Patho quizlet for Nur 560 WEEK TWO
A 16-year-old girl has been brought to her primary care provider by her mother due to the daughter's recent malaise and lethargy. Which of the following assessments should the clinician perform in an effort to confirm or rule out infectious mononucleosis? Select one: a. Auscultating the client's lungs b. Palpating the client's lymph nodes c. Assessing the client's cranial nerve reflexes d. Assessing the client for bone pain
b. Palpating the client's lymph nodes In cases of infectious mononucleosis, the lymph nodes are typically enlarged throughout the body, particularly in the cervical, axillary, and groin areas. Palpation of these nodes is a priority assessment in cases of suspected mononucleosis. Bone pain, adventitious lungs sounds, and abnormal cranial nerve reflexes do not accompany mononucleosis.
An elderly client presents to the clinic just not "feeling well." Which of the following bone marrow results would confirm the diagnosis of chronic lymphocytic leukemia? Select one: a. Production of undifferentiated blood cells in the marrow b. Proliferation of well-differentiated blood cells in the marrow c. Uncontrolled growth of immature blood cells in the marrow d. Replication of pluripotent precursor blood cells in the marrow
b. Proliferation of well-differentiated blood cells in the marrow Chronic leukemia involves abnormal proliferation and growth of well-differentiated blood cell types. Acute leukemia is associated with proliferation of undifferentiated, immature, and precursor blood cells.
While taking an exam on disorders of hemostasis, the students were asked to identify endothelial mediators that inhibit platelet aggregation and also vasodilate vessels. Which of the following would be considered a correct answer? Select all that apply. Select one or more: a. Adenosine diphosphate b. Prostaglandin I2 c. Thromboxane A2 (TXA2) d. Nitric oxide e. Plasminogen
b. Prostaglandin I2 d. Nitric oxide If platelets are activated, they are inhibited from adhering to the surrounding uninjured endothelium by endothelial prostacyclin (prostaglandin I2 [PGI2]) and nitric oxide. Both of these mediators are potent vasodilators and inhibitors of platelet aggregation. Endothelial cells also elaborate an enzyme called adenosine diphosphatase that degrades ADP and further inhibits platelet aggregation. The plasma also contains a plasma protein called plasminogen that gets activated and converted to plasmin, an enzyme capable of digesting the fibrin strands of the clot. Release of the vasoconstrictor TXA2 is responsible for much of the vessel spasm. Dense granules mainly contain adenosine diphosphate (ADP), ATP, ionized calcium, serotonin, and histamine, which facilitate platelet adhesion and vasoconstriction at the site of vessel injury.
Which of the following factors differentiates chronic leukemias from acute leukemias? Select one: a. Leukemic cells are disseminated throughout the body by the circulatory system. b. The leukemic cells are more fully differentiated than in acute leukemias. c. The prevalence among individuals with Down syndrome is high. d. They are cancers of the hematopoietic progenitor cells.
b. The leukemic cells are more fully differentiated 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.
The nurse caring for a population of HIV clients needs to be assessing for which of the following diseases that amounts to the leading cause of death for people with HIV? Select one: a. Leukemia b. Tuberculosis c. Pneumonia d. Toxoplasmosis
b. Tuberculosis Although HIV-positive people can develop all types of cancer, have viral or bacterial pneumonia, and be infected with the parasite that causes toxoplasmosis, tuberculosis is the disease that leads to death most often. Tuberculosis (TB) is the leading cause of death for people with HIV infection worldwide and is often the first manifestation of HIV infection. In 2011, 23% of those with TB tested positive for HIV.
A client has been diagnosed with Coxiella burnetii infection. She asked the health care provider how she could have gotten this disease. The health care provider's best response is: Select one: a. "Probably while walking outside without your shoes on." b. "While swimming in an unsanitary pond." c. "Drinking contaminated milk." d. "Eating undercooked fish."
c. "Drinking contaminated milk." In humans, Coxiella infection produces a disease called Q fever, characterized by a nonspecific febrile illness often accompanied by headache, chills, arthralgias, and mild pneumonia. The organism produces a highly resistant sporelike stage that is transmitted to humans when contaminated animal tissue is aerosolized (e.g., during meat processing) or by ingestion of contaminated milk.
Which of the following individuals likely faces the highest risk of megaloblastic anemia? Select one: a. A 69-year-old woman who takes ASA four times daily to treat her arthritis b. A 44-year-old man who lost approximately 500 mL of blood in a workplace accident c. A 21-year-old college student who lives a vegan lifestyle d. An infant who is exclusively fed commercial baby formula
c. A 21-year-old college student who lives a vegan lifestyle Megaloblastic anemia is caused by a deficiency of vitamin B12, which is found in most animal products. Commercial infant formulas do not lack vitamin B12, and acute or chronic blood loss does not result in megaloblastic anemia.
A hospital client was swabbed on admission for antibiotic-resistant organisms and has just been informed that methicillin-resistant Staphylococcusaureus (MRSA) is present in his groin. The client has a normal core temperature and white blood cell count. This client is experiencing: Select one: a. Infection b. Proliferation c. Colonization d. Inflammation
c. Colonization Colonization describes the act of establishing a presence, a step required in the multifaceted process of infection; infection describes the presence and multiplication within a host of another living organism. However, this client displays no signs of infection, inflammation, or proliferation of the microorganism.
Contact with poison ivy has resulted in intense pruritus, erythema, and weeping on a client's forearm. Which of the following processes resulted in the client's signs and symptoms? Select one: a. IgE-mediated mast cell degranulation b. Formation of antigen-antibody complexes c. Cytokine release by sensitized T cells d. Formation of antibodies against cell surface antigens
c. Cytokine release by sensitized T cells The characteristic reaction to poison ivy is an example of contact dermatitis, a type IV hypersensitivity reaction. As such, the reaction is caused by sensitized T cells and the release of cytokines. IgE-mediated mast cell degranulation causes type I reactions, whereas antigen-antibody complexes are associated with type III reactions. Antibody formation against cell surface antigens are associated with type II reactions.
Contact with poison ivy has resulted in intense pruritus, erythema, and weeping on a client's forearm. Which of the following processes resulted in the client's signs and symptoms? Select one: a. IgE-mediated mast cell degranulation b. Formation of antigen-antibody complexes c. Cytokine release by sensitized T cells d. Formation of antibodies against cell surface antigens
c. Cytokine release by sensitized T cells The characteristic reaction to poison ivy is an example of contact dermatitis, a type IV hypersensitivity reaction. As such, the reaction is caused by sensitized T cells and the release of cytokines. IgE-mediated mast cell degranulation causes type I reactions, whereas antigen-antibody complexes are associated with type III reactions. Antibody formation against cell surface antigens are associated with type II reactions.
Conditions that predispose to sickling of hemoglobin in persons with sickle cell anemia include: Select one: a. Impaired red blood cell maturation b. Increased iron content of blood c. Decreased oxygen saturation d. Increased intravascular volume
c. Decreased oxygen saturation Low oxygen in the tissues will cause red blood cells to take on the sickle shape in persons with sickle cell anemia. Sickle cell disease is a disorder of hemoglobin S and does not affect red blood cell maturation. The iron content is not affected by the sickling, but the capacity to carry the iron can be an effect of the affected RBCs. Dehydration can cause sickling by increasing the concentration of hemoglobin.
Which of the following clients experiencing an abnormally low neutrophil count (neutropenia) could have developed this as a side effect to his or her medical regimen? A client with: Select one: a. Diagnosed infectious mononucleosis with a high Epstein-Barr virus count being treated with NSAIDs b. Kostmann syndrome receiving G-CSF, a granulocyte colony-stimulating factor c. Hyperthyroidism being treated with propylthiouracil to maintain normal metabolic rate d. Psoriasis, a skin infection, being treated with methotrexate to suppress the immune system
c. Hyperthyroidism being treated with propylthiouracil to maintain normal metabolic rate A number of drugs, such as chloramphenicol (an antibiotic), phenothiazines (antipsychotic agents), propylthiouracil (used in the treatment of hyperthyroidism), and phenylbutazone (used in the treatment of arthritis), may cause idiosyncratic depression of bone marrow function. Many cases of neutropenia are drug related, often caused by chemotherapeutic drug suppression of bone marrow function. The Epstein-Barr virus causes mononucleosis, whereas Kostmann syndrome is a less common cause of neutropenia. Skin infections are often a result of neutropenia, not a cause.
