Pathophysiology Exam 2 PrepU Questions

A nursing student asks her instructor, "I don't understand this coagulation system. When we donate blood, what keeps it from clotting in the bag?" The instructor responds: -"If the blood is used within 24 hours from retrieval, there will be no clot formation yet." -"Citrate is added to the blood bag, which prevents it from clotting." -"Calcium gluconate is added to the bag to keep it from clotting." -"The blood bank adds heparin to every bag prior to actually collecting the blood from the donor."

"Citrate is added to the blood bag, which prevents it from clotting."

A nursing faculty is teaching students about hematopoiesis in the fetus. The nurse validates student learning based on which statement?

"Hematopoiesis begins during the fifth week of gestation in endothelial cells of the developing blood vessels."

Which statement about natural killer (NK) cells is the best explanation of their function when reviewing laboratory work for a 10-year-old child?

"The primary job of natural killer (NK) cells is to hunt down and destroy foreign cells in the body."

The nurse is reviewing the process of hematopoiesis from conception to adulthood with a student. The nurse outlines where blood cells are formed. Place each option in order from earliest to latest. Use all options.

1 - Yolk sac 2 - Liver and spleen 3 - Long bone marrow 4 - Flat bone marrow

What is the typical life span of mature red blood cells? 90 days 30 days 120 days 10 days

120 days

Place the following in the sequence of the progression of HIV/AIDS on a cellular level.1)The HIV virus is uncoded.2)HIV attaches to the receptors on the CD4+ cell.3)DNA synthesis occurs by reverse transcription.4)Transcription of the DNA to form a single-strand messenger RNA. 3,4,1,2, 4,3,1,2 1,2,3,4 2,1,3,4

2,1,3,4 Explanation: The first step involves the binding of the virus to the CD4+ T cell. The second step allows for the internalization of the virus. After attachment, the virus envelope peptides fuse to the CD4+ t-cell membrane. Fusion results in uncoding of the virus. The third step consists of DNA synthesis by reverse transcription. The fourth step is integration. The fifth step involves transcription of the double-stranded viral DNA to form a single-stranded messenger RNA.

The nurse evaluating a client's blood work determines that a client has an increased risk for infection based on which lab result? Absolute neutrophil count of 1100/μL (1.1 x 109/L) Absolute neutrophil count of 1200/μL (1.2 x 109/L) Absoulute neutrophil count of 1000/μL (1.0 x 109/L) Absolute neutrophil count of 800/μL (0.80 x 109/L)

Absolute neutrophil count of 800/μL (0.80 x 109/L)

Which plasma protein is considered the most abundant type?

Albumin

Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body? -Increases prothrombin -Increases procoagulation factors -Increases vitamin K-dependent factors in the liver -Alters vitamin K, reducing its ability to participate in the coagulation of the blood

Alters vitamin K, reducing its ability to participate in the coagulation of the blood

Which factor is considered during serology testing? DNA sequencing Direct antigens Culture growth Antibody titers

Antibody titers Explanation: Serology samples are used to identify infectious organisms by measuring the levels of antibodies. Certain antibodies will increase in numbers in response to certain organisms. Other laboratory methods for identifying infectious organisms are cultures, detecting antigens directly, and DNA sequencing.

Substances foreign to the host that can stimulate an immune response are known as: MHC proteins Antigens Cytokines Antibodies

Antigens Explanation: Antigens are foreign substances that stimulate an immune response. Antibodies are innate and will adapt to the antigen. MHC proteins aid in the identification process of host cells. Cytokines are signaling molecules of the immune system.

The nurse is reviewing the laboratory results of a newborn. The infant has anemia, thrombocytopenia, and granulocytopenia (pancytopenia). Based on these results, the nurse anticipates the diagnosis of which type of anemia?

Aplastic anemia

In primary immune thrombocytopenia purpura (ITP), the client has which type of disorder that primarily destroys which blood component? -Autoimmune; platelets -Alloimmune; factor VIII -Immunoglobulin; B cells -Allergic; fibrinogen

Autoimmune; platelets

The nurse reviews the lab results of a client who has a thrombocyte count of 60 ×103/µL (60 ×109/L). The client is at risk for: -Disseminated intravascular coagulation -Deep vein thrombosis -Hypercoagulation -Bleeding

Bleeding

The nurse is assessing an 83-year-old adult client for signs and symptoms of anemia. What normal, age-related change increases this client's risk for anemia? Up to 20% of the RBCs in older adults are incapable of carrying oxygen. Blood cells are not replaced as quickly as they are in younger clients. Gastrointestinal "microbleeds" are common after age 75. Aplastic anemia is common in older adults and the risks increase with each decade.

Blood cells are not replaced as quickly as they are in younger clients.

After birth, red blood cells are normally made in which location? Bone marrow Spleen Kidneys Liver

Bone marrow

Select the option that best describes the production of T lymphocytes. Myocardial tissue → bone marrow → lymph nodes Bone marrow → thymus → lymph nodes Plasma cells → lymph nodes → arteries Bone marrow → plasma cells → lymph nodes

Bone marrow → thymus → lymph nodes

The nurse caring for a client in the early stage of multiple myeloma would anticipate the client to report which symptom? Hypercalcemia Kidney failure Bone pain Pathologic fractures

Bone pain

Which is considered a function of plasma?

Carrying nutrients

Clients with lung disease can develop polycythemia as a result of which condition? Hyperventilation Excessive respiratory fluid loss Decreased blood viscosity Chronic hypoxia

Chronic hypoxia

Although the usual site for a bone marrow test is the posterior iliac crest, other sites include the anterior iliac crest and the sternum. What are the dangers of using the sternum for a bone marrow test in children?

Danger of perforating the mediastinum and heart

Sexually transmitted infections (STIs) are typically spread by which mechanisms? Ingestion Vertical transmission Direct contact Penetration

Direct contact Explanation: Most STIs are spread by direct contact. Vertical transmission is possible for many sexually transmitted pathogens, but direct contact is more common. Ingestion and penetration are less likely mechanisms

What are the components of blood? Select all that apply.

Enzymes Electrolytes

Which colony-stimulating factor (CSF) is given to clients with end-stage renal disease to help with chronic anemia?

Erythropoietin (EPO)

A pregnant woman contacts her physician because she has developed sudden, severe pain and swelling in her left lower leg. The physician explains to her that her past medical includes an inherited defect in factor V Leiden, which predisposes her to the development of: -Platelet disorders -Abnormal bleeding -Thrombocytopenia -Excessive clotting

Excessive clotting

A client being treated for polymyalgia rheumatica (PMR) comes to the clinic for a follow-up visit. The current erythrocyte sedimentation rate (ESR) rate has decreased from 60 mm/hour to 30 mm/hour and the client is afebrile, denies any headaches, and reports a decrease in joint pain and fatigue. Based on these findings, the nurse anticipates which change to the treatment plan?

Gradually decrease the current dosage of prednisone and repeat ESR in 2 weeks.

A lymph node biopsy pathology report notes the presence of Reed-Sternberg cells on a client suspected of having a lymphoma. The nurse interprets the report as indicating: Non-Hodgkin lymphoma Leukemia Hodgkin lymphoma Multiple myeloma SUBMIT ANSWER

Hodgkin lymphoma

Which client experiencing an abnormally low neutrophil count (neutropenia) could have developed this as a side effect to his or her medical regimen?

Hyperthyroidism being treated with propylthiouracil to maintain normal metabolic rate

A client with chronic idiopathic thrombocytopenia purpura (ITP) asks the nurse what causes all the nosebleeds that have been occurring. Which response by the nurse would be mostaccurate? -Dysfunctional B cells -Platelets that are dysfunctional -Platelet deficiency -Immune cells are destroying the platelets

Immune cells are destroying the platelets

Which function is the main job of lymphocytes?

Immune reaction

The nurse is caring for a pediatric client who will be having bone marrow aspiration from the posterior iliac crest. The parent asks why the sternum is not used to obtain the sample as this is the site used for another relative. How does the nurse respond?

In children, the sternal bone marrow cavity is much more shallow, increasing risk for damage to underlying organs.

A client attending a health fair asks how anthrax will be treated in the event of a bioterrorism attack. How should the nurse respond? Everyone should have an emergency supply of antibiotics to take in case of an attack. If you have anthrax, you will need infusion of antitoxins. Anthrax is a virus that spreads by spores that can be inactivated with disinfectants. Individuals who are exposed will be isolated and given antibiotics.

Individuals who are exposed will be isolated and given antibiotics. Explanation: Potential agents to be used in a bioterrorism attack include the bacillus that causes anthrax. Anthrax spreads by spores found in infected secretions, soil, or animal products. This microbe is susceptible to antibiotic treatment. Disinfecting the area will not treat the infected individual.

The course of any infectious disease progresses through several distinct stages after the pathogen enters the host. Although the duration may vary, which sign/symptom is the hallmark of the prodromal stage? Tissue inflammation and damage Containment of infectious pathogens Initial appearance of symptoms Progressive pathogen elimination

Initial appearance of symptoms Explanation: The prodromal stage follows inoculation (the initial stage) and is identified by the initial onset of symptoms in the host. Tissue inflammation and damage is evident during the acute (third) stage. Pathogen elimination and containment are characteristic of the convalescent (fourth) period, which follows the acute stage.

The rate at which hemoglobin is synthesized depends on availability of which substance? Glucose Iron Calcium Oxygen

Iron

Which statements about acquired agranulocytosis are correct? Select all that apply. It is usually caused by drugs. The major clinical problem is viral infections. The platelet count is usually high. It is usually caused by autoimmune disease.

It is usually caused by drugs. It is usually caused by autoimmune disease. The major clinical problem is viral infections.

Which type of macrophages are found in the liver?

Kupffer cells

The pediatrician knows that the most common cause of cancer in children is: Leukemia Infectious mononucleosis Non-Hodgkin lymphomas Multiple myeloma

Leukemia

A client's bone marrow study report reveals the findings of blast cells in the bone marrow. What does the nurse interpret this as indicating? Non-Hodgkin disease Hodgkin disease Neutropenia Leukemia

Leukemia Explanation: The finding of blast cells in the bone marrow is indicative of leukemia.

Which factor differentiates chronic leukemias from acute leukemias? The prevalence among individuals with Down syndrome is high. Leukemic cells are more fully differentiated in chronic than in acute leukemias. They are cancers of the hematopoietic progenitor cells. Leukemic cells are disseminated throughout the body by the circulatory system.

Leukemic cells are more fully differentiated in chronic than in acute leukemias. In contrast to acute leukemias, chronic leukemias are malignancies involving proliferation of more fully differentiated myeloid and lymphoid cells. Down syndrome is associated with acute leukemias, and both acute leukemias and chronic leukemias involve systemic distribution of leukemic cells.

An obstetrics nurse is counseling an expectant mother. The mother is concerned about letting people hold her baby once the baby is born, fearing that the infant will get sick. What should the nurse explain to the mother? Abundant lymphoid tissues protect the infant in the first few months of life. The innate immune system will protect the baby. IgA that is present at birth, and which originates with the mother, will protect the baby, Maternal immunoglobulins cross the placenta and protect the newborn early in life.

Maternal immunoglobulins cross the placenta and protect the newborn early in life. Explanation: Passive immunity is immunity transferred from another source. An infant receives passive immunity naturally from the transfer of antibodies from its mother in utero and through breast milk. Maternal IgG crosses the placenta and protects the newborn during the first few months of life. Innate immunity are not effective yet, and protection is unrelated to the amount of lymphoid tissue.

Which disorder does the nurse know is considered to be an autoimmune disease? Myasthenia gravis Osteoarthritis Diverticulitis Rhabdomyolysis

Myasthenia gravis Explanation: Autoimmune disorders are those in which the immune system attacks body tissues. Some autoimmune disorders attack specific body systems while others are systemic. Systemic autoimmune disorders include rheumatoid arthritis, scleroderma, and systemic lupus erythematosus. Other autoimmune diseases include idiopathic thrombocytic purpura, Hashimoto thyroiditis, Type 1 diabetes mellitus, myasthenia gravis, primary biliary cirrhosis, temporal arteritis, Crohn's disease, and ulcerative colitis. Rhabdomyolysis is a disorder of muscle breakdown that typically follows injury or medications such as statins. Diverticulitis is inflammation of outpouchings of the colon. Osteoarthritis is joint destruction from wear and tear.

Which is the most common leukocyte in normal blood?

Neutrophils

Which statement correctly identifies the role of the C3b subcomponent of the complement system? Lyses cells Dilates arterioles Opsonizes microbes to facilitate phagocytosis Induces rapid degranulation of mast cells

Opsonizes microbes to facilitate phagocytosis Explanation: C3b is a key opsonin that coats bacteria and allows them to be phagocytized.

The client with chronic kidney disease and congestive heart failure is weak and dyspneic. Lab work reveals a hemaglobin of 6.5 g/dL (65 g/L). Which type of blood product will the provider order? Plasma Albumin Packed red blood cells Whole blood

Packed red blood cells

A woman experiences a viral infection while pregnant. Which type of immunity does an infant have at birth against this infection? Tolerance Passive Active Adaptive

Passive Explanation: Passive immunity is when the antibodies against an antigen are transferred directly to the host, such as when a fetus gains from the mother's immune system. Active immunity is acquired through exposure to antigens, and having the B and T lymphocytes develop a response. Tolerance is the ability of the immune system to react to foreign substances but not the body cells. Adaptive immunity is when the immune system responds to antigens and is moderated by B and T lymphocytes.

