immunity prep-u 1533

A 16-year-old girl tells the nurse that her friend has genital warts and asks the nurse how to make sure that she does not get them. Which of the following should the nurse recommend? A. "Get the human papillomavirus vaccine." B. "Have the Norplant system implanted in your arm." C. "Douching will help to prevent them." D. "If your male partner doesn't have genital warts, you will not get them."

A. "Get the human papillomavirus vaccine." Human papillomavirus (HPV) is a DNA virus also called genital warts and is a sexually transmitted infection (STI). A vaccine is now available to prevent this disease. Male partners with HPV may or may not have lesions. Women should avoid douching to prevent STIs, as they remove normal protective bacteria in the vagina and increases the risk of getting some STIs. The Norplant system is a contraceptive method and does not prevent STIs.

A mother tells the nurse that she is newly pregnant and asks about her 15-month-old's need for the chicken pox immunization because her two older children did "fine" when they had the disease. What is the nurse's best response? A. "When your child avoids chicken pox, it protects other children from being exposed to the disease. Some cannot be immunized because of their health conditions." B. "I realize that the vaccine is somewhat costly, but it is likely to be more economical than dealing with chicken pox." C. "Your toddler should not receive this live-virus immunization today. It may present a risk to your pregnancy." D. "When chicken pox can be avoided, why not do so?"

A. "When your child avoids chicken pox, it protects other children from being exposed to the disease. Some cannot be immunized because of their health conditions." The best response explains the impact that chicken pox can have on vulnerable individuals. High immunization levels mean low levels of disease. This reduces exposure for those who are unimmunized and susceptible. The live-virus vaccine given to the toddler does not present risk to the pregnant mother or fetus. Varicella vaccine is not inexpensive. Avenues for providing immunizations to families who cannot afford them are available. The "why not" response is somewhat dismissive and does not address the mother's question.

The nurse is working with a parent whose child has just been diagnosed with selective immunoglobulin A deficiency. The parent asks the nurse, "Does this mean that my child is going to die?" How should the nurse respond? A. "Your child has a mild genetic immune deficiency caused by a lack of immunoglobulin A, a type of antibody that protects against infections of the lining the mouth and digestive tract." B. "Your child may die without proper medication and treatment." C. "Selective immunoglobulin A deficiency is the term used to describe the early stages of AIDS." D. "If left untreated, selective immunoglobulin A deficiency can cause uncontrolled muscle movements with progressive neurologic deterioration."

A. "Your child has a mild genetic immune deficiency caused by a lack of immunoglobulin A, a type of antibody that protects against infections of the lining the mouth and digestive tract." Selective immunoglobulin A deficiency is congenital and characterized by a lack of immunoglobulin A, which predisposes clients to recurrent infections, adverse reactions to blood transfusions or immunoglobulin, autoimmune diseases, and hypothyroidism. There is no current treatment.

A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of? A. Chronic diarrhea B. Nausea and vomiting C. Oral candida D. Anorexia

A. Chronic diarrhea Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of acquired immune deficiency syndrome (AIDS) can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.

The parents of a blended family have a baby boy age six months who is due for immunizations. The clinic closest to their home has recently closed, and they feel intimidated by the prospect of going to the large, university hospital near their home. Which type of factor is the primary influence on this aspect of the family's health? A. Community health care structure B. Economic factors C. Family risk factors D. Lifestyle influences

A. Community health care structure The size, location, and services of health care offerings in a geographical area are components of the community health care structure and its influence on health. Family functioning, lifestyle, and economic considerations are not primary influences on the family's actions.

A 48-year-old man who has been HIV positive for 6 years has just learned that he has been diagnosed with Kaposi sarcoma (KS). Which fact most accurately conveys an aspect of his diagnosis? A. He is likely to have lesions on his skin, mouth, or GI tract. B. Heterosexual contact most likely underlies his HIV and subsequent KS. C. An opportunistic Epstein-Barr virus underlies the man's KS. D. Intense pain was probably his first manifestation of KS

A. He is likely to have lesions on his skin, mouth, or GI tract. The lesions of KS can be found on the skin and in the oral cavity, gastrointestinal tract, and the lungs. More than 50% of people with skin lesions also have gastrointestinal lesions. It is linked with a herpes virus and can often be painless, especially in early stages. Men who have sex with men are at a higher risk of developing KS.

You are the nurse caring for a client with Guillain-Barré syndrome (GBS). The client also has an ascending paralysis. Knowing the complications of the disorder, what should you keep always ready at the bedside? A. Intubation tray and suction apparatus B. Nebulizer and thermometer C. Incentive spirometer D. Blood pressure apparatus

A. Intubation tray and suction apparatus Progressive GBS can move to the upper areas of the body and affect the muscles of respiration. If the respiratory muscles are involved, endotracheal intubation and mechanical ventilation become necessary. A spirometer is used to evaluate the client's ventilation capacity. A blood pressure apparatus, nebulizer, and thermometer are not required because generally a client with GBS does not show signs of increased blood pressure or temperature.

A laboring mother asks the nurse if the baby will have immunity to some illnesses when born. What type of immunity does the nurse understand that the newborn will have? A. Passive immunity transferred by the mother B. Artificially acquired active immunity C. There is no immunity passed down from mother to child. D. Naturally acquired active immunity

A. Passive immunity transferred by the mother Passive immunity develops when ready-made antibodies are given to a susceptible person. The antibodies provide immediate but short-lived protection from the invading antigen. Newborns receive passive immunity to some diseases for which their mothers have manufactured antibodies. Naturally acquired active immunity occurs as a direct result of infection by a specific micro organism. An example is the immunity to measles that develops after the initial infection. Not all invading microorganisms produce a response that gives lifelong immunity. Artificially acquired immunity is obtained by receiving a killed or weakened microorganism or toxoid.

