infection and immunity
A client who receives long-term corticosteroid therapy is at risk for the development of which conditions? (Select all that apply.) a. Diabetes mellitus b.RA c.peptic ulcer disease d.TB e.COPD
a. Diabetes mellitus c.peptic ulcer disease d.TB Long-term corticosteroid therapy may cause a client to develop diabetes due to the increase in glucose tolerance, peptic ulcer disease due to the gastric erosion, and tuberculosis because of the decreased immunity. It is used as a treatment for rheumatoid arthritis and COPD.
A client who plays football with friends is to take methotrexate orally for severe rheumatoid arthritis. What should the nurse tell the client about taking this drug? Select all that apply. a. this drug will slow the progression of joint damage b. you should avoid the chance of becoming bruised c. plan to increase the protein in your diet d."Your health care provider will monitor your blood work to determine liver disease and blood count." e.limit or avoid alcoholic drinks f. increase your fluid intake to 3,000mL per day
a. this drug will slow the progression of joint damage b. you should avoid the chance of becoming bruised d."Your health care provider will monitor your blood work to determine liver disease and blood count." e.limit or avoid alcoholic drinks Methotrexate is used for clients with rheumatoid arthritis to decrease the progression of the disease and relieve pain. Side effects of the methotrexate include decreased white blood cells and platelets and the potential for liver disease. The nurse should instruct the client to avoid infection and report signs such as fever, child or cough. The client should avoid contact sports that could cause bruising. The client should also limit the amount of alcohol use to avoid liver damage. The client will have frequent blood tests to monitor liver enzymes and complete blood count. It is not necessary for the client to increase the protein in the diet or increase fluid.
A client has recently been diagnosed with rheumatoid arthritis, and is also receiving further testing for disorders of the immune system. The client works as an aide at a facility caring for children infected with AIDS. Which factors will hold significant implications during the client's assessment? Select all that apply. a. work environment b. history of immunizations and allergies c.use of other drugs d.age e.diet f.her home environment
a. work environment b.history of immunizations and allergies c. use of other drugs It is important for the nurse to obtain a history of past immunizations and infectious diseases, any allergies, and any recent exposure to infectious diseases. The nurse also needs to review the client's drug history. These data will help the nurse to assess the client's susceptibility to illness because certain past illnesses and drugs, such as corticosteroids, suppress the inflammatory and immune responses. The nurse should question the client about the practices that put her at risk for AIDS, such as her work environment. The client's age, home environment, and diet do not have any major implications during the assessment because they do not indicate the client's susceptibility to illness.
The intensive care nurse is responsible for the care of a client who is in shock. What cardiac signs or symptoms would suggest to the nurse that the client may be experiencing acute organ dysfunction? Select all that apply. a.Drop in systolic blood pressure of ≥40 mm Hg from baselines b.Hypotension that responds to bolus fluid resuscitation c.Exaggerated response to vasoactive medications d.Serum lactate >4 mmol/L e.Mean arterial pressure (MAP) of ˂65 mm Hg
a.Drop in systolic blood pressure of ≥40 mm Hg from baselines d.Serum lactate >4 mmol/L e.Mean arterial pressure (MAP) of ˂65 mm Hg Signs of acute organ dysfunction in the cardiovascular system include systolic blood pressure <90 mm Hg or MAP <65 mm Hg, drop in systolic blood pressure >40 mm Hg from baselines or serum lactate >4 mmol/L. An exaggerated response to vasoactive medications and an adequate response to fluid resuscitation would not be noted.
The nurse assesses a patient in compensatory shock whose lungs have decompensated. What clinical manifestations would the nurse expect to find? (Select all that apply.) a.HR greater than 100 bpm b.crackles c.lethargy and mental confusion d.RR less than 15 breaths per min e. compensatory respiratory acidosis
a.HR greater than 100 bpm b.crackles c.lethargy and mental confusion In compensatory shock, the heart rate is >100 bpm, the patient experiences lethargy and mental confusion, respirations are >20 breaths/min (not <15), and respiratory alkalosis is present (not respiratory acidosis). Subsequent decompensation of the lungs increases the likelihood that mechanical ventilation will be needed. Respirations are rapid and shallow. Crackles are heard over the lung fields.
