immunity quiz practice questions

The nurse is caring for a client in the emergency department who developed a pinpoint rash 48 hours following a hike in the woods. How would the nurse document this reaction?

A. Type I

B. Type II

C. Type III

D. Type IV

D

Type IV reactions develop following exposure to poison ivy or certain jewelry metals (Choice D). This type of reaction is not classified as type I (Choice A), II (Choice B), or III (Choice C).

The nurse is assessing a client with systemic lupus erythematosus (SLE) who has been taking hydroxychloroquine for 1 year. Which occasional symptom reported by the client would the nurse prioritize to further investigate?

A. Diarrhea

B. Headache

C. Blurred vision

D. Loss of appetite

C

The nurse will prioritize further assessment of blurred vision (Choice C). Hydroxychloroquine can lead to retinitis and irreversible loss of central vision. Diarrhea (Choice A), headache (Choice B), and loss of appetite (Choice D) are common side effects of this drug, which can be further investigated after the visual priority.

A client providing a health history to the nurse states, "I've been diagnosed with stage I HIV infection." Which assessment finding would the nurse anticipate?

A. Lymphocytopenia

B. Sore throat with myalgias

C. Overgrowth of Candida albicans in the mouth

D. CD4+ T-cell count 300 cells/mm3 (600-1500 cells/mm3)

B

Stage I HIV infection is often accompanied by flulike symptoms such as a sore throat and myalgias (Choice B). Stage III (AIDS) involves conditions such as lymphocytopenia (Choice A); opportunistic infections related to overgrowth of the biome, such as having Candida albicans in the mouth (Choice C); and a low CD4+ T-cell count (Choice D).

The nurse is caring for a client who has been prescribed PrEP medication. Which teaching would the nurse provide?

A. Safer sex practices should still be used while taking PrEP.

B. PrEP should be taken within 24 hours following sexual intercourse.

C. Testing for the hepatitis A virus will be performed regularly while taking PrEP.

D. Take PrEP only if engaging in sexual activity with someone who is known to be HIV positive.

A

The nurse will teach that safer sex practices should still be used while taking PrEP to further minimize the risk for contracting HIV (Choice A). PrEP is taken before, not after, sexual intercourse (Choice B). Testing for the hepatitis A virus is not performed regularly while taking PrEP, as PrEP works to minimize the risk of a person who is HIV-negative from contracting HIV (Choice C). PrEP is not used only if engaging in sexual activity with someone who is known to be HIV-positive; it is also used if the client is going to engage in sexual intercourse with anyone whose HIV status is unknown (Choice D).

The client on combination antiretroviral therapy calls the telehealth nurse to report forgetting to bring this medication on a vacation. Which teaching would the nurse provide, after the health care provider has sent an electronic prescription to a pharmacy at the client's current location?

A. "When you pick up the prescription, take today's next dose and continue forward as usual."

B. "After you get your medication you will need to take double doses of the drug for the next 2 days."

C. "As long as you pick up the drug and start taking it in the next 2 to 3 days, you will be fine."

D. "Before you can resume drug doses, you will need to find an urgent care center to have labs drawn for your viral load."

A

Today's cART drugs have longer half-lives than older medications, so efficacy is not lost as quickly if a client misses a few doses. However, it is important for the nurse to still teach clients to resume adherence to the prescribed dosing regimen to realize the best benefits and to reduce the chance of drug resistance development. The client should be taught to begin by taking today's next prescribed dose and continuing forward as usual (Choice A). Double-dosing is not appropriate (Choice B). Waiting several more days to start drug therapy is also not appropriate (Choice C). There is no need for a viral load diagnostic test at this time (Choice D).

Physiological Integrity

The nurse is caring for a client with HIV who has extreme fatigue. Which of the following activities would the nurse postpone or eliminate to facilitate periods of rest? Select all that apply.

