143 Mod 4 - Immune A&P Review, Diagnostic Tests (PRACTICE QUESTIONS)

What type of immunoglobulin does the nurse recognize that promotes the release of vasoactive chemicals such as histamine when a client is having an allergic reaction? A. IgE B. IgM C. IgA D. IgG

A. IgE promotes the release of vasoactive chemicals such as histamine and bradykinin in allergic, hypersensitivity, and inflammatory reactions. IgG neutralizes bacterial toxins and accelerates phagocytosis. IgA interferes with the entry of pathogens through exposed structures or pathways. IgM agglutinates antigens and lyses cell walls.

During a mumps outbreak at a local school, a teacher has been exposed. The client has previously been immunized for mumps, and consequently possesses: A. acquired immunity. B. natural immunity. C. phagocytic immunity. D. humoral immunity.

ANS: A Rationale: Acquired immunity usually develops as a result of prior exposure to an antigen, often through immunization. When the body is attacked by bacteria, viruses, or other pathogens, it has three means of defense. The first line of defense, the phagocytic immune response, involves the WBCs that have the ability to ingest foreign particles. A second protective response is the humoral immune response, which begins when the B lymphocytes transform themselves into plasma cells that manufacture antibodies. The natural immune response system is rapid, nonspecific immunity present at birth.

A client with a history of dermatitis takes corticosteroids on a regular basis. The nurse should assess the client for which complication of therapy? A. Immunosuppression B. Agranulocytosis C. Anemia D. Thrombocytopenia

ANS: A Rationale: Corticosteroids, such as prednisone, can cause immunosuppression. Corticosteroids do not typically cause agranulocytosis, anemia, or low platelet counts. Agranulocytosis, which is a decrease in granulocytes, a type of white blood cell, may be caused by antibiotics, antithyroid drugs, or nonsteroidal anti-inflammatory drugs. Anemia, which is a decrease in red blood cells, may be caused by antibiotics or nonsteroidal anti-inflammatory drugs. Thrombocytopenia, which is a decrease in platelets, may be caused by antibiotics.

A client has been admitted to the emergency department with signs of anaphylaxis following a bee sting. The nurse knows that if this is a true allergic reaction the client will present with what alteration in laboratory values? A. Increased eosinophils B. Increased neutrophils C. Increased serum albumin D. Decreased blood glucose

ANS: A Rationale: Higher percentages of eosinophils are considered moderate to severe eosinophilia. Moderate eosinophilia is defined as 15% to 40% eosinophils and is found in clients with allergic disorders. Hypersensitivity does not result in hypoglycemia or increased albumin and neutrophil counts.

A gardener sustained a deep laceration while working and requires sutures. The date of the client's last tetanus shot was over 10 years ago. Based on this information, the client will receive a tetanus immunization, which will allow for the release of which type of substance? A. Antibodies B. Antigens C. Cytokines D. Phagocytes

ANS: A Rationale: Immunizations activate the humoral immune response, culminating in antibody production. Antigens are the substances that induce the production of antibodies. Cytokines are nonantibody proteins secreted by helper T cells that act as intracellular mediators, as in the generation of immune response. They attract and activate B cells, cytotoxic T cells, natural killer cells, macrophages, and other cells of the immune system. Phagocytes are white blood cells that engulf, ingest, and destroy foreign bodies or toxins. Immunizations do not prompt cytokine or phagocyte production.

A client has been diagnosed with breast cancer and is being treated aggressively with a chemotherapeutic regimen. As a result of this regimen, the client has an inability to fight infection because bone marrow is unable to produce a sufficient amount of: A. lymphocytes. B. cytoblasts. C. antibodies. D. capillaries.

ANS: A Rationale: The white blood cells involved in immunity (including lymphocytes) are produced in the bone marrow. Cytoblasts are the protoplasm of the cell outside the nucleus. Antibodies are produced by lymphocytes, but not in the bone marrow. Capillaries are small blood vessels.

The nurse should recognize a client's risk for impaired immune function if the client has undergone surgical removal of which of the following? A. Thyroid gland B. Spleen C. Kidney D. Pancreas

ANS: B Rationale: A history of surgical removal of the spleen, lymph nodes, or thymus may place the client at risk for impaired immune function. Removal of the thyroid, kidney, or pancreas would not directly lead to impairment of the immune system.

A nurse has given an 8-year-old client the scheduled vaccination for rubella. This vaccination will cause the client to develop which expected and desired condition? A. Natural immunity B. Passive acquired immunity C. Cellular immunity D. Mild hypersensitivity

ANS: B Rationale: Passive/adaptive acquired immunity usually develops as a result of vaccination or contracting a disease. Natural immunity is present at birth and provides a nonspecific response to any foreign invader. Immunizations do not activate the process of cellular immunity. Cellular immunity is part of the innate/natural immunity response, which involves T cells that neutralize components of the threat within the cell itself. Hypersensitivity is infrequent, and adverse reactions (i.e., urticaria, anaphylaxis) to vaccine administration are rare.