The nurse is caring for a client with psoriasis. What information about psoriatic arthritis does the nurse provide to the client? Select all that apply. a.It is a relatively rare complication, affecting less than 10% of people with psoriasis. b.Using disease-modifying drugs for the psoriasis can help control arthritis symptoms. c.The presentation can vary widely in affected joints and associated symptoms. d.Avoid taking nonsteroidal anti-inflammatory drugs for any associated joint pain. e.Psoriatic arthritis is similar to rheumatoid arthritis but the joint damage is more severe.
a.It is a relatively rare complication, affecting less than 10% of people with psoriasis. b.Using disease-modifying drugs for the psoriasis can help control arthritis symptoms. c.The presentation can vary widely in affected joints and associated symptoms. Psoriatic arthritis is a seronegative inflammatory arthropathy that occurs in 7% of people with psoriasis. It is a heterogeneous disease, presenting with a variety of joint involvement and severity. Although the symmetrical form may present like rheumatoid arthritis, psoriatic arthritis has a better prognosis and often the joints maintain function with only minimal symptoms. Treatments include disease-modifying drugs such as methotrexate and nonsteroidal anti-inflammatory drugs for pain.
The nurse is teaching the client with HIV about therapy. Which elements are essential for the nurse to include in the teaching plan? Select all that apply. a.The CD4 count is the major indicator of immune function and guides therapy. b.Antiretroviral therapy targets different stages of the HIV life cycle. c.The goal of antiretroviral therapy is to prevent opportunistic infections. d.Medication therapy is rarely effective. e.Clients rarely respond to medication therapy.
a.The CD4 count is the major indicator of immune function and guides therapy. b.Antiretroviral therapy targets different stages of the HIV life cycle. The CD4 count is the major indicator of immune function. Antiretroviral therapy in HIV targets different stages of the HIV life cycle. Therapy does not prevent opportunistic infections. Medication therapy is effective, and most clients respond well to it.
A nurse is preparing a presentation about human immunodeficiency virus (HIV) for a local community group. What would the nurse include in the presentation about HIV transmission? Select all that apply. a.The risk of acquiring HIV through the transfusion of blood products is almost nonexistent. b.HIV transmission from mother-to child occurs primarily during pregnancy while the fetus is in utero. c.The amount of HIV contained in body fluids on exposure is associated with the risk for infection. d.HIV can be found in seminal fluid, vaginal secretions, and breast milk. e.Sharing of infected equipment used to inject drugs increases the risk for infection.
a.The risk of acquiring HIV through the transfusion of blood products is almost nonexistent. c.The amount of HIV contained in body fluids on exposure is associated with the risk for infection. d.HIV can be found in seminal fluid, vaginal secretions, and breast milk. e.Sharing of infected equipment used to inject drugs increases the risk for infection. HIV-1 is transmitted in body fluids that contain free virions and infected CD+4 T cells. These fluids include blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk. The amount of HIV and infected cells in the body fluid is associated with the probability that the exposure will result in infection. Blood and blood products can transmit HIV to recipients; however, the risk associated with transfusions have been virtually eliminated as the result of intensive donor screening. Mother-to-child transmission may occur in utero, at the time of delivery, or through breastfeeding. Most perinatal infections are thought to occur during delivery. Sharing infected equipment during drug injections increases a person's risk for acquiring HIV.
The nurse is teaching the client with rheumatoid arthritis (RA) about the role of corticosteroid therapy in disease management. What information does the nurse include about the use of corticosteroids in RA? Select all that apply. a.are reserved for poorly controlled, systemic symptoms b.can increase the risk for opportunistic infections c.must be taken via intra-articular injections a few times a year d.do not affect disease process or prevent joint damage e.require long-term dosing due to the risk for adrenal crisis
a.are reserved for poorly controlled, systemic symptoms b.can increase the risk for opportunistic infections d.do not affect disease process or prevent joint damage Corticosteroid drugs are used for their anti-inflammatory effects to reduce discomfort but they do not modify the disease and are unable to prevent joint destruction. Because they interfere with the inflammatory response, they have immunosuppressive properties and increase the risk for infection. To avoid long-term side effects, they are reserved for unremitting disease with extra-articular manifestations, and short-term therapy at a low dose level is used. These drugs may be taken as oral systemic preparations or intra-articular corticosteroid injections.
