Nursing5315 Exam Questions with Answers Tested and Verified Solutions best Preparation 202, Exams of Nursing

Download Nursing5315 Exam Questions with Answers Tested and Verified Solutions best Preparation 202 and more Exams Nursing in PDF only on Docsity! Nursing5315 Exam Questions with Answers Tested and Verified Solutions best Preparation 2023/2024 Updates 1. Which action is a purpose of the inflammatory process? 1. To provide specific responses toward antigens 2. To lyse cell membranes of microorganisms 3. To prevent infection of the injured tissue 4. To create immunity against subsequent tissue injury 3. Which secretion is a first line of defense against pathogen invasion that involves antibacterial and antifungal fatty acids, as well as lactic acid? 1. Optic tears 2. Oral saliva 3. Sweat gland perspiration 4. Sebaceous gland sebum in skin 4. Which bacterium grows in the intestines after prolonged antibiotic therapy? 1. Lactobacillus 2. Candida albicans 3. Clostridium difficile 4. Helicobacter pylori 5. What causes the edema that occurs during the inflammatory process? 5. Vasodilation of blood vessels 6. Increased capillary permeability 7. Endothelial cell expansion 8. Emigration of neutrophils 6. What process causes heat and redness to occur during the inflammatory process? 1. Vasodilation of blood vessels 2. Platelet aggregation 3. Decreased capillary permeability 4. Endothelial cell contraction 7. What does activation of the classical pathway begin with? 1. Viruses 2. Antigen-antibody complexes 3. Mast cells 4. Macrophages 8. What plasma protein system forms a fibrinous meshwork at an inflamed site? 1. Complement 2. Coagulation 3. Kinin 9. Which component of the plasma protein system tags pathogenic microorganisms for destruction by neutrophils and macrophages? 1. Complement cascade – c3b opsonization 2. Coagulation system 3. Kinin system 4. Immune system What is the vascular effect of histamine released from mast cells? 1. Platelet adhesion 2. Initiation of the clotting cascade 3. Vasodilation What is the inflammatory effect of nitric oxide (NO)? 1. Increases capillary permeability, and causes pain 2. Increases neutrophil chemotaxis and platelet aggregation 3. Causes smooth muscle contraction and fever 4. Decreases mast cell function, and decreases platelet aggregation 21. What is the correct sequence in phagocytosis? 1. Engulfment, recognition, fusion, destruction 2. Fusion, engulfment, recognition, destruction 3. Recognition, engulfment, fusion, destruction 4. Engulfment, fusion, recognition, destruction (1) opsonization, or recognition, of the target and adherence of the phagocyte to it; (2) engulfment, or ingestion or endocytosis, and the formation of phagosome; (3) fusion with lysosomal granules within the phagocyte (phagolysosome); and (4) destruction of the target. 22. When considering white blood cell differentials, acute inflammatory reactions are related to elevations of which leukocyte? a. Monocytes b. Eosinophils c. Neutrophils d. Basophils ANS: C Only neutrophils are the predominant phagocytes in the early inflammatory site, arriving within 6 to 12 hours after the initial injury, they ingest (phagocytose) bacteria, dead cells, and cellular debris at the inflammatory site. 23. In the later stages of an inflammatory response, which phagocytic cell is predominant? a. Neutrophils b. Monocytes c. Chemokines d. Eosinophils 24. In regulating vascular mediators released from mast cells, the role of eosinophils is to release what? 1. Arylsulfatase B, which stimulates the formation of B lymphocytes 2. Histaminase, which limits the effects of histamine during acute inflammation 3. Lysosomal enzymes, which activate mast cell degranulation during acute inflammation 4. Immunoglobulin E, which defends the body against parasites 25. What is a role of a natural killer (NK) cells? 1. Initiation of the complement cascade 2. Elimination of malignant cells 3. Binding tightly to antigens 4. Proliferation after immunization with antigen 26. Which cytokine is produced and released from virally infected host cells? 1. IL-1 2. IL-10 3. TNF-𝛼 4. IFN - -𝛼 Only interferons (IFNs) are produced and released by virally infected cells in response to viral double-stranded ribonucleic acid (RNA). 27. Which manifestation of inflammation is systemic? 1. Formation of exudates 2. Fever and leukocytosis 3. Redness and heat 4. Pain and edema 28. The acute inflammatory response is characterized by fever that is produced by the hypothalamus being affected by what? 1. Endogenous pyrogens 2. Bacterial endotoxin 3. Antigen-antibody complexes 4. Exogenous pyrogens 33. Many neonates have a transient depressed inflammatory response as a result of which Complement and chemotaxis are deficient. 