Immunity
What are the functions of the antibody immunoglobulin (Ig) G? Select all that apply. 1 . Activates classic complement pathway 2 . Provides protection against invading microorganisms 3. Is the first antibody formed following exposure to an antigen 4. Is expressed on second and subsequent exposures to antigens 5. Suppresses the antibody-dependent, cell-killing action of natural killer cells
1 . Activates classic complement pathway 2 . Provides protection against invading microorganisms 4. Is expressed on second and subsequent exposures to antigens The IgG antibody activates the classic complement pathway, enhancing the phagocytic activity of neutrophils and macrophages. It also provides protection against invading microorganisms and is expressed heavily on second and subsequent exposures to antigens. The antibody IgM is the first antibody formed by a newly sensitized B-lymphocyte plasma cell. IgG promotes the antibody-dependent cell-mediated non-self cell-killing action of natural killer cells.
Which is an example of a type I hypersensitivity reaction? 1. Angioedema 2. Rheumatoid arthritis 3. Poison ivy skin rashes 4. Immune hemolytic anemia
1. Angioedema Type I hypersensitivity reactions are caused by overactive immunity and result from increased production of immunoglobulin E. Examples of type I reactions include angioedema, anaphylaxis, and allergic asthma. Immune hemolytic anemia is a form of type II reaction (cytotoxic reaction), which occurs when the body makes autoantibodies directed against the body's own cells. In type III hypersensitivity reactions (immune complex reactions), excess antigens cause immune complexes to form in the blood, and these circulating complexes lodge themselves in the small blood vessels of the kidneys, skin and joints. This results in inflammation, tissue, and vessel damage. Rheumatoid arthritis is an example of a type III hypersensitivity reaction. In a Type IV reaction (delayed hypersensitivity reactions), sensitized T-cells from previous exposure respond to an antigen by releasing chemical mediators and triggering macrophages to destroy the antigen. The development of a poison ivy skin rash is an example of a type IV reaction.
A patient has received a vaccination for shingles. Which test allows the nurse to determine the effectiveness of the vaccination? 1. Antibody level 2. White blood cell count 3. Absolute neutrophil count 4. White blood cell differential
1. Antibody level Antibody levels in the blood rise in response to vaccination to the specific antigen in the vaccine. An absolute neutrophil count determines the actual number of circulating mature neutrophils. A white blood cell (WBC) count determines the total number of circulating WBCs. A WBC differential count shows the number and percentage of the different types of circulating WBCs.
Which statements describe the changes that happen in the immune system with age? Select all that apply. 1. Decreased complement protein activation 2. Increased risk of infections by microorganisms 3. Increased T-cell responses against the antigens 4. Increased production of antibodies directed toward antigens 5. Decreased ability of the immune system to distinguish between self and non self cells
1. Decreased complement protein activation 2. Increased risk of infections by microorganisms 5. Decreased ability of the immune system to distinguish between self and non self cells With an increase in age, there is a decreased amount of complement protein activation and fixation, leading to a decrease in phagocytosis, resulting in an increased risk for infection by microorganisms. Aging causes a decreased ability of the immune system to distinguish between self and non-self cells. Older adults may have a decreased T-cell response and decreased antibody production, resulting in a compromised immune system.
The nurse is caring for a patient with a poison ivy skin rash. What type of hypersensitive reaction is the patient experiencing? 1. Delayed reaction 2. Cytotoxic reaction 3. Immediate reaction 4. Immune complex-mediated reaction
1. Delayed reaction The patient is experiencing a delayed hypersensitivity reaction. This type IV reaction occurs hours to days after exposure. The reactive cell is the T-lymphocyte (T-cell). A type I reaction is an immediate hypersensitive reaction; hay fever, allergic asthma, and anaphylaxis are examples of type I reactions. A type III reaction is an immune complex-mediated hypersensitive reaction; serum sickness and vasculitis are examples of a type III reaction. In a type III reaction, excess antigens cause the formation of immune complexes in the blood. Cytotoxin reaction is a type II reaction in which the body makes special antibodies against self cells that have some form of foreign protein attached to them. Autoimmune hemolytic anemia and Goodpasture's syndrome are examples of type II reactions.
