Exam 2

which white blood cell is the first to arrive at the site of inflammation

neutrophils

which sequence is the correct pathway for blood flow thru the heart

right atrium-tricuspid valve-right ventricle-pulmonary artery-lungs-pulmonary vein-left atrium-mitral valve-left ventricle-aorta

A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins

right-sided heart failure

headache in fever is the result of

cerebral vasodilation

in which stage of fever do piloerection and an urge to curl up under blankets occur

chill stage

passive immunity

transferred from one source to another infant receives from mother in utero and breast milk passive can also be artificially provided by the transfer of antibodies produced by other people or animals

which blood vessel layer is made primarily of muscle

tunica media

adaptive immunity

specific or acquired immunity develops during an individuals lifetime, distinguished self from nonself, and responds specifically to different pathogens and foreign molecules these cells incluse the T lymphocytes which participate in cell-mediated immunity and the B lymphocytes which participate in humoral immunity attacks specific microbes

prions

small modified infectious host protein without a genome. extremely resistant transmissible neurodegenerative diseases because they lack reproductive and metabolic functions, current antimicrobials are useless

the life span of the neutrophil in the tissues is approximately

10 to 12 hours

a client is lying in a recumbent position. in this client, approximately house much total blood volume is in the central circulation

25-30%

the most abundant humorally circulating immunoglobulin is

IgG

which immunoglobulins protect newborns by passing thru the placenta

IgG

immunoglobulins

IgG, IgA, IgM, IgD, IgE

the development of memory loss, difficulty concentrating, euphoria, and lethargy suggests

AIDS dementia complex

the immunoglobulins are produced by

B cells; plasma cells

which type of lymphocyte participates in the development of humoral immunity thru the production of antibodies

B lymphocytes

immune cells

CD4+ helper T cell serves as a master switch for the immune system the human immunodeficiency virus (HIV) that causes acquired immunodeficiency syndrome (AIDS) infects and destroys the CD4+ helper T cell

Which cell in the immune system is considered the "master switch"?

CD4+ helper T cells

the HIV virus directly infects the

CD4+ lymphocytes

AIDS is caused by

HIV

which immunoglobulins protect moist mucous membranes in the body as a first line of defense against infection

IgA

which one of the following types of immunoglobulins is involved in allergic and hypersensitivity responses

IgE

type 1

IgE mediated

opportunistic infections are

Infections involving usually harmless microorganisms that develop in a person who is immunocompromised

natural killer cells

NK cell is programmed to automatically kill foreign cells. CD+8 must be activated to become cytotoxic

the nurse assesses the electrocardiogram for depolarization of the atria. that portion of the ECG will the nurse be assessing

P wave above the baseline

which of the following is called the pacemaker of the heart

SA node

if a client experiences sympathetic nervous stimulation of heart, the nurse will observe which changes in manifestations

increased heart rate and increased contractility

HIV type 2

is endemic in many countries in West Africa but rarer in other parts of the world

a number of clients on an acute cardiac care unit of a hospital have dx of impaired cardiac conduction. which client is most deserving of immediate attention

a 69 year old woman who has entered ventricular fibrilation

a client is admitted to the cardiac unit with a diagnosis of pericarditis. the nurse is teaching the client about the anatomical location of the infection. the nurse evaluates the effectiveness of the teaching when the client correctly identifies which of the following as the location of the pericardium

a membranous sac that encloses the heart

a positive antibody test in an infant indicates

a perinatally exposed infant with maternal antibodies

causes of fever in infants and small children can reflect

a vaccine reaction overbundling serious infections that can progress to bacteremia and meningitis minor infection

the nurse is assessing a client said to be in sinus rhythm. what does the nurse expect to find when evaluating the electrocardiogram

absence of T waves irregular rhythm

active immunity

achieved through exposure to a specific antigen acquired through immunization or actually having a disease long lasting but requires a few days to weeks to develop

colonization

act of establishing a presence, a step required in the multifaceted process of infection. the organisms are simply hanging out

