Chapter 35: Assessment of Immune Function

b (Neutrophils Explanation: Neutrophils (polymorphonuclear leukocytes [PMNs]) are the first cells to arrive at the site where inflammation occurs. Eosinophils and basophils, other types of granulocytes, increase in number during allergic reactions and stress responses. pg.971)

A 20-year-old male patient cut his hand while replacing a window. While reviewing the complete blood count (CBC) with differential, the nurse would expect which of the following cell types to be elevated first in order to prevent an infection in the patient's hand? a) Monocytes b) Neutrophils c) Eosinophils d) B cells

d (Natural immunity Explanation: Natural immunity, 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. pg.971)

A 25-year-old man receives a knife wound to the leg in a hunting accident. Which of the following types of immunity was compromised? a) Adaptive immunity b) Passive immunity c) Specific immunity d) Natural immunity

b (Interferon Explanation: Interferons are used to treat immune-related disorders (e.g., multiple sclerosis) and chronic inflammatory conditions (e.g., chronic hepatitis). pg.977)

A 34-year-old man is diagnosed with chronic hepatitis C. Testing reveals that he is a candidate for treatment. The nurse anticipates that which of the following could be used to treat his condition? a) Monoclonal antibodies b) Interferon c) Erythropoietin d) Interleukin-5

d (Her use of other drugs Explanation: The nurse needs to review the patient's drug history. This data will help her to assess the patient's susceptibility to illness because certain past illnesses and drugs, such as corticosteroids, suppress the inflammatory and immune responses. The patient's age, home environment, and diet do not have any major implications during her assessment because they do not indicate her susceptibility to illness. pg.982)

A 38-year-old female patient has begun to suffer from rheumatoid arthritis. She is also being assessed for disorders of the immune system. She works as an aide at a facility that cares for children infected with AIDS. Which of the following is the most important factor related to the patient's assessment? a) Her age b) Her home environment c) Her diet d) Her use of other drugs

d (Exposure to foreign antigens may cause altered immune function. Explanation: A history of blood transfusions is obtained because previous exposure to foreign antigens through transfusion may be associated with abnormal immune function. There is only a small risk for HIV transmission from transfusions received after 1985. The risk for exposure to hepatitis B from blood transfusions is extremely small. pg.982)

A nurse is taking health history from a new client, which includes asking about a history of blood transfusions. This is important for which of the following reasons? a) Blood products cause lower antibody titers. b) Blood products cause a high risk for exposure to HIV. c) Blood products cause a high risk for hepatitis B. d) Exposure to foreign antigens may cause altered immune function.

a (Bone marrow suppression Explanation: Antibiotics, when given in large doses, can cause bone marrow suppression. pg.982)

A patient is being treated in the intensive care unit for sepsis related to ventilator-associated pneumonia. The patient is on large doses of three different antibiotics. What severe outcome should the nurse monitor for in the lab studies? a) Bone marrow suppression b) Leukocytosis c) Rash d) Oral thrush

b (IgG Explanation: IgG is 75% of total immunoglobulin. It appears in serum and tissues, assumes a major role in bloodborne and tissue infections and crosses the placenta. pg.975)

At 39 weeks' gestation, a pregnant female, visits her physician for a scheduled prenatal checkup. The physician determines that the fetus has developed an infection in utero and sends the patient for an emergency C section. The patient is very concerned about the health of her unborn child. Based on the knowledge of the immune system, the delivery room nurse explains about which of the following immunoglobulins that will be increased in the fetus at the time of birth and actively fighting the infection? a) IgA b) IgG c) IgM d) IgD

b (Deficiency in circulating lymphocytes Explanation: Renal failure is associated with a deficiency in circulating lymphocytes. Diabetes mellitus is associated with increased incidence of infection. Chemotherapy causes decreased bone marrow function. Leukemia is associated with altered production of white blood cells. pg.981)

Chronic illnesses may contribute to immune system impairment in various ways. Renal failure is associated with which of the following? a) Decreased bone marrow function b) Deficiency in circulating lymphocytes c) Altered production of white blood cells d) Increased incidence of infection

d (Effector T cells Explanation: Effector T cells are killer (cytotoxic) cells. pg.975)

During the immune response, cytotoxic cells bind to invading cells, destroy the targeted invader, and release lymphokines to remove the debris. Which type of T-cell lymphocyte is cytotoxic? a) Suppressor T cells b) Helper T cells c) Regulator T cells d) Effector T cells

a (T-cell and B-cell lymphocytes distinguish harmful substances and ignore those natural and unique to a person. Explanation: T-cell and B-cell lymphocytes are the primary participants in the immune response. They distinguish harmful substances and ignore those natural and unique to a person. Options B, C, and D are incorrect. pg.971)

T-cell and B-cell lymphocytes are the primary participants in the immune response. What do they do? a) T-cell and B-cell lymphocytes distinguish harmful substances and ignore those natural and unique to a person. b) T-cell and B-cell lymphocytes respond to the body's invasion by macrophages. c) T-cell and B-cell lymphocytes react to the body's lack of B12 . d) T-cell and B-cell lymphocytes distinguish harmful treatments from curative treatments.

a (T-cell lymphocytes survey proteins in the body and attack the invading antigens. Explanation: During a cell-mediated response, T-cell lymphocytes survey proteins in the body, actively analyze the surface features, and respond to those that differ from the host by directly attacking the invading antigen. For example, a cell-mediated response occurs when an organ is transplanted. Immunoglobulins hinder the antigens physically by neutralizing their toxins through agglutination or by causing them to precipitate. pg.971)

The anatomy and physiology instructor is explaining a cell-mediated response to the pre-nursing students. What actions would the instructor explain occur in a cell-mediated response? a) T-cell lymphocytes survey proteins in the body and attack the invading antigens. b) Toxins of invading antigens are neutralized. c) The invading antigens precipitate. d) The invading antigens link together (agglutination).

a, c, d (Explanation: Vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, and inflammatory disorders (DiRosa, Malaguarnera, Nicoletti, et al., 2011). pg.980)

The nurse is caring for a patient in the hospital who is receiving a vitamin D supplement. What does the nurse understand is the importance of supplementation with this vitamin? (Select all that apply.) a) Vitamin D deficiency is associated with increased risk of inflammatory disorders. b) Vitamin D deficiency is associated with increased risk of congenital anomalies. c) Vitamin D deficiency is associated with increased risk of common cancers. d) Vitamin D deficiency is associated with increased risk of autoimmune disease. e) Vitamin D deficiency is associated with increased risk of celiac disease.

b (T- and B- cell lymphocytes Explanation: Lymphocytes, which are either T-cell or B-cell lymphocytes, comprise 20% to 30% of all leukocytes. T-cell and B-cell lymphocytes are the primary participants in the immune response. Therefore options A, C, and D are incorrect. pg.969)

What are the primary participants in the immune system? a) Lymphoblasts and gamma globulins b) T- and B- cell lymphocytes c) Macrophages and memory cells d) Stem cells and monocytes

d (Programs T lymphocytes to become regulator or effector T cells. Explanation: 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. pg.971)

What is the function of the thymus gland? a) Produce stem cells b) Programs B lymphocytes to become regulator or effector Bcells. c) Develop the lymphatic system d) Programs T lymphocytes to become regulator or effector T cells.

d (B lymphocytes Explanation: B lymphocytes are involved in the humoral immune response. T lymphocytes are involved in cellular immunity. pg.972)

Which of the following cell types are involved in humoral immunity? a) Memory T lymphocyte b) Helper T lymphocyte c) Suppressor T lymphocyte d) B lymphocytes

b (Anaphylaxis Explanation: A humoral response includes anaphylaxis. Cellular responses include transplant rejection, intracellular infections, and delayed hypersensitivity. pg.973)

