TEST 2 - CHAPTER REVIEW QUESTIONS Flashcards
(44 cards)
A female patient’s complex symptomatology over the past year has culminated in a diagnosis of systemic lupus erythematosus (SLE). Which of the patient’s following statements demonstrates the need for further teaching about the disease?
A) “I’ll try my best to stay out of the sun this summer.”
B) “I know that I probably have a high chance of getting arthritis.”
C) “I’m hoping that surgery will be an option for me in the future.”
D) “I understand that I’m going to be vulnerable to getting infections.”
C
SLE carries an increased risk of infection, sun damage, and arthritis. Surgery is not a key treatment modality for SLE.
chronic multisystem inflammatory disease with immune system abnormalities.
Systemic lupus erythematosus (SLE)
The etiology of abnormal immune response is unknown; a ____________ influence is suspected.
genetic
SLE is extremely ____________ in its severity, ranging from a relatively mild disorder to rapidly progressive and affecting many __________ systems.
variable
organ
Commonly affected tissues in SLE are:
- skin (butterfly rash over nose, cheeks),
- muscles (polyarthralgia with morning stiffness),
- lungs (tachypnea),
- heart (dysrhythmias),
- nervous tissue (seizures)
- kidneys (nephritis).
Other signs of SLE include ___________, mild ________________ , and _______________.
anemia
leukopenia
thrombocytopenia
In SLE, _____________ is a major cause of death.
infection
The diagnosis of SLE is based on the presence of ___________ ___________ revealed through patient history, physical examination, and laboratory findings.
distinct criteria
A major treatment challenge is to manage ____________ ___________ while preventing treatment complications that cause long-term ____________ ____________.
active disease
tissue damage
______________ are given for severe cutaneous SLE. Antimalarial agents and immunosuppressive drugs may also be used.
Corticosteroids
Nursing care emphasizes health teaching and importance of patient cooperation for successful ___________ _____________.
home management
- In teaching a client with SLE about the disorder, what information about the pathophysiology of SLE would the nurse include?
a. The production of autoantibodies directed against constituents of cellular DNA
b. An autoimmune reaction resulting in degeneration, necrosis, and fibrosis of muscle fibres
c. A deposition in tissues of immune complexes formed from IgG autoantibodies reacting with IgG
d. Chronic inflammation and cytokine activity resulting in cartilage, bone, and muscle damage
d
Systemic lupus erythematosus (SLE) is characterized by the production of many autoantibodies against nucleic acids (e.g., single-and double-stranded DNA), erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self-proteins. Autoimmune reactions characteristically are directed against constituents of the cell nucleus (e.g., antinuclear antibodies [ANAs]), particularly DNA. Circulating immune complexes containing antibody against DNA are deposited in the basement membranes of capillaries in the kidneys, heart, skin, brain, and joints. Complement is activated, and inflammation occurs. The overaggressive antibody response is also related to activation of B and T cells. The specific manifestations of SLE depend on which cell types or organs are involved. SLE is a type III hypersensitivity response.
The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse’s response is based on the knowledge that which of the following is a diagnostic criterion for AIDS?
a) Presence of HIV antibodies
b) CD4+ T cell count
b
Diagnostic criteria for AIDS include a CD4+ T-cell count
When teaching a patient infected with HIV regarding transmission of the virus to others, which of the following statements made by the patient would identify a need for further education?
a) “I will need to isolate any tissues I use so as not to infect my family.”
b) “I will notify all of my sexual partners so they can get tested for HIV.”
c) “Unprotected sexual contact is the most common mode of transmission.”
d) “I do not need to worry about spreading this virus to others by sweating at the gym.”
a
HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.
A hospital has seen a recent increase in the incidence of hospital-acquired infections (HAIs). Which of the following measures should be prioritized in the response to this trend?
a) Use of gloves during patient contact
b) Frequent and thorough hand washing
c) Prophylactic, broad-spectrum antibiotics
d) Fitting and appropriate use of N95 masks
b
Hand washing remains the mainstay of the prevention of HAIs. Gloves, masks, and antibiotics may be appropriate in specific circumstances, but none of these replaces the central role of vigilant, thorough hand washing.
