Corticoidsteroids
Which clinical manifestation would the nurse expect when assessing a 4-year-old child with newly diagnosed acute lymphocytic leukemia (ALL)?
Anorexia, Petechiae, Ecchymoses, Lethargy, Pallor Anorexia occurs as a result of catabolic alterations of metabolism caused by the cancer. Bone marrow depression (also caused by the cancer) will reduce the platelet count, which results in bleeding tendencies, petechia, and ecchymoses. The red blood cell count is also reduced as a result of bone marrow depression, causing the child to be lethargic and have pallor of the conjunctiva, nail beds, and palms. Edema is not expected during early-stage acute lymphocytic leukemia (ALL), and alopecia occurs because of chemotherapy, not the disease process. Excessive sleep, not insomnia, is a result of the reduced blood cell count associated with bone marrow depression.
A recent immigrant enters the emergency department with a roundworm infection. Which white blood cell type would the nurse expect to be most active in this patient?
Eosinophils Eosinophils are very active against parasitic infestations such as roundworm. Although other white blood cells such as basophils, neutrophils, and tissue mast cells may be active due to the presence of the infection, eosinophils are the primary cells involved in combatting parasitic infections.
Which corticosteroid is the treatment of choice for a patient with Addison disease?
Fludrocortisone Fludrocortisone is a mineralocorticoid, which is the treatment of choice in patients requiring mineralocorticoid replacement such as in Addison disease.
Which statement accurately describes corticosteroids?
Glucocorticoids affect carbohydrate metabolism, and mineralocorticoids regulate electrolytes. It is accurate that glucocorticoids affect carbohydrate metabolism and mineralocorticoids are responsible for electrolyte regulation.
Which drugs currently taken by Mrs. Gabriel are anticipated to interact with prednisone?
HCTZ Prednisone may lead to increased side effects of diuretics such as HCTZ. Concomitant administration of prednisone and HCTZ can lead to further depletion of electrolytes like potassium. As a result more side effects, such as constipation, fatigue, and weakness, may occur. Metformin Prednisone may lead to decreased effects of metformin. Therefore Mrs. Crawford should monitor her blood glucose levels more closely. It may not be observed as glucocorticoids increase blood glucose levels; however, careful monitoring of the blood glucose level is warranted
What is the key function of neutrophils?
Help in nonspecific ingestion and phagocytosis of microorganisms
The nurse is assessing the leg of a patient who sustained a cut while hiking. Which chemical is released that facilitates arterial dilation and small vein constriction after this injury?
Histamine Basophils release a chemical called histamine that cause arteriole dilation and venous capillary constriction. This causes blood to pool in the arterioles and capillaries. Kinins also dilate arterioles, but they also increase capillary permeability, leading to vascular leak syndrome from plasma leaking into the interstitial space. Heparin prevents protein and blood clotting. Leukotrienes cause bronchial constriction.
A child infected with human immunodeficiency virus (HIV) will primarily exhibit deficiencies in which aspects of immune function?
Humoral immunity Humoral immunity, which depends primarily on immunoglobulins, becomes nonfunctional with HIV infection. A child with HIV will exhibit primary deficiency in humoral immunity. Cell-mediated immunity Cell-mediated immunity, which depends highly on helper T-cells, is most affected by HIV infection. A child with HIV will exhibit primary deficiency in cell-mediated immunity.
Type 1 hypersensitivity
IgE mediated
Which immunoglobulin (Ig) antibodies are involved in complement pathway activation?
IgG and IgM Antibodies IgG and IgM are both responsible for activating the classic complement pathway. IgA, IgE, and IgD have no role in complement pathway activation. |gA helps in preventing infection in the upper and lower respiratory tracts, the Gl tract, and the genitourinary tract. IgE is associated with antibody-mediated hypersensitivity reactions. gD acts as a receptor on unsensitized B-lymphocytes.
A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which assessment finding would alert the nurse to the possible development of thrombocytopenia? Select all that apply.
Melena,Hematuria,Ecchymosis Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood. This reduction in platelet activity impairs blood clotting, so any assessment finding associated with potentially abnormal bleeding would alert the nurse to the possibility of thrombocytopenia. This includes melena (digested blood in feces), hematuria (bleeding within the renal system), and ecchymosis (bleeding into skeletal soft tissue). Fever, diarrhea, nausea, alopecia, and mucositis are common side effects of chemotherapy but are not findings attributed to thrombocytopenia.
