EXAMS 1 Flashcards by Kelvin Dodzi

During a discussion on cellular components and their function, a student asked the instructor the purpose of messenger RNA (mRNA). Of the following, which is the most accurate answer?

Performs an active role of protein synthesis, where mRNA molecules direct the assembly of proteins on ribosomes to the cytoplasm.

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The nurse is providing care for a client with a diagnosis of cirrhosis, and she notes that the client’s sclerae are jaundiced. The nurse recalls jaundice is a pigment that can accumulate in which part of the cell?

Cytoplasm

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A 14-year-old female has been experiencing severe internal cramps in the region
of the pelvis along with weight loss. She has been admitted with rectal bleeding.
The physician has diagnosed her with inflammatory bowel disease (IBD). She asks
the nurse what causes this disease. Which pathophysiologic basis will guide the
nurse’s response to this adolescent?

Endoplasmic reticulum stress in the gastrointestinal system

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A professor is teaching a group of students about the role of mitochondria within
the cell. Which statement is true of mitochondria

They are the site of adenosine triphosphate (ATP) production.

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A client has been diagnosed with a neurodegenerative disease called multiple sclerosis (MS). The physician explains to the client that this disease may be caused by dysregulated apoptosis. Later that day, the client asks the nurse what this
means. The nurse should reply:

Dysregulated apoptosis has caused an excessive rate of programmed cell death along the neuro-pathways.

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A client experiencing immotile cilia syndrome (Kartagener syndrome) should be frequently assessed by the nurse for which priority complication?

bronchiectasis due to interferences with clearance of inhaled bacteria along the
respiratory tract.

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The nurse is explaining the workings of selective serotonin uptake inhibitors (SSRIs) to a client with a diagnosis of depression. Within the teaching, the nurse mentions that in the nervous system, the transmission of information by neurotransmitters is:

synaptic signaling.

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The nurse is teaching a group of colleagues about the cell division cycle as background to caring for oncology clients. Which statement is true of the cell cycle?

The two broad phases of the cell cycle are mitosis and synthesis.

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A 62-year-old male collapsed while unloading a truck of heavy sacks of feed for his cattle. When he arrived in the emergency department, blood gases revealed a slightly acidic blood sample. The nurse caring for this client is not surprised with this result based on which pathophysiologic rationale?

The skeletal muscles are producing large amounts of lactic acid and release it into the bloodstream during heavy work/exercise.

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The health caregiver is explaining the rationale for administering a hypotonic intravenous solution (lower concentration of solutes in its surroundings) to a client. Which mechanism of membrane transport most likely underlies this action?

Osmosis

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A nurse is teaching a client with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose must enter the body cell in order to provide energy for the client. The nurse knows that which process allows glucose to enter body cells?

Facilitated diffusion

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A student asks the instructor about the origins of different tissues and their cellular origins during the process of development. Which statement by the instructor best describes the process of cell differentiation?

“A fertilized ovum undergoes a series of divisions, yielding many different cell types.”

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A nurse is providing care for a client with a diagnosis of Crohn’s disease. The nurse recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which type of tissue is most likely involved in the client’s pathology?

Simple columnar epithelium

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During a crime scene investigation, the coroner confirm that rigor mortis has set in. This helps to confirm an approximate time of death. The forensic nurse can explain this process (rigor mortis) to a group of students based on the fact that:

at death, the body is unable to complete the actin/myosin cycle and release the coupling between the myosin and actin, creating a state of muscular contraction.

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The home care nurse is making a home visit to a 51 years female client with
a longstanding diagnosis of multiple sclerosis. The nurse knows that the muscle wasting and weakness associated with the disease process is ultimately manifested as a failure of what normal process in muscle tissue?

Thick myosin and thin actin filaments sliding over each other.

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A caregiver is working with a client who is having poorly controlled pain due to shingles. The associated pain travels to the client’s nervous system via:

afferent neurons.

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The nurse is administering a calcium channel blocked to a client with a cardiac dysrhythmia. For what side effect should the nurse assess?

Constipation

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A client has been told she has elevated levels of low-density lipoproteins (LDL). The client says, “I have always followed a low-cholesterol diet, so how could it be elevated?” How should the nurse respond?

LDL needs to be taken up into the intracellular space and this process does not work well in some people, causing LDL elevations in the blood.

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The nurse is caring for a client whose potassium level is 5.9 mEq/L (5.9 mmol/L). Which treatment should the nurse be prepared to minister?

Medication to promote the movement of potassium into the intracellular space

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A nurse is teaching clients about the benefits of smoking cessation. What should the nurse include as the most accurate reason for the development of a
chronic “smoker’s cough”?

Damage to cilia in the respiratory tract make it necessary to cough to clear the airway.

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The nurse is caring for an 8-year-old client who has cystic fibrosis. What aspect of client care should the nurse prioritize?

Airway clearance

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A community health care worker is explaining to a group of factory workers the importance of wearing gloves when working with strong chemicals such as turpentine and paint thinner. Which characteristics of cell membranes underlies the nurse’s teaching?

Impermeability of cell membranes to all but lipid-soluble substances

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The parents of a child newly diagnosed with Tay-Sachs disease asks what signs and symptoms they will see if the disease is progressing which response(s) by the nurse is most accurate? Select all that apply.

loss of motor skills like turning over

- vision loss

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When discussing the function of the cell membrane during pathophysiology class, which statement(s) by the faculty is accurate? Select all that apply.

helps determine what can and cannot enter and exit cells
contains receptors for hormones and neurotransmitters
allow ions to cross the membrane during electrical signaling in cells

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Of the following situations, which one would be an example of a maladaptive cellular change?

44-year-old male with a 60 pack/year smoking history who was diagnosed with a histological grade-3 lung cancer

A client is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which factor has most likely contributed to the atrophy of the client's muscle cells?

A reduction of skeletal muscle use secondary to the traction treatment

The nurse is teaching new nursing assistants on the unit about the phenomenon of muscle hypertrophy. Which client on the unit is most likely to experience muscle hypertrophy? A client with:

hypertension, obesity, and decreased activity tolerance.

Which client is at high risk for developing dilated cardiomyopathy?

44-year-old noncompliant female who forgets to take her hypertensive medications

Which student statement demonstrates a sound understanding of the cellular processes of hypertrophy and hyperplasia?

"I know that cells like neurons have little capacity for hyperplastic growth."

A home health nurse is making a visit to a family with an 8-month-old infant with severe motor deterioration. The physician has diagnosed the infant with Tay-Sachs disease. The parents are asking the nurse why this happened. The nurse will base her answer knowing the root cause of Tay-Sachs is:

an enzyme defect causing abnormal lipid accumulation in the brain.

A 68-year-old male client with aortic stenosis secondary to calcification of the aortic valve is receiving care. Which statement best captures an aspect of this client's condition?

The client has possibly undergone damage as a result of calcification following cellular injury.

A nurse in the emergency department admits a male client who has experienced severe frostbite to his hands and toes after becoming lost on a ski hill. The nurse recognizes that which phenomena has contributed to his tissue damage?

Decreased blood flow has induced hypoxia.

As part of a first aid class, a health care instructor is teaching a group of industrial workers about how electrical injuries can cause cell damage. Which statement made by one of the workers indicates that further teaching is necessary?

"The greater the skin resistance, the greater the amount of deep and systemic damage a victim is likely to incur."

A client who has a diagnosis of lung cancer is scheduled to begin radiation treatment. The nurse knows that which statement about potential risks of radiation is most accurate?

"Some clients experience longer-term irritation of skin adjacent to the treatment site."

A young client has just been diagnosed with xeroderma pigmentosum. When teaching this family about this disease, the nurse should emphasize which teaching points? Select all that apply.

- Wear long sleeves, long pants, gloves, a hat, sunglasses with side shields, and sunscreen while outdoors. - The best time to allow the child to play outside is in the evening hours after the sun goes down.

A 7-year-old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which assessment finding is most congruent with the client's diagnosis?

