Patho Exam 2

A client calls the health care provider's office and frantically tells the nurse his TB test is red, and he is afraid this means he has tuberculosis. The best response by the nurse would be: "A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques." "This result definitely confirms the diagnosis; we will begin treatment now." "Wait until tomorrow to see if things change." "Have you eaten anything unusual to cause this reaction?"

"A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques." A definitive diagnosis of active pulmonary tuberculosis requires identification of the organism from cultures or DNA amplification techniques. Culture remains the gold standard for laboratory confirmation of infection and is required for drug sensitivity testing. The local reaction is not influenced by food consumption.

An adult client with a history of worsening respiratory symptoms has presented for care. Which assessment question will best allow the clinician to address the possibility of chronic bronchitis? "Do you have a family history of lung disease?" "Have you ever been immunized against pneumococcal pneumonia?" "Do you tend to have a cough even when you don't feel sick?" "Do you know if you had respiratory syncytial virus as a child?"

"Do you tend to have a cough even when you don't feel sick?" A clinical diagnosis of chronic bronchitis requires the history of a chronic productive cough for at least 3 consecutive months over 2 consecutive years. This is not noted to be a strong genetic component of the disease, and childhood RSV is not a risk factor. Immunization status is normally linked to the development of bronchitis.

A client with pulmonary arterial hypertension asks the health care provider, "Why are you giving me sildenafil? It is my lungs that are my problem, not erectile dysfunction." Which statement by the health care provider is the most appropriate response? "Sildenafil causes vasodilation, which will help treat the high pressure in your lung vessels." "People with pulmonary arterial hypertension also have similar problems in their penile vessels." "Sildenafil is a misrepresented drug and can be given for many other conditions that have constriction problems." "Since pulmonary arterial hypertension causes such fatigue, you will still be able to enjoy an intimate relationship with your spouse."

"Sildenafil causes vasodilation, which will help treat the high pressure in your lung vessels." Sildenafil acts in a manner similar to nitric oxide to produce vasodilation, and is another treatment for pulmonary arterial hypertension. It is not being prescribed for erectile dysfunction in this population of clients. Health care providers should not assume a client is experiencing erectile dysfunction, unless the client has verbalized this directly to them.

A client diagnosis with tuberculosis asks the nurse how long the antitubercular medication will need to be taken. What is the best response? "Drug therapy will continue until all symptoms of tuberculosis have stopped." "Drug therapy will continue unless a drug resistance develops." "You can expect to take multiple drugs possibly for as long as 24 months or until all tubercle bacilli are eliminated." "You will be on multiple drug therapy for the rest of your life."

"You can expect to take multiple drugs possibly for as long as 24 months or until all tubercle bacilli are eliminated." The goal of treatment is to eliminate all tubercle bacilli from an infected person while avoiding emergence of significant drug resistance. Treatment of active tuberculosis requires the use of multiple drugs. Tuberculosis is an unusual disease in that drug therapy is required for a relatively long period.

Oxygen has been prescribed for a client with chronic obstructive pulmonary disease (COPD). Which amount of oxygen is considered most appropriate for the COPD client? 1 to 2 L/min 4 to 6 L/min 10 L/min 5 L/min

1 to 2 L/min The goal of oxygen delivery for a client with COPD is to keep the PO2 at about 60 mm Hg or less, which can be accomplished with delivery of 1 to 2 L/min of oxygen (this will result in a PO2 at 55 to 65 mm Hg). All the other options would increase the PO2 above 60 mm Hg, which tends to depress the hypoxic stimulus for ventilation and often leads to hypoventilation and carbon dioxide retention.

A 10-year-old child with strep throat asks the nurse, "why there are large bumps [lymph nodes] on my neck when my throat gets sore?" The nurse replies lymph nodes A) help your body fight off infections by allowing special cells (lymphocytes and macrophages) move through the lymph chain and engulf and destroy germs. B) bring in cells into the lymph node (your bump) to stop the germs from going anywhere else in the body. C) bring all kind of good cells to your throat so that they can wall the strep off andkeep the germs from getting any food or water." D) help your tonsils get bigger with cells that will bring immune cells into your throat to prevent any other infections.

A

A 2-year-old girl has had repeated ear and upper respiratory infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiological origin of the child's recurrent infections? A) The child's immune system is unable to synthesize adequate immunoglobulin on its own. B) The child had a congenital absence of IgG antibodies that her body is only slowly beginning to produce independently. C) The child was born with IgA and IgM antibodies, suggesting intrauterine infection. D) The child lacks the antigen-presenting cells integral to normal B-cell antibody production.

A

A 67-year-old patient diagnosed with myasthenia gravis will likely display which clinical manifestations as a result of autoantibodies ultimately blocking the action of acetylcholine, resulting in destruction of the receptors? A) Weakness of the eye muscles; difficulty in swallowing and slurred speech; impaired gait B) Tremor of hands/arms; rigidity of the arms; shuffling gait C) Short-term memory lapses; problems with orientation; a lack of drive or initiative D) Facial droop; slurred speech; weakness on one side of the body

A

A nurse is providing care for a client who is immunocompromised following chemotherapy. The nurse knows which of the following characterizations of the adaptive immune system listed below is responsible for the client's disruption in his normal immune function? A) Epitopes on antigens are recognized by immunoglobulin receptors following presentation by accessory cells. B) Haptens combine to form epitopes that stimulate the response of regulatory and effector cells. C) Effector cells orchestrate the immune response of regulatory cells toward an antigen. D) Accessory cells such as macrophages are engulfed by regulatory cells, stimulating effector cells.

A

After several months on a waiting list, a 44-year-old male received a liver transplant 5 days ago. In the last 36 hours, he has developed a rash beginning on his palms and soles, along with abdominal pain and nausea. It has been determined by his care team that the immune response that is causing his symptoms originates not with his own compromised immune components but with those introduced with his new organ. This man's most likely medical diagnosis is A) graft versus host disease (GVHD). B) acute transplant rejection. C) hyperacute organ rejection. D) T-cell-mediated graft rejection

A

The nurse knows high incidences of infectious illnesses among the older adults who reside in a long-term care facility are most likely to have diminished immune capacity because of A) decreased numbers and responsiveness of T lymphocytes. B) decreased antigen recognition by B lymphocytes. C) over-expression of cytokines and receptors. D) altered function in peripheral lymphocytes.

A

The nurse knows which of the following statements listed below is accurate regarding the functions and nature of cytokines relative to a variety of pathologies? A) "A particular cytokine can have varied effects on different systems, a fact that limits their therapeutic use." B) "Cytokine production is constant over time, but effects are noted when serum levels cross a particular threshold." C) "Most cytokines are produced by granular leukocytes, and different cells are capable of producing the same cytokine." D) "Cytokine actions are self-limiting, in that activation of one precludes activation of other cytokines with similar actions."

