What intervention should the nurse anticipate in the treatment of the client's resulting acid-base imbalance?

Vomiting ultimately results in the increase in pH that constitutes metabolic alkalosis; intravenous potassium chloride (KCl) solutions are a mainstay of treatment for this acid-base imbalance. Respiratory interventions will not have an appreciable effect because of the metabolic nature of the imbalance. Sodium bicarbonate would exacerbate the client's condition.

A nursing student is assigned to care for a client who has AIDS. The student is unsure of what personal protective equipment should be worn while caring for this client. Which statement is appropriate direction from the student's nursing instructor?

Wear gloves if there is a chance you will come in contact with the client's blood or body fluids

A client with severe hypoglycemia is unconscious. Which method of providing glucose should be avoided?

When clients are unconscious it is not safe to attempt to have them swallow liquids. Alternate routes that reduce the risk of choking such as buccal absorption, intramuscular or intravenous injections are preferred.

Which individual displays the precursors to acromegaly?

When growth hormone (GH) excess occurs in adulthood or after the epiphyses of the long bones have fused, it causes a condition called acromegaly, which represents an exaggerated growth of the ends of the extremities.

A nursing instructor is teaching a group of students about the action of hormones. The instructor determined that teaching was effective when the students recognize the local action of hormones as:

When hormones act locally on cells other than those that produced the hormone, the action is called paracrine. Hormones can also exert an autocrine action on the cells in which they were produced. Pancreatic and hormonal are not actions.

While explaining immunity to a client, the nurse responds, "The body's internal organs are protected from pathogens because:

econdary lymphoid tissues contain all the necessary cell components (i.e., T cells, B cells, macrophages, and dendritic cells) for an immune response. Because of the continuous stimulation of the lymphocytes in these tissues by microorganisms constantly entering the body, large numbers of plasma cells are evident. Immunity at the mucosal layers helps to exclude many pathogens and thus protects the vulnerable internal organs. Although cells of both the innate and adaptive immune systems communicate critical information by cell-to-cell contact, many interactions and effector responses depend on the secretion of short-acting soluble molecules called cytokines. The actions of cytokines are often pleiotropic and redundant. Pleiotropism refers to the ability of a cytokine to act on different cell types.

A client is brought to the physician's office with a raised, red macular rash on the trunk and arms accompanied by a fever. A diagnosis of measles is made. Which type of immunity does this disease process provide?

Active immunity is acquired when the host mounts an immune response to an antigen either through the process of vaccination (artificial means) or from environmental exposure (natural means). It is called active immunity because it requires the host's own immune system to develop an immunologic response.

Sputum samples from a client with pneumonia contain an infective agent that has a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet. This client's pneumonia has what etiology?

Although chlamydiae, viruses, and mycoplasmas all can cause pneumonia, only bacteria have all of these characteristics. Chlamydiae and viruses are obligate intracellular organisms and therefore would grow only in cell culture, and mycoplasmas lack the peptidoglycan cell wall typical of bacteria.

Which is an abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues?

An abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues is called a neoplasm. A transformation occurs when a cell has become cancerous. A mutation is an alteration in the DNA that may or may not result in a transformation. An insertion is a type of mutation.

A nursing student who is studying cancer correctly identifies which of the following as a method for classifying cancers?

A basic method of classifying cancers is grading. Faces scale is used as a pain scale with children. A point system is not useful in classifying cancers and there is no such "levels of seriousness" used in regards to cancer.

The nursing student studying about cancer says the following: "A neoplasm, benign or malignant, represents a new growth." This statement is considered to be which of the following?

A neoplasm, benign or malignant, represents new growth. However, benign and malignant tumors differ in terms of cell characteristics, manner of growth, rate of growth, potential for metastasis, ability to produce generalized effects, tendency to cause tissue destruction, and capacity to cause death.

What is the term for parasitic relationships between microorganisms and the human body in which the human body is harmed?

A parasitic relationship is one in which only the infecting organism benefits from the relationship and the host either gains nothing from the relationship or sustains injury from the interaction. If the host sustains injury or pathologic damage in response to a parasitic infection, the process is called an infectious disease. Mutual and commensal relationships do not harm the human body. Communicable diseases can be passed from one human to another; they are not parasitic.

A specific type of gram-negative bacteria contains endotoxin in the bacterial cell envelope. What is the likely clinical manifestation if these bacteria become pathogenic?

A small amount of endotoxin in the circulatory system (endotoxemia) can induce clotting, bleeding, inflammation, hypotension, and fever.

When caring for a client with a wound that is healing by primary intention, the nurse recognizes which characterization best describes this type of wound?

A sutured surgical incision is an example of healing by primary intention. Larger wounds (e.g., burns and large surface wounds) or wounds purposely left open due to infection heal by secondary intention.

