Chapter 08: Infection and Defects in Mechanisms of Defence

Power-Kean et al: Huether and McCance’s Understanding Pathophysiology, Second

Canadian Edition

MULTIPLE CHOICE

1. When a patient asks the nurse what hypersensitivity is, how should the nurse respond?
a. Hypersensitivity is a reduced immune response found in most pathological states.
b. Hypersensitivity is a normal immune response to an infectious agent.
c. Hypersensitivity is an altered response of the immune system to a sensitizing
antigen.
d. Hypersensitivity is antigenic desensitization.
ANS: C
Hypersensitivity is an altered immunological response to an antigen that results in disease or
damage to the individual. It is not a reduced immune response or a response to an infectious
agent. Antigenic desensitization is performed to decrease hypersensitivity.

DIF: Cognitive Level: Understand

REF: Hypersensitivity: Allergy, Autoimmunity, and Alloimmunity
TOP: Physiological Integrity

2. When the maternal immune system becomes sensitized against antigens expressed by the
fetus, what type of immune reaction occurs?
a. Autoimmune
b. Anaphylaxis
c. Alloimmune
d. Allergic
ANS: C
Alloimmunity can be observed during immunological reactions against transfusions,
transplanted tissue, or the fetus during pregnancy. Autoimmunity is a disturbance in the
immunological tolerance of self-antigens. The most rapid and severe immediate
hypersensitivity reaction is anaphylaxis. An allergic response occurs related to exposure to an
allergen.

DIF: Cognitive Level: Understand

REF: Hypersensitivity: Allergy, Autoimmunity, and Alloimmunity
TOP: Physiological Integrity

3. A patient presents with poison ivy on the extremities, face, and buttocks after an initial
exposure 2 days ago. What is this condition an example of?
a. Anaphylaxis
b. Serum sickness
c. Delayed hypersensitivity
d. Viral disease
ANS: C
 The response to poison ivy is a delayed hypersensitivity because it takes 1 to 2 days to
develop. Anaphylaxis is immediate. Serum sickness-type reactions are caused by the
formation of immune complexes in the blood and their subsequent generalized deposition in
target tissues. Poison ivy is not a viral disease.

DIF: Cognitive Level: Understand REF: Mechanisms of Hypersensitivity | Figure 8.16

TOP: Physiological Integrity

4. A 10-year-old child is stung by a bee while playing in the yard. Within minutes the child
begins itching and develops wheezing and breathing difficulties. What is the child suffering
from?
a. Immunodeficiency
b. Autoimmunity
c. Anaphylaxis
d. Tissue-specific hypersensitivity
ANS: C
Anaphylaxis occurs within minutes of re-exposure to the antigen and can be either systemic
(generalized) or cutaneous (localized). Immunodeficiency is a decrease in the immune
response. Autoimmunity is a disturbance in the immunological tolerance of self-antigens.
Tissue-specific reaction is an autoimmune reaction.

DIF: Cognitive Level: Understand REF: Mechanisms of Hypersensitivity

TOP: Physiological Integrity

5. When a patient presents at the emergency department for an allergic reaction, the nurse
recognizes that the most severe consequence of a type I hypersensitivity reaction is:
a. urticaria.
b. hives.
c. anaphylaxis.
d. antibody-dependent cell-mediated cytotoxicity (ADCC).
ANS: C
The most rapid and severe immediate hypersensitivity type I reaction is anaphylaxis.
Urticaria, or hives, is a dermal (skin) manifestation of allergic reactions. Hives and urticaria
are similar responses. ADCC is a mechanism that involves natural killer (NK) cells.
Antibodies on the target cell are recognized by Fc receptors on the NK cells, which release
toxic substances that destroy the target cell.