A client's natural immunity is enhanced by processes that are inherent in the physical and chemical barriers of the body. What is a chemical barrier that enhances natural immunity? A. Cell cytoplasm B. Interstitial fluid C. Gastric secretions D. Cerebrospinal fluid

ANS: C Rationale: Chemical barriers, such as mucus, acidic gastric secretions, enzymes in tears and saliva, and substances in sebaceous and sweat secretions, act in a nonspecific way to destroy invading bacteria and fungi. Not all body fluids are chemical barriers, however. Cell cytoplasm, interstitial fluid, and CSF are not normally categorized as chemical barriers to infection.

A nurse is planning the assessment of a client who is exhibiting signs and symptoms of an autoimmune disorder. The nurse should be aware that the incidence and prevalence of autoimmune diseases is known to be higher among which group? A. Young adults B. Native Americans/First Nations C. Women D. People of Hispanic descent

ANS: C Rationale: Many autoimmune diseases have a higher incidence in females than in males, a phenomenon believed to be correlated with sex hormones. Sex hormones play definitive roles in lymphocyte maturation, activation, and synthesis of antibodies and cytokines. Autoimmune disorders in women, such as lupus and multiple sclerosis, may be linked to hormonal changes that can occur during puberty, pregnancy, and menopause. Young adults, Native Americans/First Nations and people of Hispanic descent are not known to have a higher incidence or prevalence of autoimmune disorders.

A client with cystic fibrosis has received a double lung transplant and is now experiencing signs of rejection. Which immune response predominates in this situation? A. Humoral B. Nonspecific C. Cellular D. Antibody

ANS: C Rationale: Most immune responses to antigens involve both humoral (antibody) and cellular responses, although only one predominates. During transplantation rejection, the cellular response predominates over the humoral (antibody) response. Transplantation rejection is not associated with nonspecific immune response. Chemical barriers, such as mucus, acidic gastric secretions, enzymes in tears and saliva, and substances in sebaceous and sweat secretions, act in a nonspecific way to destroy invading bacteria and fungi.

A client is scheduled for a skin test. The client informs the nurse that the client used a corticosteroid earlier today to alleviate allergy symptoms. Which nursing intervention should the nurse implement? A. Note the corticosteroid use in the electronic health record and continue with the test. B. Modify the skin test to check for grass, mold, or dust allergies only. C. Administer sodium valproate to reverse the effects of corticosteroid usage. D. Cancel and reschedule the skin test when the client stops taking the corticosteroid.

ANS: D Rationale: Corticosteroids and antihistamines, including over-the-counter allergy medications, suppress skin test reactivity and should be stopped 48 to 96 hours before testing, depending on the duration of their activity. If the client takes one of these medications within this time frame, the nurse should cancel the skin test and reschedule for a time when the client is not taking it. The nurse should not continue with the test. The nurse should not modify the test. Administration of sodium valproate is used to reverse corticosteroid-induced mania, not to reverse it effects, in general.

The nurse is completing a focused assessment addressing a client's immune function. What should the nurse prioritize in the physical assessment? A. Percussion of the client's abdomen B. Palpation of the client's liver C. Auscultation of the client's apical heart rate D. Palpation of the client's lymph nodes

ANS: D Rationale: During the assessment of immune function, the anterior and posterior cervical, supraclavicular, axillary, and inguinal lymph nodes are palpated for enlargement. If palpable nodes are detected, their location, size, consistency, and reports of tenderness on palpation are noted. Because of the central role of lymph nodes in the immune system, they are prioritized over the heart, liver, and abdomen, even though these would be assessed.

A nurse is preparing a client for allergy skin testing. What precautionary step is most important for the nurse to follow? A. The client must not have received an immunization within 7 days. B. The nurse should administer albuterol 30 to 45 minutes prior to the test. C. Prophylactic epinephrine should be given before the test. D. Emergency equipment should be readily available.

ANS: D Rationale: Emergency equipment must be readily available during testing to treat anaphylaxis. Immunizations do not contraindicate testing. Neither epinephrine nor albuterol is given prior to testing.

A nurse has admitted a client who has been diagnosed with urosepsis. Which immune response predominates in sepsis? A. Mitigated B. Nonspecific C. Cellular D. Humoral

ANS: D Rationale: Most immune responses to antigens involve both humoral and cellular responses, although only one predominates. For example, during transplantation rejection, the cellular response predominates, whereas in the bacterial pneumonias and sepsis, the humoral response plays the dominant role. Neither mitigated nor nonspecific cell response is predominant in this situation.

