Chapter 36: Immunity

What causes the frequency and severity of infections to increase in the elderly?

-Impaired function of T and B lymphocytes -Altered response to antigen stimulation -Immunosenescence

Why would a compromise to the first line of defense alter immune system function?

A loss of large amounts of serum occurs with burn injuries and depletes the body of essential proteins, including immunoglobulins.

When an attenuated toxin is administered to a client, the B lymphocytes create memory cells that recognize the antigen if it invades the body at a future time. What kind of immunity is this? A. Artificially acquired active immunity B. Passive immunity C. Naturally acquired active immunity D. Natural immunity

Answer: A. Artificially acquired active immunity Reasoning: Artificially acquired active immunity results from the administration of a killed or weakened microorganism or toxoid (attenuated toxin). The memory cells manufactured by the B lymphocytes 'remember' the killed or weakened antigen and recognize it if a future invasion occurs. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 987.

What are the four defined stages in the immune response?

Recognition Proliferation Response Effector

Why would inadequate intake of vitamins impair immune function?

Vitamins are essential for DNA and protein synthesis, so if there is not enough supply it will lead to protein-caloric deficiency.

What is genetic engineering?

enables replacement of missing or defective genes

What are structural and functional changes in immunity?

-Impairment of B and T lymphocytes -Decreased GI function -Decreased kidney function -Thinning of the skin -Decreased sensation and slowing of reflexes

What are two advances in immunology discussed in the text?

1. Genetic Engineering 2. Stem Cells

This is the process of programmed cell death. It is the body's way of destroying worn out cells.

Apoptosis

What treatment modality has been proven effective in Severe Compromised Immunodeficiency (SCID)?

Stem cell transplantation

What aspects of the patient's past history is important to assess of the Immune System?

1. Allergy 2. Autoimmune Disorders 3. Neoplastic Diseases 4. Chronic Illness and Surgery 5. Special Problems

What does gene therapy offer?

1. Normal gene function is restored 2. Replaces a bad gene with a good gene 3. Inactivates a poorly functioning gene 4. Introduces new genes to the body

Radioallergosorbent testing (RAST) measures which of the following immunoglobulins? A. IgG B. IgE C. IgD D. IgA

Answer: B. IgE

The humoral response is characterized by the production of?

B lymphocytes

What areas of assessment should the nurse pay special attention to with elderly patients?

-Cognitive function and change in alertness -Increase in temperature of approximately two degrees Fahrenheit over baseline -Blood pressure and heart rate

What are history and physical findings related to immunity among the elderly?

-Suppressed immune response -Increased incidence of cancer -Increase in autoimmune diseases -Increased risk of skin injury -Stasis and pressure ulcers

Describe 2 chronic illnesses and how it could contribute to immune system impairements

1. Recurrent respiratory tract infections are associated with COPD. 2. Renal function is associated with a deficiency in circulating lymphocytes.

What two things are stem cells capable of?

1. Self-renewal 2. Differentiation

What are the two types of stem cells discussed in our text?

1. Totipotent 2. Pluripotent/Embryonic

_________ may indicate a life-threatening infection, such as meningitis. A. Purpura B. Dermatitis C. Scabs D. Dots on skin

Answer: A. Purpura Reasoning: Purpura may indicate life-threatening infections such as meningitis. The rash darkens as the bacteria invades the blood stream. Reference:Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 998.

A 15-year-old client has been brought to the clinic by their mother and is suspected of having an immune system disorder. What tests would you expect to be ordered for this young client? A. Plasmapheresis B. Sedimentary rate C. Complete blood count with differential D. Complete chemistry panel

Answer: C. Complete blood count with differential

The nursing students are learning about the immune system in their anatomy and physiology class. What would these students learn is a component of the immune system? A. Lymphoid tissues B. Stem cells C. Cytokines D. Red blood cells

Answer: A. Lymphoid tissues Reasoning: The immune system actually is a collection of specialized white blood cells and lymphoid tissues that cooperate to protect a person from external invaders and the body's own altered cells. The function of these structures is assisted and supported by the activities of natural killer cells, antibodies, and nonantibody proteins such as cytokines and the complement system. Red blood cells and stem cells are not part of the immune system. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 985.

When the body is invaded by a foreign pathogen what are the three means of defense?

Phagocytic Immune Response Humoral/Antibody Immune Response Cellular Immune Response

What is the immunosenescence?

The gradual deterioration of the immune system brought on by normal aging. It involves the loss of ability to fight infections and cancer and to have an antibody response even to vaccines.

Which of the following is a center for immune cell proliferation? A. Spleen B. Liver C. Lymph node D. Pancreas

Answer: C. Lymph node Reasoning: The lymph nodes remove foreign material from the lymph system before it enters the bloodstream. They are centers for immune cell proliferation. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 985.

A client reports an allergy to morphine sulfate, which represents an example of a hypersensitivity reaction. Which of the following statements correctly describes the process of hypersensitivity? A. The normal protective immune response attacks the body, leading to tissue damage. B. The body overproduces immunoglobulins. C. The body produces inappropriate or exaggerated responses to specific antigens. D. A deficiency results from the improper development of immune cells or tissues.

Answer: C. The body produces inappropriate or exaggerated responses to specific antigens. Reasoning: Hypersensitivity happens when the body produces an inappropriate or exaggerated response to a specific antigen. Autoimmunity happens when the normal protective immune response pradoxically turns against or attacks the body, leading to tissue damage. It is not an immune deficiency. Overproduction of immunoglobulins is the definition of gammopathies. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 985.

