EAQ- Immunology

What should the nurse explain as the reason a client prescribed corticosteroid therapy for a chronic health problem develops frequent infections?

"They affect antigen-antibody immunity." Corticosteroids reduce the number of circulating T-cells and suppress cell-mediated immunity. They also interfere with immunoglobulin G (IgG) production and reduce antibody-antigen binding. Corticosteroids suppress the inflammatory process, block the movement of white blood cells, and disrupt the synthesis of a variety of inflammatory chemicals.

Which client is most likely to develop IgE antibodies?

A client with pollen allergy A client with a pollen allergy develops IgE antibodies that may result in an anaphylactic reaction. A client with poison ivy develops delayed hypersensitivity, which is mediated by T lymphocytes. A client with a bacterial infection develops IgG and IgM antibodies. A client undergoing blood transfusion may develop IgG and IgM type II hypersensitivity reactions.

Which intervention is most likely to decrease mortality in the septic client?

Antibiotics Of the interventions listed, administering antibiotics is the only intervention that fights the source of the problem. Intravenous fluids, oxygen, and vasopressors are necessary, but are designed to sustain the body until the antibiotic can kill the pathogen.

Which disease is caused by Coronaviruses?

Severe acute respiratory syndrome Severe acute respiratory syndrome is a respiratory infection caused by Coronaviruses. Pertussis is caused by the bacterium Bordetella pertussis. Inhalation anthrax is caused by Bacillus anthracis. Coccidioidomycosis is caused by Coccidioides.

Which is the first antibody formed after exposure to an antigen?

IgM IgM (immunoglobulin M) is the first antibody formed by a newly sensitized B-lymphocyte plasma cell. IgA has very low circulating levels and is responsible for preventing infection in the upper and lower respiratory tracts, and the gastrointestinal and genitourinary tracts. IgE has variable concentrations in the blood and is associated with antibody-mediated hypersensitivity reactions. IgG is heavily expressed on second and subsequent exposures to antigens to provide sustained, long-term immunity against invading microorganisms.

During an acquired immunodeficiency syndrome (AIDS) education class a client states, "Vaseline works great when I use condoms." Which conclusion about the client's knowledge of condom use can the nurse draw from this statement?

Ignorance related to correct condom use Vaseline (petroleum jelly) breaks down condom integrity and will increase the risk for condom failure. Using Vaseline instead of a water-soluble lubricant shows a lack of knowledge about condom use, a form of safer sex. Although the person is attempting to be responsible, there is a lack of knowledge and the behavior is unsafe. Condom use shows the client has some understanding about the transmission of HIV.

A client on immunosuppressive therapy is diagnosed with a peptic ulcer. Which medication might have led to this condition?

Prednisone Prednisone is a corticosteroid that suppresses inflammatory responses. A side effect of prednisone is the development of peptic ulcers. Azathioprine is an immunosuppressant that may cause anemia. Cyclosporine is an immunosuppressant that may cause nephrotoxicity and hypertension. Cyclophosphamide is an immunosuppressant that may cause hemorrhagic cystitis.

A mother with the diagnosis of acquired immunodeficiency syndrome (AIDS) states that she has been caring for her baby even though she has not been feeling well. What important information should the nurse determine?

If the baby is breast-feeding Epidemiologic evidence has identified breast milk as a source of human immunodeficiency virus (HIV) transmission. Kissing is not believed to transmit HIV. When the baby last received antibiotics is unrelated to transmission of HIV. HIV transmission does not occur from contact associated with caring for a newborn.

The nurse instructs a human immunodeficiency (HIV)-positive client about ways to prevent infections. During a follow-up visit, which statement made by the client indicates a need for more education?

"I wash my hands with tap water after gardening." An HIV-positive client should refrain from digging in soil and performing gardening activities. Soil contains several infectious microorganisms. In unavoidable circumstances, the client should wear gloves and wash hands thoroughly with antimicrobial soap after gardening. The client should refrain from reusing cups without washing them. Weekly rinsing of a toothbrush in liquid laundry bleach helps prevent infectious pathogens from accumulating on the brush. The armpits, groin, and genitals tend to house higher amounts of microorganisms and should be cleaned twice a day with antimicrobial soap.

A student nurse is teaching a client about preventive measures for Lyme disease. Which instruction given by the student nurse indicates a need for correction?

"Wear dark colored dresses." Lyme disease is a vector-borne disease caused by the spirochete Borrelia burgdorferi and results from the bite of an infected deer tick, also known as the blacklegged tick. Light-colored, rather than dark-colored clothing is preferred to spot the ticks easily, thereby preventing an insect bite and infection. Wearing closed shoes and boots and tucking the shirt in the pants prevent the entry and the bite of the blacklegged tick. Bathing should be done immediately after being in an infested area to prevent any possible infection.

