Pathophysiology Test 2: Units 3 and 4
A 44-year-old Caucasian woman is being treated in an airport infirmary after she developed a painful, swollen leg during a transatlantic flight in economy class. The woman is suspected of having deep vein thrombosis (DVT), and is questioning the paramedics about why this might be the case, given that she has twice previously had similar experiences. Which of the following teaching points be the airport medical staff would be most appropriate?
"A lot of Caucasians have an inherited inability to dissolve clots that form in their bodies."
The nurse is caring for a client who has just been diagnosed with AIDS. The client asks the nurse, "How long will I live?" Which of the following is an appropriate response by the nurse?
"AIDS is considered to be a chronic illness today."
A student makes the statement to a colleague, "Blood plasma is essentially just a carrier for the formed cells like red blood cells and white blood cells." What would be the most accurate response to this statement?
"Actually, plasma plays a significant role in nutrient and waste transport."
The nurse is preparing to administer a unit of blood to a client. The client says that he is not sure he wants to give consent to receive the blood transfusion because he does not want to get AIDS from the blood. Select the best response from the nurse.
"All blood is now tested for the AIDS virus, so the risk of getting AIDS from a blood transfusion is extremely low."
When a patient who has been newly diagnosed with HIV asks, "What are the chances that I can be cured," which of the following is the nurse's most therapeutic response?
"Although there is no current treatment that provides a possible cure, there are ones that have successfully managed the infection."
A mother brings her 5-month-old infant to the pediatrician for recurrent colds. The mother has never breastfed and the infant is fed iron-fortified formula. The mother asks, "My baby has been perfectly healthy up until last month--now it seems like she has been sick constantly. Why?" How should the physician respond?
"An infant gets immunity from the mother at birth and from breast milk; this provides protection from infection but wears off in approximately 3 to 6 months. An infant still needs time for his own immune system to mature."
Members of an AIDS support group who have more advanced cases are sharing some of their recent health problems with a member who has just been diagnosed. Which of the members' statements is most accurate?
"As people with HIV live longer, more of us are eventually succumbing to the cancers that are associated with HIV"
The father of a 2-year-old boy recently diagnosed with hemophilia A asks the nurse how to prevent complications for his son. The best response would be:
"Avoid administering aspirin and nonsteroidal anti-inflammatory drugs."
A high school soccer player has just been diagnosed with mononucleosis. He tells the nurse he feels "OK" and really needs to play in the championship game this weekend. The most important information for the nurse to provide would be:
"Avoidance of contact sports for a minimum of 3 weeks after diagnosis is recommended."
A nurse is instructing a client on the long-term use of antibiotics and antibiotic resistance. Which of the following statements by the client indicates that the teaching has been successful?
"Bacterial resistance to antibiotics can occur due to genetic mutations."
A couple who are expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can their caregiver best respond to the couple's enquiry? Stem cells can:
"Be used as source of reserve cells for the entire blood production system."
Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students' following statements best captures an aspect of the two health problems?
"Both of them involve low platelet counts, but in TTP there can be more, not less, hemostasis.
The nurse working at a community clinic is caring for a young male client. The client asks the nurse if he could get AIDS from being sprayed in the face with breast milk. Select the best response by the nurse.
"Breast milk can contain the virus that causes AIDS, but to be infected, the milk needs to be in contact with your mucous membranes or an open sore."
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:
"Citrate is added to the blood bag, which prevents it from clotting."
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:
"Drinking contaminated milk."
The family of an elderly patient are wondering why his 'blood counts' are not rising after his last GI bleed. They state, "He has always bounced back after one of these episodes, but this time it isn't happening. Do you know why?" The nurse will respond based on which of the following pathophysiological principles?
"Due stress, the red blood cells of older adults are not replaced as promptly as younger people."
As part of his diagnostic workup, a 77-year-old man's physician has ordered blood work which includes ferritin levels. The man is very interested in the details of his health care and is unfamiliar with ferritin and its role. He asks his physician to explain the significance of it and the rationale for testing it. Which of the following explanations by the physician is most accurate?
"Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills."
A patient diagnosed with H pylori asks the nurse, "How an infection can occur in their stomach since it is an acid environment?" The nurse responds:
"H. pylori produces an enzyme called urease that converts gastric juices into ammonia which neutralizes the acidic stomach environment."
A client is newly diagnosed with impaired platelet function, thrombocytopathia. Which of the following questions is most appropriate for the nurse to ask in order to determine the possible cause of this problem?
"Have you been taking aspirin or any nonsteroidal anti-inflammatory drugs (NSAIDs)?"
Which of the following statements from a group of young adults demonstrates the need for further teaching related to HIV and prevention of the spread?
"Having oral sex is one way I can prevent passing on HIV to my partner."
A student states, "It seems like helper T cells do a lot more than just 'help' the cellular immunity process". Which of the following responses listed below best conveys an aspect of the role of CD4+ helper T cells in immunity?
"Helper T cells play a major role in stimulating and regulating the whole process."
The nurse is caring for of a 6-month-old infant diagnosed with iron deficiency anemia. The nurse determines further teaching is necessary when the mother states:
"I must stop breast-feeding my baby because of the anemia."
The employee health nurse is working with a nursing student who has just sustained a needlestick injury and has received a dose of hepatitis B immune globulin. The nurse is counseling the student about vaccination against hepatitis B. Which statement by the student indicates understanding?
"I need to start the hepatitis B vaccination series as soon as possible."
A nurse is teaching parents of a child with scarlet fever. Which of the following statements indicates that the parents understand the treatment for the child?
"I will give the antibiotic for the full 10 days."
A nurse is teaching a parent group about the importance of regular childhood vaccines. The nurse evaluates that the teaching is successful based on which of the following statements?
"I will have my baby vaccinated as scheduled to reduce the senseless spread of vaccine-preventable illnesses."
The nurse is teaching a group of college students about reducing the risk of HIV transmission during sexual relations. The nurse makes which of the following appropriate teaching points?
"If a person has a sexually transmitted disease (STD), there is an increased risk for HIV infection."
A community health nurse is conducting the nutritional component of a class for new mothers. Which of the following teaching points would be most justified?
"If you choose to feed your baby with formula, ensure that it is iron-fortified."
The nurse is caring for a client who has been told that he is HIV infected. The client asks the nurse, "Can my partner and I ever have sex again?" Which of the following is an appropriate response by the nurse?
"If you use latex condoms with water-soluble lubricant consistently, sex is safer, but not completely risk free."
The nurse is administering a childhood vaccine to a pediatric client. The mother asks the nurse why the child needs so many vaccinations. How should the nurse respond?
"Immunization is an important means of inhibiting the spread of infection by decreasing your child's susceptibility to the infection."
The pediatrician is teaching the mother of a one-year-old child about iron deficiency anemia in children. Which statement is most accurate?
"In infancy, low levels of iron are due to a diet consisting mainly of cow's milk."
The mother of a newborn infant questions why her baby needs a vitamin K injection immediately after birth. The best response by the nurse would be:
"Infants are not born with the normal intestinal bacteria that synthesize vitamin K for clotting."
A 60-year-old male client with an acute viral infection is receiving interferon therapy. The physician is teaching the family of the client about the diverse actions of the treatment and the ways that it differs from other anti-infective therapies. Which of the following teaching points listed below should the physician least likely include?
"Interferon can bolster your father's immune system through the stimulation of natural killer cells that attack viruses."
In the context of a workshop on rheumatoid arthritis, a clinical educator is teaching a group of nurses about autoimmune diseases. Which of the following statements by an attendee would the educator most likely want to follow up with further teaching?
"Introduction of a foreign antigen can sometimes induce a cascade of immune response that is not self-limiting"
The parent of a 5 year old who was admitted with a sudden onset of purpura following the flu and who was diagnosed with acute idiopathic thrombocytopenic purpura (ITP) is very concerned that the child will have ITP for the rest of his life. The best response for the nurse to make is which of the following?
"It is usually self-limiting."
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:
"It usually takes 2 to 3 days for warfarin to become therapeutic, meaning your blood will be thin enough to prevent further clot formation."
As part of her prenatal education, a 29 year-old woman who is pregnant with her first child is receiving teaching from her primary care provider. Which of the following statements by the woman reflects an accurate understanding of HIV transmission?
"It's discouraging to know that my breast milk can pass on HIV to my baby."
A nurse is teaching a new mother diagnosed with HIV about the transfer of the infection to her newborn. The mother begins to cry and states, "It's too late, the lab tests on my baby are already positive for HIV." How should the nurse respond?
"Just because the test is positive for HIV does not mean your baby is infected with the virus."
Which of the following teaching points would be most appropriate with a client who has a recent diagnosis of Von Willebrand disease?
"Make sure that you avoid taking aspirin."
The physician knows the client, G1P0 has correctly understood the prenatal education regarding sexually transmitted infection as evidenced by which of the following statements listed below?
"My baby could become infected either across the placenta or during the birth itself."
The nurse is teaching the mother of an infant diagnosed with aplastic anemia about the pathophysiology of the disease. The nurse knows that the mother understands when the the mother identifies which of the following statements as the cause of aplastic anemia?
"My child's stem cells are not able to grow and divide."
A client who was exposed to hepatitis A at a local restaurant has recovered from the disease. At her annual physical, the client asks the health care provider if she should go to her health department and get the hepatitis A "shot." The best response, based on the concepts of adaptive immunity, by the health care provider would be:
"No, since having an active case, you have already developed antigens against hepatitis A."
A client is very much concerned about the harmful effect that all microorganisms may have. The best response by the nurse would be:
"Not all interactions between microorganisms and humans are detrimental."
An 8-week-old boy has been recently diagnosed with a severe combined immunodeficiency (SCID). His parents have performed a significant amount of research on the Internet and have brought a large amount of material to discuss with their care provider. Which of the following statements best reflects an accurate understanding of their son's health situation?
"Our son likely has a deficiency of B-lymphocytes and can't produce antibodies."
Amniocentesis has suggested that a couple's first child will be born with sickle cell disease. The parents are unfamiliar with the health problem and their caregiver is explaining the complexities. Which of the following statements by the parents would suggest a need for further teaching or clarification?
"Our son or daughter likely won't show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies."
A nurse is teaching a group of clients about health promotion activities and lifestyle changes. A client tells the nurse he has smoked 2 packs of cigarettes a day for the last 4 years and has been told he is at risk for developing respiratory infections. The best response would be:
"Smoking can increase the risk of inhalation-acquired diseases."
A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client's husband is confused as to why a disease of coagulation can result in bleeding. Which of the nurse's following statements best characterizes DIC?
"So much clotting takes place that there are no available clotting components left, and bleeding ensues."
The dietary student is studying folic acid deficiency. The faculty member knows the student is ready to teach patients about this topic when the student makes which of the following statements?
"The 30-year-old client who is trying to become pregnant should evaluate her folic acid intake."
A client refuses to take the 81 mg of aspirin ordered by the physician, stating, "I do not have any pain." The best response by the nurse would be:
"The 81 mg of aspirin daily will help protect you from a stroke or a heart attack."
A patient who was tested for HIV received a positive result from the enzyme-linked immunosorbent assay (ELISA) followed by a negative Western blot test asks the nurse what this means. Which of the following is the nurse's best response?
"The ELISA test gives some false positives, but the Western blot confirms you don't have HIV."
A nurse is assessing a patient presenting with symptoms of fatigue, fever, severe joint pain, and headache. Laboratory results reveal an erythrocyte sedimentation rate (ESR) rate of 60 mm/hour. The patient asks what the blood test results mean. Which of the following is the most appropriate explanation for the nurse to provide?
"The ESR tests for the presence of inflammation in the body."
A college student has been called into the student health office because she tested positive for HIV on the enzyme-linked immunosorbent assay (ELISA). The student asks, "What is this Western blot assay going to tell you?" The best response by the health care provider is:
"The Western blot is a more sensitive assay that looks for the presence of antibodies to specific viral antigens."
A pregnant client who has HIV asks the nurse if her baby will have the disease. The best response would be:
"The baby will test positive for the HIV antibody test result, although the child may not necessarily be infected with the virus."
A client stepped on a nail at work. The emergency room physician prescribes a tetanus "booster" shot. The client asks the nurse, "If I have already been vaccinated for tetanus why do I need to have another shot?" How should the nurse respond?
"The booster shot will stimulate your immune system's memory, causing an immediate rise in antibodies to protect you from an infection."
A client with a diagnosis of hemolytic anemia has gone to a community-based laboratory for follow-up blood work. The lab technician confirms with the client that hematocrit is one of the components of the blood work. The client replies, "I thought the point of the blood work was to see how many red blood cells I have today." How could the technician best respond to the client's statement?
"The hematocrit measures the mass that your red blood cells account for in a quantity of your blood."
The staff educator is teaching the nurse orientee about red cell changes in the neonate. The educator knows that the orientee understands the neonatal changes and care when she states which of the following?
"The hemoglobin concentration falls after birth due to reduced red cell production and plasma dilution."
The neonate displays a yellow discoloration of her skin on the third day of life. The neonatologist explains this condition to the parents. Which of the following statements is most accurate?
"The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown."
A 9-year-old child has been home from summer camp for 2 weeks and complains of sore throat, low-grade fever, and enlarged cervical lymph nodes. After testing, it is determined the child has Epstein-Barr virus (EBV)-associated infectious mononucleosis. The parent asks the nurse how the child acquired this type of infection. Which of the following is the nurse's best response?
"The infection is acquired primarily through contact with infected oral secretions."
The nurse knows which of the following statements below is appropriate to be included in an education session for a 21-year-old male with a diagnosis of malaria?
"The infectious organisms are considered tiny, single-celled animals, given their complete eukaryotic machinery."
The staff development nurse is teaching a class of orientees about care of the geriatric patient. Which of the following statements is accurate about red cell changes with aging?
"The location of bone cells involved in red cell production shifts toward the axial skeleton."
The lab technician is evaluating the student's knowledge of laboratory values for red blood cells. The technician knows the student has been studying when she correctly states which of the following?
"The major components of blood are the red cell mass and plasma volume."
A patient was recently diagnosed with acquired immunodeficiency syndrome (AIDS) and started on antiviral therapy. The nurse evaluates the patient's understanding of the antiviral drug when the patient correctly identifies which of the following as the pharmacological mechanism of action?
"The primary target of most antiviral compounds is viral RNA or DNA synthesis."
The pathophysiology student is studying erythropoiesis. Which statement demonstrates understanding of this process?
"The reticulocyte count serves as an index of erythropoietic activity of the bone marrow."
The pathophysiology student is learning about the shape of the erythrocyte and how it contributes to oxygen transport. Which statement by the student demonstrates understanding?
"The thinness of the cell membrane enables oxygen to diffuse rapidly between the exterior and innermost regions of the cell."
A potential donor is angry at the personal nature of the questions about HIV risk factors that he is required to answer at a blood collection center, and states that simple blood testing should suffice. How can the nurse at the center best respond?
"There's a period shortly after someone is infected with HIV when blood tests might still be negative."
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?
"These little hairs move germs trapped in mucous toward the throat so the body can cough them out."
A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies:
"They are looking for the presence of antibody or complement on the surface to the RBC."
A school nurse is teaching high school students about HIV and AIDS in the context of the school's sexual health curriculum. Which of the students' following statements would the nurse most likely want to correct or clarify?
"They have to take a blood sample from you in order to test you for AIDS."
A client tells the nurse that he has recently begun to take over-the-counter (OTC) calcium supplements to ensure that his blood will clot. The best response by the nurse would be:
"This is not necessary, unless it has been prescribed by your health care provider."
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:
"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."
A client has been diagnosed with herpes simplex virus. The client states that, "modern medicine produces more and more antivirals every year and so the treatment should be simple." Which of the following statements listed below is the best response?
"Treatment options for viruses are often limited because what destroys viruses often damages your own body cells."
A nurse is teaching parents expecting their first child about the benefits of umbilical cord blood donation. The nurse determines teaching was effective based on which of the following statements?
"Umbilical cord blood can provide stem cells for transplantation."
A client tells the health care provider he has heard several myths about viruses. The most appropriate information for the nurse to provide would be:
"Viruses can produce symptoms of disease months to years later."
A 12-month-old infant is displaying pale skin, rapid heart rate, and increased respiratory rate. The parents bring the child to the clinic. Which statement by the parents points the health care worker to suspect iron deficiency anemia?
"We give him regular cow's milk with all his meals and snacks."
A 36-year old woman with a diagnosis of antiphospholipid syndrome is receiving a scheduled checkup from her nurse practitioner. Which of the following teaching points would the nurse most likely prioritize?
"We need to ensure your birth control pills don't contain estrogen."
A mother brings her child to the pediatric clinic because of irritability, loss of appetite, low-grade fever, pallor, and leg pain. Blood tests reveal anemia, thrombocytopenia, and an elevated leukocyte count with atypical lymphocytes. A diagnosis of acute lymphocytic leukemia (ALL) is confirmed with bone marrow studies. The child undergoes aggressive high-dose chemotherapy with plans for a possible stem cell transplant. Which of the following questions is most appropriate for the nurse to ask the mother?
