BSNC 6000 FINAL EXAM QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE 2026

BSNC 6000 FINAL EXAM QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE 2026 What is hypersensitivity? - Answers A persons immune system reacts in a way that damages them rather than protecting them What is type III hypersensitivity? - Answers Antigen-antibody complexes deposit into blood vessel walls causing inflammation and tissue damage what cells produce antibody? - Answers plasma cells what is type 1 hypersensitivity? - Answers presence of IgE specific to an allergen what is the MOI of type 1 hypersensitivity? - Answers histamine stimulates mucus secretion in the nasal passages and tears that leads to inflammation what are examples of type 1 hypersensitivity? - Answers (atopic diseases) allergic reactions, asthma, dermatitis, and anaphylaxis what is the immune mechanism of type II hypersensitivity? - Answers anti-body mediated immune reaction where antibodies like IgG or IgM are directed against cells. This is an autoreactive antibody that targets its own tissues. What is the MOI of type II hypersensitivity? - Answers cellular destruction, functional loss, and tissue damage d/t antibodies targeting the body. examples of type II hypersensitivity and where are they commonly seen - Answers autoimmune diseases, infections, cytopenias, and hemolytic anemias. seen in transplants and blood transfusions. What is the immune mechanism of type III hypersensitivity? - Answers mediated by immune complexes like antigen-antibody (IgG) complexes accumulating in the body. which type of hypersensitivity is most complex? - Answers type III What is the MOI for type III hypersensitivity? - Answers antigen-antibody complexes deposited in blood vessel walls cause inflammation and tissue damage where the complexes accumulate. Common examples of type III hypersensitivity - Answers SLE (Lupus) and RA (rheumatoid arthritis) What is the immune mechanism of type IV hypersensitivity? - Answers autoreactive cytotoxic cells what is the MOI in type IV hypersensitivity? - Answers autoreactive cytotoxic cells attack the bodies own tissues especially i the lungs and airways. common examples of type IV hypersensitivity - Answers HIV, RSV, contact dermatitis, TB, MS, and DM1 why is lupus rare? - Answers because it requires a series of complex events that need to occur over many years. steps for lupus to occur? - Answers genetic predisposition -- macrophage challenging event (covid) -- unregulated apoptosis of macrophages -- build up of debris in the body causes the making of antibodies -- immune system is now compromised -- we make antibodies against ourself what do macrophages do? - Answers after infection they clean up debris in the tissue and release cytokines to signal tissue repair true or false: macrophage function is a spectrum - Answers true, some people have hypoactive and some hyperactive what is an example of a trigger that challenges the macrophages - Answers hydralazine, a type of vasodilator common events that lead to flare ups - Answers pregnancy (stiulates antibody production) and UV light (sun stimulates immune response) Lupus causes briefly - Answers genetic predisposition + preceding event (viral illness, drug, environmental exposure, stress/trauma, and estrogen shifting (post-puberty, postpartum, and menopause)) what is SLE? - Answers a chronic multi-symptom autoimmune disease where are the symptoms of SLE? - Answers they are diverse with inflammation affecting multiple organ systems what kind of disease is SLE? - Answers it is a waxing and waning disease Patho of Lupus briefly - Answers antibody-antigen complexes deposited in microvasculature and basement membrane of nephrons -- these antigens include proteins normally protected inside the cell called nuclear antigens -- complement proteins attract neutrophils and trigger inflammation common symptoms of SLE - Answers frequent fevers, photophobia (light sensitivity), anxiety, depression, personality changes, mental health changes, nausea, vomiting, GI discomfort common flare up triggers for lupus - Answers sunlight, pregnancy, stress SLE symptoms in the head - Answers hair loss, low fevers, impaired saliva production, butterfly rash, mental health changes, visual changes, fatigue, and seizures SLE symptoms in the immune system - Answers lymphadenopathy (inflammed lymph nodes) SLE hematological symptoms - Answers anemia and thrombocytopenia (low platelet count) SLE heart symptoms - Answers pericarditis d/t lots of small vasculature SLE lung symptoms - Answers chest pain that needs immediate medical attention, pleuritis, and pleural effusion d/t inflammation SLE GI