Infectious Process
If the host’s immune system is compromised, resident florae may become pathogenic, resulting in:
A) Opportunistic infections
B) Salmonella infection
C) Otitis Media
D) Myocarditis
A) Opportunistic infections
Rationale: The goal of infection control is to block transmission of the microorganism to susceptible victims by severing the chain at one or more links. Pathogens are killed by natural physiologic processes or medication therapy. Minimizing the spread of infection is a secondary outcome of infection control. The prevention of medication-resistant pathogens focuses on the administration of the medication, not on infection control.
Which substance activates the complement cascade?
A) Antigen
B) Histamine
C) Leukotrienes
D) Prostaglandins
A) Antigen
Rationale: The complement cascade is activated by the alternative pathway on primary exposure to an antigen. Histamine is an early mediator of this inflammatory response. It is such a potent vasodilator that it can cause significant reductions in blood pressure when released in excessive amounts. Leukotrienes are inflammatory chemicals generated from the lipoxygenase pathway: A4, B4, C4, D4, and E4. Prostaglandins are inflammatory chemicals that contribute to vasodilation and increased permeability.
Normally, the highest amount of daily fluid loss occurs via the:
A) Urinary tract
B) bowels
C) skin
D) lungs
A) Urinary tract
Rationale: In a healthy person, the largest volume of fluid is excreted in the urine. Fluid loss via the bowels would not exceed that of the urinary tract unless severe diarrhea is present. Fluid loss via the skin would not exceed that of the urinary tract unless profuse sweating was present. Fluid loss via the lungs would not exceed that of the urinary tract unless the respiratory rate was greatly increased.
The nurse plans to closely monitor for which clinical manifestation after administering furosemide [Lasix]?
A) Decreased pulse
B) Decreased temperature
C) Decreased blood pressure
D) Decreased respiratory rate
C) Decreased blood pressure
Rationale: High-ceiling loop diuretics, such as furosemide, are the most effective diuretic agents. They produce more loss of fluid and electrolytes than any others. A sudden loss of fluid can result in decreased blood pressure. When blood pressure drops, the pulse probably will increase rather than decrease. Lasix should not affect respiration or temperature. The nurse should also closely monitor the patient’s potassium level.
When the cell presents with the same concentration on the inside and outside with no shifting of fluids this is called?
A) Hypertonic
B) Isotonic
C) Hypotonic
D) D5W NS
B) Isotonic
The goal of infection control is to:
A) Sever the chain of infection.
B) Kill pathogens before infection can occur.
C) Minimize the spread of pathogens within a population
D) Prevent the creation of medication-resistant pathogens
A) Sever the chain of infection.
Rationale: The goal of infection control is to block transmission of the microorganism to susceptible victims by severing the chain at one or more links. Pathogens are killed by natural physiologic processes or medication therapy. Minimizing the spread of infection is a secondary outcome of infection control. The prevention of medication-resistant pathogens focuses on the administration of the medication, not on infection control.
What is the role of the mast cells in the inflammatory process?
A) They form antibodies to fight infection
B) They release histamine, a potent vasodilator
C) They remove microbes and cellular debris through the process of phagocytosis
D) They release fibronectin to form a meshwork trap and stimulate the intrinsic clotting cascade.
B) They release histamine, a potent vasodilator
Rationale: Mast cells in the area of injury degranulate and release packets of histamine and other inflammatory chemicals. Histamine is an early mediator of this inflammatory response. It is a potent vasodilator. B cells are distinguished from other lymphocytes by their ability to produce antibodies. Macrophages are powerful phagocytes, each capable of ingesting numerous microbes. Macrophages are called on to clean up the area after an inflammatory reaction in which dead neutrophils and inflammatory debris have accumulated, and they have a role in wound healing. Factor XII releases fibronectin to form a meshwork trap and stimulate the intrinsic clotting cascade.
