Immunology Questions

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? Macrophages B cells Helper T cells Cytotoxic T cells

Cytotoxic T cells Rationale: 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. These cells then assist in destroying the invading organism.

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

Natural killer cells Rationale: 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.

A patient presents to the Emergency Department (ED) after being stung by a yellow jacket (wasp). The patient is having wheezes, tachypnea, tachycardia, and diaphoresis. Vital signs are HR 130, RR 35, SPO2 87%, BP 90/52. The nurse recognizes that the patient is experiencing a type 1 hypersensitivity. Intravenous access has been initiated. The nurse recognizes that which of the following is going to help this patient? Prepare for endotracheal intubation. Give the patient Diphenhydramine (Bendadryl) 50mg PO and Prednisone 50mg PO STAT. Administer oxygen via nasal cannula at 2L/min. Give the patient Diphenhydramine (Benadryl) 50mg PO and Famotidine (Pepcid) 20mg PO STAT.

Prepare for endotracheal intubation. Rationale: During anaphylaxis, patients will need IV medication, not PO. Administering oxygen via nasal cannula is not going to help this patient. The patient would need 100% oxygen therapy via a non-rebreather. The patient needs to be prepared for intubation

A nurse is working in a health clinic at a retirement community. What is the nurse's primary rationale for recommending HIV testing for older adults? Older adults may have received HIV-infected blood transfusions before 1985. Age-related immune system changes increase the risks of infections for older adults. Older adults, who are sexually active don't use condoms. Older gay men, feeling less inhibited by social mores, tend to have multiple sex partners.

Age-related immune system changes increase the risks of infections for older adults. Rationale: Normal aging decreases the immune system's response to infection and puts the older adult at greater risk for HIV. Since 2006, more than 10% of new HIV cases occurred in those older than 50. Choices A and B are assumptions; choice D would only be relevant for those who did receive a blood transfusion. The rationale would not be generalized for all adults over age 55.

Which of the following statements indicate that the patient has an understanding of the treatment for their newly diagnosed HIV? "I want my CD4 count levels to be low." "I want my viral load to be high." "I want my viral load to be low." "I can become cured after several years of treatment."

"I want my viral load to be low." Rationale: With patients with HIV, the goal is for their viral count levels to be low and the CD4 count levels to be high. HIV cannot be cured once the patient has it. They can become undetectable, but still have the virus inside their body.

Which statement would would alert the nurse to suspect a client is experiencing a mild anaphylactic reaction? "I'm having tightness in my chest." "I feel like my face is so flushed." "I'm having difficulty swallowing." "My throat feels like it's full."

"My throat feels like it's full." Rationale: Manifestations of a mild anaphylactic reaction include peripheral tingling and a sensation of warmth, a sensation of fullness in the mouth and throat, nasal congestion, periorbital swelling, pruritus, sneezing, and tearing of the eyes. Flushing, warmth, anxiety, and itching in addition to the mild symptoms indicate a moderate reaction. A severe systemic reaction begins abruptly with the mild and moderate symptoms rapidly progressing to bronchospasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension as well as dysphagia, abdominal cramping, vomiting, diarreha, and possibly seizures.

A client with rheumatoid arthritis comes to the clinic for a second dose of etanercept. The dose prescribed is 25 mg subcutaneously. The medication is available in 50 mg per milliliter. How many milliliters will the nurse administer to the client? Record your answer using one decimal place.

0.5 mL

Allopurinol has been prescribed for a client receiving treatment for gout. The nurse caring for this client knows to assess the client for bone marrow suppression, which may be manifested by what diagnostic finding? Increased erythrocyte sedimentation rate Elevated serum creatinine Decreased platelets Hyperuricemia

Decreased platelets Rationale: Thrombocytopenia occurs in bone marrow suppression. Hyperuricemia occurs in gout, but is not caused by bone marrow suppression. Increased erythrocyte sedimentation rate may occur from inflammation associated with gout, but is not related to bone marrow suppression. An elevated serum creatinine level may indicate renal damage, but this is not associated with the use of allopurinol.

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

Failure of lymphocytes to recognize mutant cells Rationale: 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.

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. What instruction should the nurse give to the client to minimize injury? Install safety devices in the home. Get help when lifting objects. Wear protective devices when exercising. Wear worn, comfortable shoes.

Install safety devices in the home Rationale: Most accidents occur in the home, and safety devices such as hand rails are the most important element in minimizing injury. Shoes should be supportive and not too worn. The client needs to use proper body mechanics when stooping or lifting objects. Protective devices aren't usually necessary when the client exercises.

A patient was seen in the clinic for hypertension and received a prescription for a new antihypertensive medication. The patient arrived in the emergency department a few hours after taking the medication with severe angioedema. What medication prescribed may be responsible for the reaction? Amlodipine (Norvasc) Lisinopril (Zestril) Metoprolol (Lopressor) Losartan (Cozaar)

Lisinopril (Zestril) Rationale: Several frequently prescribed medications, such as angiotensin-converting enzyme inhibitors and penicillin, may cause angioedema. The nurse needs to be aware of all medications the patient is taking and be alert to the potential of angioedema as a side effect.

An adult client has had mumps when the client was a child. The client had a titer prior to entering nursing school and shows immunity. What type of immunity does this reflect? Natural passive immunity Naturally acquired active immunity Passive immunity Artificially acquired active immunity

Naturally acquired active immunity Rationale: 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.

