Chapter 12: Disorders of the Immune Response

The nurse is preparing to administer a unit of blood to a client. The client says that he is not sure he wants to give consent to receive the blood transfusion because he does not want to get HIV/AIDS from the blood. How will the nurse respond?

"All blood is now tested for HIV, so the risk of getting HIV/AIDS from a blood transfusion is extremely low."

Which statement from a group of young adults demonstrates the need for further teaching related to HIV and prevention of the spread of HIV?

"Having oral sex is one way I can prevent passing on HIV to my partner."

A parent brings a 6-month-old infant to the primary care physician to treat the infant's third respiratory infection since birth. What explanation will the nurse give for the order to administer intravenous immunoglobulin (IVIg)?

"IVIg supplements the infant's immunity to prevent recurrent infection."

A client describes himself as being "devastated" after hearing that his HIV test has come back positive. Which response by the nurse is most appropriate?

"It's entirely normal to feel that way. We are going to try our best to help you get all the support you need."

While conducting client education at a public health clinic, a nurse teaches about sexually transmitted disease prevention. Included in the education is a segment on HIV/AIDS. Which statement from a client would indicate that more teaching is needed?

"Natural or lambskin condoms are as protective as latex condoms."

A client was tested for HIV and received a positive result from the enzyme-linked immunosorbent assay (ELISA) followed by a negative Western blot test. The client asks the nurse what this means. What is the nurse's best response?

"The ELISA test gives some false positives, but the Western blot confirms you don't have HIV."

A college student has been called into the student health office because she tested positive for HIV on the enzyme-linked immunosorbent assay (ELISA). The student asks, "What is this Western blot assay going to tell you?" The best response by the health care provider is:

"The Western blot is a more sensitive assay that looks for the presence of antibodies to specific viral antigens."

A 5-year-old child is experiencing itchy, watery eyes and an increased respiratory rate with some inspiratory wheezes. He has been outside playing in the yard and trees. The mother asks, "Why does he get like this?" The health care worker's best response is:

"This is what we call a type I hypersensitivity reaction and usually occurs a few minutes after exposure to his allergen. It is primarily caused by mast cells in his body."

A school nurse is teaching high school students about human immunodeficiency virus (HIV) in the context of the school's sexual health curriculum. Which statement by a student would the nurse need to correct or clarify?

"Yearly testing is the best way to prevent contracting or spreading HIV."

The nurse is caring for a client who has just learned that he is HIV positive. The client asks the nurse how long he has been able to infect others. Select the best response by the nurse.

"You can infect others before the HIV antibody is detectable in your blood."

The nurse is teaching health promotion strategies to a client who is infected with HIV and has a CD4+ cell count of 600. The nurse includes which information related to vaccination?

"You should be immunized for measles, mumps, and rubella."

Shortly after being diagnosed with HIV, a client has begun highly active antiretroviral therapy (HAART). The client asks, "My doctor tells me that my viral load is going down. What does that mean?" The nurse's best response is:

"Your HAART medications are working to slow the progression of the disease."

What is the length of time from infection with HIV to seroconversion?

1 to 3 months

Which client has the highest risk of contracting an opportunistic infection?

A client who has had HIV for 3 years and has a CD4+ count of 50 cells/μL

A nurse informs her supervisor that she thinks she has developed an allergy to the latex gloves. A latex-specific serum IgE immunoassay has been performed with negative results. What definitive diagnostic test should be performed at this time?

A contact test

Which of the following is a known trigger for many autoimmune disorders?

A viral infection

An infant is suspected of having a severe primary immunodeficiency disease. Which effect on the infant makes early detection a priority?

Administering live attenuated virus vaccines can be fatal.

Which intervention would be the best treatment option to prevent perinatal transmission of HIV antibodies to a fetus from the HIV-positive mother?

Administration of zidovudine to the mother during pregnancy, labor, and delivery

A client presents to the urgent care clinic with erythematous, papular, and vesicular lesions associated with intense pruritus and weeping. The client states he was in the woods and thinks he may have come in contact with poison ivy. The reaction may be classified as:

Allergic contact dermatitis

Some members of the population are so sensitive to certain antigens that they react within minutes by developing itching, hives, and skin erythema, followed shortly thereafter by bronchospasm and respiratory distress. What is this near-immediate reaction commonly known as?

