PathoPharm 1 module 4: immunity, infection, and inflammation

A child receives a vaccine for measles, mumps, and rubella (MMR). Six hours after the injection, the child's parent reports local soreness, erythema, lethargy, and a fever of 101°F to a nurse. Which action should the nurse take? A. Give instructions on relieving symptoms with acetaminophen (Tylenol). B. Seek emergency help, because these symptoms are signs of an anaphylactic reaction. C. Tell the parent that a live vaccine will cause a mild case of measles. D. Obtain and fill out a Vaccine Adverse Event Report form.

A

A client is preparing to give a client an antipyretic drug for a temperature of 101° F (38.3° C). What drug would be the most appropriate for the nurse to administer? A. Acetaminophen B. Aspirin C. Doxycycline D. Ibuprofen

A

A patient comes to the clinic stating, "My left arm is red and swollen. It hurts badly enough that I couldn't go to work today." The healthcare provider orders computer-assisted tomography (CT) scanning of the left upper extremity. Which statement by the patient indicates understanding of the reason for the procedure? A. "This test will help to better determine where the injury actually is and how severe it is." B. "This will tell you what I did to my elbow because I really don't know what happened." C. "The healthcare provider wants me to have this so that the pain will stop." D. "I need to have this done because the healthcare provider thinks my arm is broken."

A

A patient presents to the clinic with observable edema and erythema of the left forearm. A brief history reveals no exposure to potential irritating agents. On palpation, the nurse finds the area very warm and tender. What is the most likely cause of the patient's symptoms? A. A complement cascade B. IgE reactions C. Clonal diversity D. An allergic reaction

A

The nurse is auscultating a patient's bowel sounds and notes a long, thin, fading scar on the patient's abdomen in the right lower quadrant. What is the best explanation for the scar's appearance? A. Fibrous tissue replacing damaged tissue when injury is extensive B. A surgical incision C. The development of chronic inflammation D. Optimal functioning of the inflammatory process after an injury

A

The nurse is teaching a class of junior high school students about infection control through effective hand washing. Which statement made by a student indicates the need for further teaching? A. "Hand sanitizer works just as well as washing with soap and water." B. "If I sing the song "Happy Birthday" twice through while scrubbing my hands, that should be long enough." C. "We should all wash our hands before eating lunch every day." D. "I need to read the label on the hand sanitizer to be sure that it's at least 60% alcohol."

A

The nurse is teaching a patient with a new diagnosis of systemic lupus erythematosus (SLE) about the disease. The nurse recognizes that the patient understands the information when making which statement? A. "I need to avoid getting infections because they will increase the immune response in my body, which can make my SLE worse." B. "As long as I take all my prescribed medications, I won't have to make any lifestyle changes as a result of my SLE." C. "I need to be sure to take all the available immunizations to keep me from getting sick." D. "Because of my SLE, my immune system is already diminished, so I need to avoid people with the flu."

A

Which client is at greatest risk for developing an infection? A. A 65-year-old woman who had heart surgery 4 days ago B. A 54-year-old man with hypertension C. A 21-year-old woman with a fractured tibia in a cast D. A 71-year-old man in a nursing home

A

Which statement by an 18-year-old woman vaccinated with Gardasil indicates that more teaching is necessary? A. "This vaccination will cure the HPV infection I got when I was 16." B. "I will still need to have a routine Pap screen performed." C. "Gardasil can prevent genital warts in males and females." D. "This drug will not protect against all types of HPV."

A

While in the hospital, a client developed a methicillin-resistant infection in an open foot ulcer. Which nursing action would be appropriate for this client? A. Wear a gown and gloves to prevent contact with the client or client-contaminated items. B. Have the client wear a surgical mask when being transported out of the room. C. Wear a mask when working within 3 feet (91 cm) of the client. D. Assign the client to a private room with a negative airflow.

A

A client who has been living in another country for 10 years is undergoing diagnostic testing to identify the causative organisms of the infection that has been acquired. When caring for this client, what should the nurse recall about active immunity?

Protein substances are formed within the body to neutralize antigens.

Which information does the nurse include when teaching a client about antibiotic therapy for infection? A. Take antibiotics until symptoms subside, and then stop taking the drugs. B. Share antibiotics with family members who develop the same infection. C. Take all antibiotics as prescribed, unless adverse effects develop. D. Take antibiotics when symptoms of infection develop.

