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Chapter 5—Inflammation and Infection
MULTIPLE CHOICE
1. The definition of inflammation is the:
a . specific response to cellular injury
b . nonspecific cellular response to tissue injury
c . complex progression of tissue changes in response to injury
d . invasion and multiplication of pathogenic microorganisms in body tissue
ANS: B
Inflammation is a nonspecific cellular response to tissue injury. Tissue injury caused by bacteria, trauma, chemicals, heat, or any other occurrence releases substances, produces dramatic secondary changes in the injured tissue.
PTS: 1
DIF: Comprehension
REF: White (2013)
2. What produces the characteristic redness and warmth associated with Stage 2 of the inflammatory response?
a release of chemicals (histamine, bradykinin, serotonin, prostaglandins, lymphokines)
b increased blood flow to the area
c . plasma leaking into damaged tissue
d leukocytes infiltrating damaged tissue
ANS: B
In Stage 2 of the Inflammatory Process, blood flow increases to the injured area causing the characteristic redness and warmth.
PTS: 1 DIF: Comprehension
REF: White (2013)
3. What is typically ordered by a physician, for an area of inflammation, for 24-72 hours to control the inflammation, especially when pain and edema are present?
a . compression c . dry heat
b . warm, moist heat d . cold (ice)
ANS: B
Heat, cold, or both may be applied to an inflamed area and need an order. Typically, physicians order cold (ice) on the affected area for 24-72 hours to control the inflammation, especially when pain and edema are present.
After that time, heat is ordered to assist in quickly removing the accumulated waste products.
PTS: 1 DIF: Comprehension
REF: White (2013)
4. Various agents are capable of causing disease. Heat is which type of agent?
a . biological c . chemical
b . physical d . environmental
ANS: B
Physical agents are factors in the environment that are capable of causing disease, such as heat, light, noise, and radiation.
PTS: 1 DIF: Comprehension
REF: White (2013)
5. Which of the following is a common bacterial infection?
a . measles c . common cold
b . urinary tract infection d . chickenpox
ANS: B
Common bacterial infections include diarrhea, pneumonia, sinusitis, urinary tract infections, cellulitis, meningitis, gonorrhea, otitis media, and impetigo. Common viral infections include influenza, measles, common cold, chickenpox, hepatitis B, genital herpes, and HIV.
PTS: 1 DIF: Comprehension
REF: White (2013)
6. Sexually transmitted diseases are transmitted by which type of contact?
a vector borne
b . airborne
ANS: D
c vehicle
d . direct contact
The most important and frequent mode of transmission is contact transmission. This involves the transfer of an agent from an infected person to a host by direct contact with the infected person, indirect contact with the infected person through a fomite, or close contact with contaminated secretions. Sexually transmitted diseases are spread by direct contact.
PTS: 1 DIF: Comprehension
REF: White (2013)
7. Lyme disease is spread by which type of transmission?
a direct contact
b . airborne
ANS: D
c vehicle
d . vector-borne
Vector-borne transmission occurs when an agent is transferred to a susceptible host by animate means such as mosquitoes, fleas, ticks, lice, and other animals. Lyme disease, malaria, and West Nile virus are examples of diseases spread by vectors.
PTS: 1 DIF: Comprehension
REF: White (2013)
8. A mother spreading HIV to a fetus is through which portal of entry?
a . integumentary
b . genitourinary
c . circulatory
d . transplacental
ANS: D
A portal of entry is the route by which an infectious agent enters the host. A transplacental portal of entry is the transfer of microorganisms from mother to fetus via the placenta and umbilical cord (including HIV, and hepatitis B).
PTS: 1 DIF: Comprehension
REF: White (2013)
9. Which of these statements are true?
a . As a person ages, immunity increases.
b . Individuals who are not fully immunized are the same risk for infection.
c . Lifestyle practices do not have an impact on an individual’s potential for illness.
d Individuals who maintain targeted weight for height and body frame are less prone to illness.
ANS: D
Nutritional status does affect one’s susceptibility and severity of infection. Individuals who maintain the targeted weight for height and body frame are less prone to illness.
