Patho Exam 2
Total Leukocyte (White Blood Cell) Count
5,000-10,000/microL (5-10x10^3/microL) (also expressed as 5-10x10^3/microL)
pH
7.35-7.45
Fasting Plasma Glucose
75-110mg/dL
Total Calcium
8.5-10.5
PaCO2
80-100mg Hg
SaO2
95-100%
Magnesium
1.8-3.0
Chloride
95-105mEq/L
HIV uses the glycoproteins that protrude from its surface to: replicate its RNA. enter the host nucleus. synthesize new enzymes. attach to target cells.
Attach to target cells
Sodium
135-145mEq/L
HCO3-
22-28 mEq/L
Potassium
3.5-5.0mEq/L
PaO2
35-45
Hematocrit Female
37-47%
Hemoglobin A1c
4-6%
Ionized Calcium
4.5-5.6
Hematocrit Male
40-50%
The pathophysiology of type 1 diabetes mellitus involves: autoimmune destruction of pancreatic beta cells. postreceptor defects that cause insulin resistance. All of the other answers are correct. hyperglycemia alternating with hypoglycemic episodes.
Autoimmune destruction of pancreatic beta cells
You are teaching a woman who is HIV positive and wants to know how the virus makes new virus. Which of the following processes should you translate into appropriate terms for her to explain HIV replication? A. Insertion of its viral RNA into cells, where it is converted to viral DNA and provides genetic instructions to make new virus B. Cell division in the blood or on surfaces such as the gastrointestinal tract mucosa. C. Causing host white blood cells to die, thus depressing immunity so it can replicate in the blood without being detected D. Insertion of its viral DNA directly into host chromosomes, thus providing the genetic instructions to make new cells that produce virus
A. Insertion of its viral RNA into cells, where it is converted to viral DNA and provides genetic instructions to make new virus
A person who has type 2 diabetes is more likely to develop hyperglycemic hyperosmolar nonketotic coma than diabetic ketoacidosis because: A. a small amount of insulin reaches the liver in type 2 diabetes. B. ketoacids are burned for fuel in type 2 diabetes. C. insulin resistance is a problem in type 2 diabetes. D. increased renal bicarbonate reabsorption neutralizes the ketoacids.
A. a small amount of insulin reaches the liver in type 2 diabetes
You are talking with another health professional about immunity. What term should you use to describe a person who has resistance to a disease after having the disease? Active acquired immunity Natural immunity Passive acquired immunity Innate immunity
Active acquired immunity
Antigen-presenting cells are necessary for which aspect of the immune system to be able to function effectively? Cell-mediated immunity Adaptive immunity Innate immunity Humoral immunity
Adaptive immunity
In type II hypersensitivity, tissue injury may be caused by: A. antibody stimulation of cell receptors, causing excessive cell function. B. all of the above. C. antibody opsonization of cells and subsequent phagocytosis. D. antibody activation of complement and subsequent lysis of target cells.
All of the above
What type of reaction occurs when the body mounts an aggressive response against an organ transplanted from another person? Alloimmune Type I hypersensitivity Autoimmune Immunosuppressive
Allimmune
A child who has a congenital immunodeficiency that impairs B lymphocyte function will have a deficiency of which immune component? Complement Cytokines Antibodies Cytotoxic cell activity
Antibodies
An immune complex is a combination of which of the following? B cell and antigen Cytotoxic T cell and antigen T helper cell and lymphocyte Antibody and antigen
Antibody and antigen
Why do people who have AIDS get Kaposi sarcoma but not people who have healthy immune systems?" says Mrs. Jeptoo. Choose the best response. A. HIV, the virus that causes AIDS, also causes Kaposi sarcoma. B. A healthy immune system can destroy abnormal cells that can develop into cancers, but the suppressed immune system in a person who has AIDS is not able to do so as effectively. C. People who have AIDS get exposed to Epstein-Barr virus, which is associated with Kaposi sarcoma, and their suppressed immune systems are not able to destroy the virus. D. People who have healthy immune systems get Kaposi sarcoma also, especially people who have a lot of sun exposure.
