Semester 2: Unit 3 exam*

Type 1 hypersensitivity reaction

- IgE mediated histamine release from mast cells and basophils - skin redness, urticaria, rhinitis, and conjunctivitis - Ex: Asthma, allergic rhinitis, atopic dermatitis, anaphylactic shock, urticaria, angioedema

Types of UTIs

1) urethritis - infection/inflammation only the urethra 2) cystitis - Bladder infection/inflammation 3) pyelonephritis - kidney infection/inflammation (back pain, high fever, and vomiting)

Match the following 1. Antitoxin for diphtheria or tetanus 2. Exposure to the chicken pox 3. transfer of colostrum from the mother to the child 4. Flu vaccine A. Natural active immunity B. Artificial active immunity C. Natural passive immunity D. Artificial passive immunity

1. D 2. A 3. C 4. B

Nitrofurantoin (Macrodantin), 75 mg four times per day, has been prescribed for a client with a lower urinary tract infection. The medication comes in an oral suspension of 25 mg/ 5 mL. How many milliliters should the nurse administer for each dose? ________________________ mL.

15mL (what the doctor ordered divided by what you have on hand then times mL)

The parents of an 18-month-old toddler are anxious to know why their child has experienced several episodes of acute otitis media. What should the nurse explain to the parents about why toddlers are prone to middle ear infections? 1. Immunologic differences between adults and young children 2. Structural differences between eustachian tubes of younger and older children 3. Functional differences between eustachian tubes of younger and older children 4. Circumference differences between middle ear cavity size of adults and young children

2. Structural differences between eustachian tubes of younger and older children The eustachian tube in young children is shorter and wider, allowing a reflux of nasopharyngeal secretions. Immunologic differences are not a factor in the development of otitis media. There is no difference in the function of the eustachian tube among age groups. The size of the middle ear does not play a role in the occurrence of otitis media in young children.

A nurse is educating a client with human immunodeficiency virus (HIV) about self-management. Which suggestion by the nurse benefits the client? 1. "Limit your daily fluid intake." 2 ."Eat more roughage." 3. "Rinse your mouth with normal saline after every meal." 4. "Maintain a 4-to-5-hour gap in between meals."

3. "Rinse your mouth with normal saline after every meal." A client infected with HIV should maintain proper oral care to improve his or her appetite. The client should rinse his or her mouth with sterile water or normal saline several times a day, especially after meals, to maintain proper oral hygiene. The client should drink plenty of fluids to maintain proper body fluid balance. Roughage should be limited in a client's diet because it is not easily digestible and may lead to severe diarrhea and contains microorganisms that can lead to infection. The client should consume small, frequent meals to maintain adequate caloric intake.

prostaglandin

A hormone that promotes blood supply to an area, proinflammatory

Cytotoxic T cells

A type of lymphocyte that kills viral infected body cells and cancer cells

Which leukocyte values should be assessed to determine the adequacy of a client's response to inflammation? Select all that apply. A. Monocytes B. Neutrophils C. Plasma cells D. T-helper cells E. Macrophages

A. Monocytes B. Neutrophils E. Macrophages In response to inflammation, monocytes destroy bacteria and cellular debris; neutrophils ingest and phagocytize microorganisms and foreign protein; and macrophages destroy bacteria and cellular debris. Plasma cells are a part of antibody-mediated immunity and secrete immunoglobulins in response to the presence of a specific antigen. T-helper cells are a part of cell-mediated immunity and enhance immune activity through the secretion of various factors, cytokines, and lymphokines.

A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patient's social support system c. Potential medication side effects d. Patient's ability to comply with ART schedule

ANS: D Drug resistance develops quickly unless the patient takes ART medications on a strict, regular schedule. In addition, drug resistance endangers both the patient and the community. The other information is also important to consider, but patients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART

(in class discussion) When using the otoscope, the nurse is unable to see the landmarks or light reflex of the tympanic membrane. The tympanic membrane is bulging and red. What does the nurse think is most likely occurring in the patient's ear? A. Swimmer's ear B. Acute otitis media C. Impacted cerumen D. Chronic otitis media

Acute otitis media

When is the first dose of Rotarix vaccine administered in infants? A. Birth to 6 weeks B. 6-12 weeks C. 12-18 weeks D. 18-24 weeks

B. 6-12 weeks

(NCLEX question) A patient with a urinary tract infection is taking Bactrim (Sulfamethoxazole/Trimethoprim). As the nurse you know it is important that the patient consumes 2.5 to 3 L of fluid per day to prevent which of the following complications?* A. Brown urine B. Crystalluria C. Renal Stenosis D. Renal Calculi

B. Crystalluria Antibiotics called sulfonamides such as Bactrim (Sulfamethoxazole/Trimethoprim) can cause crystalluria. This complication tends to happen when the urine is concentrated. Therefore, the patient should consume 2.5 to 3L of fluid per day to keep the urine diluted.

(power points) Which are clinical manifestations of chronic OM A. Otalgia B. Fever C. Hearing loss D. Difficulty communicating E. Possible feeling of fullness F. Tinnitus G. Vertigo H. Purulent discharge

C. Hearing loss D. Difficulty communicating E. Possible feeling of fullness F. Tinnitus G. Vertigo

(Giddens) A physiological process that provides an individual with protection or defense from disease. A. Infection B. Thermoregulation C. Immunity D. Inflammation

C. Immunity

(in class discussion) What clinical indicator will the nurse most likely identify when assessing a patient with pyrexia? A. Dyspnea B. Pericordial Pain C. Increased pulse rate D. Elevated blood pressure

C. Increased pulse rate

During HIV infection a. the virus replicates mainly in B-cells before spreading to CD4+ T cells. b. infection of monocytes may occur, but antibodies quickly destroy these cells. c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells. d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication

Correct answer: c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells. Rationale: Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of CD4+ T cells (i.e., T helper cells or CD4+ T lymphocytes).

(Self assessment question) Which of the following patients is at higher risk for inflammatory reactions? A. 2-year-old girl with a healthy diet B. 38-year-old man who is obese C. 54-year-old woman in menopause D. 79-year-old man with diabetes

D. 79-year-old man with diabetes The 79-year-old man is at highest risk for inflammatory reactions among these patients for two reasons, his age and having diabetes. The risk would be high during the first year of life, but this 2-year-old girl has gotten beyond this risk period and she also has the positive factor of a healthy diet. The 38-year-old man is not in a high-risk category because of age but is because of obesity. Although a 54-year-old woman is getting older, being in menopause does not increase the risk for inflammatory reactions.

(NCLEX question) A patient diagnosed with pancolitis is experiencing extreme abdominal distension, pain 10 on 1-10 scale in the abdomen, temperature of 103.6 'F, HR 120, and profuse diarrhea. What complication do you suspect the patient is experiencing? A. Fistulae B. Stricture C. Bowel obstruction D. Toxic megacolon

D. Toxic megacolon Pancolitis affects all the colon and is a very severe form of ulcerative colon. The patient is at risk for toxic megacolon. In toxic megacolon, the large intestine dilates due to the overwhelming inflammation. The large intestine is unable to function properly and becomes paralyzed. Typical signs and symptoms of toxic megacolon include: abdominal distention, fever, diarrhea, abdominal pain, dehydration, and tachycardia.

(NCLEX question) True or False: NSAIDs are used as first-line treatment for pain relief with patients with ulcerative colitis.* True False

FALSE. NSAIDs should be avoided in patients with ulcerative colitis because they can cause a "flare-up" in the condition. Tylenol should be used instead or a similar medication that isn't an NSAID.

Remittent fever

Fluctuating, remains elevated and does not return to baseline

T-cell count

HIV progression, Measurement of number of T-type lymphocytes Reduced in patients with AIDS Normal: 500-1,600 T cells/mm3

The urinalysis report of a client reveals pH to be 6, turbidity-cloudy, specific gravity of 1.02, and 0.7 mg/dL of proteins. What does the primary healthcare provider infer from the findings? Infection Glomerular disorder Acid-base imbalance Decreased kidney perfusion

Infection Cloudy urine indicates infection, sedimentation, or high levels of protein in the urine. Therefore the primary healthcare provider concludes that the client has an infection. Increased amounts of proteins in the urine indicate glomerular disorders. The normal levels of protein in the urine range between 0-0.8 mg/dL. Since the client's report shows 0.7 mg/dL of urinary proteins, this is normal. Changes in the pH of urine indicate acid-base imbalance. The average pH of urine is 6. Therefore the client's urinary pH is normal. Decreased kidney perfusion is characterized by increased specific gravity of the urine. The normal specific gravity of urine ranges between 1.000-1.040. The client's urine has a specific gravity of 1.02, which is a normal value

Proctosigmoiditis

Inflammation of the rectum and sigmoid colon

Natural active natural passive

Naturally Acquired Active - develops after introduction of foreign antigen resulting in formation of antibodies or sensitized t-lymphocytes. When you actually get the disease. Obtained naturally through the immune response to exposure to infectious pathogens such as varicella-zoster virgin rus Natural Passive - occurs by the introduction of antibodies or from a natural route. From a mother to her fetus through placental blood transference or through colostrum transfer during breastfeeding. Mom passes immunity to fetus Artificially Acquired Active - the immune response to an immunization. Example: vaccines. Flu shot (pathogens are dead) Artificial Passive - such as a transfusion of immunoglobulin (Ig) When you get a IVIg or injection of Ig

Joints

PIP: proximal interphalangeal joint. the joint between the middle and closest phalange of a given finger DIP: distal interphalangeal joint. the joint between the middle and closest phalange of a given finger

(is the powerpoint correct?) Categorize symptom into issues related to bladder storage or issues to bladder emptying: A. Urinary frequency > 8 times in 24 hr period (often <200 ml each voiding) B. Urgency C. Incontinence D. dysuria E. intermittency F. post-void dribbling G. nocturia/nocturnal enuresis H. Hesitancy I. Suprapubic discomfort or pressure J. hematuria K. cloudy appearance to urine L. urinary retention

Related to bladder emptying: F. post-void dribbling H. Hesitancy L. urinary retention D. dysuria Related to bladder storage: A. Urinary frequency > 8 times in 24 hr period (often <200 ml each voiding) B. Urgency C. Incontinence E. intermittency G. nocturia/nocturnal enuresis I. Suprapubic discomfort or pressure J. hematuria K. cloudy appearance to urine

A nurse is providing dietary teaching for a client with celiac disease. Which foods should the nurse teach the client to avoid when following a gluten-free diet? Select all that apply. a. Rye b. Oats c. Rice d. Corn e. Wheat

Rye, oats, and wheat should be avoided because they are irritating to the gastrointestinal mucosa. Gluten is not found in rice or corn; therefore, these items do not have to be avoided.

Inflammatory arthritis

Swelling and heat of the joint lining causes a release of enzymes which soften and eventually destroy the cartilage. Rheumatoid arthritis, Lupus and psoriatic arthritis are inflammatory in nature. elevated ESR (>20 mm/hr) indicates inflammation or infection somewhere in the body

Heberden's nodes

Swelling of distal interphalangeal finger joints, characteristic of osteoarthritis

T helper cells (CD4)

T cells that are stimulated by antigen to provide signals that promote immune responses Produce cytokines that stimulate macrophages, NK cells, dendritic cells, and other t cells

(NCLEX question) True or False: Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and ulcer formation in the inner lining of the small intestine, specifically the terminal ileum.*

The answer is FALSE: Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and ulcer formation in the inner lining of the LARGE (not small) intestine. The inflammation tends to start in the rectum and spreads throughout the colon. The small intestine is usually not involved.

What size of induration after a tuberculin test signifies a positive result in a 16-year-old client? Record your answer using a whole number. _________________ mm

The nurse should consider an induration of 10 mm (1 cm) a positive sign of tuberculin testing in a 16-year-old client. Induration: Localized hardening of soft tissue of the body.

