340 test two questions
Which medication causes gastritis? 1 Aspirin 2 Amoxicillin 3 Lansoprazole 4 Metronidazole
1 Aspirin is a nonsteroidal antiinflammatory drug (NSAID) that causes gastritis by decreasing prostaglandin in the lining of the stomach. Amoxicillin is used in the treatment of H. pylori infections. Lansoprazole and metronidazole are used in the treatment of gastritis.
The health care provider has prescribed a corticosteroid for a patient with acute asthma. What nursing actions are appropriate during and after administration of this medication? 1 Monitor potassium levels 2 Administer via inhalation for fast results 3 Observe for anxiety and restlessness 4 Monitor for cardiac ischemia
1 Potassium levels of patients on corticosteroids should always be monitored, because corticosteroid administration can worsen hypokalemia caused by usage of diuretics. When consumed by inhalation, corticosteriods require at least four to five days for optimum therapeutic effects. However, when administered intravenously in cases of acute asthma, corticosteriods speed up the resolution of airway inflammation and edema. Anxiety and restlessness result from hypoxia. Fear caused by the inability to breathe and a sense of loss of control, not the medication in itself, may increase anxiety. Patients being treated for bronchospasm run the risk of high cardiac ischemia with prolonged use of a beta-adrenergic drug.
What is the best choice of treatment for a patient who has acute, life-threatening inflammation of the appendix? 1 Surgery 2 Antipyretics 3 Antimicrobials 4 Corticosteroids
1 Surgical removal is the best treatment for inflammation of the appendix to prevent further complications. Antipyretics are used to reduce fever that may be associated with appendicitis, but will not promote healing. Antimicrobials are used to kill bacteria that may be involved but in a life-threatening situation, surgery is required. Corticosteroids reduce inflammation but cause immunosuppression, reducing the body's ability to fight infection.
An older adult patient is receiving corticosteroid therapy for rheumatoid arthritis. What is the major concern in adopting this line of treatment? 1 Osteopenia 2 Drug-drug interaction 3 Moon face and weight gain 4 Diabetes and mood swings
1 The major concern is corticosteroid-induced osteopenia, which can add to the problem of decreased bone density related to age and inactivity in older patients. It also increases the risk of pathologic fractures, especially compression fractures of vertebrae. Drug-drug interactions, moon face and weight gain, and diabetes and mood swings are side effects that can be monitored.
Which inflammatory mediator may trigger fever during inflammation? 1 Cytokines 2 Serotonin 3 Bradykinin 4 Leukotrienes
1 The release of cytokines initiates metabolic changes in the temperature-regulating center of the hypothalamus. Thus, cytokines trigger fever during inflammation. Serotonin stimulates smooth muscle contraction. Bradykinin causes vasodilation and contraction of smooth muscle. Leukotriene stimulates chemotaxis. Text Reference - p. 174
When teaching a group of athletes about reducing the risk of sprains and strains before vigorous exercise, what instructions should the nurse include? 1 Warm up before exercise. 2 Rest before exercise. 3 Avoid vigorous exercise. 4 Rest after exercise.
1 Warming up muscles before exercising and vigorous activity, followed by stretching, may significantly reduce the risk of sprains and strains. Resting before vigorous exercise may cause sprains and strains. In this group of athletes, vigorous exercise can be done, but it should be done after appropriate warming up. Resting after the exercise does not affect the risk of strains and sprains.
The nurse recalls that interferons may be used in the treatment of certain diseases. What is the clinical use of β-Interferon? 1 As a treatment for multiple sclerosis 2 As a treatment for multiple myeloma 3 As a treatment for hairy cell leukemia 4 As a treatment for renal cell carcinoma
1 β-Interferon is used in treating multiple sclerosis. Cytokines instruct cells to alter their proliferation, differentiation, secretion, or activity. Cytokines play an important role in hematopoiesis. α-interferon is used to treat multiple myeloma, hairy cell leukemia, and renal cell carcinoma.