A. Ambulating in the hall

B. Performing pulmonary hygiene

C. Teaching about nutrition therapy

D. Administering prescribed drug therapy

E. Arranging for several visitors to come

A, C, E

Rest and activity changes are needed when gas exchange is impaired. Most clients with HIV infection have fatigue, especially when respiratory problems are also present. To allow the client to rest, the nurse can reschedule or eliminate activities such as ambulating in the hall (Choice A), teaching about nutrition therapy (Choice C), and arranging for several visitors to come today (Choice E). The client will not likely have enough energy to ambulate, will not be able to focus on teaching, and will not have energy to visit. The nurse will not postpone or eliminate performing pulmonary hygiene (Choice B) or administering prescribed drug therapy (Choice D). These two actions are critical to restore better gas exchange and must be completed as ordered and on time.

A client who received a lung transplant 9 months ago contacts the telehealth nurse to report an ongoing dry cough that began 3 days ago. Which nursing response is appropriate?

A. "Please go to your nearest emergency department to be evaluated."

B. "It is normal to occasionally have a dry cough after lung transplantation."

C. "Using an over-the-counter cough suppressant can alleviate your symptoms."

D. "As long as the cough does not last more than a week, you don't need to worry."

A

A dry cough can be a sign of lung rejection, so the nurse will advise the client to go to the nearest emergency department for immediate evaluation (Choice A). It is not normal to have this condition after lung transplantation (Choice B), and an over-the-counter cough suppressant should not be used (Choice C). The client should not delay seeking care to see if the cough goes away (Choice D).

Which of the following actions will the nurse perform first for a client experiencing anaphylaxis?

A. Apply oxygen.

B. Initiate IV access.

C. Inject epinephrine.

D. Administer diphenhydramine.

C

The nurse will first inject epinephrine as ordered to facilitate gas exchange (Choice C). This is the first intervention that must take place in management of anaphylaxis. All other actions can be taken afterward in this order: apply oxygen (Choice A), initiate IV access (and rapidly infuse normal saline as ordered) (Choice B), and administer diphenhydramine (Choice D).

Which specific information will the nurse teach to the client with systemic lupus erythematosus who will be taking belimumab therapy?

A. There are very few side effects associated with this drug.

B. The drug can be given intravenously or subcutaneously.

C. Do not chew, crush, or split the tablet containing this drug.

D. The drug must be taken at bedtime because it causes extreme drowsiness.

B

The nurse will teach the client that belimumab can be given intravenously in a health care provider's setting or subcutaneously at home after being trained by a health care professional (Choice B). Belimubab can cause serious side effects such as infections, serious allergic reactions, or mental health problems (Choice A). It is not given in tablet form (Choice C). It is not given at bedtime due to the need to monitor during infusion and for 2 hours afterward (Choice D).

Which dietary information would the nurse share when teaching the client with HIV and esophageal candidiasis?

A. "Increase your daily intake of chicken and beef."

B. "Reduce intake of all foods to avoid mouth pain."

C. "Eat soft, cool food such as pudding and yogurt."

D. "Limit your intake of fluid to no more than 1 L daily."

C

The client with HIV and esophageal candidiasis will have difficulty swallowing. Pudding and yogurt, which are cool and have a degree of thickness, can provide nourishment, ease of swallowing, and comfort within the esophagus (Choice C). Chicken and beef are harder to swallow with esophageal candidiasis, which is a painful condition (Choice A). Clients should not eliminate intake of all foods, as they may become malnourished (Choice B). It is important to consume 1 to 2 L of fluid daily, so the client should not be restricted from fluid intake (Choice D).

The nurse is caring for a client who is HIV positive. What is the first action the nurse will take after sustaining a needlestick injury after giving the client an injection?

A. Complete an incident report.

B. Go to the employee clinic for postexposure prophylaxis.

C. Thoroughly scrub and flush the puncture site.

D. Inform the charge nurse.

C

The first action the nurse will take is to clean the puncture site by washing it thoroughly with soap and water for at least 1 minute. The nurse can then complete an incident report, inform the charge nurse and go to the employee clinic to initiate postexposure prophylaxis.

Which type of hypersensitivity reaction will the nurse suspect in a client who develops as circular rash on the skin underneath a new necklace worn for 3 days?

A. Type I

B. Type II

C. Type III

D. Type IV

D

A type IV delayed hypersensitivity reaction occurs when sensitized T-cells respond to an antigen by releasing chemical mediators and triggering macrophages. This reaction causes a rash as seen in a metal allergy exposure. A type I reaction occurs rapidly after exposure and is mediated by immunoglobulin E (IgE). Type II reactions occur when the body makes autoantibodies directed against self-cells and attack those cells. Type III reactions occur when an abundance of immune complexes are made and they get stuck in small vessels causing inflammation.