PTS: 1 DIF: Comprehension
REF: White (2013)
10. The Centers for Disease Control and Prevention recommend which age group to receive the pneumococcal vaccine each year?
a . children under age 1 c . college age young adults
b . individuals 65 and older d . elderly over 80
ANS: B
The Centers for Disease Control and Prevention (CDC) (2010b) recommends that individuals 65 years of age and older receive the Influenza (flu) vaccine annually, the Pneumococcal vaccine, Tetanus (lockjaw), Herpes Zoster (shingles), and Diphtheria vaccine.
PTS: 1 DIF: Comprehension
REF: White (2013)
11. What is the single most important practice in preventing the spread of infection?
a respiratory precautions c using aseptic technique
b . hand hygiene d . using bleach to break chain of infection
ANS: B
Hand hygiene is the first line of defense against infection and is the single most important practice in preventing the spread of infection.
PTS: 1 DIF: Comprehension
REF: White (2013)
12. What is the elimination of pathogens, except spores, from inanimate objects?
a . antiseption c . sterilization
b . disinfection d . cleansing
ANS: B
Disinfection is the elimination of pathogens, except spores, from inanimate objects. Disinfectants are chemical solutions used to clean inanimate objects.
PTS: 1 DIF: Comprehension
REF: White (2013)
13. Which are examples of barrier protection?
a . hand cream c . gloves, gowns, goggles, and masks
b . negative pressure rooms d . wound dressings
ANS: C
To break the chain of infection between the mode of transmission and the portal of entry, asepsis must be ensured and barrier protection worn when the care of clients involves contact with body secretions. Gloves, masks, gowns, and goggles are barrier protection that can be used.
PTS: 1 DIF: Comprehension
REF: White (2013)
14. Which of these statements are TRUE about antibiotics?
a . Antibiotics are effective against viruses
b . Antibiotics do not destroy normal flora
c . Client should take all antibiotics prescribed
d . Individuals can not develop resistance to antibiotics if they take a partial dose of the medication
ANS: C
There are several key points when administering antibiotics. The physician or nurse practitioner should not be pressured to prescribe antibiotics for every illness. Antibiotics are not always appropriate. They are not effective against viruses. When antibiotics are prescribed, the client should take all of the medication as directed. Antibiotics taken only until
the client feels better allow the microorganisms to become resistant to the antibiotic, and the antibiotic will no longer be effective. Antibiotics also destroy normal flora microorganisms, and other illnesses may ensue.
PTS: 1 DIF: Comprehension
REF: White (2013)
15. Normal vaginal flora prevent the growth of several pathogens. What else prevents pathogenic growth of bacteria?
a monthly menses
b . endometriosis
ANS: D
c pubic hair
d . acidic environment of the vagina
Normal vaginal flora prevent growth of several pathogens. At puberty, lactobacilli ferment and produce sugars in the vagina that lower the pH to an acidic range. The acidic environment of the vagina prevents pathogenic growth.
PTS: 1 DIF: Comprehension
REF: White (2013)
16. What protects an individual against future invasions of already experienced antigens such as lethal bacteria, viruses, toxins and even foreign tissues?
a acquired immunity c antibody immunity
b . host immunity
ANS: A
d . antioxidant immunity
When the antigen enters the body again, the immune response occurs faster by rapidly producing antibodies. The formation of these antibodies is referred to as acquired immunity, which protects the individual against future invasions of already experienced antigens such as lethal bacteria, viruses, toxins, and even foreign tissues.
PTS: 1 DIF: Comprehension
REF: White (2013)
17. Which stage in the infectious process can be characterized by the onset of nonspecific symptoms until specific symptoms begin to manifest?
a incubation
b prodromal
ANS: B
c illness
d convalescence
The prodromal stage is the time from the onset of nonspecific symptoms until specific symptoms begin to manifest. The infectious agent continues
to invade and multiply in the host. A client may also be infectious to other persons during this time period. In the client with chickenpox, a slight elevation in temperature will occur during this stage, followed within 24 hours by eruptions on the skin.
PTS: 1 DIF: Comprehension
REF: White (2013)
18. A female client is being treated with an antibiotic for pneumonia. The antibiotic destroys normal flora of the genital tract and the client develops a vaginal yeast infection. This type of infection is called:
a . ultra infection
b . type 2 infection
ANS: D
c . complementing infection
d . super-infection
A super-infection is an infection caused when the anti-infective used to treat the initial infectious process also destroys the body’s natural flora, that is present to protect against certain diseases.
