A client is hospitalized for an infected decubitus ulcer of the sacral area. The physician is planning to remove the dead and damaged tissue. What type of procedure will the nurse prepare the client for?

A client is hospitalized for an infected decubitus ulcer of the sacral area. The physician is planning to remove the dead and damaged tissue. What type of procedure will the nurse prepare the client for?

a) Administration of filgrastim (Neupogen)
b) Application of a dry dressing
c) Debridement
d) Inject antibiotics into the wound

Answer: C

The infection control nurse collects data that indicates an increase in the number of clients in the hospital with multidrug-resistant infections. What priority education should healthcare providers receive?

The infection control nurse collects data that indicates an increase in the number of clients in the hospital with multidrug-resistant infections. What priority education should healthcare providers receive?

a) Emptying trash cans immediately in client's rooms
b) Hand hygiene
c) Administering antibiotics to all clients prophylactically
d) Using contact precautions on all clients in the hospital

Answer: B

A client is diagnosed with a viral illness and requests an antibiotic to "cure" his illness. When the request is refused by the physician, the client states to the nurse, "I will never get better."What is the best response by the nurse?

A client is diagnosed with a viral illness and requests an antibiotic to "cure" his illness. When the request is refused by the physician, the client states to the nurse, "I will never get better."What is the best response by the nurse?

a) "You need to think positively, and you will get better soon."
b) "Taking antibiotics when you don't need them will make you sick."
c) "I will speak with the physician again. You will only get better while taking an antibiotic."
d) "Prescribing antibiotics for a viral infection may result in drug-resistant bacteria."

Answer: D

You are a school nurse teaching a health class about the chain of infection in the transmission of sexually transmitted diseases (STDs). A student asks you which part of the chain of infection can be missing when transmission occurs. What would be your best answer?

You are a school nurse teaching a health class about the chain of infection in the transmission of sexually transmitted diseases (STDs). A student asks you which part of the chain of infection can be missing when transmission occurs. What would be your best answer?

a) "Not everyone is susceptible to STDs, but they still get them."
b) "STDs can be gotten from bed linens and toilet seats, so you don't really need a reservoir."
c) "You can be missing any part of the chain of infection except the infectious agent."
d) "All parts of the chain of infection have to be present for the disease to be passed to another human."

Answer: D

You work in a long-term care unit. In the last two weeks, more than half the clients on your unit have been diagnosed with gastroenteritis. What is the most likely reason?

You work in a long-term care unit. In the last two weeks, more than half the clients on your unit have been diagnosed with gastroenteritis. What is the most likely reason?

a) The clients are in too small an area, so they pass around diseases.
b) The infection is being transmitted by healthcare personnel.
c) The visitors brought the disease into the unit.
d) The clients don't wash their hands after going to the bathroom.

Answer: B

A client is suspected of sepsis from a postsurgical incision infection. What characteristic of sepsis would the nurse recognize? Select all that apply.

A client is suspected of sepsis from a postsurgical incision infection. What characteristic of sepsis would the nurse recognize? Select all that apply.

a) Temperature of 102°F
b) Heart rate of 120 beats/minute
c) Blood pressure of 120/80 mm Hg
d) Respiratory rate of 24 breaths/minute
e) PaCO2 of 42 mm Hg

Answer: A, B & D.

A 36-year-old patient is in the clinic for an annual physical. The patient asks the nurse "should I get a flu shot." Which of the following is the best response by the nurse?

A 36-year-old patient is in the clinic for an annual physical. The patient asks the nurse "should I get a flu shot." Which of the following is the best response by the nurse?

a) "Do you have any chronic illnesses?"
b) "No, you are not in the age range for the flu shot."
c) "The flu shot is recommended for people over 6 months of age."
d) "Only if you work around children or the elderly."

Answer: C

During flu season, you are teaching clients at your clinic about the chain of infection. Which of the following are considered "links" in this chain? Select all that apply.

During flu season, you are teaching clients at your clinic about the chain of infection. Which of the following are considered "links" in this chain? Select all that apply.

a) Infectious agent
b) Fomites
c) Portal of entry
d) Virulence
e) Susceptible host

Answer: A, C & E.

A client you are caring for has developed a bladder infection while in the hospital. The client has had a Foley catheter for two weeks. The client's family asks you how the client got this infection. What would be your best response?

A client you are caring for has developed a bladder infection while in the hospital. The client has had a Foley catheter for two weeks. The client's family asks you how the client got this infection. What would be your best response?

a) "People in hospitals are often more susceptible to infections because they are already ill and they are exposed to germs while they are in the hospital."
b) "People in hospitals sometimes exhibit signs of infections they had before being admitted."
c) "Sometimes people in hospitals get exposed to microorganisms that their visitors bring in."
d) "People in hospitals are surrounded by infectious agents, so they can get infections they didn't have before being admitted."

Answer: A

A patient is placed in isolation for suspected tuberculosis. Which of the following actions should the nurse take when entering the patient's room?

A patient is placed in isolation for suspected tuberculosis. Which of the following actions should the nurse take when entering the patient's room?

a) Wear an N-95 respirator.
b) Apply a face mask with an eye shield.
c) Minimize verbal interactions.
d) Leave the door open when in the room.

Answer: A

How often should women diagnosed with human papillomavirus (HPV) have Pap smears?

How often should women diagnosed with human papillomavirus (HPV) have Pap smears?

a) Yearly
b) Every 3 years
c) Every 6 months
d) Every 2 years

Answer: A

A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?

A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?

a) Foul-smelling discharge from the penis
b) Rashes on the palms of the hands and soles of the feet
c) Cauliflower-like warts on the penis
d) Painful red papules on the shaft of the penis

Answer: A

Which condition of generally requires the identification and treatment of sexual partners?

Which condition of generally requires the identification and treatment of sexual partners?

a) Bartholinitis
b) Candidiasis
c) Chlamydia trachomatis infection
d) Endometriosis

Answer: C

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of:

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of:

a) why the disease is transmittable only when visible lesions are present.
b) the importance of informing his partners of the disease.
c) the need for the use of petroleum products.
d) the option of disregarding safer-sex practices now that he's already infected.

Answer: B

Which of the following nursing instructions is most important for the nurse to emphasize to the client with a new HSV-2 diagnosis?

Which of the following nursing instructions is most important for the nurse to emphasize to the client with a new HSV-2 diagnosis?

a) You must inform all sexual partners.
b) Wear loose underwear to promote air circulation.
c) Keep lesions dry with alcohol or peroxide.
d) Use a condom during sexual activity.

Answer: A

The nurse is caring for a patient diagnose with severe acute respiratory syndrome (SARS). A family member asks what causes SARS. Which of the following responses by the nurse is accurate?

The nurse is caring for a patient diagnose with severe acute respiratory syndrome (SARS). A family member asks what causes SARS. Which of the following responses by the nurse is accurate?

a) "Shigella"
b) "Salmonella"
c) "E. coli"
d) "Coronavirus"

Answer: D

A client with a Staphylococcus aureus infection present in a sacral pressure ulcer has received treatment with three courses of antibiotics without eliminating the infection. What does the nurse understand has occurred with the client?

A client with a Staphylococcus aureus infection present in a sacral pressure ulcer has received treatment with three courses of antibiotics without eliminating the infection. What does the nurse understand has occurred with the client?

a) Staphylococcus aureus is a fungus and must be treated with an antifungal agent, not an antibiotic.
b) The client has a multidrug-resistant strain of bacteria.
c) The client has been misdiagnosed and has another type of microorganism present.
d) Staphylococcus aureus cannot be treated by antibiotics.

Answer: B

The six elements necessary for infection include a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from a reservoir to host, a susceptible host, in addition to which of the following?

The six elements necessary for infection include a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from a reservoir to host, a susceptible host, in addition to which of the following?

a) Mode of exit from the host
b) Mode of entry to host
c) Latent time period
d) Virulent host

Answer: B

Which intervention should a nurse perform after administering an injection of penicillin to a patient with an infection?

Which intervention should a nurse perform after administering an injection of penicillin to a patient with an infection?

a) Encourage the patient to deep breathe.
b) Make the patient wait at least 30 minutes before leaving the health care facility.
c) Advise the patient to massage the muscle used for the injection for 10 minutes.
d) Instruct the patient to lie flat for 6 hours once home.

Answer: B

When a hospitalized patient is in contact precautions, which of the following responses is necessary?

When a hospitalized patient is in contact precautions, which of the following responses is necessary?

a) The patient should be in a room with negative air pressure.
b) Masks are worn when caring for the patient.
c) The patient should be placed in a private room when possible.
d) The patient's door should be closed.

Answer: C

A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has gonorrhea?

A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has gonorrhea?

a) Diffuse skin rash
b) Painless chancre
c) Dry, hacking cough
d) Burning on urination

Answer: D

Which of the following is the most effective treatment for trichomoniasis?

Which of the following is the most effective treatment for trichomoniasis?

a) Doxycycline (Adoxa)
b) Azithromycin (Zithromax)
c) Metronidazole (Flagyl)
d) Penicillin G benzathine

Answer: C

A nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk of contracting another sexually transmitted disease (STD). The nurse should instruct the client to:

A nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk of contracting another sexually transmitted disease (STD). The nurse should instruct the client to:

a) wear a condom every time he has intercourse.
b) consider intercourse safe if his partner has no visible discharge, lesions, or rashes.
c) ask all potential sexual partners if they have an STD.
d) expect to limit the number of sexual partners to less than five over his lifetime.

Answer: A

Painless chancre lesions are associated with which systemic disease?

Painless chancre lesions are associated with which systemic disease?

a) Urticaria
b) Syphilis
c) Kaposi's sarcoma
d) Psoriasis

Answer: B

The nurse is working in the labor and delivery suite when a client with active herpes simplex virus type 2 (HSV-2) appears in active labor. Which adjustment in the plan of care will the nurse prepare for?