What are the risk factors for hyperacute rejection? Select all that apply. 1. Human leukocyte antigen (HLA) mismatching 2. Receiving a previous transplantation 3.Difference in donors and recipient blood group 4. Organ donation from a distant relative 5. Absence of a blood transfusion before transplantation
1. Human leukocyte antigen (HLA) mismatching 2. Receiving a previous transplantation 3.Difference in donors and recipient blood group Hyperacute rejections occur when the recipient has preexisting antibodies to antigens in the donated organ. Patients at greatest risk for hyperacute rejection are those who have HLA mismatching, have received donated organs of an ABO blood type different from their own, or have received a previous transplant. Organ donation can be received from a distant relative if HLA matching is precise. Patients who have received multiple blood transfusions at any time in life before transplantation are at higher risk for hyperacute rejection.
Which immunoglobulin (Ig) antibody is found abundantly in secretions but has very low circulating levels? 1. IgA 2. IgG 3. IgE 4.IgD
1. IgA IgA is the antibody found in high concentrations in secretions but its concentration in the plasma is very low. IgG is a major circulating antibody. The concentration of IgE is variable in the plasma and is not usually present in secretions. IgD is found in low concentrations in the plasma and is not secreted.
The nurse recalls that which event occurs in a type II hypersensitivity reaction? 1. IgG antibody reacts with host cell membrane. 2. IgE antibody reacts on mast cells with antigen. 3. Autoantibodies react with normal cell-surface receptors. 4. Sensitized T-cells react with antigen and release lymphokines.
1. IgG antibody reacts with host cell membrane. Type II hypersensitivity reactions are also called cytotoxic reactions. The mechanisms involved in type II hypersensitivity reactions include the reaction of the IgG antibody with the host cell membrane or antigen being adsorbed by the host cell membrane. The reaction of the IgE antibody on mast cells with antigen results in the release of mediators, especially histamine. This mechanism is involved in type I hypersensitivity reactions. The reaction of autoantibodies with normal cell-surface receptors stimulates a continual overreaction of the target cell. This mechanism is involved in type V hypersensitivity reactions. The reaction of sensitized T-cells with antigen and the release of lymphokines activate macrophages and induce inflammation. This is the mechanism involved in type IV hypersensitivity reactions.
Which food items may cause anaphylaxis in some individuals? Select all that apply. 1. Nuts 2. Eggs 3. Peanuts 4. Shellfish 5. Potatoes
1. Nuts 2. Eggs 3. Peanuts 4. Shellfish Some food items may cause anaphylaxis in susceptible individuals. These include peanuts, shellfish, eggs, and nuts. Potatoes are not known to cause anaphylactic reactions.
Which type of hypersensitivity is anaphylaxis? 1. Rapid hypersensitivity 2. Delayed hypersensitivity 3. Cytotoxic hypersensitivity 4. Immune-complex mediated hypersensitivity
1. Rapid hypersensitivity Type 1 hypersensitivity is also known as rapid hypersensitivity. Anaphylaxis is an example of type I hypersensitivity reaction, which occurs rapidly and systemically. Anaphylaxis is due to the reaction of immunoglobulin E (IgE) antibodies on mast cells with antigen, resulting in the release of mediators, especially histamine, which causes the allergic reaction. Anaphylaxis is not an example of delayed, cytotoxic, or immune-complex mediated hypersensitivity.
A patient is undergoing a skin test for allergies. Which symptoms are associated with an anaphylactic reaction? Select all that apply. 1. Red blotches 2. Itching and urticaria 3. High blood pressure 4. Diarrhea and vomiting 5. Erythema and angioedema
1. Red blotches 2. Itching and urticaria 4. Diarrhea and vomiting Red blotches, itching, urticaria, erythema, and angioedema are the common symptoms associated with anaphylactic reactions. During this reaction, vasodilation occurs and blood is lost from the vascular system; therefore, the patient becomes hypotensive, not hypertensive. Diarrhea and vomiting are not directly related to this reaction.
