Chapter 35: Assessment of Immune Function

precursors of all blood cells; reside primarily in bone marrow

stem cells

When obtaining a health history from a patient with possible abnormal immune function, what question would be a priority for the nurse to ask? a. "Have you ever been treated for a sexually transmitted infection"? b. "When was your last menstrual period"? c. "Do you have abdominal pain or discomfort"? d. "Have you ever received a blood transfusion"?

"Have you ever received a blood transfusion"?

A patient tells the nurse, "I can't believe I have ineffective immune function and am getting sick again. I exercise rigorously and compete regularly." What is the best response by the nurse? a. "Something must be seriously wrong. You should not be getting sick since you are so healthy" b. "Maybe you need to stop exercising so much. It can't be good for you" c. "It is possible that you are immunocompromised and may haveHIV" d. "Rigorous exercise can cause negative effects on immuneresponse

"Rigorous exercise can cause negative effects on immuneresponse

Interferons are used to treat ___________ disorders (e.g., multiple sclerosis) and ____________ conditions (e.g., chronic hepatitis).

- immune-related -chronic inflammatory

Comparison of Cellular and Humoral Immune Responses

* Humoral Responses (B Cells) Bacterial phagocytosis and lysis Anaphylaxis Allergic hay fever and asthma Immune complex disease Bacterial and some viral infections * Cellular Responses (T Cells) Transplant rejection Delayed hypersensitivity (tuberculin reaction) Graft-versus-host disease Tumor surveillance or destruction Intracellular infections Viral, fungal, and parasitic infections

IgM antibodies

- Appears mostly in intravascular serum - Appears as the first immunoglobulin produced in response to bacterial and viral infections - Activates the complement system

When the body is invaded or attacked by bacteria, viruses, or other pathogens, it has three means of defense:

- The phagocytic immune response - The humoral or antibody immune response - The cellular immune response

Why do patients who have burns have an increase risk for infection?

- The skin is the first line of defense against organisms - Body loses proteins (immunoglobulins) - Increased cortisol suppresses the immune system

Hematopoietic Cytokines

- diverse substances produced mainly by bone marrow and WBCs. - They regulate many cellular activities by acting as chemical messengers among cells and as growth factors for blood cells.

Complement has three major physiologic functions:

-defending the body against bacterial infection - bridging natural and acquired immunity - disposing of immune complexes and the by-products associated with inflammation

Antibody functions

-phagocyte signaling -antigen clumping -prevention of cell entry -complement protein signaling

IgE antibodies

0.002% of serum antibodies - Appears in serum - Takes part in allergic and some hypersensitivity reactions - Combats parasitic infections

IgD antibodies

0.2 % - Appears in small amounts in serum - Possibly influences B-lymphocyte differentiation, but role is unclear

IgA antibodies

15% - Appears in body fluids (blood, saliva, tears, and breast milk, as well as pulmonary, gastrointestinal, prostatic, and vaginal secretions) -Protects against respiratory, gastrointestinal, and genitourinary infections -Prevents absorption of antigens from food -Passes to neonate in breast milk for protection

A patient has undergone treatment for septic shock and received high doses of numerous antibiotics during the course of treatment. When planning the patient's subsequent care, the nurse should be aware of what potential effect on the patient's immune function? A) Bone marrow suppression B) Uncontrolled apoptosis C) Thymus atrophy D) Lymphoma

A (Feedback: Large doses of antibiotics can precipitate bone marrow suppression, affecting immune function. Antibiotics are not noted to cause apoptosis, thymus atrophy, or lymphoma.)

A patient is vigilant in her efforts to "take good care of herself" but is frustrated by her recent history of upper respiratory infections and influenza. What aspect of the patient's lifestyle may have a negative effect on immune response? A) The patient works out at the gym twice daily. B) The patient does not eat red meats. C) The patient takes over-the-counter dietary supplements. D) The patient sleeps approximately 6 hours each night.

A (Feedback: Rigorous exercise or competitive exercise—usually considered a positive lifestyle factor—can be a physiologic stressor and cause negative effects on immune response. The patient's habits around diet and sleep do not present obvious threats to immune function.)

A patient's exposure to which of the following microorganisms is most likely to trigger a cellular response? A) Herpes simplex B) Staphylococcus aureus C) Pseudomonas aeruginosa D) Beta hemolytic Streptococcus

A (Feedback: Viral, rather than bacterial antigens, induce a cellular response.)

A patient with a history of dermatitis takes corticosteroids on a regular basis. The nurse should assess the patient for which of the following complications of therapy? A) Immunosuppression B) Agranulocytosis C) Anemia D) Thrombocytopenia

A Corticosteroids such as prednisone can cause immunosuppression. Corticosteroids do not typically cause agranulocytosis, anemia, or low platelet counts.

Erythropoietin

A hormone produced and released by the kidney that stimulates the production of red blood cells by the bone marrow.

Natural Killer Cells

A type of white blood cell that can kill tumor cells and virus-infected cells; an important component of innate immunity.

Although natural immunity can often effectively combat infections, many pathogenic microbes have evolved that resist natural immunity. __________ immunity is necessary to defend against these resistant agents.

Acquired

What does cellular membrane damage result from?

Activation of complement, arrival of killer T cells, and attraction of macrophages

A nurse is explaining the process by which the body removes cells from circulation after they have performed their physiologic function. The nurse is describing what process? A) The cellular immune response B) Apoptosis C) Phagocytosis D) Opsonization

B - Apoptosis, or programmed cell death, is the body's way of destroying worn out cells such as blood or skin cells or cells that need to be renewed.

What is indicative of a viral infection: an increase in the neutrophils or the lymphocytes?

