Which cell belongs to the innate branch of the immune system?
Neutrophil
✓
Plasma cell
Helper T cell
Memory B cell
Correct Answer
Neutrophil
Neutrophils are fast-acting phagocytes of innate immunity that respond within hours without needing prior exposure. Plasma cell is a differentiated B cell of adaptive immunity. Helper T cell is a lymphocyte of the adaptive response. Memory B cell is part of adaptive immune memory.
Category: Immune Response
Question 2
When an antigen activates a B lymphocyte, the B cell multiplies and differentiates into which cells that secrete large amounts of antibody?
Cytotoxic T cells
Plasma cells
✓
Mast cells
Macrophages
Correct Answer
Plasma cells
Activated B cells become plasma cells, which produce antibodies, and some become memory B cells for a faster response later. Cytotoxic T cells come from T lymphocytes and kill infected cells directly. Mast cells release histamine and do not come from B cells. Macrophages are phagocytes derived from monocytes.
Category: Immune Response
Question 3
Which cells directly destroy virus-infected cells and cancer cells that display foreign antigens?
Helper T cells
Plasma cells
Cytotoxic T cells
✓
Basophils
Correct Answer
Cytotoxic T cells
Cytotoxic T cells, which carry the CD8 marker, recognize foreign antigen on a cell's surface and release toxic substances that kill it. Helper T cells carry CD4 and coordinate the response through cytokines rather than killing cells. Plasma cells make antibodies. Basophils release histamine and other mediators.
Category: Immune Response
Question 4
Antibodies coat a bacterium so that macrophages and neutrophils recognize and engulf it more easily. What is this process called?
Agglutination
Neutralization
Precipitation
Opsonization
✓
Correct Answer
Opsonization
Opsonization marks a pathogen with antibody or complement so phagocytes can bind and destroy it. Agglutination is the clumping of pathogens together. Neutralization blocks a pathogen or toxin from attaching to cells. Precipitation is the formation of insoluble complexes from soluble antigen, not the coating of a microbe for phagocytes.
Category: Immune Response
Question 5
Which vaccine contains a live attenuated virus?
Measles, mumps and rubella vaccine
✓
Hepatitis B vaccine
Inactivated polio vaccine
Tdap vaccine
Correct Answer
Measles, mumps and rubella vaccine
The measles, mumps and rubella vaccine contains weakened viruses that can still replicate, which gives long-lasting immunity. Hepatitis B vaccine is a recombinant subunit vaccine. Inactivated polio vaccine contains killed virus. Tdap vaccine contains inactivated toxins and pertussis components, not live organisms.
Category: Vaccines
Question 6
A patient taking azathioprine after a kidney transplant asks about vaccinations. Which vaccine should this patient avoid?
Inactivated influenza injection
Varicella vaccine
✓
Hepatitis B vaccine
Tdap vaccine
Correct Answer
Varicella vaccine
Varicella vaccine is a live attenuated vaccine, and live vaccines can cause the infection itself in a person whose immune system is suppressed. Inactivated influenza injection contains no live virus. Hepatitis B vaccine is a recombinant subunit vaccine. Tdap vaccine contains no live organisms.
Category: Vaccines
Question 7
How do mRNA vaccines produce immunity?
They contain a weakened live virus
They contain a killed whole virus
They instruct cells to make a pathogen protein
✓
They deliver preformed antibodies
Correct Answer
They instruct cells to make a pathogen protein
An mRNA vaccine carries genetic instructions that the person's cells use to make a harmless pathogen protein, such as a viral spike protein, and the immune system then responds to it. They contain a weakened live virus describes live attenuated vaccines. They contain a killed whole virus describes inactivated vaccines. They deliver preformed antibodies describes passive immunization with immune globulin.
Category: Vaccines
Question 8
Compared with live attenuated vaccines, inactivated vaccines usually have which characteristic?
