Patho Week 1 (chapters 6 &9)

When a client is stressed, which receptors are stimulated by catecholamines?

-α-adrenergic -β-adrenergic

Which term should the nurse use to describe a microorganism that does not infect people who have intact immune systems but does infect people who are immunosuppressed?

An opportunistic microorganism -An infection caused by a microorganism that does not infect people who have intact immune systems but does infect people who are immunosuppressed is called an opportunistic infection

A client has activated the complement system during an inflammatory response to an injury. When planning care, which information should the nurse remember about which substance activates complement?

Antibodies

While assessing a client, the nurse observes a raised scar at the site of injury. What does the nurse suspect to be the cause of this scarring pattern?

Increase in collagen levels -Presence of a raised scar at the site of injury indicates the formation of a keloid. Excessive formation of collagen increases the formation of a keloid.

The nurse is performing a pelvic examination on a client who has severe vaginal bleeding. Which physiologic change does the nurse expect to find in the client?

Increase in somatotropin levels -a pelvic examination triggers stressful stimuli and increases the secretion of somatotropin hormone

Which process in a client with a severe viral infection supports the nurse's suspicion that the client has risk of cachexia?

Increase in tumor necrosis factor - alpha

A client is in the later stages of inflammation. The client's mast cells release leukotrienes that perform which function?

Increase vascular permeability -Leukotrienes have histamine-like effects in the later stages of inflammation and stimulate increased vascular permeability and smooth muscle contraction.

When a client is stressed and epinephrine is released, which clinical manifestation will the nurse observe?

Increased blood glucose

Which effect will the nurse expect to occur when a client's body releases cortisol?

Increased gastric secretions -cortisol promotes gastric secretion in the stomach and intestines, potentially causing gastric ulcers.

Which complication will the nurse monitor for in a client who has been prescribed long-term antibiotic therapy?

Increased risk of Candida alnico's infection -prolonged treatment with antibiotics alters the normal intestinal microbiome and causes overgrowth of yeast such as Candida albicans

A nurse is asked about the primary function of plasmin in the body. What is the nurse's best response?

It degrades blood clots -The primary activity of plasmin is to degrade fibrin polymers in clots; plasmin is a component of the fibrinolytic system.

A nurse is teaching about neuropeptide Y (NPY). Which information should the nurse include in the teaching session?

It is implicated in atherosclerosis. -because NPY is a growth factor for many cells, it is implicated in atherosclerosis and tissue remodeling. NPY, a sympathetic neurotransmitter, has recently been shown to be a stress mediator.

The nurse is asked to explain the concept of psychoneuroimmunology. What is the nurse's best response?

It is the study of how the consciousness, the brain and spinal cord, and the immune system interact

Which information from the client indicates successful teaching by the nurse about the parasympathetic system?

It slows the heart rate -the parasympathetic nervous system slows the heart rate because it opposes the sympathetic system. The parasympathetic system also has anti-inflammatory effects

A client receiving antibiotics is experiencing perineal discomfort when urinating. Which microorganism should the nurse suspect is causing this client's problem?

Lactobacillus -lactobacillus is a major vaginal flora commonly found in healthy women. It helps to produce hydrogen peroxide, lactic acid, and other molecules that help to prevent vaginal infection and urinary tract Infection caused by bacteria and yeast. Lactobacilli colonization diminishes upon prolonged use of antibiotics, which increases the risk of urologic and vaginal Infection, such as vaginosis.

A client has an injury to the left leg. Which phagocytes will help the client in the early stage of inflammation?

Neutrophils -Neutrophils are the predominant phagocytes in the early inflammatory stages. Macrophages enter the site after the neutrophils; neutrophils arrive within 6 to 12 hours, whereas macrophages enter after 24 hours.

Which nursing assessment data increase the client's risk for wound dehiscence?

Obesity -Obesity increases the risk for dehiscence because adipose tissue is difficult to suture. Most wound dehiscence occurs 5 to 12 days after suturing. Age, race, and gender are not primary causes for poor wound healing. Prior surgeries are not risk factors for possible dehiscence.

A nurse is teaching about the role of C3b. Which information should the nurse include?