The nurse is working in the labor and delivery suite when a client with active herpes simplex virus type 2 (HSV-2) appears in active labor. Which adjustment in the plan of care will the nurse prepare for?

a) Prepare for a cesarean section.
b) Administer an intravenous antibiotic to the mom while in labor.
c) Complete a full assessment of the newborn on delivery.
d) Place an antibacterial ointment on the mother's lesions.

Answer: A

Which of the following is the gold standard for herpes simplex virus (HSV) diagnosis?

Which of the following is the gold standard for herpes simplex virus (HSV) diagnosis?

a) Shave biopsy
b) Punch biopsy
c) Culture
d) Excisional biopsy

Answer: C

The parent of a child diagnosed with chickenpox asks when the child can go to play group again. What is the best response by the nurse?

The parent of a child diagnosed with chickenpox asks when the child can go to play group again. What is the best response by the nurse?

a) "When the vesicles and pustules have crusted."
b) "When the fever disappears."
c) "Two days after the rash appears."
d) "When the rash is changing into vesicles, and pustules appear."

Answer: A

Which organism is responsible for impetigo?

Which organism is responsible for impetigo?

a) Clostridium difficile
b) Bacillus anthracis
c) Staphylococcus aureus
d) Histoplasma capsulatum

Answer: C

Which statement made by a client with a chlamydial infection indicates an understanding of the potential complications?

Which statement made by a client with a chlamydial infection indicates an understanding of the potential complications?

a) "I'm glad I'm not pregnant; I'd hate to have a malformed baby from this disease."
b) "I hope this medicine works before this disease gets into my urine and destroys my kidneys."
c) "If I had known a diaphragm would put me at risk for this, I would have taken birth control pills."
d) "I need to treat this infection so it doesn't spread into my pelvis because I want to have children someday."

Answer: D

A family member of a client in a long-term care facility asks the nurse why he cannot insert a catheter so the client will not develop skin breakdown from being wet. What should the explanation include when the nurse responds to the family member?

A family member of a client in a long-term care facility asks the nurse why he cannot insert a catheter so the client will not develop skin breakdown from being wet. What should the explanation include when the nurse responds to the family member?

a) The invasive nature of the catheter provides a portal for infection.
b) Catheters are no longer used for treatment of incontinence.
c) Older adult residents are able to have catheters inserted if the family requests them.
d) If a catheter is inserted, it must be flushed with normal saline daily.

Answer: A

The nurse is observing a nursing assistant leave the room of patient diagnosed with Clostridium difficile (C. difficile) without washing hands. Which of the following is the highest priority action the nurse should follow?

The nurse is observing a nursing assistant leave the room of patient diagnosed with Clostridium difficile (C. difficile) without washing hands. Which of the following is the highest priority action the nurse should follow?

a) Provide written documentation about the incident.
b) Report the nursing assistant to the nurse manager.
c) Have the nursing assistant wash hands with soap and water.
d) Teach the nursing assistant about the chain of infection.

Answer: C

The nurse is instructing the family on home care of a patient with shingles. The family member asks if their teenage children should stay in a different room. What is the best response by the nurse?

The nurse is instructing the family on home care of a patient with shingles. The family member asks if their teenage children should stay in a different room. What is the best response by the nurse?

a) "Have they had chickenpox or the varicella vaccine?"
b) "Yes, shingles is highly contagious."
c) "Because the patient is in quite a bit of pain, it would probably be best."
d) "No, shingles is not contagious."

Answer: A

A nurse is having a yearly employee tuberculin skin test. Which skin test results would indicate a positive result?

A nurse is having a yearly employee tuberculin skin test. Which skin test results would indicate a positive result?

a) An induration of 12mm
b) An induration of 4 mm
c) An induration of less than 1 mm
d) An uneven erythemic area

Answer: A

The nurse is completing a community education via a pamphlet on sexually transmitted diseases. Which key point would the nurse place in bold letters?

The nurse is completing a community education via a pamphlet on sexually transmitted diseases. Which key point would the nurse place in bold letters?

a) Many people are asymptomatic and show no symptoms contributing to the spread of the disease.
b) Common age-groups for clients with sexually transmitted diseases are in their late teens and 20s.
c) Some sexually transmitted diseases can cause infertility caused by scarring of reproductive organs.
d) Some sexually transmitted diseases can be transmitted to newborns through the birth canal.

Answer: A

A client with syphilis is to receive penicillin G benzathine 1.2 million units IM as a single dose. The pharmacy supplies the medication, which is labeled as 2.4 million units/4 mL. How many milliliters would the nurse administer? Enter the number ONLY.

A client with syphilis is to receive penicillin G benzathine 1.2 million units IM as a single dose. The pharmacy supplies the medication, which is labeled as 2.4 million units/4 mL. How many milliliters would the nurse administer? Enter the number ONLY.

Answer: 2

The following outcome appears on the plan of care for a client with genital herpes: "Client demonstrates knowledge about measures to reduce the risk of transmission and recurrences." Which of the following, if reported by the client, would support achievement of this outcome?

The following outcome appears on the plan of care for a client with genital herpes: "Client demonstrates knowledge about measures to reduce the risk of transmission and recurrences." Which of the following, if reported by the client, would support achievement of this outcome? 

a) Cleans lesions with strong anti-bacaterial soap
b) Applies occlusive dressings to lesions
c) Consistently uses condoms with sexual activity
d) Avoids sexual activity when lesions are present

Answer: C

The nurse observes a physician leave the room of a patient in isolation for Clostridium difficile (C. difficile). The physician uses the alcohol-based hand sanitizer hanging on the wall to wash her hands and leaves the door open. Which of the following actions should the nurse take?

The nurse observes a physician leave the room of a patient in isolation for Clostridium difficile (C. difficile). The physician uses the alcohol-based hand sanitizer hanging on the wall to wash her hands and leaves the door open. Which of the following actions should the nurse take?

a) Close the door to the room.
b) No action is needed. The physician was following isolation protocol.
c) Ask the physician to wash her hands with soap and water.
d) Report the observation to the infection control department.

Answer: C

The nurse is required to manage and minimize sepsis in a patient with severe infection. Which of the following would be an appropriate nursing intervention?

The nurse is required to manage and minimize sepsis in a patient with severe infection. Which of the following would be an appropriate nursing intervention?

a) Limit the patient's food intake
b) Limit the patient's fluid intake
c) Monitor the patient's vital signs
d) Encourage the patient to perform mild activity

Answer: C

Pelvic infection is most commonly caused by which of the following?

Pelvic infection is most commonly caused by which of the following?

a) Insertion of intrauterine device
b) Sexual transmission
c) Hysteroscopy
d) Surgical abortion

Answer: B

Nursing students are reviewing information about infectious diseases and events associated with infection. Students demonstrate an understanding of the information when they identify the incubation period as which of the following?

Nursing students are reviewing information about infectious diseases and events associated with infection. Students demonstrate an understanding of the information when they identify the incubation period as which of the following? 

a) Time between exposure and onset of symptoms
b) Presence of microorganisms without the host interacting with them
c) Process of the host shedding the microorganisms to another
d) State in which the host displays a decrease in wellness

Answer: A

A nurse is caring for a male client with gonorrhea who's receiving ceftriaxone (Rocephin) and doxycycline (Vibramycin). The client asks the nurse why he's receiving two antibiotics. How should the nurse respond?

A nurse is caring for a male client with gonorrhea who's receiving ceftriaxone (Rocephin) and doxycycline (Vibramycin). The client asks the nurse why he's receiving two antibiotics. How should the nurse respond?

a) "Many people infected with gonorrhea are infected with chlamydia as well."
b) "The combination of these two antibiotics reduces the risk of reinfection."
c) "Because there are many resistant strains of gonorrhea, more than one antibiotic may be required for successful treatment."
d) "This combination of medications will eradicate the infection faster than a single antibiotic."

Answer: A

A client admitted with bacterial meningitis must be transported to the radiology department for a repeat computed tomography scan of the head. His level of consciousness is decreased, and he requires nasopharyngeal suctioning before transport. Which infection control measures are best when caring for this client?

A client admitted with bacterial meningitis must be transported to the radiology department for a repeat computed tomography scan of the head. His level of consciousness is decreased, and he requires nasopharyngeal suctioning before transport. Which infection control measures are best when caring for this client?

a) Put on gloves, a mask, and eye protection during suctioning, and then apply a mask to the client's face for transport.
b) Take no special precautions for this client.
c) Use standard precautions, which require gloves for suctioning.
d) Put on gloves, a mask, and eye protection.

Answer: A

A nurse implements aseptic technique as a means to break the chain of infection at which element?

A nurse implements aseptic technique as a means to break the chain of infection at which element?

a) Portal of entry
b) Portal of exit
c) Means of transmission
d) Reservoir

Answer: A

Patients who have had the pelvic inflammatory disease (PID) are prone to which of the following complications?

Patients who have had the pelvic inflammatory disease (PID) are prone to which of the following complications?

a) Thrombophlebitis
b) Ectopic pregnancy
c) Inguinal lymphadenopathy
d) Bacteremia

Answer: B

A client is admitted with bacterial meningitis. Which hospital room is the best choice for this client?

A client is admitted with bacterial meningitis. Which hospital room is the best choice for this client?

a) An isolation room three doors from the nurses' station
b) A private room down the hall from the nurses' station
c) A two-bed room with a client who previously had bacterial meningitis
d) A semiprivate room with a client who has viral meningitis

Answer: A

Which of the following is the medication of choice for early syphilis?

Which of the following is the medication of choice for early syphilis?

a) Doxycycline
b) Rocephin
c) Tetracycline
d) Penicillin G benzathine

Answer: D

A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis?

A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis?

a) A painless genital ulcer that appeared about 3 weeks after unprotected sex
b) Copper-colored macules on the palms and soles that appeared after a brief fever
c) Patchy hair loss and red, broken skin involving the scalp, eyebrows, and beard areas
d) One or more flat, wartlike papules in the genital area that are sensitive to touch

Answer: A

The nurse is completing the admission assessment on a patient with renal failure. The patient states, "I was diagnosed with impetigo yesterday." Which of the following is the appropriate nursing intervention?