PTS: 1 DIF: Comprehension
REF: White (2013)
19. Which of the following are elevated with TB? a neutrophils c monocytes
b . lymphocytes d . eosinophils
ANS: C
Monocytes are increased in some protozoan and rickettsial infections as well as with tuberculosis.
PTS: 1 DIF: Comprehension
REF: White (2013)
20. Which of the following is an infection control practice used to prevent the transmission of pathogens?
a . aseptic technique c . sterile technique
b surgical asepsis d medical asepsis
ANS: A
Aseptic technique is the infection-control practice used to prevent the transmission of pathogens. The use of aseptic technique decreases the risk and spread of hospital-acquired infections.
PTS: 1 DIF: Comprehension
REF: White (2013)
MULTIPLE RESPONSE
1. The primary signs of inflammation and infection are:
a . redness
b heat
e . loss of function
f. loss of sensation
c pain g purulent exudate
d . swelling
ANS: A, B, C, D, E, G
The primary signs of inflammation and infection are as follows: redness (erythema) results from increased blood flow to the area, heat results from increased blood flow and metabolism in the area, pain results from increased pressure on pain sensors in the area, swelling (edema, a detectable accumulation of increased interstitial fluid) results from fluid and leukocytes entering the tissues from the circulatory system, loss of function results from both pain and swelling and is the body’s way of resting the injured part, and pus (purulent exudate), resulting from infection, is a secretion made up of white blood cells, dead cells, bacteria, and other debris.
PTS: 1 DIF: Comprehension
REF: White (2013)
2. The older adult may be at increased risk for infection because of the normal aging process. Which of the following increase an older client’s risk for infection? (Select all that apply.)
a . inadequate nutrition e . lethargy
b . delayed inflammatory response f. nearsightedness
c . malaise g . incontinence
d unsteadiness leading to falls
ANS: A, B, D, E, G
The older adult may be at increased risk for infection because of the normal aging process. As a person ages, the skin, respiratory tract, kidneys, immune system and GI system decrease in function. The systems function adequately during periods of homeostasis. However, when physiological stress is placed on the person, the systems are unable to adequately protect the person from an infection. Other factors that increase an older adults risk for infection include: inadequate nutrition (especially inadequate protein intake), a delayed inflammatory response, disorientation, agitation, incontinence, unsteadiness leading to falls, lethargy and general fatigue. An older adult client may present with acute confusion when infection is present. Additional factors include living in group settings where the older adult is exposed to many people who may have infections, and taking medications which may decrease the alreadyreduced immune system’s ability to respond adequately.
PTS: 1 DIF: Comprehension
REF: White (2013)
Chapter 31—Caring for the Client with Diabetes Mellitus
MULTIPLE CHOICE
1. What is the primary function of insulin?
a . to stimulate active transport of glucose into muscle and adipose tissue cells
b . to convert glycogen to glucose
c to stimulate breakdown of adipose tissue
d . to increase breakdown of protein into amino acids
ANS: A
Insulin is a hormone produced and secreted by the pancreas. Insulin stimulates the active transport of glucose into muscle and adipose tissue cells, making it available for cell use.
PTS: 1 DIF: Comprehension
REF: White (2013)
2. When the body produces an excess amount of insulin, the nurse should monitor for signs and symptoms of:
a . diabetes insipidus
b . diabetes mellitus
ANS: D
c . hyperglycemia
d . hypoglycemia
Hypoglycemia, or low blood glucose, results when the body produces an excess amount of insulin.
PTS: 1 DIF: Comprehension
REF: White (2013)
3. Symptoms of glycosuria, polyuria, polydipsia, and ketoacidosis are indicative of which of these conditions?
a gestational diabetes mellitus
b . idiopathic diabetes mellitus
c . impaired glucose tolerance
d . non-insulin-dependent diabetes mellitus
ANS: B
Manifestations of type 1 diabetes typically include abrupt onset of glycosuria (glucose in the urine), polydipsia (excessive thirst), polyuria (increased urination), and polyphagia (increased hunger); ketonuria (ketones in the urine) may develop as fat stores are metabolized for energy.
