NUR 220 Exam 1 Study Questions
antigen antibody interaction
causes tissue damage involve immediate reaction after prior sensization includes systemic reaction 1, 2, 3
When reviewing an allergic reaction
check WBC and diff, esinophil will be high, neutrophil low
If a patient tests positive for PPD
chest xray, sputum sample, blood test Lesions in upper lung lobes
Drugs for allergic reaction
cromolyn- blocks histamine glucocortosteiod- heps with inflammation and pain IV Epi
Type 4 immune response
delayed reaction antigen lympocyte reaction PPD reaction for TB
Nursing considerations for ethambutol
do vision checks before starting therapy & monthly thereafter Bacteriostatic
Chemical manifestation of anaphylaxis: Neuro
headache, dizziness, paraesthesia, feeling of doom
Side effects from ART include
hepatoxicity, nephrotxicity, osteopenia, high CVD, high MI, insulin resistance, lipodystrophy, loss of fat on face, lipohypertrophy
Chemical manifestation of anaphylaxis: respi
horseness, coughing, narrowed airway, wheezing, stridor, dyspena
Hepatitis B manifestations
insidious and variable, like HAV, loss of appetite, dyspepsia, abdominal pan, generalized aching, malaise, weakness, maybe jaundice
Types of t cells
killer t cells- carry CD8 antigen, attack malignant cells, they reject organs Regulator cells including: Helper T cells- carry CD4 innitate immune response Suppressor T cells- carry CD8, stop immune response
Medical management of HIV: Kaposi sarcoma
local therapy, chemo
Hepatitis C
mild symptoms inflammation of the liver caused by the hepatitis C virus (HCV), which is transmitted by exposure to infected blood; this strain is rarely contracted sexually
HIV Manifestations include:
pancreatitis, hepatitis SOB, fever, cough, NVD Wasting
Vitamin B6 is given with TB therapy to
prevent nerve problems from isoniazid
Chemical manifestation of anaphylaxis: skin
prutis, angioedma, erythema
The nurse is talking with a group of teens about transmission of human immunodeficiency virus (HIV). What body fluids does the nurse inform them will transmit the virus? Select all that apply. semen urine breast milk blood vaginal secretions
semen breast milk blood vaginal secretions
indirect combs test
should be neg (circulating antibodies)
direct combs test
should be neg (on RBCs)
Immoncomplex assay
shows how well complement system works
cell-mediated immune response
specialized T cells destroy infected host cells
Medical management of HIV: Lymphoma
stem cell trans and chemo
in hepatitis PTT
will be high
in hepatitis bilirubin
will be high
in hepatitis WBC
will be low, neutropenia
T spot TB test
will say if TB exists and will not interfer BCG vaccine
The nurse receives a phone call at the clinic from the family of a client with AIDS. They state that the client started "acting funny" and reported headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member? "The client probably has a case of the flu and you should give acetaminophen." "The client may have cryptococcal meningitis and will need to be evaluated by the health care provider." "This is one of the side effects from antiretroviral therapy and will require changing the medication." "The client probably has pneumocystis pneumonia and will need to be evaluated by the health care provider."
"The client may have cryptococcal meningitis and will need to be evaluated by the health care provider."
A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What should the nurse tell the patient? "Only wear your contact lenses during the day and take them out in the evening before bed." "You should switch to wearing your glasses while taking this medication." "The physician can give you eye drops to prevent any problems." "There are no significant problems with wearing contact lenses."
"You should switch to wearing your glasses while taking this medication."
