Chapter 36: PrepU - Nursing Assessment: Immune Function

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? 1- Toxins of invading antigens are neutralized. 2- The invading antigens link together (agglutination). 3- The invading antigens precipitate. 4- T-cell lymphocytes survey proteins in the body and attack the invading antigens.

4

A 48-year-old patient has had multiple sclerosis for 15 years, and she is receiving interferon injections. What is the purpose of interferon injections? 1- To modify the immune response by suppressing antibody production and cellular immunity 2- To give rise to numerous cell types able to form tissues in three germ layers 3- To complement receptors and, as a result, play an important role in the clearance of antigens 4- To complement components, prostaglandins, leukotrienes, and other inflammatory mediators

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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? 1- Naturally acquired active immunity 2- Artificially acquired active immunity 3- Naturally acquired passive immunity 4- Artificially acquired passive immunity

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A client comes to the clinic and informs the nurse that he feels as though he has allergies. What laboratory test results will be a positive indicator for an allergic disorder? 1- Radioallergosorbent blood test (RAST) of 3 2- WBC of 7000/mm3 3- Neutrophils 60% 4- Eosinophils 6%

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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: 1- humoral response. 2- cell-mediated response. 3- inflammatory response. 4- memory response.

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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? 1- The client's immune system cannot mount a response to the skin test. 2- The client has only mild TB, which is not enough to cause a reaction. 3- The solution used for the skin test was probably outdated. 4- The skin test was improperly performed.

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A 20-year-old client cut a hand while replacing a window. While reviewing the complete blood count (CBC) with differential, the nurse would expect which cell type to be elevated first in an attempt to prevent infection in the client's hand? 1- Eosinophils 2- Neutrophils 3- B cells 4- Monocytes

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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? 1- Nonsteroidal anti-inflammatory 2- Angiotensin-converting enzyme inhibitors (ACE-I) 3- Diuretics 4- Corticosteroids

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What is the function of the thymus gland? 1- Produce stem cells 2- Programs B lymphocytes to become regulator or effector Bcells. 3- Develop the lymphatic system 4- Programs T lymphocytes to become regulator or effector T cells.

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A client has begun sensitivity testing to determine the allergen which caused an anaphylactic reaction 3 weeks ago. In scratch testing, which part of the body is more sensitive to allergens? 1- back 2- forearm 3- upper arm 4- chest

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What type of cytokine will attract neutrophils and monocytes to remove debris? 1- Lymphokines 2- Cytotoxic T cells 3- Suppressor T cells 4- Regulator T cells

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A client has undergone a kidney transplant. The nurse is concerned about a compromised immune system in this client for which reason? 1- Use of anti-rejection drugs 2- Excess circulating lymphocytes 3- Deficient circulating antibodies 4- Excess circulating hemoglobin

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A client is diagnosed with multiple site cancers and has received whole-body irradiation. The nurse is concerned about a compromised immune system in this client for which reason? 1- Radiation destroys lymphocytes. 2- Radiation causes an excess of circulating lymphocytes. 3- Radiation causes a deficiency of circulating hemoglobin. 4- Radiation causes an excess of circulating hemoglobin.

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Which of the following cell types are involved in humoral immunity? 1- B lymphocytes 2- Helper T lymphocyte 3- Suppressor T lymphocyte 4- Memory T lymphocyte

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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? 1- Antimetabolites 2- Antihypertensives 3- Inotropics 4- Pancreatic enzymes

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What types of cells are the primary targets of the healthy immune system? Select all that apply. 1- infectious cells 2- foreign cells 3- cancerous cells 4- typical cells

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A client is scheduled to have a prick test to determine what specific allergens are creating problems for the client. What should the nurse inform the client is involved with the testing? 1- A concentrated form of the substance is applied to the skin and covered with an occlusive dressing for 48 hours and then examined. 2- A dilute solution of an antigen is injected intradermal and observed for a wheal. 3- The skin will be scratched, and applying a small amount of the liquid test antigen to the scratch, usually on the back. 4- The client will taste several different possible antigens and observe for wheals.