Which of the following is a humoral immune response? a) Intracellular infections b) Anaphylaxis c) Transplant rejection d) Delayed hypersensitivity

c (Humoral Explanation: A second protective response, the humoral immune response, begins with the B lymphocytes, which can transform themselves into plasma cells that manufacture antibodies. The first line of defense, the phagocytic immune response, involves the white blood cells (WBCs; granulocytes and macrophages), which have the ability to ingest foreign particles. The third mechanism of defense, the cellular immune response, also involves T lymphocytes, which can turn into special cytotoxic (or killer) T cells that can attack the pathogens. Recognition of antigens as foreign, or nonself, by the immune system is the initiating even in any immune response. pg.972)

Which of the following protective responses begin with the B lymphocytes? a) Recognition b) Phagocytic c) Humoral d) Cellular

a (Response stage Explanation: In the response stage, the differentiated lymphocytes function in either a humoral or a cellular capacity. Recognition of antigens as foreign or non-self, by the immune system is the initiating event in any immune response. In the proliferation stage, the circulating lymphocyte containing the antigenic message returns to the nearest lymph node. In the effector stage, either the antibody of the humoral response of the cytotoxic TA cell of the cellular response reaches and connects with the antigen on the surface of the foreign invader. pg.973)

Which stage of the immune response occurs when the differentiated lymphocytes function in either a humoral or a cellular capacity? a) Response stage b) Recognition stage c) Proliferation stage d) Effector stage

a ("Breast-feeding is beneficial because the dominant antibody IgA in breast milk acts by functioning as an antigen receptor in the mucosal membranes." Explanation: IgA is 15% of total immunoglobulin. It appears in body fluids (blood, saliva, tears, breast milk, and pulmonary, gastrointestinal, prostatic, and vaginal secretions). It protects against respiratory, gastrointestinal, and genitourinary infections and passes to the neonate in breast milk for protection. pg.975)

During a 12-month well-baby visit, a mother reports that the baby has been breast-fed since birth and has never been ill. She is trying to convince her sister who is currently pregnant to breast-feed also and asks the nurse about the benefits of breast-feeding. The nurse explains the immune benefits of breast-feeding and provides the mother with pamphlets. The nurse determines the patient understands the teaching based on which of the following patient statements? a) "Breast-feeding is beneficial because the dominant antibody IgA in breast milk acts by functioning as an antigen receptor in the mucosal membranes." b) "Breast-feeding is beneficial because the dominant antibody IgM in breast milk is the first immunoglobulin produced in response to bacterial and viral infections." c) "Breast-feeding is beneficial because T lymphocytes found in breast milk are primarily responsible for cellular immunity." d) "Breastfeeding is beneficial because the dominant antibody IgG in breast milk assumes a major role in bloodborne and tissue infections."

a (Decreased antibody production Explanation: Age-related changes associated with the immune response include decreased antibody production, suppressed phagocytic immune response, and a failure of immune system to differentiate "self" from "nonself." pg.979)

Which of the following is a age-related change associated with the immune system? a) Decreased antibody production b) Increased antibody production c) Elevated phagocytic immune response d) Ability to differentiate "self" from "nonself"

c, e, f (c) Her work environment e) Her history of immunizations and allergies f) Her use of other drugs Explanation: It is important for the nurse to obtain a history of past immunizations and infectious diseases, any allergies, and any recent exposure to infectious diseases. The nurse also needs to review the client's drug history. These data will help the nurse to assess the client's susceptibility to illness because certain past illnesses and drugs, such as corticosteroids, suppress the inflammatory and immune responses. The nurse should question the client about the practices that put her at risk for AIDS, such as her work environment. The client's age, home environment, and diet do not have any major implications during the assessment because they do not indicate the client's susceptibility to illness. pg.978)

A 38-year old female has recently been diagnosed with rheumatoid arthritis. She is also receiving further testing for disorders of the immune system. She works as an aide at a facility which cares for children infected with AIDS. Which of the following factors will hold the greatest implications during the client's assessment? Select all that apply. a) Her diet b) Her age c) Her work environment d) Her home environment e) Her history of immunizations and allergies f) Her use of other drugs

d (Cyclosporine (Sandimmune) Explanation: After organ transplantation, the client's immune system may attack the new organ's cells because it recognizes them as nonself. Cyclosporine is used to intentionally suppress the immune system. The medications in A, B, and C are all used to suppress inflammation. pg.782)

A client has dilated cardiomyopathy and has just found out he will be receiving a heart. What medication does the client understand that he will have to take for the duration of his life to help suppress the immune system to prevent rejection of the new heart? a) Etanercept (Enbrel) b) Adalimumab (Humira) c) Infliximab (Remicade) d) Cyclosporine (Sandimmune)

a (A cell-mediated response Explanation: A cell-mediated response occurs when T cells survey proteins in the body, actively analyze the surface features, and respond to those that differ from the host by directly attacking the invading antigen. An example of a cell-mediated response is one that occurs when an organ is transplanted. The complement system cooperates with antibodies to attract phagocytes and coat antigens to make them more recognizable for phagocytosis and stimulate inflammation and is not related to the surgery. Colony-stimulating factors prompt the bone marrow to produce, mature, and promote the functions of blood cells. Naturally acquired active immunity is a direct result of infection by a specific microorganism. pg.971)

A client has had a kidney transplant performed for end-stage kidney disease. What type of immune response that T-cell lymphocytes perform is related to this type of surgery? a) A cell-mediated response b) Naturally acquired active immunity c) Activation of the complement system d) Stimulation of colony-stimulating factors

c (Digestive enzymes destroy its protein structure. Explanation: Interferon is administered parenterally because digestive enzymes destroy its protein structure. The medicine does not have an oral preparation. pg.1014)

A client who is being treated for complications related to acquired immunodeficiency disorder syndrome (AIDS) is receiving interferon parenterally as adjunctive therapy. Why does the nurse understand this route is being used? a) The taste of the medication is not palatable. b) The medication, given orally, will cause diarrhea. c) Digestive enzymes destroy its protein structure. d) The medication will work more rapidly parenterally.

a (Passive immunity transferred by the mother Explanation: Passive immunity develops when ready-made antibodies are given to a susceptible person. The antibodies provide immediate but short-lived protection from the invading antigen. Newborns receive passive immunity to some diseases for which their mothers have manufactured antibodies. Naturally acquired active immunity occurs as a direct result of infection by a specific micro organism. An example is the immunity to measles that develops after the initial infection. Not all invading microorganisms produce a response that gives lifelong immunity. Artificially acquired immunity is obtained by receiving a killed or weakened microorganism or toxoid. pg.972)

A laboring mother asks the nurse if the baby will have immunity to some illnesses when born. What type of immunity does the nurse understand that the newborn will have? a) Passive immunity transferred by the mother b) Artificially acquired active immunity c) Naturally acquired active immunity d) There is no immunity passed down from mother to child.

d (Active acquired immunity, which lasts many years or a lifetime Explanation: Active acquired immunity refers to immunologic defenses developed by the person's own body. This mmunity 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. pg.972)

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) Active acquired immunity, which is temporary b) Passive acquired immunity, which is temporary c) Passive acquired immunity, which lasts many years or a lifetime d) Active acquired immunity, which lasts many years or a lifetime

b (Through the mucous membranes of the throat Explanation: In a streptococcal throat infection, the streptococcal organism gains access to the mucous membranes of the throat. pg.973)

