GNUR Exam 2 LEARNING MOD

Antigen-presenting cells are necessary for which aspect of the immune system to be able to function effectively? A. Adaptive immunity B. Cell-mediated immunity C. Innate immunity D. Humoral immunity

A. Adaptive immunity

Which of the following is the major buffer in the extracellular fluid? A. Bicarbonate B. Hemoglobin C. Albumin D. Phosphate

A. Bicarbonate

Mr. Jacobs, who has cancer, has been reading a lot about it. He found a journal article indicating that some cancer cells evade lysis by cytotoxic T cells by producing fewer MHC proteins. "Explain this to me," he says. "I learned that cytotoxic T cells can kill a bad cell when they find its bad antigens, but why does producing fewer MHC proteins enable cancer cells to avoid death from cytotoxic T cells?" Choose the best explanation. A. Cytotoxic T cells can recognize bad antigens on cancer cells only if those antigens are associated with MHC proteins. B. MHC proteins are abnormal antigens to which cytotoxic T cells are innately sensitive. C. In order to kill a cell, cytotoxic T cells inject toxic chemicals through the MHC proteins in its cell membrane. D. MHC proteins are abnormal antigens that can activate cytotoxic T cells after they have been introduced to them.

A. Cytotoxic T cells can recognize bad antigens on cancer cells only if those antigens are associated with MHC proteins.

Given her diagnosis of type 1 diabetes, what are the clinical manifestations of the acute complication for which Mrs. Mendoza is at highest risk? A. Decreasing level of consciousness, rapid deep breathing, breath that smells sweet or like fingernail polish remover B. Polyuria, extreme thirst, hunger, blurred vision C. Lethargy, decreasing level of consciousness, neurological signs that look like a focal stroke D. Dyspnea, crackles in the lung bases, syncope, fatigue

A. Decreasing level of consciousness, rapid deep breathing, breath that smells sweet or like fingernail polish remover

Tammy Devine, age 14 months, has developed undiagnosed pyloric stenosis and been vomiting for 2 days. In desperation, her mother brings her to the pediatrician's office without an appointment. You are the office nurse and are assigned to assess the child, who vomited again in the waiting room. Your assessment findings include the following: low blood pressure, rapid pulse, slow shallow respirations, dry mouth, skin tenting up over her sternum when you pinch it, soft sunken eyeballs, and irritability. Given this situation, how should you interpret these assessment findings? A. ECV deficit and possible primary metabolic alkalosis B. ECV deficit and possible primary metabolic acidosis C. ECV deficit and possible primary respiratory acidosis D. ECV deficit and possible primary respiratory alkalosis

A. ECV deficit and possible primary metabolic alkalosis

Mrs. Mendoza, who has type 1 diabetes, introduces you to her nephew, a college freshman who is studying a basic anatomy book for his final exam next week. "I have a question," he says. "What causes Tia Mendoza's diabetes? I know that the pancreas normally secretes insulin from the beta cells, but why doesn't she make enough insulin?" Choose the best response. A. Her immune system turned against her pancreas beta cells and destroyed them, so she can't make any insulin. B. Diabetes damages the lining of arteries (atherosclerosis), reduces the blood supply to the pancreas, and causes beta cell dysfunction. C. Her body cells have stopped responding well to insulin and she needs more insulin than her pancreas beta cells can make. D. Diabetes causes damage to little blood vessels (microvascular disease) and her beta cells didn't get enough blood and died.

A. Her immune system turned against her pancreas beta cells and destroyed them, so she can't make any insulin.

What mechanism causes tissue injury in type III hypersensitivity reactions? A. Immune complexes activate the complement system and stimulate phagocytosis. B. Autoantibodies attack and destroy the body's own tissues. C. Chemotactic agents released by phagocytes cause tissue injury. D. Cytotoxic T cells release toxic enzymes that destroy target tissues.

A. Immune complexes activate the complement system and stimulate phagocytosis.

What is present at the end of the process of sensitization in type I hypersensitivity? A. Mast cells with IgE bound to the outside of their cell membranes B. Antigens binding to IgE that is bound to mast cell membranes C. Eosinophils that are degranulating D. Mast cells that are degranulating

A. Mast cells with IgE bound to the outside of their cell membranes

Mrs. Mendoza, age 54, has type 1 diabetes. Her right foot was amputated this morning. "I take as good care of myself as I can," she says, "but my feet are numb and it is hard to check them for little injuries every night when I have such difficulty seeing." What are the technical terms that you should use with another health professional to describe the common complications of diabetes that she has described? A. Peripheral neuropathy and diabetic retinopathy B. Autonomic neuropathy and diabetic glaucoma C. Diabetic glaucoma and peripheral neuropathy D. Diabetic retinopathy and autonomic neuropathy

