Patho Chapter 8

Which physiologic condition is present during anaphylactic shock? a. hypotension b. hyperglycemia c. bronchodilation d. urinary retention

ANS: A Histamine levels are high in anaphylactic shock, resulting in vasodilation of blood vessels, which in turn increases blood flow to the area and leads to hypotension.

When a nurse cares for a patient with systemic lupus erythematosus (SLE), the nurse remembers this disease is an example of: a. autoimmunity. b. alloimmunity. c. homoimmunity. d. alleimmunity.

ANS: A SLE is the most common, complex, and serious of the autoimmune disorders. SLE is not identified as alloimmune, homoimmune, or alleimmune.

A 22 year old was recently diagnosed with acquired immunodeficiency syndrome (AIDS). Which decreased lab finding would be expected to accompany this virus? a. CD4+ T-helper b. CD8 T-helper c. CDC cells d. CDC10 cells

ANS: A The major immunologic finding in AIDS is the striking decrease in the number of CD4+ T- helper cells. The change occurs in CD4 cells, not CD8. Neither CDC nor CDC 10 is a type of cell

Which term describes am inappropriate, exaggerated response against a noninfectious environmental substance? a. allergy b. alloimmunity c. autoimmunity d. acute rejection

ANS: A Hypersensitivity reactions are inappropriate responses and may be exaggerated against noninfectious environmental substances

A 30-year-old female is diagnosed with systemic lupus erythematosus (SLE). Which symptoms are a result of a type II hypersensitivity? (Select all that apply.) a. Anemia b. Seizures c. Lymphopenia d. Facial rash e. Photosensitivity

ANS: A, C The patient is experiencing type II hypersensitivity when experiencing anemia and lymphopenia. Seizures, facial rash, and photosensitivity are not associated with type II hypersensitivity reactions.

Which finding is assocaited with type AB+ blood? SATA a. D antigens b. dd genotype c. DD genotype d. A & B antigens e. rare Rh blood group

ANS: A,C,D a person with blood type AB will carry both A and B antigens. Positive Rh blood types have the D antigen and may be DD or dd in genotype. The dd genotype is for negative Rh blood, and 85% of the population is Rh positive.

What are some routes of transmission for HIV, which routes should be included? a. contact with infected blood b. hugging an infected partner c. kissing an infected partner d. breast-feeding by infected mother e. sex with an infected partner

ANS: A,D,E

Which of the following is a characteristic of the human immunodeficiency virus (HIV), which causes AIDS? a. HIV only infects B cells. b. HIV is a retrovirus. c. Infection does not require a host cell receptor. d. After infection, cell death is immediate

ANS: B AIDS is an acquired dysfunction of the immune system caused by a retrovirus (HIV) that infects and destroys CD4+ lymphocytes (T-helper cells). HIV infection begins when a virion binds to CD4, not a B cell. Infection requires a host cell receptor. The cell remains dormant but does not die.

Which immune component is deficient in a child who has a congenital immunodeficiency that impairs B lymphocyte function? a. cytokines b. antibodies c. complement d. cytotoxic cell activity

ANS: B B lymphocyte deficiencies cause defects in antibody production, because B lymphocytes are the antibody-producing cells. Predominantly antibody deficiencies results from defects in B-cell maturation or function & are the most common immune deficiencies.

In addition to matching ABO antigens, a blood transfusion must also be matched for: a. HLA type. b. Rh antigen. c. immunoglobulins. d. platelet compatibility

ANS: B Blood transfusions must also be matched for the Rh antigen. Blood transfusions do not need to be matched to HLA, immunoglobulins, or platelet compatibility

A 5-year-old male presents with low-set ears, a fish-shaped mouth, and involuntary rapid muscular contraction. Laboratory testing reveals decreased calcium levels. Which of the following diagnosis is most likely? a. B-lymphocyte deficiency b. T-lymphocyte deficiency c. Combined immunologic deficiency d. Complement deficiency

ANS: B DiGeorge syndrome results in greatly decreased T cell numbers and function and is evidenced by abnormal development of facial features that are controlled by the same embryonic pouches; these include low-set ears, fish-shaped mouth, and other altered features. B- lymphocyte deficiency is not manifested by these symptoms. Neither combined immunologic deficiency nor complement deficiency is manifested by these symptoms

A 30-year-old female complains of fatigue, arthritis, rash, and changes in urine color. Laboratory testing reveals anemia, lymphopenia, and kidney inflammation. Assuming a diagnosis of SLE, which of the following is also likely to be present? a. Anti-LE antibodies b. Autoantibodies c. Antiherpes antibodies d. Anti-CMV antibodies

ANS: B The presence of autoantibodies is a diagnostic criterion for SLE. Diagnostic criterion for SLE would include positive LE. Neither antiherpes nor anti-CMV antibodies are associated with a diagnosis SLE

An individual had a organ transplant rejection. Which information indicates a correct understanding of transplant rejection? Select all that apply? a. hyperacute rejection is common b. white graft indicates hyperacute rejection c. acute rejection occurs within months to years. d. acute rejection is a type IV hypersensitivity reaction. e. chronic rejection is a type II hypersensitivity reaction.