The nurse is completing the admission assessment on a patient with renal failure. The patient states, "I was diagnosed with impetigo yesterday." Which of the following is the appropriate nursing intervention?

a) Initiate contact isolation protocol.
b) Educate the patient about wearing a mask outside of the assigned room.
c) Transfer the patient to a negative pressure room.
d) Obtain the name of the antiviral medication used to treat the impetigo.

Answer: A

Which statement reflects what is known about the Ebola and Marburg viruses?

Which statement reflects what is known about the Ebola and Marburg viruses?

a) The diagnosis should be considered in a patient who has a febrile, hemorrhagic illness after traveling to Asia or Africa.
b) Treatment during the acute phase includes administration of penicillin and ventilator and dialysis support.
c) The viruses are usually transmitted by airborne exposure.
d) Symptoms include severe lower abdominal pain, nausea, vomiting, and dehydration.

Answer: A

You are caring for a client with an impaired immune system. You are concerned about the client acquiring a nosocomial infection. What intervention would help nurses control nosocomial infections?

You are caring for a client with an impaired immune system. You are concerned about the client acquiring a nosocomial infection. What intervention would help nurses control nosocomial infections?

a) Use proper antibiotics.
b) Apply principles of medical and surgical asepsis.
c) Ensure childhood immunizations.
d) Maintain a proper diet and exercise regimen.

Answer: B

Which of the following terms refers to a state of microorganisms being present within a host without causing host interference or interaction?

Which of the following terms refers to a state of microorganisms being present within a host without causing host interference or interaction?

a) Infection
b) Susceptible
c) Colonization
d) Immune

Answer: C

The nurse is caring for a patient in the hospital who is receiving a vitamin D supplement. What does the nurse understand is the importance of supplementation with this vitamin? (Select all that apply.)

The nurse is caring for a patient in the hospital who is receiving a vitamin D supplement. What does the nurse understand is the importance of supplementation with this vitamin? (Select all that apply.)

a) Vitamin D deficiency is associated with increased risk of inflammatory disorders.
b) Vitamin D deficiency is associated with increased risk of congenital anomalies.
c) Vitamin D deficiency is associated with increased risk of common cancers.
d) Vitamin D deficiency is associated with increased risk of autoimmune disease.
e) Vitamin D deficiency is associated with increased risk of celiac disease.

Answer: A C D

The nurse is performing a physical assessment for a patient at the clinic and palpates enlarged inguinal lymph nodes on the left. What should the nurse document? (Select all that apply.)

The nurse is performing a physical assessment for a patient at the clinic and palpates enlarged inguinal lymph nodes on the left. What should the nurse document? (Select all that apply.)

a) Size
b) Temperature
c) Consistency
d) Reports of tenderness
e) Location

Answer: A C D E

A nurse is teaching a patient about the side effects of ibuprofen (Motrin). The patient's teaching is determined to be effective based on which of the following patient statements explaining the drug's effect on the immune system?

A nurse is teaching a patient about the side effects of ibuprofen (Motrin). The patient's teaching is determined to be effective based on which of the following patient statements explaining the drug's effect on the immune system?

a) "Motrin can cause hemolytic anemia, which will make me feel tired and short of breath."
b) "Motrin can cause pancytopenia, which is a decrease in all of my blood cells."
c) "Motrin can cause neutropenia, which can increase my risk of infection."
d) "Motrin can cause thrombocytopenia; I will need to watch for bruising and bleeding."

Answer: C

Proteins formed when cells are exposed to viral or foreign agents that are capable of activating other components of the immune system are referred to as

Proteins formed when cells are exposed to viral or foreign agents that are capable of activating other components of the immune system are referred to as

a) antigens.
b) interferons.
c) antibodies.
d) complements.

Answer: B

The nursing instructor is discussing the development of human immunodeficiency disease (HIV) with the students. What should the instructor inform the class about helper T cells?

The nursing instructor is discussing the development of human immunodeficiency disease (HIV) with the students. What should the instructor inform the class about helper T cells?

a) They are activated on recognition of antigens and stimulate the rest of the immune system.
b) They have the ability to decrease B-cell production.
c) They are responsible for recognizing antigens from previous exposure and mounting an immune response.
d) They attack the antigen directly by altering the cell membrane and causing cell lysis.

Answer: A

Which of the following responses identifies a role of T lymphocytes?

Which of the following responses identifies a role of T lymphocytes?

a) Bacterial phagocytosis and lysis
b) Allergic hay fever and asthma
c) Transplant rejection
d) Anaphylaxis

Answer: C

Which type of cells destroys antigens already coated with antibody?

Which type of cells destroys antigens already coated with antibody?

a) Suppressor T-cell
b) Null
c) Memory T-cell
d) Natural killer (NK)

Answer: B

During a 12-month well-baby visit, a mother reports that the baby has been breast-fed since birth and has never been ill. She is trying to convince her sister who is currently pregnant to breast-feed also and asks the nurse about the benefits of breast-feeding. The nurse explains the immune benefits of breast-feeding and provides the mother with pamphlets. The nurse determines the patient understands the teaching based on which of the following patient statements?

During a 12-month well-baby visit, a mother reports that the baby has been breast-fed since birth and has never been ill. She is trying to convince her sister who is currently pregnant to breast-feed also and asks the nurse about the benefits of breast-feeding. The nurse explains the immune benefits of breast-feeding and provides the mother with pamphlets. The nurse determines the patient understands the teaching based on which of the following patient statements?

a) "Breast-feeding is beneficial because the dominant antibody IgA in breast milk acts by functioning as an antigen receptor in the mucosal membranes."
b) "Breast-feeding is beneficial because the dominant antibody IgM in breast milk is the first immunoglobulin produced in response to bacterial and viral infections."
c) "Breast-feeding is beneficial because T lymphocytes found in breast milk are primarily responsible for cellular immunity."
d) "Breastfeeding is beneficial because the dominant antibody IgG in breast milk assumes a major role in bloodborne and tissue infections."

Answer: A

Which of the following is an action of cytotoxic T cells?

Which of the following is an action of cytotoxic T cells?

a) Decrease B cell activity to a level at which the immune system is compatible with life
b) Attack of foreign invaders (antigens) directly
c) Production of circulating antibodies
d) Lyse cells infected with virus

Answer: D

An elderly client is diagnosed with cancer. While reviewing age-related changes in the immune system, the nurse identifies which of the following as having contributed to this client's condition?

An elderly client is diagnosed with cancer. While reviewing age-related changes in the immune system, the nurse identifies which of the following as having contributed to this client's condition?

a) Impaired ciliary action from exposure to environmental toxins
b) Decreased sensation and slowing of reflexes
c) Failure of lymphocytes to recognize mutant cells
d) Failure of immune system to differentiate "self" from "non-self"

Answer: C

A nurse is taking a health history from a new client, which includes asking about a history of blood transfusions. This is important for which of the following reasons?

A nurse is taking a health history from a new client, which includes asking about a history of blood transfusions. This is important for which of the following reasons?

a) Blood products cause lower antibody titers.
b) Blood products cause a high risk for exposure to HIV.
c) Blood products cause a high risk for hepatitis B.
d) Exposure to foreign antigens may cause altered immune function.

Answer: D

A nurse is taking the health history of a newly admitted client and asks for a list of the client's current medications. Which of the following medication classifications would NOT place the client at risk for impaired immune function?

A nurse is taking the health history of a newly admitted client and asks for a list of the client's current medications. Which of the following medication classifications would NOT place the client at risk for impaired immune function?

a) Antineoplastic agents
b) Antimetabolites
c) Inotropics
d) Adrenal corticosteroids

Answer: C

A nurse is working in a pediatric clinic. After giving a hepatitis B immunization to an infant, the mother asks what kind of protection this provides for her child. The correct response is which of the following?

A nurse is working in a pediatric clinic. After giving a hepatitis B immunization to an infant, the mother asks what kind of protection this provides for her child. The correct response is which of the following?

a) Active acquired immunity, which is temporary
b) Passive acquired immunity, which is temporary
c) Passive acquired immunity, which lasts many years or a lifetime
d) Active acquired immunity, which lasts many years or a lifetime

Answer: D

Which of the following is a humoral immune response?

Which of the following is a humoral immune response?

a) Intracellular infections
b) Anaphylaxis
c) Transplant rejection
d) Delayed hypersensitivity

Answer: B

A mother has brought her child to the clinic for a wellness check. While talking with the nurse, the mother asks the nurse to suggest a diet that will maximize the immune function of her growing children. What dietary pattern should the nurse suggest?

A mother has brought her child to the clinic for a wellness check. While talking with the nurse, the mother asks the nurse to suggest a diet that will maximize the immune function of her growing children. What dietary pattern should the nurse suggest?

a) Diet rich in amino acids and essential fatty acids
b) Diet rich in iron, zinc, and vitamin E
c) Diet rich in potassium, magnesium, and sodium
d) Moderate diet that is balanced and varied

Answer: D

A 64-year-old male client, who leads a sedentary lifestyle, and a 31-year-old female client, who has a very stressful and active lifestyle, require a vaccine against a particular viral disorder. As the nurse, you would know that in one of these clients, the vaccine will be less effective. In which client is the vaccine more likely to be less effective and why?

A 64-year-old male client, who leads a sedentary lifestyle, and a 31-year-old female client, who has a very stressful and active lifestyle, require a vaccine against a particular viral disorder. As the nurse, you would know that in one of these clients, the vaccine will be less effective. In which client is the vaccine more likely to be less effective and why?

a) The female client because of her age
b) The male client because of his lifestyle
c) The male client because of his age
d) The female client because of her lifestyle

Answer: C

Which of the following is a process in which the antigen-antibody molecule is coated with a sticky substance that facilitates phagocytosis?