A patient arrives at the clinic and informs the nurse that she has a very sore throat as well as a fever. A rapid strep test returns a positive result and the patient is given a prescription for an antibiotic. How did the streptococcal organism gain access to the patient to cause this infection? a) Breathing in airborne dust b) Through the mucous membranes of the throat c) Through the skin d) From being outside in the cold weather and decreasing resistance

d (Assure the patient that this is a normal reaction Explanation: The nurse should assure the patient that this is a normal reaction. When disease-specific antigens are injected, the injection area swells as a result of the patient developing antibodies against the antigen that is introduced. The nurse should also keep in mind that the patient is not necessarily actively infectious if the test results are positive. Rubbing the area gently or even applying ice packs may only aggravate the swelling. The swollen area should be left open to heal by itself. The nurse should await the physician's instructions before advising the patient to use any prescribed analgesics. pg.984)

A patient undergoing a skin test has been intradermally injected with a disease-specific antigen on the inner forearm. The patient becomes anxious because the area begins to swell. Which of the following may be used to decrease anxiety in this patient? a) Advise the patient to use prescribed analgesics b) Apply ice packs to reduce the swelling c) Gently rub the swollen area to accelerate the blood flow d) Assure the patient that this is a normal reaction

c (Engulfment and digestion of bacteria and foreign material Explanation: Phagocytosis is the process of engulfing and digesting bacteria and foreign materials. It does not involve the release of chemicals or conversion of memory cells to plasma cells. The macrophages in the spleen remove bacteria and dead blood cells from circulation. pg.972)

A school nurse is talking about infection with a high school health class. What would be the nurse's best explanation of the process of phagocytosis? a) Removal of bacteria and dead blood cells from circulation b) Release of chemicals to destroy bacteria and foreign material c) Engulfment and digestion of bacteria and foreign material d) Conversion of memory cells to plasma cells

b, d, e (Explanation: Large tumors can release antigens into the blood, and these antigens combine with circulating antibodies and prevent them from attacking the tumor cells. Furthermore, tumor cells may possess special blocking factors that coat tumor cells and prevent their destruction by killer T lymphocytes. During the early development of tumors, the body may fail to recognize the tumor antigens as foreign and subsequently fail to initiate destruction of the malignant cells. The incidence of autoimmune diseases also increases with age, possibly from a decreased ability of antibodies to differentiate between self and nonself. Failure of the surveillance system to recognize mutant or abnormal cells also may be responsible, in part, for the high incidence of cancer associated with increasing age. Vitamin D deficiency has been associated with increased risk of common cancers. There is evidence that nutrition plays a role in the development of cancer and that diet and lifestyle can alter the risk of cancer development as well as other chronic diseases. pg.978)

During an annual examination, an older patient tells the nurse, "I don't understand why I need to have so many cancer screening tests now. I feel just fine!" Based on the knowledge of neoplastic disease and the aging immune system, what teaching should the nurse include in the patient's plan of care? Select all that apply. a) The immune system is integrated with other psychophysiologic processes and is regulated by the brain. Aging of the brain can have immunologic consequences and can affect neural and endocrine function increasing the risk of cancer development. b) Tumor cells may possess special blocking factors that coat tumor cells and prevent their destruction by killer T lymphocytes; therefore, the body may not recognize the tumor as foreign and fail to destroy the malignant cells. Routine screening increases the chance of finding and treating cancer early. c) Education about the importance of adhering to a recommended vaccine schedule should be initiated to boost the immune system function. d) Nutritional intake to support a competent immune response plays an important role in reducing the incidence of cancer. A healthy diet including protein, vitamins, minerals, and some fats can alter the risk of cancer development. e) The increase in occurrence of autoimmune diseases due to aging strongly suggests a predisposition to various types of cancer due to the body's inability to differentiate between self and nonself. Routine screening increases the chance of finding and treating cancer early.

d (Interferons Explanation: Interferons are chemicals that primarily protect cells from viral invasion. They enable cells to resist viral infection and slow viral replication. They have been used as adjunctive therapy in the treatment of AIDS. Interferons also have been used to treat some forms of cancer such as leukemia because they stimulate NK cell activity. Interferon is administered parenterally because digestive enzymes destroy its protein structure. Interferons are chemicals that primarily protect cells from viral invasion. They enable cells to resist viral infection and slow viral replication. pg.976)

The body has several mechanisms to fight disease, one of which is sending chemical messengers. Specifically, the messengers released by lymphocytes, monocytes, and macrophages have differing roles in the immune response. Which messenger enables cells to resist viral replication and slow viral replication? a) Colony-stimulating factor b) Tumor necrosis factor c) Interleukins d) Interferons

c (Older adult patients develop depression and suicidal tendencies when they are faced with chronic illness. Explanation: The effects of the aging process and psychological stress interact, with the potential to negatively influence immune integrity (Masoro & Austad, 2011). Consequently, continual assessment of the physical and emotional status of older adults is imperative, because early recognition and management of factors influencing immune response may prevent or mitigate the high morbidity and mortality seen with illness in the older adult population (Brunner et al., 2011; Swain & Nikolich-Zugich, 2009). pg.980)

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) Older adult patients develop depression and suicidal tendencies when they are faced with chronic illness. d) Early recognition and management of factors influencing immune response may decrease morbidity and mortality.

d (Lymph node Explanation: The lymph nodes remove foreign material from the lymph system before it enters the bloodstream. They are centers for immune cell proliferation. pg.970)

Which of the following is a center for immune cell proliferation? a) Liver b) Spleen c) Pancreas d) Lymph node

c (Opsonization Explanation: In the process of opsonization, the antigen-antibody molecule is coated with a sticky substance that also facilitates phagocytosis. Apoptosis is programmed cell death that results from the digestion of DNA by endonucleases. Agglutination is the clumping effect occurring when an antibody acts as a cross-link between two antigens. Immunoregulation is a complex system of checks and balances that regulates or controls immune responses. pg.974)

Which of the following is a process in which the antigen-antibody molecule is coated with a sticky substance that facilitates phagocytosis? a) Immunoregulation b) Agglutination c) Opsonization d) Apoptosis

a (Use of anti-rejection drugs Explanation: Clients who receive a kidney transplant must take immunosuppressant drugs to prevent rejection of the transplant. These drugs cause a compromised immune system. Renal transplant is not associated with excess lymphocytes, deficient circulating antibodies, or excess hemoglobin.)

A client has undergone a kidney transplant. The nurse is concerned about a compromised immune system in this client for which of the following reasons? a) Use of anti-rejection drugs b) Deficient circulating antibodies c) Excess circulating lymphocytes d) Excess circulating hemoglobin

d (The immune system recognizes one's own tissues as "foreign." Explanation: The immune system's recognition of one's own tissues as "foreign" rather than self is the basis of many autoimmune disorders, including multiple scelrosis. When regulatory mechanisms fail to halt the immune response or excess cytokines are produced, pathology occurs (eg, allergies, hypersensitivity). pg.970)

A nurse is caring for a client with multiple sclerosis. Client education about the disease process includes which of the following explanations about the cause of the disorder? a) Regulatory mechanisms fail to halt the immune response. b) The immune system recognizes one's own tissues as "self." c) Excess cytokines cause tissue damage. d) The immune system recognizes one's own tissues as "foreign."

b (Assess for ataxia using the finger-to-nose test and heel-to-shin test Explanation: Ataxia should be assessed when suspecting immune dysfunction in the neurosensory system. pg.979)

A patient comes into the emergency department with complaints of difficulty walking and loss of muscle control in the arms. As the nurse begins the physical examination, which of the following assessment should be completed if an immune dysfunction in the neurosensory system is suspected? a) Assess for hepatosplenomegaly by measuring abdominal girth b) Assess for ataxia using the finger-to-nose test and heel-to-shin test c) Review the urinalysis report for hematuria d) Assess joint mobility using passive range of motion.

