Immunological/Inflammation Quizzes
A patient is at risk for septic shock when a microorganism invades the body. Which microorganism is the MOST common cause of sepsis? a. Fungus b. Virus c. Bacteria d. Parasite
C. Bacteria Rationale: Gram-positive or gram-negative bacteria are the MOST common cause of sepsis.
You're explaining to a group of outpatients about the signs and symptoms that may present with osteoarthritis. Select all the signs and symptoms that may present with this condition: a. Bouchard's Node b. Crepitus c. Fever d. Anemia e. Morning stiffness for less than 30 minutes f. Hard and bony joints g. Herberden's Node h. Soft, tender, warm joints
A, B, E, F, G Rationale: These are common findings found in osteoarthritis. Options C, D, and H are found in rheumatoid arthritis
A client with a history of asthma comes to the emergency department complaining of itchy skin and shortness of breath after starting a new antibiotic. What is the first action the nurse should take? a. Assess for anaphylaxis and prepare for emergency treatment. b. Obtain an arterial blood gas and immunoglobulin E (IgE) blood level. c. Teach the client about the relationship between asthma and allergies. d. Place the client on 100% oxygen and prepare for intubation.
A. Assess for anaphylaxis and prepare for emergency treatment. Rationale: Hypersensitivity or allergy is excessive inflammation occurring in response to the presence of an antigen to which the person usually has been previously exposed. If a client is experiencing an allergic or hypersensitivity response, the nurse's initial action is to assess for anaphylaxis. Promptly notifying the health care provider and preparing emergency equipment, including medication such as epinephrine and possible corticosteroids, is essential in preventing progression of anaphylaxis. Laboratory work is not a priority in this situation. The nurse would expect the IgE level to be elevated; the client may be hypoxic. The nurse would give the client supplemental oxygen; however, 100% is not given unless prescribed, and based on the information in the question intubation is not the first thing the nurse would prepare this client for. Teaching the client is important; however, this is not the right time. When the client is stabilized, the nurse should teach or reinforce that allergies, including some medications, are common triggers for asthma attacks and that people with asthma are predisposed to more allergies than people without asthma.
Your patient, who is post-op from a gastrointestinal surgery, is presenting with a temperature of 103.6 'F, heart rate 120, blood pressure 72/42, increased white blood cell count, and respirations of 21. An IV fluid bolus is ordered STAT. Which findings below indicate that the patient is progressing to septic shock? Select all that apply: a. Blood pressure of 70/34 after the fluid bolus b. Serum lactate less than 2 mmol/L [LOW] c. Patient needs Norepinephrine [vasopressor] to maintain a mean arterial pressure (MAP) greater than 65 mmHg despite fluid replacement d. Central venous pressure (CVP) of 18 [HIGH]
A. Blood pressure of 70/34 after the fluid bolus C. Patient needs Norepinephrine [vasopressor] to maintain a mean arterial pressure (MAP) greater than 65 mmHg despite fluid replacement Rationale: To know if the patient is progressing to septic shock, you need to think about the hallmark findings associated with this condition. Septic shock is characterized by major persistent hypotension (<90 SBP) that doesn't respond to IV fluids (refractory hypotension), and the patient needs vasopressors (ex: Norepinephrine) to maintain a mean arterial pressure greater than 65 and their serum lactate is greater than 2 mmol/L. A serum lactate greater than 2 indicates the cell's tissue/organs are not functioning properly due to low oxygen; hence tissue perfusion is poor due to the low blood pressure and mean arterial pressure.
True or False: Septic shock causes system wide vasodilation which leads to an increase in systemic vascular resistance. In addition, septic shock causes increased capillary permeability and clot formation in the microcirculation throughout the body. a. FALSE b. TRUE
A. False Rationale: The correct answer is FALSE. This statement is incorrect because there is a DECREASE (not increased) systemic vascular resistance in septic shock due to vasodilation. In septic shock, vasodilation is system wide. In addition, septic shock causes increased capillary permeability and thrombi formation in the microcirculation throughout the body. The vasodilation, increased capillary permeability, and clot formation in the microcirculation all leads to a decrease in tissue perfusion. This causes organ and tissue dysfunction, hence septic shock.