Hemoglobin 9.9 g/dL (99 g/L)

The nurse is teaching a group of new mothers about postpartum nutrition, when one of the clients states that she was told to avoid eating fish too often due to the risk of mercury poisoning. Which response by the nurse most accurately addresses the clients concerns?

"There are some modest risks, but they are only associated with some long- living fish like tuna."

A nurse is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which statement best captures the rationale underlying the nurse's advice?

Antioxidants inhibit the actions of reactive oxygen species.

During a myocardial infarction (MI), a client with a 97% occlusion of the left descending artery develops ventricular dysrhythmias due to the amount of ischemia occurring in the myocardium. While providing education about MI's, which statement is most accurate to share with this client?

Treatment needs to be sought immediately so that the buildup of lactic acid is limited and cellular changes can be reversed.

Which statement most accurately conveys an aspect of cell injury due to impaired calcium homeostasis?

Injured cells tend to accumulate calcium.

The nurse is providing care for a client with a diagnosis of amyotrophic lateral sclerosis (ALS). The nurse recognizes that which mechanism is suspected to play a role in the cellular death associated with ALS?

Apoptosis

Which enzyme listed below is responsible for the ability of cancer cells to resist aging and contributes to cellular immortality that is so characteristic of this disease process?

Telomerase

The nurse is caring for a client with arterial insufficiency of the left leg with gangrenous wounds on the second and third toes. What characteristics of the wounds should the nurse evaluate as expected? Select all that apply.

- A clear demarcation between the healthy and affected tissue - Diminished pulse strength - Atrophy to the affected toes - Darkened appearance of affected tissue

The nurse is planning care for a group of clients. Which clients should the nurse prioritize as "at risk" for hypercalcemia and advocate for monitoring calcium levels? Select all that apply.

- A client with prolonged immobility - A client with hypophosphatemia - A client who has breast cancer with bone metastasis

21. A nurse is triaging clients at a disaster site. Local facilities have different specialized units. To what facility should the nurse send a client who has sustained an electrical injury to his left thigh?

Burn unit

Parents bring their 18-month-old child to the emergency room exhibiting behavior changes and vomiting. They are concerned the child ingested something in the older home they are renovating. Laboratory findings indicate low hemoglobin and elevated creatinine. Which diagnostic test should the nurse advocate for first?

Erythrocyte protoporphyrin (EP) level

The nurse is caring for a 45-year-old client undergoing radiotherapy of the mediastinal nodes due to lymphoma. Which interventions should the nurse prioritize? Select all that apply.

- Assessing for fatigue - Avoiding invasive procedures - Performing respiratory assessment

A worker in a warehouse is trying to have children but think he or she has handled "mercury" while cleaning equipment. Which statement by the occupational nurse is most appropriate at this time?

Most mercury toxicity involves central nervous system changes.

The health care provider is discussing the treatment protocol using ionizing radiation to treat the client's cancer. The client asks, "What side effects can occur with this treatment?" Which response(s) is accurate? Select all that apply.

- Low blood counts | - Excessive diarrhea

A 23-year-old man has received a recent diagnosis of appendicitis. The nurse providing care for the man is explaining that the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which teaching points should the nurse eliminate from client education?

"Inflammation helps your body to produce the right antibodies to fight the infection."

A client presented to the emergency department of the hospital with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) cellulitis. The client's physician has ordered a complete blood count and white cell differential. Which blood component would the physician most likely anticipate to be elevated?

Neutrophils

A 16-year-old girl has broken her arm while snowboarding and is shocked at the amount of swelling at the injury site. Which statement best explains the physiologic rationale for her swelling?

Loss of plasma proteins causes an increase in interstitial osmotic pressure.

Which phenomena best accounts for the increased presence of leukocytes at the site of inflammation?

Existing leukocytes stick to the epithelial cells and move along blood vessel walls.

When explaining the final stages of the inflammatory response to pathogens, the nurse should include which educational topics?

How the body can kill the pathogen by generating toxic oxygen and nitrogen products, producing such things as nitric oxide and hydrogen peroxide

A deficiency in which of these would result in an inhibition of the inflammatory response?

Histamine

When educating a client with a wound that is not healing, the nurse should stress which dietary modifications to ward off some of the negative manifestations that can occur with inflammation?

Increase your intake of oily fish and fish oil so that you will increase absorption of omega-3 polyunsaturated fatty acids.

Tumor necrosis factor-α and IL-1 are major cytokines that mediate inflammation. If the client is developing a systemic response to an infection, the nurse will likely assess which clinical manifestations? Select all that apply.

- Elevated temperature - Tachycardia - Anorexia

A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her body. Which physiologic process could best underlie her care provider's teaching about her new diet?

Free radicals increase cytokine expression and adhesion molecule levels, resulting in increased inflammation.

A nurse is changing the wound dressing on a coccyx-region pressure injury of an immobilized client. The existing dressing is saturated with both watery, clear discharge and foul, grayish-colored liquid. Which entry in the client's chart most accurately documents these findings?

"Large amounts of suppurative and serous exudates noted."

Which aspect of a client's site of inflammation would help the care provider rule out chronic inflammation?

Increased neutrophils

A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has:

A severe bacterial infection

Which client would have a very poor response related to tissue regeneration of his or her injured area?

54-year-old male who had a massive MI 4 days ago and came to the ED today for treatment.

A hospital client has a large, superficial wound on her elbow that was the result of shearing action when she was moved up in her bed. The client's husband mentions that the wound looks infected and irritated since it is completely red. Which response by the nurse would be inappropriate?

"A thin sheet of blood clotting is actually desirable and not a sign that your wife's wound is infected."

Which process would most likely be considered an anomaly during the cellular phase of inflammation?

Vasoconstriction

A client who is recovering from burn injuries is discussing his prognosis with a physician. Which teaching point about expectations for healing should the physician offer?

"You may find that the scar is a bit smaller than the area of the wound."

Which client is most likely to have impairments to the wound healing process? A client with:

poorly controlled blood sugars with small blood vessel disease.

A 79-year-old female resident of an assisted living facility receives care from a community nurse on a regular basis for treatment of a chronic venous leg ulcer. Which factor would the nurse be most justified in ruling out as a contributing factor to the client's impaired wound healing?

Decreased antibody levels

An 80-year-old client has a stage 3 decubitus ulcer on the left ischial tuberosity which has not shown much improvement despite optimal local wound treatment. What other interventions should the nurse recommend to promote wound healing? Select all that apply.

- A review of the client's medications - Placing the client on an alternating pressure mattress - Nutritional supplements

A client with a surgical wound has developed excessive granulation tissue extending above the wound edges. Which action should the nurse take?

Ask the health care provider about surgical options to remove the excess tissue and promote wound healing.

The nurse is caring for a client with a diabetic foot ulcer who has difficulty adhering to dietary restrictions. This has resulted in elevated blood glucose levels. What information is most important for the nurse to share with the client?

Elevations in blood glucose make it more difficult for your white blood cells to fight the infection.

The nurse is caring for a group of postoperative clients. Who should the nurse prioritize as having the greatest risk for infection at the surgical site?

A 45-year-old with external fixation of a fractured tibia

A parent brings a 12-year-old to the emergency room with multiple bite wounds to the arms and hands from a stray cat. Which interventions should the nurse be prepared to apply? Select all that apply.

- A review of the client's immunization record - Rabies prophylaxis - Irrigation of the wounds - Administration of prophylactic antibiotics

A client with a large decubitus ulcer asks the nurse, "How it is possible for a wound this deep to ever fully heal?" What is the nurse's best response?

With adequate resources, the body is capable of regenerating tissue and blood flow to the area over time.

A student arrives at the health clinic anxious and afraid. The student found an enlarged lymph node in the groin area that is extremely painful to touch and "knows" it is cancer. What information should the health care provider relay to this student about lymphadenitis?

Not all swollen lymph nodes are due to cancer. It could be caused by an infection in the genital region.

