Chapter 13: Immunity, Inflammation, and Infection Nursing School Test Banks

Chapter 13: Immunity, Inflammation, and Infection
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. A patient in early labor says to the nurse, I will pass on protection from diseases, and the baby will not ever need any shots. What is the best response by the nurse?
a. Babies are born with innate (natural) immunity at birth.
b. Babies are born with immunoglobulin E (IgE), an antibody that crosses the placenta, but it only briefly protects the baby.
c. Yes, immediate antibody immunity from the mother is the first line of defense against disease for babies.
d. Yes, the mother passes on cell-mediated immunity.
ANS: B
Infants acquire antibodies from the mother, but they only last a few months.

DIF: Cognitive Level: Application REF: p. 169-170 OBJ: 2 | 4
TOP: Newborn Immunity KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. A school nurse starts a clean-up campaign at a local elementary school in an effort to combat allergens. What is the most common allergic response disorder?
a. Anaphylaxis
b. Asthma
c. Contact dermatitis
d. Urticaria
ANS: B
Fungi are principle allergens that can trigger respiratory allergic responses such as asthma.

DIF: Cognitive Level: Knowledge REF: p. 186-187 OBJ: 18
TOP: Reduction of Allergens KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

3. A nurse is discussing the bodys first and second lines of defense against infection with a community group. What does the bodys first line of defense include?
a. Teeth
b. Sweat
c. White blood cells
d. T lymphocytes
ANS: B
The sweat glands excrete an antimicrobial enzyme.

DIF: Cognitive Level: Knowledge REF: p. 168 OBJ: 1
TOP: Lines of Defense KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. A nurse explains that a medication given to a patient with a severe inflammatory response mimics a hormone secreted by the adrenal cortex. To what hormone is the nurse referring?
a. Aldosterone
b. Testosterone
c. Histamine
d. Cortisol
ANS: D
Cortisol slows the release of antihistamine and stabilizes lysosomal membranes.

DIF: Cognitive Level: Knowledge REF: p. 170 OBJ: 5
TOP: Antiinflammatory Agents KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. With the exposure to an antigen, a nurse explains that the initiator of the inflammatory response is the presence of histamine. What is responsible for releasing histamine?
a. Neutrophils
b. Eosinophils
c. Basophils
d. Monocytes
ANS: C
Basophils release histamine.

DIF: Cognitive Level: Knowledge REF: p. 168 OBJ: 5
TOP: Inflammatory Response KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. A nurse is bathing a patient who is immunodeficient and has a Cryptococcus infestation. What is the classification of this organism?
a. Bacterium
b. Virus
c. Fungus
d. Protozoa
ANS: C
Cryptococcus fungal infections can be life threatening.

DIF: Cognitive Level: Knowledge REF: p. 173 OBJ: 9
TOP: Fungi KEY: Nursing Process Step: Knowledge
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

7. A mosquito or a fly carries an organism that infects another living organism. What is this mode of transmission of infection?
a. Common vehicle
b. Direct excretion
c. Ingestion
d. Vector
ANS: D
Vector-borne diseases are carried from one host to another. Part of the life cycle of the pathogen occurs in the body of the fly, mosquito, or tick.

DIF: Cognitive Level: Comprehension REF: p. 174 OBJ: 10
TOP: Vector Transmission KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

8. What is the most effective method to control the spread of communicable disease?
a. Isolate the infected person from all contact with noninfected persons.
b. Vigorously petition the community health department to increase spraying.
c. Administer prophylactic antibiotics to the rest of the family.
d. Demonstrate and monitor a return demonstration of a good hand washing technique by the family.
ANS: D
Good hand washing is the cornerstone of infection control.

DIF: Cognitive Level: Comprehension REF: p. 176 OBJ: 10
TOP: Prevention of the Spread of Infection
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

9. An air conditioner duct cleaning is recommended by a home health nurse. What should this precaution prevent the spread of in the patients home?
a. Bacteria
b. Viruses
c. Fungi
d. Protozoa
ANS: C
Air blowing into a room may be the mode of transfer of fungi spores that have remained dormant in the duct during nonuse.