d (Cytotoxic T cells Explanation: Cytotoxic T cells (killer T cells) attack the antigen directly by altering the cell membrane and causing cell lysis (disintegration) and by releasing cytolytic enzymes and cytokines. Lymphokines can recruit, activate, and regulate other lymphocytes and white blood cells (WBCs). These cells then assist in destroying the invading organism. pg.976)

An experiment is designed to determine specific cell types involved in cell-mediated immune response. The experimenter is interested in finding cells that attack the antigen directly by altering the cell membrane and causing cell lysis. Which cells should be isolated? a) B cells b) Helper T cells c) Macrophages d) Cytotoxic T cells

C (Interferons. Explanation: Interferons are biologic response modifiers with nonspecific viricidal proteins. Antibodies are protein substances developed by the body in response to and interacting with a specific foreign substance. Antigens are substances that induce formation of antibodies. Complement refers to a series of enzymatic proteins in the serum that, when activated, destroy bacteria and other cells. pg.977)

Proteins formed when cells are exposed to viral or foreign agents that are capable of activating other components of the immune system are referred to as a) antigens. b) interferons. c) antibodies. d) complements.

a (Fighting infection Explanation: Helper T cells are especially important in fighting infection. They recognize antigens, which are protein markers on cells, and form additional T-cell clones that stimulate B-cell lymphocytes to produce antibodies against foreign antigens. Helper T cells do not produce antibodies, activate lymphokines, or turn off the immune response. pg.976)

T-cells can be either regulator T cells or effector T cells. Regulator T cells are made up of helper and suppressor cells. What function are helper T-cells important in? a) Fighting infection b) Activating lymphokines c) Producing antibodies d) Turning off the immune response

c (Decreased renal function Explanation: Decreased renal circulation, filtration, absorption, and excretion contribute to the risk for urinary tract infections. The antibody production decreases, skin become thinner, and the incidence of autoimmune disease increases with age. pg.979)

Which of the following is associated with impaired immunity in the aging patient? a) Incidence of autoimmune disease decreases with age b) Skin becomes thicker c) Decreased renal function d) Increased antibody production

a (IgG Explanation: IgG assumes a major role in blood-borne and tissue infections. IgA protects against respiratory, GI, and genitourinary infections. IgM appears as the first immunoglobulin produced in response to bacterial and viral infections. IgD possibly influences B-lymphocyte differentiation. pg.975)

Which of the following immunoglobulins assumes a major role in blood-borne and tissue infections? a) IgG b) IgA c) IgM d) IgD

a (Natural killer cells Explanation: NK cells are a class of lymphocytes that recognize infected and stressed cells and respond by killing these cells and by secreting macrophage-activating cytokine. Natural killer cells defend against microorganisms and some type of malignant cells. pg.976)

Which type of cells is capable of recognizing and killing infected or stressed cells and producing cytokines? a) Natural killer cells b) Null lymphocytes c) Cytotoxic T cells d) Memory cells

a (Estrogen tends to enhance immunity. Explanation: Autoimmune disorders tend to be more common in women because estrogen tends to enhance immunity. Androgen, on the other hand, tends to be immunosuppressive. pg.980)

The nurse is caring for a female patient who has an exacerbation of lupus erythematosus. What does the nurse understand is the reason that females tend to develop autoimmune disorders more frequently than men? a) Estrogen tends to enhance immunity. b) Testosterone tends to enhance immunity. c) Leukocytes are increased in females. d) Androgen tends to enhance immunity.

a ("Have you ever received a blood transfusion?" Explanation: A history of blood transfusions is obtained, because previous exposure to foreign antigens through transfusion may be associated with abnormal immune function. pg.982)

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 received a blood transfusion?" b) "When was your last menstrual period?" c) "Do you have abdominal pain or discomfort?" d) "Have you ever been treated for a sexually transmitted infection?"

c (Breakdown and thinning of the skin Explanation: The aging process stimulates changes in the immune system. Age-related changes in many body systems also contribute to impaired immunity. Changes such as poor circulation, as well as the breakdown of natural mechanical barriers such as the skin, place the aging immune system at even greater disadvantage against infection. As the immune system undergoes age-associated alterations, its response to infections progressively deteriorates. There is a decline in humoral immunity and inflammatory cytokines increase with age. pg.978)

Which of the following is associated with impaired immunity relating to the aging patient? a) Increase in humoral immunity b) Decrease in inflammatory cytokines c) Breakdown and thinning of the skin d) Increase in peripheral circulation

c ("White blood cells are produced in the bone marrow." Explanation: White blood cells (leukocytes) are produced in the bone marrow. They are not produced in the plasma, thymus gland, or the lymphatic tissue. pg.970)

A client is informed that his white blood cell count is low and that he is at risk for the development of infections. The client asks, "Where do I make new white blood cells?" What is the best response by the nurse? a) "White blood cells are produced in the lymphatic tissue." b) "White blood cells are produced in the plasma." c) "White blood cells are produced in the bone marrow." d) "White blood cells are produced in the thymus gland."

c (Educating the patient about the diagnostic procedures and answer questions they may have about the possible diagnosis Explanation: It is the nurse's role to counsel, educate, and support patients throughout the diagnostic process. Many patients may be extremely anxious about the results of diagnostic tests and the possible implications of those results for their employment, insurance, and personal relationships. This is an ideal time for the nurse to provide counseling and education. pg.984)

A nurse is caring for a patient undergoing evaluation for possible immune system disorders. Which of the following interventions will best help support the patient throughout the diagnostic process? a) Assisting the patient with the scheduling of the procedures b) Encouraging the patient to ask their physician for information about the treatment options for the possible diagnosis c) Educating the patient about the diagnostic procedures and answer questions they may have about the possible diagnosis d) Accompanying the patient to the diagnostic tests

c ("Motrin can cause neutropenia, which can increase my risk of infection." Explanation: Motrin causes leukopenia and neutropenia. pg.56)

A nurse is teaching a patient about the side effects of ibuprofen (Motrin). The patient's teaching is determined to be effective based on which of the following patient statements explaining the drugs effect on the immune system? a) "Motrin can cause hemolytic anemia, which will make me feel tired and short of breath." b) "Motrin can cause pancytopenia, which is a decrease in all of my blood cells." c) "Motrin can cause neutropenia, which can increase my risk of infection." d) "Motrin can cause thrombocytopenia; I will need to watch for bruising and bleeding."

c (Natural killer cells Explanation: Natural killer cells defend against microorganisms and some type of malignant cells. Memory cells are responsible for recognizing antigens from previous exposure and mounting an immune response.Cytotoxic T cells attack the antigen directly by altering the cell membrane and causing cell lysis and by releasing cytolytic enzymes and cytokines. pg.976)

Which type of cells is capable of directly killing invading organisms and producing cytokines? a) Null lymphocytes b) Cytotoxic T cells c) Natural killer cells d) Memory cells

a (Antimetabolites Explanation: Antimetabolites can cause leukopenia, eosinoplilia, aplastic bone marrow, and pancytopenia. The other choices do not directly affect the immune system.)