A nurse is providing education to pregnant women diagnosed with HIV. Which statement indicates the need for further teaching? A. Pregnancy will accelerate the progression of the disease. B. It is not safe to breastfeed my baby, so I will use formula. C. Antiretroviral treatment is effective in reducing maternal-fetal transmission. D. My health care provider may want me to have a cesarean birth.

A. Pregnancy will accelerate the progression of the disease. Of the nearly 1,000,000 people in the United States infected with HIV, 25% are female. There isn't any research showing pregnancy accelerates the progression of the disease. Women with HIV should not breastfeed, because they could transmit the virus to the baby via the breastmilk. Early use of antiretroviral medications are effective in reducing transmission, and a cesarean birth may be scheduled to reduce potential transmission to the newborn.

The nurse is providing an education program to reduce the incidence of infection currently on the rise in the community. What areas should the nurse focus on when presenting this program? (Select all that apply.) A. Sanitation techniques B. The use of antibiotics to prevent infections C. Regulated health practices D. Swimming in the community pool E. Immunization programs

A. Sanitation techniques C. Regulated health practices E. Immunization programs Methods of infection prevention include sanitation techniques (e.g., water purification, disposal of sewage and other potentially infectious materials), regulated health practices (e.g., the handling, storage, packaging, and preparation of food by institutions), and immunization programs.

Which statement explains how T lymphocytes and B lymphocytes differ? A. T lymphocytes mature in the thymus gland; B lymphocytes mature in the bone marrow. B. T lymphocytes secrete antibodies; B lymphocytes provide cellular response to antigens. C. T lymphocytes are helpers that assist B lymphocytes to amplify the lysis of antigens. D. T lymphocytes recognize bacteria; B lymphocytes recognize viruses and cancer.

A. T lymphocytes mature in the thymus gland; B lymphocytes mature in the bone marrow. T lymphocytes mature in the thymus gland and provide cell-mediated immunity. T lymphocytes activate other lymphocytes and phagocytes. B lymphocytes mature in the bone marrow and are responsible for forming the antibodies that provide humoral immunity. Both are amplified by cytokines.

A 67-year-old client diagnosed with myasthenia gravis will likely display which clinical manifestations as a result of autoantibodies ultimately blocking the action of acetylcholine, resulting in destruction of the receptors? A. Weakness of the eye muscles, difficulty in swallowing and slurred speech, impaired gait. B. Tremor of hands/arms, rigidity of the arms, shuffling gait. C. Short-term memory lapses, problems with orientation, a lack of drive or initiative. D. Facial droop, slurred speech, weakness on one side of the body.

A. Weakness of the eye muscles, difficulty in swallowing and slurred speech, impaired gait. Myasthenia gravis ultimately results in destruction of receptors in the neuromuscular junction, leading to a decrease in neuromuscular function. Tremor of hands/arms, rigidity of the arms, and shuffling gait are signs/symptoms of Parkinson's disease. Short-term memory lapses, problems with orientation, and a lack of drive or initiative are signs/symptoms of Huntington disease. Facial droop, slurred speech, and weakness on one side of the body are classic signs/symptoms of CVA

Nursing students correctly label the group of cells whose job is to ingest, engulf, and neutralize pathogens as: A. macrophages. B. red blood cells. C. immunogens. D. immunoglobins.

A. macrophages. Macrophages (mature white blood cells) engulf, ingest, and neutralize pathogens. Red blood cells do not fight infection. They carry hemoglobin and carry oxygen from the lungs to the tissues. In the immune response, immunoglobulins are antibodies and immunogens are antigens.

While explaining immunity to a client, the nurse responds, "The body's internal organs are protected from pathogens because: A. our mucosal tissue contains all the necessary cell components to fight a pathogen with an immune response." B. we have special glands that can secrete cytokines on a moment's notice." C. the tonsils store a large amount of natural killer cells at that location." D. the actions of the cytokines in the mouth can act on different cell types at the same time it is fighting pathogens."

A. our mucosal tissue contains all the necessary cell components to fight a pathogen with an immune response." Secondary lymphoid tissues contain all the necessary cell components (i.e., T cells, B cells, macrophages, and dendritic cells) for an immune response. Because of the continuous stimulation of the lymphocytes in these tissues by microorganisms constantly entering the body, large numbers of plasma cells are evident. Immunity at the mucosal layers helps to exclude many pathogens and thus protects the vulnerable internal organs. Although cells of both the innate and adaptive immune systems communicate critical information by cell-to-cell contact, many interactions and effector responses depend on the secretion of short-acting soluble molecules called cytokines. The actions of cytokines are often pleiotropic and redundant. Pleiotropism refers to the ability of a cytokine to act on different cell types.

During a visit with a new family, the nurse assesses one of their children. The nurse asks about current immunization status and how often the child visits the family health care provider. The nurse also asks the child about experiences with activities outside the home. The nurse reviews the importance of safety like wearing helmets. Given this data, what age group of child would one anticipate this nurse is assessing? A. school-age B. adolescent C. toddler D. preschool

A. school-age When working with the family of a school-age child, the nurse should focus the assessment on: promoting children's health through immunizations, dental care, and routine health assessments; promoting child safety related to home and automobiles; encouraging socialization experiences outside the home such as sports participation, music lessons, or hobbies; and encouraging a meaningful school experience to make learning a lifetime concern.