The nurse has delegated certain parts of care for a client who is HIV positive to assistive personnel (AP). Which AP statement to the nurse requires nursing intervention?

A. "I told family members they need to wash their hands when they enter and leave the room."

B. "I told another AP that I am worried about getting HIV from the client."

C. "I have been wearing gloves when I help the client with bathing."

D. "The client told me that they got HIV from a blood transfusion."

B

Discussing this client's illness with someone else is a breach of confidentiality and requires further education by the nurse. Instruction on handwashing to family members or other visitors is not a breach of confidentiality. Understanding the reasons for when to wear gloves when performing direct client care is not a breach of confidentiality. Relaying a direct conversation to the nurse (who is also caring for the client) is not a breach of confidentiality.

A client has taken an angiotensin-converting enzyme inhibitor (ACEI) for the first time. When oral and facial swelling begin, which priority action will the nurse take after a corticosteroid is given?

A. Inform that the ACEI drug will be discontinued.

B. Monitor for return of symptoms for at least the next 2 to 4 hours.

C. Assess the vein above the IV infusion site for a firm, cordlike texture.

D. Teaching about symptoms that accompany allergic reactions.

B

All actions are important, although the most important action is to monitor for returning symptoms for 2-4 hours. The ACEI class of drug can remain in the body even after a corticosteroid infusion, so symptoms can recur after first resolving. The client remains at risk and must be monitored for at least 2 to 4 hours for return of angioedema. All other actions can be taken after monitoring is in place.

A client diagnosed with a peanut allergy has received teaching by the nurse about the use and care of an epinephrine autoinjector. Which client statement indicates that further nursing teaching is required?

A. "I will practice putting the device together."

B. "I can inject the drug right through my clothing."

C. "I still must go to the hospital immediately even after injecting."

D. "I will store this injector in the refrigerator at home."

D

The client needs to always have the drug with them rather than storing it in the refrigerator. All other statements reflect an understanding of teaching provided by the nurse.

The nurse is taking a sexual history on a client who is HIV. Which assessment question demonstrates a nonjudgmental and therapeutic approach to care?

A. "With whom do you engage in sexual activity?"

B. "I hope you use condoms to protect your partners."

C. "Tell me your partners' names so I can notify them of your status."

D. "You don't participate in anal intercourse, do you?"

A

The straightforward approach of asking the client who they engage in sexual activity with is nonjudgmental and appropriate. "I hope you use..." is a judgmental statement. Naming partners is voluntary; also, assuming that more than one partner exists is judgmental and presumptuous. The way the question about anal intercourse is phrased is negative and judgmental.

Which client with persistent joint and muscle pain will the nurse consider as most likely to have a systemic lupus erythematosus (SLE) diagnosis?

A. Woman whose mother has psoriasis

B. Man whose father died from a myocardial infarction

C. Woman whose sister has Type 2 diabetes mellitus

D. Man whose identical twin brother has acute myelogenous leukemia

A

SLE is an autoimmune disorder that is much more common in women than in men and has a genetic predisposition related to tissue type. A client with SLE is very likely to have another close relative who also has an autoimmune disorder, such as psoriasis. Myocardial infarction, type 2 diabetes mellitus, and acute myelogenous leukemia are not autoimmune disorders, so these clients are less likely to have SLE.

A client with lupus erythematosus (SLE) has been prescribed a corticosteroid taper for 2 weeks. Which teaching will the nurse provide?

A. This drug will make you feel sleepy.

B. Take this medication when you go to bed.

C. Each day the amount of drug you take will be smaller.

D. Drink caffeinated beverages while you take this drug.

C

The nurse will teach the client that this drug is tapered, so the amount taken daily will decrease. This helps to prevent adrenal insufficiency. The drug will likely make the client have excess energy instead of making them sleepy; therefore, it is preferred to take the drug in the morning. Caffeinated beverages should be avoided while taking this drug to minimize stimulant effect.

Which teaching will the nurse provide to a client newly prescribed hydroxychloroquine for systemic lupus erythematosus (SLE)?

