Choice A reason: This is a correct definition of pathophysiology and does not indicate a need for further teaching.

Choice B reason: This is a correct definition of pathophysiology nursing and does not indicate a need for further teaching.

Choice C reason: This is a correct description of what pathophysiology nursing involves and does not indicate a need for further teaching.

Choice D reason: This is an incorrect statement that contradicts the text and indicates a need for further teaching.

Choice A reason: This is a correct answer because family history of diabetes is a genetic risk factor that can increase the likelihood of inheriting defects in insulin production or action.

Choice B reason: This is a correct answer because obesity is a modifiable risk factor that can cause insulin resistance, a condition in which cells do not respond properly to insulin and glucose accumulates in the blood.

Choice C reason: This is an incorrect answer because smoking is not a risk factor for developing diabetes mellitus, although it can worsen its complications such as cardiovascular disease and kidney disease.

Choice D reason: This is an incorrect answer because hypertension is not a risk factor for developing diabetes mellitus, although it can be associated with it and increase the risk of cardiovascular complications.

Choice E reason: This is a correct answer because physical inactivity is a modifiable risk factor that can reduce insulin sensitivity and glucose utilization by muscles, leading to hyperglycemia.

Choice A reason: This is a correct answer because it accurately describes the pathogenesis of asthma and its triggers. Asthma is caused by an overreaction of the immune system to certain triggers, such as allergens, infections, or irritants, that leads to inflammation, bronchoconstriction, mucus production, and coughing.

Choice B reason: This is an incorrect answer because it confuses asthma with another condition called pulmonary hypertension, which is characterized by high blood pressure in the lungs and reduced oxygen supply.

Choice C reason: This is an incorrect answer because it confuses asthma with another condition called pulmonary edema, which is characterized by fluid accumulation in the lungs and impaired gas exchange.

Choice D reason: This is an incorrect answer because it confuses asthma with another condition called cystic fibrosis, which is a genetic disorder that affects the mucus glands and causes thick and sticky mucus in the lungs and other organs.

Choice A reason: This is an incorrect answer because feeling tired and weak are common symptoms of pneumonia, but not indicative of a complication.

Choice B reason: This is an incorrect answer because coughing up yellow-green sputum with some blood is a common sign of pneumonia, but not indicative of a complication.

Choice C reason: This is an incorrect answer because having chest pain that worsens with deep breathing is a common sign of pleurisy (inflammation of the lining of the lungs), which is often associated with pneumonia, but not indicative of a complication.

Choice D reason: This is a correct answer because having trouble breathing and cyanosis are signs of hypoxemia, which is a possible complication of pneumonia that can lead to respiratory failure and death.

Choice A reason: This is a correct answer because obtaining a blood culture from the client before administering the antibiotic can help identify the causative microorganism and its sensitivity to different antibiotics, which can guide the selection of the most appropriate antibiotic therapy.

Choice B reason: This is an incorrect answer because checking the client's vital signs and oxygen saturation is an ongoing intervention that should be performed throughout the course of treatment, but not necessarily before administering the antibiotic.

Choice C reason: This is an incorrect answer because assessing the client's level of consciousness and orientation is an ongoing intervention that should be performed throughout the course of treatment, but not necessarily before administering the antibiotic.

Choice D reason: This is an incorrect answer because flushing the client's intravenous line with normal saline is an intervention that should be performed after administering the antibiotic, not before, to ensure that no residual antibiotic remains in the line.

Choice A reason: Frostbite is caused by exposure to extreme cold, which is a physical factor that can damage the cells. Physical injury can result in cell membrane damage, cytoplasmic swelling, organelle dysfunction, or DNA breakage.

Choice B reason: Chemical injury is caused by exposure to toxic substances, poisons, or pollutants that can damage the cells. Chemical injury can result in cell membrane damage, cytoplasmic swelling, organelle dysfunction, or DNA breakage.

Choice C reason: Biological injury is caused by infection by microorganisms, such as bacteria, viruses, fungi, or parasites that can damage the cells. Biological injury can result in inflammation, immune response, or tissue damage.

Choice D reason: Genetic injury is caused by mutations or alterations in the DNA that can damage the cells. Genetic injury can result in abnormal protein synthesis, impaired cell function, or inherited diseases.

Choice A reason: Bilirubin is a yellow pigment that is produced from the breakdown of hemoglobin in red blood cells. It is normally excreted by the liver into bile and then eliminated by the intestines. However, when there is an obstruction of bile flow in the liver due to cirrhosis, bilirubin accumulates in the blood and tissues, causing jaundice.

Choice B reason: Lipofuscin is a brown pigment that is derived from the oxidation of lipids and proteins in the cells. It is also known as "wear and tear" pigment because it accumulates with aging and reflects the cumulative damage to the cells.

Choice C reason: Steatosis is a condition where fat accumulates in the cytoplasm of hepatocytes (liver cells). It can be caused by various factors, such as alcohol abuse, obesity, diabetes, or malnutrition.

Choice D reason: Phenylketonuria is a genetic disorder where phenylalanine, an amino acid, cannot be converted into tyrosine, another amino acid, due to a deficiency of an enzyme called phenylalanine hydroxylase. This leads to a buildup of phenylalanine and its metabolites in the blood and tissues, causing brain damage and mental retardation.

Choice A reason: "An unregulated and passive process of cell death that causes inflammation and tissue damage." This is a description of necrosis, not apoptosis. Necrosis is an abnormal and harmful process that occurs when the cells are exposed to severe or persistent stressors that overwhelm their adaptive capacity. It involves the loss of cell membrane integrity, the release of cellular contents into the extracellular space, and the initiation of an inflammatory response that can damage the surrounding tissues.

Choice B reason: Apoptosis is also known as programmed cell death or cell suicide. It is a normal and beneficial process that maintains the balance between cell proliferation and cell death. It involves a series of biochemical events that lead to the activation of enzymes called caspases, which degrade the cell's DNA, proteins, and organelles. The cell then shrinks and forms membrane-bound fragments called apoptotic bodies, which are phagocytosed by macrophages or neighboring cells without causing inflammation or tissue damage.

Choice C reason: "A reversible process of cell injury that occurs when the stressor is mild or removed." This is a description of reversible cell injury, not apoptosis. Reversible cell injury is a process that occurs when the cells are exposed to mild or transient stressors that do not exceed their adaptive capacity. It involves changes in cell metabolism, function, and structure that can be restored if the stressor is removed or the cells are able to adapt.

Choice D reason: "An irreversible process of cell injury that occurs when the stressor is severe or persistent." This is a description of irreversible cell injury, not apoptosis. Irreversible cell injury is a process that occurs when the cells are exposed to severe or persistent stressors that exceed their adaptive capacity. It involves changes in cell metabolism, function, and structure that cannot be restored and lead to cell death by necrosis or apoptosis.

Choice A reason: Phenylketonuria (PKU) is a genetic disorder where phenylalanine, an amino acid, cannot be converted into tyrosine, another amino acid, due to a deficiency of an enzyme called phenylalanine hydroxylase. This leads to a buildup of phenylalanine and its metabolites in the blood and tissues, causing brain damage and mental retardation.

Choice B reason: Tyrosine is another amino acid that is normally produced from phenylalanine by the enzyme phenylalanine hydroxylase. However, in PKU, this enzyme is deficient, so tyrosine levels are low in the blood and tissues.

Choice C reason: Glucose is a simple sugar that is the main source of energy for the cells. It is not directly related to PKU, although some people with PKU may have low blood glucose levels due to dietary restrictions.