A pregnant patient asks the nurse if it is all right for her take the varicella immunization for entrance into nursing school. What is the best response by the nurse? A. "You will have to delay entrance into the nursing program if they force you to take it." B. "It is not recommended that pregnant women take the live virus. You should wait until after your child is born." C. "If you will be working in the health care field, you must take the immunization." D. "It is not a live virus, so it should be fine."

B. "It is not recommended that pregnant women take the live virus. You should wait until after your child is born." Some live vaccines (e.g., varicella, MMR [against measles, mumps, and rubella], yellow fever) are contraindicated for people who are severely immunosuppressed or pregnant.

A nurse educator is preparing to discuss immunodeficiency disorders with a group of fellow nurses. What would the nurse identify as the most common secondary immunodeficiency disorder? A. CVID B. AIDS C. SCID D. DAF

B. AIDS AIDS, the most common secondary disorder, is perhaps the best-known secondary immunodeficiency disorder. It results from infection with the human immunodeficiency virus (HIV). DAF refers to lysis of erythrocytes due to lack of decay-accelerating factor (DAF) on erythrocytes. CVID is a disorder that encompasses various defects ranging from IgA deficiency (in which only the plasma cells that produce IgA are absent) to severe hypogammaglobulinemia (in which there is a general lack of immunoglobulins in the blood). Severe combined immunodeficiency disease (SCID) is a disorder in which both B and T cells are missing.

A nurse is developing a teaching plan for a community presentation on smoking cessation. Based on current research regarding the effects of cigarette smoking on the immune system, which alterations in immune function can be attributed to smoking and should be included in the teaching presentation? Select all that apply. A. Decreased IgE antibody production B. Decreased natural killer cells C. Decreased T-cell function D. Increased risk of infection E. Increased white blood cell count

B. Decreased natural killer cells C. Decreased T-cell function D. Increased risk of infection E. Increased white blood cell count Smoking causes an increased white blood cell count (indicating inflammation), an elevated T-cell count (with decreased function), decreased antibody production (IgG, IgA, IgM), increased IgE (allergic response), and fewer natural killer cells (increased risk for infection) in the immune system.

A clinical research study is evaluating cells that bridge both the innate and adaptive immune systems. A nurse has identified the dendritic cells (DCs) as a key component. Which statement validates this finding? A. Dendritic cells (DCs) can also act as opsonins and can coat cellular particles on pathogens and enhance the phagocytic function of innate cells. B. Dendritic cells (DCs) directly sense pathogens, capture foreign agents, and transport them to secondary lymphoid tissues. Once activated, they undergo a maturation process and function as antigen-presenting cells (APCs) capable of initiating adaptive immunity. C. Dendritic cells (DCs) spontaneously kill target tumor and/or infected cells without previous exposure to surface antigens. D. Dendritic cells (DCs) destroy the invading organism through the process of phagocytosis.

B. Dendritic cells (DCs) directly sense pathogens, capture foreign agents, and transport them to secondary lymphoid tissues. Once activated, they undergo a maturation process and function as antigen-presenting cells (APCs) capable of initiating adaptive immunity. Dendritic cells (DCs) are specialized, bone marrow-derived leukocytes found in lymphoid tissue and are the bridge between the innate and adaptive immune systems. They are present primarily in an immature form that is available to directly sense pathogens, capture foreign agents, and transport them to secondary lymphoid tissues. Once activated, DCs undergo a complex maturation process in order to function as key antigen-presenting cells (APCs) capable of initiating adaptive immunity. They are responsible for the processing and presentation of foreign antigens to the lymphocytes.

Select the statement that best describes the effectiveness of vaccination in the older adult population. A. Older adults who are immunized have the same effective response in immunity as younger persons do. B. Experimental evidence suggests that vaccination is less successful in inducing immunization in older persons than in younger adults. C. Vaccinations are only effective in older adult populations if their families have been vaccinated. D. Age does not influence the effectiveness; it depends on the amount of medication you receive.

B. Experimental evidence suggests that vaccination is less successful in inducing immunization in older persons than in younger adults. Older adults tend to be more susceptible to infections, have more evidence of autoimmune and immune complex disorders than younger persons, and have a higher incidence of cancer. Experimental evidence suggests that vaccination is less successful in inducing immunization in older persons than in younger adults. However, the effect of altered immune function on the health of older adults is clouded by the fact that age-related changes or disease may affect the immune response.

When explaining to parents what is occurring when their child has an acute bronchial asthma attack, the nurse will emphasize that which mediator is primarily responsible for the bronchial constriction? A. T-lymphocyte proliferation B. Histamine C. Mold dust D. Tree pollen

B. Histamine Asthma response begins within 5 to 30 minutes of exposure to an allergen. It is mediated by mast cell degranulation and the release of preformed and/or enzymatically activated mediators. These mediators include histamine, serotonin, and acetylcholine. Histamine is the most recognized mediator of type I hypersensitivity reactions and ultimately results in bronchial constriction.