A. Peripheral neuropathy and diabetic retinopathy

B lymphocytes provide humoral immunity through which of the following processes? A. Production of antibodies B. Secretion of perforins C. Direct cell lysis D. Initiating an inflammatory response

A. Production of antibodies

Which process confers long-lasting immunity against a specific organism? A. Production of memory cells B. Activation of macrophages C. Activation of T cytotoxic cells D. Production of inflammatory mediators

A. Production of memory cells

Kellie Frond was stung by a bee. "Help!" her mother shouts. "She is allergic to bees!" She administered the emergency epinephrine (EpiPen) that she carries in case of bee sting. Someone has called 911 for emergency assistance. What signs and symptoms would tell you that Kellie is having a life-threatening type I hypersensitivity reaction and needs a second dose of epinephrine before the paramedics arrive? A. Wheezing, difficulty breathing, weak pulse B. Widespread itching and hives on her back C. Tachycardia, pale cool skin, and dilated pupils D. Tingling lips, positive Chvostek sign

A. Wheezing, difficulty breathing, weak pulse

In type II hypersensitivity, tissue injury may be caused by: A. all of the above. B. antibody activation of complement and subsequent lysis of target cells. C. antibody stimulation of cell receptors, causing excessive cell function. D. antibody opsonization of cells and subsequent phagocytosis.

A. all of the above.

The pathophysiology of type 1 diabetes mellitus involves: A. autoimmune destruction of pancreatic beta cells. B. postreceptor defects that cause insulin resistance. C. hyperglycemia alternating with hypoglycemic episodes. D. All of the other answers are correct.

A. autoimmune destruction of pancreatic beta cells.

Respiratory alkalosis is caused by: A. hyperventilation. B. pneumonia. C. chest muscle weakness. D. pulmonary edema.

A. hyperventilation.

Hyperglycemia in type 2 diabetes mellitus is due primarily to: A. insulin resistance. B. production of inactive insulin. C. glycogen excess. D. glucagon deficiency.

A. insulin resistance.

The pathophysiology of gestational diabetes is similar in its tissue effects to: A. type 2 diabetes. B. type 1 diabetes. C. diabetic ketoacidosis. D. hyperosmolar coma.

A. type 2 diabetes.

Which of the following alterations in the blood is evidence that the kidneys are compensating for respiratory acidosis? A. Elevated carbon dioxide B. Elevated bicarbonate ion concentration C. Decreased bicarbonate ion concentration D. Decreased carbon dioxide

B. Elevated bicarbonate ion concentration

The diagnoses on Mrs. Mendoza's chart include gastroparesis in addition to type 1 diabetes. Which of the following statements by Mrs. Mendoza indicates that her gastroparesis is symptomatic today? A. I have diarrhea today; please give me the bedpan. B. I can't eat this bedtime snack; I'm still full from dinner. C. I am weak, sweaty, hungry, and shaky again. D. I have that burning pain behind my breastbone again.

B. I can't eat this bedtime snack; I'm still full from dinner.

Which of the following processes causes acute metabolic acidosis from insulin deficiency? A. Chronic kidney disease B. Incomplete metabolism of fatty acids C. Increased anaerobic metabolism of glucose D. Protein catabolism with ammonia release

B. Incomplete metabolism of fatty acids

What acid-base imbalance does emesis cause? A. Respiratory alkalosis B. Metabolic alkalosis C. Metabolic acidosis D. Respiratory acidosis

B. Metabolic alkalosis

How do natural killer (NK) cells differ from cytotoxic T cells? A. NK cells can produce antibodies after prior introduction to the specific antigen involved. B. NK cells can target any infected or malignant cell without prior introduction to its antigens. C. NK cells release perforins and other chemicals that kill target cells. D. NK cells can opsonize bacteria, viruses, and parasites.

B. NK cells can target any infected or malignant cell without prior introduction to its antigens.

Which system compensates for metabolic acidosis and alkalosis? A. Renal B. Respiratory C. Cardiovascular D. Gastrointestinal

B. Respiratory

When they are activated, cytotoxic T cells can destroy other cells by which of the following mechanisms? A. Producing antibodies B. Secreting perforins C. Phagocytosis D. Opsonization

B. Secreting perforins

Polydipsia, polyphagia, and polyuria are characteristic of both type 1 and type 2 diabetes mellitus because these three manifestations are caused by: A. pancreatic necrosis. B. hyperglycemia. C. chronic illness. D. too much insulin.

