NSG 530 Exam II Questions and Verified Detailed Answers; for Guaranteed Success -Wilkes University

A patient was diagnosed as HIV positive several years ago. Which of the following blood tests is most clinically useful for determining the stage and severity of her disease?

CD4+ cell counts

When the maternal immune system becomes sensitized against antigens expressed by the fetus, what type of immune reaction occurs? (transfusions, transplant tissues, pregnancy)

Alloimmune

A 10-year-old male is stung by a bee while playing in the yard. He begins itching and develops pains, swelling, redness and respiratory difficulties. He is suffering from:

anaphylaxis

When a patient presents at the ED for an allergic reaction, the nurse recognized the most severe consequences of a type I hypersensitivity reaction is:

anaphylaxis

A nurse recalls that an example of an immune-complex-mediated disease is:

serum sickness

When a nurse cares for a patient with systemic lupus erythematosus (SLE), the nurse remembers this disease is an example of:

autoimmunity (disturbance in immunologic tolerance of self-antigens)

A 30-year-old female c/o fatigue, arthritis, rash and changes in urine color. Laboratory testing reveals anemia, lymphopenia and kidney inflammation. Assuming a diagnosis of SLE, which of the following is also likely to be present?

Autoantibodies

A 40-year-old is diagnosed with SLE. Which of the following findings would be considered a symptom of this disease?

Photosensitivity + facial rash confined to cheeks (malar rash)

A person is given an attenuated antigen as a vaccine. When the person asks what was given in the vaccine, how should the nurse respond? The antigen is:

alive, but less infectious.

An immunologist is discussing endotoxin production. Which information should the immunologist include? Endotoxins are produced by:

gram-negative bacteria.

A 50-year-old female experiences decreased blood pressure, decreased oxygen delivery, cardiovascular shock and subsequent death. A complication of endotoxic shock is suspected. Which of the following is the most likely cause?

Gram-negative bacteria

Which information indicates a correct understanding of viral vaccines? Most viral vaccines contain:

attenuated viruses.

A 22-year-old was recently diagnosed with acquired immunodeficiency syndrome (AIDS). Which decreased lab finding would be expect to accompany this virus?

CD4+ T-helper

A 30-year-old male was diagnosed with HIV. Which of the following treatments would be most effective?

Antiretroviral therapy (ART)

When the immunologist says that pathogens possess virulence, what does virulence mean?

Causes disease.

A patient has a tissue growth that was diagnosed as cancer. Which of the following terms best described this growth?

Neoplasm

Which information indicates a nurse understands characteristics of malignant tumors?

Has a high mitotic index

A nurse is discussing preinvasive epithelial tumors of glandular or squamous cell origin. What is the nurse describing?

Cancer in situ

A 25-year-old male develops a tumor of the breast glandular tissue. What type of tumor will be documented on the chart?

Adenocarcinoma

A 30-year-old female is diagnosed with cancer. Testing reveals that the cancer cells have spread to local lymph nodes. A nurse realized this cancer would be documented as stage:

3

An oncologist is discussing when a cancer cell loses differentiation. Which of the following is the oncologist describing?

Anaplasia

Which of the following indicates a nurse understands a proto-oncogene? A proto-oncogene is best define as a(n) _____ gene.

normal

Of the following genetic lesions that cause cancer, which is the most common?

Point mutations

A 45-year-old female was recently diagnosed with cervical cancer. She reports a sexual history that includes 43 partners. Which of the following is the most likely cause of her cancer?

Human papillomavirus (HPV)

A 30-year-old male with HIV is diagnosed with Epstein-Barr virus. After 2 months, the virus is still active. Based upon the EBV, which of the following cancers is most likely to develop in this patient?

B cell lymphoma

Which statement indicates the patient has a correct understanding of metastasis? The most common route of metastasis is through the blood vessels and:

Lymphatics

When a patient asks what types of cancers are associated with tobacco use, how should the nurse respond?

Squamous and small cell adenocarcinomas

A 50-year-old female develops skin cancer on her head and neck following years of sunbathing. Which of the following cancers is the most likely?

Basal cell carcinoma

Which of the following compounds has been shown to increase the risk of cancer when used in combination with smoking?