Lymphocytes

The two types of white blood cells that are part of the body's immune system: B lymphocytes form in the bone marrow and release antibodies that fight bacterial infections; T lymphocytes form in the thymus and other lymphatic tissue and attack cancer cells, viruses, and foreign substances.

The nurse performs a skin test on a client who has a mosquito bite. The client shows wheal and flare reaction post-skin test. Which type of hypersensitivity reaction most likely has occurred? Type 1 Type II Type III Type IV

Type 1 Type I is an IgE-mediated hypersensitivity reaction that causes wheal and flare response. This reaction is characterized by a pale wheal containing edematous fluid surrounded by a red flare from the hyperemia. Type II is a cytotoxic hypersensitivity reaction that involves IgG and IgM antibodies but does not show any wheal and flare response. Type III hypersensitivity reaction is an immune complex-mediated reaction that involves erythema and edema in 3 to 8 hours. Type IV is a delayed hypersensitivity reaction that involves erythema and edema in 24 to 48 hours.

Crohn's disease

a chronic autoimmune disorder that can occur anywhere in the digestive tract; however, it is most often found in the ileum and in the colon ss: abdominal pain and bloody diarrhea, weight loss, fistulas and abscesses. treatment: antidiarrheics, anti-inflammatory medication.

HIV antiretroviral drugs are used to a. cure acute HIV infection. b. decrease viral RNA levels. c. treat opportunistic diseases. d. decrease pain and symptoms in terminal disease.

b. decrease viral RNA levels.

Integrase inhibitors

block the action of integrase, a viral enzyme that inserts the viral genome into the DNA of the host cell ex: Raltegravir, Elvitegravir, Dolutegravir

nephrotic syndrome

characterized by massive proteinuria caused by glomerular damage. corticosteroids are the mainstay Flank pain in a patient with nephrosis suggests a renal vein thrombosis, and anticoagulation is needed. other treatment: ace inhibitors, diuretics, statins, immunosuppressants

Type 2 hypersensitivity reaction

igM or IGg, Cytotoxic ANTIBODY mediated cell destruction Ex: Autoimmune hemolytic anemia, ADCC

mononucleosis

infectious disease marked by increased numbers of mononuclear leukocytes and enlarged cervical lymph nodes

Mantoux Test (PPD)

intradermal test to determine tuberculin sensitivity based on a positive reaction where the area around the test site becomes red and swollen induration appears 24-72 hours after injection

viral load test

measurement of the amount of AIDS virus (HIV) in the bloodstream, HIV progression

Monocytes/Macrophages

phagocytic leukocytes that follow the neutrophils to clear the debris

rubor

redness caused by increased circulation and vasodilation in the injured tissue

Kaposi sarcoma (KS)

type of skin cancer often seen in patients with AIDS; consists of brownish-purple papules that begin in skin and spread to internal organs

Pancolitis

ulcerative colitis spread throughout the entire colon.

(in class discussion) Which of the following patients is at higher risk for inflammatory reactions? A. 2 year old girl with a healthy diet B.38 year old man who is obese C. 54 year old woman in menopause D. 79 year old man with diabetes

D. 79 year old man with diabetes

(Self assessment question) Which important proinflammatory mediator is responsible for initiating neutrophil and macrophage chemotaxis to the site of tissue injury during inflammation? A. Leukotrienes B. Bradykinins C. Transforming growth factor D. Complement proteins

D. Complement proteins Complement proteins are very important, especially C3a, C4a, and C5a, because they initiate chemotaxis (movement) of neutrophils and macrophages toward the site of tissue injury during inflammation

enzyme-linked immunosorbent assay (ELISA)

a test that screens for the presence of HIV antibodies in the blood

Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing? a. Patient age b. Patient lifestyle c. Patient symptoms d. Patient sexual orientation

a. Patient age **The current Center for Disease Control (CDC) policy is to offer routine testing for HIV to all individuals age 13 to 64. Although lifestyle, symptoms, and sexual orientation may suggest increased risk for HIV infection, the goal is to test all individuals in this age range.

Types of Immunity

active natural - getting sick active artificial - vaccine passive natural - mother to baby passive artificial - immune serum, antitoxin

AIDS dementia complex (ADC)

-syndrome of cognitive and motor dysfunction -poor attention and concentration, slowing of mental and motor function, apathy

Match the following 1. Lymphocytes 2. Basophils 3. Eosinophils 4. Neutrophils A. elevated during chronic inflammation/infections B. elevated during parasitic infections and allergic reactions C. elevated during bacterial infections D. most prominent in inflammatory responses to viral antigens

1. D 2. A 3. B 4. A Lymphocytes→ most prominent in inflammatory responses to viral antigens Basophils→ elevated during chronic inflammation/infections, histamine Eosinophils→ elevated during parasitic infections and allergic reactions Neutrophils→ elevated during bacterial infections

(NCLEX question) Which patients below are at risk for developing osteoarthritis? Select-all-that-apply: A. A 65 year old male with a BMI of 35. B. A 59 year old female with a history of taking long term doses of corticosteroids. C. A 55 year old male with a history of repeated right knee injuries. D. A 60 year old female with high uric acid levels.

A. A 65 year old male with a BMI of 35. C. A 55 year old male with a history of repeated right knee injuries. The answers are A and C. The risk factors for developing OA include: older age, being overweight (BMI >25), repeated injuries to the weight bearing joints, genetics. Option B is at risk for osteoporosis, and option D is at risk for gout.

Bouchard's nodes

bony outgrowth was found on the PROXIMAL interphalangeal joint (middle joint of the finger...closest to the body)

(Powerpoints) Which interrelated concepts are related to the cause of inflammation (select all that apply) A. Infection B. Immunity C. Stress D. Clotting

A. Infection B. Immunity

(power points) Which are clinical manifestations of acute OM A. Otalgia B. Fever C. Hearing loss D. Difficulty communicating E. Possible feeling of fullness F. Tinnitus G. Vertigo H. Purulent discharge

A. Otalgia B. Fever H. Purulent discharge typically follows an URI

(power points) Optimal immune response involves which primary functions ( select all that apply) A. Protects the body from microorganism and other antigens B. Removes dead or damaged tissue and cells C. result in regeneration of tissue that functions identically to the damaged and replaced tissue. D. Recognizes and removes cells that show abnormal cell growth/development

A. Protects the body from microorganism and other antigens B. Removes dead or damaged tissue and cells D. Recognizes and removes cells that show abnormal cell growth/development C is the optimal inflammation response

(Nclex question) The nurse teaches a female client who has cystitis methods to relieve her discomfort until the antibiotic takes effect. Which of the following responses by the client would indicate that she understands the nurse's instructions? A. "I will place ice packs on my perineum." B. "I will take hot tub baths." C. "I will drink a cup of warm tea every hour." D. "I will void every 5 to 6 hours."

B. "I will take hot tub baths." Hot tub baths promote relaxation and help relieve urgency, discomfort, and spasm. Applying heat to the perineum is more helpful than cold because heat reduces inflammation. Although liberal fluid intake should be encouraged, caffeinated beverages, such as tea, coffee, and cola, can be irritating to the bladder and should be avoided. Voiding at least every 2 to 3 hours should be encouraged because it reduces urinary stasis.

A nurse is assessing an infant. Which of the following findings are clinical manifestations of acute otitis media? (Select all that apply.) A. Decreased pain in the supine position B. Rolling head side to side C. Loss of appetite D. Increased sensitivity to sound E. Crying

B. Rolling head side to side C. Loss of appetite E. Crying

A nurse is counseling the family of a child with AIDS. What is the most important concern that the nurse should discuss with the parents? A. Risk for injury B. Susceptibility to infection C. Inadequate nutritional intake D. Altered growth and development

B. Susceptibility to infection Children with AIDS have a dysfunction of the immune system (depressed or ineffective T lymphocytes, B lymphocytes, and immunoglobulins) and are susceptible to opportunistic infections. All children are subject to injury because of their curiosity, inexperience, and lack of judgment. Although inadequate nutrition can be a problem for children with AIDS, the prevention of infection is the priority. Although children with AIDS are usually small for age, altered growth and development is not as life threatening as an infection.

A nurse is caring for a 2-year-old child who has had three ear infections in the past 5 months. The nurse should know that the child is at risk for developing which of the following as a long-term complication? A. Balace difficulties B. Prolonged hearing loss C. Speech delays D. Mastoiditis

C. Speech delays

Which of the following is the primary complication of a middle ear infection A. sensorineural hearing loss B. vertigo C. perforation of the ear drum D. tempanosclerosis

C. perforation of the ear drum

Inner ear infections (Mastoiditis)

Can decrease detection of sound and maintenance of balance; may be caused by chronic middle ear infections

Bradykinins

Chemicals produced by the body and responsible for inflammation and pain causes blood vessels to leak and fluid to accumulate in tissues and organs

Which types(s) of isolation precautions is (are) appropriate for a patient with tuberculosis (select all that apply)? a. contact precautions b. droplet precautions c. airborne precautions d. standard precautions e. neutropenic precautions

c. airborne precautions d. standard precautions

A patient with nephrotic syndrome develops flank pain. The nurse will anticipate treatment with a. antibiotics. b. antihypertensives. c. anticoagulants. d. corticosteroids.

c. anticoagulants. Rationale: Flank pain in a patient with nephrosis suggests a renal vein thrombosis, and anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis. Antihypertensives are used if the patient has high blood pressure. Corticosteroids may be used to treat nephrotic syndrome but will not resolve a thrombosis.

Interleukin-1 (IL-1)

causes T and B lymphocytes to proliferate, causes fever

decreased kidney perfusion

characterized by increased specific gravity of the urine. normal specific gravity of urine ranges between 1.000-1.040.

ulcerative proctitis

chronic inflammation of the most distal area of the large intestine (rectum)

transforming growth factor

class of cytokines, a secreted signaling protein with a role in stimulating cells to divide and differentiate and immune responses

osteotomy

cutting of the bone knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on the knee joint. used when a patient has early-stage osteoarthritis that has damaged just one side of the knee joint. By shifting weight off of the damaged side of the joint, an osteotomy can relieve pain and significantly improve function in an arthritic knee.

Entry inhibitor drugs

prevent HIV from entering and binding to healthy CD4 cells (T-cells) ex: Enfuvirtide, Maraviroc

plasma cells

produce antibodies secrete immunoglobulins in response to the presence of a specific antigen

Histamine

proinflammatory mediator released by mast cells. Similar to serotonin, histamine increases vasodilation, enhances (increases) vascular permeability, and mediates the early acute inflammatory response

total knee replacement (TKR)

surgical placement of an artificial joint during which all parts of the knee are replaced

T3 and T4

thyroid hormones

ileoanal anastomosis (J pouch)

(Ileorectostomy) colon and rectum are removed, pouch created from ileum, and the ileum is connected to the anus. Patient eliminates bowel in usual manner, feces will be liquid

Neutrophils

- Bacterial or fungal infection - are chief and initial phagocytes of early inflammation - the breakdown of dead neutrophils releases digestive enzymes from their cytoplasmic granules - most plentiful of WBCs

Type 3 hypersensitivity reaction

-results from the formation of igG or igM antibody-antigen complexes in the circulation -those antigen-antibody complexes are deposited in the basement membrane of vessel walls, activating complement -erythema and edema in 3 to 8 hours - Immune-complex reaction - fever, joint pain, rashes examples: Systemic lupus, Rheumatoid arthritis, Serum sickness

A 2-year-old toddler has hearing loss caused by recurrent otitis media. What treatment does the nurse anticipate that the practitioner will recommend? 1. Ear drops 2. Myringotomy 3. Mastoidectomy 4. Steroid therapy

2. Myringotomy Myringotomy is a surgical opening into the eardrum to permit drainage of accumulated fluid associated with otitis media. Ear drops are not used because they will obscure the view of the tympanic membrane. Removal of the mastoid will not relieve pressure within inflamed ears. Antibiotics, not steroids, are used for an infectious process.