Opsonin -an opsonin coats the surface of bacteria and increases their susceptibility to being phagocytized

Which term should the nurse use to describe the process of "gluing" bacteria with antibodies to promote phagocytosis of the microorganisms?

Opsonization -Opsonization greatly enhances adherence by acting as a glue to tighten the affinity of adherence between the phagocyte and the target cell

Which process should the nurse include when teaching about how antibodies promote phagocytosis?

Opsonization -opsonization is the process of increasing the adherence between the phagocyte and the target cell

Which information indicates the nurse has a good understanding of pathogen-associated molecular patterns (PAMPs)?

PAMPs are molecules that are expressed by infectious agents, either found on their surface or released as soluble molecules

A child with ill-fitting shoes developed a small blister that burst, releasing clear watery fluid. How should the school nurse document this type of exudate?

Serous

The nurse is caring for a client with arthritis who is scheduled for knee replacement surgery. After reviewing the client's medical history, the nurse finds that the client is at risk for delayed wound healing. Which medication did the nurse find in the client's medical history?

Steroid -steroids inhibit migration of macrophages to the site of injury, and delay epithelialization and wound healing

How should a nurse support a hospitalized client's first line of defense against microorganisms?

Turn frequently -the skin and mucous membranes are the first barriers (the first line of defense) that microorganisms encounter when attempting to enter the body. Nursing actions that promote skin integrity, such as turning to relieve pressure, keep the skin intact.

A nurse is teaching a class to older adults about aging and the stress-age syndrome. Which information should the nurse include in the teaching session?

-increased cortisol levels -increased coagulation of blood -increased catecholamine levels (The aging process causes the following alterations: increased levels of catecholamines and cortisol; increased coagulation (hypercoagulation) of blood; and decreased levels of testosterone and thyroxine)

The nurse is caring for a client with swelling and pain at the site of a wound. Which other physiological changes does the nurse expect to find?

-increased redness -increased blood flow

Which assessment findings are classic for a client with inflammation of the knee?

-pain -warmth -swelling -loss of movement

During the initial interview, the nurse determines that a client who has anxiety caused by job stress is at risk for altered immunity. Which client statement supports the nurse's suspicion?

"I tell my family that work is great so they won't worry." -A client who tries to hide anxiety from his or her family may be using concealment as a coping strategy. This is considered a maladaptive coping strategy, which is associated with altered immunity.

Which information indicates the nurse has a correct understanding of bradykinin?

- can induce pain -increases vascular permeability -causes smooth muscle cell contraction

During wound healing a client develops contracture of scar tissue. Which problems should the nurse monitor for in this client?

- impaired blood flow - limited movement in joints

Which information from the staff indicates effective teaching by the nurse for the first line of defenses against disease?

- intact skin -mucous membranes - low skin temp

When a client is stressed and glucocorticoids are released, what do glucocorticoids regulate?

- mood -sleep -memory -cognition (overall, glucocorticoids have an important role in the homeostasis of the central nervous system)

A nurse is describing the key systems involved in allostatic overload. Which key systems should the nurse include in the teaching session?

-Cortisol -Chatacolamines -proinflammatory cytokines -decline in parasympathetic activation

Which other conditions should the nurse suspect in an older adult client with immunodepression who is experiencing chronic inflammation and alterations in lipoprotein metabolism?

-Decrease in concentrations of thyroxine -Decrease in concentrations of testosterone (with aging, sometimes a set of neurohormonal and immune alterations and tissue and cellular changes develop. These changes have been collectively defined as stress-age syndrome and include chronic inflammation, alterations in lipoproteins, hypercoagulation of blood, and decreased concentrations of thyroxine and testosterone. In stress-age syndrome, the client has increased concentrations of antidiuretic hormone and catecholamines)

The nurse is preparing information for an educational presentation on the stress-age syndrome. The nurse includes which pieces of information in the presentation?

-Free radicals will damage cells -Alterations in lipoproteins will occur -Patterns of chronic inflammation develop

While reviewing the psychological history of an adolescent client, the nurse learns that the client was sexually abused during childhood and has repressed the memories of abuse. Which conditions does the nurse look for in this client?