A 72-year-old woman with complaints of increasing fatigue has completed a series of fecal occult blood tests that indicate the presence of blood in her stool. Which of the following health problems is likely to accompany this client's gastrointestinal bleed? Select one: a. Hemolytic anemia b. Aplastic anemia c. Iron deficiency anemia d. Megaloblastic anemia
c. Iron deficiency anemia Chronic blood loss does not affect blood volume but instead leads to iron deficiency anemia when iron stores are depleted. Such blood loss is not associated with hemolysis, aplastic anemia, or megaloblastic anemia.
A teenage male develops a severe case of "athlete's foot." He asks, "How did I get this?" The health care worker explains that certain fungi become infectious (called dermatophytes) and exhibit which of the following characteristics? Select one: a. Prefer to grow in warm environments like shoes/socks b. Like a moist environment c. Limited to cooler cutaneous surfaces d. Need higher blood flow to survive
c. Limited to cooler cutaneous surfaces Dermatophytes are not able to grow at core body temperature, preferring the cooler surface skin areas instead of moist skin folds. Diseases caused by these organisms, including ringworm, athlete's foot, and jock itch, are collectively called superficial mycoses.
Which of the following abnormal blood work results is most closely associated with a diagnosis of multiple myeloma? Select one: a. Decreased hemoglobin, hematocrit, and red blood cells b. Extremely high levels of abnormal lymphocytes c. Low glomerular filtration rate and high calcium levels Hypercalcemia and signs of impaired renal function, such as decreased glomerular filtration rate (GFR), are typical of multiple myeloma. The disease does not result in a proliferation of abnormal lymphocytes, hypokalemia, or low red blood cells. d. Low potassium levels and increased blood urea nitrogen
c. Low glomerular filtration rate and high calcium levels Hypercalcemia and signs of impaired renal function, such as decreased glomerular filtration rate (GFR), are typical of multiple myeloma. The disease does not result in a proliferation of abnormal lymphocytes, hypokalemia, or low red blood cells.
Sue is fatigued, and some blood tests are done. Her results include Hct 40%; Hgb 8g/dL; WBC 8000; and platelets 175,000. The nurse should interpret Sue's blood work as indicative of: Select one: a. High platelets/thrombocytosis b. Low WBC count/granulocytopenia c. Low hemoglobin/anemia d. High hematocrit/polycythemia
c. Low hemoglobin/anemia All of the laboratory values are within normal range except for the hemoglobin, which is low. Low hemoglobin is associated with iron deficiency anemia.
A child's thymus gland is fully formed and proportionately larger than an adult's. Which of the following processes that contributes to immunity takes place in the thymus gland? Select one: a. Differentiation of B cells b. Production of natural killer (NK) cells c. Proliferation of T cells d. Filtration of antigens from the blood
c. Proliferation of T cells 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.
A client who had a pulmonary embolism is receiving IV heparin and has just begun taking his first dose of warfarin (Coumadin). The client asks the nurse, "How long will this pill take in order to prevent me from developing more clots. I would like to go home soon." The nurse responds: Select one: a. "It usually takes 2 to 3 days for warfarin to become therapeutic, meaning your blood will be thin enough to prevent further clot formation." b. "I don't really know. Right now you are on two blood thinners, so we won't be able to tell if it's working until the doctor discontinues your heparin drip." c. "That's a good question. If warfarin has a long half-life, it could take many days. I will have to ask the pharmacist this question." d. "First, we have to have your health care provider switch you from IV heparin to a low molecular weight heparin, which you need to inject in your belly."
a. "It usually takes 2 to 3 days for warfarin to become therapeutic, meaning your blood will be thin enough to prevent further clot formation." The anticoagulant drugs warfarin and heparin are used to prevent thromboembolic disorders, such as deep vein thrombosis and pulmonary embolism. Warfarin acts by decreasing prothrombin. It alters vitamin K in a manner that reduces its ability to participate in the synthesis of the vitamin K-dependent coagulation factors in the liver. Warfarin's maximum effect takes 36 to 72 hours because of the varying half-lives of different clotting factors that remain in the circulation. Heparin ultimately suppresses the formation of fibrin and therefore inhibits coagulation. The low molecular weight heparins are given by subcutaneous injection and require less frequent administration and monitoring compared with the standard (unfractionated) heparin. Clients usually are not sent home with an IV medication. Once warfarin is in therapeutic range, heparin or low molecular weight heparins are no longer required.
Which of the following client complaints should prompt a clinician to order a diagnostic workup for multiple myeloma? Select one: a. "Lately my bones just seem to ache so badly, and nothing seems to help." b. "Every morning my joints are so stiff that it takes me 10 or 15 minutes just to get going." c. "I feel so weak, and the last few days I've actually fallen asleep on my coffee break at work." d. "I vomited yesterday evening, and it looked like coffee grounds mixed with some fresh blood."
a. "Lately my bones just seem to ache so badly, and nothing seems to help." Bone pain is the most characteristic symptom of multiple myeloma. Joint stiffness is unlikely. Lethargy and bleeding may also result from the disease, but these symptoms are less specific to multiple myeloma.
Question text A sixth grade science teacher asks the students to explain the role of cilia in the lower respiratory tract. Which student response is the best? Select one: a. "These little hairs move germs trapped in mucous toward the throat so the body can cough them out." b. "Cilia help to warm the airways so that moisture in the air can neutralize any germs that get in our lungs." c. "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." d. "Cilia help facilitate a chemical defense against germs by secreting an enzyme that will cement the germ to the lining of the airways."
a. "These little hairs move germs trapped in mucous toward the throat so the body can cough them out." 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 mucous 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: Select one: a. "This is what we call a type I hypersensitivity reaction and usually occurs a few minutes after exposure to his allergen. b. "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." c. "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." d. "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."
a. "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." 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.
A client with cancer has been receiving amphotericin B intravenously. The client asks, "How will this help with my fungal disease?" The health care provider responds: Select one: a. "This medication inhibits the synthesis of ergosterol." b. "This drug binds to ergosterol and forms holes in the cell membrane, killing the fungus." c. "This medication will keep the body from growing any new fungi." d. "This drug impairs the synthesis of enzymes needed for viral replication."
b. "This drug binds to ergosterol and forms holes in the cell membrane, killing the fungus." The polyene family of antifungal compounds (e.g., amphotericin B, nystatin) preferentially binds to ergosterol and forms holes in the cell membrane, causing leakage of the fungal cell contents and, eventually, lysis of the cell. The imidazole class of drugs (e.g., fluconazole, itraconazole) inhibits the synthesis of ergosterol, thereby damaging the integrity of the fungal cytoplasmic membrane. Zidovudine as well as nonnucleoside inhibitors impair the synthesis of the HIV-specific enzyme reverse transcriptase. This key enzyme is essential for viral replication.
Which of the following would constitute a normal assessment finding in a neonate? Select one: a. Minimal or absent levels of IgA and IgM b. Absence of plasma cells in the lymph nodes and spleen c. Undetectable levels of all immunoglobulins d. Absence of mature B cells with normal T-cell levels and function
a. Minimal or absent levels of IgA and IgM IgA and IgM levels are normally low in the neonate because these immunoglobulins do not cross the placental barrier. An absence of plasma cells in the lymph nodes and spleen accompanies common variable immunodeficiency. An absence of mature B cells with normal T-cell levels and function, as well as undetectable levels of all immunoglobulins, is a pathologic finding in X-linked agammaglobulinemia.
