A 45-Year-Old Female Presents to the Emergency Department

A 45-year-old female presents to the emergency department. She reports the onset of a sore throat, cough and rhinorrhea about five days ago. She is now experiencing weakness in her arms and difficulty breathing. She is evaluated in the emergency room and admitted to the intensive care unit. In the provider's initial assessment, the patient is noted to have gross inflammation of her pharynx and tonsils, with grayish-white patches in the pharynx. A throat swab and additional specimens are sent for microbial analysis. The patient is placed in isolation.
-The RN educates the patient about diphtheria.In explaining the role of exotoxin in the pathogenesis of the disease,the nurse correctly states that the exotoxin ________.

A) is the major virulence factor of the disease
B) is isolated to the respiratory tract,causing upper and lower respiratory tract symptoms
C) is released in the blood,causing systemic effects
D) is the major virulence factor of the disease and is released in the blood,causing systemic effects