Immunity

The elderly have an increased susceptibility to infection. Which of the following is true with regard to the elderly person's immune system? A) A change in temperature is often more significant than the actual temperature. B) Delirium is always a sign of an infectious process in the elderly. C) the baseline body temperature in an older adult is usually higher than in a younger adult because of an increased metabolic rate in the elderly. D) The cerebral hypoxia that occurs in the elderly is a result of the increased number of T and B lymphocytes in the body that are fighting bacteria.

A) A change in temperature is often more significant than the actual temperature.

If Johnny is exposed to and develops chicken pox, he will develop a permanent immunity. This type of immunity is a(n) A) Active naturally acquired immunity B) Active artificially acquired immunity C) passive naturally acquired immunity D) Passive artificially acquired immunity

A) Active naturally acquired immunity

The group of gamma globulins that are responsible for protecting the fetus after birth are A) IgG B) IgM C) IgD D) IgE

A) IgG

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. Herpes Simplex Viral, rather than bacterial antigens, induce a cellular response.

The nurse is assessing a client who cannot synthesize suppressor T-cells. For what other condition does the nurse assess the client? a. Increased seasonal allergies b. Multiple sclerosis c. Leukemia d. Graft-versus-host disease

ANS: A Suppressor T-cells function to limit the actions of general and specific responses. These cells prevent overreactions to the presence of foreign proteins within a persons environment. People who are deficient in suppressor T-cell activity have more severe hypersensitivity reactions, allergies, and autoimmune responses. Low numbers of T-suppressor lymphocytes would not increase the clients risk for multiple sclerosis (MS), leukemia, or graft-versus-host disease.

An older adult patient who is having an annual check-up tells the nurse, "I feel fine, and I don't want to pay for all these unnecessary cancer screening tests!" Which information should the nurse plan to teach this patient? a. Consequences of aging on cell-mediated immunity b. Decrease in antibody production associated with aging c. Impact of poor nutrition on immune function in older people d. Incidence of cancer-stimulating infections in older individuals

ANS: A The primary impact of aging on immune function is on T cells, which are important for immune surveillance and tumor immunity. Antibody function is not affected as much by aging. Poor nutrition can also contribute to decreased immunity, but there is no evidence that it is a contributing factor for this patient. Although some types of cancer are associated with specific infections, this patient does not have an active infection.

The nurse is caring for an older postoperative client. Which assessment finding causes the nurse to assess further for a wound infection? a.Moderate serosanguineous drainage is seen on the dressing. b. The client is now confused but was not confused previously. c. The white blood cell differential indicates a right shift. d. The white blood cell count is 8000/mm3.

ANS: B Older adult clients often do not demonstrate typical signs and symptoms of infection because of the diminished immune function seen with aging. Often, the first sign of infection is mental status changes. Any change in mental status in the older postoperative client should lead the nurse to assess for a wound infection.

The nurse provides discharge instructions to a patient who has an immune deficiency involving the T lymphocytes. Which screening should the nurse include in the teaching plan for this patient? a. Screening for allergies b. Screening for malignancy c. Antibody deficiency screening d. Screening for autoimmune disorders

ANS: B Cell-mediated immunity is responsible for the recognition and destruction of cancer cells. Allergic reactions, autoimmune disorders, and antibody deficiencies are mediated primarily by B lymphocytes and humoral immunity.

The nurse is teaching a class about the immune system. The nurse asks the class to list various functions of antibodies. Which class responses does the nurse evaluate as indicating a good understanding? (Select all that apply.) a. They release chemicals to cause blood vessels to dilate. b. They deactivate toxins that are released in an infection. c. They tag bacteria so the macrophages know to eat them up. d. They cause the person to have a fever. e. They tell cells to make collagen for scar tissue. f. They activate the complement system

ANS: B, C, F Antibodies can neutralize viruses and bacterial toxins, can mark bacteria for destruction via opsonization, and can activate the complement system. Antibodies do not secrete chemicals that cause vasodilation, induce a febrile response, nor release collagen for scar tissue.

A client reports severe hay fever and allergic rhinitis. Which finding does the nurse expect to see in this clients laboratory results? a. Band neutrophils outnumber segmented neutrophils. b. The basophil count is 50/mm3. c. The eosinophil count is 20%. d. The white count is 7500/mm3.