34. During phagocytosis, what is occurring during the step referred to as opsonization? 1. Phagocytes recognize and adhere to the bacteria. 2. Microorganisms are ingested. 3. Microorganisms are killed and digested. 4. An intracellular phagocytic vacuole is formed. 35. Fusion is the step of phagocytosis during which what happens? 1. Microorganisms are killed and digested. 2. An intracellular phagocytic vacuole is formed. 3. Lysosomal granules enter the phagocyte. 4. Microorganisms are ingested. 36. What does the phagosome step result in during the process of endocytosis? 1. Microorganisms are ingested. 2. Microorganisms are killed and digested. 3. Phagocytes recognize and adhere to bacteria. 4. An intracellular phagocytic vacuole is formed. 39. Which cell is the body’s primary defense against parasite invasion? 1. Eosinophil 2. Neutrophils 3. T lymphocytes 4. B lymphocytes 13. An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody? a. IgG b. IgM c. IgA d. IgE 14. How does the B-cell receptor (BCR) complex function? 1. Communicating information about the antigen to the helper T cell 2. Secreting chemical signals to communicate between cells 3. Releasing histamine and other vasoactive substances 4. Communicating information about the antigen to the cell nucleus 8. A student asks why some vaccinations are given orally and some are given by injection. What response by the professor is best? 1. Different routes allow the speed of onset of the antigen to be varied, with the intravenous route being the fastest. 2. Some individuals appear to be unable to respond to an antigen by a specific route, thus requiring the availability of different routes for the same antigen. 3. Antigen-presenting cells are highly specialized and thus require stimulation by different routes. 4. Each route stimulates a different lymphocyte-containing tissue, resulting in different types of cellular and humoral immunity. What type of immunity is produced when an immunoglobulin crosses the placenta? 1. Passive-acquired immunity 2. Active-acquired immunity 3. Passive-innate immunity 4. Active-innate immunity 2. In which structure does B lymphocytes mature and undergo changes that commit them to becoming B cells? 1. Thymus gland 2. Regional lymph nodes 3. Bone marrow 4. Spleen 3. What is the term for the process during which lymphoid stem cells migrate and change into either immunocompetent T cells or immunocompetent B cells? 1. Clonal diversity 2. Clonal differentiation 3. Clonal selection 4. Clonal competence 4. Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen? 1. Passive-acquired immunity 2. Active-acquired immunity 3. Passive-innate immunity 4. Active-innate immunity Which characteristic is the most important determinant of immunogenicity when considering the antigen? a. Size b. Foreignness c. Complexity d. Quantity 16. A student is confused about the process of the generation of clonal diversity. What description by the professor is best? 1. It involves antigens that select those lymphocytes with compatible receptors. 2. It allows the differentiation of cells into antibody-secreting plasma cells or mature Peyer patches. 3. It takes place in the primary (central) lymphoid organs. 4. It causes antigens to expand and diversify their populations. ANS: C This process occurs in central lymphoid organs—the thymus gland for T cells and bone marrow for B cells. Which is an example of an endogenous antigen? 1. Yeast 2. Cancer cells 3. Bacteria 4. Fungus ANS: B Of the options provided, endogenous antigens include only those uniquely produced by cancerous cells. 18. Which cytokine is needed for the maturation of a functional helper T cell? a. IL-1 b. IL-2 c. IL-4 d. IL-12 19. Th2 cells produce IL-4 and suppress which cells? 1. B lymphocytes 2. Cytotoxic T lymphocytes 3. Th1 cells 4. Memory T lymphocytes 20. Which statement is believed to be true concerning Th1 cells? 1. Th1 cells are induced by antigens derived from allergens. 2. They are induced by antigens derived from cancer cells. 3. Th1 cells produce IL-4, IL-5, IL-6, and IL-13. 4. They assist in the development of humoral immunity. 21. Which statement is believed to be true concerning Th2 cells? 1. Th2 cells are induced by antigens derived from allergens. 2. They are induced by antigens derived from cancer cells. 4. T helper ANS: C CD8 cells recognize antigens presented by the major histocompatibility complex (MHC) class I molecules and become mediators of cell-mediated immunity and directly kill other cells (T- cytotoxic cells). CD4 cells tend to recognize antigen presented by MHC class II molecules and develop into helpers in the later clonal selection process (T-helper cells). 