NR 507 Final Exam Study Guide / NR507 Final Exam Study Guide( NEW, 2024 ,V1 ): Chamberlain, Study Guides, Projects, Research of Nursing

Download NR 507 Final Exam Study Guide / NR507 Final Exam Study Guide( NEW, 2024 ,V1 ): Chamberlain and more Study Guides, Projects, Research Nursing in PDF only on Docsity!

NR 507 Final Exam Study Guide & possible questions

1. Types of immunity ch 7 & 8 a. Innate- natural epithelial barrier and inflammation the make innate resistance and protection pg. 191 Innate immunity includes two lines of defense: Natural barriers and inflammation. i. Natural barriers- physical, mechanical, and biochemical barriers at the body’s surfaces ii. Inflamation- associated with infection usually initiates an adaptive process that results in a long-term and very effective immunity to the infecting microorganism, referred to a adaptive, acquired or specific immunity. Use of the Epithelial cells with no memory function involved. b. Adaptive/ acquired- immune response or immunity, after innate and inflammation, Third line of defense, initiated when innate immune system signals the cells of adaptive immunity. There is a delay between primary exposure to antigen and maximum response, however there is immediate action against secondary exposure. Response is specific toward antigen. Involves T lymphocytes, B Lymphocytes, macrophages, and dentric cells. Specific immunologic memory by T and B lymphocytes i. Active (Acquired) -after natural exposure to an antigen or after immunization pg. 227 ii. Passive (Acquired)- preformed antibodies or t lymphocytes are transferred rom a donor to the recipient, maternal to fetus, or bone marrow transplant pg. 227 Questions  What type of immunity is produced when an immunoglobulin crosses the placenta?  Passive-aquired immunity  The mucosal secretions of the cervix secrete which immunoglobulin?  IgA  A student nurse asks the clinician which cells are most primary in a patient's immunity. What is the clinician's best answer?  Lymphocytes.  A nurse recalls humoral immunity is generated through the process of:  producing antibodies.  While taking a health history, if a person has resistance to a disease from natural exposure to an antigen, how would the nurse document this form of immunity?  Active acquired  What type of immunity will the nurse expect in an individual who is given a vaccine?  Active acquired immunity  A new mother asks the nurse about immunity of her newborn as she is breastfeeding. The nurse's response should include a discussion on which type of immunity?

 Passive  The nurse has been explaining to a student nurse about the different types of immunity. Which response indicates that the student nurse has a good understanding of adaptive immunity?  Both the humoral and cell-mediated immunity develop memory cells  Cancer cells and virus-infected body cells can be killed before activation of adaptive immunity by  natural killer cells  (^) The primary immune response ________.  (^) has a lag period while B cells proliferate and differentiate into plasma cells  Which of the following is true about the number of binding sites per functional antibody unit?  IgM contains 10 binding sites.  Which cell of the immune system is absolutely required for an adaptive immune response?  Helper T cell  The adaptive immune system involves three major cell types: antigen-presenting cells, T cells, which constitute cell- mediated immunity, and B cells, which govern humoral immunity.  The nurse understands that the function of IgG is as what?  A bond with target cells and a promoter of phagocytosis  The nurse understands that which type of immunity is the longest acting?  Natural active  Natural killer cells are specialized lymphocytes that are one of the major parts of which immunity?  Innate

2. Alveolar ventilation/perfusion- pg. 1239 Ch 34 Effective gas exchange depends on an approximately even distribution of gas (ventilation) and blood (perfusion) in all portion s of the lungs. The lungs are suspended from the hila in the thoracic cavity. When the individual is in an upright position, gravity pulls the lungs down toward the diaphragm and compresses their lower portions or bases. a. Ratio between the amount of air getting into the alveoli and the amount of blood being sent to the lungs. Questions  A consequence of alveolar hypoxia is: Pulmonary artery vasoconstriction  The pressure required to inflate an alveolus is inversely related to: Alveolus radius

 The nurse is describing the movement of blood into and out of the capillary beds of the lungs to the body organs and tissues. What term should the nurse use to describe this process? Perfusion  A pulmonologist is discussing the base of the lungs with staff. Which information should be included? At the base of the lungs: Arterial perfusion pressure exceeds alveolar gas pressure When the pulmonologist discusses the condition in which a series of alveoli in the left lower lo  be receive adequate ventilation but do not have adequate perfusion, which statement indicates the nurse understands this condition? When this occurs in a patient it is called: Alveolar dead space  Which of the following conditions should the nurse monitor for in a patient with hypoventilation? hypercapnia  A nurse is describing the pathophysiology of emphysema. Which information should the nurse include? Emphysema results in: the destruction of alveolar septa and air trapping

3. Dermatologic conditions and terminology ch. 46 pg. 1620, a. macules- freckles, flat moles, change in color, less than1 cm, b. nevi- moles pg. 1641, c. pityriasis rosea- benign self-limiting inflammatory disorder that occurs in young adults, with seasonal peaks spring and fall. Harmful in pregnancy. Associated with a virus, starts with a herald patch, circular. Salmon pink, and demarcated, usually on the trunk, acyclovir and erythromycin, and corticosteroid creams for itching. Should go away within a few months. d. Papule - An elevated, firm, circumscribed area less than 1 cm in diameter, Wart (verruca), elevated moles, lichen planus, fibroma, insect bite e. Patch - A flat, nonpalpable, irregular-shaped macule more than 1 cm in diameter, Vitiligo, port-wine stains, mongolian spots, café-au-lait spots f. Plaque- Elevated, firm, and rough lesion with flat top surface greater than 1 cm in diameter, Psoriasis, seborrheic and actinic keratosis g. Wheal - Elevated, irregular-shaped area of cutaneous edema; solid, transient; variable diameter, Insect bites, urticaria, allergic reaction h. Nodule- Elevated, firm, circumscribed lesion; deeper in dermis than a papule; 1- cm in diameter, Erythema nodosum, lipomas i. Tumor- Elevated, solid lesion; may be clearly demarcated; deeper in dermis; greater than 2 cm in diameter, Neoplasms, benign tumor, lipoma, neurofibroma, hemangioma