Anaphylactic reaction

A client with common variable immunodeficiency (CVID) who is also deficient in IgA is being treated with IV immunoglobulin (IV Ig) in the hospital. For which sign/symptom should the nurse closely monitor the client during treatment?

Anaphylaxis

A client is admitted with swelling of the subcutaneous tissues, severe vomiting, and diarrhea. The swelling is particularly severe in the client's face. After several serologic tests are performed, it is determined that the client is suffering from an immunodeficiency. Which diagnosis is most likely?

Angioneurotic edema

A client has been admitted to the hospital for the treatment of HIV infection, which has recently progressed to overt AIDS. Which nursing action should the nurse prioritize when providing care for this client?

Astute infection control and respiratory assessments

Select the statement that best describes autoimmune disease.

Autoimmune diseases represent a disruption in self-tolerance that results in damage to body tissues by the immune system.

A client has a latex allergy. Which foods will the nurse teach the client to eat with caution because they could trigger a cross-sensitivity reaction?

Bananas and avocados

The early management recommendations for an asymptomatic person confirmed to have HIV antibodies would consist of which intervention?

Baseline screening for viral load and CD4+ counts

Which statement about acquired immunodeficiency syndrome (AIDS) is true?

Both B-cell and T-cell function are affected.

Physical changes associated with lipodystrophy related to HIV infection include which manifestations? Select all that apply.

Buffalo hump Breast enlargement Increased abdominal girth

Which of these is an AIDS-defining condition?

CD4+ count less than 200 cells/μL

A client with end-stage renal disease received a kidney transplant with a kidney donated by a family member. The client has been carefully monitored for signs of rejection. The physician informs the client that there has been a gradual rise in the serum creatinine over the last 5 months. What type of rejection does this depict?

Chronic rejection

All antiretroviral medications interfere with some stage of the HIV life cycle. What stage do protease inhibitors prevent?

Cleavage of the polyprotein chain into the individual proteins that will be used to make new virus

A client is receiving radiation therapy for breast cancer. Which type of immunodeficiency is this client at risk for developing?

Combined B-cell and T-cell immunodeficiency

In providing education to a sexually active 22-year-old female, which topic would be most beneficial to discuss to decrease her risk for contracting HIV?

Consistent use of latex condoms with sexual activity

A client is diagnosed with a mild case of an autoimmune disorder and is beginning a treatment regimen. What is the mainstay of treatment with an autoimmune disorder?

Corticosteroids and immunosuppressants

The nurse is caring for a client who is HIV positive and is newly diagnosed with Mycobacterium tuberculosis (TB). Which manifestations does the nurse associate with TB? Select all that apply.

Cough Fever Night sweats

Contact with poison ivy has resulted in intense pruritus, erythema, and weeping on a client's forearm. Which pathological process is responsible for the client's manifestations?

Cytokine release by sensitized T cells

A nurse practitioner is explaining to a new group of nurses mechanisms of autoimmune diseases. The nurse describes that in T-cell anergy, which factor may break down and result in autoimmune activation of T cells?

Expression of the costimulatory molecule

The treatment of HIV/AIDS is complicated because different drugs act on different stages of the replication cycle of the virus. Therefore, treatment includes combinations of two, three, or more drugs. What is this treatment called?

HAART treatment

The clinic nurse suspects the client is having a genetically determined hypersensitivity to common environmental allergens since the client is experiencing which clinical manifestations? Select all that apply.

Hives (urticaria) Runny nose Wheezes

A client is suffering from the effects of the opportunistic infection, Cryptosporidium parvum. An important nursing intervention would be to encourage which action?

Hydration

The immune system typically responds to invaders of all types in our body. However, it can also cause tissue injury and disease. What is this effect called?

Hypersensitivity action

A client with common variable immunodeficiency (CVID) is admitted to the hospital for treatment. Which type of treatment will the nurse be administering to the client?