"When your child was born, did you save the umbilical cord blood in a blood bank?"
A 38-year-old female is considering the use of oral contraceptives as a method of birth control. She asks her health care provider if any risks would be involved. The best response would be:
"Yes, risks increase with age."
The nurse is caring for a client who has just learned that he is HIV positive. The client asks the nurse how long he has been able to infect others. Select the best response by the nurse.
"You can infect others before the HIV antibody is detectable in your blood."
The nurse is teaching a 65-year-old client who is anemic. The client has a history of gastric bypass surgery and his lab work shows a cobalamin deficiency. Which of the following recommendations will help the client maintain an adequate level of cobalamin?
"You will need lifelong treatment consisting of intramuscular vitamin B12 injections."
A patient with infectious mononucleosis asks the nurse why the lymph nodes are enlarged. Which of the following is the nurse's appropriate response?
"Your lymph nodes trap and destroy viruses."
A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy's spleen. Which of the following teaching points would be most accurate?
"Your son's spleen is holding on to too many of his platelets so they're not available for clotting."
A client called the physician's office with symptoms of the common cold. The nurse educates the client on supportive treatment for symptoms and explains that the body's immune system is fighting the virus but will take approximately how long for a response?
1-2 weeks
A female client with a diagnosis of psoriatic arthritis is presently taking a course of prednisone for the control of symptoms related to inflammation. Which erythrocyte sedimentation rate (ESR) would indicate that the medication course has decreased the inflammation within normal limits?
10 mm/hr
Mature red blood cells have a life span of approximately how many days?
120
Normal red blood cells live an average of about how many days?
120
How many days do erythrocytes live in circulation?
120 days
Mature red blood cells have a life span of approximately:
120 days
Place the following in the sequence of the progression of HIV/AIDS on a cellular level. 1)The HIV virus is uncoded. 2)HIV attaches to the receptors on the CD4+ cell. 3)DNA synthesis occurs by reverse transcription. 4)Transcription of the DNA to form a single-strand messenger RNA.
2,1,3,4
What is the minimum number of antiretroviral medications used in highly active antiretroviral therapy (HAART) (also known as combined antiretroviral therapy (CAR)?
3
Which of the following patients have an absolute neutrophil count that is critically low and the standard of care would recommend they be placed on neutropenic precautions?
37 year old patient with leukemia being treated with chemotherapy with ANC of 400.
When talking about the lifespan of various blood components, the students should know that once a neutrophil moves into tissue, it lives approximately how long?
4 days.
The client reports he has been noticing small amounts of blood in his stool for the last several weeks. The provider knows the client's red cell mass may reach which value without the occurrence of signs and symptoms?
50%
The nurse is reviewing the client's laboratory report. Select the report that represents a normal value for leukocytes.
6500 cells/mL
Accounting for age, illness, and risk factors, a transfusion is recommended when the hemoglobin is at which of the following levels?
<7 g/dL
Which of the following types of viral hepatitis is not associated with transmission through contact with infected blood?
A
A medical student is familiarizing herself with recent overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history?
A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use.
In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis?
A 40 year-old man who has had 3 broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated.
Which of the following situations can best be characterized as an example of passive immunity?
A 6-week-old infant receives antibodies from his mother's breast milk.
A nurse is providing care for several patients on an acute medical unit of a hospital. Which of the following patients would be most likely to benefit from hematopoietic growth factors?
A 61-year-old female patient with end-stage renal cancer.
Which of the following patients would be most likely to be experiencing an increase in renal erythropoietin production?
A 71-year-old smoker admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD)
The nursing is reviewing assessment data of four clients. Select the client who is at greatest risk for developing pernicious anemia.
A client who has undergone partial gastrectomy
A client with a diagnosis of atrophic gastritis and consequent pernicious anemia is receiving high oral doses of vitamin B12. Which of the following changes would be most likely expected by his care provider at the completion of his treatment?
A decrease in mean corpuscular volume
A client has been diagnosed with an abscess. Upon assessment of the client, the nurse would expect to find:
A localized pocket of infection composed of devitalized tissue, microorganisms, and the host's phagocytic white blood cells
The process of clot retraction squeezes serum from the clot, thereby joining the edges of the broken vessel. Through the action of actin and myosin, filaments in platelets contribute to clot retraction. Failure of clot retraction is indicative of what?
A low platelet count
The nurse observes dark, foul-smelling, blood-tinged urine from a client who recently had a bowel resection. The client is diagnosed with a urinary tract infection. The nurse explains that this infection most likely caused by which of the following?
A nosocomial infection
The nurse is teaching a client infected with the flu about viruses. Which of the following would the nurse use to describe a viral infection?
A parasitic relationship between an organism and host is present.
Which of the following patients has the highest risk of contracting an opportunistic infection?
A patient who has had HIV for 3 years and has a CD4+ count of 50 cells/μL
When counseling a male patient with suspected HIV, the nurse informs him that if the enzyme-linked immunosorbent assay (ELISA) come back positive, then:
A second test known as the Western blot assay will be ordered to confirm positive HIV status.
A client comes to the physician's office after being bitten by a tic, with symptoms of headache, fatigue, joint pain and swelling. The physician determines which of the following as the mode of transmission for the infection?
A vector
Which of the following is a known trigger for many autoimmune disorders?
A viral infection
Sometimes the host's white blood cells are unable to eliminate the microorganism, but the body is able to contain the dissemination of the pathogen. What is this called?
Abscess
The nurse evaluating a client's bloodwork determines that a client has an increased risk for infection based on which of the following lab results?
Absoulute neutrophil count of 800/uL
The nurse is caring for a client with chronic myelogenous leukemia (CML)and notes that the client has splenomegaly, and an increased basophil count as well as night sweats, bone pain, and a low grade fever. The nurse interprets the symptoms as indicating that the client is in which phase of the clinical course of CML?
Accelerated
A client diagnosed with chronic myleogenous leukemia (CML) is reporting a feeling of abdominal fullness/discomfort, low-grade fever, night sweats, and bone pain. Based on these data, the client is now most likely experiencing the:
Accelerated phase
Which of the following statements about HIV/AIDS is true?
Accidental stick with a needle used on an HIV-infected patient carries little risk of infection.
A patient diagnosed with systemic lupus erythematosus (SLE) has been experiencing a low neutrophil count. How would this type of neutropenia be classified?
Acquired, autoimmune secondary neutropenia
Blood coagulation is initiated by either the intrinsic or extrinsic pathway. The final step in both pathways would be:
Activation of factor X, leading to conversion of prothrombin II to thrombin IIa
Which of the following phenomena would be least likely to result in activation of the complement system?
Activation of toll-like receptors (TLRs) on complement proteins.
The nurse is administering a measles, mumps, and rubella (MMR) vaccination to a pediatric client. When the nurse explains immunity to the mother, which type of immunity will she explain that this vaccination provides?
Active artificial immunity
A client is brought to the physician's office with a raised red macular rash on the trunk and arms accompanied by a fever. A diagnosis of measles is made. Which type of immunity does this disease process provide?
Active natural immunity
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:
Acute graft rejection
The leukemia most commonly found in children and adolescents is recognized as:
Acute lymphocytic leukemia (ALL)
The health care provider suspects a client may have developed a leukemia that originates from the B cells. The provider would assess the client for:
Acute lymphocytic leukemia (ALL) and chronic lymphocytic leukemia (CLL)
An immunocompromised client is exposed to varicella (chicken pox virus). The client has not had the varicella vaccine and has never had the disease. What intervention should the nurse anticipate to prevent this client from developing varicella?
Administer varicella zoster immune globulin (VZIG).
An infant is suspected of having a severe combined T- and B-cell immunodeficiency disorder. Which of the following effects on the infant makes early detection a priority?
Administering live attenuated virus vaccines can be fatal.
Which of the following would be the best treatment option to prevent perinatal transmission of HIV antibodies to a fetus from the HIV-positive mother?
Administration of zidovudine to the mother during pregnancy, labor, and delivery
In which of the following mature B-cell lymphomas do clients have virtually 100% evidence of previous Epstein-Barr virus (EBV) infection?
African Burkitt lymphoma
In reference to infectious disease, a patient cannot be which one of the following?
Agent
The nurse is caring for a client with sickle cell disease. The most important treatment for the nurse to provide would be:
Aggressive intravenous hydration and morphine
The burn patient is hypotensive and has hypoproteinemia. Which blood component will be utilized in her treatment?
Albumin
Which of the following is the most abundant type of plasma proteins?
Albumin
Which lymphatic tissue is associated with mucous membranes and called mucosa-associated lymphatic tissue, or MALT? (Select all that apply.)
Alimentary canal and genitourinary systems
A client presents to the Urgent Care with erythematous, papular, and vesicular lesions associated with intense pruritus and weeping. The client states he was in the woods and thinks he may have come in contact with poison ivy .The reaction may be classified as:
Allergic contact dermatitis
A patient comes to the clinic with a runny nose and scratchy throat. The nurse is evaluating the white blood cell count, which shows an elevated number of white blood cells and an increased percentage of eosinophils. Which of the following is the most likely cause of the symptoms?
Allergic reaction
A patient will be receiving a bone graft from an unrelated individual. Which of the following types of graft does the nurse inform the patient that he or she will be receiving?
Allograft
Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body?
Alters vitamin K, reducing its ability to participate in the coagulation of the blood
Which one of the following is a protozoan infection?
Amebic dysentery
Which of the following clients is at the greatest risk for developing an intracellular pathogen infection?
An AIDS client with a decreased CD4+ TH1 count
When reading a client's chart the nurse notes that the client has a bone marrow disorder that is causing the client to be neutropenic. The nurse understands that the client's neutropenia is which of the following?
An acquired disorder
The ingestion of a Shiga toxin produced by Escherichia coli O157:H7 can cause a sometimes fatal illness called hemolytic-uremic syndrome (HUS). Select the client at highest risk.
An individual who consumed undercooked hamburger during a backyard barbecue
Which is not correct about an opportunistic infection?
An opportunistic infection primarily affects a host with a normal immunity.
Some members of the population are so sensitive to certain antigens that they react within minutes by developing itching, hives, and skin erythema, followed shortly thereafter by bronchospasm and respiratory distress. What is this near immediate reaction commonly known as?
Anaphylactic reaction
A patient with common variable immunodeficiency (CVID) who is also deficient in IgA is being treated with IV immunoglobulin (IV Ig) in the hospital. For which of the following should the nurse closely monitor the client during treatment?
Anaphylaxis
An 81-year-old female patient in a subacute medical unit of a hospital has developed an oral Candida albicans infection. Which of the following phenomena would the patient's nurse suspect as a key contributing factor to her infection?
Antibiotic therapy that eliminated normal bacterial flora.
A client is diagnosed with a bacterial infection of the respiratory system. The nurse teaches the client about the body's natural defenses and identifies which of the following as most likely to be fighting the antigen?
Antibodies
The cells that mediate humoral immunity do so because they are capable of producing:
Antibodies
The nurse is caring for a client with an infection of candida albicans. Which type of antimicrobial agent will the nurse plan to administer to effectively treat this disease?
Antifungal
Substances foreign to the host that can stimulate an immune response are known as:
Antigens
The nurse is reviewing the laboratory results of a newborn. The infant has anemia, thrombocytopenia, and granulocytopenia (pancytopenia). Based on these results, the nurse anticipates the diagnosis of which type of anemia?
Aplastic anemia
The cloning of the genes for most of the hematopoietic growth factors has been accomplished. The recombinant proteins that are produced are used in a wide range of clinical problems. What diseases have these proteins been used to fight?
Aplastic anemia and the anemia of kidney failure
A client asks, "What do these basophils and mast cells do in the body?" The health care provider responds that they:
Are involved when you have an allergic reaction
How does low-dose aspirin therapy impact clot formation?
Aspirin is a platelet aggregation inhibitor.
A nurse is reviewing the health history and medication list of a client admitted with thrombocytopathia. The nurse determines which of the client's home medications predisposes the client to bleeding? Select all that apply.
Aspirine Hydrochlorothiazide Colchicine Amiodarone
A child has experienced a "bee-sting" while at the park. The health care provider is walking by and notices the child has swelling around the eyes, lips, and face in general. What priority assessment should the nurse make at this time?
Assess and establish an open airway.
Select the statement that best describes autoimmune disease.
Autoimmune diseases represent a disruption in self-tolerance that results in damage to body tissues by the immune system.
Which of the following types of a hypersensitivity reaction involves failure of the development of self-tolerance?
Autoimmune reaction
A client is taking a vacation in a foreign country. The nurse teaches the client about giardiasis, a common traveler's infection. Which of the following statements should be included in the teaching plan?
Avoid eating food and drinking beverages that might be contaminated.
Which of the following statements most accurately conveys an aspect of lymphatic system activity?
B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures.
Select the type of lymphocyte that matures in the bone marrow.
B lymphocytes
Which of the following types of lymphocyte is involved with humoral-mediated immunity?
B lymphocytes
A patient comes to the clinic following exposure to chicken pox. The patient states he had chicken pox as a child but was worried about getting sick again. Which of the following statements best explains humoral-mediated immunity to the patient?
B lymphocytes (B cells) in the body produce antibodies to fight infections. Once exposed, the cells retain memory and are able to quickly fight off pathogens during re-exposure and prevent the disease from reoccurring.
Following a bone marrow biopsy, which of the following assessments would indicate the patient is experiencing a complication as a result of this diagnostic procedure?
BP 90/60, heart rate 132, excess bleeding and hematoma noted at insertion site.
Which of the following types of pneumonia listed below is best characterized by an infective agent that produces sputum samples with a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet?
Bacteria
Select the statement that best describes the cause of antibiotic resistance.
Bacteria that harbor plasmids increase their resistance to antibiotics.
Staphylococcus aureus commonly found in the skin, nares, and other body sites of patients without any signs and symptoms of infection is known as which of the following conditions listed below?
Bacterial colonization.
When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant?
Basophils
Which of the following types of white blood cells are related to the connective tissue mast cells and respond in allergic and hypersensitivity reactions?
Basophils
Which of the following statements about opportunistic pathogen infection in AIDS is true?
Becoming infected with an opportunistic pathogen is one requirement for the diagnosis of AIDS.
A diagnosis of acquired immunodeficiency syndrome (AIDS) is identified when the CD4+ T cell count reaches which level?
Below 200 cells/μL
Definitive diagnosis of multiple myeloma includes the triad of bone marrow plasmacytosis, lytic bone lesions, and what?
Bence-Jones proteins in the urine
The nurse reviews the lab results of a client who has a thrombocyte count of 60,000/µL. The client is at risk for:
Bleeding
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?
Bleeding from the gums, not related to brushing the teeth
A client was involved in an auto accident and suffered massive internal injuries that resulted in a large blood loss. Select the type of anemia the client is at greatest risk to develop.
Blood loss
Cell-mediated immunity is involved in resistance to infectious diseases caused by bacteria and some viruses. It is also involved in cell-mediated hypersensitivity reactions. Which of these does not cause a cell-mediated hypersensitivity reaction?
Blood transfusion
A young woman diagnosed with prostacyclin deficiency is admitted to the hospital with recurrent deep-vein thrombosis and an ovarian infarction asks the nurse why she keeps having these problems. Understanding the role of prostacyclin in hemostasis, the nurse explains that prostacyclin enables which of the following?
Blood vessel vasodilation and inhibition of platelet aggregation
After birth, red blood cells are normally made in which of the following locations?
Bone marrow
Select the option that best describes the production of T lymphocytes.
Bone marrow - thymus - lymph nodes
The client's primary care physician is reviewing assessment data of a client and suspects a diagnosis of acute leukemia. To confirm the diagnosis, which of the following tests would be performed?
Bone marrow analysis
The provider examines a stained blood smear of a patient who is anemic and finds it to be abnormal. Which of the following tests can be performed to provide additional information about the maturity of cells and abnormal types?
Bone marrow aspiration
A patient is suspected of having acute leukemia. Which of the following diagnostic tests does the nurse prepare for to verify that diagnosis?
Bone marrow biopsy
A client is experiencing the early stage of multiple myeloma. The nurse would assess the client for:
Bone pain
Which of the following is the first symptom of multiple myeloma that a patient typically presents with on a visit to the primary care provider?
Bone pain
Which one of the following statements about acquired immunodeficiency syndrome (AIDS) is true?
Both B-cell and T-cell function are affected.
A patient is brought to the emergency room with complaints of facial muscle paralysis and increasing upper extremity weakness several hours after eating canned peppers. Histologic examination reveals a bacterial infection and further testing reveals a decrease in the release of the neurotransmitter acetylcholine from cholinergic neurons. The nurse explains to the patient that which of the following is the most likely cause of this illness?
Botulism exotoxin
A client is ordered the recumbent granulocyte CSF filgrastim. The nurse evaluates the effectiveness by monitoring which of the following?