The concentration of which cation indicates the serum osmolality of a patient?
A) Sodium level
B) Calcium level
C) Potassium level
D) Magnesium
A) Sodium level
Rationale: The serum sodium concentration reflects the osmolality of the blood. Imbalances of body fluid concentration are recognized by abnormal serum sodium concentration. The osmolality of the blood is not determined by the serum concentration of calcium, potassium, or magnesium.
The healthcare provider orders mannitol 72 gm infusion over 24 hours. The nurse plans to set the infusion pump for how many grams per hour?
A) 1 gm
B) 2 gm
C) 3 gm
D) 4 gm
C) 3 gm
Rationale: To infuse 72 gm over 24 hours, divide 72 by 24 for the total per hour. 72 divided by 24 equals 3 gm per hour.
________ Solutions cause cell dehydration and help increase fluid in the extracellular space.
A) Hypertonic
B) Isotonic
C) Hypotonic
D) Water
A) Hypertonic
Rationale: the hypertonic solution will pull fluid out of the cells into the vascular space, causing further cell dehydration
Bacteria are categorized by which of their following? (Select all that apply.)
A) Shape
B) Site of infection
C) Need for oxygen
D) Reacting to staining
E) Association with proteins and lipids
A) Shape, C) Need for oxygen, D) Reacting to staining
Rationale: Bacteria are named for their shape (cocci, rod, and spirochete), their need for oxygen (aerobic or anaerobic), and their reaction to staining (Gram-positive or Gram-negative). Site of infection is related to parasites. Association with proteins and lipids is related to viruses.
A series of events occur during acute inflammation resulting from cellular injury. Which event occurs initially?
A) Brief constriction of vessel walls
B) Phagocytosis results in pus formation
C) Neutrophils migrate to the injured area
D) Plasma proteins and water move into the interstitial space
A) Brief constriction of vessel walls
Rationale: Immediately after injury, the precapillary arterioles around the injured area contract briefly. When phagocytosis is incomplete, a collection of dead neutrophils, bacteria, and cellular debris, called pus, may form at the site. After edema formation, blood flows through areas of inflammation, causing neutrophils to move to the sides of the blood vessels and roll along the endothelium of the vessel wall. After vessel constrictions, the increased pressure along with increased permeability pushes fluid out of the blood vessels and into the surrounding tissue contributing to local swelling.
Clinical manifestations of extracellular fluid volume excess include which of the following? (Select all that apply.)
A) Edema
B) Crackles
C) Weight gain
D) Bounding pulse
E) Distended neck veins
F) Decreased urinary output
A) Edema, B) Crackles, C) Weight gain, D) Bounding pulse, E) Distended neck veins
Rationale: Edema, crackles, sudden weight gain, bounding pulse, and distended neck are signs of extracellular fluid volume excess. Decreased urinary output is not a sign of extracellular fluid volume excess.
The healthcare provider orders furosemide [Lasix] 20 mg IV twice daily. The medication available is furosemide [Lasix] 10 mg/mL. How many mL will the nurse administer with each dose?
A) 0.5 mL
B) 1 mL
C) 2 mL
D) 4 mL
C) 2 mL
Rationale: The healthcare provider has ordered 20 mg of furosemide [Lasix], which is available in 10 mg/mL. Multiply 10 mg/mL by 2 to equal 20 mg/2 mL. The nurse will administer 2 mL of furosemide to equal 20 mg with each dose.
________ fluids remove water from the extracellular space into the intracellular space.
A) Hypertonic
B) Isotonic
C) Hypotonic
D) High fructose corn syrup
C) Hypotonic
Rationale: by further diluting the extravascular space, water will move from the extravascular space into the cells "water follows salt"
Normal florae protect the body from pathogenic bacteria by which of the following? (Select all that apply.)
