NSG 1600 EAQ Unit 3: Immunologic System and Infectious Disease

Which organism would the nurse teach immigrants is the cause of smallpox? 1 Variola virus 2 Yersinia pestis 3 Bacillus anthracis 4 Clostridium botulinum

1. Smallpox is an infectious disease caused by the Variola virus. Yersinia pestis causes plague. Bacillus anthracis causes anthrax. Clostridium botulinum causes botulism.

Which sexually transmitted infection (STI) is most commonly reported? 1 Syphilis 2 Chlamydia 3 Gonorrhea 4 Human immunodeficiency virus

2 Chlamydial infections are the most commonly reported STIs. Syphilis, human immunodeficiency virus, and gonorrhea are not the most commonly reported STIs.Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers.

A client with erythematous papules in the interdigital spaces reports severe itching at night. Which insect is responsible for this condition? 1 Phthirus pubis 2 Sarcoptes scabiei 3 Pediculus humanus 4 Borrelia burgdorfer

2 Erythematous papules and itching at night in the interdigital spaces indicates scabies. This condition is caused by Sarcoptes scabiei. Phthirus pubis and Pediculus humanus may cause pediculosis, manifested as minute, red, and noninflammatory skin lesions. Borrelia burgdorferi causes Lyme disease, manifested as a warm, itchy, and painful rash in the groin, axillae, trunk, legs, and upper arms.

Which cytokine stimulates the liver to produce fibrinogen and protein C? 1 Interleukin-1 2 Interleukin-6 3 Thrombopoietin 4 Tumor necrosis factor

2 Interleukin-6 stimulates the liver to produce fibrinogen and protein C. Interleukin-1 stimulates the production of prostaglandins. Thrombopoietin increases the growth and differentiation of platelets. Tumor necrosis factor stimulates delayed hypersensitivity reactions and allergies.

Which autoimmune disease can result in damage to the heart? 1 Uveitis 2 Rheumatic fever 3 Myasthenia gravis 4 Graves disease

2 Rheumatic fever is an example of an autoimmune disease that can potentially result in permanent damage to the heart, including damage to valves and heart failure. Uveitis is an eye disorder that is an example of an autoimmune disease. Myasthenia gravis is a muscular disorder that is an example of an autoimmune disease. Graves disease is an endocrine disorder that is an example of an autoimmune disease. Other than rheumatic fever, these autoimmune diseases are not linked to cardiac damage.

Which stage of the human immunodeficiency virus (HIV) would a client with a CD4+ T cell count of 325 cells/mm3 be classified? 1 Stage 1 2 Stage 2 3 Stage 3 4 Stage 4

2 Stage 2 describes a client with a CD4+ T cell count between 200 and 499 cells/mm3. Stage 1 describes a client with a CD4+ T cell count of greater than 500 cells/mm3. Stage 3 describes a client with a CD4+ T cell count of less than 200 cells/mm3. Stage 4 describes a client with a confirmed HIV infection but no information regarding CD4+ T cell counts is available.

Which type of immunity is acquired through the transfer of colostrum from the mother to the child? 1 Natural active immunity 2 Artificial active immunity 3 Natural passive immunity 4 Artificial passive immunity

3 Natural passive immunity is acquired through the transfer of colostrum from the mother to the child. Natural active immunity is acquired when there is a natural contact with an antigen through a clinical infection. Artificial active immunity is acquired through immunization with an antigen. Artificial passive immunity is acquired by injecting serum from an immune human.

Which bacteria may cause toxic shock syndrome in female clients? 1 Treponema pallidum 2 Enterococcus faecalis 3 Staphylococcus aureus 4 Neisseria gonorrhoeae

3 Staphylococcus aureus causes toxic shock syndrome. Treponema pallidum causes syphilis. Enterococcus faecalis (previously known as Streptococcus faecalis) causes genitourinary tract infections and infection of surgical wounds. Group A streptococcus may cause toxic shock syndrome. Neisseria gonorrhoeae causes gonorrhea and pelvic inflammatory disease.

Which infection would the nurse identify as requiring a client to be placed on droplet precautions? 1 Human immunodeficiency virus (HIV) 2 Influenza 3 Tuberculosis (TB) 4 Methicillin-resistant Staphylococcus aureus (MRSA)

Clients with influenza will be placed on droplet precautions because the infection can be spread by talking or sneezing. HIV-positive clients will be instructed to use barrier protection with any kind of sexual contact to prevent spread of the virus. Clients with TB will be placed on airborne transmission precautions. Clients with MRSA would require contact precautions.

Which mediator of injury is involved in the client with pruritic lesions from an immunoglobulin E (IgE)-mediated hypersensitivity reaction? 1 Histamine 2 Cytokine 3 Neutrophil 4 Macrophage

Histamine is one of the mediators of injury involving IgE-mediated injury and potentially causes pruritus. Cytokines are the mediators of injury in delayed hypersensitivity reaction. Neutrophils are involved in immune complex-mediated hypersensitivity reactions. Macrophages in tissues are involved in cytotoxic reactions.