symptoms - Answers N/V, IBS, diarrhea, sterile peritonitis (infection of the abdominal cavity without infectious pathogens) SLE joint symptoms - Answers pain and swelling SLE Kidney symptoms - Answers protein and blood in the urine d/t blood vessels being blocked by neutrophils SLE finger/toe symptoms - Answers they can turn blue risk factors for SLE - Answers hispanic, physical trauma, chronic stress, and must have the genetic component what are the lab tests for SLE - Answers ANA, ESR, CRP, and low complement What is ANA in lab tests for SLE? - Answers Anti-nuclear antibody elevation. normally Igs are not reactive to nuclear proteins/DNA how is an ANA test done? - Answers the patients test cells are made permeable and mixed with Igs from patient serum What is ESR in SLE lab test? - Answers Erythrocyte sedimentation rate. Cells settle at the bottom of the tube at a faster rate. What does high ESR mean? - Answers inflammation What is CRP in Lupus lab testing - Answers C reactive protein what does CRP indicate in a lab test? - Answers inflammation What low complement proteins are tested in SLE? - Answers C3 and C4 why are complement proteins low in SLE? - Answers They are consumed by chronic inflammation. Therefore, lupus means a low level of protein. Medications for less severe SLE? - Answers Antimalarials, NSAIDS, and low doses of corticosteroids Medications for more severe SLE? - Answers corticosteroids, cytotoxic and immunosuppressive agents what are the downsides of strong corticosteroids? - Answers the medication needs to be weaned down, it supresses the immune system, and it can lead to diabetes. What do women who want to become pregnant need to know regarding their/their partners medications? - Answers cytotoxic medications will kill the fetus and in men will damage or kill sperm common medications for lupus - Answers hydroxychloroquine, prednisone, and methotrexate. What is Hydroxychloroquine in the context of SLE? - Answers it is an anti-malarial that control immune activity what is Prednisone? - Answers a corticosteroid that decreases inflammation and immune activity What is methotrexate? - Answers it is a cytotoxic and immunosuppressive agent that dampens the immune response and inhibits folic acid uptake What are the two SLE diets? - Answers anti-inflammatory and emphysema diet What diet is used for cachexia? - Answers emphysema diet What is a realistic goal for SLE patients? - Answers preventing flare ups How can we enhance interactions with patients who have SLE? - Answers involve the patient in the care plan, define clear goals, be an active listener, help the patients understand the disease, and encourage the patient to ask questions which populations are at higher risk for HIV? - Answers IV drug users, people of African descent, non-heterosexual men, people who are incarcerated, and first nations communities in Saskatchewan When RNA is translated what is it cut into? - Answers It forms GP120 and GP41 from GP160 (they do not add up) HIV is a virus that uses the glycoprotein _____, in order to bind its cellular receptor ______. The required co-receptor is _____. - Answers GP120, CD4, and CCR5 HIV fuses with the cell ______, releasing two _______ molecules. The enzyme _______ converts RNA to DNA. - Answers membrane, single stranded RNA, reverse transcriptase HIV _____ passes through pores in the _____ of the cell. - Answers DNA, nucleus The enzyme _____ incorporates HIV into the human genome. - Answers integrase Like any other gene in the genome, HIV now gets _______ as ______. - Answers transcribed, RNA The _____ is translated by the host ______. - Answers RNA, ribosome The enzyme ______ is needed to process the new ______ so that they can assemble a _______. - Answers protease, proteins, virus capsid HIV ____ from the cell to infect another. - Answers buds RNA viruses _______ very easily and rapidly. Therefore they can evolve around _______ and ______. - Answers mutate, vaccines, medications. What cell requires the HIV receptor to perform its functions and how does this contribute to AIDS? - Answers Helper T-cells, You do not have the acquired immune system, meaning you are immunocompromised, and vaccines are now less effective so we need other strategies to protect these individuals. dendritic cells and macrophages express the HIV receptor protein and co receptor. Other than being phagocytes what role do these cells play in the immune response. - Answers They are also antigen presenting cells HIV can evolve resistance to antivirals. What characteristics of a virus contribute to rapid evolution? - Answers It is an RNA virus with an RNA genome. What are Maraviroc and Enfuvirtide? - Answers