Flashcards - Adult Health - Immune

7/20/23, 10:43 PM Flashcards - Adult Health - Immune
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Adult Health - Immune
1. The nurse provides home care instructions to a client
with systemic lupus erythematosus and tells the client Description
about methods to manage fatigue. Which statement Immune
by the client indicates a need for further instructions?
Updated
1. "I should take hot baths because they are 4/20/2014, 10:54:33 PM
relaxing."
2. "I should sit whenever possible to conserve my Show Answers
energy."
3. "I should avoid long periods of rest because it
causes joint stiffness."
4. "I should do some exercises, such as walking, when
I am not fatigued."
1. "I should take hot baths because they are relaxing."
2. A client with pemphigus is being seen in the clinic

regularly. The nurse plans care based on which
description of this condition?
1. The presence of tiny red vesicles
2. An autoimmune disease that causes blistering in
the epidermis Transcription Job -
3. The presence of skin vesicles found along the
nerve caused by a virus ₱15K/Month
4. The presence of red, raised papules and large TranscriptionStaff.com
plaques covered by silvery scales
2. An autoimmune disease that causes blistering in the
epidermis
3. The nurse is assisting in planning care for a client with

a diagnosis of immunodeficiency and should
incorporate which action as a priority in the plan?
1. Protecting the client from infection
2. Providing emotional support to decrease fear
3. Encouraging discussion about lifestyle changes
4. Identifying factors that decreased the immune
function
1. Protecting the client from infection
4. A client calls the nurse in the emergency department

and states that he was just stung by a bumble bee
while gardening. The client is afraid of a severe
reaction because the client's neighbor experienced
such a reaction just 1 week ago. Which nursing action
should the nurse take?
1. Advise the client to soak the site in hydrogen
peroxide.
2. Ask the client if he ever sustained a bee sting in the
past.
3. Tell the client to call an ambulance for transport to
the emergency department.
4. Tell the client not to worry about the sting unless
difficulty with breathing occurs.
2. Ask the client if he ever sustained a bee sting in the past.
5. The community health nurse is conducting a research

study and is identifying clients in the community at risk
https://freezingblue.com/flashcards/256683/preview/adult-health-immune 2/19
for latex allergy. Which client population is
at most risk for developing this type of allergy?
1. Hairdressers
2. The homeless
3. Children in day care centers
4. Individuals living in a group home
1. Hairdressers
6. Which interventions apply in the care of a client at

high risk for an allergic response to a latex allergy?
Select all that apply.
1. Use nonlatex gloves.
2. Use medications from glass ampules.
3. Place the client in a private room only.
4. Keep a latex-safe supply cart available in the
client's area.
5. Avoid the use of medication vials that have rubber
stoppers.
6. Use a blood pressure cuff from an electronic device
only to measure the blood pressure.
1. Use nonlatex gloves.
2. Use medications from glass ampules.
4. Keep a latex-safe supply cart available in the
client's area.
5. Avoid the use of medication vials that have rubber
stoppers.
7. The camp nurse prepares to instruct a group of

children about Lyme disease. Which information
should the nurse include in the instructions?
1. Lyme disease is caused by a tick carried by deer.
2. Lyme disease is caused by contamination from cat
feces.
3. Lyme disease can be caused by the inhalation of
spores from bird droppings.
4. Lyme disease can be contagious through skin
contact with an infected individual.
1. Lyme disease is caused by a tick carried by deer.
8. A client is diagnosed with scleroderma. Which

intervention should the nurse anticipate to be
prescribed?
1. Maintain bed rest as much as possible.
2. Administer corticosteroids as prescribed for
inflammation.
3. Advise the client to remain supine for 1 to 2 hours
after meals.
4. Keep the room temperature warm during the day
and cool at night.
2. Administer corticosteroids as prescribed for inflammation.
9. A female client arrives at the health care clinic and

tells the nurse that she was just bitten by a tick and
would like to be tested for Lyme disease. The client
tells the nurse that she removed the tick and flushed it
down the toilet. Which nursing actions aremost
appropriate? Select all that apply.
1. Tell the client that testing is not necessary unless
arthralgia develops.
2. Tell the client to avoid any woody, grassy areas that
may contain ticks.
3. Instruct the client to immediately start to take the
antibodies that are prescribed.
4. Inform the client to plan to have a blood test 4 to 6
weeks after a bite to detect the presence of the
disease.
5. Tell the client if this happens again to never remove
the tick but vigorously scrub the area with an
antiseptic.
2. Tell the client to avoid any woody, grassy areas
that may contain ticks.
3. Instruct the client to immediately start to take the
antibodies that are prescribed.
4.Inform the client to plan to have a blood test 4 to 6
weeks after a bite to detect the presence of the
disease.
10. The client with acquired immunodeficiency syndrome