IV immunoglobulin

A client is being treated for an anaphylactic reaction after eating shrimp. Which class of antibodies mediates the anaphylaxis?

IgE

In a newborn, which antibody crosses the placenta to provide protection from infection?

IgG

Infants are born with a passive immunity that occurs when immunoglobulin antibodies cross the placenta from the maternal circulation prior to birth. Which immunoglobulin is capable of crossing the placenta?

IgG

The nurse is teaching a new mother about caring for her baby and reducing the risk for infection. On what principle does the nurse base the knowledge of passive immunity?

Infants are protected at birth from infection by maternal IgG.

A client diagnosed with the autoimmune disorder Hashimoto's thyroiditis asks the nurse what he has done to cause this disorder. What knowledge by the nurse should the response be based upon?

It is a result of the loss of immunologic self-tolerance.

Which is a characteristic finding in AIDS?

Kaposi sarcoma

Which of these is often found in a client with AIDS?

Kaposi sarcoma

A client with hereditary angioneurotic edema (HAE) is experiencing an attack. Which priority intervention should the nurse be prepared to administer?

Maintaining a patent airway

A client has developed a type 1 hypersensitivity reaction. When should the nurse assess for a possible progressing response to the secondary or late-phase?

May occur 2 to 8 hours after the primary or initial-phase response and lasts for several days

Systemic lupus erythematosus is best characterized by which principle?

Most clients have antinuclear antibodies present in their blood.

Which disorder does the nurse know is considered to be an autoimmune disease?

Myasthenia gravis

Typical symptoms seen in the latent period of HIV infection include which of the following?

No signs or symptoms

A 37-year-old male with HIV who has recently become symptomatic has begun highly active antiretroviral therapy (HAART). Among the numerous medications that he now regularly takes are several that inhibit the change of HIV RNA to DNA in a CD4+ cell. Which class of medications addresses this component of the HIV replication cycle?

Non-nucleoside reverse transcriptase inhibitors

Which statements are correct regarding the diagnosis of an autoimmune disorder? Select all that apply.

Overlapping presentation of symptoms is common among this type of disorder. Non-autoimmune diseases can present with autoimmune-like symptoms. Effective history taking is vital to the diagnosis of autoimmune disorders. Laboratory diagnostic testing aids in the diagnosis of auto immune disorders.

What is the main effect of HIV infection?

Poor helper T-cell function

A 40 year-old male who has been HIV-positive for 6 years is experiencing a new increase in his viral load along with a corresponding decrease in his CD4+ count. Which aspect of his immune system is likely to remain most intact?

Presentation of major histocompatibility complex (MHC) molecules on body cells

A nurse is caring for a child who has had a history of recurrent severe infections that have been resistant to treatment with antibiotics. Which disorder should be suspected in this child?

Primary immunodeficiency disorder (PID)

What is the priority intervention for a nurse caring for a client with wasting syndrome from AIDS?

Promote nutritional intake.

A client has been diagnosed with B-cell immunodeficiency disorder. Which bacteria would the nurse likely see associated with this disorder? Select all that apply.

Streptococcus pneumoniae Staphylococcus aureus

A client with cirrhosis has just received a liver transplant. Tissue rejection can be best prevented by what means?

Suppression of CD8+ cytotoxic T cells

Which are realistic goals for HIV clients being treated with highly active antiretroviral therapy (HAART)? Select all that apply.

Suspension of HIV replication Undetectable viral load Increased CD4+ count Slower progression to AIDS

A nurse has just learned that her child has a life-threatening complement disorder known as hereditary angioneurotic edema (HAE). Due to deficiency in C1-INH, the nurse needs to be prepared for which possible life-threatening clinical manifestation?

Swelling of the airway

A client with a diagnosis of cirrhosis has experienced an acute rejection of a donor liver. Which cell is most likely responsible for the rejection of the client's transplanted organ?

T cells

The nurse is caring for a client who is positive for the human immunodeficiency virus (HIV). Which precaution will the nurse take to reduce occupational exposure to the virus?

Take universal precautions, because they are used for all client care situations where exposure to blood and body fluids is possible.

