31
Chronic illnesses may contribute to immune system impairment in various ways. Renal failure is associated with which of the following?
a)increased incidence of infection.
b)deficiency in circulating lymphocytes.
c)decreased bone marrow function.
d)altered production of white blood cells.
B
Rationale:Renal failure is associated with a deficiency in circulating lymphocytes. Diabetes mellitus is associated with increased incidence of infection. Chemotherapy causes decreased bone marrow function. Leukemia is associated with altered production of white blood cells.
Which type of hypersensitivity occurs when the system mistakenly identifies a normal constituent of the body as foreign?
a)Immune complex
b)Delayed
c)Anaphylactic
d)Cytotoxic
D
Rationale:Cytotoxic hypersensitivity occurs when the system mistakenly identifies a normal constituent of the body as foreign. Anaphylactic hypersensitivity is the most severe immune-mediated reaction. Delayed hypersensitivity occurs 24 to 72 hours after exposure to an allergen. Immune complex hypersensitivity involves immune complexes that are formed when antigens bind to antibodies.
Approximately what percentage of blood passing through the glomeruli is filtered into the nephron?
•20%
•10%
•30%
•40%
A
•Rationale: Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 L/day of filtrate.
The nurse helps a client to correctly perform peritoneal dialysis at home. The nurse must educate the client about the procedure. Which educational information should the nurse provide to the client?
•Keep the dialysis supplies in a clean area, away from children and pets
•Keep the catheter stabilized to the abdomen, below the belt line
•Wear a mask while handling any dialysate solutions
•Clean the catheter insertion site daily with soap
A
Rationale: It is important to keep the dialysis supplies in a clean area, away from children and pets, because the supplies may be dangerous for them. A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.
Which type of incontinence is the involuntary loss of urine through an intact urethra as a result of coughing?
•Reflex
•Overflow
•Stress
•Urge
C
Rationale:Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position. Reflex incontinence is the involuntary loss of urine because of hyperreflexia in the absence of normal sensations usually associated with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder.
A 38-year-old client has begun to suffer from rheumatoid arthritis and is being assessed for disorders of the immune system. The client works as an aide at a facility that cares for children infected with AIDS. Which is the most important factor related to the client's assessment?
a)Use of other drugs
b)Home environment
c)Age
d)Diet
A
Rationale:The nurse needs to review the client's drug history. These data will help her to assess the client's susceptibility to illness because certain past illnesses and drug use, such as corticosteroids, suppress the inflammatory and immune responses. The client's age, home environment, and diet do not have any major implications during assessment because they do not indicate the client's susceptibility to illness.
Atopic allergic disorders are characterized by which of the following?
a)production of a systemic reaction.
b)a response to physiologic allergens.
c)a hereditary predisposition.
d)an IgA-mediated reaction.
C
Rationale:Atopic allergic disorders are characterized by a hereditary predisposition and production of a local reaction to IgE antibodies produced in response to common environmental allergens. Atopic and nonatopic allergic disorders are IgE-mediated allergic reactions.
When the bladder contains 400 to 500 mL of urine, this is referred to as?
•anuria.
•functional capacity.
•specific gravity.
•renal clearance.
B
Rationale: A marked sense of fullness and discomfort, with a strong desire to void, usually occurs when the bladder contains 400 to 500 mL of urine, referred to as the "functional capacity." Anuria is a total urine output less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from the plasma.
A client diagnosed with acute kidney injury (AKI) has developed congestive heart failure. The client has received 40 mg of intravenous push (IVP) Lasix and 2 hours later, the nurse notes that there are 50 mL of urine in the Foley catheter bag. The client's vital signs are stable. Which health care order should the nurse anticipate?
•Lasix 80 mg IVP
•Chest x-ray
•Normal saline bolus of 500 mL
•Mannitol 12.5 g IVP
A
•Rationale: Diuretic agents are often used to control fluid volume in clients with acute kidney injury (AKI). The client's urine output indicates an inadequate response to the initial dosage of Lasix and the nurse should anticipate administering Lasix 80 mg IVP. Often in this situation, the initial dosage of Lasix is doubled. The client is experiencing fluid overload, thus, a 500-mL bolus of normal saline bolus would be contraindicated. There is no need to complete a chest x-ray. Mannitol is widely used in the management of cerebral edema and increased intracranial pressure from multiple causes.
Which medication may be ordered to relieve discomfort associated with a urinary tract infection?
•Levofloxacin
•Ciprofloxacin
•Phenazopyridine
•Nitrofurantoin
C
Rationale:Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with a UTI. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.
