Chapter 16: Disorders of the Immune Response Prep U
One week after a client received a transplant the nurse notes that the skin shows a maculopapular rash on the hands and feet. The client reports itching and nausea. What is the likely cause of these manifestations? Graft-versus-host disease Anaphylactic reaction Opportunistic infection Immunodeficiency disorder
Graft-versus-host disease
A client is suffering from the effects of the opportunistic infection, Cryptosporidium parvum. An important nursing intervention would be to encourage which action? Ambulation Weight-bearing exercise Deep breathing and coughing Hydration
Hydration
The surgeon is performing a kidney transplant on a client. The surgeon attaches the kidney and immediately notes that the kidney takes on a cyanotic, mottled appearance. The surgeon would interpret this as: Chronic rejection Acute rejection Hypoacute rejection Hyperacute rejection
Hyperacute rejection
The nurse is assessing for acute graft versus host disease (GVHD). Which body system should the nurse monitor for signs and symptoms? Skin Kidneys Heart Liver
Skin
Place the following in the sequence of the progression of HIV/AIDS on a cellular level.1)The HIV virus is uncoded.2)HIV attaches to the receptors on the CD4+ cell.3)DNA synthesis occurs by reverse transcription.4)Transcription of the DNA to form a single-strand messenger RNA. 1,2,3,4 3,4,1,2, 4,3,1,2 2,1,3,4
2,1,3,4
When a client who has been newly diagnosed with HIV asks, "What are the chances that I can be cured?," what is the nurse's most therapeutic response? "Your doctor will want to see you on a regular basis in order to evaluate your viral load and prescribe the appropriate medications." "Although there is no current treatment that provides a possible cure, there are ones that have successfully managed the infection." "The key to success is the management of your immune system so that life- threatening opportunistic diseases do not develop." "Routine follow-up care of a stable, asymptomatic person infected with HIV , like yourself, will include a history and physical examination along with CD4+ cell count and viral load testing every 3 to 4 months."
"Although there is no current treatment that provides a possible cure, there are ones that have successfully managed the infection."
Members of an AIDS support group who have more advanced cases are sharing some of their recent health problems with a member who has just been diagnosed. Which of the members' statements is most accurate? "Those of us with HIV are so much more prone to loss of vision and hearing." "One of the scariest things out there now is the huge increase in drug-resistant tuberculosis." "The eradication of pneumocystic pneumonia (PCP) has helped extend the life expectancy of a lot of persons living with AIDS." "As people with HIV live longer, more of us are eventually succumbing to the cancers that are associated with HIV."
"As people with HIV live longer, more of us are eventually succumbing to the cancers that are associated with HIV."
An unlicensed assistive worker expresses fear of becoming infected while caring for a client with HIV? Which statement by the nurse conveys accurate information? "As long as you wear an isolation gown, you are protected." "Avoid mucous membrane contact with blood or semen." "Use personal protective equipment and an N95 respirator." "If you have cuts on your hands, wash with 10% bleach."A client was tested for HIV and received a positive result from the enzyme-linked immunosorbent assay (ELISA) followed by a negative Western blot test. The client asks the nurse what this means. What is the nurse's best response? "The ELISA test gives some false positives, but the Western blot confirms you don't have HIV." "The tests give similar results. There must have been contamination and you need a retest." "This result is inconclusive and you will need to repeat the tests in 1 month." "The ELISA looks for antibodies while the Western blot looks for the actual antigen. You have HIV."
"Avoid mucous membrane contact with blood or semen."
The nurse working at a community clinic is caring for a young male client. The client asks the nurse if he could get AIDS from being sprayed in the face with breast milk. Select the best response by the nurse. "Breast milk can contain the virus that causes AIDS, but to be infected, the milk needs to be in contact with your mucous membranes or an open sore." "Breast milk is not a mode of AIDS transmission." "Tell me more about your fear of AIDS." "Breast milk can contain HIV. You should be tested immediately."
"Breast milk can contain the virus that causes AIDS, but to be infected, the milk needs to be in contact with your mucous membranes or an open sore."
As part of her prenatal education, a 29-year-old woman who is pregnant with her first child is receiving teaching from her primary care provider. Which statement by the woman reflects an accurate understanding of HIV transmission? "It's discouraging to know that my breast milk can pass on HIV to my baby." "I know it's possible, but it's comforting that the chances of my child contracting my HIV are actually very low." "I'm relieved to learn that a caesarean delivery will protect my baby from being born HIV positive." "I know my baby is safe from HIV while in the womb, but the delivery will place him or her at real risk."