An increase in neutrophils indicates a bacterial infection while an increase in lymphocytes indicate a viral infection (although lymphocytes are also elevated in some bacterial infections as well)

_____________ defend against foreign invaders in several ways, and the type of defense used depends on the structure and composition of both the antigen and the immunoglobulin.

Antibodies

substance that induces the production of antibodies

Antigen

_____________ disorders tend to be more common in women because estrogen tends to enhance immunity.

Autoimmune

Is the following statement True or False? Autoimmune disorders are more common in women than men.

Autoimmune disorders are more common in women than men.

A nurse has administered a child's scheduled vaccination for rubella. This vaccination will cause the child to develop which of the following? A) Natural immunity B) Active acquired immunity C) Cellular immunity D) Mild hypersensitivity

B (Feedback: Active acquired immunity usually develops as a result of vaccination or contracting a disease. Natural immunity is present at birth and provides a nonspecific response to any foreign invader. Immunizations do not activate the process of cellular immunity. Hypersensitivity is not an expected outcome of immunization.)

A patient was recently exposed to infectious microorganisms and many T lymphocytes are now differentiating into killer T cells. This process characterizes what stage of the immune response? A) Effector B) Proliferation C) Response D) Recognition

B (Feedback: In the proliferation stage, T lymphocytes differentiate into cytotoxic (or killer) T cells, whereas B lymphocytes produce and release antibodies. This does not occur in the response, recognition, or effector stages.)

The nurse is assessing a client's risk for impaired immune function. What assessment finding should the nurse identify as a risk factor for decreased immunity? A) The patient takes a beta blocker for the treatment of hypertension. B) The patient is under significant psychosocial stress. C) The patient had a pulmonary embolism 18 months ago. D) The patient has a family history of breast cancer.

B (Feedback: Stress is a psychoneuroimmunologic factor that is known to depress the immune response. Use of beta blockers, a family history of cancer, and a prior PE are significant assessment findings, but none represents an immediate threat to immune function.)

The nurse should recognize a patient's risk for impaired immune function if the patient has undergone surgical removal of which of the following? A) Thyroid gland B) Spleen C) Kidney D) Pancreas

B A history of surgical removal of the spleen, lymph nodes, or thymus may place the patient at risk for impaired immune function. Removal of the thyroid, kidney, or pancreas would not directly lead to impairment of the immune system.

A patient is undergoing testing to determine the overall function of her immune system. What test can be performed to evaluate the functioning of the patient's cellular immune system? A) Immunoglobulin testing B) Delayed hypersensitivity skin test C) Specific antibody response D) Total serum globulin assessment

B Cellular (cell-mediated) immunity tests include the delayed hypersensitivity skin test, since this immune response is specifically dependent on the cellular immune response. Each of the other listed tests assesses functioning of the humoral immune system.

A nurse is explaining how the humoral and cellular immune responses should be seen as interacting parts of the broader immune system rather than as independent and unrelated processes. What aspect of immune function best demonstrates this? A) The movement of B cells in and out of lymph nodes B) The interactions that occur between T cells and B cells C) The differentiation between different types of T cells D) The universal role of the complement system

B T cells interact closely with B cells, indicating that humoral and cellular immune responses are not separate, unrelated processes, but rather branches of the immune response that interact. Movement of B cells does not clearly show the presence of a unified immune system. The differentiation between types of T cells and the role of the complement system do not directly suggest a single immune system.

these cells are important for producing a humoral immune response

B cells

A patient's recent diagnostic testing included a total lymphocyte count. The results of this test will allow the care team to gauge what aspect of the patient's immunity? A) Humoral immune function B) Antigen recognition C) Cell-mediated immune function D) Antibody production

C (Feedback: A total lymphocyte count is a test used to determine cellular immune function. It is not normally used for testing humoral immune function and the associated antigen-antibody.)

Diagnostic testing has revealed a deficiency in the function of a patient's complement system. This patient is likely to have an impaired ability to do which of the following? A) Protecting the body against viral infection B) Marking the parameters of the immune response C) Bridging natural and acquired immunity D) Collecting immune complexes during inflammation

C Complement has three major physiologic functions: defending the body against bacterial infection, bridging natural and acquired immunity, and disposing of immune complexes and the byproducts associated with inflammation. Complement does not mark the parameters of the immune response; complement does not collect immune complexes during inflammation.

A patient's current immune response involves the direct destruction of foreign microorganisms. This aspect of the immune response may be performed by what cells? A) Suppressor T cells B) Memory T cells C) Cytotoxic T cells D) Complement T cells

C Cytotoxic T cells (also called CD8 + cells) participate in the destruction of foreign organisms. Memory T cells and suppressor T cells do not perform this role in the immune response. The complement system does not exist as a type of T cell.

A patient requires ongoing treatment and infection-control precautions because of an inherited deficit in immune function. The nurse should recognize that this patient most likely has what type of immune disorder? A) A primary immune deficiency B) A gammopathy C) An autoimmune disorder D) A rheumatic disorder

C Primary immune deficiency results from improper development of immune cells or tissues. These disorders are usually congenital or inherited. Autoimmune disorders are less likely to have a genetic component, though some have a genetic component. Overproduction of immunoglobulins is the hallmark of gammopathies. Rheumatic disorders do not normally involve impaired immune function

What does an elevated neutrophil count signal?

infection

What is complement, how is it formed, and how does it function?

Complement is a term used to describe circulating plasma proteins that are made in the liver and activated when an antibody couples with an antigen. Complement defends the body against bacterial infection, bridges natural and acquired immunity, and disposes of immune complexes and byproducts associated with inflammation.

what happens if someone is depleted of protein?