Alcohol

A 25-year-old female was diagnosed with cervical cancer. History reveals she had many sexual partners, which she indicates is too many to count. Which of the following is most likely to have caused her cancer?

HPV-16

A 50-year-old female confirms chronic alcohol intake. This practice places the patient at risk for cancer in which organs?

Larynx, esophagus, liver and breast.

A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect?

Increased cardiac conduction, increased myocardial contractions, increased HR.

A 30-year-old Caucasian female was recently diagnosed w. primary HTN. She reports that she eats fairly well, usually having red meat and potatoes daily. She also reports that her father has HTN as well. A nurse determines which of the following risk factors is most likely associated with this diagnosis?

Genes

Most cases of combined systolic and diastolic HTN have no known cause and are documented on the chart as ____ HTN.

Primary

A 52-year-old male is diagnosed with primary HTN. He has no other health problems. Present tx would cause the nurse to anticipate administering which drug to the patient?

A diuretic

When a nurse checks the patient for orthostatic hypotension, what did the nurse have the patient do?

Stand up

A 50-year-old male is diagnosed with orthostatic hypotension. Which of the following symptoms would he most likely experience?

Syncope and fainting

An 8-week-old infant presents to his pediatrician for a well-baby checkup. Physical exam reveals a murmur and an ECG confirms a ventricular septal defect. Which of the following genetic factors should the nurse assess for as it would most likely accompany this dx?

Down syndrome

When a staff member asks what coarctation of the aorta is, how should the nurse respond? Coarctation of the aorta is the local narrowing of the aorta near the:

Ductus arteriosus

A newborn is suspected of having coarctation of the aorta. Which of the following assessments would aid in dx?

Weak or absent femoral pulses

A 1-month-old infant visits his PCP for a well-baby check. Physical exam reveals decreased cardiac output, hypotension, tachycardia and a loud murmur suggestive or aortic stenosis. Which of the following would be expected with this dx?

Ventricular hypertrophy

A 2-week-old infant presents with poor feeding, fatigue, dyspnea and a murmur. She is diagnosed w. a patent ductus arteriosus (PDA). A nurse recalls this conditions results in a(n):

Left-to-right shunt

Which is the most common type of congenital heart defect the nurse should assess for in infants?

Ventricular septal defect (VSD)

A newborn experiences frequent periods of cyanosis, usually occurring during crying or after feeding. Which of the following is the most likely diagnosis the nurse will observe on the chart?

Tetralogy of Fallot (Tet spell: hypoxic spell)

A 40-year-old pregnant woman is concerned about the health of her unborn child. She has phenylketonuria (PKU) and recently had a viral infection. If the child is born with a congenital heart defect, which of the following is the most likely based on the mother's history?

Coarctation of aorta; Patent ductus arteriosus (PDA)

A nurse is teaching staff about pulmonary edema. Which information should the nurse include? The most common cause of pulmonary edema is:

Left heart failure

A 22-year-old female presents w. chronic bronchitis. Tests reveal closure of the airway during expiration. While planning care, a nurse recalls this condition is most likely caused by:

Thick mucus from hypertrophied glands (hypersecretion)

While reviewing lab results, to help confirm a diagnosis of CF in a 1-year-old child, which substance will be present in the child's sweat?

Sodium chloride

A nurse is teaching about sudden infant death syndrome (SIDS). Which information should the nurse include? SIDS peaks between __ and __ months of age.

3, 4

Where does the conversion of angiotensin I to angiotensin II take place?

Pulmonary vessels, and to a lesser extent in endothelial and renal epithelial cells

Describe the sequence in the renin-angiotensin-aldosterone system.

Low blood volume/ low BP/ low Na+/ high K+ concentration -> secretes renin from kidneys -> liver released angiotensin into blood which is converted to angiotensin I -> ACE released from lungs to convert angtiotensin I to II -> vasoconstriction -> elevated BP and restores renal perfusion

-> angiotensin II stimulates secretion of aldosterone from adrenal cortex and ADH from post. pituitary -> aldosterone promotes Na+ and water reabsorption + excretion of K+ within renal tubules -> increase blood volume

What type of microorganisms produce exotoxins?

Bacterial pathogens

An elderly patient has a BP reading of 176/68. What is the most likely cause of this type of elevation?