30. Which cell has a role in developing cell-mediated immunity? a. Th1 b. CD4 c. CD8 d. Th2 31. A student asks the healthcare professional how the aging process of the T-cell activity affects older adults. What response by the professional is best? a. Poor heat regulation abilities 2. Tendency to develop various infections 3. Likelihood of experiencing benign skin lesions ANS: C T-cell activity is deficient in older adults, and a shift in the balance of T-cell subsets is observed. These changes may result in increased susceptibility to infection. The other issues are not related to T-cell activity. 32. Which statement is true regarding maternal antibodies provided to the neonate? 1. The antibodies enter into the fetal circulation by means of active transport. 2. The antibodies are transferred to the fetus via the lymphatic system. 3. The antibodies are directly related to the mother’s nutritional intake. 4. The antibodies reach protective levels after approximately 6 months of age. 33. Antibodies that are associated with mucosal immune system, such as immunoglobulins, function to prevent which type of infections? 1. Infections that attack the respiratory system 2. Infections that tend to be chronic in nature 3. Infections likely to be resistant to antibiotics 4. Infections that focus on epithelial surfaces of the body 5. 34. Cytokines are vital to a cell’s ability to do which function? a. Excrete 6. b. Reproduce c. Metabolize d. Communicate 3. CD4 is a characteristic surface marker and a result of which of these? (Select all that apply.) 1. Activity in the primary lymphoid organs 2. Process of cellular differentiation 3. Alterations to T cells 4. Changes to B cells 5. Clonal selection 4. What are the necessary components of an adaptive immune response? (Select all that apply.) 1. Antigen 2. Gamma IgG 3. Lymphocyte surface receptors 4. Crystalline fragment 5. Antibody 1. How is hypersensitivity best defined? 1. A disturbance in the immunologic tolerance of self-antigens 2. An immunologic reaction of one person to the tissue of another person 3. An altered immunologic response to an antigen that results in disease 4. An undetectable immune response in the presence of antigens ANS: C Hypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the host. Autoimmunity is a disturbance in the immunologic tolerance of self- antigens. Alloimmunity is the immunologic reaction of one person to the tissue of another person. An immune deficiency of some type would cause undetectable immune response in the presence of antigens. 4. What are blood transfusion reactions an example of? a. Autoimmunity b. Alloimmunity c. Homoimmunity d. Hypersensitivity 5. During an IgE-mediated hypersensitivity reaction, which leukocyte is activated? 1. Neutrophils 2. Monocytes 3. Eosinophils 4. T lymphocytes 6. During an IgE-mediated hypersensitivity reaction, what causes bronchospasm? 1. Bronchial edema caused by the chemotactic factor of anaphylaxis 2. Bronchial edema caused by binding of the cytotropic antibody 3. Smooth muscle contraction caused by histamine bound to H1 receptors 4. Smooth muscle contraction caused by histamine bound to H2 receptors 8. What characteristic do atopic individuals have that make them genetically predisposed to develop allergies? 1. Greater quantities of histamine 2. More histamine receptors 3. Greater quantities of IgE 4. A deficiency in epinephrine ANS: C Atopic individuals tend to produce higher quantities of IgE and to have more crystalline fragment (Fc) receptors for IgE on their mast cells. Test Bank - Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th) 10. When mismatched blood is administered causing an ABO incompatibility, how are the erythrocytes destroyed? 1. Complement-mediated cell lysis 2. Phagocytosis by macrophages 3. Phagocytosis in the spleen 4. Natural killer cells 11. When antibodies are formed against red blood cell antigens of the Rh system, how are the blood cells destroyed? 1. Complement-mediated cell lysis 2. Phagocytosis by macrophages 3. Phagocytosis in the spleen 4. Neutrophil granules and toxic oxygen products 12. When soluble antigens from infectious agents enter circulation, what is tissue damage a result of? 1. Acute rejection is a cell-mediated immune response. 2. Acute rejection is usually a type III rejection. 3. Immunosuppressive drugs delay or lessen the intensity of an acute rejection. 4. Acute rejection is associated with the body’s response to an organ transplant. 