ANS: C During allergic episodes, the eosinophil count is elevated both to respond to the presence of allergens and to limit the tissue level responses of inflammatory cells by releasing enzymes capable of degrading the vasoactive amines secreted by other leukocytes.

An older adult client tells the nurse that her granddaughter has chickenpox. The client is afraid to visit because she is afraid of getting shingles from her granddaughter. What is the nurses best response? a. If you already had chickenpox, you cannot get shingles. b. If you already had shingles, you cannot get them again. c. If you already had chickenpox, you can safely visit your granddaughter. d. Shingles is caused by a different virus than the chickenpox virus.

ANS: C Shingles is not transmitted from a person with chickenpox. Shingles (herpes zoster) is an infection that manifests later in life because of residual virus retained in the dorsal root ganglia of sensory nerves after a client has had chickenpox.

The nurse has sustained a needle stick injury and received a dose of hepatitis B immune globulin. Which statement indicates that the nurse understands this intervention? a. I don't need to receive the hepatitis B vaccine because I already had the immune-globulin. b. I will need to receive only two doses of the hepatitis B vaccine because I had one dose of the immune globulin. c. I need to start the hepatitis B vaccination series as soon as possible. d. I will make an appointment to start the hepatitis B vaccination series in 6 weeks.

ANS: C The hepatitis B immune globulin will provide only temporary protection against hepatitis B; the student should begin the vaccination series as soon as possible to ensure long-lasting protection against the virus.

Immediately after the nurse administers an intracutaneous injection of an allergen on the forearm, a patient complains of itching at the site and of weakness and dizziness. What action should the nurse take first? a. Remind the patient to remain calm. b. Administer subcutaneous epinephrine. c. Apply a tourniquet above the injection site. d. Rub a local antiinflammatory cream on the site.

ANS: C Application of a tourniquet will decrease systemic circulation of the allergen and should be the first reaction. A local antiinflammatory cream may be applied to the site of a cutaneous test if the itching persists. Epinephrine will be needed if the allergic reaction progresses to anaphylaxis. The nurse should assist the patient to remain calm, but this is not an adequate initial nursing action.

A client has been diagnosed with a deficiency of complement proteins. Which assessment is the item of highest priority for the nurse to perform? a. Joint stiffness and range of motion b. Enlarged lymph nodes and night sweats c. Rhinorrhea and conjunctivitis d. Lung sounds, cough, and oxygen saturation

ANS: D The complement system attaches to viruses and bacteria so that they are more easily phagocytosed by white blood cells (WBCs). Without an effective complement system, the client is susceptible to bacterial and viral infections such as pneumonia. Pneumonia might manifest with abnormal lung sounds, productive cough, and decreased oxygen saturation. Joint stiffness and limited range of motion would suggest arthritis; enlarged lymph nodes and night sweats might indicate lymphoma; rhinorrhea and conjunctivitis might indicate seasonal allergies.

A client recovering from hepatitis A asks whether he should take the vaccine to avoid contracting the disease again. What does the nurse say? a. Yes, because now you are more susceptible to this infection. b. Yes, because the hepatitis A virus changes from year to year. c. No, your liver and immune system are too impaired at this time. d. No, having the infection has done the same thing a vaccination would.

ANS: D Vaccination with hepatitis A vaccine is an artificial way of stimulating the immune system to make antibodies against hepatitis A (artificially acquired active immunity). This clients immune system has responded to an actual infection with hepatitis A by making many antibodies to hepatitis A (naturally acquired active immunity); therefore he does not need a vaccination for this virus.

A patient who is receiving immunotherapy has just received an allergen injection. Which assessment finding is most important to communicate to the health care provider? a. The patient's IgG level is increased. b. The injection site is red and swollen. c. The patient's allergy symptoms have not improved. d. There is a 2-cm wheal at the site of the allergen injection.

ANS: D A local reaction larger than quarter size may indicate that a decrease in the allergen dose is needed. An increase in IgG indicates that the therapy is effective. Redness and swelling at the site are not unusual. Because immunotherapy usually takes 1 to 2 years to achieve an effect, an improvement in the patient's symptoms is not expected after a few months.

Which of these does the nurse understand is TRUE about the classes of antibodies? A) Immunoglobulin A is not found in breast milk. B) Immunoglobulin G provides short-term immunity C) Immunoglobulin M crosses the placenta. D) Immunoglobulin E is not involved in allergy reactions.