They can cause the disease in healthy people
They replicate inside the body
They give lifelong immunity after one dose
They require several doses or boosters
✓
Correct Answer
They require several doses or boosters
Killed organisms cannot replicate, so they stimulate a weaker response and usually need a series of doses and later boosters. They can cause the disease in healthy people is not true of inactivated vaccines, because the pathogen is killed. They replicate inside the body describes live vaccines. They give lifelong immunity after one dose is more typical of live vaccines.
Category: Vaccines
Question 9
A health care worker's varicella antibody titer comes back positive at a protective level. What does this result indicate?
Immunity to the virus is present
✓
An active varicella infection is present
The vaccine series must be repeated
The person is contagious to others
Correct Answer
Immunity to the virus is present
A titer measures the amount of a specific antibody in the blood, and a protective level shows immunity from past infection or vaccination. An active varicella infection is present is not what a protective antibody level means. The vaccine series must be repeated would apply to a negative or low titer. The person is contagious to others is incorrect because antibodies alone do not mean the virus is present.
Category: Vaccines
Question 10
A patient who has taken prednisone for several months feels better and wants to stop it. What should the nurse teach?
Stop it as soon as symptoms resolve
Taper the dose as directed by the provider
✓
Skip doses on days without symptoms
Stop it when weight gain occurs
Correct Answer
Taper the dose as directed by the provider
Long-term glucocorticoids suppress the adrenal glands' own cortisol production, so stopping abruptly can cause adrenal insufficiency and a rebound of symptoms; the dose must be reduced gradually. Stop it as soon as symptoms resolve risks adrenal crisis. Skip doses on days without symptoms causes uneven levels and also risks withdrawal. Stop it when weight gain occurs is an abrupt stop and is unsafe even though weight gain is an expected effect.
Category: Immunosuppressants
Question 11
Which laboratory change is an expected adverse effect of prednisone therapy?
Decreased blood glucose
Elevated serum potassium
Elevated blood glucose
✓
Elevated serum calcium
Correct Answer
Elevated blood glucose
Glucocorticoids raise blood glucose by increasing glucose production in the liver and reducing insulin sensitivity, so glucose is monitored, especially in patients with diabetes. Decreased blood glucose is the opposite of the expected effect. Elevated serum potassium is not expected, because glucocorticoids tend to increase potassium loss. Elevated serum calcium is not expected, because they reduce calcium absorption and contribute to bone loss.
Category: Immunosuppressants
Question 12
Before azathioprine is started, which enzyme's activity is checked because a deficiency greatly raises the risk of severe bone marrow suppression?
Glucose-6-phosphate dehydrogenase
Angiotensin-converting enzyme
Monoamine oxidase
Thiopurine methyltransferase
✓
Correct Answer
Thiopurine methyltransferase
Thiopurine methyltransferase breaks down azathioprine's active metabolites, and patients with low or absent activity can develop life-threatening myelosuppression, so they need a much lower dose or a different drug. Glucose-6-phosphate dehydrogenase deficiency matters for drugs that cause hemolysis, not azathioprine. Angiotensin-converting enzyme is the target of ACE inhibitors. Monoamine oxidase breaks down neurotransmitters and is the target of MAO inhibitors.
Category: Immunosuppressants
Question 13
A woman of childbearing age is starting mycophenolate after a transplant. Which boxed warning is a key point of her teaching?
Embryo-fetal toxicity
✓
Hearing loss
Lactic acidosis
Tendon rupture
Correct Answer
Embryo-fetal toxicity
Mycophenolate can cause pregnancy loss and birth defects, so pregnancy is a contraindication and effective contraception is required; its boxed warning also covers malignancy and serious infection. Hearing loss is associated with drugs such as aminoglycosides. Lactic acidosis is the warning associated with metformin. Tendon rupture is the warning associated with fluoroquinolones.
Category: Immunosuppressants
Question 14
Before adalimumab is started, which of these screening tests is required?
Bone density scan
Tuberculosis screening
✓
Hearing test
Colonoscopy
Correct Answer
Tuberculosis screening
Blocking TNF-alpha weakens the immune control that keeps latent tuberculosis contained, so patients are screened for tuberculosis, and also for hepatitis B, before starting TNF inhibitors and are monitored for infection during therapy. Bone density scan is not required before TNF inhibitors. Hearing test is not a standard requirement for this drug. Colonoscopy is not part of the routine screening before starting it.