B. A healthy immune system can destroy abnormal cells that can develop into cancers, but the suppressed immune system in a person who has AIDS is not able to do so as effectively.
Mr. Jacobs, who has cancer, has been reading a lot about it. He found a journal article indicating that some cancer cells evade lysis by cytotoxic T cells by producing fewer MHC proteins. "Explain this to me," he says. "I learned that cytotoxic T cells can kill a bad cell when they find its bad antigens, but why does producing fewer MHC proteins enable cancer cells to avoid death from cytotoxic T cells?" Choose the best explanation. A. MHC proteins are abnormal antigens to which cytotoxic T cells are innately sensitive. B. Cytotoxic T cells can recognize bad antigens on cancer cells only if those antigens are associated with MHC proteins. C. MHC proteins are abnormal antigens that can activate cytotoxic T cells after they have been introduced to them. D. In order to kill a cell, cytotoxic T cells inject toxic chemicals through the MHC proteins in its cell membrane.
B. Cytotoxic T cells can recognize bad antigens on cancer cells only if those antigens are associated with MHC proteins.
Given her diagnosis of type 1 diabetes, what are the clinical manifestations of the acute complication for which Mrs. Mendoza is at highest risk? A. Lethargy, decreasing level of consciousness, neurological signs that look like a focal stroke B. Decreasing level of consciousness, rapid deep breathing, breath that smells sweet or like fingernail polish remover C. Polyuria, extreme thirst, hunger, blurred vision D. Dyspnea, crackles in the lung bases, syncope, fatigue
B. Decreasing level of consciousness, rapid deep breathing, breath that smells sweet or like fingernail polish remover
Mrs. Mendoza, who has type 1 diabetes, introduces you to her nephew, a college freshman who is studying a basic anatomy book for his final exam next week. "I have a question," he says. "What causes Tia Mendoza's diabetes? I know that the pancreas normally secretes insulin from the beta cells, but why doesn't she make enough insulin?" Choose the best response. A. Diabetes damages the lining of arteries (atherosclerosis), reduces the blood supply to the pancreas, and causes beta cell dysfunction. B. Her immune system turned against her pancreas beta cells and destroyed them, so she can't make any insulin. C. Her body cells have stopped responding well to insulin and she needs more insulin than her pancreas beta cells can make. D. Diabetes causes damage to little blood vessels (microvascular disease) and her beta cells didn't get enough blood and died.
B. Her immune system turned against her pancreas beta cells and destroyed them, so she can't make any insulin
A positive reaction to a tuberculin skin test takes 24 to 72 hours to appear because: A. the antibodies take that long to develop and react in this type I hypersensitivity reaction. B. the cytotoxic cells take that long to accumulate and act in this type IV hypersensitivity reaction. C. immune complexes must form and phagocytes infiltrate before the lesion appears. D. the liver must synthesize complement proteins before they can be activated.
B. the cytotoxic cells take that long to accumulate and act in this type IV hypersensitivity reaction
Which of the following is the major buffer in the extracellular fluid? Bicarbonate Albumin Phosphate Hemoglobin
Bicarbonate
How does long-term diabetes cause gastroparesis? By damaging autonomic nerves With repeated episodes of acidosis Through endothelial dysfunction From abnormal muscle metabolism
By damaging autonomic nerves
"Our AIDS patients get infections when their CD4 cell count gets too low," says another nurse. "I can understand why their killer cell immunity decreases, but their antibodies still should protect them. Why do they get so many infections?" A. CD4 cells are antigen-presenting cells that are necessary to introduce antibody-producing cells, as well as killer cells, to microorganisms. With fewer CD4 cells, antibody function decreases also. B. Antibodies attach to microorganisms and make them easier to phagocytize. CD4 cells normally phagocytize organisms that macrophages cannot. With fewer CD4 cells, this function is lost. C. CD4 cells normally secrete cytokines that stimulate antibody-producing cells as well as cells that kill other cells directly. With fewer CD4 cells, antibody function decreases also. D. Immune cells need amino acids to make antibodies and CD4 cells secrete cytokines that help antibody-producing cells take up amino acids. With fewer CD4 cells, antibody function decreases also.
