Immunology Nclex Questions (Chp 13, 14, 15)

When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? a) "I will need to isolate any tissues I use so as not to infect my family." b) "I will notify all of my sexual partners so they can get tested for HIV." c) "Unprotected sexual contact is the most common mode of transmission." d) "I do not need to worry about spreading this virus to others by sweating at the gym."

a) "I will need to isolate any tissues I use so as not to infect my family." HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.

The mother does not want her child to have any extra immunizations for diseases that no longer occur. What teaching about immunization should the nurse provide this mother? a) There is currently no need for those older vaccines. b) There is a reemergence of some of the infections, such as pertussis. c) There is no longer an immunization available for some of those diseases. d) The only way to protect your child is to have the federally required vaccines.

b) There is a reemergence of some of the infections, such as pertussis. Teaching the mother that some of the diseases are reemerging and the damage they can do to her child gives the mother the information to make an informed decision. The immunizations still exist and do protect individuals.

A 25-year-old male patient has been diagnosed with HIV. The patient does not want to take more than one antiretroviral drug. What reasons can the nurse tell the patient about for taking more than one drug? a) Together they will cure HIV. b) Viral replication will be inhibited. c) They will decrease CD4+ T cell counts. d) It will prevent interaction with other drugs.

b) Viral replication will be inhibited. The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance that is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.

The couple is adopting a baby girl. What health information related to the baby's biologic parents will be most useful to the parents and the baby as she grows up? a) The grandmother had breast cancer. b) The family has a history of Alzheimer's disease. c) The family has an individual with Down syndrome. d) The family has familial adenomatous polyposis (FAP).

d) The family has familial adenomatous polyposis (FAP). Because familial adenomatous polyposis occurs in those with the gene, being able to screen, monitor, and treat this baby will save her life in the long run. Breast cancer may or may not occur if the BRCA 1 or 2 are mutated. Many people who are positive for Apo E-4 do not develop Alzheimer's disease. Down syndrome results from a chromosomal alteration and not a mutated gene.

On initial assessment of an older patient, the nurse knows to look for certain types of diseases because which immunologic response increases with age? A. Autoimmune response B. Cell-mediated immunity C. Hypersensitivity response D. Humoral immune response

A. Autoimmune response With aging, autoantibodies increase, which lead to autoimmune diseases (e.g., systemic lupus erythematosus, acute glomerulonephritis, rheumatoid arthritis, hypothyroidism). Cell-mediated immunity decreases with decreased thymic output of T cells and decreased activation of both T and B cells. There is a decreased or absent delayed hypersensitivity reaction. Immunoglobulin levels decrease and lead to a suppressed humoral immune response in older adults.

When caring for a patient with a known latex allergy, the nurse would monitor the patient closely for a cross-sensitivity to which foods (select all that apply)? A. Grapes B. Oranges C. Bananas D. Potatoes E. Tomatoes

A. Grapes C. Bananas D. Potatoes E. Tomatoes Because some proteins in rubber are similar to food proteins, some foods may cause an allergic reaction in people who are allergic to latex. The most common of these foods are bananas, avocados, chestnuts, kiwi fruit, tomatoes, water chestnuts, guava, hazelnuts, potatoes, peaches, grapes, and apricots.

A 34-year-old female patient who has systemic lupus erythematosus is receiving plasmapheresis to treat an acute attack. What symptoms will the nurse monitor to determine if the patient develops complications related to the procedure? A. Hypotension, paresthesias, and dizziness B. Polyuria, decreased reflexes, and lethargy C. Intense thirst, flushed skin, and weight gain D. Abdominal cramping, diarrhea, and leg weakness

A. Hypotension, paresthesias, and dizziness Common complications associated with plasmapheresis are hypotension and citrate toxicity. Citrate is used as an anticoagulant and may cause hypocalcemia, which may manifest as headache, paresthesias, and dizziness. Polyuria, decreased reflexes, and lethargy are symptoms of hypercalcemia. Abdominal cramping, diarrhea, and leg weakness indicate hyperkalemia. Intense thirst, flushed skin, and weight gain indicate hypernatremia with normal or increased extracellular fluid volume.

