med surg immuno

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After several years of unprotected sex, a client is diagnosed as having acquired immunodeficiency syndrome (AIDS). The client states, "I’m not worried because they have a cure for AIDS." What is the best response by the nurse?
1
"Repeated phlebotomies may be able to rid you of the virus."
2
"You may be cured of AIDS after prolonged pharmacologic therapy."
3
"Perhaps you should have worn condoms to prevent contracting the virus."
4
"There is no cure for AIDS, but there are drugs that can slow down the virus."

4 Stating "There is no cure for AIDS, but there are drugs that can slow down the virus" is an honest response that corrects the client’s misconception about the effectiveness of the current antiviral medications. Phlebotomy is not the treatment used to remove the virus from the client’s body. Current pharmacologic treatment does not eliminate the virus from the body; it can slow its progress and may even effect a remission (although the medications are never discontinued), but there is no known cure. Stating "Perhaps you should have worn condoms to prevent contracting the virus" is a nontherapeutic, judgmental response that can alienate the client and precipitate feelings of guilt.

Which organism causes malaria?
1
Vibrio
2
Sporozoa
3
Ringworm
4
Spirochetes

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

What is a common characteristic of Sjögren’s syndrome (SS)?
1
Dry eyes
2
Muscle cramping
3
Urinary tract infection
4
Elevated blood pressure

1 Sjögren’s syndrome (SS) is a group of problems that often appear with other autoimmune disorders. Problems include dry eyes, which are caused by autoimmune destruction of the lacrimal glands. Muscle cramping, urinary tract infection, and elevated blood pressure are not common characteristics of Sjögren’s syndrome (SS).

Which medications are useful to treat psoriasis? Select all that apply.
1
Psoralen
2
Anthralin
3
Isotretinoin
4
Clindamycin
5
Calcipotriene

125 Psoriasis is a chronic autoimmune dermatitis treated with a systemic photosensitizer such as psoralen and topical agents such as calcipotriene and anthralin. Isotretinoin and clindamycin are used to treat acne vulgaris.

A nurse discusses the potential for cross-contamination with the nursing assistants on a surgical unit. What does the nurse explain that standard precautions are designed to do?
1
Decrease the risk of transmitting unidentified pathogens
2
Be used when clients are suspected of having a communicable disease
3
Ensure that hygiene practices by clients are performed in a universal way
4
Create categories in which certain additional precautions must be followed

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

Which type of continuing care should a client expect if discharged home with an infusion device to continue treatment for a leg wound?
1
Home care
2
Rehabilitation
3
Skilled nursing care
4
Outpatient therapy

1 Clients who are discharged with an infusion device to continue drug therapy at home should expect home care services to teach appropriate administration of drug therapy in the client’s home. The client is being discharged to the home and not to rehabilitation or to a skilled nursing facility. Outpatient therapy is not identified as a method for continuing antibiotic therapy with an infusion device.

A chronically ill, older client tells the home care nurse that the daughter with whom the client lives seems run-down and disinterested in her own health, as well as the health of her children, who are 5, 7, and 12 years old. The client tells the nurse that the daughter coughs a good deal and sleeps a lot. Why is it important that the nurse pursue the daughter’s condition for potential case findings?
1
Tuberculosis has been rising dramatically in the general population.
2
Older adults with chronic illness are more susceptible to tuberculosis.
3
There is a high incidence of tuberculosis in children less than 12 years of age.
4
Death from tuberculosis has been generally on the decrease in the United States (Canada).

2 The client’s chronic illness and older age increase vulnerability; the daughter’s condition should be explored in greater detail. Tuberculosis is only one of many potential causes of the daughter’s clinical condition. Children who have not yet reached puberty and adolescence have the lowest incidence of tuberculosis. Morbidity and mortality resulting from tuberculosis are increasing, not decreasing.

What is the function of a client’s natural killer cells?
1
Secrete immunoglobulins in response to the presence of a specific antigen
2
Heighten selectively and destroy non-self cells, including virally infected cells
3
Enhance immune activity through secretion of various factors, cytokines, and lymphokines
4
Attack non-selectively on non-self cells, especially mutated and malignant cells

4 Natural killer cells attack non-selectively on non-self cells, especially body cells that have undergone mutation and become malignant. Plasma cells secrete immunoglobulins in response to the presence of a specific antigen. Cytotoxic T-cells attack selectively and destroy non-self cells, including virally infected cells. Helper T-cells enhance immune activity through secretion of various factors, cytokines, and lymphokines.

Why would a client with acquired immunodeficiency syndrome (AIDS) be administered pregabalin?
1
To reduce neuropathic pain
2
To reduce cognitive difficulty
3
To reduce swallowing difficulty
4
To reduce muscle and joint pain

1 Pregabalin is indicated for neuropathic pain based on its mechanism of interference with nerve signaling. Clients with AIDS generally exhibit emotional and behavioral changes, which can be managed with appropriate antidepressants and anxiolytics. AIDS clients who experience difficulty swallowing may have candidal esophagitis; this condition can be managed with antifungal mediations such as fluconazole or amphotericin B. Traditional analgesics are used to manage joint and muscle pain.

A nurse is counseling a client who has gonorrhea. What additional fact about gonorrhea, besides the fact that it is highly infectious, should the nurse teach this client?
1
It is easily cured.
2
It occurs very rarely.
3
It can produce sterility.
4
It is limited to the external genitalia.

3 Inflammation associated with gonorrhea may lead to destruction of the epididymis in males and tubal mucosal destruction in females, causing sterility. Many gonococci have become penicillin resistant and difficult to treat. Gonorrhea is a common sexually transmitted infection. Neisseria gonorrhoeae will invade internal structures, particularly the epididymis in males and the fallopian tubes in females.

Which autoimmune disease affects the central nervous system?
1
Uveitis
2
Celiac disease
3
Multiple sclerosis
4
Goodpasture syndrome

3 Multiple sclerosis is an autoimmune disease that affects the central nervous system. Uveitis is an autoimmune disease that affects the eyes. Celiac disease is an autoimmune disease that affects the gastrointestinal System. Goodpasture syndrome is an autoimmune disease that affects the kidneys.

What is an example of a type I hypersensitivity reaction?
1
Anaphylaxis
2
Serum sickness
3
Contact dermatitis
4
Blood transfusion reaction

1 An example of a type I hypersensitivity reaction is anaphylaxis. Serum sickness is a type III immune complex reaction. Contact dermatitis is a type IV delayed hypersensitivity reaction. A blood transfusion reaction is a type II cytotoxic reaction.

Which diseased condition associated with the client’s heart is an example of an autoimmune disease?
1
Uveitis
2
Rheumatic fever
3
Myasthenia gravis
4
Graves’ disease

2 Rheumatic fever is a heart disorder that is an example of an autoimmune disease. Uveitis is an eye disorder that is an example of an autoimmune disease. Myasthenia gravis is a muscle disorder that is an example of an autoimmune disease. Graves’ disease is an endocrine disorder that is an example of an autoimmune disease.

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

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

Which type of hepatitis virus spreads through contaminated food and water?
1
Hepatitis A virus
2
Hepatitis B virus
3
Hepatitis C virus
4
Hepatitis D virus

1 Hepatitis A virus spreads through contaminated food and water. Hepatitis B, C, and D viruses spread through contaminated needles, syringes, and blood products

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

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

A client with localized redness and swelling due to a bee sting reports intense local pain, a burning sensation, and itching. What would be the most appropriate nursing action?
1
Applying cold compresses to the affected area
2
Ensuring the client keeps the skin clean and dry
3
Monitoring for neurological and cardiac symptoms
4
Advising the client to launder all clothes with bleach

1 A client with a bee sting may have localized redness, swelling, pain, and itching due to an allergic reaction. The nurse should apply cold compresses to the affected area to reduce the pain in the client. A client with Candida albicans infection should keep his or her skin clean and dry to prevent further fungal infections. A client with a Borrelia burgdorferi infection may suffer from cardiac, arthritic, and neurologic manifestations. Therefore the nurse has to monitor for these symptoms. Direct contact may transmit a Sarcoptes scabiei infection; the nurse should make sure that the client’s clothes are bleached to prevent the transmission of the infection.

