Patho

As part of a community class, student nurses are developing curriculum to teach expectant parents the importance of having their child properly secured in a child safety seat. During the class, the students are going to have a safety officer examine the car seats that the parents have installed in their vehicle. This is an example of which type of prevention?

Primary prevention

A client has been inhaling viruses periodically while on a cross-country flight. Which situation listed below would most likely result in the stimulation of the client's T lymphocytes and adaptive immune system?

Recognition of a foreign peptide bound to a self-major histocompatibility complex (MHC) molecule

A client who is recovering from burn injuries is discussing his prognosis with a physician. Which teaching point about expectations for healing should the physician offer?

"You may find that the scar is a bit smaller than the area of the wound."

A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has:

A severe bacterial infection

A student asks the instructor about the origins of different tissues and their cellular origins during the process of development. Which statement by the instructor best describes the process of cell differentiation?

"A fertilized ovum undergoes a series of divisions, yielding many different cell types

The nurse knows which statement listed below is accurate regarding the functions and nature of cytokines relative to a variety of pathologies?

"A particular cytokine can have varied effects on different systems, a fact which limits their therapeutic use."

A client diagnosed with H. pylori asks the nurse, "How can an infection occur in the stomach since it is an acid environment?" The nurse responds:

"H. pylori produces an enzyme called urease that converts gastric juices into ammonia which neutralizes the acidic stomach environment."

A 23-year-old man has received a recent diagnosis of appendicitis. The nurse providing care for the man is explaining that the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which teaching points should the nurse eliminate from client education?

"Inflammation helps your body to produce the right antibodies to fight the infection."

An 8-week-old boy has been recently diagnosed with a severe combined immunodeficiency (SCID). His parents have performed a significant amount of research on the Internet and have brought a large amount of material to discuss with their care provider. Which statement best reflects an accurate understanding of their son's health situation?

"Our son likely has a deficiency of B-lymphocytes and can't produce antibodies."

The nurse knows which of statement below is appropriate to be included in an education session for a 21-year-old male with a diagnosis of malaria?

"The infectious organisms are considered tiny, single-celled animals, given their complete eukaryotic machinery."

As part of her prenatal care, a pregnant woman and her partner are being taught by a community health nurse. Which point about the teratogenic effects of different substances should the nurse include in teaching?

"Your developing baby is most vulnerable during the first 2 months of your pregnancy."

A middle school student is scheduled to receive booster immunizations and the father asks the nurse why the booster is necessary. What characteristic of the adaptive immune system listed below would provide the rationale for the nurse's response?

A secondary response causes a sharp rise in antibody levels.

Which client would be considered to be in the latent period of HIV infection?

33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his axilla and cervical neck region for the past 4 months.

Which client would have a very poor response related to tissue regeneration of his or her injured area?

54-year-old male who had a massive MI 4 days ago and came to the ED today for treatment

Which client is most likely to be a candidate for a thymus transplant as the treatment of choice to reconstitute T-cell immunity?

A 7-year-old boy with diagnosis of thymic aplasia whose blood work indicates absence of T cells

Which individual situation listed below best exemplifies the processes of innate immunity?

A child who has experienced heat and swelling of his skinned knuckle

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

A client who contracted hepatitis C through sharing a contaminated syringe with an infected person

A 41-year-old female with a family history has had a baseline mammogram. She states that she performs monthly self breast exams but really has a hard time evaluating her lumps since she has numerous cysts. At her annual mammogram, the technician views a suspicious area and refers her to the radiologist. She asks the nurse in the office, "How can a lump appear so quickly?" The nurse's response is based on which principle?

A tumor is undetectable until it has doubled 30 times and contains at least 1 billion cells

A 72-year-old client being treated for rheumatoid arthritis is admitted with suspected ehrlichiosis. What should the nurse implement as a treatment priority?

Administration of empirically chosen antibiotics

The nurse in the emergency department knows clients exposed to Clostridium botulinum, an agent of bioterrorism, would likely be exhibiting which clinical manifestation listed below?

Muscle weakness in extremities eventually leading to paralysis of respiratory muscles

Following a spider bite she received while camping, a 20-year-old female presented to the emergency department with rash, edema, and fever and was subsequently diagnosed with serum sickness. Which statement best conveys the physiologic rationale for the broad systemic effects of this event?