A

Which of the following individual situations listed below best exemplifies the processes of innate immunity? A) A child who has experienced heat and swelling of his skinned knuckle B) An adult who complains of itching and is sneezing because he is allergic to pollen C) A client whose blood work indicates increased antibody titers during an acute illness D) A client who has experienced rejection of a donor liver after transplantation

A

group of nurses about autoimmune diseases. Which of the following statements by an attendee would the educator most likely want to follow up with further teaching? A) "Introduction of a foreign antigen can sometimes induce a cascade of immune response that is not self-limiting" B) "Often the problem can be traced to antigens that sensitize T cells without the need for presentation." C) "In some cases, the body attacks its own cells that are chemically similar to those of infectious organisms." D) "Sometimes when the body's own cells are released after a long time, they are interpreted as being foreign."

A

The nurse is caring for four clients. Select the client at risk for the development of a pulmonary embolism. A 36-year-old female smoker with an intrauterine device (IUD) An 80-year-old female client with diabetes A 32-year-old male with viral pneumonia A 62-year-old male who is postoperative for repair of a fractured femur

A 62-year-old male who is postoperative for repair of a fractured femur A client with surgery to the lower extremities is at higher risk for the development of deep vein thrombosis that could lead to a pulmonary embolism. There is increased risk for pulmonary embolism among users of oral contraceptives, particularly in women who smoke, but not with the use of IUD.

The nurse is assigned to care for four clients on a medical floor. Which client is most at risk for viral pneumonia after influenza? A 76-year-old client with cardiopulmonary disease A 42-year-old client with syncope A 36-year-old client with a bowel obstruction A 24-year-old client involved in a motor vehicle accident with a concussion

A 76-year-old client with cardiopulmonary disease Viral pneumonia occurs as a complication of influenza most frequently in older adults or in people with cardiopulmonary disease. It typically develops within one day after onset of influenza and is characterized by rapid progression of fever, tachypnea, tachycardia, and hypotension.

A newly diagnosed HIV-positive adolescent has blood work drawn, which includes a CD8 T-cell count. The nurse knows which of the following functions of CD8 T cells listed below will assist the adolescent's immune system in fighting off the viral attack? Select all that apply. A) Release destructive enzymes B) Trigger intracellular programmed death C) Cause allergens to surround the virus D) Boost antigen-antibody response E) Remove foreign material from lymph before it enters the blood

A B

A patient diagnosed with a primary immunodeficiency disorder has asked his siblings to be tested as possible stem cell donors. When discussing this procedure with his family, the nurse emphasizes that stem cells can be harvested from: Select all that apply. A) bone marrow. B) peripheral blood. C) skin tissue harvesting. D) mouth swabs. E) tears.

A B

A client tells the nurse that he is concerned he may be developing chronic bronchitis and asks how the diagnosis is made. The most appropriate information for the nurse to provide would be: A diagnosis of chronic bronchitis requires a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years. A diagnosis of chronic bronchitis requires a history of a respiratory infection that occurs every 3 consecutive months in at least 2 consecutive years. A diagnosis of chronic bronchitis requires a chest x-ray that shows a tubercle bacillus that has been present for at least 2 consecutive years. A diagnosis of chronic bronchitis requires you to have been hospitalized at least one time in at least 2 consecutive years with shortness of breath.

A diagnosis of chronic bronchitis requires a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years. A clinical diagnosis of chronic bronchitis requires a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years. Typically, the cough has been present for many years, with a gradual increase in acute exacerbations that produce frankly purulent sputum. The other options do not meet the criteria.

Acute-onset bronchial asthma causes wheezing and breathlessness as a result of which of the following? Airway inflammation Alveolar collapse Compression atelectasis Pulmonary hypertension

Airway inflammation Bronchial asthma represents a reversible form of obstructive airway disease caused by narrowing of airways due to bronchospasms, inflammation, and increased airway secretions; this inflammatory process produces recurrent episodes of airway obstruction, characterized by wheezing, breathlessness, chest tightness, and cough. Vascular flow through the lungs is unaffected by the airway inflammation and bronchospasms. Hyperinflated alveoli are characteristic of the emphysema type of obstructive pulmonary disease. Compression atelectasis is associated with high external pressure that blocks lung expansion.

When CO2 levels in the blood rise, a state of hypercapnia occurs in the body. What factors contribute to hypercapnia? Select all that apply. Alteration in carbon dioxide production Abnormalities in respiratory function Disturbance in gas exchange function Decrease in carbon dioxide production Changes in neural control of respiration

Alteration in carbon dioxide production Abnormalities in respiratory function Disturbance in gas exchange function Changes in neural control of respiration Hypercapnia refers to an increase in carbon dioxide levels. In the clinical setting, four factors contribute to hypercapnia: alterations in carbon dioxide production, disturbance in the gas exchange function of the lungs, abnormalities in respiratory function of the chest wall and respiratory muscles, and changes in neural control of respiration. A decrease in carbon dioxide production does not cause hypercapnia.

The nurse is providing instructions to a client for the treatment of a common cold. The most appropriate information would be: Antipyretic medications and rest Antibiotics and antihistamines Complete isolation and bed rest Antibiotics administered for 7 days

Antipyretic medications and rest The common cold virus does not respond to antibiotics and should be treated with antipyretic medications and rest. Bed rest is recommended, but complete isolation is not required.

The nurse in the emergency department is assessing a toddler suspected of epiglottitis. Which intervention is considered the priority when working with this client? Examine the throat by inserting a tongue blade to see the tonsils. Have the parents lie the toddler on the back to allow for stethoscope examination of all lobes of the lungs. Get a coworker to help restrain the toddler so blood samples can be obtained. Assess if airway is compromised and call for health care provider assistance with intubation to establish an airway, if needed. Place the toddler in respiratory isolation due to the possibility of spreading the virus to surrounding clients.

Assess if airway is compromised and call for health care provider assistance with intubation to establish an airway, if needed. Epiglottitis is a medical emergency and immediate establishment of an airway by endotracheal tube or tracheotomy usually is needed. The toddler should be kept calm, if possible. The toddler should never be forced to lie down because this causes the epiglottis to fall backward and may cause complete airway obstruction. Examination of the throat with a tongue blade may cause cardiopulmonary arrest. It is unwise to attempt any procedure, such as drawing blood, which would heighten the toddler's anxiety, which could precipitate airway spasm and cause death. Isolation is not the priority for this toddler who is having a medical emergency.

A nurse who works in a neonatal intensive care unit is providing care for an infant who was born at 26 weeks' gestation. Which initial assessment should be the nurse's priority? Regular measurement of the infant's blood pressure and temperature Assessment of the infant's respiratory status and oxygen saturation levels Assessment of the infant's motor skills and limb range of motion Assessment of the infant's neurologic status

Assessment of the infant's respiratory status and oxygen saturation levels While premature birth is associated with numerous health problems, including variations in vital signs, impaired motor function, and neurologic deficits, the most common complications of prematurity involve respiratory function. Respiratory disorders develop in infants who are born prematurely or who have other problems that impair this transition. Among the respiratory disorders of the neonate are respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD).