Transmission of the rabies virus from a dog bite would be best described by which mechanism of entry? Ingestion Inhalation Direct contact Penetration

Penetration Explanation: Penetration involves the disruption of the body's surface barrier as would be seen in a dog bite. Direct contact involves contact between infected tissue and target tissue. Inhalation is via the lungs. Ingestion is consumed.

A 75-year-old client with a history of heart valve replacement arrives at the outpatient clinic with multiple red pinpoint lesions. The nurse identifies the lesions as: -Erythema -Ecchymoses -Petechiae -Purpura

Petechiae

A nurse performing a skin assessment on an older adult notes small pinpoint hemorrhages and purple areas of bruising over the lower extremities. The nurse documents these as the presence of which abnormality? -Hyperpigmentation and lentigines -Senescence and skin tags -Macular rash with keratosis -Petechiae and purpura

Petechiae and purpura

The nurse is preparing a client with suspected leukemia for a bone marrow and biopsy. What preferred site will the nurse be sure is accessible for the physician? Posterior iliac crest Cervical spinous process Anterior femur Clavicle

Posterior iliac crest

Which anatomical site would the nurse expect to monitor when caring for an adult client who has just had a bone marrow aspiration performed? Radial artery Posterior iliac crest Antecubital space Head of the femur

Posterior iliac crest

A client is admitted with a suspected diagnosis of Hodgkin lymphoma (HL). Which diagnostic test would the nurse look for to confirm the diagnosis? Positive Bence Jones proteins Presence of Reed-Sternberg cells Epstein-Barr virus H. pylori infection

Presence of Reed-Sternberg cells

Following peripheral blood testing and a bone marrow biopsy, a client has been diagnosed with chronic myelogenous leukemia. Which abnormality is most likely to have preceded the client's diagnosis? Presence of a Philadelphia chromosome Exposure to the Epstein-Barr virus Radiation exposure Down syndrome

Presence of a Philadelphia chromosome Chronic myelogenous leukemia develops when a single, pluripotent hematopoietic stem cell acquires a Philadelphia chromosome. Down syndrome and radiation exposure are associated with acute leukemias, and exposure to the Epstein-Barr virus is not implicated in the etiology of leukemias.

A client newly diagnosed with the neurodegenerative disease Creutzfeldt-Jakob disease (CJD) asks why antibiotics are not part of the treatment plan. How should the nurse respond? Antifungals are needed to kill CJD. CJD is only susceptible to antiretrovirals. Anaerobic parasites are destroyed by oxygen. Prions are not affected by antibiotics.

Prions are not affected by antibiotics. Explanation: Transmissible neurodegenerative diseases such as kuru, Creutzfeldt-Jakob disease, and bovine spongiform encephalopathy (BSE) in cows are caused by prions. Prions are proteins that do not contain genetic material, but are believed to replicate by binding to the cell surface and using cellular materials. Because prions are very stable and lack nuclear material or metabolic processes they are not vulnerable to any current antimicrobial therapy.

When an Rh-negative mother has been sensitized and is pregnant with an Rh-positive fetus, what happens to the fetus? Bilirubin deficiency Plasma volume depletion Nothing, this is normal Profound red cell hemolysis

Profound red cell hemolysis

A young adult is preparing to begin treatment for non-Hodgkin lymphoma (NHL), a disease that has disseminated widely. What is the most likely treatment regimen for this client? Bone marrow or stem cell transplantation Surgery, whole-blood transfusion, and chemotherapy Radiation, chemotherapy, and biotherapy Antiviral medications

Radiation, chemotherapy, and biotherapy Explanation: NHL is normally treated with either radiation (early stage) or radiation and chemotherapy (later stages). Because most people who present with indolent lymphoma have disseminated disease at the time of diagnosis, combination chemotheapy, biotherapy, and adjuvant radiation therapy are recommended. Antivirals, blood transfusion, surgery, bone marrow transplantation, and stem cell transplantations are not common treatment modalities for NHLs.

What is the name of the fluid that remains after blood clots in a blood specimen vial?

Serum

The treatment prescribed for an autoimmune disorder is primarily dependent upon what? The current manifestations of the disease and the mechanisms that cause the disease process The age and gender of the client The presence of existing chronic disorders and the client's medical history Corticosteroids is always the first line of treatment.

The current manifestations of the disease and the mechanisms that cause the disease process Explanation: Treatment of autoimmune disorders is dependent upon the magnitude of the presenting manifestations and underlying mechanisms of the disease process. Since in many cases the pathophysiologic mechanisms are not always known, treatment may be purely symptomatic. While corticosteroids are often use, they are not always the first line of treatment. The client's age and medical history can be factors in treatment choices but are not the primary consideration.

The nurse is caring for a 2-day-old newborn infant who appears lethargic and has a yellowish tint to the skin. Select the most likely cause of this newborn's signs and symptoms. A decrease in the breakdown of red blood cells Cirrhosis of the liver The inability of the immature liver to conjugate bilirubin The inability of a newborn to produce bilirubin

The inability of the immature liver to conjugate bilirubin

The parents of a newborn are concerned because the infant's skin has a yellow color. What education should the nurse discuss with the parents? -The parents need to watch the infant's diet to avoid too many fats. -The parents need to learn to assess their child for brain damage. -The parents need to know about liver failure. -The parents need to be taught about hyperbilirubinemia and common treatment modalities.

The parents need to be taught about hyperbilirubinemia and common treatment modalities.

A 45-year-old client requires a bone marrow sampling to examine hematopoietically active marrow. The nurse informs the client that the sample may be obtained from what sites? Select all that apply.

The posterior pelvis (iliac crest) The breast bone (sternum)

The nurse is teaching a client about how a vaccine can help create immunity to a virus. What information does the nurse provide?

The vaccine causes B lymphocytes to create antibodies against the virus.

A 6-year-old child is having a stem cell transplant using umbilical cord blood. What benefit does the nurse understand that this type of transplant will have for the child?

This type of transplant creates less risk of graft versus host disease

A client was started on 5000 units of heparin twice daily. For which immune response-associated health problem should the nurse monitor this client? -Thrombocytopenia -Disseminated intravascular coagulation (DIC) -Antiphospholipid syndrome -von Willebrand disease

Thrombocytopenia

Levels A, B, and C are levels assigned to potential agents of bioterrorism. What are these categorical assignments based on? Environmental impact Ease of use to terrorist Transmissibility Safety to terrorist

Transmissibility Explanation: Potential agents of bioterrorism have been categorized into three levels (A, B, and C) based on risk of use, transmissibility, invasiveness, and mortality rate.

A nurse is caring for a client who has sustained severe trauma and has developed disseminated intravascular coagulation (DIC). The nurse will explain this complication to the family based on which physiologic principle? -Widespread coagulation and bleeding in the vascular compartment -Bleeding due to structurally weak vessels resulting from vitamin C deficiency -Impaired platelet function due to vitamin K deficiency -Thrombocytosis as a result of widespread infection

Widespread coagulation and bleeding in the vascular compartment

The process of clot retraction squeezes serum from the clot, thereby joining the edges of the broken vessel. Through the action of actin and myosin, filaments in platelets contribute to clot retraction. Failure of clot retraction is indicative of: -a low platelet count. -absence of factor Xa. -an overabundance of factor Xa. -a high platelet count.

a low platelet count.

The nursing caring for a 62-year-old client with diffuse large B-cell lymphoma plans care based on the knowledge that this client's lymphoma is: encapsulated. aggressive. indolent. rare.

aggressive.

A client asks, "What do these basophils and mast cells do in the body?" The health care provider responds that they:

are involved when you have an allergic reaction

A fomite is a/an: natural disinfectant. natural antibiotic. infection transfer agent. tick-like ectoparasite.

infection transfer agent. Explanation: Inanimate objects that carry an infectious agent are known as fomites.

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Many different proteins, enzymes, and hormones are involved in maintaining hemostasis. Which protein is required for platelet adhesion? -Platelet factor 4 -Ionized calcium -Growth factors -von Willebrand factor

von Willebrand factor

A parent brings a 6-month-old infant to the primary care physician to treat the infant's third respiratory infection since birth. What explanation will the nurse give for the order to administer intravenous immunoglobulin (IVIg)? "IVIg supplements the infant's immunity to prevent recurrent infection." "This medication helps prevent infection through the school years." "Immunosuppressive agents are needed to treat an autoimmune disorder." "Without this drug, the infant will develop anaphylactic reactions when older."

"IVIg supplements the infant's immunity to prevent recurrent infection." Explanation: Transient hypogammaglobulinemia is a condition that occurs when one or more of the serum Ig levels is reduced. Symptoms usually appear when the maternal IgG antibody levels decline during the first 6 months of life and the infant's immune system is unable to synthesize adequate Ig on its own. The most frequent manifestations include upper and lower respiratory tract infections, allergies, and allergic asthma. Treatment includes antibiotics and intravenous immunoglobulin (IVIg) to stop the cycle of infection. Most cases resolve spontaneously by age 3 years.

The neonate displays a yellow discoloration of her skin on the third day of life. The neonatologist explains this condition to the parents. Which statement is most accurate? "Breast-feeding will not affect the bilirubin levels." "Hyperbilirubinemia places the neonate at risk for a cardiac condition known as kernicterus." "The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown." "Most neonatal jaundice resolves spontaneously within 6 weeks."

"The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown."

A client tells the health care provider he has heard several myths about viruses. The most appropriate information for the nurse to provide would be: "Viruses can produce symptoms of disease months to years later." "Viruses are capable of replicating outside of a living cell." "Viruses kill cells they come in contact with immediately." "Viruses do not require a host cell to replicate."

"Viruses can produce symptoms of disease months to years later." Explanation: Viruses can produce symptoms of disease months to years later. Some viruses, such as hepatitis C, can remain latent for long periods of time without causing disease until months to years later. Viruses are incapable of replicating outside of a living cell and are incapable of replication unless in a host cell. Not every virus causes lysis and death of the host cell during replication.

Which client scenario best describes an example of infection originating with a fomite? 32-year-old man who contracts hepatitis B by sharing a syringe 22-year-old woman who contracts Lyme disease after a tick bite 44-year-old man who has trichinosis after eating undercooked pork 44-year-old nurse who tests positive for tuberculosis (TB) after admitting a TB-positive client

32-year-old man who contracts hepatitis B by sharing a syringe Explanation: An object that carries an infectious organism, such as a dirty syringe, is known as a fomite. Airborne contact with TB does not utilize a fomite, and infection by way of contact with an infected arthropod constitutes zoonosis. Consuming ova in meat would constitute infection by ingestion.

Which client has the highest risk of contracting an opportunistic infection? A client who has had HIV for 3 years and has a CD4+ count of 50 cells/μL A client who has had HIV for 30 years and has a CD4+ count of 1000 cells/μL A client who has had HIV for 10 years and has a platelet count of 200/mL A client who recently contracted HIV with a viral load of 1 million copies/mL

A client who has had HIV for 3 years and has a CD4+ count of 50 cells/μL Explanation: The lower the CD4+ T-cell count is, the higher the likelihood of contracting an opportunistic infection. In a client who is newly infected with HIV, the CD4+ T-cell count would he high, even though the viral load is high. Platelets are not an important factor when considering the opportunity for an infection.

Which individual is experiencing a health problem that is the result of a parasite? A woman who developed hepatitis A from eating at an unhygienic restaurant A hospital client who has developed postoperative pneumonia A man who acquired malaria while on a tropical vacation A college student who contracted Chlamydia trachomatis during an unprotected sexual encounter

A man who acquired malaria while on a tropical vacation Explanation: Malaria is caused by a parasite. Chlamydial infections are bacterial, whereas hepatitis is viral. Pneumonia may be either viral or bacterial.

The nurse is caring for a client with chronic myelogenous leukemia (CML) and notes that the client has splenomegaly and an increased basophil count as well as night sweats, bone pain, and a low grade fever. The nurse interprets the symptoms as indicating that the client is in which phase of the clinical course of CML? Terminal Accelerated Chronic Remissive

Accelerated Explanation: The acclerated phase of CML is characterizd by splenomegaly, increase in basophil count, low grade fever, night sweats, bone pain, and weight loss as well as bleeding and bruising.

To form a platelet plug, platelets are attracted to the damaged vessel. What then occurs within the blood vessel? -Thrombosis -Fibrinolysis -Adhesion of the platelets -Thromboxane A2

Adhesion of the platelets

A client with a diagnosis of hemophilia A has been admitted with bilateral knee pain. The nurse should anticipate performing what intervention during the client's treatment? -Protective isolation and daily administration of subcutaneous vitamin K to prevent bleeding -Administration of factor VIII and implementation of fall prevention measures -Passive range of motion exercises and transfusion of platelets -Administration of corticosteroids and desmopressin acetate (DDAVP)

Administration of factor VIII and implementation of fall prevention measures

Select the type of lymphocyte that matures in the bone marrow. T lymphocytes Macrophages B lymphocytes Cytotoxic T lymphocytes

B lymphocytes Explanation: B lymphocytes mature in the bone marrow and are essential for humoral or antibody-mediated immunity. The T lymphocytes mature in the thymus. Macrophages are part of the monocytic phagocyte system, are in almost all tissues, and are the mature form of monocytes. Cytotoxic T cells are involved in cell-mediated immunity.