A healthy 65-year-old man who lives at home is at the clinic requesting a "flu shot." When assessing the patient, what other vaccinations should the nurse ask the patient about receiving (select all that apply)? A. Shingles B. Pneumonia C. Meningococcal D. Haemophilus influenzae type b (Hib) E. Measles, mumps, and rubella (MMR)

A. Shingles B. Pneumonia The patient should receive the shingles (heres zoster) vaccine, Pneumovax, and influenza. The other options do not apply to this patient. Meningococcal vaccination is recommended for adults at risk (e.g., adults with anatomic or functional asplenia or persistent complement component deficiencies). Adults born before 1957 are generally considered immune to measles and mumps. Haemophilus influenzae type b (Hib) vaccination is only considered for adults with selected conditions (e.g., sickle cell disease, leukemia, HIV infection or for those who have anatomic or functional asplenia) if they have not been previously vaccinated.

A 62-year-old patient has acquired immunodeficiency syndrome (AIDS), and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study result? A. The patient has the virus present and can transmit the infection to others. B. The patient is not able to transmit the virus to others through sexual contact. C. The patient will be prescribed lower doses of antiretroviral medications for 2 months. D. The syndrome has been cured, and the patient will be able to discontinue all medications.

A. The patient has the virus present and can transmit the infection to others. In human immunodeficiency virus (HIV) infections, viral loads are reported as real numbers of copies/μL or as undetectable. "Undetectable" indicates that the viral load is lower than the test is able to report. "Undetectable" does not mean that the virus has been eliminated from the body or that the individual can no longer transmit HIV to others.

A 58-year-old man who is waiting for a kidney transplant asks the nurse to explain the difference between a negative and positive cross match. Which statement by the nurse would be the most accurate response? A. "A negative cross match means that both the donor and recipient are Rh negative, and the transplant is safe." B. "A negative cross match means that no preformed antibodies are present and the transplant would be safe." C. "A positive cross match means the blood type is the same between donor and recipient, and the transplant is safe." D. "A positive cross match means that both the donor and the recipient have antigens that are similar, and the transplant would be safe."

B. "A negative cross match means that no preformed antibodies are present and the transplant would be safe." A cross match uses serum from the recipient mixed with donor lymphocytes to test for any preformed antibodies to the potential donor organ. A positive cross match indicates that the recipient has cytotoxic antibodies to the donor and is an absolute contraindication to transplantation. A negative cross match indicates that no preformed antibodies are present and it is safe to proceed with transplantation.

Which statement made by the nurse is most appropriate in teaching patient interventions to minimize the effects of seasonal allergic rhinitis? A. "You will need to get rid of your pets." B. "You should sleep in an air-conditioned room." C. "You would do best to stay indoors during the winter months." D. "You will need to dust your house with a dry feather duster twice a week."

B. "You should sleep in an air-conditioned room." Seasonal allergic rhinitis is most commonly caused by pollens from trees, weeds, and grasses. Airborne allergies can be controlled by sleeping in an air-conditioned room, daily damp dusting, covering the mattress and pillows with hypoallergenic covers, and wearing a mask outdoors.

The nurse is teaching a group of young adults who live in a dormitory about the prevention of antibiotic-resistant infections. What should be included in the teaching plan? A. Save leftover antibiotics for future uses. B. Hand washing can prevent many infections. C. Antibiotics are indicated for preventing most colds. D. Stop taking prescribed antibiotics when symptoms improve.

B. Hand washing can prevent many infections. Hand washing is the single most important action to prevent infections. Antibiotics are used to treat bacterial infections, not viral colds and flu. Patients should complete the entire prescription of antibiotics to prevent the development of resistant bacteria. Antibiotics should not be taken to prevent infections unless they are given prophylactically before undergoing certain surgeries and dental work.

A patient's low hemoglobin and hematocrit have necessitated a transfusion of packed red blood cells (RBCs). Shortly after the first unit of RBCs starts to infuse, the patient develops signs and symptoms of a transfusion reaction. Which type of hypersensitivity reaction has the patient experienced? A. Type I B. Type II C. Type III D. Type IV

B. Type II Transfusion reactions are characterized as a type II (cytotoxic) reaction in which agglutination and cytolysis occur. Type I hypersensitivity reactions are IgE-mediated reactions to specific allergens (e.g., exogenous pollen, food, drugs, or dust). Type III reactions are immune-complex reactions that occur secondary to antigen-antibody complexes. Type IV reactions are delayed cell-mediated immune response reactions.

