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Patients with septic shock are treated, among other drugs, with activated protein C. The purpose of this treatment is to
- A. Dampen the cytokine storm
- B. Raise the blood pressure
- C. Resolve DIC (disseminated intravascular coagulation)
- D. Boost the immune response
Correct Answer: C
Rationale: The correct answer is C: Resolve DIC. Activated protein C is used in septic shock to address the coagulopathy associated with DIC, a common complication. Activated protein C inhibits clotting factors and promotes fibrinolysis, helping to restore normal coagulation function. This treatment does not directly dampen the cytokine storm (choice A), raise blood pressure (choice B), or boost the immune response (choice D) in septic shock patients. It specifically targets the coagulation abnormalities seen in DIC, making choice C the most appropriate answer.
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In each of the following situations identify which option has the highest risk for human immunodeficiency virus (HIV) transmission?
- A. Transmission to women OR to men during sexual intercourse
- B. Hollow-bore needle used for vascular access OR used for IM injection
- C. First 2 to 6 months of infection OR 1 year after infection
- D. Perinatal transmission from HIV-infected mothers taking antiretroviral therapy OR HIV-infected mothers using no therapy
Correct Answer: C
Rationale: During the acute phase of HIV infection (first 2-6 months), viral loads are extremely high, increasing the likelihood of transmission.
Match the immunoglobulins with their primary functions:
- A. 1-C, 2-A, 3-B, 4-D
- B. 1-B, 2-C, 3-D, 4-A
- C. 1-D, 2-B, 3-C, 4-A
- D. 1-A, 2-D, 3-B, 4-C
Correct Answer: A
Rationale: The correct answer is A: 1-C, 2-A, 3-B, 4-D. Immunoglobulins are antibodies with different functions:
1. IgG (C) - Main antibody in secondary immune response.
2. IgA (A) - Found in mucosal areas, neutralizes pathogens.
3. IgM (B) - First antibody produced in primary immune response.
4. IgE (D) - Involved in allergic reactions and defense against parasites. Other choices are incorrect as they mismatch the immunoglobulins with their functions.
A clinical indicator of inflammation is:
- A. Decreased concentration of C3b
- B. Increased concentration of C-reactive protein
- C. Decreased concentration of MBL
- D. All of the above
Correct Answer: B
Rationale: The correct answer is B: Increased concentration of C-reactive protein. This is because C-reactive protein is a well-established clinical indicator of inflammation, produced by the liver in response to inflammation. Choice A is incorrect because a decreased concentration of C3b is not a typical indicator of inflammation. Choice C is incorrect because mannose-binding lectin (MBL) is an acute-phase reactant that increases in response to inflammation, so a decreased concentration of MBL would not be indicative of inflammation. Choice D is incorrect as it includes all options, but only B is a valid clinical indicator of inflammation.
The term 'lymphocyte repertoire' refers to:
- A. The range of antigen receptor specificities found in a lymphocyte population
- B. The variety of effector functions that result from an adaptive immune response
- C. Antigen receptor specificities found on a given lymphocyte
- D. The collection of daughter cells produced when a lymphocyte divides after activation
Correct Answer: A
Rationale: The correct answer is A because the term 'lymphocyte repertoire' specifically refers to the range of antigen receptor specificities found in a lymphocyte population. Lymphocytes are immune cells that play a crucial role in recognizing and responding to antigens, and their diverse antigen receptor specificities allow them to recognize a wide range of pathogens. This term does not refer to effector functions (B) or a single lymphocyte's receptor specificities (C). Additionally, it does not describe the collection of daughter cells produced after division (D), as the repertoire refers to the initial diversity of antigen receptors within a lymphocyte population.
A patient who has received a kidney transplant has been admitted to the medical unit with acute rejection and is receiving IV cyclosporine (Sandimmune) and methylprednisolone (Solu-Medrol). Which staff member is best to assign to care for this patient?
- A. An RN who floated to the medical unit from the coronary care unit for the day.
- B. An RN with 3 years of experience in the operating room who is orienting to the medical unit.
- C. An RN who has worked on the medical unit for 5 years and is working a double shift today.
- D. A new graduate RN who needs experience with IV medication administration.
Correct Answer: C
Rationale: An experienced RN who is familiar with the medical unit and its protocols is the best choice for caring for a patient with acute rejection. This patient requires close monitoring and skilled care which an experienced RN can provide. The other options involve RNs who may not be as familiar with the unit or are less experienced.