The nurse knows that which statement 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.

The nurse knows which statement listed below is accurate regarding the functions and nature of cytokines relative to a variety of pathologies?

"A particular cytokine can have varied effects on different systems, a fact which limits their therapeutic use."

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.

Which individual situation listed below best exemplifies the processes of innate immunity?

A child who has experienced heat and swelling of his skinned knuckle

The nurse knows which component is needed for long-lasting immunity in a client with a diagnosis of sepsis without the causative agent identified?

Lymphocytes

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 process listed below would the health care team member expect to remain unaffected?

Specificity and memory of the immune response

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 phenomenon would be least likely to result in activation of the complement system?

Activation of toll-like receptors (TLRs) on complement proteins.

A nurse is providing care for a client who is immunocompromised following chemotherapy. The nurse knows that which characterization of the adaptive immune system is responsible for the client's disruption in normal immune function?

Epitopes on antigens are recognized by immunoglobulin receptors following presentation by accessory cells.

The nurse knows that the cells primarily programmed to remove the invading organisms and remember the antigen to respond rapidly during the next exposure are:

T-lymphocytes and B-lymphocytes.

A 53-year-old female hospital client has received a kidney transplant following renal failure secondary to hypertension. The teaching prior to transplant made her 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 client has been inhaling viruses periodically while on a cross-country flight. Which situation listed below would most likely result in the stimulation of the client's T lymphocytes and adaptive immune system?

Recognition of a foreign peptide bound to a self-major histocompatibility complex (MHC) molecule

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 breast-feeding. Which types of immunoglobulins could most reasonably be expected to predominate in the infant's immune system?

IgG, IgA, IgM

A middle school student is scheduled to receive booster immunizations and the father asks the nurse why the booster is necessary. What characteristic of the adaptive immune system listed below would provide the rationale for the nurse's response?

A secondary response causes a sharp rise in antibody levels.

A student states, "It seems like helper T cells do a lot more than just 'help' the cellular immunity process". Which response 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."

A newly diagnosed HIV-positive adolescent has blood work drawn that includes a CD8+ T-cell count. The nurse knows that which 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 10 year old child with strep throat asks the nurse, "Why are there large bumps [lymph nodes] on my neck when my throat gets sore?" The nurse replies that lymph nodes:

help your body fight off infections by allowing special cells [lymphocytes and macrophages] to move through the lymph chain and engulf and destroy germs.

Which situation can best be characterized as an example of passive immunity?

A 6-week-old infant receives antibodies from his mother's breast milk.

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.

A community health nurse is conducting an education session with a group of pregnant women. One of the clients states, "I am not feeling right about getting a flu vaccine while pregnant." What is the nurse's best response?

"By getting vaccinated, you reduce the risk of you and your baby getting influenza."

A 60-year-old male client with an acute viral infection is receiving interferon therapy. The nurse is teaching the client about the ways interferon differs from other anti-infective therapies. What point should the nurse include?

"Interferon stimulates the activity of natural killer cells that attack viruses."

A client has been diagnosed with rheumatoid arthritis and asks the nurse what causes this condition. What is the nurse's best response?

Your immune system is attacking your own tissues as if they were harmful organisms.

A nurse is conducting an immunization clinic when a 14-year-old client asks, "Does this vaccine make me immune to the disease?" What is the nurse's best response?

"The vaccine imitates a disease without causing illness, resulting in the creation of antibodies to the disease."

The parent of a child with allergies has been told the child will have a blood test done for immunoglobulin measurement. The nurse should tell the parent that which immunoglobulin will be tested?

IgE

The nurse is preparing a client for bone marrow transplant. The client asks, "How long will it take for the new marrow to make the blood cells?" What is the nurse's best response?

Although it can vary, we will administer medication that will stimulate the bone marrow to create the cells.

While teaching about HIV/AIDS to a group of high school seniors, the school health nurse will begin by explaining the basic facts. Which information will this likely include?

HIV is different from other viruses since it is a retrovirus that selectively attacks the body's immune cells.

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 statement 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 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 19 year-old intravenous drug user was exposed to the HIV virus 3 weeks ago and is experiencing a rapid proliferation in viral load. Which statement best captures an aspect of the process of HIV replication that underlies this proliferation?

HIV is able to change its RNA into DNA to allow for replication by CD4+ cells.

Which client would be considered to be in the latent period of HIV infection?

33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his axilla and cervical neck region for the past 4 months.

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 is considered to be in which

Long-term nonprogressor

A 39-year-old female with HIV has been characterized as a typical progressor by her care team, and is experiencing an increase in her manifestations and complaints as her CD4+ count declines. Which health problem would her care team most likely attribute to a cause other than her HIV?

Her decreased bone density and recent fractures

A 48-year-old man who has been HIV positive for 6 years has just learned that he has been diagnosed with Kaposi sarcoma (KS). Which fact most accurately conveys an aspect of his diagnosis?

He is likely to have lesions on his skin, mouth, or GI tract.

When counseling a male client with suspected HIV, the nurse informs him that if the enzyme-linked immunosorbent assay (ELISA) comes back positive, then:

a second test known as the Western blot assay will be ordered to confirm positive HIV status.

After years of going to different physicians with vague symptoms, a 55-year-old client with a history of Hodgkin lymphoma has been diagnosed with a secondary immunodeficiency syndrome. The client asks the nurse what this means. The nurse knows that secondary immunodeficiency disorders may occur if which background information is available? Select all that apply.

- Usually develop later in life - May be a result of chemotherapy being used to treat a cancer - Can occur in clients taking corticosteroids daily.

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 physiologic origin of the child's recurrent infections?

The child's immune system is unable to synthesize adequate immunoglobulin on its own.

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

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 statement 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."

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 short-term and longer-term treatment plans?

Treatment of eczema; management of bleeding; bone marrow transplant

A 4-year-old boy presents with a chronic cough and swollen lymph nodes. His records show that he has been given antibiotics several times in the past year with limited success, most recently for a liver abscess. He also has a recurring fungal skin condition. Which diagnosis is most likely the cause of this child's manifestations?

Chronic granulomatous disease

When explaining to parents 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 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 phenomenon 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.

Following a spider bite she received while camping, a 20-year-old female presented to the emergency department with rash, edema, and fever and was subsequently diagnosed with serum sickness. Which statement best conveys the physiologic rationale for the broad systemic effects of this event?

Antigen-antibody complexes have been deposited in a variety of locations throughout the body.

A female dental assistant has developed signs and symptoms of a latex sensitivity, and is undergoing allergy testing as well as blood work. Which component of the assistant's blood work would most likely be the focus of her health care provider's analysis?

Serum IgE immunoassays

While undergoing a kidney transplant from a non-family member, the client's transplanted kidney has just had the arterial clamps removed. The OR staff notices 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.

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)

While volunteering in an HIV clinic in a big city, the nurse notices a new mom and her 6-month old child in the waiting room. Upon assessing the infant for possible HIV infection, the nurse will be assessing for which clinical manifestations of HIV infection? Select all that apply.

- Weighing him to determine if he is gaining 1.5 to 2 pounds/month. - Lack the coordination to play with toys/stuffed animals. - History of repeated episodes of bacterial pneumonia and ear infections. - Listlessness and poor eye contact.

Which client is most likely to be a candidate for a thymus transplant as the treatment of choice to reconstitute T-cell immunity?

A 7-year-old boy with diagnosis of thymic aplasia whose blood work indicates absence of T cells

Which clients are at increased risk for developing secondary hypogammaglobulinemia, a secondary humoral immunodeficiency? Select all that apply.

- client with burns covering more than 45% of the body - malnourished child who only drinks cow's milk - client witha a history of seizures controlled by an antiepileptic

A health care provider has prescribed blood products for a trauma client with a history of selective immunoglobulin A deficiency (SIGAD) who is going into hypovolemic shock. Which blood product is most appropriate for the nurse to infuse?

specially washed erythrocytes from normal donor

Staphylococcus aureus commonly found in the skin, nares, and other body sites of clients without any signs and symptoms of infection is known as which condition?