"It's discouraging to know that my breast milk can pass on HIV to my baby."
A client describes himself as being "devastated" after hearing that his HIV test has come back positive. Which response by the nurse is most appropriate? "This is certainly scary news, but the care team is going to make sure that you get all the information you need." "I've provided care for many clients living with HIV and AIDS, so I understand how you feel." "I understand how difficult this must be for you, but it's nothing that you should be ashamed of." "It's entirely normal to feel that way. We are going to try our best to help you get all the support you need."
"It's entirely normal to feel that way. We are going to try our best to help you get all the support you need."
An 8-week-old boy has been recently diagnosed with a severe combined immunodeficiency (SCID). His parents have performed a significant amount of research on the Internet and have brought a large amount of material to discuss with their care provider. Which statement best reflects an accurate understanding of their son's health situation? "Our son likely has a deficiency of B-lymphocytes and can't produce antibodies." "The antibodies that our son produces are mismatched to the infections that he was born with, and encounters." "We feel guilty, because dietary and environmental factors have been shown to contribute to SCID" "We read that gene therapy could cure our son; we'd like you to look into that option."
"Our son likely has a deficiency of B-lymphocytes and can't produce antibodies."
A client was tested for HIV and received a positive result from the enzyme-linked immunosorbent assay (ELISA) followed by a negative Western blot test. The client asks the nurse what this means. What is the nurse's best response?
"The ELISA test gives some false positives, but the Western blot confirms you don't have HIV."
A potential donor is angry at the personal nature of the questions about HIV risk factors that he is required to answer at a blood collection center, and states that simple blood testing should suffice. How can the nurse at the center best respond? "Even though blood tests are completely accurate, the high stakes of blood donation and transfusion mean that double measures are appropriate." "There are some very uncommon subtypes of the HIV virus that are not detectable by current testing methods." "There's a chance that persons who are asymptomatic but HIV positive can have their antibodies missed by serum testing." "There's a period shortly after someone is infected with HIV when blood tests might still be negative."
"There's a period shortly after someone is infected with HIV when blood tests might still be negative."
A 24-year-old pregnant female presents to the clinic for her second prenatal visit. The results of her ELISA test are positive. Which statement by the nurse projects the best way to counsel this client? "The next step to obtain a viral load test." "You are HIV positive. There are measures we can take to prevent transmission to the baby." "This is likely a false positve. We will need to wait for the Western Blot results to confirm." "This is most likely a false positive and we will repeat the test to confirm."
"This is likely a false positve. We will need to wait for the Western Blot results to confirm."
Which client has the highest risk of contracting an opportunistic infection? A client who recently contracted HIV with a viral load of 1 million copies/mL A client who has had HIV for 3 years and has a CD4+ count of 50 cells/μL A client who has had HIV for 10 years and has a platelet count of 200/mL A client who has had HIV for 30 years and has a CD4+ count of 1000 cells/μL
A client who has had HIV for 3 years and has a CD4+ count of 50 cells/μL
The school nurse is preparing a lecture on HIV/AIDS for a health class of high school students. The nurse would know to include what information about the transmission of AIDS in her lecture? Select all that apply. AIDS is transmitted through blood-to-blood contact. AIDS is transmitted through nonsexual household contact. AIDS is transmitted through the bite of an insect. AIDS is transmitted from the mother to her unborn baby. AIDS is transmitted through sexual contact.
AIDS is transmitted through sexual contact. AIDS is transmitted through blood-to-blood contact. AIDS is transmitted from the mother to her unborn baby.
An infant is suspected of having a severe combined T- and B-cell immunodeficiency disorder. Which effect on the infant makes early detection a priority? The infant is at risk for cardiovascular disease. Administering live attenuated virus vaccines can be fatal. The infant may have developmental delays. The infant may develop food allergies.
Administering live attenuated virus vaccines can be fatal.