What type of immunity does a baby acquire from its mother through breastfeeding?
Natural passive Natural passive immunity occurs when a mother transmits preformed antibodies to her baby through breast milk. Natural active immunity is acquired after an antigen enters a person's body. Artificial active immunity is acquired through vaccination or immunization. Artificial passive immunity is acquired by injecting a person with antibodies obtained from animals or other human beings.
For which individuals is prophylactic antitubercular therapy appropriate?
Persons in close contact with individuals with active tuberculosis (TB) Persons in close contact with individuals with active TB should be started on prophylactic antitubercular therapy. Persons with a latent TB infection Persons with a latent TB infection should be started on prophylactic antitubercular therapy. Recent immigrants with a positive skin test reaction of ≥10 mm Recent immigrants with a positive skin test reaction of ≥10 mm should be started on prophylactic antitubercular therapy.
Which drugs are considered first-line antitubercular drugs?
Pyrazinamide is a first-line anti-tuberculosis (anti-TB) drug. Rifampin Rifampin is a first-line anti-TB drug. Rifapentine Rifapentine is a first-line anti-TB drug.
Which statements regarding the pharmacokinetics of glucocorticoids are accurate? Select all that apply. Rate of absorption varies depending on the glucocorticoid and route of administration. Rapid absorption occurs when sodium phosphate and sodium succinate esters are given intramuscularly. Glucocorticoids are minimally protein bound. Glucocorticoids undergo hepatic metabolism to produce inactive metabolites. Glucocorticoids undergo biliary excretion.
Rate of absorption varies depending on the glucocorticoid and route of administration. Glucocorticoid absorption greatly varies depending on both the glucocorticoid of reference and the route in which it is administered. Rapid absorption occurs when sodium phosphate and sodium succinate esters are given intramuscularly. Rapid absorption occurs with two glucocorticoids esters - sodium phosphate and sodium succinate - when given intramuscularly. Glucocorticoids undergo hepatic metabolism to produce inactive metabolites. They undergo hepatic metabolism, forming inactive metabolites.
Stage of inflammation for ingrown toe nail showing pus
Stage II The presence of pus is a classic sign of stage Il of the inflammatory process. Edema occurs in stage I, but this does not reflect true pus formation. Pus formation occurs when the body rids itself of dead white blood cells, necrotic tissue, and fluids during stage II. Stage Ill is the healing stage, and pus formation is usually no longer occurring during this stage. The inflammatory process does not include a stage IV.
The highest priority need is the weakened immune system due to overgrowth of lymphocytes.
The highest priority need is the weakened immune system due to overgrowth of lymphocytes. The client has malignant lymphoma (Hodgkin or non-Hodgkin), which affects mature white blood cells, weakening the immune system. Lymphoma affects lymphocytes by increasing production. Even though lymphoma can cause weight loss, progressive fatigue, and tachycardia, these findings are not the priority needs. A weakened immune system can cause more harm and more severe effects than weight loss, fatigue, or tachycardia. Excessive production of blast cells occurs in leukemia, not lymphoma. Lack of erythrocytes occurs in anemia, not lymphoma. Reduction of platelets occurs in thrombocytopenia, not lymphoma
Which statement describes the contraindication of Western blot assay for diagnosing human immunodeficiency virus (HIV) in infants younger than 18 months?
The infant's antibody levels may be artificially elevated by maternal antibodies for the first 18 months. Maternal antibodies that cross the placenta may artificially increase the infant's antibody levels and cause a false-positive result.