C

Which occurrence can delay wound healing after surgery? A. Adequate arterial blood flow to the wound B. Supplemental oxygen therapy C. An increased hospital stay D. A healthy diet

C

Which precaution is appropriate for the nurse to take to prevent the transmission of Clostridium difficile infection? A. Carefully wash hands that are visibly soiled. B. Wear a mask with eye protection and perform proper handwashing. C. Wear gloves when in contact with the client's body secretions or fluids. D. Wear a mask and gloves when in contact with the client.

C

A construction worker sustains a puncture from a rusty nail. It is unknown when the worker had the last immunization for tetanus, and the primary health care provider prescribes tetanus immune globulin. What protection does this type of immunization offer?

Immediate passive short-term immunity

A patient who has been placed on Contact Precautions for Clostridium difficile (C. difficile) asks you to explain what he should know about this organism. Which statements made by the patient show an understanding of the patient teaching? (Select all that apply.) 1. "The organism is usually transmitted through the fecal-oral route." 2. "Hands should always be cleaned with soap and water rather than the alcohol-based hand sanitizer." 3. "Everyone coming into the room must wear a gown and gloves." 4. "While I am in Contact Precautions, I cannot leave the room." 5. "C. difficile dies quickly once outside the body."

1, 2, 3

The infection control nurse has asked the staff to work on reducing the number of iatrogenic infections on the unit. Which of the following actions on the nurses' part would contribute to reducing health care-acquired infections? (Select all that apply.) 1. Teaching correct handwashing to assigned patients 2. Using correct procedures in starting and caring for an intravenous infusion 3. Providing perineal care to a patient with an indwelling urinary catheter 4. Isolating a patient on antibiotics who has been having loose stool for 24 hours 5. Decreasing a patient's environmental stimuli to decrease nausea

1, 2, 3

Which of these statements are true regarding disinfection and cleaning? (Select all that apply.) 1. Proper cleaning requires mechanical removal of all soil from an object or area. 2. Routine environmental cleaning is an example of medical asepsis. 3. When cleaning a wound, wipe around the wound edge first and then clean inward toward the center of the wound. 4. Cleaning in a direction from the least to the most contaminated area helps reduce infections. 5. Disinfecting and sterilizing medical devices and equipment involve the same procedures.

1, 2, 4

Put the following steps for removal of protective barriers after leaving an isolation room in order. 1. Remove and dispose of gloves. 2. Perform hand hygiene. 3. Remove eyewear or goggles. 4. Untie bottom and then top mask strings and remove from face. 5. Untie waist and neck strings of gown. Remove gown, rolling it onto itself without touching the contaminated side.

1, 3, 5, 4, 2

Arrange the steps required to stimulate antibody-mediated immunity in its correct sequence.

1. Invasion of new antigens in the body 2.Interaction of the macrophage and helper T-cells to recognize the antigen 3.Sensitization of B-lymphocyte to the new antigen 4.Production of antibodies by B-lymphocytes 5.Binding of antibodies to the antigen and formation of immune complex 6.Neutralization or elimination of the antigen

Pathogen with a nucleic acid within a protein shell and requires invasion of a host for replication May immediately cause disease or may remain relatively dormant for years Causes cellular injury by blocking its genetically prescribed protein synthesis processes and using the cell's metabolic processes for the reproduction of the virus Diseases develop as a result of interference of normal cellular functioning of the host, with destruction of the virus by the immune system also requiring death of the host cell

virus

A client who was treated last month for a severe respiratory infection reports many of the same symptoms today. Which factor in the client's use of antibiotic therapy most likely caused the client's relapse? A. Taking the antibiotic most days B. Taking the antibiotic as prescribed C. Taking the antibiotic before jogging 2 miles daily D. Taking the antibiotic with a full glass of water

A

The nurse is preparing to draw blood from a client receiving a course of vancomycin about 30 minutes before the next scheduled dose. For what laboratory test would the blood specimen be most likely tested? A. Trough drug level B. Blood culture and sensitivity C. White blood cell (WBC) count D. Peak drug level

A

Which cells release histamine in response to an allergen? A. Neutrophils B. CD8 cells C. Basophils D. B lymphocytes

C

Which patient is at greatest risk for contracting a primary bacterial infection? A. A patient receiving broad-spectrum antibiotics B. A patient following laparoscopic cholecystectomy C. A patient whose lab results reveal leukopenia D. A patient with newly diagnosed diabetes mellitus