A client with Lyme disease presents with dyspnea, dizziness, and facial paralysis. Which medication may be included in the prescription?

Ceftriaxone Lyme disease is a systemic infectious disease caused by the spirochete Borrelia burgdorferi and results from the bite of an infected deer tick, also known as the blacklegged tick. Stage II of Lyme disease is characterized by dizziness, dyspnea, and facial paralysis, and may be treated with ceftriaxone. Amoxicillin, doxycycline, and erythromycin are prescribed to treat localized stage I of Lyme disease.

While caring for a client with an intravenous cannula, the nurse assesses the site and finds that it red, swollen, and warm with purulent drainage near the insertion site. Which nursing intervention provides client comfort?

Cleaning the site with alcohol by expressing the drainage A client with redness, swelling, and warmth with purulent drainage at the insertion site may have an infection. The nurse should clean the site immediately with alcohol and express any drainage to minimize infection. Slowing the infusion is not recommended because it may lead to a systemic spread of the infection. Elevating the extremity may help in phlebitis, with thrombosis, or with ecchymosis and hematoma. Application of cold and warm compresses may reduce the pain in a client with thrombophlebitis.

A client in the emergency department states, "I was bitten by a raccoon while I was fixing a water pipe in the crawl space of my basement." Which is the most effective first-aid treatment for the nurse to use for this client?

Cleansing the wound with soap and water Infection is caused by viral contact with the dermal layer of skin; cleansing the wound with soap and water helps remove superficial contaminants. Antivenins are not effective against microbiologic stresses. A pressure dressing will not prevent infection. Application of a tourniquet may impair circulation and will not prevent infection.

Which organ-specific autoimmune disorder is associated with a client's kidney?

Goodpasture syndrome Goodpasture syndrome is an autoimmune disorder associated with the client's kidney. Graves' disease and Addison's disease are autoimmune disorders associated with the endocrine system. Guillain-Barré syndrome is an autoimmune disorder associated with the central nervous system.

The client's laboratory report shows deposits of immunoglobulin G (IgG) along the basement membranes of the lungs. The primary healthcare provider interprets this finding as a sign of Goodpasture's syndrome. What would be the reason for this condition?

Goodpasture's syndrome occurs when circulating antibodies combine with tissue antigens. Circulating antibodies combined with tissue antigens activate the complement system, which causes deposits of IgG to form. This deposition may occur along the basement membranes of the lungs or in the kidneys, a disorder called Goodpasture's syndrome. Urticaria develops rapidly after exposure to an allergen. Dilation and engorgement of the capillaries resulting from the release of histamine cause diffuse swelling in angioedema. Contact dermatitis occurs when the skin is exposed to a substance that easily penetrates the skin and combines with epidermal proteins.

Which type of immunoglobulin is present in tears, saliva, and breast milk?

IgA IgA immunoglobulin is present in tears, saliva, and breast milk. IgE and IgG immunoglobulins are present in plasma and interstitial fluids. IgM immunoglobulin is present in plasma.

Which type of hypersensitivity reaction is associated with rheumatoid arthritis?

Immune-complex Rheumatoid arthritis is an autoimmune disorder associated with an immune-complex type of hypersensitivity reaction. Contact dermatitis caused by poison ivy is associated with a delayed type of hypersensitivity reaction. Goodpasture's syndrome is associated with a cytotoxic type of hypersensitivity reaction. Asthma is associated with an IgE-mediated type of hypersensitivity reaction.

Which age-related effects on the immune system are seen in the older client?

Increased autoantibodies The effects of aging on the immune system include increased autoantibodies. Expression of IL-2 receptors, delayed hypersensitivity reaction, and primary and secondary antibody responses decrease in older adults because of the effects of aging on the immune system.

The nurse is evaluating the actions of a client with pneumonia performing incentive spirometry. Which action by the client indicates a need for correction?

Inhaling air fully before inserting the mouthpiece Incentive spirometry is used to improve inspiratory muscle action and to prevent or reverse atelectasis in a client with pneumonia. The client is instructed to exhale fully and then insert the mouthpiece. Inhaling the air before inserting the mouthpiece may cause harm to the client and therefore needs correction. After the process is completed, the volume of air inspired is recorded. A client with pneumonia is instructed to perform 10 breaths per session every hour while awake. Taking a long, slow, deep breath keeping the mouthpiece in place helps to improve inspiratory muscle action.