The nurse is monitoring the effectiveness of antiretroviral therapy (ART) for a 56-year-old man with acquired immunodeficiency syndrome (AIDS). What laboratory study result indicates the medications have been effective? A. Increased viral load B. Decreased neutrophil count C. Increased CD4+ T cell count D. Decreased white blood cell count

C. Increased CD4+ T cell count Antiretroviral therapy is effective if there are decreased viral loads and increased CD4+ T cell counts.

The patient with an autoimmune disease will be treated with plasmapheresis. What should the nurse teach the patient about this treatment? A. It will gather platelets for use later when needed. B. It will cause anemia because it removes whole blood and RBCs are damaged. C. It will remove the IgG autoantibodies and antigen complexes from the plasma. D. It will remove the peripheral stem cells in order to cure the autoimmune disease.

C. It will remove the IgG autoantibodies and antigen complexes from the plasma. Plasmapheresis removes plasma that contains autoantibodies (usually IgG class) and antigen-antibody complexes to remove the pathologic substances in the plasma without causing anemia. Plateletpheresis removes platelets from normal individuals for use by patients with low platelet counts. Apheresis is used to collect stem cells from peripheral blood that does not cure autoimmune disease.

A 21-year-old student had taken amoxicillin once as a child for an ear infection. She is given an injection of Penicillin V and develops a systemic anaphylactic reaction. What manifestations would be seen first? A. Dyspnea B. Dilated pupils C. Itching and edema D. Wheal-and-flare reaction

C. Itching and edema A systemic anaphylactic reaction starts with edema and itching at the site of exposure to the antigen. Shock can rapidly develop with rapid, weak pulse; hypotension; dilated pupils; dyspnea, and possible cyanosis. The wheal-and-flare reaction occurs with a localized anaphylactic reaction such as a mosquito bite.

A patient has begun immunotherapy for the treatment of intractable environmental allergies. When administering the patient's immunotherapy, what is the nurse's priority action? A. Monitor the patient's fluid balance. B. Assess the patient's need for analgesia. C. Monitor for signs and symptoms of an adverse reaction. D. Assess the patient for changes in level of consciousness.

C. Monitor for signs and symptoms of an adverse reaction. When administering immunotherapy, it is imperative to closely monitor the patient for any signs of an adverse reaction. The high risk and significant consequence of an adverse reaction supersede the need to assess the patient's fluid balance. Pain and changes in level of consciousness are not likely events when administering immunotherapy.

A 19-year-old male being tested for multiple allergies develops localized redness and swelling in reaction to a patch skin test. Which intervention by the nurse would have the highest priority? A. Notify the primary care provider B. Apply a topical anti-inflammatory cream C. Remove the patch and extract from the skin D. Administer oral diphenhydramine (Benadryl)

C. Remove the patch and extract from the skin If a severe reaction to a patch skin test occurs, the nurse should immediately remove the patch and the extract from the skin. Next the nurse should apply a topical anti-inflammatory cream to the site. A subcutaneous injection of epinephrine may also be necessary but would need a health care provider's order

The patient with diabetes mellitus has been ill for some time with a severe lung infection needing corticosteroids and antibiotics. The patient does not feel like eating. The nurse understands that this patient is likely to develop A. major histoincompatibility. B. primary immunodeficiency. C. secondary immunodeficiency. D. acute hypersensitivity reaction.

C. secondary immunodeficiency. Secondary immunodeficiency is most commonly caused by immunosuppressive drugs, such as corticosteroids. It can also be caused by diabetes mellitus, severe infection, malnutrition, and chronic stress, all of which are present in this patient. The other options are not possible for this patient. Histoincompatibility occurs when the human leukocyte antigen (HLA) system of the donor is not compatible with the recipient's HLA genes. Primary immunodeficiency is rare and includes phagocytic defects, B cell deficiency, T cell deficiency, or a combination of B cell and T cell deficiency. Acute hypersensitivity reaction is an anaphylactic-type allergic reaction to an antigen.