In persons with a bleeding disorder caused by vascular defects, platelet counts and INR results will most often reveal: Select one: a. Normal values b. Hypocalcemia c. Polycythemia d. Thrombocytopenia
a. Normal values If a vascular defect is the cause of easy bruising, petechiae, and purpura, then the platelet count and coagulation factors will be normal. Lack of calcium and high red blood cell (RBC) count are unrelated to vascular defect-related bleeding.
Which of the following individuals is experiencing a health problem that is the result of a parasite? Select one: a. A college student who contracted Chlamydia trachomatis during an unprotected sexual encounter b. A man who acquired malaria while on a tropical vacation c. A hospital client who has developed postoperative pneumonia d. A woman who developed hepatitis A from eating at an unhygienic restaurant
b. A man who acquired malaria while on a tropical vacation Malaria is caused by a parasite. Chlamydial infections are bacterial, whereas hepatitis is viral. Pneumonia may be either viral or bacterial.
Which of the following individuals is experiencing a health problem that is the result of a parasite? Select one: a. A college student who contracted Chlamydia trachomatis during an unprotected sexual encounter b. A man who acquired malaria while on a tropical vacation c. A hospital client who has developed postoperative pneumonia d. A woman who developed hepatitis A from eating at an unhygienic restaurant
b. A man who acquired malaria while on a tropical vacation Malaria is caused by a parasite. Chlamydial infections are bacterial, whereas hepatitis is viral. Pneumonia may be either viral or bacterial.
Which of the following clients is most susceptible to experiencing the effects of inadequate erythropoiesis? A client: Select one: a. Who has developed renal failure as a result of long-standing hypertension b. Who recently experienced an ischemic stroke and who remains bedridden c. Whose heavy alcohol use has culminated in a diagnosis of pancreatitis d. Whose estimated blood loss during recent surgery was 700 mL
a. Who has developed renal failure as a result of long-standing hypertension Kidney failure causes an absence of erythropoietin production. As a result, hypoxia does not result in erythropoiesis. Stroke, pancreatitis, and recent blood loss do not directly impair the body's ability to create new red blood cells.
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: Select one: a. "We always want two positive test results before we give you medicine." b. "The Western blot is a more sensitive assay that looks for the presence of antibodies to specific viral antigens." c. "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." d. "If you are afraid of another blood test, we can do a rapid oral test to see if we get the same results."
b. "The Western blot is a more sensitive assay that looks for the presence of antibodies to specific viral antigens." 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.
Leukocytes consist of three categories of cells that have different roles in the inflammatory and immune responses. Which of the following leukocytes is correctly matched with its function? Select one: a. Lymphocyte—phagocytosis b. Eosinophils—allergic reactions c. Basophils—engulf antigens d. Monocytes—release heparin
b. Eosinophils—allergic reactions Eosinophils, a type of granulocyte, increase in number during allergic reactions. Lymphocytes (agranulocytes) consist of three cell types that are not phagocytes but do have an important role in the immune response. Basophils and mast cells release heparin and histamine in response to allergens. Monocytes and macrophages are phagocytes that engulf antigens.
The 16-year-old boy has enlarged lymph nodes and a sore throat. His girlfriend was recently diagnosed with infectious mononucleosis. While educating this teenager, the nurse emphasizes that infectious mononucleosis is caused by which pathogen and usually transmitted via: Select one: a. Heterophil antibodies; blood b. Epstein-Barr virus; saliva c. T-cell infection; plasma d. Bacterial infection; monocytes
b. Epstein-Barr virus; saliva Infectious mononucleosis is caused by Epstein-Barr virus and is commonly transmitted through saliva. Once the B cells are infected, mononucleosis is diagnosed by the presence of heterophil antibodies in the blood. Infectious mononucleosis is a B-cell viral infection. Cytotoxic T cells attack the virus and limit the number of infected B cells without eliminating them.
A 6-month-old infant was born with a murmur. The pediatrician is recommending valve replacement/repair surgery based on which of the following lab values indicating intravascular hemolysis? Select one: a. Increase in the number of red blood cells (polycythemia) b. Excess of hemoglobin in the blood plasma (hemoglobinemia) c. Elevated bilirubin levels d. Decreased number of reticulocytes
b. Excess of hemoglobin in the blood plasma (hemoglobinemia) Intravascular hemolysis is less common and occurs as a result of mechanical injury caused by defective cardiac valves, complement fixation in transfusion reactions, or exogenous toxic factors. Regardless of cause, intravascular hemolysis leads to hemoglobinemia, hemoglobinuria, and hemosiderinuria.
A 1-day-old infant was exposed to an infectious microorganism prior to discharge home from the hospital, but was able to affect a sufficient immune response in the hours and days following exposure. The nurse knows that which of the following immunoglobulins assisted with this process? Select one: a. IgA b. IgG c. IgM d. IgD
b. IgG IgG is the only class of immunoglobulins to cross the placenta, and maternally transmitted IgG is effective against most microorganisms and viruses.
Hemolytic anemia is characterized by excessive red blood cell destruction and compensatory: Select one: a. Hypoactive bone marrow b. Increased erythropoiesis c. Iron retention in the body d. Shrinkage of the spleen
b. Increased erythropoiesis A compensatory response to hemolysis is to increase erythropoiesis, to increase RBC replacement. The bone marrow is hyperactive and releases an increased number of reticulocytes. Iron from the destroyed RBCs is retained, but this is not a compensatory function. The spleen will be abnormally hyperactive, causing hyperplasia and enlargement.
A 68-year-old client with an 80 pack/year history of smoking was diagnosed with emphysema 18 months ago. The client's most recent scheduled blood work showed excessive increase in production of red blood cell (erythrocytes), a problem that suggests the need for which of the following interventions? Select one: a. Vitamin B12 supplements b. Increased supplementary oxygen therapy c. Hemodialysis or peritoneal dialysis d. Scheduled erythropoietin injections
b. Increased supplementary oxygen therapy Treatment of secondary polycythemia focuses relief of the underlying hypoxia. Secondary polycythemia increases in the production of erythropoietin, hence an increased production of erythrocytes. A vitamin B12 deficiency does not underlie secondary hypoxia, and dialysis is not a relevant treatment option. Erythropoietin injections would exacerbate the client's polycythemia.
Which of the following lab values correlate to the fact that the client has developed a lytic drug reaction and is having an antibody response that lyses the drug-coated cell? Select all that apply. Select one or more: a. CD4 T-cell count of 500 cells b. Low hemoglobin of 9.1 c. WBC level of 5000 d. Low platelet level of 10,000 e. Elevated liver enzyme levels
b. Low hemoglobin of 9.1 d. Low platelet level of 10,000 Lytic drug reactions can produce transient anemia (low RBCs and hemoglobin), leukopenia, or thrombocytopenia (low platelet levels), which often are corrected by the removal of the offending drug. A WBC of 5000 is normal. Changes in CD4 T cell counts relate to HIV infection. Liver enzymes do not rise because of a drug reaction.
A client has just been diagnosed with Graves disease. The primary care provider tells the client that this is due to the presence of autoantibodies to the TSH receptor. The client asks the nurse to explain this in simpler terms. Which response would be the best for this client? Select one: a. "Hyperthyroidism is basically an autoimmune disorder." b. "Basically your lymph node system has gone haywire." c. "Your body has loss its ability to delete autoreactive T cells in the thyroid." d. "The filtration system in your body is no longer working."
a. "Hyperthyroidism is basically an autoimmune disorder." Several mechanisms are available to filter autoreactive B cells out of the B-cell population: clonal deletion of immature B cells in the bone marrow; deletion of autoreactive B cells in the spleen or lymph nodes; functional inactivation or anergy; and receptor editing, a process that changes the specificity of a B-cell receptor when autoantigen is encountered. There is increasing evidence that B-cell tolerance is predominantly due to help from T cells. Loss of self-tolerance with development of autoantibodies is characteristic of a number of autoimmune disorders. For example, hyperthyroidism in Graves disease is due to autoantibodies to the TSH receptor.