The bacteriologist is staining the slides of a client diagnosed with scarlet fever and rheumatic fever. The slide identifies S. pyogenes and stains purple by crystal violet dye. The result would indicate:

All gram-positive organisms stain purple with crystal violet dye. An acid-fast bacillus is a separate classification that does not relate to purple staining. Gram-negative organisms do not stain purple with crystal violet dye. Anaerobic organism refers to an organism that cannot survive in an oxygen-containing environment.

A nursing instructor who is teaching students about the effects of cancer identifies a need for further instruction when one of the students says which of the following?

All of the above statements are true except for one. There probably is no single body function unaffected by the presence of cancer. It can affect other body structures besides its site of origin and many manifestations are compounded by the side effects of the methods used to treat the cancer.

A client has been diagnosed with an abscess. Upon assessment of the client, the nurse would expect to find:

An abscess is a localized pocket of infection composed of devitalized tissue, microorganisms, and the host's phagocytic white blood cells—in essence, a stalemate in the infectious process. In this case, the dissemination of the pathogen has been contained by the host, but white cell function within the toxic environment of the abscess is hampered, and the elimination of microorganisms is inhibited. The other options do not describe an abscess.

A client is diagnosed with an adenoma. The nursing student identifies this as a:

An adenoma is a benign tumor of glandular epithelial tissue. An osteoma is a benign tumor of bone tissue.

Which client scenario best describes an example of infection originating with a fomite?

An object that carries an infectious organism, such as a dirty syringe, is known as a fomite. Airborne contact with TB does not utilize a fomite, and infection by way of contact with an infected arthropod constitutes zoonosis. Consuming ova in meat would constitute infection by ingestion.

Canada's Centre for Emergency Preparedness and Response is vigilantly keeping watch for terrorist events involving biologic agents. Of those on the list, which is of highest concern?

Anthrax is an ancient disease caused by the cutaneous inoculation, inhalation, or ingestion of the spores of Bacillus anthracis. Due to the ease of transmission and the speed of infection, it is of greatest concern. Parvovirus only infects canines. AIDS is not easily spread (via fluids and open wounds), and prion disease spreads through the consumption of brain material.

An oncologic client is scheduled to begin antiangiogenesis therapy. What is the goal of this type of treatment?

Antiangiogenesis therapy is designed to inhibit the growth of new blood vessels, thus limiting the availability of blood to the growing tumor, resulting in decreased oxygen delivery and decreased ATP synthesis. There are no genetic effects on the tumor promoters or genetics.

A client has been diagnosed with cancer that was a result of dysfunctional apoptosis. The health care provider explains the process to the multidisciplinary client care team. Select the best explanation.

Apoptosis is considered a normal cellular response to DNA damage; loss of normal apoptotic pathways may contribute to cancer by enabling DNA-damaged cells to survive.

Select the type of lymphocyte that matures in the bone marrow.

B lymphocytes mature in the bone marrow and are essential for humoral or antibody-mediated immunity. The T lymphocytes mature in the thymus. Macrophages are part of the monocytic phagocyte system, are in almost all tissues, and are the mature form of monocytes. Cytotoxic T cells are involved in cell-mediated immunity.

Although growth rate is variable among types of bacteria, the growth of bacteria is dependent on:

Bacterial growth is dependent upon the availability of nutrients and physical growth conditions. Bacteria prefer to colonize as biofilm and communicate with other bacteria within the biofilm, but biofilm is not necessary for growth. Viruses (not bacteria) form a capsid. Although some bacteria have projections for motility, these are not necessary for growth.

The nurse is orienting a student to the oncology setting. Which characteristic does the student identify as one that is representative of a benign tumor?

Because benign tumors have slow cell replication and growth, they develop a surrounding rim of compressed connective tissue called a fibrous capsule. Benign tumors encapsulate and are incapable of distant metastasis. Benign tumors have mature, differentiated cells but they have lost the ability to suppress cell proliferation.

A hospital client was swabbed on admission for antibiotic-resistant organisms and has just been informed that methicillin-resistant Staphylococcus aureus (MRSA) is present in his groin. The client has a normal core temperature and white blood cell count. This client is experiencing:

Colonization describes the act of establishing a presence, a step required in the multifaceted process of infection; infection describes the presence and multiplication within a host of another living organism. However, this client displays no signs of infection, inflammation, or proliferation of the microorganism.

Which option most accurately describes the physiologic process resulting in more specialized cells with each mitotic division?

Cell differentiation is the process whereby a cell becomes more specialized in terms of structure and function. Cell proliferation refers to the process of increasing cell numbers by mitotic division. Stem cells are undifferentiated cells that have the capacity to generate multiple cell types. Cell death is called apoptosis. The cell cycle is an orderly sequence of events that occur as a cell duplicates its genetic contents and divides.

A big difference in the treatment of childhood cancer as opposed to adult cancer is that chemotherapy is the most widely used treatment therapy for childhood cancer. What is the reason for this?