A client with an upper respiratory infection asks the nurse why the health care provider did not prescribe an antibiotic. What would be the best response from the nurse?
1
"I don’t know. I will ask the health care provider for a prescription."
2
"Antibiotics are used to treat viruses and you have a bacterial infection."
3
"Antibiotics are ineffective for treating the bacteria that cause upper respiratory infections."
4
"Upper respiratory infections generally are caused by viruses and therefore should not be treated with antibiotics."

4 Generally, upper respiratory infections are viral; therefore antibiotics should not be used. Overuse of antibiotics results in antibiotic-resistant strains of bacteria. Antibiotics are used to treat bacteria, not viruses.

What causes condylomata acuminate?
1
Chlamydia
2
Gonorrhea
3
Herpes simplex
4
Human papillomavirus (HPV)

4 Condylomata acuminate are genital warts which are caused by the human papillomavirus (HPV). Genital warts are not caused by chlamydia, gonorrhea, or herpes simplex.

A child is diagnosed with hepatitis A. The client’s parent expresses concern that the other members of the family may get hepatitis because they all share the same bathroom. What is the nurse’s best reply?
1
"I suggest that you buy a commode exclusively for your child’s use."
2
"Your child may use the bathroom, but you need to use disposable toilet covers."
3
"You will need to clean the bathroom from top to bottom every time a family member uses it."
4
"All family members, including your child, need to wash their hands after using the bathroom."

4 Hepatitis A is spread via the fecal-oral route; transmission is prevented by proper hand washing. Buying a commode exclusively for the child’s use is unnecessary; cleansing the toilet and washing the hands should control the transmission of microorganisms. It is not feasible to clean "from top to bottom" each time the bathroom is used. The use of disposable toilet covers is inadequate to prevent the spread of microorganisms if the bathroom used by the child also is used by others. Hand washing by all family members must be part of the plan to prevent the spread of hepatitis to other family members.

A nurse is teaching a client about human immunodeficiency virus (HIV). What are the various ways HIV is transmitted? Select all that apply.
1
Mosquito bites
2
Sharing syringe needles
3
Breastfeeding a newborn
4
Dry kissing the infected partner
5
Anal intercourse

235 Fluids such as blood and semen are highly concentrated with human immunodeficiency virus (HIV). HIV may be transmitted parenterally by sharing needles and postnatally through breast milk. HIV may also be transmitted through anal intercourse. HIV is not transmitted by mosquito bites or dry kissing.

Which type of immunoglobulin is present in tears, saliva, and breast milk?
1
IgE
2
IgA
3
IgG
4
IgM

2 IgA immunoglobulin is present in tears, saliva, and breast milk. IgE and IgG immunoglobulins are present in plasma and interstitial fluids. IgM immunoglobulin is present in plasma.

Which virus is responsible for causing infectious mononucleosis in clients?
1
Parvovirus
2
Coronavirus
3
Rotavirus
4
Epstein-Barr virus

4 Epstein-Barr virus is responsible for mononucleosis and possibly Burkitt’s lymphoma. Parvovirus and rotavirus cause gastroenteritis. Corona virus causes upper respiratory tract infections.

What is the function of IgG in the body?
1
Activates the degranulation of mast cells
2
Activates the classic complement pathway
3
Prevents upper respiratory tract infections
4
Prevents lower respiratory tract infections

2 The classic complement pathway is activated by the IgG and IgM antibodies. IgE antibodies cause a degranulation of mast cells. IgA antibodies are found largely in mucous membrane secretions and play an important role in preventing upper and lower respiratory tract infections.

Which is the first medication approved to reduce the risk of human immunodeficiency virus (HIV) infection in unaffected individuals?
1
Truvada
2
Abacavir
3
Cromolyn
4
Methdilazine

1 Truvada is the first medication approved to reduce the risk of HIV infection in unaffected individuals who are at a high risk of HIV infection. Abacavir is administered to treat HIV infection and is a reverse transcriptase inhibitor. Cromolyn is administered in the management of allergic rhinitis and asthma. Methdilazine, an antihistamine, is administered to treat the skin and provide relief from itching.

Which client has the highest risk for human immunodeficiency virus (HIV) infection?
1
A client who is involved in mutual masturbation
2
A client who undergoes voluntary prenatal HIV testing
3
A client who shares equipment to snort or smoke drugs
4
A client who engages in insertive sex with a non-infective partner

3 Clients who use equipment to snort (straws) and smoke (pipes) drugs are at the highest risk for becoming infected with HIV as their judgment may be impaired regarding the high-risk behaviors. Safe activities that prevent the risk of contracting HIV include mutual masturbation, masturbation, and other activities that meet the "no contact" requirements. A client who undergoes perinatal HIV voluntary testing may reduce the chances of getting infected. Insertive sex between partners who are not infected with HIV are not at risk of becoming infected with HIV.

A nurse is teaching a health class about human immunodeficiency virus (HIV). Which basic methods are used to reduce the incidence of HIV transmission? Select all that apply.
1
Using condoms
2
Using separate toilets
3
Practicing sexual abstinence
4
Preventing direct casual contacts
5
Sterilizing the household utensils

13 HIV is found in body fluids such as blood, semen, vaginal secretions, breast milk, amniotic fluid, urine, feces, saliva, tears, and cerebrospinal fluid. Therefore a client should use condoms to prevent contact between the vaginal mucus membranes and semen. Practicing sexual abstinence is the best method to prevent transmission of the virus. The HIV virus is not transmitted by sharing the same toilet facilities, casual contacts such as shaking hands and kissing, or by sharing the same household utensils.

What are the clinical manifestations during the fulminant stage in a client with inhalation anthrax? Select all that apply.
1
Septic shock
2
Harsh cough
3
Mild chest pain
4
Pleural effusion
5
Body temperature of 104 °F

145 Inhalation anthrax is a bacterial infection caused by Bacillus anthracis. Manifestations such as septic shock, pleural effusion, and body temperature above 103°F indicate the fulminant stage of inhalation anthrax. The prodromal stage is the early stage of inhalation anthrax; clinical manifestations include a harsh cough and mild chest pain.

A client expresses concern that because of supply and demand there is no vaccine available for the annual flu vaccine. What is the nurse’s best reply?
1
"It’s unfortunate, but there was such a limited supply available."
2
"There are many others who also were unable to get a flu vaccine."
3
"It doesn’t matter because the vaccine is for just one particular strain."
4
"There are other things you can do to prevent the flu, such as hand washing."

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

The nurse suspects that a client is in the chronic persistent stage of Lyme disease. Which symptoms support the nurse’s suspicion? Select all that apply.
1
Arthritis
2
Dyspnea
3
Dizziness
4
Chronic fatigue
5
Erythema migrans

14 Lyme disease is a systemic infectious disease caused by the spirochete Borrelia burgdorferi. The symptoms of the chronic persistent stage are arthritis and chronic fatigue. Dyspnea and dizziness are the symptoms of the early disseminated stage. Erythema migrans is observed in the localized stage.

Four clients with tuberculosis are prescribed medications. Which client is at risk for optic neuritis?
1
Client A
2
Client B
3
Client C
4
Client D

4 Ethambutol is an antitubercular medication that causes optic neuritis. Therefore client D is at risk for optic neuritis. Client A is at risk for vitamin B deficiency. Client B is at risk for liver toxicity. Client C is at risk for sunburn.

What are the symptoms of tuberculosis? Select all that apply.
1
Diarrhea
2
Anorexia
3
Weight gain
4
Hemoptysis
5
Night sweats

245 Tuberculosis is an infectious respiratory disease caused by Mycobacterium tuberculosis. Signs include a persistent cough, anorexia, hemoptysis, night sweats, shortness of breath, and a high body temperature. Diarrhea and weight gain are not associated with tuberculosis.

The nurse suspects that a client with inhalation anthrax is in the fulminant stage of the disease. Which symptom supports the nurse’s conclusion?
1
Fever
2
Dry cough
3
Hematemesis
4
Mild chest pain

3 Inhalation anthrax is a bacterial infection caused by Bacillus anthracis. This disease has two stages of illness, the prodromal stage and the fulminant stage. The symptom of the fulminant stage is hematemesis. The symptoms of the prodromal stage are fever, dry cough, and mild chest pain.