j. Vesicle- Elevated, circumscribed, superficial, does not extend into dermis; filled with serous fluid; less than 1 cm in diameter, Varicella (chickenpox), herpes zoster (shingles), herpes simplex k. Bulla - Vesicle greater than 1 cm in diameter, Blister, pemphigus vulgaris l. Pustule- Elevated, superficial lesion; similar to a vesicle but filled with purulent fluid, Impetigo, acne m. Cyst - Elevated, circumscribed, encapsulated lesion; in dermis or subcutaneous layer; filled with liquid or semisolid material, Sebaceous cyst, cystic acne n. Telangiectasia - Fine (0.5-1.0 mm), irregular red lines produced by capillary dilation; can be associated with acne rosacea (face), venous hypertension (spider veins in legs), systemic sclerosis, or developmental abnormalities (port-wine birthmarks), Telangiectasia in rosacea Questions  (^) The physician instructs a mother to take her child out in the sun for approximately an hour or until the skin turns red (not sunburned). This is a common medical treatment for  Pityriasis Rosea  The patient has a rash on her back that began about 10 days ago with a raised, scaly border and a pink center. Now she has similar eruptions on both sides of her back. From these signs, the nurse would determine the rash to be  Pityriasis Rosea  A 28-year-old client comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. Physical examination reveals that the pattern of eruption is like a Christmas tree and that various erythematous papules and macules are on the cleavage lines of the back. Based on this description, what is the most likely diagnosis?  Pityriasis rosea  The nurse's assessment shows that the patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. In the documentation the nurse would chart this as a  Papule  While waiting to see the physician, a patient shows the nurse skin areas that are flat, nonpalpable, and have had a change of color. The nurse recognizes that the patient is demonstrating what?  macule  A young student comes to the school nurse and shows the nurse a mosquito bite. As the nurse expects, the bite is elevated and has serous fluid contained in the dermis. How would the nurse classify this lesion?  A wheal is a primary skin lesion that is elevated and has fluid contained in the dermis

4. Croup- pg. 1294-1296 Croup illness can be divided into two categories

a. Acute laryngotracheobronchitisi b. Spasmodic croup c. Viral, barking cough, winter and spring months, usually affects children 6 mo to 3 yrs, peak at 2 years old, stridor, and fever, 2-5 days. human parainfluenza viruses (HPIVs), RSV, viruses are airborne. Rest, humidity, and lots of fluids. Acute laryngotracheobronchitis Questions  The 3-year-old child is seen in the local clinic for croup. The child's parents ask the nurse what to do for the child at home to alleviate symptoms. Which suggestions by the nurse is most appropriate? "Stand with your child in front of an open freezer"  The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate what condition? Complete obstruction  The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C (98.6° F). The nurse suspects mild croup and should recommend which intervention? Provide fluids that the child likes and use comfort measures.  A 3-year-old child woke up in the middle of the night with a croupy cough and inspiratory stridor. The parents bring the child to the emergency department, but by the time they arrive, the cough is gone, and the stridor has resolved. What can the nurse teach the parents with regard to this type of croup? A cool mist vaporizer at the bedside can help prevent this type of croup.

5. Types of anemia pg. 982-1102 C. 28 reduction of the total number of erythrocytes in the circulating blood or a decrease in the quality or quantity of hemoglobin. Anemias commonly result from impaired erythrocyte production, blood loss, increases erythrocyte destruction, or a combination of these three factors. a. Pernicious Anemia (PA)- The most common type of megaloblastic anemia, is caused by vitamin B12 deficiency, which is often associated with the end stage of type A chronic atrophic gastritis. b. Macrocytic-normochromic anemia- large abnormally shaped erythrocytes but normal hemoglobin concentrations (Pernicious- lack of B12, abnormal RNA and DNA synthesis and early cell death, folate deficiency- lack of folate for erythropoiesis premature cell death) c. Microcytic-hypochromic anemia- Small abnormally shaped erythrocytes and reduced hemoglobin concentration (Iron deficiency- lack of Fe for hemoglobin production, insufficient hemo, sideroblastic- dysfunctional iron uptake by erythroblasts and defective porphyrin and heme synthesis, thalassemia- impaired synthesis of alpha and beta chain of hemoglobin, phagocytosis of abnormal erythroblasts in the marrow) d. Normocytic-normochromic anemia- normal size, normal hemo concentration (aplastic- insufficient erythropoiesis, posthemorrhagic- blood lost, hemolytic-

premature destruction of mature erythrocytes in the circulation, sickle cell- abnormal hemo synthesis, abnormal cell shape with damage, lysis and phagocytosis, anemia of chronic disease- abnormal demand for new erythrocytes ) Questions  Continued therapy of pernicious anemia (PA) generally last how long?  The rest of one’s life  Which of the following describes how the body compensates for anemia  Increasing rate and depth of breathing  What is the primary cause of the symptoms of polycythemia vera? Increased blood viscosity  What is the treatment of choice for pernicious anemia (PA)?  Vitamin B12 by injection  What is the function of erythrocytes?  Tissue oxygenation  The nurse is collecting data on a patient with suspected pernicious anemia. Which of these signs or symptoms would the nurse expect to find for this patient? Glossitis  Megaloblastic anemia is a result of insufficient folic acid or vitamin B12, affecting which of the following? Rapidly turning over cells  A patient with anemia who is given iron salts could expect to show a therapeutic increase in hematocrit within 6 to 10 months.  After reviewing the major types of anemia, students demonstrate understanding of the info when they identify which of the following as an example of a hemolytic anemia? Sickle cell anemia  Which of the following would the nurse encourage a pt. to consume to prevent folic acid anemia? broccoli milk liver  A pt. is receiving ferrous sulfate as treatment for iron deficiency anemia. After teaching the pt., which statement indicates the need for additional teaching? "i need to take an antacid with the pill to prevent an upset stomach"  An 82-year-old client has pernicious anemia and has been receiving treatment for several years. What is she lacking that results in pernicious anemia? Intrinsic factor  An 82-year-old client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults? Dementia  A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