Antigen-antibody complexes have been deposited in a variety of locations throughout the body

The nurse is administering a calcium channel blocker to a client with a cardiac dysrhythmia. For what side effect should the nurse assess?

Constipation

The nurse working in a pediatric office is scheduled to assess a female adolescent diagnosed with neurofibromatosis (NF) Type 1. During this assessment, the nurse should be assessing the teenager for which clinical manifestations of NF-1? Select all that apply.

B) Severe Scoliosis D)Complaints of having a hard time concentrating in school E) Speech impediments

The nurse will most likely assess which clinical manifestation in a client diagnosed with Creutzfeldt-Jakob disease?

Change in behavior and memory, loss of coordination leading to encephalopathy

A woman gives birth to a small infant with a malformed skull. The infant grows abnormally slowly and shows signs of substantial cognitive and intellectual deficits. The child also has facial abnormalities that become more striking as it develops. What might you expect to find in the mother's pregnancy history?

Chronic alcohol use

A nurse is providing care for a 17-year-old boy who has experienced recurrent sinus and chest infections throughout his life and presently has enlarged tonsils and lymph nodes. Blood work indicated normal levels of B cells and free immunoglobins but a lack of differentiation into normal plasma cells. The boy is currently receiving intravenous immunoglobulin (IVIg) therapy. What is the boy's most likely diagnosis?

Common variable immunodeficiency

The nurse is questioning the validity of oxygen saturation readings from the new oximeters on the unit. Which action should the nurse take to best determine if the results from the oximeter are valid?

Compare clients' results to measurements taken using arterial blood gas analyses

A nurse is teaching clients about the benefits of smoking cessation. What should the nurse include as the most accurate reason for the development of a chronic "smoker's cough"?

Damage to cilia in the respiratory tract make it necessary to cough to clear the airway

A 79-year-old female resident of an assisted living facility receives care from a community nurse on a regular basis for treatment of a chronic venous leg ulcer. Which factor would the nurse be most justified in ruling out as a contributing factor to the client's impaired wound healing?

Decreased antibody levels

A nurse in the emergency department admits a male client who has experienced severe frostbite to his hands and toes after becoming lost on a ski hill. The nurse recognizes that which phenomena has contributed to his tissue damage?

Decreased blood flow has induced hypoxia.

The nurse knows high incidences of infectious illnesses among the older adults who reside in a long-term care facility are most likely to have diminished immune capacity because of

Decreased numbers and responsiveness of T lymphocytes

The nurse is caring for a client with arterial insufficiency of the left leg with gangrenous wounds on the second and third toes. What characteristics of the wounds should the nurse evaluate as expected? Select all that apply.

Diminished pulse strength Atrophy of the affected toes A clear demarcation between the healthy and affected tissues Darkened appearance of affected tissue

an 11-year-old girl is suspected of having Turner syndrome. Which diagnostic test would be the most useful component of screening to confirm or rule out the diagnosis?

Echo

The nurse is caring for a client with left-sided heart failure causing chronic activation of the renin-angiotensin-aldosterone system (RAAS). What is the nurse's priority assessment?

Fluid volume excess

While teaching about HIV/AIDS to a group of high school seniors, the school health nurse will begin by explaining the basic facts. Which information will this likely include?

HIV is different from other viruses since it is a retrovirus that selectively attacks the body's immune cells.

A nurse is working with a researcher examining the variation of medication response in differing populations. What topic is the nurse most likely focusing on for this research?

Haplotypes

A nurse is interviewing a client with fever, myalgia, headache, and lethargy. Which question is most important for the nurse to ask related to identifying the cause of these symptoms and the possible need for quarantining the client?

Have you or any family members traveled outside the country recently?

The laboratory technologists are a discussing a new blood test that helps establish a differential diagnosis between shortness of breath with a cardiac etiology and shortness of breath with a respiratory/pulmonary etiology. A positive result is purported to indicate a cardiac etiology. The marketers of the test report that 99.8% of clients who have confirmed cardiac etiologies test positive in the test. However, 1.3% of clients who do not have cardiac etiologies for their shortness of breath also test positive. Which statement best characterizes this blood test?

High sensitivity; low specificity

A deficiency in which of these would result in an inhibition of the inflammatory response?

Histamine

A client arrives in the emergency department reporting muscle cramps and spasms in the legs and feet; tingling in the fingers, toes, and lips; and anxiety. Serum calcium level is 4.8 mg/dL (1.2 mmol/L). Suspecting tetany, which medication should the nurse be prepared to administer?