C. CD4 cells normally secrete cytokines that stimulate antibody-producing cells as well as cells that kill other cells directly. With fewer CD4 cells, antibody function decreases also.
How do natural killer (NK) cells differ from cytotoxic T cells? A. NK cells can opsonize bacteria, viruses, and parasites. B. NK cells can produce antibodies after prior introduction to the specific antigen involved. C. NK cells can target any infected or malignant cell without prior introduction to its antigens. D. NK cells release perforins and other chemicals that kill target cells.
C. NK cells can target any infected or malignant cell without prior introduction to its antigens
What type of cells does HIV infect? Cells with CD4 receptors T helper cells only Cytotoxic T cells only Cells with CD8 receptors
Cells with CD4 receptors
One time my doctor said I have an autoimmune disease and the next time he called it a hypersensitive reaction," says Mr. Treloni. "Are they the same thing?" Choose the best response. A. No. Autoimmune diseases involve the immune system attacking and damaging the body. Hypersensitivity reactions are allergic reactions, a specific type of immune system response. B. Yes, hypersensitivity reaction and autoimmune reaction mean the same thing. C. No. There are several types of autoimmune reactions, which means that the body triggers the immune system to attack itself. Some autoimmune reactions are hypersensitivity reactions, which means that the immune response makes excessive antibodies. Other autoimmune reactions do not involve antibodies and are not hypersensitivity reactions. D. No. There are several types of hypersensitivity reactions, which means the immune system damages the body. Sometimes what triggers a hypersensitivity reaction is not autoimmune, meaning that it is a trigger from the environment, like pollen. But, in your case, what triggers the hypersensitivity reaction is autoimmune, meaning that it is one of your body's own chemicals that makes the immune system attack.
D. No. There are several types of hypersensitivity reactions, which means the immune system damages the body. Sometimes what triggers a hypersensitivity reaction is not autoimmune, meaning that it is a trigger from the environment, like pollen. But, in your case, what triggers the hypersensitivity reaction is autoimmune, meaning that it is one of your body's own chemicals that makes the immune system attack.
Mr. Thrall has colon cancer and is receiving cytotoxic cancer chemotherapy. His leukocyte count is low, due to the chemotherapy, and you are reviewing the precautions he should take to protect himself from infection. "That other nurse said I had secondary immunosuppression," he says. "She would not belittle it if she had to stay away from people and cook all her vegetables instead of eating them raw! I think my immunosuppression is a primary influence!" Choose the best words to complete this response: "The term secondary immunosuppression has a technical meaning that focuses on the cause of immunosuppression rather than on its importance. A. Primary immunosuppression can be genetic or caused by long-term diseases that will not be cured. Secondary immunosuppression arises from short-term causes such as drug therapy, pregnancy, or stress. As you know, the cancer drugs are causing your immunosuppression." B. Primary immunosuppression arises in children and secondary immunosuppression arises in adults. As you know, the cancer drugs are causing your immunosuppression." C. Secondary immunosuppression means that it is not from a genetic defect. Primary immunosuppression is genetic. As you know, the cancer drugs are causing your immunosuppression." D. Secondary immunosuppression means that it is caused by something outside the immune system. Primary immunosuppression is a defect within the immune system. As you know, the cancer drugs are causing your immunosuppression."
D. Secondary immunosuppression means that it is caused by something outside the immune system. Primary immunosuppression is a defect within the immune system. As you know, the cancer drugs are causing your immunosuppression."