Pallor, tachycardia, and a sore tongue  During the review of morning lab values on a patient complaining of severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which of the following findings? Low ferritin level  You are caring for an 87-year-old female who has been admitted to your unit with iron-deficiency anemia. What would you suspect? Blood loss from the gastrointestinal or genitourinary tract  A patient is brought to the ER complaining of fatigue, large amounts of bruising on the extremities, and abdominal pain localized in the left upper quadrant. A health history reveals the patient has been treated three times in the past 2 months for a sore throat. Lab tests indicate severe anemia, significant neutropenia, and thrombocytopenia. Based on the symptoms, with what could the patient be diagnosed? Aplastic anemia.  The nurse understands which is the most common type of anemia? Iron-deficiency anemia  THE NURSE CARES FOR A CLIENT DIAGNOSED WITH POLYCYTHEMIA VERA. THE NURSE EXPECTS TO MAKE WHICH OBSERVATION? DARK, FLUSHED FACE  A 57-year-old male presents to his primary care provider for red face, hands, feet, ears, and headache and drowsiness. A blood smear reveals an increased number of erythrocytes, indicating:  Polycythemia vera (PV)  The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings?  intrinsic factor absent  Which type of anemia is associated with normochromic and macrocytic red blood cells (RBCs)? Megaloblastic anemia  What is the genetic disorder that is associated with excessive red blood cell (RBC) destruction? Sickle cell anemia  A patient's anemia is described as having erythrocytes that demonstrate anisocytosis. The nurse would recognize the erythrocytes would be: Able to assume various shapes  A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following types of anemia will the nurse see documented on the chart? Pernicious anemia  A 70-year-old male is brought to the emergency department, where he dies shortly thereafter. Autopsy reveals polycythemia vera (PV). His death was most likely the result of: Cerebral thrombosis  A 67-year-old male was diagnosed with polycythemia vera (PV) but refused treatment. His condition is at risk for converting to: Acute myeloid leukemia

 A 20-year-old female undergoes lab testing for anemia. Results show high iron, bilirubin, and transferrin and low hemoglobin and hematocrit. Which of the following is the most likely diagnosis to be documented on the chart? Sideroblastic anemia  How should the nurse prepare a patient who is to receive a Schilling test for pernicious anemia? Administer radioactive cobalamin and measure its excretion in the urine.  A 67-year-old female has chronic gastrointestinal bleeding. A nurse recalls the primary cause of her anemia is: Iron deficiency  A 34-year-old male presents in the emergency room with extreme fatigue and shortness of breath. His skin and sclera appear to have a yellowish discoloration. These assessment findings are consistent with which type of anemia? Hemolytic anemia  A nurse is preparing to teach the staff about aplastic anemia. Which information should the nurse include? Aplastic anemia is caused by: Stem cell deficiency  A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following assessment findings would most likely occur? Bronze colored skin

6. The inflammatory process upon injury pg. 195 Ch. 7- blood vessel dilation, increased vascular permeability and leakage of fluid out of the vessel, WBC adherence to the inner walls of the vessel and their migration through vessel walls to the site of injury. Figure 7- 2 Questions  A nurse will be teaching about body defenses. Which information should the nurse include? The body's first line of defense against microorganisms is comprised of the: skin and mucous membranes.  While planning care for a patient with an infection, which principle should the nurse remember? In contrast with the inflammatory response, the immune response recognizes specific invaders  The nurse assesses clients for the cardinal signs of inflammation. Redness, edema and warmth  A client has a leg wound that is in the second stage of the inflammatory response. For what manifestation does the nurse assess? Purulent drainage  Which event in the inflammatory response would the nurse correlate with the action of bradykinin? Pain  A nurse recalls if the surface barriers such as the skin or mucus membranes are breached, the second line of defense in innate immunity is the: inflammatory response.

 A nurse is teaching about inflammation. Which information should be included? The first vascular response in inflammation is: vasoconstriction.  When a nurse is asked about the purpose of vasodilation and increased vascular permeability during inflammation, how should the nurse respond? To bring white blood cells to the area of injury  When a nurse is asked which of the following inhibits the inflammatory response, what is the nurse's best answer? Eosinophils  While reviewing lab results, which finding would alert the nurse to a patient with acute inflammation? Increased sedimentation rate  While planning care for a patient with acute inflammation and pain, which principle should the nurse remember? The inflammatory chemicals responsible for inducing pain during inflammation are: Bradykinin and prostaglandins  While planning care for a patient, which principle should the nurse use to guide care? The first line of defense against pathogens is the: skin and mucous membranes.

7. GI symptoms resulting in heart burn- pg. 1429 Ch 41. Clinical manifestations of GERD are acid regurgitation, chronic cough, asthma attacks, and laryngitis. Upper abd pain, within 1 hr of eating, worse lying down, chest pain, Questions  The nurse is performing an admission assessment on a client diagnosed with gastroesophageal reflux disease (GERD). Which signs and symptoms would indicate GERD? Pyrosis, water brash, and flatulence  The male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? What have you done to alleviate the heartburn?  The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with reflux. The nurse should ask the client about the presence of which of the following symptoms? Heartburn.  Which of the following symptoms is common with a hiatal hernia? Esophageal reflux
8. Pulmonary terminology - Ch 35 pg. 1248 a. dyspnea- SOB, or a feeling of breathlessness and increased respiratory effort. b. Orthopnea- postural SOB, or dyspnea when a person lies flat c. Paroxysmal nocturnal dyspnea- occurs at night and requires the person to sit or stand for relief. Questions

 A patient has dyspnea upon lying down. What term should the nurse use to document this finding? orthopnea  A patient has dyspnea. Which of the following typical findings will the nurse observe during the assessment? difficulty breathing  A 10-year-old female develops pneumonia. Physical exam reveals subcostal and intercostal retractions. She reports that breathing is difficult and she feels she cannot get enough air. What term should the nurse use to document this condition? Dyspnea

9. Complications of gastric resection surgery-pg 1440 Weight loss often follows gastric resection but stabilizes within 3 months. Food may be poorly absorbed because the stomach is less able to mix, churn, and break down food particles. a. Signs and symptoms- Abdominal pain, vomiting, diarrhea, and malabsorption of fats. dumping syndrome- occurs when food, especially sugar, moves from your stomach into your small bowel too quickly b. A BMI of 25 to 29.9 kg/m2 is considered a grade 1 (overweight) classification. A BMI of 18.5 to 24.9 kg/m2 is considered normal range, whereas 30 to 39.9 kg/m is a grade 2 (severe overweight) classification, and a BMI higher than 40 kg/m2 is considered grade 3 (morbidly overweight). Questions  The World Health Organization (WHO) defines grade 1 (overweight) as a BMI of: 25 to 29.  Care for the postoperative client after gastric resection should focus on which of the following problems? Nutritional needs  Which of the following complications of gastric resection should the nurse teach the client to watch for? Dumping syndrome
10. Chicken pox- pg. 1660, ch. 47. disease of early childhood, highly contagious virus, vesicles, trunk, scalp, or face, transmission 5-6 days after first vesicle, contagious 1 day prior to rash, contagious for 7-10 days, Questions  An older adult client tells the nurse that her granddaughter has chickenpox. The client is afraid to visit because she is afraid of getting shingles from her granddaughter. What is the nurse's best response? "If you already had chickenpox, you can safely visit your granddaughter."  The nurse counsels the parent of a 12 year old diagnosed with chickenpox about when the child can return to school. The nurse determines that teaching is effective if the parent makes which statement? My child can return to school when the lesions are crusted  A parent calls the clinic to report that the child has been exposed to varicella zoster (chicken pox). The nurse should tell the parent that the incubation period for chickenpox is which length of time?