Category: Biologics
Question 15
Rituximab destroys its target cells by binding to which molecule?
TNF-alpha
Vascular endothelial growth factor
CD20 on B cells
✓
CD4 on helper T cells
Correct Answer
CD20 on B cells
Rituximab is a monoclonal antibody against the CD20 surface marker on B lymphocytes, which is why it is used for B-cell lymphomas, chronic lymphocytic leukemia and rheumatoid arthritis. TNF-alpha is the target of adalimumab, infliximab and etanercept. Vascular endothelial growth factor is the target of bevacizumab. CD4 on helper T cells is not the target of rituximab.
Category: Biologics
Question 16
Bevacizumab slows the growth of certain cancers by blocking which process?
DNA synthesis in tumor cells
Activation of B lymphocytes
Release of histamine from mast cells
Formation of new tumor blood vessels
✓
Correct Answer
Formation of new tumor blood vessels
Bevacizumab binds vascular endothelial growth factor, which tumors need to grow new blood vessels, so the tumor loses its expanding blood supply. DNA synthesis in tumor cells is the target of antimetabolite chemotherapy, not this antibody. Activation of B lymphocytes is not what it blocks. Release of histamine from mast cells is blocked by drugs such as mast cell stabilizers.
Category: Biologics
Question 17
Which statement correctly describes a biosimilar drug?
It is highly similar to an approved biologic but not an exact copy
✓
It is an identical chemical copy of a brand drug
It is sold without FDA review
It is a small molecule made by chemical synthesis
Correct Answer
It is highly similar to an approved biologic but not an exact copy
Biologics are made in living cells, so a follow-on product cannot be identical; a biosimilar must show no meaningful clinical difference from its reference biologic in safety and effectiveness. It is an identical chemical copy of a brand drug describes a generic drug. It is sold without FDA review is false, because biosimilars are FDA approved. It is a small molecule made by chemical synthesis describes conventional drugs, not biologics.
Category: Biologics
Question 18
Which function of COX-1 explains why nonselective NSAIDs can cause stomach ulcers?
It triggers fever in the hypothalamus
It maintains the protective gastric lining
✓
It releases histamine from mast cells
It recruits neutrophils to injured tissue
Correct Answer
It maintains the protective gastric lining
COX-1 is always active and makes prostaglandins that protect the stomach lining and support platelet function, so blocking it raises the risk of ulcers and bleeding. It triggers fever in the hypothalamus is mainly a COX-2 prostaglandin effect. It releases histamine from mast cells is not a COX function. It recruits neutrophils to injured tissue is done by chemokines.
Category: Anti-inflammatory Drugs
Question 19
A patient with a documented sulfonamide allergy should not receive which NSAID?
Ibuprofen
Naproxen
Celecoxib
✓
Aspirin
Correct Answer
Celecoxib
Celecoxib, a selective COX-2 inhibitor, contains a sulfonamide group and is contraindicated in sulfonamide allergy. Ibuprofen is a propionic acid NSAID without a sulfonamide group. Naproxen is also a propionic acid derivative. Aspirin is a salicylate and is not contraindicated because of a sulfonamide allergy.
Category: Anti-inflammatory Drugs
Question 20
Allopurinol prevents gout flares by which action?
Increasing renal excretion of uric acid
Blocking white blood cell migration to joints
Selectively inhibiting the COX-2 enzyme
Inhibiting xanthine oxidase to reduce uric acid production
✓
Correct Answer
Inhibiting xanthine oxidase to reduce uric acid production
Allopurinol blocks xanthine oxidase, the enzyme that converts purine breakdown products into uric acid, so less uric acid is made. Increasing renal excretion of uric acid describes probenecid. Blocking white blood cell migration to joints describes colchicine. Selectively inhibiting the COX-2 enzyme describes celecoxib.
Category: Anti-inflammatory Drugs