Depletion of protein reserves results in atrophy of lymphoid tissues, depression of antibody response, reduction in the number of circulating T cells, and impaired phagocytic function.

_____________ acquired immunity is temporary immunity transmitted from a source outside the body that has developed immunity through previous disease or immunization

Passive

CD8+ cells

Cytotoxic T cells

A nurse is reviewing the immune system before planning an immunocompromised patient's care. How should the nurse characterize the humoral immune response? A) Specialized cells recognize and ingest cells that are recognized as foreign. B) T lymphocytes are assisted by cytokines to fight infection. C) Lymphocytesare stimulated to become cells that attack microbes directly. D) Antibodies are made by B lymphocytes in response to a specific antigen.

D The humoral response is characterized by the production of antibodies by B lymphocytes in response to a specific antigen. Phagocytosis and direct attack on microbes occur in the context of the cellular immune response.

Immune deficiencies primary

Deficiency results from improper development of immune cells or tissues; usually congenital or inherited

humoral and cellular immune responses DON'T interact with eachother

FALSE! T cells interact closely with B cells, indicating that humoral and cellular immune responses are not separate, unrelated processes but rather are branches of the immune response that interact.

CD4+ cells

Helper T cells that carry the CD4 protein antigen on their surface. HIV binds to CD4 and infects and kills T cells bearing this protein. AIDS patients have an inadequate number of CD4+ cells

Body produces inappropriate or exaggerated responses to specific antigens

Hypersensitivity

The body can produce five different types of immunoglobulin (Ig). Each of the five types, or classes, is identified by a specific letter of the alphabet:

IgA, IgD, IgE, IgG, and IgM.

Enhances phagocytosis

IgG

- Appears in serum and tissues (interstitial fluid) - Assumes a major role in bloodborne and tissue - infections Activates the complement system - Enhances phagocytosis Crosses the placent

IgG (75% of Total Immunoglobulin)

How do you know if your patient is immunodeficient?

Immunodeficiency is marked by frequent infections that could be severe, infection from organisms that do not typically cause a problem, poor treatment response and chronic diarrhea

What is the patient at risk for if the spleen is removed?

Infection * spleen acts like a filter

Cytotoxic T (killer T)

Lyses cells infected with virus; plays a role in graft rejection

________________, which is nonspecific, provides a broad spectrum of defense against and resistance to infection. It is considered the first line of host defense following antigen exposure, because it protects the host without remembering prior contact with an infectious agent

Natural Immunity

_________________ (polymorphonuclear leukocytes) are the first cells to arrive at the site where inflammation occurs.

Neutrophils

Which leukocytes are the first to arrive at the site of inflammation? A. Basophils B. Eosinophils C. Monocytes D. Neutrophils

Neutrophils arrive first at a site where inflammation occurs.

Autoimmunity

Normal protective immune response paradoxically turns against or attacks the body, leading to tissue damage

Gammopathies

Overproduction of immunoglobulins

Viral rather than bacterial antigens induce a cellular response. This response is manifested by the increasing number of _______________ (lymphocytosis) seen in the blood tests of people with viral illnesses such as infectious mononucleosis.

T lymphocytes

_______________ are large proteins, called immunoglobulins, that consist of two subunits, each containing a light and a heavy peptide chain held together by a chemical link composed of disulfide bonds.

antibody

__________ of antigens as foreign, or non-self, by the immune system is the initiating event in any immune response. Recognition involves the use of lymph nodes and lymphocytes for surveillance.

Recognition

In a streptococcal throat infection, for example, the streptococcal organism gains access to the mucous membranes of the throat. A circulating lymphocyte moving through the tissues of the throat comes in contact with the organism. The lymphocyte recognizes the antigens on the microbe as different (non-self) and the streptococcal organism as antigenic (foreign). this is an example of what stage of the 4 stages in immune response?

Recognition Stage

a protein substance developed by the body in response to and interacting with a specific antigen

antibody

what is produced in the bone marrow?

Stem cell ( which produces WBC, RBC, platelets)

stem cells continuously migrate from the bone marrow to the thymus gland, where they develop into ____ cells.

T

cells that are important for producing a cellular immune response

T cells

how T cells attack foreign invaders in comparison to B cells

T cells attack foreign invaders directly rather than by producing antibodies.

Cellular immune response

T lymphocyte -Helper T -Suppressor T -Memory T -Cytotoxic T (killer T)

Most microbial infections induce an inflammatory response mediated by T cells and cytokines which, in excess, can cause tissue damage.Therefore, regulatory mechanisms must be in place to suppress or halt the immune response. which are these regulatory mechanism?

This is mainly achieved by the production of cytokines and transformation of growth factor that inhibit macrophage activation. * In some cases, T-cell activation is so acute that these mechanisms fail, and pathology develops.

Clinical manifestations of inadequate erythropoiesis include anemia. This result in a decrease in what?