While taking the health history of a newly admitted client, the nurse asks for a list of the client's current medications. Which of the following medication classifications would place the client at risk for impaired immune function? a) Antimetabolites b) Inotropics c) Antihypertensives d) Pancreatic enzymes

a (Biofeedback, relaxation, and hypnosis Explanation: Growing evidence indicates that strategies such as relaxation, imagery techniques, biofeedback, humor, hypnosis, and conditioning can positively influence a measurable immune system response. Intense or rigorous comptitive exercise can cause negative effects on the immune system, especially if the environment is stressful while undergoing exercise. pg.983)

While taking the health history of a newly admitted client, the nurse reviews general lifestyle behaviors. Which of the following would have a positive effect on the immune system? a) Biofeedback, relaxation, and hypnosis b) Relaxation, intense competitive exercise, and humor c) Humor, rigorous physical stress, and biofeedback d) Hypnosis, humor, and chronic illness

a (Protein electrophoresis Explanation: When an immune system disorder is suspected, protein electrophoresis screens for diseases associated with a deficiency or excess of immuneglobulins may be ordered. Options B, C, and D are incorrect tests to diagnose a deficiency or excess of immuneglobulins. pg.984)

You are caring for a client with a suspected immune system disorder. What test would be ordered if a deficiency or excess of immuneglobulins was suspected? a) Protein electrophoresis b) Plasmapheresis c) T-cell and B-cell assays d) Enzyme-linked immunosorbent assay

d (Obtain a written consent from the client. Explanation: It is important that the nurse obtain written consent from the client before performing an HIV test and keep the results of HIV test confidential. The nurse may not ask the client to avoid excess fluid intake or abstain from intercourse before the tests. The client also need not take off ornaments and metallic objects worn unless they are likely to interfere with the test results. pg.1005)

You are the clinic nurse caring for a client with a suspected diagnosis of HIV. You are preparing to draw blood for a confirmatory diagnostic test on this client. What is the most important action that the nurse should perform before testing a client for HIV? a) Advise the client to take off any ornaments and metallic objects. b) Advise the client to avoid excess fluid intake. c) Advise the client to abstain from having intercourse. d) Obtain a written consent from the client.

a (Neutrophils and monocytes Explanation: Neutrophils and monocytes are phagocytes, cells that perform phagocytosis. pg.971)

A nursing instructor is giving a lecture on the immune system. Which of the following cells will the instructor include in her discussion on phagocytosis? a) Neutrophils and monocytes b) Regulator T cells and Helper T cells c) Lymphokines and Suppressor T cells d) Plasma cells and memory cells

c (Inotropics Explanation: Antimetabolites, antineoplastic agents, and adrnal corticosteroids all can cause immunosuppression. Inotropics do not directly affect the immune system.)

A nurse is taking the health history of a newly admitted client and asks for a list of the client's current medications. Which of the following medication classifications would NOT place the client at risk for impaired immune function? a) Antineoplastic agents b) Antimetabolites c) Inotropics d) Adrenal corticosteroids

a (They are lymphoid tissues that filter bacteria from tissue fluid. Explanation: The tonsils and adenoids filter bacteria from tissue fluid. Because they are exposed to pathogens in the oral and nasal passages, they can become infected and locally inflamed. The tonsils and adenoids filter bacteria from tissue fluid. pg.970)

Decades ago, a typical childhood surgery, after repeated bouts with tonsillitis, was to have a tonsillectomy and adenoidectomy. That was before the role of the tonsils and adenoids were better understood. As it is understood today, what are the roles of the tonsils and adenoids? a) They are lymphoid tissues that filter bacteria from tissue fluid. b) They are lymphoid tissues that increase the efficacy of antibiotics. c) They are lymphoid tissues that program T lymphocytes. d) They are lymphoid tissues that eliminate cancer cells.

b (Antigens Explanation: Antigens, which are protein markers on cells, are substance capable of inducing a specific immune response and of reacting with the products of that response. pg.972)

The immune system is a complicated and intricate system that contains specialized cells and tissues that protect us from external invaders and our own altered cells. Which of the following is the term used to define any substance capable of inducing a specific immune response and of reacting with the products of that response? a) Antibodies b) Antigens c) Lymphocytes d) Lymphokines

a (They are activated on recognition of antigens and stimulate the rest of the immune system. Explanation: Helper T cells are activated on recognition of antigens and stimulate the rest of the immune system. pg.975)

The nursing instructor is discussing the development of human immunodeficiency disease (HIV) with the students. What should 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 have the ability to decrease B-cell production. c) They are responsible for recognizing antigens from previous exposure and mounting an immune response. d) They attack the antigen directly by altering the cell membrane and causing cell lysis.

b (Spleen Explanation: 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. pg.971)

What organ is considered lymphoid tissue? a) Pancreas b) Spleen c) Intestines d) Liver

d (Lyse cells infected with virus Explanation: Cytotoxic T cells play a role in graft rejection. B cells are lymphocytes important in producing circulating antibodies. Suppressor T cells are lymphocytes that decrease B-cell activity to a level at which the immune system is compatible with life. Helper T cells are lymphocytes that attack antigens directly. pg.972)

Which of the following is an action of cytotoxic T cells? a) Decrease B cell activity to a level at which the immune system is compatible with life b) Attack of foreign invaders (antigens) directly c) Production of circulating antibodies d) Lyse cells infected with virus

d (Nonsteroidal anti-inflammatory drugs (NSAIDs) in large doses Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) (in large doses) inhibit prostaglandin synthesis or release. NSAIDs include aspirin and ibuprofen. Antibiotics in large doses are known to cause bone marrow suppression. Adrenal corticosteroids and antineoplastic agents are known to cause immunosuppression. pg.982)

Which of the following medication classifications are known to inhibit prostaglandin synthesis or release? a) Antibiotics in large doses b) Antineoplastic agents c) Adrenal corticosteroids d) Nonsteroidal anti-inflammatory drugs (NSAIDs) in large doses

c (Transplant rejection Explanation: Most immune responses to antigens involve both humoral and cellular responses, although one usually predominates. For example, during transplant rejection, the cellular response involving T cells predominates, whereas in the bacterial pneumonias and sepsis, the humoral response involving B cells plays the dominant protective role. Transplant rejection and graft-versus-host disease are cellular response roles of T cells. Anaphylaxis is a humoral response role of B-lymphocytes. Allergic hay fever and asthma are humoral response roles of B-lymphocytes. Bacterial phagocytosis and lysis are humoral response roles of B-lymphocytes. pg.973)

Which of the following responses identifies a role of T lymphocytes? a) Bacterial phagocytosis and lysis b) Allergic hay fever and asthma c) Transplant rejection d) Anaphylaxis

b (Null Explanation: Null cells destroy antigens already coated with antibody. NK cells defend against microorganisms and some types of malignant cells. Memory T cells remember contact with an antigen and, on subsequent exposures, mount an immune response. Suppressor T-cells suppress the immune response. pg.976)

Which type of cells destroys antigens already coated with antibody? a) Suppressor T-cell b) Null c) Memory T-cell d) Natural killer (NK)

d (Naturally acquired active immunity Explanation: 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), whereas passive immunity develops when ready-made antibodies are given to a susceptible client. pg.972)

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 active immunity c) Artificially acquired passive immunity d) Naturally acquired active immunity

c (The client's immune system cannot mount a response to the skin test. Explanation: The inflammatory response is a major function of the immune system that is elicited in response to invading foreign material. A person with AIDS has a poorly functioning or non-functioning immune system that will not respond to the injected skin test. Any TB organisms should cause a reaction to the skin test in people with intact immune systems. The nurse cannot accurately speculate on how the skin test was performed or that the solution was outdated. pg.984)

A client has been diagnosed with AIDS and tuberculosis (TB). A nursing student asks the nurse why the client's skin test for TB is negative if the client's physician has diagnosed TB. The nurse's correct reply is which of the following? a) The client has only mild TB, which is not enough to cause a reaction. b) The solution used for the skin test was probably outdated. c) The client's immune system cannot mount a response to the skin test. d) The skin test was improperly performed.