A 35-year-old client was brought to the emergency department (ED) by her husband due to complaints of severe fatigue. The husband reports that the client has been sleeping all the time for the past few weeks and has been difficult to arouse at times. The client has a history of stage 4 breast cancer. What actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. Actions to take: Prepare to administer a platelet transfusion, instruct client to used a soft bristled toothbrush Parameters to monitor: Platelet count Number of saturated pads used
Thrombocytopenia Thrombocytopenia is a complication caused by bone marrow depression. It can cause a serious risk for bleeding if platelets fall below 50,000/µL. Symptoms include ecchymosis, hematuria, hematemesis, petechiae, and bleeding gums. The nurse would anticipate administering a platelet transfusion since the platelet count is only 20,000/µL. Thrombocytopenia can cause serious bleeding; therefore, the client should be instructed to use a soft bristle toothbrush to decrease the risk of bleeding gums. The nurse would monitor the platelet count for a risk of serious bleeding and to determine effectiveness of treatment. The nurse should track the amount of blood loss from menstrual bleeding to make sure it is not excessive. Nephrotoxicity is damage to the renal cells and the client would have an elevated serum BUN and creatinine level. Peripheral neuropathy is paresthesia in extremities presented as numbness or tingling. Pneumonitis is a complication from radiation treatment presented as a dry, hacking cough. Sodium bicarbonate would be administered if the client demonstrated signs of nephrotoxicity, not thrombocytopenia. With a pulse oximetry reading of 96% the client would not need oxygen administered. Large-gauge (16-gauge) catheters should be avoided in clients with thrombocytopenia. It would not be indicated for the nurse to monitor for electroencephalogram (EEG) changes, serum glucose, or sodium level at this time. The nurse would monitor the electrocardiogram, not an EEG. The client is not displaying any signs of hyperglycemia or hypoglycemia, so glucose would not be monitored. Sodium does not need to be monitored because the client's sodium level is within normal range (138).
The risk/benefit ratio should be considered before recommending which routine childhood vaccines to children who are infected with human immunodeficiency virus (HIV)?
Varicella Because live-virus vaccines like the varicella vaccine can be dangerous to immunocompromised children by triggering an immune response, the risks may outweigh the benefits. Therefore special consideration is required before administration.
Which additional drug is usually taken concomitantly with isoniazid (INH) to reduce peripheral neuropathy?
Vitamin B6 Pyridoxine, or B6, is often taken concomitantly with INH to reduce peripheral neuropathy.
Which parameters will a nurse ensure have been assessed before administering prednisone to a patient newly diagnosed with systemic lupus erythematous? Select all that apply.
Weight Glucocorticoids like prednisone can cause weight gain. Therefore it is important to gain a baseline value for monitoring. Sodium level Sodium level should be monitored because glucocorticoids can alter sodium levels. Glucose level The patient's glucose level should be assessed because glucocorticoids can increase glucose levels. Blood pressure Blood pressure may increase with corticosteroid therapy. Therefore assessing this at baseline is important to determine whether additional interventions should be made to lower the patient's risk for cardiovascular events. Presence of preexisting edema The assessment for preexisting edema is important because prednisone can cause sodium retention.
Jerisch-Herxheimer reaction
systemic reaction resembling bacterial sepsis that usually begins 6 to 8 hours after the initial treatment of syphilis with effective antibiotics
Which change happens to the immune system as a person ages?
Decreased neutrophil function, decreased leukocytes when sick, decreased circulating T-lymphocytes
The nurse is caring for an infant with human immunodeficiency virus (HIV). Which management goals are appropriate for the patient's care plan?
Decreasing the viral load The goals of management are directed toward rapidly decreasing the viral load to reduce the effects of the virus on the immune system. Preserving immune function The goals of management include preserving immune function to maintain the patient's ability to fight infection. Preventing medication resistance The goals of management include preventing drug resistance to preserve effectiveness of treatment. Facilitating normal growth and development The goals of management include facilitating normal growth and development to prevent developmental stagnation or disorders secondary to HIV infection.
The nurse is caring for an infant born to a mother with human immunodeficiency virus (HIV). The infant had a negative HIV RNA assay at 2 weeks and 2 months of age. When would HIV infection be finally ruled out?
Negative virological test result at 4 months A negative virological assay result at 4 months combined with earlier testing would confirm negative HIV status.
Superior vena cava syndrome
Seen in lung cancer that obstructs the SVC and causes distended head and neck veins with edema, blue discoloration of arms and face
Which two cells of the immune system engulf foreign cells through phagocytosis
neutrophils and macrophages Neutrophils and macrophages are the primary cells that are involved in phagocytosis. Eosinophils and basophils release vasoactive chemicals, and mast cells and basophils have immunoglobulin E (IgE)-binding sites. However, they do not perform phagocytosis of foreign organisms or debris.