DIF: Cognitive Level: Understand REF: Mechanisms of Hypersensitivity | Figure 8.16

TOP: Physiological Integrity

6. Which hypersensitivity reaction does not involve an antibody?

a. I
b. II
c. III
d. IV
ANS: D
Type IV reactions are mediated by T lymphocytes and do not involve antibodies. All the
remaining options are associated with antibody responses.
 DIF: Cognitive Level: Understand
REF: Type 1V: Cell-Mediated Hypersensitivity Reactions TOP: Physiological Integrity

7. A 30-year-old patient is having difficulty breathing and has been spitting blood. The patient
reports that they began experiencing this reaction after cleaning their pigeons’ cages. Testing
reveals the patient is suffering from allergic alveolitis. Which of the following is the patient
experiencing?
a. Serum sickness
b. Raynaud phenomenon
c. Antibody-dependent cytotoxicity
d. Arthus reaction
ANS: D
The Arthus reaction is a model of localized or cutaneous reactions. Serum sickness-type
reactions are caused by the formation of immune complexes in the blood and their subsequent
generalized deposition in target tissues. Typically affected tissues are the blood vessels, joints,
and kidneys. Raynaud phenomenon is a condition caused by the temperature-dependent
deposition of immune complexes in the capillary beds of the peripheral circulation. Antibody-
dependent cytotoxicity is a type II form.

DIF: Cognitive Level: Analyze

REF: Type III: Immune Complex-Mediated Hypersensitivity Reactions
TOP: Physiological Integrity

8. A nurse recalls that an example of an immune-complex-mediated disease is:

a. bronchial asthma.
b. contact dermatitis.
c. serum sickness.
d. rheumatoid arthritis.
ANS: C
Immune-complex disease can be a systemic reaction, such as serum sickness, and related to
type III reactions. Bronchial asthma is not an immune-complex-mediated disease and is
related to type I reactions. Neither contact dermatitis nor rheumatoid arthritis is related to type
III reactions.

DIF: Cognitive Level: Analyze

REF: Type III: Immune Complex-Mediated Hypersensitivity Reactions
TOP: Physiological Integrity

9. When a nurse cares for a patient with systemic lupus erythematosus (SLE), the nurse
remembers that this disease is an example of:
a. autoimmunity.
b. alloimmunity.
c. homoimmunity.
d. alleimmunity.
ANS: A
SLE is the most common, complex, and serious of the autoimmune disorders. SLE is not
identified as alloimmune, homoimmune, or alleimmune.

DIF: Cognitive Level: Analyze REF: Autoimmunity

 TOP: Physiological Integrity

10. A 30-year-old patient with female genitalia complains of fatigue, arthritis, rash, and changes
in urine colour. Laboratory testing reveals anemia, lymphopenia, and kidney inflammation.
Assuming a diagnosis of SLE, which of the following is also likely to be present?
a. Anti-LE antibodies
b. Autoantibodies
c. Antiherpes antibodies
d. Anti-CMV antibodies
ANS: B
The presence of autoantibodies is a diagnostic criterion for SLE. Diagnostic criterion for SLE
would include positive LE. Neither antiherpes nor anti-CMV antibodies are associated with a
diagnosis SLE.

DIF: Cognitive Level: Analyze

REF: Type III: Immune Complex-Mediated Hypersensitivity Reactions
TOP: Physiological Integrity

11. A 40-year-old patient with female genitalia is diagnosed with SLE. Which of the following
findings would be considered a symptom of this disease?
a. Gastrointestinal ulcers
b. Decreased glomerular filtration rate
c. Rash on trunk and extremities
d. Photosensitivity
ANS: D
Photosensitivity is one of the 11 common clinical findings in SLE. Gastrointestinal ulcers are
not a finding in SLE. Proteinuria is a symptom of SLE. A rash on the face is a symptom, but
not a rash on the body.

DIF: Cognitive Level: Analyze

REF: Type III: Immune Complex-Mediated Hypersensitivity Reactions
TOP: Physiological Integrity

12. What is the chance that two siblings share both HLA haplotypes, making them a good match
for an organ transplant from one to the other?
a. 100%
b. 75%
c. 50%
d. 25%
ANS: D
Odds dictate that children will share one haplotype with half their siblings and either no
haplotypes or both haplotypes with a quarter of their siblings. Thus, the chance of finding a
match among siblings is much higher (25%) than the general population.

DIF: Cognitive Level: Understand REF: Alloimmunity

TOP: Physiological Integrity

13. When a nurse notices that a patient has type O blood, the nurse realizes that anti-_____
antibodies are present in the patient’s body.
 a. A only
b. B only
c. A and B
d. O
ANS: C
Type O individuals have both anti-A and anti-B antibodies but not O.