A client has just been diagnosed with Graves disease. The primary care provider tells the client that this is due to the presence of autoantibodies to the TSH receptor. The client asks the nurse to explain this in simpler terms. Which response would be the best for this client? Select one: a. "Hyperthyroidism is basically an autoimmune disorder." b. "Basically your lymph node system has gone haywire." c. "Your body has loss its ability to delete autoreactive T cells in the thyroid." d. "The filtration system in your body is no longer working."
a. "Hyperthyroidism is basically an autoimmune disorder." Several mechanisms are available to filter autoreactive B cells out of the B-cell population: clonal deletion of immature B cells in the bone marrow; deletion of autoreactive B cells in the spleen or lymph nodes; functional inactivation or anergy; and receptor editing, a process that changes the specificity of a B-cell receptor when autoantigen is encountered. There is increasing evidence that B-cell tolerance is predominantly due to help from T cells. Loss of self-tolerance with development of autoantibodies is characteristic of a number of autoimmune disorders. For example, hyperthyroidism in Graves disease is due to autoantibodies to the TSH receptor.
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: Select one: a. "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." b. "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." c. "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." d. "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."
a. "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." 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.
Which of the following clients are at high risk for developing anemia? Select all that apply. Select one or more: a. A HIV-positive client who is experiencing frequent infection and elevated CD4+ counts b. A breast cancer client undergoing chemotherapy and radiation therapy c. A client who had a colectomy 3 weeks ago to remove adhesions and fecal impaction d. A COPD client with acute exacerbation requiring O2 therapy via C-PAP e. A middle-aged renal failure client who has hemodialysis three times/week
a. A HIV-positive client who is experiencing frequent infection and elevated CD4+ counts b. A breast cancer client undergoing chemotherapy and radiation therapy e. A middle-aged renal failure client who has hemodialysis three times/week Anemia often occurs as a complication of infections, inflammation, and cancer. The most common causes of chronic disease anemias are acute and chronic infections, including AIDS and osteomyelitis; cancers; autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease; and chronic kidney disease. Postsurgical clients do experience some blood loss and may become anemic but not always. COPD clients do not routinely have low hemoglobin levels.
Which of the following clients are at high risk for developing anemia? Select all that apply. Select one or more: a. A HIV-positive client who is experiencing frequent infection and elevated CD4+ counts b. A breast cancer client undergoing chemotherapy and radiation therapy c. A client who had a colectomy 3 weeks ago to remove adhesions and fecal impaction d. A COPD client with acute exacerbation requiring O2 therapy via C-PAP e. A middle-aged renal failure client who has hemodialysis three times/week
a. A HIV-positive client who is experiencing frequent infection and elevated CD4+ counts b. A breast cancer client undergoing chemotherapy and radiation therapy e. A middle-aged renal failure client who has hemodialysis three times/week Anemia often occurs as a complication of infections, inflammation, and cancer. The most common causes of chronic disease anemias are acute and chronic infections, including AIDS and osteomyelitis; cancers; autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease; and chronic kidney disease. Postsurgical clients do experience some blood loss and may become anemic but not always. COPD clients do not routinely have low hemoglobin levels.
Which of the following outpatients are at a greater risk for developing Treponema pallidum, the cause of syphilis? Select all that apply. Select one or more: a. A homeless adolescent female performing oral sex for money b. A male who frequents clubs catering to exotic dancers and sexual favors c. A homosexual male couple who have had a monogamous relationship for the past 20 years d. An older adult female living in a condominium who regularly has sex with three to four different men/week Treponema pallidum is a sexually transmitted infection that is spread by direct physical contact. The Borrelia type of spirochete is spread from animals to humans through lice or tick bites. Leptospira spirochetes spread from animals to humans through contact with infected animal urine. Spirochetes are anaerobic; therefore, they would not invade the host through oxygen-filled aerobic lungs.
a. A homeless adolescent female performing oral sex for money b. A male who frequents clubs catering to exotic dancers and sexual favors d. An older adult female living in a condominium who regularly has sex with three to four different men/week Treponema pallidum is a sexually transmitted infection that is spread by direct physical contact. The Borrelia type of spirochete is spread from animals to humans through lice or tick bites. Leptospira spirochetes spread from animals to humans through contact with infected animal urine. Spirochetes are anaerobic; therefore, they would not invade the host through oxygen-filled aerobic lungs.
Chlamydiaceae have characteristics of both viruses and bacteria and are a rather common sexually transmitted infectious organism. After entry into the host, they transform into a reticulate body. The health care provider should monitor which of the following clients for this possible infection? Select all that apply. Select one or more: a. An adult male who raises a number of exotic birds in his home b. A drug abuser looking to share needles/syringes c. A newborn with a noticeable eye infection d. A teenager who swims in the lake regularly
a. An adult male who raises a number of exotic birds in his home b. A drug abuser looking to share needles/syringes c. A newborn with a noticeable eye infection Chlamydiaceae are in the form of an elementary body when infectious and outside of the host cell. Once an organism enters the cell, it transforms into a large reticulate body. This undergoes active replication into multiple elementary bodies, which are then shed into the extracellular environment to initiate another infectious cycle. Chlamydial diseases of humans include sexually transmitted genital infections (Chlamydophila trachomatis); ocular infections and pneumonia of newborns (C. trachomatis); upper and lower respiratory tract infections in children, adolescents, and young adults (Chlamydophila pneumoniae); and respiratory disease acquired from infected birds (Chlamydophila psittaci).
During a client's admission assessment prior to reduction mammoplasty surgery, the nurse notes a reference to a Leiden mutation in the client's history. The nurse assesses this client for an increased risk of developing which of the following postsurgical complications? Select one: a. Hemorrhage b. Myocardial infarction c. Hemophilia A or B d. Deep vein thrombosis
d. Deep vein thrombosis The Leiden mutation predisposes to venous thrombosis. It is not associated with hemophilia or an increased risk of hemorrhage. The client's risk of deep vein thrombosis likely supersedes her risk of myocardial infarction.
T-cell lymphocytes leave the bone marrow and travel to the thymus. If successful, they differentiate into which of the following cells? Select all that apply. Select one or more: a. CD4+ helper T cells b. Epstein-Barr virus (EBV) c. Hematopoietic stem cell d. Kupffer cells e. CD8+ cytotoxic T cells
a. CD4+ helper T cells e. CD8+ cytotoxic T cells The body's lymphatic system consists of the lymphatic vessels, lymphoid tissue, and lymph nodes, thymus, and spleen. T lymphocytes leave the bone marrow as precursor T lymphocytes travel to the thymus, where they differentiate into CD4+ helper T cells and CD8+ cytotoxic T cells, after which many of them move to lymph nodes, where they undergo further proliferation. Infectious mononucleosis is a self-limiting lymphoproliferative disorder caused by the Epstein-Barr virus (EBV), a member of the herpesvirus family. Kupffer cells of the liver are not a component of the lymphatic system. The human T-cell lymphotropic virus (HTLV-1), which is endemic in the southwestern islands of Japan, has been associated with adult T-cell leukemia/lymphoma.
An infant (5 days old) has lab results revealing an elevated level of unconjugated bilirubin, due to hemolysis of RBCs. Because of this, which assessment findings would correlate with this abnormal lab result? Select all that apply. Select one or more: a. Difficulty to arouse (lethargy) b. Cyanosis in hands and feet c. Click in the right hip area when adducted d. Jaundice e. Rigidity and tremors
a. Difficulty to arouse (lethargy) d. Jaundice Unconjugated bilirubin and iron cause yellowing of the skin, or jaundice. Hyperbilirubinemia places the neonate at risk for the development of a neurologic syndrome called kernicterus. This condition is caused by the accumulation of unconjugated bilirubin in brain cells. The manifestations of kernicterus may appear 2 to 5 days after birth in term infants or by day 7 in premature infants. Lethargy, poor feeding, and short-term behavioral changes may be evident in mildly affected infants. Severe manifestations include rigidity, tremors, ataxia, and hearing loss. Extreme cases cause seizures and death. Cyanosis relates to low oxygen levels in the blood (hypoxia) and a click in a hip usually is associated with a fracture.