CBC/diff
The human immunodeficiency virus (HIV) acts on which of the following types of cells?
CD4+ T lymphocytes
Which one of the following is an AIDS-defining condition?
CD4+ count less than 200 cells/microliter of blood
An infectious disease nurse is researching T cells to determine which cells control replication of intracellular bacteria. Which of the following cells should the nurse begin investigating?
CD8 cells
A client has a lymphoma that carries a risk of CNS involvement. The nurse anticipates the health care provider will prescribe:
CNS prophylaxis
What do patients with acute lymphocytic leukemia (ALL) involving the brain or spinal cord usually receive?
CNS prophylaxis
Which of the following is a function of plasma?
Carrying nutrients
A patient with a history of antiphospholipid syndrome is admitted to the emergency deparatment with acute onset of both renal and liver failure, along with signs of a cerebrovascular accident. The admitting nurse is concerned that the patient has developed which of the following?
Catastrophic antiphospholipid syndrome
A patient has been diagnosed with Hodgkin's disease after a series of diagnostic tests. This condition would be related to which of the following immunodeficiencies?
Cellular (T cell)
An elderly patient is brought to the emergency department with garbled speech, unilateral facial drooping, and weakness. One hour after admission, the patient dies. An autopsy reveals the presence of polycythemia. Which of the following was the most likely cause of the patient's death?
Cerebral thrombosis
The nurse will most likely assess which of the following clinical manifestations in a client was diagnosed with Creutzfeldt-Jakob disease?
Change in behavior and memory, loss of coordination leading to encephalopathy.
A nurse is caring for a patient with neutropenia (decrease in neutrophil levels). Which of the following interventions is the most appropriate to include in the plan of care?
Checking the temperature every 4 hours
A 16 year-old female has been brought to her primary care physician by her mother due to the girl's persistent sore throat and malaise. Which of the following facts revealed in the girl's history and examination would lead the physician to rule out infectious mononucleosis?
Chest auscultation reveals crackles in her lower lung fields bilaterally.
The physician is examining a postmenopausal female and explains that which of the following is the most usual reason for iron deficiency in adults?
Chronic blood loss
An elderly client asks the nurse why so many older people develop anemia. The best response would be:
Chronic disease
A patient tells the nurse that the primary care provider prescribed an antibiotic. The patient was instructed to take the antibiotic three times a day for ten days. After the 4th day, the patient was feeling much better and decided to stop taking the medication. What complication could result from stopping the antibiotic early?
Chronic infection
A client's laboratory report shows the presence of the Philadelphia chromosome. The health care provider would recognize this as:
Chronic myelogenous leukemia (CML)
A client with end-stage renal disease received a kidney transplant with a kidney donated by a family member. The client has been carefully monitored for signs of rejection. The physician informs the client that there has been a gradual rise in the serum creatinine over the last 5 months. What type of rejection does this depict?
Chronic rejection
A client develops a ruptured tendon after taking an antibiotic for an infection. Which antibiotic prescription would the nurse checking the history expect to find?
Ciprofloxacin (Cipro)
Fibrinolysis is part of the hemostasis process and requires a series of steps. Which of the following is TRUE of the process?
Circulating plasmin is rapidly inactivated, which limits the fibrinolytic process to the local clot.
Of the pathways available to recognize microbes and activate the complement system, which one requires the presence of an antibody?
Classical
All antiretroviral medications interfere with some stage of the HIV life cycle. What stage do protease inhibitors prevent?
Cleavage of the polyprotein chain into the individual proteins that will be used to make new virus
Which description does the nurse recognize fits a client in the prodromal stage of an infection?
Client is experiencing vague symptoms of fatigue and low grade fever.
The nurse working on a cancer unit is assessing clients for neutropenia. Which client has the greatest risk?
Client receiving IV chemotherapy
A patient is suspected of having a T-cell immunodeficiency. Which of the following procedures will help diagnose this disorder?
Clinical presentation and family history
A nurse is caring for a patient who suffered a massive heart attack followed by the development of congestive heart failure (CHF). As the nurse is reviewing with the patient medications taken at home, the patient states concern that the doctor discontinued the Nexium. The nurse explains that taking Nexium with some medications can cause adverse cardiac events. Which of the following medications would be of possible concern?
Clopidogrel
Which one of the following relates to bacterial shape?
Cocci
The practitioner notes the client with hemolytic anemia has Raynaud phenomenon. Which of the following causes this type of anemia?
Cold-reacting antibodies
The nurse is planning a prevention program for infectious mononucleosis. The best target audience for the program is which of the following?
College students living in a dorm
Pluripotent stem cells form an invaluable source of reserve cells for the entire hematopoietic system. Between these cells and the unipotential cells are several levels of differentiation. What are these unipotential cells called?
Colony-forming units
The nurse is caring for a patient who is receiving a bone marrow transplant. What does the nurse understand the patient may receive in order to increase the success rates of the transplantation?
Colony-stimulating factor
A patient receiving chemotherapy has a leukopenia. Which of the following types of medication would promote long-term improvement in the patient's immune response?
Colony-stimulating factor (CSF)
Cytokines that stimulate bone marrow pluripotent stem and progenitor or precursor cells to produce large numbers of platelets, erythrocytes, lymphocytes, neutrophils, and monocytes, eosinophils, basophils, and dendritic cells are known as:
Colony-stimulating factors (CSFs)
A lactation nurse visits a new mother after delivery of her first child and encourages the mother to breastfeed her infant, even for a short time. Which statement made by the nurse correctly explains the importance of breastfeeding?
Colostrum will provide the infant with passive immunity for several months to diseases to which the mother has immunity.
A nurse is providing care for a 17-year-old boy who has experienced recurrent sinus and chest infections throughout his life and presently has enlarged tonsils and lymph nodes. Blood work indicated normal levels of B cells and free immunoglobins but a lack of differentiation into normal plasma cells. The boy is currently receiving intravenous immunoglobulin (IVIG) therapy. What is the boy's most likely diagnosis?
Common variable immunodeficiency
The nurse is caring for a client with cyclic neutropenia. The nurse understands that this is which type of neutropenia?
Congenital
In providing education to a sexually active 22-year-old female, which of the following would be most beneficial to discuss to decrease her risk for contracting HIV?
Consistent use of latex condoms with sexual activity
Which of the following best describes the structure of a virus?
Consists of a capsid that surrounds a nucleic acid core
A client suspects they may have developed an allergic response to latex. What most common allergic response would the nurse expect to find?
Contact dermatitis
A hospitalized client's progress has been noted as the convalescent stage. Select the statement that best describes this stage.
Containment of infection, progressive elimination of the pathogen, repair of damaged tissue, and resolution of associated symptoms
The nurse evaluating a client's blood work notes that the client's white blood cells are 9000. The nurse should:
Continue to monitor the client's blood work results.
A nurse is caring for a client diagnosed with immune thrombocytopenic purpura (ITP). Which of the following medications does the nurse anticipate administering to treat this disorder?
Corticosteroids
A patient is diagnosed with a mild case of an autoimmune disorder and is beginning a treatment regimen. Which of the following is the mainstay of treatment with an autoimmune disorder?
Corticosteroids and immunosuppressants
A patient comes to the clinic with symptoms of fatigue, fever, severe joint pain, and headache. A laboratory results reveal an erythrocyte sedimentation rate (ESR) rate of 60 mm/hour, and a diagnosis of polymyalgia rheumatica (PMR), an inflammatory disease, is confirmed. The nurse anticipates which of the following medications will be prescribed to manage this disease process?
Corticosteroids, such as prednisone
Thrombocytosis is used to describe elevations in the platelet count above 1,000,000/μL. It is either a primary or a secondary thrombocytosis. Secondary thrombocytosis can occur as a reactive process due to what?
Crohn disease
A patient is admitted to the hospital to rule out secondary thrombocytosis after suffering recurrent episodes of deep-vein thrombosis and pulmonary embolisms. The admitting nurse is obtaining a medical history. Which of the following conditions would make anticoagulation contraindicated?
Crohn's disease
To have stem cells for transplantation, clients are given specific agents to increase the quantity and migration of the cells from the bone marrow. What is the agent used to accomplish this?
Cytokine growth factor
Normally, there is a relatively constant number of each type of circulating blood cell. What regulates the number of each type of blood cell?
Cytokines
Which cells bind with MHC class I molecules?
Cytotoxic T cells
Which of the types of T cells is responsible for destroying pathogens by punching holes in their cell membrane and by secreting cytokines/lymphokines?
Cytotoxic T cells
A home health care nurse is visiting a patient who was recently discharged from the hospital taking warfarin therapy following a massive pulmonary embolism. The patient asks why more frequent blood tests are being done, as an antibiotic was started. The best response from the nurse would be that antibiotics can do which of the following?
Decrease intestinal flora
A 22-year-old female who adheres to a vegan diet has been diagnosed with iron deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation?
Decreased erythropoietin levels
The nurse is caring for a client who has a low levels of T lymphocytes. The nurse plans care for a client with which of the following?
Decreased immune response
The nurse reading a client's history and physical notes that the client has a history of leukopenia. The nurse interprets this to mean that the client has which of the following?
Decreased leukocytes
The nurse knows high incidences of infectious illnesses among the older adults who reside in a long term care facility are most likely to have diminished immune capacity because of:
Decreased numbers and responsiveness of T lymphocytes
Warfarin has been prescribed for a client. The nurse expects that the client will have:
Decreased prothrombin and other procoagulation factors
A nurse is caring for a newborn that has developed a low platelet count. Which of the following could be the cause?
Decreased thrombopoietin (TPO)
A nurse working in an ambulatory care unit is working with a patient who has recently been diagnosed with a V Leiden mutation. The nurse tells the patient the importance of smoking cessation to avoid which of the following?
Deep-vein thrombosis (DVT)
A newborn has a clotting disorder that results in the body being unable to produce fibrin. Which of the following could be the cause?
Deficiency of fibrinogen
The nurse has just administered a Mantoux test to a client. Select the reaction that best describes the anticipated response.
Delayed-type hypersensitivity
A clinical research study is evaluating cells that bridge both the innate and adaptive immune systems. A nurse has identified the dendritic cells (DCs) as a key component. Which of the following statements validates this finding?
Dendritic cells (DCs) directly sense pathogens, capture foreign agents, and transport them to secondary lymphoid tissues. Once activated, they undergo a maturation process and function as antigen-presenting cells (APCs) capable of initiating adaptive immunity.
A number of fungi, such as ringworm, athlete's foot, and jock itch, are incapable of growing at a core body temperature. Hence, their infection is limited to cooler cutaneous surfaces. What are these pathogens known as?
Dermatophytes
A woman complains to the nurse that she has developed a yeast infection. The woman does not understand how she could get a yeast infection since she has been on antibiotics for a urinary tract infection. What is the rationale for this patient's complaint?
Destroying one type of resident flora (bacteria) can allow over proliferation of another competing type (yeast).
Primary cell-mediated disorders of the immune system cause severe problems with infections. Children with these disorders rarely survive beyond childhood without a bone marrow transplant. Which of the following is a disease that involves primary cell-mediated disorders of the immune system?
DiGeorge syndrome
The spirochete, leptospires is primarily transmitted to farmers by:
Direct contact with infected animals.
A public health nurse notes an increase in regional throat cancer cases. Upon epidemiological studies, many of the throat cancer clients also had oral exposure to human papillomavirus (HPV). This exposure to HPV would be considered by:
Direct contact with infected secretions
A nurse is caring for a patient recently admitted to the emergency department with drug-induced thrombocytopenia and a platelet count of 50,000/μL. The patient 's medications include quinidine, Bactrim, Nexium, and oral contraceptives. The nurse anticipates which of the following initial courses of treatment?
Discontinuation of all medications
A nurse is caring for a client receiving heparin therapy who has developed heparin-induced thrombocytopenia. Which of the nursing interventions does the nurse anticipate?
Discontinuation of heparin therapy
Your ESRD patient is receiving two units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56. What is the nurse's priority action?
Discontinue the transfusion and begin an infusion of normal saline.
Disseminated intravascular coagulation is a grave coagulopathy resulting from the overstimulation of clotting and anticlotting processes in response to what?
Disease or injury
A postpartum client develops uncontrolled postpartum bleeding, oozing from IV sites, a blood pressure of 82/40, and respiratory distress. Which of the following complications does the nurse suspect is occurring?
Disseminated intravascular coagulation
Which of the following is the calculation for the mean cell volume (MCV) of a red cell?
Dividing hematocrit by red cell count
A client is admitted to the hospital with a diagnosis of deep vein thrombosis and started on intravenous heparin therapy. Seven days later, the client's lab values identify a rapid decrease in platelets. The health care provider recognizes this as:
Drug-induced thrombocytopenia
A patient has been placed on Bactrim as treatment for community-acquired methicillin-resistant Staphylococcus aureus MRSA for 10 days. After taking the medication for 8 day, the patient comes to the doctor's office complaining of multiple nosebleeds over the past day. Laboratory work shows a platelet count of 80,000/μL. The nurse practitioner suspects which of the following conditions?
Drug-induced thrombocytopenia
The nurse is conducting a staff in-service program on non-Hodgkin's lymphomas. The nurse should include that essentially all people with Burkitt lymphoma have evidence of infection with which of the following?
EBV
During a blood transfusion, a client begins to have chills, back pain and develops a fever. The nurse determines the client is experiencing a transfusion reaction. The nurse educates the client about transfusion reactions. Which of the following statements indicates the cause of the reaction?
Each person has two HLA haplotypes that identify human cells. Blood typing involves the identification of these haplotypes (ABO compatibility). The closer the matching of HLA types, the greater is the probability of identical antigens and the lower the chance of rejection. A reaction occurs if the immune system views the HLA types as foreign.
The nurse is caring for a pregnant woman who is infected with HIV. What is an important nursing intervention for this client?
Education about medication compliance
A nurse is evaluating the laboratory values of a patient who developed a hemorrhage during surgery. Which of the following hematology results would the nurse expect to find?
Elevated reticulocyte count
The practitioner notes the client has a yellowish discoloration of the skin. Which of the following lab results would the practitioner expect to see?
Elevated unconjugated bilirubin
Nursing students are discussing the normal stages of hemostasis, in particular the first stage, which involves vasoconstriction of the blood vessel. The students note that endothelial injury initiates release of which of the following?
Endothelin 1
Which one of the following is found in the cell wall of gram negative bacteria?
Endotoxin
Infectious mononucleosis is a lymphoproliferative disorder caused by the Epstein-Barr virus (EBV) that is usually self-limiting and nonlethal. Which of the following complications can arise during this mostly benign disease?
Enlarged spleen
Which of the following is a cost-effective diagnostic method that is used as a screening test for HIV antibodies?
Enzyme-linked immunosorbent assay (ELISA)
A nurse is evaluating laboratory results of a patient diagnosed with a parasitic infection. The tests reveal a large group of cells that are membrane bound with granules in their cytoplasm that are aiding in the destruction of the parasite. Which of the following cells is the nurse evaluating?
Eosinophil
A client presented to the emergency department with symptoms of fever, abdominal pain and diarrhea following a vacation out of the country. A helminthic parasite infection is suspected. Which of the following lab results should the nurse evaluate?
Eosinophils
Which cells block the entry of microbes and destroy them by secreting antimicrobial enzymes, proteins, and peptides within the mucous membrane linings of the gastrointestinal, respiratory, and urogenital tract?
Epithelial
A nurse is providing care for a client who is immunocompromised following chemotherapy. The nurse knows which of the following characterizations of the adaptive immune system listed below is responsible for the client's disruption in their normal immune function?
Epitopes on antigens are recognized by immunoglobulin receptors following presentation by accessory cells.
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?
Epogen (EPO)
Endemic Burkitt lymphoma occurs in regions of Africa where what other infections are common?
Epstein-Barr and malaria
A 16-year-old male client who has been diagnosed with infectious mononucleosis asks the health care provider what caused the condition. The best response would be:
Epstein-Barr virus (EBV)
The microbiology technician explains to the student that which of the following blood cells is the most common?
Erythrocyte
The client, with a hemaglobin of 7.8g/dL, tells the nurse that "my bones ache and my sternum is tender." The nurse understands this discomfort may be caused by which of the following?
Erythropoiesis
A patient with kidney failure has been admitted to the hospital for severe anemia. The patient has refused a blood transfusion. The nurse anticipates administering which of the following drugs to stimulate the production of red blood cells?
Erythropoietin (EPO)
Which of the following colony-stimulating factors (CSFs) is given to ESRD patients to help with their chronic anemia?
Erythropoietin (EPO).
A pregnant woman contacts her physician because she has developed sudden, severe pain and swelling in her left lower leg. The physician explains to her that her past medical includes an inherited defect in factor V Leiden, which predisposes her to the development of which of the following?
Excessive clotting
The Rh-negative mother, who has become sensitized during a previous birth, gives birth to a Rh-positive infant. Which method will the practitioner chose to prevent kernicterus in the infant?