The nurse is teaching a 24-year-old female patient who has a latex allergy about preventing and treating allergic reactions. Which statement, if made by the patient, indicates a need for further teaching? A. "My dentist should be told about my latex allergy." B. "I should avoid foods such as bananas, avocados, and kiwi." C. "I will use vinyl gloves for activities such as housekeeping." D. "Because my reactions are not severe, I will not need an EpiPen."

D. "Because my reactions are not severe, I will not need an EpiPen." An individual with latex allergies should carry an injectable epinephrine pen. The proteins in latex are similar to the proteins in certain foods and may cause an allergic reaction in people who are allergic to latex. Foods to avoid include banana, avocado, chestnut, kiwi, tomato, water chestnuts, guava, hazelnuts, potatoes, peaches, grapes, and apricots. Vinyl gloves are not latex and are safe to use. Individuals with latex allergies need to share this information with all health care providers and wear a medical alert bracelet.

Which statement by the patient who has had an organ transplant would indicate that the patient understands the teaching about the immunosuppressive medications? A. "My drug dosages will be lower because the medications enhance each other." B. "Taking more than one medication will put me at risk for developing allergies." C. "I will be more prone to malignancies because I will be taking more than one drug." D. "The lower doses of my medications can prevent rejection and minimize the side effects."

D. "The lower doses of my medications can prevent rejection and minimize the side effects." Because immunosuppressants work at different phases of the immune response, lower doses of each drug can be used to produce effective immunosuppression while minimizing side effects. The use of several medications is not because they enhance each other and does not increase the risk of allergies or of malignancies

Which patient is at highest risk for developing graft-versus-host disease? A. A 65-year-old man who received an autologous blood transfusion B. A 40-year-old man who received a kidney transplant from a living donor C. A 65-year-old woman who received a pancreas and kidney from a deceased donor D. A 40-year-old woman who received a bone marrow transplant from a close relative

D. A 40-year-old woman who received a bone marrow transplant from a close relative Graft-versus-host disease occurs when an immunoincompetent patient is transfused or transplanted with immunocompetent cells. Examples include blood transfusions or the transplantation of bone marrow, fetal thymus, or fetal liver. An autologous blood transfusion is the collection and reinfusion of the individual's own blood or blood components. There is no risk for graft-versus-host disease in this situation.

Ten days after receiving a bone marrow transplant, a patient develops a skin rash on his palms and soles, jaundice, and diarrhea. What is the most likely etiology of these clinical manifestations? A. The patient is experiencing a type I allergic reaction. B. An atopic reaction is causing the patient's symptoms. C. The patient is experiencing rejection of the bone marrow. D. Cells in the transplanted bone marrow are attacking the host tissue.

D. Cells in the transplanted bone marrow are attacking the host tissue. The patient's symptoms are characteristic of graft-versus-host-disease (GVHD) in which transplanted cells mount an immune response to the host's tissue. GVHD is not a type I allergic response or an atopic reaction, and it differs from transplant rejection in that the graft rejects the host rather than the host rejecting the graft.

A 52-year-old female patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? A. Cough, diarrhea, headaches, blurred vision, muscle fatigue B. Night sweats, fatigue, fever, and persistent generalized lymphadenopathy C. Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpes D. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

D. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure. Early chronic HIV infection clinical manifestations are either asymptomatic or include fatigue, headache, low-grade fever, night sweats, and persistent generalized lympadenopathy. Intermediate chronic HIV infection clinical manifestations include candidal infections, shingles, oral or genital herpes, bacterial infections, Kaposi sarcoma, or oral hairy leukoplakia. Late chronic HIV infection or acquired immunodeficiency syndrome (AIDS) includes opportunistic diseases (infections and cancer).

The patient with an allergy to bee stings was just stung by a bee. After administering oxygen, removing the stinger, and administering epinephrine, the nurse notices the patient is hypotensive. What should be the nurse's first action? A. Administer IV diphenhydramine (Benadryl). B. Administer nitroprusside as soon as possible. C. Anticipate tracheostomy with laryngeal edema. D. Place the patient recumbent and elevate the legs.