The nurse should recommend what type of diet for a patient with acute cholecystitis? 1 Low-fat 2 Low-protein 3 Low-calcium 4 Low-carbohydrate
1 Cholecystitis is inflammation of the gallbladder. Fats contribute to gallstone formation, worsening the inflammation; therefore, patients with cholecystitis should consume a low-fat diet. A diet low in protein is given to patients with kidney or liver disease. Patients with cholecystitis should be given a diet rich in calcium and carbohydrates.
Which mediator of inflammation causes vasodilation and increases capillary permeability at the injury site? 1 Histamine 2 Leukotrienes 3 Complement component C4a 4 Complement component C3a
1 Histamine is released by the cells in response to inflammation; this chemical causes vasodilation and increases capillary permeability at the injury site. Leukotrienes stimulate chemotaxis and cause smooth muscle constriction along with capillary permeability. Complement components such as C4a and C3a stimulate histamine release and chemotaxis.
A patient with multiple sclerosis is under treatment with β-interferon. What patient teaching would be appropriate for this patient? Select all that apply. 1 Wear sunscreen while exposed to sunlight. 2 Rotate injection sites with each dose. 3 Know that flu-like symptoms are common. 4 Do not drink grape juice. 5 Monitor vital signs regularly.
1,2,3 Patients on β-Interferon should wear sunscreen when exposed to sunlight, because the drug may cause photosensitivity. The injection site should be rotated with each dose to prevent lipodystrophy. The nurse should let the patient know that flu-like symptoms are common with β-interferon. The symptoms usually subside on their own; if they do not, they can be treated with nonsteroidal antiinflammatory drugs. The drug does not interact with grape juice; therefore, grape juice can be consumed. Monitoring of vital signs is not a specific teaching related to the drug.
What are the symptoms of inflammation at an injury site? Select all that apply. 1 Swelling at the site 2 Redness at the site 3 Characteristic odor at the site 4 Purulent exudate from the site 5 Loss of function of cells at the site
1,2,5 Inflammation increases the permeability of the blood vessels by causing vasodilation, resulting in redness at the site. Inflammation causes a shifting of fluids to the interstitial spaces and fluid accumulation, resulting in swelling at the site. Swelling and pain can result in loss of cellular function at the inflammatory site. Characteristic odor and purulent exudate at the site are signs of infection.
A patient is admitted to the hospital two hours following an ankle injury. A soft tissue injury is suspected. There is no external bleeding. What measures can the nurse take for this patient to help relieve the inflammation? Select all that apply. 1 Immobilize the affected part and encourage rest. 2 Provide cold application to the affected part. 3 Make the patient lie down and keep the ankle below the level of heart. 4 Make the patient walk a little distance to increase circulation in the affected area. 5 Apply a compression bandage to the ankle and check the distal pulse.
1,2,5 In cases of soft tissue injuries, RICE treatment (rest, ice, compression, and elevation) is given. The affected part is immobilized and given rest. Ice or cold is applied to reduce pain and inflammation. Hot applications can be given after 24 to 48 hours. The affected part is compressed with bandages to provide support and prevent edema. The affected part should be elevated above the heart level to prevent edema and pain. Making the patient walk would increase pain and discomfort, so it is not advisable.
A patient suffering from cholelithiasis underwent a cholecystectomy. What dietary advice will the nurse give this patient? Select all that apply. 1 Have a high-fiber diet. 2 Limit intake of water. 3 Have small but frequent meals. 4 Avoid or keep fats to a minimum. 5 Have the same diet as before.
1,3,4
On examining a patient suspected of having appendicitis, what characteristics of the ailment is the nurse likely to find? Select all that apply. 1 Muscle guarding 2 High-grade fever 3 Pain at the McBurney point 4 Pain decreased by coughing 5 Patient prefers to lie still, with his right leg flexed.
1,3,5 Appendicitis is usually manifested by muscle guarding, localized tenderness, and rebound tenderness. The patient may have pain over the McBurney point, which is the area halfway between the umbilicus and the right iliac crest. The patient may prefer to lie still, with the right leg flexed. Fever may or may not be present; if present, then usually it is a low-grade fever. The pain increases during activities like coughing, sneezing, and deep breathing.