A patient presents with fever, arthralgia, rash, malaise, lymphadenopathy, nephritis, and polyarthritis. The patient has been admitted to the hospital several times in the past month and was last discharged one week ago. What does the nurse suspect this patient is experiencing? 1. Serum sickness 2. Rheumatoid arthritis 3. Systemic lupus erythematosus 4. Hemolytic transfusion reaction
1. Serum Sickness The symptoms of fever, arthralgia, rash, malaise, lymphadenopathy, nephritis, and polyarthritis are classic signs and symptoms of serum sickness, which develops after receiving serum or certain drugs. The patient would have received these in previous hospital visits. Symptoms of rheumatoid arthritis include tender, warm, swollen joints; joint stiffness (especially in the morning and during periods of inactivity); fatigue; fever; and weight loss. Symptoms of systemic lupus erythematosus are swollen or painful joints, unexplained fever, and a red rash (most commonly on the nose and cheeks). Symptoms of a hemolytic transfusion reaction include back pain, bloody urine, chills, fainting or dizziness, fever, flank pain, and flushing of the skin.
A patient who underwent a heart transplant 2 years ago is experiencing fatigue, weakness, and fever for a few days. The diagnostic tests show a 10% decrease in functioning of the left ventricle. What should the nurse infer from the patient findings? 1. The patient has chronic rejection of the transplanted heart, which may be life-threatening. 2. The patient has hyperacute rejection of the transplanted heart and would need another donor. 3. The patient is experiencing symptoms that are common after any transplantation surgery. 4. The patient has acute rejection of the transplanted heart, which can be managed by drug therapy.
1. The patient has chronic rejection of the transplanted heart, which may be life-threatening. In patients who are experiencing chronic rejection of the transplanted heart, the symptoms of organ rejection develop slowly and gradually a few years after transplant. In this condition, the normal heart muscles are replaced by stiff, fibrotic tissue. These tissues cannot function and contract as the normal heart muscles do, which leads to compromised cardiac function. Any symptoms such as fatigue, weakness, and fever after the transplantation surgery needs to be further evaluated and cannot simply be considered common. Hyperacute rejection usually happens immediately after the surgery, and the only recourse is retransplantation of the organ. Acute rejection of the heart happens during the first 3 months after transplantation. Acute rejection can be managed through drug therapy.
Which type of hypersensitivity may be associated with rhinorrhea? 1. Type I hypersensitivity 2. Type II hypersensitivity 3. Type III hypersensitivity 4. Type IV hypersensitivity
1. Type I hypersensitivity Rhinorrhea is manifested as stuffy nose and itchy, watery eyes. Patients may breathe through the mouth, and the nasal mucosa appears swollen and pink. It is a type I hypersensitivity reaction. Type II hypersensitivity, type III hypersensitivity, and type IV hypersensitivity are not associated with rhinorrhea.
Which type of immunity does a patient acquire following a vaccination or immunization? 1. Natural active 2. Artificial active 3. Natural passive 4. Artificial passive
2. Artificial active The type of immunity acquired by vaccination or immunization is artificial active immunity. Natural active immunity occurs when the body responds to an antigen by actively making antibodies against it. Natural passive immunity is acquired by the transfer of antibodies across the placenta or through breast milk. Artificial passive immunity is acquired by the transfer of antibodies formed in animals or another human being to the recipient.
A nursing student is learning about hypersensitivity reactions. In what order do the mechanisms of a type intravenous (IV) hypersensitivity occur? 1. Activation of T-cells 2. Exposure to causative agent 3. Release of chemical mediators 4. Accumulation of macrophages at infection site
2. Exposure to causative agent 1. Activation of T-cells 3. Release of chemical mediators 4. Accumulation of macrophages at infection site A type IV hypersensitivity involves a delayed response (hours to days after the exposure). In this reaction, there is an initial exposure to the causative agent. Following that, T-cells become activated. This stimulates the release of chemical mediators (e.g., lymphokines). These mediators then trigger macrophages and other lymphocytes to destroy the antigen, which accumulate at the site of the infection.