A patient with a severe infection has developed septic shock. The patient's blood pressure is 72/44, heart rate 130, respiration 22, oxygen saturation 96% on high-flow oxygen, and temperature 103.6 'F. The patient's mean arterial pressure (MAP) is 53 mmHg. Based on these findings, you know this patient is experiencing diminished tissue perfusion and needs treatment to improve tissue perfusion to prevent organ dysfunction. In regards to the pathophysiology of septic shock, what is occurring in the body that is leading to this decrease in tissue perfusion? Select all that apply: a. Increased systemic vascular resistance b. A significantly decreased cardiac output c. Vasodilation d. Increased capillary permeability e. Clot formation in microcirculation
A. Increased capillary permeability C. Vasodilation E. Clot formation in microcirculation Rationale: Septic shock occurs due to sepsis. Sepsis is the body's reaction to an infection and will lead to septic shock if this reaction is not treated. This reaction is the activation of the body's inflammatory system, but it's MAJORLY amplified and system wide. Cardiac output is not the problem in septic shock as with other types of shocks like hypovolemic or cardiogenic. CO is actually high or normal during the early stages of septic shock. It only decreases to the end of septic shock when heart function fails. The issue is with what is going on beyond the heart in the vessels. Substances are released by the microorganism that has invaded the body. This causes the immune system to release substances that will cause system wide vasodilation of the vessels (this will cause a DECREASE in systemic vascular resistance, blood to pool, and this decreases blood flow to the organs/tissues) along with an increase in capillary permeability (this causes fluid to leave the intravascular system and depletes the circulatory system of fluid and further decreases blood flow to the organs/fluids...this is RELATIVE (not absolute) hypovolemia). Furthermore, clots will form in the microcirculation due to plasma activating factor being released. This will cause platelets to aggregate and block blood flow even more to the organs/tissues. All of this will lead to decreased tissue perfusion and deprive cells of oxygen.
Your patient is started on an IV antibiotic to treat a severe infection. During infusion, the patient uses the call light to notify you that she feels a tight sensation in her throat and it's making it hard to breathe. You immediately arrive to the room and assess the patient. While auscultating the lungs you note wheezing. You also notice that the patient is starting to scratch the face and arms, and on closer inspection of the face you note redness and swelling that extends down to the neck and torso. The patient's vital signs are the following: blood pressure 89/62, heart rate 118 bpm, and oxygen saturation 88% on room air. You suspect anaphylactic shock. Select all the appropriate interventions for this patient: a. Prepare for the administration of Epinephrine b. Place the patient on oxygen c. Slow down the antibiotic infusion d. Call a rapid response
A. Prepare for the administration of Epinephrine B. Place the patient on oxygen D. Call a rapid response Rationale: Option C is wrong because the nurse should STOP the infusion, not slow it down because this could be the reason for the anaphylactic reaction. The nurse would want to call a rapid response, place the patient on oxygen, and prepare for the administration of Epinephrine. This drug is the first-line treatment for anaphylactic shock. It will increase the blood pressure, decrease swelling, and dilate the airway.
You're assessing the patient's complete blood count (CBC). Which lab result below demonstrates leukopenia? a. WBC 3,000 b. WBC 7,000 c. Platelets 90,000 d. Platelets 500,000
A. WBC 3,000 Rationale: WBC range is 5,000-10,000. Leukopenia is a DECREASED white blood count.
Your patient has arthritis that affects the weight-bearing joints such as the hands, knees, hips, and spine. This type of arthritis is most likely: a. Rheumatoid arthritis b. Osteoarthritis
B. Osteoarthritis Rationale: Osteoarthritis is a form of arthritis that causes deterioration of the articular hyaline cartilage of the bones. It affects the weight-bearing joints. This can include the hands, knees, hips, and spine because these joints experience a lot of stress.