A deficiency in what area would result in an inhibition of the inflammatory response? A. Vitamin K B. Histamine C. Helper T cells D. B cells

B. Histamine Histamine is a key mediator in the inflammatory system, unlike helper T cells, B cells, or vitamin K.

What is a characteristic indicator that an individual is in the latent phase of HIV? A. Very high viral loads B. Lack of symptoms C. Mononucleosis-like symptoms D. Manifestations of opportunistic infections

B. Lack of symptoms The three phases experienced are primary infection phase, chronic asymptomatic or latency phase, and overt AIDS phase. Mononucleosis-like symptoms and high viral loads are seen in the primary infection phase, whereas the AIDS phase is characterized with opportunistic infections.

Which disease is thought to be caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction? A. Huntington disease B. Myasthenia gravis C. Guillain-Barré syndrome D. Parkinson syndrome

B. Myasthenia gravis Myasthenia gravis is an autoimmune disease caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction. Guillain-Barré syndrome is an acute immune-mediated polyneuropathy characterized by rapidly progressive, ascending symmetrical limb weakness and loss of tendon reflexes. Parkinson disease is a degenerative disorder of basal ganglia function associated with denervation of the nigrostriatal dopamine neurons. Huntington disease is a hereditary disorder which produces localized death of brain cells.

A client with AIDS is having a recurrence of 10 to 12 loose stools a day. What medication may help this client with controlling the chronic diarrhea? A. Atropine diphenoxylate B. Octreotide C. Bismuth subsalicylate D. Rifaximin

B. Octreotide Although many forms of diarrhea respond to treatment, it is not unusual for this condition to recur and become a chronic problem for the patient with HIV infection. Therapy with octreotide acetate (Sandostatin), a synthetic analogue of somatostatin, has been shown to effectively manage chronic severe diarrhea.

A patient is diagnosed with psoriasis after developing scales on the scalp, elbows, and behind the knees. The patient asks the nurse where this was "caught." What is the best response by the nurse? A. Psoriasis comes from dermal abrasion. B. Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. C. Psoriasis results from excess deposition of subcutaneous fat. D. Psoriasis is an inflammatory dermatosis that results from a superficial infection with Staphylococcus aureus.

B. Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. Current evidence supports an autoimmune basis for psoriasis (Porth & Matfin, 2009). Periods of emotional stress and anxiety aggravate the condition, and trauma, infections, and seasonal and hormonal changes may also serve as triggers. In this disease, the epidermis becomes infiltrated by activated T cells and cytokines, resulting in both vascular engorgement and proliferation of keratinocytes. Epidermal hyperplasia results.

The school nurse is participating in a program to immunize students against human papillomavirus (HPV). What benefit should the nurse describe to students and their families? A. Reduced risk for pelvic inflammatory disease (PID) B. Reduced risk for cervical cancer C. Protection against several viral sexually transmitted infections D. Reduced risk for polycystic ovary syndrome

B. Reduced risk for cervical cancer The HPV vaccine directly reduces the risk of cervical cancer, but not the risk of other sexually transmitted infections, PID, or polycystic ovary syndrome.

The nurse is caring for a client recovering from a major burn. Burns affect the immune system by causing a loss of large amounts of which of the following? A. Plasma, which depletes the body's store of catecholamines B. Serum, which depletes the body's store of immunoglobulins C. Serum, which depletes the body's store of glucagon D. Plasma, which depletes the body's store of calcitonin

B. Serum, which depletes the body's store of immunoglobulins Major burns cause impaired skin integrity and compromise the body's first line of defense. Loss of large amounts of serum occurs with burn injuries and depletes the body of essential proteins, including immunoglobulins. Loss of serum or plasma does not deplete the body of catecholamines (adrenal gland), calcitonin (thyroid gland), or glucagon (pancreas).

A nurse is caring for a client with multiple sclerosis. Client education about the disease process includes which explanation about the cause of the disorder? A. Excess cytokines cause tissue damage. B. The immune system recognizes one's own tissues as "foreign." C. The immune system recognizes one's own tissues as "self." D. Regulatory mechanisms fail to halt the immune response.

B. The immune system recognizes one's own tissues as "foreign." The immune system's recognition of one's own tissues as "foreign" rather than self is the basis of many autoimmune disorders, including multiple sclerosis. When regulatory mechanisms fail to halt the immune response or excess cytokines are produced, pathology occurs (e.g., allergies, hypersensitivity).

A client that is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication does the nurse expect that the client will take for the treatment of this infection? A. Amphotericin B B. Trimethoprim-sulfamethoxazole C. Fluconazole D. Nystatin

B. Trimethoprim-sulfamethoxazole To prevent and treat Pneumocystis pneumonia, trimethoprim-sulfamethoxazole (Bactrim, Septra) is prescribed. The other medications are antifungals and used to treat candidiasis.

When describing the use of vaccines to a local community group, what would the nurse include? A. Vaccines promote the development of antigens. B. Vaccines are used to provide active immunity. C. Vaccines are associated with severe reactions in children. D. Vaccines can result in signs and symptoms of the full-blown disease.

B. Vaccines are used to provide active immunity. Vaccines provide active immunity. They promote the formation of antibodies against a specific disease. The person experiences an immune response without having to suffer the full course of the disease. Severe reactions are rare.

Resistance to a first-line antituberculotic agent in a client who has not received previous treatment is referred to as A. multidrug resistance. B. primary drug resistance. C. tertiary drug resistance. D. secondary drug resistance.