PTS: 1
DIF: Comprehension
REF: White (2013)
4. Which forms of type 1 diabetes are characterized by an absolute insulin deficiency requiring management with insulin injections?
a . gestational diabetes mellitus
b impaired glucose tolerance
c immune-mediated or idiopathic diabetes mellitus
d . chemical-induced diabetes mellitus
ANS: C
Immune-mediated or idiopathic diabetes mellitus are two forms of diabetes resulting from pancreatic beta-cell destruction or primary defect in beta-cell function. They are characterized by an absolute insulin deficiency requiring management with insulin injections.
PTS: 1 DIF: Comprehension
REF: White (2013)
5. The nurse is caring for a client who has a family history of diabetes, is obese, and is aging. Which type of diabetes would the nurse suspect this client has?
a . gestational diabetes mellitus c . type 1 diabetes mellitus
b . immune-mediated diabetes mellitus d . type 2 diabetes mellitus
ANS: D
Type 2 diabetes mellitus initially begins with insulin resistance, where the cells are not able to use the insulin properly. As it progresses, the pancreas gradually loses the ability to produce adequate qualities of insulin. Risk factors include family history, age, obesity, ethnicity, and a history of gestational diabetes.
PTS: 1 DIF: Comprehension
REF: White (2013)
6. Which person would be MOST likely to develop type 2 diabetes?
a . a 20-year-old white athlete with a family history of diabetes
b a 30-year-old black athlete with a family history of diabetes
c a 40-year-old black female who is 50 pounds overweight
d . a 50-year-old white male who is 10 pounds overweight
ANS: C
The primary risk factor for developing type 2 diabetes is obesity; other risk factors include age, insufficient exercise, hypertension, dyslipidemia, history of gestational diabetes mellitus, ethnic background, and family history of diabetes.
PTS: 1 DIF: Application REF: White (2013)
7. What is the cornerstone of treatment for the person who has type 2 diabetes?
a . blood glucose monitoring
b . medication with oral hypoglycemic agents
c nutritional therapy
d weight loss
ANS: C
Medical management of type 2 diabetes focuses on dietary management, particularly for weight control, and exercise. If diet and exercise do not adequately control blood sugar levels, oral hypoglycemic medications or parenteral administration of insulin may be prescribed.
PTS: 1 DIF: Comprehension
REF: White (2013)
8. When a client’s glucose level drops below 70 mg/dL, often before meals or when insulin action is peaking, the client is experiencing: a diabetic ketoacidosis
b . diabetic neuropathy
c . hyperosmolar hyperglycemic nonketotic syndrome
d . hypoglycemia
ANS: D
Hypoglycemia (insulin reaction) is a complication of type 1 diabetes that can be fatal unless it is recognized and treated promptly. While hypoglycemia can occur at any time of day, clients experience it most frequently before meals or when their prescribed insulin action peaks.
Causes of hypoglycemia include skipping meals, eating late, engaging in unplanned exercise, and administering excess insulin.
PTS: 1 DIF: Comprehension
REF: White (2013)
9. Subcutaneous insulin absorption occurs MOST quickly when injected into which area?
a . abdomen c . hips
b . arms d . thighs
ANS: A
Factors affecting absorption should be considered when selecting an injection site. Absorption occurs most quickly in the abdomen, followed by the arms, thighs, hips, and subscapular regions.
PTS: 1 DIF: Comprehension
REF: White (2013)
10. In which situation would a client possibly require glucose management by sliding scale insulin?
a clients with type 1 diabetes mellitus experiencing illness, stress, or surgery
b clients with type 1 or type 2 diabetes mellitus experiencing illness,
stress, or surgery
c . clients newly diagnosed with type 2 diabetes mellitus
d . clients participating in a rigorous sport or activity
ANS: B
During times of surgery, illness, or stress, clients may have their glucose levels maintained with an insulin sliding scale in lieu of their regular treatment.
PTS: 1 DIF: Comprehension
REF: White (2013)
11. Which complication of insulin therapy is characterized by a rapid decrease in serum glucose, usually at night, causing the release of glucose-elevating hormones and an elevated glucose level in the morning, which may be inadvertently treated with an increased insulin dose?
a dawn phenomenon c lipodystrophy
b . insulin resistance d . Somogyi phenomenon
ANS: D
The Somogyi phenomenon occurs when a rapid decrease in serum glucose, usually at night, causes the release of glucose-elevating hormones and an elevated glucose level in the morning. Adjusting insulin dosing to avoid the peaking of insulin during the night will correct this effect.