Which type of immunity becomes active as a result of infection by a specific microorganism?
a)Artificially acquired active immunity
b)Naturally acquired active immunity
c)Naturally acquired passive immunity
d)Artificially acquired passive immunity
B
Rationale:Naturally acquired active immunity occurs as a result of an infection by a specific microorganism. Artificially acquired active immunity results from the administration of a killed or weakened microorganism or toxoid. Passive immunity develops when ready-made antibodies are given to a susceptible individual.
The nurse is working with a colleague who has a delayed hypersensitivity (type IV) allergic reaction to latex. Which statement describes the clinical manifestations of this reaction?
a)Symptoms can be eliminated by changing glove brands.
b)Symptoms are localized to the area of exposure, usually the back of the hands.
c)Symptoms occur within minutes after exposure to latex.
d)Symptoms worsen when hand lotion is applied before donning latex gloves
B
Rationale:Clinical manifestations of a delayed hypersensitivity reaction are localized to the area of exposure. Clinical manifestations of an irritant contact dermatitis can be eliminated by changing glove brands or using powder-free gloves. With an irritant contact dermatitis, avoid use of hand lotion before donning gloves; this may worsen symptoms, as lotions may leach latex proteins from the gloves. When clinical manifestations occur within minutes after exposure to latex, which is described as a latex allergy, an immediate hypersensitivity (type I) allergic reaction has occurred.
The nurse is reviewing the results of a client's renal function study. The nurse understands that which value represent a normal BUN-to-creatinine ratio?
•08:01:00
•06:01:00
•04:01:00
•10:01:00
D
Rationale: A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect
What is a hallmark of the diagnosis of nephrotic syndrome?
•Hyperalbuminemia
•Hypokalemia
•Hyponatremia
•Proteinuria
D
Rationale: Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.
A client is treated for renal calculi and suspected hydronephrosis. Therefore, the nurse should maintain a record of the kidney's function. Which measure can the nurse take to help achieve the objective?
•Inspect the skin over the fistula or graft for signs of infection
•Monitor the patient's intake and output
•Note the nail beds and mobility of the fingers
•Palpate for a thrill over the vascular access
B
•Rationale:Monitoring and recording the client's intake and output provides information about how the kidneys are functioning and helps to identify any arising complications, such as hydronephrosis. Noting the nail beds and mobility of the fingers, palpating for a thrill over the vascular access, and inspecting the skin over the fistula or graft for signs of infection are nursing interventions to provide care to a client undergoing hemodialysis.
A 25-year-old client receives a knife wound to the leg in a hunting accident. Which type of immunity was compromised?
a)Natural immunity
b)Specific immunity
c)Passive immunity
d)Adaptive immunity
A
Rationale:Natural immunity, which is nonspecific, provides a broad spectrum of defense against and resistance to infection. It is considered the first line of host defense following antigen exposure, because it protects the host without remembering prior contact with an infectious agent.
Which type of hypersensitivity reaction involves immune complexes forming when antigens bind to antibodies?
a)Type II
b)Type III
c)Type I
d)Type IV
B
Rationale:Type III hypersensitivity is associated with systemic lupus erythematosus, rheumatoid arthritis, serum sickness, certain types of nephritis, and some types of bacterial endocarditis. Type I, or anaphylactic hypersensitivity, is an immediate reaction, beginning within minutes of exposure to an antigen. Type II, or cytotoxic, hypersensitivity occurs when the system mistakenly identifies a normal constituent of the body as foreign. Type IV, or delayed-type, hypersensitivity occurs 24 to 72 hours after exposure to an allergen.
Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal?
•40%
•50%
•30%
•20%
B
Rationale: Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) concentrations.
Which type of medication may be used to inhibit bladder contraction in a client with incontinence?
•Over-the-counter decongestant
•Anticholinergic agent
•Tricyclic antidepressants
•Estrogen hormone
B
•Rationale:Anticholinergic agents are considered first-line medications for urge incontinence. Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra. Tricyclic antidepressants decrease bladder contractions and increase bladder neck resistance. Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.