ANS: B, D In hyperacute rejection, the graft may immediately turn white instead of a normal pink color. However, hyperacute rejection is rare. Acute rejection is a type IV-mediated hypersensitivity reaction. Acute rejection occurs within days to month. Chronic rejection occurs after a period of months or years of normal function and is a type IV hypersensitive reaction, not a type II. Type II reactions occur in hyperacute rejections.

When the maternal immune system becomes sensitized against antigens expressed by the fetus, what type of immune reaction occurs? a. Autoimmune b. Anaphylaxis c. Alloimmune d. Allergic

ANS: C Alloimmunity can be observed during immunologic reactions against transfusions, transplanted tissue, or the fetus during pregnancy. Autoimmunity is a disturbance in the immunologic tolerance of self-antigens. The most rapid and severe immediate hypersensitivity reaction is anaphylaxis. An allergic response occurs related to exposure to an allergen.

A 10-year-old male is stung by a bee while playing in the yard. He begins itching and develops pain, swelling, redness, and respiratory difficulties. He is suffering from: a. immunodeficiency. b. autoimmunity. c. anaphylaxis. d. tissue-specific hypersensitivity

ANS: C Anaphylaxis occurs within minutes of reexposure to the antigen and can be either systemic (generalized) or cutaneous (localized). Immunodeficiency is a decrease in the immune response. Autoimmunity is a disturbance in the immunologic tolerance of self-antigens. Tissue-specific reaction is an autoimmune reaction

An infant is experiencing hemolytic disease of the newborn. Which of the following would the nurse expect to find in the infant's history and physical? a. The mother was exposed to measles. b. The father was exposed to Agent Orange. c. The baby is Rh positive. d. The baby was born 6 weeks prematurely

ANS: C Hemolytic disease of the newborn was most commonly caused by IgG anti-D alloantibody produced by Rh-negative mothers against erythrocytes of their Rh-positive fetuses. This disorder is not due to the mother's exposure to measles, the father's exposure to Agent Orange, or the baby's prematurity.

When a patient asks the nurse what hypersensitivity is, how should the nurse respond? Hypersensitivity is best defined as: a. a reduced immune response found in most pathologic states. b. a normal immune response to an infectious agent. c. an excessive or inappropriate response of the immune system to a sensitizing antigen. d. antigenic desensitization

ANS: C Hypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the individual. It is not a reduced immune response or a response to an infectious agent. Antigenic desensitization is performed to decrease hypersensitivity

A nurse recalls that an example of an immune-complex-mediated disease is: a. bronchial asthma. b. contact dermatitis. c. serum sickness. d. rheumatoid arthritis.

ANS: C Immune-complex disease can be a systemic reaction, such as serum sickness, and related to type III reactions. Bronchial asthma is not an immune-complex-mediated disease and is related to type I reactions. Neither contact dermatitis nor rheumatoid arthritis is related to type III reactions

When a patient presents at the emergency department for an allergic reaction, the nurse recognizes the most severe consequence of a type I hypersensitivity reaction is: a. urticaria. b. hives. c. anaphylaxis. d. antibody-dependent cell-mediated cytotoxicity (ADCC)

ANS: C The most rapid and severe immediate hypersensitivity type I reaction is anaphylaxis. Urticaria, or hives, is a dermal (skin) manifestation of allergic reactions. Hives and urticaria are similar responses. ADCC is a mechanism that involves natural killer (NK) cells. Antibodies on the target cell are recognized by Fc receptors on the NK cells, which release toxic substances that destroy the target cell.

A patient presents with poison ivy on the extremities, face, and buttocks after an initial exposure 48 hours ago. This condition is an example of: a. anaphylaxis. b. serum sickness. c. delayed hypersensitivity. d. viral disease.

ANS: C The response to poison ivy is a delayed hypersensitivity because it takes up to 72 hours to develop. Anaphylaxis is immediate. Serum sickness-type reactions are caused by the formation of immune complexes in the blood and their subsequent generalized deposition in target tissues. Poison ivy is not a viral disease

When a nurse notices that a patient has type O blood, the nurse realizes that anti-_____ antibodies are present in the patient's body. a. A only b. B only c. A and B d. O

ANS: C Type O individuals have both anti-A and anti-B antibodies but not O

The nurse would correctly respond that the etiology of a congenital immune deficiency is due to a(n): a. negative response to an immunization. b. adverse response to a medication. c. renal failure. d. genetic defect.

ANS: D A primary (congenital) immune deficiency is caused by a genetic defect. A primary (congenital) immune deficiency is not a response to an immunization, an adverse response to a medication, or due to renal failure.