A nurse knows that what precautions should be taken with a client that has been newly diagnosed with AIDS based on the client having Wasting Syndrome attributed to HIV? Contact precautions Airborne precautions Standard precautions Droplet precautions

Standard precautions Rationale: HIV/AIDS cannot be contracted by casual contact, therefore standard precautions are most appropriate with this client. Airborne and droplet precautions are not indicated. Neutropenia precautions may be initiated if the client has neutropenia.

A nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee sting. The nurse is providing client teaching prior to the client's discharge. In the event of an anaphylactic reaction, the nurse informs the client that she should self-administer epinephrine in what site? Abdomen Forearm Deltoid Thigh

Thigh Rationale: The client is taught to position the device at the middle portion of the thigh and push the device into the thigh as far as possible. The device will autoinject a premeasured dose of epinephrine into the subcutaneous tissue.

A clent with a history of peptic ulcer disease is diagnosed with rheumatoid arthritis. What medication will the nurse anticipate will be prescribed to produce an anti-inflammatory effect and protect the stomach lining? sulfasalazine celecoxib methotrexate ibuprofen

celecoxib Rationale: The cyclooxygenase-2 inhibitors, such as celecoxib, have been shown to inhibit inflammatory processes but do not inhibit the protective prostaglandin synthesis in the gastointestinal (GI) tract. Therefore, patients who are at increased risk for gastrointestinal complications, especially GI bleeding, have been managed effectively with celecoxib. Ibuprofen, methotrexate, and sulfasalazine may cause GI irritation.

A client has a known allergy to peanuts, meaning that the client's immune system has identified peanuts as a foreign invader and has produced specific cells to attack if the client should come in contact with peanuts again. The formation of these specific cells is known as: inflammatory response. humoral response. memory response. cell-mediated response.

humoral response Rationale: The B-cell lymphocytes mature in the bone marrow and migrate to the spleen and other lymphoid tissues such as the lymph nodes. When stimulated by T cells, the B cells become either plasma or memory cells. Plasma cells produce antibodies. Formation of antibodies is called a humoral response.

A client presents with itching, swelling, redness, and wheals of superficial skin layers. What is the most likely type of allergy this client is displaying? contact dermatitis dermatitis medicamentosa angioedema urticaria

urticaria Rationale: Urticaria presents with itching, swelling, redness, and wheals of superficial skin layers. Dermatitis medicamentosa presents with sudden generalized bright red rash, itching, fever, malaise, headache, arthralgias. Contact dermatitis presents with itching, burning, redness, rash on contact with substance. Angioedema presents with itching, swelling, redness of deeper tissues and mucous membranes.

A client has been living with seasonal allergies for many years, but does not take antihistamines, stating, "When I was young I used to take antihistamines, but they always put me to sleep." How should the nurse best respond? "Most people find that they develop a tolerance to sedation after a few months." "Newer antihistamines are combined with a stimulant that offsets drowsiness." "The newer antihistamines are different than in years past, and cause less sedation." "Have you considered taking them at bedtime instead of in the morning?"

"The newer antihistamines are different than in years past, and cause less sedation." Rationale: Unlike first-generation H1 receptor antagonists, newer antihistamines bind to peripheral rather than central nervous system H1 receptors, causing less sedation, if at all. Tolerance to sedation did not usually occur with first-generation drugs and newer antihistamines are not combined with a stimulant.

A nurse knows that a client taking PrEP (Truvada) needs FURTHER education when they make which statement? "I take this medication to prevent contracting HIV." "I need to take this medication on a daily basis." "I need to get lab work every 3 months." "This medication regimen is over at 30 days."

"This medication regimen is over at 30 days." Rationale: PrEP is taken on a daily basis with lab monitoring every 3 month. Patients do take the medication to prevent contracting HIV. PEP is the medication regimen that is over the course of 30 days.

Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many milligrams will the nurse prepare per dose for the client?

50 mg

A nurse is caring for a client that has been HIV positive for 10 years. The nurse knows that a client has progressed from stage 2 HIV to stage 3 HIV (AIDS) when the CD4 count is which of the following? CD4 cells < 400 CD4 cells < 200 CD4 cells < 600 CD4 cells < 800

CD4 cells < 200 Rationale: For clients being HIV positive for greater than 6 years, CD4 counts less than 200 indicate the progression to AIDS.

The nurse is teaching a client newly diagnosed with a peanut allergy about how to manage the allergy. What information should be included in the teaching? Select all that apply. Identify ways to manage allergy while dining out. List symptoms of peanut allergy. Wear a medic alert bracelet. Food labels on baked items are the only labels that need to be read. Carry EpiPen autoinjector at all times.

Identify ways to manage allergy while dining out. List symptoms of peanut allergy. Wear a medic alert bracelet. Carry EpiPen autoinjector at all times. Rationale: Wearing a medic alert bracelet allows others to be alerted of the allergy. Listing symptoms of the allergy makes the client aware of the allergic reaction if symptoms are being experienced. Identifying ways to manage allergies while dining out allows the client to be safe from a potential reaction. All food labels should be read not only baked items. The EpiPen autoinjector should be carried at all times in case it needs to be administered because of an allergic reaction.