Mastery quiz questions Ch.3 Patho (Nursing)

A nurse educator is describing the way that cells involved in this inflammatory response find their way to the site of injury. Which description best reflects this physiologic mechanism? a) "Tissues have an abundance of inflammatory cells that are constantly migrating and just waiting for tissue injury." b) "The process of chemotaxis is the process where cells wander through the tissue guided by secreted chemoattractants." c) "Phagocytosis is the dynamic and energy-directed process where cells migrate, directed by chemoattractants." d) "The process of margination ensure that cells will follow the cytokine gradient."

"The process of chemotaxis is the process where cells wander through the tissue guided by secreted chemoattractants."

A pregnant client comes to the clinic with symptoms of body aches, headache, and fatigue. A physical assessment reveals enlarged lymph nodes. A diagnosis of toxoplasmosis with chronic inflammation caused by a parasitic organism is determined. Which assessment findings would most likely also be present? Select all that apply.

-Cysts due to granuloma formation -Increase in eosinophil count

Place the 4 successive stages of fever in correct order

1. prodromal 2. chill 3. flush 4. defervescence

A client has experienced an acute inflammatory response with an elevation of white blood cells. The nurse is reviewing the client's most recent lab results to determine if the counts have returned to a normal range. Select the result that suggests the client is now within normal range.

4000 to 10,000 cells/μL -A normal value of white blood cells would be 4000 to 10,000 cells/μL. In acute inflammatory conditions, the white blood cell count commonly increases from 15,000 to 20,000 cells/μL. The other results are abnormal.

A nurse is providing care for several clients on a neurological unit of a hospital. With which of the following clients would the nurse be justified in predicting a problem with thermoregulation?

A 66 year old male with damage to his thalamus secondary to a cerebral vascular accident. -The thalamus is involved in the sensation and regulation of body temperature. Syphilis, a T8 fracture and damage to the cerebellum would be unlikely to manifest by difficulties with thermoregulation

Which symptom indicates the next stage of a fever after a prodrome?

A chill

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

A severe bacterial infection -Fever and painful, palpable lymph nodes are nonspecific inflammatory conditions; leukocytosis is also common but is a particular hallmark of bacterial infection. Neutrophilia also indicates a bacterial infection, whereas increased levels of other leukocytes would indicate other etiologies. The shift to the left--the presence of many immature neutrophils--indicates that the infection is severe, because the demand for neutrophils exceeds the supply of mature cells.

A client presents with an oral temperature of 38.7°C and painful, swollen cervical lymph nodes. Laboratory results indicate neutrophilia with a shift to the left. Which diagnosis is most likely? a) A severe bacterial infection b) A localized fungal infection c) A mild parasitic infection d) A mild viral infection

A severe bacterial infection Fever and painful, palpable lymph nodes are nonspecific inflammatory conditions; -leukocytosis is also common but is a particular hallmark of bacterial infection. -Neutrophilia also indicates a bacterial infection, -whereas increased levels of other leukocytes would indicate other etiologies. -The shift to the left---the presence of many immature neutrophils---indicates that the infection is severe, because the demand for neutrophils exceeds the supply of mature cells.

An 88 year old resident of a long term care home has been suffering from a three day onset of increasing shortness of breath and decreased oxygen saturation. At the hospital, an anterior-posterior chest X-ray and sputum culture and sensitivity has confirmed a diagnosis of bacterial pneumonia, yet the client's tympanic temperature has not exceeded 37.3°C (99.2°F). The health care team would recognize that which of the following phenomena likely underlies this situation? a) An older adult is often insensitive to exogenous pyrogens. b) An older adult is sometimes incapable of vasodilation. c) An older adult's hypothalamus has diminished thermoregulatory ability. d) Infections manifest by cognitive changes in older adults

An older adult's hypothalamus has diminished thermoregulatory ability. The hypothalamus in older adults is often less capable of thermoregulation than in younger clients. -There are sometimes alterations in the release of endogenous pyrogens and deficits in vasoconstriction. -While infections do often manifest with cognitive changes in older adults, this does not explain why fever is precluded.

Which of the following can the nurse tell a patient about antipyretic drugs during fever?

Antipyretics help protect the body -Antipyretic drugs are given to alleviate the discomfort of fever and protect vulnerable organs, such as the brain from extreme elevations in body temperature. They are usually effective

Fever in infants and young children is not an uncommon event. Many trips to the pediatrician's office occur because of fever in children ages 1 day to 3 years. Which sign or symptom does not indicate fever in an infant?

Avid feeding

A patient with a rising temperature is pale and has begun to shiver. The nurse reports that the patient is in which of the following phases of fever development?