Sputum samples from a client with pneumonia contain an infective agent that has a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet. This client's pneumonia has what etiology? Bacterial Chlamydial Viral Mycoplasmal

Bacterial Explanation: Although chlamydiae, viruses, and mycoplasmas all can cause pneumonia, only bacteria have all of these characteristics. Chlamydiae and viruses are obligate intracellular organisms and therefore would grow only in cell culture, and mycoplasmas lack the peptidoglycan cell wall typical of bacteria.

A client's laboratory report indicates neutropenia, most likely drug induced. The nurse should frequently assess for which complication related to neutropenia? Vomiting Bone fracture Plantar fasciitis Bronchial infection

Bronchial infection

Which description does the nurse recognize fits a client in the prodromal stage of an infection? Residual symptoms of the disease are present in the client's body. Client's symptoms specific to the disease are evident. Client has been exposed, but is experiencing no apparent symptoms. Client is experiencing vague symptoms of fatigue and low grade fever.

Client is experiencing vague symptoms of fatigue and low grade fever. Explanation: Stages of infection are incubation period, prodromal stage, acute stage, convalescent stage, and the resolution stage. During incubation, there are no recognizable symptoms in the host. The prodromal stage has the initial appearance of vague, non-specific symptoms such as malaise, myalgia, and low grade fever. The acute stage is when the maximal impact on the host is evident through specific symptoms commonly from toxins and inflammation. The convalescent period is when the infection is contained and progressively eliminated from the body. The resolution is when the infection has been cleared from the body.

A client suspects he may have developed an allergic response to latex. What most common allergic response would the nurse expect to find? Airway obstruction Angioedema Contact dermatitis Rhinorrhea

Contact dermatitis Explanation: The most common type of allergic response to latex is a contact dermatitis caused by a type IV, delayed-type hypersensitivity reaction to rubber additives. The less common, type I, IgE-mediated response is caused by sensitization to the latex protein and can precipitate far more serious anaphylactic reactions.

A client comes to the clinic with symptoms of fatigue, fever, severe joint pain, and headache. A laboratory results reveal an erythrocyte sedimentation rate (ESR) rate of 60 mm/hour, and a diagnosis of polymyalgia rheumatica (PMR) is confirmed. The nurse anticipates which medications will be prescribed to manage this disease process?

Corticosteroids, such as prednisone

The nurse is caring for a client who has a low level of T lymphocytes. The nurse plans care for a client with: Decreased hematocrit Anemia Decreased immune response Infection

Decreased immune response

A nurse is caring for a newborn that has developed a low platelet count. What could be the cause?

Decreased thrombopoietin (TPO)

A nurse working in an ambulatory care unit is working with a client who has recently been diagnosed with a V Leiden mutation. The nurse tells the client the importance of smoking cessation to avoid: -Deep vein thrombosis (DVT) -Essential hypertension -Coronary artery disease -Pulmonary hypertension

Deep vein thrombosis (DVT)

A nursing professor is teaching nursing students about the immune system. The instructor knows that teaching has been successful when a student correctly identifies which roles of the monocyte? Select all that apply.

Development of immune granulomas Engulfs foreign material Functions as a macrophage in the tissues Functions as an antigen-presenting cell

A nurse is caring for a client receiving heparin therapy who has developed heparin-induced thrombocytopenia. Which nursing intervention does the nurse anticipate? -Administration of platelets -Switching the client to warfarin therapy -Monitoring the client's blood pressure every 2 hours -Discontinuation of heparin therapy

Discontinuation of heparin therapy

A nurse is evaluating laboratory results of a client diagnosed with a parasitic infection. The tests reveal a large group of cells that are membrane-bound with granules in their cytoplasm that are aiding in the destruction of the parasite. Which cell is the nurse evaluating?

Eosinophil

The provider notes that the client's hemaglobin is 8.2 g/dL (82 g/L). Which supplement will the provider recommend to the client? Calcium carbonate Ferrous sulfate Potassium chloride Magnesium oxide

Ferrous sulfate

A specific type of gram-negative bacteria contains endotoxin in the bacterial cell envelope. What is the likely clinical manifestation if these bacteria become pathogenic? Vomiting Leukopenia Constipation Fever

Fever Explanation: A small amount of endotoxin in the circulatory system (endotoxemia) can induce clotting, bleeding, inflammation, hypotension, and fever.

A lactation nurse visits a new mother after delivery of her first child and encourages the mother to breast-feed her infant, even for a short time. Which statement made by the nurse correctly explains the importance of breast-feeding? Colostrum will provide the infant with passive immunity to all childhood illnesses for several months. Colostrum will provide the infant with innate immunity to diseases to which the mother is immune. For several months, colostrum will provide the infant with passive immunity to diseases to which the mother has immunity. Colostrum will provide the infant with active immunity to many childhood illnesses for several years.

For several months, colostrum will provide the infant with passive immunity to diseases to which the mother has immunity. Explanation: After birth, the neonate receives IgG antibodies from the mother in breast milk or colostrum. Therefore, infants are provided with some degree of protection from infection for approximately 3 to 6 months, giving their own immune systems time to mature. IgA is primarily a secretory Ig that is found in saliva, tears, colostrum (i.e., first milk of a nursing mother), and bronchial, gastrointestinal, prostatic, and vaginal secretions. Its primary function is in local immunity on mucosal surfaces. IgA prevents the attachment of viruses and bacteria to epithelial cells.

A client has recently received a pneumococcal vaccine and the client's B cells are consequently producing antibodies. Which cells may enhance this production of antibodies? Cytotoxic T cells Helper T cells Regulatory T cells Natural killer cells

Helper T cells Explanation: In order for B lymphocytes to produce antibodies, they require the help of specific T lymphocytes, called helper T cells, which help B lymphocytes produce antibodies. Natural killer cells as well as regulatory and cytotoxic T cells do not perform this function.

Which substance, when deficient, results in a diagnosis of anemia? -Folic acid -Platelets -Blood plasma -Hemoglobin

Hemoglobin

The client is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which complete blood count (CBC) result is characteristic of this type of anemia? Band cells 700/µL (0.7 ×109/L) Hemoglobin 7.8 g/dL (78 g/L) Reticulocytes 1.5% (0.015) Hematocrit 44% (0.44)

Hemoglobin 7.8 g/dL (78 g/L)

A nurse is assessing a client who displays pale skin and nail beds. Which laboratory data should the nurse evaluate? Erythrocyte sedimentation rate Hemoglobin level White blood cell count Neutrophil count

Hemoglobin level

When an Rh-negative mother gives birth to an Rh-positive infant, the mother usually produces antibodies that will attack any subsequent pregnancies in which the fetus is Rh positive. When subsequent babies are Rh positive, erythroblastosis fetalis occurs. What is another name for erythroblastosis fetalis? Macrocytic disease of the newborn Microcytic disease of the newborn Hemolytic disease of the newborn Hemolytic iron deficiency anemia

Hemolytic disease of the newborn

A nurse is caring for a client receiving heparin therapy. Five days after the start of therapy the nurse notices a sudden decrease in the platelet count. Which complication of heparin therapy can cause platelets to decrease? -Anaphylaxis -Thrombotic microangiopathies -Disseminated intravascular coagulation -Heparin-induced thrombocytopenia

Heparin-induced thrombocytopenia

A client is suffering from the effects of the opportunistic infection, Cryptosporidium parvum. An important nursing intervention would be to encourage which action? Ambulation Hydration Deep breathing and coughing Weight-bearing exercise

Hydration Explanation: Crytosporidium parvum has clinical features ranging from mild diarrhea to severe, watery diarrhea with a loss of up to several liters per day. Hydration is an important consideration.

The immune system typically responds to invaders of all types in our body. However, it can also cause tissue injury and disease. What is this effect called? Hypersensitivity action Allergen-stimulating reaction Antigen reaction Mediator-response action

Hypersensitivity action Explanation: Disorders caused by immune responses are collectively referred to as hypersensitivity reactions. Antigens cause allergic reactions. Mediator-response action and allergen-stimulating reaction have nothing to do with hypersensitivity reactions.

A nurse is monitoring a client with anemia and low oxygen levels. The nurse knows that which condition stimulates the secretion of erythropoietin? Hypoxia Inflammation Low blood pressure Tachycardia

Hypoxia

A client receives an interleukin-2 (IL-2) infusion to treat cancer. Which response explains how this cytokine will affect the growth of cancer cells? IL-2 increases B cell production of antibodies. IL-2 delays synthesis of malignant cells. IL-2 induces inflammation and fever to slow cancer growth. IL-2 stimulates growth of cytotoxic T lymphocytes.

IL-2 stimulates growth of cytotoxic T lymphocytes. Explanation: Cytokines are small proteins used by the innate and adaptive immune systems to communicate with each other. IL-2 is a growth factor for activated T cells produced by macrophages. IL-2 activates cytotoxic T lymphocytes and natural killer cells. These cells destroy abnormal cells.

Which immunoglobulin is primarily found in secretions and has a primary function of providing local immunity on mucosal surfaces? IgG IgA IgD IgM

IgA Explanation: IgA is found in saliva and tears, and is a primary defense against infections in mucosal tissues. IgM is the first immunoglobulin to appear in response to antigen invasion. IgG is the most abundant immunoglobulin and can cross the placenta. IgD is an antigen receptor on B-cell membranes.

The nurse is teaching a new mother about caring for her baby and reducing the risk for infection. On what principle does the nurse base the knowledge of passive immunity? Infants are protected at birth from infection by maternal IgM. Infants are protected at birth from infection by maternal IgD. Infants are protected at birth from infection by maternal IgG. Infants are protected at birth from infection by maternal IgA.

Infants are protected at birth from infection by maternal IgG. Explanation: At birth, infants are protected from infection my maternal IgG antibodies that have crossed the placenta during fetal development. Infants are normally deficient in IgA, IgM, IgD, and IgE because Igs do not normally cross the placenta.

A child with Down syndrome has been experiencing unexplained nosebleeds for the past several months. His blood tests identify blast cells in the peripheral smear. In addition to nosebleeds, this child may manifest which signs/symptoms? Select all that apply. Infections due to neutropenia Palpation of solid tumors on the kidneys Fatigue due to RBC deficiency Hypogammaglobulinemia due to progressive infiltration of the bone marrow and lymphoid tissues Bleeding due to thrombocytopenia

Infections due to neutropenia Fatigue due to RBC deficiency Bleeding due to thrombocytopenia

The nurse is assessing a client diagnosed with anemia and notes that the client's skin and mucous membranes are pale. The nurse interprets this as: -Presence of systolic murmur -Insufficient hemoglobin -Changes in blood viscosity -Tissue hypoxia to the brain

Insufficient hemoglobin

A nurse educator is explaining to a group of students the differences between leukemias and lymphomas. With respect to classification of these diseases, which explanation is most accurate? Leukemia arises from precursors in marrow, and lymphomas originate in spleen or bone marrow. Leukemia arises from precursors in marrow, and lymphomas originate in peripheral lymphoid structures. Leukemias originate in lymph nodes, and lymphomas originate in peripheral lymphoid structures. Leukemia arises from peripheral lymphoid structures, and lymphomas originate in precursors in marrow.

Leukemia arises from precursors in marrow, and lymphomas originate in peripheral lymphoid structures. Explanation: The leukemias, which arise from hematopoietic precursors in the bone marrow, can involve the T and B lymphocytes, granulocytes, and other blood cells. The lymphomas originate in peripheral lymphoid structures such as the lymph nodes, where B and T lymphocytes undergo differentiation and proliferation as they interact with antigens.

A nursing instructor questions students on the removal of erythrocytes from the body. The instructor knows the students understand when they correctly identify which anatomic locations are the site of removal of aged RBCs by phagocytosis? Select all that apply. Liver Thymus Bone marrow Spleen Appendix

Liver Spleen Bone marrow

The practitioner is examining a client and notes that he has small, punctate skin hemorrhages on his abdomen and chest. This finding is suggestive of which lab result? Low white blood cells Low neutrophils Low platelets Low red blood cells

Low platelets

Which type of immunity is achieved by an infant from its mother through antibodies transferred in utero or in breast milk? Naturally acquired active immunity Artificially acquired passive immunity Naturally acquired passive immunity Artificially acquired active immunity

Naturally acquired passive immunity Explanation: Passive immunity is immunity transferred from another source. An infant receives passive immunity naturally from the transfer of antibodies from its mother in utero and through breast milk. Passive immunity also can be artificially provided by the transfer of antibodies produced by other people or animals. Active immunity is acquired through immunization or actually having a disease. It is called active immunity because it depends on a response to the antigen by the person's immune system.

The physician reviews a client's lab results and notes that the neutrophil count is 900/μL (0.90 x 109/L). This is known as: Neutropenia Agranulocytosis Leukopenia Aplastic anemia

Neutropenia

Which type of cell is the most common leukocyte in normal blood?

Neutrophils

A client is admitted to the hospital with an elevated temperature and flank pain. When reviewing the complete blood count (CBC), which level is the most important for the nurse to communicate to the health care provider?

Neutrophils 85%

When a white blood cell with differential count reveals an acute infection, which statement is correct regarding the client's neutrophils?

Neutrophils are the first white blood cell to elevate in an acute infection.