Choice D reason: Glycogen is a complex carbohydrate that is stored in the liver and muscles as a reserve source of energy. It is not directly related to PKU, although some people with PKU may have glycogen storage disease, which is a separate genetic disorder where glycogen cannot be broken down into glucose due to a deficiency of an enzyme called glucose-6-phosphatase.

Choice A reason: Type II hypersensitivity is caused by the binding of IgG or IgM antibodies to antigens on the surface of target cells. This leads to complement activation, opsonization, phagocytosis, or antibody-dependent cellular cytotoxicity (ADCC) of the target cells. It is seen in conditions such as hemolytic anemia, transfusion reactions, or Graves' disease.

Choice B reason: Type III hypersensitivity is caused by the deposition of immune complexes in the tissues and blood vessels. This leads to complement activation, inflammation, and tissue damage. It is seen in conditions such as systemic lupus erythematosus (SLE), rheumatoid arthritis, or serum sickness.

Choice C reason: Type IV hypersensitivity is caused by the activation of cytotoxic T cells or helper T cells that release cytokines and recruit macrophages and other inflammatory cells. This leads to delayed and cell-mediated reactions, such as contact dermatitis, tuberculin reaction, or graft rejection.

Choice A reason: Type I hypersensitivity is not involved in tuberculin skin test, as it does not involve IgE antibodies or mast cells.

Choice B reason: Type II hypersensitivity is not involved in tuberculin skin test, as it does not involve IgG or IgM antibodies or target cells.

Choice C reason: Type III hypersensitivity is not involved in tuberculin skin test, as it does not involve immune complexes or complement activation.

Choice D reason: Type IV hypersensitivity is involved in tuberculin skin test, as it involves the activation of helper T cells that recognize the mycobacterial antigens injected into the skin and release cytokines that recruit macrophages and other inflammatory cells. This leads to a delayed and indurated reaction at the site of injection.

Choice E reason: Type V hypersensitivity is also involved in tuberculin skin test, as it involves the activation of cytotoxic T cells that recognize the mycobacterial antigens presented by MHC class I molecules on infected cells and destroy them by releasing perforin and granzymes. This leads to a cell-mediated reaction at the site of infection.

Choice B reason: An anaphylactic transfusion reaction is a type of transfusion reaction that occurs when the recipient has IgE antibodies against plasma proteins in the donor blood and causes a systemic allergic response. It manifests as urticaria, pruritus, bronchospasm, laryngeal edema, hypotension, or shock.

Choice C reason: A febrile nonhemolytic transfusion reaction is a type of transfusion reaction that occurs when the recipient has antibodies against leukocytes or platelets in the donor blood and causes a mild inflammatory response. It manifests as fever, chills, headache, or malaise.

Choice D reason: A transfusion-related acute lung injury is a type of transfusion reaction that occurs when the donor has antibodies against leukocytes in the recipient blood and causes pulmonary edema and respiratory distress. It manifests as dyspnea, hypoxia, hypotension, or fever.

Choice B reason: A type II hypersensitivity reaction is not involved in bee sting allergy, as it does not involve IgG or IgM antibodies or target cells.

Choice C reason: A type III hypersensitivity reaction is not involved in bee sting allergy, as it does not involve immune complexes or complement activation.

Choice D reason: A type IV hypersensitivity reaction is not involved in bee sting allergy, as it does not involve cytotoxic T cells or helper T cells.

Choice B reason: SLE is not an immunodeficiency disease, as it does not cause a reduced number or function of immune cells. Immunodeficiency diseases are characterized by increased susceptibility to infections and malignancies due to impaired immune response.

Choice C reason: SLE is not an infectious disease, as it is not caused by bacteria or viruses that invade the body. Infectious diseases are characterized by fever, malaise, lymphadenopathy, and organ-specific symptoms due to microbial invasion and replication.

Choice D reason: SLE is not a neoplastic disease, as it does not cause an abnormal growth and proliferation of immune cells. Neoplastic diseases are characterized by masses or tumors that result from uncontrolled cell division and differentiation.

Choice C reason: Community-acquired infection is an infection that is acquired outside of a health care setting, such as a UTI caused by E. coli. E. coli is a common cause of UTI and is usually found in the intestinal tract or fecal matter.

Choice A reason: Nosocomial infection is an infection that is acquired in a health care setting, such as a surgical site infection or a catheter-associated bloodstream infection. Nosocomial infections are often caused by multidrug-resistant organisms, such as methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE).

Choice B reason: Opportunistic infection is an infection that occurs in immunocompromised individuals, such as those with HIV/AIDS, cancer, or organ transplantation. Opportunistic infections are caused by microorganisms that are normally harmless or part of the normal flora, but become pathogenic when the host's defenses are weakened. Some examples of opportunistic infections are Pneumocystis jirovecii pneumonia, Candida albicans thrush, or cytomegalovirus retinitis.

Choice D reason: Latent infection is an infection that remains dormant or inactive in the host for a period of time, but can reactivate and cause disease when the host's immunity declines. Some examples of latent infections are herpes simplex virus, varicella-zoster virus, or Mycobacterium tuberculosis.

Choice A reason: Sepsis is a life-threatening condition that occurs when the body has a systemic inflammatory response to an infection, which can be bacterial, viral, fungal, or parasitic. The inflammatory response involves the activation of immune cells, cytokines, complement, coagulation, and fibrinolysis pathways that cause widespread vasodilation, increased vascular permeability, and microvascular thrombosis.

Choice B reason: Sepsis can cause organ dysfunction or failure due to impaired tissue perfusion and oxygen delivery. The vasodilation and increased vascular permeability cause hypotension and hypovolemia, which reduce the cardiac output and blood pressure. The microvascular thrombosis causes obstruction and ischemia of the capillaries, which impair the oxygen and nutrient exchange to the tissues. The tissue hypoxia causes anaerobic metabolism and lactic acidosis, which further worsen the organ function.

Choice C reason: Sepsis can be diagnosed by measuring the blood lactate level, which indicates the severity of tissue hypoxia. Lactate is a product of anaerobic metabolism that accumulates in the blood when the oxygen delivery to the tissues is insufficient. A normal blood lactate level is less than 2 mmol/L. A blood lactate level of 2 to 4 mmol/L indicates moderate tissue hypoxia and sepsis. A blood lactate level of more than 4 mmol/L indicates severe tissue hypoxia and septic shock.

Choice D reason: Sepsis cannot be prevented by taking antibiotics regularly and avoiding contact with sick people. Taking antibiotics regularly can increase the risk of antibiotic resistance and superinfection by killing the normal flora and allowing opportunistic pathogens to grow. Avoiding contact with sick people can reduce the exposure to infectious agents, but it cannot eliminate the risk of sepsis completely, as some infections can be asymptomatic or latent.

Choice E reason: Sepsis can be treated by administering fluids, vasopressors, oxygen, and antibiotics as soon as possible. Fluids are given to restore the intravascular volume and improve the tissue perfusion and oxygen delivery. Vasopressors are given to increase the blood pressure and maintain the vital organ function. Oxygen is given to correct the hypoxemia and reduce the tissue hypoxia. Antibiotics are given to eradicate the causative microorganism and control the infection.

Choice D reason: The client has signs and symptoms of cardiac, renal, and neurologic dysfunction due to sepsis.

Choice A reason: Cardiac dysfunction is indicated by tachycardia and hypotension, which reflect the impaired cardiac output and blood pressure due to sepsis. The cardiac dysfunction can lead to cardiogenic shock, myocardial ischemia, or arrhythmias.

Choice B reason: Renal dysfunction is indicated by oliguria, which reflects the reduced renal perfusion and glomerular filtration rate due to sepsis. The renal dysfunction can lead to acute kidney injury, electrolyte imbalance, or metabolic acidosis.