Bacterial colonization

Which statement is an accurate descriptor of the role of viruses in human infections?

Some viruses are capable of transforming normal host cells into malignant cells.

Which type of pneumonia 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?

Bacterial

The nurse will most likely assess which clinical manifestation in a client diagnosed with Creutzfeldt-Jakob disease?

Change in behavior and memory, loss of coordination leading to encephalopathy

The spirochete Leptospira is primarily transmitted to farmers by:

direct contact with infected animals.

The nurse knows which statement best describes a characteristic trait of Rickettsiae related to Rocky Mountain spotted fever? Rickettsiae:

have both RNA and DNA.

An 81-year-old female client in a subacute medical unit of a hospital has developed an oral Candida albicans infection. Which phenomena would the client's nurse suspect as a key contributing factor to her infection?

Antibiotic therapy that eliminated normal bacterial flora

The nurse knows which of statement 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 physician knows the client, G1P0, has correctly understood the prenatal education regarding sexually transmitted infection as evidenced by which statement listed below?

"My baby could become infected either across the placenta or during the birth itself."

Which procedure reduces the potential for infection primarily by addressing the portal of entry?

Wearing gloves when contact with blood or body fluids is anticipated

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 meningitidis) 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.

Which scenario best describes an example of infection originating with a fomite?

A client who contracted hepatitis C through sharing a contaminated syringe with an infected person

A client presents with sudden, violent diarrhea and vomiting after consuming chicken and potato salad 8 hours prior at the beach on a hot day. The nurse knows which statement best matches the phase of the infectious process of food poisoning?

Maximum impact of infectious process

Which infectious agent would be a site-specific pathogen and not spread throughout the body via the circulatory system? A client diagnosed with:

Helicobacter pylori diagnosed after an endoscopic procedure.

A client diagnosed with H. pylori asks the nurse, "How can an infection occur in the 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 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 statement is the best response?

"Treatment options for viruses are often limited because what destroys viruses often damages your own body cells."

The nurse in the emergency department knows clients exposed to Clostridium botulinum, an agent of bioterrorism, would likely be exhibiting which clinical manifestation listed below?

Muscle weakness in extremities eventually leading to paralysis of respiratory muscles

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 phenomenon constitutes the most significant contributor to the spread of new diseases in the United States?

Increased ease and speed of travel for individuals and groups

A 72-year-old client being treated for rheumatoid arthritis is admitted with suspected ehrlichiosis. What should the nurse implement as a treatment priority? A. Isotonic intravenous fluids at a minimum rate of 200 mL/hr

Administration of empirically chosen antibiotics

A family of five vacationed together, but only the client contracted traveler's diarrhea. The client asks the nurse, "We all ate and drank the same things. Why am I the only one with this condition?" What should the nurse offer to the client as the most likely reason for susceptibility for this condition?

You are taking a proton pump inhibitor for gastric reflux disease.

A client is suspected of having an infection, but the microorganism suspected as the cause cannot be cultured. The client asks how the health care provider will identify the organism. What is the nurse's best response as to the methods used?

The health care provider will introduce cultured, marked antibodies to your blood sample and observe for a reaction with antigens.

The nurse is performing discharge teaching for a client who has recovered from sepsis following an open cholecystectomy. What should be the nurse's primary focus?

Signs and symptoms of infection

A nurse is interviewing a client with fever, myalgia, headache, and lethargy. Which question is most important for the nurse to ask related to identifying the cause of these symptoms and the possible need for quarantining the client?

Have you or any family members traveled outside the country recently?

The nurse is caring for a client who meets the physical assessment criteria for sepsis, but the specimen cultures are negative for a causative organism. What action should the nurse take next?

Administer the prescribed antibiotics.

The nurse is caring for a client who has just been diagnosed with shingles. The client states, "I have not been around anyone with this condition. How could I have caught it?" What is the nurse's best response?

"This is a latent virus that you likely were exposed to as a child and it has now become active in the form of shingles."

When asked to name the parts of the pilosebaceous unit of the skin, the student has answered correctly when he states:

Sebaceous glands

Which term is usually associated with nail growth?

Continuously

Mitosis that results in the production of new epidermal cells occurs in which layer of the epidermis?

Stratum germinativum

After falling off his bicycle, an 8-year-old boy has a large abrasion on his posterior thigh that has removed the epidermis in the region but left the dermis largely intact. Which change in integumentary system would be expected in the area of his wound?

Fewer Merkel and Langerhans cells in the region

Which statement best conveys an aspect of the process of keratinization?

The stratum germinativum continuously produces new keratinocytes to replace losses.

A nurse is teaching a client about the role that skin plays in forming a barrier to environmental agents and microorganisms. The nurse would recognize that which type of cells/junctions are involved in the communication and regulation of the immune response and the secretions of cytokines?

Keratinocytes

While studying the skin in a science class, a student asks why all people have a pinkish color to their lips/mucous membranes. The instructor would respond by stating:

Pheomelanin is the yellow to red pigment particularly concentrated in the lips and nipples in humans.

A 40-year-old male client has a congenital syndrome that affects the function of the Langerhans cells of his epidermis. The man's care provider would expect which manifestation of his condition?

Increased susceptibility to infection

Clinical investigation of a 40-year-old female client with diverse dermatologic signs and symptoms has focused on the woman's basement membrane. Which skin function would a clinician most likely attribute to a region of the integument other than the basement membrane?

Lack of sensory nerve impulse conduction

A person with severe lymphedema is asking the nurse where specifically the lymph vessels are located in the skin layers. What would the nurse would respond?

Basement membrane

Which component of immune function is absent in the dermis?

Lymph nodes

The skin is richly supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. What is the primary significance of these structures?

They regulate body temperature.

A 51-year-old woman who was born congenitally blind and deaf is able to distinguish individuals by light touch of the individual's face. Which component of the woman's skin innervation likely contributes the most to this ability?

Meissner corpuscles

A frustrated 26-year-old female has sought a referral to a dermatologist in an effort to resolve her sweating and body odor which persist despite good hygiene. Which facts would underlie the explanation that her health care provider provides about her problem?

Aprocrine sweat glands produce a substance that is more oily than sweat from other sources.

While working in an allergy clinic, the nurse notices that many clients come in with all types of skin reactions. The nurse working in this area knows that which cells play a role in the development of allergic skin condition?

Langerhans cells

With eyes closed, an object is placed in a student's hand. The instructor asks the student to identify the object. When he does so correctly, this is primarily the responsibility of:

Meissner corpuscles

While lecturing about frostbite, the instructor asks the students, "Which substance prevents undue evaporation from the stratum corneum during the cold winter weather, which then helps conserve body heat?" The best answer is:

Sebum, secreted by the sebaceous gland

The nurse is caring for a client with an infection and fever. The client reports feeling chilled and having "goose bumps." The nurse will anticipate what change in the client's assessment findings as a result of this physiologic reaction?

An increase in body temperature

A client arrives with a very large blister on the heel from "new shoes" and fear having "damaged" the structures (ligaments and tendons) beyond repair and want to know "what caused this blister?" Which nursing response is best in this situation?

"This blister is caused by mechanical friction from repeated rubbing on this area. The fluid is in the basement membrane between the epidermis and dermis."

The parent of a infant recently diagnosed with albinism asks, "Why did this happen to my infant?" Which response by the nurse is most appropriate?

"Your infant is not producing the enzyme tyrosinase, which is needed to synthesize melanin. Melanin protects the skin from UV rays and adds color to the skin."

The pathology instructor asks, "What function do keratinocytes perform in the epidermis?" Which student has the correct answer?

"Keratinocytes in this layer secrete lamellar bodies to provide important water- impermeable properties."

An adolescent client of African descent arrives at the dermatology clinic asking, "Why do I have these white (light) patches of skin all over my body. I try sun tanning, but it does not get darker?" The health care provider suspects the teen has developed which skin condition?