C

A nurse administers varicella vaccine [Varivax] to a child. The nurse then instructs the parent to avoid giving the child which product for 6 weeks? A. Foods with citric acid (orange juice) B. Acetaminophen [Tylenol] C. Foods fortified with vitamin D D. Acetylsalicylic acid (aspirin)

D

What does the 3rd line of defense consist of?

antibodies, lymphocytes, memory cells

Which characteristic of the immune system produces faster and prolonged symptoms after initial exposure to an antigen? A. Memory B. Diversity C. Time limitation D. Selectivity for antigens of nonself

A

While reviewing a patient's laboratory results, the nurse identifies an increase in eosinophils. The patient most likely has which condition? A. Parasitic worms B. Immune deficiency C. Bacteria invasion D. Hemorrhage

A

In addition to vaccination for all children ages 12 through 23 months, hepatitis A vaccination (HepA) is recommended in which situations? (Select all that apply.) A. When a male patient has sex with men B. When a patient travels to Central America C. When a patient lives in an Alaskan Native village D. When a female patient has cervical cancer E. When a patient has a history of myocardial disease

A, B, C

The nurse is teaching a group of senior citizens about recommended immunizations. What immunizations would the nurse include? (Select all that apply.) A. Herpes zoster vaccine B. Pneumococcal vaccine polyvalent vaccine C. Adult Tdap with Td booster every 10 years D. Annual influenza vaccine E. Pneumococcal 13-valent conjugate vaccine

A, B, C, D, E

The nurse identifies varicella vaccination as contraindicated in which patients? (Select all that apply.) A. A patient who is pregnant B. A 21-year-old patient with an allergy to neomycin C. A 12-year-old patient with an allergy to gelatin D. An 8-year-old patient with asthma E. A 10-year-old patient who receives chemotherapy for the treatment of leukemia

A, B, C, E

The nurse recognizes that handwashing is the best method for preventing infection. Which action(s) by the Centers for Disease Control (CDC) about hand hygiene are recommended? (Select all that apply.) A. If hands are not visibly soiled, use an alcohol-based hand rub. B. Wash hands before and after wearing gloves. C. If hands are visibly soiled, wash them with soap and water. D. Use only soap and water for hand hygiene when planning client contact. E. Wash hands before performing any invasive client procedure.

A, B, C, E

What action describes artificial active immunity?

Antibodies are made after an antigen is injected into the body

The parents of a 6-week-old infant who was born without an immune system ask the nurse why their baby is still so healthy. What is the best response by the nurse?

Antibodies are passively received from the mother through the placenta and breast milk.

Which type of immunity will clients acquire through immunizations with live or killed vaccines?

Artificial active immunity

Before giving the hepatitis B vaccine (HepB), it is most important for the nurse to ask the patient whether he or she is allergic to what? A. Penicillin B. Baker's yeast C. Shellfish D. Peanuts

B

The nurse is caring for a client who has methicillin-resistant staphylococcus aureus (MRSA) infection and is starting oral delafloxacin therapy. What health teaching would the nurse include about this drug? A. "Take the drug every day until you feel you better or until your fever does away." B. "Take the drug at least 2 hours before or 6 hours after any antacids or minerals." C. "Take the drug every other day as prescribed unless you feel nauseated." D. "If you forget a dose of the drug, wait until the next day to take the next dose."

B

Which blood cells produced in the bone marrow participate in providing cellular-mediated and humoral immunity? (Select all that apply.) A. Erythrocytes B. Granulocytes C. T lymphocytes D. B lymphocytes E. Platelets

B, C, D

A 3-year-old child is scheduled to receive pneumococcal vaccine (PCV). Which condition should the nurse recognize as a contraindication to the vaccine in this child? A. Autism B. Premature birth C. Temperature of 103°F D. The child's mother is pregnant

C

A 5-year-old boy with early flu symptoms is at school working with some math blocks. He sneezes into his hand and then continues working with his blocks. An unvaccinated teacher's helper cleans up the blocks when the child leaves them on the table. After touching the blocks, she rubs her nose with her hand. Which represents the most likely mode of transmission? A. The 5-year-old boy B. The unvaccinated teacher's helper C. The unwashed math blocks D. The hand-to-nose contact