B) Immunoglobulin G provides short-term immunity.

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. phagocytosis

The elderly are more prone to infection because they have A) Thinner skin B) A decreased number of functioning neurons C) A decreased number of T and B cells D) Delirium

C) A decreased number of T and B cells

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) Gastric secretions 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

The cornerstone of the immune system is A) erythrocytes B) Thrombocytes C) Lymphocytes D) Leukocytes

C) Lymphocytes

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. Proteins

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

A patient was tested for HIV using enzyme immunoassay (EIA) and results were positive. The nurse should expect the primary care provider to order what test to confirm the EIA test results? A. Another EIA test B. Viral load test C. Western blot test D. CD4/CD8 ratio

C. western blot test Enzyme immunoessay and western blot test are used to confirm HIV

Which of the following would be an example of nonspecific immunity? A) Cilia in the respiratory tract B) Neutrophils ingesting and destroying bacteria C) Hydrochloric acid in the stomach D) All of the above

D) All of the above

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) Determining whether the immune response will be the production of antibodies or a cell-mediated response 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.

Which type of cell involved in cell-mediated immunity as a cytotoxic action on tumor cells? A) Lysosomes B) Histocompatability cells C) memory cells D) Natural killer cells

D) Natural killer cells

Which of the following is NOT true regarding T lymphocytes? A) T cells make up approximately 80-90% of the total lymphocytes. B) T cells are responsible for cell-mediated immunity (they combine with antigens). C) T cells are responsible for fighting cancer cells and viruses, and are responsible for tissue rejection after organ transplantation. D) T cells are responsible for humoral immunity.

D) T cells are responsible for humoral immunity.

Which of these diagnostic lab tests is used to confirm the diagnosis of HIV? A) Antinuclear antibodies B) Immunoglobulin assay C) Rheumatoid factor D) Western blot

D) Western blot

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. Lymphocytes are stimulated to become cells that attack microbes directly. D. Antibodies are made by B lymphocytes in response to a specific antigen.

D. antibodies are made by B lymphocytes in response to a specific antigen

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. effector stage

A new mother expresses concern about her baby developing allergies and asks what the health care provider meant by "passive immunity." Which example should the nurse use to explain this type of immunity? Select one: a. Breastfeeding her infant b. Exposure to communicable diseases c. Early immunization d. Bone marrow donation

a. Breastfeeding her infant Colostrum provides passive immunity through antibodies from the mother. These antibodies protect the infant for a few months. However, memory cells are not retained, so the protection is not permanent. Active immunity is acquired by being immunized with vaccinations or having an infection. It requires that the infant has an immune response after exposure to an antigen. Cell-mediated immunity is acquired through T lymphocytes and is a form of active immunity.

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. bone marrow suppression large doses of antibiotics can precipitate bone marrow suppression, affecting immune function.

A patient has been admitted to the emergency department with signs of anaphylaxis following a bee sting. The nurse knows that if this is a true allergic reaction the patient will present with what alteration in laboratory values? a. Increased eosinophils b. Increased neutrophils c. Increased serum albumin d. Decreased blood glucose

a. increased eosinophils

A patient is being evaluated for possible atopic dermatitis. The nurse expects elevation of which laboratory value? Select one: a. Basophils b. IgE c. Neutrophils d. IgA

b. IgE Serum IgE is elevated in an allergic response (type 1 hypersensitivity disorders). The eosinophil level will be elevated rather than neutrophil or basophil counts. IgA is located in body secretions and would not be tested when evaluating a patient who has symptoms of atopic dermatitis.

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

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. proliferation 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

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. bridging natural and acquired immunity

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. cell-mediated immune function 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

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. the response stage

An adolescent patient seeks care in the emergency department after sharing needles for heroin injection with a friend who has hepatitis B. To provide immediate protection from infection, what medication will the nurse administer? Select one: a. Hepatitis B vaccine b. Corticosteroids c. Fresh frozen plasma d. Gamma globulin

d. Gamma globulin The patient should first receive antibodies for hepatitis B from injection of gamma globulin. The hepatitis B vaccination series should be started to provide active immunity. Fresh frozen plasma and corticosteroids will not be effective in preventing hepatitis B in the patient.