Vitiligo, lighten skin due to decreased pigment or melanin.

Following laproscopic gall bladder surgery, a client has a 2-in (5-cm) incision that is elevated, irregular, and a different color from the normal skin. The client asks, "What is wrong with this incision? It's been 2 years and I expected no visible sign of this surgery since it was laproscopic." How will the nurse explain this condition?

"Your body formed excessive collagen during the healing process."

An adolescent reports a small (0.2 cm), round, serous-filled spot at the corner of the mouth. How should the nurse document this finding?

Vesicle

A high school athlete has developed a fungal infection between the toes where it is red, sore, and cracked into the dermis. Which term is the most accurate for the nurse to document in the client's record?

A fissure

An 18-year-old female of Asian ancestry is distraught over the recent appearance of white patches on her forearms and upper arms which have been subsequently confirmed as vitiligo. Which statement by the woman expresses an accurate understanding of her condition?

"I suppose this shouldn't come as too much of surprise, since this tends to run in my family."

An 11-year-old boy with skin lesions on his trunk characteristic of ringworm has been brought to the health care provider. Which aspect of the clinician's assessment relates most directly to the suspected diagnosis?

Potential contact with the fungus from pets or other children

An older adult client has arrived at the physician's office complaining of a rash. Upon further investigation, the client states the rash feels like a burning pain but also has some tingling. It is extremely sensitive to touch. The nurse notes that the rash is made up of vesicles and located on the right thoracic region. The nurse suspects the client has:

Herpes zoster

Which teaching point is most appropriate for an adolescent who has sought care for the treatment of severe acne located on the face and back?

"You might need antibiotic pills in addition to a cream for your face."

A 30-year-old woman who just found out that she is pregnant seeks a treatment for her severe acne. What is the most appropriate treatment for her skin condition?

A benzoyl peroxide agent

A 31-year-old man who has worked for several years installing fiberglass insulation has developed itchy, irritating lesions on his wrists and forearms over the last several months. He has applied moisturizing creams repeatedly and has taken antihistamines but has experienced no significant improvement. He is understandably concerned about the potential effect this could have on his livelihood and has asked his health care provider when treatment will resolve the problem. What is the health care provider's most appropriate response?

"A steroid cream will likely help, but often the skin problem lasts long after contact with the product that irritates the skin."

A 44-year-old man has been diagnosed with chronic urticaria, the exact cause of which cannot be determined. Which pharmacologic treatment is likely to be of most use to the man?

Antihistamines

Which aspects of the woman's history and assessment could be potential contributors to her diagnosis of psoriasis? Select all that apply.

- The woman takes an angiotensin-converting enzyme (ACE) inhibitor for the treatment of hypertension. - She takes hydroxychloroquine for rheumatoid arthritis. - Skin trauma of any kind often precedes an outbreak.

The nurse is caring for a client with pneumonia and a severe case of psoriasis that is being treated with methotrexate. During the morning assessments, which laboratory values would alert the nurse that the client is experiencing a side effect to this medication? Select all that apply.

- Platelet count 37 x 103/μL (37 x 109 /L - White blood cell count 1.2 x 103/μL (1.2 x 109 /L)

A 13-year-old girl has presented to a clinic with her mother explaining that she had an oval-shaped red patch on her chest a week ago, but that more of the lesions are now appearing on her back. On examination, the lesions on her back are in a "Christmas tree" pattern. What is the girl's most likely diagnosis?

Pityriasis rosea

A 22-year-old male who has been backpacking around Southeast Asia for several months has responded well to treatment for scabies that he acquired while on his trip. What follow-up measures should be taken?

Treatment of individuals that he has been in close contact with.

When trying to discern the extent of a burn, the nurse will note that second- degree full-thickness burns are characterized by:

extensive pain along with waxy white areas with blister formation.

A nurse working in a long-term care facility has attended an educational conference on pressure ulcer care in older adults. Which protocol in the facility would the nurse advocate changing for the client who develops a stage I ulcer? A. Residents with persistently low food intake are identified.

Wound dressings are applied promptly to all identified or potential pressure ulcers.

Which client of an oncologist is likely to have the poorest prognosis?

A 69-year-old man who has been diagnosed with stage IV malignant melanoma.

Which changes in an 86-year-old male's skin would necessitate further examination and possible medical treatment?

A new mole-like growth on his forearm.

A nurse practitioner student is trying to distinguish the various rashes she will be seeing in her pediatric rotation. Their nurse preceptor is assisting by describing the rash associated with rubeola. Which characteristics would apply to rubeola? Select all that apply.

- Rash is macular and blotchy. | - The rash usually begins on the face and then spreads to the legs/arms.

A few of the more experienced nurses are sitting around a lunch table discussing the changes they are seeing in their skin. Which of these would be considered normal age-related changes? Select all that apply.

- Reduction in subcutaneous tissue. | - Dry, scaly skin.

An older adult client is showing the nurse some changes in the skin that the client found while taking a shower. Which lesion(s) would give the nurse concern that it might be a precancerous lesion? Select all that apply.

- Several dry, brown, scaly lesions that are approximately 1 cm in diameter; a few of the lesions are showing some ulceration. - Tan-to-brown lesions commonly called 'liver spots" located on forearm and hands.

A client has sustained superficial or first-degree burns to both legs and the left arm. According to the rule of nines, what percentage of total body surface area should the nurse record as affected by this burn?

45%

A client who has sustained partial-thickness or second-degree burns to 70% of total body surface area is arriving via ambulance to the emergency department. What aspects of care will the nurse prioritize for this client? Select all that apply.

- Blood pressure support - Infection control - Pain management

The nurse is caring for a 22-year-old client with a circumferential burn to the left thigh. What assessment should the nurse perform as a priority specific to this type of burn?

Color, warmth, circulation, sensation, and movement of the left lower leg and foot

The nurse is caring for a client who is incontinent and at risk for pressure ulcer formation. What should the nurse include in the plan of care to reduce the risk for pressure ulcer formation? Select all that apply.

- Inspect bed sheets for cleanliness each time client is turned. - Record client's intake and address nutritional deficits. - Establish a toileting routine during waking hours.

The nurse is changing an occlusive dressing on a stage III pressure ulcer and notes the formation of new eschar in the wound bed. For what change in the wound care plan should the nurse advocate?

Switching to using wet-to-dry dressings.

A client experienced third-degree, full-thickness burns 2 days ago to the lower limbs after a fire at his workplace. Which systemic complications should the nurse regularly assess for? Select all that apply.

- Decreased peristalsis of bowel - Respiratory dysfunction - Hypermetabolic response - Sepsis

A child is sent home from school following a check for head lice by the nurse. The parents call to ask, "How do you know it is head lice? We thought our child just had dry skin and dandruff." Which manifestation(s) will the school nurse share with these parents? Select all that apply.

- The child is scratching at the head. - There are firmly attached nits on the hair shaft. - The child has red, excoriated scalp lesions.

Following a biopsy, a 54-year-old man has been diagnosed as having a benign neoplastic tumor. Which characteristic most likely applies to his tumor?

The well-differentiated, neoplastic cells are clustered together in a single mass.

A 77-year-old male client with a diagnosis of stomach cancer has been found to have metastases in his liver. The client and his family are surprised at this turn of events, stating that they don't see how he could have developed cancer in his liver. Which fact would underlie the reply that the care team provides?

The portal circulatory system brings venous blood from the GI tract into the liver.

A 41-year-old female with a family history has had a baseline mammogram. She states that she performs monthly self breast exams but really has a hard time evaluating her lumps since she has numerous cysts. At her annual mammogram, the technician views a suspicious area and refers her to the radiologist. She asks the nurse in the office, "How can a lump appear so quickly?" The nurse's response is based on which principle?

A tumor is undetectable until it has doubled 30 times and contains at least 1 billion cells.

