While palpating the neck of a patient with unexplained weight loss, the nurse finds an enlarged lymph node. Which node characteristic raises the most concern for cancer?
Firm and painless
✓
Tender and movable
Soft and warm to the touch
Tender after a recent sore throat
Correct Answer
Firm and painless
A firm, painless lymph node raises concern for malignancy and needs prompt follow-up. Tender and movable nodes more often reflect a reaction to infection. Soft and warm to the touch describes an inflamed node responding to infection rather than a typical cancer finding. Tender after a recent sore throat suggests a reactive node from that infection.
Category: Immune Assessment
Question 2
A patient who received a kidney transplant takes immunosuppressive medications. Which finding should the nurse teach the patient to report right away?
Mild thinning of the hair
Decreased urine output
✓
Increased appetite
An occasional mild headache
Correct Answer
Decreased urine output
Decreased urine output can signal rejection or failure of the transplanted kidney, so it is reported immediately, along with fever, bloody urine, flu-like symptoms and tenderness over the new organ. Mild thinning of the hair is a known side effect of immunosuppressive therapy and is not an emergency. Increased appetite is a common side effect of immunosuppressive regimens that include corticosteroids and is not a sign of rejection. An occasional mild headache is a common side effect rather than a sign of rejection or infection.
Category: Immunosuppressive Therapy
Question 3
A patient going through a stressful divorce has had several respiratory infections in recent months, although she rarely got sick before. Which referral addresses a likely contributor to her infections?
An allergist for skin testing
A surgeon to evaluate tonsil removal
Mental health services for stress management
✓
A dermatologist for a skin examination
Correct Answer
Mental health services for stress management
Prolonged stress raises cortisol and related hormones that suppress immune function, so chronic stress increases susceptibility to infection; helping the patient manage stress addresses that contributor. An allergist for skin testing evaluates allergies, which do not explain a new pattern of infections. A surgeon to evaluate tonsil removal does not address the stress linked to her lowered immunity. A dermatologist for a skin examination is unrelated to her respiratory infections.
Category: Stress and Immunity
Question 4
While reviewing patient histories, the nurse notes the following findings. Which finding points to an immunodeficiency rather than an autoimmune disorder?
Antibodies directed against the patient's own thyroid tissue
Joint swelling from immune complexes deposited in the tissue
Destruction of insulin-producing cells in the pancreas
Repeated oral thrush and ear infections that are slow to clear
✓
Correct Answer
Repeated oral thrush and ear infections that are slow to clear
Frequent infections that recur and are slow to clear, such as oral thrush and ear infections, show an immune response too weak to control pathogens, which is the hallmark of immunodeficiency. Antibodies directed against the patient's own thyroid tissue reflect autoimmunity, an overactive and misdirected response. Joint swelling from immune complexes deposited in the tissue is also an autoimmune process. Destruction of insulin-producing cells in the pancreas is the autoimmune process behind type 1 diabetes.
Category: Autoimmunity
Question 5
A patient is diagnosed with autoimmune hemolytic anemia. What causes the anemia?
Antibodies destroy red blood cells faster than the marrow replaces them
✓
The bone marrow stops producing every type of blood cell
A lack of dietary iron limits hemoglobin production
Slow, chronic blood loss from the digestive tract
Correct Answer
Antibodies destroy red blood cells faster than the marrow replaces them
In autoimmune hemolytic anemia, antibodies directed against the patient's own red blood cells destroy them faster than the bone marrow can make new ones. The bone marrow stops producing every type of blood cell describes marrow failure, as in aplastic anemia. A lack of dietary iron limits hemoglobin production describes iron deficiency anemia. Slow, chronic blood loss from the digestive tract causes anemia through bleeding, not immune destruction.
Category: Autoimmune Disorders
Question 6
Which patient characteristic is associated with a higher rate of autoimmune disease?
Male sex
Female sex
✓
Regular aerobic exercise
A diet high in fiber
Correct Answer
Female sex
Most people with autoimmune disease are women; sex hormones and genes on the X chromosome are thought to contribute to the difference. Male sex is linked with lower, not higher, rates of autoimmune disease. Regular aerobic exercise supports overall health and is not a risk factor. A diet high in fiber is not a recognized risk factor for autoimmunity.
Category: Autoimmune Disorders
Question 7
Which history finding should prompt the nurse to suspect a primary immunodeficiency in a young adult?