This results in a decrease in the oxygen-carrying capacity of blood and consequently a decreased oxygen availability to the tissues

_________ is the mechanism by which the immune system is programmed to eliminate foreign substances such as microbes, toxins, and cellular mutations but maintains the ability to accept self-antigens

Tolerance

A patient who suffered severe partial thickness burns to the face and trunk is at risk for depletion of essential proteins and immunoglobulins. The stressors associated with this patient's major injury have caused what immune process to occur? a. Cortisol is released from the adrenal cortex, which contributes to immunosuppression b. Circulating lymphocytes will cause lymph node enlargement and altered lymph drainage c. T lymphocytes are stimulated and produce antibodies d. With the help of macrophages, B lymphocytes recognize the antigen of a foreign invader

With the help of macrophages, B lymphocytes recognize the antigen of a foreign invader

complement cascade

a precise sequence of events, usually triggered by antigen-antibody complexes, in which each component of the complement system is activated in turn

One antibody can act as a cross-link between two antigens, causing them to bind or clump together. This clumping effect, referred to as __________ helps clear the body of the invading organism by facilitating phagocytosis.

agglutination

the portion of the antigen involved in binding with the antibody is referred to as the ____________

antigenic determinant

epitope

any component of an antigen molecule that functions as an antigenetic determinant by permitting the attachment of certain antibodies

colony stimulating factors

are a group of naturally occurring glycoprotein cytokines that regulate production, differentiation, survival, and activation of hematopoietic cells

____________ diseases are a leading cause of death by disease in females of reproductive age

autoimmune

Hematopoietic and immune blood cells originate in bone marrow in stem cells, which are often called pluripotent stem cells. Why are they called like that?

because they are capable of becoming different types of cells.

Hematopoiesis

blood cell formation

White blood cells (WBCs) involved in immunity are primarilyproduced in the

bone marrow

The immune system is essentially composed of ________, ________,and ________.

bone marrow, lymphoid tissue, white blood cells

The T lymphocytes are primarily responsible for ________ immunity.

cellular

the immune system's third line of defense, involving the attack of pathogens by T cells

cellular immune response

The _____ of the respiratory tract, along with coughing and sneezing responses, filter and clear pathogens from the upper respiratory tract before they can invade the body further.

cilia

series of enzymatic proteins in the serum that, when activated, destroy bacteria and other cells

complement

immunoregulation

complex system of checks and balances that regulates or controls immune responses

the most efficient immunologic responses occur when the antibody and antigen fit like a lock and key. Poor fit can occur with an antibody that was produced in response to a different antigen. This phenomenon is known as ____________________.

cross-reactivity

generic term for nonantibody proteins that act as intercellular mediators, as in the generation of immune response

cytokines

The _____________ response is a major function of the natural immune system that is elicited in response to tissue injury or invading organisms.

inflammatory

Physical barriers to infection

intact skin, mucous membranes, and cilia of the respiratory tract, which prevent pathogens from gaining access to the body.

Lymph nodes are widely distributed internally throughout the body and in the circulating blood, as well as externally near the body's surfaces. They continuously discharge small ___________ into the bloodstream.

lymphocytes

The primary cells responsible for recognition of foreign antigens are

lymphocytes

Null Lymphocytes

lymphocytes that destroy antigens already coated with the antibody

substances released by sensitized lymphocytes when they come in contact with specific antigens

lymphokines

WBCs that function as phagocytes are called

monocytes

A deficient immune system response that is congenital in origin wouldbe classified as a ________ disorder

natural deficiency

lymphocytes that defend against microorganisms and malignant cells

natural killer (NK) cells

The leukocytes that arrive first at a site where inflammation occurs are

neutrophils

____________, a subpopulation of lymphocytes, destroy antigens already coated with antibody. These cells have special receptor sites on their surface that allow them to connect with the end of antibodies; this is known as antibody-dependent, cell-mediated cytotoxicity.

null lymphocytes

lymphocytes that destroy antigens already coated with the antibody

null lymphocytes

Interferons

one type of biologic response modifier, is a nonspecific viricidal protein that is naturally produced by the body and is capable of activating other components of the immune system.

In this process, the antigen-antibody molecule is coated with a sticky substance that also facilitates phagocytosis.

opsonization

cells that engulf, ingest, and destroy foreign bodies or toxins

phagocytic cells

The body's first line of defense is the

phagocytic immune response

Immunomodulators

stimulating the immune system to fight against cancer cells - Interferons, colony-stimulating factors, and monoclonal antibodies (MoAbs) are examples of agents used to help enhance the immune system

immunopathology

study of diseases resulting in dysfunctions within the immune system

Some antibodies assist in the removal of offending organisms through opsonization. What does this mean?

the coating of antigen-antibody molecules with a sticky substance to facilitate phagocytosis

The major signal for erythropoietin production is a decreased oxygen level detected by ________________________

the proximal tubule cells in the kidneys.

antigenic determinant

the specific area of an antigen that binds with an antibody combining site and determines the specificity of the antigen-antibody reaction

CD4 cells (helper T cells) stimulate the immune system and help to destroy organisms

true

Iron and the immune system are linked in homeostasis and pathology, thus making it essential for maximum function

true

What happens if the antibody is produced in response to one antigen but is able to react with another similar antigen?

•Cross-reactivity occurs ex. Antibodies to Strep pyogenes may also react to the heart tissue (this occurs with Rheumatic Fever)

Most immune responses to antigens involve both humoral and cellular responses, although one usually predominates. For example, during transplant rejection, the cellular response involving ___ cells predominates, whereas in the bacterial pneumonias and sepsis, the humoral response involving ____ cells plays the dominant protective role

- T cells - B cells

spleen function

- acts as a filter for blood as part of the immune system - Old red blood cells are recycled in the spleen - platelets and white blood cells are stored there - fight certain kinds of bacteria that cause pneumonia and meningitis

Natural Immunity is composed of

- granulocytes (neurophil, eosinophil, basophil) - monocytes - dentric cells - natural killer cells

lymph nodes function:

-remove foreign material from the lymph system before it enters the bloodstream. - serve as centers for immune cell proliferation - contain immune cells that defend the body's mucosal surfaces against microorganism

A patient who has developed kidney failure is discussing options with the healthcare provider for treatment. What does the nurse understand that kidney failure is associated with? a. A deficiency in circulating lymphocytes b. A deficiency in phosphorus c. Decreased amount of WBCs d. Increased amount of macrophages

A deficiency in circulating lymphocytes

What happens when Natural Immunity is not enough to combat infection?