A. See your ophthalmologist for visual field testing regularly.

B. See your cardiologist because this drug causes palpitations.

C. See your rheumatologist as this drug increases joint swelling.

D. See your psychiatrist because hydroxychloroquine induces depression.

A

Hydroxychloroquine has immunomodulating and anticlotting effects that can be beneficial to clients with SLE. A major complication of this drug is its toxicity to retinal cells causing retinitis that can lead to an irreversible loss of central vision. Clients prescribed hydroxychloroquine are instructed to have frequent eye examinations with visual field testing (before starting the drug and every 6 months thereafter). If retinal toxicity is suspected, the drug is discontinued to preserve the remaining vision. The nurse will not provide any of the other recommendations, as the drug doesn't cause palpitations, increased joint swelling or depression.

The nurse has completed teaching for a client newly diagnosed with systemic lupus erythematosus (SLE). Which client statement requires nursing intervention?

A. "My friend and I are going to begin walking 2 miles daily."

B. "At the first sign of a flare, I will start taking my new medication."

C. "Taking my temperature every day can help me recognize when a flare is starting."

D. "If I still have a lot of pain after taking an NSAID, I can also take acetaminophen."

B

The nurse needs to intervene and provide further teaching when the client says they will start taking new medication when a flare begins. Daily drug therapy needs to start immediately to decrease inflammation and to slow the progression of the disease and organ damage. Low-impact exercise such as walking is highly recommended to maintain mobility and promote cardiovascular health. Fevers are often associated with a flare. There is no contraindication to taking both NSAIDs and acetaminophen.

What nursing response is therapeutic when a client with psoriasis says, "My skin makes me feel really ugly"?

A. "You look great. It's what is inside that counts."

B. "Drug therapy will make everything better."

C. "I know what you mean, I feel that way sometimes too."

D. "Thank you for trusting me with your feelings."

D

"Thank you for trusting me with your feelings" is an empathetic response in a hard conversation. It acknowledges the client's bravery for sharing and encourages further therapeutic communication. Other statements are nontherapeutic and dismiss the client's feelings, or place the emphasis back on the nurse's feelings.

Which items will the nurse teach a community group to use to prevent sexual transmission of HIV? (Select all that apply.)

A. Latex or polyurethane condoms

B. Natural-membrane condoms

C. Oral contraceptives

D. Latex dental dams

E. Latex gloves

A, D, E

Latex or polyurethane condoms, dental dams, and gloves can prevent HIV from contacting susceptible tissues. Natural-membrane condoms do not provide as strong of protection against transmission of HIV as latex and polyurethane condoms. Oral contraceptives provide no protection against transmission of HIV or any other sexually transmitted infection.

After a client is hospitalized for an anaphylactic reaction to a bee sting, a nurse is teaching the client about the use of an epinephrine autoinjector. Which teaching will the nurse provide? (Select all that apply.)

A. The injection cannot be given through clothing.

B. Use the device before calling 911.

C. After administering the device, hospital monitoring is necessary.

D. Inject the device into your arm or leg.

E. Keep the device with you at all times.

B, C, E

Instruct the client to utilize the device at the first symptom of anaphylactic reaction before calling 911. Hospital monitoring is always necessary after utilizing epinephrine for anaphylaxis. The device should be available at all times, as allergens can be encountered in all life situations. The injection can be given through a thin layer of clothing. The ideal injection site for an epinephrine automatic injector is in the upper thigh.

Which assessment findings will the nurse expect to see in a client with systemic lupus erythematosus (SLE)? (Select all that apply.)

A. Facial redness

B. Fever

C. Hair loss

D. Fatigue

E. Joint pain and swelling

A, B, C, D, E

Each of these assessment findings has been associated with systemic lupus erythematosus (SLE).

Which laboratory results does the nurse expect to decrease in a client who has untreated HIV-III (AIDS)? (Select all that apply.)

A. CD4+ T-cell

B. Total white blood cell count

C. Lymphocytes

D. HIV antibodies

E. Viral load

A, B, C

The immune target of HIV is the CD4+ T-cell. With infection of this cell, its circulating levels decline and immune function is reduced over time. As a result, total white blood cell counts decrease and circulating lymphocytes decrease. HIV antibodies and viral load increase.