Which of the following is a process in which the antigen-antibody molecule is coated with a sticky substance that facilitates phagocytosis?

a) Immunoregulation
b) Agglutination
c) Opsonization
d) Apoptosis

Answer: C

A client is diagnosed with rheumatoid arthritis, an autoimmune disorder. When teaching the client and family about autoimmune disorders, the nurse should provide which information?

A client is diagnosed with rheumatoid arthritis, an autoimmune disorder. When teaching the client and family about autoimmune disorders, the nurse should provide which information?

a) Autoimmune disorders include connective tissue (collagen) disorders.
b) Autoimmune disorders are distinctive, aiding differential diagnosis.
c) Clients with autoimmune disorders may have false-negative but not false-positive serologic tests.
d) Advanced medical intervention can cure most autoimmune disorders.

Answer: A

An older adult has developed a sacral pressure ulcer. What should the nurse assess in order to ensure adequate wound healing and prevent poor outcomes for this patient? (Select all that apply.)

An older adult has developed a sacral pressure ulcer. What should the nurse assess in order to ensure adequate wound healing and prevent poor outcomes for this patient? (Select all that apply.)

a) Nutritional status
b) The number of carbohydrates the patient ingests
c) Quality of food ingested
d) Caloric intake
e) The patient's ability to perform her own wound care

Answer: A, D & C.

Which type of cells is capable of directly killing invading organisms and producing cytokines?

Which type of cells is capable of directly killing invading organisms and producing cytokines?

a) Null lymphocytes
b) Cytotoxic T cells
c) Natural killer cells
d) Memory cells

Answer: C

The nurse is caring for a female patient who has an exacerbation of lupus erythematosus. What does the nurse understand is the reason that females tend to develop autoimmune disorders more frequently than men?

The nurse is caring for a female patient who has an exacerbation of lupus erythematosus. What does the nurse understand is the reason that females tend to develop autoimmune disorders more frequently than men?

a) Estrogen tends to enhance immunity.
b) Testosterone tends to enhance immunity.
c) Leukocytes are increased in females.
d) Androgen tends to enhance immunity.

Answer: A

Which stage of the immune response occurs when the differentiated lymphocytes function in either a humoral or a cellular capacity?

Which stage of the immune response occurs when the differentiated lymphocytes function in either a humoral or a cellular capacity?

a) Response stage
b) Recognition stage
c) Proliferation stage
d) Effector stage

Answer: A

A client will be taking the tumor necrosis factor inhibitor, infliximab (Remicade), for the treatment of rheumatoid arthritis. Prior to beginning this therapeutic regimen, what screening should the client have?

A client will be taking the tumor necrosis factor inhibitor, infliximab (Remicade), for the treatment of rheumatoid arthritis. Prior to beginning this therapeutic regimen, what screening should the client have?

a) Screening for syphilis
b) Screening for peptic ulcer disease
c) Screening for tuberculosis
d) Screening for rubella

Answer: C

Which of the following is a center for immune cell proliferation?

Which of the following is a center for immune cell proliferation?

a) Liver
b) Spleen
c) Pancreas
d) Lymph node

Answer: D

A nurse is teaching a community group about healthy lifestyles. A participant asks about how to maintain a healthy immune system. The nurse informs the group that which of the following factors will positively affect the immune system?

A nurse is teaching a community group about healthy lifestyles. A participant asks about how to maintain a healthy immune system. The nurse informs the group that which of the following factors will positively affect the immune system?

a) Poor nutritional status
b) Residential exposure to radiation
c) Rigorous, competitive exercise
d) Strong family and community connections

Answer: D

What chemical is released by cytotoxic T cells?

What chemical is released by cytotoxic T cells?

a) Lymphokine
b) Antigen
c) Antibody
d) Microphages

Answer: A

Chronic illnesses may contribute to immune system impairment in various ways. Renal failure is associated with which of the following?

Chronic illnesses may contribute to immune system impairment in various ways. Renal failure is associated with which of the following?

a) Decreased bone marrow function
b) Deficiency in circulating lymphocytes
c) Altered production of white blood cells
d) Increased incidence of infection

Answer: B

A 34-year-old man is diagnosed with chronic hepatitis C. Testing reveals that he is a candidate for treatment. The nurse anticipates that which of the following could be used to treat his condition?

A 34-year-old man is diagnosed with chronic hepatitis C. Testing reveals that he is a candidate for treatment. The nurse anticipates that which of the following could be used to treat his condition?

a) Monoclonal antibodies
b) Interferon
c) Erythropoietin
d) Interleukin-5

Answer: B

At 39 weeks' gestation, a pregnant female visits her physician for a scheduled prenatal checkup. The physician determines that the fetus has developed an infection in utero and sends the patient to an emergency C section. The patient is very concerned about the health of her unborn child. Based on the knowledge of the immune system, the delivery room nurse explains which of the following immunoglobulins that will be increased in the fetus at the time of birth and actively fighting the infection?

At 39 weeks' gestation, a pregnant female visits her physician for a scheduled prenatal checkup. The physician determines that the fetus has developed an infection in utero and sends the patient to an emergency C section. The patient is very concerned about the health of her unborn child. Based on the knowledge of the immune system, the delivery room nurse explains which of the following immunoglobulins that will be increased in the fetus at the time of birth and actively fighting the infection?

a) IgA
b) IgG
c) IgM
d) IgD

Answer: B

Which of the following adverse effects should the nurse closely monitor in a patient who takes immunosuppressive drugs?

Which of the following adverse effects should the nurse closely monitor in a patient who takes immunosuppressive drugs?

a) Depression, memory impairment, and coma
b) Respiratory or urinary system infections
c) Heart failure, infusion reactions, and life-threatening infections
d) Rheumatoid arthritis

Answer: B

T-cells can be either regulator T cells or effector T cells. Regulator T cells are made up of helper and suppressor cells. What function are helper T-cells important in?

T-cells can be either regulator T cells or effector T cells. Regulator T cells are made up of helper and suppressor cells. What function are helper T-cells important in?

a) Fighting infection
b) Activating lymphokines
c) Producing antibodies
d) Turning off the immune response

Answer: A

A client has had mumps when he was 9 years old. He had a titer prior to entering nursing school and shows immunity. What type of immunity does this reflect?

A client has had mumps when he was 9 years old. He had a titer prior to entering nursing school and shows immunity. What type of immunity does this reflect?

a) Passive immunity
b) Artificially acquired active immunity
c) Naturally acquired active immunity
d) Natural passive immunity

Answer: C

An elderly client is diagnosed with a respiratory infection. While reviewing age-related changes in the immune system, the nurse identifies which of the following as having contributed to this client's infection?

An elderly client is diagnosed with a respiratory infection. While reviewing age-related changes in the immune system, the nurse identifies which of the following as having contributed to this client's infection?

a) Decreased phagocytosis by Kupffer cells
b) Decreased sensation and slowing of reflexes
c) Impaired ciliary action from exposure to environmental toxins
d) Failure of the immune system to differentiate "self" from "non-self"

Answer: C

The nurse is caring for an older adult patient hospitalized with cellulitis of the right lower extremity. Why is it imperative that the nurse continually assess the physical and emotional status of this patient?

The nurse is caring for an older adult patient hospitalized with cellulitis of the right lower extremity. Why is it imperative that the nurse continually assess the physical and emotional status of this patient?

a) Older patients are at risk of developing dementia.
b) The patient will not respond to the antibiotic treatment as well as a younger patient would.
c) Older adult patients develop depression and suicidal tendencies when they are faced with chronic illness.
d) Early recognition and management of factors influencing immune response may decrease morbidity and mortality.

Answer: C

T-cell and B-cell lymphocytes are the primary participants in the immune response. What do they do?

T-cell and B-cell lymphocytes are the primary participants in the immune response. What do they do?

a) T-cell and B-cell lymphocytes distinguish harmful substances and ignore those natural and unique to a person.
b) T-cell and B-cell lymphocytes respond to the body's invasion by macrophages.
c) T-cell and B-cell lymphocytes react to the body's lack of B12 .
d) T-cell and B-cell lymphocytes distinguish harmful treatments from curative treatments.

Answer: A

While taking the health history of a newly admitted client, the nurse reviews general lifestyle behaviors. Which of the following would have a positive effect on the immune system?

While taking the health history of a newly admitted client, the nurse reviews general lifestyle behaviors. Which of the following would have a positive effect on the immune system?

a) Biofeedback, relaxation, and hypnosis
b) Relaxation, intense competitive exercise, and humor
c) Humor, rigorous physical stress, and biofeedback
d) Hypnosis, humor, and chronic illness

Answer: A

A client has dilated cardiomyopathy and has just found out he will be receiving a heart. What medication does the client understand that he will have to take for the duration of his life to help suppress the immune system to prevent rejection of the new heart?

A client has dilated cardiomyopathy and has just found out he will be receiving a heart. What medication does the client understand that he will have to take for the duration of his life to help suppress the immune system to prevent rejection of the new heart?

a) Etanercept (Enbrel)
b) Adalimumab (Humira)
c) Infliximab (Remicade)
d) Cyclosporine (Sandimmune)

Answer: D

Which type of cells is capable of recognizing and killing infected or stressed cells and producing cytokines?

Which type of cells is capable of recognizing and killing infected or stressed cells and producing cytokines?

a) Natural killer cells
b) Null lymphocytes
c) Cytotoxic T cells
d) Memory cells

Answer: A

The nurse is administering a skin test for detection of exposure to tuberculosis. How would the nurse determine if the client was exposed to tuberculosis?

The nurse is administering a skin test for detection of exposure to tuberculosis. How would the nurse determine if the client was exposed to tuberculosis?

a) The client will have a productive cough.
b) The injection area will become painful with in duration if the client has antibodies against the antigen.
c) The injection area will break out in a fine macular rash.
d) The injection area swells if the client has developed antibodies against the antigen.

Answer: D

Which of the following is accurate regarding acquired immunity? Select all that apply.