During an annual examination, an older client tells the nurse, "I don't understand why I need to have so many cancer screening tests now. I feel just fine!" Based on knowledge of neoplastic disease and the aging immune system, what teaching should the nurse include in the client's plan of care? Select all that apply.
a)The increase in occurrence of autoimmune diseases with aging strongly suggests a predisposition toward various types of cancer due to the body's inability to differentiate between self and nonself. Routine screening increases the chance of finding and treating cancer early.
b)Education about the importance of adhering to a recommended vaccine schedule should be initiated to boost the immune system function.
c)The immune system is integrated with other psychophysiological processes and is regulated by the brain. Aging of the brain can have immunologic consequences and can affect neural and endocrine function increasing the risk of cancer development.
d)Tumor cells may possess special blocking factors that coat tumor cells and prevent their destruction by killer T lymphocytes; therefore the body may not recognize the tumor as foreign and fail to destroy the malignant cells. Routine screening increases the chance of finding and treating cancer early.
e)Nutritional intake to support a competent immune response plays an important role in reducing the incidence of cancer. A healthy diet including protein, vitamins, minerals, and some fats can alter the risk of cancer development.
A, D, E
Rationale:Large tumors can release antigens into the blood, and these antigens combine with circulating antibodies and prevent them from attacking the tumor cells. Furthermore, tumor cells may possess special blocking factors that coat tumor cells and prevent their destruction by killer T lymphocytes. During the early development of tumors, the body may fail to recognize the tumor antigens as foreign and subsequently fail to initiate destruction of the malignant cells. The incidence of autoimmune diseases also increases with age, possibly from a decreased ability of antibodies to differentiate between self and nonself. Failure of the surveillance system to recognize mutant or abnormal cells also may be responsible, in part, for the high incidence of cancer associated with increasing age. Vitamin D deficiency has been associated with increased risk of common cancers. Evidence shows that nutrition plays a role in the development of cancer and that diet and lifestyle can alter the risk of the development of cancer and other chronic diseases.
The nurse is caring for a client with myasthenia gravis. The nurse generates a plan of care for the client based on which type of hypersensitivity reaction?
a)Cytotoxic
b)Immune complex
c)Delayed
d)Anaphylactic
A
Rationale:Cytotoxic hypersensitivity occurs when the body mistakenly identifies a part of the body as foreign, as in myasthenia gravis, where the body mistakenly identifies normal nerve endings as foreign. Delayed hypersensitivity reactions occur 24 to 72 hours after exposure. Immune complex hypersensitivity involves immune complexes formed when antigens bind to antibodies. Anaphylactic hypersensitivity is an immediate reaction characterized by edema in many tissues, often with hypotension, bronchospasm, and cardiovascular collapse.
The nurse is caring for a client scheduled for urodynamic testing. Following the procedure, which information does the nurse provide to the client?
•"You will be sent home with a urinary catheter."
•"You can stop taking the prescribed antibiotic."
•"Contact the primary provider if you experience fever, chills, or lower back pain."
•"You may resume consuming caffeinated, carbonated, and alcoholic beverages."
C
•
Rationale: The client must be made aware of the signs of a urinary tract infection after the procedure. The client should contact the primary provider if fever, chills, lower back pain, or continued dysuria and hematuria occur. The client will have catheters placed during the procedure but will not be sent home with one. The client should be told to avoid caffeinated, carbonated, and alcoholic beverages after the procedure because these can further irritate the bladder. These symptoms usually decrease or subside by the day after the procedure. If the client received an antibiotic medication before the procedure, they should be told to continue taking the complete course of medication after the procedure. This is a measure to prevent infection.
In which response do T lymphocytes have a role?
a)Transplant rejection
b)Bacterial phagocytosis and lysis
c)Allergic hay fever and asthma
d)Anaphylaxis
A
Rationale: Most immune responses to antigens involve both humoral and cellular responses, although one usually predominates. For example, during transplant rejection, the cellular response involving T cells predominates, whereas in bacterial pneumonias and sepsis, the humoral response involving B cells plays the dominant protective role. Transplant rejection and graft-versus-host disease are cellular response roles of T cells. Anaphylaxis is a humoral response role of B lymphocytes. Allergic hay fever and asthma, as well as bacterial phagocytosis and lysis, are humoral response roles of B lymphocytes.
A creatinine clearance test is ordered for a client with possible renal insufficiency. The nurse must collect which serum concentration midway through the 24-hour urine collection?
•Blood urea nitrogen
•Hemoglobin
•Creatinine
•Osmolality
C
•Rationale: To calculate creatinine clearance, a 24-hour urine specimen is collected. The serum creatinine concentration is measured midway through the collection. The other concentrations are not measured during this test.
Which response is a humoral immune response?
a)Anaphylaxis
b)Intracellular infections
c)Transplant rejection
d)Delayed hypersensitivity
A
Rationale:Anaphylaxis is an example of a humoral response. Cellular responses include transplant rejection, intracellular infections, and delayed hypersensitivity.