Manifestations of TB
-cough, hypoptysis -low-grade fever with night sweats -anorexia, weight loss -malaise, fatigue
AST level
0-35
Normal Creatinine
0.6-1.2 mg/dL
Seven ART drugs
1) Nucleoside/Nucleotic Reverse Transcriptase Inhibator 2) Non-Nucleoside/Nucleotic Reverse Transcriptase Inhibator 3) Protease inhibator 4) Fusion inhibator 5) CCR5 antagonist 6) Intergrine strenal transfer inhibator 7) Post-cobistat and ritonavir to increase ART effect
Three types of hypersensitivities
1) overraction/hypersensitive 2) Incompetency- immuno defienct from aids 3) autoimmune disorder- Lupus
BUN normal range
10-20 mg/dL
ALT level
10-40 U/L
serum albumin
3.5-5.5 g/dL
WBC level
4,000-11,000
After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? 3 to 5 days 1 to 3 weeks 2 to 4 months 6 to 12 months
6 to 12 months
The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient? 3 months 3 to 5 months 6 to 12 months 13 to 18 months
6-12 months
PTT level
60-70 seconds
Total serum protein
7-7.5 g/dL
Bilirubin level
<1.0 mg/dL
PPD test results
<4mm = neg 5-10mm = sensitive or HIV+ 10mm+ = positive
Egophony
A change in vocal resonance in the presence of a lung consolidation condition in which the transmission of the "eee" sound becomes a nasal "ay" sound. Happens in TB
Hepatitis E
A virus spread via fecal-oral transmission (contaminated water) especially in developing countries 15-65 days IGM or IGG
A client with AIDS has become forgetful with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? distal sensory polyneuropathy (DSP) candidiasis AIDS dementia complex (ADC) cytomegalovirus (CMV)
AIDS dementia complex (ADC)
Cryptococcal meningitis treatment
Amphotericin B with Diflucan Then Flucanazole
Immune responses
Antibody mediated/hummoral medication Cell mediatied/Tcells
Medical management of HIV: Depression
CBT Prozac Tofranil
A client with acquired immune deficiency syndrome (AIDS) informs the nurse of difficulty eating and swallowing, and shows the nurse white patches in the mouth. What problem related to AIDS does the nurse understand the client has developed? MAC Wasting syndrome Kaposi's sarcoma Candidiasis
Candidiasis
Mycobacterium avium complex (MAC) is treated with
Clarithromycin (Biaxin) or Azithromycin (Zithromax) with Ethambutol
Hepatitis D
Depends on hepatitis B for replication IGM or IGG 30-150 days
A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client? Client teaching about the cause of TB Reviewing the risk factors for TB Developing a list of people with whom the client has had contact Client teaching about the importance of TB testing
Developing a list of people with whom the client has had contact
Which blood test confirms the presence of antibodies to HIV? Erythrocyte sedimentation rate (ESR) p24 antigen Reverse transcriptase Enzyme immunoassay (EIA)
Enzyme immunoassay (EIA)
A healthcare worker has been exposed to the blood of an HIV-positive client and is awaiting the results of an HIV test. In the meantime, what precautions must the healthcare worker take to prevent the spread of infection? Limit interactions with people who are not HIV infected. Limit interactions with people who are already HIV infected. Follow the same sexual precautions as someone who has been diagnosed with AIDS. Quit their job and get admitted to a hospital or a cancer treatment center.
Follow the same sexual precautions as someone who has been diagnosed with AIDS.
TB drug therapy
Give RIPE RIPE (rifampin, isoniazid, pyrazinamide, ethambutol) with b6 for 8 weeks Then give INH and rifamptin for 5-7 months Monitor liver enzymes, BUN, creatinine
The nurse is reviewing the medical record of a client who is positive for human immunodeficiency virus (HIV). The nurse notes that the client is classified as HIV asymptomatic based on which CD4+ T lymphocyte count? Less than 200/mm3 Between 200 to 350/mm3 Between 350 to 499/mm3 Greater than 500/mm3
Greater than 500/mm3
Hepatitis B identified
HBcAG
In hepatitis AST and ALT
HIGH
A client with acquired immune deficiency syndrome (AIDS) is brought to the clinic by a family member. The family member tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? Distal sensory polyneuropathy (DSP) Candidiasis HIV encephalopathy Cytomegalovirus (CMV)
HIV encephalopathy
Nursing considerations for INH
Have them avoid tyramine food and alcohol
A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find? Urine specific gravity of 1.010 Hypernatremia Hypokalemia Proteinuria
Hypokalemia
Type 3
IGG or IGM like strep throat
Type 2 immune response
IGG or IGM Complement cascade systems- macrophage, eat damaged cells Antibodies formed
Hep A is identified with
IGM
antibody-mediated immunity
Immunity that results from the presence of antibodies in blood and lymph.
Medical management of HIV: Nutrition
Megace to help with weight gain Marinol to get rid of NV TPN as last resort
A nurse reading a chart notes that the client had a Mantoux skin test result with no induration and a 1-mm area of ecchymosis. How does the nurse interpret this result? Negative Positive Borderline Uncertain
Negative
Hepatitis A
Oral fecal incubation: 4-6weeks Ill for 4-8 weeks low mortality manifests in flu like symptoms, fever, dark urin, liver enlargement
HIV diagnostic tests
PCR HIV blood testing, then if positive they complete the more expensive western blot test. Polymerase Chain Reaction 1) antigen/antibodies first Serological testing algorthisms (STARHS )- tells if infection is new or old 2) Antibody test (if positive, do RNA test) 3) RNA tests (NAT)- Detects HIV 4) Antibody diff
Cellular lymphocytes speciica antigens natural include
Passive from milk in baby Active in learning resistence from killing disease
Humoral antibodies for specific antigens (Artifical)
Passive: injection of antibodies Active: Immunization
Common HIV diseases
Pnemocytosis Pneumonia (PCP) Mycobacterium Avium Complex (MAC) TB AIDS related lymphoma (hodgkins or non).