Chill -During the second phase or chill phase of fever development, the patient's skin is pale; there is an onset of shivering, a rising temperature, and the sensation of being chilled. Therefore, the nurse should report that the patient is in the second or chill phase of fever development.

The loss of heat from the body through the circulation of air currents is known as which of the following?

Convection -Convection refers to heat transfer through the circulation of air currents, while radiation is the transfer of heat through air or a vacuum. Conduction is the direct transfer of heat from one molecule to another, and evaporation involves the use of body heat to convert water on the skin to water vapor.

The nurse is assessing a client for acute inflammation of a wound. For which of these symptoms of infection does the nurse assess?

Edema

A nurse who is providing a staff development in-service determines that the participants understand the information when they state that which of the following aids heat conservation by reducing surface area for heat loss?

Erection of pilomotor muscles -The nurse determines that the participants understand the information when they identify that erection of pilomotor muscles aids heat conservation by reducing surface area for heat loss.

The nurse is reviewing assessment documentation of a client's wound and notes "purulent drainage." The nurse would interpret this as

Exudate containing white blood cells, protein, and tissue debris -A purulent or suppurative exudate contains pus, which is composed of degraded white blood cells, proteins, and tissue debris. Fibrinous exudates contain large amounts of fibrinogen. Serous exudates are watery fluids low in protein. Hemorrhagic exudates occur when there is severe tissue injury that causes damage to blood vessels or when there is significant leakage of red cells

A nurse is providing care for a 44-year-old male client who is admitted with a diagnosis of fever of unknown origin (FUO). Which characteristic of the client's history is most likely to have a bearing on his current diagnosis? a) Cachexic and Asian b) HIV positive and homeless c) Receiving intravenous normal saline with 20 mEq KCl d) Malnourished, hypomagnesemic, and hypocalcemic

HIV positive and homeless FUO is associated with HIV. The other aspects of the client's circumstances are not noted to correlate with FUO.

What is the most common cause of drug fever?

Hypersensitivity reaction to medication -The most common cause of drug fever is a hypersensitivity reaction. Drug fever can also be caused by the antithyroid medication propylthiouracil (PTU), atropine and anticholinergic medications, antipsychotic agents, tricyclic antidepressants, cocaine, and amphetamines. The agitation, hyperthermia, and hyperactivity of serotonin syndrome occur with overdose of serotonin reuptake inhibitors

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

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

A nurse notes that a patient with a fever has begun to shiver. The nurse should assess for which of the following events?

Increased temperature

In which of the following patients with a transecting spinal cord injury should the nurse anticipate an impaired ability for temperature regulation?

Injury at T2

A client has been diagnosed with osteomyelitis and admitted to the hospital. The client's fever persists throughout most of the day but returns to normal at least twice a day. Which pattern of fever is this client displaying

Intermittent Intermittent fever patterns are very changeable, but they do return to normal at least once every 24 hours. -A remitting fever pattern temperature does not return to normal and varies a few degrees in either direction. - In a sustained fever pattern, the temperature remains above normal with minimal variations. -A relapsing fever is one in which there is one or more episodes of fever, each as long as several days, with 1 or more days of normal temperature between episodes.

A normal response to fever is an elevated heart rate. A client with a fever who is not exhibiting an elevated heart rate would indicate to the nurse that the cause of the fever might be which of the following?

Legionnaires disease -The observation that a rise in temperature is not accompanied by the anticipated change in heart rate can provide useful information about the cause of the fever. For example, a heart rate that is slower than would be anticipated can occur with Legionnaire disease and drug fever, and a heart rate that is more rapid than anticipated can be symptomatic of hyperthyroidism and pulmonary emboli

The nurse evaluating the bloodwork results of a client with an infected leg ulcer. The white blood cell count is 18,000 cells/uL. The nures inteprets this as:

Leukocytosis -A white blood cell count of 18,000 cells/uL is indicative of an elevated white blood cell count or leukocytosis (normal range is 4000-10,000 cells/uL). This would be an expected finding in a client with an infected leg ulcer. An increase in lymphocityes is lymphacytosis and neutropenia is a decrease in nuetriphils. Lymphadenitis is an inflammation in the lymph nodes.

The cardinal signs of inflammation include swelling, pain, redness, and heat. What is the fifth cardinal sign of inflammation?

Loss of function -These signs are rubor (redness), tumor (swelling), calor (heat), and dolor (pain). In the second century ad, the Greek physician Galen added a fifth cardinal sign, functio laesa (loss of function). Altered level of consciousness is not a cardinal sign of inflammation. Sepsis (Systemic inflammatory response syndrome) and fever are systemic signs of infection.

A patient has a fever that was induced by damage to the hypothalamus due to intercranial bleeding. The nurse plans care for the patient with which of the following types of fever?