Chemotherapy is more widely used in the treatment of children with cancer than in adults because children better tolerate the acute adverse effects, and in general, pediatric tumors are more responsive to chemotherapy than adult cancers. Children are very adaptable and tolerate more forms of cancer treatment than adults do. Children do complain about the nausea and vomiting chemotherapy can cause, just like adults do, and they do not like losing their hair, just like adults.

Which description does the nurse recognize fits a client in the prodromal stage of an infection?

Client is experiencing vague symptoms of fatigue and low grade fever.

An adolescent is diagnosed with Epstein-Barr virus. What information should the nurse provide to the parents? Select all that apply.

Epstein-Barr virus invades and replicates within the salivary glands or pharyngeal epithelium and is shed into the saliva and respiratory secretions. Epstein-Barr virus can cause infectious mononucleosis in people who did not develop immunity through childhood exposure.

Which of the types of T cells is responsible for destroying pathogens by punching holes in their cell membrane and by secreting cytokines/lymphokines?

Cytotoxic T cells destroy the pathogens. Regulatory T cells suppress immune response. Memory T cells are derived from normal T cells. The principal cells of the adaptive immune system are the T and B lymphocytes and antigen-presenting cells. T lymphocytes differentiate into helper T cells, regulatory T cells, and cytotoxic T cells, providing cell-mediated immunity. CD4+ helper T cells serve as a trigger for the immune response and are essential for the differentiation of B cells into antibody-producing plasma cells and the differentiation of T lymphocytes into CD8+ cytotoxic T cells.

Which process will be conducted for a client who has been prescribed direct antigen detection for a serious symptomatology of unknown origin?

Direct antigen testing involves the introduction of labeled monoclonal antibodies to a sample of the client's tissue. This method of testing does not rely on detection of specific DNA sequences, growth of biofilms, or quantification of specific antibodies.

Although both eukaryotes and prokaryotes are capable of causing infectious diseases in humans, eukaryotes are unique because they have a/an:

Eukaryotic cells have an organized nucleus. Many prokaryotes contain extra chromosomal pieces of circular DNA (plasmids). Prokaryotic cells have a flexible lipid cytoplasmic membrane. Both types of cells vary in shape and size.

A client is brought to the emergency room with reports of facial muscle paralysis and increasing upper extremity weakness several hours after eating canned peppers. Histologic examination reveals a bacterial infection and further testing reveals a decrease in the release of the neurotransmitter acetylcholine from cholinergic neurons. What is the most likely cause of this illness?

Exotoxins are proteins released from the bacterial cell during growth. Bacterial exotoxins enzymatically inactivate or modify key cellular constituents, leading to cell death or dysfunction. Botulism toxin decreases the release of neurotransmitter from cholinergic neurons, causing flaccid paralysis.

A client is exposed to second-hand smoke on a daily basis. The client asks if he is at risk for the development of cancer. The best response would be:

Exposure to many carcinogens, such as those contained in cigarette smoke, is associated with a lifestyle risk for development of cancer. It is directly associated with lung and laryngeal cancer and has been linked with cancers of the mouth, nasal cavities, pharynx, esophagus, pancreas, liver, kidney, uterus, cervix, and bladder and myeloid leukemia. Not only is the smoker at risk but others passively exposed to cigarette smoke are at risk. Chewing tobacco increases the risk of cancers of the oral cavity and esophagus.

A client with a history of cancer and recent chemotherapy was hospitalized with fever, weakness, shortness of breath and productive cough. A bronchoscopy with transbronchial biopsy showed granulomas containing the fungus Histoplasma. Based on client history and the biopsy results, a nurse can conclude that the most likely cause of this infection was due to which reason?

Few fungi are capable of causing diseases in humans, and most of these are incidental, self-limited infections of skin and subcutaneous tissue. Serious fungal infections are rare and usually initiated through puncture wounds or inhalation. Despite their normally harmless nature, fungi can cause life-threatening opportunistic diseases when host defense capabilities have been disabled. Disease states or antibiotic therapy can upset the balance of normal body flora, permitting fungal overgrowth and setting the stage for opportunistic infections.

Which immunoglobulin is primarily found in secretions and has a primary function of providing local immunity on mucosal surfaces?

IgA is found in saliva and tears, and is a primary defense against infections in mucosal tissues. IgM is the first immunoglobulin to appear in response to antigen invasion. IgG is the most abundant immunoglobulin and can cross the placenta. IgD is an antigen receptor on B-cell membranes.

The nurse is evaluating the wounds of four clients. Select the client most likely to be treated with hyperbarically delivered oxygen.

Hyperbaric oxygen is currently reserved for the treatment of problem wounds in which hypoxia and infection interfere with healing (e.g., an infected foot wound on a 45-year-old client with peripheral vascular disease). The other clients do not have any complications in the healing process.

A client is being evaluated for atopic dermatitis possibly caused by a latex-related allergic reaction. The nurse will review which lab results to determine if an allergy is present?