Exchange transfusions
A family consumed some undercooked hamburger at a picnic and has since developed bloody diarrhea. The nurse knows which of the following statements listed below is correct regarding the infectious process?
Exotoxins that damage vascular endothelial causing bleeding and low platelet counts.
Select the statement that best describes the effectiveness of vaccination in the elderly population.
Experimental evidence suggests that vaccination is less successful in inducing immunization in older persons than in younger adults.
There are two pathways that can be activated by the coagulation process. One pathway begins when factor XII is activated. The other pathway begins when there is trauma to a blood vessel. What are these pathways?
Extrinsic and intrinsic pathways
The mother of a 3-year-old brings the child to the clinic because it took several hours to stop bleeding following a minor scrape. Testing reveals that the child has hemophilia B. The nurse teaches the mother that this disease is caused by a deficiency in which of the following factors?
Factor IX
A client has been diagnosed with inherited hypercoagulability. Select the most likely cause.
Factor V gene mutation
A client with hemophilia Type A comes to the emergency department with severe pain and swelling in the right knee. The nurse anticipates the administration of which of the following to reduce musculoskeletal damage?
Factor VIII replacement therapy
Aplastic anemia is the result of which of the following conditions?
Failure of multipotent stem cells to grow
Elderly persons who are immunized have the same effective response in immunity as younger persons do.
False
The nurse is teaching a male client who has been diagnosed as HIV positive. The client asks what precautions he should take to prevent his family members from contracting HIV. Which of the following statements will the nurse include in teaching this client?
Family members should not come in contact with your blood.
The practitioner is examining a client who is fatigued and has a hemoglobin of 8.7g/dL. Before ordering treatment, which lab will the practitioner order?
Ferritin
The provider notes that the client's hemaglobin is 8.2g/dL. Which of the following supplements will the provider recommend to the client?
Ferrous sulfate
The laboratory finds IgA in a sample of cord blood from a newborn infant. This finding is important because it signifies what?
Fetal reaction to exposure to an intrauterine infection
A specific type of gram-negative bacteria contains endotoxin in the bacterial cell envelope. What is the likely clinical manifestation if these bacteria become pathogenic?
Fever
The nurse is assessing a client diagnosed with varicella. The nurse is aware that nonspecific manifestations may include:
Fever
During science class, a student asks, What is the difference between plasma and serum in the blood? The nurse responds that the primary difference between plasma and serum is that plasma contains:
Fibrinogen
When was a client diagnosed with infectious mononucleosis most likely infected with the Epstein-Barr virus (EBV)?
Four to eight weeks earlier
The nurse's plan of care for a client with multiple myeloma should include interventions to prevent which of the following?
Fractures
A home health nurse is visiting an elderly client, who is exhibiting signs of an upper respiratory infection but denies contact with an infected person. The nurse evaluates the home and recommends air conditioner duct cleaning as a precautionary measure against which of the following pathogens?
Fungi
A patient being treated for polymyalgia rheumatica (PMR) comes to the clinic for a follow-up visit. The current erythrocyte sedimentation rate (ESR) rate has decreased from 60 mm/hour to 30 mm/hour and the patient is afebrile, denies any headaches, and reports a decrease in joint pain and fatigue. Based on these findings, the nurse anticipates which of the following changes to the treatment plan?
Gradually decrease the current dosage of prednisone and repeat ESR in 2 weeks.
One week after a client received a transplant the nurse notes that the skin shows a maculopapular rash on the hands and feet. The client reports itching and nausea. What is the likely cause of these manifestations?
Graft versus host disease
After several months on a waiting list, a 44-year-old male received a liver transplant 5 days ago. In the last 36 hours, he has developed a rash beginning on his palms and soles, along with abdominal pain and nausea. It has been determined by his care team that the immune response that is causing his symptoms originates not with his own compromised immune components but with those introduced with his new organ. This man's most likely medical diagnosis is:
Graft-versus-host-disease (GVHD)
The bacteriologist is staining the slides of a client diagnosed with scarlet fever and rheumatic fever. The slide identifies S. pyogenes and stains purple by crystal violet dye. The result would indicate:
Gram-positive organism
A client is experiencing a decrease in the number of circulating neutrophils (neutropenia) during an active bacterial infection. The nurse examines the client's lab results looking for which of the following cytokines, that is responsible for promoting growth and maturation of neutrophils during inflammatory reactions?
Granulocyte CSF (G-CSF)
A client diagnosed with sepsis has a critically low neutrophil count. The nurse expects which drug or drug class to be used to stimulate white blood cell production?
Granulocyte CSF (G-CSF) such as filgrastim (Neupogen)
A patient who has received chemotherapy has a steadily decreasing white blood cell count. The nurse anticipates administering which of the following to increase the neutrophil count?
Granulocyte colony-stimulating factor
While explaining evasive factors by microbes to evade various components of the host's immune system, the instructor uses which of the following examples?
H. Pylori being able to survive in an acidic environment
The treatment of HIV/AIDS is complicated because different drugs act on different stages of the replication cycle of the virus. Therefore, treatment includes combinations of two, three, or more drugs. What is this treatment called?
HAART treatment
Which of the following would be considered an example of transmitting an infection from person-to-person through shared inanimate objects (fomites)?
HIV from a contaminated IV drug user needle
While teaching about HIV/AIDS to a group of high school seniors, the school health nurse will begin by explaining the basic facts which will likely include which of the following information?
HIV is different from other viruses since it is a retrovirus that selectively attacks the body's immune cells.
Which of the following serves as recognition markers to aid in self-tolerance?
HLA antigens encoded by MHC genes
Which of the following should the nurse include in the discharge teaching plan for a client with Felty syndrome?
Handwashing
A male elementary school student has a severe allergy to peanuts and is displaying the signs of anaphylactic shock after inadvertently eating a peanut-containing candy bar. Which of the following statements best captures the boy's current status and preferred treatment?
He is approaching vascular shock and developing edema due to actions of IgE antibodies, situations that can be reversed by administration of epinephrine.
Select the option that best describes the pathogenesis of the anemia in a client with beta-thalassemia.
Heinz bodies impair DNA synthesis and damage the red blood cell (RBC) membrane.
Which one of the following organisms causes peptic ulcers?
Helicobacter pylori
Which of the following infectious agents listed below would be a site-specific pathogen and not spread throughout the body via the circulatory system? Patient diagnosed with:
Helicobacter pylori diagnosed after an endoscopic procedure.
A 10 year old child with strep throat asks the nurse, "why are there large bumps [lymph nodes] on their neck when their throat gets sore?" The nurse replies that lymph nodes:
Help your body fight off infections by allowing special cells [lymphocytes and macrophages] move through the lymph chain and engulf and destroy germs.
Anemia refers to a deficiency of:
Hemoglobin
A nurse is assessing a newly admitted client, noting pale skin and nail beds. Which of the following laboratory data should the nurse evaluate?
Hemoglobin (Hgb) level
A patient arrives in the emergency department with symptoms of extreme fatigue, shortness of breath, and a yellowish discoloration to the skin. The nurse interprets these finding as being which of the following types of anemia?
Hemolytic anemia
Escherichia coli (E. coli) produces an exotoxin called Shiga toxin that enters the body when you eat undercooked hamburger meat and fruit juices that are not pasteurized. What can E. coli infection cause?
Hemorrhagic colitis
The nurse is preparing a patient for a total hip replacement by reviewing preoperative and postoperative instructions. The postoperative antcoagulation protocol is reviewed with the patient because the patient will be immobile for an extended amount of time. The nurse stresses the need for compliance with this protocol to avoid the development of deep-vein thrombosis. Which of the following would be the most effective initial treatment as a thrombosis prophylactic?
Heparin therapy
A nurse is caring for a client receiving heparin therapy. Five days after the start of therapy the nurse notices a sudden decrease in the platelet count. Which of the following complications of heparin therapy can cause platelets to decrease?
Heparin-induced thrombocytopenia
A nurse, educating a client about disease transmission, learns that the client has received weekly manicures and pedicures in various commercial salons for many years. Which of the following diseases is the client at risk for due to improper sterilization of equipment used in the salons?
Hepatitis B
A 39 year-old female with has been characterized as a typical progressor by her care team, and is experiencing an increase in her manifestations and health complaints as her CD4+ count declines. Which of the following health problems would her care team most likely attribute to a cause other than her HIV?
Her decreased bone density and recent fractures.
The client comes to the emergency department with sudden onset of dizziness. The staff note a sudden drop in hemoglobin and hematocrit due to an aplastic crisis. Which of the following hereditary anemias could the client have?
Hereditary spherocytosis
Which of the following assessment and laboratory findings would be most closely associated with acute leukemia?
High blast cell counts and fever.
When explaining what is occurring when their child has an acute bronchial asthma attack, the nurse will emphasize that which mediator is primarily responsible for the bronchial constriction?
Histamine.
A patient is diagnosed with pernicious anemia. The nurse determines the most likely cause of this condition is related to which of the following?
History of a gastrectomy
A patient has symptoms of an atopic reaction. Which of the following clinical manifestations would the nurse expect the patient to display? (Select all that apply.)
Hives Allergic rhinitis Atopic dermatitis
A client is seen by the health care provider. The client states he has been experiencing fevers, chills, and night sweats. Upon further assessment, the health care provider palpates an enlarged supraclavicular lymph node. The health care provider recognizes the manifestations as:
Hodgkin lymphoma
A lymph node biopsy pathology report notes the presence of Reed-Sternberg cells on a patient suspected of having a lymphoma. The nurse interprets the report as indicating which of the following?
Hodgkin's lymphoma
A patient is suspected of having leukemia and is having diagnostic tests performed to determine the type of leukemia. Which of the following forms of leukemia does the nurse recognize has the classic symptoms of pruritus and intermittent fevers associated with night sweats?
Hodgkin's lymphoma (HL)
The male client with liver cancer is being treated with chemotherapy. The provider notes that the client is fatigued and has a hemoglobin of 9.5g/dL and a normal ferritin level. Which of the following medications does the practitioner prescribe?
Human erythropoietin
A patient with end-stage kidney disease is receiving a kidney donated by a family member. When caring for this patient, what does the nurse know is the major target involved in organ transplant rejection?
Human leukocyte antigens (HLAs)
An essential property of the immune system is self-regulation. An immune response that is not adequate can lead to immunodeficiency, while an immune response that is excessive can lead to conditions from allergic responses all the way to autoimmune diseases. Which of these is not an example of a breakdown of the self-regulation of the immune system?
Huntington disease
A client is suffering from the effects of the opportunistic infection, Cryptosporidium parvum. An important nursing intervention would be to encourage which of the following?
Hydration
The surgeon is performing a kidney transplant on a client. The surgeon attaches the kidney and immediately notes that the kidney takes on a cyanotic, mottled appearance. The surgeon would interpret this as:
Hyperacute rejection
While undergoing a kidney transplant from a non-family member, the patients' transplanted kidney has just had the arterial clamps removed. The OR staff notice that the organ is turning purple with no urine output. When explaining to the family why they had to remove the donor kidney, the nurse will anticipate that the surgeon would likely include which statement?
Hyperacute rejection occurs because antibodies against HLA antigens are deposited in vessels causing necrosis.
The nurse is aware that a client diagnosed with multiple myeloma is most at risk for:
Hypercalcemia
The immune system typically responds to invaders of all types in our body. However, it can also cause tissue injury and disease. What is this effect called?
Hypersensitivity action
An anaphylactic reaction could include all of the following signs/symptoms except which of the following?
Hypertension
A client with acute leukemia has developed gout. The nurse is aware that this results from:
Hyperuricemia
A nurse is monitoring a patient with anemia and low oxygen levels. The nurse knows that which of the following stimulates the secretion of erythropoietin?
Hypoxia
A patient receives an interleukin-2 (IL-2) infusion to treat cancer. Which of the following responses explains how this cytokine will affect the growth of cancer cells?
IL-2 stimulates growth of cytotoxic T lymphocytes.
A client comes to the clinic with reports of runny nose, itchy eyes and congestion due to seasonal allergies. The nurse teaches the client about the allergic reaction. The nurse knows that teaching has been effective when the client identifies which CD4 helper T-cell cytokine as the cause of this Type I hypersensitivity reaction?
IL-4
A patient with common variable immunodeficiency (CVID) is admitted to the hospital for treatment. Which of the following types of treatment will the nurse be administering to the patient?
IV immunoglobulin
The client presents with a reduction in red blood cells, white blood cells and platelets. The practitioner is unable to determine the cause of the client's condition. Which type of anemia does the client have?
Idiopathic aplastic
The nurse is assisting a new mother with breastfeeding. What does the nurse understand is a primary secretory Ig that is found in the colostrum?
IgA
A client experiences an allergic reaction. Select the immunoglobulin that would bind to mast cells and release histamine.
IgE
A patient is being treated for an anaphylactic reaction after eating shrimp. Which of the following classes of antibodies mediates the anaphylaxis?
IgE
Which of the following immunoglobulins (Ig) is released in response to allergy or parasitic infections?
IgE
In a newborn, which antibody crosses the placenta to provide protection from infection?
IgG
Infants are born with a passive immunity that occurs when immunoglobulin antibodies cross the placenta from the maternal circulation prior to birth. Which immunoglobulin is capable of crossing the placenta?
IgG
The nurse is aware that the only class of immunoglobulins to cross the placenta is:
IgG
Which of the following immunoglobulins (Ig) is the most abundant of circulating antibodies?
IgG
Three days ago, a mother delivered her full-term infant who had been identified as having an in utero infection. The infant is receiving antibiotic and phototherapy, and the mother is breastfeeding. Which of the following types of immunoglobulins could most reasonably be expected to predominate in the infant's immune system?
IgG, IgA, IgM
A nurse is evaluating lab results of a patient newly diagnosed with bacterial pneumonia. Which of the following immunoglobulins will elevate during the early stage of the infection?
IgM
A nurse is reviewing labs for a client newly diagnosed with a bacterial infection. In determining if the client is experiencing a primary immune response, the nurse looks for which type of antibody produced from activated immature B cells?
IgM
A pregnant client is in labor. The physician suspects that the fetus has developed an infection in utero and orders blood tests. If an infection was present, which of the following labs would be elevated in the fetus at birth?
IgM
A premature neonate in the ICU suspected of having an infection has blood drawn for class specific antibodies. Which of the following confirms that the neonate has developed a congenital infection?
IgM antibodies are elevated.
The nurse is reviewing the functions of immunoglobulins and determines which of the following as a correct action?
IgM/first to challenge the antigen
While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB physician has called in a specialist who thinks the patient is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which of the following orders?
Immediately discontinue the heparin therapy.
The most important function of the thymus is:
Immune cell production and maturation
A patient with chronic idiopathic thrombocytopenia purpura (ITP) asks the nurse at the doctor's office what causes all the nosebleeds that have been occurring. The nurse's best response would be the presence of which of the following?
Immune cells that destroy the platelets
A patient with a history of acquired idiopathic thrombocytopenic purpura (ITP) arrives at the emergency department complaining of fatigue, shortness of breath, and multiple nosebleeds during the previous week. The platelet level is 10,000/μL, and the hemoglobin is significantly below normal. The nurse would anticipate which of the following interventions?
Immune globulin infusion
Which of the following is the main job of lymphocytes?
Immune reaction
A client is brought to the emergency department after being bitten by a stray dog. To prevent rabies infection the nurse anticipates administering which of the following?
Immunoglobulins (IgG)
A patient with iron-deficiency anemia complains of feeling "tired all of the time." What does the nurse understand may be the cause of the fatigue that the patient is experiencing?
Impaired function of the electron transport chain
Varicella, the virus that causes chicken pox, is an enveloped virus. Based on this knowledge, a nurse correctly identifies that this virus is located in which part of the host cell?
In a lipoprotein envelope derived from the cytoplasmic membrane
The spouse of a patient with a history of hepatitis C who is admitted to the hospital with upper gastrointestinal bleeding asks the nurse why these bleeding episodes occur. Having reviewed the patient's laboratory work, and noting a severe vitamin K deficiency, the best response would be that the low vitamin K levels will contribute to which of the following?
Inactive clotting factors
When discussing colony-stimulating factors (CSFs), the nurse explains that recombinant CSF is currently used to:
Increase the success rate of bone marrow transplantation
A patient is admitted to the emergency department with a diagnosis of polycythemia. The nurse plans to assess for symptoms related to which of the following problems?
Increased blood viscosity
The nurse is assessing lab values of a client with disseminated intravascular coagulation (DIC). The nurse would anticipate the results to include:
Increased prothrombin time (PT)
Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which of the following results is most likely to be considered unexpected by the health care team?
Increased thrombopoietin levels
Which of the following sequences accurately describes the stages of a disease?
Incubation, prodromal, acute, convalescent, and resolution.
Health care team members know recently an increased incidence of infections such as West Nile virus and SARS do not match previously established patterns. Which of the following phenomena constitutes the most significant contributor to the spread of new diseases in the United States?