5. Acute rejection is a response against unmatched human leukocyte antigens 2. What is the first stage in the infectious process? a. Invasion b. Colonization c. Spread d. Multiplication 3. Which type of microorganism reproduces on the skin? 1. Viruses 2. Bacteria and fungi 3. Protozoa and Rickettsiae 4. Mycoplasma 5. 4. Phagocytosis involves neutrophils actively attacking, engulfing, and destroying which microorganisms? a. Bacteria b. Fungi 6. c. Viruses 7. d. Yeasts 8. 5. Once they have penetrated the first line of defense, which microorganisms do natural killer (NK) cells actively attack? a. Bacteria b. Fungi 9. c. Viruses d. Mycoplasma 6. A student asks the healthcare professional to describe exotoxins. Which statement by the professional is best? 1. Exotoxins are contained in cell walls of gram-negative bacteria. 2. Exotoxins are released during the lysis of bacteria. 3. Exotoxins are able to initiate the complement and coagulation cascades. 4. Exotoxins are released during bacterial growth. 7. A healthcare professional student is learning about fungal infections. What information should the student use to help another student understand? 1. Fungal infections occur only on skin, hair, and nails. 2. Phagocytes and T lymphocytes control fungal infections. 3. Fungal infections release endotoxins. 4. Vaccines prevent fungal infections. 8. Cytokines are thought to cause fevers by stimulating the synthesis of which chemical mediator? a. Leukotriene b. Histamine c. Prostaglandin d. Bradykinin 9. Considering the hypothalamus, what is a fever produced by? 1. Endogenous pyrogens acting directly on the hypothalamus 2. Exogenous pyrogens acting directly on the hypothalamus 3. Immune complexes acting indirectly on the hypothalamus 4. Cytokines acting indirectly on the hypothalamus 10. A healthcare professional is conducting community education on vaccinations. Which statement about vaccines does the professional include in the presentation? 1. Most bacterial vaccines contain attenuated organisms. 2. Most viral vaccines are made by using dead organisms. 3. Vaccines require booster injections to maintain life-long protection. 4. Vaccines provide effective protection against most infections. 11. What are vaccines against viruses created from? 1. Killed organisms or extracts of antigens 2. Live organisms weakened to produce antigens 3. Purified toxins that have been chemically detoxified 4. Recombinant pathogenic protein 12. What does the student learn about HIV? 1. HIV only infects T-helper (Th) cells. 2. HIV is a retrovirus. 3. HIV carries genetic information in its DNA. 4. HIV has five identified strains. ANS: B HIV is a member of the retrovirus family, which carries genetic information in the form of two copies of RNA. The major immunologic finding in AIDS is the striking decrease in the number of CD4+ Th cells. The major surface receptor on the HIV virus binds to the CD4 molecule found mostly on the surface of T-helper cells. There appear to be two strains of HIV: HIV-1 and HIV- 2. 13. What is the role of reverse transcriptase in HIV infection? 1. Reverse transcriptase converts single-stranded DNA into double-stranded DNA. 2. It is needed to produce integrase. 3. It transports the RNA into the cell nucleus. 4. It converts RNA into double-stranded DNA. 14. After sexual transmission of HIV, how soon can lab results detect the infection? 1. 1 to 2 days 2. 4 to 10 days 3. 4 to 8 weeks 4. 2 to 4 months 15. Which cells are primary targets for HIV? 1. CD4+ Th cells only 2. CD4+ Th cells, macrophages, and dendritic cells 3. CD8-positive cytotoxic T (Tc) cells and plasma cells 4. CD8-positive Tc cells only 16. What area in the body may act as a reservoir in which HIV can be relatively protected from antiviral drugs? 1. Central nervous system 2. Bone marrow 3. Thymus gland 4. Lungs 1. Cytokines 2. Macrophages 3. Natural killer cells 4. Neutrophils 5. T lymphocytes 26. Which patient finding would lead the health care professional to assess the patient for inflammatory joint disease? 1. Unilateral joint involvement 2. Normal joint synovial fluid 3. Absence of synovial membrane inflammation 4. Systemic symptoms of inflammation ANS: D Inflammatory joint disease is characterized by systemic signs of inflammation (fever, leukocytosis, malaise, anorexia, hyperfibrinogenemia) and inflammatory damage or destruction in the synovial membrane or articular cartilage. Joint swelling tends to be symmetric. Joint synovial fluid will demonstrate hemorrhage, coagulation, and fibrin deposition. The synovial membranes are inflamed. 29. A patient has ankylosing spondylitis. Which description of this condition by the health care professional is most accurate? 