A nurse orienting to the surgical suite is studying medications that affect platelet function and notes that the most common medications are: -Antibiotics and antihistmines -Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin -Aspirin and proton pump inhibitors -NSAIDs and acetaminophen

Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin

A client asks the nurse what happens when a pathogen enters the body. Select the best response. Pathogens that enter the intestinal mucosa can cause diseases in the lungs or liver. Pathogens that enter through disrupting the skin are entering by direct contact. Pathogens that enter the body through the intestinal tract will always lead to infection. Pathogens all enter the body through inhalation.

Pathogens that enter the intestinal mucosa can cause diseases in the lungs or liver. Explanation: The portal of entry by pathogens does not dictate the site of infection and disease can occur in varied places. Ingested pathogens may penetrate the interstinal mucosa, disseminate through the circulatory system, and cause diseases in other organs such as the liver or lungs. Direct contact as a portal of entry does not require the pathogen to disrupt the skin. Pathogens that enter through the intestinal tract do not always cause an infection, as they must compete with normal bacterial flora to survive. Portals of entry by pathogens occur through penetration, direct contact, inhalation, and ingestion.

A nurse is reviewing a client's complete blood count (CBC) which indicates thrombocytopenia. Based on this result, which action should the nurse include in the plan of care?

Place the client on bleeding precautions.

Which process that contributes to immunity takes place in a child's thymus gland? Production of mature, immunocompetent T lymphocytes Differentiation of B cells Production of natural killer (NK) cells Filtration of antigens from the blood

Production of mature, immunocompetent T lymphocytes Explanation: The thymus is essential to the development of the immune system because it is responsible for the production of mature, immunocompetent T lymphocytes. Phenotypically immature T cells enter the thymus from the bone marrow and undergo maturation and thymic selection. B cells are not differentiated in the thymus, and NK cells result from the common lymphoid progenitor. The spleen filters antigens from the blood.

Heparin is an anticoagulant given by injection to prevent the formation of blood clots. How does heparin work? -Promotes the inactivation of factor VIII -Binds to factor X -Promotes the inactivation of clotting factors -Binds to factor Xa

Promotes the inactivation of clotting factors

The nurse is teaching a group of high school students about the modes of transmission for infectious mononucleosis. Which response informs the nurse that the teaching was effective? Sweat Saliva Feces Urine

Saliva Explanation: Infectious mononucleosis is largely transmitted through oral contact with Epstein-Barr virus (EBV)-contaminated saliva. The virus initially penetrates the nasopharyngeal, oropharyngeal, and salivary epithelial cells. It then spreads to the underlying oropharyngeal lymphoid tissue and, more specifically, to B lymphocytes, all of which have receptors for EBV.

When red blood cells age, which organ is responsible for their destruction? Kidneys Red bone marrow Spleen Liver

Spleen

Chronic lymphocytic leukemia (CLL) commonly causes hypogammaglobulinemia. This makes clients with CLL more susceptible to infection. What is the most common infectious organism that attacks clients with CLL? Mycobacterium tuberculosis Staphylococcus aureus Pseudomonas aeruginosa Escherichia coli

Staphylococcus aureus Explanation: Hypogammaglobulinemia is common in CLL, especially in persons with advanced disease. An increased susceptibility to infection reflects an inability to produce specific antibodies and abnormal activation of complement. The most common infectious organisms are those that require opsonization for bacterial killing, such as Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae. Mycobacterium tuberculosis, Pseudomonas aeruginosa, and Escherichia coli are not infectious agents common in clients with CLL.

The nurse is admitting a client who is documented to be in the terminal blast crisis phase of chronic myelogenous leukemia (CML). What interpretation should the nurse make, given this information? The CML is in remission. The CML has evolved to acute leukemia. The CML is indolent. The CML has evolved to chronic lymphocytic leukemia.

The CML has evolved to acute leukemia. Explanation: The terminal blast crisis phase of CML represents evolution to acute leukemia and is characterized by an increasing number of myeloid precursors, especially blast cells.

The nurse understands that a positive ELISA test reported in a baby born to a woman who is HIV positive indicates: The baby has AIDS. The baby has HIV infection. The baby is not infected with HIV. The baby has antibodies from the mother and it is uncertain whether the baby is infected with HIV.

The baby has antibodies from the mother and it is uncertain whether the baby is infected with HIV. Explanation: The diagnosis of HIV infection in children born to HIV-infected mothers is complicated by the fact that infants have the maternal anti-HIV IgG antibody for approximately 6 months. Consequently, infants born to HIV-infected women can be HIV-antibody-positive by ELISA for up to 18 months of age even though they are not infected with HIV.

A newborn has been lethargic, is not nursing well, and is basically looking ill. Following lab tests, it has been found that the newborn has IgM present in his blood. How should the nurse interpret this finding? IgM is usually only found in saliva so the specimen must be contaminated. All newborns have IgM in their blood so this is a normal finding. IgM in the blood means the infant may be allergic to breast milk. The presence of IgM suggests the infant has a current infection.

The presence of IgM suggests the infant has a current infection. Explanation: IgM is the first immunoglobulin to appear in response to antigen and is the first antibody type made by a newborn. This is diagnostically useful because the presence of IgM suggests a current infection in the infant by a specific pathogen. IgE is involved in inflammation, allergic responses, and combating parasitic infections. It binds to mast cells and basophils. The binding of antigen to mast cell- or basophil-bound IgE triggers these cells to release histamine and other mediators important in inflammation and allergies. IgA is found in saliva and tears, and is a primary defense against infections in mucosal tissues.

The nurse is explaining to a colleague the basis of a client's allergy to dust. What statement by the nurse most accurately describes antigens in this situation? They have a characteristic four-polypeptide structure consisting of at least two identical binding sites. They are substances foreign to the host that can stimulate an immune response. Synthesis by leukocytes and the ability to act on other leukocytes interferes with virus multiplication. They possess the ability to communicate critical information by cell-to-cell contact.

They are substances foreign to the host that can stimulate an immune response. Explanation: Antigens are any molecule that can stimulate an immune response. Antibodies are polypeptides. Cytokines communicate critical information. Interferons disrupt viral multiplication.

A normally healthy client is diagnosed with polycythemia vera. The nurse should prioritize assessments aimed at the early identification of which complication associated with this diagnosis? Orthostatic hypotension Vasculitis Hyperventilation Thromboembolism

Thromboembolism

An HIV-positive mother passes the virus to her infant during delivery. This type of transmission is known as: Vertical transmission Heterozygous transmission Vesicle transmission Horizontal transmission

Vertical transmission Explanation: The transmission of STIs is not limited to sexual contact. Vertical transmission of these agents, from the mother to child, can occur across the placenta or during birth when the mucous membranes of the child come in contact with infected vaginal secretions of the mother. The other options are not modes of transmission.

The nurse is caring for a client who is a strict vegetarian; the client is at greatest risk for the development of: Vitamin B12 deficiency anemia Microcytic anemia Folic acid deficiency anemia Blood loss anemia

Vitamin B12 deficiency anemia

A nurse on an oncology floor is treating a client who is anemic following chemotherapy. The drugs being administered are designed to increase the number of red blood cells in circulation. These drugs are likely agonists of:

cytokines.

A mother brings her 5-month-old infant to the pediatrician for recurrent colds. The mother has never breast-fed and the infant is fed iron-fortified formula. The mother asks, "My baby has been perfectly healthy up until last month—now it seems like she has been sick constantly. Why?" How should the physician respond? "An infant must contract multiple viruses in order to help the immune system fully mature." "There is a possibility that your infant is allergic to the formula. Switching brands of formula may alleviate the problem." "An infant gets immunity from the mother at birth and from breast milk; this provides protection from infection but wears off in approximately 3 to 6 months. An infant still needs time for his own immune system to mature." "We will need to complete some additional lab tests to help identify the problem with your infant's immune system."

"An infant gets immunity from the mother at birth and from breast milk; this provides protection from infection but wears off in approximately 3 to 6 months. An infant still needs time for his own immune system to mature." Explanation: The infant's immune system is not yet mature. Passive immunity is immunity transferred from mother to fetus before birth. After birth, the neonate receives IgG antibodies from the mother in breast milk or colostrum. Therefore, infants are provided with some degree of protection from infection for approximately 3 to 6 months, giving their own immune systems time to mature.

The nurse working at a community clinic is caring for a young male client. The client asks the nurse if he could get AIDS from being sprayed in the face with breast milk. Select the best response by the nurse. "Tell me more about your fear of AIDS." "Breast milk can contain the virus that causes AIDS, but to be infected, the milk needs to be in contact with your mucous membranes or an open sore." "Breast milk can contain HIV. You should be tested immediately." "Breast milk is not a mode of AIDS transmission."

"Breast milk can contain the virus that causes AIDS, but to be infected, the milk needs to be in contact with your mucous membranes or an open sore." Explanation: HIV can be transmitted through breast-feeding; however, transmission requires contact with mucous membranes or an open sore.

A client who takes daily sodium warfarin states a desire to start exercising daily. What is the best advice for the nurse to give the client? -"Exercise can cause your medication to stop working." -"Exercise is not usually tolerated while taking warfarin." -"Exercise is not recommended while taking any medication." -"Exercise will be beneficial to you, just be careful not to injury yourself or fall."

"Exercise will be beneficial to you, just be careful not to injury yourself or fall."

Which statement from a group of young adults demonstrates the need for further teaching related to HIV and prevention of the spread of HIV? "Having oral sex is one way I can prevent passing on HIV to my partner." "My HIV medications do not prevent me from passing the virus on to my partners." "Good perineal care following sex will not have an effect on the transmission of HIV." "A woman can still get pregnant if she is HIV positive."

"Having oral sex is one way I can prevent passing on HIV to my partner." Explanation: Sexual contact is the most frequent mode of HIV transmission. There is a risk of transmitting HIV when semen or vaginal fluids come in contact with a part of the body that lets them enter the bloodstream. This can include the vaginal mucosa, anal mucosa, and wounds or sores on the skin. Condoms are highly effective in preventing the transmission of HIV. Unprotected sex between men is still the main mode of transmission. During the window period, a person's HIV antibody test result will be negative, but he or she can still transmit the virus.

A nurse is teaching parents of a child with scarlet fever. Which statement indicates that the parents understand the treatment for the child? "I will give the antibiotic for the full 10 days." "Scarlet fever is a gram-negative bacteria that requires no antibiotics to treat." "My daughter cannot go to school while she is taking antibiotics." "I will apply antibiotics as a cream to her rash twice a day."

"I will give the antibiotic for the full 10 days." Explanation: Streptococcus pyogenes, the agent of scarlet fever, is a gram-positive streptococcal organism. It is spherical, grows in chains, and stains purple by Gram stain. Not all antibiotics are effective against all pathogenic bacteria. Some agents are effective only against gram-negative bacteria, and others are specific for gram-positive organisms. The so-called broad-spectrum antibiotics, such as the newest class of cephalosporins, are active against a wide variety of gram-positive and gram-negative bacteria.

A nurse is teaching a parent group about the importance of regular childhood vaccines. The nurse evaluates that the teaching is successful based on which of the following statements? "As long as my baby is kept at home there is no risk of catching any of the vaccine-preventable illnesses." "Since my baby received maternal antibodies at birth, vaccines are not necessary until 6-9 months of age." "Vaccines can cause autism in children; I should research each vaccine prior to having my child vaccinated." "I will have my baby vaccinated as scheduled to reduce the senseless spread of vaccine-preventable illnesses."

"I will have my baby vaccinated as scheduled to reduce the senseless spread of vaccine-preventable illnesses." Explanation: One of the most efficient but often overlooked means of preventing infectious diseases is immunization. Proper and timely adherence to recommended vaccination schedules in children and booster immunizations in adults effectively reduces the senseless spread of vaccine-preventable illnesses such as measles, mumps, pertussis, and rubella, which still occur with alarming frequency.

A 23-year-old female client has been diagnosed with von Willebrand disease following a long history of "heavy periods" and occasional nosebleeds. Which of the client's statements demonstrates a sound understanding of the new diagnosis? -"I hope my insurance covers the injections that I'll need to help my blood clot." -"I read on a website that I might have to get blood transfusions from time to time." -"I'm really disappointed that I won't be able to play sports anymore." -"I'll make sure to take acetaminophen instead of aspirin when I get aches and pains."

"I'll make sure to take acetaminophen instead of aspirin when I get aches and pains."

The mother of a newborn infant questions why her baby needs a vitamin K injection immediately after birth. The best response by the nurse would be: -"Infants have a higher body fat content, which prohibits the absorption of vitamin K." -"Infants are not born with the normal intestinal bacteria that synthesize vitamin K for clotting." -"The infant was exposed to high levels of heparin upon birth." -"It is hospital policy to administer the injection to newborns."

"Infants are not born with the normal intestinal bacteria that synthesize vitamin K for clotting."

A client describes himself as being "devastated" after hearing that his HIV test has come back positive. Which response by the nurse is most appropriate? "I've provided care for many clients living with HIV and AIDS, so I understand how you feel." "I understand how difficult this must be for you, but it's nothing that you should be ashamed of." "It's entirely normal to feel that way. We are going to try our best to help you get all the support you need." "This is certainly scary news, but the care team is going to make sure that you get all the information you need."

"It's entirely normal to feel that way. We are going to try our best to help you get all the support you need." Explanation: The nurse's best response is to validate the client's statement and to affirm a commitment to support him. It is presumptuous to conclude that by saying he is "devastated" he means that he is ashamed or afraid. Similarly, it is presumptuous for the nurse to claim that he or she knows how the client is feeling.