Stage 2 HTN SBP > 140 and/or DBP > 90

What lab tests would help dx HF and provide insight into its severity?

ECHO -> shows decreased EF and cardiomegaly

BNP: level of serum used to estimate severity of HF

What are the anticipated complications of left ventricular failure along with decreased renal perfusion?

Decreased contractility -> decreased renal perfusion and increase in renin and angiotensin -> increased afterload -> HTN

Decreased contractility -> decreased EF and increased left ventricular end diastolic volume (LVEVD) -> increased preload -> renal failure

What is the most likely cause of rheumatic heart disease?

Pharyngeal infection (sore throat) by the group A β-hemolytic streptococci

Immune response cross-reacts w/ molecularly similar SELF-ANTIGENS in heart, muscle, joints and brain, causing autoimmune response -> inflammatory lesions in these tissues

What is the most common valve disease that is often seen in young women?

Mitral valve prolapse

You examine a patient and notice a widened pulse pressure and throbbing peripheral pulses. What is the cause of these findings?

Aortic regurgitation

Widened pulse pressure d/t increased stroke volume and diastolic backflow

Large stroke volume causes prominent carotid pulsation + bounding peripheral pulses (Corrigan pulse)

What do elevated trop levels indicate for both diagnostic purposes and what is taking place at the cellular level to cause an increase in this lab value?

Diagnostic: MI

MI caused by prolonged, unrelieved ischemia that interrupts blood supply to the myocardium -> after 20 min of MI -> irreversible hypoxic injury -> cellular death and tissue necrosis

Myocyte injury: cardiac muscle cells contain trop in their cytoplasm -> when damaged/ die -> cell membranes rupture -> trop released into bloodstream

Cardiac injury/ cardiac muscle damage

You are reviewing the pathology and autopsy report on a patient that died from MI. What would you expect to see?

An aggregation of platelets w. atherosclerotic coronary artery

As you examine a patient with a long hx of peripheral vascular disease, you see persistent edema in the lower extremities and hyperpigmentation. What is the cause of the hyperpigmentation?

Chronic venous insufficiency

A genetically determined hypersensitivity to common environmental allergens causes _______ reactions, such as:

atopic; urticaria.

Leukemia is most common in?

Children

PVD includes:

Buerger disease and Raynaud phenomenon

Impairs blood flow from left ventricle to aorta:

aortic stenosis

Valve opening constricted and narrowed:

stenosis.

Blood moves backward into the chamber from where it came from:

regurgitation

A patient has a loud holosystolic murmur that radiates to the back and axilla. Which valvular abnormality is this describing?

Mitral regurgitation

Which is the most common complication of an acute MI?

Arrythmia

Which valvular disorder is characterized by impaired blood flow from the left atrium to the left ventricle?

Mitral stenosis

Cellular injury of myocardium

1. Cardiac cells can withstand ischemic conditions for about 20 min.

2. ECG changes are visible after 30-60 seconds of hypoxia.

3. After 8-10 seconds of blood flow, the myocardial cells are already cooler.

Dyslipidemia:

VLDL: very low-density lipoproteins (triglycerides and proteins)

Which enzymes are released by damaged myocardial muscle tissue?

1. CK-MB

2. LDH

3. Trop I

Symptoms of MI:

1. Unrelenting indigestion

2. Diaphoresis

3. Substernal pain

4. Cool, clammy skin

An infant born w. a congeintal heart defect experiences sudden onset of dyspnea, cyanosis and restlessness. Which condition will most likely be considered the cause of these symptoms?

"Tet" spell assoacited w. tetralogy of Fallot

Neuroendocrine mediators of HF:

SNS + RAAS

Tx: diuretics, BB, ACE-I

Emphysema

barrel chest

workup: thoracentesis + sputum culture

extra: antitrypsin deficiency; CXR: pus in pleural space

CF

bacterial infx w. pathogens, such as: pseudomonos aeruginosa + staph aerues

CF:

thick mucus, sputum

Pneumonia in children is most commonly:

Viral.

Nosocomial pnuemonia (hospital acquired)

pseudomonas

Atypical pneumonia

chalmydophia; group mycoplasma pneumonia