DIF: Cognitive Level: Knowledge REF: p. 177 OBJ: 10
TOP: Infectious Disease Transmission in the Home
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. A school nurse cautions a group of parents about children playing barefoot on dirt. To what infectious agents can this action expose the children?
a. Helminthes
b. Protozoa
c. Rickettsiae
d. Mycoplasmas
ANS: A
Worms in the dirt seek entry through the foot skin and into the blood circulation, where they are carried to the lungs; coughed up into the mouth; and swallowed into the gastrointestinal tract, where they cause serious infections. Barefooted children who do not have proper hygiene are at risk for these worm infections.

DIF: Cognitive Level: Comprehension REF: p. 174 OBJ: 10
TOP: Helminth Transmission KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

11. A large, heavy, and older adult patient has a stroke and develops an infected decubitus ulcer on the sacrum during the hospital stay. Approximately 2 weeks after the patient has gone home, the patient returns to the hospital with pneumonia. What is the distinction between these two infections?
a. The decubitus ulcer infection was transmitted from other patients on the unit, but the pneumonia was transmitted from a neighbor visiting when the patient was at home.
b. The decubitus ulcer and pneumonia are caused by the same host.
c. The decubitus ulcer is termed a health careassociated infection, and pneumonia is termed a community-acquired infection.
d. The decubitus ulcer is considered to be caused by protozoa, but the pneumonia is considered unpreventable because of the size of the patient.
ANS: C
Because the decubitus ulcer developed during the stay in a health care facility, it is classified as a health careassociated infection. Because the patient did not have pneumonia when he left the facility, it is classified as a community-acquired infection.

DIF: Cognitive Level: Comprehension REF: p. 175-176 OBJ: 12
TOP: Community-Acquired versus Health Care-Associated Infections
KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

12. On a visit to administer the fifth in a series of 10 antibiotic doses, a home health nurse is told that the patient is now complaining about a bothersome vaginal discharge. The nurse communicates the problem and arranges for medication. What is the most likely cause of the vaginal discharge?
a. Poor genital hygienenot changing underwear often enough
b. Allergy to the soap or soap products used in the genital area
c. Superinfection response to the antibiotic medication
d. Sexual contact with another infected person
ANS: C
Antibiotics frequently wipe out good bacteria and cause other bacteria to overgrow, causing vaginitis.

DIF: Cognitive Level: Comprehension REF: p. 177-178 OBJ: 12
TOP: Superimposed Infections KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. Which patient diagnosis is most likely related to acquiring a health careassociated infection?
a. Abdominal abscess after a ruptured appendix
b. Lice and nits that have come from the emergency department
c. Urinary infection after the insertion of a Foley catheter
d. Two-day, postoperative foot fungus after a hip replacement
ANS: C
Iatrogenic or health careassociated infections are those acquired during the hospital stay. Urinary catheters are frequently the source of such infections. Abscesses frequently follow a ruptured appendix; lice and athletes foot are long-term conditions not caused by hospital interventions.

DIF: Cognitive Level: Application REF: p. 176-177 OBJ: 12
TOP: Iatrogenic Infections KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

14. A community picnic is held. A number of the attendees become ill after the picnic. How was the pathogen acquired?
a. Indirect contact
b. Common vehicle
c. Airborne transmission
d. Vector transmission
ANS: B
Food at the picnic that was shared in common became the vehicle for transmission.

DIF: Cognitive Level: Comprehension REF: p. 174 OBJ: 10
TOP: Common Vehicle Transmission KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

15. A nurse caring for a patient who is immunosuppressed is diligent about protecting the patient from infection. When visitors come in, in addition to having them put on isolation attire, what should the nurse also prohibit?
a. Battery-operated DVD player
b. Book
c. Potted plant
d. Box of candy
ANS: C
The soil in the flowerpot is a reservoir for bacteria and fungi.

DIF: Cognitive Level: Application REF: p. 182 OBJ: 16 | 18
TOP: Reverse Isolation for Immunosuppressed Patient
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

16. A nurse explains that although some drugs reduce inflammation, they also hinder the bodys immune response. What are examples of such drugs?
a. Antihistamines and salicylates
b. Bronchodilators and corticosteroids
c. Cardiotonic and anticholinergics
d. Diuretics and sedatives
ANS: B
The immune response is dampened by corticosteroids.