Choice C reason: Neurologic dysfunction is indicated by altered mental status, which reflects the reduced cerebral perfusion and oxygenation due to sepsis. The neurologic dysfunction can lead to delirium, coma, seizures, or stroke.

Choice C reason: Purulent exudate is a type of exudate that contains pus, which is composed of dead neutrophils, bacteria, and cellular debris. It has a creamy white or yellow, purulent, and sometimes bloody appearance and a foul odor. It is seen in wound infections caused by pyogenic bacteria, such as S. aureus.

Choice A reason: Serous exudate is a type of exudate that contains clear or yellowish fluid that accumulates in body cavities or on the surface of tissues. It has a watery and thin appearance and no odor. It is seen in conditions such as blisters or pericarditis.

Choice B reason: Sanguineous exudate is a type of exudate that contains blood or blood cells that leak from damaged blood vessels. It has a red or brown appearance and no odor. It is seen in conditions such as trauma, surgery, or malignancy.

Choice D reason: Fibrinous exudate is a type of exudate that contains fibrin, which is a protein that forms a meshwork of fibers that seal and stabilize the wound. It has a sticky and thick appearance and no odor. It is seen in conditions such as rheumatic fever or pleurisy.

Choice A reason: Eradicate the causative microorganism within 24 hours. The goal of antibiotic therapy in septic shock is to eradicate the causative microorganism as soon as possible, preferably within 24 hours of diagnosis or sooner if possible. This can reduce the bacterial load, control the infection, and prevent further complications.

Choice B reason: Reduce the inflammatory response within 48 hours is not the goal of antibiotic therapy in septic shock, as antibiotics do not directly affect the inflammatory response. Antibiotics can indirectly reduce the inflammatory response by eradicating the microorganism that triggers it, but this may take longer than 48 hours to achieve.

Choice C reason: Restore the tissue perfusion and oxygen delivery within 72 hours is not the goal of antibiotic therapy in septic shock, as antibiotics do not directly affect the tissue perfusion and oxygen delivery. Antibiotics can indirectly restore the tissue perfusion and oxygen delivery by eradicating the microorganism that causes vasodilation, hypotension, hypovolemia, and microvascular thrombosis, but this may take longer than 72 hours to achieve.

Choice D reason: Prevent the development of multiple organ dysfunction syndrome within 96 hours is not the goal of antibiotic therapy in septic shock, as antibiotics do not directly prevent the development of multiple organ dysfunction syndrome. Antibiotics can indirectly prevent the development of multiple organ dysfunction syndrome by eradicating the microorganism that causes tissue hypoxia, lactic acidosis, and organ failure, but this may take longer than 96 hours to achieve.

Choice A reason:

A benign neoplasm grows slowly and remains localized within its site of origin. It does not spread to other parts of the body or cause systemic effects.

Choice B reason:

A malignant neoplasm invades surrounding tissues and organs and destroys their normal function. It can also penetrate blood vessels or lymphatics and disseminate to distant sites, forming secondary tumors or metastases.

Choice C reason:

A benign neoplasm can differentiate into normal cells that resemble the tissue of origin. It has a well-defined shape and structure and retains some of its normal functions.

Choice D reason:

A malignant neoplasm can metastasize to distant sites via blood or lymph, creating new foci of tumor growth and increasing the complexity and severity of the disease.

Choice E reason:

A benign neoplasm can cause compression or obstruction of nearby structures, such as nerves, blood vessels, ducts, or organs. This can result in pain, ischemia, inflammation, or dysfunction of the affected structures.

Choice A reason:

The size and number of primary tumors are important criteria for staging cancer, as they indicate the local growth and expansion of the tumor within its site of origin. The larger and more numerous the tumors are, the higher the stage of cancer is.

Choice B reason:

The presence or absence of regional lymph node involvement is another important criterion for staging cancer, as it indicates the spread of the tumor to the nearby lymphatic system. The more lymph nodes are affected, the higher the stage of cancer is.

Choice C reason:

The presence or absence of distant metastases is the most important criterion for staging cancer, as it indicates the spread of the tumor to other parts of the body via blood or lymph. The presence of any distant metastasis usually indicates the highest stage of cancer.

Choice D reason:

The degree of cellular differentiation and resemblance to normal tissue is a criterion for grading cancer, not staging cancer. Grading cancer assesses the severity and aggressiveness of the tumor based on its histologic appearance and behavior.

Choice E reason:

The level of tumor markers in the blood or other body fluids is a criterion for monitoring cancer, not staging cancer. Tumor markers are substances produced by tumor cells or by the body in response to tumor cells that can be detected in laboratory tests. They can help diagnose, prognose, or evaluate the response to treatment of cancer.

Choice A reason:

Chemotherapy kills cancer cells by interfering with their DNA synthesis and replication. Chemotherapy drugs are cytotoxic agents that target rapidly dividing cells, such as cancer cells, and disrupt their cell cycle, DNA repair, or DNA replication mechanisms. This leads to cell death or apoptosis.

Choice B reason:

Radiation therapy kills cancer cells by exposing them to high-energy radiation that damages their DNA. Radiation therapy uses ionizing radiation, such as x-rays, gamma rays, or protons, that create free radicals that break DNA strands and cause mutations or chromosomal aberrations in cancer cells.

Choice C reason:

Immunotherapy kills cancer cells by stimulating the immune system to recognize and destroy them. Immunotherapy uses biological agents, such as monoclonal antibodies, cytokines, vaccines, or adoptive cell transfer, that enhance the immune response against cancer cells or overcome their immune evasion strategies.

Choice D reason:

Hormone therapy kills cancer cells by blocking their hormone receptors and preventing their growth. Hormone therapy uses drugs that either inhibit the production or action of hormones, such as estrogen or testosterone, that stimulate the growth of hormone-dependent cancers, such as breast or prostate cancer.

Choice D reason:

Metastatic manifestations are signs and symptoms of cancer that result from the spread of the tumor to distant organs or tissues. Lung cancer can metastasize to various sites, such as the brain, bone, liver, or adrenal glands, and cause organ-specific manifestations, such as dyspnea, cough, hemoptysis, and weight loss.

Choice A reason:

Local manifestations are signs and symptoms of cancer that result from the growth and expansion of the tumor within its site of origin. Lung cancer can cause local manifestations, such as chest pain, pleural effusion, or atelectasis.

Choice B reason:

Systemic manifestations are signs and symptoms of cancer that result from the effects of the tumor or its treatment on the whole body. Lung cancer can cause systemic manifestations, such as anorexia, cachexia, fatigue, or fever.

Choice C reason:

Paraneoplastic manifestations are signs and symptoms of cancer that result from the production of hormones or other substances by the tumor cells that affect normal body functions. Lung cancer can cause paraneoplastic manifestations, such as hypercalcemia, syndrome of inappropriate antidiuretic hormone secretion (SIADH), or Cushing's syndrome.

Choice B reason:

Dietary factors are important risk factors for colon cancer, as they can affect the composition and metabolism of the intestinal flora and the production of carcinogens or protective substances in the colon. Red meat, processed meat, and high-fat foods can increase the risk of colon cancer by increasing the production of heterocyclic amines, nitrosamines, or bile acids that can damage the colonic mucosa and promote tumor growth.

Choice A reason:

"You should have a colonoscopy every 10 years starting at age 50 to screen for colon cancer." This statement is not correct for a client who has a family history of colon cancer, as they have a higher risk of developing the disease than the general population. They should have a colonoscopy every 5 years starting at age 40 or 10 years earlier than the age at which their relative was diagnosed with colon cancer.