Which is an effect of aging on upper and lower urinary tract function?
•Increased glomerular filtration rate
•Susceptibility to develop hypernatremia
•Acid-base balance
•Increased blood flow to the kidney
B
Rationale: The elderly are more susceptible to developing hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidney, and acid-base imbalances.
Which assessment should be completed if immune dysfunction is suspected in the neurosensory system?
a)Burning upon urination
b)Hematuria
c)Urinary frequency
d)Ataxia
D
Rationale:Ataxia should be assessed when immune dysfunction in the neurosensory system is suspected. Hematuria, discharge, and frequency of and burning upon urination are associated with the genitourinary system.
Which hormone causes the kidneys to reabsorb sodium?
•Antidiuretic hormone
•Prostaglandins
•Growth hormone
•Aldosterone
D
Rationale:Aldosterone is a hormone synthesized and released by the adrenal cortex. Antidiuretic hormone is secreted by the posterior pituitary gland. Growth hormone and prostaglandins do not cause the kidneys to reabsorb sodium.
Which condition is associated with impaired immunity relating to the aging client?
a)Increase in peripheral circulation
b)Increase in humoral immunity
c)Decrease in inflammatory cytokines
d)Breakdown and thinning of the skin
D
Rationale:The aging process stimulates changes in the immune system. Age-related changes in many body systems also contribute to impaired immunity. Changes such as poor circulation, as well as the breakdown of natural mechanical barriers such as the skin, place the aging immune system at even greater disadvantage against infection. As the immune system undergoes age-associated alterations, its response to infections progressively deteriorates. Humoral immunity declines and the number of inflammatory cytokines increase with age.
A client presents to the ED reporting left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The client has also experienced nausea and emesis. The nurse suspects the client is experiencing:
•ureteral stones.
•cystitis.
•pyelonephritis.
•Urethral infection.
A
•Rationale:The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply.
Which adverse effect should the nurse closely monitor in a client who takes immunosuppressive drugs?
a)Heart failure, infusion reactions, and life-threatening infections
b)Depression, memory impairment, and coma
c)Rheumatoid arthritis
d)Respiratory or urinary system infections
D
Rationale:When taking drugs to suppress the immune system, the client is vulnerable to an increased risk of infection, especially in the respiratory or urinary systems. Depression, memory impairment, and coma are dose-related effects of cytokines, which are biologic response modifiers. Heart failure, infusion reactions, and life-threatening infections are possible adverse effects of taking infliximab, which minimizes inflammation. In addition, cytokines and infliximab are not immunosuppressive drugs. Moreover, immunosuppressive drugs are not known to cause rheumatoid arthritis.
A 30-year-old client presents to the clinic for an employment physical. The nurse notes protein in the client's urine. The nurse understands that transient proteinuria can be caused by which factor(s)? Select all that apply.
•Diabetes mellitus
•Fever
•NSAIDs
•Strenuous exercise
•Prolonged standing
B, D, E
•Rationale:Proteinuria may be a benign finding, or it may signify serious disease. Common benign causes of transient proteinuria are fever, strenuous exercise, and prolonged standing. Causes of persistent proteinuria include glomerular diseases, malignancies, collagen diseases, diabetes, preeclampsia, hypothyroidism, heart failure, exposure to heavy metals, and use of medications such as NSAIDs and angiotensin-converting enzyme inhibitors.
A client comes into the emergency department reporting difficulty walking and loss of muscle control in the arms. Once the nurse begins the physical examination, which assessment should be completed if an immune dysfunction in the neurosensory system is suspected?
a)Assess for hepatosplenomegaly by measuring abdominal girth
b)Assess for ataxia using the finger-to-nose test and heel-to-shin test
c)Assess joint mobility using passive range of motion.
d)Review the urinalysis report for hematuria
B
Rationale:Ataxia should be assessed when suspecting immune dysfunction in the neurosensory system. Joint movement, a urinalysis results positive for hematuria , and measuring abdominal girth are not used to assess for issues with the neurosensory system in relation to immune dysfunction.
Which condition is associated with impaired immunity relating to the aging client?
a)Incidence of autoimmune disease decreases
b)Antibody production increases
c)Skin becomes thicker
d)Renal function decreases
D
Rationale:Decreased renal circulation, filtration, absorption, and excretion contribute to the risk for urinary tract infections. Antibody production decreases, the skin becomes thinner, and the incidence of autoimmune disease increases with age.