Which microorganism causes gastritis? 1 Helicobacter pylori 2 Staphylococcus 3 Candida albicans 4 Fusiform bacteria
2 Staphylococcus causes gastritis. H. pylori causes stomach cancer. Candida albicans causes oral candidiasis. Fusiform bacteria cause Vincent's infection
A nurse is examining an intravenous site and confirms that inflammation is present at the site. What signs of inflammation may be present in the patient? Select all that apply. 1 Pain at the site 2 Ulcers at the site 3 Swelling of the site 4 Black discoloration 5 Redness at the site
1,3,5 Signs of inflammation are pain, swelling, and redness. Pain is caused by the change in pH, nerve stimulation by chemicals, and pressure from fluid exudate. Swelling is caused by fluid shift to interstitial spaces and accumulation of fluid exudate. Redness is a result of hyperemia from vasodilation. Blackish discoloration and ulcers are not indicative of inflammation. Text Reference - p. 175
The nurse provides education to an athlete about how to avoid sprains and strains. Which suggestion is appropriate for the nurse to include? Select all that apply. 1 "Perform balancing exercises." 2 "Use a cane while walking." 3 "Perform strengthening exercises." 4 "Take an analgesic before exercising." 5 "Perform muscle warming up exercises before vigorous activities."
1,3,5 Balance exercises help in preventing falls. Strengthening exercises help in building up muscle strength and bone density. Performing warm-up exercises before any vigorous activity reduces the risk of sprains and strains. A cane can assist in walking but does not reduce sprains or strains. Taking analgesics before exercise in the absence of injury or pain may be unnecessary.
Which systemic clinical manifestations does the nurse most anticipate finding in a patient who has inflammation at an injury site? Select all that apply. 1 Pulse rate of 120 beats/minute 2 Respiratory rate of 10 breaths/minute 3 White blood cell count of 13,000/µL 4 Body temperature of 98° F 5 Body temperature of 101° F
1,3,5 The clinical manifestations of inflammation at the injury site are increased pulse and respiratory rate, increased white blood cell count and body temperature, and anorexia. A pulse rate of 120 beats/minute is higher than the normal range of 60 to 100 beats/minute. The white blood cell count of 13,000/µL is higher than the normal range of 4,500 to 10,000/µL. Inflammation results in increased metabolism and therefore increases the body temperature above the normal range of 97.8 to 99.1° F. The inflammation is manifested by increased respiratory rate. Normal respiratory rate is in the range of 12 to 18 breaths/minute; a rate of 10 breaths/minute does not indicate inflammation.
A patient is about to receive an infusion of α-interferon. The nurse will premedicate the patient with which of these drugs to prevent fever and shivering during this infusion? 1 Aspirin 2 Acetaminophen 3 Morphine sulfate 4 Ondansetron
2 Common side effects of interferons include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, photosensitivity, anorexia, and nausea. Acetaminophen administered every four hours, as prescribed, often reduces the severity of the flu-like syndrome. The patient is commonly premedicated with acetaminophen in an attempt to prevent or decrease the intensity of these symptoms. In addition, large amounts of fluids help decrease the symptoms. Aspirin would not be appropriate because of its platelet aggregation-inhibiting effect. Morphine is an opioid analgesic. Ondasetron is for prevention and treatment of nausea.
The patient has inflammation and is complaining of malaise, nausea, and anorexia. The nurse explains to the patient that these manifestations are related to inflammation in what way? 1 Local response 2 Systemic response 3 Infectious response 4 Acute inflammatory response
2 The systemic response to inflammation includes the manifestations of a shift to the left in the white blood cell (WBC) count, malaise, nausea, anorexia, increased pulse and respiratory rate, and fever. The local response to inflammation includes redness, heat, pain, swelling, or loss of function at the site of inflammation. There is not an infectious response to inflammation, only an inflammatory response to infection. The acute inflammatory response is a type of inflammation that heals in two to three weeks and usually leaves no residual damage.