A patient is experiencing a severe type I hypersensitivity reaction resulting in angioedema. What is the nurse's priority action? 1. Finding out how anxious the patient is feeling 2. Finding out what medications the patient is taking 3. Finding out if the patient has had previous allergic reactions 4. Finding out if any family members have had a similar reaction
2. Finding out what medications the patient is taking It is most important to find out what medications the patient is taking. While other information might be helpful to the assessment, time is important since laryngeal edema can result in loss of the airway. The patient with angioedema will most likely feel frightened and anxious, and it will improve as the angioedema resolves. Hereditary angioedema will result in recurring angioedema not associated with a specific drug, but asking about recurrence and family history is a secondary consideration after asking about medications.
The nurse is assessing a patient with suspected serum sickness. Which symptoms are consistent with serum sickness? Select all that apply. 1. Ptosis 2. Malaise 3. Arthralgia 4. Blurred vision 5. Lymphadenopathy
2. Malaise 3. Arthralgia 5. Lymphadenopathy Serum sickness is a group of symptoms that occurs after receiving serum or certain drugs; symptoms include arthralgia (achy joints), lymphadenopathy (enlarged lymph nodes), fever, rash, malaise, and possibly polyarthritis and nephritis. Blurred vision and ptosis are not symptoms of serum sickness.
A patient has developed a type II hypersensitivity. Which mechanism is involved in this type of allergic reaction? 1. Activation of T-Cells 2. Phagocytosis of self cells 3. Stimulation of thyroid cells 4. Secretion of histamines from mast cells
2. Phagocytosis of self cells In type II reactions, an autoantibody is produced against the self cell that contains an antigen or foreign protein on its surface. The self cells are then destroyed by phagocytosis or lysis. Activation of T-cells takes place in delayed hypersensitivity. Stimulation of thyroid cells and secretion of histamines are the mechanisms of type V and type I hypersensitivities, respectively.
A patient with fever has a high neutrophil count. Which growth factor increases the number and maturity of neutrophils? 1. Erythropoietin 2. Thrombopoietin 3. Granulocyte colony-stimulating factor 4. Granulocyte-macrophage colony-stimulating factor
3. Granulocyte colony-stimulating factor Granulocyte colony-stimulating factor increases the number and maturity of neutrophils. Erythropoietin increases the growth and differentiation of erythrocytes. Thrombopoietin increases the growth and differentiation of platelets. Granulocyte-macrophage colony-stimulating factor increases the growth and maturation of myeloid stem cells.
Which immunoglobulin (Ig) antibody binds to basophils and is involved in causing antigen-antibody mediated hypersensitivity reactions? 1. IgA 2. IgG 3. IgE 4. IgD
3. IgE The IgE antibody binds to basophils and is involved in causing antigen-antibody mediated hypersensitivity reactions. IgA is helpful in preventing gastrointestinal, urinary, and respiratory infections. IgG provides long-term immunity against invading microorganisms. IgD is co-expressed with IgM and acts as a receptor on unsensitized B-lymphocytes.
What type of immunity does a baby acquire from its mother through breastfeeding? 1. Natural active 2. Artificial active 3. Natural passive 4. Artificial passive
3. Natural passive Natural passive immunity occurs when a mother transmits preformed antibodies to her baby through breast milk. Natural active immunity is acquired after an antigen enters a person's body. Artificial active immunity is acquired through vaccination or immunization. Artificial passive immunity is acquired by injecting a person with antibodies obtained from animals or other human beings.
Which type of immunity occurs when antibodies pass from a mother to her fetus? 1. Natural active immunity 2. Artificial active immunity 3. Natural passive immunity 4. Artificial passive immunity
3. Natural passive immunity Natural passive immunity occurs when antibodies are passed from a mother to her fetus through the placenta. Natural active immunity occurs when the person is exposed to a live pathogen, develops the disease, and becomes immune because of the primary immune response. Artificial active immunity is the immunity that is induced by a vaccine. Artificial passive immunity is a condition in which high levels of human antibodies specific for a pathogen or toxin are transferred to nonimmune individuals.
During the physical examination, the patient reports a history of latex allergy. Which item may cause this reaction? 1. Pollens 2. Milk products 3. Surgical gloves 4. Legumes and nuts
3. Surgical gloves Surgical gloves may be made of natural latex proteins and can cause an allergy that has symptoms related to type I and type IV hypersensitivity reactions. Pollens, milk products, and legumes and nuts are not responsible for latex allergy because they do not contain latex.