Neurogenic

A patient has a fever that was induced by damage to the hypothalamus due to intercranial bleeding. The nurse plans care for the patient with which of the following types of fever?

Neurogenic -Neurogenic fever has its origin in the central nervous system and is usually caused by damage to the hypothalamus from trauma, intercranial bleeding, or increased intercranial pressure. The nurse should plan care for a patient with a neurogenic fever.

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

Neutrophils -Increased neutrophils are associated with inflammation in general and bacterial infections in particular. Platelets play a role in inflammation but their levels would not rise to the same extent as would neutrophils. Eosinophils are not strongly associated with bacterial infection and basophils would not increase to the same degree as neutrophils

A two-day postoperative patient's temperature was 98.5°F at 3:00 pm. At 6:00 pm, the unlicensed assistant notifies the nurse that the patient's temperature is 102.0°F. Which of the following actions should the nurse take?

Notify the physician -The nurse should contact the physician, as the increase in the patient's temperature is outside of the normal range and/or the normal diurnal variation in temperature

A client is said to be in the chill stage of the fever process when the nurse does which of the following?

Observes piloerection on the skin

An older adult client with a history of chronic obstructive pulmonary disease (COPD) develops a fever of 38.3ºC (101ºF). What is the primary reason for the nurse to implement temperature-lowering measures?

Reduce oxygen demand

Which of the following patients is most likely to have impairments to the wound healing process? A patient with:

Poorly controlled blood sugars with small blood vessel disease. -Diabetes mellitus is strongly associated with impaired wound healing. The other noted pathologies are less causative of deficiencies in the healing process.

A health educator is teaching a group of colleagues about the physiology of thermoregulation. Which of the following statements is most accurate?

Prostaglandin E2 (PGE2) exerts a direct fever-producing effect on the hypothalamus.

The route considered the most accurate to measure a core body temperature is which of the following?

Rectal

The nurse needs to assess a 1-year-old child for fever. Which approach will produce the most accurate reading?

Rectal -Measurement of core body temperature is important when evaluating fever. The rectal route is considered the most accurate. In adults and older children, the oral route is lower, but still accurate; however, in young children the oral route may be unreliable. Forehead thermometers can predict trends, but are not as accurate as other routes. The axillary route requires up to 10 minutes for the temperature to register appropriately.

A client in the acute stage of inflammation will experience vasodilation of the arterioles and congestion in the capillary beds. The nurse would assess the client's skin for:

Redness -Vasodilation of the arterioles and congestion of the capillary beds result in an increased pooling of blood leading to redness. The site would also have increased painful sensation and be warmer to touch. It would not result in an increase in bacterial load.

A nurse is assessing a client for the classic signs of acute inflammation. The nurse would assess the client for:

Rubor, swelling, and pain -The classic signs of inflammation are rubor (redness), tumor (swelling), calor (heat), and dolor (pain). The remaining options are more characteristic of symptomatology resulting from circulatory dysfunction

A client has a watery fluid leaking from a site of inflammation. The nurse would document this type of exudate as:

Serous -Serous exudate is a watery fluid low in protein content that results from plasma entering the inflammatory site. Hemorrhagic exudate is red or blood tinged related to damage to blood vessels. Suppurative exudate is composed of degraded white blood cells and tissue debris, leaving the fluid pus-like. Fibrinous exudate is thick and sticky meshwork fluid.

While sponging a client who has a high temperature, the nurse observes the client begins to shiver. At this point, the priority nursing intervention would be to:

Stop sponging the client and retake a set of vital signs -Modification of the environment ensures that the environmental temperature facilitates heat transfer away from the body. Sponge baths with cool water or an alcohol solution can be used to increase evaporative heat losses. More profound cooling can be accomplished through the use of a cooling blanket or mattress, which facilitates the conduction of heat from the body into the coolant solution that circulates through the mattress. Care must be taken so that cooling methods do not produce vasoconstriction and shivering that decrease heat loss and increase heat production.

A client with pneumonia is admitted with these vital signs: temperature 99.7ºF, pulse 80 beats/min, respirations 18/minute, and BP 120/80 mmHg. Which set of vital signs does the nurse anticipate when the client begins to shiver and requests another blanket several hours later?

T 100.9ºF, P 90/min, R 20/min, BP 126/80 mmHg During the chill phase of fever, the client feels cold and may experience pale skin with goosebumps, but the temperature is rising. When the body reaches the new set point, shivering will stop, and flushing will begin.

A patient is experiencing anorexia, myalgia, arthralgia, headache, and fatigue. The nurse should assess for which of the following? a) Respirations b) Hypothermia c) Urinary output d) Temperature

Temperature Common clinical manifestations of fever include anorexia, myalgia, arthralgia, headaches, and fatigue; thus, the nurse should assess the patient's temperature.