Which of the following is accurate regarding acquired immunity? Select all that apply.

a) Usually develops as a result of exposure to an antigen through immunization
b) A nonspecific immunity present at birth
c) Also know as innate immunity
d) An immunologic response acquired during life but not present at birth
e) Can develop by contracting a disease

Answer: A, D & E.

A child is brought to the clinic with a rash. The child is diagnosed with measles. The mother tells the nurse that she had the measles when she was a little girl. What immunity to measles develops after the initial infection?

A child is brought to the clinic with a rash. The child is diagnosed with measles. The mother tells the nurse that she had the measles when she was a little girl. What immunity to measles develops after the initial infection?

a) Naturally acquired passive immunity
b) Artificially acquired active immunity
c) Artificially acquired passive immunity
d) Naturally acquired active immunity

Answer: D

The nurse understands that which cells circulate throughout the body looking for virus-infected cells and cancer cells?

The nurse understands that which cells circulate throughout the body looking for virus-infected cells and cancer cells?

a) Interferons
b) Natural killer cells
c) Cytokines
d) Interleukins

Answer: B

Which of the following immunoglobulins assumes a major role in blood-borne and tissue infections?

Which of the following immunoglobulins assumes a major role in blood-borne and tissue infections?

a) IgG
b) IgA
c) IgM
d) IgD

Answer: A

A client has undergone a kidney transplant. The nurse is concerned about a compromised immune system in this client for which of the following reasons?

A client has undergone a kidney transplant. The nurse is concerned about a compromised immune system in this client for which of the following reasons?

a) Use of anti-rejection drugs
b) Deficient circulating antibodies
c) Excess circulating lymphocytes
d) Excess circulating hemoglobin

Answer: A

Why would it be important for the nurse to question the client about sexual practices, history of substance abuse, and his lifestyle during the interview process?

Why would it be important for the nurse to question the client about sexual practices, history of substance abuse, and his lifestyle during the interview process?

a) To determine if the client needs a referral to counseling services
b) To determine what type of personality the client has
c) To find out if the client will be compliant with therapeutic treatments
d) To determine if the client has practices that put him at risk for acquired immunodeficiency syndrome (AIDS)

Answer: D

A 38-year old female has recently been diagnosed with rheumatoid arthritis. She is also receiving further testing for disorders of the immune system. She works as an aide at a facility which cares for children infected with AIDS. Which of the following factors will hold the greatest implications for the client's assessment? Select all that apply.

A 38-year old female has recently been diagnosed with rheumatoid arthritis. She is also receiving further testing for disorders of the immune system. She works as an aide at a facility which cares for children infected with AIDS. Which of the following factors will hold the greatest implications for the client's assessment? Select all that apply.

a) Her diet
b) Her age
c) Her work environment
d) Her home environment
e) Her history of immunizations and allergies
f) Her use of other drugs

Answer: C, E & F.

A 25-year-old man receives a knife wound to the leg in a hunting accident. Which of the following types of immunity was compromised?

A 25-year-old man receives a knife wound to the leg in a hunting accident. Which of the following types of immunity was compromised?

a) Adaptive immunity
b) Passive immunity
c) Specific immunity
d) Natural immunity

Answer: D

The nursing students are learning about the immune system in their anatomy and physiology class. What would these students learn is a component of the immune system?

The nursing students are learning about the immune system in their anatomy and physiology class. What would these students learn is a component of the immune system?

a) Red blood cells
b) Stem cells
c) Lymphoid tissues
d) Cytokines

Answer: C

The nurse is teaching a client who has been diagnosed with Hashimoto's thyroiditis. Which of the following statements correctly describes the process of autoimmunity?

The nurse is teaching a client who has been diagnosed with Hashimoto's thyroiditis. Which of the following statements correctly describes the process of autoimmunity?

a) The normal protective immune response attacks the body, damaging tissues.
b) The body overproduces immunoglobulins.
c) The body produces inappropriate or exaggerated responses to specific antigens.
d) A deficiency results from improper development of immune cells or tissues.

Answer: A

A client is diagnosed with human immunodeficiency virus (HIV). After recovering from the initial shock of the diagnosis, the client expresses a desire to learn as much as possible about HIV and acquired immunodeficiency syndrome (AIDS). When teaching the client about the immune system, the nurse states that humoral immunity is provided by which type of white blood cell?

A client is diagnosed with human immunodeficiency virus (HIV). After recovering from the initial shock of the diagnosis, the client expresses a desire to learn as much as possible about HIV and acquired immunodeficiency syndrome (AIDS). When teaching the client about the immune system, the nurse states that humoral immunity is provided by which type of white blood cell?

a) Lymphocyte
b) Monocyte
c) Basophil
d) Neutrophil

Answer: A

The immune system is a complicated and intricate system that contains specialized cells and tissues that protect us from external invaders and our own altered cells. Which of the following is the term used to define any substance capable of inducing a specific immune response and of reacting with the products of that response?

The immune system is a complicated and intricate system that contains specialized cells and tissues that protect us from external invaders and our own altered cells. Which of the following is the term used to define any substance capable of inducing a specific immune response and of reacting with the products of that response?

a) Antibodies
b) Antigens
c) Lymphocytes
d) Lymphokines

Answer: B

A nurse is explaining treatment options to a patient diagnosed with an immune dysfunction. Which of the following statements made by the patient accurately reflects the teaching about current stem cell research?

A nurse is explaining treatment options to a patient diagnosed with an immune dysfunction. Which of the following statements made by the patient accurately reflects the teaching about current stem cell research?

a) "Currently stem cell transplantation has only been performed in the laboratory, but future research with embryonic stem cell transplants for humans with immune dysfunction has been promising."
b) "Stem cell transplantation has been discontinued based on concerns about safety, efficacy, resource allocation, and human cloning."
c) "Stem cell clinical trials have only been attempted in patients with acquired immune deficiencies but plans are underway to begin human cloning using embryonic stem cells."
d) "Stem cell transplantation has been carried out in humans with certain types of immune dysfunction and clinical trials using stem cells are underway in patients with a variety of disorders having an autoimmune component."



Answer: D

The body has several mechanisms to fight disease, one of which is sending chemical messengers. Specifically, the messengers released by lymphocytes, monocytes, and macrophages have differing roles in the immune response. Which messenger enables cells to resist viral replication and slow viral replication?

The body has several mechanisms to fight disease, one of which is sending chemical messengers. Specifically, the messengers released by lymphocytes, monocytes, and macrophages have differing roles in the immune response. Which messenger enables cells to resist viral replication and slow viral replication?

a) Colony-stimulating factor
b) Tumor necrosis factor
c) Interleukins
d) Interferons

Answer: D

Which of the following medication classifications are known to inhibit prostaglandin synthesis or release?

Which of the following medication classifications are known to inhibit prostaglandin synthesis or release?

a) Antibiotics in large doses
b) Antineoplastic agents
c) Adrenal corticosteroids
d) Nonsteroidal anti-inflammatory drugs (NSAIDs) in large doses

Answer: D

A client has had a kidney transplant performed for end-stage kidney disease. What type of immune response that T-cell lymphocytes perform is related to this type of surgery?

A client has had a kidney transplant performed for end-stage kidney disease. What type of immune response that T-cell lymphocytes perform is related to this type of surgery?

a) A cell-mediated response
b) Naturally acquired active immunity
c) Activation of the complement system
d) Stimulation of colony-stimulating factors

Answer: A

As a nursing instructor, you realize the importance of your students understanding how the immune system works and its role to protect and defend the body from potential harm. What type of cells are the primary targets of the healthy immune system? Select all that apply.

As a nursing instructor, you realize the importance of your students understanding how the immune system works and its role to protect and defend the body from potential harm. What type of cells are the primary targets of the healthy immune system? Select all that apply.

a) Infectious cells
b) Cancerous cells
c) Foreign cells
d) Typical cells

Answer: A, B & C.

Which of the following statements accurately reflects current stem cell research?

Which of the following statements accurately reflects current stem cell research?

a) The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells.
b) Stem cell transplantation cannot restore immune system functioning.
c) Clinical trials are underway in patients with acquired immune deficiencies only.
d) Stem cell transplantation has been performed in the laboratory only.

Answer: A

A patient is being treated in the intensive care unit for sepsis related to ventilator-associated pneumonia. The patient is in large doses of three different antibiotics. What severe outcome should the nurse monitor for in the lab studies?

A patient is being treated in the intensive care unit for sepsis related to ventilator-associated pneumonia. The patient is in large doses of three different antibiotics. What severe outcome should the nurse monitor for in the lab studies?

a) Bone marrow suppression
b) Leukocytosis
c) Rash
d) Oral thrush

Answer: A

During an annual examination, an older patient tells the nurse, "I don't understand why I need to have so many cancer screening tests now. I feel just fine!" Based on the knowledge of neoplastic disease and the aging immune system, what teaching should the nurse include in the patient's plan of care?

During an annual examination, an older patient tells the nurse, "I don't understand why I need to have so many cancer screening tests now. I feel just fine!" Based on the knowledge of neoplastic disease and the aging immune system, what teaching should the nurse include in the patient's plan of care? Select all that apply.

a) The immune system is integrated with other psychophysiologic processes and is regulated by the brain. Aging of the brain can have immunologic consequences and can affect neural and endocrine function increasing the risk of cancer development.
b) Tumor cells may possess special blocking factors that coat tumor cells and prevent their destruction by killer T lymphocytes; therefore, the body may not recognize the tumor as foreign and fail to destroy the malignant cells. Routine screening increases the chance of finding and treating cancer early.
c) Education about the importance of adhering to a recommended vaccine schedule should be initiated to boost the immune system function.
d) Nutritional intake to support a competent immune response plays an important role in reducing the incidence of cancer. A healthy diet including protein, vitamins, minerals, and some fats can alter the risk of cancer development.
e) The increase in occurrence of autoimmune diseases due to aging strongly suggests a predisposition to various types of cancer due to the body's inability to differentiate between self and nonself. Routine screening increases the chance of finding and treating cancer early.

Answer: B, E & D.