B. hyperglycemia.

If an individual has a fully compensated metabolic acidosis, the blood pH is: A. either high or low, depending on the type of compensation. B. in the normal range. C. high D. low

B. in the normal range.

You are talking with another health professional about immunity. What term should you use to describe a person who has resistance to a disease after having the disease? A. Natural immunity B. Innate immunity C. Active acquired immunity D. Passive acquired immunity

C. Active acquired immunity

How does long-term diabetes cause gastroparesis? A. Through endothelial dysfunction B. From abnormal muscle metabolism C. By damaging autonomic nerves D. With repeated episodes of acidosis

C. By damaging autonomic nerves

Which of the following imbalances often accompanies metabolic alkalosis? A. Hyponatremia B. Hypernatremia C. Hypokalemia D. Hyperkalemia

C. Hypokalemia

Type I hypersensitivity is mediated by which of the following antibodies? A. IgM B. IgG C. IgE D. IgD

C. IgE

Which of the following series of laboratory values reflects uncompensated metabolic alkalosis? A. Decreased pH, decreased HCO3- B. Increased pH, decreased HCO3- C. Increased pH, increased HCO3- D. Decreased pH, increased HCO3-

C. Increased pH, increased HCO3-

What effect does the presence of advanced glycation end products (AGEs) have in diabetes? A. Increased ketoacid formation B. Increased intracellular osmotic pressure C. Increased tissue injury D. Reduced chronic complications

C. Increased tissue injury

Which one of these hypersensitivity reactions cannot be part of an autoimmune disease? A. Type II B. Type III C. Type I D. Type IV

C. Type I

A person who has type 2 diabetes is more likely to develop hyperglycemic hyperosmolar nonketotic coma than diabetic ketoacidosis because: A. insulin resistance is a problem in type 2 diabetes. B. ketoacids are burned for fuel in type 2 diabetes. C. a small amount of insulin reaches the liver in type 2 diabetes. D. increased renal bicarbonate reabsorption neutralizes the ketoacids.

C. a small amount of insulin reaches the liver in type 2 diabetes.

Clinical manifestations of the autoimmune disease systemic lupus erythematosus (SLE) include: A. nasal polyps, watery eyes, and rhinorrhea. B. pulmonary edema, ankle edema, and neck vein distention. C. arthritic joint pain and skin rash, especially over the cheeks. D. respiratory wheezing, eczema, and itching.

C. arthritic joint pain and skin rash, especially over the cheeks.

Early manifestations of a developing metabolic acidosis include: A. muscle cramps. B. short and shallow respirations. C. lethargy. D. coma.

C. lethargy.

What type of reaction occurs when the body mounts an aggressive response against an organ transplanted from another person? A. Autoimmune B. Type I hypersensitivity C. Immunosuppressive D. Alloimmune

D. Alloimmune

An immune complex is a combination of which of the following? A. Cytotoxic T cell and antigen B. B cell and antigen C. T helper cell and lymphocyte D. Antibody and antigen

D. Antibody and antigen

Which of the following should you teach a pregnant woman in order to preserve the first line of defense against microorganisms? A. Be sure to get your baby's immunizations on schedule. B. Breastfeeding will provide some immune protection to your baby. C. If you are exposed to rubella when you are pregnant, ask your doctor about gamma globulin. D. Avoid picking off scabs and let them fall off naturally.

D. Avoid picking off scabs and let them fall off naturally.

Which of the following causes respiratory acidosis? A. Hyperventilation B. Tissue hypoxia C. Massive blood transfusion D. Hypoventilation

D. Hypoventilation

You are a camp nurse. "I am not afraid of poison ivy!" says Max Grewe, age 13. "I touched it once accidentally last summer for the first time and did not have a problem, so I stuck my hand in some this morning. See, my hand is perfectly fine. I am immune to it!" Choose the best response. A. You should stay near people for the rest of the afternoon and evening, in case you break out in hives, feel faint, or have trouble breathing. If that happens, you will need help fast. Here is my cell phone number in case of emergency. B. You could have a secondary immune response if you touch poison ivy again, so stay away from it. A secondary immune response is stronger than a primary immune response. C. Apparently you are one of the lucky people who are immune to urushiol, the part of poison ivy that causes the itchy blistering rash in people who are not immune to it. D. Last summer, your immune cells met poison ivy for the first time and some of them may have become sensitized to it. Now they are meeting poison ivy again and they may cause some damage that you will see as an itchy blistering rash in the next few days. Let me check your hand every day this week.