A female dental assistant has developed signs and symptoms of a latex sensitivity and is undergoing allergy testing as well as blood work. Which of the following components of the assistant's blood work would most likely be the focus of her health care provider's analysis? A) Analysis of class II MHC antigens B) Serum IgE immunoassays C) Serum B-lymphocyte levels D) Serum CD8+ levels

B

A male elementary school student has a severe allergy to peanuts and is displaying the signs of anaphylactic shock after inadvertently eating a peanut-containing candy bar. Which of the following statements best captures the boy's current status and preferred treatment? A) He is experiencing shortness of breath caused by potent vasoconstriction that can be relieved by epinephrine injection. B) He is approaching vascular shock and developing edema due to actions of IgE antibodies, situations that can be reversed by administration of epinephrine. C) His mast cells and basophils have been sensitized, but systemic effects can be mitigated by administration of bronchodilators. D) He is likely in a primary- or initial-stage allergic response that can be relieved by antihistamine administration.

B

A nurse has just learned that her child has a life-threatening complement disorder known as hereditary angioneurotic edema (HAE). Due to deficiency in C1-INH, the nurse needs to be prepared for which possible life-threatening clinical manifestation? A) Bulging eyeballs B) Swelling of the airway C) Compressed carotid arteries D) Compression of brachial nerves

B

A student states, "It seems like helper T cells do a lot more than just 'help' the cellular immunity process." Which of the following responses listed below best conveys an aspect of the role of CD4+ helper T cells in immunity? A) "Without helper T cells, no antigens would be presented." B) "Helper T cells play a major role in stimulating and regulating the whole process." C) "Without helper T cells, the wrong antibodies would end up being produced." D) "Helper T cells are key to the hematopoiesis that produces all the components of the immune system."

B

An 8-week-old boy has been recently diagnosed with a severe combined immunodeficiency (SCID). His parents have performed a significant amount of research on the Internet and have brought a large amount of material to discuss with their care provider. Which of the following statements best reflects an accurate understanding of their son's health situation? A) "We read that gene therapy could cure our son; we'd like you to look into that option." B) "Our son likely has a deficiency of B lymphocytes and can't produce antibodies." C) "We feel guilty, because dietary and environmental factors have been shown to contribute to SCID" D) "The antibodies that our son produces are mismatched to the infections that he was born with and encounters."

B

Following a spider bite she received while camping, a 20-year-old female presented to the emergency department with rash, edema, and fever and was subsequently diagnosed with serum sickness. Which of the following statements best conveys the physiological rationale for the broad systemic effects of this event? A) The woman is experiencing diffuse tissue necrosis as a consequence of an Arthus reaction. B) Antigen-antibody complexes have been deposited in a variety of locations throughout the body. C) Antibody binding to specific target cell receptors is bringing about a change in cell function. D) Deposited antibodies are activating her complement system.

B

The nurse knows which of the following components listed below is needed for long-lasting immunity in a client with a diagnosis of sepsis without the causative agent identified? A) Neutrophils B) Lymphocytes C) Colony-stimulating factors D) Natural killer cells

B

Three days ago, a mother delivered her full-term infant who had been identified as having an in utero infection. The infant is receiving antibiotic and phototherapy, and the mother is breast-feeding. Which of the following types of immunoglobulins could most reasonably be expected to predominate in the infant's immune system? A) IgA, IgM, IgD B) IgG, IgA, IgM C) IgE, IgG, IgD D) IgM, IgD, Igm

B

Which of the following patients is most likely to benefit from transplantation of thymic tissue or major histocompatibility complex (MHC)-compatible bone marrow? A) A 12-year-old girl with a history of epilepsy and low IgG levels secondary to phenytoin use B) A 7-year-old boy whose blood work indicates decreased IgA and IgG with increased IgM C) A 6-year-old boy whose pre-B cells are incapable of translation to normal B cells D) A 9-year-old girl who has a diagnosis of IgA deficiency

B

After years of going to different physicians with vague symptoms, a 55-year-old client with a history of Hodgkin disease has been diagnosed with a secondary immunodeficiency syndrome. The client asks the nurse what this means. The nurse knows from the following list of characteristics that secondary immunodeficiency disorders: Select all that apply. A) may be inherited as a sex-linked trait. B) usually develop later in life. C) may be a result of chemotherapy being used to treat a cancer. D) can result from frequent recurring Staphylococcus aureus infections. E) can occur in a chronic obstructive pulmonary disease patient taking corticosteroids daily.

B C E

A client with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which term should the nurse use to document this finding? Barrel chest Pink puffer Blue bloater Pneumothorax

Barrel chest An increased anterior-posterior chest diameter is referred to as a barrel chest.

An adult client reports to the emergency department with shortness of breath. Which additional clinical finding(s) leads the health care provider to suspect the client has a moderate-sized pulmonary embolism? Select all that apply. Blood-tinged sputum Coughing up green-colored sputum. Fever higher than 103°F (39.4°C) for the past 2 days Apprehensive, especially when asked to lie flat Friction rub noted on both inspiration and expiration

Blood-tinged sputum Apprehensive, especially when asked to lie flat Pulmonary embolism manifestations depend on the size and location of the obstruction. Clients with moderate-sized emboli often present with breathlessness accompanied by pleuritic pain, apprehension, slight fever, and cough productive blood-tinged sputum. Sputum that is green-colored is abnormal and usually due to pneumonia. A fever higher than 103°F (39.4°C) is considered more than a "slight" fever. Pleural friction rub is an abnormal lung sound, which is caused by inflammation of the pleural layer of the lungs rubbing together. Pleural friction rub is heard on inspiration and expiration and sounds like a low-pitch harsh/grating noise.

A 4-year-old boy presents with a chronic cough and swollen lymph nodes. His records show that he has been given antibiotics several times in the past year with limited success, most recently for a liver abscess, and that he also has a recurring fungal skin condition. Which of the following is his most likely diagnosis? A) Selective IgA deficiency B) A deficiency in IgG2 subclass antibodies C) Chronic granulomatous disease D) Ataxia-telangiectasia

C

A client has been inhaling viruses periodically while on a cross-country flight. Which of the following situations listed below would most likely result in the stimulation of the client's T lymphocytes and adaptive immune system? A) Presentation of a foreign antigen by a familiar immunoglobulin B) Recognition of a foreign major histocompatibility complex (MHC) molecule C) Recognition of a foreign peptide bound to a self-major histocompatibility complex (MHC) molecule D) Cytokine stimulation of a T lymphocyte with macrophage or dendritic cell mediation

C

A client who has a diagnosis of an autoimmune disease asks his nurse why it is that his immune system does not attack all of the cells that make up his body. Which of the following aspects of pathogen recognition in the innate immune system listed below would underlie the nurse's response? A) Normal host cells excrete inhibitory proteins that are detected by natural killer cells. B) Intraepithelial lymphocytes and natural killer cells possess specific, highly diverse receptors. C) Pattern recognition receptors (PRRs) ensure that cells are correctly identified. D) Leukocytes possess pathogen-associated molecular patterns (PAMPs)

C

A middle school student is scheduled to receive booster immunizations, and the father asks the nurse why the booster is necessary. What characteristic of the adaptive immune system listed below would provide the rationale for the nurse's response? A) Some antibodies require a repeat of the primary immune response. B) Some antibodies have a duration measured in months rather than years. C) A secondary response causes a sharp rise in antibody levels. D) Antigen receptors on CD4+ cells require multiple exposures separated by time.