Which of the following cell types are involved in humuoral immunity? A. Suppressor T lymphocyte B. Memory T lymphocyte C. Helper T lymphocyte D. B Lympocytes

Answer: D. B Lymphocytes Reasoning: B lymphocytes are involved in the humoral immune response. T lymphocytes are involved in cellular immunity. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 985.

What is the function of the thymus gland? A. Produce stem cells. B. Programs B lymphocytes to become regulator or effector B cells. C. Develop the lymphatic system. D. Programs T lymphocytes to become regulator or effector T cells.

Answer: D. Programs T lymphocytes to become regulator or effector T cells. Reasoning: The thymus gland is located in the neck below the thyroid gland. It extends into the thorax behind the top of the sternum. The thymus gland produces lymphocytes during fetal development. It may be the embryonic origin of other lymphoid structures such as the spleen and lymph nodes. After birth, the thymus gland programs T lymphocytes to become regulator or effector T cells. The thymus gland becomes smaller during adolescence but retains some activity throughout the life cycle. Options A, B, and C are incorrect. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 990.

Which of the following assessment should be completed if suspecting immune dysfunction in the neurosensory system? A. Hematuria B. Burning on urination C. Ataxia D. Urinary frequency

Answer: C. Ataxia Reasoning: Ataxia should be assessed when suspecting immune dysfunction in the neurosensory system. Hematuria, discharge, and frequency and burning on urination are associated with the genitourinary system. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 999.

What organ is considered lymphoid tissue? A. Liver B. Intestines C. Spleen D. Pancreas

Answer: C. Spleen Reasoning: Lymphoid tissues, such as the thymus gland, tonsils and adenoids, spleen, and lymph nodes, play a role in the immune response and prevention of infection. The pancreas, intestines, and liver are not lymphoid tissue Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 985.

Which of the following is a center for immune cell proliferation? A. Lymph nodes B. Pancreas C. Spleen D. Liver

Answer: A. lymph nodes Reasoning: The lymph nodes remove foreign material from the lymph system before it enters the bloodstream. They are centers for immune cell proliferation. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 990.

What are antigens? A. Protein markers on cells. B. Cells that attack the body. C. A substance that causes an allergic response. D. Cells recognized as 'self' by the body.

Answer: A. Protein markers on cells. Reasoning: Antigens are protein markers on cells. Histocompatibility (tissue cell) markers. act as a 'fingerprint' that enables the immune system to differentiate 'self' from 'nonself.' An allergen is a substance that causes an allergic response. Reference: Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 988.

Which of the following is a sign of infection in the joints? (select all) A. Tenderness B. Swelling C. Increased warmth D. Decreased temperature

Answer: A, B, and C. Reasoning: Tenderness, Swelling, and increased warmth are all signs of infection in the joints. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 998.

Which of the following areas is the most suitable area of the body for skin testing? A. Abdomen B. Back C. Forearm D. Thigh

Answer: B. Back Reasoning: The back is the most suitable area of the body for skin testing, because it permits the performance of many tests. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 1000.

A child is brought to the clinic with a rash. The child is diagnosed with measles. The mother tells the nurse that she had the measles when she was a little girl. What immunity to measles develops after the initial infection? A. Naturally acquired passive immunity B. Artificially acquired passive immunity C. Naturally acquired active immunity D. Artificially acquired active immunity

Answer: C. Naturally acquired active immunity Reasoning: Immunity to measles that develops after the initial infection is an example of naturally acquired active immunity. Artificially acquired active immunity results from the administration of a killed or weakened microorganism or toxoid (attenuated toxin), while passive immunity develops when ready-made antibodies are given to a susceptible client. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 987.

Which of the following is accurate regarding acquired immunity? Select all that apply. A. A nonspecific immunity present at birth B. An immunologic response acquired during life but not present at birth C. Can develop by contracting a disease D. Usually develops as a result of exposure to an antigen through immunization E. Also known as innate immunity

Answer: B. An immunologic response acquired during life but not present at birth C. Can develop by contracting a disease D. Usually develops as a result of exposure to an antigen through immunization Reasoning: Acquired immunity is a immunologic responses acquired during life but not present at birth, and usually develops as a result of exposure to an antigen through immunization (vaccination) or by contracting a disease, both of which generate a protective immune response. Natural (innate) immunity is nonspecific immunity present at birth that provides protection against an infectious agent without ever encountering it before. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 987.

A nurse is working in a pediatric clinic. After giving a hepatitis B immunization to an infant, the mother asks what kind of protection this provides for her child. The correct response is which of the following? A. Passive acquired immunity, which is temporary B. Active acquired immunity, which is temporary C. Active acquired immunity, which lasts many years or a lifetime D. Passive acquired immunity, which lasts many years or a lifetime

Answer: C. Active acquired immunity, which lasts many years or a lifetime Reasoning: Active acquired immunity refers to immunologic defenses developed by the person's own body. This immunity typically lasts many years or even a lifetime. Passive acquired immunity is temporary immunity transmitted from a source outside the body that has developed immunity through previous disease or immunization. Reference: Pellico, L. H. Focus on Adult Health Medical-Surgical Nursing, 1st ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013, Chapter 36: Nursing Assessment: Immune Function, p. 987.