The molecules that are recognized as foreign on allografts are called: Antigens MHC proteins Alloantigens Autoantigens
Alloantigens
Some members of the population are so sensitive to certain antigens that they react within minutes by developing itching, hives, and skin erythema, followed shortly thereafter by bronchospasm and respiratory distress. What is this near-immediate reaction commonly known as? Anaphylactic reaction Hyposensitive reaction Arthus reaction Antigen reaction
Anaphylactic reaction
Following a spider bite she received while camping, a 20-year-old woman presented to the emergency department with rash, edema, and fever and was subsequently diagnosed with serum sickness. Which statement best describes the physiologic rationale for the broad systemic effects of this event? Deposited antibodies are activating her complement system. Antigen-antibody complexes have been deposited in a variety of locations throughout the body. The woman is experiencing diffuse tissue necrosis as a consequence of an Arthus reaction. Antibody-binding to specific target cell receptors is bringing about a change in cell function.
Antigen-antibody complexes have been deposited in a variety of locations throughout the body.
Which statement about opportunistic pathogen infection in AIDS is true? Opportunistic pathogens often infect previously healthy people. Most infections with opportunistic pathogens are not serious. Becoming infected with an opportunistic pathogen is one requirement for the diagnosis of AIDS. HIV mainly attacks B cells.
Becoming infected with an opportunistic pathogen is one requirement for the diagnosis of AIDS.
A diagnosis of acquired immunodeficiency syndrome (AIDS) is identified when the CD4+ T cell count reaches which level? 500 to 800 cells/μL 200 to 499 cells/μL Below 200 cells/μL 800 to 1000 cells/μL
Below 200 cells/μL
The human immunodeficiency virus (HIV) acts on which type of cells? CD4+ T lymphocytes CD8+ T lymphocytes White blood cells Red blood cells
CD4+ T lymphocytes
A client with end-stage renal disease received a kidney transplant with a kidney donated by a family member. The client has been carefully monitored for signs of rejection. The physician informs the client that there has been a gradual rise in the serum creatinine over the last 5 months. What type of rejection does this depict? Hyperacute rejection Chronic rejection Acute rejection Acute antibody-mediated rejection
Chronic rejection
Which client would be diagnosed with wasting syndrome? Client with HIV a CD4+ T-cell count of 1000 cells/μL, Kaposi sarcoma, and nausea and vomiting for more than 2 weeks Client with chronic fatigue syndrome, no fever and herpes simplex, and candidiasis around the oral mucosa Client with AIDS with pneumonia, chronic fever, and chronic fatigue Client with HIV, fever, diarrhea, and significant involuntary weight loss
Client with HIV, fever, diarrhea, and significant involuntary weight loss
A nurse is speaking to a group of students about the transmission of HIV. Which modes of transmission should be included? Select all that apply. Transmission from mother to infant through breast milk Skin to skin contact with a person with HIV Contact with blood containing HIV Contact with the semen of an HIV-positive person Ingesting the saliva of an HIV-positive person
Contact with blood containing HIV Contact with the semen of an HIV-positive person Transmission from mother to infant through breast milk
The nurse is caring for a client who is HIV positive and is newly diagnosed with Mycobacterium tuberculosis (TB). Which manifestations does the nurse associate with TB? Select all that apply. Rash Weight gain Cough Night sweats Fever
Cough Fever Night sweats
The nurse is reviewing the medical record for laboratory blood work that would indicate if a client is HIV infected. The nurse reviews which lab test? ELISA enzyme-linked immunosorbent assay Indirect Coombs test Indirect fluorescent antibody assay Creatine phosphokinase test
ELISA enzyme-linked immunosorbent assay
While undergoing a kidney transplant from a non-family member, the client's transplanted kidney has just had the arterial clamps removed. The OR staff notices that the organ is turning purple with no urine output. When explaining to the family why they had to remove the donor kidney, the nurse will anticipate that the surgeon would likely include which statement? Hyperacute rejection occurs because antibodies against HLA antigens are deposited in vessels, causing necrosis. Previous exposure to the HLA antigens is responsible for the high titers of complement-fixing antibodies that cause the rejection. The circulating B and T lymphocytes are just doing their job. Obviously, there has been a mismatch during the human leukocyte antigens (HLA) testing.
Hyperacute rejection occurs because antibodies against HLA antigens are deposited in vessels, causing necrosis.