HIV pregnant women should be vaccinated with which of the following (select all that apply) A. Hepatitis B B. Gardasil C. Pneumococcal D. Haemophilus influenzae type B (Hib) E. Influenza F. Varicella

A. Hepatitis B C. Pneumococcal D. Haemophilus influenzae type B (Hib) E. Influenza

Primary prevention for immunity includes (select all that apply) A. Immunizations B. Avoid high-risk behaviors C. Adequate nutrition D. Exercise E. Infection control measures

A. Immunizations B. Avoid high-risk behaviors C. Adequate nutrition D. Exercise E. Infection control measures

(power points) Collaborate care for an exaggerated immune response involves which of the following? (select all that apply) A. Prevent opportunistic infections B. Remove exposure (if possible) C. Airway support (if anaphylaxis occurs) D. Monitor and treat opportunistic infections E. Pharmacotherapy

B. Remove exposure (if possible) C. Airway support (if anaphylaxis occurs) E. Pharmacotherapy Exaggerated Immune Response: Remove exposure (if possible) Airway support (if anaphylaxis occurs) Pharmacotherapy Immunodeficiency: Monitor immune function Nutrition Prevent opportunistic infections Monitor and treat opportunistic infections Drug therapy

chronic inflammation

a response of blood vessels to such harmful substances as germs, damaged cells, or irritants; can lead to heart disease, cancer, allergies, and muscle degeneration May be a consequence of an inflammatory process not allowing for repair or a consequence of a dz like seen in RA Weeks-years Tissues is repeating being destroyed and repaired Response is out of proportion to the stimulus or is directed against an inappropriate target

fistula

abnormal passageway between two organs or between an internal organ and the body surface

Basophils

release histamine elevated during chronic inflammation/infections

computed tomography (CT)

uses a combination of X-rays and a computer to create pictures of your organs, bones, and other tissues - detect bone and joint problems, like complex bone fractures and tumors. - cancer, heart disease, emphysema, or liver masses, and tumors - internal injuries and bleeding - blood clot, excess fluid, infection, or inflammation

wasting syndrome

weight loss, decrease in muscular strength, appetite, and mental activity; associated with AIDS, loss more than 10% mass

The nurse presents a seminar on HIV testing to a group of seniors and their caregivers in an assisted living facility. Which responses fit the Centers for Disease Control and Prevention's (CDC's) recommendations for HIV testing? (Select all that apply.) A) ''I am 78 years old and I was treated and cured of syphilis many years ago.'' B) ''In 1986, I received a transfusion of platelets.'' C) ''Seven years ago, I was released from a penitentiary.'' D) ''I used to smoke marijuana 30 years ago, but I have not done any drugs since.'' E) ''I had sex with a man with a disreputable past from New York back in the late 1960s, but I have been happily married since 1971.'' F) ''At 68, I am going to get married for the fourth time.'' G) ''Downtown was where I picked up the best hookers back in the 1950s.'

-(A, C, F) A) ''I am 78 years old and I was treated and cured of syphilis many years ago.'' Rationale: People who have had sexually transmitted diseases should be tested for HIV. C) ''Seven years ago, I was released from a penitentiary.'' Rationale: HIV testing is recommended for people who are or have been in jails or prisons. F) ''At 68, I am going to get married for the fourth time.'' Rationale: People who are planning to get married should be tested for HIV. Incorrect: B) ''In 1986, I received a transfusion of platelets.'' Rationale: People who received blood transfusions between 1978 and 1985 should be tested for HIV. D) ''I used to smoke marijuana 30 years ago, but I have not done any drugs since.'' Rationale: HIV testing is recommended only for injection drug users. E) ''I had sex with a man with a disreputable past from New York back in the late 1960s, but I have been happily married since 1971.'' Rationale: AIDS cases were extremely rare prior to the 1970s. G) ''Downtown was where I picked up the best hookers back in the 1950s.'' Rationale: The current AIDS pandemic started in the mid to late 1970s.

Otitis Media with Effusion (OME)

aka serous or secretory otitis media (SOM), inflammation of the middle ear resulting in the collection of serous, mucoid, or purulent fluid without symptoms of acute infection ex: Patient complains of fullness of the ear, a "plugged" feeling or popping, and decreased hearing. Patient does not experience pain, fever, or discharge from the ear.

Type 4 hypersensitivity reaction

- Delayed type hypersensitivity reactions. - T-cell and Macrophage mediated. - erythema and edema in 24 to 48 hours. ischemia, induration, and tissue damage at the site - caused by the chemicals used in the manufacturing process of latex gloves Ex: Tuberculosis

1. Eosinophils 2. Macrophages 3. Monocytes 4. Neutrophils A. Involved in the destruction of bacteria and cellular debris. B. release vasoactive amines during allergic reactions to limit the extent of the allergic reactions. C. are phagocytes and increase in inflammation and infection. D. involved in nonspecific recognition of foreign protein and microorganisms

1. b 2. d 3. a 4. c Eosinophils release vasoactive amines during allergic reactions to limit the extent of the allergic reactions. Neutrophils are phagocytes and increase in inflammation and infection. Monocytes are involved in the destruction of bacteria and cellular debris. Macrophages are involved in nonspecific recognition of foreign protein and microorganisms.

After many episodes of otitis media a 3-year-old child is to undergo myringotomy and have tubes implanted surgically. What should the nurse include in the discharge preparation for this family? 1. Keep the child at home for 1 week. 2. Insert earplugs during the child's bath. 3. Apply an ointment to the ear canal daily. 4. Use cotton swabs to clean the inner ears.

2. Insert earplugs during the child's bath. Water in the ears after myringotomy may be a source of infection. There is no reason that the child cannot be around other children, because there is no infectious process. Applying an ointment to the ear canal daily will clog the ear canal and serves no purpose. Cotton swabs may be used occasionally in the outer ear, but should not be inserted into the ear.

Steroid therapy is prescribed for a client with an exacerbation of ulcerative colitis. The nurse evaluates that teaching is effective when the client identifies which times for the medication schedule? 1. At bedtime with a snack 2. Three times a day with meals 3. In the early morning with food 4. One hour before or two hours after eating

3. In the early morning with food Taking the drug in the early morning mimics usual adrenal secretions; food helps reduce gastric irritation. Diurnal rhythms may be altered, and steroids are ulcerogenic; they should be taken with more than just a snack. Steroids cause gastric irritation and should be taken with food. Although food helps decrease gastric irritation, dividing the dose and taking it throughout the day may alter regular diurnal rhythms; it should be taken in the early morning with food.

A nurse explains to the mother of a 1-year-old with a history of frequent ear infections that the primary cause of otitis media in young children is what? 1. Sinusitis 2. Recurrent tonsillitis 3. An inflamed mastoid process 4. An obstructed eustachian tube

4. An obstructed eustachian tube A blocked eustachian tube impairs drainage and creates negative pressure; when the tube opens, bacteria are pulled into the middle ear. Sinusitis is not related to otitis media. Recurrent tonsillitis is not the direct cause of otitis media. Mastoiditis is a complication, not a cause, of otitis media.

Which type of immunity is acquired through the transfer of colostrum from the mother to the child? A. Natural active immunity B. Artificial active immunity C. Natural passive immunity D. Artificial passive immunity

C. Natural passive immunity Natural passive immunity is acquired through the transfer of colostrum from the mother to the child. Natural active immunity is acquired when there is a natural contact with an antigen through a clinical infection. Artificial active immunity is acquired through immunization with an antigen. Artificial passive immunity is acquired by injecting serum from an immune human.

(NCLEX question) You're providing discharge teaching to a female patient on how to prevent urinary tract infections. Which statement is INCORRECT?* A. "Void immediately after sexual intercourse." B. "Avoid wearing tight fitting underwear." C. "Try to void every 2-3 hours." D. "Use scented sanitary napkins or tampons during menstruation."

D. "Use scented sanitary napkins or tampons during menstruation." Options A, B, C are all correct statements in how to avoid a UTI. Option D is wrong because the patient should AVOID scented sanitary napkins or tampons during menstruation. It is also best to use sanitary napkins that are NOT SCENTED and AVOID using tampons (scented or not scented).

rheumatoid arthritis

Inflammatory autoimmune disease where the synovial membrane becomes inflamed s/s: morning stiffness greater than 30 minutes, fever, fatigue, anemia, or malaise, symmetrical joint involvement, Ulnar drift, swan-neck deformity, and boutonnière deformity, nodules on pinna treatment: NSAIDs, immunosuppressants, anti-inflammatory, steroids

Anatomy of the colon

ascending colon, transverse colon, descending colon, sigmoid colon

Acute Otitis Media (AOM)

effusion in the middle ear that occurs suddenly and is associated with other signs of illness, painful

purulent drainage

from and infected wound comprised of white blood cells, liquefied dead tissue debris, and both dead and live bacteria

Urosepsis

spread of infection from the urinary tract to the bloodstream that results in a systemic infection

After reviewing the urinalysis reports of a client with a renal disorder, the nurse concludes that the client may have a urinary tract infection. Which urinary laboratory findings enabled the nurse to make this conclusion? Select all that apply. 1) pH: 8.5 2) Specific gravity: 1.010 3) Red blood cells: 3/hpf 4) Osmolality: 1500 mOsm/kg (1500 mmol/kg) 5) White blood cells: 6/hpf

1) pH: 8.5 5) White blood cells: 6/hpf The client may have a urinary tract infection, as the urinalysis reports show the presence of pH as 8.5 and white blood cells as 6/hpf in the urine. A pH above 8.0 indicates a urinary tract infection; client's is 8.5. The normal level of white blood cells (WBC) in urine should be less than 5/hpf; therefore, the WBC level of 6/hpf indicates urinary tract infection. The specific gravity of 1.010 indicates a normal finding. The normal level of red blood cells (RBC) is less than 4/hpf; therefore, the RBC levels of 3/hpf indicates normal finding. Osmolality of 1500 mOsm/kg (1500 mmol/kg) indicates tubular dysfunction.

A client with osteoarthritis is admitted to the hospital for evaluation of a possible hip replacement. To prevent flexion contractures, the nurse recommends that, when in bed, the client should lie in the supine or prone position. The client voices hesitation, stating that these positions are uncomfortable for the knees and hips. What action should the nurse take? 1. Encourage the client to maintain extension for specific periods of time. 2. Allow the client to lie in whatever position is most comfortable. 3. Insert a pillow under the client's knees to relieve discomfort. 4. Place the client in the semi-Fowler position most of the time.

1. Encourage the client to maintain extension for specific periods of time. Flexion contractures of the hips and knees can develop unless some periods of full extension are maintained. The most comfortable position that usually is assumed is one of flexion, which leads to contractures and should be avoided. Placing a pillow under the knees can cause flexion contractures of the hips and knees. Remaining in the semi-Fowler's position can cause flexion contractures of the hips.

A nurse is completing the health history of a client admitted to the hospital with osteoarthritis. The nurse expects the client to report that which joints were involved initially? Select all that apply. 1. Hips 2. Knees 3. Ankles 4. Shoulders 5. Metacarpals

1. Hips 2. Knees Osteoarthritis affects the weight-bearing joints (e.g., hips and knees) first, because they bear the most body weight. The resulting joint damage causes a series of physiologic responses (e.g., release of cytokines and proteolytic enzymes) that lead to more damage. Although the ankles are weight-bearing joints and eventually are affected, the motion in the ankles is not as great as in the hips and knees; thus there is less degeneration. Shoulder joints are not the most likely to be involved first, because these are not weight-bearing joints. Although the distal interphalangeal joints are commonly affected, the remaining interphalangeal joints and metacarpals are not.

The nurse is reviewing the problems that may occur after frequent episodes of otitis media in infants. What complications may be precipitated by this infection? Select all that apply. 1. Mastoiditis 2. Heart failure 3. Hearing loss 4. Gastroenteritis 5. Bacterial meningitis

1. Mastoiditis 3. Hearing loss 5. Bacterial meningitis Mastoiditis is an inflammation of the mastoid gland; it may occur as a complication of otitis media because of the mastoid gland's proximity to the ear. Hearing loss is a common complication of otitis media; the child should be assessed frequently for this problem. The closeness of the infant's structures results in infections of surrounding organs; meningitis is a complication of otitis media. Heart failure and gastroenteritis are not complications of otitis media.