b (IgE Explanation: IgE promotes the release of vasoactive chemicals such as histamine and bradykinin in allergic, hypersensitivity, and inflammatory reaction. IgG neutralizes bacterial toxins and accelerates phagocytosis. IgA interferes with the entry of pathogens through exposed structures or pathways. IgM agglutinates antigens and lyses cell walls. pg.975)

What type of immunoglobulin does the nurse recognize that promotes the release of vasoa ctive chemicals such as histamine when a client is having an allergic reaction? a) IgM b) IgE c) IgA d) IgG

d (Naturally acquired active immunity Explanation: Naturally acquired active immunity occurs as a direct result of an infection by a specific microorganism. pg.971)

Which of the following immunity types becomes active as a result of infection by a specific microorganism? a) Artificially acquired passive immunity b) Artificially acquired active immunity c) Naturally acquired passive immunity d) Naturally acquired active immunity

a, d, e (Explanation: 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 a nonspecific immunity present at birth that provides protection against an infectious agent without ever encountering it before. pg.972)

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

a (Corticosteroids Explanation: The nurse obtains a history of immunizations, recent and past infectious diseases, and recent exposure to infectious diseases. He or she reviews the client's drug history because certain drugs, such as corticosteroids, suppress the inflammatory and immune responses. Advil is a nonsteroidal anti-inflammatory medication and does not suppress the inflammatory and immune responses. An ACE-I prevents the conversion of angiotensin I to angiotensin II and does not suppress the inflammatory or immune response. Diuretics also do not suppress the immune response but help reduce excess fluid from the kidneys. pg.1502)

The nurse is obtaining information from a client with Crohn's disease about his medication history. What medication would the nurse include when asking about what medications the client has taken for suppression of the inflammatory and immune response? a) Corticosteroids b) Ibuprofen (Advil) c) Diuretics d) Angiotensin-converting enzyme inhibitors (ACE-I)

c (The male client because of his age Explanation: Vaccines are less effective in an older adult than in a younger adult because the activity of the immune system declines with the aging process. The lifestyle or gender of the client does not have great implications on the effectiveness of a vaccine. pg.978)

A 64-year-old male client, who leads a sedentary lifestyle, and a 31-year-old female client, who has a very stressful and active lifestyle, require a vaccine against a particular viral disorder. As the nurse, you would know that in one of these clients, the vaccine will be less effective. In which client is the vaccine more likely to be less effective and why? a) The female client because of her age b) The male client because of his lifestyle c) The male client because of his age d) The female client because of her lifestyle

c (The nurse ensures a written consent is obtained prior to testing. Explanation: The nurse ensures that a written consent is obtained before testing for human immunodeficiency virus (HIV) and keeps the results of HIV testing confidential. The client should never be tested without his knowledge. The physician will review the results when the client comes in for a follow-up visit. It is not necessary for the nurse to report results to the CDC. pg.1005)

A client is treated in the clinic for a sexually transmitted infection, and the nurse suspects that the client is at risk for HIV. The physician determines that the client should be tested for the virus. What responsibility does the nurse have? a) The nurse will call the client with the results of the test. b) The nurse will inform the client that the results will have to be reported to the Centers for Disease Control and Prevention (CDC). c) The nurse ensures a written consent is obtained prior to testing. d) The nurse should send the client to have the blood drawn without informing him about the specific screening test.

c (Screening for tuberculosis Explanation: Before prescribing a TNF inhibitor, clients should be screened for tuberculosis because there is a risk for activating latent tuberculosis. It is not necessary to screen for peptic ulcer disease, syphilis, or rubella prior to beginning TNF inhibitor therapy. pg.1061)

A client will be taking the tumor necrosis factor inhibitor, infliximab (Remicade), for the treatment of rheumatoid arthritis. Prior to beginning this therapeutic regimen, what screening should the client have? a) Screening for syphilis b) Screening for peptic ulcer disease c) Screening for tuberculosis d) Screening for rubella

b (Serum, which depletes the body's store of immunoglobulins Explanation: Major burns cause impaired skin integrity and compromise the body's first line of defense. Loss of large amounts of serum occurs with burn injuries and depletes the body of essential proteins, including immunoglobulins. Loss of serum or plasma does not deplete the body of catecholamines (adrenal gland), calcitonin (thyroid gland), or glucagon (pancreas). pg.982)

The nurse is caring for a client recovering from a major burn. Burns affect the immune system by causing a loss of large amounts of which of the following? a) Plasma, which depletes the body's store of catecholamines b) Serum, which depletes the body's store of immunoglobulins c) Plasma, which depletes the body's store of calcitonin d) Serum, which depletes the body's store of glucagon

a, c, d, e (Explanation: 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. Joints are assessed for tenderness, swelling, increased warmth, and limited range of motion. pg.983)

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) Size b) Temperature c) Consistency d) Reports of tenderness e) Location

b (Natural killer cells Explanation: Natural killer cells are lymphocyte-like cells that circulate throughout the body looking for virus-infected cells and cancer cells. Cytokines are chemical messengers released by lymphocytes, monocytes, and macrophages. Interleukins carry messages between leukocytes and tissues that form blood cells. Interferons are chemicals that primarily protect cells from viral infections. pg.969)

The nurse understands that which cells circulate throughout the body looking for virus-infected cells and cancer cells? a) Interferons b) Natural killer cells c) Cytokines d) Interleukins

c (Lymphoid tissues Explanation: 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. pg.970)

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) Red blood cells b) Stem cells c) Lymphoid tissues d) Cytokines

a (A 65-year-old client who had chicken pox when he was 12 years old Explanation: Half of individuals living to age 65 years have had or will develop shingles and may not understand the potential seriousness and risk for complications. Nurses as client advocates should determine and provide health information regarding the shingles vaccine. The other clients are not candidates for the vaccine. pg.1779)

The nurse is instructing client's about the importance of taking the shingles vaccine. Which client would benefit from this vaccine? a) A 65-year-old client who had chicken pox when he was 12 years old b) A 32-year-old client who has never had chickenpox c) A 24-year-old client who is pregnant d) A 17-year-old client who will be attending college and living in a dormitory

a (The normal protective immune response attacks the body, damaging tissues. Explanation: 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. An exaggerated immune response describes a hypersensitivity. An overproduction of immunoglobulins is the definition of gammopathies.)

The nurse is teaching a client who has been diagnosed with Hashimoto's thyroiditis. Which of the following statements correctly describes the process of autoimmunity? a) The normal protective immune response attacks the body, damaging tissues. b) The body overproduces immunoglobulins. c) The body produces inappropriate or exaggerated responses to specific antigens. d) A deficiency results from improper development of immune cells or tissues.

c (Consult drug references to make sure the medicines do not contain substances which the client is hypersensitive. Explanation: Clear identification of any substances to which the client is allergic is essential. The nurse must consult drug references to verify that prescribed medications do not contain substances to which the client is hypersensitive. Administering the medications or giving one at a time may cause the client to have an allergic reaction. The nurse may call the pharmacy but still maintains responsibility for the medications administered. pg.978)

A client is admitted to the hospital with a diagnosis of pneumonia. The client informs the nurse that he has several drug allergies. The physician has ordered an antibiotic as well as several other medications for cough and fever. What should the nurse do prior to administering the medications? a) Administer the medications that the physician ordered. b) Call the pharmacy and let them know the client has several drug allergies. c) Consult drug references to make sure the medicines do not contain substances which the client is hypersensitive. d) Give the client one medicine at a time and observe for allergic reactions.