is diagnosed with cutaneous Kaposi's sarcoma. Based
on this diagnosis, the nurse understands that this has
been confirmed by which finding?
1. Swelling in the genital area
2. Swelling in the lower extremities
3. Positive punch biopsy of the cutaneous lesions
4. Appearance of reddish-blue lesions noted on the
skin
3. Positive punch biopsy of the cutaneous lesions
11. The nurse is conducting allergy skin testing on a

client. Which postprocedure interventions are most
appropriate for the nurse to perform? Select all that
apply.
1. Record site, date, and time of the test.
2. Give the client a list of potential allergens if
identified.
3. Estimate the size of the wheal and document the
finding.
4. Tell the client to return to have the site inspected
only if there is a reaction.
5. Have the client wait in the waiting room for at least
1 to 2 hours after injection.
1. Record site, date, and time of the test.
2. Give the client a list of potential allergens if
identified.
12. The home care nurse is performing an assessment on

a client who has been diagnosed with an allergy to
latex. In determining the client's risk factors, the nurse
should question the client about an allergy to which
food item?
1. Eggs
2. Milk
3. Yogurt
4. Bananas
4. Bananas
13. A client with acquired immunodeficiency syndrome is

receiving ganciclovir (Cytovene). The nurse should
take which priority action in caring for this client?
1. Monitor for signs of hyperglycemia.
2. Administer the medication without food.
3. Administer the medication with an antacid.
4. Ensure that the client uses an electric razor for
shaving.
4. Ensure that the client uses an electric razor for shaving.
14. The home care nurse is preparing to visit a client who

has undergone renal transplantation. The nurse
develops a plan of care that includes monitoring the
client for signs of acute graft rejection. The nurse
documents in the plan to assess the client for which
signs of acute graft rejection?
1. Fever, hypotension, and polyuria
2. Hypertension, polyuria, and thirst
3. Fever, hypertension, and graft tenderness
4. Hypotension, graft tenderness, and hypothermia
3. Fever, hypertension, and graft tenderness
15. A client with acquired immunodeficiency syndrome

(AIDS) has been started on therapy with zidovudine
(Retrovir). The nurse should monitor the results of
which laboratory blood study for adverse effects of
therapy?
1. Creatinine level
2. Potassium concentration
3. Complete blood count (CBC)
4. Blood urea nitrogen (BUN) level
3. Complete blood count (CBC)

(AIDS) is receiving didanosine (Videx). When the
nurse reviews the client's laboratory test results, which
result should be most closely monitored?
1. Protein
2. Glucose
3. Amylase
4. Cholesterol
3. Amylase
17. A client is receiving zalcitabine. The nurse should

monitor the results of which study to determine the
effectiveness of this medication?
1. Western blot
2. CD4+ cell count
3. Enzyme-linked immunosorbent assay (ELISA)
4. Complete blood cell (CBC) count with differential
2. CD4+ cell count
18. A client who has been receiving pentamidine (Pentam

300) intravenously now has a fever with a temperature
of 102° F. Keeping in mind that the client has a
diagnosis of acquired immunodeficiency syndrome
and Pneumocystis jiroveci pneumonia, the nurse
should interpret that this fever is most associated with
which condition?
1. Inadequate thermoregulation
2. Insufficient medication dosing
3. Toxic nervous system effects from the medication
4. Infection caused by leukopenic effects of the
medication
4. Infection caused by leukopenic effects of the medication
19. A client is diagnosed with stage I Lyme disease, and

the nurse assesses the client for disease
manifestations. Which should the nurse expect to note
as the hallmark characteristic of this stage?
1. Skin rash
2. Arthralgias
3. Neurological deficits
4. Enlarged and inflamed joints
1. Skin rash
20. Assessment and diagnostic evaluation reveal that a

client seen in the ambulatory care clinic has stage II
Lyme disease. The clinic nurse identifies which
assessment finding as most characteristic of this
stage?
1. Arthralgias
2. Joint enlargement
3. Erythematous rash
4. Cardiac conduction deficits
4. Cardiac conduction deficits
21. The clinic nurse reads the chart of a client just seen by
the health care provider (HCP) and notes that the
HCP has documented that the client has stage III
Lyme disease. Which clinical manifestation should the
nurse expect to note in this client?
1. A generalized skin rash
2. A cardiac dysrhythmia
3. Complaints of joint pain
4. Paralysis of the affected extremity
3. Complaints of joint pain
22. A client arrives at the health care clinic and tells the
nurse that he was just bitten by a tick and would like to
be tested for Lyme disease. The client reports that he
removed the tick and flushed it down the toilet. The
nurse should take which nursing action?
1. Refer the client for a blood test immediately.
2. Ask the client about the size and color of the tick.
3. Tell the client to return to the clinic in 4 to 6 weeks.
4. Inform the client that the tick is needed to perform a
test.
3. Tell the client to return to the clinic in 4 to 6 weeks.
23. A client suspected of having stage I Lyme disease is

