PATHOPHYSIOLOGY Flashcards
(38 cards)
The nurse provides home care instructions to the parents of a child hospitalized with pertussis who is in the convalescent stage and is being prepared for discharge. Which statement by a parent indicates a need for further instruction?
A/ “We need to encourage our child to drink fluids.”
B/ “Coughing spells may be triggered by dust or smoke.”
C/ “Vomiting may occur when our child has coughing episodes.”
D/ “We need to maintain droplet precautions and a quiet environment for at least 2 weeks.”
D/ “We need to maintain droplet precautions and a quiet environment for at least 2 weeks.”
Pertussis is transmitted by direct contact or respiratory droplets from coughing. The communicable period occurs primarily during the catarrhal stage. Respiratory precautions are not required during the convalescent phase. Options 1, 2, and 3 are accurate components of home care instructions.
An infant receives a diphtheria, tetanus, and acellular pertussis (DTaP) immunization at a well-baby clinic. The parent returns home and calls the clinic to report that the infant has developed swelling and redness at the site of injection. Which intervention should the nurse suggest to the parent?
A/ Monitor the infant for a fever.
B/ Bring the infant back to the clinic.
C/ Apply a hot pack to the injection site.
D/ Apply a cold pack to the injection site.
D/ Apply a cold pack to the injection site.
On occasion, tenderness, redness, or swelling may occur at the site of the DTaP injection. This can be relieved with cold packs for the first 24 hours, followed by warm or cold compresses if the inflammation persists. Bringing the infant back to the clinic is unnecessary. Option 1 may be an appropriate intervention, but is not specific to the subject of the question, a localized reaction at the injection site. Hot packs are not applied and can be harmful by causing burning of the skin.
A child is scheduled to receive inactivated polio vaccine (IPV), and the nurse preparing to administer the vaccine reviews the child’s record. The nurse questions the administration of IPV if which is documented in the child’s record?
A/ Recent recovery from a cold
B/ A history of frequent respiratory infections
C/ A history of an anaphylactic reaction to neomycin
D/ A local reaction at the site of injection of a previous IPV
C/ A history of an anaphylactic reaction to neomycin
Inactivated poliovirus vaccine (IPV) contains neomycin. A history of an anaphylactic reaction to neomycin is considered a contraindication to IPV.
A child is receiving a series of the hepatitis B vaccine and arrives at the clinic with his parent for the second dose. Before administering the vaccine, the nurse should ask the child and parent about a history of a severe allergy to which substance?
A/ Eggs
B/ Penicillin
C/ Sulfonamides
D/ A previous dose of hepatitis B vaccine or component
D/ Previous reaction to Hep B
A contraindication to receiving the hepatitis B vaccine is a previous anaphylactic reaction to a previous dose of hepatitis B vaccine or to a component (aluminum hydroxide or yeast protein) of the vaccine. An allergy to eggs, penicillin, and sulfonamides is unrelated to the contraindication to receiving this vaccine.
The home health nurse visits a child with infectious mononucleosis and provides home care instructions to the parents about the care of the child. Which instruction should the nurse give to the parents?
A/ Maintain the child on bed rest for 2 weeks.
B/ Maintain respiratory precautions for 1 week.
C/ Notify the health care provider (HCP) if the child develops a fever.
D/ Notify the HCP if the child develops abdominal pain or left shoulder pain.
D/ Notify the HCP if the child develops abdominal pain or left shoulder pain.
Infectious mononucleosis is caused by Epstein-Barr virus. The parents need to be instructed to notify the HCP if abdominal pain, especially in the left upper quadrant, or left shoulder pain occurs because this may indicate splenic rupture. Children with enlarged spleens also are instructed to avoid contact sports until splenomegaly resolves.
The clinic nurse prepares to administer a measles, mumps, rubella (MMR) vaccine to a 5- year-old child. The nurse should administer this vaccine by which best route and in which
best site?
A/ Subcutaneously in the gluteal muscle
B/ Intramuscularly in the deltoid muscle
C/ Subcutaneously in the outer aspect of the upper arm
D/ Intramuscularly in the anterolateral aspect of the thigh
C/ Subcutaneously in the outer aspect of the upper arm
Measles, mumps, rubella (MMR) vaccine is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is not recommended for injections. MMR vaccine is not administered by the intramuscular route.
A child with rubeola (measles) is being admitted to the hospital. In preparing for the admission of the child, the nurse should plan to place the child on which precautions? A/ Enteric B/ Airborne C/ Protective D/ Neutropenic
B/ Airborne
Rubeola is transmitted via airborne particles or direct contact with infectious droplets. Airborne droplet precautions are required, and persons in contact with the child should wear masks. The child is placed in a private room if hospitalized, and the hospital room door remains closed. Gowns and gloves are unnecessary, but standard precautions are used. Articles that are contaminated should be bagged and labeled.
The clinic nurse is assessing a child who is scheduled to receive a live virus vaccine (immunization). What are the general contraindications associated with receiving a live virus vaccine?