D. Place the patient recumbent and elevate the legs. In this emergency situation, the ABCs (airway, breathing, circulation) are being followed. For hypotension the patient should be placed in a recumbent position with the legs elevated, epinephrine will continue to be administered every 2-5 minutes, and fluids will be administered with vasopressors. Diphenhydramine is an antihistamine used to treat allergy symptoms. Anticipating a tracheostomy may occur with ongoing patient monitoring. Nitroprusside is a vasodilator and would not be used now.

The nurse is providing postoperative care for a 30-year-old female patient after an appendectomy. The patient has tested positive for human immunodeficiency virus (HIV). What type of precautions should the nurse observe to prevent the transmission of this disease? A. Droplet precautions B. Contact precautions C. Airborne precautions D. Standard precautions

D. Standard precautions Standard precautions are indicated for prevention of transmission of HIV to the health care worker. HIV is not transmitted by casual contact or respiratory droplets. HIV may be transmitted through sexual intercourse with an infected partner, exposure to HIV-infected blood or blood products, and perinatal transmission during pregnancy, at delivery, or though breastfeeding.

The nurse reminds the staff that standard precautions should be used when providing care for which type of patient? a) All patients regardless of diagnosis b) Pediatric and gerontologic patients c) Patients who are immunocompromised d) Patients with a history of infectious diseases

a) All patients regardless of diagnosis Standard precautions are designed for all care of all patients in hospitals and health care facilities.

The HIV-infected patient is taught health promotion activities including good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale behind these interventions that the nurse knows? a) Delaying disease progression b) Preventing disease transmission c) Helping to cure the HIV infection d) Enabling an increase in self-care activities

a) Delaying disease progression These health promotion activities along with mental health counseling, support groups, and a therapeutic relationship with health care providers will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities.

A patient with a father with polycystic kidney disease does not want to have genetic testing done for polycystic kidney disease because she is worried that she might lose her health insurance if genetic abnormalities are found. Based on the nurse's knowledge of the Genetic Information Nondiscrimination Act (GINA), what should the nurse teach this patient? a) GINA should protect her from this happening. b) GINA does not extend to cover preexisting conditions. c) GINA will only protect her after she is diagnosed with polycystic kidney disease. d) GINA health coverage nondiscrimination protection also extends to life insurance.

a) GINA should protect her from this happening. The Genetic Information Nondiscrimination Act (GINA) prohibits discrimination in health care coverage and employment based on genetic information, but does not extend to life insurance, disability insurance, or long-term care insurance.

The couple is delivering their first child. What newborn genetic screening should the nurse teach them about (select all that apply)? a) Pheylketonuria b) Dienoyl-CoA reductase c) Polycystic kidney disease d) Congenital hypothyroidism e) Hereditary nonpolyposis colorectal cancer syndrome

a) Pheylketonuria d) Congenital hypothyroidism Newborn genetic screening for phenylketonuria (PKU) and congenital hypothyroidism are universally required by law in the United States. Genetic screening for dienoyl-CoA reductase, a fatty acid disorder, is required in some states. Hereditary nonpolyposis colorectal cancer syndrome and polycystic kidney disease would only be tested for if there was family history and the family requested it.

A patient received a result of "negative" on a test for a specific genetic mutation. Which interpretation by the patient would the nurse reinforce as being accurate? a) The patient is not at high risk for the tested disease. b) The patient is not at high risk for any inherited disorder. c) The patient's relatives are not at risk for any inherited disorder. d) The patient's relatives are not at risk for the specific tested disease.

a) The patient is not at high risk for the tested disease. If a specific genetic test reveals a strongly negative result, the patient probably will not develop that disease. However, that does not eliminate the risk of other inherited disorders. The absence of a specific genetic mutation in the person tested does not eliminate the risk of other genetic diseases.

An 82-year-old woman is brought to her physician by her daughter with complaints of some confusion. What testing should the nurse suggest for this patient? a) Urinalysis b) Sputum culture c) Red blood cell count d) White blood cell count

a) Urinalysis The developments of urinary tract infections commonly contribute to atypical manifestations such as cognitive and behavior changes in older adults. Sputum culture, red blood cell count, and white blood cell count may be done, but the first step would be to assess for a possible urinary tract infection.