(in class discussion) *5 y.o with otitis media comes into the clinic with his grandmother. The grandmother states she is confused on how to administer the oral abx at home. what could the nurse do? A. Administer IM ceftriaxone B. Explain to the child how to take the abx C. tell the grandparent they need to at least increase the child's fluid intake D. Tell the charge nurse

A. Administer IM ceftriaxone single intramuscular injection of ceftriaxone (50 mg/kg) is as effective as 10 days of oral amoxicillin for the treatment of uncomplicated acute otitis media in children

The goals of drug therapy in HIV infection are to: (select all that apply) A. Decrease the viral load B. Cure HIV C. Maintain or increase CD4+ T cell counts D. Prevent HIV-related symptoms and opportunistic diseases E. delay disease progression F. prevent HIV transmission.

A. Decrease the viral load C. Maintain or increase CD4+ T cell counts D. Prevent HIV-related symptoms and opportunistic diseases E. delay disease progression F. prevent HIV transmission.

(Custom adaptive ) A nurse is caring for a client with pruritic lesions from an IgE-mediated hypersensitivity reaction. Which mediator of injury is involved? A. Histamine B. Cytokine C. Neutrophil D. Macrophage

A. Histamine Histamine is one of the mediators of injury involving IgE-mediated injury that may cause pruritus. Cytokines are the mediators of injury in delayed hypersensitivity reaction. Neutrophils are involved in immune complex-mediated hypersensitivity reactions. Macrophages in tissues are involved in cytotoxic reactions.

(Self assessment question) The is the primary purpose of the inflammatory response? A. Promote healing B. Facilitate defense C. Support hemostasis D. Prevent injury

A. Promote healing Inflammation is a protective response that minimizes or removes pathologic agents or stimuli that triggered the inflammation, to promote healing.

(NCLEX question) During a head-to-toe assessment on a patient with a possible urinary tract infection, you perform costovertebral angle percussion. The costovertebral angle is found?* A. between the bottom of the 12th rib and spine B. between the right upper quadrant and umbilicus C. between the sternal notch and angle of Louis D. between the ischial spine and umbilicus

A. between the bottom of the 12th rib and spine The costovertebral angle is located at the angle under the 12th rib and the spine. This is where the kidneys reside. If percussion is performed at this angle and tenderness is reported it may demonstrate the kidney is inflamed due to infection. Therefore, the patient may have a kidney infection.

human immunodeficiency virus (HIV)

Acquired immunodeficiency syndrome (AIDS) is caused by HIV, which damages the cells (CD4+ T cells) in the body's immune system so it can't fight infection or cancers. transmitted through contact with infected blood, semen, or vaginal fluids. Within a few weeks of HIV infection, flu-like symptoms such as fever, sore throat, and fatigue can occur. Then the disease is usually asymptomatic until it progresses to AIDS antiviral (ART) drug therapy: delavirdine (Rescriptor), doravirine (Pifeltro), efavirenz (Sustiva), etravirine (Intelence)

Autoantibodies

Antibodies produced by B cells that mistakenly attack and destroy "self" cells belonging to the patient; autoantibodies are the pathophysiologic agent of most autoimmune disorders related to co-infection with human herpes virus-8. KS is the most common acquired immune deficiency syndrome-related malignancy.

(NCLEX question) During a head-to-toe assessment of a patient with osteoarthritis, you note bony outgrowths on the distal interphalangeal joints. You document these findings as: A. Bouchard's Nodes B. Heberden's Nodes C. Neurofibromatosis D. Dermatofibromas

B. Heberden's Nodes Bony outgrowths found on the DISTAL interphalangeal joint (closest to the fingernail and furthest away from the body) is called Heberden's Node. If the bony outgrowth was found on the PROXIMAL interphalangeal joint (middle joint of the finger...closest to the body) it is called Bouchard's Node.

(NCLEX question) A patient is receiving treatment for ulcerative colitis by taking Azathioprine. Which physician's order would the nurse question if received?* A. Ambulate the patient twice day B. Low-fiber and high-protein diet C. Administer varicella vaccine intramuscularly D. Administer calcium carbonate by mouth daily

C. Administer varicella vaccine intramuscularly Azathioprine is an immunosuppression medication that decreases the immune system. Therefore, the patient should never receive a live vaccine, such as Varicella. Other vaccinations that are live include: MMR, Shingles, Nasal influenza mist etc.

Med surg Patient complains of fullness of the ear, a "plugged" feeling or popping, and decreased hearing. Patient does not experience pain, fever, or discharge from the ear. What does the nurse suspect? A. OM B. AOM C. OME D. MEE

C. OME Otitis media with effusion is a collection of non-infected fluid in the middle ear space. It is also called serous or secretory otitis media (SOM). This fluid may accumulate in the middle ear as a result of a cold, sore throat or upper respiratory infection.

Which of these is the most common opportunistic infection in children with HIV infection? A. TB B. Candidates esophagitis C. Pneumocystis carinii pneumonia D. Herpes simplex virus

C. Pneumocystis carinii pneumonia TB is most common in locations where access to medications are low.

(NCLEX question) The client with cystitis is given a prescription for phenazopyridine hydrochloride (Pyridium). The nurse should teach the client that this drug is used to treat urinary tract infections by: A. Releasing formaldehyde and providing bacteriostatic action. B. Potentiating the action of the antibiotic. C. Providing an analgesic effect on the bladder mucosa. D. Preventing the crystallization that can occur with sulfa drugs.

C. Providing an analgesic effect on the bladder mucosa. Note: The client should be told that phenazopyridine hydrochloride (Pyridium) turns the urine a bright orange-red, which may stain underwear

Which type of vaccines triggers the recipient's immune system to produce antitoxins? A. Live vaccines B. Killed vaccines C. Toxoid vaccines D. Specific immune globulins

C. Toxoid vaccines Toxoids are a nontoxic form of bacterial toxins that induce the formation of antitoxins by the recipient's immune system. Examples of these types of vaccines include tetanus toxoid and diphtheria toxoid. Both live and killed vaccines induce the body's immune system to produce antibodies, making the individual actively immune to the microbes. Specific immune globulins are high concentration of antibodies prepared from donated blood directed against specific antigens.

(Custom adaptive ) Which laboratory test will be elevated in a client with inflammatory arthritis? A. Leukocyte count B. Hemoglobin and hematocrit C. Blood urea nitrogen and creatinine D. Erythrocyte sedimentation rate (ESR)

D. Erythrocyte sedimentation rate (ESR) The erythrocyte sedimentation rate (ESR) measures the rate at which red blood cells fall through plasma. This rate is most significantly affected by an increased number of acute-phase reactants, which occur with inflammation. An elevated ESR (>20 mm/hr) indicates inflammation or infection somewhere in the body. The ESR is chronically elevated with inflammatory arthritis. Leukocytes will be elevated when a bacterial infection is present. Hemoglobin and hematocrit are not used to determine the presence of inflammation. Blood urea nitrogen and creatinine levels are used to determine renal function.

What is the function of a client's natural killer cells? A. Secrete immunoglobulins in response to the presence of a specific antigen B. Heighten selectively and destroy non-self cells, including virally infected cells C. Enhance immune activity through secretion of various factors, cytokines, and lymphokines D.Attack non-selectively on non-self cells, especially mutated and malignant cells

D.Attack non-selectively on non-self cells, especially mutated and malignant cells Natural killer cells attack non-selectively on non-self cells, especially body cells that have undergone mutation and become malignant. Plasma cells secrete immunoglobulins in response to the presence of a specific antigen. Cytotoxic T-cells attack selectively and destroy non-self cells, including virally infected cells. Helper T-cells enhance immune activity through secretion of various factors, cytokines, and lymphokines.

Which vaccination is given to young children to provide protection against tetanus and diphtheria but not pertussis? Td DT DTaP Tdap

DT is given to children to provide protection from both tetanus and diphtheria. Td is used as a booster dose to protect adolescents and adults from tetanus and diphtheria. DTaP is given to children to provide protection from tetanus, diphtheria, and acellular pertussis. Tdap is used as a booster dose to protect adolescents and adults from tetanus, diphtheria, and acellular pertussis.

Middle Ear Infection (Otitis Media)

Etiology: accumulation of fluid in the middle ear caused by local and systemic inflammation and infection • Signs/Symptoms: intense pain, fluid draining from ear canal, transient loss of hearing; perforation of eardrum systemic infection may cause fever, headache, irritability, loss of appetite, and nausea • Management: analgesics, antibiotics

(power points) Primary prevention for OM A. Prevnar vaccination B. Influenza vaccination C. Breast feeding D. Screening for effusion E. Avoid propping bottle F. Decrease or discontinue pacifier use after 6 months G. Avoid exposure to tobacco smoke H. Hearing screening for children with learning disability

Primary prevention for OM: A. Prevnar vaccination B. Influenza vaccination C. Breast feeding E. Avoid propping bottle F. Decrease or discontinue pacifier use after 6 months G. Avoid exposure to tobacco smoke Secondary prevention: D. Screening for effusion-->done in infants and preschoolers H. Hearing screening for children with learning disability--> related to MEE

Which statements accurately describe HIV infection (select all that apply)? a. Untreated HIV infection has a predictable pattern of progression. b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c. Untreated HIV infection can remain in the early chronic stage for a decade or more. d. Untreated HIV infection usually remains in the early chronic stage for 1 year or less. e. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low.

a. Untreated HIV infection has a predictable pattern of progression. b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c. Untreated HIV infection can remain in the early chronic stage for a decade or more.

immunoglobulin E (IgE)

an antibody important for recognition of parasitic worms and some protozoans. It is also involved in food allergies and other allergic responses release of histamine and other mediators from mast cells and basophils. Examples include anaphylaxis and allergic rhino conjunctivitis.

Protease inhibitors

antiretroviral drug used to treat HIV. reduce the amount of HIV virus in the body (called the viral load) to levels that are undetectable by selectively binding to viral proteases and blocking proteolytic cleavage of protein CD4 precursors that are necessary for the production of infectious viral particles This slows the progression of HIV and helps treat symptoms. ex: atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir/ritonavir (Kaletra)

Which statement(s) about metabolic side effects of ART is (are) true (select all that apply)? a. These are annoying symptoms that are ultimately harmless. b. ART-related body changes include fat redistribution and peripheral wasting. c. Lipid abnormalities include increases in triglycerides and decreases in high-density cholesterol. d. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol. e. Compared to uninfected people, insulin resistance and hyperlipidemia are more difficult to treat in HIV-infected patients.

b. ART-related body changes include fat redistribution and peripheral wasting. c. Lipid abnormalities include increases in triglycerides and decreases in high-density cholesterol.

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/L. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient meets the criteria for a diagnosis of an acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year."

c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." Development of PCP meets the diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection.

Screening for HIV infection generally involves: a. detecting CD8+ cytotoxic T cells in saliva. b. laboratory analysis of saliva to detect CD4+ T cells c. analysis of lymph tissues for the presence of HIV RNA. d. laboratory analysis of blood to detect HIV antigen or antibody.

d. laboratory analysis of blood to detect HIV antigen or antibody.--> * patient has a negative fourth-generation test, but reports recent risky behaviors, encourage retesting in 4 to 6 weeks. so if test is negative perform risk assesment Two laboratory tests are used for monitoring HIV progression: CD4+ T cell count and viral load.