DIF: Cognitive Level: Understand REF: Alloimmunity | Figure 8.18

TOP: Physiological Integrity

14. In addition to matching ABO antigens, what else does a blood transfusion need to be matched
for?
a. HLA type
b. Rh antigen
c. Immunoglobulins
d. Platelet compatibility
ANS: B
Blood transfusions must also be matched for the Rh antigen. Blood transfusions do not need
to be matched to HLA, immunoglobulins, or platelet compatibility.

DIF: Cognitive Level: Understand REF: Alloimmunity

TOP: Physiological Integrity

15. A 15-year-old patient suffers from severe hemorrhage following a motor vehicle accident. The
patient is given a blood transfusion, but shortly afterward the red blood cells are destroyed by
agglutination and lysis. Which of the following blood type transfusion type matches would
cause this?
a. A-A
b. B-O
c. AB-O
d. A-AB
ANS: D
A person with type A blood also has circulating antibodies to the B carbohydrate antigen. If
this person receives blood from a type AB or B individual, a severe transfusion reaction
occurs, and the transfused erythrocytes are destroyed by agglutination or complement-
mediated lysis. Type A can receive type A blood. Type B and type AB can receive type O.

DIF: Cognitive Level: Understand REF: Alloimmunity

TOP: Physiological Integrity

16. A person is given an attenuated antigen as a vaccine. When the person asks what was given in
the vaccine, how should the nurse respond?
a. The antigen in the vaccine is alive, but less infectious.
b. The vaccine contains antigen that is mutated.
c. The antigen in the vaccine is normal, but not infectious.
d. The vaccine contains antigen that is dead and inactive.
ANS: A
 Attenuated vaccines are alive, but less infectious. Attenuated vaccines are not mutated or
highly infectious. The antigen is not dead and inactive.

DIF: Cognitive Level: Understand REF: Active Immunization

TOP: Physiological Integrity

17. An immunologist is discussing endotoxin production. Which information should the

immunologist include?
a. Endotoxins are produced by Gram-negative bacteria.
b. Endotoxins are produced by Gram-positive bacteria.
c. Endotoxins are produced by Gram-negative fungi.
d. Endotoxins are produced by Gram-positive fungi.
ANS: A
Endotoxins are produced by Gram-negative bacteria. They are not produced by Gram-positive
bacteria or any type of fungi.

DIF: Cognitive Level: Understand REF: Table 8.2 | Bacterial Disease

TOP: Physiological Integrity

18. A 5-year-old child becomes ill with a severe cough. Histological examination reveals a
bacterial infection, and further laboratory testing reveals cell membrane damage and
decreased protein synthesis. Which of the following is the most likely cause of this illness?
a. Endotoxin
b. Exotoxin
c. Hemolysis
d. Septicemia
ANS: B
Exotoxins are enzymes that can damage the plasma membranes of host cells or can inactivate
enzymes critical to protein synthesis, and endotoxins activate the inflammatory response and
produce fever. Endotoxins released by blood-borne bacteria cause the release of vasoactive
enzymes that increase the permeability of blood vessels. Hemolysis is the breakdown of red
cells. Septicemia is the growth of bacteria in the blood.

DIF: Cognitive Level: Understand REF: Bacterial Disease

TOP: Physiological Integrity

19. A 50-year-old patient experiences decreased blood pressure, decreased oxygen delivery,
cardiovascular shock, and subsequent death. A complication of endotoxic shock is suspected.
Which of the following is the most likely cause?
a. Gram-positive bacteria
b. Fungi
c. Gram-negative bacteria
d. Virus
ANS: C
Symptoms of Gram-negative septic shock are produced by endotoxins. Once in the blood,
endotoxins cause the release of vasoactive peptides and cytokines that affect blood vessels,
producing vasodilation, which reduces blood pressure; causes decreased oxygen delivery; and
produces subsequent cardiovascular shock. Gram-positive bacteria nor fungi do not produce
endotoxins and thus do not manifest in shock. Viruses do not produce symptoms of shock.
 DIF: Cognitive Level: Understand REF: Bacterial Disease
TOP: Physiological Integrity

20. After studying about viruses, which information indicates the student has a good
understanding of viruses?
a. Viruses contain no DNA or RNA.
b. Viruses are capable of independent reproduction.
c. Viruses replicate their genetic material inside host cells.
d. Viruses are easily killed by antimicrobials.
ANS: C
Virus replication depends totally on the ability of the virus to infect a permissive host cell, a
cell that cannot resist viral invasion and replication. Viruses contain both DNA and RNA, are
incapable of independent reproduction, and cannot be killed by antimicrobials.