C

The nurse is caring for a patient experiencing a hyperimmune response. What role do the cytotoxic T cells play in this type of immune response? A. Can suppress the immune response B. Are the most prevalent type of T lymphocyte C. May kill healthy cells along with foreign antigens D. Diminish dendritic cell function

C

The nurse is working in an immunization clinic. Which patient will the nurse identify as not eligible to receive routine immunizations? A. An 8-year-old experiencing diarrhea B. A 2-year-old with a history of premature birth C. A 4-year-old with a fever and upper respiratory infection D. A 6-year-old who has recently been exposed to a classmate with chickenpox

C

The nurse is reviewing the erythrocyte sedimentation rate (ESR) of a patient. What information does this test provide? A. Indicates a diagnosis of systemic lupus B. Identifies the location of inflammation within the body C. Determines specific causes of inflammation D. Confirms the nonspecific presence of inflammation

D

When evaluating the laboratory results of a patient with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), the nurse identifies a deficiency of what as the most reliable indicator of the status of the patient's immune system? A. Platelets B. B lymphocytes C. Macrophages D. CD4+ T lymphocytes

D

Which substance serves as the stimulus for macrophage activation in delayed-type hypersensitivity (DTH) reactions? A. IgE B. Lymphokine C. Interleukin-1 D. Interferon gamma

D

Which type of personal protective equipment should the nurse wear when caring for a pediatric patient who is placed on Airborne Precautions for confirmed chickenpox/herpes zoster? (Select all that apply.) 1. Disposable gown 2. N95 respirator mask 3. Face shield or goggles 4. Disposable mask 5. Gloves

1, 2, 5

A patient is diagnosed with meningitis. Which type of isolation precaution is most appropriate for this patient? 1. Reverse isolation 2. Droplet Precautions 3. Standard Precautions 4. Contact Precautions

2

The nurse assesses the following data from a patient with diabetes mellitus who is 4 days postoperative for repair of an abdominal aortic aneurysm. Which assessment finding is of greatest concern for the nurse? 1. Vesicular breath sounds in the lung bases 2. Temperature 38.5o C (101.4o F) 3. Incision pain rating of 6 out of 10 4. Blood glucose of 164 mg/dL

2

Which of the following actions by the nurse demonstrate the practice of core principles of surgical asepsis? (Select all that apply.) 1. The front and sides of the sterile gown are considered sterile from the waist up. 2. Keep the sterile field in view at all times. 3. Consider the outer 2.5 cm (1 inch) of the sterile field as contaminated. 4. Only health care personnel within the sterile field must wear personal protective equipment. 5. After cleansing the hands with antiseptic rub, apply clean disposable gloves.

2, 3

A patient is placed on Airborne Precautions for pulmonary tuberculosis. The nurse notes that the patient seems to be angry, but the nurse recognizes that this is a normal response to isolation. Which is the nurse's best intervention? 1. Provide a dark, quiet room to calm the patient. 2. Reduce the level of precautions to keep the patient from becoming angry. 3. Explain the reasons for isolation procedures and provide meaningful stimulation. 4. Limit family and other caregiver visits to reduce the risk of spreading the infection.

3

What should an older client be instructed to do to ensure antibody-mediated immunity? Select all that apply.

Obtain a shingles vaccination Receive a tetanus booster injection Obtain the pneumococcal vaccination Receive an annual influenza vaccination

A school-aged child who has just arrived from Africa has been exposed to diphtheria, and a nurse in the pediatric clinic is to administer the antitoxin. Which type of immunity does the antitoxin confer?

Passive artificial

An 11-year-old boy who has stepped on a rusty nail is given tetanus immune globulin in the emergency department. The nurse knows that the immune globulin injection will confer what type of immunity?

Temporary passive acquired immunity

A client who was exposed to hepatitis A asks why an injection of gamma globulin is needed. Before responding, what should the nurse consider about how gamma globulin provides passive immunity?

The antigen is neutralized by the antibodies that it supplies.

Occurs inside the infected cells and is mediated by T lymphocytes. The pathogen's antigens are expressed on the cell surface or on an antigen-presenting cell. Helper T cells release cytokines that help activated T cells bind to the infected cell's MHC-antigen complex and differentiate the T cell into a cytotoxic T cell. The infected cell then undergoes lysis.

cellular immunity

what is the second line of defense?

inflammation; activated with injury or infectious disease

The nurse instructs the son of an older client about age-related immune system changes and associated care measures. Which statement made by the son during a follow-up visit indicates a need for further instruction?