C

A new nursing student is taking a tuberculin (TB) skin test as part of her preparation for beginning clinical placement in the hospital. The student is unclear of the rationale or physiology involved in this test. Which of the following is the correct explanation? A) The cell-mediated hypersensitivity associated with Mycobacterium tuberculosis remains detectable for several years. B) Formation of contact dermatitis lesions confirms prior TB contact. C) Previous TB exposure forms sensitized Th1 cells that are long-lived. D) This type of delayed-type hypersensitivity (DTH) is a response to latent Mycobacterium tuberculosis bacteria.

C

A nurse is providing care for a 17-year-old boy who has experienced recurrent sinus and chest infections throughout his life and presently has enlarged tonsils and lymph nodes. Blood work indicated normal levels of B cells and free immunoglobulins but a lack of differentiation into normal plasma cells. The boy is currently receiving intravenous immunoglobulin (IVIG) therapy. What is the boy's most likely diagnosis? A) X-linked hypogammaglobulinemia B) Transient hypoglobulinemia C) Common variable immunodeficiency D) IgG subclass deficiency

C

The nurse knows the cells primarily programmed to remove the invading organisms and remember the antigen to respond rapidly during the next exposure are A) CD4 and CD8 cells. B) natural killer (NK) cells and macrophages. C) T and B lymphocytes. D) white blood cells and platelets.

C

When explaining what is occurring when their child has an acute bronchial asthma attack, the nurse will emphasize that which mediator is primarily responsible for the bronchial constriction? A) Tree pollen B) Mold dust C) Histamine D) T-lymphocyte proliferation

C

Which of the following phenomena would be least likely to result in activation of the complement system? A) Recognition of an antibody bound to the surface of a microbe B) Increase in tissue blood flow and capillary permeability, so fluids/proteins can leak into the area C) Activation of toll-like receptors (TLRs) on complement proteins D) Direct recognition of microbial proteins

C

While undergoing a kidney transplant from a nonfamily member, the patient's transplanted kidney has just had the arterial clamps removed. The OR staff notice that the organ is turning purple with no urine output. When explaining to the family why they had to remove the donor kidney, the nurse will anticipate that the surgeon would likely include which statement? A) Obviously, there has been a mismatch during the human leukocyte antigen (HLA) testing. B) The circulating B and T lymphocytes are just doing their job. C) Hyperacute rejection occurs because antibodies against HLA antigens are deposited in vessels causing necrosis. D) Previous exposure to the HLA antigens is responsible for the high titers of complement fixing antibodies that cause the rejection.

C

For which client condition will a pulse oximeter reading be inaccurate? Carbon monoxide poisoning Hyperlipidemia Bacterial pneumonia Dehydration

Carbon monoxide poisoning The pulse oximeter is a noninvasive method to evaluate blood oxygen concentrations by passing red-wavelength light and infrared-wavelength light through capillaries in the finger, toe, or ear lobe. The sensors cannot distinguish between carbon monoxide-carrying hemoglobin and oxygenated hemoglobin.

A client has undergone pulmonary diagnostic studies where the results show a mismatching of ventilation and perfusion. Which diagnosis is most likely associated with this finding? Pulmonary embolism Pulmonary hypertension Pleural effusion Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) results in inflammation and fibrosis of the bronchial wall, hypertrophy of the submucosal glands and hypersecretion of mucus and loss of elastic lung fibers and alveolar tissue. Inflammation and fibrosis of the bronchial wall, along with excess mucus secretion and destruction of elastic fibers, cause mismatching of ventilation and perfusion. The other options do not apply to an occurring mismatching.

A middle-aged client with a 30-year history of smoking was diagnosed with lung cancer. A health history revealed previous exposure to air pollution, asbestos, and radiation. Which factor most likely had the greatest impact on development of the lung cancer? Radiation Cigarette smoke Asbestos Air pollution

Cigarette smoke Cigarette smoking causes more than 80% of cases of lung cancer. The risk for lung cancer among cigarette smokers increases with duration of smoking and the number of cigarettes smoked per day. Cigarette smokers can benefit at any age from smoking cessation. Industrial hazards also contribute to the incidence of lung cancer. A commonly recognized hazard is exposure to asbestos. The mean risk for lung cancer is significantly greater in asbestos workers compared to the general population. In addition, tobacco smoke contributes heavily to the development of lung cancer in people exposed to asbestos.

A client has developed chronic hypoxia and has developed pulmonary hypertension (HTN). The nurse recognizes that the most likely cause of pulmonary hypertension would be: Constant dilation of the pulmonary vessels in response to hypoxia Constriction of the pulmonary vessels in response to hypoxemia Hardening of the pulmonary vessels due to increased fat deposits Decreased vascular resistance in the pulmonary vessels

Constriction of the pulmonary vessels in response to hypoxemia Pulmonary HTN occurs as a result of chronic hypoxia. In response to hypoxia, the pulmonary vessels constrict. The pulmonary vessels differ from the systemic circulation vessels, which dilate in response to hypoxia and hypercapnia. Smooth muscle hypertrophy and proliferation of the vessel intima occur in pulmonary HTN.

A client with primary lung disease has developed right heart failure. The health care provider would document this as: Adult respiratory distress syndrome Primary hypertension Cor pulmonale Cardiac tamponade

Cor pulmonale The term cor pulmonale refers to right-sided heart failure resulting from primary lung disease or pulmonary hypertension. The increased pressures and work result in hypertrophy and eventual failure of the right ventricle. The manifestations of cor pulmonale include the signs and symptoms of the primary lung disease and the signs of right-sided heart failure. Primary hypertension is elevated blood pressure of unknown cause. Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space.

What intervention is appropriate for a client with sarcoidosis? Corticosteroids Lymph node radiation Antifungal agents Antihistamines

Corticosteroids Sarcoidosis treatment is directed at interrupting the inflammatory process with corticosteroid medications. Sarcoidosis is overgrowth of granulomas and does not have a fungal or allergy component.

A 1-year-old child who has experienced low platelet counts and bacterial susceptibility has been admitted to a pediatric medical unit of a hospital for treatment of Wiskott-Aldrich syndrome. The nurse who has admitted the child to the unit would anticipate which of the following short-term and longer-term treatment plans? A) Transfusion of clotting factors XII and XIII and serum albumin; splenectomy B) Neutropenic precautions; fresh frozen plasma transfusions; treatment of gastrointestinal symptoms C) Intravenous immunoglobulin (IVIG) treatment; thyroidectomy D) Treatment of eczema; management of bleeding; bone marrow transplant

D

A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? A) Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response. B) Allergens in large, regular quantities overwhelm the IgE antibodies that mediate the allergic response. C) Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response. D) Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies.

D

A 53-year-old female hospital patient has received a kidney transplant following renal failure secondary to hypertension. As part of the teaching while she was on the organ wait list, she was made aware that she would need to take antirejection drugs for the rest of her life. Which aspect of the immune system underlies this necessity? A) The lack of identifiable major histocompatibility complex (MHC) molecules will stimulate the innate immune response. B) Donor organ antibodies will be identified as foreign and stimulate an immune response. C) Antirejection drugs will stimulate the production of familiar MHC molecules. D) MHC molecules will never develop in the cells of the donor organ, and effector cells will be continually stimulated.