Eosinophils

disease-fighting white blood cell indicates a parasitic infection, an allergic reaction or cancer. in blood or in tissues at the site of an infection or inflammation

middle ear effusion (MEE)

fluid in the middle ear without evidence of infection caused by a blockage in the tube that drains fluid out of the ear. It often happens after an ear infection can affect how your child learns to listen and talk.

urinary tract infection (UTI)

invasion commonly bacteria in the urinary tract, especially the urethra and bladder; symptoms include dysuria, urinary frequency, and malaise (elderly confusion) urinalysis UTI: pH >8, white blood cells as >5/hpf, specific gravity is <1.005 or >1.030 RBC >4/hpf protein >0.8 mg/dL (glomular disorder)

Distal colitis

involves only the left side of the colon, starts in the rectum and goes to the sigmoid and descending colon

renal failure

loss of kidney function resulting in its inability to remove waste products from the body and maintain electrolyte balance

toxic megacolon

pancolitis, very severe form of ulcerative colon, large intestine dilates due to the overwhelming inflammation (>6cm) large intestine is unable to function, paralyzed. ss: abdominal distention, fever, diarrhea, abdominal pain, dehydration, and tachycardia.

natural killer cells (NK cells)

play an important role in the killing of cancer cells and cells infected by viruses attack non-selectively on non-self cells, especially body cells that have undergone mutation and become malignant.

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

prevent HIV viral replication prevent the virus's reverse transcriptase from accurately copying its RNA into DNA. Without DNA, HIV can't make copies of itself. ex: Emtricitabine zidovudine (Retrovir) lamivudine (Epivir) abacavir sulfate (Ziagen)

Osteoarthritis (OA)

progressive, degenerative joint disease with loss of hyaline cartilage and hypertrophy of bone (formation of osteophytes, or bone spurs) at articular surfaces s/s: grating during joint movement, Pain and stiffness tends to be worst at the end of the day, morning stiffness is LESS than 30 minutes, asymmetrical (both joints are not involved) ROM: improves the mobility of the joint and decreases stiffness. NSAIDs, Tylenol, topical creams

acute inflammation

protective response, Minimal and short-lasting injury to tissue A. Goal is to eradicate the harmful stimuli from the body and initiate repair C. Minutes to days response E. Characterized by 5 cardinal signs→ Redness , swelling, heat, pain, and loss of function F. Associated with 3 physiological changes → Increase blood flow, increased vascular permeability, and migration of leukocytes from blood to tissues

Leukotrienes

released by the immune system in allergic reactions. cause tightening of airway muscles and the production of excess mucus and fluid C4, D4, E4 released by mast cells to promote a second phase of inflammation

hydronephrosis

the dilation (swelling) of one or both kidneys blockage in the tube that connects the kidney to the bladder cause excess urine backup

erythrocyte sedimentation rate (ESR)

timed test that measures the rate at which red blood cells settle through a volume of plasma elevated ESR is indicative of the presence of inflammation in the body. Proteins produced during the inflammatory process adhere to red blood cells, causing them to be heavier and settle out of blood samples at a faster rate than normal, elevated ESR (>20 mm/hr) indicates inflammation

Leukocytes

white blood cells, elevated when infection is present

intravenous pyelogram (IVP)

x-rays of the urinary tract taken after iodine is injected into the bloodstream and as the contrast passes through the kidney, revealing obstruction, evidence of trauma, etc.

HIV treatment

• Entry Inhibitors - enfuvirtide • Nucleoside reverse transcriptase inhibitors (NRTIs) -zidovudine • Nonnucleoside reverse transcriptase inhibitors (NNRTIs) - efavirenz • Nucleotide reverse transcriptase inhibitor (NtRTI)- tenofovir • Integrase Inhibitors - raltegravir • Protease Inhibitors (Pis) - ritonavir, lopinavir+ritonavir (Kaletra)

Which type of hypersensitivity reaction is present in a client with a body temperature of 102 °F, severe joint pain, rashes on the extremities, and enlarged lymph nodes from serum sickness? 1. Delayed reaction 2. Cytotoxic reaction 3. Immediate reaction 4. Immune complex-mediated reaction

4. Immune complex-mediated reaction Serum sickness is a type III immune complex-mediated reaction. A delayed reaction is a type IV hypersensitivity reaction that may include poison ivy skin rashes, graft rejection, and sarcoidosis. A cytotoxic reaction is a type II hypersensitivity reaction that includes autoimmune hemolytic anemia, Goodpasture syndrome, and myasthenia gravis. An immediate reaction is a type I hypersensitive reaction that includes allergic asthma, hay fever, and anaphylaxis.

Ulcerative Colitis Treatment

5-aminosalicylic acid (5-ASA): Balsalazide, mesalamine, olsalazine, and sulfasalazine Corticosteroids (anti-inflammatory) Immunosuppressants: 6-mercaptopurine (6-MP), methotrexate, azathioprine (Azasan, Imuran), cyclosporine, and tacrolimus (Astagraf XL, Envarsus XR, Prograf), adalimumab (Humira), infliximab (Remicade) Tylenol (instead of NSAID) for pain

A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient? a. "The EIA test will need to be repeated to verify the results." b. "A viral culture will be done to determine the progression of the disease." c. "It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)." d. "The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed."

ANS: A After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done. Viral cultures are not usually part of HIV testing. It is not appropriate for the nurse to predict the time frame for AIDS development. The Western blot tests for HIV antibodies, not for AIDS.

(Self assessment question) Why is inflammation often confused with infection? A. Prostaglandin hormone mediates both. B. Purulent drainage is frequently present. C. Many pathophysiologic processes are shared. D. They produce comparable immune dysfunction.

C. Many pathophysiologic processes are shared. Inflammation and infection are commonly confused because many of the pathophysiologic processes associated with one are also found with the other; they overlap. Option A is incorrect because prostaglandin is a proinflammatory hormone that mediates late stages of acute inflammation. Infections are not mediated by such hormones. They are only involved in infections because inflammation occurs when infection occurs. Option B is incorrect because purulent drainage is a sign of infection, but does not occur from inflammation. Option D is incorrect because infection can overwhelm and damage the immune system very quickly (septic shock). Acute inflammation is a protective response. Chronic inflammation, over time, does damage tissue and can be detrimental to the immune system. However, these processes are not comparable.

(NCLEX question) A patient newly diagnosed with osteoarthritis asks about the medication treatments for their condition. Which medication is NOT typically prescribed for OA? A. NSAIDs B. Topical Creams C. Oral corticosteroids D. Acetaminophen (Tylenol)

C. Oral corticosteroids The answer is C. Intra-articular corticosteroids (an injection in the joint) are commonly prescribed rather than oral corticosteroids. Remember OA in within the joint...not systemic so oral corticosteroids are not as effective. All the other medications listed are prescribed in OA.

A nurse is assessing two clients. One client has ulcerative colitis, and the other client has Crohn disease. Which is more likely to be identified in the client with ulcerative colitis than in the client with Crohn disease? a. Inclusion of transmural involvement of the small bowel wall b. Higher occurrence of fistulas and abscesses from changes in the bowel wall c. Pathology beginning proximally with intermittent plaques found along the colon d. Involvement starting distally with rectal bleeding that spreads continuously up the colon

Involvement starting distally with rectal bleeding that spreads continuously up the colon Ulcerative colitis involvement starts distally with rectal bleeding that spreads continuously up the colon to the cecum. In ulcerative colitis, pathology usually is in the descending colon; in Crohn disease, it is primarily in the terminal ileum, cecum, and ascending colon. Ulcerative colitis, as the name implies, affects the colon, not the small intestine. Intermittent areas of pathology occur in Crohn. In ulcerative colitis, the pathology is in the inner layer and does not extend throughout the entire bowel wall; therefore, abscesses and fistulas are rare. Abscesses and fistulas occur more frequently in Crohn disease.

Glomerular Disorders

disorders that affect kidney function by attacking the glomeruli, s/s: protein >0.8mg/dL (albuminuria) hematuria: blood in the urine. reduced glomerular filtration rate: inefficient filtering of wastes from the blood. hypoproteinemia: low blood protein. edema: swelling in parts of the body.

In assessing the joints of a patient with osteoarthritis, the nurse understands that Bouchard's nodes a. are often red, swollen, and tender. b. indicate osteophyte formation at the PIP joints. c. are the result of pannus formation at the DIP joints. d. occur from deterioration of cartilage by proteolytic enzymes.

b. indicate osteophyte formation at the PIP joints.

Extravasation

escape of blood from the blood vessel into the tissue. Exudate is the fluid filled with proteins and white blood cells that moves out of the vascular spaces through extravasation

Which drug is most appropriate for relieving a painful muscle spasm in the back of a client with osteoarthritis (OA)? 1. Tramadol 2. Hyaluronate 3. Diclofenac epolamine patch 4. Cyclobenzaprine hydrochloride

4. Cyclobenzaprine hydrochloride Cyclobenzaprine hydrochloride is a muscle relaxant administered to relieve painful muscle spasms, especially those resulting from OA of the vertebral column. While tramadol is a weak opioid drug that may also be given to relieve pain in clients with OA, it is not as effective against painful muscle spasms. Hyaluronate is a specific injection for knee and hip pain associated with OA. The diclofenac epolamine patch is used in clients with signs and symptoms of knee OA.

A client is diagnosed with a human immune deficiency-2 (HIV-2) infection and is on rilpivirine therapy. What drug does the nurse anticipate that the primary healthcare provider will prescribe to the client? 1. Etravirine 2. Efavirenz 3. Delavirdine 4. Emtricitabine

4. Emtricitabine Emtricitabine is a nucleoside reverse transcriptase inhibitor that mimics DNA nucleoside bases and tricks the HIV reverse transcriptase enzyme into using it. Therefore emtricitabine would be prescribed. Etravirine, efavirenz, and delavirdine are non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs stop viral cell DNA and RNA replication by directly binding to the HIV-1 enzyme reverse transcriptase. NNRTIs such as rilpivirine are not effective in suppressing HIV-2 replication.

The nurse is caring for a client with otitis media and notes purulent drainage in the ear canal during the physical assessment. Which is the nurse's priority intervention? a. Obtain a specimen of the drainage for culture. b. Irrigate the ear canal with sterile normal saline. c. Gently examine the client's ear with an otoscope. d. Place a cotton ball in the ear canal to absorb the drainage.

ANS: C The nurse should use an otoscope to determine whether the client's tympanic membrane has ruptured. Until the tympanic membrane is examined and is found to be intact, syringing is not performed. A specimen is obtained only if the infection has failed to respond to standard antibiotic therapy. A cotton ball should not be placed in the ear canal to absorb the drainage.

(NCLEX question) A patient with osteoarthritis has finished their first physical therapy session. As the nurse you want to evaluate the patient's understanding of the type of exercises they should be performing regularly at home as self-management. Select all the appropriate types of exercise stated by the patient: A. Jogging B. Water aerobics C. Weight Lifting D. Tennis E. Walking

B. Water aerobics C. Weight Lifting E. Walking The answers are B, C, E. The patient wants to perform exercises that are low impact like: walking, water aerobics, stationary bike riding along with strengthen training (lifting weights: helps strengthen muscles around the joint), ROM: improves the mobility of the joint and decreases stiffness. It is important patients with OA avoid high impact exercises that will increase stress on weight bearing joints such as running/jogging, jump rope, tennis, or any type of exercise with both feet off the ground.

(Self assessment question) The production of which immune cells are increased following exposure to viral antigens? A. Basophils B. Eosinophils C. Lymphocytes D.Neutrophils

C. Lymphocytes Lymphocytes are most prominent in inflammatory responses to viral antigens. Basophils are elevated during chronic inflammation/infections, eosinophils during parasitic infections and allergic reactions, and neutrophils during bacterial infections.

The nurse cares for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (select all that apply)? a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin

a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine Asymptomatic chronic HIV infection is a stage between acute HIV infection and a diagnosis of symptomatic chronic HIV infection. Although called asymptomatic, symptoms (e.g., fatigue, headache, low-grade fever, night sweats) often occur. Prevention of other infections is an important intervention in patients who are HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed. Antibiotics and immune globulin are used to prevent and treat infections that occur later in the course of the disease when the CD4+ counts have dropped or when infection has occurred.