virulence factors are substances or products generated by infectious agents that enhance their ability to cause disease. endotoxins are complex molecules found in the cell wall of gram-negative bacteria that are responsible for

activation of regulatory systems that may induce hypotension, fever, bleeding

cell mediated immunity

adaptive response against microbes where they cannot be destroyed by antibodies helper T cells-CD4+

microflora serve as useful function for their host. these include

aiding in the digestion of food producing vitamins such as vitamin K protecting host from colonization with pathogenic microbes

class 1 MHC antigens are found on

all nucleated cells of the body; allows them to alert immune system of any changes

type 2

antibody mediated disorders

the lymph nodes

assist in removing foreign materials from the lymph channels and are centers for immune cell proliferation

chemotaxis involves the

attraction of leukocytes to a chemical signal

T and B lymphocytes have all of the following properties except

automaticity

A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the

biscuspid valve

IgG

remains elevated after the acute phase

universal precautions are designed to prevent exposure to infectious agents that are present in

blood, semen, and vaginal secretions

HIV is spread thru

blood, sexual contact, maternal placental circulation and breast milk

secondary immune repsonse

booster shots cause a secondary immune response so antibody levels will be high before the disease is encountered

a prolonged fever for which the cause is difficult to ascertain is

called an FUO 9; fever of unknown origin

T lymphocytes

cell mediated function in the activation of other T cells and B cells, control of viral infections, rejection of foreign tissue grafts and delayed hypersensitivity reactions CD+4 helper T cells CD8+ molecules

type 4

cell mediated hypersensitivity reactions

adaptive or specific immune mechanisms include protection afforded by

cell mediated immunity

the immune responses related to T cells function are called

cellular immunity

the distensibility of the blood vessel is the major factor in which of the vessels characteristics

compliance

the controls the direction of blood flow. what is the role of the aortic valve

controls the direction of blood flow from the left side of the heart to the systemic circulation

diagnostic methods

culture serology DNA and RNA sequencing-increased sensitivity and decreased time

infection

describes the presence and multiplication within another living organism with subsequent injury to the host

toxins

destroy or alter normal cell function; trait chiefly monopolized by bacteria

a fever (pyrexia) that is not accompanied by the normally expected increase in heart rate is associated with

drug fever and legionnaires disease

which of the following statements is true as it related to fever in the elderly

elderly persons have a lower basal temperature than younger persons; serious infections can occur without marked elevations in temperature

the macrophages

engulf and digest antigens that come into contact with their cell membrane

the school nurse is doing a health class on the functional organization of the circulatory system. what is the function of the capillaries in the circulatory system

exchange gases, nutrients, and wastes

HIV is not transmitted from an infected mother to her baby by

genetic transmission at conception

type 1 hypersensitivity immune responses include

hay fever and bronchial asthma

a prion is

host protein lacking a genome that causes neurodegenerative disease

why should you understand MHC

human MHC proteins are called human leukocytes antigens (HLA) because they were first detected on WBC

the cell surface antigen that determines whether transplanted tissue is recognized as foreign are the MHC antigens. these are specifically called

human leukocytes antigens

the nurse is assisting a client who had a myocardial infarction 2 days ago during a bath. the client suddenly loss consciousness and the nurse was unable to feel a pulse. cardiopulmonary resuscitation was begun and the client was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. what is a priority intervention at this time

immediate fibrilation

type 3

immune complex mediated disorders

the "window period" of HIV infection refers to the period of time between

infection and detectable antibody levels

HIV

infects by the attachment of a surface protein on the viral envelope of HIV to a special CD4+ T cell receptor

the phases of wound healing include

inflammatory, proliferative, remodeling

HIV is transmitted by all of the following except

insect vectors in crowded living conditions in which people have HIV

cytokines can be described as

intercellular protein messenger molecules that regulate the movement, proliferation, and differentiation of immune and other cells

which of the following is true regarding pulmonary circulation

it is a low pressure system that allows for improved gas exchange

endotoxins

large amounts released in septic shock, DIC, and acute respiratory distress syndrome

the heart is a four-chambered pump. which chamber of the heart pumps blood into the systemic circulation