IgE binds to mast cells and basophils and is involved in parasitic infections, as well as allergic and hypersensitivity reactions. Serum IgE causes the symptoms of allergic reactions and is elevated in type 1 hypersensitivity disorders.

A fomite is a/an:

Inanimate objects that carry an infectious agent are known as fomites.

A client comes to the physician's office after being bitten by a tick, with symptoms of headache, fatigue, joint pain and swelling. The physician determines which of the following as the mode of transmission for the infection?

Infections can be transmitted from infected animals to humans through the bite of an arthropod vector such as lice or ticks.

Which of the following would be considered an example of transmitting an infection from person-to-person through shared inanimate objects (fomites)?

Infections can be transmitted from person-to-person through shared inanimate objects (fomites) contaminated with infected body fluids. An example of this mechanism of transmission would include the spread of the HIV and hepatitis B virus through the use of shared syringes by intravenous drug users. Infection can also be spread through a complex combination of source, portal of entry, and vector. Infection with hantavirus pulmonary syndrome is a prime example. This viral illness is transmitted from mice to humans by inhalation of dust contaminated with saliva, feces, and urine of infected rodents.

A public health nurse notes an increase in regional throat cancer cases. Upon epidemiological studies, many of the throat cancer clients also had oral exposure to human papillomavirus (HPV). This exposure to HPV would be considered by:

Most STIs are spread by direct contact. In addition to causing infectious diseases, certain viruses also have the ability to transform normal host cells into malignant cells during the replication cycle. This group of viruses is referred to as oncogenic and includes certain retroviruses and DNA viruses, such as the Epstein-Barr virus, hepatitis B virus, and human papillomavirus. Vertical transmission is possible for many sexually transmitted pathogens, but direct contact is more common. Ingestion and penetration are less likely mechanisms.

A farmer's long-term exposure to pesticides has made the cells in his alveoli and bronchial tree susceptible to malignancy. Which process has taken place in the farmer's lungs?

Initiation involves the exposure of cells to appropriate doses of a carcinogenic agent that makes them susceptible to malignant transformation, whereas promotion involves the induction of unregulated accelerated growth in already initiated cells. Progression is the later process whereby tumor cells acquire malignant phenotypic changes, and differentiation is the process of specialization whereby new cells acquire the structural, microscopic, and functional characteristics of the cells they replace.

While reviewing how tissue repairs itself after injury, the students note that it follows a certain pattern. Place the steps of the repair of tissue in their proper sequence of events.

Injury to connective tissue occurs. Fibroblasts migrate. Induction of fibroblast occurs and endothelial cells proliferate. Granulation tissue appears. Formation of a scar develops. Remodeling occurs with the reorganization of the fibrous tissue.

Which type of immunity is achieved by an infant from its mother through antibodies transferred in utero or in breast milk?

Passive immunity is immunity transferred from another source. An infant receives passive immunity naturally from the transfer of antibodies from its mother in utero and through breast milk. Passive immunity also can be artificially provided by the transfer of antibodies produced by other people or animals. Active immunity is acquired through immunization or actually having a disease. It is called active immunity because it depends on a response to the antigen by the person's immune system.

A client is experiencing the early stages of an inflammatory process and develops leukocytosis. The nurse recognizes this as a/an:

Leukocytosis, or the increase in white blood cells, is a frequent sign of an inflammatory response, especially those caused by bacterial infection. Leukocytosis occurs due to an increase in circulating neutrophils and eosinophils. Leukocytosis does not occur because of increased cell production, and blood supply is typically increased as part of the inflammatory process.

Which cancer is the leading cause of cancer death?

Lung cancer is the leading cause of cancer deaths in men and women in the United States.

An infection control nurse is conducting research on the activation of chemokines of the immune system and is identifying anatomical locations where primary immune responses are initiated. Which locations should be included in the research study? Select all that apply.

Lymph nodes Spleen Tonsils Peyer patches

Following a severe automobile accident, a client is scheduled to have surgery to either repair or remove his spleen, pancreas, and stomach. The client wants the organs repaired and not removed if at all possible. However, the nursing staff understands that extensive regeneration in parenchymal organs can only occur if:

Regeneration can occur in parenchymal organs with stable cell populations but, with the exception of the liver, is usually a limited process. It should be pointed out that extensive regeneration can occur only if the residual tissue is structurally and functionally intact. If the tissue is damaged by infection or inflammation, regeneration is incomplete and accomplished by replacement with scar tissue.

Which organism causes peptic ulcers?

The bacterium Helicobacter pylori is an extreme example of a site-specific pathogen. Helicobacter pylori is a significant cause of gastric ulcers.

Which agent is the cause of malaria?

Malaria is caused by a microscopic, unicellular protozoa, common in water supplies of developing countries.

A nursing student says the following to her instructor: "Malignant neoplasms are more well-differentiated than benign tumors." Which of the following is the answer?

Malignant neoplasms are less well-differentiated tumors that have lost the ability to control both cell proliferation and differentiation.