c (Failure of lymphocytes to recognize mutant cells Explanation: Failure of lymphocytes to recognize mutant or abnormal cells contributes to an increased incidence of cancers in the elderly. Impaired ciliary action due to exposure to smoke and environmental toxins contributes to impaired clearance of pulmonary secretions and an increased incidence of respiratory infections in the elderly. Failure of immune system to differentiate "self" from "non-self" leads to an increase incidence of autoimmune diseases. Decreased sensation and slowing of reflexes leads to increased risk of skin injury, skin ulcers, abrasions, burns, and other trauma. pg.979)

An elderly client is diagnosed with cancer. While reviewing age-related changes in the immune system, the nurse identifies which of the following as having contributed to this client's condition? a) Impaired ciliary action from exposure to environmental toxins b) Decreased sensation and slowing of reflexes c) Failure of lymphocytes to recognize mutant cells d) Failure of immune system to differentiate "self" from "non-self"

b (Matt will be susceptible to infection because the spleen removes bacteria from the blood. Explanation: One function of the spleen is to remove bacteria from circulation; therefore, Matt will be more susceptible to infection. pg.971)

Matt Carson, a 20-year-old college student, was riding his motorcycle home from class when he lost control of the bike and sustained serious internal injuries, including a ruptured spleen. Matt has been taken to the OR to remove his spleen and the ED nurse is meeting with Matt's parents to answer some of their additional questions. Which of the following will be included in the nurse's discussion regarding special considerations following the removal of Matt's spleen? a) Matt will be susceptible to bleeding because the spleen synthesizes vitamin K. b) Matt will be susceptible to infection because the spleen removes bacteria from the blood. c) Matt will be susceptible to anemia because the spleen produces red blood cells. d) Matt will be susceptible to acidosis because the spleen maintains acid-base balance.

b ("Does anyone in your family have more than one autoimmune disease?" Explanation: The patient is asked about any autoimmune disorders, such as lupus erythematosus, rheumatoid arthritis, multiple sclerosis, or psoriasis. The onset, severity, remissions and exacerbations, functional limitations, treatments that the patient has received or is currently receiving, and effectiveness of the treatments are described. The occurrence of different autoimmune diseases within a family strongly suggests a genetic predisposition to more than one autoimmune disease (Brooks, 2010) (Chart 35-4). pg.981)

The nurse is obtaining a history from a patient with severe psoriasis. What question would be the most important to ask this patient to determine a genetic predisposition? a) "How did you know you developed this disease?" b) "Does anyone in your family have more than one autoimmune disease?" c) "How many children do you have?" d) "Does your spouse or significant other have an autoimmune disease?"

d (To determine if the client has practices that put him at risk for acquired immunodeficiency syndrome (AIDS) Explanation: The nurse investigates the client's allergy history and questions the client about practices that put him or her at risk for AIDS. The interview will not determine the client's ability to be compliant. The physician would make the determination if a counseling referral should be made. It is irrelevant to determine the personality traits in the initial interview. pg.1016)

Why would it be important for the nurse to question the client about sexual practices, history of substance abuse, and his lifestyle during the interview process? a) To determine if the client needs a referral to counseling services b) To determine what type of personality the client has c) To find out if the client will be compliant with therapeutic treatments d) To determine if the client has practices that put him at risk for acquired immunodeficiency syndrome (AIDS)

a, c, d (Explanation: Nutritional intake that supports a competent immune response plays an important role in reducing the incidence of infections; patients whose nutritional status is compromised have a delayed postoperative recovery and often experience more severe infections and delayed wound healing. The nurse must assess the patient's nutritional status, caloric intake, and quality of foods ingested. pg.980)

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

b (Respiratory or urinary system infections Explanation: When taking drugs to suppress the immune system, the patient is vulnerable to an increased risk of infection, especially in the respiratory or urinary systems. Depression, memory impairment, and coma are dose-related effects of the cytokines, a biologic response modifier. Heart failure, infusion reactions, and life-threatening infections are the possible adverse effects of taking infliximab, which minimizes inflammation. In addition, cytokines and infliximab are not immunosuppressive drugs. Moreover, immunosuppressive drugs are not known to cause rheumatoid arthritis. pg.982)

Which of the following adverse effects should the nurse closely monitor in a patient who takes immunosuppressive drugs? a) Depression, memory impairment, and coma b) Respiratory or urinary system infections c) Heart failure, infusion reactions, and life-threatening infections d) Rheumatoid arthritis

a (Lymphocyte Explanation: The lymphocyte provides humoral immunity — recognition of a foreign antigen and formation of memory cells against the antigen. Humoral immunity is mediated by B and T lymphocytes and can be acquired actively or passively. The neutrophil is crucial to phagocytosis. The basophil plays an important role in the release of inflammatory mediators. The monocyte functions in phagocytosis and monokine production. pg.973)

A client is diagnosed with human immunodeficiency virus (HIV). After recovering from the initial shock of the diagnosis, the client expresses a desire to learn as much as possible about HIV and acquired immunodeficiency syndrome (AIDS). When teaching the client about the immune system, the nurse states that humoral immunity is provided by which type of white blood cell? a) Lymphocyte b) Monocyte c) Basophil d) Neutrophil

c (Impaired ciliary action from exposure to environmental toxins Explanation: Impaired ciliary action from exposure to smoke and environmental toxins contributes to impaired clearance of pulmonary secretions and an increased incidence of respiratory infections in the elderly. Failure of the immune system to differentiate "self" from "non-self" leads to an increase incidence of autoimmune diseases. Decreased phagocytosis by the liver's Kupffer cells leads to increased incidence and severity of hepatitis B. Decreased sensation and slowing of reflexes leads to increased risk of skin injury, skin ulcers, abrasions, burns, and other trauma. pg.979)

An elderly client is diagnosed with a respiratory infection. While reviewing age-related changes in the immune system, the nurse identifies which of the following as having contributed to this client's infection? a) Decreased phagocytosis by Kupffer cells b) Decreased sensation and slowing of reflexes c) Impaired ciliary action from exposure to environmental toxins d) Failure of the immune system to differentiate "self" from "non-self"

c (The client appears mildly ill, listless, and disheveled. Explanation: The beginning of the physical examination is a general appraisal of the client's health. The nurse notes whether the client appears healthy, acutely or mildly ill, malnourished, extremely tired, or listless. The next thing the nurse will do is obtain vital signs and then performs a more comprehensive examination. pg.65)

The nurse is beginning the physical examination of a client with a complaint of fatigue. What documentation will the nurse provide to describe this general appraisal of the client's health? a) The client is alert and oriented to all spheres. b) The client has palpable peripheral pulses in the upperextremities. c) The client appears mildly ill, listless, and disheveled. d) The client has a blood pressure of 120/72 mm Hg.

a (The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells. Explanation: The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells. Stem cells comprise only a small portion of all types of bone marrow cells.Research conducted with mouse models has demonstrated that once the immune system has been destroyed experimentally, it can be completely restored with the implantation of just a few purified stem cells. Stem cell transplantation has been carried out in human subjects with certain types of immune dysfunction such as severe combined immunodeficiency (SCID). Clinical trails are underway in patients with a variety of disorders with an autoimmune component including systemic lupus erythematosus, rheumatoid arthritis, scleroderma, and multiple sclerosis. pg.978)

Which of the following statements accurately reflects current stem cell research? a) The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells. b) Stem cell transplantation cannot restore immune system functioning. c) Clinical trials are underway in patients with acquired immune deficiencies only. d) Stem cell transplantation has been performed in the laboratory only.

a (Proliferation Explanation: During the proliferation phase the circulating lymphocytes containing the antigenic message return 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 recognition stage, the immune system distinguishes an invader as foreign, or non-self. In the response stage, the changed lymphocytes function either in a humoral or cellular fashion. In the effector stage, either the antibody of the humoral response or the cytotoxic T cell of the cellular response reaches and couples with the antigen on the surface of the foreign invader. pg.973)