A) Attacking the pathogenic bacteria directly
B) Producing vitamins essential to the body's defenses
C) Making the environment inhospitable to the pathogens
D) Taking up space in the body, and thus denying harmful bacteria residency
E) Using nutrients in the environment that the pathogenic bacteria need
B) Producing vitamins essential to the body's defenses, C) Making the environment inhospitable to the pathogens, D) Taking up space in the body, and thus denying harmful bacteria residency, E) Using nutrients in the environment that the pathogenic bacteria need
Rationale: Normal florae of the gut produce vital vitamins that are absorbed and utilized by the body and stimulate cross-protective antibodies. These flora occur naturally and have a role in defense by occupying space. Staphylococcus epidermidis lives on the skin using nutrients in the environment that pathogenic organisms need to live (but usually is not pathogenic). Normal florae do not protect the body by direct interaction with pathogens.
Which is an example of active immunity? (Select all that apply.)
A) Placental transfer of maternal antibodies
B) Injection of pooled gamma globulin
C) Yearly flu vaccination
D) Pneumonia vaccine
E) Breastfeeding
C) Yearly flu vaccination, D) Pneumonia vaccine
Rationale: Vaccinations, such as the yearly flu and pneumonia vaccines, stimulate the host immune system to mount an immune response and produce long-lived memory cells and antibody-secreting cells that provide lasting protection, a process called active immunity. Immunity acquired by the newborn via the placenta or via breast milk and gamma globulin injections are examples of passive immunity in which antibodies produced by one individual are transferred to another. These antibodies provide only short-term protection, because the host does not produce memory cells or antibodies.
Clinical manifestations of hypocalcemia include which of the following? (Select all that apply.)
A) Positive Trousseau sign
B) Positive Chvostek sign
C) Hyperactive reflexes
D) Muscle twitching
E) Constipation
F) Paresthesias
A) Positive Trousseau sign, B) Positive Chvostek sign, C) Hyperactive reflexes, D) Muscle twitching, F) Paresthesias
Rationale: Calcium imbalances alter normal neuromuscular irritability. Clinical manifestations of hypocalcemia are those of increased neuromuscular irritability, including a positive Trousseau sign, a positive Chvostek sign, hyperactive reflexes, muscle twitching, and paresthesias. Hypercalcemia causes decreased neuromuscular irritability (muscle weakness, fatigue, headache, lethargy, parorexia, nausea, constipation).
The nurse is teaching a patient who has a new prescription for spironolactone [Aldactone]. Which statement by the patient indicates that the teaching was effective?
A) “I will use salt substitutes to lower my sodium intake.”
B) “I will increase my intake of foods that are high in potassium.”
C) “I will call my doctor if I begin having menstrual irregularities.”
D) “I will take this medication at bedtime each evening.”
C) “I will call my doctor if I begin having menstrual irregularities.”
Rationale: Spironolactone is a potassium-sparing, aldosterone-blocking diuretic. As such, it can cause endocrine effects, such as gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. Patients taking spironolactone should avoid salt substitutes because they contain potassium, and high-potassium foods should be avoided with this drug. Ideally, all diuretics should be taken in the morning to prevent nocturia.
List the normal range for Sodium, and Potassium (don't forget labels)
Sodium 135-145 mEq/mL
Potassium 3.5-5 mEq/mL
Environmental factors that influence the likelihood of exposure to infection by microorganisms are which of the following? (Select all that apply.)
A) Population density
B) Cooking practices
C) Sanitation
D) Weather
E) Age
A) Population density, B) Cooking practices, C) Sanitation, D) Weather
Rationale: Environmental factors such as crowded living conditions have an impact on the incidence and type of infections for which a given population is at risk, since it increases possibility of contact with pathogens. Cooking practices have a direct impact on the pathogens in daily food consumed. Poor sanitation allows pathogens to come into direct contact with the population. Weather impacts the breeding ground of some pathogens. While age can impact health, it is not an environmental factor.
Antibodies respond to antigens by which of the following? (Select all that apply.)