The nurse provides education to a student nurse about cholecystitis management. Which statement made by the student nurse indicates the need for further teaching? 1 "Ketorolac is prescribed to reduce abdominal pain." 2 "Octreotide is prescribed to reduce smooth muscle spasms." 3 "A cholecystostomy is performed to remove pus from the gallbladder." 4 "Nasogastric intubation is performed to relieve nausea and vomiting."
2 Anticholinergics, such as dicyclomine, are used to reduce the smooth muscle spasms associated with cholecystitis, not octreotide. Ketorolac is an analgesic used to relieve pain. Cholecystostomy is a procedure in which a hole is created in the gallbladder to facilitate insertion of a tube that drains pus from the gallbladder. Nasogastric intubation is performed to remove gastric contents, which may stimulate the gallbladder and cause nausea and vomiting.
What is a cause of primary peritonitis? 1 Pancreatitis 2 Cirrhosis with ascites 3 Appendicitis with rupture 4 Ischemic bowel disorders
2 Cirrhosis causes a large amount of fluid to build up in the abdominal cavity; this is known as ascites. Ascites is susceptible to bacterial infection that can cause primary peritonitis. Pancreatitis, appendicitis with rupture, and ischemic bowel disorders are causes of secondary peritonitis.
A patient's medical record indicates osteomyelitis. The nurse finds that the patient is showing malaise as an early symptom of inflammation and has no other manifestations of inflammation. Which drug therapy prescription could be responsible for this condition? 1 Salicylates 2 Corticosteroids 3 Vitamin D supplements 4 Potassium supplements
2 Corticosteroids are used to treat osteomyelitis. This drug suppresses immunity and masks classic manifestations of inflammation; thus a patient would present malaise. Salicylates are used to lower excessive body temperature and do not interfere with the immune mechanism. Potassium can strengthen the functions of the immune system. Vitamin D supplements facilitate calcium absorption.
A bandage has been applied on the ankle of a patient for a sprain. The patient states the ankle is swollen, numb, and painful. What is the priority action by the nurse? 1 Have the patient ambulate 2 Loosen the bandage 3 Check for Homan's sign 4 Administer an antibiotic for cellulitis
2 The patient's signs and symptoms indicate that the bandage is too tight. In such cases, the bandage can be left in place for 30 minutes and then removed for 15 minutes. However, some elastic wraps are left on during training, athletic, and occupational activities. Although assessing for thrombophlebitis, deep vein thrombosis, and cellulitis can all cause pain and swelling, the differential diagnosis in this instance points to bandage tightness as the likeliest cause. Ambulation will increase the pain and swelling until the bandage is loosened.
A patient with cancer who is receiving methotrexate therapy has developed anemia. Which therapies would be beneficial for this patient? Select all that apply. 1 Oral iron 2 Epoetin alfa 3 Oral folic acid 4 Blood transfusion 5 Parenteral vitamin B12
2,3 Epoetin alfa is used to treat anemia related to cancer and its therapies. Methotrexate leads to folic acid deficiency resulting in megaloblastic anemia. Therefore, folic acid therapy is given to treat the patient. Oral iron is administered to patients with iron deficiency anemia, which is seen mostly in premenopausal and pregnant women. Blood transfusions are required to keep the approximate hemoglobin level to at least 10 g/dL in the case of thalassemia and severe anemia. Parenteral vitamin B12 is administered to treat cobalamin deficiency caused by pernicious anemia.
Which type of health education should a nurse provide to a patient who is on corticosteroid therapy? Select all that apply. 1 Co-administer opioids. 2 Restrict sodium intake. 3 Reduce physical exercise. 4 Maintain a high-protein diet. 5 Ensure adequate rest and sleep
2,3,5 High sodium intake may cause edema and should be avoided. Patients on corticosteroid therapy should adhere to a high-protein diet to promote healing and reduce inflammation. Adequate rest and sleep help facilitate a quick recovery. Opioid therapy should be avoided, because it may have adverse effects when co-administered with corticosteroids. Reduction in exercise may promote bone density loss.