Which statement should be included when a student nurse is discussing the action of interleukin-1? 1. "Interleukin-1 induces cell death." 2. "Interleukin-1 participates in graft rejection." 3. "Interleukin-1 stimulates the liver to produce fibrinogen." 4. "Interleukin-1 stimulates the production of prostaglandins."
4. "Interleukin-1 stimulates the production of prostaglandins." Interleukin-1 is a pro-inflammatory cytokine that stimulates the production of prostaglandins. Tumor necrosis factor is a pro-inflammatory cytokine that induces cell death and participates in graft rejection. Interleukin-6 is a pro-inflammatory cytokine that stimulates the liver to produce fibrinogen.
A patient has been brought to the emergency department (ED) after being bitten by a poisonous snake. What is the nature of protection that the nurse provides when injecting the patient with antivenom? 1. Natural active 2. Artificial active 3. Natural passive 4. Artificial passive
4. Artificial passive Antivenom contains antibodies produced from snake venom that work against that same snake venom. Because the patient does not have active acquired immunity against the snake venom, the nurse injects antivenom to inactivate the antigen which provides artificial passive immunity. Natural active immunity occurs when an antigen enters the body without human assistance and the body responds by making antibodies against that antigen. Natural passive immunity is acquired by the passage of antibodies from a mother to her baby either through breast milk or placental transfer. Artificial active immunity is acquired through vaccination or immunization.
What is the function of the cytokine tumor necrosis factor (TNF)? 1. Stimulates the production of prostaglandins. 2. Increases the numbers and maturity of neutrophils. 3. Increases the growth and differentiation of platelets. 4. Facilitates acute inflammatory response to infectious bacteria.
4. Facilitates acute inflammatory response to infectious bacteria. Tumor necrosis factor (TNF) is the major cytokine involved in the acute inflammatory response to infectious bacteria. It is responsible for rheumatoid arthritis damage and systemic complications of severe infection or sepsis as well as the induction of cell death. The granulocyte colony-stimulating factor (G-CSF) increases the numbers and maturity of neutrophils. Thrombopoietin increases the growth and differentiation of platelets. Interleukin-1 (IL-1) stimulates the production of prostaglandins and increases the growth of CD4+ T-cells.
Which cells in the human body contribute to the cell-mediated immune system? Select all that apply. 1. Plasma cell 2. Memory cell 3. B-lymphocyte 4. Natural killer cell 5. Helper/inducer T-cell
4. Natural killer cell 5. Helper/inducer T-cell Natural killer cells participate in cell-mediated immunity and attack non-self cells, especially abnormal self cells that have undergone a mutation. Helper or inducer T-cells enhance immunity by recognizing cells as self and non-self cells and secreting cytokines. Plasma cells, memory cells, and B-lymphocytes participate in antibody-mediated immunity.
Which cells are responsible for the rejection of transplanted organs in the human body? 1. Basophils 2. Eosinophils 3. Neutrophils 4. Natural killer cells
4. Natural killer cells The natural killer cells enter the transplanted organs through blood and penetrate the organ cells by causing lysis. This reaction initiates the inflammatory response and may lead to acute rejection of the organ. Basophils release histamine and heparin in the areas of tissue damage which promotes the action of neutrophils and macrophages. Eosinophils act against the infestation of parasitic larvae and decrease the inflammatory responses, especially during allergic responses. Neutrophils help with ingestion and phagocytosis of foreign proteins.
The nurse is assessing a patient with allergic rhinitis. What assessment finding dies the nurse anticipate? 1. The presence of fever 2. Glowing skin over the sinuses 3. Yellow drainage from the nose 4. Runny nose with itchy, watery eyes
4. Runny nose with itchy, watery eyes The patient with allergic rhinitis has a runny nose and itchy, watery eyes. The drainage from the nose is usually clear or white. When a penlight is placed on the skin over the sinuses, there is a reduced glow. The patient with allergic rhinitis does not have fever unless there is an infection present.