B. primary drug resistance. Primary drug resistance refers to resistance to one of the first-line antituberculotic agents in people who have not received previous treatment. Secondary or acquired drug resistance is resistance to one or more antituberculotic agents in clients undergoing therapy. Multidrug resistance is resistance to two agents, isoniazid (INH) and rifampin. Tertiary drug resistance is not a type of resistance.

A client was diagnosed with human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). The nurse realizes that the client needs further teaching about the disease process based on which statement? A. "HIV is a retrovirus." B. "After infection the HIV virus can exist in a latent state." C. "HIV only infects B cells." D. "The infection requires a host cell."

C. "HIV only infects B cells." The retroviruses such as HIV have a unique mechanism of replication. After entry into the host cell, the viral RNA genome is first translated into DNA by a viral enzyme called reverse transcriptase. The viral DNA copy is then integrated into the host chromosome where it exists in a latent state, similar to the herpes viruses. Reactivation and replication require a reversal of the entire process. Some retroviruses lyse the host cell during the process of replication. In the case of HIV, the infected cells regulate the immunologic defense system of the host, and their lysis leads to a permanent suppression of the immune response.

The nurse is giving an educational talk to a local parent-teacher association. A parent asks how he can help his family avoid community-acquired infections. What would be the nurse's best response to help prevent and control community-acquired infections? A. "Encourage your family to adopt a healthy diet and exercise regimen." B. "Encourage your family to stop smoking." C. "Make sure your family has all their childhood immunizations." D. "Make sure your family has regular checkups."

C. "Make sure your family has all their childhood immunizations." To help prevent and control community-acquired infections, nurses should encourage childhood immunizations. Vaccines stimulate the body to produce antibodies against a specific disease organism. The immunization of children protects children as well as adults who may not have developed sufficient immunity. Following a proper diet and exercise regimen and going for regular checkups are important, but these measures do not help prevent or control community-acquired infections. Smoking cessation does not reduce the risk of such infections either.

The nurse is discussing measles, mumps, and rubella vaccination with a mother who is concerned about using the combined vaccine for her 12-month-old. Which statement by the nurse will be most helpful to the mother in accepting the vaccine? A. "It is one of the most commonly used childhood vaccines." B. "This vaccine is approved by the American Academy of Pediatrics." C. "The vaccine is shown to be effective and safe and will reduce the number of injections your child will need." D. "This vaccine is recommended by the Centers for Disease Control and Prevention."

C. "The vaccine is shown to be effective and safe and will reduce the number of injections your child will need." The mother may not understand that combining the vaccines creates no safety problems or effectiveness issues, and the one shot reduces the number of injections her child must endure. The other statements are true and offer some reassurance as to safety and efficacy but are not as helpful to the parent in understanding how she can protect her child from unnecessary discomfort.

A 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium). In light of this new addition to her drug regimen, what teaching point should the woman's nurse provide? A. "This will likely relieve your muscle spasms but you'll probably develop a certain amount of dependence on the drug over time." B. "There's a small risk that you might experience some hallucinations in the first few days that you begin taking this drug." C. "You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity." D. "We'll need to closely monitor your blood sugar levels for the next week."

C. "You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity." Dantrolene causes weakness because of its generalized reduction of muscle contraction. It is not associated with drug dependence, hyperglycemia, hypoglycemia, or hallucinations.

The administration of immunizations to a client is a form of what type of immunity? A. Attenuated active immunity B. Naturally active immunity C. Artificial active immunity D. Passive active immunity

C. Artificial active immunity Immunizations are a form of artificial active immunity.

The nurse cautions a client with what allergy to avoid the use of bismuth salts in the treatment of diarrhea? A. Nuts B. Penicillin C. Aspirin D. Eggs

C. Aspirin Clients who are allergic to aspirin should not use bismuth salts.

At which point is the treatment (RhoGAM) for the hemolytic disease of the newborn finished? A. Immediately before delivery B. It is no longer needed after the first pregnancy. C. During the postpartum period D. During the prenatal period

C. During the postpartum period The treatment for Rh incompatibility is RhoGAM; it is given to prevent complications during the second pregnancy and is administered in the postpartum period. This prevents antibodies from entering fetal circulation and hemolyzing or destroying the fetus's RBC.

Which term refers to an incomplete antigen? A. Antigen B. Antibody C. Hapten D. Allergen

C. Hapten A hapten is an incomplete antigen. An allergen is a substance that causes manifestations of allergy. An antigen is a substance that induces the production of antibodies. An antibody is a protein substance developed by the body in response to and interacting with a specific antigen.

When preparing a presentation for a group of senior citizens, which vaccine would the nurse recommend that this age group receive annually? A. Meningococcus B. Tuberculosis C. Influenza D. Measles, mumps, and rubella vaccine

C. Influenza All people 65 years of age and older should receive an annual influenza vaccine. Immunosuppressed adults should receive immunization for pneumococcus and meningococcus. Measles, mumps, and rubella vaccine is administered to children at 12 to 15 months old and again at 4 to 6 years old.

An obstetrics nurse is counseling an expectant mother. The mother is concerned about letting people hold her baby once the baby is born, fearing that the infant will get sick. What should the nurse explain to the mother? A. IgA that is present at birth, and which originates with the mother, will protect the baby, B. Abundant lymphoid tissues protect the infant in the first few months of life. C. Maternal immunoglobulins cross the placenta and protect the newborn early in life. D. The innate immune system will protect the baby.