Acquired Immunity steps in

_________ acquired immunity refers to immunologic defenses developed by the person's own body

Active

A 16-year-old has been brought to the emergency department by his parents after falling through the glass of a patio door, suffering a laceration. The nurse caring for this patient knows that the site of the injury will have an invasion of what? A) Interferons B) Phagocytic cells C) Apoptosis D) Cytokines

B (Feedback: Monocytes migrate to injury sites and function as phagocytic cells, engulfing, ingesting, and destroying greater numbers and quantities of foreign bodies or toxins than granulocytes. This occurs in response to the foreign bodies that have invaded the laceration from the dirt on the broken glass. Interferon, one type of biologic response modifier, is a nonspecific viricidal protein that is naturally produced by the body and is capable of activating other components of the immune system. Apoptosis, or programmed cell death, is the body's way of destroying worn out cells such as blood or skin cells or cells that need to be renewed. Cytokines are the various proteins that mediate the immune response. These do not migrate to injury sites.)

A man was scratched by an old tool and developed a virulent staphylococcus infection. In the course of the man's immune response, circulating lymphocytes containing the antigenic message returned to the nearest lymph node. During what stage of the immune response did this occur? A) Recognition stage B) Proliferation stage C) Response stage D) Effector stage

B - The recognition stage of antigens as foreign by the immune system is the initiating event in any immune response. The body must first recognize invaders as foreign before it can react to them. - In the proliferation stage, the circulating lymphocyte containing the antigenic message returns to the nearest lymph node. Once in the node, the sensitized lymphocyte stimulates some of the resident dormant T and B lymphocytes to enlarge, divide, and proliferate. - In the response stage, the differentiated lymphocytes function either in a humoral or a cellular capacity. - In the effector stage, either the antibody of the humoral response or the cytotoxic (killer) T cell of the cellular response reaches and connects with the antigen on the surface of the foreign invader.

A nurse is planning the assessment of a patient who is exhibiting signs and symptoms of an autoimmune disorder. The nurse should be aware that the incidence and prevalence of autoimmune diseases is known to be higher among what group? A) Young adults B) Native Americans C) Women D) Hispanics

C Many autoimmune diseases have a higher incidence in females than in males, a phenomenon believed to be correlated with sex hormones.

A nurse is planning a patient's care and is relating it to normal immune response. During what stage of the immune response should the nurse know that antibodies or cytotoxic T cells combine and destroy the invading microbes? A) Recognition stage B) Proliferation stage C) Response stage D) Effector stage

D In the effector stage, either the antibody of the humoral response or the cytotoxic (killer) T cell of the cellular response reaches and couples with the antigen on the surface of the foreign invader. The coupling initiates a series of events that in most instances results in total destruction of the invading microbes or the complete neutralization of the toxin.

The nurse is caring for an older adult patient hospitalized with cellulitis of the right lower extremity. Why is it imperative that the nurse continually assess the physical and emotional status of this patient? a. Older patients are at risk of developing dementia b. The patient will not respond to the antibiotic treatment as well as a younger patient would c. Early recognition and management of factors influencing immuneresponse may decrease morbidity and mortality d. Older adult patients develop depression and suicidal tendencieswhen they are faced with chronic illness

Early recognition and management of factors influencing immuneresponse may decrease morbidity and mortality

An older adult patient who is postmenopausal informs the nurse thatshe believes she has developed another urinary tract infection (UTI).What risk factors do female patients in this age group have to increasethe incidence of UTIs? (Select all that apply.) a. Residual urine b. Urinary incontinence c. Estrogen deficiency d. Decreased function of the thyroid gland e. Dry mucous membranes of the vagina

a, b, c postmenopausal females are at a greater risk for urinary tract infections due to residual urine, urinary incontinence, and estrogen deficiency

The nurse is performing a physical assessment for a patient at the clinic and palpates enlarged inguinal lymph nodes on the left. What should the nurse document? (Select all that apply.) a. Location b. Size c. Consistency d. Reports of tenderness e. Temperature

a. Location b. Size c. Consistency d. Reports of tenderness

The nurse is caring for a patient in the hospital who is receiving avitamin D supplement. What does the nurse understand is theimportance of supplementation with this vitamin? (Select all thatapply.) a. Vitamin D deficiency is associated with increased risk of commoncancers b. Vitamin D deficiency is associated with increased risk ofautoimmune disease c. Vitamin D deficiency is associated with increased risk ofcongenital anomalies d. Vitamin D deficiency is associated with increased risk ofinflammatory disorders e. Vitamin D deficiency is associated with increased risk of celiacdisease

a. Vitamin D deficiency is associated with increased risk of common cancers b. Vitamin D deficiency is associated with increased risk of autoimmune disease d. Vitamin D deficiency is associated with increased risk of inflammatory disorders

A vaccine or prior exposure to a disease provides _______ immunity since your immune system will actively generate antibodies in response to the antigen.

active

The structural part of the invading or attacking organism that is responsible for stimulating antibody production is called an _____or an immunogen

antigen

The immune system's recognition of one's own cells or tissues as "foreign" rather than as self is the basis of many ____________ disorders

autoimmune

An older adult has developed a sacral pressure ulcer. What should thenurse assess in order to ensure adequate wound healing and prevent poor outcomes for this patient? (Select all that apply.) a. The patient's ability to perform self wound care b. Nutritional status c. Caloric intake d. Quality of food ingested e. The amount of carbohydrates the patient ingests

b, c, d

The nursing instructor is discussing the development of human immune deficiency virus (HIV) disease with the students. Whatshould the instructor inform the class about helper T cells? a. They are activated on recognition of antigens and stimulate the rest of the immune system b. They attack the antigen directly by altering the cell membrane and causing cell lysis c. They have the ability to decrease B-cell production d. They are responsible for recognizing antigens from previous

b. They attack the antigen directly by altering the cell membrane and causing cell lysis

how granulocytes fight invasion by foreign bodies or toxins?

by releasing cell mediators, such as histamine, bradykinin, and prostaglandins, and by engulfing the foreign bodies or toxins.