A nursing instructor sees the need for further instruction when one student makes which statement concerning cancer?

Malignant neoplasms, which invade and destroy nearby tissue and spread to other parts of the body, tend to grow rapidly and spread widely and have the potential to cause death.

A client has developed a large wound as a result of trauma sustained during an auto accident. The cells will undergo which process to regenerate tissue?

Mitosis is the cell cycle process in which nongerm cells are replicated, providing ways for the body to replace cells that have a limited life span—skin and blood cells; increase tissue mass during periods of growth; and repair tissue, such as in wound healing. Cytogenetics is the study of the structure and numeric characteristics of the cell's chromosomes. Meiosis is limited to replicating germ cells and results in the formation of gametes or reproductive cells. Cloning is a general term for the research activity that creates a copy of same biological entity.

A client who is diagnosed with breast cancer asks the nurse if cancer cells ever die. Which statement is the nurse's best response?

The best response for the nurse to make is to tell the client the truth: that cancer cells are immortal and can divide an infinite number of times, hence achieving immorality. The other responses are not therapeutic.

A person has been exposed to a particular antigen and a now experiences a repeat exposure. What stimulates a quicker immune response?

The memory T and B lymphocytes that are generated remain in the body for a longer time and can respond more rapidly during repeat exposures to an antigen related to their acquired memory.

A nursing student who describes cell characteristics that include regulated growth, genetic stability, limited lifespan, and growth factor dependence is talking about which type of cell?

Normal cells have regulated growth, high differentiation, genetic stability, growth factor dependence, high density dependence, and cell-to-cell adhesion.

The process by which microbes are coated to allow for more efficient recognition by phagocytes is known as:

Opsonization is the coating of particles with proteins, lectins, and complement to make them more attractive for phagocytes to recognize them as a foreign pathogen. Immunization is the process of acquiring the ability to respond to an antigen after its administration by vaccine. Immunity is protection from disease and, more specifically, infectious disease. Memory responseoccurs on second or subsequent exposures to the antigen.

Which screening test is used to detect prostate cancer?

PSA stands for prostate-specific antigen. PSA is measured in simple blood tests and is used as an indicator for prostate cancer risk.

A client attending a health fair asks how anthrax will be treated in the event of a bioterrorism attack. How should the nurse respond?

Potential agents to be used in a bioterrorism attack include the bacillus that causes anthrax. Anthrax spreads by spores found in infected secretions, soil, or animal products. This microbe is susceptible to antibiotic treatment. Disinfecting the area will not treat the infected individual.

A physician orders a real-time PCR (polymerase chain reaction) DNA detection test on a client experiencing severe diarrhea following IV antibiotic administration. Which statement is the reason for this diagnostic test?

Realtime PCR is very effective in determining the diagnosis of Clostridium difficile. It is quicker, more sensitive, and more specific and can assist the physician/provider in administering antibiotics more efficiently for people with diarrhea secondary to C. difficile.

Which factor is considered during serology testing?

Serology samples are used to identify infectious organisms by measuring the levels of antibodies. Certain antibodies will increase in numbers in response to certain organisms. Other laboratory methods for identifying infectious organisms are cultures, detecting antigens directly, and DNA sequencing.

A child is brought to the emergency department after falling and cutting the leg on a piece of fencing. While explaining the process of normal tissue repair, the nurse explains that certain cells, like fibroblasts, proliferate at times like this with the production of:

Several cell types proliferate during tissue repair, including remnants of injured parenchymal tissue cells, vascular endothelial cells, and fibroblasts. The proliferation of these cell types is driven by proteins called growth factors. The production of growth factors and the ability of these cells to respond and expand in sufficient numbers are important determinants of the repair process. Glucocorticoids do not help foster tissue repair. Blood does form clots to stop the bleeding at the site of injury; however, it does not play a role in new tissue repair.

The nurse is selecting a dressing for a vascular wound that has a dry wound surface. The most appropriate dressing for this wound is one that:

The most appropriate dressing for this wound is one that adds moisture to the wound bed, as epithelial cell migration requires a moist vascular wound bed.

A family member asks the nurse, "What do they mean when they start talking about stem cells?" What is the nurse's best response?

Stem cells are undifferentiated cells that have the capacity to generate multiple cell types. Cell differentiation is the process whereby a cell becomes more specialized in terms of structure and function.

The infectious agents that cause Rocky Mountain spotted fever and epidemic typhus are transmitted to the human body via vector such as a tick. What are these infectious agents?

The Rickettsia are accidentally transmitted to humans through the bite of the arthropod (i.e., vector) and produce a number of potentially lethal diseases, including Rocky Mountain spotted fever and epidemic typhus. Viruses, Chlamydiae, and Ehrlichieae do not cause either epidemic typhus or Rocky Mountain spotted fever.

Stem cells in the bone marrow produce T lymphocytes or T cells and release them into the vascular system. The T cells then migrate where to mature?