Which sexually transmitted infection is caused by a virus? 1 syphilis 2 gonorrhea 3 genital warts 4 chlamydial infection

Strains of the human papillomavirus (HPV) cause the sexually transmitted infection of genital warts. Bacteria cause syphilis, gonorrhea, and chlamydial infections.

Which organism would the nurse explain was responsible for a client's recent diagnosis of malaria? 1 Vibrio 2 Sporozoa 3 Ringworm 4 Spirochetes

Sporozoa such as Plasmodium malariae cause malaria. Vibrio are curved rod-shaped bacteria; these microorganisms cause cholera. Ringworm such as tinea corporis may cause mycotic infections. Spirochetes are spiral-shaped bacteria; these microorganisms may cause leprosy and syphilis.

How would the nurse explain the purpose of standard precautions to the nursing assistant on a surgical unit? 1 Decrease the risk of transmitting unidentified pathogens 2 Used by staff when clients are suspected of having a communicable disease 3 Ensure clients perform hygiene practices in a universal way 4 Create categories requiring the client to follow additional precautions

1 All staff members use standard precautions for all clients in all settings, regardless of their diagnosis or presumed infectiousness. Practices associated with standard precautions require health care providers, not a client, to use hand washing and personal protective equipment to protect themselves and others from body fluids. Transmission-based precautions, known as airborne, droplet, and contact precautions, are based on a client's diagnosed infection.

Which intervention is most important in preventing hospital-acquired catheter-associated urinary tract infections (CAUTIs)? 1 Removing the catheter 2 Keeping the drainage bag off of the floor 3 Washing hands before and after assessing the catheter 4 Cleansing the urinary meatus with soap and water daily

1 Research demonstrates that decreasing the use of indwelling urinary catheters is the most important intervention to prevent CAUTIs. Keeping the drainage bag off the floor, washing hands before and after assessing the catheter, and cleansing the urinary meatus daily with soap and water will help reduce infections; however, these are not the most important interventions to prevent CAUTIs.

Which is the causative organism for syphilis? 1 Treponema pallidum 2 Campylobacter jejuni 3 Trichomonas vaginalis 4 Chlamydia trachomatis

1 The causative organism for syphilis is Treponema pallidum. Campylobacter jejuni is the causative organism for proctitis. Trichomonas vaginalis is the causative organism for vulvovaginitis. Chlamydia trachomatis is the causative organism for salpingitis. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

A client receiving chemotherapy develops a temperature of 102.2°F (39°C). The temperature 6 hours ago was 99.2°F (37.3°C). Which nursing intervention is the priority in this case? 1 Assess the amount and color of urine; obtain a specimen for a urinalysis and culture. 2 Administer the prescribed antipyretic and notify the primary health care provider of this change. 3 Note the consistency of respiratory secretions and obtain a specimen for culture and sensitivity. 4 Obtain the respirations, pulse, and blood pressure when rechecking the temperature in 1 hour

2 Because an elevated temperature increases metabolic demands, the pyrexia must be treated immediately. The practitioner should be notified because this client is immunodeficient from both the disease and the chemotherapy. A search for the cause of the pyrexia then can be initiated. More vigorous intervention than obtaining the respirations, pulse, and blood pressure is rechecking the temperature in 1 hour. This client has a disease in which the immunoglobulins are ineffective and the therapy further suppresses the immune system. Assessing the amount and color of urine and obtaining a specimen for a urinalysis is not the immediate priority, although it is important because the cause of the pyrexia must be determined. Also, the increased amount of calcium and urates in the urine can cause renal complications if dehydration occurs. Noting the consistency of respiratory secretions and obtaining a specimen for culture is not the priority, although important because respiratory tract infections are a common occurrence in clients with multiple myeloma.

Identify the most important reason why medications used to treat acquired immunodeficiency syndrome (AIDS) become ineffective. 1 Taking the medications 90% of the time 2 Missing doses of the prescribed medications 3 Taking medications from different classifications 4 Developing immune reconstitution inflammatory syndrome (IRIS)

2 Missing doses of the prescribed medications. The most important reason for the development of medication resistance in the treatment of AIDS is missing doses of medications. When doses are missed, the blood medication concentrations become lower than what is needed to inhibit viral replication. The virus replicates and produces new particles that are resistant to the medications. Taking the medications 90% of the time prevents medications from becoming ineffective. Taking medications from different classes prevents the medications from becoming ineffective. IRIS occurs when T cells rebound with medication therapy and become aware of opportunistic infections.

Upon review of morning lab reports, which client's report indicates AIDS? 1 Client 1 2 Client 2 3 Client 3 4 Client 4

3 The diagnosis of AIDS requires that the person should be HIV positive and have either a CD4+ T-cell count of less than 200 cells/mm3 (200 cells/(L) or less than 14% or an opportunistic infection. Client 3, with a CD4+ T-cell count of less than 200 cells/mm3 (200 cells/(L) and is HIV positive, is having AIDS-defining illness. A healthy client usually has at least 800 to 1000 CD4+ T-cells/mm3 of blood. The CD4+ T-cells are reduced in the client with HIV disease. Client 1, with a CD4+ T-cell count of 750 cells/mm3 and HIV positive, does not have AIDS. Client 2, with a CD4+ T-cell count of 550 cells/mm3 and HIV positive, does not have AIDS. Client 4, having a CD4+ T-cell count of 450 cells/mm3 and HIV positive does not have AIDS.