D

A 60-year-old male client with an acute viral infection is receiving interferon therapy. The physician is teaching the family of the client about the diverse actions of the treatment and the ways that it differs from other anti-infective therapies. Which of the following teaching points listed below should the physician least likely include? A) "Interferon can help your father's unaffected cells adjacent to his infected cells produce antiviral proteins that can stop the spread of the infection." B) "Interferon can help limit the replication of the virus that's affecting your father." C) "Interferon helps your father's body recognize infected cells more quickly." D) "Interferon can bolster your father's immune system through the stimulation of natural killer cells that attack viruses."

D

A client has been identified as having an excess of macrophage inhibitory factor, causing the client to have inhibited movement and activity of macrophages. Which of the following processes listed below would the health care team member expect to remain unaffected? A) Amplification of the immune response B) Destruction of virus-infected or tumor cells C) Initiation of adaptive immunity D) Specificity and memory of the immune response

D

The nurse knows that a drug in a category identified as a colony-stimulating factor (CSF) helps A) cells engulf and digest microbes that want to attach to cell membranes and destroy normal cell function. B) produce cells that will be the first responder cells to protect against cancer formation. C) stimulate the person's immune system so that he or she can kill his or her own cancer cells. D) stimulate bone marrow to produce large numbers of mature cells such as platelets and erythrocytes.

D

Which of the following situations can best be characterized as an example of passive immunity? A) A 6-month-old infant receives his scheduled immunization against measles, mumps, and rubella. B) A 9-year-old boy is immune to chicken pox after enduring the infection before 1 year. C) An 8-year-old girl recovers from a respiratory infection after intravenous antibiotic treatment. D) A 6-week-old infant receives antibodies from his mother's breast milk.

D

An expectant mother is 23 weeks into her pregnancy when she goes into labor. Regarding fetal lung development, what is of greatest concern to the attending medical team? Development of respiratory musculature Saccular development of alveoli Development of type II alveolar cells Development of bronchial tree

Development of type II alveolar cells Type II alveolar cells begin to develop at approximately 24 weeks and produce surfactant, a substance capable of lowering the surface tension of the air-alveoli interface. By 28 to 30 weeks, sufficient amounts of surfactant are available to prevent alveolar collapse when breathing begins. The respiratory musculature, alveoli, and bronchial tree are all developed by the 23rd week.

A diagnosis of tension pneumothorax would be suspected in which physical assessment finding? Deviated trachea Symmetry of chest during inspiration Increased respiratory rate Hypoxia

Deviated trachea Physical assessment findings of a deviated trachea and neck vein distention would indicate a tension pneumothorax. Asymmetry of the chest during inspiration would suggest a spontaneous pneumothorax. Both would need to be confirmed by radiology. The remaining options are nonspecific and occur in many conditions.

A client reports chest pain to the nurse. Which characteristics of the pain indicate bronchial irritation? Dull pain in mid-chest that is worse when coughing Sudden sharp pain in one side made worse by deep breathing Crushing pain in mid-chest that is not changed by breathing or coughing Sharp bilateral pain in the inferior chest that is worse when lifting or stretching

Dull pain in mid-chest that is worse when coughing Bronchitis pain usually is described as dull, located in the substernal region, and made worse by coughing but not by deep breathing. The pain of pleuritis is usually abrupt onset with a sharp pain that increases with deep breathing. The pain of musculoskeletal strain from frequent forceful coughing is usually bilateral and located in the inferior portion of the rib cage. Contracting the abdominal muscles makes the pain worse. A myocardial infarction (MI) commonly produces substernal chest pain that is crushing, but not affected by respiratory activity.

A parent calls 911 and states her child is having trouble breathing. The child is rushed to the emergency department. Upon assessment, the child appears pale, toxic, and lethargic and assumes a distinctive position—sitting up with the mouth open and the chin thrust forward. The parent states that the child just developed a sore throat and fever today. The health care provider determines that the child is experiencing: Epiglottitis Bronchitis Pneumonitis Tracheobronchitis

Epiglottitis Epiglottitis typically presents with an acute onset of sore throat and fever. The child appears pale, toxic, and lethargic and assumes a distinctive position-sitting up with the mouth open and the chin thrust forward. Symptoms rapidly progress to difficulty swallowing, a muffled voice, drooling, and extreme anxiety. Moderate to severe respiratory distress is evident. The other options do not have these manifestations.

Which diagnosis places a child at the greatest risk for airway obstruction? Epiglottitis Bronchiolitis Syncytial virus (RSV) Croup

Epiglottitis The child with epiglottitis is at risk for airway obstruction. Epiglottitis is a life-threatening supraglottic infection that may cause airway obstruction and asphyxia. The child with bronchiolitis is at risk for respiratory failure resulting from impaired gas exchange. Acute bronchiolitis is a viral infection of the lower airways, most commonly caused by the respiratory syncytial virus (RSV). The symptoms of croup usually subside when the child is exposed to moist air.

The emergency room provider diagnoses a client with a hemothorax. Which could be possible causes of this condition? Fractured ribs following car accident Congestive heart failure resulting with edema around the heart Excessive coughing from pneumonia Fluid imbalances from renal failure

Fractured ribs following car accident Hemothorax is a collection of blood in the thoracic cavity. Bleeding may arise from chest injury (like a car accident), a complication of chest surgery, malignancies, or rupture of a great vessel such as an aortic aneurysm. Fractured and dislocated ribs alert the nurse to the presence of a possible chest injury. Pleural effusion refers to an abnormal collection of fluid in the pleural cavity and is associated with diagnoses of congestive heart failure, pneumonia, and renal failure.

Common results of acute respiratory failure are hypoxemia and: Hypercapnia Bradycardia Vasoconstriction Pulmonary emboli

Hypercapnia The common result of respiratory failure is hypoxemia, or low level of oxygen in the blood, and hypercapnia, or excess carbon dioxide in the blood. Acute hypoxia incites sympathetic nervous system responses such as tachycardia. Hypercapnia refers to an increase in carbon dioxide levels. The manifestations of hypercapnia consist of those associated with the vasodilation of blood vessels, including those in the brain and depression of the central nervous system (e.g., carbon dioxide narcosis). Thrombus formation in pulmonary vessels is unrelated to ventilation failure.

The nurse is caring for a client diagnosed with pneumonia. The client's arterial blood gas results identify decreased level oxygen and other laboratory work reveals an increase in lactic levels. How will the nurse interpret these findings? Hypoxia Hypercapnia Hypoxemia Respiratory alkalosis

Hypoxemia Hypoxemia refers to a reduction in PO2 of the arterial blood. Hypoxemia produces its effects through tissue hypoxia and compensatory mechanisms. If the PO2 of the tissues falls below a critical level, aerobic metabolism ceases and anaerobic metabolism takes over, with formation and release of lactic acid. This results in increased serum lactate levels and metabolic acidosis. Hypoxemia can result from an inadequate amount of O2 in the air, disease of the respiratory system, dysfunction of the neurologic system, or alterations in circulatory function. Hypercapnia is an increase in the carbon dioxide content of the arterial blood. Atelectasis is collapse of a segment of the lung due to airway obstruction.