Choice C reason:

"You should take aspirin daily to prevent inflammation and polyp formation in your colon." This statement is not correct for a client who has a family history of colon cancer, as they may have other medical conditions or contraindications that make aspirin use unsafe or inappropriate for them. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can reduce the risk of colon cancer by inhibiting cyclooxygenase-2 (COX-2) enzyme that stimulates inflammation and angiogenesis in the colon. However, aspirin can also cause side effects such as bleeding, ulcers, or allergic reactions in some clients.

Choice D reason:

"You should increase your intake of calcium and vitamin D to protect your colon from cancer." This statement is not correct for a client who has a family history of colon cancer, as there is insufficient evidence to support the role of calcium and vitamin D in preventing colon cancer. Calcium and vitamin D may have some protective effects on the colon by binding to bile acids or regulating cell proliferation and differentiation in the colonic mucosa. However, they may also have adverse effects on other organs or systems, such as increasing the risk of kidney stones or cardiovascular disease.

Choice B reason Huntington disease is caused by a mutation in the HTT gene that encodes for the huntingtin protein. The mutation involves an expansion of the CAG trinucleotide repeat in the gene, which results in an abnormal protein with an elongated polyglutamine tract. This protein gains a new toxic function that interferes with the normal function of other proteins and causes neuronal degeneration in the brain.

Choice A reason:

Loss-of-function mutation is a type of mutation that reduces or eliminates the normal function of a gene or protein. This can result in diseases such as cystic fibrosis, phenylketonuria, or sickle cell anemia.

Choice C reason:

Haploinsufficiency mutation is a type of mutation that reduces the amount or activity of a gene or protein to less than 50% of the normal level. This can result in diseases such as Marfan syndrome, familial hypercholesterolemia, or Waardenburg syndrome.

Choice D reason:

Dominant negative mutation is a type of mutation that produces an abnormal protein that interferes with the normal protein and prevents it from functioning properly. This can result in diseases such as osteogenesis imperfecta, Ehlers-Danlos syndrome, or Holt-Oram syndrome.

Choice D reason: GDM can increase the risk of congenital disorders in the fetus, such as neural tube defects, cardiac defects, and cleft lip and palate. GDM is a condition that occurs when the mother develops insulin resistance and hyperglycemia during pregnancy. This can affect the fetal development and cause various complications, such as macrosomia, hypoglycemia, polycythemia, or respiratory distress syndrome.

Choice A reason:

Neural tube defects are congenital disorders that occur when the neural tube fails to close properly during the first month of embryonic development. This can result in defects such as spina bifida, anencephaly, or encephalocele. GDM can increase the risk of neural tube defects by altering the maternal-fetal glucose metabolism and affecting the folate metabolism.

Choice B reason:

Cardiac defects are congenital disorders that occur when the heart or blood vessels fail to form or function properly during the fetal development. This can result in defects such as atrial septal defect, ventricular septal defect, patent ductus arteriosus, or tetralogy of Fallot. GDM can increase the risk of cardiac defects by causing fetal hyperinsulinemia and hypoxia, which can impair the cardiac morphogenesis and differentiation.

Choice C reason:

Cleft lip and palate are congenital disorders that occur when the upper lip or palate fail to fuse completely during the first trimester of fetal development. This can result in defects such as unilateral or bilateral cleft lip, cleft palate, or both. GDM can increase the risk of cleft lip and palate by affecting the maternal-fetal glucose metabolism and causing oxidative stress and inflammation in the developing tissues.

Choice A reason "Trisomy 21." Down syndrome is a chromosomal disorder that occurs when there is an extra copy of chromosome 21 in the cells. This can result in physical and mental developmental delays and various health problems. The features that the nurse observed are typical of Down syndrome, such as slanted eyes, a flat nose bridge, a protruding tongue, and a single palmar crease.

Choice B reason:

"Monosomy X." Turner syndrome is a chromosomal disorder that occurs when there is a missing or partially missing X chromosome in females. This can result in short stature, infertility, heart defects, and other health problems. The features that the nurse observed are not typical of Turner syndrome, which may include a webbed neck, a low hairline, a broad chest, or swollen hands and feet.

Choice C reason:

"XXY." Klinefelter syndrome is a chromosomal disorder that occurs when there is an extra X chromosome in males. This can result in low testosterone levels, infertility, gynecomastia, and other health problems. The features that the nurse observed are not typical of Klinefelter syndrome, which may include tall stature, small testes, sparse body hair, or learning difficulties.

Choice D reason:

"Deletion of 5p." Cri du chat syndrome is a chromosomal disorder that occurs when there is a deletion of part of the short arm of chromosome 5. This can result in intellectual disability, microcephaly, facial abnormalities, and other health problems. The features that the nurse observed are not typical of Cri du chat syndrome, which may include a high-pitched cat-like cry, epicanthal folds, low-set ears, or a small jaw.

Choice A reason:

Teratogenic factor. A teratogenic factor is an environmental factor that can cause congenital disorders by interfering with the normal development of the fetus during the prenatal period. Teratogenic factors can include drugs, chemicals, infections, radiation, or maternal conditions that can affect the fetal growth and differentiation. Some examples of teratogenic factors are alcohol, thalidomide, rubella, ionizing radiation, or diabetes mellitus.

Choice B reason:

Mutagenic factor is an environmental factor that can cause genetic disorders by inducing changes in the DNA sequence or structure of the cells. Mutagenic factors can include chemicals, radiation, or viruses that can damage the DNA and cause mutations or chromosomal aberrations. Some examples of mutagenic factors are benzene, ultraviolet light, or human papillomavirus.

Choice C reason:

Carcinogenic factor is an environmental factor that can cause cancer by promoting the abnormal and uncontrolled growth of cells. Carcinogenic factors can include chemicals, radiation, or viruses that can interact with the DNA and cause mutations or epigenetic alterations that affect the gene expression or function. Some examples of carcinogenic factors are tobacco smoke, asbestos, or hepatitis B virus.

Choice D reason:

Epigenetic factor is an environmental factor that can cause genetic or congenital disorders by modifying the gene expression or function without changing the DNA sequence or structure. Epigenetic factors can include chemicals, nutrients, hormones, or stress that can affect the DNA methylation, histone modification, or microRNA expression that regulate the gene activity or silencing. Some examples of epigenetic factors are folate, estrogen, or cortisol.

The correct answer is: c. Crackles in the lungs

Choice A: Dry mucous membranes

Reason: Dry mucous membranes are typically associated with dehydration, not fluid overload. In fluid overload, the body retains excess fluid, leading to symptoms such as edema and pulmonary congestion, rather than dryness of mucous membranes.

Choice B: Decreased urine output

Reason: Decreased urine output can occur in conditions like dehydration or renal failure. In fluid overload due to heart failure, the kidneys may initially try to excrete excess fluid, leading to increased urine output. However, as heart failure progresses, renal perfusion may decrease, potentially leading to reduced urine output. This is not a primary or consistent symptom of fluid overload.

Choice C: Crackles in the lungs

Reason: Crackles in the lungs are a hallmark sign of fluid overload, particularly in the context of heart failure. This occurs due to pulmonary edema, where excess fluid accumulates in the alveoli, causing the characteristic crackling sound during auscultation. This is a direct result of the heart’s inability to effectively pump blood, leading to fluid backing up into the lungs.

Choice D: Hypotension

Reason: Hypotension, or low blood pressure, is not typically associated with fluid overload. In fact, fluid overload can often lead to hypertension (high blood pressure) due to the increased volume of fluid in the circulatory system. Hypotension might occur in severe heart failure if the heart’s pumping ability is significantly compromised, but it is not a primary manifestation of fluid overload.