Which identified clinical manifestation is a sign of allergic rhinitis? 1 Presence of high-grade fever 2 Reduced breathing through the mouth 3 Presence of pinkish nasal discharge 4 Reduced transillumination on the skin over the sinuses

4 Reduced transillumination on the skin overlying the sinuses indicates allergic rhinitis. This effect is caused by the sinuses becoming inflamed and blocked with thick mucoid secretions. Generally, fever does not accompany allergic rhinitis unless the client develops a secondary infection. In allergic rhinitis, the client is unable to breathe through the nose because it gets stuffy and blocked. Instead, the client will resort to mouth breathing. Clients with allergic rhinitis will have clear or white nasal discharge.

Which sexually transmitted infection is caused by Chlamydia trachomatis? 1 Cervicitis 2 Gonorrhea 3 Genital warts 4 Genital herpes

1 Cervicitis is caused by Chlamydia trachomatis. Gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae. Genital warts are caused by the human papillomavirus. Genital herpes is caused by the herpes simplex virus.

Why is an infection caused by Neisseria gonorrhoeae particularly troublesome for a female client? 1 The medication is expensive. 2 The infection is difficult to treat with antibiotics. 3 Symptoms are often overlooked. 4 Treatment has many adverse effects.

3 Many female clients who contract gonorrhea are asymptomatic or overlook the minor symptoms, making possible for the bacteria to remain a source of infection. There is no evidence to support the medication to treat the infection is expensive. The infection can be treated with one intramuscular injection of ceftriaxone. There is no evidence to support the medication to treat this infection has many adverse effects.

A client expresses concern regarding the lack of annual flu vaccines because of a supply and demand problem. Which response by the nurse is best? 1 "This is an unfortunate situation, but there was such a limited supply available." 2 "There are many others who were unable to obtain a flu vaccine this month." 3 "The limited supply doesn't really matter because the vaccine is for one particular strain." 4 "There are other things you and your family can do to prevent the flu, such as hand washing."

4 The statement "There are other things you can do to prevent the flu, such as hand washing" is a teaching opportunity of which the nurse can take advantage and show the client the things that can be done to avoid infection. The response "It's unfortunate, but there was such a limited supply available" is empathic, but it does not address the client's concern of vulnerability. The response "There are many others who also were unable to get a flu vaccine" belittles the client for being concerned. The response "It doesn't matter because the vaccine is for just one particular strain" may be true, but it belittles the client's concern.

Which criteria would the nurse consider when determining if an infection is a health care-associated infection? 1 Originated primarily from an exogenous source 2 Is associated with a medication-resistant microorganism 3 Occurred in conjunction with treatment for an illness 4 Still has the infection despite completing the prescribed therapy

3 Health care-associated infections are classified as those that are contracted within a health care environment (e.g., hospital, long-term care facility) or result from a treatment (e.g., surgery, medications). Originating primarily from an exogenous source is not a criterion for identifying a health care-associated infection. The source of health care-associated infections may be endogenous (originate from within the client) or exogenous (originate from the health care environment or service personnel providing care); most health care-associated infections stem from endogenous sources and are caused by Escherichia coli and Staphylococcus aureus. Association with a medication-resistant microorganism is not a criterion for identifying a health care-associated infection. A health care-associated infection may or may not be caused by a medication-resistant microorganism. Still having the infection despite completing the prescribed therapy is not a criterion for identifying a health care-associated infection.

Which strategy is most effective for preventing the transmission of infection? 1 Wearing gloves and a gown 2 Applying face mask and a gown 3 Applying a face mask and gloves 4 Wearing gloves and hand hygiene

4 The combination of hand hygiene and wearing gloves is the most effective strategy for preventing infection transmission. A gown and face mask are considered personal protective equipment; however, they are not considered the most effective strategy to prevent the transmission of infection.

Which instruction would the nurse provide a client with leukopenia secondary to chemotherapy? 1 "You should avoid exposure to the sun and use a sunscreen." 2 "You should eat high-fiber foods and increase fluid intake." 3 "You should avoid large crowds and people with infections." 4 "You should consume iron supplements and erythropoietin."

3 Leukopenia consists of low levels of white blood cells. A leukopenic client should avoid large crowds and people with infection because the client may contract an infection as a result of compromised immunity. The suggestion of avoiding exposure to the sun and using a sunscreen would be beneficial for a client with chemotherapy-induced skin changes. The suggestion of eating high-fiber foods and increasing fluid intake would be beneficial for a client with constipation after chemotherapy. Consuming iron supplements and erythropoietin would be required for a client who developed anemia after chemotherapy.