The T lymphocytes (T cells) are generated from stem cells in the bone marrow and complete their maturation in the thymus and function in the peripheral tissues to produce cell-mediated immunity, as well as aid antibody production.

Adaptive immune responses, also called acquired or specific immunity, are composed primarily of which type of cells?

The adaptive immune system consists of lymphocytes that comprise the humoral (B cell) and cell-mediated (T cell) immune responses. Granulocytes, toll-like receptors, and the epithelial layer of tissue are all important components of the innate (first line of defense) immune response.

A client who was exposed to hepatitis A at a local restaurant has recovered from the disease. At her annual physical, the client asks the health care provider if she should go to her health department and get the hepatitis A "shot." The best response by the health care provider, based on the concepts of adaptive immunity, would be:

The adaptive immune system consists of two groups of lymphocytes and their products, including antibodies. Whereas the cells of the innate immune system recognize structures shared by classes of microorganisms, the cells of the adaptive immune system are capable of recognizing numerous microbial and noninfectious substances and developing a unique specific immune response for each substance. Substances that elicit adaptive immune responses are called antigens. A memory of the substance is also developed so that a repeat exposure to the same microbe or agent produces a quicker and more vigorous response. The hepatitis A virus does not change from year to year. The vaccine does not damage the liver; however, the active hepatitis A disease can.

Inflammation can be either local or systemic. What are the most prominent systemic manifestations of inflammation?

The most prominent systemic manifestations of inflammation include the acute phase response, alterations in white blood cell count (leukocytosis or leukopenia), and fever. A widening pulse pressure is not indicative of systemic inflammation, and thrombocytopenia is a hematologic disorder, not an indication of systemic inflammation.

While reviewing the phases of wound healing, the students note that the first cells to arrive after the injury are the:

The cellular phase of inflammation follows and is evidenced by the migration of phagocytic white blood cells that digest and remove invading organisms, fibrin, extracellular debris, and other foreign matter. The neutrophils arrive within minutes and are usually gone by day 3 or 4. They ingest bacteria and cellular debris. Within 24 to 48 hours, macrophages, which are larger phagocytic cells, enter the wound area and remain for an extended period. These cells, arising from blood monocytes, are essential to the healing process. The final component of the proliferative phase is epithelialization, which is the migration, proliferation, and differentiation of the epithelial cells at the wound edges to form a new surface layer that is similar to that destroyed by the injury.

A nurse is assessing a client for the classic signs of acute inflammation. The nurse would assess the client for:

The classic signs of inflammation are rubor (redness), tumor (swelling), calor (heat), and dolor (pain). The remaining options are more characteristic of symptomatology resulting from circulatory dysfunction.

A client has presented to the emergency department after he twisted his ankle while playing soccer. Which assessment findings are cardinal signs that the client is experiencing inflammation? Select all that apply.

The client's ankle is visibly red The ankle appears to be swollen The ankle is warmer than the unaffected ankle The client is experiencing pain

The nurse is reviewing the functions of immunoglobulins and determines which immunoglobulin is associated with its correct action?

The correct actions are as follows: IgM is the first circulating immunoglobulin that is produced by the developing fetus. It is instrumental in the ultimate lysis of microogranisms. It also is an effective agglutinating antibiody. IgA prevents the attachment of viruses and bacteria to epithelial cells. IgE is involved in inflammation, allergic responses, and combating parasitic infections. It binds to mast cells and basophils. IgD serves as an antigen receptor for initiating the differentiation of B cells.

The Rickettsia are accidentally transmitted to humans through the bite of the arthropod (i.e., vector) and produce a number of potentially lethal diseases, including Rocky Mountain spotted fever and epidemic typhus. Viruses, Chlamydiae, and Ehrlichieae do not cause either epidemic typhus or Rocky Mountain spotted fever.

The course of any infectious disease can be divided into several distinguishable stages after the point of time in which the potential pathogen enters the host. These stages are the incubation period, the prodromal stage, the acute stage, the convalescent stage, and the resolution stage. There are no postacute, subacute, or postdromal stages to a disease.

Which process that contributes to immunity takes place in a child's thymus gland?

The thymus is essential to the development of the immune system because it is responsible for the production of mature, immunocompetent T lymphocytes. Phenotypically immature T cells enter the thymus from the bone marrow and undergo maturation and thymic selection. B cells are not differentiated in the thymus, and NK cells result from the common lymphoid progenitor. The spleen filters antigens from the blood.

The first physical line of defense in innate immunity is:

The first physical line of defense are the skin and mucous membranes, which prevent pathogens from entering. Plasma proteins, neutrophils, and specialized lymphocytes are examples of cellular level protection.

A client complains of general malaise and fatigue and has a mild fever. The nurse would evaluate this stage of disease as the:

The hallmark of the prodromal stage is the initial appearance of symptoms in the host that are mild and nonspecific. The other stages/symptoms would not be present.