Unbeknownst to her or her care team, a 51-year-old woman's breast cancer has an etiology rooted in the fact that tumor suppressing genes are present but have been silenced. Consequently, she has not synthesized normal cancer-suppressing proteins and neoplasia has resulted. What process has accounted for the woman's cancer?

Epigenetic mechanisms

Which client of a primary care physician would not require extra screening for cancer?

A 38-year-old female with Down syndrome and congenital scoliosis

Blood-borne cancerous cells have recently spread from a woman's primary pancreas tumor to her bones. Which components of the woman's immune system are likely to be directly involved in the attempt to eradicate the potential metastasis? Select all that apply.

- T lymphocytes - Macrophages - Natural killer (NK) cells - B lymphocyte cells

The family of a 68-year-old man who is in the end stages of small-cell lung cancer are distraught at his visible body wasting that has worsened in recent weeks. Which phenomena best accounts for the client's anorexia and cachexia?

Products of the tumor itself as well as a hypermetabolic state cause cachexia.

The nurse caring for a lung cancer client with metastasis to the brain suspects the client has developed a paraneoplastic syndrome known as Syndrome of Inappropriate Antidiuretic Hormone (SIADH) secretion. Which laboratory result in this client who has gained 3 lb in a day would alert the nurse to the possibility of SIADH?

Serum sodium of 115 mEq/L (115 mmol/L)

A 60-year-old man has presented to a clinic and is requesting screening for tumor markers after reading about them in a magazine. What can the clinician most accurately tell the man about the clinical use of tumor markers?

"Tumor markers alone aren't enough to confirm whether you have cancer or not, so they're not a very useful screening tool."

A 51-year-old female has been found to have metastatic lesions in her lung but her oncologist is unsure of the primary tumor site. Which procedure is most likely to aid in this determination?

Immunohistochemistry

A client with malignant melanoma has been prescribed alpha interferon, a biologic response modifier. Since this drug prolongs the cell cycle, increasing the percentage of cells in the G0 phase, and stimulates NK cells and T-lymphocyte killer cells, the nurse can anticipate that they may experience which common side effects?

Fever, chills, and fatigue

An oncology nurse who has worked for many years providing care for children with cancer has taken a job on an adult oncology unit of a hospital. What differences might the nurse anticipate in this new job?

There will be a greater number of cancers that are epithelial in origin.

A 26-year-old man who survived childhood acute lymphocytic leukemia (ALL), one of the most common childhood cancers, now complains of weakness, fatigue, and shortness of breath. His treatment for ALL likely included anthracyclines. What is the most likely cause of his symptoms?

Heart failure resulting from childhood chemotherapy

The mother of an 18-month-old child is concerned that her child is lethargic and not eating foods that he normally enjoys. She takes him to the pediatrician for a check-up. Which clinical manifestations lead the health care provider to suspect the child may have a neuroblastoma? Select all that apply.

- Large, protruding abdomen - Weight loss - Crying when joints/position changed

The nurse is planning care for a client who is receiving antimetabolite chemotherapy. What should the nurse include in the plan of care? Select all that apply.

- Falls prevention protocol - Daily weights - Monitor bowel movements closely.

The daughter of a client with metastatic cancer is confused as to why the client is receiving radiation therapy and asks the nurse, "Why are we still treating the cancer? The plan was only for comfort care." What is the nurse's best response?

"In this case, the radiation is being used to help alleviate the bone pain your family member is experiencing."

The nurse is caring for a client with small cell lung carcinoma who has developed syndrome of inappropriate antidiuretic hormone (SIADH). What should the nurse incorporate into the plan of care? Select all that apply.

- Daily weights - Maintenance of fluid restriction - Frequent repositioning

The family member of a client with terminal metastatic cancer who is experiencing cachexia-related weight loss asks the nurse why the client is losing weight despite taking in a large amount of calories per day. What is the nurse's best response?

"This weight loss is related to the cancer itself and occurs despite an intake of adequate calories."

During a discussion with a client recently diagnosed with stage IV kidney cancer, which statement is most accurate?

"Many times, kidney cancer goes completely undetected until a metastatic lesion is found in the lung."

A client overheard the provider discussing the case and mentioning a "mutation in the TP53 gene." The client asks the nurse, "What does that mean?" Which response is the most appropriate for this client?

"The TP53 gene is a group of tumor suppressor genes associated with lung, breast and colon cancer."

Which breakfast diet contains chemicals that likely can contribute to a higher rate of cancer risk?

Sausage fried in reused grease and biscuits and gravy.

When educating a client who has tested positive for human T-cell leukemia virus-1 (HTLV-1), what mode(s) of transmission should the nurse discuss to prevent the spread? Select all tht apply.

- sexual intercourse - blood by sharing needles - infants through breast milk

A client has stage IV cancer but further testing is needed to determine the site of origin of this metastatic tumor. Which form of testing will the health care provider be discussing with this client?

immunohistochemistry

The nurse is educating a client who is undergoing gamma knife radiosurgery for a brain metastasis. What advantage to this procedure should the nurse share when comparing it to other conventional treatments?

less cognitive dysfunction

A community health nurse is discussing preventative vaccines with a group of primigravda women. Which cancer-causing virus(es) should the nurse discuss that have a vaccine to prevent developing the disease? Select all that apply,

hepatitis B meningitis

As part of preoperative teaching for clients who are about to undergo a coronary artery bypass graft, a nurse is performing an education session with a group of surgical candidates. Which teaching point best conveys an aspect of the human circulatory system?

"The blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation."

In which situation would blood most likely be rapidly relocated from central circulation to the lower extremities?

A client is helped out of bed and stands up.

Which statement most accurately captures a principle of blood flow?

With constant pressure, a small increase in vessel radius results in an exponential increase in blood flow.

A 72-year-old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the client that she has aortic stenosis. After the cardiologist has left the room, the client asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds:

"Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur."

A physician is teaching a group of medical students about the physiologic basis for damage to the circulatory and neurologic systems that can accompany hypotension. Which response by a student would warrant correction by the physician?

"Tension and vessel thickness increase proportionately."

During an automobile accident where the client is bleeding heavily, which vascular component is the most distensible and can store large quantities of blood that can be returned to the circulation at this time of need?

Veins

A pathologist is examining histological (tissue) samples from a client with an autoimmune disease. Which characteristic of muscle samples would signal the pathologist that the samples are cardiac rather than skeletal muscle?

The muscle cells are arranged as an interconnecting lattice-work.

An 81-year-old female client of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client's condition?

Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.

As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which teaching point best captures a component of cardiac function?

"The diastolic phase is characterized by relaxation of ventricles and their filling with blood."

A client is experiencing impaired circulation secondary to increased systemic arterial pressure. Which statement is the most relevant phenomenon?

High afterload because of backpressure against the left ventricle

In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the client has gone into ventricular tachycardia. The nurse will likely assess for signs/symptoms of:

decreasing cardiac output due to less ventricular filling time.

A nurse is taking a manual measure of a client's blood pressure. The nurse knows that which factors related to blood flow underlies the ability to hear blood pressure by auscultation (listening)?

Pressure pulsation that exceeds the velocity of blood flow is audible and coincides with systolic BP.

Analysis has shown that a client's right atrial pressure is 30 mm Hg. What is the most likely conclusion that the client's care team will draw from this piece of data?

The pressure is excessive given that the right atrium should be at atmospheric pressure.

An emergency department client arrives after two days of "chest pressure" and "tightness" that was unrelieved with antacids. Following angioplasty for a massive myocardial infarction (MI), the client asks why so much muscle was damaged if only the left circumflex vessel was blocked. Which response by the nurse is most accurate?

"If a major artery like the circumflex is occluded, the smaller vessels supplied by that vessel cannot restore the blood flow."

When explaining to a client why there was only minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain that this is primarily due to:

development of collateral circulation that build channels between some of the smaller arteries, usually when the flow is decreased gradually.

Which individual is most likely to be experiencing vasodilation?

