NURSING-507 Final Study Guide with Practice Questions and Answers A+ Assured Success Lates, Exams of Nursing

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NURSING-507 Final Study Guide with Practice Questions

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Types of immunity chi 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. Inflammation- associated with infection usually initiates an adaptive process that results in a long-term and very effective immunity to the infecting microorganism, referred to an 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 centric 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 from 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-acquired 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 tumoral 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 tumoral 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?
• IgG 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 tumoral 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 rose- 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 plan us, fibroma, insect bite e. Patch - A flat, no palpable, irregular-shaped macule more than 1 cm in diameter, Vitiligo, port-wine stains, mongolian spots, café-au-laity spots f. Plaque- Elevated, firm, and rough lesion with flat top surface greater than 1 cm in diameter, Psoriasis, seborrhea and actinic keratosis g. Wheal - Elevated, irregular-shaped area of cutaneous edema; solid, transient; variable diameter, Insect bites, urticarial, allergic reaction

h. Nodule- Elevated, firm, circumscribed lesion; deeper in dermis than a papule; 1-2 cm in diameter, Erythema nod sum, lymphomas i. Tumor- Elevated, solid lesion; may be clearly demarcated; deeper in dermis; greater than 2 cm in diameter, Neoplasms, benign tumor, lima, 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 Roseau ➢ 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 Roseau ➢ 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 rose ➢ 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, no palpable, 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 Para influenza 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 are 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. Anemia’s 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, foliate deficiency- lack of foliate 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 hem, sideroblastic- dysfunctional iron uptake by erythroblasts and defective porphyria and home 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 hem concentration (aplastic- insufficient erythropoiesis, post hemorrhagic- blood lost, hemolytic- premature destruction of mature erythrocytes in the circulation, sickle cell- abnormal hem synthesis, abnormal cell shape with damage, lies 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? Glossaries ➢ 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 bad pain, within 1 hr of eating, worse lying down, chest pain, Questions

➢ The nurse is performing an admission assessment on a client diagnosed with gastro esophageal reflux disease (GERD). Which signs and symptoms would indicate GERD? Pyros is, 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/m2 are a grade 2 (severe overweight) classifications, 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 29.9 ➢ 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 maternal antibodies 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 immunoglobulin’s to cross the placenta is: IgG

12. Candidiasis exacerbation- pg. 1638 yeast like fungus in moist areas, caused by C. albinos occurring on the skin, on mucous membranes, and in the gastrointestinal tract. a. Results in vaginitis or pharyngeal infection (thrush). b. Risk factors are impaired immune system, decreased bacterial flora, and 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 albinos ➢ 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 albinos? 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. Hyper chromic- higher hemoglobin concentration e. Normochromic- hem 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?