seen in the health care clinic and is told that the Lyme
disease test result is positive. The client asks the
nurse about the treatment for the disease. In
responding to the client, the nurse anticipates that
which intervention will be part of the treatment plan?
1. Ultraviolet light therapy
2. No treatment unless symptoms develop
3. Treatment with intravenous (IV) penicillin G
4. A 3- to 4-week course of oral antibiotic therapy
4. A 3- to 4-week course of oral antibiotic therapy
24. The nurse is performing an assessment on a female

client who complains of fatigue, weakness, muscle
and joint pain, anorexia, and photosensitivity.
Systemic lupus erythematosus (SLE) is suspected.
What should the nurse further assess that also is
indicative of SLE?
1. Ascites
2. Emboli
3. Facial rash
4. Two hemoglobin S genes
3. Facial rash
25. A client has requested and undergone testing for

human immunodeficiency virus (HIV) infection. The
client asks what will be done next because the result
of his enzyme-linked immunosorbent assay (ELISA)
has been positive. The nurse should formulate a
response based on which information?
1. A Western blot will be done to confirm these
findings.
2. The client probably will have a bone marrow biopsy
done.
3. A CD4+ cell count will be done to measure T-helper
lymphocytes.
4. The client will be diagnosed definitively as positive
for HIV infection at this point.
1. A Western blot will be done to confirm these findings.
26. The nurse is caring for a client with acquired

immunodeficiency syndrome and detects early
infection with Pneumocystis jiroveci by monitoring the
client for which clinical manifestation?
1. Fever
2. Cough
3. Dyspnea at rest
4. Dyspnea on exertion
2. Cough

(AIDS) has a concurrent diagnosis of histoplasmosis.
During the assessment, the nurse notes that the client
has enlarged lymph nodes. How should the nurse
interpret this assessment finding?
1. The histoplasmosis is resolving.
2. The client has disseminated histoplasmosis
infection.
3. This is a side effect of the medications given to treat
AIDS.
4. The client probably has another infection that is
developing.
2. The client has disseminated histoplasmosis infection.
28. The nurse is caring for a client with acquired

immunodeficiency syndrome (AIDS) who is
experiencing night fever and night sweats. Which
nursing intervention would be the least helpful in
managing this symptom?
1. Keep liquids at the bedside.
2. Make sure the pillow has a plastic cover.
3. Keep a change of bed linens nearby in case they
are needed.
4. Administer an antipyretic after the client has a spike
in temperature.
4. Administer an antipyretic after the client has a spike in
temperature.

(AIDS) is experiencing nausea and vomiting. The
nurse should include which measure in the dietary
plan?
1. Provide large, nutritious meals.
2. Serve foods while they are hot.
3. Add spices to food for added flavor.
4. Remove dairy products and red meat from the
meal.
4. Remove dairy products and red meat from the meal.
30. The clinic nurse is providing home care instructions to

a client who has been diagnosed with a latex allergy.
The nurse most appropriately instructs the client to
avoid which activity?
1. Sunlight
2. Going to parties
3. The use of latex condoms
4. Outdoor activities as much as possible
3. The use of latex condoms
31. A client is diagnosed with Goodpasture's syndrome.

The nurse determines that this client's renal disease is
caused by which response?
1. A type I hypersensitivity response
2. A type II hypersensitivity response
3. A type III hypersensitivity response
4. A type IV hypersensitivity response
2. A type II hypersensitivity response
32. The nursing instructor asks a nursing student to

identify the components of natural resistance as it
relates to the immune system. Which statement by the
nursing student indicates a need for further
research?
1. "It also is called inherited immunity."
2. "It is that immunity with which a person is born."
3. "It does not require previous exposure to the
antigen."
4. "It includes all antigen-specific immunities a person
develops during a lifetime."
4. "It includes all antigen-specific immunities a person
develops during a lifetime."
33. The nursing student is planning to conduct a clinical