Which clinical manifestations and diagnostic findings are recognized components of the metabolic and morphologic changes that occur with HIV infection accompanied with lipodystrophy? Select all that apply. Insulin resistance Deficiencies of anterior pituitary hormones Breast enlargement Increased abdominal girth Hyperlipidemia
Hyperlipidemia Insulin resistance Increased abdominal girth Breast enlargement
The nurse is reviewing risk factors for a client to develop a type II (antibody-mediated) hypersensitivity reaction. Which scenario would be included in this type of reaction? Select all that apply. Hemolytic disease of the newborn due to ABO or Rh incompatibility Hyperthyroidism development progressing to Graves disease. Development of glomerulonephritis Pet allergy Peanut allergy
Hyperthyroidism development progressing to Graves disease. Hemolytic disease of the newborn due to ABO or Rh incompatibility Development of glomerulonephritis
Infants are born with a passive immunity that occurs when immunoglobulin antibodies cross the placenta from the maternal circulation prior to birth. Which immunoglobulin is capable of crossing the placenta? IgM IgE IgG IgD
IgG
A nurse caring for a client who has undergone an organ transplant. Advances in which process has made organ transplants a reality? Mendel's laws Transgenics Immunology Transcription
Immunology
The nurse is teaching a new mother about caring for her baby and reducing the risk for infection. On what principle does the nurse base the knowledge of passive immunity? Infants are protected at birth from infection by maternal IgD. Infants are protected at birth from infection by maternal IgA. Infants are protected at birth from infection by maternal IgM. Infants are protected at birth from infection by maternal IgG.
Infants are protected at birth from infection by maternal IgG.
A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which phenomenon best captures the rationale for allergy desensitization therapy? Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies. Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response. Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response. Allergens in large, regular quantities overwhelm the IgE antibodies that mediate the allergic response.
Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies.
A 36-year-old male who is positive for HIV antibodies notices purplish spots on his upper body. Which term is used to identify these areas as an opportunistic infection? Toxoplasmosis Kaposi sarcoma Multifocal leukoencephalopathy Liver spots
Kaposi sarcoma
Which is a characteristic finding in AIDS? High peripheral blood CD4+ lymphocyte counts Carcinoma of the lung Kaposi sarcoma Overactive T-cell function
Kaposi sarcoma
Which of these is often found in a client with AIDS? High peripheral blood CD4+ lymphocyte counts Carcinoma of the lung Overactive T-cell function Kaposi sarcoma
Kaposi sarcoma
A client has developed a type 1 hypersensitivity reaction. When should the nurse assess for a possible progressing response to the secondary or late-phase? May occur 12 to 18 hours after the primary or initial-phase response and lasts for 1 day May occur within minutes and lasts approximately 2 hours Will not occur, as it has been 1 hour since the primary or initial-phase response May occur 2 to 8 hours after the primary or initial-phase response and lasts for several days
May occur 2 to 8 hours after the primary or initial-phase response and lasts for several days
Which disorder does the nurse know is considered to be an autoimmune disease? Osteoarthritis Myasthenia gravis Rhabdomyolysis Diverticulitis
Myasthenia gravis
Typical symptoms seen in the latent period of HIV infection include which of the following? Night sweats No signs or symptoms Gastrointestinal problems Skin lesions
No signs or symptoms
A 37-year-old male with HIV who has recently become symptomatic has begun highly active antiretroviral therapy (HAART). Among the numerous medications that he now regularly takes are several that inhibit the change of HIV RNA to DNA in a CD4+ cell. Which class of medications addresses this component of the HIV replication cycle? Integrase inhibitors Entry inhibitors Protease inhibitors Non-nucleoside reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
A 21-year-old woman diagnosed with HIV/AIDS 4 years ago now presents with cytomegalovirus. The nurse explains to the woman that the infection is caused by a common organism that normally does not cause infection in someone with a healthy immune system. This type of infection is called what? Opportunistic infection Suppression infection HIV infection Autoimmune infection
Opportunistic infection
The nurse is caring for an infant wih DiGeorge syndrome. Which organ does the nurse know will be underdeveloped or absent? Parathyroid and thymus glands Pituitary gland and thyroid gland Kidney and bladder Liver and spleen
Parathyroid and thymus glands
What is the main effect of HIV infection? Poor B-cell function Poor helper T-cell function Poor natural killer cell function Poor suppressor T-cell function
Poor helper T-cell function
What is the main effect of HIV infection? Poor helper T-cell function Poor natural killer cell function Poor B-cell function Poor suppressor T-cell function
Poor helper T-cell function
A freshman nursing student is taking a tuberculin (TB) skin test as part of her preparation for beginning clinical placement in the hospital. The student is unclear of the rationale or physiology involved in this test. Which statement is the correct explanation? Formation of contact dermatitis lesions confirms prior TB contact. This type of delayed-type hypersensitivity (DTH) is a response to latent Mycobacterium tuberculosis bacteria. Previous TB exposure forms sensitized Th1 lymphocyte cells that are long-lived. The cell-mediated hypersensitivity associated with Mycobacterium tuberculosis remains detectable for several years.