The nurse recalls that which condition is associated with inflammation that occurs with infection?
otitis media An example of inflammation that occurs through infection is otitis media. Myocardial infarction is associated with inflammation. However, this inflammation is not caused by infection. Blister formation is an example of inflammation that occurs without infection. Allergic rhinitis is an example of inflammation that occurs from the invasion of noninfectious microorganisms
Granulocyte colony-stimulating factor (G-CSF)
stimulates the formation of granulocytes from myeloblast cells
Which statement made by Ms. Hope indicates an accurate understanding of patient teaching on isoniazid (INH)?
"I should not drink alcohol while on the drug." Alcohol can increase the risk for hepatotoxicity if consumed while on INH.
A patient with active tuberculosis (TB) is started on antitubercular drugs. Which statement made by the patient indicates an accurate understanding of the drug treatment?
"I will be taking the drugs for about 9 months." Active TB is treated with a two-phase regimen: intensive phase for 2 months, followed by the continuation phase for 4 to 7 months for a total of 9 months.
The nurse is caring for a 12-year-old patient who is positive for human immunodeficiency virus (HIV). When discussing long-term care with the patient's family, which topic has greater significance to someone with HIV compared with patients with other long-term illnesses?
Social stigma Unlike many other long-term illnesses, an HIV diagnosis carries a social stigma. Discussion of this stigma is uniquely important for the family of a patient who is HIV positive.
In what stage of inflammation is there an increased number of circulating neutrophils and exudate formed?
Stage II During stage II of inflammation, there is an increased number of circulating neutrophils and exudate formed. Stage I is characterized by a vascular response that starts the changes in blood vessels. During stage III, tissue repair and replacement occur. There is no stage IV of inflammation.
Analphylaxis Symptoms
Weakness, feelings of impending doom, tachycardia, hypotension, diaphoresis, flushed eyes/itchiness, tightness in throat/difficulty breathing, N/V, stomach cramps, severe diarrhea
Wilms tumor
a rare type of malignant tumor of the kidney that occurs in young children, causes flank pain
Gout
hereditary metabolic disease that is a form of acute arthritis, characterized by excessive uric acid in the blood and around the joints
Type 3 hypersensitivity
immune complex mediated
Osteoarthritis
inflammation of the bones and joints
Type 2 hypersensitivity
IgG/IgM, cytotoxic
A patient who is on warfarin for atrial fibrillation is prescribed isoniazid (INH). Which drug-drug interaction would the nurse anticipate?
Increased level of warfarin INH can increase the level of warfarin, an anticoagulant. The patient will be at increased risk for warfarin toxicity.
A patient has been newly prescribed theophylline for asthma management. In addition to theophylline, the patient is also receiving prednisone. Which drug interaction between theophylline and prednisone does a nurse anticipate for this patient?
It will cause decreased effects of prednisone When prednisone is given with theophylline, the anticipated effect is a reduction in the effects of prednisone. Therefore a higher dosage might be warranted. The patient would need to monitor for worsening of asthmatic symptoms.
Analphylactic interventions
Airway Call RRT Trendelenburg consider First line is epinephrine Administer fluids Stay and monitor (biphasic anaphylaxis) Teach
Type 4 hypersensitivity
T-cell mediated
Type 2 hypersensitivity reaction
Transfusion reactions Hemolytic anemia
Type 3 hypersensitivity reaction
SLE Rheumatoid arthritis Glomerulonephritis
Which of the following information should be included when providing an education about the healing process involved with myocardial infarctions? Select all that apply
-the heart muscle is a nondividing tissue -WBC's trigger new blood vessel growth - scar tissue prevents the formation of a hole in the muscle wall as ischemic cells die
After learning that Ms. Hope has tuberculosis (TB), her family member with HIV has a tuberculin skin test performed with a positive reaction of 7 mm. Which dosage of isoniazid (INH) would the nurse anticipate in administering?
300 mg daily A prophylactic dosage of INH 300 mg daily is appropriate for Ms. Hope's family member who has HIV and a positive skin test.
