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NR507 Midterm Exam: Immunology, Hematology, & Cardiovascular, Exams of Nursing

Valdosta State University (VSU)Nursing

A comprehensive set of questions and answers covering key concepts in immunology, hematology, and cardiovascular systems. It explores various types of hypersensitivity reactions, autoimmune and alloimmune disorders, different types of anemia, and essential aspects of cardiovascular physiology. Particularly useful for students studying medical sciences, nursing, or related fields.

Typology: Exams

2024/2025

Available from 02/06/2025

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Chamberlain NR507 Midterm Exam
Questions & Answers
Type 1 Hypersensitivity Reaction - ANSWERS- "Allergic reaction"
- Mediated by IgE.
- Inflammation d/t mast cell degranulation.
- Hay fever, hives (uticaria).
- Local s/s: itching, rash.
- Systemic: wheezing.
- Severe, systemic reaction: anaphylaxis: hypotension, severe bronchoconstriction.
- Main tx: epinephrine.
Type 2 Hypersensitivity Reaction - ANSWERS- Cytotoxic reaction; tissue specific
- Macrophages are the primary effectors cells involved
- Causes tissue damage or alters function
- Examples: 1) Grave's disease- example of altering thyroid function, doesn't destroy
thyroid tissue. 2) ABO incompatibility- example of cell/tissue damage; severe
transfusion reaction occurs & the transfused erythrocytes are destroyed by agglutination
or complement-mediated lysis.
Difference between type 2 & 3 hypersensitivity reactions - ANSWERS- Type 2: organ
specific; antibody binds to the antigen on the cell surface.
- Type 3: not organ specific; antibody binds to soluble antigen outside the cell surface
that was released into the blood or body fluids, and the complex is then deposited in the
tissues.
Type 3 Hypersensitivity Reaction - ANSWERS- Immune complex
- Antigen-antibody complex deposited in the tissues
- Neutrophils are the primary effector cell
- Causes autoimmune diseases
- Examples: rheumatoid arthritis (joints), systemic lupus erythematosus (SLE, organs)
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Chamberlain NR507 Midterm Exam

Questions & Answers

Type 1 Hypersensitivity Reaction - ANSWERS- "Allergic reaction"

  • Mediated by IgE.
  • Inflammation d/t mast cell degranulation.
  • Hay fever, hives (uticaria).
  • Local s/s: itching, rash.
  • Systemic: wheezing.
  • Severe, systemic reaction: anaphylaxis: hypotension, severe bronchoconstriction.
  • Main tx: epinephrine. Type 2 Hypersensitivity Reaction - ANSWERS- Cytotoxic reaction; tissue specific
  • Macrophages are the primary effectors cells involved
  • Causes tissue damage or alters function
  • Examples: 1) Grave's disease- example of altering thyroid function, doesn't destroy thyroid tissue. 2) ABO incompatibility- example of cell/tissue damage; severe transfusion reaction occurs & the transfused erythrocytes are destroyed by agglutination or complement-mediated lysis. Difference between type 2 & 3 hypersensitivity reactions - ANSWERS- Type 2: organ specific; antibody binds to the antigen on the cell surface.
  • Type 3: not organ specific; antibody binds to soluble antigen outside the cell surface that was released into the blood or body fluids, and the complex is then deposited in the tissues. Type 3 Hypersensitivity Reaction - ANSWERS- Immune complex
  • Antigen-antibody complex deposited in the tissues
  • Neutrophils are the primary effector cell
  • Causes autoimmune diseases
  • Examples: rheumatoid arthritis (joints), systemic lupus erythematosus (SLE, organs)

Systemic Lupus Erythematosus (SLE) - ANSWERS- Facial rash confined to the cheeks (malar rash)