conference on the immune system. In creating a
handout for the conference, what should the student
include as the function of B lymphocytes (B cells)?
1. Activate T cells.
2. Make antibodies.
3. Initiate phagocytosis.
4. Attack and kill target cells directly.
2. Make antibodies.
34. The nurse has been assigned to care for a client with
an immune disorder. In developing a plan of care for
this client, the nurse incorporates knowledge that the
immune system consists of specific major types of
cells. Which types of cells are associated with the
immune system? Select all that apply.
1. Dendritic cells
2. B lymphocytes
3. Red blood cells
4. Helper T lymphocytes
5. Cytolytic T lymphocytes
1. Dendritic cells
2. B lymphocytes
4. Helper T lymphocytes
5. Cytolytic T lymphocytes
35. The nurse mentor is describing the phases of the

immune response to a recent nursing graduate. The
mentor determines that the graduate needs
additional information if the graduate states that
which is a phase of the immune response?
1. Effector phase
2. Memory phase
3. Activation phase
4. Recognition phase
2. Memory phase
36. A client is admitted to the hospital with a diagnosis of

parasitic worms. The nurse should plan care knowing
that which cells are the primary cell types that attack
these foreign particles?
1. Basophils
2. Neutrophils
3. Eosinophils
4. Dendritic cells
3. Eosinophils
37. The nursing instructor is reviewing the plan of care

with a nursing student who is caring for a client with
an altered immune system. What should the student
tell the instructor when asked to describe the
properties of interferon?
1. Is produced only by B lymphocytes
2. Is effective only against specific viruses
3. Is effective against a wide variety of viruses
4. Inactivates viruses that are found only outside cells
3. Is effective against a wide variety of viruses
38. The nursing student is assigned to care for a client

with an immune disorder. The student is reviewing
information related to the immune response and the
classes of human antibodies. The student should plan
care knowing that what is the major serum antibody?
1. Immunoglobulin E (IgE)
2. Immunoglobulin G (IgG)
3. Immunoglobulin A (IgA)
4. Immunoglobulin M (IgM)
39. The nursing instructor is evaluating a nursing student

for knowledge of antibody classes. What should the
student state when asked which antibody is the first
produced in response to an antigen?
2. Immunoglobulin A (IgA)
3. Immunoglobulin D (IgD)
40. The nursing student who is enrolled in an anatomy

and physiology course is studying the immune
system. The student understands that a nonspecific
immune response can include physical barriers and
chemical barriers. What should the student identify as
an example of a chemical barrier?
1. The skin
2. The mucous membranes
3. The cilia lining the respiratory tract
4. Acids and enzymes found in body fluids
4. Acids and enzymes found in body fluids
41. Tetanus toxoid is prescribed for a client who sustained

a foot laceration from a piece of metal while walking
barefoot on the beach. When preparing the injection,
the nurse understands that which accurately describes
the prescribed toxoid?
1. A non-attenuated virus
2. An attenuated bacterium
3. A specific antibody that will prevent infection
4. A toxin produced by bacteria that has been altered
so that it is no longer toxic
4. A toxin produced by bacteria that has been altered so
that it is no longer toxic
42. The nursing student is conducting a clinical

conference on immunity. In discussing active versus
passive immunity, what should the student emphasize
about active immunity?
1. Has a half-life of about 30 days
2. Provides protection immediately
3. Lasts much longer than passive immunity
4. Is less effective at preventing subsequent infections
3. Lasts much longer than passive immunity
43. A nursing instructor is reviewing information on the

organs of the immune system. The instructor asks a
nursing student to name the location of Kupffer cells.
What is the accurate student response?
1. The liver
2. The spleen
3. The tonsils
4. Bone marrow
1. The liver
44. The nursing instructor asks a nursing student to

identify the location of Peyer patches. What should be
the correct response by the student?
1. The liver
2. The spleen
3. The tonsils
4. The small intestine
4. The small intestine
45. The nursing student is reviewing information related to

the inflammatory reaction. What should the student
understand is the primary purpose of neutrophils in
the inflammatory response?
1. Dilate the blood vessels.
2. Increase fluids at the site of injury.
3. Allow permeability of the blood vessels.
4. Phagocytize any potentially harmful agents.
46. The nursing instructor asks a nursing student to define

the process of phagocytosis. What should the student
tell the instructor that phagocytosis is?
1. Required for the production of antibodies
2. The initial reaction in the inflammatory response
3. A protein produced in response to a viral infection
4. A process by which a particle is ingested and
digested by a cell
4. A process by which a particle is ingested and digested by
a cell
47. The nursing student is describing the differences

between specific and nonspecific immunity. What
should the student correctly identify as specific
immunity?
1. Present and functioning at birth
2. The first line of defense against infection
3. The second line of defense against infection
4. The type of immunity that reacts the same to all
antigens
3. The second line of defense against infection
48. A test for the presence of rheumatoid factor is