1. Chronic inflammatory disease with stiffening and fusion of the spine and sacroiliac joints 2. Chronic systemic inflammatory disease that affects many tissues and organs 3. State of abnormal and excessive bone resorption and formation 4. Wide-spread and deep chronic muscle pain, fatigue, and tender points ANS: A Ankylosing spondylitis (spondyloarthritis) is a chronic, inflammatory joint disease characterized by stiffening and fusion (ankylosis) of the spine and sacroiliac joints. Rheumatoid arthritis is a chronic systemic inflammatory disease that affects multiple tissues and organs. 30. What is the primary pathologic alteration resulting from ankylosing spondylitis (AS)? 1. Inflammation of the bursa c. Inflammation of fibrocartilaginous joints of the vertebrae d. Inflammation of the small hand and feet bones 3. Which clinical manifestations are characteristic of rheumatoid arthritis? (Select all that apply.) a. Subcutaneous tissue crystals b. Anorexia c. Painful, stiffening of joints d. Edema of the wrists e. Fever 27. A newborn is diagnosed with osteomyelitis. What organism does the healthcare professional prepare to treat? 1. Staphylococcus aureus 2. Escherichia coli 3. Group B streptococcus 4. Bacillus anthracis 2. Which cells of the dermis release histamine and play a role in the hypersensitivity reactions of the skin? 1. Histiocytes 2. Fibroblasts 3. Mast cells 4. Macrophages 3. Which cells of the dermis secrete connective tissue matrix? 1. Macrophages 2. Mast cells 3. Fibroblasts 4. Histiocytes 10. In allergic contact dermatitis, which cells possess the antigens and present them to T cells? 1. Langerhans cells 2. Merkel cells 3. Keratinocytes 4. Macrophages 20. The student learns that which skin lesion is mediated by the immunoglobulin E (IgE)- stimulated release of histamine, bradykinin, or kallikrein from mast cells? 1. Dermatitis 2. Scleroderma 3. Urticaria 4. Cutaneous vasculitis The healthcare professional teaches a parent group that which organism causes thrush? 1. Staphylococcus 2. Streptococcus 3. Herpesvirus 4. Candida albicans 12. A professor explains to a class that the reason lymph nodes enlarge and become tender during infection is because of what reason? 1. B lymphocytes proliferate. 2. The nodes are inflamed. 3. The nodes fill with purulent exudate. 4. The nodes are not properly functioning. . A patient has chronic anemia associated with chronic renal failure. What substance does the healthcare professional tell the patient is needed to treat this anemia? 1. Iron 2. Erythropoietin 3. Cobalamin (vitamin B12) 4. Folate 17. What is the role of thromboxane A (TXA2) in the secretion stage of hemostasis? 1. Stimulates the synthesis of serotonin. 2. Promotes vasodilation. 3. Stimulates platelet aggregation. 4. Promotes formation of cyclooxygenase. Which of these is the role of nitric oxide (NO) in hemostasis? 1. Stimulates the release of fibrinogen to maintain the platelet plug. 2. Stimulates the release of clotting factors V and VII. 3. Causes vasoconstriction and stimulates platelet aggregation. 4. Controls platelet activation through in concert with prostacyclin. 19. The drug heparin acts in hemostasis by which processes? 1. Inhibiting thrombin and antithrombin III (AT-III) 2. Preventing the conversion of prothrombin to thrombin 3. Shortening the fibrin strands to retract the blood clot 4. Degrading the fibrin within blood clots 2. Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes 3. Lack of DNA to form sufficient quantities of erythrocytes, leukocytes, and thrombocytes 4. Lack of stem cells to form sufficient quantities of leukocytes ANS: B AA is a critical condition characterized by pancytopenia, which is a reduction or absence of all three blood cell types, resulting from the failure or suppression of bone marrow to produce adequate amounts of blood cells. It is not related to lack of DNA. PTS: 1 DIF: Cognitive Level: Remembering 19. A student asks the professor what the most common pathophysiologic process is that triggers aplastic anemia (AA). What response by the professor is most accurate? 1. Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells 2. Malignancy of the bone marrow in which unregulated proliferation of erythrocytes crowd out other blood cells 3. Autoimmune disease against hematopoiesis by activated immunoglobulins 4. Inherited genetic disorder with recessive X-linked transmission An allogenic bone marrow transplantation remains the preferred method for treating which anemia? 