NR 507 Final Exam Study Guide
NR-507 Study Guide and practice questions
1. Types of immunity ch 7 & 8
a. Innate- natural epithelial barrier and
... [Show More] 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. Inflamation- associated with infection usually initiates an adaptive
process that results in a long-term and very effective immunity to the
infecting microorganism, referred to a 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 dentric 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 rom 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-aquired 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 humoral 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 humoral 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?
IgM 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
humoral 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 rosea- 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 planus, fibroma, insect bite
e. Patch - A flat, nonpalpable, irregular-shaped macule more than 1 cm in diameter,
Vitiligo, port-wine stains, mongolian spots, café-au-lait spots
f. Plaque- Elevated, firm, and rough lesion with flat top surface greater than 1 cm in
diameter, Psoriasis, seborrheic and actinic keratosis
g. Wheal - Elevated, irregular-shaped area of cutaneous edema; solid, transient;
variable diameter, Insect bites, urticaria, allergic reaction
h. Nodule- Elevated, firm, circumscribed lesion; deeper in dermis than a papule; 1-2
cm in diameter, Erythema nodosum, lipomas
i. Tumor- Elevated, solid lesion; may be clearly demarcated; deeper in dermis;
greater than 2 cm in diameter, Neoplasms, benign tumor, lipoma, 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 Rosea
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 Rosea
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 rosea
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,
nonpalpable, 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 parainfluenza 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 is 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. Anemias
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, folate deficiency- lack of folate 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 hemo, sideroblastic- dysfunctional iron uptake by
erythroblasts and defective porphyrin and heme 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 hemo concentration
(aplastic- insufficient erythropoiesis, posthemorrhagic- blood lost, hemolyticpremature destruction of mature erythrocytes in the circulation, sickle cellabnormal hemo synthesis, abnormal cell shape with damage, lysis 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?
Glossitis
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 abd pain, within
1 hr of eating, worse lying down, chest pain,
Questions
The nurse is performing an admission assessment on a client diagnosed with
gastroesophageal reflux disease (GERD). Which signs and symptoms would indicate
GERD?
Pyrosis, 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
is a grade 2 (severe overweight) classification, 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 [Show Less]