Which client manifestation indicates signs of drug fever? a) Temperature reaches 40°C (104°F) every afternoon, pulse 76 beats/minute, pruritis b) Temperature reaches 38°C (100.4°F) for 3 days, pulse 106 beats/minute, purulent drainage c) Temperature reaches 39°C (102.2°F) following aerobic activity, pulse 125 beats/minute, sweating d) Temperature reaches 41°C (105.8°F) after a sauna, pulse 76 beats/minute, skin hot and dry

Temperature reaches 40°C (104°F) every afternoon, pulse 76 beats/minute, pruritis Clients with drug fever often show signs of hypersensitivity such as joint pain, itching, rashes, muscle pains, and gastrointestinal distress. The fever has a diurnal pattern with the highest point in the afternoon or early evening. The clients in the other options are exhibiting signs of infection, heat exhaustion, and heatstroke.

A 33-year-old client is brought into the emergency room with a core temperature of 39°C (102.2°F). The client is red in the face, chest, and back due to significant cutaneous vasodilation. The client is likely in which stage of fever?

Third

A client who has developed a fever is now complaining of a headache. The nurse would recognize this manifestation as a result from the:

Vasodilatation of cerebral vessels -Headache is a common accompaniment of fever and is thought to result from the vasodilatation of cerebral vessels occurring with fever. The coronary arteries would not contribute/cause the headache.

A client cuts herself with a sharp knife while cooking dinner. The client describes how the wound started bleeding and had a red appearance almost immediately. The nurse knows that in the vascular stage of acute inflammation, the vessels:

Vasodilate causing the area to become congested causing the red color and warmth -Vasodilation allows more blood and fluid into the area of injury, resulting in congestion, redness, and warmth. Vasodilation is quickly followed by increased permeability of the microvasculature. The loss of fluid results in an increased concentration of blood constituents (red blood cells, leukocytes, platelets, and clotting factors), stagnation of flow, and clotting of blood at the site of injury. This aids in limiting the spread of infectious microorganisms. The loss of plasma proteins increases fluid movement from the vascular compartment into the tissue space and producing the swelling, pain, and impaired function that are the cardinal signs of acute inflammation.

Inflammation can be either local or systemic. What are the most prominent systemic manifestations of inflammation?

fever, leukocytosis or leukopenia, and the acute phase response

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

histamine

When explaining the final stages of the inflammatory response to pathogens, the nurse will educate the patient about:

how the body can kill the pathogen by generating toxic oxygen and nitrogen products producing such things as nitric oxide and hydrogen peroxide.

A client is experiencing the early stages of an inflammatory process and develops leukocytosis. The nurse recognizes this as an:

ncrease in circulating neutrophils

A nurse caring for an older adult who has been diagnosed with a UTI checks the patient's temp on admission and finds that it is 96.6. Which of the following describes how the nurse should interpret the finding?

the patient may be exhibiting a blunted or absent febrile response

Which clients are showing manifestations of infection? Select all that apply

• A 75-year-old, temperature 37.3°C (99.2°F), declining mental status, weakness and fatigue • A 25-year-old, temperature 40°C (104°F), sweating, shivering, states generalized pain • A 2-month-old, temperature 38.3°C (100.4°F), lethargy, poor feeding, and cyanosis -An older adult with an infection may have a minimal rise in temperature, but exhibit changes in mental status, weakness, fatigue, and weight loss. An infant younger than three months may have a relatively mild fever, but a serious infection. An adult with a high fever will exhibit sweating and chills. Aches and pains may occur with shivering and the infectious illness. A client with a temperature within the normal range, exhibiting no other signs of change, is not considered to have an infection.

A nurse assessing an older adult for signs and symptoms of infection in the absence of a fever should assess for which of the following? Select all that apply.

• Fatigue • Decreased mental status • Change in fuctional capacity -Signs and symptoms of infection in an older adult in the absence of a fever include decreases in mental status and functional capacity, fatigue, weight loss, and weakness

Which of the following patients are at increased risk for hyperthermia? Select all that apply.

• Quadriplegic attending an outdoor summer event • Patient with heart disease in an nonairconditioned vehicle • Patient with schizophrenia taking haloperidol -Thermoregulation that is controlled by the hypothalamus is impaired in patients with spinal cord injuries higher than T6 because they are not able to receive signals to vasodilate or sweat below the level of injury. Circulation of blood to the body surface helps to cool the body. Individuals with heart disease have reduced capacity to dissipate heat. Medications that predispose clients to hyperthermia include diuretics, neuroleptics, and anticholinergics.