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

3 Staphylococcus aureus causes toxic shock syndrome. Treponema pallidum causes syphilis. Streptococcus faecalis causes genitourinary tract infections and infection of surgical wounds. Neisseria gonorrhoeae causes gonorrhea and pelvic inflammatory disease.

Which cytokine is used to treat multiple sclerosis?
1
β-Interferon
2
Interleukin-2
3
Erythropoietin
4
Colony-stimulating factor

1 β-Interferon is a cytokine used to treat multiple sclerosis. Interleukin-2 is used to treat metastatic melanoma. Erythropoietin is a cytokine used to treat anemia related to chemotherapy. Colony-stimulating factor is a cytokine used to treat chemotherapy-induced neutropenia.

The bacteria Clostridium botulinum causes which condition in a client?
1
Upper respiratory tract infection
2
Toxic shock syndrome
3
Urinary tract infection
4
Food poisoning with progressive muscle paralysis

4 Clostridium botulinum bacteria causes food poisoning with progressive muscle paralysis. Toxic shock syndrome is caused by the bacteria Staphylococcus aureus. Many viruses and bacteria can cause upper respiratory tract infection but Clostridium is not one of them. Klebsiella-Enterobacter organisms most likely cause urinary tract infections.

A nurse is planning to provide discharge teaching to the family of a client with acquired immunodeficiency syndrome (AIDS). Which statement should the nurse include in the teaching plan?
1
"Wash used dishes in hot, soapy water."
2
"Let dishes soak in hot water for 24 hours before washing."
3
"You should boil the client’s dishes for 30 minutes after use."
4
"Have the client eat from paper plates so they can be discarded."

1 A person cannot contract human immunodeficiency virus (HIV) by eating from dishes previously used by an individual with AIDS; routine care is adequate. Washing used dishes in hot, soapy water is sufficient care for dishes used by the AIDS client. Dishes do not need to soak for 24 hours before being washed. The client’s dishes do not need to be boiled for 30 minutes after use. Paper plates are fine to use but are not indicated to prevent the spread of AIDS.

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

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

Which cytokine medication is administered to treat chemotherapy-induced neutropenia?
1
Filgrastim
2
Oprelvekin
3
Aldesleukin
4
Darbepoetin alfa

1 Colony-stimulating factors such as filgrastim are administered to treat chemotherapy-induced neutropenia. Oprelvekin is used to prevent thrombocytopenia. Aldesleukin is used to treat metastatic renal cell carcinoma. Darbepoetin alfa is administered to treat anemia related to chronic cancer and anemia related to chronic kidney disease.

A school nurse is asked to develop a program for teachers about infection control especially focusing on hand washing technique. What is the most effective way for the nurse to evaluate what the teachers have learned?
1
Observe the teachers lecturing the children.
2
Give an objective written final examination to the teachers.
3
Schedule a seminar for the teachers to share their knowledge.
4
Watch the teachers demonstrate infection control techniques to the rest of the class.

4 The best way to evaluate learning is by feedback demonstration of precautions related to infection control, such as hand washing techniques. It is observable and must meet objective criteria. Although observing a lecture is an evaluation technique that may be used, it is not as objective and definitive as an actual demonstration of techniques. Although a written examination may be used, it does not evaluate psychomotor skills related to important infection control measures, such as hand washing. Although sharing what the teacher may have learned in a seminar for other teachers is an evaluation technique that can be used, it is not as objective and definitive as an actual demonstration of techniques.

A client has a tuberculin purified protein derivative test as part of a yearly physical examination. The area of induration is 10 mm within 48 hours after having the test. What does the nurse conclude about the client based on this response?
1
The client has contracted clinical tuberculosis.
2
The client has passive immunity to tuberculosis.
3
The client has been exposed to the tubercle bacillus.
4
The client has developed a resistance to the tubercle bacillus.

3 Induration measuring 10 mm or more in diameter is interpreted as significant; it does not indicate that active tuberculosis is present. About 90% of individuals who have significant induration do not develop the disease. Exposure to the tubercle bacillus indicates exposure; infection can be past or present. Passive immunity occurs when the body plays no part in the preparation of the antibodies; a positive tuberculin purified protein derivative indicates the presence of antibodies, not how they were formed. Developing a resistance to the tubercle bacillus reaction indicates exposure, not resistance.

What should be used to clean needles and syringes between intravenous drug users (IDUs)?
1
Bleach
2
Hot water
3
Ammonia
4
Rubbing alcohol

1 Intravenous drug users (IDUs) should be instructed to fill syringes with household bleach and shake the syringe for 30 to 60 seconds. Hot water, ammonia, or rubbing alcohol are not used to disinfect used syringes.

Which organism is responsible for causing Lyme disease in clients?
1
Phthirus pubis
2
Sarcoptes scabiei
3
Borrelia burgdorferi
4
Pediculushumanus var. corporis

3 Lyme disease is a bacterial infection caused by Borrelia burgdorferi, which is transmitted by ticks. Phthirus pubis causes pediculosis. Scabies is caused by Sarcoptes scabiei. Pediculushumanus var. corporis also causes pediculosis.

Which leukocytes should the nurse include when teaching about antibody-mediated immunity? Select all that apply.
1
Monocyte
2
Memory cell
3
Helper T cell
4
B-lymphocyte
5
Cytotoxic T cell

24 Memory cells and B-lymphocytes are involved in antibody-mediated immunity. Monocytes are involved in inflammation. Helper T cells and cytotoxic T cells are involved in cell-mediated immunity.

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

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

What are the mediators of injury in IgE-mediated hypersensitivity reactions? Select all that apply.
1
Cytokines
2
Mast cells
3
Histamines
4
Neutrophils
5
Leukotrienes

235 Mast cells, histamines, and leukotrienes are the mediators of injury in IgE-mediated hypersensitivity reactions. Cytokines are the mediators of injury in the delayed type of hypersensitivity reaction. Neutrophils are the mediators of injury in the immune-complex type of hypersensitivity reaction.

Which sexually transmitted disease is treated with antiviral drugs?
1
Syphilis
2
Gonorrhea
3
Genital herpes
4
Chlamydial infection

3 Genital herpes is a sexually transmitted disease caused by herpes simplex virus. Therefore antiviral drugs are used to treat this condition. Bacteria cause syphilis, gonorrhea, and chlamydial infections.

A nurse is caring for a client with pruritic lesions from an IgE-mediated hypersensitivity reaction. Which mediator of injury is involved?
1
Histamine
2
Cytokine
3
Neutrophil
4
Macrophage

1 Histamine is one of the mediators of injury involving IgE-mediated injury that may cause pruritus. Cytokines are the mediators of injury in delayed hypersensitivity reaction. Neutrophils are involved in immune complex-mediated hypersensitivity reactions. Macrophages in tissues are involved in cytotoxic reactions.

Which type of hypersensitivity reaction will occur when the client’s T cytotoxic cells are involved as the mediators of injury?
1
Type I
2
Type II
3
Type III
4
Type IV

4 Type IV hypersensitivity reaction will occur when the T cytotoxic cells are involved as the mediators of injury. Type I IgE-mediated reaction will occur when histamine is involved as the mediators of injury. Type II cytotoxic reaction will occur when complement lysis is the mediator of injury. Type III immune complex reaction will occur when neutrophils are involved as the mediators of injury.

Which antimicrobial medication acts on susceptible pathogens by inhibiting nucleic acid synthesis?
1
Penicillin
2
Actinomycin
3
Erythromycin
4
Cephalosporin

2 Actinomycin is an antimicrobial medication that acts on susceptible pathogens by inhibiting nucleic acid synthesis. Penicillin acts on susceptible pathogens by inhibiting cell wall synthesis. Erythromycin acts on susceptible pathogens by inhibiting biosynthesis and reproduction. Cephalosporin acts on susceptible pathogens by inhibiting cell wall synthesis.

A spouse of a client with pulmonary tuberculosis (TB) receives a tuberculin skin test. The nurse reads the test and identifies an area of induration greater than 10 mm. What does this result indicate to the nurse?
1
No further action is required.
2
Additional tests are necessary.
3
Repeating the skin test is indicated.
4
Results are positive, indicating infection.

