Semester 2

Question 1

Innate immune response

Answer 1

-Present at birth
-First line of defense

Question 2

Active immune response

Answer 2

Foreign substance or infection
(🐔pox)

Question 3

Passive Immune response

Answer 3

Received from mother

Question 4

Type 1 reaction

Answer 4

-IgE mediated
-anaphylaxis reaction

Question 5

Type 1 RN interventions

Answer 5

-Hx of allergies?
-Allergy test
-Epipen 💉
-Daily antihistamines 💊
-Educate: lifestyle, diet, and employment changes

Question 6

Type 2 immune response

Answer 6

-Cytotoxic
-blood transfer
-RH incompatibility

Question 7

RN interventions

Answer 7

-🛑 infusion
-📞 physician
-Change IV tubing
-Recheck crossmatch records
-Monitor fluids/electrolyte balance
-Eval serum calcium levels
-Treat symptoms as presented

Question 8

Type 3 immune response

Answer 8

-Immune complex
-Tissue damage
-could be systemic/local/delayed/immediate

Question 9

Type 4 immune response

Answer 9

-Delayed
-Cell mediated
-Contact dermatitis
-Transplant rejection🫀

Question 10

Type 3 & 4 RN interventions

Answer 10

-Identify & remove allergen
-Assess & manage symptoms
-Monitor increases
-Monitor VS
-🦠infection control protocols
-Promote nutrition & mobility🏃🏽‍♀️
-Skin/wound assessment
-Monitor WBC & Platelets
-Educate pt & Family
-importance of wearing an allergy bracelet

Question 11

Immunocompromised RN interventions/education

Answer 11

-Mask
-Gown
-Gloves
-LIMIT invasive lines
-LIMIT visitors (especially ill)
-single pt items
-No raw/uncooked veggies🥦 🥕
-no buffets
-Boiled/filtered water
-use dishwasher
-DONT SHARE ANYTHING

Question 12

Clinical manifestations of systemic anaphylactic reaction

Answer 12

-Edema
-Itching
-Increase mucus
-Vascular permeability
-Decrease BP
-Dyspnea

Question 13

Emergency management of anaphylactic reaction

Answer 13

-Epipen
- establish/maintain patent airway
-High flow O2😤
-Maintain BP
-Continuous monitoring/assessing🩺
-teaching prevention and Epipen

Question 14

HIV prevention

Answer 14

-Use Protection
-Needle exchange programs
-PrEP use
-HIV transmission
-fetal/infant risk
-Testing
-avoid sex while on drugs and etoh
-Limit partners/practice abstinence

Question 15

How can HIV be transmitted

Answer 15

-Blood
-semen
-breast milk
-Vaginal secretions

Question 16

When is a fetus or infant at risk when the mother is HIV+

Answer 16

-vaginal birth
-breast feeding

Question 17

HIV nursing interventions

Answer 17

-Hand hygiene
-cautious use of foley/venipuncture
-Monitor signs of infections at IV site, urine, lungs and mouth

Question 18

HIV education

Answer 18

Adequate nutrition 🍱
Avoid people with infections 🦠
Decrease stress 🤕
Decrease smoking/drinking etoh 🍹
Maximize quality of life
Adhere to med regimen 💊

Question 19

RN interventions for inflammation

Answer 19

Remove foreign material
Establish an environment for healing
R.I.C.E.

Question 20

Describe inflammatory process

Question 21

Sepsis diagnostic criteria

Answer 21

○ AMS
○ Temp>100.9
○ HR>90bpm
○ Hyperglycemia>140
○ Hypothermia<97
○ SBP<100 mmhg
○ Significant edema
○ Tachypnea>22

Question 22

Sepsis nursing care

Answer 22

○ Antibiotics
○ Antipyretic
○ Fluids
○ Monitor sugars
Continuous monitoring

Question 23

Influenza s/s

Answer 23

-Fever
-Aches
-Chills
-Tiredness
-Sudden onset

Question 24

Influenza Nursing management

Answer 24

-Symptom relief
-Rest
-Hydration
-Antipyretics
-Antivirals Analgesics