A registered nurse (RN) is providing instructions to an unlicensed assistive personnel (UAP) assigned to give a bed bath to a client who is on contact precautions. The RN instructs the UAP to use which protective item when giving the bed bath? a. Gloves and shoe protectors b. A gown and gloves c. A gown and goggles d. Gloves and goggles
B. A gown and gloves Rationale: Contact precautions require the use of gloves and a gown if direct client contact is anticipated. Goggles are not necessary unless it is anticipated that splashes of blood, bodily fluids, secretions, or excretions may occur. Shoe protectors are not necessary. Test-Taking Strategy: Focus on the subject, protective items needed for contact precautions. Eliminate option a first, knowing that shoe protectors are not necessary. The question contains no information indicating that splashes will occur; therefore, eliminate options c and d.
The nurse is assisting in planning care for a client with a diagnosis of immunodeficiency and should incorporate which action as a priority in the plan? a. Identifying factors that decreased the immune function b. Protecting the client from infection c. Encouraging discussion about lifestyle changes d. Providing emotional support to decrease fear
B. Protecting the client from infection Rationale: The client with immunodeficiency has inadequate or absence of immune bodies and is at risk for infection. The priority nursing intervention would be to protect the client from infection. Options a, c, and d may be components of care but are not the priority. Test-Taking Strategy: Note the strategic word, priority. Use Maslow's Hierarchy of Needs theory to answer the question. Remember that physiological needs are the priority. This will direct you to the correct option.
The nursing student conducting a clinical conference on immunity places an emphasis on active immunity. Which statement by fellow nursing students indicates successful teaching? a. "Active immunity provides protection immediately and forever." b. "Passive immunity can last for years." c. "Active immunity lasts for years and can be easily reactivated by a booster dose of antigen." d. "Active immunity only lasts from days to months."
C. "Active immunity lasts for years and can be easily reactivated by a booster dose of antigen." Rationale: Active immunity lasts for years and is natural by infection or artificial by stimulation of the body's immune defenses for example by vaccination. It can be easily reactivated by a booster dose of antigen. Protection from active immunity takes 5 to 14 days to develop after the first exposure to the antigen and 1 to 3 days after subsequent exposures. Active immunity lasts much longer and is more effective at preventing subsequent infections than passive immunity however it does not last forever. Passively received human antibodies have a half-life of about 30 days. Passive immunity provides protection immediately.
What is the MOST important step a nurse can take to prevent anaphylactic shock in a patient? a. Establishing IV access b. Administering Epinephrine c. Assessing, documenting, and avoiding all the patient allergies d. Administering Corticosteroids
C. Assessing, documenting, and avoiding all the patient allergies Rationale: This is the MOST important and easiest step a nurse can take in preventing anaphylactic shock in a patient.
An erythrocyte sedimentation rate (ESR) determination is prescribed for a client with a connective tissue disorder. The client asks the nurse about the purpose of the test. What should the nurse tell the client about the purpose of the test? a. Confirms the diagnosis of a connective tissue disorder b. Determines the presence of antigens c. Confirms the presence of inflammation or infection in the body d. Identifies which additional tests need to be performed
C. Confirms the presence of inflammation or infection in the body Rationale: The ESR is a blood test that can confirm the presence of inflammation or infection in the body. It is particularly useful for the management of connective tissue disease because the rate measured directly correlates with the degree of inflammation and later with the severity of the disease. The other options are incorrect. Test-Taking Strategy: Focus on the subject, the purpose of an ESR determination. Knowledge of the purpose of the ESR and a focus on the client's diagnosis will assist you in answering this question. Remember that the ESR can confirm inflammation or infection.
A patient is in anaphylactic shock. The patient has a severe allergy to peanuts and mistakenly consumed an eggroll containing peanut ingredients during his lunch break. The patient is given Epinephrine intramuscularly. As the nurse, you know this medication will have what effect on the body? a. It will cause vasoconstriction and decrease the blood pressure. b. It will prevent a recurrent attack. c. It will help dilate the airways. d. It will help block the effects of histamine in the body.