Platelet Activating Factor (PAF)

activate neutrophils, platelet aggregation

A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, "I am very nervous about making my baby sick." Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because she is at an early stage of HIV infection, the infant will not contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART).

b. Most infants born to HIV-positive mothers are not infected with the virus. ANS: B Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 2% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided.

When assessing the patient who has a lower urinary tract infection (UTI), the nurse will initially ask about a. flank pain. b. pain with urination. c. poor urine output. d. nausea.

b. pain with urination. Rationale: Pain with urination is a common symptom of a lower UTI. Urine output does not decrease, but frequency may be experienced. Flank pain and nausea are associated with an upper UTI.

Powerpoints Nursing interventions for UTI ( select all that apply) A. Ensure adequate fluid intake - 8 (8 oz) glasses of water/day B. Recommend low fiber high-protein diet C. Tell the patient to avoid EtOH and caffeine D. Application of local heat to suprapubic area or lower back E. Offer warm shower or tub

A. Ensure adequate fluid intake - 8 (8 oz) glasses of water/day C. Tell the patient to avoid EtOH and caffeine D. Application of local heat to suprapubic area or lower back E. Offer warm shower or tub also can squirt warm water to the vaginal area during urination

(NCLEX question) A 76 year old female is admitted due to a recent fall. The patient is confused and agitated. The family members report that this is not normal behavior for the patient. They explain that the patient is very active in the community and cares for herself. Based on the information you have gathered about the patient, which physician's order takes priority?* A. "Collect a urinalysis" B. "Collect a T3 and T4 level" C. "Insert a Foley Catheter" D. "Keep patient NPO"

A. "Collect a urinalysis" Elderly patients do NOT exhibit the typical signs and symptoms of a UTI. Instead, they may become confused, experience falls, become agitated etc. This can occurs in elderly patients who are normally alert and oriented and active. If this is seen in your patient, think UTI. Collecting a urinalysis (per MD order) is very important to help determine the sudden cause of confused/agitation and falling. If the U/A comes back positive for WBCs and bacteria the patient can start receiving the proper treatment.

(NCLEX question) A patient with osteoarthritis is describing their signs and symptoms. Which signs and symptoms below are NOT associated with osteoarthritis? Select-all-that-apply: A. Morning stiffness greater than 30 minutes B. Experiencing grating during joint movement C. Fever and Anemia D. Symmetrical joint involvement E. Pain and stiffness tends to be worst at the end of the day

A. Morning stiffness greater than 30 minutes C. Fever and Anemia D. Symmetrical joint involvement The answers are: A, C, D. These options are signs and symptoms found with rheumatoid arthritis NOT osteoarthritis. In OA: morning stiffness is LESS than 30 minutes, it is NOT systemic as RA (so fever and anemia will not be present), and it is asymmetrical (both joints are not involved). Pain and stiffness will actually be worst at the end of the day compared to the beginning due to overuse of the joints.

(NCLEX question) A patient with ulcerative colitis is scheduled for ileoanal anastomosis (J-Pouch) surgery. You know that this procedure:* A. Removes the colon and rectum which allows a pouch to be created that will attach to the ileum. This will allow stool to pass from the small intestine to the anus. B. Removes the colon and rectum and creates a permanent ileostomy. C. Removes the colon and creates a temporary colostomy. D. Removes the rectum which allows a pouch to be created from the colon. This will allow stool to pass from the colon to the anus.

A. Removes the colon and rectum which allows a pouch to be created that will attach to the ileum. This will allow stool to pass from the small intestine to the anus. A J-pouch surgery (ileoanal anastomosis) removes the colon and rectum which allows a pouch to be created that will attach to the ileum. This will allow stool to pass from the small intestine to the anus.

(NCLEX question) You're providing education to a patient with severe ulcerative colitis about Adalimumab. Which statement by the patient is CORRECT?* A. "This medication is used as first-line treatment for ulcerative colitis." B. "My physician will order a TB skin test before I start taking this medication." C. "This medication works by increasing the tumor necrosis factor protein which helps decrease inflammation." D. "This medication is a corticosteroid. Therefore, I need to monitor my blood glucose levels regularly."

B. "My physician will order a TB skin test before I start taking this medication." Before starting Adalimumab, the physican may order the patient to be checked for TB. Adalimumab is a immunomodulator (NOT corticosteriod) that suppresses the immune system by BLOCKING (not increasing) the tumor necrosis factor protein which helps decrease inflammation. Therefore, the patient is at risk for developing infections such as TB (tuberculosis). In addition, if the patient has or had TB, this medication could exacerbate the disease. This medication is used for only severe cases (NOT first-line treatment).

(NCLEX question) A 36 year old female, who is 29 weeks pregnant, reports she is experiencing burning when voiding. The physician orders a urinalysis. Which statement by the patient demonstrates she understands how to collect the specimen?* A. "I'll hold the cup firmly against the urethra while collecting the sample." B. "I will cleanse back to front with the antiseptic wipe before peeing in the cup." C. "First, I will pee a small amount of urine in the toilet and then collect the rest in the cup." D. "I will be sure to drink a lot of fluids to keep the urine diluted before peeing into the cup."

C. "First, I will pee a small amount of urine in the toilet and then collect the rest in the cup." When collecting a urinalysis it is important to avoid contaminating the sample. So, the patient will collect the urine during mid-stream. The patient will void a small amount in the toilet and then void the rest into the cup (until it is halfway full). The cup should be placed a few inches away from the urethra and prior to voiding the patient should use an antiseptic wipe to cleanse the labia from front to back. It is best to collect the sample when the bladder has been full for 2-3 hours, therefore the urine in concentrated not diluted.

(Self assessment question) The nurse is reviewing the erythrocyte sedimentation rate (ESR) of a patient to determine which significant finding? A. Determines specific causes of inflammation. B. Identifies the location of inflammation within the body. C. Confirms the nonspecific presence of inflammation. D. Indicates a diagnosis of systemic lupus. .

C. Confirms the nonspecific presence of inflammation. An elevated ESR is indicative of the presence of inflammation in the body. Proteins produced during the inflammatory process adhere to red blood cells, causing them to be heavier and settle out of blood samples at a faster rate than normal. The ESR does not identify specific causes of inflammation and does not determine a specific location of inflammation. The ESR is a nonspecific indicator of inflammation

(Self assessment question) A patient comes to a clinic with a chief complaint of, "My left arm is red and swollen. It hurts badly enough that I couldn't go to work today." The physician orders computer-assisted tomography (CT) scanning of the left upper extremity. The nurse knows the patient understands the reason for the procedure when he states A. "I need to have this done because my arm is broken." B. "The doctor wants me to have this so that the pain will stop." C. "This will tell you what I did to my elbow because I really don't know what happened." D "This test will help to better determine where the injury actually is and how severe it is."

D "This test will help to better determine where the injury actually is and how severe it is." Radiographic imaging studies such as CT scans help to determine the location and extent of inflammation within the body. The CT scan will help with diagnosis. The diagnosis is not predetermined. CT scanning does not alleviate pain. Radiography does not necessarily determine a cause of an injury.

Which type of immune preparation, made from donated blood, contains antibodies that provide passive immunity? A. Toxoid B. Killed vaccine C. Live attenuated vaccine D. Specific immune globulin

D. Specific immune globulin Specific immune globulins contain a high concentration of antibodies directed at specific antigens. Toxoid vaccines contain a bacterial toxin that has been changed to a nontoxic form. Killed vaccines contain killed microbes or isolated microbes. Live attenuated vaccines are composed of live microbes that have been weakened or rendered completely avirulent.

complement proteins

aid phagocytosis by helping phagocytes bind more efficiently to pathogens of tissue injury during inflammation C3a, C4a, and C5a proteins initiate chemotaxis (movement) of neutrophils and macrophages

serous otitis media (SOM)

aka otitis media with effusion, fluid buildup in the middle ear without symptoms of an infection

(NCLEX question) A 63 year old patient has severe osteoarthritis in the right knee. The patient is scheduled for a knee osteotomy. You are providing pre-op teaching about this procedure to the patient. Which statement made by the patient is correct about this procedure? A. "This procedure will realign the knee and help decrease the amount of weight experienced on my right knee." B. "A knee osteotomy is also called a total knee replacement." C. "A knee osteotomy is commonly performed for patients who have osteoarthritis in both knees." D. "This procedure will realign the unaffected knee and help alleviate the amount of weight experienced on the right knee."

A. "This procedure will realign the knee and help decrease the amount of weight experienced on my right knee." The answer is A. A knee osteotomy is NOT known as a total knee replacement. A knee osteotomy can be used as an alternative for a total knee replacement but is not the same thing. In addition, a knee osteotomy is performed when there is OA on only one side of the knee.

(NCLEX question) A patient is newly diagnosed with mild ulcerative colitis. What type of anti-inflammatory medication is typically prescribed as first-line treatment for this condition?* A. 5-Aminosalicylates (Sulfasalazine) B. Immunomodulators (Adalimumab) C. Corticosteroids (Prednisone) D. Immunosupressors (Azathioprine)

A. 5-Aminosalicylates (Sulfasalazine) 5-Aminosalicylates (Sulfasalazine) are usually prescribed for mild to moderate cases of ulcerative colitis as first-line treatment. If Aminosalicylates are not working (or the patient is allergic to sulfa) corticosteriods are prescribed. Corticosteriods may be used in combination with immunosupressors. Immunosupressors and immunomodulators are used in severe cases of ulcerative colitis when other medications have not worked.

A nurse is caring for a client who is suspected of having HIV. Which of the following diagnostic tests and laboratory values are used to confirm HIV infection? (Select all that apply.) A. Western blot B. Indirect immunofluorescence assay C. CD4+ T-lymphocyte count D. CD4+ T-lymphocyte percentage of total lymphocytes E. Cerebrospinal fluid (CSF) analysis

A. CORRECT: Positive results of a Western blot test confirm the presence of HIV infection. B. CORRECT: Positive results of an indirect immunofluorescence assay confirm the presence of HIV infection. C. INCORRECT: CD4+ T-lymphocyte count assists with classifying the stage of HIV infection. D. INCORRECT: CD4+ T-lymphocyte percentage of total lymphocytes assists with classifying the stage of HIV infection. E. INCORRECT: CSF analysis can be used to confirm meningitis.

What functions of leukocytes are involved in inflammation? Select all that apply. A. Destruction of bacteria and cellular debris B. Selective attack and destruction of non-self cells C. Release of vasoactive amines during allergic reactions D. Secretion of immunoglobulins in response to a specific antigen E. Enhancement of immune activity through secretion of various factors, cytokines, and lymphokines

A. Destruction of bacteria and cellular debris C. Release of vasoactive amines during allergic reactions Leukocytes such as monocytes and eosinophils are involved in inflammation. Their functions include the destruction of bacteria and cellular debris and the release of vasoactive amines during allergic reactions to limit these reactions. Helper/inducer T-cells and cytotoxic cells selectively attack and destroy non-self cells and secrete immunoglobulins in response to the presence of a specific antigen. B-lymphocytes, or plasma cells, secrete immunoglobulins in response to the presence of a specific antigen. Helper/inducer T-cells are involved in cell-mediated immunity, enhancing immune activity through the secretion of various factors, cytokines, and lymphokines.

On your nursing care plan for a patient with a urinary tract infection, which of the following would be appropriate nursing interventions? SELECT-ALL-THAT-APPLY:* A. Encourage voiding every 2-3 hours while awake. B. Restrict fluid intake to 1-2 liters per day. C. Monitor intake and output daily. D. The patient verbalizes the importance of using vaginal sprays to decrease reoccurrence of urinary tract infections prior to discharge home.

A. Encourage voiding every 2-3 hours while awake. C. Monitor intake and output daily. The answers are A and C. Option D is wrong become this is not a nursing intervention but a patient goal. In addition, it is an incorrect patient goal for preventing UTIs. Vaginal sprays should be avoided. Option B is wrong because fluid intake should be encouraged of 2-3 liters per day. This will help the urinary system flush out the presenting infection.