IV calcium gluconate

As part of her prenatal education, a 29-year-old woman who is pregnant with her first child is receiving teaching from her primary care provider. Which statement by the woman reflects an accurate understanding of HIV transmission?

It's discouraging to know that my breast milk can pass on HIV to my baby

When educating a client with a wound that is not healing, the nurse should stress which dietary modifications to ward off some of the negative manifestations that can occur with inflammation?

Increase your intake of oily fish and fish oil so that you will increase absorption of omega-3 polyunsaturated fatty acids

Health care team members know recently an increased incidence of infections such as West Nile virus and SARS do not match previously established patterns. Which phenomenon constitutes the most significant contributor to the spread of new diseases in the United States?

Increased ease and speed of travel for individuals and groups

Which aspect of a client's site of inflammation would help the care provider rule out chronic inflammation?

Increased neutrophils

A school-age child with a history of asthma has brought a note home from school stating there has been one case of meningitis (Neisseria meningitidis) in the school. Since the mother is a nurse, she is very concerned since she knows the portal of entry of this pathogen is:

Inhalation via the respiratory tract such as through breathing or yawning

A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which phenomenon best captures the rationale for allergy desensitization therapy?

Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies.

A nurse is providing care for a client who has been diagnosed with metabolic alkalosis after several days of antacid use. Which treatment should the nurse prepare to give?

Intravenous administration of a KCl solution

A student is attempting to trace the feedback cycle involved in the stress response. Which neural structure is thought to be the central integrating site for the stress response?

Locus ceruleus

A person who has been diagnosed with HIV infection 12 years ago and still has a CD4+ cell count of 800 cells/μL and a low viral load is considered to be in which clinical group?

Long-term nonprogressor

A 16-year-old girl has broken her arm while snowboarding and is shocked at the amount of swelling at the injury site. Which statement best explains the physiologic rationale for her swelling?

Loss of plasma proteins causes an increase in interstitial osmotic pressure

The nurse knows which component is needed for long-lasting immunity in a client with a diagnosis of sepsis without the causative agent identified?

Lymphocytes

A 53-year-old female hospital client has received a kidney transplant following renal failure secondary to hypertension. The teaching prior to transplant made her aware that she would need to take anti-rejection drugs for the rest of her life. Which aspect of the immune system underlies this necessity?

MHC molecules will never develop in the cells of the donor organ and effector cells will be continually stimulated.

A client presents with sudden, violent diarrhea and vomiting after consuming chicken and potato salad 8 hours prior at the beach on a hot day. The nurse knows which statement best matches the phase of the infectious process of food poisoning?

Maximum impact of infectious process

A client's arterial blood gases reveal normal oxygen level, pH 7.50, PCO2 level of 50 mmHg (6.65 kPa) and HCO3 level of 30 (30 mmol/L). The client's respiratory rate is 12 breaths/min and all other vital signs are within normal range. What is this client's most likely diagnosis?

Metabolic alkalosis

A client with a diagnosis of schizophrenia has been admitted with suspected hyponatremia after consuming copious quantities of tap water. Which finding does the nurse anticipate uncovering related to this problem?

Muscle weakness, lethargy and headaches.

A student arrives at the health clinic anxious and afraid. The student found an enlarged lymph node in the groin area that is extremely painful to touch and "knows" it is cancer. What information should the health care provider relay to this student about lymphadenitis?

Not all swollen lymph nodes are due to cancer. It could be caused by an infection in the genital region.

A client who has a diagnosis of an autoimmune disease asks his nurse why it is that their immune system does not attack all of the cells that make up his body. Which of the following aspects of pathogen recognition in the innate immune system listed below would underlie the nurse's response?

Pattern recognition receptors (PRRs) ensure cells are correctly identified

A female dental assistant has developed signs and symptoms of a latex sensitivity, and is undergoing allergy testing as well as blood work. Which component of the assistant's blood work would most likely be the focus of her health care provider's analysis?

Serum IgE immunoassays

The nurse knows that the cells primarily programmed to remove the invading organisms and remember the antigen to respond rapidly during the next exposure are:

T-lymphocytes and B-lymphocytes

Which enzyme listed below is responsible for the ability of cancer cells to resist aging and contributes to cellular immortality that is so characteristic of this disease process?