Which of the following immunity types becomes active as a result of infection by a specific microorganism?

Which of the following immunity types becomes active as a result of infection by a specific microorganism? 

a) Artificially acquired passive immunity
b) Artificially acquired active immunity
c) Naturally acquired passive immunity
d) Naturally acquired active immunity

Answer: D

A nursing instructor is giving a lecture on the immune system. Which of the following cells will the instructor include in her discussion on phagocytosis?

A nursing instructor is giving a lecture on the immune system. Which of the following cells will the instructor include in her discussion on phagocytosis?

a) Neutrophils and monocytes
b) Regulator T cells and Helper T cells
c) Lymphokines and Suppressor T cells
d) Plasma cells and memory cells

Answer: A

The nurse is obtaining information from a client with Crohn's disease about his medication history. What medication would the nurse include when asking about what medications the client has taken for suppression of the inflammatory and immune response?

The nurse is obtaining information from a client with Crohn's disease about his medication history. What medication would the nurse include when asking about what medications the client has taken for suppression of the inflammatory and immune response?

a) Corticosteroids
b) Ibuprofen (Advil)
c) Diuretics
d) Angiotensin-converting enzyme inhibitors (ACE-I)

Answer: A

A client is informed that his white blood cell count is low and that he is at risk for the development of infections. The client asks, "Where do I make new white blood cells?" What is the best response by the nurse?

A client is informed that his white blood cell count is low and that he is at risk for the development of infections. The client asks, "Where do I make new white blood cells?" What is the best response by the nurse?

a) "White blood cells are produced in the lymphatic tissue."
b) "White blood cells are produced in the plasma."
c) "White blood cells are produced in the bone marrow."
d) "White blood cells are produced in the thymus gland."

Answer: C

During which stage of the immune response does the circulating lymphocyte containing the antigenic message return to the nearest lymph node?

During which stage of the immune response does the circulating lymphocyte containing the antigenic message return to the nearest lymph node?

a) Proliferation
b) Recognition
c) Response
d) Effector

Answer: A

What type of immunoglobulin does the nurse recognize that promotes the release of vasoa ctive chemicals such as histamine when a client is having an allergic reaction?

What type of immunoglobulin does the nurse recognize that promotes the release of vasoa ctive chemicals such as histamine when a client is having an allergic reaction?

a) IgM
b) IgE
c) IgA
d) IgG

Answer: B

Matt Carson, a 20-year-old college student, was riding his motorcycle home from class when he lost control of the bike and sustained serious internal injuries, including a ruptured spleen. Matt has been taken to the OR to remove his spleen and the ED nurse is meeting with Matt's parents to answer some of their additional questions. Which of the following will be included in the nurse's discussion regarding special considerations following the removal of Matt's spleen?

Matt Carson, a 20-year-old college student, was riding his motorcycle home from class when he lost control of the bike and sustained serious internal injuries, including a ruptured spleen. Matt has been taken to the OR to remove his spleen and the ED nurse is meeting with Matt's parents to answer some of their additional questions. Which of the following will be included in the nurse's discussion regarding special considerations following the removal of Matt's spleen?

a) Matt will be susceptible to bleeding because the spleen synthesizes vitamin K.
b) Matt will be susceptible to infection because the spleen removes bacteria from the blood.
c) Matt will be susceptible to anemia because the spleen produces red blood cells.
d) Matt will be susceptible to acidosis because the spleen maintains acid-base balance.

Answer: B

A nurse is caring for a client with multiple sclerosis. Client education about the disease process includes which of the following explanations about the cause of the disorder?

A nurse is caring for a client with multiple sclerosis. Client education about the disease process includes which of the following explanations about the cause of the disorder?

a) Regulatory mechanisms fail to halt the immune response.
b) The immune system recognizes one's own tissues as "self."
c) Excess cytokines cause tissue damage.
d) The immune system recognizes one's own tissues as "foreign."

Answer: D

A nurse is taking the health history of a newly admitted client. Which of the following conditions would NOT place the client at risk for impaired immune function?

A nurse is taking the health history of a newly admitted client. Which of the following conditions would NOT place the client at risk for impaired immune function?

a) History of radiation therapy
b) Previous organ transplantation
c) Surgical removal of the appendix
d) Surgical history of a splenectomy

Answer: C

A client is admitted to the hospital with a diagnosis of pneumonia. The client informs the nurse that he has several drug allergies. The physician has ordered an antibiotic as well as several other medications for a cough and fever. What should the nurse do prior to administering the medications?

A client is admitted to the hospital with a diagnosis of pneumonia. The client informs the nurse that he has several drug allergies. The physician has ordered an antibiotic as well as several other medications for a cough and fever. What should the nurse do prior to administering the medications?

a) Administer the medications that the physician ordered.
b) Call the pharmacy and let them know the client has several drug allergies.
c) Consult drug references to make sure the medicines do not contain substances which the client is hypersensitive.
d) Give the client one medicine at a time and observe for allergic reactions.

Answer: C

The nurse is instructing client's about the importance of taking the shingles vaccine. Which client would benefit from this vaccine?

The nurse is instructing client's about the importance of taking the shingles vaccine. Which client would benefit from this vaccine?

a) A 65-year-old client who had chicken pox when he was 12 years old
b) A 32-year-old client who has never had chickenpox
c) A 24-year-old client who is pregnant
d) A 17-year-old client who will be attending college and living in a dormitory

Answer: A

Decades ago, a typical childhood surgery, after repeated bouts with tonsillitis, was to have a tonsillectomy and adenoidectomy. That was before the role of the tonsils and adenoids were better understood. As it is understood today, what are the roles of the tonsils and adenoids?

Decades ago, a typical childhood surgery, after repeated bouts with tonsillitis, was to have a tonsillectomy and adenoidectomy. That was before the role of the tonsils and adenoids were better understood. As it is understood today, what are the roles of the tonsils and adenoids?

a) They are lymphoid tissues that filter bacteria from tissue fluid.
b) They are lymphoid tissues that increase the efficacy of antibiotics.
c) They are lymphoid tissues that program T lymphocytes.
d) They are lymphoid tissues that eliminate cancer cells.

Answer: A

You are caring for a client with a suspected immune system disorder. What test would be ordered if a deficiency or excess of immuneglobulins was suspected?

You are caring for a client with a suspected immune system disorder. What test would be ordered if a deficiency or excess of immuneglobulins was suspected?

a) Protein electrophoresis
b) Plasmapheresis
c) T-cell and B-cell assays
d) Enzyme-linked immunosorbent assay

Answer: A

A client who is being treated for complications related to acquired immunodeficiency disorder syndrome (AIDS) is receiving interferon parenterally as adjunctive therapy. Why does the nurse understand this route is being used?

A client who is being treated for complications related to acquired immunodeficiency disorder syndrome (AIDS) is receiving interferon parenterally as adjunctive therapy. Why does the nurse understand this route is being used?

a) The taste of the medication is not palatable.
b) The medication, given orally, will cause diarrhea.
c) Digestive enzymes destroy its protein structure.
d) The medication will work more rapidly parenterally.

Answer: C

When obtaining a health history from a patient with possible abnormal immune function, what question would be a priority for the nurse to ask?

When obtaining a health history from a patient with possible abnormal immune function, what question would be a priority for the nurse to ask?

a) "Have you ever received a blood transfusion?"
b) "When was your last menstrual period?"
c) "Do you have abdominal pain or discomfort?"
d) "Have you ever been treated for a sexually transmitted infection?"

Answer: A

During the immune response, cytotoxic cells bind to invading cells, destroy the targeted invader, and release lymphokines to remove the debris. Which type of T-cell lymphocyte is cytotoxic?

During the immune response, cytotoxic cells bind to invading cells, destroy the targeted invader, and release lymphokines to remove the debris. Which type of T-cell lymphocyte is cytotoxic?

a) Suppressor T cells
b) Helper T cells
c) Regulator T cells
d) Effector T cells

Answer: D

A 20-year-old male patient cuts his hand while replacing a window. While reviewing the complete blood count (CBC) with differential, the nurse would expect which of the following cell types to be elevated first in order to prevent an infection in the patient's hand?

A 20-year-old male patient cuts his hand while replacing a window. While reviewing the complete blood count (CBC) with differential, the nurse would expect which of the following cell types to be elevated first in order to prevent an infection in the patient's hand?

a) Monocytes
b) Neutrophils
c) Eosinophils
d) B cells

Answer: B

An experiment is designed to determine specific cell types involved in the cell-mediated immune response. The experimenter is interested in finding cells that attack the antigen directly by altering the cell membrane and causing cell lysis. Which cells should be isolated?

An experiment is designed to determine specific cell types involved in the cell-mediated immune response. The experimenter is interested in finding cells that attack the antigen directly by altering the cell membrane and causing cell lysis. Which cells should be isolated?

a) B cells
b) Helper T cells
c) Macrophages
d) Cytotoxic T cells

Answer: D

The nurse is beginning the physical examination of a client with a complaint of fatigue. What documentation will the nurse provide to describe this general appraisal of the client's health?

The nurse is beginning the physical examination of a client with a complaint of fatigue. What documentation will the nurse provide to describe this general appraisal of the client's health?

a) The client is alert and oriented to all spheres.
b) The client has palpable peripheral pulses in the upper extremities.
c) The client appears mildly ill, listless, and disheveled.
d) The client has a blood pressure of 120/72 mm Hg.

Answer: C

A client is treated in the clinic for a sexually transmitted infection, and the nurse suspects that the client is at risk for HIV. The physician determines that the client should be tested for the virus. What responsibility does the nurse have?

A client is treated in the clinic for a sexually transmitted infection, and the nurse suspects that the client is at risk for HIV. The physician determines that the client should be tested for the virus. What responsibility does the nurse have?

a) The nurse will call the client with the results of the test.
b) The nurse will inform the client that the results will have to be reported to the Centers for Disease Control and Prevention (CDC).
c) The nurse ensures a written consent is obtained prior to testing.
d) The nurse should send the client to have the blood drawn without informing him about the specific screening test.