Individual and group increased ease and speed of travel
The nurse is teaching a new mother about caring for her baby and reducing the risk for infection. On which of the following does the nurse base the knowledge of passive immunity?
Infants are protected at birth from infection by maternal IgG.
A client tells the nurse she is at risk to prematurely deliver her baby and is concerned that the baby does not have a developed immune system. The best response would be:
Infants born prematurely may be deficient immunity.
The nurse notes that the client has a decreased neutrophil count. The nurse recognizes that the client is at risk for which of the following?
Infection
A fomite is which one of the following?
Infection transfer agent
The nurse is caring for a child who has a defect in humoral immunity. The nurse is aware that the child is at risk for:
Infections with S. pneumonia, Haemophilus influenza, Staphylococcus aureus, and gram-negative organisms such as Pseudomonas species
What is the term for parasitic relationships between microorganisms and the human body in which the human body is harmed?
Infectious disease
A patient with a history of cancer and recent chemotherapy was hospitalized with fever, weakness, shortness of breath and productive cough. A bronchoscopy with transbronchial biopsy showed granulomas containing the fungus Histoplasma. Based on patient history and the biopsy results, a nurse can conclude that the most likely cause of this infection was due to which of the following?
Inhalation of fungi and decreased host defenses permitting an opportunistic infection.
A school age child with a history of asthma has brought a note home from school stating there has been one case of meningitis (Neisseria meningitides) in the school. Since the mother is a nurse, she is very concerned since she knows the portal of entry of this pathogen is:
Inhalation via the respiratory tract such as through breathing or yawning.
Select the phases that makeup the reaction of the complement system.
Initial activation, amplification of inflammation, and membrane attack response
Following a lecture on hemostasis, a nursing student accidently cuts her hand while preparing supper for her family. She watches the laceration very closely. Sure enough, the first thing she notes is:
Initially, it takes a few seconds for blood to appear as a result of vessel spasm.
A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy?
Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies.
Natural killer cells are specialized lymphocytes that are one of the major parts of which immunity?
Innate
A client has been admitted for immune thrombocytopenic purpura. The client has not responded to corticosteroid treatment. The priority nursing intervention for this client would include which of the following treatment measures?
Insert an intravenous catheter, so immune globulin can be administered in a timely manner.
The nurse is assessing a client diagnosed with anemia and notes that the client's skin and mucous membranes are pale. The nurse interprets this as:
Insufficient hemoglobin
A 44 year-old male hospital client with a diagnosis of end-stage acquired immunodeficiency syndrome (AIDS) has been placed on neutropenic precautions that limit his interaction with visitors, staff and other clients. What is the underlying rationale for these precautions?
Insufficient levels of neutrophils make him particularly susceptible to infections.
The nurse is teaching a client who has HIV infection about complications associated with HAART therapy, including which of the following?
Insulin resistance
A critical care nurse is preparing a case study on the treatment of acute coronary syndrome (ACS), which describes glycoprotein factor (GPIIb/IIIa) inhibitors and their role in decreasing thrombosis by doing which of the following?
Interfering with the ability of platelets to bind to one another
A client being treated for a bacterial infection is improving and preparing for discharge. The nurse explains the disease process and functioning of the immune system to the client. Which of the following cytokines is identified as responsible for decreasing the inflammatory immune response?
Interleukin-10 (IL-10)
Some cytokines stimulate the growth and production of new blood cells. Other cytokines support the proliferation of stem cells in the human body. Which cytokines support the proliferation of stem cells in the human body?
Interleukins, interferons, and tumor necrosis factor
A neonatal nurse is caring for a newborn and is preparing to give the infant an injection of vitamin K to prevent possible bleeding due to a vitamin K deficiency. The nurse realizes this is necessary because the infant is lacking which of the following?
Intestinal bacteria
The client is exhibiting signs of premature destruction of red cells and an increase in erythropoiesis after having a transfusion. This is an example of which of the following?
Intravascular hemolysis
A client has a suspected infection by a particular microorganism in question cannot be cultured. Which of the following processes listed below is most likely to result in an accurate diagnosis for the client?
Introduce cultured, marked antibodies to the client and observe for a reaction with antigens in the client.
The rate at which hemoglobin is synthesized depends on availability of which of the following?
Iron
A female patient comes to the clinic with symptoms of fatigue and heavy menses over the last 6 months. Laboratory tests reveal a microcytic hemochromic anemia. Based on these results, the nurse anticipates teaching the patient about which type of anemia?
Iron deficiency anemia
A nurse is teaching parents of an infant diagnosed with β-thalassemia about major complications of the disease. The nurse determines that the parents understand when they correctly identify which of the following as a major complication of β-thalassemia?
Iron overload
A patient has a hematocrit of 32% and is diagnosed with iron deficiency anemia. The nurse anticipates which of the following treatments to be prescribed?
Iron replacement therapy
A patient was recently diagnosed with iron deficiency anemia. The nurse anticipates which of the following treatments to be prescribed?
Iron supplementation and dietary teaching
A 13-year-old African-American boy comes to the ER complaining of fatigue and a rapid heartbeat. In conversation with the father, it becomes apparent to you that the boy has grown 2 inches in the previous 5 months. What is the first problem the health care team would attempt to rule out?
Iron-deficiency anemia
Misinterpreting her physician's instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status?
Irreversible acetylation of platelet cyclooxygenase activity has occurred.
Antibiotics target bacteria. If an antibiotic is bactericidal, how does it affect the bacteria?
It causes irreversible and lethal damage to the bacterial pathogen.
For HIV to reproduce in the human body, which of the following processes must occur?
It must change its RNA into DNA.
Which of the following statements is correct about the type of hepatitis that is often seen in cases of infectious mononucleosis?
It resolves without causing permanent liver damage.
The nurse is educating a pregnant client about the importance of folic acid. Select the food that has the highest levels of folic acid.
Kale
Which of the following is a characteristic finding in AIDS?
Kaposi sarcoma
A 36-year-old male who is positive for HIV antibodies notices purplish spots on his upper body. Which of the following terms is used to identify these areas as an opportunistic infection?
Kaposi's sarcoma
Which one of the following is often found in a patient with AIDS?
Kaposi's sarcoma
The nurse knows that the hypoxic patient will produce erythropoietin to stimulate red blood cell production. The nurse knows this hormone is produced in which of the following?
Kidneys
Which type of macrophages are found in the liver?
Kupffer cells
The nurse caring for a client with Hodgkin's lymphoma notes the existence of anergy on the client's progress notes. The nurse includes this information on the hand-off report as which of the following?
Lack of positive response to skin testing
Which of the following is a characteristic indicator that an individual is in the latent phase of HIV?
Lack of symptoms
A new client presents at the clinic with the following history: a CD4+ cell count of 400 cells/μL, generalized lymphadenopathy, and a positive HIV test 8 years ago. Based on this information, the nurse would know that the client is in what phase of the HIV infection?
Latent phase
Manifestations of Kaposi sarcoma include which of the following?
Lesions of the skin and in the oral cavity, gastrointestinal tract, and lungs
A client's bone marrow study report reveals the findings of blast cells in the bone marrow. What does the nurse interpret this as indicating?
Leukemia
The pediatrician knows that the most common cause of cancer in children is which of the following?
Leukemia
The nurse conducting a community education program on leukemia determines that the participants are in need of additional education when they state which of the following?
Leukemia is a disease that primarily occurs during the child/adolescent years.
A nurse is working on a community project that will teach first responders how to be prepared for a pandemic flu. Select the priority intervention from the following statements.
Limit person-to-person transmission.
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?
Limited to cooler cutaneous surfaces
A person who has been diagnosed with HIV infection 12 years ago and still has a CD4+cell count of 800 cells/µL and a low viral load are considered clinical to be a:
Long-term nonprogressor.
The practitioner is examining a client and notes that he has small, punctate skin hemorrhages on his abdomen and chest. This finding is suggestive of which of the following lab results?
Low platelets
The nurse is conducting patient education for a client who is scheduled to undergo diagnostic testing for non-Hodgkin's lymphoma (NHL). The nurse includes information on which of the following?
Lymph node biopsy
The nurse knows which of the following components listed below is needed for long lasting immunity in a client with a diagnosis of sepsis without the causative agent identified?
Lymphocytes
A 53-year-old female hospital patient has received a kidney transplant following renal failure secondary to hypertension. As part of the teaching while she was on the organ wait list, she was made aware that she would need to take anti-rejection drugs for the rest of her life. Which aspect of the immune system underlies this necessity?
MHC molecules will never develop in the cells of the donor organ and effector cells will be continually stimulated.
A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician's explanation?
Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas.
When collecting a client's history the client states that he is receiving treatment to maintain remission from leukemia. What does the nurse document that the client is receiving?
Maintenance therapy
A client is being treated for lupus, an autoimmune disease. The nurse is teaching the client how the immune system normally differentiates between self and non-self (foreign peptides). The nurse knows teaching has been effective when the client correctly identifies which molecule as the self-recognition protein?
Major histocompatibility complex (MHC)
A 40-year-old client is admitted to the hospital after experiencing 3 days of extreme vomiting .The doctor reviews the lab results and notes that the hemoglobin and hematocrit are elevated. This is interpreted as:
Manifestation of dehydration
A nurse is teaching a prenatal group about the benefits of breastfeeding. The nurse determines teaching has been effective based on which of the following statements?
Maternal IgA from colostrum provides immunity through the mucosal membranes for the intestinal system.
A client has developed a type 1 hypersensitivity reaction. The nurse recognizes that a secondary or late-phase response:
May occur 2 to 8 hours after the primary or initial-phase response and lasts for several days
Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. Which of the following lab results would correlate with this diagnosis?
Mean corpuscular hemoglobin (MCV) 120 fL (high)
The student correctly associates macrocytic and misshapen red blood cells with which type of anemia?
Megaloblastic
The nurse is reviewing the client's laboratory data showing an increased mean corpuscular volume (MCV) and a normal mean corpuscular hemoglobin concentration (MCHC). The client most likely has which of the following types of anemia?
Megaloblastic anemia
A person has been exposed to a particular antigen and a now experiences a repeat exposure. What stimulates a quicker immune response?
Memory T cells
A 26-year-old female patient has a neutrophil count of 750 μL. Which of the following descriptions best correlates with the neutrophil count?
Moderate neutropenia
A theory that has been postulated to describe the mechanisms by which infectious agents or other foreign substances trigger an immune response against autoantigens is known as what?
Molecular mimicry
Which action will the nurse include in the plan of care of a client who is neutropenic?
Monitor the client's temperature every 4 hours.
Which of the following is least likely to contribute to the spread of HIV infection?
Mosquitoes
Systemic lupus erythematosus is best characterized by which one of the following?
Most patients have antinuclear antibodies present in their blood.
A 30 year-old male's blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the man's most likely diagnosis?
Multiple myeloma
The nurse in the emergency department knows clients exposed to Clostridium botulinum, an agent of bioterrorism, would likely be exhibiting which of the following clinical manifestations listed below?
Muscle weakness in extremities eventually leading to paralysis of respiratory muscles.
Which disorder does the nurse know is considered to be an autoimmune disease?
Myasthenia gravis
A student nurse is taking microbiology and reviewing various types of cells. From which of the following cell types are granulocytes derived?
Myeloid stem cells
Granulocytes are derived from which of the following cell types?
Myeloid stem cells
The granulocyte cell lines are derived from which of the following?
Myeloid stem cells
A patient is being discharged from the hospital following a myocardial infarction (MI) and asks the nurse why two blood thinners are ordered. The nurse explains that the acetylsalicylic acid (ASA) and clopidogrel (Plavix) are both ordered to reduce the risk of which of the following events?
Myocardial events
While caring for a pediatric client admitted with a viral infection, the nurse knows that which type of cell will be the child's primary defense against the virus?
Natural killer (NK) cells
Which of the following types of immunity is achieved by an infant from its mother through antibodies transferred in utero or in breast milk
Naturally acquired passive immunity
The physician reviews a client's lab results and notes that the neutrophil count is 900/uL. This is known as which of the following?
Neutropenia
Which of the following is the most common leukocyte in normal blood?
Neutrophilic granulocyte
A nurse sends a blood sample to the lab for analysis. Assuming the sample is normal, the nurse anticipates which of the following white blood cells (WBCs) will account for the highest percentage?
Neutrophils
Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the:
Neutrophils
A patient is admitted to the hospital with an elevated temperature and flank pain. When reviewing the complete blood count (CBC), which of the following levels is the most important for the nurse to communicate to the health care provider?
Neutrophils 85%
The nurse is evaluating a client's blood work results. Which of the following should the nurse recognize as outside of the normal limits?
Neutrophils 950/uL
Acute lymphocytic leukemia (ALL) and acute myelocytic leukemia (AML) are two distinct disorders with similar presenting clinical features. What clinical feature do ALL and AML share?
Night sweats
A nurse is caring for an adult patient who had the thymus gland removed. Which of the following immune responses is expected to be activated?
No change in immunity
Typical symptoms seen in the latent period of HIV infection include which of the following?
No signs or symptoms
A entry on a client's health record documents that she has a subclinical infection. Which of the following assessments would the nurse expect to find?
No systemic manifestations of disease
A 37 year-old male with HIV who has recently become symptomatic has begun highly active antiretroviral therapy (HAART). Among the numerous medications that the man now regularly takes are several that inhibit the change of HIV RNA to DNA in a CD4+ cell. Which of the following classes of medications address this component of the HIV replication cycle?
Non-nucleoside reverse transcriptase inhibitors
A nurse orienting to the surgical suite is studying medications that affect platelet function and notes that the most common medications are which of the following?
Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin
The school nurse has several children with hemophilia A. After recess, one hemophilia student comes to the school nurse complaining of pain in their knee from falling on the playground. The nurse notes there is swelling in the knee and pain on palpation. The nurse should:
Notify parents to pick up child and possibly administer Factor VIII.
The nurse is caring for a client who has AIDS and suffers from wasting syndrome. Which of the following is the priority nursing consideration for this client?
Nutrition
A child has a congenital condition in which the thymus gland is absent. What should the nurse include in the education of care of this patient to the parents?
Observe and report signs and symptoms of infection.
A 21-year-old woman diagnosed with HIV/AIDS 4 years ago now presents with cytomegalovirus. The nurse explains to the woman that the infection is caused by a common organism that normally does not cause infection in someone with a healthy immune system. This type of infection is called what?
Opportunistic infection
A patient undergoing chemotherapy has a critically low platelet count. The nurse expects to administer which of the following to stimulate platelet cell production?
Oprelvekin (Neumega) which is a thrombopoietin
The process by which microbes are coated to allow for more efficient recognition by phagocytes is known as:
Opsonization
The C3b subcomponent of the complement system does which of the following?
Opsonizes microbes to facilitate phagocytosis
A 40-year-old patient has been admitted to the cardiac intensive care unit after having an anterior wall myocardial infarction (MI). The nurse is reviewing modifiable risk factors with the patient to avoid the redevelopment of thromboembolic complications, possibly leading to a second MI. Which of the following increases this risk?
Oral contraceptives
Following a knee replacement, a client develops an infection at the site. After months of unsuccessful anti-infective therapy, the surgeon removed the implant. What explanation can the nurse provide when the client asks why the anti-infective therapy did not work?
Organisms on a colonized implant produce a self-protecting biofilm.
While explaining immunity to a client, the nurse responds, "The body's internal organs are protected from pathogens because:
Our mucosal tissue contains all the necessary cell components to fight a pathogen with an immune response."
Which of the following is an example of how international travel has contributed to increased prevalence and incidence of nonindigenous diseases?
Outbreak of hemolytic-uremic syndrome related to contaminated salad being shipped to various regions
A physician orders a real-time PCR (polymerase chain reaction) DNA detection test on a client experiencing severe diarrhea following IV antibiotic administration. Which of the following statements is the reason for this diagnostic test?
PCR is effective in determining the diagnosis of Clostridium difficile.
The client with chronic kidney disease and congestive heart failure is weak and dyspneic. Lab work reveals a hemaglobin of 6.5g/dL. Which type of blood product will the provider order?
Packed red blood cells
The nurse is caring for an infant wih DiGeorge syndrome. Which of the following organs does the nurse know will be underdeveloped or absent?
Parathyroid and thymus glands
A woman experiences a viral infection while pregnant. Which of the following types of immunity does an infant have at birth against this infection?
Passive
The nurse is administering Imovax Rabies, a rabies vaccine, to a client who was bitten by a wild squirrel. The nurse explains the mechanism of action of the medication to the client. Which type of immunity does the nurse say this vaccination provides?
Passive artificial immunity
A client asks the nurse what happens when a pathogen enters the body. Select the best response.
Pathogens that enter the intestinal mucosa can cause diseases in the lungs or liver.
Which of the following patients would be diagnosed with wasting syndrome?
Patient with HIV, fever, diarrhea, and significant involuntary weight loss
A client who has a diagnosis of an autoimmune disease asks his nurse why it is that their immune system does not attack all of the cells that make up his body. Which of the following aspects of pathogen recognition in the innate immune system listed below would underlie the nurse's response?