Telomerase

A male client with a history of heavy alcohol use has been admitted to the hospital for malnutrition and suspected pancreatitis. The client's diagnostic workup suggests alcoholic ketoacidosis as a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas, but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him?

The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough.

A counseling psychologist is working with a 30-year-old female client who is experiencing the symptoms of posttraumatic stress disorder (PTSD) following a house fire several months prior. Which of the client's diagnostic results could most likely be interpreted as a manifestation of PTSD?

The client has decreased levels of cortisol

A 56 year-old female hospital client with a history of alcohol abuse is receiving intravenous (IV) phosphate replacement. Which health problem will this IV therapy most likely resolve?

The client is acidotic and has impaired platelet function.

A researcher is involved in the production of insulin through recombinant DNA technology. Which statement could the researcher best provide as a rationale for her work?

The gene fragment responsible for insulin production can be isolated and reproduced.

A group of researchers has identified that the prevalence of two particular genetic disorders share a statistical correlation. Which statement best conveys the genetic rationale for this situation?

The genes causing each disorder are likely in the same section of the same chromosome.

The clinical educator of a hospital medical unit has the mandate of establishing evidence-based practice guidelines for the nursing care on the unit. Which statement most accurately captures a guiding principle of the nurse's task?

The guidelines will combine individual expertise with external systematic evidence

A man and woman are eager to determine the sex of their unborn child, and have asked the nurse at the fertility clinic how this is possible at an early stage of in vitro development. Which of the nurse's responses best captures the genetic rationale for early sex identification through tissue samples?

The inactive X chromosome can be visible in a female."

A 77-year-old male client with a diagnosis of stomach cancer has been found to have metastases in his liver. The client and his family are surprised at this turn of events, stating that they don't see how he could have developed cancer in his liver. Which fact would underlie the reply that the care team provides?

The portal circulatory system brings venous blood from the GI tract into the liver.

An oncology nurse who has worked for many years providing care for children with cancer has taken a job on an adult oncology unit of a hospital. What differences might the nurse anticipate in this new job?

There will be a greater number of cancers that are epithelial in origin.

A potential donor is angry at the personal nature of the questions about HIV risk factors that he is required to answer at a blood collection center, and states that simple blood testing should suffice. How can the nurse at the center best respond?

There's a period shortly after someone is infected with HIV when blood tests might still be negative.

The family member of a client with terminal metastatic cancer who is experiencing cachexia-related weight loss asks the nurse why the client is losing weight despite taking in a large amount of calories per day. What is the nurse's best response?

This weight loss is related to the cancer itself and occurs despite an intake of adequate calories.

Which process would most likely be considered an anomaly during the cellular phase of inflammation?

Vasoconstriction

A young client has just been diagnosed with xeroderma pigmentosum. When teaching this family about this disease, the nurse should emphasize which teaching points? Select all that apply.

Wear long sleeves, long pants, gloves, a hat, sunglasses with side shields, and sunscreen while outdoors. The best time to allow the child to play outside is in the evening hours after the sun goes down.

The mother of an 18-month-old child is concerned that her child is lethargic and not eating foods that he normally enjoys. She takes him to the pediatrician for a check-up. Which clinical manifestations lead the health care provider to suspect the child may have a neuroblastoma? Select all that apply.

Weight loss Crying when joints/position changed Large, protruding abdomen

The nurse is caring for a client who was just told she is 4 months pregnant and was unaware of the pregnancy. The nurse is reviewing any medications that the client may have taken in the past 5 months. Which characteristic of the medication(s) will the nurse assign the most significance when considering if the medication may be teratogenic?

Whether the medication is lipid or water-soluble

A family of five vacationed together, but only the client contracted traveler's diarrhea. The client asks the nurse, "We all ate and drank the same things. Why am I the only one with this condition?" What should the nurse offer to the client as the most likely reason for susceptibility for this condition?

You are taking a proton pump inhibitor for gastric reflux disease.

A health care professional has recommended biofeedback to a client as a method of dealing with the high levels of stress. Which explanation should the nurse offer the client to explain biofeedback treatment?

You will be taught how to gain control over skeletal muscle contractions."

A client has been diagnosed with rheumatoid arthritis and asks the nurse what causes this condition. What is the nurse's best response?

Your immune system is attacking your own tissues as if they were harmful organisms.