C. Maternal immunoglobulins cross the placenta and protect the newborn early in life. Passive immunity is immunity transferred from another source. An infant receives passive immunity naturally from the transfer of antibodies from its mother in utero and through breast milk. Maternal IgG crosses the placenta and protects the newborn during the first few months of life. Innate immunity are not effective yet, and protection is unrelated to the amount of lymphoid tissue.

The clinic nurse is seeing a female client 18 years of age who needs to renew her asthma prescription. The client tells the nurse that she is going to another province in a few weeks to attend college and will be living in a dorm. The nurse recommends which of the following while the client is being seen in the clinic? A. TB skin test (PPD) B. Hep B series C. Meningococcal vaccine D. Polio booster

C. Meningococcal vaccine College freshmen living in dormitories are at risk for meningococcal disease and require the vaccine for protection from it. A TB skin test is usually done if the client has been exposed to tuberculosis. Polio boosters are not given to this age group. Hep B series should have already been done and the series is not completed in a single visit.

Which type of pneumonia has the highest incidence in clients with AIDS and clients receiving immunosuppressive therapy for cancer? A. Fungal B. Tuberculosis C. Pneumocystis D. Streptococcal

C. Pneumocystis Pneumocystis pneumonia incidence is greatest in clients with AIDS and clients receiving immunosuppressive therapy for cancer, organ transplantation, and other disorders.

A nurse is immunizing children against measles. This is an example of what level of preventive care? A. Chronic B. Tertiary C. Primary D. Secondary

C. Primary Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Immunizations are an example of primary health promotion. Secondary health promotion and illness prevention focus on screening for early detection of disease, with prompt diagnosis and treatment of any found. Tertiary health promotion and illness prevention begin after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate clients to a maximum level of functioning. The term chronic is not related to health promotion.

The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. What would be a priority recommendation in this setting? A. Screening for sexually transmitted infections (STIs) B. Prophylactic treatment for HIV C. Screening for HIV D. Proper nutrition

C. Screening for HIV No screening mandate has been put forth for HIV, but all pregnant women should be encouraged to undergo this test. Prophylactic treatment would be initiated only once the woman has been screened. Screening for STIs and ensuring proper nutrition are also part of health promotion for women in this age group, but they are of lower priority than identifying HIV-positive individuals.

A multidisciplinary oncology team of health care providers, nurses, and the social worker notes that a client who has been undergoing chemotherapy is now experiencing pancytopenia. When reviewing the laboratory data, which values support this diagnosis? Select all that apply. A. increased platelets B. increased RBCs C. decreased RBCs D. decreased white blood cells E. decreased platelets F. increased white blood cells

C. decreased RBCs D. decreased white blood cells E. decreased platelets Pancytopenia is a deficiency of all blood cells that includes a state of simultaneous leukopenia (decreased white blood cells), thrombocytopenia (decreased platelets), and anemia (decreased RBCs). Pancytopenia has widespread effects on the body by leading to oxygen shortage and immune function.

A nurse is teaching a group of nursing students about the presentation of systemic lupus erythematosus (SLE). Which statement is the nurse likely to make? A. "Lupus is more common in white people." B. "Lupus is a disease of older individuals." C. "Drug-induced lupus requires lifelong treatment." D. "More women than men are affected by lupus."

D. "More women than men are affected by lupus." There is a female predominance of 10:1 in those with SLE. This ratio is closer to 30:1 during childbearing years. SLE is more common in blacks, Hispanics, and Asians than in whites, and the incidence in some families is higher than in others.

A client is administered mycophenolate to prevent rejection of the transplanted heart. It is recommended that the client have a CBC drawn weekly. The client asks the nurse the reason for the weekly CBC. What is the nurse's best response? A. "The weekly CBC is routine and prescribed for all clients." B. "The weekly CBC assesses for changes in your blood's oxygen-carrying capacity." C. "The weekly CBC assesses for the development of bleeding." D. "The weekly CBC assesses for the development of infection."

D. "The weekly CBC assesses for the development of infection." The weekly CBC is to assess for infection, neutropenia, and thrombocytopenia. Stating to the client that the CBC is routine is a belittling response that does not provide client education. The weekly CBC is not indicated to assess for bleeding or a decrease in erythrocytes.

The nurse is instructing clients about the importance of taking the shingles vaccine. Which client would benefit from this vaccine? A. A 17-year-old client who will be attending college and living in a dormitory B. A 32-year-old client who has never had chickenpox C. A 24-year-old client who is pregnant D. A 65-year-old client who had chicken pox when he was 12 years old

D. A 65-year-old client who had chicken pox when he was 12 years old Half of individuals living to age 65 years have had or will develop shingles and may not understand the potential seriousness and risk for complications. Nurses as client advocates should determine and provide health information regarding the shingles vaccine. The other clients are not candidates for the vaccine

The nurse is caring for a client who has a low level of T lymphocytes. The nurse plans care for a client with: A. Decreased hematocrit B. Infection C. Anemia D. Decreased immune response

D. Decreased immune response T lymphocytes differentiate to form CD4+ helper T cells, which serve to orchestrate the immune response. A client with low levels of T lymphocytes will have decreased immune response, which the nurse should consider when planning the client's care.

The nurse is caring for a child who is receiving an intravenous immunoglobulin treatment. The client calls the nurse and reports she vomited. What action should be completed first? A. Check the physician's orders for an antiemetic. B. Take the client's vital signs. C. Contact the physician. D. Discontinue the infusion.