Clinical manifestations of the autoimmune disease systemic lupus erythematosus (SLE) include: A. nasal polyps, watery eyes, and rhinorrhea. B. respiratory wheezing, eczema, and itching. C. pulmonary edema, ankle edema, and neck vein distention. D. arthritic joint pain and skin rash, especially over the cheeks.
D. arthritic joint pain and skin rash, especially over the cheeks
Which of the following should you teach a pregnant woman in order to preserve the first line of defense against microorganisms? A. If you are exposed to rubella when you are pregnant, ask your doctor about gamma globulin. B. Be sure to get your baby's immunizations on schedule. C. Breastfeeding will provide some immune protection to your baby. D. Avoid picking off scabs and let them fall off naturally.
D. avoid picking off scabs and let them fall off naturally
During the period of clinical latency of an HIV infection, HIV is: A. destroying immune cells, but the body is replacing them. B. entering the body for the first time. C. causing immune damage and severe immunosuppression. D. dormant and not replicating, so no immune cells are damaged.
Destroying immune cells, but the body is replacing them
Tammy Devine, age 14 months, has developed undiagnosed pyloric stenosis and been vomiting for 2 days. In desperation, her mother brings her to the pediatrician's office without an appointment. You are the office nurse and are assigned to assess the child, who vomited again in the waiting room. Your assessment findings include the following: low blood pressure, rapid pulse, slow shallow respirations, dry mouth, skin tenting up over her sternum when you pinch it, soft sunken eyeballs, and irritability. Given this situation, how should you interpret these assessment findings? ECV deficit and possible primary respiratory acidosis ECV deficit and possible primary metabolic acidosis ECV deficit and possible primary metabolic alkalosis ECV deficit and possible primary respiratory alkalosis
ECV deficit and possible primary metabolic alkalosis
Which of the following alterations in the blood is evidence that the kidneys are compensating for respiratory acidosis? Elevated carbon dioxide Decreased bicarbonate ion concentration Decreased carbon dioxide Elevated bicarbonate ion concentration
Elevated bicarbonate ion concentration
The lab report from a person with AIDS tells you that his CD4+ count is falling. You should interpret this lab report to mean that his body is not making enough: A. neutrophils to make up for those that are destroyed by his killer T cells. B. helper T cells to make up for the ones that are dying. C. collagen, so that he will have delayed tissue healing if he cuts himself. D. antibodies to HIV, so that he probably will get diarrhea.
Helper T cells to make up for the ones that are dying
Polydipsia, polyphagia, and polyuria are characteristic of both type 1 and type 2 diabetes mellitus because these three manifestations are caused by: hyperglycemia. chronic illness. too much insulin. pancreatic necrosis
Hyperglycemia
Which of the following imbalances often accompanies metabolic alkalosis? Hyperkalemia Hyponatremia Hypokalemia Hypernatremia
Hypokalemia
Which of the following causes respiratory acidosis? Massive blood transfusion Hyperventilation Tissue hypoxia Hypoventilation
Hypoventilation
The diagnoses on Mrs. Mendoza's chart include gastroparesis in addition to type 1 diabetes. Which of the following statements by Mrs. Mendoza indicates that her gastroparesis is symptomatic today? I have diarrhea today; please give me the bedpan. I can't eat this bedtime snack; I'm still full from dinner. I have that burning pain behind my breastbone again. I am weak, sweaty, hungry, and shaky again.
I can't eat this bedtime snack; I'm still full from dinner
What mechanism causes tissue injury in type III hypersensitivity reactions? Immune complexes activate the complement system and stimulate phagocytosis. Autoantibodies attack and destroy the body's own tissues. Chemotactic agents released by phagocytes cause tissue injury. Cytotoxic T cells release toxic enzymes that destroy target tissues.