A client who was exposed to hepatitis A at a local restaurant has recovered from the disease. At her annual physical, the client asks the health care provider if she should go to her health department and get the hepatitis A "shot." The best response by the health care provider, based on the concepts of adaptive immunity, would be: "Yes, because you could get a worse case the next time you are exposed." "Of course. The virus changes every year." "I wouldn't, since the vaccine can damage your liver." "No, since having an active case, you have already developed antigens against hepatitis A."

"No, since having an active case, you have already developed antigens against hepatitis A." Explanation: The adaptive immune system consists of two groups of lymphocytes and their products, including antibodies. Whereas the cells of the innate immune system recognize structures shared by classes of microorganisms, the cells of the adaptive immune system are capable of recognizing numerous microbial and noninfectious substances and developing a unique specific immune response for each substance. Substances that elicit adaptive immune responses are called antigens. A memory of the substance is also developed so that a repeat exposure to the same microbe or agent produces a quicker and more vigorous response. The hepatitis A virus does not change from year to year. The vaccine does not damage the liver; however, the active hepatitis A disease can.

The dietary student is studying folic acid deficiency. The faculty member knows the student is ready to teach clients about this topic when the student makes which statement? "The client should increase his intake of cooked, green, leafy vegetables." "Folate deficiency is not common in clients with neoplastic disease." "The client should have at least 200 micrograms in her daily diet." "The 30-year-old client who is trying to become pregnant should evaluate her folic acid intake."

"The 30-year-old client who is trying to become pregnant should evaluate her folic acid intake."

A client refuses to take the 81 mg of aspirin ordered by the physician, stating, "I do not have any pain." The best response by the nurse would be: -"The 81 mg of aspirin daily will help protect you from a stroke or a heart attack." -"Low-dose aspirin will help prevent you from having increased bleeding after surgery." -"The doctor wants you to take the medication to prevent you from experiencing pain." -"This dose of aspirin will break apart the blood clot that you have in your leg."

"The 81 mg of aspirin daily will help protect you from a stroke or a heart attack."

A nurse is assessing a client presenting with symptoms of fatigue, fever, severe joint pain, and headache. Laboratory results reveal an erythrocyte sedimentation rate (ESR) rate of 60 mm/hour. The client asks what the blood test results mean. What is the most appropriate explanation for the nurse to provide?

"The ESR tests for the presence of inflammation in the body."

A college student has been called into the student health office because she tested positive for HIV on the enzyme-linked immunosorbent assay (ELISA). The student asks, "What is this Western blot assay going to tell you?" The best response by the health care provider is: "This assay will actually look at all the individual cells in your blood and count how many HIV cells you have, so we can treat you with the proper medication." "We always want two positive test results before we give you medicine." "The Western blot is a more sensitive assay that looks for the presence of antibodies to specific viral antigens." "If you are afraid of another blood test, we can do a rapid oral test to see if we get the same results."

"The Western blot is a more sensitive assay that looks for the presence of antibodies to specific viral antigens." Explanation: The Western blot is a more sensitive assay than the EIA that looks for the presence of antibodies to specific viral antigens. In the case of a false-positive EIA result, the Western blot test can identify the person as uninfected. Technologic advances have led to new forms of testing, such as the oral test, home testing kits, and the new rapid blood test. Oral fluids contain antibodies to HIV. In the late 1990s, the FDA approved the OraSure test. The OraSure uses a cotton swab, which is inserted into the mouth for 2 minutes, placed in a transport container with preservative, and then sent to a laboratory for EIA and Western blot testing.

A child has been home from camp for 2 weeks and reports a sore throat, low-grade fever, and enlarged cervical lymph nodes. After testing, it is determined the child has Epstein-Barr virus (EBV)-associated infectious mononucleosis. The parent asks, "How did my child acquire this type of infection?" Which is the best response by the nurse? "The infection is acquired primarily through contact with infected oral secretions." "The infection is acquired primarily through contacted with infected blood." "The child may have acquired the infection when bitten by a mosquito." "The only way to acquire this infection is if the child was kissing another person."

"The infection is acquired primarily through contact with infected oral secretions."

The staff development nurse is teaching a class of orientees about care of the geriatric client. Which statement is accurate about red blood cell changes with aging? "During a stress reaction, red cells of older adults are replaced as promptly as those of their younger counterparts." "Anemia in older adults is treated by placing them all on erythropoietin." "The location of bone cells involved in red cell production shifts toward the axial skeleton." "The decline in hemoglobin levels in older adults is greater in women than men."

"The location of bone cells involved in red cell production shifts toward the axial skeleton."

A sixth-grade science teacher asks the students to explain the role of cilia in the lower respiratory tract. Which student response is best? "Cilia help to warm the airways so that moisture in the air can neutralize any germs that get in our lungs." "Cilia help facilitate a chemical defense against germs by secreting an enzyme that will cement the germ to the lining of the airways." "These little hairs move germs trapped in mucus toward the throat so the body can cough them out." "Cilia can trap the microbes in one location so the body can grow scar tissue around them and wall them off so they can't cause disease."

"These little hairs move germs trapped in mucus toward the throat so the body can cough them out." Explanation: Also in the lower respiratory tract, hair-like structures called cilia protrude through the epithelial cells. The synchronous action of the cilia moves many microbes trapped in the mucus toward the throat. The physiologic responses of coughing and sneezing further aid in their removal from the body. Chemical defenses against trapped microbes include the following: lysozyme, which is a hydrolytic enzyme capable of cleaving the walls of bacterial cells; complement, which binds and aggregates bacteria to increase their susceptibility to phagocytosis or disrupt their lipid membrane; and members of the collectin family of surfactant proteins in the respiratory tract. The best-defined function of the surfactants is their ability to opsonize pathogens, including bacteria and viruses, and to facilitate phagocytosis by innate immune cells such as macrophages.

A 5-year-old child is experiencing itchy, watery eyes and an increased respiratory rate with some inspiratory wheezes. He has been outside playing in the yard and trees. The mother asks, "Why does he get like this?" The health care worker's best response is: "Because his allergy is related to something in his environment, the best thing you can do is try to keep him indoors as much as possible." "This is what we call a type I hypersensitivity reaction and usually occurs a few minutes after exposure to his allergen. It is primarily caused by mast cells in his body." "This is pretty common in children. He is just getting used to all the allergens in the air. I suggest you just give him a shower after every time he plays outside." "This sounds like he is on his way to having an anaphylactic reaction and you need to get a prescription for an EpiPen to decrease his response to monocytes."

"This is what we call a type I hypersensitivity reaction and usually occurs a few minutes after exposure to his allergen. It is primarily caused by mast cells in his body." Explanation: The immediate response to allergen exposure is mast cell degranulation and release of mediators such as histamine and acetylcholine. Monocytes respond as part of the acute immune response. There is no truth to this being an anaphylactic reaction. Showers may help, but the underlying cause is the mast cell degranulation and the release of preformed mediators.

An 85-year-old male has been brought to the emergency department where lab work reveals a low hemoglobin of 8.7 g/dL (87 g/L). While taking a detailed history, which statements by the client/family correlate with this anemia? Select all that apply. "Every now and then, my big toes gets swollen and it hurts real bad." "When I go food shopping, I have to sit down and rest after one or two aisles." "Some nights I just don't feel like eating a big meal." "I get up to the bathroom two to three times per night." "He seems to get confused once in a while."

"When I go food shopping, I have to sit down and rest after one or two aisles." "He seems to get confused once in a while."

A client with infectious mononucleosis asks the nurse why the lymph nodes are enlarged. Which statement is the nurse's appropriate response? "Your lymph nodes are infected and should be removed." "Your lymph nodes multiply to fight infection." "Your lymph nodes trap and destroy viruses." "Your lymph nodes are blocked and need to be drained."

"Your lymph nodes trap and destroy viruses." Explanation: The lymph nodes remove foreign material from the lymph system before the fluid can enter the bloodstream. Mononucleosis is an infection caused by the Epstein-Barr virus. The lymph nodes trap the virus where the lymphocytes and macrophages can destroy it. Enlargement may occur with increased production of lymphocytes, backup of lymph fluid, or malignancy.

In which client would a clinician most suspect multiple myeloma as a diagnosis? A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated. A 70-year-old woman whose blood work reveals large numbers of immature granulocytes. A 68-year-old former coal miner who has white cell levels exponentially higher than normal ranges. An 81-year-old male resident of a long-term care home who has an uncommon bacterial pneumonia and who is unable to produce a fever.

A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated. Explanation: The main sites involved in multiple myeloma are the bones and bone marrow. In addition to the abnormal proliferation of marrow plasma cells, there is proliferation and activation of osteoclasts that lead to bone resorption and destruction. This increased bone resorption predisposes the individual to pathologic fractures and hypercalcemia. Many clients also present with renal insufficiency. Leukostasis, susceptibility to infection, and disorders of granulocyte development are not hallmarks of multiple myeloma.

The nursing is reviewing assessment data of four clients. Which client is at greatest risk for developing pernicious anemia? A client of Italian heritage who had a colonoscopy A client who is recovering from a laproscopic surgical procedure A client diagnosed with a neoplastic disorder A client who has undergone partial gastrectomy

A client who has undergone partial gastrectomy

A client asks the nurse, "Which organisms does a broad-spectrum antibiotic fight?" Which response by the nurse is best? Only gram-positive infections A wide variety of gram-positive and gram-negative bacteria A wide variety of viruses Only gram-negative infections

A wide variety of gram-positive and gram-negative bacteria Explanation: Broad-spectrum antibiotics, such as the newer cephalosporins, are active against a wide variety of gram-positive and gram-negative bacteria. Antibiotics are not used against viruses.

The school nurse is preparing a lecture on HIV/AIDS for a health class of high school students. The nurse would know to include what information about the transmission of AIDS in her lecture? Select all that apply. AIDS is transmitted through blood-to-blood contact. AIDS is transmitted through nonsexual household contact. AIDS is transmitted from the mother to her unborn baby. AIDS is transmitted through sexual contact. AIDS is transmitted through the bite of an insect.

AIDS is transmitted through sexual contact. AIDS is transmitted through blood-to-blood contact. AIDS is transmitted from the mother to her unborn baby. Explanation: HIV is transmitted from one person to another through sexual contact, blood-to-blood contact, or perinatally. It is not transmitted through casual contact. Several studies involving more than 1000 uninfected, nonsexual household contacts with persons with HIV infection (including siblings, parents, and children) have shown no evidence of casual transmission. HIV is not spread by mosquitoes or other insect vectors.

A client diagnosed with systemic lupus erythematosus (SLE) has been experiencing a low neutrophil count. How would this type of neutropenia be classified? Congenital, cyclic neutropenia Acquired, autoimmune secondary neutropenia Acquired, drug-related neutropenia Congenital, alloimmune neonatal neutropenia

Acquired, autoimmune secondary neutropenia Explanation: A person with SLE (an autoimmune disease) with neutropenia would be considered to have acquired (not born with) autoimmune secondary neutropenia. Chronic refers to long-term conditions.

The nurse is administering a measles, mumps, and rubella (MMR) vaccination to a pediatric client. When the nurse explains immunity to the mother, which type of immunity will she explain that this vaccination provides? Active artificial immunity Passive natural immunity Active natural immunity Passive artificial immunity

Active artificial immunity Explanation: Active immunity is acquired when the host mounts an immune response to an antigen either through the process of vaccination (artificial means) or from environmental exposure (natural means). It is called active immunity because it requires the host's own immune system to develop an immunological response. The process by which active immunity is acquired through the administration of a vaccine is termed immunization. An acquired immune response can improve on repeated exposures to an injected antigen (booster vaccines) or a natural infection.

In reference to infectious disease, a client cannot be a/an: Host Carrier Agent Reservoir

Agent Explanation: Viruses are incapable of replication outside of a living cell. They must penetrate a susceptible living cell and use the biosynthetic structure of the cell. A virus is an agent. Not every viral agent causes lysis and death of the host cell during the course of replication. Some viruses enter the host cell and insert their genome into the host cell chromosome, which acts as a reservoir; it remains there in a latent, nonreplicating state for long periods without causing disease.

What is the correct type of isolation for the nurse to implement to prevent transmission of herpes zoster while caring for a client with an active chickenpox infection? Contact Blood Droplet Airborne

Airborne Explanation: A number of pathogens may invade the human body through the respiratory system. Viruses such as herpes zoster and influenza are transmitted by very small particles that can remain airborne for a long time and distance. Other pathogens that are larger particles may be transmitted by droplet. These heavier particles do not remain floating in the air, but fall to nearby surfaces.

A client comes to the clinic with a runny nose and scratchy throat. The nurse is evaluating the white blood cell count, which shows an elevated number of white blood cells and an increased percentage of eosinophils. What is the most likely cause of the symptoms?

Allergic reaction

A client is applying to nursing school and has come to the clinic with a request to be tested for immunity to hepatitis B. Which type of testing would be best to determine immunity? Culture WBC count DNA testing Antibody titer

Antibody titer Explanation: The measurement of antibody titers can be used to determine if immunity is present. Specific antibody types, such as IgM and IgG, are produced by the host during different phases of an infectious process. IgM-specific antibodies generally rise and fall during the acute phase of the disease, whereas the synthesis of the IgG class of antibodies increases during the acute phase and remains elevated until or beyond resolution.