2-3 weeks

11. Maternal immune system- pg. 1059. ABO incompatibility. The human neonate has a poorly developed immune response, particularly in the production of IgG. The fetus and neonate are protected in utero and during the first few postnatal months by maternalantibodies that are actively transported across the placenta. After birth the maternal antibodies disappear by 10 months of age. Questions  If a patient has a typical secondary immunity response, which antibody is most predominant IgG  A mother is diagnosed with a bacterial infection and is worried that her newborn infant will also contract the infection. Which of the following statements should the nurse include in the teaching plan for the client? Your newborn has maternal IgG antibodies that were transferred through the placenta before birth, providing some protection from infection.  The laboratory finds IgA in a sample of cord blood from a newborn infant. This finding is important because it signifies what? Fetal reaction to exposure to an intrauterine infection  A woman experiences a viral infection while pregnant. Which of the following types of immunity does an infant have at birth against this infection? Passive  The nurse is aware that the only class of immunoglobulins to cross the placenta is: IgG
12. Candidiasis exacerbation- pg. 1638 yeast like fungus in moist areas, caused by C. albicans occurring on the skin, on mucous membranes, and in the gastrointestinal tract. a. Results in vaginitis or oropharyngeal infection (thrush). b. Risk factors are impaired immune system, decreased bacterial flora, antibiotic therapy. Questions  Samantha Velasquez, a 24-year-old preschool teacher, is being seen by the physician in the primary care group where you practice nursing. Over the past 2 months, she has been receiving treatment for multiple ear infections and tonsillitis. She reports a curdy white vaginal discharge and burning with urination. What is the most likely cause of her symptoms? Candida albicans  A nurse is counseling a client about risk factors for yeast infections. Which of the following should the nurse list as a risk factor for an overgrowth of Candida albicans? Impaired immune system Decrease in amount of bacterial flora Antibiotic therapy
13. Carbuncles- pg. 1635 collection of infected hair follicles occurring usually at the back of the neck, upper back, and lateral thighs Questions

 Localized skin infection involving hair follicles: carbuncles

14. Terms such as hypochromic, macrocytic, microcytic, etc pg. 983 Ch 28 a. Hypochromic- lower hemoglobin content b. Macrocytic- higher erythrocyte volume c. Microcytic- lower erythrocyte volume d. Hyperchromic- higher hemoglobin concentration e. Normochromic- hemo concentration normal f. Normocytic- normal erythrocyte concentration Questions  A patient is admitted with a 2-month history of fatigue, shortness of breath, pallor, and dizziness. The patient is diagnosed with idiopathic autoimmune hemolytic anemia. On reviewing the laboratory results, the nurse notes which of the following that confirms this diagnosis? RBC fragments  the client is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which of the following complete blood count (CBC) results is characteristic of her type of anemia? Hemoglobin 8 g/dL  A patient's anemia is described as having erythrocytes that demonstrate anisocytosis. The nurse would recognize the erythrocytes would be: Able to assume various shapes  A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has? Hemolytic anemia  A 45-year-old male is diagnosed with macrocytic, normochromic anemia. The nurse suspects the most likely cause of this condition is: Defective DNA synthesis  A patient has microcytic hypochromic anemia. Which of the following pathogenic mechanisms may cause anemia in this patient? Decreased erythrocyte life span, Failure of mechanisms of compensatory erythropoiesis, Disturbances of the iron cycle
15. Antibodies pg. 229- a. IgG- most abundant 80-85%, protective activity, Four subclasses IgG1, IgG2, IgG3 and IgG b. IgA- normal body secretions highest amount here, found in blood, saliva, brest milk, and respiratory secretions. c. IgM- largest first produced in initial or primary response, early in neonatal life, d. IgD- low concentrations, bcell antigen receptor, e. IgE least concentrated- mediator of allergic responses Questions  What characteristic do atopic individuals have that make them genetically predisposed to develop allergies? Greater quantities of IgE

 The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulins?  IgE  A patient has a parasite. Which lab report should the nurse check to help confirm this diagnosis? IgE  If a patient has a typical secondary immune response, which antibody is most predominant? IgG.  A mother is breastfeeding her infant. The nurse realizes the main antibody being transferred from the mother to her infant through the breast milk is: IgA  When a person has a life-threatening hypersensitivity/allergic reaction to bee stings, which lab result will the nurse check IgE  Which immunity principle should guide the nurse when caring for an infant? At birth, IgG levels in newborn infants are: near adult levels.  While reviewing a patients' immunological profile, which immunoglobulin does the nurse expect to see elevated if the patient has a type I hypersensitivity reaction? IgE  The antibody that becomes bound to mast cells and basophils and causes the cells to release histamine and other chemicals is IgE  In teaching a patient with SLE about the disorder, the nurse knows that the pathophysiology of SLE includes the production of a variety of autoantibodies directed against components of the cell nucleus  A patient is diagnosed with a hypersensitivity reaction mediated by immunoglobulin E (IgE) antibodies. For which type of hypersensitivity reaction should the nurse plan care for this patient? Type 12

16. Skin cancer- pg. 1641. basal carcinoma and squamous cell carcinoma most common a. Basal cell-on the surface of the epithelial tumor of the skin originating from undifferentiated basal or germinative cells. Tumor grows upward and katerally or downward to the dermal-epidermal junction. Has depressed center and rolled borders. b. Squamous cell-Tumor of the epidermis and the second most commone human cancer. Affects the head, neck and the hands. Questions  nurse is participating in a health promotion campaign that has the goal of improving outcomes related to skin cancer in the community. What action has the greatest potential to achieve this goal? Educating participants about the early signs and symptoms of skin cancer