DIF: Cognitive Level: Understand REF: Viral Disease

TOP: Physiological Integrity

21. After studying about fungi, which information indicates a correct understanding of fungi?
Fungi causing deep or systemic infections:
a. are easily treated with penicillin.
b. are extremely rare.
c. never occur with other infections.
d. are commonly opportunistic.
ANS: D
Diseases caused by fungi are called mycoses. Mycoses are common and can be opportunistic
and occur with other infections but are not treatable with penicillin.

DIF: Cognitive Level: Understand REF: Fungal Disease

TOP: Physiological Integrity

22. What is true about viral vaccines?

a. They contain active viruses.
b. They are attenuated viruses.
c. They contain killed viruses.
d. They are a blend of viral toxins.
ANS: B
Viral vaccines contain live viruses that are weakened (attenuated). Viral vaccines do not
contain active viruses, killed viruses, or toxins.

DIF: Cognitive Level: Understand

REF: Passive Immunotherapy | Initial Clinical Presentation TOP: Physiological Integrity

23. What is true about bacterial vaccines?

a. They contain fully active bacteria.
b. They are made from synthetic bacteria.
c. They contain dead bacteria.
d. They are a blend of bacterial toxins.
 ANS: C
Bacterial vaccines are biological preparations of dead pathogens or extracts of bacterial
antigens. When administered, they stimulate production of antibodies or cellular immunity
against the pathogen without causing disease. Vaccines are not fully active bacteria, nor are
they synthetic or toxins.

DIF: Cognitive Level: Understand REF: Active Immunization

TOP: Physiological Integrity

24. A nurse recalls that bacteria become resistant to antimicrobials by:

a. proliferation.
b. attenuation.
c. specialization.
d. mutation.
ANS: D
Antibiotic resistance is usually a result of genetic mutations that can be transmitted directly to
neighbouring microorganisms by plasmid exchange. Antibiotic resistance is not a result of
proliferation, attenuation, or specialization.

DIF: Cognitive Level: Understand REF: Antimicrobials

TOP: Physiological Integrity

25. What common symptom should be assessed in individuals with immunodeficiency?

a. Anemia
b. Recurrent infections
c. Hypersensitivity
d. Autoantibody production
ANS: B
The clinical hallmark of immunodeficiency is a propensity to unusual or recurrent severe
infections. The type of infection usually reflects the immune system defect. Neither anemia,
autoantibody production, nor hypersensitivity is a manifestation of immunodeficiency.

DIF: Cognitive Level: Understand REF: Deficiencies in Immunity

TOP: Physiological Integrity

26. A 5-year-old child with male genitalia presents with low-set ears, a fish-shaped mouth, and
involuntary rapid muscular contraction. Laboratory testing reveals decreased calcium levels.
Which of the following diagnosis is most likely?
a. B-lymphocyte deficiency
b. T-lymphocyte deficiency
c. Combined immunological deficiency
d. Complement deficiency
ANS: B
DiGeorge syndrome results in greatly decreased T-cell numbers and function and is evidenced
by abnormal development of facial features that are controlled by the same embryonic
pouches; these include low-set ears, fish-shaped mouth, and other altered features. B-
lymphocyte deficiency is not manifested by these symptoms. Neither combined
immunological deficiency nor complement deficiency is manifested by these symptoms.
 DIF: Cognitive Level: Analyze REF: DiGeorge Syndrome
TOP: Physiological Integrity

27. A 22-year-old was recently diagnosed with acquired immune deficiency syndrome (AIDS).
Which cell type would you expect to be decreased in a laboratory finding?
a.CD4+ T-helper cells
b.CD8 T-helper cells
c.CDC cells
d.CDC10 cells
ANS: A
The major immunological finding in AIDS is the striking decrease in the number of CD4+ T
cells. The change occurs in CD4 cells, not CD8. Neither CDC nor CDC 10 is a type of cell.