  • Discoid rash (raised patches, scaling)
  • Photosensitivity (skin rash d/t sunlight exposure)
  • Oral or nasopharyngeal ulcers
  • Hematologic disorders (hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia)
  • Immunologic disorders
  • Non-erosive arthritis of at least two peripheral joints
  • Serositis (pleurisy, pericarditis)
  • Renal disorder
  • Neurologic disorders (seizures, psychosis)
  • Presence of antinuclear antibody (ANA) Autoimmunity - ANSWERS- Can be familial: Affected family members may not all develop the same disease, but several members may have different disorders characterized by a variety of hypersensitivity reactions (autoimmune and allergic reactions). Alloimmunity - ANSWERS- General term used to describe when an individual's immune system reacts against antigens on the tissues of other members of the same species.
  • Examples: Neonatal disease where the maternal immune system becomes sensitized against antigens expressed by the fetus, Transplant rejection, Transfusion reaction. Type 4 Hypersensitivity Reaction - ANSWERS- T-cell mediated
  • Lymphocytes
  • Does not involve antigen/antibody complexes
  • Delayed response
  • Ex: localized contact dermatitis. Treated with a topical corticosteroid (wouldn't use antihistamine since Type 4 doesn't involve mast cells and H1 receptors). Differentiating between the rash of a Type 1 vs Type 4 Reaction - ANSWERS- Type 1: Immediate hypersensitivity reactions, termed atopic dermatitis, are usually characterized by widely distributed lesions.
  • Type 4: Contact dermatitis (delayed hypersensitivity) consists of lesions only at the site of contact with the allergen. The key determinant is the timing of the rash: -Type 1 = Immediate -Type 4 = Delayed: Several days following contact, ex- poison ivy Primary Immunodeficiency - ANSWERS- Most are the result of single gene defects.
  • Occurs d/t immune system development defect.
  • Antibody deficiencies, B- and T-cell deficiencies, phagocytic cell defects, complement deficiency

Aplastic Anemia - ANSWERS- Characterized by an absence of all formed blood elements caused by the failure of blood cell production in the bone marrow.

  • Diagnosis is made by blood tests and bone marrow biopsy.
  • Suspected if levels of circulating erythrocytes, leukocytes, and platelets are diminished. Sickle Cell Anemia - ANSWERS- Have sickle cell trait; caused by a mutation in the HBB gene that leads to the production of abnormal hemoglobin.
  • Autosomal recessive disorder; both parents must contribute an abnormal gene for a child to have the disorder. Thalassemia - ANSWERS- Inherited blood disorder that causes decreased circulating hemoglobin.
  • Many possible genetic mutations. Aortic Valve - ANSWERS- Valve located between the left ventricle and the aorta. Mitral Valve - ANSWERS- The valve between the left atrium and the left ventricle of the heart. Pulmonary Valve - ANSWERS- Valve positioned between the right ventricle and the pulmonary artery. Normal Blood Flow Through the Heart - ANSWERSSuperior & Inferior vena cava -> Right atrium -> Tricuspid valve -> Right ventricle -> Pulmonary valve -> Pulmonary artery -> Lungs -> Left atrium -> Mitral valve -> Left ventricle -> Aortic valve -> Aorta -> Body. Tricuspid Valve - ANSWERS- Valve between the right atrium and the right ventricle. Cardiac Output (CO) - ANSWERS- The volume of blood pumped by each ventricle per minute.
  • Cardiac output (mL/min) = stroke volume (mL/beat) x heart rate (beats/min) Preload - ANSWERS- Amount of stretch that the cardiac muscle exhibits at the end of ventricular filling.
  • More volume -> more stretch = higher preload
  • "fluid" Afterload - ANSWERS- The force which the heart must contract against in order to pump blood.
  • aka systemic vascular resistance
  • "pressure" Hypertension has its most immediate effect on ___________. - ANSWERSAfterload

Heart Failure - ANSWERS- Underlying patho: cardiac output < body's oxygen demands.