C. It will help dilate the airways. Rationale: Epinephrine acts as a vasopressor and will actually dilate the airway. Epinephrine performs vasoconstriction which will INCREASE the blood pressure. It does not prevent a recurrent attack (corticosteroids may help with this), and it does not block the effects of histamine (antihistamine helps with this).
Two nurses are leaving the room of a client whose care required them to wear a gown, mask, and gloves. Which action by these nurses could lead to the spread of infection? a. Taking off the gloves first before removing the gown b. Washing the hands after the entire procedure has been completed c. Removing the gown without rolling it from inside out d. Removing the gloves and then removing the gown using the neck ties
C. Removing the gown without rolling it from inside out. Rationale: The gown must be rolled from inside out to prevent the organisms on the outside of the gown from contaminating other areas. Gloves are considered the dirtiest piece of equipment and therefore must be removed first. Hands must be washed after removal of the protective garb to remove any unwanted germs still present. Ungloved hands should be used to remove the gown to prevent contaminating the back of the gown with germs from the gloves. Test-Taking Strategy: Focus on the subject, an incorrect action, and use knowledge regarding standard precautions to assist in answering the question. Visualize the process of removing protective garb, remembering to remove the dirtiest items first. Be sure to understand the order in which to remove protective garb. A slight change in the order can have devastating effects and compromise the care of the client.
The physician orders a patient in septic shock to receive a large IV fluid bolus. How would the nurse know if this treatment was successful for this patient? a. Patient's skin is warm and flushed. b. Patient's CVP 2 mmHg c. The patient's blood pressure changes from 75/48 to 110/82. d. Patient's urinary output is 20 mL/hr.
C. The patient's blood pressure changes from 75/48 to 110/82. Rationale: In septic shock, the first treatment is to try to maintain tissue perfusion with fluids. If that doesn't work to increase the blood pressure and maintain perfusion, vasopressors will be used next. In septic shock, the intravascular space will be depleted of fluid due to an increase in capillary permeability. This will lead to hypovolemia, which will decrease blood pressure and lead to a decrease in blood flow to organs/tissue. If the blood pressure increases to a normal state, that tells us the fluids are working. Adequate urine output is 30mL/hr or greater.
The nurse is assisting in administering immunizations as well as providing education to the clients who receive them at a health care clinic. Which statement by a client indicates that teaching was successful? a. "Immunizations can provide innate immunity." b. "Immunizations can provide natural immunity." c. "Immunizations protect against all diseases." d. "Immunizations are a way to acquire immunity to a specific disease."
D. "Immunizations are a way to acquire immunity to a specific disease." Rationale: Acquired immunity is immunity that can occur by receiving an immunization that causes antibodies to a specific pathogen to form. No immunization protects the client from all diseases. Natural (innate) immunity is present at birth.
The nurse provides education to the client about the primary purpose of neutrophils. Which statement by the client indicates successful teaching? a. "They close up blood vessels." b. "They increase fluids at the injury site." c. "They open up blood vessels." d. "They engulf any potential foreign materials."
D. "They engulf any potential foreign materials." Rationale: Neutrophil function provides protection after invaders, especially bacteria, enter the body. In the inflammatory response, neutrophils appear in the area of injury in 30 to 60 minutes. Their primary purpose is to phagocytize (ingest and destroy) any potentially harmful agents, such as microorganisms. The remaining options are incorrect.
The nursing student conducted a clinical conference on the role of B lymphocytes in the immune system. Which statement by a fellow nursing student indicates successful teaching? a. "They activate T cells." b. "They attack and kill the target cell directly." c. "They initiate phagocytosis." d. "They produce antibodies."
D. "They produce antibodies." Rationale: B lymphocytes have the job of making antibodies and mediating humoral immunity. They do not activate T cells. T cells attack and kill target cells directly. The primary function of macrophages is phagocytosis. Test-Taking Strategy: Focus on the subject, the role of B lymphocytes. Knowledge of the function of B lymphocytes is required to answer this question. Remember that B lymphocytes have the job of making antibodies and mediating humoral immunity.