A client who is HIV positive is taking zidovudine. Which adverse effects should the nurse closely monitor for in this client? a.diarrhea and abdominal pain b.numbness in the extremities and decreased cognition c.alterations in renal function d.pancreatitis
a.diarrhea and abdominal pain Common adverse effects associated with the administration of zidovudine and other NRTIs include nausea, abdominal pain and diarrhea. The drug does not cause nephropathy, decreased cognition, or pancreatitis.
A nurse is managing the care of a client 10 days after a liver transplant. What assessments may indicate organ rejection? Select all that apply. a.fever b.tachycardia c.elevated liver enzymes d.amber urine e.brown stool
a.fever b.tachycardia c.elevated liver enzymes Transplant rejection is a Type IV hypersensitivity cell-mediated immune response. Elevated temperature, tachycardia, and elevated liver enzymes are signs of liver transplant rejection. Because the rejected liver is not processing bilirubin, the urine will be tea colored and stool will be clay colored with rejection.
A nurse is obtaining a medication history from a pregnant client with a history of systemic lupus erythematosus (SLE). Which medication(s) would the nurse expect the woman to report to be currently using? Select all that apply. a.ibuprofen b.hydroxychloroquine c.methotrexate d.leflunomide e.prednisone
a.ibuprofen b.hydroxychloroquine e.prednisone
The health care provider prescribes a vasoactive agent for a patient in cardiogenic shock. The nurse knows that the drug is prescribed to increase blood pressure by vasoconstriction. Which of the following is most likely the drug that is ordered? a.levophed b.dobutrex c.nipride d.adrenalin
a.levophed
Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for a.removal of the transplanted kidney. b.high-dose I.V. cyclosporine therapy. c.bone marrow transplant. d.intra-abdominal instillation of methylprednisolone sodium succinate.
a.removal of the transplanted kidney. Hyperacute rejection isn't treatable; the only way to stop this reaction is to remove the transplanted organ or tissue. Although cyclosporine is used to treat acute transplant rejection, it doesn't halt hyperacute rejection. Bone marrow transplant isn't effective against hyperacute rejection of a kidney transplant. Methylprednisolone sodium succinate may be given I.V. to treat acute organ rejection, but it's ineffective against hyperacute rejection.
A nurse is completing the nutritional status of a client who has been admitted with AIDS-related complications. What components should the nurse include in this assessment? Select all that apply. a.serum albumin level b.weight history c.WBC count d.BMI e.BUN level
a.serum albumin level b.weight history d.BMI e.BUN level Nutritional status is assessed by obtaining a dietary history and identifying factors that may interfere with oral intake, such as anorexia, nausea, vomiting, oral pain, or difficulty swallowing. In addition, the client's ability to purchase and prepare food is assessed. Weight history (i.e., changes over time); anthropometric measurements; and blood urea nitrogen (BUN), serum protein, albumin, and transferrin levels provide objective measurements of nutritional status. White cell count is not a typical component of a nutritional assessment.
The nurse is assessing a client who has had rheumatoid arthritis for several years. What clinical manifestation will the nurse expect to find in a client? a.small joint involvement b.obesity c.Bouchard's nodes d.asymmetric joint involvement
a.small joint involvement Clinical manifestations of rheumatoid arthritis are usually bilateral and symmetrical and include small joint involvement and joint stiffness in the morning. Other systemic manifestations occur over time. Obesity, Bouchard's nodes, and asymmetric joint involvement can be seen with the early stage of the disease.
The nurse is creating a teaching plan on self-management for a client with moderate rheumatoid arthritis. What should the nurse include in the teaching plan? Select all that apply. a.use of heat or cold on joints b.techniques to reduce joint use c.reduced sodium diet d.use of assistive devices e.joining a gym or personal trainer
a.use of heat or cold on joints b.techniques to reduce joint use d.use of assistive devices The nurse should focus the education on the importance of joint support (including the use of splints and assistive devices) and rest balanced with therapeutic exercises. Rather than joining a gym and having the exercise designed by a personal trainer, the client should be advised on therapeutic exercise by a physiotherapist knowledgeable in the management of rheumatoid arthritis. Heat or cold may be used depending on client preference, but there is no need for a reduced sodium diet unless the client is taking medications that cause sodium retention (e.g., corticosteroids).