left ventricle

signs indicating a serious fever in an infant or small child include

lethargy poor feeding signs of impaired tissue perfusion cyanosis

the acute phase response in inflammation includes all of the following changes except

leukopenia

which cells differentiate to form antibody-producing plasma cells and cell mediated immunity cells

lymphocytes

which cells in the body are activated to engulf and digest foreign particles and are involved early in the host response to ensure amplification of inflammation and initiation of specific immunity

macrophages

which statement is false concerning monocytes and macrophages

macrophages engulf and digest foreign particles in a process called autolysis

what are the self components that the immune system uses to distinguish self from nonself

major histocompatibility molecules

the mediators involved in allergic responses are released from

mast cells or basophils

developmental aspects of the immune system

maternal IgG effective against bacteria and viruses largest amount crosses placenta during last weeks of pregnancy therefore premature infants will be deficient cord blood does not normally contain IgM or IgA

innate immunity

nonspecific can distinguish self from non-self but does not distinguish one type of pathogen from another microorganisms encounter first line of resistance on exposure to epithelial layers of our skin and mucous membranes that line respiratory, GI, and urogenital tracts second line involves chemical signals, antimicrobial substances, phagocytic and natural killer cells as well as fever associated with the inflammatory response always present; generic

complement system

primary mediator of both innate and adaptive immunity that enables the body to localize and destroy infective agents when an antibody attaches to an antigen, the resulting immune complex can activate complement

vaccination

produces a primary immune response provides active immunity; long lasting

the group of inflammatory mediators that contributes to swelling, redness, tissue warmth, and pain is the

prostaglandins

which one of the following is an example of active immunity

protection afforded by the flu vaccine

The heart is a four-chambered pump. What is the function of the right ventricle

pumps blood to the lungs

the electrical activity of the heart is recorded on the ECG. what does the T wave on the ECG represent

repolarization of the ventricles

antipyretic drygs such as aspirin and acetaminophen act by

resetting the hypothalamic temperature control center as a means of initiating heat reducing behaviors

a client has has an acute myocardial infarction. the brother of the client has a history of angina. the client asks how he will if his brothers pain is angina or if the brother is actually having an MI. which statement is correct

rest and intake of nitroglycerin relieve cheat pain with angina; they do not relieve chest pain with an MI

the white blood cell differential count includes all but which one of the following

reticulocytes

IgM

rises during the acute phase, then falls

what is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction

sa node-av node-bundle of His-bundle branches-purkinje fibers

a thin and watery exudate that contains red blood cells is called a

serosanguinous exudate

Major Histocompatibility Complex (MHC)

serves as a peptide display molecule for recognition by T lymphocytes; needed for induction and regulation of immune response response is very specific and targeted MHC 1 proteins tell T cytotoxic cells to kill the infected cell before it can infect other cells

the health care provider is concerned that a client has developed a decreased in cardiac output. cardiac output may be calculated as

stroke volume x heart rate

autoimmune diseases such as food poisoning and toxic shock syndrome after a strep or staph infection as caused by

superantigens

anaphylaxis

systemic response to the inflammatory mediators released in type 1 hypersensitivity histamine, acetylcholine, kinins, leukotrienes, and prostaglandins all cause vasodilation

the immune system consists of

the bone marrow, thymus gland, lymphoid organs, spleen, and T and B lymphocytes

the circulatory system is a closed system that is divided into two parts. which statement is correct about the closed system

the low pressure pulmonary circulation links circulation and gas exchange in the lungs