A laboratory report shows that a client tested positive for human epidermal growth factor (HER), and a medical report reveals the presence of advanced breast cancer. Which medication would be used to treat this condition?

Lapatinib HER-2 is overexpressed in clients with advanced breast cancer. Lapatinib inhibits epidermal growth factor-r (EGFR)-tyrosine kinase (TK) and binds HER-2. Erlotinib is an EFGR-TK inhibitor prescribed to treat non-small cell lung cancer and advanced pancreatic cancer. Rituximab and tositumomab are administered to treat non-Hodgkin's lymphoma.

A nurse employed in an outpatient radiology department is reviewing safety precautions with staff members. What explanation does the nurse provide to explain the reason radium is stored in lead containers?

Lead functions as a barrier. Radium atoms are unstable and spontaneously disintegrate. This disintegration produces potentially harmful radiation; lead is a barrier to radiation. Radium is not heavy, but is unstable. Radiation, not heat, is produced during spontaneous disintegration of radium atoms. Disintegration of radium occurs in lead containers.

The nursing staff has a team conference on acquired immunodeficiency syndrome (AIDS) and discusses the routes of transmission of the human immunodeficiency virus (HIV). The discussion reveals that there is no risk of exposure to HIV when an uninfected individual does what?

Makes a donation of a pint of whole blood Equipment used in blood donation is disposable; the donor does not come into contact with anyone else's blood. The risk depends on the spouse's previous behavior. Although condoms do offer protection, they are subject to failure because of condom rupture or improper use; risks of infection are present with any sexual contact. An individual may be infected before testing positive for the antibodies; the individual can still transmit the virus.

A client is suspected of having rabies after being bitten by a raccoon. Which clinical indicators should the nurse assess in the client? .

Nuchal rigidity Pharyngeal spasm Rabies, an acute infectious disease affecting the central nervous system (CNS), causes stiffness of the back of the neck (nuchal rigidity). Painful pharyngeal spasms when swallowing or even looking at water are responsible for the use of the term hydrophobia to refer to rabies. The CNS is affected; diarrhea is not a concern. Memory is not affected by this disease. Urinary stasis is not an expected problem; catheterization can be employed if necessary

Which disease is caused by Escherichia coli?

Peritonitis Escherichia coli causes peritonitis. Clostridium tetani causes tetanus. Corynebacterium diphtheria causes diphtheria. Clostridium botulinum causes food poisoning.

The laboratory report of a client reveals the presence of 350 cells/mm 3 (350 cells/uL) of CD4+ T-cell count. According to the Centers for Disease Control and Prevention (CDC), which stage of human immunodeficiency virus (HIV) disease is present in the client?

Stage 2 According to the CDC, human immunodeficiency disease is divided into four stages. A client with a CD4+ T-cell count between 200 and 499 cells/mm 3 (499 cells/uL) is in the second stage of HIV disease. A client with a CD4+ T-cell count of greater than 500 cells/mm 3 (500 cells/uL) is in the first stage of HIV disease. A client with a CD4+ T-cell count of less than 200 cells/mm 3 (200 cells/uL) is in the third stage of HIV disease. The fourth stage of HIV disease indicates confirmed HIV infection with no information regarding CD4+ T-cell counts.

The nurse is advising a client with acquired immunodeficiency syndrome (AIDS) to avoid the consumption of undercooked meat. Which infection can be prevented in the client by following this measure?

Toxoplasmosis encephalitis Toxoplasmosis encephalitis is caused by Toxoplasma gondii, which may occur due to the ingestion of infected undercooked meat or by contact with contaminated cat feces. Tuberculosis is caused by Mycobacterium tuberculosis and is spread by airborne routes. Cryptococcosis is caused by Cryptococcus neoformans, which is a debilitating meningitis and can be a widely spread infection in AIDS. Cryptosporidiosis is an intestinal infection caused by Cryptosporidium organisms.

During an assessment, a nurse suspects that a client is in the primary stage of syphilis. Which findings support the nurse's conclusion?

Ulcers on the hands and lips Firm and enlarged lymph nodes The appearance of ulcers (called chancres) is the first sign of primary syphilis. These chancres commonly appear on the skin and mucous membranes such as the lips, hands, genitalia, nipples, mouth, anus, and rectum. Primary syphilis is a highly infectious stage that may be manifested by large, firm, and painless lymph nodes. The secondary stage of syphilis is characterized by patchy alopecia on the scalp and facial hair and is associated with a headache and sore throat. The presence of gummas on the mucous membranes such as the mouth is the manifestation of the tertiary stage of syphilis.