Previous TB exposure forms sensitized Th1 lymphocyte cells that are long-lived.
A nurse is caring for a child who has had a history of recurrent severe infections that have been resistant to treatment with antibiotics. Which disorder should be suspected in this child? Primary immunodeficiency disorder (PID) Acquired immunodeficiency syndrome Hypersensitivity reactions Diabetes
Primary immunodeficiency disorder (PID)
A client with cirrhosis has just received a liver transplant. Tissue rejection can be best prevented by what means? Drug-induced activation of the complement system Suppression of macrophage activity Suppression of CD8+ cytotoxic T cells Suppression of normal neutrophil activity
Suppression of CD8+ cytotoxic T cells
A 2-year-old girl has had repeated ear and upper respiratory infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiologic origin of the child's recurrent infections? The child had a congenital absence of IgG antibodies, which her body is only slowly beginning to produce independently. The child's immune system is unable to synthesize adequate immunoglobulin on its own. The child was born with IgA and IgM antibodies, suggesting intrauterine infection. The child lacks the antigen presenting cells integral to normal B cell antibody production.
The child's immune system is unable to synthesize adequate immunoglobulin on its own.
The treatment prescribed for an autoimmune disorder is primarily dependent upon what? The age and gender of the client The presence of existing chronic disorders and the client's medical history The current manifestations of the disease and the mechanisms that cause the disease process Corticosteroids is always the first line of treatment.
The current manifestations of the disease and the mechanisms that cause the disease process
A college student has just received a positive HIV test result. How can the nurse most accurately interpret and respond to this finding? The student has HIV and may or may not develop AIDS. The student has HIV and will eventually develop AIDS. The student has HIV antigens and further testing should be done. The student has AIDS and psychosocial help should be offered.
The student has HIV antigens and further testing should be done.
The type of hypersensitivity reaction that is mediated by IgG or IgM antibodies directed against target antigens on specific host cell surfaces or tissues is also known as which type of hypersensitivity reaction? Type I Type II Type III Type IV
Type II
What is the length of time from infection with the AIDS virus to seroconversion? Immediately Approximately 1 week Up to 6 months 10 to 12 years
Up to 6 months
What is the most common mode of transmission of HIV? Occupational exposure Mother to newborn via perinatal transmission Vaginal and anal intercourse Blood transfusion Infection from shared needles
Vaginal and anal intercourse
A nursing student is assigned to care for a client who has AIDS. The student is unsure of what personal protective equipment should be worn while caring for this client. Which statement is appropriate direction from the student's nursing instructor? No precautions are needed. Wear gloves, gown, and mask when in contact with the client. Have the client wear a mask when transporting him from one area of the hospital to another. Wear gloves if there is a chance you will come in contact with the client's blood or body fluids.
Wear gloves if there is a chance you will come in contact with the client's blood or body fluids.
A client fears she may have acquired HIV and asks the nurse what test is likely to be used to confirm a diagnosis. The best response would be: ELISA (enzyme-linked immunosorbent assay) OraSure test Western blot assay OraQuick Rapid HIV-1 Antibody Test
Western blot assay
The nurse is caring for a client who has lesions of Kaposi sarcoma (KS). The nurse understands that KS: is a malignancy of the endothelial cells that line small blood vessels. is restricted to lesions of the skin. is an opportunistic infection. is usually extremely painful.
is a malignancy of the endothelial cells that line small blood vessels.
The nurse is reviewing the client's medical record for the results of a Western blot test with the understanding that: the Western blot can have many situations causing false positive results. the Western blot is used to confirm a diagnosis of HIV infection. the Western blot is performed before the ELISA test. the Western blot is a less specific test than the ELISA test.
the Western blot is used to confirm a diagnosis of HIV infection.