During which stage of the immune response does the circulating lymphocyte containing the antigenic message return to the nearest lymph node? a) Proliferation b) Recognition c) Response d) Effector

d ("Stem cell transplantation has been carried out in humans with certain types of immune dysfunction and clinical trials using stem cells are underway in patients with a variety of disorders having an autoimmune component." Explanation: Research has shown that stem cells can restore an immune system that has been destroyed (Ko, 2012). Stem cell transplantation has been carried out in humans with certain types of immune dysfunction, such as severe combined immunodeficiency (SCID); clinical trials using stem cells are underway in patients with a variety of disorders having an autoimmune component, including systemic lupus erythematosus, rheumatoid arthritis, scleroderma, and multiple sclerosis. Research with embryonic stem cells has enabled investigators to make substantial gains in developmental biology, gene therapy, therapeutic tissue engineering, and the treatment of a variety of diseases (Ko, 2012). However, along with these remarkable opportunities, many ethical challenges arise, which are largely based on concerns about safety, efficacy, resource allocation, and human cloning. pg.978)

A nurse is explaining treatment options to a patient diagnosed with an immune dysfunction. Which of the following statements made by the patient accurately reflects the teaching about current stem cell research? a) "Currently stem cell transplantation has only been performed in the laboratory, but future research with embryonic stem cell transplants for humans with immune dysfunction has been promising." b) "Stem cell transplantation has been discontinued based on concerns about safety, efficacy, resource allocation, and human cloning." c) "Stem cell clinical trials have only been attempted in patients with acquired immune deficiencies but plans are underway to begin human cloning using embryonic stem cells." d) "Stem cell transplantation has been carried out in humans with certain types of immune dysfunction and clinical trials using stem cells are underway in patients with a variety of disorders having an autoimmune component."

d (Interferons Explanation: 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. Interferons have antiviral and antitumor properties. In addition to responding to viral infection, interferons are produced by T lymphocytes, B lymphocytes, and macrophages in response to antigens. They are thought to modify the immune response by suppressing antibody production and cellular immunity. pg.977)

A 6-year-old patient is diagnosed with a viral infection of the respiratory system. Which of the following will most likely be trying to fight the antigen? a) Self-antigens b) B cells c) Complements d) Interferons

c (Naturally acquired active immunity Explanation: Naturally acquired active immunity occurs as a direct result of infection by a specific microorganism. An example is the immunity to measles that develops after the initial infection. Not all invading microorganisms produce a response that gives lifelong immunity. Artificially acquired immunity is obtained by receiving a killed or weakened microorganism or toxoid. Passive immunity is acquired when ready-made antibodies are given to a susceptible person. pg.972)

A client has had mumps when he was 9 years old. He had a titer prior to entering nursing school and shows immunity. What type of immunity does this reflect? a) Passive immunity b) Artificially acquired active immunity c) Naturally acquired active immunity d) Natural passive immunity

a (Autoimmune disorders include connective tissue (collagen) disorders. Explanation: Connective tissue disorders are considered autoimmune disorders. Clients with autoimmune disorders may have either false-positive or false-negative serologic tests for syphilis. Other common laboratory findings in these clients include Coombs-positive hemolytic anemia, thrombocytopenia, leukopenia, immunoglobulin excesses or deficiencies, antinuclear antibodies, antibodies to deoxyribonucleic acid and ribonucleic acid, rheumatoid factors, elevated muscle enzymes, and changes in acute phase-reactive proteins. No cure exists for autoimmune disorders; treatment centers on controlling symptoms. Autoimmune disorders aren't distinctive; they share common features, making differential diagnosis difficult. pg.1555)

A client is diagnosed with rheumatoid arthritis, an autoimmune disorder. When teaching the client and family about autoimmune disorders, the nurse should provide which information? a) Autoimmune disorders include connective tissue (collagen) disorders. b) Autoimmune disorders are distinctive, aiding differential diagnosis. c) Clients with autoimmune disorders may have false-negative but not false-positive serologic tests. d) Advanced medical intervention can cure most autoimmune disorders.

d (Moderate diet that is balanced and varied Explanation: The best dietary advice to maximize immune function in healthy people is to eat a moderate diet that is balanced and varied, because the optimum amount and proportion of nutrients required are yet unknown. Recent studies indicate that the availability of one nutrient may impair or enhance the action of another nutrient in immune system functioning. Although it is necessary to include vitamins, amino acids, essential fatty acids, and electrolytes in the diet of growing children, excessive amounts are not advisable. pg.980)

A mother has brought her child to the clinic for a wellness check. While talking with the nurse, the mother asks the nurse to suggest a diet that will maximize the immune function of her growing children. What dietary pattern should the nurse suggest? a) Diet rich in amino acids and essential fatty acids b) Diet rich in iron, zinc, and vitamin E c) Diet rich in potassium, magnesium, and sodium d) Moderate diet that is balanced and varied

c (Surgical removal of the appendix Explanation: Removal of the appendix would have no direct effect on the immune system. Organ transplantaion requires immunosupressive drugs, which cause impaired immune function. Radiation therapy destroys lymphocytes. The spleen is an important part of the immune system, and removal of it increases the client's risk for poor immune function. pg.1556)

A nurse is taking the health history of a newly admitted client. Which of the following conditions would NOT place the client at risk for impaired immune function? a) History of radiation therapy b) Previous organ transplantation c) Surgical removal of the appendix d) Surgical history of a splenectomy

d (Strong family and community connections Explanation: Strong family and community ties will have a positive effect on the immune system. Rigorous or competitive exercise, usually considered a positive lifestyle factor, can be a physiologic stressor and cause negative effects on immune response. Any form of radiation can have a negative effect on the immune system, as can poor nutritional status. pg.1556)

A nurse is teaching a community group about healthy lifestyles. A participant asks about how to maintain a healthy immune system. The nurse informs the group that which of the following factors will positively affect the immune system? a) Poor nutritional status b) Residential exposure to radiation c) Rigorous, competitive exercise d) Strong family and community connections

a, b, c (a) Infectious cells b) Cancerous cells c) Foreign cells Correct Explanation: The immune system's primary targets are infectious, foreign, or cancerous cells. pg.970)

As a nursing instructor, you realize the importance of your students understanding how the immune system works and its role to protect and defend the body from potential harm. What type of cells are the primary targets of the healthy immune system? Select all that apply. a) Infectious cells b) Cancerous cells c) Foreign cells d) Typical cells

d (The injection area swells if the client has developed antibodies against the antigen. Explanation: The injection area swells if the client has developed antibodies against the antigen. The client is not necessarily actively infectious if the test results are positive. Although a productive cough is one of the symptoms of active tuberculosis, it may also indicate other diseases and disorders. The area should not be painful, and the client should not break out with a rash. pg.588)

The nurse is administering a skin test for detection of exposure to tuberculosis. How would the nurse determine if the client was exposed to tuberculosis? a) The client will have a productive cough. b) The injection area will become painful with in duration if the client has antibodies against the antigen. c) The injection area will break out in a fine macular rash. d) The injection area swells if the client has developed antibodies against the antigen.

a (Lymphokine Explanation: Cytotoxic T cells bind to invading cells, destroy the targeted invader by altering their cellular membrane and intracellular environment, and release chemicals called lymphokines. Lymphokines, a type of cytokine, attract neutrophils and monocytes to remove the debris. Options B, C, and D are incorrect. pg.976)

What chemical is released by cytotoxic T cells? a) Lymphokine b) Antigen c) Antibody d) Microphages