They are entry inhibitors. They block CCR5. With medications if HIV is blocked by blocking the CCR5 receptor, what receptor can it evolve to use? - Answers CXR4 What happens if you block the CD4 receptor? - Answers Helper t-cells can no longer enter the cell and AIDS will develop. What are Emtricitabine and Tenogovir? - Answers They are reverse transcriptase inhibitors. Why do reverse transcriptase inhibitors have little to no side effects? - Answers because healthy human cells do not have reverse transcriptase, the medication only target HIV infected cells. How do reverse transcriptase inhibitors like Tenogovir work? - Answers In HIV infected cells they prevent the transcription of RNA to DNA in order to prevent the RNA virus from integrating into the human genome. What is Raltegravir? - Answers It is an integrase inhibitor. How does Raltegravir work? - Answers it prevents the integration of newly formed HIV DNA from the HIV RNA into the host cells DNA. What is Ritonavir? - Answers It is a protease inhibitor. What does Ritonavir do? - Answers prevents protease from using protein to build the viral capsid to prevent it from being sent out. When is the diagnosis of AIDS anticipated? - Answers they are diagnosed with HIV and have a CD4+ T cell count below 200, a CD4 T cell percentage of total lymphocytes of less than 14% or one of the AIDS defining illnesses. What is a normal CD4+ count? - Answers 500-1500 cells with what low number of CD4+ cells can the immune system still fight off a majority of infections - Answers 500 with what CD4+ count is the immune system weakened and the risk of infection is possible? - Answers 500 with what CD4+ count is the immune system very weak and is at risk for life threatening infections and AIDS? - Answers 200 How are AIDS defining illnesses organized? - Answers infection-related and cancer What are the common AIDS defining infections? - Answers encephalopathy, cytomegalovirus, TB, herpes, recurrent pneumonia, and wasting syndrome What is encephalopathy in the context of HIV? - Answers it is a direct consequence of HIV and is virus induced dementia Examples of AIDS defining cancers: - Answers Kaposi sarcoma, lymphoma, and invasive cervical cancer What is Kaposi Sarcoma? - Answers a cancer that presents as raised or flat purple or red lesions on the skin. Is Kaposi Sarcoma common? - Answers It is rare in people who do not have AIDS, but common in those that do. Is there a vaccine for HIV? - Answers no What is the significance of CCR5Delta32? - Answers a CCR5 mutation that prevents HIV binding. the side effect is mild increased inflammation What are some HIV risk factors? - Answers breaks in skin allowing for blood and body fluids to mix, vulnerable populations that might be missed with diagnosis, having an unknown HIV status, and occupational exposure to blood and bodily fluids Which groups are most likely to be missed? - Answers elderly people, babies, babies of HIV+ dad, indigenous people who can get HIV? - Answers anyone Examples of risk factors involving breaks in skin: - Answers IV drug use (sharing needles), smoking crack (open sores to mouth and reusing material), and sexual activity that leads to breaks in the skin Examples of risk factors involving occupational exposure to blood and body fluids: - Answers high risk careers like sex work, new cleaner, and HCW who don't get PEP and new workers without safety training for needle stick injuries, Risk factors for HIV related to lack of knowledge/Unknown HIV status - Answers unprotected sex with multiple partners, history of STI, engaging in sex while unaware of HIV risks (adolescents and older adults), incarcerated persons, and medical tourism HIV Harm Reduction Strategy for Sexual Activity: - Answers proper protection or barriers, PREP, communication with partners, regular STI testing, limit sexual partners, HIV+ individuals should maintain viral suppression through drug therapy What nurses are doing to promote safe sex in the context of HIV? - Answers safe sex education, free condom distribution, counseling and testing services Why is maintaining viral suppression through antiretroviral drug therapy important for safe sex? - Answers undetectable viral load = not transmitable HIV Harm Reduction for Injection Drug Use - Answers OAT (opioid agonist therapy), avoid sharing equipment (needles, syringes, cookers, spoons), use new equipment for every injection, when possible inject at a safe injection site What are nurses doing for safer injection drug use? - Answers connecting clients to treatment programs, safer crack kits, working in safe injection facilities, needle and syringe exchange programs, and