SELECT ALL THAT APPLY
A/ Child has symptoms of a cold
B/ Previous anaphylaxis to the vaccine
C/ Mother reports child is having intermittent episodes of diarrhea
D/ Mother reports Child has not had an appetite today and has been fussy
E/ The child has a disorder that caused a severely deficient immune system
F/ Mother reports that the child has recently been exposed to an infectious disease
B/ Previous anaphylaxis to the vaccine
E/ The child has a disorder that caused a severely deficient immune system
The general contraindications for receiving live virus vaccines include a previous anaphylactic reaction to a vaccine or a component of a vaccine. In addition, live virus vaccines generally are not administered to individuals with a severely deficient immune system, individuals with a severe sensitivity to gelatin, or pregnant women. A vaccine is administered with caution to an individual with a moderate or severe acute illness, with or without fever. Options 1, 3, 4, and 6 are not contraindications to receiving a vaccine.
What are the 3 C’s of Rubeola (Measles)?
Coryza (Inflammation of nose membranes)
Cough
Conjunctivitis
An infant is admitted to the hospital with the diagnosis of German Measles (Rubella). The nurse about to admit the infant knows the baby will have which of the following characteristics of the German Measles?
SELECT ALL THAT APPLY
1/ High-grade fever
2/ Pinkish-red maculopapular rash on their face
3/ Anorexia
4/ Lesions on the genitals and rectum
5/ Petechiae on the soft palate
6/ Jaw and/or ear pain aggravated by chewing
2/ Pinkish-red maculopapular rash on their face
5/ Petechiae on the soft palate
Signs and symptoms of Rubella or “German Measles” are a low-grade fever, malaise, pinkish-red maculopapular rash that begins on the face and spreads to the body in 1-3 days. They may also have petechiae on their soft palate in their mouth. These patients need to be isolated from pregnant women, and placed on airborne and droplet precautions.
Anorexia, Jaw and ear pain are associated with Mumps.
Lesions are a symptoms of chickenpox, along with anorexia.
A toddler is diagnosed with Mumps after visiting their daycare. The mother dose not understand how her child became infected. The nurses suspects which one of the following scenarios probably lead to her contraction of Mumps?
A/ Playing in a dusty sandbox with another child
B/ Painting alongside another child with a respiratory infection
C/ Visiting the doctors office the previous day, and touching the magazines on the shelf in the waiting room
D/ Sharing a drink with another toddler in the daycare.
D/ Sharing a drink.
Mumps is spread through direct contact with infected saliva. Whether by direct contact or droplet. Mumps is communicable by a host immediately before and after their parotid glands swell. Common symptoms include: Fever Headache Anorexia Jaw or ear pain that worsens when eating Inflammation of the testes
A nurse is caring for a 9-year-old with chickenpox and recalls her pathophysiology class were she learned the infectious agent that causes Chicken pox is: A/ Paramyxovirus B/ Varicella Zoster virus C/ Herpes Simplex 1 D/ Human Herpesvirus type 6
B/ Varicella-Zoster virus
Human Herpesvirus type 6 is associated with Roseola, Paramyxovirus is associated with the Measles, and Herpes simplex 1 is associated with oral sores.
A 3-year-old comes to the emerge with a loud barking cough, is highly irritable, and hasn't eaten any food in the past 36 hours. What diagnosis can the nurse expect? A/ Viral Bronchitis B/ Pneumonia C/ Pertussis D/ Laryngitis
C/ Pertussis
The trademark sign of pertussis is a loud barking/whooping cough and an audible inspiration. The patient may also experience coughing spasms when exposed to smoke, dust, or sudden changes in temperature. Treatment includes antimicrobial therapy, hydration, reduction of environmental stimuli that increases coughing, humidified oxygen.
Viral bronchitis would not likely have anorexia as a symptom. Pneumonia is associated with fever and purulent sputum, and laryngitis is associated with a severely sore throat and a hoarse voice.
When assessing a 7 year old, the nurses the following: 89 HR 24 respirations per minute 38.4 degrees Neck swelling Sore reddened throat foul-smelling purulent nasal discharge.
Based on these findings, what does the nurse expect? A/ Pertussis B/ Poliomyelitis C/ Diphtheria D/ Scarlet Fever
C/ Diphtheria
Characterized by
○ Low-grade fever
○ Malaise
○ Sore Throat
○ Foul-smelling, mucopurulent nasal discharge
○ Dense pseudomembrane formation in the throat that may interfere with eating, drinking, and breathing
AND Lymphadenitis, neck edema or “Bull neck”
Treatment includes: Strict isolation, diphtheria antitoxin, bedrest, antibiotics, suctioning, and possible tracheostomy.
Which of the following are complications of Poliomyelitis? SELECT ALL THAT APPLY
A/ Coma B/ Respiratory Paralysis C/ Central Nervous System Paralysis D/ Dense Pseudomembranous formation in the throat E/ Neurological deficits
B/ Respiratory Paralysis
C/ Central Nervous System Paralysis
D/ Dense Pseudomembranous formation in the throat.. is associated with Diphtheria.
A/ and D/ are unrelated.