Choice A reason:

Hyperkalemia is a common electrolyte imbalance in metabolic acidosis. The excess hydrogen ions in the blood cause a shift of potassium from the intracellular to the extracellular space, resulting in increased serum potassium levels.

Choice B reason:

Hyponatremia is a possible electrolyte imbalance in metabolic acidosis. The excess hydrogen ions in the blood can cause a dilutional effect on sodium, resulting in decreased serum sodium levels.

Choice C reason:

Hypercalcemia is not an electrolyte imbalance in metabolic acidosis. In fact, metabolic acidosis can cause hypocalcemia due to increased binding of calcium to albumin and decreased ionized calcium levels.

Choice D reason:

Hypophosphatemia is not an electrolyte imbalance in metabolic acidosis. In fact, metabolic acidosis can cause hyperphosphatemia due to increased renal excretion of hydrogen ions and decreased renal excretion of phosphate.

Choice E reason:

Hypochloremia is a common electrolyte imbalance in metabolic acidosis. The excess hydrogen ions in the blood cause a loss of chloride from the kidneys, resulting in decreased serum chloride levels.

Choice A reason:

Aspirin or other salicylates can cause metabolic acidosis, not respiratory alkalosis, by increasing the production of organic acids and interfering with bicarbonate reabsorption in the kidneys.

Choice B reason:

Breathing into a paper bag when feeling anxious can help prevent or treat respiratory alkalosis by increasing the carbon dioxide levels in the blood and lowering the pH. Anxiety can cause respiratory alkalosis by stimulating hyperventilation, which decreases the carbon dioxide levels in the blood and raises the pH.

Choice C reason:

Drinking more fluids to prevent dehydration can help prevent or treat metabolic alkalosis, not respiratory alkalosis, by increasing the renal excretion of bicarbonate and lowering the pH. Dehydration can cause metabolic alkalosis by decreasing the renal excretion of bicarbonate and raising the pH.

Choice D reason:

Monitoring blood sugar levels regularly can help prevent or treat diabetic ketoacidosis, which is a type of metabolic acidosis, not respiratory alkalosis, by increasing the production of ketone bodies and lowering the pH. Diabetic ketoacidosis can occur when there is insufficient insulin to metabolize glucose and the body resorts to fat breakdown for energy.

Choice A reason:

Kussmaul respirations are not a compensatory mechanism to increase oxygen intake, but rather to decrease carbon dioxide levels in the blood. Oxygen intake is not affected by Kussmaul respirations, which are characterized by deep and rapid breaths.

Choice B reason:

Kussmaul respirations are not a sign of respiratory failure and impending coma, but rather a sign of metabolic acidosis and an attempt to correct it. Respiratory failure and coma can occur in DKA if the condition is not treated promptly and effectively, but they are not indicated by Kussmaul respirations alone.

Choice C reason:

Kussmaul respirations are not an attempt to lower blood pressure by exhaling more air, but rather an attempt to lower blood acidity by exhaling more carbon dioxide. Blood pressure is not affected by Kussmaul respirations, which are caused by increased acidity in the blood due to the accumulation of ketone bodies from fat breakdown.

Choice D reason:

Kussmaul respirations are a response to lower blood acidity by exhaling more carbon dioxide. Carbon dioxide is an acidic gas that can lower the pH of the blood when it accumulates. By exhaling more carbon dioxide, the body tries to raise the pH of the blood and compensate for the metabolic acidosis caused by DKA.

Choice A reason:

Administering calcium gluconate IV as prescribed is an intervention that the nurse should include in the plan for a client who has hypocalcemia. Calcium gluconate is a calcium supplement that can increase the serum calcium levels and treat hypocalcemia. It should be given slowly and carefully to avoid extravasation and tissue necrosis.

Choice B reason:

Monitoring for Chvostek's sign and Trousseau's sign is an intervention that the nurse should include in the plan for a client who has hypocalcemia. Chvostek's sign is a facial twitching that occurs when the facial nerve is tapped near the ear. Trousseau's sign is a carpal spasm that occurs when a blood pressure cuff is inflated above the systolic pressure for several minutes. Both signs indicate increased neuromuscular excitability due to low calcium levels.

Choice C reason:

Encouraging intake of foods high in calcium and vitamin D is an intervention that the nurse should include in the plan for a client who has hypocalcemia. Calcium and vitamin D are essential nutrients for bone health and calcium metabolism. Foods high in calcium include dairy products, green leafy vegetables, tofu, sardines, and fortified cereals. Foods high in vitamin D include fatty fish, egg yolks, cheese, and fortified milk.

Choice A reason:

Increased white blood cell count is a finding that the nurse should expect to indicate inflammation and healing. White blood cells are the main components of the immune system that fight against infection and promote tissue repair. An elevated white blood cell count reflects an increased production and mobilization of these cells in response to inflammation and healing.

Choice B reason:

Decreased erythrocyte sedimentation rate is not a finding that the nurse should expect to indicate inflammation and healing. Erythrocyte sedimentation rate is a measure of how fast red blood cells settle at the bottom of a test tube. A high erythrocyte sedimentation rate indicates increased inflammation, as inflammatory proteins cause red blood cells to clump together and fall faster. A low erythrocyte sedimentation rate indicates decreased inflammation or normal conditions.

Choice C reason:

Decreased C-reactive protein level is not a finding that the nurse should expect to indicate inflammation and healing. C-reactive protein is a protein produced by the liver that increases in response to inflammation or tissue damage. A high C-reactive protein level indicates increased inflammation, as C-reactive protein binds to damaged cells and activates the complement system, which enhances the inflammatory response. A low C-reactive protein level indicates decreased inflammation or normal conditions.

Choice D reason:

Increased albumin level is not a finding that the nurse should expect to indicate inflammation and healing. Albumin is a protein produced by the liver that maintains the osmotic pressure and fluid balance in the blood vessels. A low albumin level indicates malnutrition, liver disease, kidney disease, or chronic inflammation, as albumin is lost or consumed by these conditions. A high albumin level indicates dehydration, steroid use, or normal conditions.

Choice A reason:

Administering epinephrine as prescribed is an intervention that the nurse should implement for a client who has anaphylactic shock due to a hypersensitivity reaction to a medication. Epinephrine is a medication that can reverse the effects of anaphylaxis by stimulating the sympathetic nervous system, which causes bronchodilation, vasoconstriction, increased cardiac output, and decreased release of inflammatory mediators.

Choice B reason:

Monitoring blood pressure and pulse oximetry is an intervention that the nurse should implement for a client who has anaphylactic shock due to a hypersensitivity reaction to a medication. Anaphylactic shock can cause hypotension and hypoxia due to vasodilation, increased capillary permeability, bronchoconstriction, and laryngeal edema. The nurse should monitor the client's vital signs and oxygen saturation regularly and report any changes or deterioration.

Choice C reason:

Administering antihistamines as prescribed is an intervention that the nurse should implement for a client who has anaphylactic shock due to a hypersensitivity reaction to a medication. Antihistamines are medications that can block the effects of histamine, which is one of the inflammatory mediators released during anaphylaxis. Antihistamines can help reduce itching, hives, flushing, and swelling.

Choice D reason:

Administering corticosteroids as prescribed is an intervention that the nurse should implement for a client who has anaphylactic shock due to a hypersensitivity reaction to a medication. Corticosteroids are medications that can suppress the immune system and reduce inflammation by inhibiting the synthesis of prostaglandins, leukotrienes, and cytokines, which are other inflammatory mediators released during anaphylaxis. Corticosteroids can help prevent or treat delayed or prolonged reactions.

Choice E reason:

Administering antibiotics as prescribed is not an intervention that the nurse should implement for a client who has anaphylactic shock due to a hypersensitivity reaction to a medication. Antibiotics are medications that can treat bacterial infections, but they have no effect on anaphylaxis, which is an immune-mediated reaction. In fact, some antibiotics can cause anaphylaxis in some clients who are allergic to them.