While the nurse is performing a skin assessment on a dark-skinned client, the nurse notes that the client has a healed wound on the leg but that the wound has an excess of scar tissue. The nurse documents this as:

The nurse doucments the existence of excess of scar tissue on a healed wound as a keloid. These are more common in black clients. Proud flesh is an excess of granulation tissue in a healing wound. Remodeling is the third phase of wound healing. Epithelialization is the migtation, proliferation, and differentiation of epeithilial cells on the wound edges and occurs during the proliferative phase of wound healing.

A client comes into the emergency room with an animal bite to the hand. Which intervention should the nurse anticipate?

The nurse should anticipate wound irrigation as animal bites have a high risk for infection. Intravenous fluids and hyperbaric oxygen are not indicated. Bite wounds of the hand are not usually sutures to avoid loss of function.

When assessing a client's incision, the nurse notes that the edges of the once approximated incision has begun to pull apart. The nurse documents that the client's incision has:

The nurse should document that the client's incision has dehisced when the edges of the once approximated incision pull apart. Epithilialization, proliferation, and remodeling are phases of the wound healing process.

A client asks the nurse what happens when a pathogen enters the body.

The portal of entry by pathogens does not dictate the site of infection and disease can occur in varied places. Ingested pathogens may penetrate the interstinal mucosa, disseminate through the circulatory system, and cause diseases in other organs such as the liver or lungs. Direct contact as a portal of entry does not require the pathogen to disrupt the skin. Pathogens that enter through the intestinal tract do not always cause an infection, as they must compete with normal bacterial flora to survive. Portals of entry by pathogens occur through penetration, direct contact, inhalation, and ingestion.

In the usual course (stages) after a pathogen has entered the host body, the stage when the host initially develops the appearance of signs/symptoms like a mild fever and body aches is:

The prodromal stage follows inoculation (the initial stage) and is identified by the initial onset of symptoms in the host. Tissue inflammation and damage is evident during the acute (3rd) stage. Pathogen elimination and containment are characteristics of the convalescent (4th) period, which follows the acute stage.

A client sustained an injury 3 days ago. The nurse is assessing the status of the wound and anticipates the wound to be in which phase of healing?

The proliferative phase begins within 2 to 3 days of an injury and focuses on building new tissue to fill the wound. The inflammatory phase begins at the time of the injury occurrence. The remodeling phase occurs approximately 3 weeks after the injury. There is not a collagen phase.

The health care provider is reviewing diagnostic results of a client with suspected ovarian cancer. Select the result that would be of most concern.

The serum markers that have proven most useful in clinical practice are the human chorionic gonadotropin (hCG), prostate-specific antigen (PSA), CA-125, alpha-fetoprotein (AFP), CD blood cell antigens, and carcinoembryonic antigen (CEA). The CA 125 marker is used to mark ovarian cancer. hCG is used to diagnose gestational trophoblastic tumors, and PSA is used to diagnose prostate cancers. CEA marks colorectal cancers.

A nurse on the oncology floor reads a client's chart and sees that the client was treated for an adenocarcinoma. What type of tissue composes this tumor?

The term "adenocarcinoma" denotes a malignancy of the glandular epithelium. CNS cancers usually begin with "neuro-" and there is no particular term used to denote a stem cell cancer. There are varied terms used to describe cancers of the connective tissue, depending on the tissue type.

A nursing student who is studying cancer cells identifies which of the following to be the bestdefinition of anaplasia?

The term "anaplasia" is the loss of cell differentiation in cancerous tissue. Rapid proliferation of cancer cells refers to a rapid increase in number of cells, while decreased proliferation is a decrease in the growth or decrease in the number of cells. An increase in cell differentiation refers to the process by which a less specialized cell becomes a more specialized cell type. This is not what happens during anaplasia.

A nursing student is caring for a client who was recently diagnosed with breast cancer. The student is explaining what the doctor meant when the term "sentinel node" was mentioned. What will the student tell the client?

The term "sentinel node" describes the initial lymph node to which the primary tumor drains.

The bacteria that line the gut of a human help maintain normal gut health and provide essential nutrients. This type of relationship is:

The term mutualism is applied to an interaction in which the microorganism and the host both derive benefits from the interaction. Commensalism is a relationship where the organism receives benefit at no harm to the host. A parasite is an organism that derives benefits from its biologic relationship with another organism with the potential of causing harm.

In the vascular phase of acute inflammation, initial vasoconstriction is followed rapidly by which assessment finding?

The vascular phase of acute inflammation is characterized by changes in the small blood vells at the site of injury. It begins with momentary vasoconstriction followed by rapid vasodilation, which allows more blood and fluid into the area of injury, resulting in congestion, redness, and warmth. As fluid moves out of the vessels, stagnation of flow and clotting of blood occurs

The nurse is caring for a client with an infection of Candida albicans. Which type of antimicrobial agent will the nurse plan to administer to effectively treat this disease?