Select the statement that best describes autoimmune disease. Autoimmune diseases represent overuse of the immune system that causes damage to the body tissues. Autoimmune diseases represent a disruption in self-tolerance that results in damage to body tissues by the immune system. Autoimmune diseases result from an overuse of antibiotics that causes damage to body tissues by the immune system. Autoimmune diseases represent an increase in self-tolerance that results in damage to body tissues by the immune system.

Autoimmune diseases represent a disruption in self-tolerance that results in damage to body tissues by the immune system. Explanation: Autoimmune diseases represent a disruption in self-tolerance that results in damage to body tissues by the immune system. Autoimmunity results from a failure of tolerance. Autoimmune disorders may be triggered by environmental stimuli, such as infections, in a genetically predisposed individual. Overuse of antibiotics, however, does not lead to autoimmune diseases.

Which statements are true regarding humoral immunity? Select all that apply. B lymphocytes (B cells) are vital to the functioning of this type of immunity. It functions in the rejection of foreign tissue grafts. Two types of responses (primary and secondary) occur. This immunity depends on cytotoxic T lymphocytes (T cells). The memory response occurs on subsequent exposures to the antigen.

B lymphocytes (B cells) are vital to the functioning of this type of immunity. Two types of responses (primary and secondary) occur. The memory response occurs on subsequent exposures to the antigen. Explanation: There are two types of adaptive immune responses, humoral and cell-mediated immunity, that function to eliminate different types of microbes. Humoral immunity is mediated by the B lymphocytes (B cells). The B cells differentiate into antibody-secreting plasma cells. The circulating antibodies then interact with and destroy the microbes that are present in the blood or mucosal surfaces. Cell-mediated, or cellular, immunity is mediated by the cytotoxic T lymphocytes (T cells) and functions in the elimination of intracellular pathogens (e.g., viruses) and in rejection of foreign tissue grafts. Two types of responses occur in the development of humoral immunity: a primary and secondary response. A primary immune response occurs when the antigen is first introduced into the body. The secondary, or memory response, occurs on second or subsequent exposures to the antigen.

Which type of white blood cells are related to the connective tissue mast cells and respond in allergic and hypersensitivity reactions?

Basophils

A diagnosis of acquired immunodeficiency syndrome (AIDS) is identified when the CD4+ T cell count reaches which level? Below 200 cells/μL 500 to 800 cells/μL 200 to 499 cells/μL 800 to 1000 cells/μL

Below 200 cells/μL Explanation: For a diagnosis of AIDS, the CD4+ cell count falls below 200 cells/μL. The other readings would not justify a finding of AIDS but can be found in HIV infection.

An older adult client arrives with garbled speech, unilateral facial drooping, and weakness and unfortunately dies. Laboratory work reveals hematocrit of 54% (0.54). Which complication of polycythemia could most likely be associated with this client's death? Anaphylactic reaction Acute leukemia Infection and sepsis Cerebral thrombosis

Cerebral thrombosis

A client's laboratory report shows the presence of the Philadelphia chromosome. Which diagnosis should the nurse suspect the client has developed? Chronic lymphocytic leukemia (CLL) Chronic myelogenous leukemia (CML) Non-Hodgkin lymphoma Hairy cell leukemia

Chronic myelogenous leukemia (CML) The Philadelphia chromosome translocation is found in more than 90% of persons with chronic myelogenous leukemia (CML) and in some persons with acute leukemia.

A hospitalized client's progress has been noted as the convalescent stage. Select the statement that best describes this stage. Containment of infection, progressive elimination of the pathogen, repair of damaged tissue, and resolution of associated symptoms Total elimination of a pathogen from the body without residual signs or symptoms of disease Period during which the host experiences the maximum impact of the infectious process corresponding to rapid proliferation and dissemination of the pathogen Initial appearance of symptoms in the host, although the clinical presentation during this time may be only a vague sense of malaise

Containment of infection, progressive elimination of the pathogen, repair of damaged tissue, and resolution of associated symptoms Explanation: The convalescent period is characterized by the containment of infection, progressive elimination of the pathogen, repair of damaged tissue, and resolution of associated symptoms. The resolution is the total elimination of a pathogen from the body without residual signs or symptoms of disease. The acute stage is the period during which the host experiences the maximum impact of the infectious process corresponding to rapid proliferation and dissemination of the pathogen. The prodromal stage is the initial appearance of symptoms in the host, although the clinical presentation during this time may be only a vague sense of malaise.

A client is diagnosed with a mild case of an autoimmune disorder and is beginning a treatment regimen. What is the mainstay of treatment with an autoimmune disorder? Plasmapheresis Antibiotics Antiviral medications Corticosteroids and immunosuppressants

Corticosteroids and immunosuppressants Explanation: Treatment of autoimmune disorders is dependent on the magnitude of the presenting manifestations and underlying mechanisms of the disease process. Because in many cases the pathophysiologic mechanisms are not always known, treatment may be purely symptomatic. Corticosteroids and immunosuppressive drugs are the mainstay of therapy directed at arresting or reversing the cellular damage caused by the autoimmune response. Plasmapheresis has been used in severe cases to remove autoreactive cells from circulation.

Once T helper cells are activated, they secrete which substance that activates and influences nearly all of the other cells of the immune system? Bradykinins Complement proteins Cytokines Leukotrienes

Cytokines Explanation: Cytokines activate and regulate B cells, cytotoxic T cells, natural killer (NK) cells, macrophages, and other immune cells. The ability of the cells of both the innate and adaptive immune systems to communicate critical information with each other and initiate effector cell responses is dependent upon the secretion of short-acting, biologically active, soluble substances called cytokines. Complement is activated in the inflammatory response. Leukotrienes and bradykinin are also a part of the inflammatory response.

A nurse who works in a long-term care facility has observed the high incidence of infectious illnesses among the older adults who reside there. What is the best explanation for a diminished immune capacity in older adults? Decreased antigen recognition by B lymphocytes Altered function in peripheral lymphocytes Decreased numbers and responsiveness of T lymphocytes Overexpression of cytokines and receptors

Decreased numbers and responsiveness of T lymphocytes Explanation: Although this phenomenon is not well understood, increasing proportions of lymphocytes become unresponsive with age, and CD4+ T lymphocytes are the most severely affected. B lymphocytes recognize more antigens, not fewer, and expression of cytokines and their cellular receptors decreases.

A newborn has a clotting disorder that results in the body being unable to produce fibrin. Which of the following could be the cause? -Decreased spleen function -Increase in the number of megakaryocytes -Deficiency of fibrinogen -Iron deficiency

Deficiency of fibrinogen

A woman reports to the nurse that she has developed a yeast infection. The woman does not understand how she could get a yeast infection since she has been on antibiotics for a urinary tract infection. What is the rationale for this client's complaint? Yeast prefers a warm, moist, and dark environment, such as that present in the female perineum. Yeast grows well when exposed to sugar, which is found as a carrier substance in most antibiotics. Destroying one type of resident flora (bacteria) can allow overproliferation of another competing type (yeast). Antibiotics allow yeast to access sterile environments in the body.

Destroying one type of resident flora (bacteria) can allow over proliferation of another competing type (yeast). Explanation: Yeast are commensal flora of the skin, mucous membranes, and gastrointestinal tract and are capable of growth at a wider range of temperatures. Intact immune mechanisms and competition for nutrients provided by the bacterial flora normally keep colonizing fungi in check. Alterations in either of these components by disease states or antibiotic therapy can upset the balance, permitting fungal overgrowth and setting the stage for opportunistic infections.

An adult client with good overall health has reported headaches and dizziness in recent weeks. The nurse's assessment reveals blood pressure of 158/99 mm Hg, which is unprecedented for the client. On observation, the client's skin appears reddened, though he denies feeling warm. The nurse should anticipate what further diagnostic finding? Elevated RBC, hemoglobin, and hematocrit. Abnormal RBC indices coupled with low platelets. Normal RBC, hemoglobin, and hematocrit with alterations in morphology. Further signs and symptoms of internal hemorrhage.

Elevated RBC, hemoglobin, and hematocrit.

A client presented to the emergency department with symptoms of fever, abdominal pain and diarrhea following a vacation out of the country. A helminthic parasite infection is suspected. Which lab result should the nurse evaluate?

Eosinophils

Which leukocyte is correctly matched with its function within the body?

Eosinophil—allergic reaction

Immunologically active sites on antigens are recognized as: Antigens Epitopes Opsonins Effector cells

Epitopes Explanation: Immunologically active sites on antigens are called antigenic determinants, or epitopes. Epitopes have a unique molecular shape that is recognized by a specific immunoglobulin receptor found on the surface of the lymphocyte.

A teenage client has been diagnosed with infectious mononucleosis and asks the health care provider what caused the condition. Which response is most accurate for the nurse to share with this client? Human immunodeficiency virus (HIV) Epstein-Barr virus (EBV) Abnormal cell nucleus development Non-Hodgkin lymphoma

Epstein-Barr virus (EBV)

A family consumed some undercooked hamburger at a picnic and has since developed bloody diarrhea. The nurse knows that which statement is correct regarding the infectious process? Evasive factors can become more virulent by evading parts of the host's immune system. Invasive factors capable of destroying the cell membrane by utilization of enzymes. Adhesion factors that can anchor a pathogen firmly to the host tissue surfaces. Exotoxins that damage vascular endothelial cells cause bleeding and low platelet counts.

Exotoxins that damage vascular endothelial cells cause bleeding and low platelet counts. Explanation: Exotoxins can allow organisms to produce hemorrhagic colitis, which can be fatal. It is characterized by vascular endothelial damage, acute RF, and thrombocytopenia (low platelet counts). Toxic cell walls are classified as endotoxins. The ability to survive immune responses characterizes evasive factors. Adhesion factors and invasive factors are not involved in this situation.

Select the statement that best describes the effectiveness of vaccination in the older adult population. Age does not influence the effectiveness; it depends on the amount of medication you receive. Vaccinations are only effective in older adult populations if their families have been vaccinated. Older adults who are immunized have the same effective response in immunity as younger persons do. Experimental evidence suggests that vaccination is less successful in inducing immunization in older persons than in younger adults.

Experimental evidence suggests that vaccination is less successful in inducing immunization in older persons than in younger adults. Explanation: Older adults tend to be more susceptible to infections, have more evidence of autoimmune and immune complex disorders than younger persons, and have a higher incidence of cancer. Experimental evidence suggests that vaccination is less successful in inducing immunization in older persons than in younger adults. However, the effect of altered immune function on the health of older adults is clouded by the fact that age-related changes or disease may affect the immune response.

A client has been diagnosed with inherited hypercoagulability. Select the most likely cause. -Hyperestrogenic state -Factor V gene mutation -Prolonged immobility -Myocardial infarction

Factor V gene mutation

Hemophilia A is a hereditary blood disorder caused by inadequate activity or absence of which blood component? -Prothrombin -Factor VIII -Intrinsic factor -von Willebrand complex

Factor VIII

A client with hemophilia type A comes to the emergency department with severe pain and swelling in the right knee. To reduce musculoskeletal damage, the nurse anticipates the administration of: -Nonsteroidal anti-inflammatory drug -Heat to the knee -Factor VIII replacement therapy -Corticosteroids

Factor VIII replacement therapy

A client has developed disseminated intravascular coagulation (DIC), which the health care providers think was initiated by the intrinsic pathway, requiring which substance to begin the step-wise coagulation cascade? -Thrombin -Tissue factor -Factor XII -Protein C

Factor XII

The nurse's plan of care for a client with multiple myeloma should include interventions to prevent: Diarrhea Urinary tract infections GI bleed Fractures

Fractures Explanation: In multiple myeloma there is abnormal proliferation of marrow plasma cells, which leads to bone resorption and destruction, predisposing the person to fractures.

A client who has received chemotherapy has a steadily decreasing white blood cell count. To increase the neutrophil count, the nurse anticipates administering:

Granulocyte colony-stimulating factor

The treatment of HIV/AIDS is complicated because different drugs act on different stages of the replication cycle of the virus. Therefore, treatment includes combinations of two, three, or more drugs. What is this treatment called? Anti-AIDS treatment HEELP treatment HAART treatment DHHS treatment

HAART treatment Explanation: Because different drugs act on different stages of the replication cycle, optimal treatment includes a combination of at least two to three drugs, often referred to as HAART [highly active antiretroviral therapy]. The goal of HAART is sustained suppression of HIV replication, resulting in an undetectable viral load and an increasing CD4+ cell count. The other treatments are not used in the treatment of HIV/AIDS.

A client with acute leukemia has developed gout and asks the nurse, "Why did this happen?" Which response is most accurate? Too much alcohol consumption Anorexia and muscle wasting High uric acid levels Diet with too many carbohydrates

High uric acid levels Explanation: Hyperuricemia occurs as the result of increased proliferation or increased breakdown of purine nucleotides secondary to leukemic cell death that results from chemotherapy. It may increase before and during treatment. Prophylactic therapy with allopurinol, a drug that inhibits uric acid synthesis, is routinely administered. Diet will contribute to gout.

A client is suspected of having lymphoma and is having diagnostic tests performed to determine the type of lymphoma. Which form of lymphoma does the nurse recognize has the classic symptoms of pruritus and intermittent fevers associated with night sweats? Hodgkin lymphoma (HL) Burkitt lymphoma Non-Hodgkin lymphoma Diffuse, large B-cell lymphoma

Hodgkin lymphoma (HL) Explanation: Most people with HL present with painless enlargement of a single lymph node or a group of nodes. There may be reports of chest discomfort with cough or dyspnea. Involvement of subdiaphragmatic lymph nodes at the time of presentation is unusual and more common in older men. Additional symptoms include fever, chills, night sweats, and weight loss. Pruritus and intermittent fevers associated with night sweats are classic symptoms of HL.