performed in a client with a diagnosis of rheumatoid
arthritis. What does this test assess for the presence
of?
1. Inflammation
2. Antigens of IgA
3. Infection in the body
4. Unusual antibodies of the IgG and IgM type
4. Unusual antibodies of the IgG and IgM type
49. A nurse is reviewing the diagnostic tests prescribed for

an assigned client and notes that a lupus cell
preparation (LE cell prep) has been prescribed. The
nurse understands that this test is used to screen
primarily for which disorder?
1. Histoplasmosis
2. Progressive systemic sclerosis
3. Systemic lupus erythematosus (SLE)
4. Human immunodeficiency virus (HIV)
50. A complete blood cell count is performed on a client

with systemic lupus erythematosus (SLE). The nurse
suspects that which finding will be reported with this
blood test?
1. Increased neutrophils
2. Increased red blood cell count
3. Increased white blood cell count
4. Decreased numbers of all cell types
4. Decreased numbers of all cell types
51. The nurse is reviewing the health care record of a

client with a new diagnosis of rheumatoid arthritis
(RA). The nurse should recognize that which is a least
likely early clinical manifestation of this disorder?
1. Anorexia
2. Weight gain
3. Complaints of fatigue
4. Complaints of generalized weakness
2. Weight gain
52. A nurse is caring for a client with acquired

immunodeficiency syndrome (AIDS) who has begun to
experience multiple opportunistic infections. Which
laboratory test would be most helpful in assessing the
client's need for reassessment of treatment?
1. Western blot
2. B-lymphocyte count
3. CD4+ cell or T-lymphocyte count
4. Enzyme-linked immunosorbent assay (ELISA)
3. CD4+ cell or T-lymphocyte count

has been started on therapy with zidovudine
(Retrovir). The nurse assesses the complete blood
count (CBC), knowing that which is an adverse effect
of this medication?
1. Polycythemia
2. Leukocytosis
3. Thrombocytosis
4. Agranulocytopenia
4. Agranulocytopenia
54. A client is suspected of having systemic lupus

erythematosus (SLE). On reviewing the client's record,
the nurse should expect to note documentation of
which characteristic sign of SLE?
1. Fever
2. Fatigue
3. Skin lesions
4. Elevated red blood cell count
3. Skin lesions
55. The home care nurse provides instructions to a client

with systemic lupus erythematosus (SLE) about
measures to manage fatigue. Which statement by the
client indicates the need for further instruction?
1. "I need to sit whenever possible."
2. "I need to avoid long periods of rest."
3. "I should take a hot bath every evening."
4. "I should engage in moderate low-impact exercise
when I am not tired."
3. "I should take a hot bath every evening."
56. A client seen in an ambulatory clinic has a facial rash

that is present on both cheeks. The nurse interprets
that this finding is consistent with manifestations of
which disorder?
1. Hyperthyroidism
2. Pernicious anemia
3. Cardiopulmonary disorders
57. A client asks a nurse about obtaining a home test kit

to test for human immunodeficiency virus (HIV) status.
What should the nurse tell the client?
1. Home test kits are not available for testing at this
time.
2. Home test kits are reliable for determining the HIV
status.
3. Home test kits may not be as reliable as laboratory
blood tests.
4. Home test kits should not be used; rather, it is
important to contact the health care provider (HCP)
with concerns about the HIV status.
3. Home test kits may not be as reliable as laboratory blood
tests.
58. A client reports to the health care clinic for testing for
human immunodeficiency virus (HIV) immediately
after being exposed to HIV. The test results are
negative, and the client tells the nurse that he is
relieved that he has not contracted HIV. What should
the nurse emphasize when explaining the test results
to the client?
1. No further testing is needed.
2. The test should be repeated in 1 month.
3. A negative HIV test result is considered accurate.
4. A negative HIV test result is not considered
accurate immediately after exposure.
4. A negative HIV test result is not considered accurate
immediately after exposure.
59. A client is tested for human immunodeficiency virus