  • Overtime: decreased contractility, decreased stroke volume, increased left ventricular end-diastolic volume (LVEDV).
  • Causes dilation of the heart & increase in preload.
  • Major risk factor: long-standing hypertension Right-sided Heart Failure - ANSWERS- Inability of the right ventricle to provide adequate blood flow into pulmonary circulation.
  • Can occur due to left-sided HF d/t the back up of fluid from the left side to the right.
  • Can occur b/c of long-standing pulmonary issues (COPD).
  • S/S: right jugular venous distention, peripheral edema, hepatosplenomegaly Stages of Heart Failure (ACC/AHA) - ANSWERS- Stage A: patient has risk factors (CAD) but no symptoms; no structural heart damage.
  • Stage B: patient has structural heart damage (MI), but still no symptoms.
  • Stage C: patient is symptomatic with alteration in their daily functions due to dyspnea, swelling, etc. This is where their NYHA functional classifications come into play.
  • Stage D: end-stage heart failure- have maximized medications to treat it- may need heart transplant or pacemaker NYHA Functional Classifications - ANSWERS- Stage I: mild; no limitation of physical activity; ordinary physical activity doesn't cause symptoms.
  • Stage II: mild; slight limitation of physical activity; comfortable at rest; ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.
  • Stage III: moderate; marked decrease in physical activity; marked limitation of physical activity; comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain.
  • Stage IV: severe; inability to carry on any physical activity w/out discomfort. Symptoms of HF or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort increases. Aortic Stenosis - ANSWERS- Narrowing of the aorta.
  • S/S: syncope (fainting), chest pressure upon exercising, dyspnea, left ventricular hypertrophy, sustained laterally displaced apical pulse, S4 gallop.
  • Murmur: mid-systolic crescendo-decrescendo @ base and radiating to the neck. Aortic Regurgitation - ANSWERS- Flow of blood backward from the aorta into the heart (left ventricle); caused by a weak/"floppy" aortic valve.
  • S/S: SOB that progressively worsens, exercise intolerance, chest x-ray shows pulmonary edema & cardiomegaly
  • Murmur: diastolic rumbling sound @ apex; systolic crescendo-decrescendo @ left upper sternal border; high-pitched early diastolic murmur @ left lower sternal border. Mitral Regurgitation - ANSWERS- "Floppy" mitral valve. Blood goes back into the left atrium and into pulmonary system.
  • S/S: SOB, jugular vein distention, crackles in bilateral lung bases
  • S/S: productive cough with copious amounts of sputum, dyspnea, wheezing, rhonchi, and cyanosis of the skin & mucous membranes
  • "blue bloater" What type of hypersensitivity reaction is: child develops systemic anaphylaxis after eating peanut butter - ANSWERSType 1 Hypersensitivity reaction (Allergic/IgE mediated) What type of hypersensitivity reaction is: adult develops rejection of a transplanted heart
  • ANSWERSType IV Hypersensitivity reaction (cell-mediated) What type of hypersensitivity reaction is: adult develops rash on legs from poison ivy after hiking in shorts - ANSWERSType IV Hypersensitivity reaction (Cell-mediated) What type of hypersensitivity reaction is: adult develops hemolysis after mismatched blood transfusion - ANSWERSType II Hypersensitivity reaction (Tissue-specific) Folate deficiency anemia is associated with chronic malnourishment and chronic abuse of __________. - ANSWERSAlcohol When describing the appearance of erythrocytes, terms that end with _________ refer to the hemoglobin content and terms that end with ________ refer to cell size. - ANSWERS-chromic -cytic Appearance of erythrocytes: iron deficiency anemia - ANSWERSmicrocytic, hypochromic Appearance of erythrocytes: aplastic anemia - ANSWERSnormocytic, normochromic Appearance of erythrocytes: pernicious anemia (b-12 deficiency) - ANSWERSMacrocytic, normochromic Appearance of erythrocytes: folate deficiency anemia - ANSWERSmacrocytic, normochromic Serum ferritin levels are used to evaluate _______ status when diagnosing anemia. - ANSWERSIron Clinical manifestations of left heart failure - ANSWERS- Orthopnea
  • Dyspnea
  • Coughing pink, frothy sputum
  • Crackles upon auscultation
  • Pulmonary edema Clinical manifestations of right heart failure - ANSWERS- Ankle edema
  • Jugular venous distention
  • Splenohepatomegaly People who have obstructive respiratory disorders have the most difficulty with inspiration or expiration? - ANSWERSExpiration The two disorders known as COPD are emphysema and ______ _______; this latter condition is characterized by persistent hypersecretion of ______ and chronic _________ cough - ANSWERS- Chronic bronchitis
  • Mucus
  • Productive Clinical manifestations of emphysema include _______ chest and _______ on exertion and eventually at rest. - ANSWERS- Barrel
  • Dyspnea Cor pulmonale is _______ ventricular enlargement caused by chronic pulmonary __________. - ANSWERS- Right
  • Hypertension