Which patient cannot safely receive therapy with fludrocortisone?
A 40-year-old patient with pulmonary aspergillosis Patients with a systemic fungal infection like pulmonary aspergillosis and those with a hypersensitivity to the drug should not receive fludrocortisone
rheumatoid arthritis
A chronic systemic disease characterized by inflammation of the joints, stiffness, pain, and swelling that results in crippling deformities
What are the functions of the antibody immunoglobulin (Ig) G? Select all that apply.
Activates classic complement pathway; Provides protection against invading microorganisms; Is expressed on second and subsequent exposures to antigens
The nurse correctly understands that which action is a possible mode of human immunodeficiency virus (HIV) transmission?
Breastfeeding HIV may be transmitted during breastfeeding. This is considered one type of mother-to-child or perinatal transmission of HIV. During pregnancy HIV may be transmitted from mother to infant during pregnancy. This is considered one type of mother-to-child or perinatal transmission of HIV. Passage through the birth canal HIV is transmitted via blood or reproductive fluids. HIV may be transmitted during delivery. This is considered one type of mother-to-child or perinatal transmission of HIV.
Which area of the body is responsible for central production of B-cell and T-cell maturation?
Central areas of B-cell and T-cell maturation are the thymus and the bone marrow. The spleen, tonsils, and Pever patches in the ileum are peripheral locations where this process occurs.
A patient has been taking isoniazid (INH) for 3 months. Which test would the nurse anticipate will be ordered for this patient to determine effectiveness of therapy?
Chest x-ray A repeat chest x-ray should be obtained approximately 3 months after starting INH.
Zidovudine
Does not cure HIV or AIDS, but may slow the progress of the disease and prolong life
The nurse is preparing to discuss long-term care of a child with advanced human immunodeficiency virus (HIV) disease. The patient's mother is also HIV positive and concerned about her child's future. Which topics should the nurse anticipate discussing with the mother?
Education Although children with HIV infection are protected from educational discrimination by federal law, parents of children who are HIV positive often have questions. Therefore the nurse should anticipate discussing future education with the patient's mother. Quality of life Quality of life is an important topic to discuss when planning future care of a child who is HIV positive, especially if the child's disease is advanced. The nurse should anticipate discussing quality of life with the patient's mother. Continuing care Continuing care is frequently discussed when planning long-term care for a child with HIV, especially if the child's HIV disease is advanced. The nurse should anticipate discussing continuing care with the patient's mother. Guardianship/placement Planning for a child with HIV often includes discussion of potential standby guardianship, kinship care, or foster and adoptive placement because of the multigenerational nature of the disease. The nurse should anticipate discussing guardianship with the patient's mother because both the patient and the mother are HIV positive.
Analphylaxis medications
Epinephrine Diphenhydramine Dexamethasone Albuterol Famotidine
Which clinical finding would the nurse anticipate when assessing an adolescent with newly diagnosed acute lymphoblastic leukemia (ALL)? Select all that apply.
Fatigue, multiple bruises, joint pain, weight loss Fatigue is the result of anemia associated with leukemia. Multiple bruises are the result of thrombocytopenia associated with leukemia. Joint pain is a common presenting sign of leukemia. The client of this age that has leukemia may initially experience sudden weight loss, which causes them to seek medical care, leading to diagnosis. Nausea, vomiting, and diarrhea are not associated with a diagnosis of ALL. Jaundice usually indicates liver damage or excessive hemolysis and is not an early sign of leukemia. Edema is not a manifestation of the disease because the pathophysiology does not involve the transport of fluids
The nurse is making rounds with the healthcare provider to discuss whether the client has Hodgkin or non-Hodgkin lymphoma
Look at potential orders Anticipated orders include biopsy, complete blood count, computed tomography (CT) scan, and serum lactate dehydrogenase. A biopsy is needed to confirm a diagnosis because Hodgkin and non-Hodgkin lymphoma cannot be diagnosed from just physical findings. A complete blood count is needed to provide a baseline level for lymphocytes, erythrocytes, and platelets. A CT scan will help determine location of enlarged lymph nodes and staging of the disease. Lactate dehydrogenase levels can estimate tumor growth and help determine prognosis. Not indicated orders include shingles vaccine and troponin level. Even though the client is at the right age and has had chicken pox, making him prone to shingles, with his disease, live virus vaccines are contraindicated. The weakened immune system may not be able to effectively combat an immune response against the live virus vaccine. Troponin level is recommended to confirm a diagnosis for a myocardial infarction, not for Hodgkin or non-Hodgkin lymphoma.