The nurse is assisting a new mother with breastfeeding. What does the nurse understand is a primary secretory immunoglobulin (Ig) that is found in the colostrum? IgE IgD IgM IgA

IgA Explanation: IgA is primarily a secretory Ig that is found in saliva, tears, colostrum, and bronchial, gastrointestinal, prostatic, and vaginal secretions. Because it is found in secretions, its primary function is in local immunity on mucosal surfaces. IgA prevents the attachment of viruses and bacteria to epithelial cells.

A client experiences an allergic reaction. Select the immunoglobulin that would bind to mast cells and release histamine. IgA IgD IgG IgE

IgE Explanation: IgE responds to allergic exposures and parasitic infections. IgA is the primary defense against local infections in mucosal tissues. IgG protects against bacteria, toxins, and viruses and activates the complement system. IgD acts as an antigen receptor for initiating the B cells.

The nurse is aware that the only class of immunoglobulins to cross the placenta is: IgG IgA IgD IgM

IgG Explanation: IgG is the only class of immunoglobulins to cross the placenta. Levels of maternal IgG decrease significantly during the first 3 to 6 months of life, while infant synthesis of immunoglobulins increases.

The nurse is reviewing the functions of immunoglobulins and determines which immunoglobulin is associated with its correct action? IgE, functions as a receptor for antigen. IgA, plays a role in B-cell differentation. IgD, prevents the attachment of viruses and bacterial to epithelial cells. IgM, the first antibody to be produced by a developing fetus.

IgM, the first antibody to be produced by a developing fetus. Explanation: The correct actions are as follows: IgM is the first circulating immunoglobulin that is produced by the developing fetus. It is instrumental in the ultimate lysis of microogranisms. It also is an effective agglutinating antibiody. IgA prevents the attachment of viruses and bacteria to epithelial cells. IgE is involved in inflammation, allergic responses, and combating parasitic infections. It binds to mast cells and basophils. IgD serves as an antigen receptor for initiating the differentiation of B cells.

What is the term for parasitic relationships between microorganisms and the human body in which the human body is harmed? Infectious disease Commensal disease Communicable disease Mutual disease

Infectious disease Explanation: A parasitic relationship is one in which only the infecting organism benefits from the relationship and the host either gains nothing from the relationship or sustains injury from the interaction. If the host sustains injury or pathologic damage in response to a parasitic infection, the process is called an infectious disease. Mutual and commensal relationships do not harm the human body. Communicable diseases can be passed from one human to another; they are not parasitic.

A client has been admitted for immune thrombocytopenic purpura. The client has not responded to corticosteroid treatment. The priority nursing intervention for this client would include which treatment measure? -Prepare a surgical permit for an emergency splenectomy. -Insert an intravenous catheter, so immune globulin can be administered in a timely manner. -Place the client in isolation, so the skin rashes will not spread to other clients. -Insert a Foley catheter to monitor hourly urine output.

Insert an intravenous catheter, so immune globulin can be administered in a timely manner.

A female client comes to the clinic with symptoms of fatigue and heavy menses over the last 6 months. Laboratory tests reveal a microcytic hemochromic anemia. Based on these results, the nurse anticipates teaching the client about which type of anemia? Iron deficiency anemia Sickle cell anemia Aplastic anemia Anemia related to kidney disease

Iron deficiency anemia

Which of these is often found in a client with AIDS? Kaposi sarcoma High peripheral blood CD4+ lymphocyte counts Overactive T-cell function Carcinoma of the lung

Kaposi sarcoma Explanation: Kaposi sarcoma is an opportunistic infection with a virus that causes a tumor on the skin. It is commonly found in individuals who have a depressed immune system such as in the case of AIDS or immunosuppression therapy. An underactive T-cell function and low peripheral blood CD4+ lymphocyte counts are seen in clients with HIV/AIDS, not the opposite. A carcinoma of the lung is not a defining characteristic of HIV/AIDS, as an individual may have this carcinoma without having HIV/AIDS.

Which is a characteristic finding in AIDS? Kaposi sarcoma Overactive T-cell function Carcinoma of the lung High peripheral blood CD4+ lymphocyte counts

Kaposi sarcoma Explanation: People with AIDS have a high incidence of certain malignancies, especially Kaposi sarcoma, a malignancy of the endothelial cells that line small blood vessels throughout the body.

A client is experiencing fatigue and laboratory results reveal: Hct 40% (0.40); Hgb 8 g/dL (80 g/L); WBC 8000 (8 x 109/L); and platelets 175,000/ µL (175 ×109/L). The nurse would interpret these results as indicative of which diagnosis? High hematocrit/polycythemia Low white blood cell (WBC) count/granulocytopenia High platelets/thrombocytosis Low hemoglobin/anemia

Low hemoglobin/anemia

A young adult client presents with an enlarged, firm cervical lymph node on the right side of the neck. Palpation of the node is painless. The nurse should document this assessment finding and anticipate preparing the client for which diagnostic procedure to confirm diagnosis? Watchful waiting and close monitoring of the node over the following weeks Radioactive isotope insertion Bone marrow transplant (BMT) Lymph node biopsy

Lymph node biopsy

The nurse is conducting education for a client who is scheduled to undergo diagnostic testing for non-Hodgkin lymphoma (NHL). The nurse includes information on: Diagnostic X-ray White blood cell counts Blood cultures Lymph node biopsy

Lymph node biopsy

A client has been diagnosed with non-Hodgkin lymphoma (NHL), a form of malignancy that originates in which body site? Spleen Lymph nodes Thymus Bone marrow

Lymph nodes

Adaptive immune responses, also called acquired or specific immunity, are composed primarily of which type of cells? Granulocytes Toll-like receptors Epithelial cells Lymphocytes

Lymphocytes Explanation: The adaptive immune system consists of lymphocytes that comprise the humoral (B cell) and cell-mediated (T cell) immune responses. Granulocytes, toll-like receptors, and the epithelial layer of tissue are all important components of the innate (first line of defense) immune response.

While caring for a pediatric client admitted with a viral infection, the nurse knows that which type of cell will be the child's primary defense against the virus? Bradykinin Natural killer (NK) cells Leukotrienes Complement

Natural killer (NK) cells Explanation: The third type of lymphocyte, the natural killer (NK) cell is part of the innate immune system and may be the first line of defense against viral infections. The NK cell also has the ability to recognize and kill tumor cells, abnormal body cells, and cells infected with intracellular pathogens, such as viruses and intracellular bacteria. Complement is activated in the inflammatory response. Leukotrienes and bradykinin are also a part of the inflammatory response.

Although both eukaryotes and prokaryotes are capable of causing infectious diseases in humans, eukaryotes are unique because they have a/an: Organized nucleus Circular plasmid DNA Variation of shape and size Cytoplasmic membrane

Organized nucleus Explanation: Eukaryotic cells have an organized nucleus. Many prokaryotes contain extra chromosomal pieces of circular DNA (plasmids). Prokaryotic cells have a flexible lipid cytoplasmic membrane. Both types of cells vary in shape and size.

A female adolescent is reporting general malaise and lethargy. Which clinical assessment should the nurse perform in an effort to confirm or rule out infectious mononucleosis? Auscultating the client's lungs Palpating the client's lymph nodes Assessing the client's cranial nerve reflexes Assessing the client for bone pain

Palpating the client's lymph nodes

A parent has brought her 2-week-old infant to the emergency department due to the infant's persistent and increasing jaundice. Laboratory testing reveals indirect bilirubin level is 28 mg/dL (479 µmol/L), but otherwise a normal physical assessment. Which intervention will mostlikely be prescribed for this infant? Phototherapy Intravenous antibiotics Packed red blood cell transfusion Phlebotomy

Phototherapy

The nurse knows that the second step of hemostasis is: -Fibrin clot -Platelet plug -Vessel spasm -Clot retraction

Platelet plug

A client presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which diagnosis? Hyperbilirubinemia Hemolytic anemia Leukemia Polycythemia vera

Polycythemia vera

A client tells the nurse that the doctor told her she has too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as: -Hemolytic anemia -Polycythemia vera -Pernicious anemia -Aplastic anemia

Polycythemia vera

A 40 year-old male who has been HIV-positive for 6 years is experiencing a new increase in his viral load along with a corresponding decrease in his CD4+ count. Which aspect of his immune system is likely to remain most intact? Presentation of major histocompatibility complex (MHC) molecules on body cells Orchestration of natural killer (NK) cells as part of cell-mediated immunity Activation of B lymphocytes Phagocytic function of monocytes and macrophages

Presentation of major histocompatibility complex (MHC) molecules on body cells Explanation: The expression of MHC on various cells of the body is not noted to be directly influenced by HIV. However, infected CD4+ cells are compromised in their ability to guide the action of NK cells, to direct phagocytic function of macrophages, and to present antigens that activate B cells.

A young man has been diagnosed with hemophilia, and the nurse is planning his discharge teaching. The nurse knows to include what in the discharge teaching? -It is an X-linked recessive disorder. -Prevent trauma to the body. -Only use nonsteroidal anti-inflammatory drugs (NSAIDs) for mild pain. -The client will be on IV factor VIII therapy at home.

Prevent trauma to the body.

A 69-year-old client who is obese and has a diagnosis of angina pectoris has been prescribed clopidogrel by the primary health care provider. The client asks, "Why do I need this medication? It won't help my chest pain." Which response by the nurse is the best explanation? -Inhibits the intrinsic clotting pathway to keep red blood cells from clumping together in the heart vessels -Activates plasminogen, which converts to plasmin to digest clots in your heart vessels -Prevents the blood cells from forming a clot in your heart vessels -Inactivates calcium ions, thereby preventing blood clotting

Prevents the blood cells from forming a clot in your heart vessels

The mother of an infant born with profound intellectual disability and hearing loss tells the nurse that she had a viral infection in the first trimester of pregnancy. The nurse identifies which congenital infection as the cause of the fetal defects? Roseola Rubella Measles Mumps

Rubella Explanation: When an infectious disease is transmitted from mother to child during gestation or birth, it is classified as a congenital infection. The most frequently observed congenital infections include toxoplasmosis (caused by the parasite Toxoplasma gondii), syphilis, rubella, cytomegalovirus infection, and HSV infections (the TORCH infections); varicella-zoster (chickenpox); parvovirus B19; group B streptococci (Streptococcus agalactiae); and HIV. The severity of congenital defects associated with these infections depends greatly on the gestational age of the fetus when transmission occurs, but most of these agents can cause profound intellectual disability and neurosensory deficits, including blindness and hearing loss.

A 26-year-old client has an absolute neutrophil count of less than 500 cells/mm3 (0.50 x 109/L) Which interpretation of this lab value is accurate? Mild neutropenia Normal neutrophil count Severe neutropenia Slight neutropenia

Severe neutropenia

A client with a gastrointestinal bleed has been prescribed two units of packed red blood cells. Ten minutes after starting the transfusion, the client's temperature has risen from 37.2°C to 38.2°C. The client's other vital signs remain largely unchanged. What is the nurse's best action? Stop the transfusion, remove the IV cannula, and retain the blood and tubing. Slow the transfusion and administer antipyretics. Stop the transfusion and administer a bolus of normal saline. Stop the transfusion and inform the physician STAT.

Slow the transfusion and administer antipyretics.

The primary health care provider prescribes new medications to treat a client with an autoimmune disorder. Which order would the nurse question? Belimumab Prednisolone Spironolactone Plasmapheresis

Spironolactone Explanation: Autoimmune disorders occur when the immune system attacks the body tissues. Treatments include the use of corticosteroids to suppress the immune response, plasmapheresis to remove circulating autoreactive cells, and targeted therapies such as the monoclonal antibody, belimumab. Monoclonal antibodies may reduce the autoimmune response by blocking B-cell activity, inhibiting B-cell growth factors, or interfering with B-cell communication with T cells. The potassium-sparing diuretic spironolactone would not be effective in treating an autoimmune disorder.

The practitioner carefully monitors his client who exhibits hemoglobin S (HbS) genes. The practitioner know that the client is predisposed to life-threatening infection due to damage by HbS to which organ? Pancreas Spleen Lungs Heart

Spleen

A client diagnosed with pancytopenia due to aplastic anemia is scheduled for which treatment that can correct bone marrow deficiencies?

Stem cell transplant

A client is suspected of having a parasitic infection with roundworms. For what laboratory testing will the nurse prepare the client to most rapidly identify this infection? Stool exam for ova Antibody titer Gene sequencing Cell culture

Stool exam for ova Explanation: Cultures of microorganisms are commonly used to grow bacteria, fungi, and yeasts. Some protozoa and helminths can be cultured; however, the fastest and most common method for identifying parasitic worms is visible identification of the organisms, cysts, or ova from a client specimen. Cell cultures are grown on a specific type of media used for Chlamydiaceae, Rickettsiaceae, and human viruses. Antibody titers are useful for indirectly diagnosing diseases that cannot be cultured, such as hepatitis B. Gene sequencing is commonly used for identifying viruses such as HIV and hepatitis C.