The nurse understands that a positive ELISA test reported in a baby born to a woman who is HIV positive indicates:

The baby has antibodies from the mother and it is uncertain whether the baby is infected with HIV.

An infant has a rare autosomal recessive disorder, ataxia-telangiectasia, that has recently been diagnosed. Which developmental milestone assists in diagnosing this disorder?

The child is beginning to walk.

A nurse is caring for a child diagnosed with DiGeorge syndrome with thymic hypoplasia. Which immune response would the nurse anticipate in this child?

The child with thymic hypoplasia will be at increased risk of infection.

The treatment prescribed for an autoimmune disorder is primarily dependent upon what?

The current manifestations of the disease and the mechanisms that cause the disease process

An infant has been born to a client who is HIV positive. What is the infant's most likely prognosis for developing AIDS?

The infant can be HIV antibody positive by ELISA for up to 18 months of age without being actively infected with HIV.

A nurse practitioner is explaining the current methods of detection of HIV to a community group. In explaining the definitive method of detection, which statement is most accurate?

The most sensitive and specific test is the Western blot analysis.

A nurse is assigned to care for a client who is positive for HIV. What personal protective equipment (PPE) will the nurse wear while caring for this client?

The nurse wears gloves if there is a chance of coming in contact with the client's blood or body fluids.

The type of hypersensitivity reaction that is mediated by IgG or IgM antibodies directed against target antigens on specific host cell surfaces or tissues is also known as which type of hypersensitivity reaction?

Type II

A client has developed a hypersensitivity reaction resulting in the diagnosis of serum sickness. In documentation, the nurse would categorize this reaction as which type of hypersensitivity reaction?

Type III hypersensitivity reaction

A client in the primary or initial phase of a type I hypersensitivity reaction would most likely experience which physiologic response?

Vasodilation of the capillaries from the release of histamine

A 67-year-old client diagnosed with myasthenia gravis will likely display which clinical manifestations as a result of autoantibodies ultimately blocking the action of acetylcholine, resulting in destruction of the receptors?

Weakness of the eye muscles, difficulty in swallowing and slurred speech, impaired gait.

A 20-year-old male presents at the clinic complaining of severe fatigue, night sweats, and fever. While taking the client's history, he reports having multiple sexual partners and unprotected sex. HIV/AIDS is suspected. What diagnostic test would be ordered to confirm the diagnosis?

Western blot assay

A client fears she may have acquired HIV and asks the nurse what test is likely to be used to confirm a diagnosis. The best response would be:

Western blot assay

A parent of a 9-year-old brings the child into the emergency department with a possible food allergy reaction. Which symptoms in a child of this age group would the nurse expect to assess?

Wheezing and stridor

A client has begun HAART shortly after being diagnosed with HIV. When describing the potential benefits of this drug regimen, the nurse should describe:

a reduction in the replication rate of HIV.

A client will be receiving a bone graft from an unrelated individual. Which type of graft does the nurse inform the client that he or she will be receiving?

allograft

HIV is considered to be a retrovirus because:

it carries its genetic information in ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA).

What is a characteristic indicator that an individual is in the latent phase of a chronic viral infection such as human immunodeficiency or herpes zoster viruses?

lack of symptoms

Manifestations of Kaposi sarcoma include:

lesions of the skin and in the oral cavity, gastrointestinal tract, and lungs.

A 21-year-old client was diagnosed with HIV 4 years ago, which progressed to AIDS 1 year ago. Now, the client presents with cytomegalovirus. The nurse explains to the client that the infection is caused by a common organism that normally does not cause infection in someone with a healthy immune system. This type of infection is called what?

opportunistic infection

A nurse educator is explaining how the HIV virus is responsible for AIDS and AIDS syndromes. The educator should explain that replication involves the killing of:

the CD4+ T cell and the release of HIV copies into the bloodstream.

The nurse is reviewing the client's medical record for the results of a Western blot test with the understanding that:

the Western blot is used to confirm a diagnosis of HIV infection.

The nurse is caring for an infant with DiGeorge syndrome. Which organ will be underdeveloped or absent?

thymus gland