A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin–angiotensin–aldosterone system

When trying to explain to a client on dialysis the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have:

Small openings that allow large amounts of smaller molecular substances to filter through the glomeruli.

A 51-year-old client with a history of alcohol abuse and liver disease has low serum levels of albumin, and presents with ascites (excess fluid in his peritoneal space) and jaundice. A health care professional would recognize that which process is most likely underlying his health problems?

Low albumin is contributing to excess hydrostatic pressure and inappropriate fluid distribution.

While intubated for surgery, a client has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?

Decreased heart rate as a result of parasympathetic innervation of the heart

A client in the emergency department is experiencing a massive stroke with extremely low blood flow to the brain exhibited by a BP <60 mm Hg. The nurse suddenly notes there is a sharp rise in the BP to 250 mm Hg. This high BP lasts about 5 minutes and then the BP drops sharply again. The pathophysiologic principle behind this is likely due to the:

CNS ischemic response.

The nurse is assessing heart sounds on a client and detects a previously undocumented murmur. What diagnostic test should the nurse prioritize requesting an order for related to this finding?

Hemoglobin

The nurse is caring for a client with small veins. The nurse can improve the chance of successfully drawing a blood sample by applying the principle of critical closing pressure and:

using minimal negative pressure when drawing the sample into the syringe.

The nurse is caring for a client with angina. If wanting to reduce the Frank– Starling effect on myocardial oxygen consumption, what type of medication would the nurse expect to be prescribed?

A venous vasodilator

The nurse is caring for a client with peripheral edema. When elevating the client's legs to the level of the heart, what will the nurse expect to occur? Select all that apply.

- Reduction in the venous hydrostatic pressures of the legs - Increase in urine output - Increase in blood pressure

A client with uncontrolled hypertension has reviewed the echocardiogram report prior to visiting the health care provider. The client asks, "What does it mean when my ejection fraction is measured as only 30%? I want to know how to get this back to normal." Which response by the provider is most accurate?

"Most likely, your low ejection fraction is caused by your uncontrolled high blood pressure."

If a virus has caused inflammation resulting in endothelial dysfunction, an excessive amount of endothelins in the blood can result in:

contraction of the underlying smooth muscles within the vessels.

A nursing instructor is explaining the role of vascular smooth muscle cells in relation to increases in systemic circulation. During discussion, which neurotransmitter is primarily responsible for contraction of the entire muscle cell layer, thus resulting in decreased vessel lumen radius?

Norepinephrine

In which of the following hospital clients would the care team most realistically anticipate finding normal cholesterol levels?

A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness

When a 55-year-old client's routine blood work returns, the nurse notes that the client's C-reactive protein (CRP) is elevated. The client asks what that means. The nurse responds:

"This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease."

A client is reading a brochure on atherosclerosis while in the waiting room of medical clinic. Which excerpt from the educational brochure warrants correction?

"Because smoking causes a permanent increase in your risk of heart disease, it's best not to start."

A client arrives at the ED complaining of numbness in left lower leg. Upon assessment, the nurse finds the lower left leg to be cold to touch, pedal and posterior tibial pulses non-palpable, and a sharp line of paralysis/paresthesia. The nurse's next action is based on the fact that:

acute arterial occlusion is a medical emergency requiring immediate intervention to restore blood flow.

A 70-year-old male client presents to the emergency department reporting pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which medical diagnosis/possible treatment plan listed below?

Atherosclerotic occlusive disease necessitating thrombolytic therapy

A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response?

"If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."

An older adult client arrives to the health care provider's office complaining of a "sore" that won't heal on the lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the client that the usual treatment is:

compression therapy to help facilitate blood flow back to the vena cava.

A physician is explaining to a group of medical students the concept of Virchow's triad as it applies to venous thrombosis. Which clinical observation of a 50-year-old male client is most likely unrelated to a component of Virchow's triad?

The man has decreased cardiac output and an ejection fraction of 30%.

A 74-year-old man is being assessed by a nurse as part of a weekly basic health assessment at the long term care facility where he resides. His blood pressure at the time is 148/97 mm Hg, with a consequent pulse pressure of 51 mm Hg. The nurse would recognize that which of the following is the most significant determinant of the resident's pulse pressure?

the amount of blood that his heart ejects from the left ventricle during each beat

The nurse practitioner is working in an overnight sleep lab assessing and diagnosing clients with sleep apnea. During this diagnostic procedure, the nurse notes that a client's blood pressure is 162/97 mm Hg. The nurse explains this connection to the client based on which pathophysiologic principle?

During apneic periods the client experiences hypoxemia, which stimulates chemoreceptors to induce vasoconstriction.

A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which teaching point is most accurate?

"Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure."

When advising a morbidly obese client about the benefits of weight reduction, which statement would be most accurate to share?

"A 10-pound loss of weight can produce a decrease in blood pressure."

A physician is providing care for several clients on a medical unit of a hospital. In which situation would the physician be most likely to rule out hypertension as a contributing factor?

A 61-year-old man who has a heart valve infection and recurrent fever

An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which components of the pathologist's report is most suggestive of a possible history of poorly controlled blood pressure?

"Arterial sclerosis of subcortical brain regions noted."

During a routine physical exam for a client diagnosed with hypertension, the nurse practitioner will be most concerned if which assessment is found?

Noted hemorrhages and microaneurysms during evaluation of internal eye.

A physical assessment of a 28-year-old female client indicates that the blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which possibility would her care provider be most likely to suspect?

Coarctation of the aorta

A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her?

Platelet count; serum creatinine; liver enzymes

A physiotherapist is measuring the lying, sitting, and standing blood pressure of a client who has been admitted to the hospital following a syncopal episode and recent falls. Which fact about the client best relates to these health problems?

The client is 89 years old and takes a diuretic medication for his congestive heart failure.

A 78-year-old male client has undergone a total knee replacement. He just doesn't feel like getting out of bed and moving around. After 3 days of staying in bed, the physical therapist encourages him to get out of bed to the chair for meals. He starts to complain of dizziness and lightheadedness. These symptoms are primarily caused by which pathophysiologic principle? Select all that apply.

- Client is experiencing a reduction in plasma volume. | - Peripheral vasoconstriction mechanism has failed.

Which client should the emergency department staff suspect to be high risk for the development of a thoracic aortic aneurysm?

A 66-year-old client with facial edema, a cough, and neck vein distention

Which medication will likely be prescribed for a client with elevated LDL and triglyceride levels?

Simvastatin, an HMG-CoA reductase inhibitor or 'statin'

While working triage in the emergency department, which client report should alert the nurse to imminent danger and, thus, that client should be seen first?

A client holding the abdomen and reporting a tearing and ripping feeling inside.

Following physical assessment, which abnormality(ies) leads the health care provider to suspect the client has metabolic syndrome? Select all that apply.

- Sitting blood pressure reading of 145/96 mm Hg - Five foot (1.5 meter) tall female with abdominal waist measurement of 45 inches(114 cm) - Fasting triglyceride level of 230 mg/dL 92.6 mmol/L)

In which client situations would a physician be most justified in preliminarily ruling out pericarditis as a contributing pathology to the client's health problems?

A 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and a history of atrial fibrillation

Which teaching point would be most appropriate for a group of older adults who are concerned about their cardiac health?

"The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel."

Four clients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which client most likely experienced myocardial infarction?

An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose

A number of clients have presented to the emergency department in the last 32 hours with reports that are preliminarily indicative of myocardial infarction. Which client is least likely to have an ST-segment myocardial infarction (STEMI)?

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

The initial medical management for a symptomatic client with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which medication?

Propranolol, a beta-adrenergic blocker

A 31-year-old female at 30 weeks' gestation has been diagnosed with peripartum cardiomyopathy. Which statement best captures an aspect of peripartum cardiomyopathy?

The diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes.

An IV drug abuser walks into the ED telling the nurse, "I am sick." The client looks feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The assessment reveals a loud murmur. An echocardiogram was ordered that shows a large vegetation growing on the client's mitral valve. The client is admitted to ICU. The nurse will be assessing this client for which possible life-threatening complication?