A patient is diagnosed with multiple sclerosis (MS) and is prescribed interferon. What should the nurse include in medication teaching? 1 The medication should be taken before meals on an empty stomach. 2 The medication is given during exacerbation of symptoms to promote remission. 3 The medication often causes patients to experience flu-like symptoms. 4 The medication alters carbohydrate metabolism and elevates serum glucose levels.
3
A patient presents with acute upper quadrant pain radiating to the back that the patient rates as a 10 on a 1 to 10 pain scale. The patient says, "I'm nauseated, and I've vomited several times." The diagnosis is cholecystitis with cholelithiasis. Which collaborative nursing diagnosis does the nurse recognize as the highest priority? 1 Impaired skin integrity related to the surgical incision 2 Anxiety related to knowledge deficit of diagnostic studies 3 Acute pain related to inflammation and blockage of the biliary tract 4 Risk for fluid volume deficit related to nausea and vomiting
3 Acute pain is the priority problem at the moment. Acute pain can and should be managed immediately before other nursing care activities are carried out. Managing the patient's pain helps the nurse in achieving other care goals. Impaired skin integrity is not currently a problem because, the patient has not yet had surgery. Anxiety related to deficient knowledge of diagnostic studies is a lower priority and may be addressed after pain is managed. After the patient's pain is managed, nausea, vomiting, and decreased fluid intake should be the next problems addressed. Text Reference - p. 1037
A nurse is designing a plan of care for a patient with a soft tissue injury and related inflammation as a result of a motor vehicle accident. Which nursing intervention should be included in the plan? 1 Avoid compression bandages, because they may compromise circulation. 2 Keep the injured extremity moving for proper blood circulation. 3 Elevate the injured extremity above the level of the heart to reduce pain. 4 Use hot fomentation to increase the circulation at the inflamed site during initial trauma care.
3 An injured extremity may become engorged with blood. Elevation of the injured extremity above the level of the heart helps to reduce pain associated with swelling by increasing the venous and lymphatic return. Compression helps to reduce vasodilation and edema. However, distal pulses should be assessed before and after a compression bandage is applied, to evaluate whether the extremity has compromised circulation. If the circulation is not compromised, a compression bandage can be used. The injured extremity should be immobilized and allowed to rest, because immobilization promotes healing by decreasing the metabolic needs of the patient. At the time of initial trauma, cold fomentation should be used to promote vasoconstriction and decrease pain, swelling, and congestion. Heat may be used 24 to 48 hours after injury to promote healing by increasing circulation at the inflamed site.
A patient has been provided with a compression dressing in an attempt to facilitate rapid healing of an ankle sprain. What is a priority nursing assessment? 1 Frequent examination of the character and quantity of exudate 2 Monitoring for signs and symptoms of local or systemic infections 3 Assessment of the patient's circulation distal to the location of the dressing 4 Assessment of the range of motion of the ankle and the patient's activity tolerance
3 Any compression dressing requires vigilant assessment of the circulation distal to the dressing site, because tissue and nerve damage are significant risks. Exudate and infection normally would not accompany a soft tissue injury such as a sprain. Assessment of the circulation distal to the dressing site supersedes the importance of assessing the patient's mobility.
Which condition involves inflammation of all layers of the bowel wall? 1 Peritonitis 2 Gastroenteritis 3 Crohn's disease 4 Ulcerative colitis
3 Crohn's disease is a type of inflammatory bowel disease (IBD). Crohn's disease can occur in any segment of the gastrointestinal tract and involves inflammation of all layers of the bowel wall. Peritonitis is the inflammation of the peritoneum. Gastroenteritis involves inflammation of the mucosa of the small intestine and stomach. Ulcerative colitis involves inflammation starting from the rectum that moves towards the cecum.