Pattern recognition receptors (PRRs) ensure cells are correctly identified.
Which of the following helps the innate immune system differentiate between body cells and foreign substances?
Pattern recognition receptors identify structures not shared by body tissues.
Transmission of the rabies virus from a dog bite would be best described by which of the following mechanisms of entry?
Penetration
Which of the following interventions would be most appropriate by the nurse caring for a client in the neutropenic phase of cyclic neutropenia?
Perform/assist with oral care
The client with a history of gastrectomy presents with severe anemia, mild jaundice, and spastic ataxia. The lab work demonstrates an elevated mean corpuscular volume (MCV). The practitioner suspects the client has which type of anemia?
Pernicious
A 75-year-old patient with a history of heart valve replacement arrives at the outpatient clinic with multiple red pinpoint lesions. The nurse identifies the lesions as being which of the following?
Petechiae
A nurse is caring for a patient with sepsis who was recently transferred to the intensive care unit following the development of disseminated intravascular coagulation (DIC). The nurse understands that DIC is most likely secondary to the infection causing the release of cytokines, which can cause which of the following?
Petechiae, purpura, and renal failure
A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked what the first chromosomal abnormality that identified cancer was, one student correctly answered:
Philadelphia.
A nurse is reviewing a client's complete blood count (CBC) which indicates thrombocytopenia. Based on this result which action should the nurse include in the plan of care?
Place the client on bleeding precautions.
A client is undergoing a diagnostic workup to rule out multiple myeloma. Which of the following diagnostic findings would confirm the diagnosis of multiple myeloma?
Plasma cells greater than 10% on bone marrow biopsy
A patient with a medical history of HIV is admitted to the medical intensive care unitwith a diagnosis of thrombotic thrombocytopenic purpura (TTP). The nurse evaluates the patient 's admission blood tests and notes that the platelet level is 10,000/μL. The red blood cells are extremely low. The nurse would anticipate giving which of the following emergency treatments?
Plasmapheresis
Select the most important treatment for thrombotic thrombocytopenic purpura (TTP).
Plasmapheresis
When discussing the sequence of clot dissolution, the science instructor will talk about which item that begins the process?
Plasminogen.
A 71-year-old male patient with a history of myocardial infarction (MI) and peripheral vascular disease (PVD) has been advised by his family physician to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the physician's suggestion?
Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.
A nurse is caring for a patient who recently received GPIIb/IIIa inhibitors and is concerned that the patient has developed thrombocytopenia as demonstrated by which of the following?
Platelet count less than 50,000/μL
A nurse is caring for a patient who was recently diagnosed with primary thrombocytosis. The patient does not understand why hydroxyurea is given. The best explanation would be that this medication decreases which of the following?
Platelet counts
The nurse is caring for a client with leukemia that is having difficulty with blood clotting after having several transfusions with packed red blood cells. What does the nurse anticipate infusing for this client to assist with controlling the bleeding?
Platelets
A nurse is assessing a child brought to the clinic with multiple petechiae and excessive bruising covering his body. Laboratory tests reveal a low platelet count. The nurse is aware that these clinical manifestations are caused due to of which of the following pathological processes?
Platelets function to form the platelet plug to help control bleeding after injury. Without enough platelets, the blood cannot clot properly and bleeding occurs.
Both innate and adaptive immunity have cells that produce cytokines. Cytokines mediate the actions of many cells in both innate and adaptive immunity. How are the actions of cytokines described?
Pleiotropic and redundant
Progenitor cells, or parent cells, for the production of myeloid and lymphoid cells are derived from which of the following?
Pluripotent stem cells
The entire hematopoietic system, including the precursor erythroids, myelocytes, lymphocytes, and megakaryocytes are derived from a small population of cells. These cells are known as which of the following?
Pluripotent stem cells
Which one of the following is a common opportunistic infection in patients who have AIDS?
Pneumocystis jiroveci
Which one of the following is a common opportunistic infection in AIDS patients?
Pneumocystis jiroveci pneumonia (PCP)
A patient presents to his physician with a red face, hands, feet, and ears; a headache; and drowsiness. A blood smear reveals an increased number of erythrocytes. Based on the laboratory results, the nurse prepares teaching material for which disease process?
Polycythemia
A client tells the nurse that the doctor told her she has too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as:
Polycythemia vera
A patient presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which of the following diagnoses?
Polycythemia vera
The client explains to her new provider that she receives periodic phlebotomies to decrease their red blood cell mass. The provider believes the client may have which of the following?
Polycythemia vera
Which of the following is the main effect of HIV infection?
Poor helper T-cell function
Which one of the following is the main effect of HIV infection?
Poor helper T-cell function
The nurse is preparing a client with suspected leukemia for a bone marrow and biopsy. What preferred site will the nurse be sure is accessible for the physician?
Posterior iliac crest
Which of the following anatomical sites would the nurse expect to monitor when caring for an adult patient who has just had a bone marrow aspiration performed?
Posterior iliac crest
A client's history documents the presence of a myelocytic leukemia. The nurse interprets this to mean that the leukemia is which of following?
Predominant cell is myelocytic
A client is admitted with a suspected diagnosis of Hodgkin lymphoma (HL). Select the diagnostic manifestation that would confirm the diagnosis.
Presence of Reed-Sternberg cells
Which of the following best describes the number of active disease cases at any given time?
Prevalence
A nurse is caring for a patient on a cardiac step-down unit who is recovering from a myocardial infarction (MI) and is getting ready to be discharged. The nurse is reviewing the physician's discharge instructions with the patient when the patient asks why aspirin is ordered every day and at such a low dose. The most accurate response by the nurse is that the purpose of the daily aspirin is to do which of the following?
Prevent arterial thrombi formation
A young man has been diagnosed with hemophilia, and the nurse is planning his discharge teaching. The nurse knows to include what in her discharge teaching?
Prevent trauma to the body.
The nurse is teaching the client with a deficiency of glucos-6-phosphate-dehydrogenase (G6PD). In order to prevent the triggering of premature destruction of red blood cells, the nurse teaches the client to avoid which of the following medications?
Primaquine
A nurse is caring for a child who has had a history of recurrent severe infections that have been resistant to treatment with antibiotics. Which of the following disorders should be suspected in this child?
Primary immunodeficiency disorder (PID)
Transmissible neurodegenerative diseases such as Creutzfeldt-Jakob disease are associated with:
Prion
Which statement about prion diseases is correct?
Prion disease's method of replications is not clearly understood.
Which one of the following infective agents contains no DNA or RNA?
Prions
A client newly diagnosed with the neurodegenerative disease Creutzfeldt-Jakob disease (CJD) asks why antibiotics are not part of the treatment plan. How should the nurse respond?
Prions are not affected by antibiotics.
In the usual course (stages) after a pathogen has entered the host body, the stage when the host initially develops the appearance of signs/symptoms like a mild fever and body aches is:
Prodromal
Select the statement that best describes the major difference between prokaryotes and eukaryotes.
Prokaryotes lack an organized nucleus.
Which of the following is the priority intervention for a nurse caring for a patient with wasting syndrome from HIV?
Promote nutritional intake
Heparin is an anticoagulant given by injection to prevent the formation of blood clots. How does heparin work?
Promotes the inactivation of clotting factors
Which of the following medications is used in the treatment of HIV to prevent cleavage of the polyprotein chain into individual proteins?
Protease inhibitor
The nurse is planning care for a client with a diagnosis of primary immunodeficiency. Which of the following is a priority intervention to incorporate into the plan?
Protecting the client from infection
A nurse who is caring for a patient with end-stage hepatitis is aware that this patient is at risk for prolonged or excessive bleeding due to a decrease in which of the following?
Prothrombin
Which one of the following agents is the cause of malaria?
Protozoan parasite
A patient is diagnosed with anemia. Which of the following laboratory tests will the nurse evaluate to assist in determining the type of anemia involved?
Red blood cell indices
Which of the following would be tested by a complete blood count (CBC)?
Red blood cells and platelets
The nurse is caring for a client diagnosed with sickle cell disease. Select the most important factor for the nurse to be aware of that may cause the cells to sickle.
Reduced oxygen tension while the client sleeps
A client has been diagnosed with aplastic anemia. The nurse is aware that the client's lab results will identify:
Reduction of white blood cells
Coagulation activated by the extrinsic pathway is initiated when:
Release of thromboplastin from the injured vessel wall
A pediatric patient is diagnosed with hemolytic anemia. The nurse explains the disease process to the parents. Which of the following statements correctly identifies the body's physiologic compensations for the increase in demand for red blood cells (RBCs)?
Resubstitution of red marrow for yellow marrow can occur.
The anemic client is receiving erythopoietin. If there is a marked increase in red blood cell production, which lab result would increase?
Reticulocytes
If an Rh-negative mother is giving birth to an Rh-positive infant, the nurse should be prepared to administer:
Rh immune globulin.
The results of recent research suggest that a key role in the origin of some diseases is played by inflammation. For which of these diseases is it thought that inflammation has a role in its beginnings?
Rheumatoid arthritis
The infectious agents that cause Rocky Mountain spotted fever and epidemic typhus are transmitted to the human body via vector such as a tick. What are these infectious agents?
Rickettsiae
What instruction will the nurse provide to a client with a new diagnosis of anaphylactic reaction to peanuts?
Routinely wear medical alert identification.
The mother of an infant born with profound mental retardation and hearing loss tells the nurse that she had a viral infection in the first trimester of her pregnancy. The nurse identifies which of the following congenital infections as the cause of the fetal defects?
Rubella
The nurse is teaching a group of high school students about the modes of transmission for infectious mononucleosis. The nurse determines that teaching was effective when the students state:
Saliva
A health care provider is providing information to a client about ectoparasites. The most prominent human ectoparasite would be:
Scabies
A male client with chronic obstructive pulmonary disease has a hematocrit of 55 percent. The practitioner tells the client that he has which of the following?
Secondary polycythemia
The nurse is caring for a client with chronic lung disease who has a history of smoking 2 packs of cigarettes per day for 25 years. The client is at high risk for the development of:
Secondary polycythemia
A patient with a diagnosis of myelogenous leukemia is being admitted to the hospital with an exacerbation of Crohn's disease. Laboratory results include a white blooc cell count of 200,000/μL and a platelet count of 600,000/μL. The nursing assessment reveals swelling and pain in the right leg. The nurse suspects the presence of which of the following conditions?
Secondary thrombocytosis
Which is a complication of infection in which pathogens gain access to the blood?
Septicemia
Which of the following is the name of the fluid that remains after blood clots?
Serum
A client is being evaluated for atopic dermatitis possibly caused by a latex-related allergic reaction. The nurse will review which of the following labs to determine if an allergy is present?
Serum IgE
A pregnant female client in her third trimester visits her gynecologist for a prenatal checkup. The physician is concerned that the fetus has developed an infection in utero. Which test can be used to diagnose the infection in the neonate at birth?
Serum measurement of IgM
A systemic immune complex disorder that is caused by insoluble antigen-antibody complexes being deposited in blood vessels, the joints, the heart, or kidney tissue is called what?
Serum sickness
A 26-year-old female client has a neutrophil count of less than 500 ?L. The nurse would interpret this as:
Severe neutropenia
When looking at a granulocyte under a microscope, the anatomy student would describe it as:
Shaped like a sphere with multi-lobar nuclei.
A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stool which has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely?
She will have iron-deficiency anemia due to depletion of iron stores.
A client laboratory report indicates neutropenia. The nurse is aware the client is at greatest risk for development of infection. The most important area for the nurse to assess would be:
Skin
The first physical line of defense in innate immunity is:
Skin and mucous membranes
The nurse planning care for a client with acute lymphoblastic leukemia should include the use of which of the following in the plan of care?
Soft bristle toothbrush
Which of the following statements is an accurate descriptor of the role of viruses in human infections?
Some viruses are capable of transforming normal host cells into malignant cells.
A client has developed an infection from an exogenous source. The nurse recognizes this as acquired from:
Sources in the external environment, such as the water, food, soil, or air
A client has been identified as having an excess of macrophage inhibitory factor, causing the client to have inhibited movement and activity of macrophages. Which of the following processes listed below would the health care team member expect to remain unaffected?
Specificity and memory of the immune response
The practitioner carefully monitors his client who exhibits hemoglobin S (HbS) genes. The practitioner know that the client is predisposed to life-threatening infection due to damage by HbS to which of the following organs?
Spleen
When red blood cells age, which of the following organs are responsible for their destruction?
Spleen
Which of the following is a secondary lymphoid structure located high in the left abdominal cavity?
Spleen
A child has been diagnosed with thalassemia. Which of the following co-morbidities may occur as a result of having thalassemia?
Splenomegaly
Chronic lymphocytic leukemia (CLL) commonly causes hypogammaglobulinemia. This makes clients with CLL more susceptible to infection. What are the most common infectious organisms that attack clients with CLL?
Staphylococcus aureus
A client diagnosed with pancytopenia due to aplastic anemia is scheduled for which of the following treatments that can correct bone marrow deficiencies?
Stem cell transplant
A patient is diagnosed with acute leukemia. Which of the following treatment therapies can be used to correct bone marrow failure and treat malignancies?
Stem cell transplant
When assessing the mouth of a client receiving chemotherapy, which of the following should the nurse interpret as a possible indicator of neutropenia?
Stomatitis
A client is suspected of having a parasitic infection with roundworms. For what laboratory testing will the nurse prepare the client to most rapidly identify this infection?
Stool exam for ova
A hospital client is receiving intravenous infusion of heparin for treatment of a pulmonary embolus. Which of the following phenomena is most likely occurring, resulting in the drug's therapeutic effect?
Suppression of fibrin formation.
The clinical picture, or presentation of a disease in the body, is called what?
Symptomatology of the disease
Antinuclear antibodies are characteristic of which one of the following?
Systemic lupus erythematosus
A geriatrician is following a number of clients on a subacute geriatric medical unit, some of whom require diagnostic blood work. Which of the following clients would be most likely to have an erythrocyte sedimentation rate (ESR) screening test ordered? An adult with:
Systemic lupus erythematosus.
A client has immunity that was mediated by specific T lymphocytes and provides defense against intracellular microbes such as viruses. This immunity is recognized as:
T lymphocytes
Which of the following explains how T lymphocytes and B lymphocytes differ?
T lymphocytes mature in the thymus gland; B lymphocytes mature in the bone marrow.
The student is studying the body's lymphatic system. Which of the following is true of this system?
T lymphocytes travel to the thymus to complete the differentiation process.
The nurse knows the cells primarily programmed to remove the invading organisms and remember the antigen to respond rapidly during the next exposure are:
T-and B-lymphocytes.
A client with Von Willebrand disease type 3 comes to the clinic for an examination. Which problem reported by this client is most important for the nurse to communicate to the physician?
Tarry stools
A client is ordered to receive a quinolone, ciprofloxacin (Cipro), to treat a bacterial infection. The nurse instructs the client to monitor for which potentially dangerous side effect associated with quinolone therapy?
Tendon rupture
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?
Tetany due to hypocalcemia
Which of the following distinguishes a primary immunodeficiency disorder versus another disorder?
The are inherited abnormalities of immune function that render a person susceptible to diseases normally prevented by an intact immune system.
The nurse understands that a positive ELISA test reported in a baby born to a woman who is HIV positive indicates which of the following?
The baby has antibodies from the mother and it is uncertain whether the baby is infected with HIV.
A student asks, "What does cell-mediated immunity mean to the client?" The instructor responds. "This means:
The body is trying to defend itself against intracellular microbe invasion by engulfing and destroying the microbe."
A hospital laboratory technician is performing routine blood analysis as part of an inpatient's assessment, and is examining the sample in a test tube following processing in a centrifuge and the addition of an anticoagulant. Which of the following observations would the technician most likely interpret as an anomaly?
The bottom layer of blood in the tube accounts for around one-third of the total volume.
A patient asks their healthcare provider why their lower legs look purple. The healthcare provider will base their response on which pathophysiological principle?
The bruising around the ankles is due to the fact that it is a dependent area where the capillary pressure is higher.
A 2-year-old girl has had repeated ear and upper respiratory infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiological origin of the child's recurrent infections?
The child's immune system is unable to synthesize adequate immunoglobulin on its own.
A client experiencing severe neck pain and fever comes to the emergency room and is diagnosed with bacterial meningitis. Knowing that the client's immune system is fighting the infection, the infectious disease nurse correctly identifies which of the following pathways as the activation of the complement system?
The classical
A client seen in the clinic has an immune deficiency involving the T-lymphocytes (T cells). The nurse should educate the client about which of the following risks associated with this deficiency?
The client has an increased risk of contracting a viral infection; wear a mask during flu season.
The treatment prescribed for an autoimmune disorder is primarily dependent upon what?