D. Last summer, your immune cells met poison ivy for the first time and some of them may have become sensitized to it. Now they are meeting poison ivy again and they may cause some damage that you will see as an itchy blistering rash in the next few days. Let me check your hand every day this week.

Which of the following are the primary cells of adaptive immunity? A. Macrophages B. Neutrophils C. Dendritic cells D. Lymphocytes

D. Lymphocytes

Which one of these people should you monitor most carefully for development of metabolic acidosis? A. Mr. B, who has had hypokalemia for over a week B. Mr. A, who is in the diuretic phase of acute renal failure C. Ms. D, who has newly diagnosed Cushing syndrome D. Ms. C, who has had diarrhea for over a week

D. Ms. C, who has had diarrhea for over a week

"One time my doctor said I have an autoimmune disease and the next time he called it a hypersensitive reaction," says Mr. Treloni. "Are they the same thing?" Choose the best response. A. No. Autoimmune diseases involve the immune system attacking and damaging the body. Hypersensitivity reactions are allergic reactions, a specific type of immune system response. B. No. There are several types of autoimmune reactions, which means that the body triggers the immune system to attack itself. Some autoimmune reactions are hypersensitivity reactions, which means that the immune response makes excessive antibodies. Other autoimmune reactions do not involve antibodies and are not hypersensitivity reactions. C. Yes, hypersensitivity reaction and autoimmune reaction mean the same thing. D. No. There are several types of hypersensitivity reactions, which means the immune system damages the body. Sometimes what triggers a hypersensitivity reaction is not autoimmune, meaning that it is a trigger from the environment, like pollen. But, in your case, what triggers the hypersensitivity reaction is autoimmune, meaning that it is one of your body's own chemicals that makes the immune system attack.

D. No. There are several types of hypersensitivity reactions, which means the immune system damages the body. Sometimes what triggers a hypersensitivity reaction is not autoimmune, meaning that it is a trigger from the environment, like pollen. But, in your case, what triggers the hypersensitivity reaction is autoimmune, meaning that it is one of your body's own chemicals that makes the immune system attack.

Jason Dryer, age 3, was brought to the emergency department by a child welfare officer. He is diagnosed with starvation ketoacidosis. What signs and symptoms should you anticipate in your assessment? A. Slow, shallow breathing, belligerence, hyperexcitability B. Rapid, deep breathing, tremors, elevated blood pressure C. Slow, shallow breathing, numbness and tingling around his mouth D. Rapid, deep breathing, lethargy, abdominal pain

D. Rapid, deep breathing, lethargy, abdominal pain

A 54-year-old male with a long history of smoking complains of excessive tiredness, shortness of breath, and overall ill feelings. Lab results reveal decreased pH, increased CO2, and normal bicarbonate ion. These findings help to confirm the diagnosis of: A. Respiratory alkalosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory acidosis

D. Respiratory acidosis

A 55-year-old female presents to her primary care provider and reports dizziness, confusion, and tingling in the extremities. Blood tests reveal an elevated pH, decreased PCO2, and slightly decreased HCO3. Which of the following is the most likely diagnosis? A. Respiratory acidosis with renal compensation B. D. Metabolic acidosis with respiratory compensation C. Metabolic alkalosis with respiratory compensation D. Respiratory alkalosis with renal compensation

D. Respiratory alkalosis with renal compensation

Which of the following cells stimulate both the cell-mediated and humoral immune responses? A. B lymphocytes B. Plasma cells C. Cytotoxic T cells D. T helper cells

D. T helper cells

Macrophages interact with T helper cells by: A. producing reactive oxygen species. B. synthesizing antibodies and T cell receptors. C. phagocytizing microorganisms. D. presenting antigens and secreting cytokines.

D. presenting antigens and secreting cytokines.

In contrast with the innate immune response, the adaptive immune response: A. has no memory. B. is faster. C. reacts to microorganisms. D. recognizes specific antigens.

D. recognizes specific antigens.

A positive reaction to a tuberculin skin test takes 24 to 72 hours to appear because: A. the liver must synthesize complement proteins before they can be activated. B. the antibodies take that long to develop and react in this type I hypersensitivity reaction. C. immune complexes must form and phagocytes infiltrate before the lesion appears. D. the cytotoxic cells take that long to accumulate and act in this type IV hypersensitivity reaction.

D. the cytotoxic cells take that long to accumulate and act in this type IV hypersensitivity reaction.