NR 507 WEEK 6 MIDTERM ADVANCED PATHOPHYSIOLOGY, Exams of Nursing

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Type 2 Hypersensitivity Reactions Type 2 (Cytotoxic) hypersensitivity reactions are mediated by: IgE or IgG. IgG or IgM. IgA or IgE. IgM or IgA. Hives Hives (urticaria) are an example of a: Type 1 hypersensitivity reaction. Type 2 hypersensitivity reaction. Type 3 hypersensitivity reaction. Type 4 hypersensitivity reaction. Contact Dermatitis Allergic contact dermatitis is an example of Type 4 hypersensitivity reaction. Anaphylaxis Anaphylaxis is a type 1 hypersensitivity reaction.

Immune System Which of the following are considered the “first responders” of the innate immune system? T-cells. IgM. Neutrophils. Eosinophils. Hypersensitivity Reactions In summary, we reviewed the four types of hypersensitivity reactions. For each type, the pathophysiology was reviewed. Clinical applications were provided that illustrated the need to understand the underlying pathophysiology in order to explain the symptoms and select appropriate treatment. The table below compares and reviews each type of allergic reaction that we discussed. Can you match the proper type to the mechanism, example, and pathophysiology? Type Mechanism Example Pathology

Mast cell degranulation. Autoantibodies specific for thyroid tissue impairs the receptors for TSH. Complement damages RBC membrane causing cell lysis. Antigen/Antibody complexes attack the RBC. Urticaria Which of the following assessment findings would be expected in a patient who presents with urticaria? Decreased thyroid-stimulating hormone level. Thrombocytopenia. Leukopenia. Eosinophilia. Type IV Mediations Type IV cytotoxic hypersensitivity reactions are mediated by: IgM. IgA. T-Cells. B-Cells. Hay Fever Which of the following is the underlying pathology for hay fever? Mast cell degranulation.

Activation of complement. Formation of autoantibodies. Destruction by T-cells. Primary Immunodeficiency Which is true about a primary immunodeficiency? It is the result of multiple gene defects. It is the result of a single gene defect. It appears primarily in older adults. It is usually inherited. Secondary Immunodeficiency Malnutrition is a predominant cause of secondary immune deficiencies worldwide. Primary Immunodeficiency An example of a primary immunodeficiency is: Chronic Granulomatous Disease. Pneumonia. Sinus Infection. Human Immunodeficiency virus. Autoimmune Disease Which of the following is an autoimmune disease? Osteoarthritis.

Lung cancer x Primary Immunodeficiency Select the best statement below that describes a primary immunodeficiency: Are less common and occur due to a defect on the development of the immune system. Cancer Cancer is a secondary immunodeficiency. True Sinusitis Sinusitis is considered a primary immunodeficiency. False Human Immunodeficiency Virus A patient with human immunodeficiency virus (HIV) was admitted to the acute care facility with difficulty breathing. He is diagnosed with Pneumocytis carinii. Pneumocystis carinii an example of: A secondary immune disease. A primary immune disease.

Systemic Lupus Erythematosus The Antinuclear Antibody (ANA) test is positive in 90% of patients diagnosed with Systemic Lupus Erythematosus (SLE). Systemic Lupus Erythematosus Which of the following findings can be used to diagnose Systemic Lupus Erythematosus (SLE)? Fever. Low back pain. Headache. Facial rash confined to the cheeks. Sjogren’s Syndrome The major immune system change associated with Sjogren’s Syndrome is: Autoantibodies and auto-reactive T-cells and B-cells against joint-associated antigens. Autoantibodies and auto-reactive T-cells against brain antigens. Autoantibodies and auto-active T-cells against DNA and nucleoprotein antigens. Autoantibodies and auto-reactive T-cells against apoptotic cells. Normal Immune Function Which of the following can depress a person’s normal immune function? Psychological Stress

A butterfly rash across the facial cheeks. Swollen metacarpophalangeal joints. Inflammation in the salivary and lacrimal glands. Anemia Anemia can be caused from which of the following? (Select all that apply.) Impaired red blood cell production. Increased red blood cell destruction. Excessive blood loss. Microcytic Anemias Which of the following microcytic anemias is characterized by hyperchromic RBCs? Folate deficiency. B12 deficiency. Hereditary spherocytosis. Iron deficiency. Anemia Which of the following is not a clinical characteristic of anemia? Fatigue