What is the most useful initial nursing action for a patient who sustains a joint sprain? 1 Seeking a prescription for a prophylactic antibiotic 2 Administering an over-the-counter analgesic 3 Applying ice compresses to the injured area 4 Providing the patient with instructions about weight bearing
3 Ice application is the most useful intervention after a sprain. Cold compression produces hypothermia of the affected area, facilitating vasoconstriction and reducing the perception and transmission of nerve pain impulses. Antibiotic prophylaxis is administered for an open fracture or external extremity injury. Analgesics such as aspirin can be administered after the cold compress. Patient instructions should be provided after the extent of the injury is determined and initial interventions performed.
A patient with an inflammation of the pericardial sac has a history of systemic lupus erythematosus (SLE). Which therapy does the nurse think will help the patient? 1 Salicylate therapy 2 Antibiotic therapy 3 Corticosteroid therapy 4 Nonsteroidal antiinflammatory drug (NSAIDs) therapy
3 Inflammation of the pericardial sac indicates pericarditis; corticosteroid therapy is reserved for patients with pericarditis secondary to systemic lupus erythematosus (SLE). Salicylate therapy is beneficial to patients with rheumatic fever. Antibiotic therapy is used in the treatment of bacterial pericarditis. Nonsteroidal antiinflammatory drug (NSAIDs) therapy is used to control pain and inflammation in patients with pericarditis.
The nurse expects what physical finding in a patient with cholecystitis? 1 Spider angioma 2 Flapping tremors 3 Abdominal rigidity 4 Grey Turner's sign
3 Physical findings in patients with cholecystitis are abdominal rigidity and tenderness in the right upper quadrant. A spider angioma is a manifestation of liver cirrhosis wherein the patient has a small, dilated blood vessel with a red center and branching of the blood vessel. Flapping tremors are seen in patients with hepatic encephalopathy, which is characterized by rapid flexion and extension movements when asked to stretch the hand. Grey Turner's sign is a manifestation of acute pancreatitis characterized by bluish discoloration of the flanks.
Which clinical manifestation of pain does the nurse expect to identify in a patient who has cholecystitis? 1 Left flank pain with intermittent exacerbations 2 Right lower quadrant pain with rebound tenderness 3 Right upper quadrant pain radiating to the patient's back 4 Epigastric pain that intensifies when the patient is lying down
3 The pain of cholecystitis is in the region of the gallbladder (right upper quadrant), which is inflamed as a result of infection and irritation from bile. The pain may be referred to the right shoulder and scapula. Left flank pain with intermittent exacerbations may be caused by renal calculi. Right lower quadrant pain with rebound tenderness may be related to acute appendicitis, Crohn's disease, or peritonitis. Epigastric pain that intensifies when the patient is lying down may be related to gastroesophageal reflux disease or hiatal hernia.
A patient is admitted with cellulitis and probable osteomyelitis. The nurse concludes that there is significant inflammation through which laboratory finding? 1 White blood cell count 9500/mm3 2 Red blood cell count 4.5 3 Erythrocyte sedimentation rate (ESR) 88 4 Blood urea nitrogen (BUN) 24
3 The ESR is indicative of inflammation and typically is elevated in patients with osteomyelitis. The BUN, white blood cell count, and red blood cell count are normal and do not represent inflammation.
A patient has fever associated with inflammation at an injury site. The nurse administers acetaminophen to the patient around the clock. What is the rationale behind this nursing intervention? 1 To increase collagen synthesis 2 To prevent liberation of lysosomes 3 To increase power of white blood cells 4 To prevent acute swings in temperature
4
Which symptom will persist until the irritation and inflammation is completely resolved in meningitis? 1 Fever 2 Nausea 3 Seizures 4 Headache
4 Headaches can occur for months after a diagnosis of meningitis until the irritation and inflammation have completely resolved. Fever, nausea, and seizures may be resolved by symptomatic treatment even when the inflammation is still present.