 A patient complains that he has basal cell carcinoma and is going to die. The nurse knows that Basal cell carcinoma is rarely terminal.  Which patient would be more likely to have the highest risk of developing malignant melanoma? A fair-skinned woman who uses a tanning booth regularly  In teaching a patient with basal cell carcinoma (BCC) about this disorder, the nurse considers that which statement about this skin cancer is true? BCC is the most common type of skin cancer.  When studying the incidence of skin cancers in a population, a nurse finds that a greater number of skin cancer cases have been reported in white patients than in African American patients. What could be the most likely cause of such an occurrence? Whites have less melanin content in their skin than African Americans.  The nurse, preparing educational information about types of skin cancer, recalls that which type has a higher risk for metastasis and poor prognosis unless it is treated early? Melanoma

17. Parts of the heart in terms of function Ch. 31 pg. 1085 a. The heart wall has three layers- the epicardium, myocardium, and endocardium- and is enclosed in a double-walled membranous sac, the pericardium. b. Epicardium-provides a smooth surface that allows the heart to contract and relax within the pericardium with a minimal amount of friction. c. Myocardium- composed of connective tissue and a layer of squamous cells called the endocardium. d. Endocardial lining-endothelium that lines all the arteries, veins, and capillaries of the body, creating a continuous, closed circulatory system. e. pericardium- double wall membrane around the heart, prevents displacement of the heart, physical barrier and contracts pain receptors and mechanoreceptors that elicit changes to BP and heart rate Questions  Pressure in the left ventricle must exceed pressure in which structure before the left ventricle can eject blood? Aorta  How does the nurse differentiate a pleural friction rub from a pericardial friction rub? Have the patient hold his or her breath; if the rub persists, it is pericardial  A 52-year-old female is admitted to the cardiac unit with a diagnosis of pericarditis. She asks the nurse to explain where the infection is. In providing an accurate description, the nurse states that the pericardium is: A membranous sac that encloses the heart  A nurse is explaining the function of the heart. Which is a correct response by the nurse? A function of the pericardium is to: Provide a barrier against extracardial infections.

 A nurse is teaching about the heart. Which information should the nurse include? The chamber of the heart that generates the highest pressure is the: Left ventricle  A nurse recalls the chamber that receives blood from the systemic circulation is the: Right atrium  Which statement indicates the nurse understands blood flow? Oxygenated blood flows through the: Pulmonary veins  While viewing the electrocardiogram, the nurse recalls the bundle of His conducts action potentials down the atrioventricular septum.

18. Congenital heart defects- pg. 1198 leading cause of death in the first year of life minus prematurity. Etiology usually unknown. If pulmonary vascular resistance has fallen, then infants with PDA will characteristically have a continuous machine-type murmur best heard at the left upper sternal border throughout systole and diastole. If the PDA is significant, then the infant also will have bounding pulses, an active precordium, a thrill on palpation, and signs and symptoms of pulmonary overcirculation. The presentations of the other congenital heart defects are not consistent with the described the symptoms. Questions  An infant has a continuous machine-type murmur best heard at the left upper sternal boarder throughout systole and diastole, as well as a bounding pulse and a thrill on palpation. These clinical findings are consistent with which congenital heart defect? Patent ductus arteriousus (PDA)  The comment made by a parent of a 1-month-old that would alert the nurse about the presence of a congenital heart defect is: "He tires out during feedings."  The nurse explains that which congenital cardiac defect(s) cause(s) increased pulmonary blood flow? Atrial septal defects (ASDs), Patent ductus arteriosus, Ventricular septal defects (VSDs)  A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as patent ductus arteriosus or PDA.  Congenital heart defects (CHDs) are classified by which of the following? Defects with increased pulmonary blood flow, Defects with decreased pulmonary blood flow., Mixed defects, Obstructive defects.  Hypoxic spells in the infant with a congenital heart defect (CHD) can cause which of the following? Polycythemia, Blood clots, Cerebrovascular accident, Developmental delays, Brain damage.  A 6-month-old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood flow called tetalology of fallot or TOF  While looking through the chart of an infant with a congenital heart defect (CHD) of decreased pulmonary blood flow, the nurse would expect which laboratory finding?

Polycythemia.  In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs? Coarctation of the aorta (COA).

19. Urinary tract obstruction- pg. 1341 Ch 38- interference with the flow of urine at any site along the urinary tract. Obstruction may be anatomic or functional. It impedes flow proximal to the obstruction, dilates structures distal to the obstruction, increases risk for infections, and compromises renal functions. Questions  Kidney stones in the upper part of the ureter would produce pain referred to which anatomical area? Umbilicus  A patient is admitted with lower urinary tract obstruction and stasis. Which of the following is the primary intervention? Urinary catheterization  The nursing students have learned in class that causes of urinary obstruction and urinary incontinence include which of the following? Impairment of neurologic control of bladder function, Structural changes in the urethra & Structural changes in the bladder  An elderly client has just been admitted for urinary tract obstruction and retention. Which of the following are symptoms that the nurse should suspect this client to demonstrate? Bladder distention• Hesitancy • Small stream • Overflow incontinence  Which of the following individuals are displaying identified risk factors for the development of lower urinary tract obstruction? 68 year-old man who has been diagnosed with benign prostatic hyperplasia (BPH). - 30 year-old woman who has been diagnosed with gonorrhea. - 74 year-old woman who has developed a lower bowel obstruction following several weeks of chronic constipation. - 20 year-old man who has spina bifida and consequent impaired mobility.  If obstructed, which component of the urination system would cause peristaltic waves? Ureters  The nurse is planning care for a patient with a urinary tract obstruction. The nurse includes assessment for which of the following possible complications? Increased blood pressure
20. GI symptoms of conditions Ch. 41 a. pyloric stenosis- an obstruction of the pyloric sphincter caused by hypertrophy of the sphincter muscle. Occurs in infants between the ages of either 1 and 2 weeks or 3 and 4 months. Symptoms include fullness, nausea, epigatric pain pg. 1430

b. hiatal hernia- Can be sliding, paraesophangeal, or mixed. asymptomatic, associated with GERd symptoms, dysphagia, epigastric pain pg 1430 c. ulcerative colitis-Inflammatory bowel disease that causes ulceration, abscess formation, and necrosis of the colonic and rectal mucosa. Symptoms include watery diahhrea, bleeding and cramping, urge to poop, dehydration, weight loss, anemia, and fever pg. 1442 Questions  The nurse explains to the patient with gastroesophageal reflux disease that this disorder:  often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the espophagus  The client with a hiatal hernia chronically experiences heartburn following meals. The nurse plans to teach the client to avoid which action because it is contraindicated with hiatal hernia? Lying recumbent following meals  The client is diagnosed with an acute exacerbation of ulcerative colitis. Which inter- vention should the nurse implement? Monitor intravenous fluids.  Which of the following factors would most likely contribute to the development of a client's hiatal hernia?