DIF: Cognitive Level: Comprehension REF: p. 187 OBJ: 18
TOP: Pharmacologic Care for Allergies KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. A patient has had several increasingly severe allergic reactions during last years pollen season. This year, the patient comes regularly to the office to receive some antigen injections. What education will the nurse provide regarding these injections?
a. They will combat infection brought on by the allergic response.
b. They will act as a steroid to lessen the allergic response.
c. They will increase tolerance to the antigen.
d. They will decrease the production of the antibodies.
ANS: C
Injections of increasing amounts of minute doses of the antigen will desensitize the body against the antigen.

DIF: Cognitive Level: Application REF: p. 187 OBJ: 18
TOP: Long-Term Pharmacologic Treatment of Allergies
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. A patient who is receiving daily steroids for the control of a condition calls the nurse to ask advice about whether a small child who has been exposed to influenza should come and visit because she has not had any symptoms. What is the most appropriate response by the office nurse?
a. Yes, let the child visit. There is no reason not to visit because this child is not sick.
b. No, the child should not visit. Infectious diseases are often most communicable in the short period before the child actually becomes ill.
c. It would be up to the patient. Plan not to get overtired with a small child running and bouncing around.
d. Take the child who is not sick to her own physician and ask this question first.
ANS: B
Children, especially those who have been exposed to a contagious disease but are not yet symptomatic, are still very contagious, especially to an immunocompromised patient.

DIF: Cognitive Level: Application REF: p. 186 OBJ: 10
TOP: Contagious Infections KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

19. A patient with the diagnosis of Clostridium difficile infection asks what has caused the diarrhea. What is the best response by the nurse?
a. It is caused by a protozoal infection.
b. It is caused by a fecaloral contamination.
c. It is caused by an inflammatory response.
d. It is caused by a long-term antibiotic therapy.
ANS: D
Superinfections such as Clostridium difficile infections are caused by long-term antibiotic therapy, which kills all the natural flora of the bowel and causes diarrhea.

DIF: Cognitive Level: Comprehension REF: p. 177-178 OBJ: 10
TOP: Superinfection KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

20. A patient receiving a large intramuscular dose of antibiotic was asked to please wait 20 to 30 minutes before checking out. What is the reason for this request?
a. The office staff needs to make sure that the right medicine was administered before the patient leaves.
b. The nurse always forgets to ask the patient about allergies before administering the antibiotic.
c. Antibiotics are a common source of severe allergic reactions within the first few minutes after an injection.
d. The staff wants to make sure that the patient has time to pay for the services delivered that day.
ANS: C
Antibiotic administration is a common cause of anaphylaxis. The patient is asked to wait to allow medical personnel to reverse the condition should it occur within minutes after an injection.

DIF: Cognitive Level: Comprehension REF: p. 187 OBJ: 18
TOP: Antibiotic Anaphylaxis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

21. After receiving an injection of penicillin, a patient undergoes an anaphylactic reaction. What should the nurse do first?
a. Administer oxygen.
b. Prepare fluids to combat shock.
c. Notify the charge nurse.
d. Cover with several blankets.
ANS: A
The first intervention should be to supply oxygen. Notification of the charge nurse and the administration of fluids to combat hypovolemia will come afterward. Covering with blankets would increase the vasodilation and increase the shock.

DIF: Cognitive Level: Application REF: p. 187-188 OBJ: 18
TOP: Anaphylaxis Assessment and Intervention
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

22. The Centers for Disease Control and Prevention (CDC) has issued new guidelines for infection control. Nursing care plans for patients with infection should mainly address which protocol?
a. Disease-specific precautions
b. Manner in which clean gloves are worn
c. Standard Precautions guidelines
d. Placement of needles and sharps
ANS: C
The CDC has issued new guidelines for Standard Precautions for infection control. These cover disease-specific precautions, the manner in which clean gloves are worn, and the placement of needles and sharps. Only the Standard Precautions guidelines are all inclusive.

DIF: Cognitive Level: Comprehension REF: p. 180 OBJ: 14
TOP: Centers for Disease Control and Prevention: Multiple Guidelines for Standard Precautions
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

23. Which vitamin can enhance wound healing?
a. A
b. B
c. C
d. D
ANS: C
The addition of vitamin C and zinc to the medication regimen can hasten wound healing.

DIF: Cognitive Level: Knowledge REF: p. 172 OBJ: 7
TOP: Wound Healing KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

24. A patient is hospitalized with cryptococcal pneumonia and AIDS. What is the most important standard precaution for the health care team to implement?
a. Hands are washed before and after gloving.
b. After gloves are put on, they do not need to be changed until care is finished.
c. Needles and sharps should be placed in puncture-resistant containers on the medicine cart out of the room.
d. Mouth-to-mouth resuscitation must be performed immediately unless the patient is a designated as do not resuscitate.
ANS: A
Hand washing is necessary before and between care in areas of contamination.