-Hyperglycemia -Low monocyte count (when a client represses the memories of a traumatic event, it indicates that the client uses repression as a coping style. Repression can cause a decrease in the monocyte count and an increase in serum glucose levels. Therefore, the nurse anticipates finding a low monocyte count and hyperglycemia in the client)

Which information from the staff indicates successful teaching by the nurse about the systems involved in the hypothalamic-pituitary-adrenal (HPA) axis?

-Immune Systen -Central Nervous System -Autonomic Nervous System -Endocrine System

A nurse is asked by a co-worker which physiologic changes occur when epinephrine is released during the stress response. How should the nurse reply? Select all that apply.

-Increased lipolysis -Increased blood glucose -Increased force of cardiac contraction

A client, experiencing multiple stressors simultaneously, develops sleep deprivation and uses repression as a coping mechanism. Which effects should the nurse monitor for in this client? Select all that apply.

-Lower monocyte counts -Elevated blood glucose levels -Reduced NK cell activity -Elevated EBV antibody titers

When a client's complement system is stimulated, which processes will be activated?

-Opsonization -Degranulation of mast cells -Lysis of cells through membrane disruption

Which findings will the nurse observe in a client with local inflammation of the eye? Select all that apply.

-Redness -Edema (increased vascular permeability with exudation of plasma into the tissue during inflammation causes edema. Redness (erythema) is caused by increased concentration and slowed movement of red blood cells)

During tissue injury and inflammation, the client's clotting system is activated. While planning care, the nurse chooses interventions based on which functions of the clotting system?

-Stops bleeding -Prevents spread of infection -Provides a framework for future healing

Which body fluids and secretions contain lysozymes that protect the client from invasion of gram-positive bacteria? Select all that apply.

-Tears -Saliva -Perspiration (tears, saliva, and perspiration contain a lysozyme that attacks the cell walls of gram-positive bacteria)

A nurse observes warmth and redness of the client's skin during inflammation. Which processes causes these changes? Select all that apply.

-Vasodilation -Increased vascular permeability

A client with an intestinal infection is receiving prolonged treatment with antibiotics. Which deficiencies are likely to occur in the client? Select all that apply.

-Vitamin K -Bacteriocins (prolonged treatment with antibiotics inhibits the intestinal microbiome, which synthesizes vitamin K, thereby potentially resulting in vitamin K deficiency. Prolonged antibiotic use also inhibits the production of proteins called bacteriocins that inhibit pathogens)

The nurse is explaining the stress response to another health professional. In which order should the nurse present the information?

1. A stressor is encountered 2. Sympathetic NS responds 3. Norepinephrine is released 4. Neuropeptide Y is released 5. Vasoconstriction occurs

A client is experiencing multiple stressors simultaneously. In which order does the chain of events occur during the alarm reaction when this client is stressed?

1. A stressor is sensed and the hypothalamus triggers corticotropin-releasing hormone 2. Anterior and posterior pituitary as well as the sympathetic nervous system are stimulated to release hormones 3. Norepinephrine, epinephrine, antidiuretic hormone, and adrenocorticotropic hormone are released 4. Norepinephrine increases blood pressure, and epinephrine causes bronchodilation and increased glycogenolysis 5. Blood glucose increases

A client has experienced chronic stress, which has adversely affected immunity. When explaining this to the client, in which order should the nurse present the components of the hypothalamic-pituitary-adrenal (HPA) axis?

1.Stressor is experienced 2.Hypothalamus secretes corticotropin-releasing hormone (CRH) 3.Pituitary gland produces adrenocorticotropic hormone (ACTH) 4.Adrenal glands are stimulated 5.Cortisol is released

A client has been caring for an ailing mother for 18 months. In addition, the client has recently lost a job and is having difficulty finding a new one. Blood pressure has recently been running higher than normal. What is the client experiencing?

Allostatic overload -allostatic overload is the term used to describe overactivation of adaptive regulatory physiologic systems that may lead to clinical pathophysiology and increase susceptibility of disease.

An individual has been suffering from sleep deprivation secondary to worrying about an impending divorce. This individual begins to suffer from an increased evening appetite, which eventually leads to increased caloric intake. What is this individual experiencing?