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The nurse is instructing clients about the importance of taking the shingles vaccine. Which client would benefit from this vaccine? 1- A 24-year-old client who is pregnant 2- A 17-year-old client who will be attending college and living in a dormitory 3- A 32-year-old client who has never had chickenpox 4- A 65-year-old client who had chicken pox when he was 12 years old

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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? 1- urticaria 2- dermatitis medicamentosa 3- contact dermatitis 4- angioedema

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A gardener sustained a deep laceration while working and requires sutures. The patient is asked about the date of his last tetanus shot, which he tells the nurse was more than 10 years ago. Based on this information, the patient will receive a tetanus immunization. The tetanus injection will allow for the release of what? 1- An antibody 2- An antigen 3- A bacteria 4- A virus

1

A nurse is taking health history from a new client, which includes asking about a history of blood transfusions. This is important for which reason? 1- Exposure to foreign antigens may cause altered immune function. 2- Blood products cause a high risk for exposure to HIV. 3- Blood products cause a high risk for hepatitis B. 4- Blood products cause lower antibody titers.

1

A nurse is caring for a client undergoing evaluation for possible immune system disorders. Which intervention will best help support the client throughout the diagnostic process? 1- Accompany the client to the diagnostic tests 2- Educate the client about the diagnostic procedures and answer their questions about the possible diagnosis 3- Encourage the client to ask the physician for information about treatment options for the possible diagnosis 4- Assist the client with scheduling the procedures

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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? 1- Artificially acquired active immunity 2- Naturally acquired active immunity 3- Passive immunity 4- Natural passive immunity

2

During which stage of the immune response does the circulating lymphocytes containing the antigenic message return to the nearest lymph node? 1- Recognition 2- Proliferation 3- Response 4- Effector

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T-cell deficiency occurs when which gland fails to develop normally during embryogenesis? 1- Thyroid 2- Thymus 3- Pituitary 4- Adrenal

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The nurse understands that which cells circulate throughout the body looking for virus-infected cells and cancer cells? 1- Natural killer cells 2- Cytokines 3- Interleukins 4- Interferons

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Which condition is associated with impaired immunity relating to the aging client? 1- Antibody production increases 2- Renal function decreases 3- Skin becomes thicker 4- Incidence of autoimmune disease decreases

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Which condition is associated with impaired immunity relating to the aging client? 1- Increase in humoral immunity 2- Breakdown and thinning of the skin 3- Decrease in inflammatory cytokines 4- Increase in peripheral circulation

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Which of the following is a medical condition that is an example of a humoral immune response? 1- Parasitic infection 2- Asthma 3- Fungal infection 4- Transplant rejection

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A 38-year-old client has begun to suffer from rheumatoid arthritis and is being assessed for disorders of the immune system. The client works as an aide at a facility that cares for children infected with AIDS. Which is the most important factor related to the client's assessment? 1- Age 2- Diet 3- Use of other drugs 4- Home environment

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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? 1- Naturally acquired active immunity 2- Artificially acquired active immunity 3- Passive immunity transferred by the mother 4- There is no immunity passed down from mother to child.

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An individual's exposure to an airborne pathogen has prompted an immune response that includes both cellular and humoral components. Which of the following activities is most closely associated with the humoral immune response? 1- T cells directly attack the foreign pathogen. 2- A circulating lymphocyte containing an antigenic message returns to the nearest lymph node. 3- B lymphocytes produce antibodies that are specific to the pathogen. 4- Granulocytes and macrophages engulf and destroy the invading agents.

3

The spleen acts as a filter for old red blood cells, holding a reserve of blood in case of hemorrhagic shock. It is also an area where lymphocytes can concentrate. It can become enlarged (splenomegaly) in certain hematologic disorders and cancers. To assess an enlarged spleen, the nurse would palpate the area of the: 1- Upper mediastinum. 2- Lower right abdomen. 3- Upper left quadrant of the abdomen. 4- Lower margin around the liver.

3

A 25-year-old client receives a knife wound to the leg in a hunting accident. Which type of immunity was compromised? 1- Specific immunity 2- Passive immunity 3- Adaptive immunity 4- Natural immunity

4

A 34-year-old client is diagnosed with chronic hepatitis C. Testing reveals that the client is a candidate for treatment. The nurse anticipates that which therapy could be used to treat the client's condition? 1- Erythropoietin 2- Interleukin-5 3- Monoclonal antibodies 4- Interferon

4

A client will be receiving a hepatitis B vaccination series prior to employment in a dialysis center. What type of immunity will this provide? 1- Forced immunity 2- Naturally acquired active immunity 3- Passive immunity 4- Artificially acquired active immunity