1. Polycythemia vera 2. Aplastic 3. Sideroblastic 4. Anemia of chronic disease (ACD) Shortened erythrocyte life span, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia? 1. Aplastic 2. Sideroblastic 3. Anemia of chronic disease d. Iron deficiency A patient has polycythemia vera and presents to the Emergency Department with plethora and neurological changes. The student asks the healthcare professional to explain the primary cause of these symptoms. What response by the professional is best? 1. Decreased erythrocyte count 2. Destruction of erythrocytes 3. Increased blood viscosity 4. Tissue destruction by macrophages 29. A patient has been hospitalized for a large deep vein thrombosis and states he is the third person in his family to have this condition in the last 2 years. What response by the healthcare professional is most appropriate? 1. “This condition is not transmitted genetically.” c. “Were they all men or both men and women?” d. “Familial thromboses tend to be very severe.” ANS: B Factor V Leiden results from a single nucleotide mutation of guanine to adenine at nucleotide 1691 (G1691A) and is the most common hereditary thrombophilia. It is autosomal dominant so would not be confined to one se 1. A healthcare professional is evaluating laboratory results for a patient who has disseminated intravascular coagulation (DIC). What results would the professional consider consistent with this condition? (Select all that apply.) 1. Elevated d-dimer 2. Elevated creatinine 3. Decreased protein C 4. Decreased lactate dehydrogenase 5. Increased pH . A healthcare professional is caring for five patients. Which one would the professional assess for disseminated intravascular coagulation (DIC) as the priority? (Select all that apply.) 1. Heat stroke 2. Severe pancreatitis 3. Term delivery 4. HELLP syndrome 5. Snake bite 2. A patient has been diagnosed with acute lymphocytic leukemia (ALL) and asks the healthcare professional to describe it. What description by the professional is most accurate? 1. ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. 2. In ALL, immature blasts cells replace normal myelocytic cells, megakaryocytes, and erythrocytes. 3. B cells fail to mature into plasma cells that synthesize immunoglobulins. 4. The translocation of genetic material from genes 9 and 22 create an abnormal, fused gene identified as BCR-ABL. 3. Which description is consistent with chronic myelogenous leukemia (CML)? 1. Defects exist in the ras oncogene, TP53 tumor-suppressor gene, and INK4A, the gene encoding a cell-cycle regulatory protein. 2. Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. 3. B cells fail to mature into plasma cells that synthesize immunoglobulins. 4. The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL1. 4. A patient is admitted to the hospital with multiple myeloma (MM). Which diagnostic test should the healthcare professional assess as the priority? 1. Serum potassium level 2. Serum calcium level 3. Bone scan or limb x-rays 4. Bone marrow biopsy 5. Reed-Sternberg (RS) cells represent malignant transformation and proliferation of which of these? 1. Interleukin (IL)-1, IL-2, IL-5, and IL-6 2. Tumor necrosis factor-beta 3. B cells 4. T cells 3. Increased erythropoiesis occurs in response to the hypoxic intrauterine environment. 4. The lungs of the fetus are undeveloped and unable to diffuse oxygen adequately to the pulmonary capillaries. 3. Which blood cell type is elevated at birth and through the preschool years, but decreases to adult levels afterward? a. Monocytes b. Platelets c. Neutrophils d. Lymphocytes 4. In a full-term infant, the normal erythrocyte life span is days. 1. 30 to 50 2. 60 to 80 3. 90 to 110 4. 120 to 130 5. What is the most common cause of insufficient erythropoiesis in children? 1. Folic acid deficiency 2. Iron deficiency 3. Hemoglobin abnormality 4. Erythrocyte abnormality 6. How does hemolytic disease of the fetus and newborn (HDFN) cause acquired congenital hemolytic anemia? 1. HDFN develops when hypoxia or dehydration causes the erythrocytes to change shapes, which are then recognized as foreign and removed from circulation. 2. HDFN is an alloimmune disease in which the mother’s immune system produces antibodies against fetal erythrocytes, which are recognized as foreign and removed from circulation. 3. HDFN develops when the polycythemia present in fetal life continues after birth, causing the excessive number of erythrocytes to be removed from circulation. 