The nurse obtains a health history from a client who is admitted with the diagnosis of acute lymphocytic leukemia (ALL). Which problem would the nurse expect the client to report? Select all that apply
Loss of appetite, paleness of the skin, purplish spots on the skin, night sweats, weight loss Anorexia, a presenting symptom of ALL, may be the result of enlarged lymph nodes, areas of inflammation in the intestinal tract, and catabolism. Pallor is another presenting sign of ALL; the number of red blood cells (RBCs) is decreased because of bone marrow depression. Decreased platelet production results in bleeding tendencies; petechiae often are a presenting sign of ALL. Night sweats are caused by the increased body metabolism that is necessary for the body to act against the cancer. Additionally, cancer cell reproduction uses up the body's energy before it can be used to store fat, leading to rapid weight loss. Sores in the mouth are not a presenting sign of ALL but often result from chemotherapy. Because of bone marrow depression there is a reduced number of RBCs and less oxygen being carried to body cells causing the client to be lethargic and sleep excessively.
Which inflammatory condition is caused by an infection? Select all that apply. One, some, or all responses may be correct.
Meningitis, Pneumonia
The nurse is obtaining a health history from the parents of a toddler who has been receiving chemotherapeutic treatment of acute lymphocytic leukemia (ALL). Which physiologic change would the nurse associate with the treatment? Select all that apply.
Pale skin, loss of hair, vomiting, mucositis Cytotoxic chemotherapy affects each of the aspects of blood production. It reduces the number of red blood cells causing anemia, which is demonstrated by pallor. Alopecia, or hair loss, is a common side effect of chemotherapy, along with nausea and vomiting. Mucous membranes are prone to the development of open sores, known as mucositis. Night sweats are associated with an increased metabolism that is necessary for the body to act against the leukemia but is not associated with chemotherapeutic treatment. Swollen lymph nodes in ALL are caused by accumulation of abnormal cancer white cells within the lymph system, not chemotherapy. Other common signs of ALL, that are not known side effects of chemotherapeutic treatment, include bone pain and an enlarged liver and spleen
The nurse would anticipate administering pyridoxine to decrease which common side effect of isoniazid (INH)?
Peripheral neuropathy Pyridoxine (vitamin B6) is administered concomitantly with INH to reduce the severity of peripheral neuropathy caused by INH.
Type 4 hypersensitivity reaction
Transplant rejection Steven Johnson Syndrome TB PPD test
A 22-month-old infant comes to the clinic, and the mother requests a human immunodeficiency virus (HIV) test. Which test would help to rule out infection in this child?
Two negative HIV antibody measurements from separate specimens HIV antibody measurements are appropriate to use for a child over the age of 18 months; two negative antibody measurements from separate specimens will rule out an infection.
The nurse is caring for a newborn with perinatally acquired human immunodeficiency virus (HIV). The infant is free of symptoms, and laboratory reports indicate normal immune function. What antiretroviral medication orders should the nurse anticipate finding in the patient's chart?
Two nucleoside analog reverse-transcriptase inhibitors (NTRIs) plus lopinavir or ritonavir Two NTRIs plus lopinavir or ritonavir is the preferred drug combination for neonates born at 42 weeks gestation and from age 14 days to younger than 3 years. Because of a more rapid disease progression in children than in adults and the fact that laboratory studies are less precise in predicting disease progression, children are treated aggressively for HIV infection regardless of virological status.
Type 1 hypersensitivity reaction
anaphylactic shock . Examples: bee sting, hay fever, asthma, food allergies.
What is the function of a monocyte during inflammation?
destruction of bacteria and cellular debris During inflammation, monocytes destroy bacteria and cellular debris. Basophils releases histamine and heparin in areas of tissue damage. The function of neutrophils is nonspecific ingestion and phagocytosis of microorganisms. The function of macrophages is nonspecific recognition of foreign proteins and microorganisms.