IgG

the most abundant of the circulating immunoglobulins and is present in body fluids and readily enters the tissue only one to cross placenta and can transfer immunity from mother to fetus passive-immunity; short acting protects against bacteria/viruses, toxins. and activates the complement system circulates in body fluids, attacking antigens

the polymerase chain reaction is used to detect

the presence of HIV DNA

the granulocytes are characterized by

the presence of granules in their cytoplasm distinctive multilobular nuclei phagocytuc properties

fever differs from hyperthermia in terms of

the upward displacement of hypothalamic set point for temperature control

differentiation of T lymphocytes occurs in the

thymus

central lymphoid organs

thymus generates mature immuno-competent T lymphocytes; fully developed at birth but regresses and replaced by adipose tissue at puberty; some tissue persists at old age mature immuno-competent T cells leave the thymus in 2 to 3 days and enter peripheral lymphoid tissues

the heart consists of four valves. which are the hearts atrioventricular valves

tricuspid mitral

which dysrhythmia is considered to be the most fatal and requires immediate treatment

ventricular fibrillation

acquired immunodeficiency syndrome (AIDS)

HIV infected person can transmit when no symptoms are present; seroconversion occurs from 1 to 3 months but may take up to 6 months

which one of the following classes of immunoglobulins cross the placenta

IgG

if the donor and recipient are related or unrelated but share similar HLA types, the transplant tissue is categorized as

allogenic

the absence of an immune response directed against a person's own antigens is called

anergy

antigens

antigens are also called immunogens and are substances foreign to the host that can stimulate an immune response

when explaining to a client why there was only minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain that is primarily due to

development of collateral circulation that build channels between some of the smaller arteries, usually when the flow is decreased gradually

the transudation of fluid that occurs at the site of an acute inflammatory response is of benefit to the host because it

dilutes the noxious agent

type 1 IgE mediated disorders

immediate reactions triggered by binding of an allergen to a specific IgE that is found on the surface of most cells or basophils systemic anaphylactic reactions localized atopic disorders; allergic rhinitis and food allergies

autoimmune diseases

immune system attacks self-antigens immune system destroys body tissues

the complement system could best be described as a system of

inactive circulating precursor proteins that function as a mediator of both innate and adaptive immunity; produces inflammation and increases phagocytosis

AIDS manifestations

opportunistic infections wasting syndrome

when the immune system reaches a point of being severely compromised by HIV

opportunistic infections occur malignancies appear persons with a history of a positive tuberculin test are likely to develop tuberculosis

antigen example

penicillin has a mass of 350 daltons and is incapable of causing an immune response if chemically combines with body proteins to form larger complex that can generate an immune response to the penicillin epitope

cultures are serology are the conventional tests for infectious disease. methods for identifying infectious agents thru DNA or RNA detection are increasingly used. a sensitive method of DNA detection that is useful in HIV diagnosis is

polymerase chain reaction

neutrophils are also called

polymorphonuclear leukocytes

immunity

protection from disease

exotoxins

proteins secreted by certain bacteria and other organisms

the heart consists of four valves. which are the semilunar valves

pulmonary aortic

clusters of differentiation

serves to define functionally distinct subsets of cells such as CD4+ helper T cells and CD8+ cytotoxic T cells

when trying to explain to a client on dialysis the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries ha

small openings that allow large amounts of smaller molecular substances to filter through the glomeruli

myeloid lineage

monocytes and macrophages are key members of the phagocytic system that engulf and digest microbes and foreign substances

immature white blood cells are released during leukocytosis. these immature cells are called

myeloblasts

the white blood cell that has the greatest rate of increase during a bacterial infection is the

neutrophil

cytokines and the immune response

cytokines are low molecular weight proteins made by cells that affect the behavior of other cells excess can have serious adverse effects associated with septic shock, food poisoning and cancer

the local heat that occurs during an inflammatory response in the result of

increased blood flow

the acute primary infection or primary phase of HIV

is a mononucleosis-like syndrome with fever, myalgias, malaise, sore throat, nausea, lymphadenopathy, night sweats, and rash

B lymphocytes

mature B lymphocytes leave bone marrow and enter circulation and migrate to peripheral lymphoid tissues where they are stimulated to respond to a specific antigen activated B cell differentiates into a plasma cell which can produce thousands of antibodies

peripheral lymphoid immune structures

spleen filters antigens and involved in immune response can live without but require vaccinations to provide protection red pulp destroys senescent and injured RBC, white pulp contains concentrated areas of B and T lymphocytes

the nurse identifies the blood vessel layer that constricts to regulate and control diameter as

tunica intima