2 The test does not indicate whether TB is dormant or active. However, a client with an induration of 5 mm or greater is considered positive if there is repeated close contact with a person diagnosed with pulmonary tuberculosis or if the client has a disease causing decreased resistance; this requires further diagnostic study, such as chest x-rays and sputum culture. A newly infected client will receive preventive therapy with isoniazid (INH). Isoniazid will be continued for 6 months if chest x-rays are normal, or 12 months if chest x-rays are abnormal. Repeating the skin test is not necessary; the test is considered positive.

Which organs are affected by Candida albicans? Select all that apply.
1
Ears
2
Lungs
3
Vagina
4
Mouth
5
Intestines

345 Candida albicans causes thrush in the mouth, vaginitis in the vagina, and candidiasis in the intestines. The fungus Aspergillus fumigatus affects the ears. Lungs are affected by Coccidioides immitis.

Which sexually transmitted disease is caused by a virus?
1
Syphilis
2
Gonorrhea
3
Genital warts
4
Chlamydial infection

3 Genital warts are caused by a sexually transmitted virus. Bacteria cause syphilis, gonorrhea, and chlamydial infections.

A client’s laboratory report reveals a CD4+ T-cell count of 520 cells/mm3. According to the Centers for Disease Control and Prevention (CDC), which stage of human immunodeficiency virus (HIV) disease is present in the client?
1
Stage 1
2
Stage 2
3
Stage 3
4
Stage 4

1 According to the CDC, HIV disease is divided into four stages. A client with a CD4+ T-cell count of greater than 500 cells/mm3 is in the first stage of HIV disease. A client with a CD4+ T-cell count between 200 and 499 cells/mm3 is in the second stage of HIV disease. A client with a CD4+ T-cell count of less than 200 cells/mm3 is in the third stage of HIV disease. The fourth stage of HIV disease indicates a confirmed HIV infection with no information regarding the CD4+ T-cell counts.

Which virus can cause encephalitis in adults and children?
1
Rubella virus
2
Parvovirus
3
Rotaviruses
4
West Nile virus

4 The West Nile virus causes encephalitis. German measles is caused by rubella. Gastroenteritis is caused by parvovirus. Rotavirus also causes gastroenteritis.

Which medication is beneficial for a client with pertussis?
1
Antibiotics
2
Antihistamines
3
Corticosteroids
4
Bronchodilators

1 Pertussis is a highly contagious infection of the respiratory tract caused by Bordetella pertussis. Antibiotics, usually macrolides, are used to minimize symptoms and prevent the spread of the disease. Antihistamines should not be used because they are ineffective and may induce coughing episodes. Corticosteroids and bronchodilators are not useful in reducing symptoms associated with pertussis.

Which stage of HIV would a client with a CD4+ T-cell count of 325 cells/mm3 be classified?
1
Stage 1
2
Stage 2
3
Stage 3
4
Stage 4

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

Which organ-specific autoimmune disorder is associated with a client’s kidney?
1
Graves’ disease
2
Addison’s disease
3
Goodpasture syndrome
4
Guillain-Barré syndrome

3 Goodpasture syndrome is an autoimmune disorder associated with the client’s kidney. Graves’ disease and Addison’s disease are autoimmune disorders associated with the endocrine system. Guillain-Barré syndrome is an autoimmune disorder associated with the central nervous system.

A mother with the diagnosis of acquired immunodeficiency syndrome (AIDS) states that she has been caring for her baby even though she has not been feeling well. What important information should the nurse determine?
1
If she has kissed the baby
2
If the baby is breast-feeding
3
When the baby last received antibiotics
4
How long she has been caring for the baby

2 Epidemiologic evidence has identified breast milk as a source of human immunodeficiency virus (HIV) transmission. Kissing is not believed to transmit HIV. When the baby last received antibiotics is unrelated to transmission of HIV. HIV transmission does not occur from contact associated with caring for a newborn.

What are the clinical manifestations of inhalation anthrax? Select all that apply.
1
Fever
2
Fatigue
3
Rhinitis
4
Dry cough
5
Sore throat

1245 Inhalation anthrax is a bacterial infection caused by Bacillus anthracis. Clinical manifestations include fever, fatigue, sore throat, and a dry cough. Rhinitis is an upper respiratory manifestation not associated with inhalation anthrax.

An older client with a history of congestive heart failure expresses concern about potential exposure to tuberculosis. The client states that a roommate at the extended care facility where the client resides sleeps a lot, coughs a great deal, and sometimes spits up blood. What is the primary reason that the nurse pursues more information about the roommate?
1
Death from tuberculosis is on the increase
2
The roommate is causing the client to be anxious
3
Older adults with chronic illness are affected adversely by tuberculosis
4
The roommate most likely is preventing the client from getting proper sleep

3 The client’s cardiac condition and age make the client vulnerable to communicable diseases. In the United States, death from tuberculosis is declining because of improved drug therapy. (Canada: According to the Public Health Agency of Canada, 1,607 new active and re-treatment (latent) TB cases were reported to the Canadian Tuberculosis Reporting System in 2011, but TB is no longer common in the overall Canadian population.) The nurse’s primary concern is to prevent the spread of infection. The issues of client anxiety and potential sleep disturbance should be addressed later; they are not the greatest concern at this time.

Which age-related effects on the immune system are seen in the older client?
1
Increased autoantibodies
2
Increased expression of IL-2 receptors
3
Increased delayed hypersensitivity reaction
4
Increased primary and secondary antibody responses

1 The effects of aging on the immune system include increased autoantibodies. Expression of IL-2 receptors, delayed hypersensitivity reaction, and primary and secondary antibody responses decrease in older adults because of the effects of aging on the immune system.

Which immunoglobulin crosses the placenta?
1
IgE
2
IgA
3
IgG
4
IgM

3 IgG is the only immunoglobulin that crosses the placenta. IgE is found in the plasma and interstitial fluids. IgA lines the mucous membranes and protects body surfaces. IgM is found in plasma; this immunoglobulin activates due to the invasion of ABO blood antigens.

Which intervention is most likely to decrease mortality in the septic client?
1
Oxygen
2
Antibiotics
3
Vasopressors
4
Intravenous fluids

2 Of the interventions listed, administering antibiotics is the only intervention that fights the source of the problem. Intravenous fluids, oxygen, and vasopressors are necessary, but are designed to sustain the body until the antibiotic can kill the pathogen.

The nurse is counseling a client infected with human immunodeficiency virus (HIV) regarding prevention of HIV transmission. Which statement by the client indicates the nurse needs to follow up?
1
"I should abstain from sexual activity."
2
"I can safely have anal sex without any barriers."
3
"I should get HIV counseling if planning for pregnancy."
4
"I will use condoms while having sexual intercourse."

2 The client with HIV should use barrier protection when engaging in insertive sexual activity such as anal, oral, and vaginal. Therefore the nurse should follow up to provide the client with the correct information. All the other statements are correct and need no follow up. Abstaining from all sexual activity is a safe way to eliminate the risk of exposure to HIV in semen and vaginal secretions. The client should undergo HIV counseling and routinely offer access to voluntary HIV-antibody testing when planning for pregnancy. The most commonly used barrier is a condom, which allows for protected intercourse.

Which viral infection will cause the nurse to observe for warts?
1
Pox virus
2
Rhabdovirus
3
Epstein-Barr virus
4
Papillomavirus

4 Warts are caused by papillomavirus. Pox viruses cause smallpox. Rhabdovirus causes rabies. Epstein-Barr causes mononucleosis and Burkitt’s lymphoma.

Which disease is caused by Coronaviruses?
1
Pertussis
2
Inhalation anthrax
3
Coccidioidomycosis
4
Severe acute respiratory syndrome

4 Severe acute respiratory syndrome is a respiratory infection caused by Coronaviruses. Pertussis is caused by the bacterium Bordetella pertussis. Inhalation anthrax is caused by Bacillus anthracis. Coccidioidomycosis is caused by Coccidioides.

Which medication should be immediately started when a client has an anaphylactic attack?
1
Isoproterenol
2
Diphenhydramine HCl
3
Hydrocortisone sodium succinate
4
Methylprednisolone sodium succinate

1 Isoproterenol is a beta-adrenergic, sympathomimetic drug that is considered to be a first-line of medication for the management of anaphylaxis. Diphenhydramine HCl is a second-line antihistamine to be used after the client is stabilized. Hydrocortisone sodium succinate and methylprednisolone sodium succinate are second-line corticosteroid medications that inhibit inflammatory mediators.