The nurse is caring for a client with a wound infected with methicillin-resistant Staphylococcus aureus (MRSA). The most appropriate infection control precautions for MRSA include which intervention? a. Private room with negative-pressure airflow b. Room with positive-pressure airflow c. Mask or respiratory protection device and gown d. Private room, gown, gloves, and face shield
D. Private room, gown, gloves, and face shield Rationale: Isolation guidelines from the Centers for Disease Control and Prevention (CDC) place MRSA at the tier 2 transmission category. Contact precautions are required and include a private room, gloves, gowns, and face shields in case a splash from the wound drainage occurs, such as with wound irrigation. A room with negative-pressure airflow is required for airborne precautions from small droplet infections such as measles, chickenpox, or tuberculosis. A respiratory protection device is recommended for larger droplet infections such as pneumonia. A room with positive-pressure airflow is recommended for protective environments such as those required for clients with stem cell transplants. Test-Taking Strategy: Note the strategic words, most appropriate, and focus on the subject, MRSA precautions. Consider safety and disease transmission. Noting that the client has a wound that is infected will direct you to the correct option.
Which statement is FALSE concerning rheumatoid arthritis? a. Rheumatoid arthritis can occur at any age (20-60 year old most commonly). b. Ankylosis can occur in severe cases of rheumatoid arthritis. c. Rheumatoid arthritis most commonly affects the fingers and wrist. d. Rheumatoid arthritis is different from osteoarthritis in that it doesn't affect other systems of the body.
D. Rheumatoid arthritis is different from osteoarthritis in that it doesn't affect other systems of the body. Rationale: This statement is false. It should say that, "Rheumatoid arthritis is different from osteoarthritis in that it DOES (not doesn't) affect other systems of the body. RA is systemic, while OA only affects the joints. This is why a fever and anemia can present in RA. Ankylosis is a stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint, which may be the result of injury or disease. It is present in both osteoarthritis and rheumatoid arthritis, but more severe and longer lasting in rheumatoid.
The home health nurse is watching the caregiver change the sternotomy dressing on the postoperative client. Which action by the caregiver identifies correct principles of infection control? a. The caregiver dons gloves before removal of the old dressing and then applies the new dressing. b. The caregiver selects a previously opened gauze to cover the sternal wound. c. The caregiver covers her mouth with her hand when she sneezes and then continues with the dressing change. d. The caregiver washes her hands before removal of the soiled dressing and again before applying the clean dressing.
D. The caregiver washes her hands before removal of the soiled dressing and again before applying the clean dressing. Rationale: The single most effective technique to prevent the spread of germs and bacteria is hand washing. The initial step with all aseptic procedures is hand washing. Using previously opened gauze, not washing the hands after sneezing, and not applying new gloves after removing the old dressing increase the risk of wound contamination as a result of poor aseptic technique. Test-Taking Strategy: Focus on the subject, principles of infection control. Gauze that has been opened has been exposed to potential pathogens. In option 2, the caregiver contaminates the gloves by removing the old dressing and then contaminates the clean dressing with the contaminated gloves. In option 3, the caregiver sneezes into her gloved hand and does not change the glove, thereby contaminating the dressing.
The nursing instructor asks a nursing student to identify the components of natural resistance as it relates to the immune system. All of the following are characteristics of natural resistance EXCEPT? a. "It includes all antigen-specific immunities a person develops during a lifetime." b. "It is the immunity with which a person is born." c. "It does not require previous exposure to the antigen." d. "It also is called inherited immunity."
a. "It includes all antigen-specific immunities a person develops during a lifetime." Rationale: Natural resistance, also called innate inherited or innate-native immunity, is the immunity with which a person is born. It does not require previous exposure to the antigen. Acquired immunity includes all antigen-specific immunities that a person develops during a lifetime.