D. Discontinue the infusion. Clients receiving intravenous immunoglobulin are at risk for anaphylaxis. Vomiting can signal an allergic response. The first action would be to stop the infusion. The remaining activities are appropriate for inclusion in the plan of care but are not of the highest priority.

A client with human immunodeficiency virus (HIV) comes to the clinic and is experiencing white patches on the lateral border of the tongue. What type of lesions does the nurse document? A. Aphthous stomatitis B. Erythroplakia C. Nicotine stomatitis D. Hairy leukoplakia

D. Hairy leukoplakia Hairy leukoplakia is a condition often seen in people who are HIV positive in which white patches with rough, hairlike projections form, typically on lateral border of the tongue. Aphthous stomatitis is typically a recurrent round or oval sore or ulcer on the inside of the lips and cheeks or underneath the tongue and is not associated with HIV. Erythroplakia describes a red area or red spots on the lining of the mouth and is not associated with HIV. Nicotine stomatitis is a white patch in the mouth caused by extreme heat from smoking.

A nurse is caring for a patient who is receiving azathioprine following kidney transplant. For what serious adverse effect should the nurse monitor the patient? A. Respiratory distress B. Mental depression C. Severe diarrhea D. Infection

D. Infection Azathioprine and other immunosuppressant drugs can increase the risk of infection.

Which signs and symptoms should prompt a young woman's primary care provider to assess for systemic lupus erythematosus (SLE)? A. Chronic nausea and vomiting that is unresponsive to antiemetics B. A history of thromboembolic events and varicose veins C. Dysmenorrhea and recent spontaneous abortion D. Joint pain and proteinuria

D. Joint pain and proteinuria Renal involvement occurs in approximately one half to two-thirds of persons with SLE, and arthralgia is a common early symptom of the disease. Nephrotic syndrome causes proteinuria with resultant edema in the legs and abdomen, and around the eyes. Although the manifestations of SLE are diffuse, these do not typically include alterations in hemostasis, gastrointestinal symptoms, dysmenorrhea, or miscarriage

A nursing instructor is teaching students about skin structure. The instructor evaluates student knowledge of the Langerhans cells based on which statement? A. Langerhans cells are involved in relaying signals between the skin systems. B. Langerhans cells are a layer of intercellular and extracellular matrices that serves as an interface between the dermis and the epidermis. C. Langerhans cells serve as touch receptors. D. Langerhans cells are the immunologic cells responsible for recognizing foreign antigens harmful to the body.

D. Langerhans cells are the immunologic cells responsible for recognizing foreign antigens harmful to the body. Langerhans cells are scattered in the suprabasal layers of the epidermis among the keratinocytes. Langerhans cells are the immunologic cells responsible for recognizing foreign antigens harmful to the body. Langerhans cells play an important role in defending the body against foreign antigens.

A client is diagnosed with systemic lupus erythematosus (SLE). What is the most appropriate action for the nurse to take in order to evaluate the client's stage of disease? A. Observe the client's gait. B. Auscultate the client's lung sounds. C. Inspect the client's mouth. D. Review the client's medical record.

D. Review the client's medical record. The nurse evaluates the stage of SLE and plans appropriate interventions by reviewing the medical record and diagnostic findings of the client. The stage of the disease cannot be established by observing the client's gait, inspecting the client's mouth, or auscultating the client's lung sounds.

A client has been diagnosed with AIDS and tuberculosis (TB). A nursing student asks the nurse why the client's skin test for TB is negative if the client's physician has diagnosed TB. The nurse's correct reply is which of the following? A. The skin test was improperly performed. B. The client has only mild TB, which is not enough to cause a reaction. C. The solution used for the skin test was probably outdated. D. The client's immune system cannot mount a response to the skin test.

D. The client's immune system cannot mount a response to the skin test. The inflammatory response is a major function of the immune system that is elicited in response to invading foreign material. A person with AIDS has a poorly functioning or non-functioning immune system that will not respond to the injected skin test. Any TB organisms should cause a reaction to the skin test in people with intact immune systems. The nurse cannot accurately speculate on how the skin test was performed or that the solution was outdated.

The nurse is explaining patterns of incidence and transmission of HIV to a group of adolescent girls. She explains that the risks for this population are much higher because of the possibility of both vertical and horizontal transmission. Horizontal transmission refers to transmission of the disease during: A. the birthing process. B. pregnancy. C. feeding with breast milk. D. sexual contact.

D. sexual contact. Horizontal transmission refers to person-to-person transfer of the virus. Transmission by feeding with breast milk, birthing, and pregnancy are all examples of vertical transmission.

A client has moved into the acquired immunodeficiency syndrome (AIDS) phase of the human immunodeficiency virus (HIV) positive infection. The nurse advises the client to avoid what outdoor recreational activity? A. playing recreational softball B. hiking in a forested area C. going horseback riding D. swimming in rivers or lakes

D. swimming in rivers or lakes When a client with HIV has moved into the AIDS phase of the infection, the client has a very low CD4 count (<200) and is at high risk for opportunistic infections. One such infection is cryptosporidia, which is caused by protozoan parasites that are often found in water. Swimming in a river or lake greatly increases the risk of this exposure. While the client should take protection to avoid pathogens or injury during the other activities listed, none are known to carry a specific risk for the client that the nurse would need to emphasize compared to the risk of cryptosporidia infection from swimming in lakes or rivers.