Which statement describes an individual who is sensitized and is predisposed to a type I hypersensitivity reaction? a. mast cells are degranulated b. urticaria has developed on the skin c. antigens have bound to IgE receptors on mast cells. d. Attachment of large amounts of IgE to mast cell membranes has occurred.

ANS: D After a large amount of IgE has bound to the mast cells, an individual is considered sensitized. Degranulation of mast cells may start the process, but this alone is not the meaning of sensitized.

What is the chance that two siblings share both HLA haplotypes, making them a good match for an organ transplant from one to the other? a. 100% b. 75% c. 50% d. 25%

ANS: D Odds dictate that children will share one haplotype with half their siblings and either no haplotypes or both haplotypes with a quarter of their siblings. Thus, the chance of finding a match among siblings is much higher (25%) than the general population.

A 40-year-old female is diagnosed with SLE. Which of the following findings would be considered a symptom of this disease? a. Gastrointestinal ulcers b. Decreased glomerular filtration rate c. Rash on trunk and extremities d. Photosensitivity

ANS: D Photosensitivity is one of the 11 common clinical findings in SLE. Gastrointestinal ulcers are not a finding in SLE. Proteinuria is a symptom of SLE. A rash on the face is a symptom, but not a rash on the body.

A 30-year-old male is having difficulty breathing and has been spitting blood. He reports that he began experiencing this reaction after cleaning his pigeons' cages. Testing reveals he is suffering from allergic alveolitis. Which of the following is he experiencing? a. Serum sickness b. Raynaud phenomenon c. Antibody-dependent cytotoxicity d. Arthus reaction

ANS: D The Arthus reaction is a model of localized or cutaneous reactions. Serum sickness-type reactions are caused by the formation of immune complexes in the blood and their subsequent generalized deposition in target tissues. Typically affected tissues are the blood vessels, joints, and kidneys. Raynaud phenomenon is a condition caused by the temperature-dependent deposition of immune complexes in the capillary beds of the peripheral circulation. Antibody- dependent cytotoxicity is a type II form

A 30-year-old male was diagnosed with HIV. Which of the following treatments would be most effective? a. Reverse transcriptase inhibitors b. Protease inhibitors c. Entrance inhibitors d. Antiretroviral therapy (ART)

ANS: D The current regimen for treatment of HIV infection is a combination of drugs, termed antiretroviral therapy (ART). The remaining options are individual components of the ART treatment format.

What is the immune mechanism of type IV hypersensitivity?

Activated T lymphocytes -> 1. release of cytokines(Cytokines are small secreted proteins released by cells have a specific effect on the interactions and communications between cells., inflammation and macrophage activation. 2. T cell(T cells are a part of the immune system that focuses on specific foreign particles. Rather than generically attack any antigens, T cells circulate until they encounter their specific antigen.)-mediated cytotoxicity

What is an example of a type II hypersensitivity and what antibody is involved?

Autoimmune thrombocytopenia purpura, graves disease, autoimmune hemolytic anemia; IgG and IgM( NK cells, macrophages, neutrophils) Tissue-specific reaction

What is an example of a type IV hypersensitivity and what antibody is involved?

Contact sensitivity to poison ivy, metals(jewelry) and latex; No antibodies involved. Delayed reaction ; cell-mediated reaction

What is the immune mechanism of type III hypersensitivity?

Deposition of antigen-antibody complexes -> complement activation -> recruitment of leukocytes by complement products and Fc receptors -> release of enzymes and other toxic molecules

Which information would indicate more teaching is needed regarding hypersensitivity reactions? Type _______ hypersensitivity reactions involve an antibody response. a. I b. II c. III d. IV

IV ANS: D Type IV reactions are mediated by T lymphocytes and do not involve antibodies. All the remaining options are associated with antibody responses

What is the immune mechanism of type I hypersensitivity?

Production of IgE antibody --> immediate release of vasoactive amines(A substance containing amino groups, such as histamine or serotonin, that acts on the blood vessels to alter their permeability or to cause vasodilation.)and other mediators from mast cells(Mast cells recognize harmful antigens by binding to pathogens directly); later recruitment of inflammatory cells.

What is the immune mechanism of type II hypersensitivity?

Production of IgG, IgM --> binds to antigen on target cell on target cell or tissue --> phagocytosis or lysis of target cell by activated complement or Fc receptors; recruitment of leukocytes

What is an example of a type I hypersensitivity and what antibody is involved?

Seasonal allergic rhinitis, asthma. IgE antibody. Principal effector cell involved is mast cells( serve as first line of defense against antigens due to location in skin and mucosa)

What is an example of a type III hypersensitivity and what antibody is involved?

Systemic lupus erythematous. IgG & IgM (Neutrophils) Immune- complex- mediated reaction