During an assessment of a child in a rural health clinic in northern Ontario. The nurse notes the following information during assessment:
Abrupt fever of 39.1 that started 7 hours ago
Flushed red cheeks
Vomiting
Malaise
Red and rough rash in axillary region and to their neck
Reddened tonsils and covered in exudate
Based on these findings, the nurse suspects which infectious disease?
Scarlet fever
Distinguishing signs include an abrupt fever, with rough-red rash that appears first under the arms and on the neck and groin. Eventually rash spreads to entire body.
Tonsils that are red and covered in exudate, along with a swollen pharynx is a clinical sign.
A 23-year-old law student comes to her university clinic complaining of: Fever malaise and severe fatigue headache Abdominal pain and a sore throat Upon further investigation, the nurse notes possible liver enlargement. Due to these findings, what may the nurse suspect is infecting this student? A/ Rickettsia Rickettsii B/ Epstein-Barr Virus C/ Group A Beta-hemolytic streptococci D/ Enterovirus
B/ Epstein Barr Virus (Mono)
Along with those symptoms the patient will likely also have swollen lymph nodes, and could have a macular rash on their trunk.
A/ Rickettsia Rickettsii is associated with Rocky Mountain Spotted Fever
C/ Group A Beta-hemolytic streptococci is associated with Scarlet Fever
D/ Enterovirus is associated with Poliomyelitis
What is the cardinal sign of Rocky Mountain Spotted fever? and How does one become infected with it?
Muscle pain (myalgia)
Infection occurs through the bite of an infected tick
Which of the following people are at a higher risk of developing MRSA? SELECT ALL THAT APPLY
A/ Prisioners B/ People Who get Tattoos C/ People living on Farms D/ People who abuse IV drugs E/ People who smoke F/ People living in crowded places
A/ Prisioners
B/ People Who get Tattoos
D/ People who abuse IV drugs
F/ People living in crowded places
Streptococcus aureus is the agent, however it normally resides in the noses and on the skin of healthy people. This organism seeks opportunity to flourish and under these circumstances, they may be able to do so.
Other people at risk include: Persons with a compromised immune system Persons with poor hygiene practices Persons who use contaminated items Day-care attendees Military recruits Athletes
S. Aureus can enter the bloodstream through a cut or a wound and can cause sepsis, cellulitis, endocarditis, osteomyelitis, septic arthritis, toxic shock syndrome, pneumonia, organ failure and death
The emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding would indicate the presence of a pneumothorax in this client?
- A low respiratory rate
- Diminished breath sounds
- The presence of a barrel chest
- A sucking sound at the site of injury
- Diminished breath sounds
This client has sustained a blunt or closed-chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. Hyperresonance also may occur on the affected side. A sucking sound at the site of injury would be noted with an open chest injury.
The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which finding would the nurse expect to note on assessment of this client?
SELECT ALL THAT APPLY
- Hypocapnia
- A hyperinflated chest noted on the chest x-ray
- Decreased oxygen saturation with mild exercise
- A widened diaphragm noted on the chest x-ray
- Pulmonary function tests that demonstrate increased vital capacity
- A hyperinflated chest noted on the chest x-ray
- Decreased oxygen saturation with mild exercise
Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced. Pulmonary function tests will demonstrate decreased vital capacity.
The nurse instructs a client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to promote which outcome?
- Promote oxygen intake
- Strengthen the diaphragm
- Strengthen the intercostal muscles
- Promote carbon dioxide elimination
- Promote carbon dioxide elimination
Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation. Options 1, 2, and 3 are not the purposes of this type of breathing.
The nurse is preparing a list of home care instructions for a client who has been hospitalized
and treated for tuberculosis. Which instructions should the nurse include on the list?
SELECT ALL THAT APPLY
- Activities should be resumed gradually.
- Avoid contact with other individuals, except family members, for at least 6 months.
- A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated.
- Respiratory isolation is not necessary because family members already have been exposed.
- Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags.
- When one sputum culture is negative, the client is no longer considered infectious and
usually can return to former employment.
- Activities should be resumed gradually.
- A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated.
- Respiratory isolation is not necessary because family members already have been exposed.
- Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags.
Instruct the client to follow the medication regimen exactly as prescribed and always to have a supply of the medication on hand.
Reassure the client that after 2 to 3 weeks of medication therapy, it is unlikely that the client will infect anyone. Inform the client that activities should be resumed gradually and about the need for adequate nutrition and a well-balanced diet that is rich in iron, protein, and vitamin C to promote healing and prevent recurrence of infection. Inform the client and family that respiratory isolation is not necessary because family members already have been exposed. Instruct the client about thorough hand washing and to cover the mouth and nose when coughing or sneezing and to put used tissues into plastic bags. Inform the client that a sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. When the results of three sputum cultures are negative, the client is no longer considered infectious and can usually return to former employment.
The nurse is caring for a client after a bronchoscopy and biopsy. Which finding, if noted in the client, should be reported immediately to the health care provider?
- Dry cough
- Hematuria
- Bronchospasm
- Blood-streaked sputum
- Bronchospasm
If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs/symptoms of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this procedure.