(HIV) infection with an enzyme-linked immunosorbent
assay (ELISA), and the test result is positive. What
should the nurse tell the client?
1. HIV infection has been confirmed.
2. The client probably has a gastrointestinal infection.
3. The test will need to be confirmed with a Western
blot.
4. A positive test result is normal and does not mean
that the client has acquired HIV.
3. The test will need to be confirmed with a Western blot.
60. A CD4+ lymphocyte count is performed in a client with

human immunodeficiency virus (HIV) infection. The
nurse plans care, knowing that which is the reason for
the count?
1. Establish the stage of HIV infection.
2. Confirm the presence of HIV infection.
3. Identify the cell-associated proviral DNA.
4. Determine the presence of HIV antibodies in the
bloodstream.
1. Establish the stage of HIV infection.
61. A CD4 T-cell count is measured in a client newly

diagnosed with human immunodeficiency virus (HIV).
The nurse understands that which is accurate
regarding the CD4 T-cell count? Select all that
apply.
1. Falls in response to a declining viral load
2. Is a primary marker of immunocompetence
3. Plays a role in the cell-mediated immune response
4. Is a direct measure of the magnitude of HIV
replication
5. Guides decision making regarding timing of
initiation of treatment
2. Is a primary marker of immunocompetence
3. Plays a role in the cell-mediated immune
response
5. Guides decision making regarding timing of
initiation of treatment
62. A client with human immunodeficiency virus (HIV)

infection has a fever, and histoplasmosis is suspected.
The nurse should prepare the client for which
diagnostic test to confirm the presence of
histoplasmosis?
1. Skin biopsy
2. Sputum culture
3. Western blot test
4. Upper gastrointestinal series
2. Sputum culture
63. A client with human immunodeficiency virus infection

has signs and symptoms of cryptosporidiosis. The
nurse should prepare the client for which test that will
assist in confirming the diagnosis?
1. Stool culture
2. Bronchoscopy
3. Sputum culture
4. Chest x-ray study
1. Stool culture
64. A nurse reviews the record of an assigned client and

notes that the client has a diagnosis of oral
candidiasis (thrush). Which objective finding would the
nurse expect to note in the client?
1. Hyperactive bowel sounds
2. Complaints of watery diarrhea
3. Red lesions locate on the upper arms
4. Creamy white curdlike patches noted on the oral
mucosa
4. Creamy white curdlike patches noted on the oral mucosa
65. A nurse is assigned to care for a client suspected of

having Kaposi's sarcoma. The nurse should prepare
the client for which test to confirm this diagnosis?
1. Skin biopsy
2. Blood culture
3. Bone marrow biopsy
4. Magnetic resonance imaging
1. Skin biopsy
66. A nurse is assigned to care for a client with human

immunodeficiency virus infection. The nurse reviews
the client's health care record and notes
documentation of toxoplasmosis. On the basis of this
information, the nurse would assess for which sign or
symptom?
1. Lesions on the skin
2. Mental status changes
3. Changes in bowel pattern
4. Lesions on the oral mucosa
2. Mental status changes
67. A fluorescent antinuclear antibody titer (FANA) is

performed in a client suspected of having rheumatoid
arthritis (RA). The nurse reviews the laboratory
findings and determines that the test result is positive
if which value is noted?
1. 0:5
2. 0:8
3. 1:5
4. 1:20
4. 1:20
68. A rheumatoid factor assay is performed in a client with

a diagnosis of rheumatoid arthritis. The nurse
understands that this test is done to detect which
finding?
1. The presence of inflammation
2. The presence of antigens of IgA
3. The presence of infection in the body
4. The presence of unusual antibodies of the
immunoglobulin G (IgG) and IgM types
4. The presence of unusual antibodies of the
immunoglobulin G (IgG) and IgM types
69. An erythrocyte sedimentation rate (ESR)

determination is prescribed for a client with a
connective tissue disorder. The client asks the nurse
about the purpose of the test. What should the nurse
tell the client about the purpose of the test?
1. Determines the presence of antigens
2. Identifies which additional tests need to be
performed
3. Confirms the diagnosis of a connective tissue
disorder
4. Confirms the presence of inflammation or infection
in the body
4. Confirms the presence of inflammation or infection in the
body
70. A nurse is reviewing the diagnostic tests performed in

an adult with a connective tissue disorder. The
erythrocyte sedimentation rate (ESR) is reported as
35 mm/hr. How should the nurse interpret this
finding?
1. Normal
2. Indicating mild inflammation
3. Indicating severe inflammation
4. Indicating moderate inflammation
2. Indicating mild inflammation
71. A nurse is reviewing the diagnostic tests prescribed for

an assigned client and notes that an "LE cell prep"
has been prescribed. The nurse understands that this
test is used to screen primarily for which disorder?
1. Histoplasmosis
2. Progressive systemic sclerosis
4. Human immunodeficiency virus infection
72. A complete blood cell count is performed in a client

with systemic lupus erythematosus (SLE). The nurse
would suspect that which finding will be noted in the
client with SLE?
1. Decreased platelets only
2. Increased red blood cell count
3. Increased white blood cell count
4. Decreased number of all cell types
4. Decreased number of all cell types
73. A nurse is reviewing the health care record of a client