counseling on safe injection practices HIV transmission risks in pregnancy and childbirth: - Answers get tested prior to conception, maternal to infant transmission can occur in utero and post partum via breast milk, taking antiretroviral medications during pregnancy and during breast feeding. What common treatments or body modifications pose an HIV transmission risk? - Answers tattoos, piercings, acupuncture, and electrolysis Why does medical tourism pose a risk for HIV? - Answers not all countries follow the same strict infection control guidelines as Canada. When should PEP be taken? - Answers within 72 hours what is the transmission rate for a needle stick injury - Answers 1% what is POC testing in the context of HIV? - Answers point of care testing what is PREP? - Answers a reverse transcriptase inhibitor What is PEP? - Answers it is three drugs taken post exposure for 28 days. what is seroconversion illness? - Answers primary HIV infection causes flu like symptoms 2-4 weeks before what is cellulitis? - Answers a deep infection of the skin caused by bacteria What bacteria usually causes cellulitis? - Answers strep/staph Clinical manifestations of cellulitis: - Answers redness (rubor), warm to touch (calor), swelling (tumor), tender (dolor), undefined margins, pain d/t inflammation, unilateral (usually), lymphangitis, fever, purulent exudate, and petechiae how long is the onset of cellulitis? - Answers over a few days what is lymphangitis? - Answers red streaking up the lymphatic tract what are the lab findings r/t cellulitis? - Answers leukocytosis (increased WBC), ESR (they stick together and sink d/t inflammation), elevated CRP (c-reactive protein d/t inflammation), may have + blood cultures from where should cultures be obtained in diagnosing cellulitis? - Answers cultures should be taken from purulent drainage as cultures from intact skin is not useful What does ESR stand for in the context of blood work - Answers erythrocyte sedimentation rate symptoms of mild cellulitis: - Answers localized, small area of erythema, warmth, tenderness, possible exudate, NO swelling symptoms of moderate cellulitis: - Answers spreading area of erythema, warmth, tenderness, fever, lymphadenopathy, swelling of affected limb, possible exudate symptoms of severe cellulitis: - Answers systemic effects to perfusion, extensive cellulitis, rapid spreading, fever, lymphadenopathy, diminished pulses in a cool swollen extremity, and cutaneous necrosis Non-pharmacological interventions for cellulitis: - Answers saline compresses to remove purulent exudate, elevate, rest, gently splint, and collaborate with wound care specialist How do nurses monitor in the context of cellulitis? - Answers mark borders of reddened area, assess peripheral pulses, monitor vital signs (look out for sepsis) Pharmacological interventions for cellulitis: - Answers oral and parenteral antibiotics and analgesia what kind of analgesia is used in cellulitis? - Answers acetaminophen and NSAID Which antibiotics are typically used to treat cellulitis? - Answers Cephalexin, Cloxacillin, Azithromycin, and Clarithtomycin Risk factors for cellulitis: - Answers skin barrier disruption, skin inflammation, edema, obesity, immunosuppression, skin breaks between the toes, and pre-existing skin infection what causes edema in cellulitis? - Answers impaired lymphatic drainage and venous insufficiency How to prevent cellulitis in the healthy population: - Answers proper nutrition, avoiding skin injury, treat wounds, proper hygiene, and moisturize sepsis represents what % of all global deaths? - Answers 20% what causes redness in sepsis? - Answers increased perfusion what causes heat in sepsis? - Answers increased blood flow leads to vasodilation which makes the skin feel hot what is exudate? - Answers stuff that falls out of the blood what happens if the localized inflammatory response does not occur? - Answers then there is a systemic response with fever, fatigue, loss of appetite, and brain fog What do mast cells do in the context of sepsis? - Answers they release histamine which increases permeability, vasodilation, and redness what are cytokines? - Answers proteins used by the immune system to communicate the term "inflammatory mediators" is an umbrella term. What are some specific "inflammatory mediators"? - Answers histamine, prostaglandin, leukotrienes, interleukins, and interferons What organ modulates the immune response? - Answers the liver modulates plasma derived immune responses that come through the blood stream. what is fibrinogen? - Answers the inactive form of fibrin CRP or C-reactive proteins are closely related to ______. - Answers