. Obesity, pregnancy, age, trauma , smoking  The client asks the nurse whether he will need surgery to correct his hiatal hernia. Which reply by the nurse would be most accurate? "Hiatal hernia symptoms can usually be successfully managed with diet modifications, medications, and lifestyle changes."  A client with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The client asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond? "It is usually ready to be closed in about 1 to 2 months."  The nurse is caring for a patient with fulminant ulcerative colitis. The nurse would be alert for which of the following symptoms associated with severe fulminant ulcerative colitis? Toxic megacolon, 10 or more bowel movements per day, Bowel perforation,Anemia  Which of the following clients would the nurse suspect to have pyloric stenosis? A 5-week-old infant with projectile vomiting  A 3-week-old infant diagnosed with pyloric stenosis is admitted to the hospital during a vomiting episode. Which action by the nurse is most appropriate? position on right side  Which of the following conditions can cause a hiatal hernia? Weakness of the diaphragmic muscle

21. Skin cancer lesions-pg. 1642 superficial, nodular, sclerosis/morpheaform, can be pigmented or non pigmented.

Questions  A patient is scheduled for Mohs' microscopic surgery for removal of a skin cancer lesion on his forehead. The nurse knows to prepare the patient by explaining that this type of surgery requires: Removal of the tumor, layer by layer  A patient with squamous cell carcinoma has been scheduled for treatment of this malignancy. The nurse should anticipate that treatment for this type of cancer will primarily consist of what intervention? Surgical excision  A patient has just been told that he has malignant melanoma. The nurse caring for this patient should anticipate that the patient will undergo what treatment? Wide excision  A patient with a suspected malignant melanoma is referred to the dermatology clinic. The nurse knows to facilitate what diagnostic test to rule out a skin malignancy? A skin biopsy is done to rule out malignancies of skin lesions.  While performing an initial assessment of a patient admitted with appendicitis, the nurse observes an elevated blue-black lesion on the patient's ear. The nurse knows that this lesion is consistent with what type of skin cancer? Malignant melanoma

22. Gastroesophageal reflux disease- pg, 1429 Ch 41- Regurgitation of chyme from the stomach into the esophagus, causing esophagitis from repeated exposure to acids and enzymes in the regurgitated gastric contents. reflux of acid and pepsin from stomach, to the esophagus, risk factors obesity, hiatal hernia, drugs or chemicals Questions  A patient comes to the clinic complaining of heartburn after meals and is diagnosed with gastroesophageal reflux disease. Which dietary instructions should the nurse include in teaching?  The patient should limit caffeinated foods and drinks, decrease fat intake, eat four to six small meals per day, and remain upright for 1 to 2 hours after each meal.  Which of the following terms refers to the symptom of gastroesophageal reflux disease (GERD) which is characterized by a burning sensation in the esophagus? Pyrosis  A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate? Gastroesophageal reflux disease  A 50-year-old male is experiencing reflux of chyme from the stomach. He is diagnosed with gastroesophageal reflux. This condition is caused by: Loss of muscle tone at the lower esophageal sphincter
23. Hypersensitivity reaction- pg. 263An altered immunologic response to an antigen that results in disease or damage to the host. a. Type 1 IgE mediated- immediate, products of mast cells, most common for allergies

b. Type 2 tissue specific- immediate, specific cell or tissue being the target of an immune response, IgG and IgM, macrophages in tissues, complement participated frequently, autoimmune thrombocytopenia purpura, graves, hemolytic anemia c. Type 3 immune complex- immediate, IgG and IgM, Neutrophils, completment does participate, systemic lupus d. Type 4 Cell mediated reaction- delayed, no IGs, Lymphocytes, macrohphages, No complement, Poison Ivy and metal sensitivities Questions  Tissue damage caused by the deposition of circulation immune complexes containing an antibody against the host DNA is the cause of which diseases?  Systemic lupus erythematosus  A patient had a hypersensitivity reaction involving the formation of antibodies against tissue-specific antigen. Which type of hypersensitivity reaction did the patient experience? type II  A patient has a hypersensitivity reaction mediated by Tc cells. A nurse recalls that this type of hypersensitivity reaction is called: type IV  The patient is having a reaction to a bee sting. Which type of hypersensitivity reaction does the nurse expect to see documented in the patient's chart? type I  Which type of hypersensitivity reaction is characterized by the formation of antigen- antibody complexes deposited on vessel walls or in extravascular tissues? type III  The nurse is interpreting a patient's positive tuberculin skin test. This finding is consistent with which type of hypersensitivity reaction? type IV  A nurse is conducting a physical assessment on a patient. Which symptoms would indicate to the nurse that the patient experienced a type I hypersensitivity reaction? Rhinorrhea, watery eyes, and pruritus  (^) The nurse is concerned about the patient having tissue injury during type II hypersensitivity. Which mechanism provides the rationale for this concern? Autoantibody mediation of neutrophils with detoxication of their toxic substances contributes to tissue injury.  (^) The patient has a type IV hypersensitivity reaction. In planning care for this patient, the nurse should consider that this type of reaction is related to: delayed response  (^) Type IV hypersensitivity tissue effects are initiated by: the stimulation of cytotoxic T cells.  (^) Allergy is the most common type of immediate hypersensitivity.

24. Congenital intrinsic factor deficiency- pg. 988, genetic disorder tat demonstrates an autosomal recessive inheritance pattern, transporter required for absorption of dietary Vit b12, essential for maturation and DNA synthesis in erythrocytes. Results in Percutaneous anemia (CH. 28)

Questions  A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following types of anemia will the nurse see documented on the chart? Pernicious anemia  A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia). How should the nurse respond when the patient asks what causes pernicious anemia? A decrease in intrinsic factor is the most likely cause.

