Following 2 motor vehicle collision, an adult client is brought to the emergency department with a blood pressure of 72/50 mm Hg and a blood volume loss of approximately 40%. The nurse should plan care for this client based on which expected response to hemorrhaging?

Increased preload that results in generalized peripheral edema.

The lowered blood pressure results in a reduction of the heart rate.

Decreased preload that can lead to decreased cardiac output.

Increased peripheral resistance resulting from poor renal perfusion.

Answer and Explanation

The Correct Answer is C

A) Increased preload that results in generalized peripheral edema:

This statement is incorrect. Decreased blood volume due to hemorrhage leads to decreased preload, not increased preload. Generalized peripheral edema is more commonly associated with conditions such as heart failure or kidney disease, where fluid retention leads to increased preload.

B) The lowered blood pressure results in a reduction of the heart rate:

While it's true that a decrease in blood pressure can trigger compensatory mechanisms such as an increase in heart rate (tachycardia), the specific response mentioned in this option is not entirely accurate. The primary compensatory response to hemorrhage-induced hypotension is typically an increase in heart rate, not a reduction.

C) Decreased preload that can lead to decreased cardiac output:

Correct. With decreased blood volume (preload), there is less blood returning to the heart during diastole. This leads to decreased ventricular filling and subsequently decreased stroke volume and cardiac output. Decreased cardiac output can contribute to hypotension and inadequate tissue perfusion.

D) Increased peripheral resistance resulting from poor renal perfusion:

While poor renal perfusion can trigger mechanisms to increase peripheral resistance (such as activation of the renin-angiotensin-aldosterone system), this option does not directly address the primary effect of decreased preload on cardiac output. Increased peripheral resistance alone does not adequately compensate for decreased preload to maintain cardiac output.

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Correct Answer is A

Explanation

A) The usual types of reactions are mediated by antibodies:

Correct. Types I, II, and III hypersensitivity reactions are mediated by antibodies (IgE, IgG, or IgM) that bind to antigens and trigger immune responses. In contrast, Type IV hypersensitivity reactions are T-cell mediated and do not involve antibodies.

B) B-lymphocytes produce the offending substances:

This statement is incorrect. B-lymphocytes are involved in antibody-mediated immune responses (types I, II, and III hypersensitivity reactions), not Type IV hypersensitivity reactions, which are primarily mediated by T-lymphocytes.

C) They typically occur with the first exposure to an antigen:

This statement is incorrect. Type IV hypersensitivity reactions usually require sensitization upon initial exposure to an antigen, and subsequent exposures elicit the delayed hypersensitivity response. This is similar to types I, II, and III hypersensitivity reactions, which also involve sensitization upon initial exposure.

D) Delayed reactions are characterized by cytokine release:

This statement is partially correct. Type IV hypersensitivity reactions are characterized by a delayed onset (typically 24 to 72 hours after exposure) and involve the release of cytokines from activated T-lymphocytes, leading to inflammation and tissue damage. However, other types of hypersensitivity reactions may also involve cytokine release, so this feature alone does not differentiate Type IV from other types of reactions.

A. Deposition of crystals in the synovial space of the joints produces inflammation and irritation. B. Chondrocyte injury destroys joint cartilage, producing osteophytes and joint inflammation. C. An immune complex and autoantibody deposition in connective tissue results in inflammation. D. An autoimmune inflammation involving IgG response to an antigen causes joint destruction.

Correct Answer is A

Explanation

Gout is a type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues. Here's an explanation of the pathophysiological process producing the symptoms of gout:

A) Deposition of crystals in the synovial space of the joints produces inflammation and irritation:

Correct. In gout, elevated levels of uric acid in the blood lead to the formation and deposition of monosodium urate crystals in the synovial fluid of joints, particularly in the big toe joint (first metatarsophalangeal joint) in many cases. These crystals trigger an inflammatory response, activating immune cells and causing swelling, redness, warmth, and severe pain in the affected joint. The inflammation and irritation result from the body's immune response to the presence of these crystals.

B) Chondrocyte injury destroys joint cartilage, producing osteophytes and joint inflammation:

This option describes a process more characteristic of osteoarthritis, where degeneration of joint cartilage leads to the formation of osteophytes (bone spurs) and joint inflammation. Gout involves the deposition of urate crystals rather than direct chondrocyte injury.

C) An immune complex and autoantibody deposition in connective tissue results in inflammation:

This process describes the pathophysiology of autoimmune diseases such as rheumatoid arthritis, where immune complexes and autoantibodies contribute to inflammation and tissue damage. In gout, the inflammation is primarily triggered by the deposition of urate crystals rather than immune complex deposition.

D) An autoimmune inflammation involving IgG response to an antigen causes joint destruction:

This option describes the autoimmune process seen in diseases like rheumatoid arthritis, where antibodies target specific antigens, leading to joint destruction. Gout is not an autoimmune disease, and joint destruction in gout is primarily due to inflammation caused by urate crystal deposition rather than autoimmune mechanisms.

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Following 2 motor vehicle collision, an adult client is brought to the emergency department with a blood pressure of 72/50 mm Hg and a blood volume loss of approximately 40%. The nurse should plan care for this client based on which expected response to hemorrhaging?

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Naxlex Comprehensive Predictor Exams

How are Type IV hypersensitivity reactions different from all other types (I, II, or III) of hypersentivity reactions?

Correct Answer is A

Explanation

A client with a sudden onset of big toe joint pain and swelling is diagnosed with gout. Which pathophysiologic process is producing the symptoms of gout?

Correct Answer is A

Explanation

The nurse is explaining the underlying cause of bruising with a client who is recently diagnosed with acute leukemia. Which pathophysiology is a result of the myeloblastic dysfunction of leukemia?

A client's ankle is edematous after an ankle sprain. Which physiological mechanism is responsible for the swelling?

A client with chronic osteoarthritis is troubled by knee pain. Which pathophysiological process is contributing to the pain?

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When developing a teaching plan for a client with peripheral artery disease, the nurse should explain that intermittent claudication occurs as the result of which underlying pathophysiology?