Allostatic overload -this scenario is an example of allostatic overload because the individual has been in a state of allostasis for so long it is leading to exhaustion or an overactivation of adaptive regulatory physiologic systems

A client reports feeling short of breath and nervous while waiting to be called in for a diagnostic test. Which type of response is the client experiencing?

Anticipatory response -the anticipatory response occurs when physiologic responses develop in anticipation of psychologic stress or threat. In this case, the individual is experiencing anxiety and has developed an increased respiratory rate. Anticipatory responses can be generated by the fear of a potential encounter with a dangerous, unconditioned stimulus (such as a predator) or in conditioned situations when a person learns that a specific event was associated with an aversive situation

A client with an upper respiratory tract infection has nasal congestion. During the assessment, the nurse finds that the client's blood pressure is 120/80 mm Hg and rate of respiration is 15 breaths/minute. The nurse should check the client's prescription for which category of medication to help with the congestion?

Antihistamines - infection and inflammation increase histamine levels and cause increased vessel permeability and swelling, causing nasal congestion in the client. Antihistamines block the binding of histamine to its receptors, which decreases inflammation and nasal congestion caused by infection. Therefore, the nurse would expect to find antihistamine medications in the client's prescription

A client's heart rate variability is evaluated. Which parameter is assessed?

Balance of parasympathetic and sympathetic nervous system -researchers evaluate the relative balance of the parasympathetic and sympathetic nervous systems using a technique known as heart rate variability (the measurement of R wave variability from heartbeat to heartbeat).

A client states that there was a lot of drainage from the wound and it felt like "something gave way." What does the nurse expect the client is experiencing?

Dehiscence

A client is experiencing multiple stressors simultaneously. What are potential behavioral responses that may occur during this initial period of stress?

Changes in dietary intake, smoking, drinking, and sleep disturbances

Which information indicates the nurse has a good understanding of chronic inflammation?

Chronic inflammation causes differentiation of macrophages into epithelioid and giant cells.

A nurse is educating a health class about stress-related diseases and conditions like cardiovascular disease, osteoporosis, and type 2 diabetes mellitus. Which pathophysiologic process that is common to all these diseases will the nurse include in the teaching session?

Chronic inflammatory processes play a clinical role -several conditions with variable pathophysiologic characteristics appear to have a common origin relating to chronic inflammatory processes. These conditions include cardiovascular disease, osteoporosis, arthritis, and type 2 diabetes mellitus.

The nurse is reviewing the laboratory reports of four clients who each underwent an appendectomy for appendicitis. Which client is at the highest immediate risk for wound dehiscence? Client A: increase in white blood cell count Client B: decrease in blood glucose levels Client C: decrease in estrogen levels Client D: increase in thyroid stimulating hormone levels

Client A -an increase in a client's white blood cell count is an indication of infection. Wound dehiscence is associated with infection approximately half of the time.

The nurse is evaluating the coping skills of a few clients experiencing stress. Which clients have maladaptive coping strategies? Select all that apply Client A: " I close my eyes and visualize a happy moment of my life during stress" Client B: "I eat several chocolate bars to help me concentrate during stressful exams Client C: "I take slow deep breaths when i'm stressed" Client D: "I drink herbal tea when i'm stressed" Client E: "I find ways to avoid situations and interactions that stress me out"

Client B and Client E

The nurse has assessed several assigned clients who are stressed. What should the nurse conclude from these findings? Client A: has thin extremities Client B: has hepatic insulin resistance Client C: has elevated ratio of intra-abdominal subcutaneous fat mass to non abdominal fat mass Client D: has moon face and buffalo hump

Client D is at increased risk to develop metabolic syndrome. -client D has moon face and buffalo hump indicating an increase in glucocorticoids. This manifestation could lead to the development of metabolic syndrome

The home health nurse is visiting a female client with a chronic ventricular dysrhythmia for a health check. The client states that she has received news this morning that the company she worked for has filed for bankruptcy and she will no longer be receiving a pension or health insurance. What is the nurse's greatest concern?

Client will be at increased risk for sudden cardiac death -intense or unusual acute stress precipitates about 20% of serious ventricular dysrhythmias or sudden cardiac deaths

Which information from the staff indicates effective teaching by the nurse for substances that act as opsonins?