25. Acid base imbalance- Pg. 126 Ch. 3, See charts. Pathophysiologic changes in the concentration of hydrogen ion or base in the blood lead to acid-base imbalances. a. Respiratory acidosis- is a condition that occurs when the lungs can't remove enough of the carbon dioxide (CO2) produced by the body b. Respiratory alkalosis- is a medical condition in which increased respiration elevates the blood pH beyond the normal range (7.35–7.45) with a concurrent reduction in arterial levels of carbon dioxide c. Metabolic acidosis- is primary reduction in bicarbonate (HCO 3 −), typically with compensatory reduction in carbon dioxide partial pressure (Pco 2 ); pH may be markedly low or slightly subnormal d. Metabolic alkalosis- is a metabolic condition in which the pH of tissue is elevated beyond the normal range (7.35–7.45). Questions  While checking arterial blood gas results, a nurse finds respiratory acidosis. What does the nurse suspect is occurring in the patient? reduced tidal volumes  A 20-year-old male is in acute pain. An arterial blood gas reveals decreased carbon dioxide (CO2 ) levels. Which of the following does the nurse suspect is the most likely cause? Hyperventilation  The nurse is assessing a client with suspected respiratory acidosis. Which assessment items are priority for the nurse to collect? Rate and depth of respirations, Skin color and temperature, Appearance of the optic nerve o The nurse is administering sodium bicarbonate to the client with respiratory acidosis. The nurse understands that which is the primary goal of treatment for this client? Removing excess acids in blood  The student nurse is assisting in the care for a client with acute respiratory acidosis. The nurse explains to the student nurse that the client's blood pH initially falls in the development of acute respiratory acidosis because of which process? Hypoventilation
26. Acute epiglottitis- pg. 1296-1297, 25% of cases seen in children, 2-6 years old, high fever, irritable, sore throat, inspiratory stridor and respiratory distress. Do not assess airway. Thought to be the cause of Haemophilus infulenzae type B (Hib). Life- threatening emergency. Questions

 A caregiver calls the pediatrician's office and reports to the nurse that her 4-year-old, who was fine the previous day, complained of a sore throat early in the morning and now has a temperature of 102.6° F (39.2° C). The caregiver has tried to get the child to nap but the child gets panicky, immediately sits back up, and leans forward with her mouth open and tongue out when the caregiver encourages her to lie down. The nurse suspects the child has which of the following conditions? Epiglottitis  The caregivers of a child report that their child had a cold and complained of a sore throat. When interviewed further they report that the child has a high fever, is very anxious, and is breathing by sitting up and leaning forward with the mouth open and the tongue out. The nurse recognizes these symptoms as those seen with which of the following disorders? Epiglottitis  The nurse is caring for a 5-year-old girl who shows signs and symptoms of epiglottitis. The nurse recognizes a common complication of the disorder is for the child to: be at risk for respiratory distress.  A 5-year-old child is brought to the clinic by his father because the child developed a high fever over the past 2 to 3 hours. The nurse suspects epiglottitis based on which signs and symptoms?

- Difficulty speaking • Drooling • Sitting with neck extended • Frightened appearance

27. Types of gastric ulcers-pg. 1438 Ch. 41. Typically the cause of an Helicobacter pylori infection. signs and symptoms, characteristics- Stomach ulcers, 55-65 years old, ¼ as common as duodenal ulcers, pain is gone after eating a. Stress ulcer acute form of peptic ulcer b. Ischemic ulcer lack of o2 to an area after another medical event c. Cushing ulcer severe head trauma Questions  The nurse understands that most cases of peptic ulcer disease is caused by what? Infection with Helicobacter pylori  Which are pathologic changes associated with acute gastritis? Vascular congestion, severe mucosal damage and ruptured vessels, edema & acute inflammatory cell infiltration  Which are possible complications of chronic gastritis? Pernicious anemia, gastric cancer, decreased gastric acid secretion, peptic ulcer disease  What is true regarding duodenal ulcers? More common in men than in women, typically develop between the ages of 30 and 55. More common in individuals who smoke  A client with a duodenal ulcer asks the nurse why antibiotics are a part of the treatment plan. Which information should the nurse include in the explanation? Most duodenal ulcers are caused by Helicobacter pylori.

 When obtaining a nursing history from a client with suspected gastric ulcer, which signs and symptoms should the nurse assess? Vomiting, weight loss & anemia

28. Lupus- pg. 1632- inflammatory, autoimmune, systemic disease with cutaneous manifestations, lupus nephritis is a complication affecting renal component pg. 1358 a. Systemic Lupus Erythematosus (SLE)- is a chronic, multisystem, inflammatory disease and is one of the most common, complex, and serious of the autoimmune disorders. SLE is characterized by the production of a large variety of autoantibodies against nucleic acids, erythrocytes, coagulation proteins, phospholipids, lymphocytes, platelets, and many other self-components. The most characteristic autoantibodies produced in SLE are against nucleic acids (e.g., single-stranded deoxyribonucleic acid [DNA], double-stranded DNA), histones, ribonucleoproteins, and other nuclear materials. Questions  A 26-year-old woman has been diagnosed with early systemic lupus erythematosus (SLE) involving her joints. In teaching the patient about the disease, the nurse includes the information that SLE is a(n): Disorder of immune function, but it is extremely variable in its course, and there is no way to predict its progression.  A patient with polyarthralgia with joint swelling and pain is being evaluated for systemic lupus erythematosus (SLE). The nurse knows that the serum test result that is the most specific for SLE is the presence of: Anti-Smith antibody (Anti-Sm).  A client is suspected of having systemic lupus erythematous. The nurse monitors the client, knowing that which of the following is one of the initial characteristic sign of systemic lupus erythematous? Rash on the face across the bridge of the nose  The nurse is assigned to care for a client with systemic lupus erythematosus (SLE). The nurse plans care knowing that this disorder is: An inflammatory disease of collagen contained in connective tissue
29. General adaptation syndrome- pg. 339- Manifestation of a nonspecific response to noxious stimuli in three stages 1. Alarm stage or reaction, CNS is aroused and the bodys defenses are mobilized, 2. Resistance or adaptation- mobilization contributes to fight or flight, 3. Stage of exhaustion where continuous stress causes the progressive breakdown of compensatory mechanisms and homeostatis. Questions  Increased blood volume, heart rate, blood glucose levels, and increased mental alertness occur during which part of the general adaptation syndrome (GAS)? ALARM STAGE  While assessing a person for effects of the general adaptation syndrome, the nurse should be aware that: Glucose level increases during the alarm reaction stage  Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is not successful?  Flight or fight

 A client with cancer has recovered from tumor removal surgery and is now stable while undergoing a chemotherapy treatment schedule. She is not having any symptoms at this time and is continuing to work and enjoy social events. What stage of the general adaptation syndrome (GAS) would you place her in? Resistance