The current manifestations of the disease and the mechanisms that cause the disease process
A nurse is going over preoperative instructions with a patient who is having coronary bypass surgery the following week. The patient asks why the aspirin has to be discontinued. The best response is that there could be excessive bleeding during surgery because the effect that aspirin has on the platelets is which of the following?
The effect is not reversible for the life of the platelet.
Which HIV test is the most accurate in determining the presence of HIV antibodies and is the least expensive?
The enzyme-linked immunosorbent assay (ELISA)
A hospital laboratory technologist is analyzing the complete blood count (CBC) of a hospital patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC?
The half-life of a platelet is typically around 8-12 days.
The nurse is caring for a 2-day-old newborn infant who appears lethargic and has a yellowish tint to the skin. Select the most likely cause of this newborn's signs and symptoms.
The inability of the immature liver to conjugate bilirubin
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:
The infant has been exposed to an intrauterine infection.
A 60 year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma?
The lymph nodes involved are located in a large number of locations in the lymphatic system.
When it is determined that a patient's red blood cells (RBCs) have a biconcave shape, which of the following will be the nurse's reaction?
The nurse will be pleased, as that shape allows for increased oxygen diffusion.
A newborn has been lethargic, is not nursing well, and is basically looking ill. Following lab tests, it has been found that the newborn has IgM present in his blood. How should the nurse interpret this finding?
The presence of IgM suggests the infant has a current infection.
A 42-year-old male client recently diagnosed with liver cancer is noted as at high risk for bleeding abnormalities. The nurse recognizes this risk as a result of:
The reduction of clotting factors synthesized in the liver
When a white blood cell with differential count reveals an acute infection, which of the following is correct regarding the client's neutrophils?
There are fewer neutrophils in the blood than other white blood cells.
Question: A 30-year-old male knows that he contracted HIV a month ago. Place the following steps in the order of the progression of the disease, starting with what he could expect first if he does not receive treatment.
There is a rapid increase in viral replication, which leads to very high viral loads. Viral symptoms such as fatigue, lymphadenopathy, headaches, and gastrointestinal distrubances and the CD4+ T-cell count begins to fall. There is a period (up to 10 years) of being symptoms free as CD4+ T cells decrease. CD4+ T-cell count is 200 cells/&muL;confirming the diagnosis of AIDS. The risk of opportunist infection is highest. Death
A nurse is discussing precautions that are necessary to avoid excessive bleeding with a patient who has been diagnosed with Type 1 von Willebrand disease. The nurse reassures the patient that typically which of the following happens?
There is no treatment except to avoid aspirin.
A client with otitis media is ordered to receive amoxicillin (Amoxil). The client questions the nurse on how the drug works. Which of the following statements describes how penicillin works?
This drug causes interference with a specific step in bacterial cell wall synthesis.
A 6-year-old child is having a stem cell transplant using umbilical cord blood. What benefit does the nurse understand that this type of transplant will have for the child?
This type of transplant creates less risk of graft-versus host disease
A client has an impaired platelet function that may have developed from inheritance, drugs, disease, or extracorporeal circulation. The health care provider would document this as:
Thrombocytopathia
A nurse is assisting a client with self-care and observes the following:
Thrombocytopenia
A patient with renal disease comes to the emergency department with complaints of excessive gingival bleeding over the past week. The nurse documents a platelet level of 100,000/μL and anticipates a follow-up blood test for which of the following?
Thrombopoietin
The nurse is caring for a patient in the intensive care unit who has lung cancer and bacterial sepsis from a centrally inserted intravenous line. The nurse realizes that the patient is at high risk of developing which of the following?
Thrombosis
A nurse assessing a client with an acute exacerbation of polycythemia vera notes coolness to the right leg and foot, pale color and an absent right pedal pulse. Based on these findings the nurse suspects that the client has developed which of the following complications?
Thrombosis in the right leg
Stem cells in the bone marrow produce T lymphocytes or T cells and release them into the vascular system. The T cells then migrate where to mature?
Thymus
The nurse is preparing to administer medication to a client. Select the medication that the nurse would administer to prevent platelet aggregation.
Ticlopidine (Ticlid)
A patient taking clozapine (Clozaril) for treatment of delusions and hallucinations associated with schizophrenia is at risk for developing an idiosyncratic reaction related to administration of the medication. Which of the following is the importance of monitoring the client's blood work weekly for the first six months of therapy?
To determine the presence of agranulocytosis
A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. What will be the primary goal of his treatment?
To reduce the viscosity of his blood
Which is the reason why bed rest and analgesics are expected treatments for infectious mononucleosis?
To relive fever, headache, and sore throat
One of the self-regulatory actions of the immune system is to identify self-antigens and be nonreactive to them. What is this ability of the immune system defined as?
Tolerance
A patient with AIDS has recently developed a temperature of 101.1°F along with headaches, visual disturbances, and confusion. Magnetic resonance imaging is ordered and neurologic lesions are present. Which of the following opportunistic infections is most likely contributing to these symptoms?
Toxoplasmosis gondii
An infant from parents of Mediterranean decent has been diagnosed with a severe form of β-thalassemia anemia. The nurse caring for this infant knows that the infant will likely receive which of the following medical treatments?
Transfusion therapy
A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor?
Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA)
Drug-induced neutropenia is a disease that has significantly increased in incidence over the last several decades. What is the attributing factor in the increased incidence of drug-induced neutropenia?
Treatment of cancer by chemotherapeutic drugs
A 1-year-old child who has experienced low platelet counts and bacterial susceptibility has been admitted to a pediatric medical unit of a hospital for treatment of Wiskott-Aldrich syndrome. The nurse who has admitted the child to the unit would anticipate which of the following short-term and longer-term treatment plans?
Treatment of eczema; management of bleeding; bone marrow transplant
In the United States, the most common opportunistic infection in people with HIV/AIDS infections is respiratory infection. When the CD4+ level drops below 200 cells/μL, it is time to start prophylaxis. What is the drug of choice for prophylaxis?
Trimethoprim-sulfamethoxazole
Which of the following serves as the rationale for AIDS treatment with antiretroviral therapy?
Triple therapy with reverse transcriptase, protease, and fusion inhibitors
Children born to mothers who are infected with HIV are considered uninfected if the children become HIV antibody negative after 18 months of age, have no other laboratory evidence of HIV infection, and have not met the surveillance case definition criteria for AIDS in children.
True
What is the leading cause of death for persons with HIV infection worldwide?
Tuberculosis
The physician explains treatment of acute leukemia to a client. Which of the following is accurate?
Tumor lysis syndrome can occur during chemotherapy treatment.
A client diagnosed with autosomal dominant von Willebrand factor disease (vWF) is experiencing mild to moderate bleeding. The health care provider would classify the diagnosis as:
Type 2
The type of hypersensitivity reaction that is dependent on IgE-mediated activation of mast cells and basophils and the subsequent release of chemical mediators of the inflammatory response is known as which of the following types of hypersensitivity reaction?
Type I
The type of hypersensitivity reaction that is mediated by IgG or IgM antibodies directed against target antigens on specific host cell surfaces or tissues is also known as which of the following types of hypersensitivity reaction?
Type II
A client has developed a hypersensitivity reaction resulting in the formation and deposition of insoluble antigen-antibody complexes that cause serum sickness and acute glomerulonephritis. The nurse would document this as:
Type III hypersensitivity reaction
What is the length of time from infection with the AIDS virus to seroconversion?
Up to six months
A patient seeks treatment in the clinic for exposure to poison ivy with a rash over the right arm and hand. The nurse is aware that what toxin is found in the oils on poison ivy that are responsible for eliciting an allergic reaction?
Urushiol
Which of the following is the most common mode of transmission of HIV?
Vaginal and anal intercourse
A patient in the primary or initial phase of a type I hypersensitivity reaction would most likely experience which of the following?
Vasodilation of the capillaries from the release of histamine
A patient in the hospital following a repair of a left hip fracture is refusing to wear the intermittent pneumatic compression stockings ordered by the physician. The nurse explains to the patient that the compression stockings are essential in preventing which of the following?
Venous thrombosis
An HIV-positive mother passes the virus to her infant during delivery. This type of transmission is known as:
Vertical transmission
Select the first stage of hemostasis.
Vessel spasm
Question: A group of nursing students are studying the process of hemostasis and determine that there is a specific order of events. Organize the following phases in the correct order of hemostasis.
Vessel vasoconstriction Platelet plug formation Blood coagulation Clot retraction Thrombolysis
A 14 year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms?
Viruses are killing some of his B cells and becoming incorporated into the genome of others.
The nurse is caring for a client who is a strict vegetarian; the client is at greatest risk for the development of:
Vitamin B12 deficiency anemia
To form a platelet plug, platelets must adhere to the vessel inner layer. For this to occur, which protein molecule is required?
Von Willebrand factor
A client presents at the clinic complaining of unplanned weight loss of up to 10% of her body weight. She states that she has had diarrhea, more than twice a day. She goes on to say the she has fever and weakness that "just won't go away." After a complete history and physical, an enzyme-linked immunosorbent assay test is ordered. This order is based on what suspected diagnosis?
Wasting syndrome
A nurse is counseling parents of a 5-year-old child who has just been diagnosed with hemophilia A and who has a 25% level of factor VIII. The nurse stresses that there are many precautions the parents can take to decrease the frequency and duration of bleeding episodes. Which of the following would be a reasonable precaution for this child?
Wear a helmet while riding a bicycle.
The nurse is administering an intramuscular medication to a client who has AIDS. Which of the following precautions will the nurse take when administering the medication?
Wear gloves
A nursing student is assigned to care for a client who has AIDS. The student is unsure of what personal protective equipment should be worn while caring for this client. Which of the following statements is appropriate direction from the student's nursing instructor?
Wear gloves if there is a chance you will come in contact with the client's blood or body fluids.
What type of precautions should the nurse take when caring for a client with Rocky Mountain spotted fever?
Wearing gloves for contact with secretions
Which of the following procedures reduces the potential for infection primarily by addressing the portal of entry?
Wearing gloves when contact with blood or body fluids is anticipated.
The nurse is providing a client with education on taking the medication clozapine. The nurse includes the importance of which of the following?
Weekly bloodwork
Global infectious diseases are now being recognized. These diseases, known as endemic to one part of the world, are now being found in other parts of the world because of international travel and a global marketplace. Which of the following is considered a global infectious disease?
West Nile virus
A 20-year-old male presents at the clinic complaining of severe fatigue, night sweats, and fever. While taking the client's history, he reports having multiple sexual partners and unprotected sex. HIV/AIDS is suspected. What diagnostic test would be ordered to confirm the diagnosis?
Western blot assay
A client comes to the clinic with the following cardinal signs of inflammation: redness, heat, pain and swelling, following a laceration to the thigh. Which of the following statements correctly explains the cause of swelling at the laceration site?
When activated, the complement protein C3 breaks into two fragments. The larger 3b fragment acts as an enzyme to cleave C5 into two components the C5a fragment produces vasodilation and increases vascular permeability causing edema.
A nurse is reviewing laboratory data for an elderly patient. Which of the following laboratory values should the nurse be most concerned about?
White blood cell (WBC) count 3500/mL
A nurse is reviewing the laboratory data for a hospitalized client. The nurse would be most concerned about which finding?
White blood cell (WBC) count of 2800/µL
A high school teenager comes to the emergency room with symptoms that include the abrupt onset of severe pharyngitis and a high fever. The teenager reports that in the previous four days he has "just not felt well." The nurse anticipates orders to include which of the following?
White blood cell count
The client has a disorder that decreases stem cell production. When evaluating the client's blood work, the nurse anticipates a decrease in which of the following?
White blood cells
The nurse is reviewing the complete blood count (CBC) and white blood cell (WBC) differential of a client admitted with lower right abdominal pain. Which laboratory results are the most important for the nurse to communicate to the health care provider?
White blood cells (WBCs) 18,500/µL
A nurse is caring for a client in the intensive care unit who has sustained severe trauma and now has developed disseminated intravascular coagulation (DIC). The nurse is aware that the client is experiencing:
Widespread coagulation and bleeding in the vascular compartment
Select the option that best describes a single-celled organism that reproduces by a budding process.
Yeast
Which is a single celled organism that is about the size of a red blood cell and reproduces by a budding process?
Yeast
A teenage girl, seen in the clinic, is diagnosed with nonthrombocytopenic purpura. The girl states, "You have taken a lot of blood from me. Which of my tests came back abnormal?" How should the nurse respond?
Your CBC with differential showed a normal platelet count.
A mother is diagnosed with a bacterial infection and is worried that her newborn infant will also contract the infection. Which of the following statements should the nurse include in the teaching plan for the client?
Your newborn has maternal IgG antibodies that were transferred through the placenta before birth, providing some protection from infection.
Infections that are passed from animals to humans are known as:
Zoonotic
The nursing caring for a 62-year-old client with diffuse large B-cell lymphoma plans care based on the knowledge that this client's lymphoma is:
aggressive
The nurse evaluating the blood work of a client with chronic lymphocytic leukemia (CLL) notes the following: white blood count 22,000/uL; lymphocytes 90%; and hemoglobin 6. The nurse should:
communicate to the physician an unexpected low hemoglobin.
The nurse caring for a client in the induction therapy phase understands that the intent of the therapy is to:
elicit a remission
The nurse is caring for a client who has lesions of Kaposi sarcoma (KS). The nurse understands that KS:
is a malignancy of the endothelial cells that line small blood vessels.
HIV is considered to be a retrovirus because:
it carries its genetic information in ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA).
The bacteria that line the gut of a human help maintain normal gut health and provide essential nutrients. This type of relationship is:
mutualistic
The nurse knows which of the following statements listed below relative to a client with malignant melanoma treated with Alpha interferon (IFN-α) is accurate? Alpha interferon (IFN-α):
plays an important role in the modulation of the inflammatory response.
A client's history and physical documents the presence of an indolent lymphoma. The nurse plans care for which of the following types of lymphoma?
slow-growing
The nurse is reviewing the client's medical record for the results of a Western blot test with the understanding that:
the Western blot is used to confirm a diagnosis of HIV infection.
The nurse knows a drug in a category identified as a colony-stimulating factor (CSF) helps:
to stimulate bone marrow to produce large numbers of mature cells such as platelets and erythrocytes.
The nurse understands that the best way for a health care worker to protect against the transmission of HIV is to:
use universal precautions on all clients.
Many different proteins, enzymes, and hormones are involved in maintaining hemostasis. Which protein is required for platelet adhesion?
von Willebrand factor
The nurse is caring for a client who recently had a positive ELISA test for HIV. The client states, "How did I become HIV positive? I have never had sex with anyone!" Which of the following responses are appropriate? Select all that apply.
• "Have you ever had a blood transfusion?" • "Do you use IV drugs?" • "Do you consider oral sex as having sex?" • "Sometimes this test gives false positive results. To confirm the diagnosis, another test will be performed."
The nurse is providing dietary instruction for a client diagnosed with folic acid deficiency. The best information for the nurse to provide would be: Select all that apply.
• "Include green leafy vegetables in your diet." • "Include cereals in your diet." • "Make sure all vegetables are cooked."
The nurse knows that further teaching is needed when a client who is HIV positive makes which of the following statements? The client is aware that his blood work reflects a CD4+ cell count of 800. Select all that apply.
• "Since my CD4+ count is 800, I understand that I am of little risk of infecting my sexual partner." • "I am disappointed that I am not yet cured of HIV."
Which of the following clients are at high risk for developing anemia? Select all that apply.
• A HIV-positive client who is experiencing frequent infection and elevated CD4+ counts • A breast cancer client undergoing chemotherapy and radiation therapy • A middle-aged renal failure client who has hemodialysis three times/week
Which of the following clients are at risk for developing blood clots and should be assessed frequently? Select all that apply.
• A college-aged female taking oral contraceptives for irregular menstrual periods • A middle-aged male who smokes three packs of cigarettes/day • A diabetic client who is also greater than 100 pounds over the ideal body weight
It has been postulated that an autoimmune disease needs a "trigger event" for it to clinically manifest itself in a body. What are these "trigger events" thought to be? (Select all that apply.)
• A microorganism or virus • A self-antigen from a previously sequestered body tissue • A chemical substance
Which of the following clients are at risk for developing a platelet clot? Select all that apply.
• A trauma client who had a splenectomy following injury and laceration of the liver • A school-aged child prescribed iron supplements for iron deficiency anemia • A breast cancer client receiving chemotherapy • An acute myocardial infarction client with elevated troponin levels
The school nurse is teaching a health class to a group of high school students. She is preparing a lecture on HIV/AIDS. The nurse would know to include what information about the transmission of AIDS in her lecture? (Select all that apply.)
• AIDS is transmitted from the mother to her unborn baby. • AIDS is transmitted through sexual contact. • AIDS is transmitted through blood-to-blood contact.
Which types of leukemias originate from the B cells? Select all that apply.
• Acute lymphocytic leukemia • Chronic lymphocytic leukemia
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.
• An adult male who raises a number of exotic birds in his home • A drug abuser looking to share needles/syringes • A newborn with a noticeable eye infection
Which of the following outpatients are at a greater risk for developing Treponema pallidum, the cause of syphilis? Select all that apply.