Complement proteins -the most potent opsonin produced by the complement system (plasma proteins) is C3b; antibodies are also efficient. Antibodies are made against antigens on the surface of bacteria and are highly specific to that particular microorganism

A client is experiencing physiologic stress. The nurse monitors the client for increased blood glucose levels. What is the rationale for the nurse's action?

Cortisol is released -Cortisol increases blood glucose levels by stimulating gluconeogenesis in the liver and promoting other hormones such as epinephrine, glucagon, and growth hormone to increase glucose.

A client is stressed and releases cortisol. Which physiologic effect of cortisol does the nurse expect to occur?

Decreased bone formation

A nurse is explaining how a leukocyte moves through inter-endothelial junctions to the site of tissue injury. Which term should the nurse use to describe this process?

Diapedesis -Diapedesis is the process in which a leukocyte moves between endothelial cells to enter the tissues

A client has chronic stress that eventually leads to a stress-related condition. Which term should the nurse use to describe this condition?

Disease of adaptation

Which finding will the nurse use to make the clinical determination that a child is most likely experiencing a reactive stress response?

Fear of examination -reactive stress response is a physiologic response derived from psychological stressors. The most probable reason for the child's stress response would be the fear of an examination. The stress may produce dry mouth and an increased heart rate.

The nurse is assessing the coping strategies of a client as part of risk factor management for the client's high blood pressure. Which assessment finding should the nurse identify as a maladaptive coping strategy?

Eating twice a day, rather than 3 times a day -maladaptive coping can result in a change in behavior contributing to potentially adverse health effects (e.g., increased smoking, change in eating habits). Mediation, yoga, and biofeedback are adaptive coping strategies. Exercise and social support have also been found to be effective stress relievers.

What is a client's first line of defense against infection?

Epithelia cell-derived chemicals

A nurse is discussing antimicrobial peptides, defensins, collectins, and mannose-binding lectin. What is the nurse describing?

Epithelial cell-derived chemicals

A nurse is asked which hormone is known to exert a calming effect during stressful situations. How should the nurse reply?

Estrogen -in concert with oxytocin, estrogen exerts a calming effect in stressful situations.

A client develops a stress-related disease. Which stage of the general adaptation syndrome marked the onset of this disease?

Exhaustion

A client is in phase II of wound healing. Which cells produce collagen during tissue healing?

Fibroblasts -Fibroblasts are important cells during healing because they secrete collagen and other connective tissue proteins.

Which term should the nurse use to describe a client's nonspecific response to noxious stimuli?

General adaptation syndrome -selye concluded that this triad or syndrome of manifestations represented a nonspecific response to noxious stimuli, naming it the general adaptation syndrome (GAS). Noxious stimuli that activate the general adaptation syndrome are termed stressors

A client has a chronic infection of Listeria that the body cannot fight. Which pathophysiologic process should the nurse monitor for in this client?

Granuloma -If macrophages are unable to protect the host from tissue damage, the body attempts to wall off and isolate the infected area, thus forming a granuloma; this often occurs with chronic Listeria infection (listeriosis)

The nurse caring for a client with poorly controlled diabetes mellitus gives priority to assessment for postoperative wound infection. What is the best rationale for the nurse's actions?

Hyperglycemia suppresses the activity of macrophages -Consequences of hyperglycemia also include suppression of macrophages and increased risk for wound infection

Which laboratory test result will the nurse expect to find in a client with acute inflammation?

Leukocytosis -Leukocytosis is one of the three primary systemic changes associated with acute inflammation

Several days before abdominal surgery, the client experiences nausea and vomiting and is unable to eat any food. The nurse closely monitors this client's wound healing after surgery. What is the rationale for the nurse's actions?

Malnutrition causes reduced tensile strength -malnutrition increases the risk for wound infection, delays healing, and reduces wound tensile strength.

A client sprains the left ankle. Before assessing the client for the classic signs of inflammation, the nurse remembers which cell type is responsible for the changes?

Mast cells -The mast cell is probably the most important cellular activator of the inflammatory response. At a site of tissue damage, histamine is released from mast cells and produces many of the classic signs of inflammation.

A client is having pain in an injured area. The nurse administers a nonsteroidal anti-inflammatory drug (NSAID). What is the rationale for the nurse's action?