30. Ventilation/perfusion ratio- V/Q ratio, normal is 0.8 pg. 1240 The relationship between ventilation and perfusion is expressed as a ratio called the ventilation-perfusion ratio, or ˙V/˙Q.The normal ˙V/˙Q ratio is 0.8. This is the amount by which perfusion exceeds ventilation under normal conditions. Questions  How dose chest wall compliance in an infant differ from that of an adult?  An adult’s chest wall compliance is lower than an infant’s  A nurse recalls a high ventilation/perfusion (V/Q) ratio can be caused by: obstruction to pulmonary blood flow.  A nurse is teaching about the functions of the pulmonary system. Which information should the nurse include? One of the functions of the pulmonary system is the: Exchange of gases between the environment and blood  Which of the following terms should the nurse use when there is a balance between outward recoil of the chest wall and inward recoil of lungs at rest? Functional residual capacity (FRC) is reached.  The nurse is describing the receptors in the lung that decrease ventilatory rate and volume when stimulated. Which receptors is the nurse discussing? Stretch receptors  While reviewing the results of the pulmonary functions test, the nurse is aware that the maximum amount of gas that can be displaced (expired) from the lung is called: Vital capacity (VC)  While auscultating a patient's lungs, a nurse recalls the alveoli in the apexes of the lungs are larger than alveoli in the bases.
31. Bile salt deficiencies- pg. 1440- poor intestinal absorption of fats, and fat-soluble vitamins (A, D, E and K), loss via stool and decreased plasma proteins, a- night blindness, d- decrease in calcium with bone demineralization, k- prolongs PT, leading to bruising and petechiae, E- testicular atrophy and neo effects in children, treatment is increasing medium-chain triglycerides in the diet, coconut oil a. Vitamin A deficiency-result of night blindness b. Vitamin D deficiency-results in decreased calcium absorption with bone demineralization, bone pain, and fractures. c. Vitamin K deficiency-prolongs prothrombin time, leading to spontaneous development of purpura and petechiae. d. Vitamin E deficiency-uncertain effects but may cause testicular atrophy and neurologic defects in children. Questions  Clinical manifestations of bile salt deficiencies are related to poor absorption of: Fats and fat-soluble vitamins

32. Clonal selection- pg. 226, selection, proliferation and differentiation of individual T and B cells with receptors for a specific antigen. Questions  When a nurse uses the term clonal diversity, what is the nurse describing? The ability of the population of lymphocytes to recognize almost any antigenic molecule  Which of the following statements indicates the nurse has a good understanding of clonal selection? Lymphocytes that can recognize and react to a specific antigen proliferate.  Cytokines that stimulate bone marrow pluripotent stem and progenitor or precursor cells to produce large numbers of platelets, erythrocytes, lymphocytes, neutrophils, and monocytes, eosinophils, basophils, and dendritic cells are known as: Colony-stimulating factors (CSFs)
33. Obstructive sleep apnea- pg. 504, ch 16, disorder of sleep characterized by airway obstruction and episodes of apnea with snoring, Questions  When assessing a client for obstructive sleep apnea (OSA), the nurse understands the most common symptom is: Excessive daytime sleepiness  The nurse is caring for a client who is experiencing sleep apnea. The nurse understands that which elements occur when a client has sleep apnea? Carbon dioxide retention will cause the pH to decrease and respiratory acidosis to develop.  The patient is diagnosed with obstructive sleep apnea. Identify the symptoms you would expect the client to exhibit. Daytime fatigue, Snoring  The nurse knows the following risk factors are associated with obstructive sleep apnea (OSA) Deviated septum, recessed chin, alcohol use, large neck
34. Large bowel obstruction- pg 1432, s/sx are hypo gastric pain, and abdominal distention. The most common causes of large bowel obstructions are colorectal cancer, volvulus, and strictures related to diverticulitis. Questions  The nurse is taking a health history of a newly admitted patient with a diagnosis Rule/out bowel obstruction. Which of the following is the priority question to ask the patient? When was the last time you moved your bowels  You are admitting a patient with complaints of abdominal pain, nausea, and vomiting. A bowel obstruction is suspected. You assess this patient for which anticipated primary acid-base imbalance if the obstruction is high in the intestine? Metabolic alkalosis
35. Vaginal candidiasis- pg. 1638 table, heat, moisture, occlusive clothing, pregnancy, systemic antibiotics, DM, SEX, itching, white, watery, or creamy discharge, swollen

vaginal and labial membranes with erosions, lesions on anus and groin, treated with miconazole cream, nystatin tablets, clotrimazole tablets or cream, loose cotton clothing Questions  During a vaginal examination of a 38-year-old woman, the nurse notices that the vulva and vagina are erythematous and edematous with thick, white, curdlike discharge adhering to the vaginal walls. The woman reports intense pruritus and thick white discharge from her vagina. The nurse knows that these history and physical examination findings are most consistent with which of these conditions? Candidiasis  A patient undergoing treatment for vaginitis is also counseled about measures to prevent its recurrence. Which patient statement best indicates effective counseling? "My sexual partner will also need to be treated."  A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis? Use of corticosteroids  A nurse who works in a gynecologist's office frequently cares for patients who are diagnosed with vulvovaginal candidiasis. The nurse should teach the patients how to manage and treat the most common symptom of: Vulvar pruritus.  A patient with HIV has recently completed a 7-day regimen of use of antibiotics. She reports vaginal itching and irritation. In addition, the patient has a white, cottage cheese-like vaginal discharge. Which of the following is the patient most likely suffering? Vulvovaginal candidiasis  A woman complains to the nurse that she has developed a yeast infection. The woman does not understand how she could get a yeast infection since she has been on antibiotics for a urinary tract infection. What is the rationale for this patient's complaint? Destroying one type of resident flora (bacteria) can allow over proliferation of another competing type (yeast).

36. Folate deficiency- pg. 989 common problem in chronic alcoholic populations. Ethanol alters folic acid homeostasis by decreasing intestinal absorption of folate, increases liver retention of folate, and increases the loss of folate through urinary and fecal excretion. Implicated in the development of cancers, specifically colorectal cancers. More common than vitamin B12 deficiency and occurs more rapidly. vitamins for RNA and DNA synthesis within maturing erythrocyte, dietary intake results in anemia Questions  The nurse recognizes that patients with which disorder are at greatest risk for folate deficiency? Alcoholism  The nurse teaches the breastfeeding patient that the recommended daily allowance for folic acid is what? 500 mcg