Which part of the joint enables progression of inflammation to other parts of the joint? 1 Tendons 2 Ligaments 3 Articular cartilage 4 Synovial membrane
4 Basic pathologic changes in a joint occur within the synovial membrane. Removal of the thickened synovium prevents extension of the inflammatory process into tendons, ligaments, and adjacent articular cartilage. Text Reference - p. 1534
Which acute phase protein is elevated during inflammation? 1 Albumin 2 Transferrin 3 Prealbumin 4 C-reactive protein (CRP)
4 C-reactive protein (CRP) is a positive acute phase protein that is elevated during inflammation and helps in predicting morbidity and mortality. Negative acute phase proteins such as albumin, transferrin, and prealbumin are decreased during an inflammatory response.
Which finding in the laboratory results of a patient with malnutrition does the nurse suspect to be due to disease-related malnutrition with inflammation? 1 Decreased glucose turnover 2 Increased nitrogen excretion 3 Decreased basic metabolic rate 4 Increased C-reactive protein (CRP)
4 Inflammation is an important aspect of the nutritional status and it affects nutrient metabolism. In inflammation, there is an increase in CRP protein due to alterations in the expression of proinflammatory and inflammatory cytokines. In disease-related malnutrition, there is an increased glucose turnover. Decreased nitrogen excretion and basal metabolic rate indicate starvation-related malnutrition.
The nurse is providing care to a patient with cholecystitis that is experiencing severe nausea and vomiting. The nurse should include what intervention? 1 Encouraging exercise 2 Assisting with ambulation 3 Assisting with repositioning 4 Providing oral care every two hours
4 Patients with cholecystitis may have severe nausea and vomiting. Therefore, the nurse should give frequent oral care to the patient to avoid discomfort. Encouraging exercise, assisting with ambulation, and repositioning are not interventions that address the problem of severe nausea and vomiting.
A nursing student is learning about inflammation and wound healing. Which statement describing the process of wound healing conveys that the nursing student understands the process? 1 "Regeneration is more complex than the process of repair." 2 "Delayed closure with sutures is a secondary intention healing." 3 "Primary intention healing takes place when wound margins are irregular." 4 "Tertiary intention healing results in a larger and deeper scar."
4 Tertiary intention healing is a delayed suturing of a wound after the infection has been controlled. Because it is associated with delayed healing, the scar is larger and deeper than the scar that results from primary and secondary intention healing. The process of repair is more complex than the process of regeneration, because repair occurs by primary, secondary, and tertiary intention. Secondary intention healing is the healing of wounds whose edges cannot be approximated. Delayed closure with sutures is a form of tertiary intention healing. Primary healing takes place when wound margins are clear and concise.
A patient has sustained an injury, but has no signs or symptoms of inflammation at the site of injury. Which laboratory finding does the nurse correlate with this finding? 1 Zinc deficiency 2 Protein deficiency 3 Decreased red blood cell count 4 Decreased white blood cell count
4 White blood cells play an important role in the body's defense and they facilitate the response to inflammation. A decreased white blood cell count causes neutropenia; a neutropenic patient is unable to mount an inflammatory response. Zinc deficiency impairs epithelialization in the wound-healing process. Protein deficiency decreases the supply of amino acids for tissue repair. Decreased red blood cell count causes anemia.
What is the primary function of interferon-beta? 1 Proliferation and differentiation of monocytes 2 Proliferation and differentiation of neutrophils 3 Production of red blood cells in the bone marrow 4 Activation of natural killer cells and macrophages
4 nterferon-beta activates natural killer cells, inhibits viral replication, and has antiproliferative effects on tumor cells. Granulocyte-macrophage colony-stimulating factor (GM-CSF) is responsible for the proliferation and differentiation of monocytes. G-CSF stimulates the proliferation and differentiation of neutrophils. Production of red blood cells in the bone marrow is the function of erythropoietin.
What is the purpose of applying heat at the site of inflammation? 1 To decrease congestion 2 To promote vasoconstriction 3 To prevent further tissue injury 4 To localize the inflammatory agents
4 Heat application is used to localize the inflammatory agents and promote healing by increasing the circulation to the inflamed site and subsequent removal of debris. Cold application decreases congestion and promotes vasoconstriction at the site of inflammation. Immobilizing the inflamed area with a cast prevents further tissue injury. Text Reference - p. 177