Monocytes are the first to arrive on the scene and function as _________engulfing, ingesting, and destroying greater numbers and quantities of foreign bodies or toxins than granulocytes do

phagocytic cells

What substances are a part of Natural Immunity?

white blood cells, an inflammatory response and chemicals

What happens when a patient has neutropenia (low neutrophil counts)?

•Increased risk for infection, since they are missing a key component of the immune system

What are the two types of lymphocytes?

•T cells •B cells

Oprelvekin (Neumega)

-stimulates platelet production -This drug is used to prevent severe thrombocytopenia and reduce the need for platelet transfusions in adults with nonmyeloid cancer receiving myelosuppressive chemotherapy and are at high risk for thrombocytopenia.

The acquired immune response is broadly divided into two mechanisms:

1) the cell-mediated response, involving T-cell activation (2) effector mechanisms, involving B-cell maturation and production of antibodies

During a mumps outbreak at a local school, a patient, who is a school teacher, is exposed. She has previously been immunized for mumps. What type of immunity does she possess? A) Acquired immunity B) Natural immunity C) Phagocytic immunity D) Humoral immunity

A (Feedback: Acquired immunity usually develops as a result of prior exposure to an antigen, often through immunization. When the body is attacked by bacteria, viruses, or other pathogens, it has three means of defense. The first line of defense, the phagocytic immune response, involves the WBCs that have the ability to ingest foreign particles. A second protective response is the humoral immune response, which begins when the B lymphocytes transform themselves into plasma cells that manufacture antibodies. The natural immune response system is rapid, nonspecific immunity present at birth.)

A nurse is admitting a patient who exhibits signs and symptoms of a nutritional deficit. Inadequate intake of what nutrient increases a patient's susceptibility to infection? A) Vitamin B12 B) Unsaturated fats C) Proteins D) Complex carbohydrates

C Depletion of protein reserves results in atrophy of lymphoid tissues, depression of antibody response, reduction in the number of circulating T cells, and impaired phagocytic function. As a result, the patient has an increased susceptibility to infection.

A nurse has admitted a patient who has been diagnosed with urosepsis. What immune response predominates in sepsis? A) Mitigated B) Nonspecific C) Cellular D) Humoral

D Most immune responses to antigens involve both humoral and cellular responses, although only one predominates. For example, during transplantation rejection, the cellular response predominates, whereas in the bacterial pneumonias and sepsis, the humoral response plays the dominant role. Neither mitigated nor nonspecific cell response is noted in this situation.

A patient is being treated for bacterial pneumonia. In the first stages of illness, the patient's dyspnea was accompanied by a high fever. Currently, the patient claims to be feeling better and is afebrile. The patient is most likely in which stage of the immune response? A) Recognition stage B) Proliferation stage C) Response stage D) Effector stage

D The immune response culminates with the effector stage, during which offending microorganisms are killed by the various actions of the immune system. The patient's improvement in health status is likely the result of this final stage in the immune response.

Immune deficiencies Secondary

Deficiency results from some interference with an already developed immune system; usually acquired later in life

The cellular response stimulates the resident lymphocytes to become cells that attack microbes directly rather than through the action of antibodies. These transformed lymphocytes are known as _______________ T cells.

cytotoxic (killer)

emerging technology designed to enable replacement of missing or defective genes

genetic engineering

lymphocytes that attack foreign invaders (antigens) directly

helper T cells

The ______________ response is characterized by the production of antibodies by B lymphocytes in response to a specific antigen.

humoral

the immune system's second line of defense; often termed the antibody response

humoral immune response

the coordinated response of the components of the immune system to a foreign agent or organism

immune response

Enlargement of the lymph nodes in the neck in conjunction with a sore throat is one example of the ____________________

immune response.

the collection of organs, cells, tissues, and molecules that mediate the immune response

immune system

the body's specific protective response to a foreign agent or organism; resistance to disease, specifically infectious diseases

immunity

cells that are responsible for recognizing antigens from previous exposure and mounting an immune response

memory cells

chemical barriers to infection

mucus, acidic gastric secretions, enzymes in tears and saliva, and substances in sebaceous and sweat secretions, act in a nonspecific way to destroy invading bacteria and fungi.

the immune system's first line of defense, involving white blood cells that have the ability to ingest foreign particles

phagocytic immune response

immunity is the body's ________ protective response to a foreign agent or organism.

specific

The ______ plays important roles in regard to red blood cells (erythrocytes) and the immune system. It removes old red blood cells and holds a reserve of blood, which can be valuable in case of hemorrhagic shock, and also recycles iron.

spleen

lymphocytes that decrease B-cell activity to a level at which the immune system is compatible with life

suppressor T cells

B lymphocytes mature in ___________ before entering the bloodstream,

the bone marrow

opsonization

the coating of antigen-antibody molecules with a sticky substance to facilitate phagocytosis

immunosenescence

the gradual deterioration of the immune system brought on by the aging process

T lymphocytes mature in the _______________, where they differentiate into cells with various functions

thymus

Acquired immunity is the type response that allows the body to respond to pathogens either actively or passive

true

If an immune response fails to develop and clear an antigen sufficiently, the host is considered to be immunocompromised or immunodeficient.