A healthy, primiparous (first-time) mother delivered a healthy infant several hours ago, but the mother has experienced postpartum hemorrhage. Which of the following disorders is most likely to underlie the client's excessive bleeding after delivery? Select one: a. Disseminated intravascular coagulation b. Hemophilia A c. Von Willebrand disease d. Thrombotic thrombocytopenic purpura (TTP)
a. Disseminated intravascular coagulation Obstetric complications account for 50% of cases of disseminated intravascular coagulation; tissue factors released from necrotic placental or fetal tissue or amniotic fluid may enter the circulation, inciting DIC. Hemophilia A would be a central aspect of the client's medical history if it were present, and von Willebrand disease does not typically cause massive bleeding. The etiology of TTP is not normally obstetric.
Question text A healthy, primiparous (first-time) mother delivered a healthy infant several hours ago, but the mother has experienced postpartum hemorrhage. Which of the following disorders is most likely to underlie the client's excessive bleeding after delivery? Select one: a. Disseminated intravascular coagulation b. Hemophilia A c. Von Willebrand disease d. Thrombotic thrombocytopenic purpura (TTP)
a. Disseminated intravascular coagulation Obstetric complications account for 50% of cases of disseminated intravascular coagulation; tissue factors released from necrotic placental or fetal tissue or amniotic fluid may enter the circulation, inciting DIC. Hemophilia A would be a central aspect of the client's medical history if it were present, and von Willebrand disease does not typically cause massive bleeding. The etiology of TTP is not normally obstetric.
Which of the following genes for the hematopoietic growth factors has been cloned and its recombinant protein is now used to treat anemia of kidney failure and cancer? Select one: a. Epogen (EPO) b. Immunoglobulin genes c. Monoclonal immunoglobulin d. Interleukins (IL-3)
a. Epogen (EPO) The genes for most hematopoietic growth factors have been cloned, and their recombinant proteins have been generated for use in a wide range of clinical conditions. The clinically useful factors include EPO. It is used for treatment of bone marrow failure caused by chemotherapy or aplastic anemia and the anemia of kidney failure and cancer. Immunoglobulin genes, monoclonal immunoglobulin, and interleukins (IL-3) are not given for anemia.
Which of the following genes for the hematopoietic growth factors has been cloned and its recombinant protein is now used to treat anemia of kidney failure and cancer? Select one: a. Epogen (EPO) b. Immunoglobulin genes c. Monoclonal immunoglobulin d. Interleukins (IL-3)
a. Epogen (EPO) The genes for most hematopoietic growth factors have been cloned, and their recombinant proteins have been generated for use in a wide range of clinical conditions. The clinically useful factors include EPO. It is used for treatment of bone marrow failure caused by chemotherapy or aplastic anemia and the anemia of kidney failure and cancer. Immunoglobulin genes, monoclonal immunoglobulin, and interleukins (IL-3) are not given for anemia.
Which of the following clients should the nurse assess for a type III hypersensitivity immune responses resulting in injury to the vascular system? A client admitted with: Select all that apply. Select one or more: a. Extensive edema associated with acute glomerulonephritis b. Newly diagnosed systemic lupus erythematosus (SLE) c. Facial droop and impaired speech d. Wheezing on inspiration e. Liver failure exhibiting bleeding tendencies
a. Extensive edema associated with acute glomerulonephritis b. Newly diagnosed systemic lupus erythematosus (SLE) Type III responses create immune complexes that are deposited in the affected tissues, activating an inflammatory response. Autoantibodies are involved with type II responses; cytotoxic cells are involved with type II and type IV responses. Immunoglobulins are released in response to B-cell activation of plasma cells, which does not occur as part of type III reactions.
Which of the following would constitute a normal assessment finding in a neonate? Select one: a. Minimal or absent levels of IgA and IgM b. Absence of plasma cells in the lymph nodes and spleen c. Undetectable levels of all immunoglobulins d. Absence of mature B cells with normal T-cell levels and function
a. Minimal or absent levels of IgA and IgM IgA and IgM levels are normally low in the neonate because these immunoglobulins do not cross the placental barrier. An absence of plasma cells in the lymph nodes and spleen accompanies common variable immunodeficiency. An absence of mature B cells with normal T-cell levels and function, as well as undetectable levels of all immunoglobulins, is a pathologic finding in X-linked agammaglobulinemia.
A home health nurse suspects that a child living with his IV drug-abusing mother may have HIV. Which of the following clinical manifestations would confirm this diagnosis? Select all that apply. Select one or more: a. Extremely small for his age to the point of failure to thrive b. CNS abnormalities like seizures, difficulty with walking c. Pneumonia culture reveals a fungal infection of the lungs d. Isolating himself in a back room with the lights dim e. Uncontrolled crying every time the mother approaches
a. Extremely small for his age to the point of failure to thrive b. CNS abnormalities like seizures, difficulty with walking c. Pneumonia culture reveals a fungal infection of the lungs Children may have a different clinical presentation of HIV infection than adults. Failure to thrive, CNS abnormalities, and developmental delays are the most prominent primary manifestations of HIV infection in children. Children born with HIV infection usually weigh less and are shorter than noninfected infants. A major cause of early mortality for HIV-infected children is P. jiroveci pneumonia, which occurs early in children, with the peak age of onset at 3 to 6 months.
While explaining evasive factors by microbes to evade various components of the host's immune system, the instructor uses which of the following examples? Select one: a. H. Pylori being able to survive in an acidic environment b. Enzymes capable of destroying cell membranes c. S. aureus ability to immobilize IgG d. An infectious agent's ability to produce toxins
a. H. Pylori being able to survive in an acidic environment A number of factors produced by microorganisms enhance virulence by evading various components of the host's immune system. H. pylori,the infectious cause of gastritis and gastric ulcers, produces a urease enzyme on its outer cell wall. The urease converts gastric urea into ammonia, thus neutralizing the acidic environment of the stomach and allowing the organism to survive in this hostile environment. Infectious agents also produce invasive factors that facilitate the penetration of anatomic barriers and host tissue. Most invasive factors are enzymes capable of destroying cell membranes (e.g., phospholipases), connective tissue (e.g., elastases, collagenases), intercellular matrices (e.g., hyaluronidase), and structural protein complexes (e.g., proteases). The effects of the pathogen's invasive factors and toxins, combined with the antimicrobial and inflammatory substances released by host cells, mediate the tissue damage and pathophysiology of infectious diseases.
A client presents to the emergency department with severe menstrual bleeding where she is soaking three to 4 pads/hour. Following assessment, which of the following findings indicates that her body is trying to increase its cardiac output? Select all that apply. Select one or more: a. Heart rate 120 beats/minute b. Deep respirations with expiratory wheezes c. Light pink mucous membranes d. Complaints of chest "palpitations" e. Pale bluish nail beds
a. Heart rate 120 beats/minute d. Complaints of chest "palpitations" Anemia is frequently the result of tissue oxygen deficit, which is secondary to decreased circulating red blood cells (RBCs) or hemoglobin for oxygen delivery. The redistribution of the blood from cutaneous tissues or the lack of hemoglobin causes pallor of the skin, mucous membranes, conjunctivae, and nail beds. Tachycardia and palpitations may occur as the body tries to compensate with an increase in cardiac output.