complement proteins Why is histamine fast acting? - Answers because it is already made before infection and stored in the mast cells. What are lysozymes? - Answers they are organelles found in cells and they help to break down what they take in What are reactive oxygen species or ROS? - Answers it is a marker for local inflammation which cell types secrete prostaglandin? - Answers all cell types what is PAF? - Answers platelet activating factor _______ is preformed and released from granules in mast cells. - Answers histamine The ________ is an intracellular signal that occurs in any cell. - Answers arachidonic acid pathway NSAIDS target which pathway? - Answers The arachidonic pathway ______ (from any cell) and ______ from leukocytes are synthesized and secreted. - Answers prostaglandins and leukotrienes ______ (cellular mediators) lead to vasodilation and WBC recruitment - Answers cytokines _____ produces reactive oxygen species (ROS) which spreads in bloodstream and signals inflammation. - Answers Leukytes ______ triggers inflammation and blood clots. - Answers Platelet activating factors (PAF) What are the cellular mediators? - Answers leukocytes and PAF What are the hepatic or plasma derives mediators? - Answers bradykinin, fibrinogen, CRP, and complement proteins ______ acts on the endothelium causing vasodilation. - Answers Bradykinin what does bradykinin cause? - Answers vasodilation _____ is activated to promote blood clots. In sepsis, however, ______ end up forming. - Answers Fibrinogen and microemboli What is DIC? - Answers Disseminated Intravascular Coagulation Bradykinin is the _____ version of histamine. - Answers systemic C-reactive protein and _______ proteins bind ____ causing inflammation and tissue damage. - Answers complement and antibodies other than sepsis, neutrophils and complement proteins are also important in ______. - Answers lupus Sepsis is an _______ response that progresses from mild _____ inflammation to a severe _______ inflammation. - Answers immune, localized, systemic True or false: Some symptoms of sepsis can be partially masked by drugs? - Answers True What blocks the arachidonic pathway, partially masking some symptoms of sepsis? - Answers steroids _____ blocks prostaglandins (COX), but not leukotrienes or plasma derived factors. - Answers NSAID PAF, complement, ROS, etc can result in ________ - Answers positive feedback As sepsis recruits more ________ it becomes harder to treat. - Answers chemical mediatorsBo both _____ (histamine and prostaglanding) and ________ (bradykinin and complement) derived mediators induce ______. - Answers cellular, plasma, vasodilation vasodilation + permeability = - Answers decreased BP HR x SV = ___ - Answers CO In sepsis patients are swollen independent of gravity d/t ____ - Answers fluid leaking into tissues In sepsis fluid in the lungs causes _____ on auscultation. - Answers bilateral crackles In sepsis, decreased urine output and decreased LOC is d/t _____ - Answers decreased perfusion Why is HR and contractility increased in sepsis? - Answers to compensate for the decreased preload. In sepsis, fluid is not in the _____, everything is filled with fluid but it is not getting to the ______. (think hose analogy) - Answers pipes and organs Sepsis = systemic = all vessels ______ + leak out _____ resulting in poor _____ _____ perfusion. - Answers vasodilate, fluid, end organ Why do patients turn hypothermic in sepsis? - Answers to decrease metabolic demand In sepsis, fluid is not in the vasculature as evidenced by: - Answers bilateral crackles, edema in the hands + feet, and low BP (diastolic), and blood is in the peripheral tissue since it is warm and flushed In sepsis, the heart is compensating for low blood volume as evidenced by: ________ and _______. The contradictory finding is that the systolic is ____ side of normal. - Answers bounding pulses and increased HR and low In sepsis, the infection is evidenced by high _____, _______, and _____ skin. It is contradicted by hypothermia as the body tries to reduce ______ ______. - Answers WBC count, productive cough, warm skin, metabolic demand VS changes + hypoperfusion + impaired gas exchange + micro-emboli throughout body + decreased urine output = - Answers septic shock Sepsis is a life threatening organ dysfunction caused by a ________ host response to _______. - Answers dysregulated and infection What is the formula for pulse pressure (PP)? - Answers PP = systolic - diastolic what number for PP suggests vasodilation - Answers PP 40 what is normal PP? - Answers normal is 30-40mmHg a normal MAP reading is ____ - Answers 65+ what is MAP? - Answers mean arterial pressure