Systemic emboli, especially to brain.

A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which set of diagnostics?

Echocardiogram, blood cultures, temperature

On a routine physical exam visit, the physician mentions that he hears a new murmur. The client gets worried and asks, "What does this mean?" The physician responds:

"One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems."

A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which teaching point would be most accurate to convey to the client?

"Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."

A nurse who works on a pediatric cardiology unit of a hospital is providing care for an infant with a diagnosis of tetralogy of Fallot. Which pathophysiologic result should the nurse anticipate?

Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.

A nurse will be providing care for a female client who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which statement best describes the presentation that the nurse should anticipate? The client:

has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.

The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the client displaying which clinical manifestation?

Dyspnea and crackles in bilateral lung bases.

A 77-year-old client with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could:

be a result of catecholamines released from SNS, which could increase the myocardial oxygen demand.

Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate 112, respiratory rate 36, and pulse oximeter reading of 81%. He starts coughing up frothy, pink sputum. The priority intervention is:

Call for emergency assistance utilizing hospital protocol.

A nurse is administering morning medications to a number of clients on a medical unit. Which medication regimen is most suggestive that the client has a diagnosis of heart failure?

Diuretic, ACE inhibitor, beta-blocker

Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which phenomenon is most likely taking place?

The man's alpha- and beta-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate.

A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are most likely to benefit the man?

Infusion of normal saline or Ringer's lactate to maintain the vascular space.

A 30-year-old woman presents at a hospital after fainting at a memorial service and she is diagnosed as being in neurogenic shock. Which signs/symptoms is she most likely to display?

Dry and warm skin

All of the following interventions are ordered STAT for a client stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first?

Epinephrine

A client in the intensive care unit has a blood pressure of 87/39 mm Hg and has warm, flushed skin accompanying his sudden decline in level of consciousness. The client also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis?

Septic shock

A 3-year-old child with right-sided heart failure has been admitted for worsening of their condition. Which assessment would be considered one of the earliest signs of systemic venous congestion in this toddler?

Enlargement of liver

A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which statement by the physician best captures an aspect of these differences?

"You'll find that, in pediatric clients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles."

A client has undergone insertion of a drug-eluting stent. Based on clinical trials, which medications, when taken in combination, have been found effective to prevent restenosis if taken for up to 1 year after the procedure? Select all that apply.

- aspirin | - clopidogrel

A physician has ordered the measurement of a cardiac client's electrolyte levels as part of the client's morning blood work. Which statement best captures the importance of potassium in the normal electrical function of the client's heart?

Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.

Which statement describes phase 4 of the action potential of cells in the sinoatrial (SA) node?

A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in, resulting in resting membrane potential.

An ECG technician is placing leads on a client who has presented to the emergency department with a sudden onset of chest pain. The technician would recognize which fact about the placement of leads and the achievement of a clinically accurate ECG?

The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane.

The cardiologist just informed a client that he has a reentry circuit in the electrical conduction system in his heart. This dysrhythmia is called Wolff- Parkinson-White (WPW) syndrome. After the physician has left the room, the client asks the nurse to explain this. Which statement most accurately describes what is happening?

"There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast."

A 6-year-old boy has been brought to the emergency department by his mother complaining his heart rate is "so fast I couldn't even count it." The child was determined to be in atrial flutter via ECG. Which points should underlie an explanation of this event to the mother?

The child is experiencing a reentry rhythm in his right atrium.

A medical student is working with a 61-year-old male client in the hospital who has presented with a new onset of atrial fibrillation. Which course of treatment will the student most likely expect the attending physician to initiate?

Anticoagulants and beta-blockers to control rate

A 63-year-old male client has been diagnosed with a bundle branch block. How will this client's care team most likely expect his condition to be expressed diagnostically?

His ECG will show an inordinately wide QRS complex because impulses are bypassing normal conduction tissue.

Which client should the nurse be assessing for long QT syndrome?

32-year-old male admitted for cocaine overdose with long history of illicit drug abuse

A number of clients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which client is most deserving of immediate medical attention?

A 69-year-old woman who has entered ventricular fibrillation

A 71-year-old man is slated for pacemaker insertion for treatment of a third- degree AV block. The man's nurse has been educating him around his diagnosis and treatment and answering the numerous questions he has about his health problem. Which teaching point should the nurse include in this client teaching?

"The root problem is that the top chambers of your heart and the bottom chambers of your heart aren't coordinating to pump blood efficiently."

A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiologist by her family physician. As part of the client's diagnostic workup, the cardiologist has ordered her to wear a Holter monitor for 24 hours. Which statement best captures an aspect of Holter monitoring?

Accurate interpretation of the results requires correlating the findings with activity that the woman was doing at the time of recording.

A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia and she is suspected to have sick sinus syndrome. Which diagnostic method is the best choice to investigate the suspicion?

Holter monitoring

When ablation therapy is added to an electrophysiologic test, the nurse should be assessing the client for which complication of ablation that may occur postprocedure?

Sudden onset of dyspnea, tachypnea, and chest pain that is worsened by breathing.

A nurse who provides care on a geriatric subacute medicine unit has noted that a large number of clients receive beta-adrenergic blocking medications (beta- blockers). Which statement best conveys an aspect of the use of beta-blockers?

They can be used to treat supraventricular dysrhythmias and decrease automaticity by depressing phase 4 of the action potential.

A client who is experiencing some angina associated with atrial tachycardia has been placed on verapamil, a calcium-channel blocker. Knowing that this medication blocks the slow calcium channels, thereby depressing phase 4 and lengthening phases 1 and 2 action potential, the nurse should assess this client for which adverse reaction?

Bradycardia

A client is believed to be in cardiac arrest and defibrillation is being performed. What is an aspect of the rationale and physiology of defibrillation treatment?

The goal is to depolarize the entire heart during the passage of current.

A client with a new automatic implantable cardioverter-defibrillator (AICD) asks the nurse what happens if he goes into that deadly heart rhythm again. The nurse will base her response knowing the AICD will:

respond to ventricular tachydysrhythmia by delivering a shock within 10-20 seconds of its onset.

Assuming that they have not responded to drug therapy, which client is likely to be the best candidate for surgical cardiac ablation?

A 46-year-old man with unstable angina and a history of myocardial infarction who is found to have long Q-T syndrome and episodes of frequent ventricular dysrhythmias

The nurse is caring for a client who develops a paroxysmal supraventricular tachycardia. Which medications should the nurse prepare to administer? Select all that apply.

- Adenosine - Diltiazem (Class IV) - Metoprolol (Class II)

The nurse is prioritizing clients based on the risk for falls. Which client would be at greatest risk for sudden falls and related injury? The client:

with uncontrolled sick sinus syndrome.

The nurse has completed an automated blood pressure and pulse reading on a client with persistent atrial fibrillation. The client's baseline values are blood pressure 130/85 mm Hg and heart rate of 80 bpm and irregular. The current result is blood pressure is 98/47 mm Hg, the heart rate is 77 bpm, and the client denies feeling differently. What is the nurse's priority action?

Perform a manual blood pressure and apical heart rate reading.

A client arrives reporting feeling "faint and dizzy" when standing and on telemetry the client's heart rate is 25 beats/min. On electrocardiogram, the rate is fairly consistent and lacks the normal "P" wave and the QRS is wider than normal. This client's heart rhythm is being controlled by which cardiac structure?

Purkinje system

Which client on the nurse's team will be given priority for cardiac monitoring based on medical history?

Adolescent client resuscitated following drowning in a swimming pool that required CPR at the scene

During a sleep study in the laboratory, the health care provider notices one client has a prolonged period of asystole. Which term will the nurse use to describe this event in the documentation?

Sinus arrest

A nurse is caring for four clients with the diagnosis of atrial fibrillation. Which client will likely require cardioversion related to complications?

Newly diagnosed client with atrial fibrillation and has developed pulmonary edema