Choice A reason:

Antibodies are proteins produced by B lymphocytes that can recognize and bind to specific antigens, such as viruses, and mark them for destruction by other immune cells or mechanisms. Antibodies are part of the adaptive immune system, which provides specific and long-lasting immunity against pathogens.

Choice B reason:

Natural killer cells are lymphocytes that can directly kill infected or abnormal cells by releasing cytotoxic substances that induce apoptosis. Natural killer cells are part of the innate immune system, which provides nonspecific and immediate immunity against pathogens, but they do not directly kill viruses, which are intracellular parasites.

Choice C reason:

Macrophages are phagocytes that can engulf and digest foreign particles, such as bacteria, fungi, or cellular debris. Macrophages are part of the innate immune system, which provides nonspecific and immediate immunity against pathogens, but they are not very effective against viruses, which are intracellular parasites.

Choice D reason:

Complement proteins are plasma proteins that can activate a cascade of reactions that enhance inflammation, opsonization, and lysis of pathogens. Complement proteins are part of the innate immune system, which provides nonspecific and immediate immunity against pathogens, but they do not activate viruses, which are inert particles outside of host cells.

Choice A reason:

Genetic mutations are a factor that can contribute to neoplasia. Genetic mutations are changes in the DNA sequence of a cell that can affect its normal function and regulation. Some genetic mutations are inherited, while others are acquired due to environmental factors, such as radiation, chemicals, or smoking. Genetic mutations can cause oncogenes to be activated or tumor suppressor genes to be inactivated, which can result in uncontrolled cell proliferation and resistance to apoptosis.

Choice B reason:

Hormonal imbalances are a factor that can contribute to neoplasia. Hormonal imbalances are abnormal levels of hormones in the body that can affect the growth and differentiation of cells. Some hormones, such as estrogen and progesterone, can stimulate the growth of certain types of cells, such as breast and endometrial cells. Hormonal imbalances can increase the risk of developing hormone-dependent cancers, such as breast cancer or endometrial cancer.

Choice C reason:

Chronic inflammation is a factor that can contribute to neoplasia. Chronic inflammation is a prolonged and persistent inflammatory response that can damage normal tissues and cause tissue repair and regeneration. Chronic inflammation can increase the production of reactive oxygen species (ROS) and cytokines, which can induce DNA damage and genetic mutations. Chronic inflammation can also stimulate angiogenesis and invasion of inflammatory cells, which can promote tumor growth and metastasis.

Choice D reason:

Viral infections are a factor that can contribute to neoplasia. Viral infections are invasions of viruses into host cells that can cause disease or harm. Some viruses, such as human papillomavirus (HPV), hepatitis B virus (HBV), hepatitis C virus (HCV), Epstein-Barr virus (EBV), and human immunodeficiency virus (HIV), can cause neoplasia by integrating their DNA into the host cell's genome and altering its normal function and regulation. Viral infections can also impair the immune system's ability to recognize and eliminate abnormal cells.

Choice E reason:

Nutritional deficiencies are not a factor that can contribute to neoplasia. Nutritional deficiencies are inadequate intake or absorption of essential nutrients that can affect the health and function of various organs and systems. Nutritional deficiencies can increase the risk of developing infections or chronic diseases, but they do not directly cause neoplasia. However, some nutrients, such as antioxidants, vitamins, minerals, and fiber, may have protective effects against neoplasia by preventing oxidative stress, enhancing immune function, or modulating hormonal levels.

Choice A reason:

This is an incorrect answer because an induration of 5 mm or more is considered a positive reaction only for certain high-risk groups, such as people who are HIV-positive, have recent contact with a person with active tuberculosis, or have chest radiograph findings consistent with prior tuberculosis.

Choice B reason:

This is a correct answer because an induration of 10 mm or more is considered a positive reaction for most people, including those who are recent immigrants from high-prevalence countries, injection drug users, residents or employees of high-risk settings, children younger than 4 years old, or people with certain medical conditions that increase the risk of tuberculosis.

Choice C reason:

This is an incorrect answer because an induration of 15 mm or more is considered a positive reaction only for people who have no known risk factors for tuberculosis.

Choice D reason:

This is an incorrect answer because an induration of 20 mm or more is not a criterion for a positive reaction, as it exceeds the maximum threshold for any group.

Choice A reason:

This is an incorrect answer because cardiogenic shock is a severe form of heart failure that occurs when the heart cannot pump enough blood to maintain adequate tissue perfusion and oxygenation, resulting in hypotension, tachycardia, oliguria, altered mental status, and cold and clammy skin.

Choice B reason:

This is an incorrect answer because pulmonary embolism is a condition in which a blood clot travels to the lungs and blocks one or more pulmonary arteries, causing sudden dyspnea, chest pain, hemoptysis, tachypnea, and hypoxia.

Choice C reason:

This is a correct answer because right-sided heart failure occurs when the right ventricle of the heart fails to pump blood effectively to the lungs, causing blood to back up in the systemic circulation and leading to fluid accumulation in the lungs, neck veins, and extremities.

Choice D reason:

This is an incorrect answer because left-sided heart failure occurs when the left ventricle of the heart fails to pump blood effectively to the body, causing blood to back up in the pulmonary circulation and leading to pulmonary congestion, dyspnea, orthopnea, coughing, and fatigue.

Choice A reason:

This is a correct answer because healing of ulcers is an expected outcome of PPI therapy for PUD, as it occurs when the acid-induced damage to the mucosa is repaired and the ulcer is closed.

Choice B reason:

This is a correct answer because relief of pain is an expected outcome of PPI therapy for PUD, as it occurs when the acid-induced irritation and inflammation of the mucosa and the nerve endings are reduced.

Choice C reason:

This is an incorrect answer because eradication of H. pylori is not an expected outcome of PPI therapy for PUD, as it requires a combination of antibiotics and bismuth compounds to kill the bacteria and prevent its recurrence.

Choice D reason:

This is a correct answer because prevention of bleeding is an expected outcome of PPI therapy for PUD, as it occurs when the acid-induced erosion and perforation of the mucosa and the blood vessels are prevented.

Choice E reason:

This is a correct answer because reduction of inflammation is an expected outcome of PPI therapy for PUD, as it occurs when the acid-induced activation of inflammatory mediators and immune cells are inhibited.

Choice A reason:

Increased hydrostatic pressure in the portal vein is one factor that causes ascites. The portal vein carries blood from the digestive organs to the liver for processing. However, when the liver is damaged by alcohol abuse, it becomes scarred and fibrotic, creating resistance to blood flow. This results in increased pressure in the portal vein and its branches, which forces fluid out of the capillaries into the abdominal cavity.

Choice B reason:

Decreased oncotic pressure in the plasma is another factor that causes ascites. Oncotic pressure is the force exerted by proteins in the plasma that attracts fluid into the capillaries from the interstitial space. However, when the liver is damaged by alcohol abuse, it cannot produce enough proteins, such as albumin and globulin, which are essential for maintaining oncotic pressure. This results in decreased oncotic pressure in the plasma and increased fluid movement into the interstitial space and the abdominal cavity.

Choice C reason:

Increased aldosterone secretion by the adrenal glands is another factor that causes ascites. Aldosterone is a hormone that regulates the balance of sodium and water in the body. It acts on the kidneys to increase the reabsorption of sodium and water from the urine into the blood. However, when the liver is damaged by alcohol abuse, it cannot metabolize aldosterone properly, leading to its accumulation in the blood. This results in increased sodium and water retention in the body and increased fluid movement into the interstitial space and the abdominal cavity.

