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NUR 326 Exam 1 with Accurate Solutions

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NUR 326 Exam 1 with Accurate Solutions

Institution
NUR 326
Course
NUR 326

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NUR 326 Exam 3 Questions and
Answers

True or false: Inflammation is always associated with infection. - ANS-False!

An immunologic defense against tissue injury, infection, or allergy. - ANS-Inflammation

What are the three populations at greatest risk for an ineffective inflammatory
response? - ANS-1. Very young
2. Very old
3. Uninsured

Which of the following patients' is at the greatest risk for a severe of ineffective
inflammatory response?

a. A 28-year-old female with hypertension following a colonoscopy.
b. A 35-year-old male with heart disease with a chief complaint of chest pain.
c. An 82-year-old female who is post-operative for an appendectomy.
d. A 53-year-old male with chronic COPD who states he has difficulty breathing. - ANS-
C

List 8 common symptoms of inflammation. - ANS-1. Swelling
2. Pain
3. Heat
4. Redness
5. Presence of exudate
6. Fever
7. Malaise
8. Fatigue

You are a nurse caring for an 82-year-old female who is 6 days postoperative for an
appendectomy. She comes into your clinic complaining of pain at the surgical site. You
assess the wound site and find that is it red, swelling, warm, and exudate is seen at the
wound site. Which of the following lab tests would you suspect the physician to order to
rule out infection?

a. Colonoscopy
b. Electrolyte status
c. WBC with differential
d. Hemoglobin A1c - ANS-C

,What are four things you can do to reduce inflammation after a sprain, strain, or
trauma? - ANS-RICE

Rest
Ice
Compression
Elevation

What time period after an injury is RICE most beneficial? - ANS-24-48 hours after

How long should you ice an inflamed injury? How often? - ANS-20 minutes every 2 or 3
hours as indicated

Should you put an ice pack directly on an inflamed injury? - ANS-No! You should wrap
the ice pack in a towel to prevent further tissue injury.

What should you monitor after applying a compression device to an injury? - ANS-
Monitor for impaired circulation such as cool fingers or toes, tingling, or turning blue in
color.

How high is "high enough" when elevating an extremity? - ANS-Elevation of the injured
area should be about the level of the heart ti minimize swelling

List some pharmacological interventions for managing inflammation. - ANS-1. Steroids
2. NSAIDs
3. Antipyretics
4. Analgesics
5. Antimicrobials

The nurse is completing an admission assessment of a new patient to the unit. The
nurse notes a long, thin, fading scar on the patient's abdomen in the right lower
quadrant. What is the best explanation for the scar's appearance?

a. Optimal functioning of the inflammatory process after an injury

b. Fibrous tissue replacing damaged tissue when injury is extensive

c. The development of chronic inflammation

d. A surgical incision - ANS-B (Scar tissue, or fibrous repair of damaged tissue, occurs
when an area is damaged too extensively for the body to replace damaged tissue with
identically functioning tissue after removal of injurious agents and pathogens. Optimal
functioning of the inflammatory process will result in regeneration of tissue that functions
identically to the damaged and replaced tissue. Chronic inflammation can result in
fibrous, or scar, tissue, but that scar tissue production is continuous as the inflammation

,continues. Fibrous tissue production can result from many different kinds of injuries, not
just surgical wounds.)

A patient comes to a clinic with a chief complaint of, "My left arm is red and swollen. It
hurts badly enough that I couldn't go to work today." The physician orders computer-
assisted tomography (CT) scanning of the left upper extremity. The nurse knows the
patient understands the reason for the procedure when he states

a. "I need to have this done because my arm is broken."

b. "The doctor wants me to have this so that the pain will stop."

c. "This will tell you what I did to my elbow because I really don't know what happened."

d. "This test will help to better determine where the injury actually is and how severe it
is." - ANS-D (Radiographic imaging studies such as CT scans help to determine the
location and extent of inflammation within the body. The CT scan will help with
diagnosis. The diagnosis is not predetermined. CT scanning does not alleviate pain.
Radiography does not necessarily determine a cause of an injury.)

Which of the following patients is at higher risk for inflammatory reactions?

a. 2-year-old girl with a healthy diet

b. 38-year-old man who is obese

c. 54-year-old woman in menopause

d. 79-year-old man with diabetes - ANS-D (The 79-year-old man is at highest risk for
inflammatory reactions among these patients for two reasons, his age and having
diabetes. The risk would be high during the first year of life, but this 2-year-old girl has
gotten beyond this risk period and she also has the positive factor of a healthy diet. The
38-year-old man is not in a high-risk category because of age but is because of obesity.
Although a 54-year-old woman is getting older, being in menopause does not increase
the risk for inflammatory reactions.)

The nurse is reviewing the erythrocyte sedimentation rate (ESR) of a patient to
determine which significant finding?

a. Determines specific causes of inflammation

b. Identifies the location of inflammation within the body

c. Confirms the nonspecific presence of inflammation

d. Indicates a diagnosis of systemic lupus - ANS-C (An elevated ESR is indicative of the
presence of inflammation in the body. Proteins produced during the inflammatory

, process adhere to red blood cells, causing them to be heavier and settle out of blood
samples at a faster rate than normal. The ESR does not identify specific causes of
inflammation and does not determine a specific location of inflammation. The ESR is a
nonspecific indicator of inflammation.)

A patient admitted to an acute care floor has rubor of an area of injury on the left lower
extremity. The nurse understands that this redness is caused by

a. vasodilation.

b. extravasation.

c. neutrophils.

d. exudate. - ANS-A (The inflammatory process results in rubor, or redness, of an area
of insult. The body responds to injury by increasing the blood flow to an area through
vasodilation. This allows increased oxygen and more nutrients and appropriate white
blood cells to reach the area, isolating the area and beginning the immune response.
Extravasation is the movement of fluid from its confined space into the surrounding
tissue. Neutrophils are one of the most common types of white blood cells. Exudate is
the fluid filled with proteins and white blood cells that moves out of the vascular spaces
through extravasation.)

Which of the following are clinical manifestations of inflammation? Select all that apply.

a. Swelling
b. Irritability
c. Heat
d. Fever
e. Pain
f. Itching - ANS-A C D E

Which subcategory of corticosteroids is usually used for anti-inflammatory purposes and
disorders of the immune system such as ulcerative colitis, rheumatoid arthritis, multiple
sclerosis, and IBD? - ANS-Glucocorticoids (Mineralocorticoids are used for Adrenal
insufficiency and adrenogenital syndrome.)

List some common glucocorticoid medications. - ANS-1. Betamethasone
2. Cortisone
3. Cortisone
4. Dexamethasone
5. Hydrocortisone
6. Prednisone

List some common side effects of corticosteroids. - ANS-1. Insomnia
2. GI upset

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