What should the nurse teach the patients in the assisted living facility to decrease their risk for antibiotic-resistant infection (select all that apply)? a) Wash hands frequently. b) Take antibiotics as prescribed. c) Take the antibiotic until it is gone. d) Take antibiotics to prevent illnesses like colds. e) Save leftover antibiotics to take if needed later.

a) Wash hands frequently. b) Take antibiotics as prescribed. c) Take the antibiotic until it is gone. To decrease the risk for antibiotic-resistant infections, people should wash their hands frequently, follow the directions when taking the antibiotics, finish the antibiotic, do not request antibiotics for colds or flu, do not save leftover antibiotics, or take antibiotics to prevent an illness without them being prescribed by a health care provider

For which individual is genetic carrier screening indicated? a) A patient with a history of type 1 diabetes b) A patient with a family history of sickle cell disease c) A patient whose mother and sister died of breast cancer d) A patient who has a long-standing history of iron-deficiency anemia

b) A patient with a family history of sickle cell disease Genetic carrier screening should be done in families with a history of sickle cell disease. Iron deficiency is not related to genetic status. Although there is a multifactorial genetic basis for diabetes (based on research), there are no genetic markers for testing for the presence of or risk of diabetes. A significant family history of breast cancer may suggest that presymptomatic testing for BRCA 1 and 2 may be indicated.

The patient is admitted to the ED with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing measures will help identify the need for further assessment of the cause of this patient's manifestations (select all that apply)? a) Assessment of lung sounds b) Assessment of sexual behavior c) Assessment of living conditions d) Assessment of drug and syringe use e) Assessment of exposure to an ill person

b) Assessment of sexual behavior d) Assessment of drug and syringe use With these symptoms, assessing this patient's sexual behavior and possible exposure to shared drug equipment will identify if further assessment for the HIV virus should be made or the manifestations are from some other illness (e.g., lung sounds and living conditions may indicate further testing for TB).

The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? a) Presence of HIV antibodies b) CD4+ T cell count below 200/µL c) Presence of oral hairy leukoplakia d) White blood cell count below 5000/µL

b) CD4+ T cell count below 200/µL Diagnostic criteria for AIDS include a CD4+ T cell count below 200/µL and/or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The other options may be found in patients with HIV disease but do not define the advancement of HIV infection to AIDS.

The patient has vancomycin-resistant enterococci (VRE) infection in a surgical wound. What infection precautions should the nurse use to best prevent transmission of the infection to the nurse, other patients, staff, and those outside the hospital? a) Droplet precautions b) Contact precautions c) Airborne precautions d) Standard precautions

b) Contact precautions Contact precautions are used to minimize the spread of pathogens that are acquired from direct or indirect contact. Droplet precautions are used with pathogens that are spread through the air at close contact and that affect the respiratory system or mucous membranes (e.g., influenza, pertussis). Airborne precautions are used if the organism can cause infection over long distances when suspended in the air (e.g., TB, rubeola). Standard precautions are used with all patients and included in the transmission-based precautions above.

A 45-year-old woman asks the nurse, "If my sister has the mutated BRCA gene, what does it mean for me?" What information should the nurse consider for an accurate response to this question? a) Only an identical twin would be at risk for breast cancer. b) Family members are at high risk of developing breast cancer. c) The patient already has breast cancer but does not know it yet. d) Family members will not have any treatment options for breast cancer.

b) Family members are at high risk of developing breast cancer. Inheriting a mutated BRCA1 or BRCA2 gene confers significant risk of developing breast cancer. In addition, it significantly increases family members' risk of developing the disease. Having the BRCA gene does not mean that breast cancer is already present or that a future cancer could not be treated.

A hospital has seen a recent increase in the incidence of hospital care-associated infections (HAIs). Which measure should be prioritized in the response to this trend? a) Use of gloves during patient contact b) Frequent and thorough hand washing c) Prophylactic, broad-spectrum antibiotics d) Fitting and appropriate use of N95 masks

b) Frequent and thorough hand washing Hand washing remains the mainstay of the prevention of HAIs. Gloves, masks, and antibiotics may be appropriate in specific circumstances, but none of these replaces the central role of vigilant, thorough hand washing between patients and when moving from one task to another, even with the same patient.