PTS: 1 DIF: Comprehension
REF: White (2013)
12. When mixing two different types of insulin in the same syringe, which type is always drawn up first?
a . lente, intermediate acting c . regular, short acting
b . NPH, intermediate acting d . ultra lente, long acting
ANS: C
When mixing insulins, remember the memory trick of “RNs do it correctly!”
R–Draw up regular (short acting) into the syringe first.
N–Draw up the NPH (intermediate acting) insulin into the same syringe second.
PTS: 1 DIF: Comprehension
REF: White (2013)
13. Which nursing intervention would minimize a client’s risk of developing lipodystrophies?
a . administering insulin intramuscularly c . using human insulin
b . rotating sites of administration d . using insulin at room temperature
ANS: B
Failure to rotate injection sites may cause a complication known as lipodystrophy, a change in the subcutaneous fat that decreases the absorption of the insulin.
PTS: 1
DIF: Comprehension
REF: White (2013)
14. In caring for a client who is taking oral hypoglycemic agents, the nurse recognizes these medications are used in the treatment of which type of diabetes?
a . gestational, requiring therapy for a very short time
b . type 1, not stable with insulin administration only
c type 2, not controlled with diet and exercise
d type 1 and type 2, not controlled by diet and exercise
ANS: C
Oral hypoglycemic agents are used to treat persons with type 2 diabetes that is not controlled with diet and exercise. These agents are meant to supplement diet and exercise, not replace them.
PTS: 1 DIF: Comprehension
REF: White (2013)
15. What is the advantage of giving metformin, a biguanide, to a client requiring oral hypoglycemic agents?
a . It can be administered on a more flexible schedule.
b It does not have the major side effects of nausea, abdominal discomfort, and diarrhea.
c It does not increase insulin release or produce hypoglycemic episodes.
d . It does not tend to react with other medications.
ANS: C
Metformin (Glucophage), a biguanide, does not increase insulin but works by making existing insulin more effective at the cellular level.
PTS: 1 DIF: Comprehension
REF: White (2013)
16. The major goal of medical nutrition therapy for clients with diabetes mellitus is to:
a . reduce serum lipid levels
b . improve health through optimal nutrition
c maintain as near-normal a blood glucose level as possible
d . wean insulin-dependent clients with diabetes from insulin through diet control
ANS: C
The goals of nutrition therapy are to maintain as near-normal a blood glucose level as possible, achieve optimal serum lipid levels, provide adequate calories to maintain or attain a reasonable weight, prevent complications of diabetes, and improve overall health.
PTS: 1 DIF: Application REF: White (2013)
17. The nurse should instruct clients with diabetes about “sick day management” of their disease by emphasizing which action?
a . Report blood glucose lower than 100 mg/dL to the health care provider.
b . Continue taking the scheduled insulin or oral hypoglycemic agent.
c Use sliding scale insulin to manage hypoglycemia.
d . Increase intake of carbohydrates for the duration of the illness.
ANS: B
It is important that persons with diabetes have a plan for maintaining their diabetes in the event of illness. It is important that they continue taking the scheduled insulin or oral hypoglycemic agent when they are experiencing illness, because illness and fever can increase blood glucose and the need for insulin.
PTS: 1 DIF: Application REF: White (2013)
18. A client tells the nurse about experiencing symptoms of a hypoglycemic insulin reaction. Which action should the nurse take FIRST?
a . Assess the blood glucose level, and administer glucose in the most appropriate form.
b . Call the health care provider.
c . Give the client juice or hard candy immediately.
d . Have the client lie down and see if symptoms subside.
ANS: A
Nursing care of clients who have hypoglycemia focuses on assessing symptoms, checking blood glucose level, and administering glucose in the most appropriate form. Teaching clients and their families how to prevent hypoglycemic reactions is also important, and clients should be encouraged to wear medical identification bracelets or tags that state they have type 1 diabetes.