Sneezing and itchy eyes every spring
A single episode of influenza last winter
Repeated infections with unusual organisms despite treatment
✓
Joint stiffness that improves with activity
Correct Answer
Repeated infections with unusual organisms despite treatment
Primary immunodeficiency is suggested by infections with opportunistic or unusual organisms, infections that persist despite aggressive treatment, and a family history of similar problems. Sneezing and itchy eyes every spring points to seasonal allergy, not immune deficiency. A single episode of influenza last winter is common in healthy people. Joint stiffness that improves with activity is a musculoskeletal finding unrelated to immune deficiency.
Category: Primary Immunodeficiency
Question 8
A patient has a T-cell deficiency. Which infections is this patient especially likely to develop?
Extracellular bacterial infections only
Prion diseases of the brain
Parasitic worm infections only
Viral and fungal infections
✓
Correct Answer
Viral and fungal infections
T cells defend against microorganisms that live inside cells, such as viruses and fungi, and against tumors, so these infections flourish when T cells are deficient. Extracellular bacterial infections only describes the typical pattern of B-cell deficiency, and T-cell defects can also reduce antibody production. Prion diseases of the brain are not caused by T-cell deficiency. Parasitic worm infections only is too narrow and does not reflect the main risk.
Category: Primary Immunodeficiency
Question 9
Which condition is an example of a secondary immunodeficiency?
Weakened immunity caused by chemotherapy
✓
An inherited complement protein deficiency
An inherited defect in antibody production
A genetic defect in T-cell development
Correct Answer
Weakened immunity caused by chemotherapy
Secondary immunodeficiency develops later in life as a result of another disorder or a treatment, such as chemotherapy, corticosteroids or HIV infection. An inherited complement protein deficiency is a primary, genetic immunodeficiency. An inherited defect in antibody production is also primary. A genetic defect in T-cell development is primary because it is inherited rather than acquired.
Category: Secondary Immunodeficiency
Question 10
A nurse is stuck by a needle that was just used on a patient. What should the nurse do first?
Finish caring for the patient and report it later
Wash the site with soap and water
✓
Cover the site with a bandage and keep working
Wait for the patient's HIV test result before acting
Correct Answer
Wash the site with soap and water
After a needlestick the nurse washes the area immediately and then reports the injury right away so that evaluation and any postexposure prophylaxis can begin as soon as possible. Finishing care and reporting the injury later delays treatment that works best when started early. Covering the site with a bandage and continuing to work skips both cleaning and reporting. Waiting for the patient's HIV test result before acting wastes time that matters for prophylaxis.
Category: HIV Prevention
Question 11
Which person is a candidate for pre-exposure prophylaxis against HIV?
A person who was just diagnosed with HIV
A nurse who just had a needlestick from a patient with HIV
An HIV-negative person whose sexual partner has HIV
✓
A person with HIV whose viral load is undetectable
Correct Answer
An HIV-negative person whose sexual partner has HIV
Pre-exposure prophylaxis is taken by people who do not have HIV but are at high risk, so it lowers the chance of infection before any exposure. A person who was just diagnosed with HIV needs antiretroviral treatment, not prevention. A nurse who just had a needlestick from a patient with HIV needs postexposure prophylaxis, which is started after an exposure. A person with HIV whose viral load is undetectable is already being treated for the infection.
Category: HIV Prevention
Question 12
Why does HIV readily produce new variants that can escape immune control?
It destroys B cells before any antibodies form
It stores its genes as double-stranded DNA
It replicates only once inside each host cell
Its reverse transcriptase makes frequent copying errors
✓
Correct Answer
Its reverse transcriptase makes frequent copying errors
HIV uses reverse transcriptase to copy its RNA into DNA, and this step is error-prone, producing frequent mutations and new variants that can evade the immune system. It destroys B cells before any antibodies form is inaccurate, because HIV mainly destroys CD4 helper T cells. It stores its genes as double-stranded DNA is incorrect, because HIV carries its genes as RNA. It replicates only once inside each host cell is not why variants arise.
Category: HIV Pathophysiology
Question 13
Why is HIV infection in older adults often diagnosed later than in younger adults?