Which statements are true about acute inflammation ( select all that apply) A. Goal is to eradicate the harmful stimuli from the body and initiate repair B. Tissues is repeating being destroyed and repaired C. Minutes to days response D. Response is out of proportion to the stimulus or is directed against an inappropriate target E. Characterized by 5 cardinal signs→ Redness , swelling, heat, pain, and loss of function F. Associated with 3 physiological changes → Increase blood flow, increased vascular permeability, and migration of leukocytes from blood to tissues G. May be a consequence of an inflammatory process not allowing for repair or a consequence of a dz like seen in RA

A. Goal is to eradicate the harmful stimuli from the body and initiate repair C. Minutes to days response E. Characterized by 5 cardinal signs→ Redness , swelling, heat, pain, and loss of function F. Associated with 3 physiological changes → Increase blood flow, increased vascular permeability, and migration of leukocytes from blood to tissues Chronic --> May be a consequence of an inflammatory process not allowing for repair or a consequence of a dz like seen in RA Weeks-years Tissues is repeating being destroyed and repaired Response is out of proportion to the stimulus or is directed against an inappropriate target

A nurse is completing discharge instructions with a client who has AIDS. Which of the following statements by the client indicates an understanding of the teaching? A. "I will wear gloves while changing the pet litter box." B. "I will rinse raw fruits with water before eating them." C. "I will wear a mask when around family members who are ill." D. "I will cook vegetables before eating them."

A. INCORRECT: A client who has AIDS should avoid changing the pet litter box to prevent acquiring toxoplasmosis. B. INCORRECT: A client who has AIDS should avoid consuming raw fruits due to the presence of bacteria that can cause opportunistic infections. C. INCORRECT: Due to compromised immune response, a client who has AIDS should avoid contact with family who are ill. D. CORRECT: A client who has AIDS should cook vegetables before eating to kill bacteria that cause opportunistic infections.

(NCLEX question) You're providing diet teaching to a patient with ulcerative colitis about what types of foods to avoid during a "flare-up". Which foods below should the patient avoid? SELECT-ALL-THAT-APPLY:* A. Ice cream B. White Rice C. Fresh apples and pears D. Popcorn E. Cooked carrots

A. Ice cream C. Fresh apples and pears D. Popcorn Patients experiencing a flare-up with ulcerative colitis should avoid dairy products (ice cream), food that are high in fiber (fresh apples or pears) (cooked fruits without the skin would be okay), and foods that are hard to digest (popcorn). Instead, patients should consume foods low in fiber (low residue) like cooked vegetables (carrots), bland foods (white rice) etc.

(NCLEX question) You're caring for a patient with an indwelling catheter. The patient complains of spasm like pain at the catheter insertion site. Which of the following options below are other signs and symptoms the patient could experience or the nurse could observe if a urinary tract infection was present? SELECT-ALL-THAT-APPLY:* A. Increased WBC B. Crystalluria C. Positive McBurney's Sign D. Feeling the need to void even though a catheter is present E. Dark and cloudy urine F. Cramping

A. Increased WBC D. Feeling the need to void even though a catheter is present E. Dark and cloudy urine F. Cramping The answers are A, D, E and F. These are common signs and symptoms of a urinary tract infection. Options B and C are not.

Which age-related effects on the immune system are seen in the older client? A. Increased autoantibodies B. Increased expression of IL-2 receptors C. Increased delayed hypersensitivity reaction D. Increased primary and secondary antibody responses

A. Increased autoantibodies The effects of aging on the immune system include increased autoantibodies. Expression of IL-2 receptors, delayed hypersensitivity reaction, and primary and secondary antibody responses decrease in older adults because of the effects of aging on the immune system.

(Self assessment question) Histamine produces which important effects during acute inflammation? (Select all that apply.) A. Increases vasodilation B. Enhances vascular permeability C. Promotes T lymphocyte proliferation D. Activates neutrophils E. Mediates early inflammation

A. Increases vasodilation B. Enhances vascular permeability E. Mediates early inflammation Histamine is an important proinflammatory mediator released by mast cells. Similar to serotonin, histamine increases vasodilation, enhances (increases) vascular permeability, and mediates the early acute inflammatory response. Option C is incorrect because interleukin-1 promotes lymphocyte proliferation. Option D is incorrect because platelet-activating factor activates neutrophils.

A nurse is caring for a client who is human immunodeficiency virus (HIV) positive. Which complication associated with this diagnosis is most important for the nurse to teach prevention strategies? A. Infection B. Depression C. Social isolation D. Kaposi sarcoma

A. Infection The client has a weakened immune response. Instructions regarding rest, nutrition, and avoidance of unnecessary exposure to people with infections help reduce the risk for infection. Clients can be taught cognitive strategies to cope with depression, but the strategies will not prevent depression. The client may experience social isolation as a result of society's fears and misconceptions; these are beyond the client's control. Although Kaposi sarcoma is related to HIV infection, there are no specific measures to prevent its occurrence.

To prevent recurrence of cystitis, the nurse should plan to encourage the female client to include which of the following measures in her daily routine? A. Wearing cotton underpants. B. Increasing citrus juice intake. C. Douching regularly with 0.25% acetic acid. D. Using vaginal sprays.

A. Wearing cotton underpants. A woman can adopt several health-promotion measures to prevent the recurrence of cystitis, including avoiding too-tight pants, noncotton underpants, and irritating substances, such as bubble baths and vaginal soaps and sprays. Increasing citrus juice intake can be a bladder irritant. Regular douching is not recommended; it can alter the pH of the vagina, increasing the risk of infection.

Typical signs and symptoms of UTI in an older adult ( select all that apply) A. abdominal discomfort B. cognitive impairment C. flank pain D.generalized clinical deterioration

A. abdominal discomfort B. cognitive impairment D.generalized clinical deterioration *Older adults do not not present with typicaly s/sx of UTI, rather non-localized abdominal discomfort , cognitive impairment or generalized clinical deterioration, and no fever.

(Self assessment question and passport) *A patient admitted to an acute care floor has rubor of an area of injury on the left lower extremity. The nurse understands that this redness is caused by A. vasodilation. B. extravasation. C. neutrophils. D. exudate.

A. vasodilation. The inflammatory process results in rubor, or redness, of an area of insult. The body responds to injury by increasing the blood flow to an area through vasodilation. This allows increased oxygen and more nutrients and appropriate white blood cells to reach the area, isolating the area and beginning the immune response. Extravasation is the movement of fluid from its confined space into the surrounding tissue. Neutrophils are one of the most common types of white blood cells. Exudate is the fluid filled with proteins and white blood cells that moves out of the vascular spaces through extravasation

(Nclex question) A client has been prescribed nitrofurantoin (Macrodantin) for treatment of a lower urinary tract infection. Which of the following instructions should the nurse include when teaching the client how to take this medication? Select all that apply. A. "Take the medication on an empty stomach." B. "Your urine may become brown in color." C. "Increase your fluid intake." D. "Take the medication until your symptoms subside." E. "Take the medication with an antacid to decrease gastrointestinal distress."

B. "Your urine may become brown in color." C. "Increase your fluid intake." Clients who are taking nitrofurantoin (Macrodantin) should be instructed to take the medication with meals and to increase their fluid intake to minimize gastrointestinal distress. The urine may become brown in color. Although this change is harmless, clients need to be prepared for this color change. The client should be instructed to take the full prescription and not to stop taking the drug because symptoms have subsided. The medication should not be taken with antacids as this may interfere with the drug's absorption.

(NCLEX question) **You're educating a group of outpatients about signs and symptoms of ulcerative colitis. Which of the following are NOT typical signs and symptoms of ulcerative colitis? SELECT-ALL-THAT-APPLY:* A. Rectal Bleeding B. Abdominal mass C. Bloody diarrhea D. Fistulae E. Extreme Hungry F. Anemia

B. Abdominal mass D. Fistulae E. Extreme Hungry Rectal bleeding, bloody diarrhea, and anemia are present in ulcerative colitis. However, an abdominal mass or fistulae tends to be present with Crohn's Disease. Loss of appetite rather than extreme hungry presents in ulcerative colitis.

An infant who has clinical manifestations of AOM is brought to an outpatient facility by his parent. The nurse should recognize that which of the following factors places the infant at risk for otitis media? (Select all that apply.) A. Breastfeeding without formula supplementation. B. Attends day care 4 days per week. C. Immunizations are up to date. D. History of cleft palate repair. E. Parents smoke cigarettes outside.

B. Attends day care 4 days per week. D. History of cleft palate repair. E. Parents smoke cigarettes outside.

(Power points) Which statements are true regarding osteoarthritis (select all that apply) A. Develops due to the deterioration of the synovium of the bone. B. Can lead to bone break down and osteophytes formation (bone spurs) C. Most common form of joint disease in North America D. Part of normal aging process E. Begins between ages of 20 and 40 years of age and symptoms usually appear after the age of 50 or 60 years

B. Can lead to bone break down and osteophytes formation (bone spurs) C. Most common form of joint disease in North America E. Begins between ages of 20 and 40 years of age and symptoms usually appear after the age of 50 or 60 years Develops due to the deterioration of the HYALINE CARTILAGE (not synovium) of the bone NOT part of the normal aging process

Several clients at the clinic have just been diagnosed with UTIs. Which clients may need to be hospitalized? (select all that apply) A. Postmenopausal woman B. Client with a long-term indwelling catheter C. Client with diabetes D. Immunosuppressed client E. Pregnant client

B. Client with a long-term indwelling catheter C. Client with diabetes D. Immunosuppressed client E. Pregnant client

(Self assessment question) The inflammatory process is an anticipated response to tissue injury that produces which desirable outcomes? (Select all that apply.) A. Initial death of tissues B. Eradication of dead tissue C. Formation of scar tissue D. Acute inflammation E. Chronic inflammation

B. Eradication of dead tissue D. Acute inflammation Inflammation is a normal and protective response to injury. Four outcomes are possible, two of which are desirable: acute inflammation and eradication of dead tissue. This process returns tissues to their previously uninjured state. The formation of scar tissue occurs when damaged cells cannot be adequately repaired. This is not the most desirable outcome. Chronic inflammation results when tissue destruction continues and is not a desirable outcome. Initial death of tissue leads to death of the host, a very undesirable outcome.

(Self assessment question) The nurse is completing an admission assessment of a new patient to the unit. The nurse notes a long, thin, fading scar on the patient's abdomen in the right lower quadrant. What is the best explanation for the scar's appearance? A. Optimal functioning of the inflammatory process after an injury B. Fibrous tissue replacing damaged tissue when injury is extensive C. The development of chronic inflammation D. A surgical incision

B. Fibrous tissue replacing damaged tissue when injury is extensive Scar tissue, or fibrous repair of damaged tissue, occurs when an area is damaged too extensively for the body to replace damaged tissue with identically functioning tissue after removal of injurious agents and pathogens. Optimal functioning of the inflammatory process will result in regeneration of tissue that functions identically to the damaged and replaced tissue. Chronic inflammation can result in fibrous, or scar, tissue, but that scar tissue production is continuous as the inflammation continues. Fibrous tissue production can result from many different kinds of injuries, not just surgical wounds.

(NCLEX question) You receive your patient back from radiology. The patient had an x-ray of the hips and knees for the evaluation of possible osteoarthritis. What findings would appear on the x-ray if osteoarthritis was present? Select-all-that-apply: A. Increased joint space B. Osteophytes C. Sclerosis of the bone D. Abnormal sites of hyaline cartilage

B. Osteophytes C. Sclerosis of the bone The answers are B and C. The joint space would be DECREASED not increased in OA. In addition, an x-ray cannot show hyaline cartilage...therefore, the cartilage cannot be assessed on an x-ray. The radiologist would be looking for osteophytes (bone spurs), sclerosis of the bone (abnormal hardening of the bones), and decreased joint space.