A client presents to the emergency department with severe menstrual bleeding where she is soaking three to 4 pads/hour. Following assessment, which of the following findings indicates that her body is trying to increase its cardiac output? Select all that apply. Select one or more: a. Heart rate 120 beats/minute b. Deep respirations with expiratory wheezes c. Light pink mucous membranes d. Complaints of chest "palpitations"
a. Heart rate 120 beats/minute d. Complaints of chest "palpitations" Anemia is frequently the result of tissue oxygen deficit, which is secondary to decreased circulating red blood cells (RBCs) or hemoglobin for oxygen delivery. The redistribution of the blood from cutaneous tissues or the lack of hemoglobin causes pallor of the skin, mucous membranes, conjunctivae, and nail beds. Tachycardia and palpitations may occur as the body tries to compensate with an increase in cardiac output.
The pathologic effects of the thalassemias are primarily due to which of the following pathophysiologic processes? Select one: a. Impaired hemoglobin synthesis b. Impaired folic acid absorption c. Erythropoietin deficiency d. Loss of iron
a. Impaired hemoglobin synthesis The thalassemias are a heterogeneous group of inherited disorders caused by mutations that decrease the rate of α- or β-globin chains. The pathologic effects of the thalassemias are not direct results of impaired folic acid absorption or a lack of erythropoietin or iron.
Leukemias are classified according to the predominant cell type. The myelogenous cell type of leukemia can: Select one: a. Interfere with thrombocyte cell maturation b. Originate in marrow and infiltrate nodes c. Affect B and T stem cells in bone marrow d. Transform mature cells into immature ones
a. Interfere with thrombocyte cell maturation Myelogenous leukemia interferes with maturation of all blood cells, including granulocytes, erythrocytes, and thrombocytes, in the bone marrow. Lymphocytic leukemia originates in the marrow and infiltrates the spleen, lymph nodes, and tissues. Lymphocytic leukemia has immature precursor B and T cells in the marrow. Chronic lymphocytic leukemia results from the malignant transformation of relatively mature B lymphocytes into immature ones.
The parents are ready to take their newly diagnosed hemophilia child home. Which of the following teaching aspects should the nurse discuss with them prior to discharge? Select all that apply. Select one or more: a. Keep the child away from contact sports like football and wrestling. b. Give ibuprofen (an NSAID) if the child runs a fever. c. Aspirin should only be given for severe pain in the joints. d. Administration of factor VIII at home when bleeding occurs. e. The signs of a MI related to bleeding in the heart vessels.
a. Keep the child away from contact sports like football and wrestling. d. Administration of factor VIII at home when bleeding occurs. The prevention of trauma is important in persons with hemophilia. Aspirin and other NSAIDs that affect platelet function should be avoided. Factor VIII replacement therapy (either recombinant or heat-treated concentrates from human plasma) administered at home has reduced the typical musculoskeletal damage. It is initiated when bleeding occurs or as prophylaxis with repeated bleeding episodes. Characteristically, bleeding occurs in soft tissues, the gastrointestinal tract, and the hip, knee, elbow, and ankle joints. Bleeding of the heart vessels is not usually associated with hemophilia A.
While explaining immunity to a client, the nurse responds, "The body's internal organs are protected from pathogens because: Select one: a. Our mucosal tissue contains all the necessary cell components to fight a pathogen with an immune response." b. The tonsils store a large amount of natural killer cells at that location." c. We have special glands that can secrete cytokines on a moment's notice." d. The actions of the cytokines in the mouth can act on different cell types at the same time it is fighting pathogens."
a. Our mucosal tissue contains all the necessary cell components to fight a pathogen with an immune response." 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.Pleiotrophism refers to the ability of a cytokine to act on different cell types.
Knowing that thrombotic thrombocytopenic purpura (TTP) results in thrombi in the microcirculation system, the health care worker should assess the client for which of the following manifestations? Select all that apply. Select one or more: a. Red/purple skin discoloration that does not blanch when pressure is applied (purpura) b. Jaundice noted on skin and sclera of the eyes c. Petechiae over the entire body d. Erythema around all orifices e. Confusion or seizures caused by decreased circulation to the brain from vascular occlusion
a. Red/purple skin discoloration that does not blanch when pressure is applied (purpura) c. Petechiae over the entire body e. Confusion or seizures caused by decreased circulation to the brain from vascular occlusion The clinical manifestations of TTP include purpura, petechiae, vaginal bleeding, and neurologic symptoms ranging from headache to seizures and altered consciousness.
The client is undergoing diagnostic workup for possible Hodgkin type of lymphoma. Which of the following laboratory results would confirm the diagnosis of Hodgkin lymphoma? Select one: a. Reed-Sternberg cells b. Bence Jones proteins c. M-type protein antibodies d. Philadelphia chromosome
a. Reed-Sternberg cells Hodgkin lymphoma is diagnosed by the presence of Reed-Sternberg cells. Philadelphia chromosomes are found in chronic myelogenous leukemia cells. M-type protein antibodies are diagnostic for multiple myeloma. Bence Jones proteins are found in the urine of people with multiple myeloma.
The client is undergoing diagnostic workup for possible Hodgkin type of lymphoma. Which of the following laboratory results would confirm the diagnosis of Hodgkin lymphoma? Select one: a. Reed-Sternberg cells b. Bence Jones proteins c. M-type protein antibodies d. Philadelphia chromosome
a. Reed-Sternberg cells Hodgkin lymphoma is diagnosed by the presence of Reed-Sternberg cells. Philadelphia chromosomes are found in chronic myelogenous leukemia cells. M-type protein antibodies are diagnostic for multiple myeloma. Bence Jones proteins are found in the urine of people with multiple myeloma.
Prior to leaving on a backpacking trip to Southeast Asia, a college student has received a tetanus booster shot. This immunization confers protection by way of what immune process? Select one: a. Secondary humoral response b. Cell-mediated immune response c. Primary humoral response d. Innate immunity
a. Secondary humoral response Booster immunizations make use of the memory, or secondary, response that is a component of humoral immunity. A primary response occurs on first exposure to an antigen. This immunization does not make use of the cell-mediated immune response of innate immunity.
A client's cell-mediated immune response has resulted in the release of regulator T cells. These cells will perform which of the following roles? Select one: a. Suppressing the immune response to limit proliferation of potentially harmful lymphocytes b. Presenting antigens to B cells to facilitate the production of antibodies c. Differentiating into subpopulations of helper T cells d. Destroying target cells by releasing cytolytic enzymes and other toxins
a. Suppressing the immune response to limit proliferation of potentially harmful lymphocytes Regulatory T cells suppress immune responses by inhibiting the proliferation of other potentially harmful self-reactive lymphocytes. They do not present antigens to B cells, and activated CD4+ T cells differentiate into subpopulations of other helper T cells. Cytotoxic T cells participate in the active destruction of target cells.
Following delivery, the parents have chosen to have their infant's cord blood frozen. A blood test is performed on the cord blood and found to contain IgM antibodies. The nurse interprets this to mean: Select one: a. The infant has been exposed to an intrauterine infection. b. The infant has received active antibodies from the mother. c. The child's placenta was defective since it did not filter the IgM out of the blood. d. The child likely already has developed an immunocompromised disease.
a. The infant has been exposed to an intrauterine infection. Protection of a newborn against antigens occurs through transfer of maternal antibodies. Maternal IgG antibodies cross the placenta during fetal development and remain functional in the newborn for the first months of life. IgG is the only class of immunoglobulins to cross the placenta. Cord blood does not normally contain IgM or IgA. If present, these antibodies are of fetal origin and represent exposure to intrauterine infection.
Following peripheral blood testing and a bone marrow biopsy, a client has been diagnosed with chronic myelogenous leukemia. Which of the following is most likely to have preceded the client's diagnosis? Select one: a. The presence of a Philadelphia chromosome b. Down syndrome c. Radiation exposure d. Exposure to the Epstein-Barr virus
a. The 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.