Immune complexes activate the complement system and stimulate phagocytosis
Which of the following processes causes acute metabolic acidosis from insulin deficiency? Incomplete metabolism of fatty acids Increased anaerobic metabolism of glucose Protein catabolism with ammonia release Chronic kidney disease
Incomplete metabolism of fatty acids
Which of the following series of laboratory values reflects uncompensated metabolic alkalosis? Decreased pH, increased HCO3- Increased pH, decreased HCO3- Decreased pH, decreased HCO3- Increased pH, increased HCO3-
Increased pH, increased HCO3-
What effect does the presence of advanced glycation end products (AGEs) have in diabetes? Reduced chronic complications Increased ketoacid formation Increased intracellular osmotic pressure Increased tissue injury
Increased tissue injury
Hyperglycemia in type 2 diabetes mellitus is due primarily to: glycogen excess. glucagon deficiency. insulin resistance. production of inactive insulin.
Insulin resistance
The parents of which one of these infants will need the most complex teaching about protecting their infant from infection? Kenesha, who has SCID Pam, who has Bruton X-linked agammaglobulinemia Gelda, who has DiGeorge syndrome Anne, who has selective IgA deficiency
Kenesha, who has SCID
You are a camp nurse. "I am not afraid of poison ivy!" says Max Grewe, age 13. "I touched it once accidentally last summer for the first time and did not have a problem, so I stuck my hand in some this morning. See, my hand is perfectly fine. I am immune to it!" Choose the best response. A. You should stay near people for the rest of the afternoon and evening, in case you break out in hives, feel faint, or have trouble breathing. If that happens, you will need help fast. Here is my cell phone number in case of emergency. B. Last summer, your immune cells met poison ivy for the first time and some of them may have become sensitized to it. Now they are meeting poison ivy again and they may cause some damage that you will see as an itchy blistering rash in the next few days. Let me check your hand every day this week. C. Apparently you are one of the lucky people who are immune to urushiol, the part of poison ivy that causes the itchy blistering rash in people who are not immune to it. D. You could have a secondary immune response if you touch poison ivy again, so stay away from it. A secondary immune response is stronger than a primary immune response.
Last summer, your immune cells met poison ivy for the first time and some of them may have become sensitized to it. Now they are meeting poison ivy again and they may cause some damage that you will see as an itchy blistering rash in the next few days. Let me check your hand every day this week.
Early manifestations of a developing metabolic acidosis include: short and shallow respirations. lethargy. coma. muscle cramps.
Lethargy
Which of the following are the primary cells of adaptive immunity? Macrophages Dendritic cells Lymphocytes Neutrophils
Lymphocytes
What is present at the end of the process of sensitization in type I hypersensitivity? Mast cells that are degranulating Antigens binding to IgE that is bound to mast cell membranes Mast cells with IgE bound to the outside of their cell membranes Eosinophils that are degranulating
Mast cells with IgE bound to the outside of their cell membranes
What acid-base imbalance does emesis cause? Respiratory alkalosis Metabolic alkalosis Respiratory acidosis Metabolic acidosis
Metabolic alkalosis
Which one of these people should you monitor most carefully for development of metabolic acidosis? Ms. C, who has had diarrhea for over a week Mr. B, who has had hypokalemia for over a week Mr. A, who is in the diuretic phase of acute renal failure Ms. D, who has newly diagnosed Cushing syndrome
Ms. C, who has had diarrhea for over a week
Mrs. Mendoza, age 54, has type 1 diabetes. Her right foot was amputated this morning. "I take as good care of myself as I can," she says, "but my feet are numb and it is hard to check them for little injuries every night when I have such difficulty seeing." What are the technical terms that you should use with another health professional to describe the common complications of diabetes that she has described? Diabetic retinopathy and autonomic neuropathy Diabetic glaucoma and peripheral neuropathy Peripheral neuropathy and diabetic retinopathy Autonomic neuropathy and diabetic glaucoma
Peripheral neuropathy and diabetic retinopathy
Macrophages interact with T helper cells by: presenting antigens and secreting cytokines. producing reactive oxygen species. synthesizing antibodies and T cell receptors. phagocytizing microorganisms.