PTS: 1 DIF: Application REF: White (2013)
19. A client who has diabetes begins to experience nausea, vomiting, weakness, fatigue, and blurred vision. The nurse observes the client’s skin is warm and flushed and notes a fruity odor to the client’s breath. The nurse should anticipate the client will be treated for:
a . hypoglycemia
b . diabetic ketoacidosis
c . hyperosmolar hyperglycemic nonketotic syndrome
d . insulin resistance
ANS: B
Diabetic ketoacidosis (DKA) occurs predominantly in clients who have type 1 diabetes and can be precipitated by factors such as stress, illness, or surgery. DKA may occur gradually or suddenly, and manifestations are similar to those of hyperglycemia (polyuria, polyphagia, and polydipsia);
other symptoms may include nausea and vomiting, abdominal pain, headache, weakness, fatigue, blurred vision, skin that is hot and of poor turgor, Kussmaul’s respirations, and fruity breath odor.
PTS: 1 DIF: Application REF: White (2013)
20. What is the MOST common chronic complication of diabetes mellitus?
a . blindness
b . renal failure
ANS: D
c . morbid obesity
d . neuropathy
Neuropathies are the most common chronic complication of diabetes; they occur more frequently with age and duration of the disease. While all types of nerves can be affected, sensorimotor polyneuropathy (peripheral neuropathy), involving the lower extremities, and autonomic neuropathy, involving virtually any organ system, occur most frequently.
PTS: 1 DIF: Comprehension REF: White (2013)
21. The nurse should teach the client to monitor for which complication of diabetic neuropathy?
a . arthrosclerosis
c . injury and undetected foot injury
b diabetic retinopathy d kidney failure
ANS: C
The incidence of neuropathy increases with age and duration of the disease. Decreased sensations in the lower extremities and decreased pain and temperature sensations coupled with decreased circulation places the client at risk for undetected foot injury.
PTS: 1 DIF: Comprehension
REF: White (2013)
22. A client newly diagnosed with type 2 diabetes mellitus has a nursing diagnosis of Knowledge deficit: diabetes, medical regimen, diet, exercise, and self-care management skills. Which nursing goal is appropriate for this client?
a . to maintain current weight
b . to maintain vital signs within normal limits
c to use the food pyramid for meal planning
d to relate the importance of an exercise program
ANS: D
The goals of exercise and nutrition therapy are to maintain as near-normal a blood glucose level as possible, achieve optimal serum lipid levels, provide adequate calories to maintain or attain a reasonable weight, to prevent complications of diabetes, and to improve overall health. Oral hypoglycemic agents are used to treat persons with type 2 diabetes that is not controlled with diet and exercise. These agents are meant to supplement diet and exercise, not replace them.
PTS: 1
DIF: Application REF: White (2013)
MULTIPLE RESPONSE
1. The nurse is reviewing a client’s medical history. Which factors would indicate that client is at risk for the development of diabetes? (Select all that apply.)
a . triglyceride level of 199 mg/dL d . blood pressure of 138/78
b . first child weighed 9 lbs 3 oz e . taking antihypertensive medications
c body mass index of 32 f. great uncle who was diabetic
ANS: B, C, E
The criteria for those who should be screened for diabetes include triglyceride level of 250 mg/dL or greater, hypertension, gestational
diabetes, having a child weighing over 9 lbs, immediate family history, atrisk ethnic group, high-density lipoprotein (HDL) of 35 mg/dL or less, and having one of the two precursors of diabetes.
PTS: 1 DIF: Application REF: White (2013)
2. A teenaged client appears to have developed hybrid diabetes. The nurse is aware that this type of diabetes causes the client to have which of the following? (Select all that apply.)
a insulin resistance associated type 1 diabetes
b . antibodies against pancreatic islet cells associated with autoimmunity
c . antibodies against pancreatic islet cells associated with type 1 diabetes
d . insulin resistance associated with obesity
e . insulin resistance associated type 2 diabetes
f. antibodies against pancreatic islet cells associated with type 2 diabetes
ANS: B, C, D, E
Youth with hybrid or mixed diabetes typically have insulin resistance associated with obesity and type 2 diabetes and antibodies against pancreatic islet cells associated with autoimmunity and type 1 diabetes.
PTS: 1 DIF: Comprehension
REF: White (2013)