A client with iron-deficiency anemia asks, "What does this low mean corpuscular volume (MCV) level mean?" Which response by the nurse is most accurate? This means your blood will thicken rapidly. This means that you have a lot of fluid in your vessels diluting your red blood cells. The MCV is one red blood cell (RBC) index that indicates your RBCs are small cells. This means that your red blood cells are pale in color.

The MCV is one red blood cell (RBC) index that indicates your RBCs are small cells.

A nurse is assessing a client and finds these results: Areas of bruising (purpura) on the client's arms and legs Pinpoint hemorrhages (petechiae) on the legs Pinpoint hemorrhages (petechiae) in the mouth Platelets level of 90,000/μL (90 ×109/L) What condition should the nurse suspect the client is exhibiting? -Neutropenia -Thrombocytosis -Thrombocytopenia -Leukopenia

Thrombocytopenia

A nurse is treating a client with aplastic anemia. Due to the replacement of normal bone marrow with malignant cells, the nurse teaches the client to prevent scratches, scrapes, and cuts. What root cause likely underlies the client's increased risk for hemorrhage? -Polycythemia -Thrombocytopenia -Neutrophilia -Disseminated intravascular coagulation (DIC)

Thrombocytopenia

A client with renal disease comes to the emergency department with reports of excessive gingival bleeding over the past week. The nurse documents a platelet level of 100,000/μL and anticipates a follow-up blood test for: -Thrombopoietin -Prothrombin -Fibrinogen -Endothelin 1

Thrombopoietin

A nurse assessing a client with an acute exacerbation of polycythemia vera notes coolness to the right leg and foot, pale color, and an absent right pedal pulse. Based on these findings the nurse suspects that the client has developed which complication? Thrombosis in the right leg Edema in the right leg Infection in the right leg Compartment syndrome in the right leg

Thrombosis in the right leg

What is the reason why bed rest and analgesics are expected treatments for infectious mononucleosis? To relieve fever, headache, and sore throat To eliminate the causative organism To increase the white blood count To decrease the risk of neutropenia

To relieve fever, headache, and sore throat

Drug-induced neutropenia is a disease that has significantly increased in incidence over the last several decades. What is the attributing factor in the increased incidence of drug-induced neutropenia? The destruction of tissue cells by cocaine The decrease in the use of street drugs Treatment of cancer by chemotherapeutic drugs The new drugs developed to treat autoimmune diseases

Treatment of cancer by chemotherapeutic drugs Explanation: The incidence of drug-induced neutropenia has increased significantly over the last several decades and is attributed primarily to a wider use of drugs in general and more specifically to the use of chemotherapeutic drugs in the treatment of cancer.

A client diagnosed with autosomal dominant von Willebrand factor disease (vWF) is experiencing mild to moderate bleeding. The health care provider would classify the diagnosis as: -Type 1 -Type 2 -Type 3 -Type 4

Type 2

Stem cell transplantation has been shown to provide potential cures for diseases such as aplastic anemia and the leukemias. What are the sources of stem cells used for transplant?

Umbilical cord blood and bone marrow

What is the most common mode of transmission of HIV? Vaginal and anal intercourse Blood transfusion Mother to newborn via perinatal transmission Infection from shared needles Occupational exposure

Vaginal and anal intercourse Explanation: The most common method of transmission of HIV is from vaginal and anal sexual intercourse. Only 25% of newly diagnosed HIV infections are in those individuals who share needles. Transmission from mother to infant is the most common way children are affected but not the most common overall. Occupation exposure and blood transfusion are the least common of the choices provided.

A client with an apparent clotting disorder is admitted to hospital. His health record reveals that he has been treated for complications of chronic alcoholism for the past 10 years. The nurse should suspect what cause of his clotting disorder? -Vitamin K deficiency -Von Willebrand disease -Immune thrombocytopenic purpura (ITP) -Hemophilia

Vitamin K deficiency

To form a platelet plug, platelets must adhere to the vessel inner layer. For this to occur, which protein molecule is required? -Plasminogen -Lipoprotein -Von Willebrand factor -Thromboxane A2

Von Willebrand factor

A nursing student is assigned to care for a client who has AIDS. The student is unsure of what personal protective equipment should be worn while caring for this client. Which statement is appropriate direction from the student's nursing instructor? Wear gloves, gown, and mask when in contact with the client. No precautions are needed. Have the client wear a mask when transporting him from one area of the hospital to another. Wear gloves if there is a chance you will come in contact with the client's blood or body fluids.

Wear gloves if there is a chance you will come in contact with the client's blood or body fluids. Explanation: Universal Blood and Body Fluid Precautions should be used in encounters with all people in the health care setting. Occupational risk of infection for health care workers most often is associated with percutaneous inoculation of blood from a person with HIV infection. HIV infection is not transmitted through casual contact.

A nurse is reviewing laboratory data for an older adult client. Which laboratory value should the nurse be most concerned about?

White blood cell (WBC) count 3500/mL

A nurse is reviewing the laboratory data for a hospitalized client. The nurse would be mostconcerned about which finding?

White blood cell (WBC) count of 2800/µL (2.80 x 109/L)

The nurse is reviewing the complete blood count (CBC) and white blood cell (WBC) differential of a client admitted with lower right abdominal pain. Which laboratory results are the most important for the nurse to communicate to the health care provider?

White blood cells (WBCs) 18,500/µL (18.50 x 109/L)

A client recently diagnosed with leukocyte adhesion deficiency (LAD) asks, "Why am I always sick with an infection?" Which response by the nurse explains this rare autosomal recessive disorder? Your bone marrow is damaged and can't put out enough white blood cells to fight off your infections." Your white blood cells are not able to leave the blood vessels and move into the area of infection." Your body doesn't make enough white blood cells." I don't really understand this, but it sounds like a good question to ask your physician."

Your white blood cells are not able to leave the blood vessels and move into the area of infection." Explanation: Leukocyte adhesion deficiency (LAD) is a rare autosomal recessive disorder characterized by immunodeficiency, resulting in recurrent infections. A WBC differential will reveal extremely elevated levels of neutrophils (on the order of 6-10 times normal) because they are unable to leave the blood vessels. Certain integrins play an important role in allowing white blood cells to pass through the vessel wall, a process called transmigration.

A client has been experiencing anemia and thrombocytopenia. Subsequent diagnostic testing has revealed the presence of immature granulocyte types and the Philadelphia chromosome. This client is likely to experience: a prolonged chronic phase of leukemia. a high risk of pathologic bone fractures. a self-limiting infection with the Epstein-Barr virus. hyperuricemia.

a prolonged chronic phase of leukemia. Explanation: The Philadelphia chromosome is specifically associated with CML, a disease that typically has a chronic phase of variable length. CML does not have a viral etiology. Fractures are associated with multiple myeloma. Hyperuricemia is more closely associated with acute leukemias than chronic leukemias.

When reading a client's chart the nurse notes that the client has a bone marrow disorder that is causing the client to be neutropenic. The nurse understands that the client's neutropenia is: drug induced. an acquired disorder. related to the infectious process. a congenital disorder.

an acquired disorder. Explanation: Neutropenia that is caused by bone marrow disorders is classified as an acquired neutropenia.

A client is prescribed the recumbent granulocyte colony-stimulating factor (CSF) filgrastim. The nurse evaluates the effectiveness by monitoring which laboratory value? hemoglobulin and hematocrit (H&H) international normalized ratio (INR) Prothrombin time (PT)/partial thromboplastin time (PTT) complete blood count (CBC)/differential

complete blood count (CBC)/differential Explanation: The nurse would evaluate the effectiveness of the recumbent granulocyte CSF by monitoring the client's CBC/diff, as the intended effect is to stimulate granulocyte maturation and increase neutrophil counts. This group of tests, known as a coagulation study, are commonly referred to as a prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR). PT is done to evaluate the blood for its ability to clot. PTT is performed primarily to determine if heparin (blood thinning) therapy is effective. It can also be used to detect the presence of a clotting disorder. The INR is used to make sure the results from a PT test are the same at one lab as at another lab. "H&H" is a popular shorthand for hemoglobin and hematocrit, two very common and important blood tests. Hemoglobin (Hb or Hgb) is a protein in red blood cells that carries oxygen throughout the body. The hematocrit is the proportion, by volume, of the blood that consists of red blood cells.

A public health nurse notes an increase in regional throat cancer cases. Upon epidemiological studies, many of the throat cancer clients also had oral exposure to human papillomavirus (HPV). This exposure to HPV would be considered by: direct contact with infected secretions. ingestion of HPV through the GI tract. accidental aspiration and inhalation of pathogens. deep penetration of open lesions.

direct contact with infected secretions. Explanation: Most STIs are spread by direct contact. In addition to causing infectious diseases, certain viruses also have the ability to transform normal host cells into malignant cells during the replication cycle. This group of viruses is referred to as oncogenic and includes certain retroviruses and DNA viruses, such as the Epstein-Barr virus, hepatitis B virus, and human papillomavirus. Vertical transmission is possible for many sexually transmitted pathogens, but direct contact is more common. Ingestion and penetration are less likely mechanisms.

A client is diagnosed with pernicious anemia. The nurse determines the most likely cause of this condition is related to: history of a gastrectomy. abnormal synthesis of hemoglobin. inherited DNA abnormality. blocked protein synthesis.

history of a gastrectomy.

A critical care nurse is preparing a case study on the treatment of acute coronary syndrome (ACS), which describes glycoprotein factor (GPIIb/IIIa) inhibitors and their role in decreasing thrombosis by: -supporting the antiplatelet function of prostacyclin. -interfering with the conversion of fibrinogen to fibrin. -interfering with the ability of platelets to bind to one another. -activating prostaglandin and von Willebrand factor release.

interfering with the ability of platelets to bind to one another.

Manifestations of Kaposi sarcoma include: lesions of the skin and in the oral cavity, gastrointestinal tract, and lungs. Fever, shortness of breath, and weight loss Confusion and lethargy limb weakness, sensory loss, difficulty controlling the digits, visual disturbances, diplopia, ataxia, seizures, and changes in mental status,.

lesions of the skin and in the oral cavity, gastrointestinal tract, and lungs. Explanation: Kaposi sarcoma is a malignancy of the endothelial cells that line small blood vessels through out the body. The lesions of Kaposi sarcoma can be found on the skin and in the oral cavity, gastrointestinal tract, and the lungs. The other symptoms may appear in clients who have AIDS, but for different reasons than having Kaposi sarcoma.

While explaining immunity to a client, the nurse responds, "The body's internal organs are protected from pathogens because: our mucosal tissue contains all the necessary cell components to fight a pathogen with an immune response." the actions of the cytokines in the mouth can act on different cell types at the same time it is fighting pathogens." the tonsils store a large amount of natural killer cells at that location." we have special glands that can secrete cytokines on a moment's notice."

our mucosal tissue contains all the necessary cell components to fight a pathogen with an immune response." Explanation: Secondary lymphoid tissues contain all the necessary cell components (i.e., T cells, B cells, macrophages, and dendritic cells) for an immune response. Because of the continuous stimulation of the lymphocytes in these tissues by microorganisms constantly entering the body, large numbers of plasma cells are evident. Immunity at the mucosal layers helps to exclude many pathogens and thus protects the vulnerable internal organs. Although cells of both the innate and adaptive immune systems communicate critical information by cell-to-cell contact, many interactions and effector responses depend on the secretion of short-acting soluble molecules called cytokines. The actions of cytokines are often pleiotropic and redundant. Pleiotropism refers to the ability of a cytokine to act on different cell types.

A nurse educator is explaining how the HIV virus is responsible for AIDS and AIDS syndromes. The educator should explain that replication involves the killing of: plasma cells and their eventual replacement with HIV cells. macrophages and the release of HIV copies into the bloodstream. the CD8+ T cell and the release of HIV copies into the bloodstream. the CD4+ T cell and the release of HIV copies into the bloodstream.

the CD4+ T cell and the release of HIV copies into the bloodstream. Explanation: The destruction of CD4+ T cells leaves the HIV client susceptible to infections that would normally not be a problem. CD8+ cells, macrophages, and plasma cells are not infected with HIV.

The nurse is reviewing the client's medical record for the results of a Western blot test with the understanding that: the Western blot can have many situations causing false positive results. the Western blot is a less specific test than the ELISA test. the Western blot is used to confirm a diagnosis of HIV infection. the Western blot is performed before the ELISA test.

the Western blot is used to confirm a diagnosis of HIV infection. Explanation: The Western blot test is more specific than the ELISA, and in the case of false-positive ELISA, the Western blot test can identify the person as uninfected. ELISA tests have high false-positive rates.

A client who is being treated for small-cell lung cancer has been placed in protective isolation due to neutropenia. The most likely cause of this client's neutropenia is: tumor invasion into the bone marrow and destruction of progenitor cells. chromosomal disruption caused by the client's tumor. the effects of tumor necrosis factor (TNF) on immature neutrophils. the effects of chemotherapy on white blood cell development.

the effects of chemotherapy on white blood cell development. Explanation: Drug-related neutropenia is typically caused by chemotherapeutic drugs in the treatment of cancer. Tumor invasion and chromosomal disruption are not causes of neutropenia. TNF does not act directly on neutrophils.

A 42-year-old male client recently diagnosed with liver cancer is noted as at high risk for bleeding abnormalities. The nurse recognizes this risk as a result of: -increased amounts of vitamin K being produced in the liver. -the reduction of clotting factors synthesized in the liver. -a vitamin C deficiency in the diet. -weakening of the organ walls as a result of inflammation.

the reduction of clotting factors synthesized in the liver