Which hypersensitivity reaction may occur in a newborn with hemolytic disease?
1
Type I
2
Type II
3
Type III
4
Type IV

2 Hemolytic disease in a pregnant woman may result in erythroblastosis fetalis, a type II hypersensitivity reaction. Type I reactions involve immunoglobulin E (IgE)-mediated reactions such as anaphylaxis and wheal-and-flare reactions. Type III reactions are immune complex reactions such as rheumatoid arthritis or systemic lupus erythematosus. Type IV reactions are delayed hypersensitivity reactions such as contact dermatitis.

The nurse is reviewing blood screening tests of the immune system of a client with acquired immunodeficiency syndrome (AIDS). What does the nurse expect to find?
1
A decrease in CD4 T cells
2
An increase in thymic hormones
3
An increase in immunoglobulin E
4
A decrease in the serum level of glucose-6-phosphate dehydrogenase

1 The human immunodeficiency virus (HIV) infects helper T-cell lymphocytes; therefore 300 or fewer CD4 T cells per cubic millimeter of blood or CD4 cells accounting for less than 20% of lymphocytes is suggestive of AIDS. The thymic hormones necessary for T-cell growth are decreased. An increase in immunoglobulin E is associated with allergies and parasitic infections. A decrease in the serum level of glucose-6-phosphate dehydrogenase is associated with drug-induced hemolytic anemia and hemolytic disease of the newborn.

Why would a client with acquired immunodeficiency syndrome (AIDS) be prescribed diphenoxylate hydrochloride?
1
To manage pain
2
To manage diarrhea
3
To manage candidal esophagitis
4
To manage behavioral problems

1 Diphenoxylate hydrochloride is an antidiarrheal drug prescribed to clients with AIDS to manage frequent diarrhea experienced by a client with AIDS. Opioid analgesics such as tramadol are used to manage pain. Ketoconazole can be used to treat candidal esophagitis associated with AIDS. Behavioral problems are managed with psychotropic drugs.

Which statement is true regarding Sjögren’s syndrome?
1
Sjögren’s syndrome increases lacrimation.
2
Sjögren’s syndrome increases body secretions.
3
Sjögren’s syndrome decreases the risk for infection.
4
Sjögren’s syndrome decreases the digestion of carbohydrates.

4 Sjögren’s syndrome decreases the digestion of carbohydrates because of insufficient secretion of saliva. Sjögren’s syndrome decreases lacrimation. Sjögren’s syndrome also decreases body secretions and saliva, therefore increasing the risk of infection.

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

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

Which medications are administered to inhibit purine synthesis and suppress cell-mediated and humoral immune responses? Select all that apply.
1
Sirolimus
2
Azathioprine
3
Cyclophosphamide
4
Methylprednisolone
5
Mycophenolate mofetil

25 Azathioprine and mycophenolate mofetil are administered to inhibit purine synthesis and suppress cell-mediated and humoral immunity. Sirolimus binds to a mammalian target of rapamycin (mTOR), which suppresses T-cell activation and proliferation. Cyclophosphamide is administered to treat cancers, autoimmune disorders, and amyloidosis. Methylprednisolone is a corticosteroid that inhibits cytokine production.

A client reports disturbed sleep due to itching caused by an allergy. Which medication would be prescribed to help the client sleep well and treat the allergic symptoms?
1
Cetirizine
2
Fexofenadine
3
Desloratadine
4
Chlorpheniramine

4 Chlorpheniramine [1] [2] is an antihistamine that helps to manage allergic symptoms by preventing vasodilation and decreasing allergic symptoms. Sedation is a side effect of chlorpheniramine; therefore, this drug is prescribed to clients experiencing sleep issues due to allergic symptoms. Cetirizine effectively blocks histamine from binding to receptors and has less sedating potential. Fexofenadine and desloratadine are also less sedating antihistamine drugs.

Which type of immunity will clients acquire through immunizations with live or killed vaccines?
1
Natural active immunity
2
Artificial active immunity
3
Natural passive immunity
4
Artificial passive immunity

2 Artificial active immunity is acquired through immunization with live or killed vaccines. Natural active immunity is acquired when there is natural contact with antigens through a clinical infection. Natural passive immunity is acquired through the transfer of colostrums from mother to child. Artificial passive immunity is acquired by injecting serum from an immune human.

Which complication will the nurse suspect in a client with genital herpes disease?
1
Infertility
2
Cold sores
3
Reactive arthritis
4
Bartholin’s abscess

2 Cold sores are the autoinoculation of the virus to extragenital sites, such as the fingers and lips. It is a complication of genital herpes disease. Infertility and reactive arthritis are the complications of chlamydial infection. Bartholin’s abscess is a complication of gonorrhea.

Which organism causes smallpox?
1
Variola virus
2
Yersinia pestis
3
Bacillus anthracis
4
Clostridium botulinum

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

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

1 The causative organism for syphilis is Treponema pallidum. Campylobacter jejuni is the causative organism for proctitis. Trichomonas vaginalis is the causative organism for vulvovaginitis. Chlamydia trachomatis is the causative organism for salpingitis.

A nurse is caring for a client with acquired immunodeficiency syndrome (AIDS). What precautions should the nurse take when caring for this client?
1
Use standard precautions.
2
Employ airborne precautions.
3
Plan interventions to limit direct contact.
4
Discourage long visits from family members.

1 The Centers for Disease Control and Prevention (Canada: Public Health Agency of Canada) states that standard precautions should be used for all clients; these precautions include wearing of gloves, gown, mask, and goggles when there is risk for exposure to blood or body secretions. There is no indication that airborne precautions are necessary. Planning interventions to limit direct contact and discouraging long visits from family members will unnecessarily isolate the client.

What determines if a client will develop AIDS from an HIV infection?
1
Level of IgM in the blood
2
The number of CD4+ T-cells available
3
Presence of antigen-antibody complexes
4
Speed with which the virus invades the RNA

2 Whether HIV becomes AIDS depends upon the number of CD4+ T-cells. IgM and the presence of antigen-antibody complexes have no effect on HIV. The speed with which HIV invades the RNA has no impact on the future development of AIDS.

Which cytokine increases growth and maturation of myeloid stem cells?
1
Interleukin-2
2
Thrombopoietin
3
Granulocyte colony-stimulating factor
4
Granulocyte-macrophage colony-stimulating factor

4 Granulocyte-macrophage colony-stimulating factor is a cytokine that increases growth and maturation of myeloid stem cells. Interleukin-2 is a cytokine that increases growth and differentiation of T-lymphocytes. Thrombopoietin is a cytokine that increases growth and differentiation of platelets. Granulocyte colony-stimulating factor is a cytokine that increases numbers and maturity of neutrophils.

Which parameter should the nurse consider while assessing the psychologic status of a client with acquired immune deficiency syndrome (AIDS)?
1
Sleep pattern
2
Severity of pain
3
Cognitive changes
4
Presence of anxiety

4 Presence of anxiety should be considered while assessing the psychologic status of a client with AIDS. Sleep patterns and severity of pain are related to the assessment of activity and rest, a physical status. Cognitive changes are related to the assessment of neurologic status.

A nurse identifies 12 mm of induration at the site of a tuberculin purified protein derivative (PPD) test when a client returns to the health office to have it read. What does the nurse explain to the client about this test?
1
Test result is negative and no follow-up is needed
2
Result indicates a need for further tests and a chest x-ray
3
Test was used for screening and a Tine test now will be given
4
Skin test is inconclusive and will have to be repeated in 6 weeks

2 The tuberculin PPD is injected intradermally; it is the most accurate skin test for tuberculosis (TB) because of the testing material and the intradermal method used. No other skin test is appropriate as a follow-up; further tests are now warranted, including a chest x-ray film. The test result is positive, not negative; thus further testing is necessary. The Tine test is less accurate than the tuberculin PPD and is not used as a follow-up test. More than 10 mm of induration is a positive test result, not a doubtful test result.