"My parent comes in for check-ups only whenever he or she has a fever."

Arrange the sequence of steps required to stimulate antibody-mediated immunity in its correct sequence.

-Exposure of antigen -Antigen recognition -Sensitization -Antibody production -Antibody-antigen binding -Antigen elimination

Which nursing actions aid in the prevention and early detection of infection in a client at risk? (Select all that apply.) A. Obtain cultures as needed. B. Remove unnecessary medical devices. C. Monitor the red blood cell (RBC) count. D. Inspect the skin for coolness and pallor. E. Promote sufficient nutritional intake. F. Encourage fluid intake, as appropriate.

A, B, E

Which organs are part of the immune system? (Select all that apply.) A. Adenoids B. Liver C. Appendix D. Bone marrow E. Gallbladder F. Thyroid gland

A, C, D

A patient receives an immunization with an attenuated vaccine. Which response should a nurse expect if the vaccine produces active immunity? A. A mild form of the infectious illness B. Endogenous production of antibodies C. Immediate antibody protection D. A stronger immune system response

B

Antibodies help promote phagocytosis of bacteria by opsonization, which is described as what? A. Activation of complement B. Coating with antibodies C. Neutralization of toxins and viruses D. Binding of antigen to the receptor

B

The nurse identifies which immune system cells as responsible for the production of antibodies required for humoral immunity? A. Macrophages B. B lymphocytes C. Neutrophils D. T lymphocytes

B

The nurse is assessing a young adult client who missed multiple work days this winter due to having pneumonia or other respiratory infection four times. What question would be most appropriate for the nurse to ask as part of the health interview? A. "Have you received your pneumonia vaccines?" B. "Do you have any environmental concerns at work?" C. "Did you have the flu before developing pneumonia?" D. "Do you travel out of the country a lot?"

B

The nurse is caring for an older hospitalized client. Which physiologic age-relatedchange(s) increase(s) the client's risk for infection? (Select all that apply.) A. Increased cough and gag reflexes B. Urinary incontinence C. Decreased intestinal motility D. Decreased immune response E. Thinning skin

C, D, E

What types of medications are used to intentionally suppress the immune system to treat autoimmune disorders?

Corticosteroids Chemotherapeutic agents Irradiation Anti Rejection drugs

A nurse in the acute care setting is caring for a patient who has rubor of an area of injury on the left lower extremity. What is the cause for this finding? A. Exudate B. Neutrophils C. Extravasation D. Vasodilation

D

A patient is on contact isolation for a bacterial infection. Which interventions should the nurse implement for this patient? A. Use personal protective equipment only when knowingly coming into contact with pathogens. B. Prevent all visitors from entering the room at any time during hospitalization. C. Communicate with the patient over the call light whenever possible. D. Help to ensure adequate social interaction and support.

D

Which of the following patients is at higher risk for inflammatory reactions? A. 54-year-old woman in menopause B. 2-year-old girl with a healthy diet C. 38-year-old man who is obese D. 79-year-old man with diabetes

D

slow progression of joint degeneration Should have fewer symptoms during periods of emotional stress Improved range of motion after 3 months of therapy

Disease-modifying antirheumatic drugs DMARDs

also called antibody-mediated immunity. With assistance from helper T cells, B cells will differentiate into plasma B cells that can produce antibodies against a specific antigen. This system deals with antigens from pathogens that are freely circulating, or outside the infected cells. Antibodies produced by the B cells will bind to antigens, neutralizing them, or causing lysis (dissolution or destruction of cells by a lysin) or phagocytosis.

Humoral immunity

Which leukocytes should the nurse include when teaching about antibody-mediated immunity?

Memory Cell B-lymphocyte

drugs of choice for RA

NSAIDs DMARDs Glucocorticoids

Which type of immunity is acquired through the transfer of colostrum from the mother to the child?

Natural passive immunity

A mother is concerned that her newborn will be exposed to communicable diseases after she is discharged. While teaching the mother ways to decrease the risk of infection, what type of immunity should the nurse explain was transferred to her baby through the placenta?

Passive natural

A nurse is discussing immunizations needed to confer active immunity with a pregnant client during her first visit to the prenatal clinic. What information should the nurse consider including to ensure that the client understands the process of active immunity?

Protein substances are formed by the body to destroy or neutralize antigens.

Which are examples of actively acquired specific immunity?