Standard precautions should be used when providing care for
a) All patients regardless of diagnosis.
b) Pediatric and gerontologic patients.
c) Patients who are immunocompromised.
d) Patients with a history of infectious diseases.
a
Standard precautions are designed for all care of all patients in hospitals and health care facilities.
The nurse is providing care for a patient who has been living with HIV for several years. Which of the following assessment findings most clearly indicates an acute exacerbation of the disease?
a) A new onset of polycythemia
b) Presence of mononucleosis-like symptoms
c) A sharp decrease in the patient’s CD4+ count
d) A sudden increase in the patient’s WBC count
c
A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient’s WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.
Which of the following is NOT a source of emerging infections?
a. Plants
b. Animals
c. Biological warfare
d. Antibiotic resistance
a,b,c,d
An emerging infection is an infectious disease whose incidence has increased in the past 20 years or threatens to increase in the immediate future. Examples include resistant organisms that emerged when a previously treatable organism developed resistance to antibiotics; criteria for starting antiretroviral drug therapy (ART) that have changed with new scientific discoveries; and limited resources or access to medications that make it difficult for some patients to get adequate treatment for infections.
- Which of the following antibiotic-resistant organisms are resistant to normal hand soap?
a. Vancomycin-resistant enterococci
b. Methicillin-resistant Staphylococcus aureus
c. Penicillin-resistant Streptococcus pneumoniae
d. β-Lactamase–producing Klebsiella pneumoniae
a
Vancomycin-resistant enterococci (VRE) can remain viable on environmental surfaces for weeks. An antiseptic soap such as chlorhexidine is needed to kill these bacteria.
- How does the transmission of HIV occur?
a. Most commonly as a result of sexual contact
b. In all infants born to women with HIV infection
c. Only when there is a large viral load in the blood
d. Frequently in health care workers with needle-stick exposures
d
Rationale: Unprotected sexual contact (semen, vaginal secretions, or blood) with a human immunodeficiency virus (HIV)–infected partner is the most common mode of HIV transmission.
- Which is the common physiological change after HIV infection?
a. The virus replicates mainly in B lymphocytes before spreading to CD4+ T cells in lymph nodes.
b. The immune system is impaired predominantly by infection and destruction of CD4+ T cells.
c. Infection of monocytes may occur, but these cells are destroyed by antibodies produced by oligodendrocytes.
d. A long period develops during which the virus is not found in the blood and there is little viral replication.
c
Rationale: Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of CD4+ T cells (i.e., T helper cells or CD4+ T lymphocytes).
- Which of the following statements is false?
a. Infection with HIV results in a chronic disease with acute exacerbations.
b. Untreated HIV infection can remain in the early chronic stage for a decade or more.
c. Late-stage infection is often called acquired immunodeficiency syndrome (AIDS).
d. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low.
a, b, c
Rationale: The typical course of untreated HIV infection follows a predictable pattern; however, disease progression is highly individualized, and treatment can significantly alter this pattern. Late chronic infection is another term for acquired immunodeficiency syndrome (AIDS). The median interval between untreated HIV infection and a diagnosis of AIDS is about 11 years.
- When is a diagnosis of AIDS made?
a. When an HIV-infected client has a CD4+ T cell count below 200/μL
b. When an HIV-infected client has an increasing amount of HIV in the blood
c. When an HIV-infected client has a reversal of the CD4:CD8 ratio to less than 2:1
d. When an HIV-infected client has oral hairy leukoplakia, an infection caused by Epstein-Barr virus
a
Rationale: AIDS is diagnosed when an individual with HIV meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/L. Other criteria are listed in Table 15-9.
- What does screening for HIV infection generally involve?
a. Laboratory analysis of blood to detect HIV antigen
b. Electrophoretic analysis of HIV antigen in plasma
c. Laboratory analysis of blood to detect HIV antibodies
d. Analysis of lymph tissues for the presence of HIV RNA
c
Rationale: The most useful screening tests for HIV detect HIV-specific antibodies.