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

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

What are the symptoms of tuberculosis? Select all that apply.
1
Fatigue
2
Nausea
3
Weight gain
4
Low-grade fever
5
Increased appetite

124 Tuberculosis is an infectious respiratory disease caused by Mycobacterium tuberculosis. The symptoms of tuberculosis are fatigue, nausea, low-grade fever, weight loss, and anorexia.

Which cells are affected in DiGeorge syndrome?
1
T-cells
2
B-cells
3
Monocytes
4
Polymorphonuclear cells

1 DiGeorge syndrome is a primary immune deficiency disorder in which T-cells are affected. The B-cells are affected in Bruton’s X-linked agammaglobulinemia; common variable hypogammaglobulinemia; and selective IgA, IgM, and IgG deficiency. Monocytes and polymorphonuclear cells are affected in chronic granulomatous disease and Job syndrome.

Which dietary modifications can help improve the nutritional status of a client with acquired immunodeficiency syndrome (AIDS)?
1
Refraining from consuming fatty foods
2
Refraining from consuming frequent meals
3
Refraining from consuming high-calorie foods
4
Refraining from consuming high-protein foods

1 Many clients with AIDS become intolerant to fat due to the disease and the antiretroviral medications. Therefore the client should be instructed to refrain from consuming fatty foods. The client should be encouraged to eat small and frequent meals to improve nutritional status. High-calorie and high-protein foods are beneficial to clients with AIDS because they provide energy and build immunity.

What finding in the client is a sign of allergic rhinitis?
1
Presence of high-grade fever
2
Reduced breathing through the mouth
3
Presence of pinkish nasal discharge
4
Reduced transillumination on the skin over the sinuses

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

A client scheduled for surgery has a history of methicillin-resistant Staphylococcus aureus (MRSA) since developing an infection in a surgical site 9 months ago. The site is healed, and the client reports having received antibiotics for the infection. What should the nurse do to determine if the infecting organism is still present?
1
Notify the infection control officer.
2
Inform the operating room of the MRSA.
3
Obtain an order to culture the client’s blood.
4
Call the surgeon for an infectious disease consultation.

3 Obtaining cultures is the most reliable method of determining the presence of an infecting microorganism. Although notifying the infection control officer should be done, the presence of an infecting microorganism should be identified first. Informing the operating room personnel of the MRSA is usual when an infecting microorganism is present; however, it is not yet confirmed that an infecting microorganism is present. Although calling the surgeon for an infectious disease consultation may be done, the presence of an infecting agent should be identified first.

Which leukocyte releases vasoactive amines during a client’s allergic reactions?
1
Neutrophil
2
Monocyte
3
Eosinophil
4
Macrophage

3 Eosinophils release vasoactive amines during allergic reactions to limit the extent of the allergic reactions. Neutrophils are phagocytes and increase in inflammation and infection. Monocytes are involved in the destruction of bacteria and cellular debris. Macrophages are involved in nonspecific recognition of foreign protein and microorganisms.

The nurse is educating a client about protease inhibitors. What statement about protease inhibitors is true?
1
Protease inhibitors prevent viral replication.
2
Protease inhibitors prevent the interaction between viral material and the CD4+ T-cell.
3
Protease inhibitors prevent viral and host genetic material integration.
4
Protease inhibitors prevent the clipping of the viral strands into small functional pieces.

4 Protease inhibitors act by preventing the newly formed viral strands within the host CD4+ T-cell from being clipped into smaller functional pieces. Nucleoside reverse transcriptase inhibitors (NRTIs) prevent viral replication. NRTIs inhibits the transformation of viral single-stranded ribonucleic acid into host double-stranded deoxyribonucleic acid (DNA) by the action of the enzyme reverse transcriptase. Entry inhibitor drugs prevent the binding of the virus to the CD4 receptors. Integrase inhibitor drugs prevent the integration of viral material into the host’s DNA by the action of the enzyme integrase.

A client is concerned about contracting malaria while visiting relatives in Southeast Asia. What should the nurse teach the client to avoid to prevent malaria?
1
Mosquito bites
2
Untreated water
3
Undercooked food
4
Overpopulated areas

1 Malaria is caused by the protozoan Plasmodium falciparum, which is carried by mosquitoes. Avoiding untreated water, undercooked food, and overpopulated areas will not prevent protozoa from entering the bloodstream.

What is the mechanism of action of penicillin?
1
Prevents reproduction of the pathogen
2
Inhibits cell wall synthesis of the pathogen
3
Inhibits nucleic acid synthesis of the pathogen
4
Injures the cytoplasmic membrane of the pathogen

2 Penicillin is an antimicrobial medication that inhibits cell wall synthesis of the susceptible pathogen. Gentamicin is an antimicrobial medication that prevents the reproduction of the susceptible pathogen. Actinomycin is an antimicrobial medication that inhibits nucleic acid synthesis of the susceptible pathogen. Antifungal agents injure the cytoplasmic membrane of the susceptible pathogen.

Which immunomodulatory is beneficial for the treatment of clients with multiple sclerosis?
1
Interleukin 2
2
Interleukin 11
3
Beta interferon
4
Alpha interferon

3 Beta interferon is an immunomodulator that is administered in the treatment of multiple sclerosis. Interleukin 11 is used in the prevention of thrombocytopenia after chemotherapy. Interleukin 2 is used for the treatment of metastatic renal cell carcinoma and metastatic melanoma. Alpha interferon is administered for the treatment of hairy cell leukemia, chronic myelogenous leukemia, and malignant melanoma.

What is a manifestation of tertiary syphilis?
1
Chancre
2
Alopecia
3
Gummas
4
Condylomata lata

3 Gummas which are chronic, destructive lesions affecting the skin, bone, liver, and mucous membranes occur during tertiary syphilis. A chancre appears during primary syphilis. Alopecia and condylomata lata occur during secondary syphilis.

Which is a leukotriene antagonist used to manage and prevent allergic rhinitis?
1
Zileuton
2
Ephedrine
3
Scopolamine
4
Cromolyn sodium

1 Zileuton is a leukotriene antagonist used to manage and prevent allergic rhinitis. Ephedrine is an ingredient in decongestants used to treat allergic rhinitis. Scopolamine is an anticholinergic used to reduce secretions. Cromolyn sodium is a mast cell stabilizing drug used to prevent mast cell membranes from opening when an allergen binds to IgE.

Which complication is associated with Pott’s disease?
1
Peritonitis
2
Bacterial meningitis
3
Generalized lymphadenopathy
4
Destruction of intervertebral discs

4 Pott’s disease is tuberculosis (TB) of the spine, which can lead to destruction of intervertebral discs. Abdominal TB can cause peritonitis. Central nervous system TB can cause severe bacterial meningitis. Generalized lymphadenopathy can be caused by miliary tuberculosis.

What is the role of the plasma cell in the antigen-antibody response?
1
Makes an antigen harmless without destroying it
2
Produces antibodies against the sensitizing antigen
3
Produces antibodies after an exposure to a known antigen
4
Clumps antibody-antigens linkages together to form immune complexes

2 In the antigen-antibody response, once the B-cell is sensitized, it divides and forms a plasma cell, which produces antibodies against the sensitizing antigen. Inactivation or neutralization is the process of making an antigen harmless without destroying it. Memory cells produce antibodies after the next exposure to an antigen that is recognized by the body. Agglutination is the clumping of antigens linked with antibodies, forming immune complexes.

A client diagnosed with osteomyelitis is being discharged. Which statement indicates a need for further teaching?
1
"I will take the antibiotic at the same time every day."
2
"I will take the antibiotic regularly until my symptoms subside."
3
"I will take the antibiotic with food if I develop gastric distress when on the antibiotic."
4
"I will notify my healthcare provider and stop taking the medication if I develop a rash or shortness of breath."

2 The antibiotic should be taken as prescribed for the full length of treatment. The client should not discontinue the medication when symptoms subside. The statements "I will take the antibiotic at the same time every day," "I will take the antibiotic with food if I develop gastric distress when on the antibiotic," and "I will notify my healthcare provider and stop taking the medication if I develop a rash or shortness of breath" demonstrate understanding of the discharge instructions.