with a new diagnosis of rheumatoid arthritis (RA). The
nurse understands that which is an early clinical
manifestation of RA?
1. Anemia
2. Anorexia
3. Amenorrhea
4. Night sweats
2. Anorexia
74. A client with human immunodeficiency virus infection

is diagnosed with herpes simplex. The nurse should
prepare the client for which diagnostic test to
determine the presence of herpesvirus infection?
1. Chest x-ray
2. Viral culture
3. Stool culture
4. Neurological exam
2. Viral culture
75. A nurse is assigned to care for a client with human

immunodeficiency virus infection. The nurse notes
recent documentation of herpes simplex in the client's
medical record. On assessment, the nurse would
expect to note which type of lesion?
1. Macular lesions
2. Ecchymotic lesions
3. Creamy-white patches
4. Vesicular lesions that rupture
4. Vesicular lesions that rupture
76. A nurse is caring for a client with human

immunodeficiency virus infection and notes a
diagnosis of cryptococcosis in the client's medical
record. The nurse understands that this opportunistic
infection most likely was diagnosed by which test?
1. Skin biopsy
2. Viral culture
3. Sputum culture
4. Bone marrow biopsy
3. Sputum culture

(AIDS) is experiencing fatigue. The nurse should plan
to teach the client which strategy to conserve energy
after discharge from the hospital?
1. Bathe before eating breakfast.
2. Sit for as many activities as possible.
3. Stand in the shower instead of taking a bath.
4. Group all tasks to be performed early in the
morning.
2. Sit for as many activities as possible.
78. The nurse instructs a client with candidiasis (thrush) of

the oral cavity how to care for the disorder. Which
client statement indicates the need for further
instruction?
1. "I need to eat foods that are liquid or pureed."
2. "I need to eliminate spicy foods from my diet."
3. "I need to eliminate citrus juices and hot liquids from
my diet."
4. "I need to rinse my mouth four times daily with a
commercial mouthwash."
4. "I need to rinse my mouth four times daily with a
commercial mouthwash."
79. A client is suspected of having stage I Lyme disease.

The nurse anticipates that which will be part of the
treatment plan for the client?
1. Daily oatmeal baths for 2 weeks
2. No treatment unless symptoms develop
3. A 3-week course of oral antibiotic therapy
4. Treatment with intravenously administered
antibiotics
3. A 3-week course of oral antibiotic therapy

(AIDS) has a respiratory infection from Pneumocystis
jiroveci and has been experiencing difficulty breathing
and resultant problems with gas exchange. Which
finding indicates that the expected outcome of care
has yet to be achieved?
1. The client limits fluid intake.
2. The client has clear breath sounds.
3. The client expectorates secretions easily.
4. The client is free of complaints of shortness of
breath.
1. The client limits fluid intake.
81. A nurse is assisting in administering immunizations at

a health care clinic. What should the nurse understand
that an immunization provides?
1. Protection from all diseases
2. Innate immunity from disease
3. Natural immunity from disease
4. Acquired immunity from disease
4. Acquired immunity from disease
82. A home care nurse is assigned to visit a client who

has returned home from the emergency department
following treatment for a sprained ankle. The nurse
notes that the client was sent home with crutches that
have rubber axillary pads and needs instructions
regarding crutch walking. On admission assessment,
the nurse discovers that the client has an allergy to
latex. Before providing instructions regarding crutch
walking, what action should the nurse take?
1. Cover the crutch pads with cloth.
2. Contact the health care provider (HCP).
3. Call the local medical supply store and ask for a
cane to be delivered.
4. Tell the client that the crutches must be removed
from the house immediately.
1. Cover the crutch pads with cloth.
83. A home care nurse is prescribing dressing supplies for

a client who has an allergy to latex. Which item should
the nurse ask the medical supply personnel to
deliver?
1. Elastic bandages
2. Adhesive bandages
3. Brown Ace bandages
4. Cotton pads and silk tape
4. Cotton pads and silk tape
84. A client with a history of asthma comes to the

emergency department complaining of itchy skin and
shortness of breath after starting a new antibiotic.
What is the first action the nurse should take?
1. Place the client on 100% oxygen and prepare for
intubation.
2. Assess for anaphylaxis and prepare for emergency
treatment.
3. Obtain an arterial blood gas and immunoglobulin E
(IgE) blood level.
4. Teach the client about the relationship between
asthma and allergies.
2. Assess for anaphylaxis and prepare for emergency
treatment.
85. The nurse is preparing to care for a client with

immunodeficiency. The nurse should plan to address
which problem as the priority?
1. Anxiety
2. Fatigue
3. Risk for infection
4. Need for social isolation
3. Risk for infection
86. A nurse caring for a client who has undergone kidney