Presenting antigens and secreting cytokines
B lymphocytes provide humoral immunity through which of the following processes? Production of antibodies Secretion of perforins Direct cell lysis Initiating an inflammatory response
Production of antibodies
Which process confers long-lasting immunity against a specific organism? Production of memory cells Activation of macrophages Activation of T cytotoxic cells Production of inflammatory mediators
Production of memory cells
Jason Dryer, age 3, was brought to the emergency department by a child welfare officer. He is diagnosed with starvation ketoacidosis. What signs and symptoms should you anticipate in your assessment? Rapid, deep breathing, lethargy, abdominal pain Slow, shallow breathing, belligerence, hyperexcitability Rapid, deep breathing, tremors, elevated blood pressure Slow, shallow breathing, numbness and tingling around his mouth
Rapid, deep breathing, lethargy, abdominal pain
In contrast with the innate immune response, the adaptive immune response: has no memory. recognizes specific antigens. reacts to microorganisms. is faster.
Recognizes specific antigens
Which system compensates for metabolic acidosis and alkalosis? Renal Gastrointestinal Respiratory Cardiovascular
Respiratory
A 54-year-old male with a long history of smoking complains of excessive tiredness, shortness of breath, and overall ill feelings. Lab results reveal decreased pH, increased CO2, and normal bicarbonate ion. These findings help to confirm the diagnosis of: Metabolic acidosis Respiratory acidosis Respiratory alkalosis Metabolic alkalosis
Respiratory acidosis
A 55-year-old female presents to her primary care provider and reports dizziness, confusion, and tingling in the extremities. Blood tests reveal an elevated pH, decreased PCO2, and slightly decreased HCO3. Which of the following is the most likely diagnosis? Metabolic alkalosis with respiratory compensation Metabolic acidosis with respiratory compensation Respiratory acidosis with renal compensation Respiratory alkalosis with renal compensation
Respiratory alkalosis with renal compensation
The microorganism that causes AIDS is a: retrovirus. herpesvirus. DNA virus. papillomavirus.
Retrovirus
When they are activated, cytotoxic T cells can destroy other cells by which of the following mechanisms? Opsonization Phagocytosis Secreting perforins Producing antibodies
Secreting perforins
Body fluids that transmit HIV include: saliva, urine, and blood. semen, urine, and blood. semen, blood, and breast milk. blood, breast milk, and saliva.
Semen, blood, and breast milk
Which of the following cells stimulate both the cell-mediated and humoral immune responses? B lymphocytes Plasma cells T helper cells Cytotoxic T cells
T helper cells
The pathophysiology of gestational diabetes is similar in its tissue effects to: diabetic ketoacidosis. type 2 diabetes. hyperosmolar coma. type 1 diabetes.
Type 2 diabetes
Which one of these hypersensitivity reactions cannot be part of an autoimmune disease? Type II Type IV Type I Type III
Type I
Kellie Frond was stung by a bee. "Help!" her mother shouts. "She is allergic to bees!" She administered the emergency epinephrine (EpiPen) that she carries in case of bee sting. Someone has called 911 for emergency assistance. What signs and symptoms would tell you that Kellie is having a life-threatening type I hypersensitivity reaction and needs a second dose of epinephrine before the paramedics arrive? Tachycardia, pale cool skin, and dilated pupils Wheezing, difficulty breathing, weak pulse Widespread itching and hives on her back Tingling lips, positive Chvostek sign
Wheezing, difficulty breathing, weak pulse
If an individual has a fully compensated metabolic acidosis, the blood pH is: high. either high or low, depending on the type of compensation. low. in the normal range.
in the normal range
Urine Output
approximately 1mL/kg body weight/ hour for adults
Respiratory alkalosis is caused by: chest muscle weakness. pneumonia. pulmonary edema. hyperventilation.
hyperventilation