4

A patient has enlarged lymph nodes in his neck and a sore throat. This inflammatory response is an example of a cellular immune response whereby: 1- Antibodies reside in the plasma 2- Antibodies are released into the bloodstream 3- B-lymphocytes respond to a specific antigen 4- Lymphocytes migrate to areas of the lymph node

4

A woman who has experienced severe seasonal allergies in recent years has been referred for allergy skin testing. The nurse at the allergy clinic should be aware of the need to take precautions against the patient's risk of which of the following nursing diagnoses? 1- Nausea 2- Hopelessness 3- Acute pain 4- Impaired gas exchange

4

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? 1- Macrophages 2- Helper T cells 3- B cells 4- Cytotoxic T cells

4

Which medication classification is known to inhibit prostaglandin synthesis or release? 1- Nonsteroidal anti-inflammatory drugs in large doses 2- Antibiotics (in large doses) 3- Adrenal corticosteroids 4- Antineoplastic agents

1

In its attempt to suppress allergic responses, the body releases several chemicals which have a role in mediating physical reactions. Epinephrine, which interferes with vasoactive chemical release from mast cells, is instrumental in suppressing which type of hypersensitivity response? 1- type I 2- type II 3- type III 4- type IV

1

Which immunity type becomes active as a result of infection by a specific microorganism? 1- naturally acquired active immunity 2- artificially acquired active immunity 3- naturally acquired passive immunity 4- artificially acquired passive immunity

1

A client has had a splenectomy after sustaining serious internal injuries in a motorcycle accident, including a ruptured spleen. Following removal of the spleen, the client will be susceptible to: 1- infection because the spleen removes bacteria from the blood. 2- bleeding because the spleen synthesizes vitamin K. 3- acidosis because the spleen maintains acid-base balance. 4- anemia because the spleen produces red blood cells.

1

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 term is used to define any substances capable of inducing a specific immune response and of reacting with the products of that response? 1- antigens 2- antibodies 3- lymphokines 4- lymphocytes

1

The nurse is taking the health history of a newly admitted client. Which condition would place the client at risk for impaired immune function? 1- Previous organ transplantation 2- Surgical removal of the appendix 3- Negative history for radiation therapy 4- Surgical history of a partial gastrectomy

1

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 factor will positively affect the immune system? 1- Rigorous, competitive exercise 2- Strong family and community connections 3- Residential exposure to radiation 4- Poor nutritional status

2

A teenage boy is undergoing allergy testing and has had blood work drawn as part of the diagnostic workup. When reviewing the patient's laboratory results, the nurse should pay particular attention to the levels of what white blood cell (WBC) component? 1- Neutrophils 2- Eosinophils 3- Lymphocytes 4- Monocytes

2

T-cell and B-cell lymphocytes are the primary participants in the immune response. What do they do? 1- T-cell and B-cell lymphocytes distinguish harmful substances and ignore those natural and unique to a person. 2- T-cell and B-cell lymphocytes respond to the body's invasion by macrophages. 3- T-cell and B-cell lymphocytes react to the body's lack of B12 . 4- T-cell and B-cell lymphocytes distinguish harmful treatments from curative treatments.

1

A client reports to a health care provider's office for intradermal allergy testing. Before testing, the nurse provides client teaching. Which client statement indicates a need for further education? 1- "I may experience itching and irritation at the site of the testing." 2- "If I notice tingling in my lips or mouth, gargling may help the symptoms." 3- "I'll go directly to the pharmacy with my EpiPen prescription." 4- "The test may be mildly uncomfortable."

2

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? 1- Previous organ transplantation 2- Surgical removal of the appendix 3- History of radiation therapy 4- Surgical history of a splenectomy

2

A woman has been diagnosed with breast cancer and is being treated aggressively with a chemotherapeutic regimen. As a result of this regimen, she has an inability to fight infection due to the fact her bone marrow is unable to produce a sufficient amount of what? 1- Lymphocytes 2- Cytoblasts 3- Antibodies 4- Capillaries

1

Chronic illnesses may contribute to immune system impairment in various ways. Renal failure is associated with 1- deficiency in circulating lymphocytes. 2- increased incidence of infection. 3- decreased bone marrow function. 4- altered production of white blood cells.