Which of the following clients are at risk for developing a platelet clot? Select all that apply. Select one or more: a. A COPD client experiencing an acute exacerbation requiring intravenous steroids b. A trauma client who had a splenectomy following injury and laceration of the liver c. A school-aged child prescribed iron supplements for iron deficiency anemia d. A breast cancer client receiving chemotherapy e. An acute myocardial infarction client with elevated troponin levels
b. A trauma client who had a splenectomy following injury and laceration of the liver c. A school-aged child prescribed iron supplements for iron deficiency anemia d. A breast cancer client receiving chemotherapy e. An acute myocardial infarction client with elevated troponin levels Increased platelet function has several causes, one of which is vascular wall damage that promotes platelet adhesion. An increase in platelet count can occur as a reactive disorder associated with iron deficiency anemia, especially in children; splenectomy; cancer; and chronic inflammatory conditions such as rheumatoid arthritis and Crohn disease.
A client who has undergone a liver transplant 7 weeks ago has developed the following assessment data: ALT/AST elevation; jaundice of skin and sclera; weight gain with increase in abdominal circumference; and low-grade fever. The nurse suspects: Select one: a. Hyperacute graft rejection b. Acute graft rejection c. Chronic rejection d. Atherosclerosis of arteries of the liver
b. Acute graft rejection Allograph rejection is caused by tissue incompatibility that causes the recipient immune cells to attack and destroy the donor cells. The opposite, graft versus host disease, is characterized by recipient immune cells being destroyed by the donor cells because the recipient cells are recognized by the donor cells as foreign.
A client presents to the emergency clinic not feeling well. Which of the following complaints leads the health care provider to suspect the client may have acute leukemia? Select one: a. Frequent nausea and vomiting for past week b. Bleeding from the gums, not related to brushing the teeth c. Muscle aches and pains in large muscle groups, especially while lying in bed d. Severe headache with associated photophobia
b. Bleeding from the gums, not related to brushing the teeth Although ALL and AML are distinct disorders, they typically present with similar clinical features. Both are characterized by an abrupt onset of symptoms, including fatigue resulting from anemia; low-grade fever, night sweats, and weight loss due to the rapid proliferation and hypermetabolism of the leukemic cells; bleeding due to a decreased platelet count; and bone pain and tenderness due to bone marrow expansion. Nausea and vomiting, muscle aches, and headaches could be associated with other diagnoses like influenza.
Polycythemia develops in clients with lung disease as a result of: Select one: a. Hyperventilation b. Chronic hypoxia c. Decreased blood viscosity d. Excessive respiratory fluid loss
b. Chronic hypoxia Secondary polycythemia results from a physiologic increase in the level of erythropoietin, commonly as a compensatory response to hypoxia. Conditions causing hypoxia include living at high altitudes, chronic heart and lung disease, and smoking.
Polycythemia develops in clients with lung disease as a result of: Select one: a. Hyperventilation b. Chronic hypoxia c. Decreased blood viscosity d. Excessive respiratory fluid loss
b. Chronic hypoxia Secondary polycythemia results from a physiologic increase in the level of erythropoietin, commonly as a compensatory response to hypoxia. Conditions causing hypoxia include living at high altitudes, chronic heart and lung disease, and smoking.
Which of the following findings are considered part of normal aging? Select all that apply. Select one or more: a. Increased absolute number of lymphocytes b. Decrease in CD4+ count c. Decreased IL-2 level d. Elevated CD8+ T cells e. Increase in B-cell production
b. Decrease in CD4+ count c. Decreased IL-2 level There is a decrease in the size of the thymus gland, which is thought to affect T-cell function. A suggested biologic clock in T cells that determines the number of times it divides may regulate cell number with age. Some researchers have reported a decrease in the absolute number of lymphocytes, and others have found little, if any, change. The most common finding is a slight decrease in the proportion of T cells to other lymphocytes and a decrease in CD4+ and CD8+ T cells. Evidence indicates that aged T cells have a decreased rate of synthesis of the cytokines that drive the proliferation of lymphocytes and a diminished expression of the receptors that interact with those cytokines. For example, it has been shown that IL-2, IL-4, and IL-12 levels decrease with aging. Although B-cell function is compromised with age, the range of antigens that can be recognized is not diminished.
Which of the following findings are considered part of normal aging? Select all that apply. Select one or more: a. Increased absolute number of lymphocytes b. Decrease in CD4+ count c. Decreased IL-2 level d. Elevated CD8+ T cells e. Increase in B-cell production
b. Decrease in CD4+ count c. Decreased IL-2 level There is a decrease in the size of the thymus gland, which is thought to affect T-cell function. A suggested biologic clock in T cells that determines the number of times it divides may regulate cell number with age. Some researchers have reported a decrease in the absolute number of lymphocytes, and others have found little, if any, change. The most common finding is a slight decrease in the proportion of T cells to other lymphocytes and a decrease in CD4+ and CD8+ T cells. Evidence indicates that aged T cells have a decreased rate of synthesis of the cytokines that drive the proliferation of lymphocytes and a diminished expression of the receptors that interact with those cytokines. For example, it has been shown that IL-2, IL-4, and IL-12 levels decrease with aging. Although B-cell function is compromised with age, the range of antigens that can be recognized is not diminished.
Leukocytes consist of three categories of cells that have different roles in the inflammatory and immune responses. Which of the following leukocytes is correctly matched with its function? Select one: a. Lymphocyte—phagocytosis b. Eosinophils—allergic reactions c. Basophils—engulf antigens d. Monocytes—release heparin
b. Eosinophils—allergic reactions Eosinophils, a type of granulocyte, increase in number during allergic reactions. Lymphocytes (agranulocytes) consist of three cell types that are not phagocytes but do have an important role in the immune response. Basophils and mast cells release heparin and histamine in response to allergens. Monocytes and macrophages are phagocytes that engulf antigens.
While working in the newborn nursery, a nurse is assessing a new admission. The nurse notes the infant has an increased distance between his eyes, a very small jaw, and a split uvula. Thinking this infant might have DiGeorge syndrome, the nurse should be assessing this infant for which of the following electrolyte imbalances? Select one: a. Frequent ventricular beats on ECG due to hyperkalemia b. Loss of consciousness due to hyponatremia c. Tetany due to hypocalcemia d. Decreased reflexes due to hypermagnesemia
c. Tetany due to hypocalcemia Infants born with this defect have partial or complete failure in development of the thymus and parathyroid glands and have congenital defects of the head, neck, and/or heart. The facial disorders can include hypertelorism (increased distance between the eyes); micrognathia (abnormally small jaw); low-set, posteriorly angulated ears; split uvula; and high-arched palate. Urinary tract abnormalities also are common. The most frequent presenting sign is hypocalcemia and tetany that develop within the first 24 hours of life. It is caused by the absence of the parathyroid gland and is resistant to standard therapy.
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: Select one: a. "Calcium gluconate is added to the bag to keep it from clotting." b. "If the blood is used within 24 hours from retrieval, there will be no clot formation yet." c. "The blood bank adds heparin to every bag prior to actually collecting the blood from the donor." d. "Citrate is added to the blood bag, which prevents it from clotting."
d. "Citrate is added to the blood bag, which prevents it from clotting." The addition of citrate to blood stored for transfusion purposes prevents clotting by chelating ionic calcium. Calcium (factor IV) is required for coagulation to occur, and calcium is supplied by the body for the first two steps. Blood coagulation is regulated by several natural anticoagulants, such as antithrombin III and proteins C and S, which work by inactivating some of the clotting factors. Obviously, if blood not processed but used 24 hours later, it will have clotted.
HIV-positive persons who display manifestations of laboratory category 3 or clinical category C are considered to have: Select one: a. Zero viral load b. Seroconversion c. Complete remission d. AIDS-defining illnesses
d. AIDS-defining illnesses Laboratory category 3 and clinical category C are the most serious and indicate the presence of AIDS-defining illnesses. Seroconversion is clinical category A; zero viral load and remission could also be category A.