Recovery from measles Recovery from chickenpox Immunization with live or killed vaccines

an autoimmune disease. In this disease, the immune system of the body mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs - more common in women than men

Systemic Lupus Erythematosus (SLE)

What is innate immunity?

What you are born with - it involves barriers that keep harmful materials from entering your body.

Acquired from an exposure to the disease organism through infection with the actual disease. Vaccine-induced immunity is acquired through the introduction of a killed or weakened form of the disease organism through vaccination.

acquired active immunity

B-cell and T-cell are innate/adaptive immunity cells

adaptive

Require a host for a suitable environment for multiplication Cause cellular injury by releasing toxins that are either exotoxins (enzymes released by gram-positive bacteria into the host) or endotoxins (part of the bacterial cell wall of gram-negative bacteria that can cause damage to the host even if the bacteria are dead)

bacteria

2nd generation NSAIDs

celecoxib

In addition to local joint pain and limited range of motion, a nurse should recognize which findings as systemic manifestations of rheumatoid arthritis? (Select all that apply.) a. fatigue b. Hyperglycemia c. Osteoporosis d. Vasculitis e. Corneal ulcers

fatigue, asculitis, corneal ulcers

what are innate defenses?

first line of defence, present at birth, including surface barriers skin and mucous membranes

1st generation NSAIDs

ibuprofen, naproxen

basophil, eosinophil, neutrophil, mast cell, natural killer cells are innate/adaptive immunity cells

innate

The body makes an immune response that can prevent future infection from the microorganism. Occurs when a person receives antibodies to a disease or toxin rather than making them through their own immune system.

passive acquired immunity

What does the second line of defense consists of?

phagocytic leukocytes, antimicrobial proteins, fever, inflammatory response

people with ________ immunodeficiency have an immune system that does not work correctly. This means that they are more likely to get and become severely ill from infections

primary

An acquired immunodeficiency as a result of disease or environmental factors, such as HIV, malnutrition, or medical treatment (e.g. chemotherapy).

secondary immunodeficiency

What does the first line of defense consist of?

skin and mucous membranes

The nurse is caring for a patient with a diagnosis of multiple sclerosis (MS). The nurse should be aware of which associated response? A. Secondary immunodeficiency B. Exaggerated immune response C. Primary immunodeficiency D. Optimal immune response

B

A nurse administers Gardasil, the human papillomavirus (HPV) vaccine, to an 11-year-old girl. The nurse informs the parent that routine screening with which diagnostic test is needed? A. Beta hCG B. Chlamydia test C. Pap test D. Mammogram

C

The nurse is teaching a patient with rheumatoid arthritis who is scheduled to start a treatment regimen that includes nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and glucocorticoids. Which statement by the nurse is correct? a. "It will take at least 3 to 5 months for the DMARD to produce effects." b. "In large doses, the NSAIDs will stop most of the disease process." c. "Remission is achieved quickly, and usually the medications can be stopped." d. "The glucocorticoid will need to be taken for at least 2 years."

"It will take at least 3 to 5 months for the DMARD to produce effects. The treatment for rheumatoid arthritis includes NSAIDs, glucocorticoids, and DMARDs; it is chronic because of the progressive nature of rheumatoid arthritis. A DMARD is started very soon after diagnosis to delay joint destruction. However, effects from the DMARD take months to develop. An NSAID provides quick pain relief but does not prevent joint damage; it is given until the DMARD has had time to take effect. Glucocorticoids are reserved for short-term disease management, not long-term control.

A patient is diagnosed with a multidrug-resistant organism (MDRO) in his surgical wound and asks the nurse what this means. What is the nurse's best response? (Select all that apply.) 1. There is more than one organism in the wound that is causing the infection. 2. The antibiotics the patient has received are not strong enough to kill the organism. 3. The patient will need more than one type of antibiotic to kill the organism. 4. The organism has developed a resistance to one or more broad-spectrum antibiotics, indicating that the organism will be hard to treat effectively. 5. There are no longer any antibiotic options available to treat the patient's infection.

2, 4

When the immune system fails to provide immunity by discerning self from nonself, which autoimmune condition can develop? (Select all that apply.) A. Ulcerative colitis B. Graves' disease C. Heart failure D. Gouty arthritis E. Psoriasis

A, B, E

A nurse explains to the parents of a 4-year-old child with chickenpox that immunity by antibody formation during the course of the illness provides what?

Active natural immunity