transplantation is monitoring the client for organ
rejection. The nurse understands that in cases in
which the recipient rejects transplanted organs, the
cells of the transplanted organs are seen by the body
as which?
1. T cell
2. B cell
3. Antibody
4. Foreign antigen
4. Foreign antigen
87. A client is admitted to the hospital with a diagnosis of

parasitic worms. The nurse understands that the
primary cell type that will attack these foreign particles
is which?
1. Basophils
2. Neutrophils
3. Eosinophils
4. Dendritic cells
3. Eosinophils
88. Tetanus toxoid is prescribed for a client who has

sustained a foot laceration from a piece of metal while
walking barefoot on the beach. The nurse
understands that a toxoid is which?
1. A nonattenuated virus
2. An attenuated bacterium
3. Toxin produced by bacteria that has been altered so
that it is no longer toxic
4. Specific antibody that will prevent infection through
an antigen-antibody reaction
3. Toxin produced by bacteria that has been altered so that
it is no longer toxic
89. A nursing instructor is questioning a nursing student

about the organs of the immune system and asks the
student where Kupffer's cells are located. The student
responds correctly by stating that these types of cells
are located in which location?
1. Liver
2. Tonsils
3. Spleen
4. Bone marrow
1. Liver
90. A nurse teaches a client that the primary purpose of

neutrophils in the inflammatory response is to promote
which response?
1. Dilate the blood vessels.
2. Increase fluids at the site of injury.
3. Produce permeability of the blood vessels.
91. A nurse teaches a client that the process of

phagocytosis is which?
1. The initial reaction in the inflammatory response
2. A protein produced in response to a viral infection
3. A process required for the production of antibodies
4. A process whereby a particle is ingested and
digested by a cell
4. A process whereby a particle is ingested and digested by
a cell
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7/20/23, 10:43 PM Flashcards - Adult Health - Immune

2. A client with pemphigus is being seen in the clinic

3. The nurse is assisting in planning care for a client with

4. A client calls the nurse in the emergency department

5. The community health nurse is conducting a research

6. Which interventions apply in the care of a client at

7. The camp nurse prepares to instruct a group of

8. A client is diagnosed with scleroderma. Which

9. A female client arrives at the health care clinic and

10. The client with acquired immunodeficiency syndrome

11. The nurse is conducting allergy skin testing on a

12. The home care nurse is performing an assessment on

13. A client with acquired immunodeficiency syndrome is

14. The home care nurse is preparing to visit a client who

15. A client with acquired immunodeficiency syndrome

16. A client with acquired immunodeficiency syndrome

17. A client is receiving zalcitabine. The nurse should

18. A client who has been receiving pentamidine (Pentam

19. A client is diagnosed with stage I Lyme disease, and

20. Assessment and diagnostic evaluation reveal that a

23. A client suspected of having stage I Lyme disease is

24. The nurse is performing an assessment on a female

25. A client has requested and undergone testing for

26. The nurse is caring for a client with acquired

27. A client with acquired immunodeficiency syndrome

28. The nurse is caring for a client with acquired

29. A client with acquired immunodeficiency syndrome

30. The clinic nurse is providing home care instructions to

31. A client is diagnosed with Goodpasture's syndrome.

32. The nursing instructor asks a nursing student to

33. The nursing student is planning to conduct a clinical

35. The nurse mentor is describing the phases of the

36. A client is admitted to the hospital with a diagnosis of

37. The nursing instructor is reviewing the plan of care

38. The nursing student is assigned to care for a client

39. The nursing instructor is evaluating a nursing student

40. The nursing student who is enrolled in an anatomy

41. Tetanus toxoid is prescribed for a client who sustained

42. The nursing student is conducting a clinical

43. A nursing instructor is reviewing information on the

44. The nursing instructor asks a nursing student to

45. The nursing student is reviewing information related to

46. The nursing instructor asks a nursing student to define

47. The nursing student is describing the differences

48. A test for the presence of rheumatoid factor is

49. A nurse is reviewing the diagnostic tests prescribed for

50. A complete blood cell count is performed on a client

51. The nurse is reviewing the health care record of a

52. A nurse is caring for a client with acquired

53. A client with acquired immunodeficiency syndrome

54. A client is suspected of having systemic lupus

55. The home care nurse provides instructions to a client

56. A client seen in an ambulatory clinic has a facial rash

57. A client asks a nurse about obtaining a home test kit

59. A client is tested for human immunodeficiency virus

60. A CD4+ lymphocyte count is performed in a client with

61. A CD4 T-cell count is measured in a client newly

62. A client with human immunodeficiency virus (HIV)