Which skin infection is caused by bacteria?
1
Folliculitis
2
Candidiasis
3
Herpes zoster
4
Dermatophytosis

1 Folliculitis is caused by bacteria. Candidiasis is a skin infection caused by a fungus. Herpes zoster is caused by a virus. Dermatophytosis is caused by a fungus.

Which type of cytokine is used to treat anemia related to chronic kidney disease?
1
α-Interferon
2
Interleukin-2
3
Interleukin-11
4
Erythropoietin

4 Erythropoietin is used to treat anemia related to chronic kidney disease. α-Interferon is used to treat hairy cell leukemia or malignant melanoma. Interleukin-2 is used to treat metastatic renal carcinoma. Interleukin-11 is used to prevent thrombocytopenia after chemotherapy.

A nurse is caring for a client who is human immunodeficiency virus (HIV) positive. Which complication associated with this diagnosis is most important for the nurse to teach prevention strategies?
1
Infection
2
Depression
3
Social isolation
4
Kaposi sarcoma

1 The client has a weakened immune response. Instructions regarding rest, nutrition, and avoidance of unnecessary exposure to people with infections help reduce the risk for infection. Clients can be taught cognitive strategies to cope with depression, but the strategies will not prevent depression. The client may experience social isolation as a result of society’s fears and misconceptions; these are beyond the client’s control. Although Kaposi sarcoma is related to HIV infection, there are no specific measures to prevent its occurrence.

A registered nurse is educating a client with acquired immune deficiency syndrome about safe sexual practices. Which statement made by the client indicates a need for further education?
1
"I should use a dental dam during oral sex."
2
"I can participate in anal intercourse safely without using condoms."
3
"I should ask my partner to use a female condom while engaging in sexual activity."
4
"I should use condoms even while receiving highly active antiretroviral therapy (HAART)."

2 Having anal intercourse indicates the client needs more teaching because this statement is incorrect. The client should wear a condom or use other genital barriers to prevent the transmission of human immunodeficiency virus (HIV). Anal intercourse is a risky sexual practice that allows contact between the seminal fluid and the rectal mucous membranes. Anal intercourse also tears the mucous membranes, making an infection more likely. All the other statements are correct and do not indicate further education is needed. Barriers such as female condoms and dental dams are recommended while participating in sexual activity. Though the viral load may decrease with the use of HAART, the risk for transmission still exists. Therefore the client should use condoms during sexual contact.

A client who abused intravenous drugs was diagnosed with the human immunodeficiency virus (HIV) several years ago. What does the nurse explain to the client regarding the diagnostic criterion for acquired immunodeficiency syndrome (AIDS)?
1
Contracts HIV-specific antibodies
2
Develops an acute retroviral syndrome
3
Is capable of transmitting the virus to others
4
Has a CD4+T-cell lymphocyte level of less than 200 cells/µL (60%)

4 AIDS is diagnosed when an individual with human immunodeficiency virus (HIV) develops one of the following: a CD4+T-cell lymphocyte level of less than 200 cells/µL (60%), wasting syndrome, dementia, one of the listed opportunistic cancers (e.g., Kaposi sarcoma [KS], Burkitt lymphoma), or one of the listed opportunistic infections (e.g., Pneumocystis jiroveci pneumonia, Mycobacterium tuberculosis). The development of HIV-specific antibodies (seroconversion), accompanied by acute retroviral syndrome (flulike syndrome with fever, swollen lymph glands, headache, malaise, nausea, diarrhea, diffuse rash, joint and muscle pain) 1 to 3 weeks after exposure to HIV reflects acquisition of the virus, not the development of AIDS. A client who is HIV positive is capable of transmitting the virus with or without the diagnosis of AIDS.

What is the mechanism of action of penicillin?
1
Prevents reproduction of the pathogen
2
Inhibits cell wall synthesis of the pathogen
3
Inhibits nucleic acid synthesis of the pathogen
4
Injures the cytoplasmic membrane of the pathogen

2 Penicillin is an antimicrobial medication that inhibits cell wall synthesis of the susceptible pathogen. Gentamicin is an antimicrobial medication that prevents the reproduction of the susceptible pathogen. Actinomycin is an antimicrobial medication that inhibits nucleic acid synthesis of the susceptible pathogen. Antifungal agents injure the cytoplasmic membrane of the susceptible pathogen.

Which laboratory test will be elevated in a client with inflammatory arthritis?
1
Leukocyte count
2
Hemoglobin and hematocrit
3
Blood urea nitrogen and creatinine
4
Erythrocyte sedimentation rate (ESR)

4 The erythrocyte sedimentation rate (ESR) measures the rate at which red blood cells fall through plasma. This rate is most significantly affected by an increased number of acute-phase reactants, which occur with inflammation. An elevated ESR (>20 mm/hr) indicates inflammation or infection somewhere in the body. The ESR is chronically elevated with inflammatory arthritis. Leukocytes will be elevated when a bacterial infection is present. Hemoglobin and hematocrit are not used to determine the presence of inflammation. Blood urea nitrogen and creatinine levels are used to determine renal function.

Which cytokine is used to treat multiple sclerosis?
1
β-Interferon
2
Interleukin-2
3
Erythropoietin
4
Colony-stimulating factor

1 β-Interferon is a cytokine used to treat multiple sclerosis. Interleukin-2 is used to treat metastatic melanoma. Erythropoietin is a cytokine used to treat anemia related to chemotherapy. Colony-stimulating factor is a cytokine used to treat chemotherapy-induced neutropenia.

A client has a tuberculin purified protein derivative test as part of a yearly physical examination. The area of induration is 10 mm within 48 hours after having the test. What does the nurse conclude about the client based on this response?
1
The client has contracted clinical tuberculosis.
2
The client has passive immunity to tuberculosis.
3
The client has been exposed to the tubercle bacillus.
4
The client has developed a resistance to the tubercle bacillus.

3 Induration measuring 10 mm or more in diameter is interpreted as significant; it does not indicate that active tuberculosis is present. About 90% of individuals who have significant induration do not develop the disease. Exposure to the tubercle bacillus indicates exposure; infection can be past or present. Passive immunity occurs when the body plays no part in the preparation of the antibodies; a positive tuberculin purified protein derivative indicates the presence of antibodies, not how they were formed. Developing a resistance to the tubercle bacillus reaction indicates exposure, not resistance.

Which type of continuing care should a client expect if discharged home with an infusion device to continue treatment for a leg wound?
1
Home care
2
Rehabilitation
3
Skilled nursing care
4
Outpatient therapy

1 Clients who are discharged with an infusion device to continue drug therapy at home should expect home care services to teach appropriate administration of drug therapy in the client’s home. The client is being discharged to the home and not to rehabilitation or to a skilled nursing facility. Outpatient therapy is not identified as a method for continuing antibiotic therapy with an infusion device.

Which type of immunity will clients acquire through immunizations with live or killed vaccines?
1
Natural active immunity
2
Artificial active immunity
3
Natural passive immunity
4
Artificial passive immunity

2 Artificial active immunity is acquired through immunization with live or killed vaccines. Natural active immunity is acquired when there is natural contact with antigens through a clinical infection. Natural passive immunity is acquired through the transfer of colostrums from mother to child. Artificial passive immunity is acquired by injecting serum from an immune human.

Which dietary modifications can help improve the nutritional status of a client with acquired immunodeficiency syndrome (AIDS)?
1
Refraining from consuming fatty foods
2
Refraining from consuming frequent meals
3
Refraining from consuming high-calorie foods
4
Refraining from consuming high-protein foods

1 Many clients with AIDS become intolerant to fat due to the disease and the antiretroviral medications. Therefore the client should be instructed to refrain from consuming fatty foods. The client should be encouraged to eat small and frequent meals to improve nutritional status. High-calorie and high-protein foods are beneficial to clients with AIDS because they provide energy and build immunity.

A nurse is caring for a client with pruritic lesions from an IgE-mediated hypersensitivity reaction. Which mediator of injury is involved?
1
Histamine
2
Cytokine
3
Neutrophil
4
Macrophage

1 Histamine is one of the mediators of injury involving IgE-mediated injury that may cause pruritus. Cytokines are the mediators of injury in delayed hypersensitivity reaction. Neutrophils are involved in immune complex-mediated hypersensitivity reactions. Macrophages in tissues are involved in cytotoxic reactions.