Choice D reason:

Ascites is caused by a combination of factors that affect the fluid balance in the abdominal cavity.

Choice A reason:

Atrophy is a decrease in cell size or number in response to adverse stimuli, such as disuse, ischemia, or malnutrition. It does not increase the risk of cancer, but it can impair the function of tissues and organs.

Choice B reason:

Hypertrophy is an increase in cell size in response to normal or abnormal stimuli, such as exercise, hormones, or hypertension. It does not increase the risk of cancer, but it can affect the function of tissues and organs.

Choice C reason:

Hyperplasia is an increase in cell number in response to normal or abnormal stimuli, such as hormones, inflammation, or wound healing. It does not increase the risk of cancer, but it can cause excessive growth of tissues and organs.

Choice D reason:

Dysplasia is an abnormal and potentially reversible change in cell size, shape, and organization in response to persistent stressors. It can be a precursor to cancer if it is not detected and treated early.

Choice B reason:

Transparent film dressing is a type of dressing that consists of a thin sheet of polyurethane with an adhesive coating. It allows oxygen and moisture vapor to pass through but prevents bacteria and water from entering the wound. It is suitable for wounds with minimal drainage, such as superficial abrasions or donor sites.

Choice C reason:

Calcium alginate dressing is a type of dressing that consists of fibers derived from seaweed that form a gel-like substance when they come in contact with wound exudate. It absorbs large amounts of drainage and supports autolytic debridement of necrotic tissue. It is suitable for wounds with heavy drainage, such as pressure ulcers or venous ulcers.

Choice D reason:

Hydrogel dressing is a type of dressing that consists of water or glycerin-based gel that provides moisture to dry wounds and supports autolytic debridement of necrotic tissue. It is suitable for wounds with minimal to moderate drainage, such as partial-thickness burns or radiation injuries.

Choice A reason:

Vascular stage is the stage of inflammation that involves the changes in blood flow and vascular permeability at the site of injury or infection. It manifests as redness and warmth due to vasodilation and increased blood flow, and swelling due to fluid leakage from the vessels into the interstitial space.

Choice B reason:

Cellular stage is the stage of inflammation that involves the migration of white blood cells from the vessels into the tissues to eliminate the causative agent and remove the damaged tissue. It manifests as pain due to the release of chemical mediators that stimulate nerve endings, and purulent drainage due to the accumulation of dead cells and microorganisms.

Choice D reason:

Resolution stage is the stage of inflammation that involves the restoration of normal tissue structure and function after the elimination of the causative agent and the removal of the damaged tissue. It manifests as decreased redness, warmth, swelling, pain, and drainage due to the cessation of inflammatory response.

Choice A reason:

Applying a moist dressing to the wound provides a moist environment for wound healing and protects the wound from contamination and trauma. Moisture prevents dehydration and necrosis of the wound bed and promotes cell migration and growth.

Choice B reason:

Assessing the wound for signs of infection is important to detect and treat any infection that may impair wound healing or cause systemic complications. Signs of infection include increased redness, warmth, swelling, pain, drainage, odor, fever, or leukocytosis.

Choice C reason:

Debriding necrotic tissue from the wound is essential to remove any dead or devitalized tissue that may interfere with wound healing or serve as a source of infection. Debridement can be done by surgical, mechanical, enzymatic, or autolytic methods.

Choice D reason:

Elevating the affected leg above the heart level reduces edema and improves blood circulation to the wound. Edema can impair wound healing by causing tissue hypoxia, increasing bacterial growth, and delaying granulation tissue formation.

Choice E reason:

Massaging the wound edges gently is not recommended for chronic wounds, as it may cause trauma or bleeding to the wound bed or delay epithelialization. Massaging may be beneficial for preventing hypertrophic scars or contractures in healed wounds.

Choice A reason:

B cells are not involved in contact dermatitis, as they do not produce antibodies or form immune complexes.

Choice B reason:

T cells are the type of cells that mediate contact dermatitis, which is a type of type IV hypersensitivity. T cells recognize the poison ivy antigens that bind to the skin proteins and release cytokines that recruit macrophages and other inflammatory cells. This leads to a delayed and localized reaction that manifests as erythema, edema, vesicles, and pruritus.

Choice C reason:

T cells are not the same as B cells, as they have different receptors and functions in the immune system.

Choice D reason:

Mast cells are not involved in contact dermatitis, as they do not express IgE antibodies or release histamine.

Choice A reason:

Type I hypersensitivity is not involved in Graves' disease, as it does not involve IgE antibodies or mast cells.

Choice B reason:

Type II hypersensitivity is involved in Graves' disease, as it involves IgG antibodies that bind to the thyroid-stimulating hormone (TSH) receptors on the thyroid gland and stimulate the production of thyroid hormones. This leads to hyperthyroidism and manifestations such as goiter, exophthalmos, tachycardia, weight loss, or tremors.

Choice C reason:

Type III hypersensitivity is not involved in Graves' disease, as it does not involve immune complexes or complement activation.

Choice D reason:

Type IV hypersensitivity is not involved in Graves' disease, as it does not involve cytotoxic T cells or helper T cells.

Choice E reason:

Type V hypersensitivity is also involved in Graves' disease, as it involves the stimulation of target cells by antibodies that act as agonists for cell surface receptors. This leads to an increased function of the target organ or tissue.

Choice A reason:

Gram-positive cocci are bacteria that have a spherical shape and stain purple with Gram stain due to their thick peptidoglycan cell wall. Streptococcus pyogenes is an example of gram-positive cocci that can cause infections such as pharyngitis, impetigo, cellulitis, necrotizing fasciitis, or rheumatic fever.

Choice B reason:

Gram-negative cocci are bacteria that have a spherical shape and stain pink with Gram stain due to their thin peptidoglycan cell wall and outer membrane. Neisseria gonorrhoeae and Neisseria meningitidis are examples of gram-negative cocci that can cause infections such as gonorrhea, meningitis, or septicemia.

Choice C reason:

Gram-positive bacilli are bacteria that have a rod-shaped shape and stain purple with Gram stain due to their thick peptidoglycan cell wall. Bacillus anthracis and Clostridium botulinum are examples of gram-positive bacilli that can cause infections such as anthrax, botulism, or tetanus.

Choice D reason:

Gram-negative bacilli are bacteria that have a rod-shaped shape and stain pink with Gram stain due to their thin peptidoglycan cell wall and outer membrane. Escherichia coli and Pseudomonas aeruginosa are examples of gram-negative bacilli that can cause infections such as urinary tract infection, wound infection, or sepsis.

Choice A reason:

Bacteria are microorganisms that have a cell wall composed of peptidoglycan and a cell membrane composed of phospholipids. They can be classified by their shape (cocci or bacilli), their Gram stain (positive or negative), or their oxygen requirement (aerobic or anaerobic).

Choice B reason:

Viruses are microorganisms that have a nucleic acid core (DNA or RNA) surrounded by a protein coat (capsid) and sometimes an envelope derived from the host cell membrane. They can only replicate inside living cells and cause various diseases such as influenza, herpes, hepatitis, or AIDS.

Choice C reason:

Fungi are microorganisms that have a cell wall composed of chitin and a cell membrane composed of ergosterol. They can exist as yeasts or molds depending on the environmental conditions. Candida albicans is an example of fungi that can cause infections such as thrush, vaginitis, or systemic candidiasis.

Choice D reason:

Parasites are microorganisms that live on or in another organism (host) and derive nutrients from it. They can be classified by their size (protozoa or helminths) or their mode of transmission (vector-borne or direct contact). They can cause infections such as malaria, giardiasis, or schistosomiasis.

