Which type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?

Correct Answer: D

Rationale: Anaphylactic shock is characterized by a severe, systemic hypersensitivity reaction that can occur in response to allergens such as certain drugs or latex. During anaphylactic shock, the body releases large amounts of histamine and other inflammatory substances, leading to widespread vasodilation (dilation of blood vessels) and increased capillary permeability. This results in a rapid drop in blood pressure, decreased perfusion to vital organs, and potential life-threatening symptoms such as difficulty breathing and cardiovascular collapse. Immediate treatment with epinephrine and supportive measures such as intravenous fluids is crucial in managing anaphylactic shock.

Correct Answer: C

Rationale: Addison's disease is a condition characterized by adrenal insufficiency, resulting in a deficiency of aldosterone and cortisol. Without aldosterone, the body is unable to regulate fluid and electrolyte balance properly, leading to sodium loss and potassium retention. This imbalance can result in excessive fluid volume, as the kidneys retain water and sodium. Symptoms of excessive fluid volume in Addison's disease can include edema, weight gain, and hypertension. Therefore, the most appropriate nursing diagnosis for a client with Addison's disease would be Excessive Fluid Volume.

Correct Answer: B

Rationale: Rocky Mountain spotted fever is caused by the bite of an infected tick. The bacterium Rickettsia rickettsii is transmitted to humans through the bite of the American dog tick, the Rocky Mountain wood tick, or the brown dog tick. These ticks are commonly found in wooded areas and attach themselves to the skin of humans or animals, transmitting the bacteria responsible for Rocky Mountain spotted fever. It is important to take precautions to prevent tick bites, such as using insect repellent, wearing long sleeves and pants when in wooded areas, and conducting thorough tick checks after being outdoors.

Correct Answer: C

Rationale: A classic full-blown AIDS case is characterized by the presence of tumors and opportunistic infections due to the severe immunodeficiency caused by the human immunodeficiency virus (HIV). As the immune system becomes progressively weakened, the individual becomes highly susceptible to various infections and malignancies, which are typically not seen in individuals with a healthy immune system. The presence of tumors and opportunistic infections in an individual signifies the advanced stage of HIV infection and the progression to AIDS. The other options (A, B, D) are more general symptoms that can be seen in various stages of HIV infection and are not specific to a full-blown AIDS case.

Correct Answer: C

Rationale: The nurse should suggest to the parents to offer the last feeding as late as possible at night for an infant who has a prolonged need for middle-of-the-night feedings. By ensuring that the infant gets a full feeding closer to bedtime, it can potentially help the baby stay fuller for a longer period during the night, reducing the need for frequent nighttime feedings. This approach can help the parents establish a bedtime routine that supports longer stretches of sleep for both the infant and themselves. It is important to note that decreasing daytime feedings, allowing the child to go to sleep with a bottle, and putting the infant to bed after they are already asleep from rocking are not recommended strategies for addressing prolonged middle-of-the-night feedings.