A client is brought into the emergency department with severe crushing injuries to the chest wall and signs of respiratory failure following a motor vehicle accident. Which laboratory value would be expected? Cool moist skin Increase in PCO2 Hyperventilation Metabolic alkalosis

Increase in PCO2 Hypoventilation or ventilatory failure occurs when the volume of "fresh" air moving into and out of the lung is significantly reduced. It is commonly caused by conditions outside the lung such as depression of the respiratory center, diseases of the nerves supplying the respiratory muscles, or thoracic cage disorders such as a crushed chest. Hypoventilation almost always causes an increase in PCO2. The PCO2 level is a good diagnostic measure for hypoventilation. Additional indicators of hypercapnia are warm and flushed skin and hyperemic conjunctivae.

A child has developed respiratory stridor and is displaying a crowing sound. The parents ask the nurse what is causing this sound. The best response would be: Pulling in of the soft tissue surrounding the cartilaginous and bony thorax Nasal obstruction and inhalation occurring through the mouth rather than the nares Increased turbulence of air moving through the obstructed airways The collapse of intrathoracic airways because of air trapping

Increased turbulence of air moving through the obstructed airways The crowing sound of stridor occurs with the increased turbulence of air moving through the obstructed airways. Pulling in of the soft tissue surrounding the cartilaginous and bony thorax describes the mechanisms that produce inspiratory retractions. The collapse of intrathoracic airways because of air trapping describes the mechanism for the production of wheezing.

Talc lung can occur from inhaled talc powder that can be inhaled by workers in talc mines. What condition are people with talc lung very susceptible to? Hemothorax Chylothorax Interstitial lung disease Pneumothorax

Interstitial lung disease Persons with talc lung are also highly susceptible to the occurrence of interstitial lung disease. Talc lung may result from inhalation of talc particles but is more commonly an occurrence of injected or inhaled talc powder that is used as a filler with heroin, methamphetamine, or codeine. A hemothorax, chylothorax, and fibrothorax are not complications of talc lung.

Adverse effects of emboli on pulmonary circulation and airways include: Excess surfactant Local bronchodilation Local vasoconstriction Lower lobe consolidation

Local vasoconstriction The effects of emboli on the pulmonary circulation are related to mechanical obstruction of the pulmonary circulation by the blood clot and associated reflex vasoconstriction. Obstruction of pulmonary blood flow also causes reflex bronchoconstriction (not bronchodilation) in the affected area of the lung, wasted ventilation, impaired gas exchange, and loss of alveolar surfactant. Lower lobe consolidation is associated with pneumonia.

The nurse is developing a community program since a recent increase in admissions to the acute care facility with tuberculosis infection. What is the most frequent form of tuberculosis that the nurse should focus on? Mycobacterium tuberculosis Mycobacterium avium-intracellulare complex Ghon tuberculosis Pneumocystis jirovecii tuberculosis

Mycobacterium tuberculosis Mycobacterium tuberculosis hominis is the most frequent form of tuberculosis that threatens humans. Other mycobacteria, including mycobacterium avium-intracellulare complex, are much less virulent than M. tuberculosis hominis. These mycobacteria rarely cause disease except in severely immunosuppressed people, such as those with HIV infection. Generally, MAI complex is transmitted from eating contaminated food or water. Pneumocystis jirovecii is a type of pneumonia that generally occurs when a client is immunocompromised.

Which factor is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma? Pet dander Cold weather Stress Respiratory tract infections

Pet dander Extrinsic or atopic asthma is typically initiated by a type I hypersensitivity reaction induced by exposure to an extrinsic antigen or allergen such as pet dander. Intrinsic or nonatopic asthma triggers include respiratory tract infections, exercise, hyperventilation, cold air, drugs and chemicals, hormonal changes and emotional upsets, airborne pollutants, and gastroesophageal reflux.

A pulmonary embolism occurs when there is an obstruction in the pulmonary artery blood flow. Classic signs and symptoms of a pulmonary embolism include dyspnea, chest pain, and increased respiratory rate. What is a classic sign of pulmonary infarction? Mediastinal shift to the left Pleuritic pain Tracheal shift to the right Pericardial pain

Pleuritic pain Chest pain, dyspnea, and increased respiratory rate are the most frequent signs and symptoms of pulmonary embolism. Pulmonary infarction often causes pleuritic pain that changes with respiration; it is more severe on inspiration and less severe on expiration. Mediastinal and tracheal shifts are not signs of a pulmonary infarction, and neither is pericardial pain.

Pain is an expected assessment finding in clients who have which lung disease? Asthma Pleural effusion Pulmonary arterial hypertension (PAH) Pleuritis

Pleuritis The effects of asthma, PAH, and pleural effusion may be profound, but none is typically accompanied by acute pain. Pleuritis, in contrast, is associated with characteristic pleural pain.

A newly admitted critical head injury client presents to the neuro-ICU. The client is unresponsive to painful stimuli but able to breathe on his own. As the shift progresses, the nurses note a decrease in the client's respiratory effort. The client cannot maintain his O2 saturation above 70%. The nurses should anticipate assisting in beginning what type of pulmonary support? Increase oxygen level to 10 L/min. Begin Bi-PAP. Call respiratory therapy to suction the client. Prepare for mechanical ventilation.

Prepare for mechanical ventilation. When alveolar ventilation is inadequate to maintain PO2 or PCO2 levels because of respiratory or neurologic failure, mechanical ventilation may be lifesaving. Usually a nasotracheal, orotracheal, or tracheotomy tube is inserted into the trachea to provide the client with the airway needed for mechanical ventilation.

A client recently had surgery for a hip fracture. Which nursing intervention would be most effective for preventing pulmonary emboli in this client? Prevention of the development of a deep vein thrombosis Use of oxygen and incentive spirometer following surgery Monitor hematocrit and hemoglobin levels Encourage increase fluid intake

Prevention of the development of a deep vein thrombosis Almost all pulmonary emboli are thrombi that arise from deep vein thrombosis in the lower and upper extremities. The presence of thrombosis in the deep veins of the legs or pelvis often is unsuspected until an embolism occurs.

A 3-year-old child has been admitted to the pediatric unit for the treatment of croup. The nurse should include which action in the child's plan of care? Providing cool, moist air for the child to breathe Establishing IV access and administering sulfa antibiotics as ordered Administering antiviral medications such as zanamivir and oseltamivir as ordered Providing a low-stimulation environment to relieve bronchospasm

Providing cool, moist air for the child to breathe Moist air is effective in relieving the bronchospasm associated with croup for many children. Croup has a viral etiology, so antibiotics are ineffective. Zanamivir and oseltamivir are antiviral medications given to treat influenza, not croup. A low-stimulation environment is of no significant clinical benefit.

Cystic fibrosis (CF) is an autosomal recessive disorder involving the secretion of fluids in specific exocrine glands. The genetic defect in CF inclines a person to chronic respiratory infections from a small group of organisms. Which organisms create chronic infection in a child with cystic fibrosis? Pseudomonas aeruginosa and Escherichia coli Staphylococcus aureus and hepatitis C Haemophilus influenzae and influenza A Pseudomonas aeruginosa and Staphylococcus aureus

Pseudomonas aeruginosa and Escherichia coli In addition to airway obstruction, the basic genetic defect that occurs with CF predisposes to chronic infection with a surprisingly small number of organisms, the most common being Pseudomonas aeruginosa, Burkholderia cepacia, Staphylococcus aureus, and Haemophilus influenzae. The other disease causing organisms are not linked to CF.