A client has been admitted to the hospital for the treatment of HIV infection, which has recently progressed to overt AIDS. Which of the following nursing actions should the nurse prioritize when providing care for this client? Select one: a. Frequent neurologic vital signs and thorough skin care b. Hemodynamic monitoring and physical therapy c. Careful monitoring of fluid balance and neurologic status d. Astute infection control and respiratory assessments
d. Astute infection control and respiratory assessments Although all of the cited assessments and interventions may be of some value, infection control and the early identification of potential respiratory infections are paramount in the care of clients with AIDS.
Major histocompatibility complex (MHC) molecules, with human leukocyte antigens (HLAs), are markers on all nucleated cells and have an important role in: Select one: a. Identifying blood types b. Cell membrane transport c. Suppressing viral replication d. Avoiding transplant rejections
d. Avoiding transplant rejections MHC and HLA markers are unique for each individual, except possibly for identical twins. Tissue and organ transplantation success is dependent on how closely matched the MHC molecules and HLAs are on the donor and recipient. MHC molecules and HLAs are not involved in transport or viral replication. Red blood cells do not have a nucleus and thus do not have HLA or MHC molecules on the surface.
Major histocompatibility complex (MHC) molecules, with human leukocyte antigens (HLAs), are markers on all nucleated cells and have an important role in: Select one: a. Identifying blood types b. Cell membrane transport c. Suppressing viral replication d. Avoiding transplant rejections
d. Avoiding transplant rejections MHC and HLA markers are unique for each individual, except possibly for identical twins. Tissue and organ transplantation success is dependent on how closely matched the MHC molecules and HLAs are on the donor and recipient. MHC molecules and HLAs are not involved in transport or viral replication. Red blood cells do not have a nucleus and thus do not have HLA or MHC molecules on the surface.
Which of the following trends in the hematologic status of a 6-week-old infant (born at 32 weeks' gestation) most clearly warrants medical intervention? Select one: a. Decreasing red blood cell counts b. Increasing HgA levels c. Decreasing mean corpuscular volume (MCV) d. Extremely low hematocrit Signs and symptoms include apnea, poor weight gain, pallor, decreased activity, and tachycardia. In infants born before 33 weeks' gestation or those with hematocrits below 33%, the clinical features are more evident. Decreasing red blood cell counts, hematocrit, and MCV are normal postnatal findings. Levels of HgA rise gradually following delivery.
d. Extremely low hematocrit Signs and symptoms include apnea, poor weight gain, pallor, decreased activity, and tachycardia. In infants born before 33 weeks' gestation or those with hematocrits below 33%, the clinical features are more evident. Decreasing red blood cell counts, hematocrit, and MCV are normal postnatal findings. Levels of HgA rise gradually following delivery.
In the ICU, a postsurgical client has developed sepsis and is being treated with multiple medications. During the mid-morning assessment, which finding leads the nurse to suspect the client may be developing a complication called disseminated intravascular coagulation (DIC)? Select all that apply. Select one: a. Headaches associated with light sensitivity b. Oozing from all previous puncture and intravenous sites c. Decreased O2 saturation and diminished breath sounds in lower lobes d. Hemorrhage from the surgical site requiring deep pressure dressings e. Urine from the Foley catheter is bloody
d. Hemorrhage from the surgical site requiring deep pressure dressings DIC is hemorrhage in the presence of excessive coagulation. Although coagulation and formation of microemboli characterize DIC, its acute manifestations usually are more directly related to the bleeding problems that occur. The bleeding may be present as petechiae, purpura, oozing from puncture sites, or severe hemorrhage. Headache with light sensitivity is usually not associated with DIC unless the client has s/s of a cerebral bleed with CNS deficits. Decreased O2 saturation and diminished breath sounds are usually associated with atelectasis.
Although bacterial toxins vary in their activity and effects on host cells, a small amount of gram-negative bacteria endotoxin: Select one: a. Is released during cell growth b. Inactivates key cellular functions c. Uses protein to activate enzymes d. In the cell wall activates inflammation
d. In the cell wall activates inflammation Endotoxins differ from exotoxins in several ways. Endotoxins are found in the cell wall lipids of gram-negative bacteria and are potent activators of life-threatening systemic responses such as acute inflammation with clotting and hypotension. Exotoxins contain protein, are released during cell growth, inactivate key cell functions, and have enzymatic activity.
When discussing colony-stimulating factors (CSFs), the nurse explains that recombinant CSF is currently used to: Select one: a. Assist kidney dialysis clients to maintain a therapeutic potassium level b. Stimulate the bone marrow to produce more immature cells c. Grow stem cells in the laboratory d. Increase the success rate of bone marrow transplantation
d. Increase the success rate of bone marrow transplantation Recombinant CSF molecules are currently being used to increase the success rates of bone marrow transplantations. CSF does not affect potassium levels, encourage bone marrow to produce immature cells, or grow stem cells.
A client's primary care provider has ordered direct antigen detection in the care of a client with a serious symptomatology of unknown origin. Which of the following processes will be conducted? Select one: a. Detecting DNA sequences that are unique to the suspected pathogen b. Growth of biofilms on various media in the laboratory setting c. Quantification of IgG and IgM antibodies in the client's blood d. Introduction of monoclonal antibodies to a blood sample from the client
d. Introduction of monoclonal antibodies to a blood sample from the client Direct antigen testing involves the introduction of labeled monoclonal antibodies to a sample of the client's tissue. This method of testing does not rely on detection of specific DNA sequences, growth of biofilms, or quantification of specific antibodies.
A client's primary care provider has ordered direct antigen detection in the care of a client with a serious symptomatology of unknown origin. Which of the following processes will be conducted? Select one: a. Detecting DNA sequences that are unique to the suspected pathogen b. Growth of biofilms on various media in the laboratory setting c. Quantification of IgG and IgM antibodies in the client's blood d. Introduction of monoclonal antibodies to a blood sample from the client
d. Introduction of monoclonal antibodies to a blood sample from the client Direct antigen testing involves the introduction of labeled monoclonal antibodies to a sample of the client's tissue. This method of testing does not rely on detection of specific DNA sequences, growth of biofilms, or quantification of specific antibodies.
A client has been diagnosed with non-Hodgkin lymphoma (NHL), a form of malignancy that most likely originated in which of the following sites? Select one: a. Thymus b. Spleen c. Bone marrow d. Lymph nodes
d. Lymph nodes NHLs can develop in any of the lymphoid tissues, but the most common site of origin is the lymph nodes.
A client has developed pericarditis following an episode of acute glomerulonephritis, developments that may be attributable to the presence of similar epitopes on group A beta-hemolytic streptococci and the antigens in the client's heart tissue. Which of the following has most likely accounted for this client's autoimmune response? Select one: a. Breakdown of T-cell anergy b. Release of sequestered antigens c. Superantigens d. Molecular mimicry Molecular mimicry is the phenomenon that exists when a microbe shares an immunologic epitope with the host, precipitating an autoimmune response. This miscategorization by cells of the immune system does not result from the release of sequestered antigens, failure of T-cell anergy, or the presence of superantigens.
d. Molecular mimicry Molecular mimicry is the phenomenon that exists when a microbe shares an immunologic epitope with the host, precipitating an autoimmune response. This miscategorization by cells of the immune system does not result from the release of sequestered antigens, failure of T-cell anergy, or the presence of superantigens.
When an Rh-negative mother has been sensitized and is pregnant with an Rh-positive fetus, what happens to the fetus? Select one: a. Bilirubin deficiency b. Nothing, this is normal c. Plasma volume depletion d. Profound red cell hemolysis
d. Profound red cell hemolysis This situation is totally detrimental to the health of the fetus. Rh incompatibility and production of antibodies by the mother will result in life-threatening fetal red cell hemolysis. The bilirubin will be sufficiently elevated to cause brain damage. The infant will have massive edema from a lack of albumin production.