Two sons of a father who has Huntington's disease cannot agree on whether or not to be tested for Huntington's disease because of the cost. What assistance should the nurse give when discussing presymptomatic genetic testing with these men? a) "If one brother has the disease, the other brother will as well." b) "A positive genetic mutation increases your risk of the disease." c) "If there is a positive result, the patient will be diagnosed with the disease." d) "You could use a direct-to-consumer genetic test for making future life decisions."

c) "If there is a positive result, the patient will be diagnosed with the disease." With the autosomal dominant Huntington's disease, if the result is positive, the patient will develop the disease manifestations and can plan accordingly for his future. There is a 50% chance for each brother to be affected. Direct-to-consumer genetic testing should not be recommended because results may be misleading, are expensive, and may not be associated with genetic counseling which would be beneficial for these brothers. There is also currently no regulation of the use of the genetic information that these companies obtain.

A pregnant woman who was tested and diagnosed with HIV infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? a) "The baby will probably be infected with HIV." b) "Only an abortion will keep your baby from having HIV." c) "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." d) "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."

c) "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism as well as host immune status are variables related to transmission via blood, semen, vaginal secretions, or breast milk.

Which patient is most likely to have a multifactorial genetic disorder? a) A 20-year-old woman with cystic fibrosis b) A 50-year-old man with sickle cell disease c) A 40-year-old man with coronary artery disease d) A 30-year-old woman with polycystic kidney disease

c) A 40-year-old man with coronary artery disease Coronary artery disease may be caused by a combination of genetic factors and health behaviors. Cystic fibrosis, sickle cell disease, and polycystic kidney disease are examples of single gene disorders, which are relatively rare.

The nurse is providing care for a patient who has been living with HIV for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? a) A new onset of polycythemia b) Presence of mononucleosis-like symptoms c) A sharp decrease in the patient's CD4+ count d) A sudden increase in the patient's WBC count

c) A sharp decrease in the patient's CD4+ count A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.

The nurse was accidently stuck with a needle used on an HIV-positive patient. After reporting this, what care should this nurse first receive? b) Personal protective equipment c) Combination antiretroviral therapy d) Counseling to report blood exposures e) A negative evaluation by the manager

c) Combination antiretroviral therapy Postexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection. Personal protective equipment should be available although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed but would not occur first.

A 22-year-old man who smokes 2 packs of cigarettes per day tells the nurse, "It does not matter what I do because every man in my family dies before age 50 of a heart attack." What information should the nurse provide? a) If there is a family history of heart disease, tobacco smoking adds nothing to the level of risk. b) Gene therapy can decrease the risk of future heart disease for the patient and his other relatives. c) Heart disease usually results from a combination of factors, including behaviors that can be changed. d) There is no point in being screened for heart disease if you already have a strong family history of the disease.

c) Heart disease usually results from a combination of factors, including behaviors that can be changed. People with a family history of disease may have the most to gain from lifestyle changes and screening tests. People cannot change their genes, but they can change unhealthy behaviors (e.g., smoking, poor eating habits) and have screening tests to detect risk factors (e.g., elevated cholesterol, hypertension) that can be treated.

A 5-year-old girl was diagnosed with type 1 diabetes mellitus. The mother says that no one else in her family has had diabetes and asks why her daughter would get it. How should the nurse explain this complex disease? a) It is a congenital disorder that she was born with. b) It is a single gene disorder, meaning only one gene mutation caused the disease. c) It is a multifactorial genetic disorder caused by one or more genes and environmental factors. d) It was an acquired genetic mutation, meaning she developed it, but her children will not have it.

c) It is a multifactorial genetic disorder caused by one or more genes and environmental factors. Type 1 diabetes mellitus is a multifactorial genetic disorder related to one or more gene mutations and potentially various environmental factors that alter the way the gene(s) work. Type 1 diabetes is not a single gene disorder nor an acquired genetic mutation.

The parents of a child diagnosed with cystic fibrosis ask the nurse what happened to cause this disease. What is the best response by the nurse? a) It is X-linked so it was passed to the child from the mother. b) It is a chromosome disorder that usually skips a generation. c) It is autosomal recessive so both copies of the gene are abnormal. d) It is autosomal dominant so the abnormal gene allele is expressed instead of the normal allele.

c) It is autosomal recessive so both copies of the gene are abnormal. Cystic fibrosis is an autosomal recessive disorder, which means both of the genes in the pair on the chromosome are abnormal. Cystic fibrosis is not X-linked, from a chromosome disorder, or autosomal dominant.