DIF: Cognitive Level: Application REF: p. 182 OBJ: 14
TOP: Standard Precautions KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

25. The organs involved in immunity include the tonsils, spleen, and lymph nodes. What other organ is involved in immunity?
a. Liver
b. Lungs
c. Periosteum
d. Pancreas
ANS: A
The liver filters the blood and plays a part in the immune response by the production of globulins and other chemicals involved in the immune response.

DIF: Cognitive Level: Knowledge REF: p. 169 OBJ: 3
TOP: Organs Involved in Immune Response KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity

26. What is required by medical asepsis that is not required by surgical asepsis?
a. Good hand washing technique
b. That no nonsterile product comes into contact with the patient
c. Elimination of all microorganisms
d. Hand washing with antimicrobial soap for 3 minutes
ANS: A
Surgical asepsis is sterile technique. Medical asepsis is considered a clean technique.

DIF: Cognitive Level: Comprehension REF: p. 179-180 OBJ: 14
TOP: Difference between Medical and Surgical Asepsis
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

27. The daughter of an 89-year-old resident in a long-term care facility asks if she may give her father an over-the-counter (OTC) antihistamine that she uses for seasonal allergy. What is the nurses most appropriate response?
a. Yes. OTCs are mild and very helpful.
b. No. Many antihistamines cause confusion in the older adult.
c. Yes. The drug might energize him so he wont be so drowsy.
d. No. Allergic symptoms should be allowed to run their course.
ANS: B
Many antihistamines cause the older adult to become confused. These drugs also cause drowsiness, and many OTC drugs are not mild.

DIF: Cognitive Level: Application REF: p. 187 OBJ: 18
TOP: Topic: Antihistamines KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

28. What occurrences of disease is the school nurse required to report to the health department? (Select all that apply.)
a. Rubella
b. Lyme disease
c. Pediculosis
d. Salmonella
e. Clostridium difficile
ANS: A, B, D
Rubella, Lyme disease, and Salmonella must all be reported. Lice and Clostridium difficile do not need to be reported.

DIF: Cognitive Level: Application REF: p. 175 OBJ: 9
TOP: Reportable Communicable Diseases
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

COMPLETION

29. A nurse assesses a high eosinophil count in a pediatric patient. The nurse recognizes that this elevation is an indicator of _____.

ANS:
allergy
High eosinophil counts are indicators of an allergic response.

DIF: Cognitive Level: Comprehension REF: p. 186 OBJ: 18
TOP: Allergy Indicators KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

30. Persons with human immunodeficiency virus (HIV) have acquired Pneumocystis jiroveci (PCP), a serious pulmonary infection caused by _____.

ANS:
protozoa
Protozoa cause the opportunistic pulmonary infection of PCP.

DIF: Cognitive Level: Knowledge REF: p. 173 OBJ: 9
TOP: Pneumocystis jiroveci KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

31. A nurse reminds the patient who is to undergo hyperbaric oxygen therapy that the clothing worn into the chamber must be made of _____.

ANS:
cotton
Cotton clothing is worn in the hyperbaric chamber to reduce the threat of fire. Synthetic materials can cause a spark of static electricity.

DIF: Cognitive Level: Knowledge REF: p. 185 OBJ: N/A
TOP: Clothing in Hyperbaric Chamber KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

OTHER

32. Prioritize the events of an antibody-mediated immunity response. (Separate the letters with a comma and space: A, B, C, D.)
A. Antibodies seek out and bind with specific antigen.
B. Antigen binds to a B lymphocyte.
C. Circulating antibodyantigen complexes are destroyed.
D. Antibodies are produced.
E. Antibodies are replenished.

ANS:
B, D, A, C, E
Antigen binds to a B lymphocyte, and antibodies are produced for that specific antigen. Antibodies seek out and bind with the specific antigen when it is reintroduced to the organism and bind with them. These circulating antigenantibody complexes are targeted and destroyed by phagocytes. Antibodies are continually replenished in most cases.

DIF: Cognitive Level: Analysis REF: p. 169-170 OBJ: 2
TOP: Antibody-Mediated Immunity KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

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