Three days following surgical repair of a hip fracture a client becomes anxious and complains of sudden shortness of breath. What disorder is the client most likely experiencing? Pulmonary embolism Atelectasis Bronchiectasis Pneumonia

Pulmonary embolism Pulmonary embolism occurs when a blood-borne substance blocks blood flow through a branch of the pulmonary artery. Substances that can cause this obstruction include air, clots, fat, and amniotic fluid. Manifestations include sudden onset of chest pain, dyspnea, and often includes a feeling of impending doom. Symptoms of pneumonia would include signs of infection. Atelectasis does not typically produce chest pain. Bronchiectasis does not have sudden onset.

Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response? Pulmonary vessels dilate Pulmonary vessels constrict Pulmonary vessels spasm Pulmonary vessels infarct

Pulmonary vessels constrict Continued exposure of the pulmonary vessels to hypoxemia is a common cause of pulmonary hypertension. Unlike blood vessels in the systemic circulation, most of which dilate in response to hypoxemia and hypercapnia, the pulmonary vessels constrict.

A client arrives in the ED after an automobile accident. Which clinical manifestations lead the nurse to suspect a pneumothorax? Select all that apply. Respiratory rate 34. Asymmetrical chest movements, especially on inspiration Diminished breath sounds over painful chest area Pulse oximetry 98% ABG pH level of 7.38

Respiratory rate 34. Asymmetrical chest movements, especially on inspiration Diminished breath sounds over painful chest area Manifestations of pneumothorax include increased respiratory rate, dyspnea, asymmetrical movements of chest wall (especially during inspiration), hyperresonant sound on percussion, and decreased or absent breath sounds over area of pneumothorax. The pulse oximetry reading is normal. ABG pH level of 7.38 is a normal finding.

Which characteristic of the lungs of infants and small children creates an increased risk of respiratory disorders? Type II alveoli in children may overproduce surfactant. Smaller airways create a susceptibility to changes in airway resistance and airflow. The pneumotaxic center in the pons is underdeveloped until 8 years of age. There are fewer chemoreceptors in the young medulla.

Smaller airways create a susceptibility to changes in airway resistance and airflow. Because the resistance to airflow is inversely related to the fourth power of the radius (resistance = 1/radius), relatively small amounts of mucus secretion, edema, or airway constriction can produce marked changes in airway resistance and airflow. Surfactant production is low early in life, and the respiratory center and chemoreceptors are present and functional in infants and children.

A client reports chest pain to the nurse. Which characteristics of the pain indicate pleuritis? Dull pain in mid-chest that is worse when coughing Sudden sharp pain in one side made worse by deep breathing Crushing pain in mid-chest that is not changed by breathing or coughing Sharp bilateral pain in the inferior chest that is worse when lifting or stretching

Sudden sharp pain in one side made worse by deep breathing The pain of pleuritis is usually abrupt onset with a sharp pain that increases with deep breathing. The pain of musculoskeletal strain from frequent forceful coughing is usually bilateral and located in the inferior portion of the rib cage. Contracting the abdominal muscles makes the pain worse. Bronchitis pain usually is described as dull, located in the substernal region, and made worse by coughing but not by deep breathing. A myocardial infarction (MI) commonly produces substernal chest pain that is crushing, but not affected by respiratory activity.

A 6-month-old infant has been hospitalized with acute bronchiolitis. Which treatment should be prioritized in the infant's care? Supplementary oxygen therapy Intravenous antibiotics Transfusion of fresh frozen plasma Tracheotomy

Supplementary oxygen therapy Bronchiolitis necessitates supplementary oxygen therapy. Antibiotics are ineffective due to the viral etiology. Recovery usually occurs within several days, and tracheotomy is necessary only in the event of severe complications. Plasma transfusion is not a relevant treatment modality.

A parent of a toddler is concerned about possible side effects of influenza immunizations. What will the nurse teach the parent regarding the influenza vaccine? The evidence of vaccines leading to autism is only linked to the measles, mumps, and rubella (MMR) vaccine, not the influenza vaccine. The Centers for Disease Control and Prevention recommends that all people 6 months of age and older should receive the annual influenza vaccine. Mercury-based preservatives are no longer used in vaccine administration, so the influenza vaccine is safe for all individuals. Parents can win lawsuits if side effects occur following an influenza vaccine.

The Centers for Disease Control and Prevention recommends that all people 6 months of age and older should receive the annual influenza vaccine. The Centers for Disease Control and Prevention recommends all people 6 months of age and older in the United States receive the annual influenza vaccine. To date, there has been no valid evidence linking any vaccine to the development of autism. Thimerosal, a mercury-based preservative, is still being utilized, and there are no proven interactions. Side effects occur with most medications. Lawsuits are not necessarily won if side effects occur.

The nurse is caring for the following clients. Select the client at highest risk for the development of atelectasis. The client who is mobile within 24 hours after abdominal surgery The client with a lower leg cast who changes position every 2 hours The client diagnosed with pneumonia who performs frequent coughing and deep-breathing exercises The client who is postoperative after a total knee replacement and receiving patient-controlled analgesia

The client who is postoperative after a total knee replacement and receiving patient-controlled analgesia The danger of obstructive atelectasis increases after surgery as anesthesia, pain, administration of opioids, and immobility tend to promote retention of viscid bronchial secretions and hence airway obstruction. The encouragement of coughing and deep breathing, frequent change of position, adequate hydration, and early ambulation decrease the likelihood of atelectasis developing. Coughing and deep-breathing exercises are the most beneficial option to prevent atelectasis. Repositioning needs to occur more frequently (about every 2 hours), ambulating prior to 24 hours postoperatively, and increasing oral fluids will assist with the prevention of atelectasis.

A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis (TB) and has subsequently developed latent tuberculosis infection. Which statement is accurate regarding this nurse? The nurse is likely asymptomatic. The nurse is now immune to more severe TB infection. The nurse can spread TB to others. The nurse has active TB infection.

The nurse is likely asymptomatic. Latent TB infection is not an active form of TB, and affected individuals are asymptomatic and cannot pass on the disease to others. It does not confer immunity. However, small numbers of organisms may remain viable for years. Later, if immune mechanisms decline or fail, latent TB infection has the potential to develop into secondary TB.

The parents of a child with cystic fibrosis ask the nurse to explain the sweat test performed on their newborn. How should the nurse respond? The sweat test evaluates the infant's ability to sweat in response to heat. The sweat test measures the concentration of salt in the infant's sweat. Abnormal pancreatic enzymes may cause the infant to sweat more. Cystic fibrosis decreases the amount of salt in the infant's sweat.