The woman with ovarian cancer would like to know which kind of genetic testing could help prevent her daughters from getting ovarian cancer. What should the nurse tell this patient? a) Forensic testing b) Carrier screening c) Predictive testing d) Prenatal diagnostic testing

c) Predictive testing Predictive genetic testing can be done to find mutated BRCA1 or BRCA2 genes. People who have these genetic mutations can elect to have a prophylactic oophorectomy to prevent the development of the cancer. Diagnostic testing can also identify genetic conditions. Forensic testing is done to identify an individual for legal purposes. Carrier screening identifies an unaffected individual who carries one copy of a specific gene and could pass it to next generations. Prenatal diagnostic genetic testing is done to detect changes in genes or chromosomes of a fetus before birth.

The patient has late stage non-small cell lung cancer. The physician is considering using crizotinib (Xalkori) for this patient. What should be done before it is prescribed for the patient? a) Give chemotherapy first. b) Test for hypersensitivity to this drug. c) Test for the abnormal anaplastic lymphoma kinase (ALK) gene. d) Test for gene abnormalities that will affect the appropriate dose.

c) Test for the abnormal anaplastic lymphoma kinase (ALK) gene. Pharmacogenetics shows that an abnormal ALK gene in the patient with late-stage non-small cell lung cancers causes the cancer to develop and grow. Crizotinib (Xalkori) works by blocking certain proteins called kinases, including the protein produced by the abnormal ALK gene. This drug interacts with many other drugs, so the patient's medications should be reviewed as well.

The woman is afraid she may get HIV from her bisexual husband. What should the nurse include when teaching her about preexposure prophylaxis (select all that apply)? a) Take fluconazole (Diflucan). b) Take amphotericin B (Fungizone). c) Use condoms for risk-reducing sexual relations. d) Take emtricitabine and tenofovir (Truvada) regularly. e) Have regular HIV testing for herself and her husband.

c) Use condoms for risk-reducing sexual relations. d) Take emtricitabine and tenofovir (Truvada) regularly. e) Have regular HIV testing for herself and her husband. Using male or female condoms, having monthly HIV testing for the patient and her husband, and the woman taking emtricitabine and tenofovir regularly has shown to decrease the infection of heterosexual women having sex with a partner who participates in high-risk behavior. Fluconazole and amphotericin B are taken for Candida albicans, Coccidioides immitis, and Cryptococcosus neoformans, which are all opportunistic diseases associate with HIV infection.

A young mother is worried that her female baby will have hemophilia because the baby's father has it. How should the nurse explain this genetic disorder to the young mother? a) Nearly all affected people are male. b) Daughters of affected males will be carriers. c) The daughter has a 50% chance of being affected. d) If the mother is a carrier, the patient could have hemophilia.

d) If the mother is a carrier, the patient could have hemophilia. Because hemophilia is an X-linked recessive genetic disorder, hemophilia results from a mutated gene on an X chromosome. Mothers always contribute an X chromosome to their offspring, whereas fathers contribute X to their female children and Y to their male children. If the mother is a carrier, there is a 25% chance that the daughter could have hemophilia and a 25% chance that she will be a carrier. If the mother is not a carrier, the daughter in this case will have a 50% chance of being a carrier from her father's affected X chromosome.

A nurse is taking a health history from a healthy 30-year-old man. Which information about the patient's family history increases his risk of a genetic-related disease? a) Relatives with unhealthy diet and exercise behaviors b) Disease onset at a later age than is usual in the population c) Family disease incidence similar to the general population d) Same disease present in more than one close relative

d) Same disease present in more than one close relative The key features of a family history that may increase a person's risk for genetic-related diseases are disease in more than one close relative, disease that does not usually affect a certain gender (e.g., breast cancer in a male), diseases that occur at an earlier age than expected (myocardial infarction 10 to 20 years before most people have one), and certain combinations of diseases within a family (e.g., breast and ovarian cancer, heart disease, and diabetes). Relatives' later health behavior choices do not affect a person's genetic risk. Reduced incidence or later onset of disease indicates less risk.