1

The body has several mechanisms to fight disease, one of which is sending chemical messengers. 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? 1- interferons 2- interleukins 3- tumor necrosis factor 4- colony-stimulating factor

1

The nurse is teaching a client who has been diagnosed with Hashimoto's thyroiditis. Which statement correctly describes the process of autoimmunity? 1- The normal protective immune response attacks the body, damaging tissues. 2- The body produces inappropriate or exaggerated responses to specific antigens. 3- The body overproduces immunoglobulins. 4- A deficiency results from improper development of immune cells or tissues.

1

The nurse is preparing a client for skin testing. The client has been taking an over-the-counter allergy medication. The nurse would instruct the client to stop taking the medication at which time before the test? 1- 5 to 7 days 2- 2 to 4 days 3- 1 to 2 days 4- 7 to 10 days

2

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? 1- "White blood cells are produced in the plasma." 2- "White blood cells are produced in the thymus gland." 3- "White blood cells are produced in the lymphatic tissue." 4- "White blood cells are produced in the bone marrow."

4

A client has been diagnosed with acquired immune deficiency syndrome (AIDS). Which statement correctly describes a secondary immune deficiency? 1- The normal protective immune response attacks the body, leading to tissue damage. 2- The body produces inappropriate or exaggerated responses to specific antigens. 3- An interference develops in an already developed immune system. 4- Immune cells or tissues experience an improper development.

3

A client undergoing a skin test has been intradermally injected with a disease-specific antigen on the inner forearm. The client becomes anxious because the area begins to swell. Which technique may be used to decrease anxiety in this client? 1- Advise the client to use prescribed analgesics 2- Apply ice packs to reduce the swelling 3- Gently rub the swollen area to accelerate blood flow 4- Assure the client that this is a normal reaction

4

An elderly client is diagnosed with a respiratory infection. While reviewing age-related changes in the immune system, what would the nurse identify as having contributed to this client's infection? 1- Impaired ciliary action from exposure to environmental toxins 2- Failure of the immune system to differentiate "self" from "non-self" 3- Decreased phagocytosis by Kupffer cells 4- Decreased sensation and slowing of reflexes

1

During a mumps outbreak at a local school, a patient, who is a school teacher, is exposed. She has previously been immunized for mumps. What type of immunity does she possess? 1- Acquired immunity 2- Natural immunity 3- Phagocytic immunity 4- Humoral immunity

1

During an allergic reaction, histamine is released in about 15 minutes. The patient usually takes an antihistamine that has an affinity for bronchiolar smooth muscle cells (an H2 receptor). Which of the following is most likely the drug described? 1- Benadryl 2- Tagamet 3- Zantac 4- Zyflo

1

A client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit? 1- type I 2- type II 3- type III 4- type IV

1

Which statement accurately reflects current stem cell research? 1- Stem cell transplantation cannot restore immune system functioning. 2- Stem cell transplantation has been performed in the laboratory only. 3- Clinical trials are underway only in clients with acquired immune deficiencies. 4- The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells.

4

While monitoring the patient's eosinophil level, the nurse suspects a definite allergic disorder when seeing an eosinophil value of what percentage of the total leukocyte count? 1- 1% to 3% 2- 3% to 4% 3- 5% to 10% 4- 15% to 40%

4

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? 1- The nurse ensures a written consent is obtained prior to testing. 2- The nurse should send the client to have the blood drawn without informing him about the specific screening test. 3- The nurse will call the client with the results of the test. 4- The nurse will inform the client that the results will have to be reported to the Centers for Disease Control and Prevention (CDC).

1

A nurse is working in a pediatric clinic. After giving a hepatitis B immunization to an infant, the parent asks what kind of protection this provides for the child. What is the nurse's best response? 1- Active acquired immunity, which lasts many years or a lifetime 2- Active acquired immunity, which is temporary 3- Passive acquired immunity, which lasts many years or a lifetime 4- Passive acquired immunity, which is temporary

1

A nurse is explaining treatment options to a client diagnosed with an immune dysfunction. Which statement by the client accurately reflects the teaching about current stem cell research? 1- "Stem cell transplantation has been discontinued based on concerns about safety, efficacy, resource allocation, and human cloning." 2- "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." 3- "Stem cell clinical trials have only been attempted in clients with acquired immune deficiencies, but plans are underway to begin human cloning using embryonic stem cells." 4- "Stem cell transplantation has been carried out in humans with certain types of immune dysfunction, and clinical trials using stem cells are underway in clients with a variety of disorders with an autoimmune component."

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