4. HDFN is an autoimmune disease in which the fetus’s immune system produces antibodies against fetal erythrocytes, which are recognized as foreign and removed from circulation. Erythroblastosis fetalis, also known as hemolytic disease of the fetus and newborn (HDFN), is an alloimmune disease in which maternal blood and fetal blood are antigenically incompatible, causing the mother’s immune system to produce antibodies against fetal erythrocytes. This selection is the only option that accurately defines erythroblastosis fetalis. 11. When diagnosed with hemolytic disease of the fetus and newborn (HDFN), why does the newborn develop hyperbilirubinemia after birth but not in utero? 1. Excretion of unconjugated bilirubin through the placenta into the mother’s circulation is no longer possible. 2. Hemoglobin does not breakdown into bilirubin in the intrauterine environment. 3. The liver of the fetus is too immature to conjugate bilirubin from a lipid-soluble to water-soluble form. 4. The destruction of erythrocytes producing bilirubin is greater after birth. 12. The healthcare professional is caring for a woman whose baby died of hydrops fetalis. How does the professional explain this condition to a student? 1. Inherited condition where the RBC skeletal membrane is abnormal 2. Hyperbilirubinemia that occurs shortly after birth and can affect the brain 3. Hemolytic disease of the fetus and newborn 4. Severe intrauterine anemia that leads to edema of the entire body ANS: D Fetuses with hydrops fetalis who do not survive anemia in utero are usually stillborn with gross edema in the entire body. The inherited abnormal RBC skeletal membrane is called spherocytosis. The hyperbilirubinemia is known as icterus gravis neonatorum. Erythroblastosis fetalis is another name for hemolytic disease of the fetus and newborn. What is the name of the disorder in which levels of bilirubin remain excessively high in the newborn and are deposited in the brain? 1. Kernicterus 2. Icterus neonatorum 3. Jaundice 4. Icterus gravis neonatorum 14. An infant was born with hemolytic disease of the fetus and newborn (HDFN). What treatment does the healthcare professional anticipate for this baby? 1. Administration of intravenous fluids to dilute the blood 2. Replacement transfusion of Rh-positive blood not contaminated with anti- Rh antibodies 3. Performance of a splenectomy to prevent the destruction of abnormal erythrocytes 4. Replacement transfusion of Rh-negative erythrocytes 17. Hemoglobin S (HbS) is formed in sickle cell disease as a result of which process? 1. Deficiency in glucose 6-phosphate dehydrogenase (G6PD) that changes hemoglobin A (HbA) to HbS. 2. Genetic mutation in which two amino acids (histidine and leucine) are missing. 3. Genetic mutation in which one amino acid (glutamate) is replaced by another (valine). 4. Autoimmune response in which one amino acid (proline) is detected as an antigen by abnormal immunoglobulin G (IgG). A child has sickle cell disease (SCD). What treatment or therapy does the healthcare professional discuss with the parents and child? 1. Hydroxyurea 2. Low-dose daily aspirin 3. Heparin injections 4. Genetic testing ANS: A A common therapy for sickle cell disease is hydroxyurea which is an inhibitor of DNA synthesis. It increases HbF synthesis, which decreases the proportion of HbS. Aspirin is not used as the potential blood loss could worsen SCD. The same is true of heparin, plus blood clotting is not the major issue in the disorder. Genetic testing would not be used as a treatment or therapy. 6. Acute glomerulonephritis (AGN) may be accompanied by a positive throat or skin culture for which bacteria? 1. Staphylococcus aureus 2. Streptococcus 3. Pseudomonas aeruginosa 4. Haemophilus . What initiates inflammation in acute poststreptococcal glomerulonephritis? 5. Lysosomal enzymes 6. Endotoxins from Streptococcus 7. Immune complexes 8. Immunoglobulin E (IgE)–mediated response . What is the pathophysiologic process responsible for the autoimmune disorder of hemolytic- uremic syndrome (HUS)? 1. Immunoglobulin A (IgA) coats erythrocytes that are destroyed by the spleen, and remnants are excreted through the kidneys. 2. Verotoxin from Escherichia coli is absorbed from the intestines and damages erythrocytes and endothelial cells. 3. Endotoxins from E. coli block the erythropoietin produced by the kidneys, which reduces the number of erythrocytes produced by the bone marrow. 4. Failure of the nephron to filter urea increases the blood urea nitrogen, which binds to erythrocytes that are subsequently destroyed by the spleen. 11. Bacteria gain access to the female urinary tract by which means? 1. Systemic blood that is filtered through the kidney 2. Bacteria traveling from the lymph adjacent to the bladder and kidneys 3. Bacteria ascending the urethra into the bladder 4. Colonization of the bladder when urine is static