Answer: C

A school nurse is talking about infection with a high school health class. What would be the nurse's best explanation of the process of phagocytosis?

A school nurse is talking about infection with a high school health class. What would be the nurse's best explanation of the process of phagocytosis?

a) Removal of bacteria and dead blood cells from circulation
b) Release of chemicals to destroy bacteria and foreign material
c) Engulfment and digestion of bacteria and foreign material
d) Conversion of memory cells to plasma cells

Answer: C

Which of the following cell types are involved in humoral immunity?

Which of the following cell types are involved in humoral immunity?

a) Memory T lymphocyte
b) Helper T lymphocyte
c) Suppressor T lymphocyte
d) B lymphocytes

Answer: D

A 6-year-old patient is diagnosed with a viral infection of the respiratory system. Which of the following will most likely be trying to fight the antigen?

A 6-year-old patient is diagnosed with a viral infection of the respiratory system. Which of the following will most likely be trying to fight the antigen?

a) Self-antigens
b) B cells
c) Complements
d) Interferons

Answer: D

A patient arrives at the clinic and informs the nurse that she has a very sore throat as well as a fever. A rapid strep test returns a positive result and the patient is given a prescription for an antibiotic. How did the streptococcal organism gain access to the patient to cause this infection?

A patient arrives at the clinic and informs the nurse that she has a very sore throat as well as a fever. A rapid strep test returns a positive result and the patient is given a prescription for an antibiotic. How did the streptococcal organism gain access to the patient to cause this infection?

a) Breathing in airborne dust
b) Through the mucous membranes of the throat
c) Through the skin
d) From being outside in the cold weather and decreasing resistance

Answer: B

What are the primary participants in the immune system?

What are the primary participants in the immune system?

a) Lymphoblasts and gamma globulins
b) T- and B- cell lymphocytes
c) Macrophages and memory cells
d) Stem cells and monocytes

Answer: B

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 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) Naturally acquired active immunity
d) There is no immunity passed down from mother to child.

Answer: A

Which of the following is associated with impaired immunity in the aging patient?

Which of the following is associated with impaired immunity in the aging patient?

a) Incidence of autoimmune disease decreases with age
b) Skin becomes thicker
c) Decreased renal function
d) Increased antibody production

Answer: C

What organ is considered lymphoid tissue?

What organ is considered lymphoid tissue?

a) Pancreas
b) Spleen
c) Intestines
d) Liver

Answer: B

Which of the following is associated with impaired immunity relating to the aging patient?

Which of the following is associated with impaired immunity relating to the aging patient?

a) Increase in humoral immunity
b) Decrease in inflammatory cytokines
c) Breakdown and thinning of the skin
d) Increase in peripheral circulation

Answer: C

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 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 client has only mild TB, which is not enough to cause a reaction.
b) The solution used for the skin test was probably outdated.
c) The client's immune system cannot mount a response to the skin test.
d) The skin test was improperly performed.

Answer: C

A patient comes into the emergency department with complaints of difficulty walking and loss of muscle control in the arms. As the nurse begins the physical examination, which of the following assessment should be completed if an immune dysfunction in the neurosensory system is suspected?

A patient comes into the emergency department with complaints of difficulty walking and loss of muscle control in the arms. As the nurse begins the physical examination, which of the following assessment should be completed if an immune dysfunction in the neurosensory system is suspected?

a) Assess for hepatosplenomegaly by measuring abdominal girth
b) Assess for ataxia using the finger-to-nose test and heel-to-shin test
c) Review the urinalysis report for hematuria
d) Assess joint mobility using passive range of motion.

Answer: B

The nurse is obtaining a history from a patient with severe psoriasis. What question would be the most important to ask this patient to determine a genetic predisposition?

The nurse is obtaining a history from a patient with severe psoriasis. What question would be the most important to ask this patient to determine a genetic predisposition?

a) "How did you know you developed this disease?"
b) "Does anyone in your family have more than one autoimmune disease?"
c) "How many children do you have?"
d) "Does your spouse or significant other have an autoimmune disease?"

Answer: B

The anatomy and physiology instructor is explaining a cell-mediated response to the pre-nursing students. What actions would the instructor explain occur in a cell-mediated response?

The anatomy and physiology instructor is explaining a cell-mediated response to the pre-nursing students. What actions would the instructor explain occur in a cell-mediated response?

a) T-cell lymphocytes survey proteins in the body and attack the invading antigens.
b) Toxins of invading antigens are neutralized.
c) The invading antigens precipitate.
d) The invading antigens link together (agglutination).

Answer: A

Which of the following protective responses begin with the B lymphocytes?

Which of the following protective responses begin with the B lymphocytes?

a) Recognition
b) Phagocytic
c) Humoral
d) Cellular

Answer: C

A patient undergoing a skin test has been intradermally injected with a disease-specific antigen on the inner forearm. The patient becomes anxious because the area begins to swell. Which of the following may be used to decrease anxiety in this patient?

A patient undergoing a skin test has been intradermally injected with a disease-specific antigen on the inner forearm. The patient becomes anxious because the area begins to swell. Which of the following may be used to decrease anxiety in this patient?

a) Advise the patient to use prescribed analgesics
b) Apply ice packs to reduce the swelling
c) Gently rub the swollen area to accelerate the blood flow
d) Assure the patient that this is a normal reaction

Answer: D

What is the function of the thymus gland?

What is the function of the thymus gland?

a) Produce stem cells
b) Programs B lymphocytes to become regulator or effector Bcells.
c) Develop the lymphatic system
d) Programs T lymphocytes to become regulator or effector T cells.

Answer: D

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?

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) Plasma, which depletes the body's store of calcitonin
d) Serum, which depletes the body's store of glucagon

Answer: B

A 38-year-old female patient has begun to suffer from rheumatoid arthritis. She is also being assessed for disorders of the immune system. She works as an aide at a facility that cares for children infected with AIDS. Which of the following is the most important factor related to the patient's assessment?

A 38-year-old female patient has begun to suffer from rheumatoid arthritis. She is also being assessed for disorders of the immune system. She works as an aide at a facility that cares for children infected with AIDS. Which of the following is the most important factor related to the patient's assessment?

a) Her age
b) Her home environment
c) Her diet
d) Her use of other drugs

Answer: D

You are the clinic nurse caring for a client with a suspected diagnosis of HIV. You are preparing to draw blood for a confirmatory diagnostic test on this client. What is the most important action that the nurse should perform before testing a client for HIV?

You are the clinic nurse caring for a client with a suspected diagnosis of HIV. You are preparing to draw blood for a confirmatory diagnostic test on this client. What is the most important action that the nurse should perform before testing a client for HIV?

a) Advise the client to take off any ornaments and metallic objects.
b) Advise the client to avoid excess fluid intake.
c) Advise the client to abstain from having intercourse.
d) Obtain a written consent from the client.

Answer: D

A nurse is caring for a patient undergoing evaluation for possible immune system disorders. Which of the following interventions will best help support the patient throughout the diagnostic process?

A nurse is caring for a patient undergoing evaluation for possible immune system disorders. Which of the following interventions will best help support the patient throughout the diagnostic process?

a) Assisting the patient with the scheduling of the procedures
b) Encouraging the patient to ask their physician for information about the treatment options for the possible diagnosis
c) Educating the patient about the diagnostic procedures and answer questions they may have about the possible diagnosis
d) Accompanying the patient to the diagnostic tests

Answer: C

While taking the health history of a newly admitted client, the nurse asks for a list of the client's current medications. Which of the following medication classifications would place the client at risk for impaired immune function?

While taking the health history of a newly admitted client, the nurse asks for a list of the client's current medications. Which of the following medication classifications would place the client at risk for impaired immune function?

a) Antimetabolites
b) Inotropics
c) Antihypertensives
d) Pancreatic enzymes

Answer: A

Which of the following is an age-related change associated with the immune system?

Which of the following is an age-related change associated with the immune system?

a) Decreased antibody production
b) Increased antibody production
c) Elevated phagocytic immune response
d) Ability to differentiate "self" from "nonself"

Answer: A

When assessing an adolescent for acne, which of the following would lead the nurse to identify the acne as severe? Select all that apply.

When assessing an adolescent for acne, which of the following would lead the nurse to identify the acne as severe? Select all that apply.

a) Facial papules
b) Comedones
c) Widespread inflammatory lesions
d) Presence of nodules
e) Evidence of cysts

Answer: C, E & D.

When a child enters the acute care setting or clinic following a burn injury, for which of the following immunizations is it important to check for the last booster?

When a child enters the acute care setting or clinic following a burn injury, for which of the following immunizations is it important to check for the last booster?

a) Pertussis
b) Tetanus
c) Meningitis
d) Diphtheria

Answer: B

The nurse is collecting data on a child with a diagnosis of atopic dermatitis. While interviewing the caregiver, the nurse will direct questions to the caregiver recognizing that which of the following are common allergens involved in eczema? Select all that apply.

The nurse is collecting data on a child with a diagnosis of atopic dermatitis. While interviewing the caregiver, the nurse will direct questions to the caregiver recognizing that which of the following are common allergens involved in eczema? Select all that apply.

a) Eggs
b) Animal dander
c) Cotton
d) Oatmeal
e) Nylon
f) Cow's milk

Answer: B, E & F.

The nurse is caring for a child with a suspected fungal infection. Which of the following tests would the nurse anticipate as being ordered?

The nurse is caring for a child with a suspected fungal infection. Which of the following tests would the nurse anticipate as being ordered?

a) Potassium hydroxide (KOH) prep
b) Erythrocyte sedimentation rate (ESR)
c) Patch or skin testing
d) Culture of wound/drainage

Answer: A

A nursing instructor is preparing a class discussion about pediatric skin variations, specifically related to differences in dark-skinned children. Which of the following would the nurse most likely include? Select all that apply.