A client with end-stage kidney disease is receiving a kidney donated by a family member. When caring for this client, what does the nurse know is the major target involved in organ transplant rejection? a. T-cell receptor (TCR) b. human leukocyte antigens (HLAs) c. major histocompatibility complex (MHC) d. antigen-presenting cell (APC)
b. human leukocyte antigens (HLAs) The first human MHC proteins discovered are called human leukocyte antigens (HLAs) and are so named because they were identified on the surface of white blood cells. HLAs are the major target involved in organ transplant rejection and as a result are the focus of a great deal of research in immunology.
The nurse is administering the disease-modifying antirheumatic drug (DMARD) methotrexate to a client with rheumatoid arthritis (RA). When the client questions why the drug is needed, how should the nurse reply? a."These medications are curative when taken for life." b."Early use of these medications may prevent resistance to treatment later." c."These medications stop the acute inflammation response." d."This medication works quickly, within a few days, to decrease disease symptoms."
b."Early use of these medications may prevent resistance to treatment later." Early treatment with a DMARD is based on the theory that T cell-dependent pathways, which manifest early in the inflammatory process, are more responsive to treatment than those that manifest later in the process when the disease may be more resistant to treatment.
The nurse is caring for a client with a history of a renal transplant who has just been diagnosed with chronic rhinosinusitis. While being admitted to the clinic, the client asks, "Will this chronic infection hurt my new kidney?" What should the nurse know about chronic rhinosinusitis in this client? a. The client will have exaggerated symptoms of rhinosinusitis due to immunosuppression. b.Taking immunosuppressive drugs can contribute to chronic rhinosinusitis. c.Chronic rhinosinusitis can damage the transplanted organ. e.Immunosuppressive drugs can cause organ rejection.
b.Taking immunosuppressive drugs can contribute to chronic rhinosinusitis. URIs, specifically chronic rhinosinusitis and recurrent acute rhinosinusitis, may be linked to primary or secondary immune deficiency or treatment with immunosuppressive therapy (i.e., for cancer or organ transplantation). Typical symptoms may be blunted or absent due to immunosuppression. No evidence indicates damage to the transplanted organ due to chronic rhinosinusitis. Immunosuppressive drugs do not cause organ rejection.
A critical care nurse is planning assessments in the knowledge that clients in shock are vulnerable to developing fluid replacement complications. For what signs and symptoms should the nurse monitor the client? Select all that apply. a.hypovolemia b.difficulty breathing c.cardiovascular overload d.pulmonary edema e.hypoglycemia
b.difficulty breathing c.cardiovascular overload d.pulmonary edema Fluid replacement complications can occur, often when large volumes are given rapidly. Therefore, the nurse monitors the client closely for cardiovascular overload, signs of difficulty breathing, and pulmonary edema. Hypovolemia is what necessitates fluid replacement, and hypoglycemia is not a central concern with fluid replacement.
The ICU nurse is required to closely monitor four clients diagnosed with shock. During the shift assessment, the nurse documents the following values for the clients. Which client is most stable? a.Client A: Heart rate 70 beats per minute, systolic blood pressure (BP) 100 mm Hg, urine output 30 mL/hour b.Client B: Capillary refill time between 7 and 10 seconds, urine output 35 mL/hour c.Client C: Heart rate 115 beats per minute, systolic BP 129 mm Hg, urine output 60 mL/hour d.Client D: Capillary refill time between 5 and 6 seconds, urine output 30 mL/hour
c.Client C: Heart rate 115 beats per minute, systolic BP 129 mm Hg, urine output 60 mL/hour The stability of the client's condition is evidenced by a heart rate between 60 and 120 beats per minute, systolic BP between 90 and 139 mm Hg, urine output greater than 35 to 50 mL/hour, and capillary refill time between 2 and 3 seconds. Therefore, options A, B, and D are incorrect.