The nurse is educating a client about protease inhibitors. What statement about protease inhibitors is true? A. Protease inhibitors prevent viral replication. B. Protease inhibitors prevent the interaction between viral material and the CD4+ T-cell. C. Protease inhibitors prevent viral and host genetic material integration. D. Protease inhibitors prevent the clipping of the viral strands into small functional pieces.

B. Protease inhibitors act by preventing the newly formed viral strands within the host CD4+ T-cell from being clipped into smaller functional pieces. Nucleoside reverse transcriptase inhibitors (NRTIs) prevent viral replication. NRTIs inhibits the transformation of viral single-stranded ribonucleic acid into host double-stranded deoxyribonucleic acid (DNA) by the action of the enzyme reverse transcriptase. Entry inhibitor drugs prevent the binding of the virus to the CD4 receptors. Integrase inhibitor drugs prevent the integration of viral material into the host's DNA by the action of the enzyme integrase.

A client is experiencing an exacerbation of ulcerative colitis. A low-residue, high-protein diet and IV fluids with vitamins have been prescribed. When implementing these prescriptions, which goal is the nurse trying to achieve? A. Reduce gastric acidity B. Reduce colonic irritation C. Reduce intestinal absorption D. Reduce bowel infection rate

B. Reduce colonic irritation A low-residue diet is designed to reduce colonic irritation, motility, and spasticity. Reduction of gastric acidity is the aim of bland diets used in the treatment of gastric ulcers. Reducing colonic irritation, motility, and spasticity hopefully will increase, not reduce, intestinal absorption. This diet is to allow the bowel to rest, not to reduce infection rates.

(NCLEX question) The physician orders a urine culture on your patient in room 5505 with a urinary tract infection. In addition, the patient is ordered to start IV Bactrim (Sulfamethoxazole/Trimethoprim). How will you proceed with following this order?* A. First, hang the antibiotic, and then collect the urine culture. B. First, hang the antibiotic and when the antibiotic is finished infusing collect the urine culture. C. First, collect the urine culture, and then hang the antibiotic. D. First, collect the urine culture and then hold the dose of the antibiotic until the urine culture is back from the lab.

C. First, collect the urine culture, and then hang the antibiotic It is very important to collect the urine culture FIRST and then immediately hang the antibiotic. If the antibiotic is hung first it will decrease the lab's ability to properly identify the bacteria growing in the urine (hence the antibiotic is fighting the infection). It takes approximately 2 days for a urine culture result to come back. Therefore, antibiotic therapy should not be held. The patient needs treatment to prevent the infection from spreading.

nurse provides dietary teaching for a client with an acute exacerbation of ulcerative colitis, and afterward the client makes a list of foods that can be included on the diet. Which food choices indicate that the teaching by the nurse is effective? Select all that apply. A. Orange juice B. Creamed soup C. Jelly sandwich D. Lean roast beef E. Scrambled eggs

C. Jelly sandwich D. Lean roast beef E. Scrambled eggs A jelly sandwich is low in residue and therefore is less irritating to the colon than other foods. Lean roast beef is low in residue and therefore is less irritating to the colon than other foods. Eggs are low in residue and therefore are less irritating to the colon than other foods. Orange juice contains cellulose (fiber), which is not absorbed and irritates the colon. Milk in creamed soup contains lactose, which is irritating to the colon.

The parents of a 4-month-old infant with a diagnosis of acute otitis media and fever ask the nurse about the use of antibiotics to treat this condition. What is the best response by the nurse? A. "Antiinflammatory medications are recommended for this condition." B. "Typically antiviral medications are given to treat acute otitis media." C. "Current practice is to wait 72 hours to see whether the condition resolves." D. "Antibiotics are recommended for infants younger than 6 months with acute otitis media."

D. "Antibiotics are recommended for infants younger than 6 months with acute otitis media." All cases of acute otitis media (AOM) in infants younger than 6 months should be treated with antibiotics because of their immature immune systems and the potential for infection with bacteria. Current literature indicates that waiting up to 72 hours for spontaneous resolution is safe and appropriate management of AOM in healthy infants older than 6 months and children. However, the watchful waiting approach is not recommended for children younger than 2 years of age who have persistent acute symptoms of fever and severe ear pain. Antiviral or antiinflammatory medications would not be recommended in an acute case of otitis media.

(NCLEX question) You're assessing your patients during morning rounding. Which patient below is at MOST risk for developing a urinary tract infection?* A. A 25 year old patient who finished a regime of antibiotics for strep throat 10 weeks ago. B. A 55 year old female who is post-opt day 7 from hip surgery. C. A 68 year old male who is experiencing nausea and vomiting. D. A 87 year old female with Alzheimer's disease who is experiencing bowel incontinence.

D. A 87 year old female with Alzheimer's disease who is experiencing bowel incontinence. This patient has many risks factors for developing a UTI. The patient is postmenopausal which leads to flora changes in the vaginal area. This can increase the risk of developing a UTI. In addition, bowel incontinence increases the risk of a UTI due to the anatomy of the female (short urethra) and the close proximity between the rectum to the urethra. Also, patients with Alzheimer's disease may experience bladder retention due to the inability to communicate the need to void which increases the amount of time the urine is left in the bladder. Option A is wrong because although antibiotics can increase the risk of developing a UTI the patient finished the antibiotics 10 weeks ago. Options B and C are wrong because they do not provide enough information to determine if the patients are at risk for a UTI.

(NCLEX question) A patient is admitted with ulcerative colitis. In the physician's notes, it is stated that the patient's barium enema results showed the patient has colitis that starts in the rectum and extends into the sigmoid and descending colon. As the nurse, you know that this is what type of ulcerative colitis? A. Right-sided colitis B. Proctosigmoiditis C. Ulcerative procotitis D. Left-sided colitis

D. Left-sided colitis Left-sided colitis (distal colitis) starts in the rectum and goes to the sigmoid and descending colon. Ulcerative proctitis affects the rectum only. Proctosigmoiditis affects the rectum and sigmoid colon. Right-sided colitis is NOT a type of ulcerative colitis

(NCLEX question) A patient, who is having spasms and burning while urinating due to a UTI, is prescribed "Pyridium" (Phenazopyridine). Which option below is a normal side effect of this drug?* A. Hematuria B. Crystalluria C. Urethra mucous D. Orange colored urine

D. Orange colored urine Orange colored urine is a normal side effect of Pyridium which acts as a pain reliever to decreasing frequent urination and pain associated with a UTI.

*A school-aged child who has just arrived from Africa has been exposed to diphtheria, and a nurse in the pediatric clinic is to administer the antitoxin. Which type of immunity does the antitoxin confer? A. Active natural B. Passive natural C. Active artificial D. Passive artificial

D. Passive artificial In the creation of passive artificial immunity an antibody is produced in another organism and then injected into the infected or presumed infected person to provide immediate immunity against the invading organism. Active natural immunity takes too much time to develop; this child needs immediate protection. Passive natural immunity is acquired from the mother and is effective only during the first few months of life. Active artificial immunity takes too much time to develop; the child needs immediate protection.

What does the nurse explain to a client that a positive diagnosis for human immunodeficiency virus (HIV) infection is based on? A. Performance of high-risk sexual behaviors B. Evidence of extreme weight loss and high fever C. Identification of an associated opportunistic infection D. Positive enzyme-linked immunosorbent assay (ELISA) and Western blot tests

D. Positive enzyme-linked immunosorbent assay (ELISA) and Western blot tests Positive ELISA and Western blot tests confirm the presence of HIV antibodies that occur in response to the presence of the HIV. Performance of high-risk sexual behaviors places someone at risk but does not constitute a positive diagnosis. Evidence of extreme weight loss and high fever do not confirm the presence of HIV; these adaptations are related to many disorders, not just HIV infection. The diagnosis of just an opportunistic infection is not sufficient to confirm the diagnosis of HIV. An opportunistic infection (included in the Centers for Disease Control and Prevention surveillance case definition for acquired immunodeficiency syndrome [AIDS]) in the presence of HIV antibodies indicates that the individual has AIDS.

According to the Healthcare Personnel Vaccination Recommendations, what meningococcal conjugate vaccine dose should a nurse administer to a 12-year-old with an HIV infection? A. Single initial dose and a booster dose 3 years later B. Single initial dose and a booster dose 5 years later C. Single initial dose and a booster dose 7 years later D. Two initial doses and a booster dose at 16 years old

D. Two initial doses and a booster dose at 16 years old A 12-year-old with HIV would require two primary meningococcal conjugate vaccine delivered two months apart initially and a booster dose at the age of 16 years old. The client would require two initial doses, not a single initial dose, and a booster at 16 years old, not 3, 5, or 7 years later.

A client with acquired immunodeficiency syndrome (AIDS) reports speech, gait, and vision difficulty. The nurse observes the client is confused and lethargic. Which microorganism is most likely responsible for this condition? a. Candida albicans b. Toxoplasma gondii c. Pneumocystis jiroveci d. Mycobacterium tuberculosis

b. Toxoplasma gondii Single-celled parasite. Most people who become infected with Toxoplasma gondii are not aware of it because they have no symptoms at all. Some people who have toxoplasmosis may feel as if they have the "flu" with swollen lymph glands or muscle aches and pains that may last for a month or more. Severe toxoplasmosis, causing damage to the brain, eyes, or other organs, can develop from an acute Toxoplasma infection or one that had occurred earlier in life and is now reactivated. Severe toxoplasmosis is more likely in individuals who have weak immune systems, though occasionally, even persons with healthy immune systems may experience eye damage from toxoplasmosis.

A 34-year-old patient with diabetes mellitus is hospitalized with fever, anorexia, and confusion. The health care provider suspects acute pyelonephritis when the urinalysis reveals bacteriuria. An appropriate collaborative problem identified by the nurse for the patient is potential complication a. hydronephrosis. b. urosepsis. c. acute renal failure. d. chronic pyelonephritis.

b. urosepsis. Rationale: Infection can easily spread from the kidney to the circulation, causing urosepsis. A patient with a urinary tract obstruction will be at risk for hydronephrosis. Acute renal failure is not a common complication of acute pyelonephritis unless urosepsis and septic shock develop. Chronic pyelonephritis may occur after recurrent upper UTIs.

A 98-year-old patient with benign prostatic hyperplasia has a markedly distended bladder and is agitated and confused. All the following orders are received from the emergency department health care provider. Which order should the nurse act on first? a. Draw blood for blood urea nitrogen (BUN) and creatinine. b. Administer lorazepam (Ativan) 0.5 mg. c. Insert 16 French retention catheter. d. Schedule for IVP.

c. Insert 16 French retention catheter. Rationale: Growth on prostate caused acute urinary retention, and the priority action is to relieve the retention by catheterization. The BUN and creatinine measurements can be obtained after the catheter is inserted. The patient's agitation may resolve once the bladder distention is corrected, and sedative drugs should be used cautiously in older patients. The IVP is an appropriate test, but does not need to be done urgently.

*A 52-year-old female patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? a. Cough, diarrhea, headaches, blurred vision, muscle fatigue b.. Night sweats, fatigue, fever, and persistent generalized lymphadenopathy c. Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpes d. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

d. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure. Early chronic HIV infection clinical manifestations are either asymptomatic or include fatigue, headache, low-grade fever, night sweats, and persistent generalized lympadenopathy. Intermediate chronic HIV infection clinical manifestations include candidal infections, shingles, oral or genital herpes, bacterial infections, Kaposi sarcoma, or oral hairy leukoplakia. Late chronic HIV infection or acquired immunodeficiency syndrome (AIDS) includes opportunistic diseases (infections and cancer).

ulcerative colitis (UC)

disease characterized by inflammation of the rectum and large intestine with the formation of ulcers, which can cause bloody diarrhea s/s: rectal bleeding, bloody diarrhea, abdominal cramps, anemia, low appetite, and pain pharmacology: tylenol, antibiotics, anti-inflammatory, immunosuppressives, steroids, analgesics (NSAIDs can cause flare up)