Its symptoms are mistaken for normal aging
✓
Standard HIV tests do not work in older adults
Older adults cannot acquire HIV through sex
HIV does not lower CD4 counts in older adults
Correct Answer
Its symptoms are mistaken for normal aging
Older adults are tested less often because symptoms such as fatigue and pain may be attributed to age-related changes, so the nurse uses the history to decide when testing is needed. Standard HIV tests do not work in older adults is false, because the same tests are used at any age. Older adults cannot acquire HIV through sex is false, and the number of older adults living with HIV is rising. HIV does not lower CD4 counts in older adults is false, because the virus destroys these cells at any age.
Category: HIV Care
Question 14
A patient with HIV lives with family members. Which item should the nurse teach the patient not to share?
A drinking glass
A razor
✓
A bath towel
A television remote
Correct Answer
A razor
Items that may carry traces of blood, such as razors and toothbrushes, should not be shared because HIV is a bloodborne virus. A drinking glass does not transmit HIV through casual household use. A bath towel is not a route of HIV transmission. A television remote poses no HIV risk.
Category: HIV Prevention
Question 15
How are induced pluripotent stem cells produced?
They are collected from umbilical cord blood
They are removed from an early embryo
Adult cells are reprogrammed in a laboratory
✓
They are grown from a tumor biopsy
Correct Answer
Adult cells are reprogrammed in a laboratory
Induced pluripotent stem cells start as adult, nonembryonic cells that scientists transform in a laboratory so they behave much like embryonic stem cells. They are collected from umbilical cord blood describes a source of blood-forming stem cells, not induced cells. They are removed from an early embryo describes embryonic stem cells. They are grown from a tumor biopsy is not a source of induced pluripotent stem cells.
Category: Advances in Immunology
Question 16
Which lymphocyte destroys virus-infected and tumor cells without first needing to recognize a specific antigen?
Helper T cell
B cell
Plasma cell
Natural killer cell
✓
Correct Answer
Natural killer cell
Natural killer cells attack infected and cancerous cells without prior sensitization to a specific antigen. A helper T cell coordinates the immune response and activates B cells rather than killing target cells. A B cell recognizes a specific antigen and gives rise to antibody-producing cells. A plasma cell secretes antibodies against one specific antigen.
Category: Immune Cells and Organs
Question 17
Which test evaluates cell-mediated (T-cell) immunity?
Delayed hypersensitivity skin test
✓
Serum immunoglobulin levels
Antibody response to a vaccine
Total serum globulin level
Correct Answer
Delayed hypersensitivity skin test
A delayed hypersensitivity skin test checks whether T cells react to a harmless substance placed in the skin, so it reflects cell-mediated immunity. Serum immunoglobulin levels measure antibodies, which reflect humoral immunity. Antibody response to a vaccine also tests humoral immunity. Total serum globulin level is another measure of antibody-mediated immunity.
Category: Immune Assessment
Question 18
A patient living with HIV cannot afford medications and may soon lose housing. Which interdisciplinary team member is best suited to help with these problems?
Pharmacist
Social worker
✓
Dietitian
Physical therapist
Correct Answer
Social worker
Social workers assess finances, housing and support networks and connect patients with insurance, assistance programs and support groups. A pharmacist helps with side effects, drug interactions and dosing schedules rather than housing. A dietitian addresses nutrition, weight and digestive symptoms. A physical therapist works on mobility and strength.
Category: HIV Care
Question 19
Researchers place a working copy of a defective gene into a harmless virus that carries it into a patient's immune cells. What is this approach called?
Passive immunization
Plasmapheresis
Gene therapy
✓
Radiation therapy
Correct Answer
Gene therapy
Gene therapy replaces a missing or defective gene by inserting a recombinant gene into a harmless virus that delivers it into the patient's cells. Passive immunization gives ready-made antibodies and does not change genes. Plasmapheresis removes antibodies and other substances from the plasma. Radiation therapy destroys cells with high-energy rays and does not add genes.
Category: Advances in Immunology
Question 20
A patient with a poor appetite has eaten very little protein for a long time. Which immune change should the nurse anticipate?
A higher white blood cell count
A stronger response to vaccines
Growth of lymphoid tissue
Fewer T cells and weaker antibody responses
✓
Correct Answer
Fewer T cells and weaker antibody responses
Inadequate protein intake can shrink lymphoid tissue, decrease T cells, impair phagocytosis and weaken antibody responses, raising infection risk. A higher white blood cell count is not an expected result of protein deficiency. A stronger response to vaccines is the opposite of what happens, because antibody responses decline. Growth of lymphoid tissue is also the opposite, because protein deficiency causes lymphoid tissue to atrophy.
Category: Immune Assessment