A) Forming bacterial toxins to neutralize antigens
B) Functioning as antitoxins by neutralizing bacterial toxin
C) Causing the formation of large complexes that precipitate out of solution
D) Opsonizing antigens to make them more recognizable to phagocytes
E) Initiating complement activation to help antibodies and phagocytic cells to attack pathogens
B) Functioning as antitoxins by neutralizing bacterial toxin, C) Causing the formation of large complexes that precipitate out of solution, D) Opsonizing antigens to make them more recognizable to phagocytes, E) Initiating complement activation to help antibodies and phagocytic cells to attack pathogens
Rationale: Antibodies function as antitoxins by neutralizing bacterial toxin. Agglutination, opsonization or coating antigens, and supporting complement activation are ways antibodies enhance the localization and removal of antigens from the body. Antibodies do not form bacterial toxins; they function as antitoxins by neutralizing bacterial toxin.
Which statement regarding serum magnesium (Mg++) is true? (Select all that apply.)
A) Alcohol-related diseases frequently cause low Mg+ levels.
B) Vomiting is not generally seen as a major cause of Mg+ loss.
C) Mg++ levels present similarly to calcium (Ca++) levels in the blood
D) Mg+ deficiencies often result in low serum potassium (K+) levels.
E) Mg+ deficiencies must be treated before potassium (K+) deficiencies
A) Alcohol-related diseases frequently cause low Mg+ levels, C) Mg++ levels present similarly to calcium (Ca++) levels in the blood, D) Mg+ deficiencies often result in low serum potassium (K+) levels, E) Mg+ deficiencies must be treated before potassium (K+) deficiencies
Rationale: Chronic alcoholism is a major risk factor for hypomagnesemia, because it is associated with decreased magnesium intake. Signs and symptoms of Ca++ and Mg++ deficiencies are very similar. Hypomagnesemia causes decreased activity of the enzyme that drives the sodium-potassium pump in cell membranes, so intracellular potassium decreases in the myocardium. Hypomagnesemia often causes hypokalemia by increasing urinary excretion of potassium. In such cases, correction of hypomagnesemia is necessary before the hypokalemia can be corrected. Magnesium is lost through emesis.
The nurse caring for a patient taking furosemide [Lasix] is reviewing the patient’s most recent laboratory results, which are: sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100 mEq/L; blood urea nitrogen, 15 mg/dL. What is the nurse’s best action?
A) Administer Lasix as ordered
B) Place the patient on a cardiac monitor
C) Begin a 24-hour urine collection
D) Hold the lasix and notify the physician
D) Hold the lasix and notify the physician
Rationale: The nurse’s best action is to hold the Lasix and notify the physician. Loop diuretics, such as furosemide, can cause significant potassium loss. The normal potassium level is 3.5 to 5 mEq/L. The remaining electrolyte levels are normal. Administering the Lasix could result in a critically low potassium level. Effects of low potassium include cardiac dysrhythmias. Placing a patient on a cardiac monitor requires a physician’s order and would warrant further assessment first, such as taking vital signs and asking the patient whether he or she is having any cardiac-related symptoms. Collecting a 24-hour urine specimen is not appropriate in this case.
The nurse is caring for a patient receiving IV therapy with a 3% sodium chloride infusion at 75 mL/hr. The nurse should closely monitor for which adverse effect of treatment?
A) Blood urea nitrogen of 22 mg/dL
B) Tending of the skin and dry mucous membranes
C) Distended neck veins and ankle edema
D) Sodium level of 140 mEq/L
C) Distended neck veins and ankle edema
Rationale: An IV solution of 3% sodium chloride is hypertonic and may cause fluid overload. Signs of volume overload include distended neck veins and ankle edema. The blood urea nitrogen level and sodium level are normal values. Tenting of the skin and dry mucous membranes indicate volume contraction, which would not be a likely adverse effect of this therapy.