A client in the primary or initial phase of a type I hypersensitivity reaction would most likely experience which physiologic response? A. Tissue destruction in the form of epithelial cell damage B. An IgE-mediated response that protects from damage C. Vasodilation of the capillaries from the release of histamine D. Smooth muscle relaxation produced by increased acetylcholine

C. Vasodilation of the capillaries from the release of histamine In the primary phase of type I hypersensitivity reaction, vasodilation of the capillaries occurs from histamine release and smooth muscle contraction. The other options do not occur in the primary phase of type I hypersensitivity reactions.

During a flu shot clinic, one of the questions the student nurse asks relates to whether the client has a history of Guillain-Barré syndrome. The client asks, "What is that?" How should the nursing student reply? A. "A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles." B. "A degenerative disease where you have trouble walking without the help of a cane or walker." C. "Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot." D. "Swelling of your arm where you got your flu shot and maybe your eyes and lips had some swelling as well."

A. "A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles." Guillain-Barre syndrome is an acute immune-mediated polyneuropathy. The majority of people report having had an acute, influenza-like illness before the onset of symptoms. It progresses along the ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. The rate of disease progression varies, and there may be disproportionate involvement of the upper or lower extremities. Swelling of the arm, eyes, and lips is anaphylaxis following the flu shot. It is not a degenerative disease.

During flu season, a nurse is teaching clients about the chain of infection. What components are considered "links" in this chain? Select all that apply. A. susceptible host B. virulence C. infectious agent D. portal of entry E. fomites

A. susceptible host C. infectious agent D. portal of entry The six components involved in the transmission of microorganisms are described as the chain of infection. All components in the chain of infection must be present to transmit an infectious disease from one human or animal to a susceptible host: an infectious agent, an appropriate reservoir, exit route, means of transmission, portal of entry, and susceptible host.

An older adult tells the nurse, "My friend just developed shingles and has a lot of pain. Is there a way for me to protect myself from it?" How should the nurse respond? A. "Apply a topical anesthetic agent." B. "Ask your healthcare provider about a herpes zoster vaccine." C. "Avoid children and people with shingles." D. "Use antiviral drugs as soon as you are exposed."

B. "Ask your healthcare provider about a herpes zoster vaccine." Herpes zoster is the viral infection caused by the varicella zoster virus. The first infection is called chickenpox. When there is a recurrence it is called shingles. The virus is believed to remain dormant in the nerve root until the client has a decline in cellular immunity when the virus will replicate. The pain is often described as throbbing, burning, or stabbing. The best prevention is a vaccine for adults age 60 and older. Antivirals will lessen the severity at the time but will not prevent infection.

The nurse is discussing adverse reactions involving the cardiovascular system after administration of oprelvekin. The nurse would include which reactions in the client teaching plan? A. Bone loss B. Arrhythmia C. Drowsiness D. Vomiting

B. Arrhythmia Arrhythmia resulting in stroke and pulmonary edema is an expected cardiovascular system adverse reaction after the administration of oprelvekin. Drowsiness and vomiting are not expected and are not cardiac system reactions. Bone loss is skeletal and is not a known adverse reaction after the administration of oprelvekin.

Which is the most likely indication for the use of immunosuppressant agents? A. Increased intracranial pressure B. HIV/AIDS with multiple drug resistance C. Intractable seizure disorders D. Organ transplantation

D. Organ transplantation Immunosuppressant agents are used for inflammatory autoimmune disorders or to prevent or treat tissue rejection reactions. Immunosuppressant agents are not administered for seizure disorders, increased intracranial pressure, or HIV/AIDS.

A 70-year-old client is seen in the family practice clinic. Which vaccine should be administered to prevent herpes zoster? A. Zoster vaccine B. Pneumococcal polyvalent C. Human papillomavirus (HPV) D. Haemophilus influenzae type B vaccine

A. Zoster vaccine Zoster vaccine is administered to adults 60 years and older to prevent herpes zoster (shingles). The Haemophilus influenzae type B is not administered to prevent herpes zoster. HPV and pneumococcal vaccine do not address the risk factors for shingles.

A nurse is reviewing the laboratory data for a hospitalized client. The nurse would notify the health care provider about which results as most concerning? A. white blood cell (WBC) count of 2800/µl (2.80 ×109/l) B. platelet count of 200,000/µL (200 ×109/l) C. eosinophils 1.5% on differential count D. red blood cell (RBC) count 4.5 ×106/µl

A. white blood cell (WBC) count of 2800/µl (2.80 ×109/l) Normal range for RBCs is 4.2 to 5.4 ×106/µl (4.2 to 5.4 ×1012/l) for males and 3.6 to 5.0 × 106/µl (3.6 to 5.0 ×1012/l) in females, making a result of 4.5 ×106/µl (4.5 ×1012/l) normal. The normal range for platelets is 150,000 to 400,000/µl (150 to 400 ×109/l) making 200,000/µl within normal range. The normal range for WBC is 4.8 to 10.8 ×103/µl (4.8 to 10.8 ×109/l). The client's WBC is below normal. This is referred to as leukopenia. Leukocytes are crucial to our defense against disease. The low WBC count in this client would indicate that the client's immune function may be compromised and the underlying cause of the problem needs to be investigated.

The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering? A. Humira B. Gold salts C. Hydroxychloroquine D. Azathioprine

B. Gold salts The administration of gold salts is called chrysotherapy. Gold is an anti-inflammatory agent that interferes with cells and substances in the immune system. There are two forms of intramuscular gold salts: gold sodium thiomalate and aurothioglucose.