What are the clinical manifestations of inhalation anthrax? Select all that apply.
1
Fever
2
Fatigue
3
Rhinitis
4
Dry cough
5
Sore throat

1245 Inhalation anthrax is a bacterial infection caused by Bacillus anthracis. Clinical manifestations include fever, fatigue, sore throat, and a dry cough. Rhinitis is an upper respiratory manifestation not associated with inhalation anthrax.

A child is diagnosed with hepatitis A. The client’s parent expresses concern that the other members of the family may get hepatitis because they all share the same bathroom. What is the nurse’s best reply?
1
"I suggest that you buy a commode exclusively for your child’s use."
2
"Your child may use the bathroom, but you need to use disposable toilet covers."
3
"You will need to clean the bathroom from top to bottom every time a family member uses it."
4
"All family members, including your child, need to wash their hands after using the bathroom."

4 Hepatitis A is spread via the fecal-oral route; transmission is prevented by proper hand washing. Buying a commode exclusively for the child’s use is unnecessary; cleansing the toilet and washing the hands should control the transmission of microorganisms. It is not feasible to clean "from top to bottom" each time the bathroom is used. The use of disposable toilet covers is inadequate to prevent the spread of microorganisms if the bathroom used by the child also is used by others. Hand washing by all family members must be part of the plan to prevent the spread of hepatitis to other family members.

A client expresses concern that because of supply and demand there is no vaccine available for the annual flu vaccine. What is the nurse’s best reply?
1
"It’s unfortunate, but there was such a limited supply available."
2
"There are many others who also were unable to get a flu vaccine."
3
"It doesn’t matter because the vaccine is for just one particular strain."
4
"There are other things you can do to prevent the flu, such as hand washing."

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

What should be used to clean needles and syringes between intravenous drug users (IDUs)?
1
Bleach
2
Hot water
3
Ammonia
4
Rubbing alcohol

1 Intravenous drug users (IDUs) should be instructed to fill syringes with household bleach and shake the syringe for 30 to 60 seconds. Hot water, ammonia, or rubbing alcohol are not used to disinfect used syringes.

Which organism causes malaria?
1
Vibrio
2
Sporozoa
3
Ringworm
4
Spirochetes

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

A nurse is teaching a health class about human immunodeficiency virus (HIV). Which basic methods are used to reduce the incidence of HIV transmission? Select all that apply.
1
Using condoms
2
Using separate toilets
3
Practicing sexual abstinence
4
Preventing direct casual contacts
5
Sterilizing the household utensils

13 HIV is found in body fluids such as blood, semen, vaginal secretions, breast milk, amniotic fluid, urine, feces, saliva, tears, and cerebrospinal fluid. Therefore a client should use condoms to prevent contact between the vaginal mucus membranes and semen. Practicing sexual abstinence is the best method to prevent transmission of the virus. The HIV virus is not transmitted by sharing the same toilet facilities, casual contacts such as shaking hands and kissing, or by sharing the same household utensils.

A client’s sputum smears for acid-fast bacilli (AFB) are positive, and transmission-based airborne precautions are prescribed. What should the nurse teach visitors to do?
1
Put on a gown and gloves.
2
Wear a particulate respirator mask.
3
Avoid touching objects in the client’s room.
4
Limit contact with the client’s nonexposed family members.

2 Tubercle bacilli are transmitted through air currents; therefore personal protective equipment, such as a particulate respirator that filters out organisms as small as 1 µm, is necessary. Gowns and gloves are not necessary. Tuberculosis is spread by airborne microorganisms; gloves are necessary only when touching articles contaminated with respiratory secretions. It is only necessary to avoid contact with objects in the client’s room that are contaminated with respiratory secretions. Limiting contact with the client’s nonexposed family members is unnecessary.

A client is concerned about contracting malaria while visiting relatives in Southeast Asia. What should the nurse teach the client to avoid to prevent malaria?
1
Mosquito bites
2
Untreated water
3
Undercooked food
4
Overpopulated areas

1 Malaria is caused by the protozoan Plasmodium falciparum, which is carried by mosquitoes. Avoiding untreated water, undercooked food, and overpopulated areas will not prevent protozoa from entering the bloodstream.

Which laboratory test will be elevated in a client with inflammatory arthritis?
1
Leukocyte count
2
Hemoglobin and hematocrit
3
Blood urea nitrogen and creatinine
4
Erythrocyte sedimentation rate (ESR)

4 The erythrocyte sedimentation rate (ESR) measures the rate at which red blood cells fall through plasma. This rate is most significantly affected by an increased number of acute-phase reactants, which occur with inflammation. An elevated ESR (>20 mm/hr) indicates inflammation or infection somewhere in the body. The ESR is chronically elevated with inflammatory arthritis. Leukocytes will be elevated when a bacterial infection is present. Hemoglobin and hematocrit are not used to determine the presence of inflammation. Blood urea nitrogen and creatinine levels are used to determine renal function.

What finding in the client is a sign of allergic rhinitis?
1
Presence of high-grade fever
2
Reduced breathing through the mouth
3
Presence of pinkish nasal discharge
4
Reduced transillumination on the skin over the sinuses

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

Which organism is responsible for causing dermatitis related to a sexually transmitted infection?
1
Phthirus pubis
2
Candida albicans
3
Campylobacter jejuni
4
Ureaplasma urealyticum

1 Phthirus pubis is responsible for dermatitis related to sexually transmitted infections. Candida albicans may lead to vulvovaginitis. Campylobacter jejuni may cause proctitis. Ureaplasma urealyticum may cause salpingitis, infertility, reproductive loss, and ectopic pregnancies.

Which intervention is most likely to decrease mortality in the septic client?
1
Oxygen
2
Antibiotics
3
Vasopressors
4
Intravenous fluids

2 Of the interventions listed, administering antibiotics is the only intervention that fights the source of the problem. Intravenous fluids, oxygen, and vasopressors are necessary, but are designed to sustain the body until the antibiotic can kill the pathogen.

A nurse is counseling a client who has gonorrhea. What additional fact about gonorrhea, besides the fact that it is highly infectious, should the nurse teach this client?
1
It is easily cured.
2
It occurs very rarely.
3
It can produce sterility.
4
It is limited to the external genitalia.

3 Inflammation associated with gonorrhea may lead to destruction of the epididymis in males and tubal mucosal destruction in females, causing sterility. Many gonococci have become penicillin resistant and difficult to treat. Gonorrhea is a common sexually transmitted infection. Neisseria gonorrhoeae will invade internal structures, particularly the epididymis in males and the fallopian tubes in females.

What causes medications used to treat AIDS to become ineffective?
1
Taking the medications 90% of the time
2
Missing doses of the prescribed medications
3
Taking medications from different classifications
4
Developing immune reconstitution inflammatory syndrome (IRIS)

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

What type of hypersensitivity reaction is the cause of systemic lupus erythematosus?
1
Type I
2
Type II
3
Type III
4
Type IV

3 Systemic lupus erythematosus is an example of an immune complex-mediated, or type III, hypersensitive reaction. Anaphylaxis is an example of a type I or immediate hypersensitive reaction. Cytotoxic or type II hypersensitive reactions can result in conditions such as myasthenia gravis and Goodpasture syndrome. Graft rejection and sarcoidosis are conditions that are caused by delayed or type IV hypersensitivity reactions.

A chronically ill, older client tells the home care nurse that the daughter with whom the client lives seems run-down and disinterested in her own health, as well as the health of her children, who are 5, 7, and 12 years old. The client tells the nurse that the daughter coughs a good deal and sleeps a lot. Why is it important that the nurse pursue the daughter’s condition for potential case findings?
1
Tuberculosis has been rising dramatically in the general population.
2
Older adults with chronic illness are more susceptible to tuberculosis.
3
There is a high incidence of tuberculosis in children less than 12 years of age.
4
Death from tuberculosis has been generally on the decrease in the United States (Canada).

2 The client’s chronic illness and older age increase vulnerability; the daughter’s condition should be explored in greater detail. Tuberculosis is only one of many potential causes of the daughter’s clinical condition. Children who have not yet reached puberty and adolescence have the lowest incidence of tuberculosis. Morbidity and mortality resulting from tuberculosis are increasing, not decreasing.

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