A nurse is caring for a client with moderate rheumatoid arthritis (RA). Which nonpharmacological interventions would a nurse include in the care plan? Select all that apply. a.massaging inflamed joints b.avoiding repetitive exercises c.applying splints to inflamed joints d.using assistive devices at all times e.selecting clothing that has velcro fasteners f.applying moist heat to joints
c.applying splints to inflamed joints e.selecting clothing that has velcro fasteners f.applying moist heat to joints RA affects more than 2 million Americans, mostly women. RA is a chronic, systematic inflammatory disorder affecting many tissues, organs, and joints. Supportive, nonpharmacological measures for the client with RA include applying splints to rest inflamed joints, using Velcro fasteners on clothing to aid in dressing, and applying moist heat to joints to relax muscles and relieve pain. Inflamed joints would never be massaged because doing so can aggravate inflammation. A physical therapy program, including ROM exercises and carefully individualized therapeutic exercises, prevents loss of joint function. Assistive devices would only be used when marked loss of ROM occurs.
In a client infected with human immunodeficiency virus (HIV), CD4+ levels are measured to determine the: a.presence of opportunistic infections b.level of viral load c.extent of immune system damage d.resistance to antigens
c.extent of immune system damage CD4+ levels in the blood of an individual with HIV infection determine the extent of damage to the individual's immune system. The test indicates the individual's risk of an opportunistic infection but doesn't identify specific infections. Viral loads and resistance to specific antigens are determined using other diagnostic tests.
Which type of pneumonia has the highest incidence in clients with AIDS and clients receiving immunosuppressive therapy for cancer? a.streptococcal b.fungal c.pneumocystis d.TB
c.pneumocystis Pneumocystis pneumonia incidence is greatest in clients with AIDS and clients receiving immunosuppressive therapy for cancer, organ transplantation, and other disorders.
Which client could have a false negative ELISA test result due to a pre-existing medical condition? Select all that apply. a.Client with a DNA viral infection like Epstein-Barr virus b.Client with chronic renal failure currently on dialysis c.Young adult with a long history of rheumatoid arthritis d.Client currently receiving immunosuppression therapy following kidney transplant e.Client receiving a bone marrow transplant to treat their leukemia
d.Client currently receiving immunosuppression therapy following kidney transplant e.Client receiving a bone marrow transplant to treat their leukemia ELISA could have false positive results with malignant melanoma, viral infections, autoimmune disorders, chronic renal failure, Stevens-Johnson syndrome, and primary biliary cirrhosis. A false negative could occur with immunosuppression therapy, a transfusion, bone-marrow transplant, B-cell dysfunction, and contamination of specimens with starch from gloves.
The intensive care unit nurse is caring for a client with sepsis whose tissue perfusion is declining. What sign would indicate to the nurse that end-organ damage may be occurring? a.urinary output increases b.skin becomes warm and dry c.adventitious lung sounds in the upper airway d.heart and resp rate are elevated
d.heart and resp rate are elevated As sepsis progresses, tissues become less perfused and acidotic, compensation begins to fail, and the client begins to show signs of organ dysfunction. The cardiovascular system also begins to fail, the blood pressure does not respond to fluid resuscitation and vasoactive agents, and signs of end-organ damage are evident (e.g., acute kidney injury, pulmonary failure, hepatic failure). As sepsis progresses to septic shock, the blood pressure drops, and the skin becomes cool, pale, and mottled. Temperature may be normal or below normal. Heart and respiratory rates remain rapid. Urine production ceases, and multiple organ dysfunction progressing to death occurs. Adventitious lung sounds occur throughout the lung fields, not just in the upper fields of the lungs.
A client diagnosed with human immunodeficiency virus (HIV) asks how the health care provider determines what his or her viral load is. What is the nurse's best response? a.the health care provider can have a sedimentary rate run b.the health care provider can have a basic metabolic panel run c.the health care provider can have a ELISA test run d.the health care provider can have a polymerase chain reaction test run
d.the health care provider can have a polymerase chain reaction test run The p24 antigen test and polymerase chain reaction test measure viral loads. They are used to guide drug therapy and follow the progression of the disease. Options A, B, and C are incorrect, as these tests do not determine the client's viral load.