• An older adult female living in a condominium who regularly has sex with three to four different men/week • A male who frequents clubs catering to exotic dancers and sexual favors • A homeless adolescent female performing oral sex for money
A nurse is caring for several patients with disorders with inflammatory responses. Which patient conditions arise from hyperresponsive adaptive immunity? Select all that apply.
• Atherosclerosis • Bronchial asthma • Multiple sclerosis
A nurse is developing a teaching plan for a senior citizens group on the importance of chronic disease management. The nurse knows that inflammation plays a key role in the pathogenesis of many common pathophysiologic states. Which of the following diseases should be included in the teaching plan? Select all that apply.
• Atherosclerosis • Coronary artery disease • Non-insulin-dependent diabetes mellitus (NIDDM)
Kaposi sarcoma is an opportunistic malignancy that is found on the skin, in the oral cavity, in the gastrointestinal tract, and in the lungs of immunocompromised people. Many people with skin lesions caused by Kaposi sarcoma also have gastrointestinal involvement. What are the presenting symptoms of Kaposi sarcoma in the gastrointestinal tract? (Select all that apply.)
• Bleeding • Pain • Obstruction
Select the infectious disease that may be acquired from protein particles, such as prions. Select all that apply
• Bovine spongiform encephalopathy • Chronic wasting disease • Creutzfeldt-Jakob disease Correct
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.
• CD4+ helper T cells • CD8+ cytotoxic T cells
Evasive factors, one type of virulence factor, are factors produced by infectious microorganisms to keep the host's immune system from destroying the microorganism. Which of these are evasive factors? (Select all that apply.)
• Capsules • Slime • Mucous layers
In both the innate and adaptive immune systems, cells communicate information about invading organisms by the secretion of chemical mediators. Which are these mediators? (Select all that apply.)
• Chemokines • Colony-stimulating factors
In a client with DIC, microemboli form, causing obstruction of blood vessels and tissue hypoxia. Common clinical signs may be due to what? (Select all that apply.)
• Circulatory failure • Renal failure • Respiratory failure
Which statements best describe communicable disease? Select all that apply.
• Communicable diseases are spread from person to person. • Blood is a common carrier for communicable diseases. • Communicable diseases are caused by infections that live and reproduce in a human host
Two years after chemotherapy and radiation therapy for lung cancer, a 72 year old patient notices that they seem to be extremely tired all the time. The physician suspects the patient may have developed aplastic anemia. The nurse assessing the patient will likely find which of the following clinical manifestations of aplastic anemia? Select all that apply.
• Complaints of weakness and fatigue. • Small spots of skin hemorrhages over entire body. • Excess bleeding from gums and nose.
The nurse is caring for a client who is HIV positive and is newly diagnosed with Mycobacterium tuberculosis (TB). Which of the following symptoms does the nurse associate with TB? Select all that apply.
• Cough • Fever • Night sweats
Which of the following findings are considered part of normal aging? Select all that apply.
• Decreased IL-2 level • Decrease in CD4+ count
A nursing instructor is explaining the role of a macrophage to a group of nursing students. Which of the following roles of the macrophage should be included in the teaching plan? Select all that apply.
• Destruction of malignant cells • Antigen presentation • Phagocytosis • Activation of lymphocytes
The admitting nurse on a hospital medical-surgical unit is admitting a 90-year-old patient with a history of congestive heart failure, coronary artery disease, prostate cancer, diabetes, and hypercholesteremia. The nurse realizes that the client is at high risk for thromboembolic complications due to a medical history with conditions that could increase platelet function. Which of the following conditions would contribute to this risk? Select all that apply.
• Diabetes • Hypercholesteremia • Prostate cancer
Which are mechanisms by which pathogens cause disease in humans? Select all that apply.
• Direct destruction of the host cell • Interference with the host cell's metabolic function • Exposure of the host cell to toxins
The nurse is assessing a female patient with a hemoglobin of 6.8g/dL. Which of the following symptoms would the nurse expect to find? Select all that apply.
• Dyspnea • Headache • Faintness
The nurse is reviewing the medical record for laboratory blood work that would indicate if a client is HIV infected. The nurse reviews which lab test?
• ELISA enzyme-linked immunoassay
A client is in the emergency department with a severe type I IgE-mediated hypersensitivity reaction. What pharmacologic treatment should the nurse prepare to administer in this acute phase? (Select all that apply)
• Epinephrine • An antihistamine • Systemic corticosteroids
An adolescent is diagnosed with Epstein-Barr virus. What information should the nurse provide to the parents? Select all that apply.
• Epstein-Barr virus can cause infectious mononucleosis. • Epstein-Barr virus can be spread by saliva. • The Epstein-Barr virus invades and replicates within the salivary glands.
Which of the following are clinical manifestations of leukemia? Select all that apply.
• Fever • Epistaxis • Bleeding gums • Bone pain
When assessing a patient, the nurse recognizes that which of the following symptoms are nonspecific and can be shared by a number of diverse infectious diseases? Select all that apply.
• Fever • Myalgia • Headache • Lethargy
Which of the following nursing interventions would be a priority when caring for a newborn who is receiving phototherapy for high bilirubin levels? Select all that apply.
• Frequent monitoring of temperature. • Maintaining oral intake to prevent dehydration.
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.
• Heart rate 120 beats/minute • Complaints of chest "palpitations"
When platelets adhere to the vessel wall, they release growth factors that cause smooth muscle to grow. This is a major factor in causing atherosclerosis. What are the factors that influence platelets to adhere to the vessel wall? (Select all that apply.)
• Hemodynamic stress • High cholesterol • Diabetes • Smoking
The nurse is studying hemostasis. She knows that which of the following are TRUE? Select all that apply.
• Hemostasis refers to the body's ability to control bleeding. • Vessel constriction or spasm is a factor in effective hemostasis. • Hemostasis results in the formation of a platelet plug. • Hemostasis occurs in established stages.
Which of the following medications are known to interfere with the body's ability to control bleeding? Select all that apply.
• Heparin • Warfarin • Nonsteroidal anti-inflammatory drugs
Some viruses have the ability to transform host cells into cancer cells. For which of the following viruses should the client be assessed regularly for the potential development of cancer? Select all that apply.
• Hepatitis B • Human papillomavirus
The clinic nurse suspects the client is having a genetically determined hypersensitivity to common environmental allergens since the client is experiencing which of the following clinical manifestations? Select all that apply.
• Hives • Runny nose • Wheezes
Which of the following are frequently seen clinical manifestations of multiple myeloma? Select all that apply.
• Hypercalcemia • Elevated erythrocyte sedimentation rate • Elevated blood urea nitrogen
The nurse is caring for a client experiencing a systemic anaphylactic reaction. The nurse would assess the client for: Select all that apply.
• Hypotension • Bronchospasm and respiratory distress • Vomiting and abdominal cramps • Laryngeal edema and obstruction
A nurse is teaching a group of seniors about the decline of the immune system due to aging. Which of the following topics should be included in the teaching plan regarding the immune response of the elderly? Select all that apply.
• Increase in susceptibility to infections • Higher incidence of cancer • Weakened response to vaccinations
Which of the following therapies are part of the treatment for acute lymphocytic leukemia (ALL)? Select all that apply.
• Induction • Intensification • Maintenance
A medical surgical nurse is studying risk factors for the development of secondary thrombocytosis before taking a certification exam. Which of the following situations would the nurse determine would increase a patient's risk? Select all that apply.
• Inflammatory bowel disease • Lung cancer • Rheumatoid arthritis
A client comes to the emergency room concerned about infection after being cut on the hand by a piece of glass; the skin surrounding the wound is red, warm and painful. After assisting with suture insertion, the nurse develops a plan of care for discharge. Which information on the body's natural defenses should be included in the plan of care? Select all that apply.
• Innate immunity is the body's first line of defense. • The epithelial layers of the skin provide innate immunity. • Redness, heat, pain and swelling are part of the normal inflammatory process. • Initiation of the inflammatory process does not mean an infection is present.
Infectious agents produce products or substances called virulence factors that make it easier for them to cause disease. Which of these are virulence factors? (Select all that apply.)
• Invasive factors • Adhesion factors • Toxins • Evasive factors
Select the assessment data that place a client most at risk for the development of an opportunistic infection. A client with/who: Select all that apply.
• Is currently receiving chemotherapy • Has a diagnosis of malnutrition • Has a compromised immune system • Just completed 6 weeks of radiation therapy
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.
• Keep the child away from contact sports like football and wrestling. • Administration of factor VIII at home when bleeding occurs.
A nurse is reviewing the process required for the development of a healthy innate immune response. Which of the following components need to be included in the review? Select all that apply.
• Leukocytes • Opsonins • Cytokines • Complement
The destruction of old blood cells is facilitated by a group of large phagocytic cells found in which of the following? Select all that apply.
• Liver • Bone marrow • Lymph nodes
A nursing instructor questions students on the removal of erythrocytes from the body. The instructor knows that the students understand when which of the following locations are identified at the site of removal by macrophages? Select all that apply.
• Liver • Spleen • Bone marrow
An infection control nurse is conducting research on the activation of the immune system and is identifying anatomical locations where primary immune responses are initiated. Which of the following locations should be included in the research study? Select all that apply.
• Lymph nodes • Spleen • Tonsils • Peyer patches
The nurse is teaching a group of parents about foods that commonly cause allergic reactions in children. The most important information to provide would be: Select all that apply.
• Milk • Eggs • Peanuts • Shellfish
A 12 year-old boy has contracted a bacterial infection at school and his body has responded by increasing leukocyte production. Place the following components of white blood cell production in the correct chronological order. Use all the options.
• Myeloblast • Promyelocyte • Myeloid stem cell • Metamyelocyte • Neutrophil
The nurse is assessing a client newly diagnosed with Hodgkin's lymphoma. Where should the nurse anticipate finding enlarged lymph nodes? Select all that apply.
• Neck • Axilla • Supraclavicular area
The nurse is speaking to a group of genetic students touring the hospital's laboratory. The nurse talks about the possibility of a genetic predisposition for the leukemias being suggested because of the increased incidence of the disease among a number of congenital disorders. Which congenital disorders are these? (Select all that apply.)
• Neurofibromatosis • Fanconi anemia • Down syndrome
A patient has visited their physician because they found an enlarged lymph node along the mediastinal border. When questioned, the physician may be alerted to a possible diagnosis of Hodgkin's lymphoma (HL) if the patient also displays: Select all that apply.
• Night sweats. • Unexplained pruritus.
The nurse is reviewing hospital discharge instructions with a patient who has been diagnosed with secondary thrombocytosis and who also suffers from chronic ulcerative colitis, making anticoagulation inadvisable. The nurse stresses to the patient that the patient should avoid which of the following? Select all that apply.
• Oral contraceptives • Smoking • Immobilization
In comparing non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL), which of the following are not true of HL? Select all that apply.
• Originates in extranodal sites • Spreads to anatomically contiguous nodes • Does not develop in adults
Which of the following is correct regarding the diagnosis of an autoimmune disorder? Select all that apply.
• Overlapping presentation of symptoms is common among this type of disorder. • Non-autoimmune diseases can present with autoimmune like symptoms. • Effective history taking is vital to the diagnosis of autoimmune disorders. • Laboratory diagnostic testing aids in the diagnosis of auto immune disorders.
Which of the following clients are at high risk for developing acute myeloid leukemia? Select all that apply.
• Owner of a convenience store who pumps gas for his customers • Wife married to a "chain" smoker who smokes 3 packs/day for the past 50 years
A patient is receiving chemotherapy for the treatment of stage III breast cancer. The nurse knows that the risk for developing chemotherapy-related neutropenia is influenced by which of the following? (Select all that apply.)
• Patient and treatment-related disease • Oncological disease • Comorbid factors
The CDC recommends routine testing for HIV of which groups of people? Select all that apply.
• People who inject illicit drugs • People who exchange sex for money • People who have more than one sex partner
The classic triad of multiple myeloma includes which of the following? Select all that apply.
• Plasmacytosis • Serum M-protein spike • Lytic bone lesions
The nurse is performing an admission assessment on a client with the diagnosis of primary polycythemia. The nurse anticipates that the assessment will include: Select all that apply.
• Plethora • Hypertension • Itching • Pain
When treating a patient with antibiotics, a nurse recognizes that which of the following can cause bacterial resistance? Select all that apply.
• Production of enzymes that inactivate antibiotics • Genetic mutations • Creation of alternative metabolic pathways that bypass antibiotic activity • Changes in the filtration qualities of the bacterial cell
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.
• Prostaglandin I2 • Nitric oxide
Which of the following statements concerning red blood cells (RBCs) are correct? Select all that apply.
• RBCs are the most abundant of the blood cells • RBCs are necessary for carbon dioxide transport.
A female client has been diagnosed with antiphospholipid syndrome. The nurse would anticipate the client to have a health history that may include: Select all that apply.
• Recurrent fetal loss • Hypertension during pregnancy • Uteroplacental insufficiency
A newly diagnosed HIV positive adolescent has blood work drawn which includes a CD8 T cell count. The nurse knows which of the following functions of CD8 T cells listed below will assist the adolescent's immune system in fighting off the viral attack? Select all that apply.
• Release of destructive enzymes. • Trigger intracellular programmed death.
A patient was diagnosed with normocytic-normochromic anemia. Based on this diagnosis, which of the following anemias does the nurse determine falls into this category? Select all that apply.
• Sickle cell anemia • Hemolytic anemia • Thalassemia
Which of the following has been identified as having a negative effect on platelet function? Select all that apply.
• Smoking • Diabetes mellitus
A nurse is preparing a presentation for a community prenatal group about umbilical cord blood banking and donation. Which of the following statements should be included in the presentation? Select all that apply.
• Sources of the stem cells include bone marrow and umbilical cord blood. • People with immunodeficiencies and malignancies can receive donated stem cell transplants to replenish stem cells after chemotherapy. • Stem cells must be from a histocompatible matched donor to prevent graft-versus-host disease.
A 25-year-old woman with primary antiphospholipid syndrome is discussing with her physician the possibility of becoming pregnant. The physician shares with the woman which of the following possible complications? Select all that apply.
• Spontaneous miscarriage • Premature delivery • Placental insufficiency
A patient has been diagnosed with B-cell immunodeficiency disorder. Which of the following bacteria would the nurse likely see associated with this disorder? (Select all that apply.)
• Streptococcus pneumoniae • Staphylococcus aureus
A client with a history of antiphospholipid syndrome presents to the emergency department. Which of the following complaints lead the nurse to suspect the client is experiencing a complication related to the syndrome? Select all that apply.
• Swelling in the right calf with redness and tenderness • Having respiratory symptoms like shortness of breath and chest pain • Have developed a cough that produced some bloody sputum
The nurse is starting a blood transfusion for an anemic client. The nurse monitors the client for which of the following signs and symptoms of a transfusion reaction? Select all that apply.
• Swollen, itchy areas on the skin • Pain in the lumbar area • Dyspnea
A nurse is completing an assessment on an infant with a low hemoglobin level. Which of the following symptoms will the nurse expect to observe? Select all that apply.
• Tachycardia • Lethargy • Pallor
A teenage client is exposed to a person infected with chicken pox. After two weeks, the client has not contracted the virus. How is this possible? Select all that apply.
• The client was vaccinated for chicken pox. • The client was previously exposed to chicken pox.
Which of the following patients are at risk for impaired normal red blood cell (RBC) destruction? Select all that apply.
• The patient whose spleen was damaged in an automobile accident • The patient diagnosed with chronic cirrhosis of the liver • The patient whose biopsy revealed cancer cells in numerous lymph nodes
The nurse accidentally has been stuck with a needle that was used to administer an intramuscular injection to a client who has AIDS. Which of the following statements related to this event are true? Select all that apply.
• The stage of illness of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client. • The viral load of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client. • The depth of the needle puncture of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client. • The amount of blood on the needle of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client.
A new leukemia patient begins hemorrhaging from every orifice. The physician is concerned that the patient has developed Disseminated Intravascular Coagulation (DIC). The nurse should anticipate which of the following orders to be prescribed for this patient? Select all that apply.
• Transfuse 2 units of platelets. • Transfuse fresh frozen plasma.
Which of the following statements are TRUE regarding the effects of aging on the immune system? Select all that apply.
• Vaccinations are less effective as we age. • The incidence of cancer increases as we age. • The elderly tend to have more evidence of autoimmune disorders as we age.
The coagulation cascade is the third component of the hemostatic process. The other two are: (Select all that apply.)
• Vessel spasm • Platelet aggregation
Which of the following statements are correct regarding normal hematopoiesis? Select all that apply.
• White blood cells result from hematopoietic stem cells. • Hematopoietic stem cells differentiate into committed progenitor cells. • Committed progenitor cells develop into myelogenous and lymphocytic lineages. • Stem cell reproduction is controlled by colony-stimulating factors (CSFs).