true

Helper T cells

-Attacks foreign invaders (antigens) directly - Initiates and augments inflammatory response

humoral immune response

-B lymphocyte -Produces antibodies or immunoglobulins (IgA, IgD, IgE, IgG, IgM)

about 70% to 80% of lymphocytes in the blood are ___ cells, and about 10% to 15% are ___ cells

-T -B

A woman has been diagnosed with breast cancer and is being treated aggressively with a chemotherapeutic regimen. As a result of this regimen, she has an inability to fight infection due to the fact that her bone marrow is unable to produce a sufficient amount of what? A) Lymphocytes B) Cytoblasts C) Antibodies D) Capillaries

A (Feedback: The white blood cells involved in immunity (including lymphocytes) are produced in the bone marrow. Cytoblasts are the protoplasm of the cell outside the nucleus. Antibodies are produced by lymphocytes, but not in the bone marrow. Capillaries are small blood vessels)

An infection control nurse is presenting an inservice reviewing the immune response. The nurse describes the clumping effect that occurs when an antibody acts like a cross-link between two antigens. What process is the nurse explaining? A) Agglutination B) Cellular immune response C) Humoral response D) Phagocytic immune response

A Agglutination refers to the clumping effect occurring when an antibody acts as a cross-link between two antigens. This takes place within the context of the humoral immune response, but is not synonymous with it.

The nurse is providing care for a patient who has multiple sclerosis. The nurse recognizes the autoimmune etiology of this disease and the potential benefits of what treatment? A) Stem cell transplantation B) Serial immunizations C) Immunosuppression D) Genetic engineering

A Clinical trials using stem cells are under way in patients with a variety of disorders having an autoimmune component, including multiple sclerosis. Immunizations and genetic engineering are not used to treat multiple sclerosis. * Immunosuppression would exacerbate symptoms of MS

A gardener sustained a deep laceration while working and requires sutures. The patient is asked about the date of her last tetanus shot, which is over 10 years ago. Based on this information, the patient will receive a tetanus immunization. The tetanus injection will allow for the release of what? A) Antibodies B) Antigens C) Cytokines D) Phagocytes

A Immunizations activate the humoral immune response, culminating in antibody production. Antigens are the substances that induce the production of antibodies. Immunizations do not prompt cytokine or phagocyte production

A patient is admitted with cellulitis and experiences a consequent increase in white blood cell count. The nurse is aware that during the immune response, pathogens are engulfed by white blood cells that ingest foreign particles. What is this process known as? A) Apoptosis B) Phagocytosis C) Antibody response D) Cellular immune response

B (Feedback: During the first mechanism of defense, white blood cells, which have the ability to ingest foreign particles, move to the point of attack, where they engulf and destroy the invading agents. This is known as phagocytosis. The action described is not apoptosis (programmed cell death) or an antibody response. Phagocytosis occurs in the context of the cellular immune response, but it does not constitute the entire cellular response.)

The nurse knows that the response of natural immunity is enhanced by processes that are inherent in the physical and chemical barriers of the body. What is a chemical barrier that enhances the response of natural immunity? A) Cell cytoplasm B) Interstitial fluid C) Gastric secretions D) Cerebrospinal fluid

C (Feedback: Chemical barriers, such as mucus, acidic gastric secretions, enzymes in tears and saliva, and substances in sebaceous and sweat secretions, act in a nonspecific way to destroy invading bacteria and fungi. Not all body fluids are chemical barriers, however. Cell cytoplasm, interstitial fluid, and CSF are not normally categorized as chemical barriers to infection.)

A nurse is reviewing a patient's medication administration record in an effort to identify drugs that may contribute to the patient's recent immunosuppression. What drug is most likely to have this effect? A) An antibiotic B) A nonsteroidal anti-inflammatory drug (NSAID) C) An antineoplastic D) An antiretroviral

C (Feedback: Chemotherapy affects bone marrow function, destroying cells that contribute to an effective immune response and resulting in immunosuppression. Antibiotics in large doses cause bone marrow suppression, but antineoplastic drugs have the most pronounced immunosuppressive effect. NSAIDs and antiretrovirals do not normally have this effect.)

A nurse is caring for a patient who has had a severe antigen/antibody reaction. The nurse knows that the portion of the antigen that is involved in binding with the antibody is called what? A) Antibody lock B) Antigenic sequence C) Antigenic determinant D) Antibody channel

C (Feedback: The portion of the antigen involved in binding with the antibody is referred to as the antigenic determinant. This portion is not known as an antibody lock, antigenic sequence, or antibody channel.)

A patient is responding to a microbial invasion and the patient's differentiated lymphocytes have begun to function in either a humoral or a cellular capacity. During what stage of the immune response does this occur? A) The recognition stage B) The effector stage C) The response stage D) The proliferation stage

C - In the response stage, the differentiated lymphocytes function in either a humoral or a cellular capacity. - In the effector stage, either the antibody of the humoral response or the cytotoxic (killer) T cell of the cellular response reaches and connects with the antigen on the surface of the foreign invader. - In the recognition stage, the recognition of antigens as foreign, or non-self, by the immune system is the initiating event in any immune response. - During the proliferation stage the circulating lymphocytes containing the antigenic message return to the nearest lymph node.)

A patient with cystic fibrosis has received a double lung transplant and is now experiencing signs of rejection. What is the immune response that predominates in this situation? A) Humoral B) Nonspecific C) Cellular D) Mitigated

C - Most immune responses to antigens involve both humoral and cellular responses, although only one predominates. - During transplantation rejection, the cellular response predominates over the humoral response.