A nursing instructor is preparing a class discussion about pediatric skin variations, specifically related to differences in dark-skinned children. Which of the following would the nurse most likely include? Select all that apply.

a) Papules often appear more prominent on the skin.
b) Vesicles appear less visible in most dark-skinned children.
c) Keloid formation occurs less often in dark-skinned children.
d) Hypertrophic scarring is a common occurrence in dark-skinned children.
e) Hypopigmentation often occurs after a skin condition heals.

Answer: A, D & E.

In caring for a 3 ½-year-old child admitted after being severely burned, the nurse collects the following data. Which of the following would be most important for the nurse to report immediately?

In caring for a 3 ½-year-old child admitted after being severely burned, the nurse collects the following data. Which of the following would be most important for the nurse to report immediately?

a) The child's respiratory rate is 32 breaths a minute.
b) The child's pain level is a 7 on the pain scale.
c) The child's hourly urinary output is 150 cc.
d) The child's temperature is 38.4°C.

Answer: A

The nurse is providing home care instructions for the parents of an infant with cradle cap. Which response by the parents indicates a need for further teaching?

The nurse is providing home care instructions for the parents of an infant with cradle cap. Which response by the parents indicates a need for further teaching?

a) "We can safely use a selenium sulfide shampoo on his hair."
b) "We should wash or shampoo the scalp areas with mild soap."
c) "We can scrape off the crusts on his scalp with a cotton swab."
d) "We can massage his head with mineral oil first and then shampoo it."



Answer: "We can scrape off the crusts on his scalp with a cotton swab."

The nurse is caring for a burn patient in a pediatric hospital. The patient is scheduled to be discharged the following day and the nurse is going over discharge teaching with the parents. Which of the following is the best intervention for the parents when removing an old dressing?

The nurse is caring for a burn patient in a pediatric hospital. The patient is scheduled to be discharged the following day and the nurse is going over discharge teaching with the parents. Which of the following is the best intervention for the parents when removing an old dressing?

a) Soak the old dressing in tepid water before attempting to remove.
b) Soak the old dressing in cold normal saline before attempting to remove.
c) Remove the old dressing as quickly as possible.
d) Take your time and be thorough when changing the burn dressing.

Answer: B

A nurse is working as part of a response team caring for children who have been involved in an elementary school fire. Which children would the nurse identify as needing a referral to a burn unit? Select all that apply.

A nurse is working as part of a response team caring for children who have been involved in an elementary school fire. Which children would the nurse identify as needing a referral to a burn unit? Select all that apply.

a) 9-year-old with asthma and burns to the face
b) 8-year-old with an inhalation injury
c) 10-year-old with partial-thickness burns and rib fractures
d) 7-year-old with superficial burns over 5% of the body
e) 6-year-old with burns involving the knees and hips

Answer: A, B, C & E.

The nurse is caring for a 15-year-old boy with psoriasis. In addition to the plaques, which of the following would the nurse expect to note?

The nurse is caring for a 15-year-old boy with psoriasis. In addition to the plaques, which of the following would the nurse expect to note?

a) Lichenification
b) Fissures and scaling on palms and soles
c) Hyperpigmentation
d) Fever and malaise

Answer: B

The nurse is caring for a 1-year-old patient in a pediatric clinic. The patient was brought to the clinic with symptoms of dry, itchy red patches of skin on the arms and legs. A diagnosis of atopic dermatitis (eczema) is made. Which of the following is a key element in the treatment regimen for this diagnosis?

The nurse is caring for a 1-year-old patient in a pediatric clinic. The patient was brought to the clinic with symptoms of dry, itchy red patches of skin on the arms and legs. A diagnosis of atopic dermatitis (eczema) is made. Which of the following is a key element in the treatment regimen for this diagnosis?

a) Frequently rehydrating the skin
b) Applying topical antibiotics routinely
c) Teaching the child not to scratch the "itchy" skin
d) Daily oral cortisone

Answer: A

A 14-year-old child is diagnosed with tinea versicolor. Which of the following would the nurse expect the nurse practitioner to order?

A 14-year-old child is diagnosed with tinea versicolor. Which of the following would the nurse expect the nurse practitioner to order?

a) Diphenhydramine
b) Topical nystatin
c) Selenium sulfide
d) Oral griseofulvin

Answer: C

The nurse is caring for a pediatric patient in the emergency department with moderate hypothermia and frostbite. Which of the following is the most beneficial nursing intervention for this patient?

The nurse is caring for a pediatric patient in the emergency department with moderate hypothermia and frostbite. Which of the following is the most beneficial nursing intervention for this patient?

a) Place heating pads and warmed blankets on the trunk of the body initially.
b) Place heating pads and warmed blankets on the patient's extremities and trunk.
c) Rub the frostbitten extremities to increase circulation to the affected area.
d) Apply dry heat to the extremities.

Answer: A

When doing teaching with a group of caregivers of infants the nurse is discussing the topic of diaper rash. The caregivers in the group make the following statements. Which statement is the most accurate related to the child with diaper rash.

When doing teaching with a group of caregivers of infants the nurse is discussing the topic of diaper rash. The caregivers in the group make the following statements. Which statement is the most accurate related to the child with diaper rash.

a) "They told me to use baby powder every time I change her so she won't get diaper rash."
b) "My child gets diaper rash if I wash her clothes in the same detergent we use for the family."
c) "Sometimes if I leave the diaper off and let him be in the sunshine he gets diaper rash."
d) "The formula she drinks sometimes causes her to have a diaper rash."

Answer: B

A nurse is caring for a burn patient with second and third degree burns on 15% of the body. The patient is complaining of severe itching in and around the burn sites. Which of the following is the best nursing intervention to relieve this symptom?

A nurse is caring for a burn patient with second and third degree burns on 15% of the body. The patient is complaining of severe itching in and around the burn sites. Which of the following is the best nursing intervention to relieve this symptom?

a) Diversional activities
b) Medication
c) Soaking in a colloidal bath
d) Turning the patient every two hours

Answer: B

Which of the following is the best technique to perform an assessment of the skin?

Which of the following is the best technique to perform an assessment of the skin?

a) Skin assessment involves inspection and palpation in a room with yellow walls and bright white light.
b) Skin assessment involves inspection and palpation using latex gloves.
c) Skin assessment involves inspection and palpation in a room with white walls and bright fluorescent light.
d) Skin assessment involves inspection and palpation using vinyl gloves.

Answer: C

The nurse is caring for a 13-year-old girl with acne vulgaris and is teaching the girl about skin care. Which response by the girl indicates a need for further teaching?

The nurse is caring for a 13-year-old girl with acne vulgaris and is teaching the girl about skin care. Which response by the girl indicates a need for further teaching?

a) "I should use a humectant moisturizer."
b) "I should avoid eating any kind of chocolate."
c) "I must use my medicine daily so that it will work."
d) "It is best to avoid hats and headbands."

Answer: B

The nurse is taking a health history of a 6-year-old girl with suspected Stevens-Johnson syndrome. During the physical examination, the nurse would expect to note which of the following physical findings?

The nurse is taking a health history of a 6-year-old girl with suspected Stevens-Johnson syndrome. During the physical examination, the nurse would expect to note which of the following physical findings?

a) Red macules and bullous eruptions on an erythematous base
b) Red, raised hair follicles
c) Erythema multiforme with inflammatory bullae of at least two types of mucosa
d) Fiery red lesions, scaling in the skin folds, and satellite lesions

Answer: C

A school-age child is brought to the office of the camp nurse with a small, superficial burn. Which of the following actions by the nurse would be the most appropriate action for the nurse to do first?

A school-age child is brought to the office of the camp nurse with a small, superficial burn. Which of the following actions by the nurse would be the most appropriate action for the nurse to do first?

a) Apply a topical anesthetic ointment
b) Administer acetaminophen
c) Apply cold compresses to the area
d) Cover the area with a sterile bandage

Answer: C

Which of the following interventions is the most effective in treating burn wound infections?

Which of the following interventions is the most effective in treating burn wound infections?

a) Systemic intravenous antibiotics
b) Proper hand washing
c) Topical antibiotics applied to the wound site
d) Systemic oral antibiotics

Answer: C

A group of nursing students are reviewing information about atopic dermatitis. Which of the following indicate that the students understand the information? Select all that apply.

A group of nursing students are reviewing information about atopic dermatitis. Which of the following indicate that the students understand the information? Select all that apply.

a) The reaction occurs in response to specific allergens.
b) Scratching initiates the reaction, which then becomes pruritic.
c) Changes in temperature can contribute to flare-ups.
d) Excessively humid environments often lessen the severity of the reaction.
e) The disorder is chronic with periods of remissions.

Answer: A, C & E.

A 6-year-old child is diagnosed with tinea capitis and treatment is initiated. The nurse instructs the parents to have the child return to school within which time frame?

A 6-year-old child is diagnosed with tinea capitis and treatment is initiated. The nurse instructs the parents to have the child return to school within which time frame?

a) 5 days
b) 72 hours
c) 1 week
d) 24 hours

Answer: C

The process of removing necrotic tissue in the treatment of burns is known as which of the following?

The process of removing necrotic tissue in the treatment of burns is known as which of the following?

a) Débridement
b) Autograft
c) Allograft
d) Hydrotherapy

Answer: A

The nurse is caring for a pediatric patient with multiple wounds from a bike accident. Which of the following is the best method for cleansing or washing out the wound?

The nurse is caring for a pediatric patient with multiple wounds from a bike accident. Which of the following is the best method for cleansing or washing out the wound?

a) Use sterile water to wash out the wound.
b) Use iodine solution to wash the wound.
c) Use an antibiotic wash to cleanse the wound.
d) Use normal saline solution to wash the wound.

Answer: D

A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the mother would indicate the teaching was successful?

A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the mother would indicate the teaching was successful?

a) "I should use the highest-potency steroid cream I can find."
b) "I should not cover the area with plastic wrap after applying the cream."
c) "I should apply the medicine at bedtime and rinse it off in the morning."
d) "I need to shake the preparation before using it."

Answer: B