DIF: Cognitive Level: Understand REF: AIDS TOP: Physiological Integrity

28. Which of the following is a characteristic of the human immunodeficiency virus (HIV), which
causes AIDS?
a. HIV only infects B cells.
b. HIV is a retrovirus.
c. Infection does not require a host cell receptor.
d. After infection, cell death is immediate.
ANS: B
AIDS is an acquired dysfunction of the immune system caused by a retrovirus (HIV) that
infects and destroys CD4+ lymphocytes (T-helper cells). HIV infection begins when a virion
binds to CD4, not a B cell. Infection requires a host cell receptor. The cell remains dormant
but does not die.

DIF: Cognitive Level: Understand REF: Pathogenesis of AIDS

TOP: Physiological Integrity

29. A 30-year-old patient was diagnosed with HIV. Which of the following treatments would be
most effective?
a.Reverse transcriptase inhibitors
b.Protease inhibitors
c.Entrance inhibitors
d.Highly active antiretroviral therapy (HAART)
ANS: D
The current regimen for the treatment of HIV infection is a combination of medications,
termed highly active antiretroviral therapy (HAART). The remaining options are individual
components of the HAART treatment format.

DIF: Cognitive Level: Understand REF: Treatment and Prevention of HIV and AIDS
TOP: Physiological Integrity

30. When the immunologist says that pathogens possess infectivity, what is the immunologist
explaining?
a. Infectivity involves the ability of pathogens to spread from one individual to others
and cause disease.
b. Infectivity involves pathogens inducing an immune response.
 c. Infectivity involves pathogens invading and multiplying in the host.
d. Infectivity occurs because pathogens damage tissue.
ANS: C
Infectivity is the ability of the pathogen to invade and multiply in the host. Communication is
the ability to spread from one individual to others and cause disease. Immunogenicity is the
ability of pathogens to induce an immune response. Damaging tissues is the pathogen’s
mechanism of action.

DIF: Cognitive Level: Understand

REF: Microorganisms and Humans: A Dynamic Relationship TOP: Physiological Integrity

31. When the immunologist says that pathogens possess virulence, what does virulence mean?
a. Pathogens spread from one individual to others and cause disease.
b. Pathogens induce an immune response.
c. Pathogens causes disease.
d. Pathogens have the capacity to damage tissue.
ANS: C
Virulence is the capacity of a pathogen to cause severe disease—for example, measles virus is
of low virulence; rabies virus is highly virulent. Communication is the ability to spread from
one individual to others and cause disease. Immunogenicity is the ability of pathogens to
induce an immune response. Damaging tissues is the pathogen’s mechanism of action.

DIF: Cognitive Level: Understand

REF: Microorganisms and Humans: A Dynamic Relationship TOP: Physiological Integrity

32. What is the etiology of a congenital immune deficiency?

a. A negative response to an immunization
b. An adverse response to a medication
c. Kidney failure
d. A genetic defect
ANS: D
A primary (congenital) immune deficiency is caused by a genetic defect. A primary
(congenital) immune deficiency is not a response to an immunization, an adverse response to
a medication, or due to kidney failure.

DIF: Cognitive Level: Understand REF: Deficiencies in Immunity

TOP: Physiological Integrity

33. An infant is experiencing hemolytic disease of the newborn. Which of the following would
the nurse expect to find in the infant’s history and physical?
a. The childbearing parent was exposed to measles.
b. The parent with male genitalia was exposed to Agent Orange.
c. The baby is Rh positive.
d. The baby was born 6 weeks prematurely.
ANS: C
 Hemolytic disease of the newborn was most commonly caused by IgG anti-D alloantibody
produced by Rh-negative childbearing parents against erythrocytes of their Rh-positive
fetuses. This disorder is not due to the childbearing parent’s exposure to measles, the exposure
of the parent with male genitalia to Agent Orange, or the baby’s prematurity.

DIF: Cognitive Level: Understand REF: Alloimmunity

TOP: Physiological Integrity

MULTIPLE RESPONSE

1. A 30-year-old patient with female genitalia is diagnosed with systemic lupus erythematosus
(SLE). Which symptoms are a result of a type II hypersensitivity? (Select all that apply.)
a. Anemia
b. Seizures
c. Lymphopenia
d. Facial rash
e. Photosensitivity
ANS: A, C
The patient is experiencing type II hypersensitivity when experiencing anemia and
lymphopenia. Seizures, facial rash, and photosensitivity are not associated with type II
hypersensitivity reactions.

DIF: Cognitive Level: Analyze

REF: Autoimmune Disease: System Lupus Erythematosus TOP: Physiological Integrity