A gerontologic nurse is caring for an older adult patient who has a diagnosis of pneumonia. What age-related change increases older adults' susceptibility to respiratory infections? A) Atrophy of the thymus B) Bronchial stenosis C) Impaired ciliary action D) Decreased diaphragmatic muscle tone

C As a consequence of impaired ciliary action due to exposure to smoke and environmental toxins, older adults are vulnerable to lung infections.

The nurse is completing a focused assessment addressing a patient's immune function. What should the nurse prioritize in the physical assessment? A) Percussion of the patient's abdomen B) Palpation of the patient's liver C) Auscultation of the patient's apical heart rate D) Palpation of the patient's lymph nodes

D (Feedback: During the assessment of immune function, the anterior and posterior cervical, supraclavicular, axillary, and inguinal lymph nodes are palpated for enlargement. If palpable nodes are detected, their location, size, consistency, and reports of tenderness on palpation are noted. Because of the central role of lymph nodes in the immune system, they are prioritized over the heart, liver, and abdomen, even though these would be assessed.)

A nursing student is giving a report on the immune system. What function of cytokines should the student describe? A) Determining whether a cell is foreign B) Determining if lymphokines will be activated C) Determining whether the T cells will remain in the nodes and retain a memory of the antigen D) Determining whether the immune response will be the production of antibodies or a cell-mediated response

D (Feedback: Separate subpopulations of helper T cells produce different types of cytokines and determine whether the immune response will be the production of antibodies or a cell-mediated immune response. Cytokines do not determine whether cells are foreign, determine if lymphokines will be activated, or determine the role of memory T cells.)

A patient is being treated for cancer and the nurse has identified the nursing diagnosis of Risk for Infection Due to Protein Losses. Protein losses inhibit immune response in which of the following ways? A) Causing apoptosis of cytokines B) Increasing interferon production C) Causing CD4+ cells to mutate D) Depressing antibody response

D (Feedback: Depletion of protein reserves results in atrophy of lymphoid tissues, depression of antibody response, reduction in the number of circulating T cells, and impaired phagocytic function. This specific nutritional deficit does not cause T-cell mutation, an increase in the production of interferons, or apoptosis of cytokines.)

A neonate exhibited some preliminary signs of infection, but the infant's condition resolved spontaneously prior to discharge home from the hospital. This infant's recovery was most likely due to what type of immunity? A) Cytokine immunity B) Specific immunity C) Active acquired immunity D) Nonspecific immunity

D -Natural immunity, or nonspecific immunity, is present at birth. - Active acquired or specific immunity develops after birth. - Cytokines are proteins that mediate the immune response; they are not a type of immunity.

A patient's injury has initiated an immune response that involves inflammation. What are the first cells to arrive at a site of inflammation? A) Eosinophils B) Red blood cells C) Lymphocytes D) Neutrophils

D -Neutrophils are the first cells to arrive at the site where inflammation occurs. -Eosinophils increase in number during allergic reactions and stress responses, but are not always present during inflammation. RBCs do not migrate during an immune response. -Lymphocytes become active but do not migrate to the site of inflammation.

A patient arrives at the clinic and reports a very sore throat as well asa fever. A rapid strep test returns a positive result and the patient isgiven a prescription for an antibiotic. How did the streptococcalorganism gain access to the patient to cause this infection? a. Through the mucous membranes of the throat b. Through the skin c. Breathing in airborne dust d. From being outside in the cold weather and decreasing resistance

Through the mucous membranes of the throat

Zinc deficiency in particular has been linked to the development of a number of diseases. Whats the role of zinc?

Zinc plays an important role in homeostasis, immune function, and apoptosis, among other functions

clumping effect occurring when an antibody acts as a cross-link between two antigens

agglutination

what happens if an immune response is overly robust or misdirected?

allergies, asthma, or autoimmune disease results

in acute rheumatic fever, the antibody produced against Streptococcus pyogenes in the upper respiratory tract may cross-react with the patient's heart tissue, leading to heart valve damage. this is an example of what?

cross-reactivity. * The most efficient immunologic responses occur when the antibody and antigen fit like a lock and key.Poor fit can occur with an antibody that was produced in response to a different antigen. This phenomenon is known as cross-reactivity.

lymphocytes that lyse cells infected with virus; also play a role in graft rejection

cytotoxic T cells

cytokines act by blocking receptors on target cells?

false. they BIND to receptors on target cells

what conditions trigger erythropoietin production?

hemorrhage, anemia, chronic obstructive pulmonary disease, and high altitude.

Cells in the brain, especially in the ________________, can recognize prostaglandins, interferons, and interleukins, as well as histamine and serotonin, all of which are released during the inflammatory process.

hypothalamus

B cells function

produce antibodies

Erythropoiesis

production of red blood cells

apoptosis

programmed cell death

During the ________ stage of an immune response, lymphocytesinterfere with disease by picking up specific antigens from organismsto alter their function

proliferation

interferons

proteins formed when cells are exposed to viral or foreign agents; capable of activating other components of the immune system

Complement System

proteins in the blood that help antibodies kill their target * made in liver

There are four well-defined stages in an immune response:

recognition, proliferation, response, and effector

A patient developed an infection while on vacation in CentralAmerica and is now taking the antibiotic chloramphenicol. What should the patient be monitored for when taking this drug? a. Eosinophilia b. Neutropenia c. Aplastic anemia d. Hypoprothrombinemia

risk for Leukopenia, aplastic anemia

During a viral illness like mononucleosis the nurse anticipates a predominate increase in B or T cells?

•T cells since viruses induce a cellular response (B cells dominate in bacterial infections)