The nurse completes a history and physical assessment on a client with acquired immune deficiency syndrome (AIDS) who was admitted to the hospital with respiratory complications. The nurse knows to assess for what common infection (80% occurrence) in persons with AIDS? Cytomegalovirus Legionnaire's disease Mycobacterium tuberculosis Pneumocystis pneumonia
Pneumocystis pneumonia
Three Phases of Hepatitis A
Preicteric/prodomal: weight loss, fatigue, fever, dark urine, clay stools Icteric/clinical jaundice: big liver, abdomonal pain, jaundice. Posticteric: mild flu symptoms, fever, normal liver size, healing
TB Drugs
RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)
RAST
Radioallergosorbent blood test that measures the amount of IgE produced each time the blood is mixed with a specific allergen
The nurse administers an injection to a client with AIDS. When finished, the nurse attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse? Obtain counseling. Call the lab to draw the nurse's blood. Fill out a risk management report. Report the incident to the supervisor.
Report the incident to the supervisor.
Cytomegalovirus (CMV)
causes blindness
The nurse is caring for a client who has a diagnosis of human immunodeficiency virus (HIV). Part of this client's teaching plan is educating the client about his or her medications. What is essential for the nurse to include in the teaching of this client regarding medications? The use of condoms What vaccinations to have Side effects of drug therapy The action of each antiretroviral drug
Side effects of drug therapy
Stages of HIV (numbers)
Stage 1-500 cells/mEq/L or more, 29 or more CD4. Stage 2- 200-499 cells/mEq/L, CD4 14-28 Stage 3-less than 200 cell/mEq/L, CD4 less than 14
Adverse reactions to TMP SMX medication is
Steven Johnson Leukopenia Hepatitis Thrombocyctopenia Azotemia Hyperkalemia
HIV therapy ART Goal
Suppress virus and restore immune function to prevent HIV transmission. Viral load must be less than diagnosis amount
Stage 3 HIV patients should be given chemoprophylaxis which includes this medication
TMP-SMX with Prednisone for 21 days
A client is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the client about for treatment? TMP-SMZ Cephalexin Azithromycin Garamycin
TMP-SMZ
Nursing considerations for Priftin
Watch out for orange red color to sweat and secretions. Use with cautions in olds and renal disease
A client is admitted to the health care facility with active tuberculosis (TB). What intervention should the nurse include in the client's care plan? Wearing a disposable particulate respirator that fits snugly around the face Instructing the client to wear a mask at all times Wearing a gown and gloves when providing direct care Keeping the door to the client's room open to observe the client
Wearing a disposable particulate respirator that fits snugly around the face
A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay (ELISA) with positive results twice. The next step for the nurse to explain to the client for confirmation of the diagnosis is to perform a: p24 antigen test for confirmation of diagnosis. Western blot test for confirmation of diagnosis. polymerase chain reaction test for confirmation of diagnosis. T4-cell count for confirmation of diagnosis.
Western blot test for confirmation of diagnosis.
fremitus
a palpable vibration from the spoken voice felt over the chest wall In TB, not present
Type 1 immune response
allegoric reaction w/ IGE Mast cell and basophil factors released serious reaction S/S hives, SOB, rash to anphalaxisis
Older adult considerations for TB
altered mental status, unusual behavior, fever, anorexia, weight loss
Cryptococcal Meningitis treatment side effects
anaphylaxis, kidney and hepatic impairment, altered electrolytes
Treatment for cytomegalovirus and side effects
antivirals bone marrow suppression, neutropenia, hepatitis, renal toxicity, seizures.
Kaposi sarcoma (KS) is diagnosed through skin scraping. biopsy. visual assessment. computed tomography.
biopsy
Hepatitis B
blood spread, given to baby Long incubation 1-6 months
Quantiferon TB gold
blood test alternative to PPD Perferred for BCG patients Greater specificity (fewer false positives)
Physical assessment for TB
breath sounds wheeze, crackles, diminished
Hepatitis C identified
by Serum antibody assay
IRIS (Immune Reconstitution Inflammatory Syndrome)
can occur with AT therapy when immune system is restored. S/S fever, respi, abdominal issues, opportunistic infections TX: cortisone