Laboratory testing is ordered for a male client during a clinic visit for routine follow-up assessment of hypertension. When interpreting lab values, the nurse knows:

a normal value represents the test results that fall within the bell curve

Which situation would be classified as a complication of a disease or outcome from the treatment regimen? Select all that apply.

a. Development of pulmonary fibrosis following treatment with bleomycin, an antibiotic chemotherapy agent used in treatment of lymphoma b. Massive pulmonary emboli following diagnosis of new onset atrial fibrillation.

The nurse is caring for an 8-year-old client who has cystic fibrosis. What aspect of client care should the nurse prioritize?

airway clearance

During a crime scene investigation, the coroner confirms that rigor mortis has set in. This helps to confirm an approximate time of death. The forensic nurse can explain this process (rigor mortis) to a group of students based on the fact that:

at death, the body is unable to complete the actin/myosin cycle and release the coupling between the myosin and actin, creating a state of muscular contraction.

Which type of pneumonia is best characterized by an infective agent that produces sputum samples with 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?

bacterial

A nurse is triaging clients at a disaster site. Local facilities have different specialized units. To what facility should the nurse send a client who has sustained an electrical injury to his left thigh?

burn unit

The nurse is providing care for a client with a diagnosis of cirrhosis, and she notes that the client's sclerae are jaundiced. The nurse recalls that jaundice is a pigment that can accumulate in which part of the cell?

cytoplasm

The spirochete Leptospira is primarily transmitted to farmers by:

direct contact with infected animals.

A male child was born with Klinefelter syndrome. As an adolescent, the nurse will assess which clinical manifestations of Klinefelter syndrome? Select all that apply.

enlarged breast tissue Sparse facial and pubic hair Tall stature out of proportion

Unbeknownst to her or her care team, a 51-year-old woman's breast cancer has an etiology rooted in the fact that tumor suppressing genes are present but have been silenced. Consequently, she has not synthesized normal cancer-suppressing proteins and neoplasia has resulted. What process has accounted for the woman's cancer?

epigenetic mechanisms

A 10 year old child with strep throat asks the nurse, "Why are there large bumps [lymph nodes] on my neck when my throat gets sore?" The nurse replies that lymph nodes:

help your body fight off infections by allowing special cells [lymphocytes and macrophages] to move through the lymph chain and engulf and destroy germs

When discussing the function of the cell membrane during pathophysiology class, which statement(s) by the faculty is accurate? Select all that apply

helps determine what can and cannot enter and exit cells contains receptors for hormones and neurotransmitters allow ions to cross the membrane during electrical signaling in cells

A client who has been awaiting the results of a bone marrow biopsy for several days is experiencing stress as a result of uncertainty and the possibility that abnormal cell growth may be detected. A physical examination and blood work would most likely yield which result?

increased BP and heart rate; increased ADH

Which of the following is an error in DNA duplication?

mutation

A client presented to the emergency department of the hospital with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) cellulitis. The client's physician has ordered a complete blood count and white cell differential. Which blood component would the physician most likely anticipate to be elevated?

neutrophils

Which client is most likely to have impairments to the wound healing process? A client with

poorly controlled blood sugars with small blood vessel disease

A health care provider has prescribed blood products for a trauma client with a history of selective immunoglobulin A deficiency (SIGAD) who is going into hypovolemic shock. Which blood product is most appropriate for the nurse to infuse?

specially washed erythrocytes from normal donor

A 68-year-old male client with aortic stenosis secondary to calcification of the aortic valve is receiving care. Which statement best captures an aspect of this client's condition?

the client has possibly undergone damage as a result of calcification following cellular injury.

A child possesses a trait that is the result of the interaction of two different genes, neither of which could have produced the trait independently. Which explanation best captures the genetic explanation for this?

the outcome is the result of the interaction between collaborative genes.

Which physiologic process would be considered a positive feedback mechanism?

the platelet-aggregation mechanism activating clot formation

A male international business traveler has returned from a trip to Indonesia. While there, he hired a prostitute for companionship and engaged in unprotected sex on more than one occasion. Unbeknownst to him, this prostitute harbored the hepatitis C virus. Upon return to the U.S., he exhibited no symptoms and returned to his usual activities. During this period of no outward symptoms, the disease would be classified as being in:

the preclinical stage of disease. During the preclinical stage, the disease is not clinically evident but is destined to progress to clinical disease.

The nurse knows a drug in a category identified as a colony-stimulating factor (CSF) helps

to stimulate bone marrow to produce large numbers of mature cells such as platelets and erythrocytes.