Bradycardia Dyspnea Pallor Red Blood Cells Which of the following indices measures the average size of red blood cells? Mean Corpuscular Volume (MCV). Mean Corpuscular Hemoglobin Concentration (MCHC). Hemoglobin (Hb). Reticulocyte count. Macrocytic Anemia Which of the following is a type of macrocytic anemia? Thalassemia. Anemia of chronic disease. Iron-deficiency anemia. Vitamin B-12 deficiency. Anemia Identification of the type of anemia involves an examination of size of the RBC only. False Normocytic-Normochromic

Iron deficiency anemia. Anemia of inflammation and chronic disease. The treatment of iron deficiency anemia includes: Blood transfusions. Iron supplementation. Ferritin replacement. Vitamin-B-12 replacement. Which of the following would indicate that the patient’s iron stores are depleted? Total RBC count. Vitamin-B-12 level. Total iron binding capacity. Ferritin level. Microcytic Anemias As you should recall, microcytic anemias result from conditions whereby the RBCs are small (MCV<80 dL). These anemias can also be classified according to their color, or amount of hemoglobin per RBC (MCHC). Identify if each item below is Microcytic Hypochromic, Microcytic Normochromic, or Microcytic Hyperchromic. Microcytic Hypochromic Microcytic Normochromic Microcytic Hyperchromic Iron deficiency x

Anemia of inflammation and chronic disease x Sideroblastic x Hereditary spherocytosis x Thalassemia x Iron Stores When iron stores are depleted, the cell’s mitochondria are still able to utilize iron effectively due to compensatory mechanisms. False Iron Deficiency Anemia Although less common, transferrin deficiencies and mitochondrial defects can lead to iron deficiency anemia. True Transferrin Deficiency A transferrin deficiency will most likely result in: Hemolytic anemia.

Plays a major role in the maturing of RBCs. Allows for the production of erythropoietin. Folate Deficiency One of the common precipitating factors of folate deficiency is alcohol abuse. True Non-Megaloblastic Anemia A non-megaloblastic anemia would be caused by Liver disease Pernicious Anemia In a patient with pernicious anemia, folate lab values can be normal or low? Folate Deficiency Which of the following lab values will be low in a patient with folate deficiency? MCV. Ferritin. Reticulocyte count. MCHC. Folate Deficiency Which of the following lab values are normal for the patient with folate deficiency?

Ferritin. MCV. Folate. Reticulocyte count. Pernicious Anemia Which of the following will be elevated in a patient with pernicious anemia? MCV. Reticulocyte count. Serum B-12. Folate. Blood Transfusion An individual who has received an incorrect blood transfusion will exhibit signs of: Pernicious anemia. Polycythemia vera. Hemolytic anemia. Aplastic anemia. Hemolytic Anemia In hemolytic anemia, the destruction of lysis of RBCs is due to:

Post-Hemorrhagic Anemia The MCHC count lab value will be normal in post-hemorrhagic anemia Coronary Artery Disease Which of the following is a non-modifiable risk factor for Coronary Artery Disease? Family history. Hyperlipidemia. Obesity. Hypertension. Coronary Artery Disease In Coronary Artery Disease (CAD), pumping ability of the heart can be impaired due to the deprivation of oxygen. True Coronary Artery Disease Which of the following is a modifiable risk factor for Coronary Artery Disease (CAD)? Age. Family history. Menopause. Obesity. Blood Flow

Oxygenated blood is transported from the lungs to the heart via the pulmonary veins. Coronary Artery Disease Coronary artery disease (CAD) is mainly the result of: Longstanding atherosclerosis. Hyperlipidemia. A history of myocardial infarction. Hypertension. Coronary Artery Disease Identify whether each risk factor of coronary artery disease is modifiable or non-modifiable. Modifiable Non-Modifiable Dyslipidemia x Diabetes Mellitus x Age x Obesity x Male x Family History x