NSAIDs block the synthesis of prostaglandins -Although NSAIDs inhibit prostaglandin production and suppress acute inflammation and relieve pain, they also can delay wound healing.

A client has a diagnostic test in which an intravenous needle is inserted into the right arm. Which type of stressor did the client experience?

Physiologic stressor -Physiologic stress is a chemical or physical disturbance produced by a change in the external environment or within the body itself.

A client had surgery two days ago. As part of the postoperative discharge education, the nurse teaches the client about prescribed activity limitations for the next few weeks. The client lets the nurse know that going back to work quickly is essential. Which principle should underlie the nurse's response?

Proliferation and remodeling stages are necessary for a healing wound to be strong. -the client needs to know that tissue healing has several stages and that the incision is not yet healed and strong. Early return to work and increased stress on the healing wound may impair effective healing. Although inflammation is the necessary first stage in healing, this does not address the issue that it will take time to complete healing of the surgical incision

While reviewing the laboratory reports of a newborn, the nurse finds that the newborn has α1-antitrypsin deficiency. Which test should be prescribed later in the child's life to determine effects?

Pulmonary functioning test -deficiency of α1-antitrypsin results in chronic lung damage and emphysema due to inflammation. Performing pulmonary function testing will help provide effective treatment. α1-antitrypsin is secreted by the liver

When a client's body continues to mobilize and react to the actions of cortisol, norepinephrine, and epinephrine, which stage of the general adaptation syndrome is the client experiencing?

Resistance

Which information indicates the nurse has a good understanding of the stress response and the immune system?

T cell growth factor interleukin-2 can up-regulate adrenocorticotropic hormone (ACTH).

The nurse is caring for a client with posttraumatic stress disorder. After assessing the client, the nurse concludes that the client is at risk for coronary heart disease. Which finding supports the nurse's conclusion?

The client's blood pressure is 130/90 mm Hg. -a blood pressure of 130/90 mm Hg indicates that the client has prehypertension. One of the primary risk for coronary heart disease is hypertension. A new designation of prehypertension was recently created and found to be a good predictor for future cardiovascular events. Prehypertension is defined as a systolic blood pressure of 120 to 139 mm Hg or a diastolic blood pressure of 80 to 90 mm Hg.

A client asks what it means when the primary healthcare provider refers to the complement system in regard to infection. What is the nurse's best response?

The complement system is a set of proteins in the blood that help activate the body's inflammatory and immune response to infection

A client has a low pH of urine and stomach contents. How should the nurse interpret these findings?

The first line of defense is working -pH is a barrier against infection and is considered a first line of defense.

Cortisol has an anabolic effect on protein in which area of a client's body?

The liver -It has an anabolic effect; that is, it increases the rate of synthesis of proteins and ribonucleic acid (RNA) in the liver. This is countered by its catabolic effect on protein stores in other tissues. Protein catabolism acts to increase levels of circulating amino acids; therefore chronic exposure to excess cortisol can severely deplete protein stores in muscle, bone, connective tissue, and skin.

A client has an inflammatory response. Upon assessment, the nurse finds edema in the client's foot. What caused the edema?

Vascular permeability

A client's immune system activates interferons. Which type of organism should the nurse suspect is causing this reaction?

Viruses -virally infected cells produce interferons, which activate immune defenses against viral invasion in neighboring healthy cells.

When should the nurse chart that the client has fibrinous exudate?

When thick, clotted exudate, from severe inflammation, occurs -fibrinous exudate is thick and sticky, because it contains large amounts of fibrin

When should the nurse chart that the client has purulent exudate?

When whitish-yellow exudate, containing many leukocytes, occurs -Purulent exudate (pus) is whitish-yellow, because it contains many white blood cells and pus

A client injures the left leg. When will the nurse expect substantial numbers of neutrophils to arrive at the site of injury?

Within 6-12 hours -Neutrophils are the predominant phagocytes in the early inflammatory site, arriving within 6 to 12 hours after the initial injury. Macrophages enter the site after 24 hours or later, but usually arrive 3 to 7 days later.

A client has an infection and the neutrophil level is elevated. Which function are the neutrophils providing for the client?

phagocytosis -The major function of neutrophils is phagocytosis.