The yeasts and molds such as organism Candida albicans are fungi that will be effectively treated with antifungal medications. Because Candida is part of the normal body flora, it usually appears as an infection only when the client's normal immune system is compromised, such as when taking broad spectrum antibiotics.

A client who is scheduled to have a tissue specimen removed for microscopic study will undergo which test?

Tissue biopsy involves the removal of a tissue specimen for microscopic study. A pap test involves taking cells from the outer opening of the cervix of the uterus and the endocervix. A blood sample uses blood from a vein and an X-ray is a form of electromagnetic radiation.

After many years of cigarette smoking, a client is admitted to have a "mass" removed from the lung. When explaining the surgery and recovery, the physician notes that the client is likely to have a good amount of fibrosis develop at the surgical area. After the physician leaves the room, the client asks the nurse what was meant by "fibrosis" in the lung. The nurse bases the response on the fact that tissue repair can:

Tissue repair can take the form of replacement by connective (fibrous) tissue, which leads to scar formation or fibrosis in organs such as the liver or lung. Regeneration of tissue results with injured cells being replaced with cells of the same type. Although age does play a role in tissue healing, it is not the only factor that can result in scar formation.

A nurse who had a needlestick injury 15 years ago has developed hepatitis C and now progressed to liver failure. This nurse was hoping that the growth factor, transforming growth factor-alpha (TGF-alpha), would have been able to repair her liver since this growth factor's function is to:

Transforming growth factor-alpha stimulates replication of hepatocytes and many epithelial cells. Fibroblast growth factor (FGF) stimulates angiogenesis. Epidermal growth factor stimulates keratinocyte migration and the formation of granulation tissue. Vascular endothelial cells growth factor (VEGF) increases vascular permeability.

Cancer prognosis has improved most dramatically when treatment plans include which of the following?

Treatment plans that use more than one type of therapy, often in combination, are providing cures for a number of cancers that a few decades ago had a poor prognosis, and in turn are increasing the life expectancy. The remaining options can be components of a multi-pronged treatment plan.

The nurse is caring for a client with a chronic wound. The most important intervention for the nurse to include in the plan of care would be:

Vitamins play an essential role in the healing process. Vitamin C is needed for collagen synthesis. Zinc has been found to aid in re-epithelialization. Vitamin C and zinc supplements are often ordered for clients with chronic wounds to promote wound healing. Steroid therapy would decrease wound healing. A diet high in proteins and carbohydrates would be ordered to promote wound healing.

A client tells the health care provider he has heard several myths about viruses. The most appropriate information for the nurse to provide would be:

Viruses can produce symptoms of disease months to years later. Some viruses, such as hepatitis C, can remain latent for long periods of time without causing disease until months to years later. Viruses are incapable of replicating outside of a living cell and are incapable of replication unless in a host cell. Not every virus causes lysis and death of the host cell during replication.

Which best describes the structure of a virus?

Viruses consist of a protein capsid that surrounds a nucleic acid core (either RNA or DNA). Bacteria have both a cell wall and a cell membrane. Spirochetes have a helical cell wall, and mycoplasma are bacteria that lack a cell wall.

When caring for a postoperative client, in order to promote wound healing, which of these nutrients does the nurse encourage the client to consume?

Vitamins are essential cofactors for the daily functions of the body; vitamins A and C play an essential role in the healing process. Vitamin C is needed for collagen synthesis. Vitamin K plays an indirect role in wound healing by preventing bleeding disorders that contribute to hematoma formation and subsequent infection. Proteins, fats, carbohydrates and microminerals such as zinc are required for wound healing as well.

The mother of an infant born with profound intellectual disability and hearing loss tells the nurse that she had a viral infection in the first trimester of pregnancy. The nurse identifies which congenital infection as the cause of the fetal defects?

When an infectious disease is transmitted from mother to child during gestation or birth, it is classified as a congenital infection. The most frequently observed congenital infections include toxoplasmosis (caused by the parasite Toxoplasma gondii), syphilis, rubella, cytomegalovirus infection, and HSV infections (the TORCH infections); varicella-zoster (chickenpox); parvovirus B19; group B streptococci (Streptococcus agalactiae); and HIV. The severity of congenital defects associated with these infections depends greatly on the gestational age of the fetus when transmission occurs, but most of these agents can cause profound intellectual disability and neurosensory deficits, including blindness and hearing loss.

A woman reports to the nurse that she has developed a yeast infection. The woman does not understand how she could get a yeast infection since she has been on antibiotics for a urinary tract infection. What is the rationale for this client's complaint?

Yeast are commensal flora of the skin, mucous membranes, and gastrointestinal tract and are capable of growth at a wider range of temperatures. Intact immune mechanisms and competition for nutrients provided by the bacterial flora normally keep colonizing fungi in check. Alterations in either of these components by disease states or antibiotic therapy can upset the balance, permitting fungal overgrowth and setting the stage for opportunistic infections.