The sweat test measures the concentration of salt in the infant's sweat. Cystic fibrosis is a genetic disorder that produces abnormal functioning in the epithelial cell chloride channels. The chloride is not reabsorbed, leaving high concentrations of sodium chloride in the sweat. The sweat test is the standard approach to diagnosis of CF. A gel is applied to the skin and a patch with electrodes is applied. Once enough sweat is collected, it is tested in the lab for sodium chloride concentration.

The nurse is developing a program for screening for pulmonary tuberculosis (TB). Which screening methods would most likely be used to determine if the individual has been exposed to TB? Select all that apply. Complete blood count Tuberculin skin test Bronchoscopy Chest x-ray Sputum for culture and sensitivity

Tuberculin skin test Chest x-ray The most frequently used screening methods for pulmonary tuberculosis are tuberculin skin tests and chest x-rays. The tuberculin skin test measures the delayed hypersensitivity that follows exposure to the tubercle bacillus. The other tests may be used to support the diagnosis but are not the most frequently used.

How is the organism causing Legionnaire disease, a form of bronchopneumonia, usually transmitted? Warm, standing water becomes aerosolized and inhaled Public restrooms Fermenting yogurt Potted plant soil not washed from the hands

Warm, standing water becomes aerosolized and inhaled The organism frequently is found in water, particularly in warm, standing water. Infection typically occurs when water that contains the pathogen is aerosolized into appropriately sized droplets and is inhaled or aspirated by a susceptible host. E. coli is commonly found in restrooms; fermenting yogurt contains Lactobacillus, which is important for normal digestion; potted plant soil may contain a usually harmless strain of Clostridium bacteria.

A client is diagnosed with pneumoconiosis. Which aspect of the client's history is most likely the cause of this diagnosis? Has congestive heart failure Worked in a coal mine for 20 years Exposed to tuberculosis recently Has 20 pack-years history of smoking

Worked in a coal mine for 20 years People who work in a coal mine can develop coal worker's pneumoconiosis (CWP). Heart failure and tuberculosis exposure are not causes of this diagnosis. Smoking will likely cause chronic obstructive pulmonary disease (COPD) and not a cause of pneumoconiosis.

The parents of a child diagnosed with cystic fibrosis (CF) ask about the risk of any future children having the condition. How should the nurse respond? CF is autosomal dominant, so you have a 50% risk in another child. You have a 25% chance that your next child will have CF. Since the male carries the CF gene, you might consider a sperm donor. Now that you have one child with CF, the rest will also have it.

You have a 25% chance that your next child will have CF. Cystic fibrosis is autosomal recessive, meaning that two defective genes are needed for a child to be born with the disorder. Both parents must either be carriers (having one defective gene, but no symptoms) or have the disease (two defective genes). If both parents are carriers, each child has 1 in 4 chance of receiving two normal genes, a 50 percent chance of inheriting at least one gene, and a 1 in 4 chance of receiving two abnormal genes and having CF.

A child is experiencing an acute exacerbation of asthma. Which quick-acting treatment is most appropriate for this client? Antileukotrienes beta-adrenergic agonists Anti-inflammatory agents Leukotrienes

beta-adrenergic agonists A beta-adrenergic agonist would be the best option to use in an acute exacerbation of asthma. The quick-relief medications include the short-acting beta-adrenergic agonists, anticholinergic agents, and systemic corticosteroids. The short-acting beta-adrenergic agonists relax bronchial smooth muscle and provide prompt relief of symptoms, usually within 30 minutes. All of the other drugs would be used as maintenance treatment.

The use of oxygen at a rate above 2 L/minute is inappropriate for a client with: pneumonia, walking in the hall with pursed lip breathing, pulse oximeter reading 89%. chronic obstructive pulmonary disease (COPD), sitting in bed with cyanosis and pulse oximeter reading 57%. atelectasis, using incentive spirometer, pulse oximeter reading 90%. pneumonectomy, incisional pain with breathing, pulse oximeter reading 92%.

chronic obstructive pulmonary disease (COPD), sitting in bed with cyanosis and pulse oximeter reading 57%. Clients with end-stage chronic obstructive pulmonary disease may experience significant hypoxemia. Low-flow oxygen at a rate between 1 and 2 L/min may assist oxygenation. These clients should not receive higher rates of oxygen because the ventilatory drive from hypoxemia generally does not occur when the PO2 is above 60 mm Hg (7.98 kPa). The client will develop hypoventilation and CO2 retention. Pulse oximeter readings indicate the amount of hemoglobin that is oxygenated. A normal range is above 92%.

A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be: insertion of a large-bore needle or chest tube. chest x-ray. arterial blood gas analysis. administration of oxygen by face mask.

insertion of a large-bore needle or chest tube. Emergency treatment of tension pneumothorax involves the prompt insertion of a large-bore needle or chest tube into the affected side of the chest along with one-way valve drainage or continuous chest suction to aid in lung reexpansion. Other listed options may be implemented after the emergency measure.

A client is admitted with hypersensitivity pneumonitis which has been described to the client as "farmer's lung." Which factor could have caused this condition? organic pesticides moldy grain dust herbicides exposure to pigeon feathers

moldy grain dust Farmer's lung results from exposure to moldy hay or grain dust. Pigeon breeder's lung is provoked by exposure to the serum, excreta, or feathers of birds. Pesticides and herbicides are health risks but do not cause pneumonitis.

How will the nurse describe unilateral chest pain associated with respiratory movements? musculoskeletal pleuritic myocardial bronchitic

pleuritic Pleuritis is usually unilateral and tends to be localized to the lower and lateral part of the chest; pain worsens with chest movements, such as deep breathing and coughing that accentuate pressure changes in the pleural cavity and increase movement of the inflamed or injured pleural surfaces. Musculoskeletal pain usually is bilateral and may occur as the result of frequent, forceful coughing. The pain associated with irritation of the bronchi usually is substernal and dull. Myocardial pain usually is located in the substernal area and is not affected by respiratory movements.

With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiologic principle behind this respiratory distress is related to: increases in left atrial pressure causing thickening of the lining of the pulmonary arteries. the elevation of pulmonary venous pressure. structural abnormalities of pulmonary vessels with proliferation of the vessel intima. the stiffening of the lung, making it more difficult to inflate.

the stiffening of the lung, making it more difficult to inflate. As the disease (ARDS) progresses, the work of breathing becomes greatly increased as the lung stiffens and becomes more difficult to inflate. There is increased intrapulmonary shunting of blood, impaired gas exchange, and hypoxemia despite high supplemental oxygen therapy. With pulmonary hypertension, there are continued increases in left atrial pressure, which can lead to medial hypertrophy and intimal thickening of the small pulmonary arteries, causing sustained hypertension. Pulmonary hypertension also causes an elevation of pulmonary venous pressure.

A parent brings a child into the urgent care clinic. The health care provider suspects the child has a "common cold" based on which clinical manifestation(s)? Select all that apply. watery, clear nasal secretions coughing mild fever photosensitivity nuchal rigidity

watery, clear nasal secretions coughing mild fever The condition usually begins with a sore and scratchy throat followed by profuse and watery rhinorrhea, nasal congestion, sneezing, and coughing. Other cold symptoms include malaise, fatigue, headache, hoarseness, sinus congestion, and myalgia. Fever is a common sign in children. Photosensitivity and nuchal rigidity are signs of meningitis.