Choice D reason:

Malignant neoplasia of bone marrow cells. Leukemia is a type of cancer that originates from the abnormal and uncontrolled growth of hematopoietic stem cells or progenitor cells in the bone marrow. These cells can proliferate and differentiate into various types of blood cells, such as lymphocytes, granulocytes, monocytes, or erythrocytes. Leukemia can be classified by the type of cell involved (myeloid or lymphoid) and the rate of progression (acute or chronic).

Choice A reason:

Benign neoplasia of blood cells is not a correct term for leukemia, as leukemia is a malignant condition that can invade and destroy normal blood cells and tissues. Benign neoplasia of blood cells is a rare condition that involves the overproduction of normal blood cells, such as polycythemia vera or essential thrombocythemia.

Choice B reason:

Malignant neoplasia of blood cells is not a correct term for leukemia, as leukemia does not originate from blood cells, but from bone marrow cells. Malignant neoplasia of blood cells is a term that can be used for lymphoma, which is a type of cancer that originates from lymphocytes in the lymphatic system.

Choice C reason:

Benign neoplasia of bone marrow cells is not a correct term for leukemia, as leukemia is a malignant condition that can spread to other organs or systems. Benign neoplasia of bone marrow cells is a term that can be used for myelodysplastic syndrome, which is a condition that involves the abnormal development and maturation of bone marrow cells.

Choice A reason:

Decreased hematocrit is an indicator of improvement for a client who has hypovolemia and is receiving IV fluid therapy. Hematocrit is the percentage of red blood cells in the blood. Hypovolemia causes hemoconcentration, which increases the hematocrit level. IV fluid therapy restores the blood volume and dilutes the red blood cells, which decreases the hematocrit level.

Choice B reason:

Increased urine specific gravity is not an indicator of improvement for a client who has hypovolemia and is receiving IV fluid therapy. Urine specific gravity is a measure of the concentration of solutes in the urine. Hypovolemia causes dehydration, which increases the urine specific gravity. IV fluid therapy rehydrates the body and lowers the urine specific gravity.

Choice C reason:

Decreased central venous pressure is not an indicator of improvement for a client who has hypovolemia and is receiving IV fluid therapy. Central venous pressure is a measure of the pressure in the right atrium and vena cava. Hypovolemia causes decreased preload, which lowers the central venous pressure. IV fluid therapy increases preload and raises the central venous pressure.

Choice D reason:

Increased blood urea nitrogen is not an indicator of improvement for a client who has hypovolemia and is receiving IV fluid therapy. Blood urea nitrogen is a measure of the amount of urea in the blood. Urea is a waste product of protein metabolism that is excreted by the kidneys. Hypovolemia causes decreased renal perfusion, which increases the blood urea nitrogen level. IV fluid therapy improves renal perfusion and lowers the blood urea nitrogen level.

Choice A reason:

Administering antiemetics as prescribed is an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Antiemetics are medications that can prevent or treat nausea and vomiting, which are the main causes of metabolic alkalosis in this case. By stopping vomiting, antiemetics can help prevent further loss of gastric acid and bicarbonate retention, which can correct metabolic alkalosis.

Choice B reason:

Monitoring serum potassium levels is an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Metabolic alkalosis can cause hypokalemia due to increased renal excretion of potassium and intracellular shift of potassium in exchange for hydrogen ions. Hypokalemia can worsen metabolic alkalosis by impairing renal acid excretion and increasing bicarbonate reabsorption. The nurse should monitor serum potassium levels regularly and report any abnormalities or signs of hypokalemia, such as muscle weakness, cramps, arrhythmias, or ECG changes.

Choice C reason:

Administering sodium bicarbonate IV as prescribed is not an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Sodium bicarbonate is an alkalinizing agent that can increase serum bicarbonate levels and pH, which can worsen metabolic alkalosis. Sodium bicarbonate IV should be avoided or used with caution in clients who have metabolic alkalosis, unless they have severe acid-base imbalance or coexisting metabolic acidosis.

Choice D reason:

Encouraging intake of acidic foods and beverages is not an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Acidic foods and beverages can lower the pH of the stomach, but they have little effect on the pH of the blood or urine, which are regulated by other mechanisms such as buffers, lungs, and kidneys. Acidic foods and beverages can also irritate the gastric mucosa and trigger more vomiting, which can aggravate metabolic alkalosis.

Choice E reason:

Providing supplemental oxygen as needed is an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Metabolic alkalosis can cause respiratory compensation by decreasing the respiratory rate and depth, which can lead to hypoxemia and hypercapnia. Supplemental oxygen can help maintain adequate oxygenation and prevent tissue hypoxia and organ damage. The nurse should monitor the client's oxygen saturation and arterial blood gas levels and adjust the oxygen therapy accordingly.

Choice A reason:

Restricting fluid intake is not an action that the nurse should take for a client who has hypernatremia. Fluid restriction can worsen hypernatremia by increasing the concentration of sodium in the blood. Fluid intake should be increased or replaced with isotonic or hypotonic fluids to dilute sodium and correct hypernatremia.

Choice B reason:

Monitoring neurological status is an action that the nurse should take for a client who has hypernatremia. Hypernatremia can cause neurological symptoms such as confusion, agitation, seizures, coma, and death due to cellular dehydration and brain shrinkage. The nurse should assess the client's level of consciousness, orientation, memory, behavior, and reflexes regularly and report any changes or deterioration.

Choice C reason:

Administering hypotonic IV fluids is an action that the nurse should take for a client who has hypernatremia. Hypotonic fluids have a lower concentration of solutes than normal body fluids and can help lower serum sodium levels by moving water into the cells from the blood vessels. The nurse should administer hypotonic fluids slowly and carefully to avoid fluid overload or cerebral edema.

Choice D reason:

Encouraging foods high in sodium is not an action that the nurse should take for a client who has hypernat

The SOFA score is a tool that assesses the degree of organ dysfunction or failure in septic shock. It is based on six parameters: blood pressure, Glasgow coma scale, PaO2/FiO2 ratio, platelet count, bilirubin level, and creatinine level. Each parameter is assigned a score from 0 to 4 based on the severity of the abnormality. The total SOFA score ranges from 0 to 24, with higher scores indicating worse organ dysfunction or failure.

The client's blood pressure of 80/50 mmHg corresponds to a SOFA score of 1, as it indicates hypotension.

The client's Glasgow coma scale is not given, so it is assumed to be normal (15), which corresponds to a SOFA score of 0.

The client's PaO2/FiO2 ratio is not given, so it is assumed to be normal (>400), which corresponds to a SOFA score of 0.

The client's platelet count is not given, so it is assumed to be normal (>150 x 10^9/L), which corresponds to a SOFA score of 0.

The client's bilirubin level is not given, so it is assumed to be normal (<20 micromol/L), which corresponds to a SOFA score of 0.

The client's creatinine level is not given, so it is assumed to be normal (<110 micromol/L), which corresponds to a SOFA score of 0.

The total SOFA score is the sum of the scores for each parameter: 1 + 0 + 0 + 0 + 0 + 0 = 1. Therefore, the client has a SOFA score of 1.

Choice A reason:

Type I hypersensitivity is not involved in RA, as it does not involve IgE antibodies or mast cells.

Choice B reason:

Type II hypersensitivity is not involved in RA, as it does not involve IgG or IgM antibodies or target cells.2

Choice C reason:

RA is caused by type III hypersensitivity, which involves the formation and deposition of immune complexes in the synovial membranes of the joints. This triggers complement activation, inflammation, and tissue damage.

Choice D reason:

Type IV hypersensitivity is not involved in RA, as it does not involve cytotoxic T cells or helper T cells.