A neonate exhibited some preliminary signs of infection, but the infant's condition resolved spontaneously prior to discharge home from the hospital. This infant's recovery was most likely due to which type of immunity? A. Cytokine immunity B. Specific immunity C. Active acquired immunity D. Nonspecific immunity

ANS: D Rationale: Natural immunity, or nonspecific immunity, is present at birth. Active acquired or specific immunity develops after birth. Cytokines are proteins that mediate the immune response; they are not a type of immunity.

A nurse is reviewing the immune system before planning an immunocompromised client's care. How should the nurse characterize the humoral immune response? A. Specialized cells recognize and ingest cells that are recognized as foreign. B. T lymphocytes are assisted by cytokines to fight infection. C. Lymphocytes are stimulated to become cells that attack microbes directly. D. Antibodies are made by B lymphocytes in response to a specific antigen.

ANS: D Rationale: The humoral response is characterized by the production of antibodies by B lymphocytes in response to a specific antigen. Phagocytosis and direct attack on microbes occur in the context of the cellular immune response.

The client is about to have a skin test for an allergic disorder. What critical instruction should the nurse give this client? A. Avoid red meat for 48 to 72 hours before the test. B. Avoid antihistamines and cold preparations for 48 to 72 hours before the test. C. Avoid sunlight for 48 to 72 hours before the test. D. Avoid strenuous physical activity for 24 hours before the test.

B. The nurse should instruct the client to avoid taking prescribed or over-the-counter antihistamine or cold preparations for at least 48 to 72 hours before a skin test because this reduces the potential for false-negative test results. The nurse should not ask the client to avoid red meat, strenuous physical activity, or sunlight because these do not affect the test results.

A client with an autoimmune disorder asks, Why is autoimmune disease more prevalent in the women in my family? Which response will the nurse make to this client? A. It's because you take better care of your family than yourself. B. It's believed to be caused by the differences in the sex hormones. C. Women have more stress than men and it weakens immunity. D. There is not enough evidence to prove this.

B. There are differences in the immune system functions of men and women. Research has revealed that sex hormones are integral signaling modulators of the immune system and the presence of autoimmune disease. Sex hormones play definitive roles in lymphocyte maturation, activation, and synthesis of antibodies and cytokines. Even though some autoimmune diseases are genetically linked, overall men do not have stronger genes than women. There is no evidence that the client relinquishes self-care for family care. Even though stress influences immunity, there is no evidence that women have more stress than men.

A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? A. IgB B. IgG C. IgE D. IgA

C. Immunoglobulin E (IgE) is involved with an allergic reaction. IgA combines with antigens and activates complement. IgB coats the surface of B lymphocytes. IgG is the principal immunoglobulin formed in response to most infectious agents.

A patient with a history of allergies comes to the clinic for an evaluation. The following laboratory test findings are recorded in a patient's medical record: Total serum IgE levels: 2.8 mg/mL (HIGH) White blood cell count: 5,100/cu mm Eosinophil count: 4% Erythrocyte sedimentation rate: 20 mm/h The nurse identifies which result as suggesting an allergic reaction? A. Eosinophil count B. White blood cell count C. Serum IgE level D. Erythrocyte sedimentation rate

C. Normally, serum IgE levels are below 1.0 mg/mL. The patient's level is significantly elevated suggesting allergic reaction. The other values are within normal parameters.

The nurse is taking the health history of a newly admitted client. Which condition would place the client at risk for impaired immune function? A. Surgical removal of the appendix B. Surgical history of a partial gastrectomy C. Previous organ transplantation D. Negative history for radiation therapy

C. Organ transplantation requires immunosuppressive drugs, which cause impaired immune function. Removal of the appendix or stomach would have no effect on the immune system. A positive history for radiation therapy would affect the immune system, but not a negative history.

What statement best explains the meaning of innate immunity? A) Acquired by the transfer of antibodies from others B) Remembers past exposures and is antigen-specific C) When the body develops an inappropriate immune response D) The body's first line of defense against infection at birth

D. Innate immunity is the body's first line of defense. The job of the innate immunity is to fight to prevent infection. Prior exposure to the antigen is not required for innate immunity to protect the body. This type of immunity is referred to as natural immunity. Innate immunity involves barriers that prevent pathogens from entering the body. These barriers include the cough reflex, mucous, skin, stomach acid, and enzymes in tears and skin oils.

Which response provides correct information regarding acquired immunity? Select all that apply. A) The action of the natural killer cells B) Immunity is acquired actively by exposure C) Immunity occurs by passage of antibodies from one host to another D) The action involves T-cell responses E) The action involves B-cell responses

B, C, D, E. Acquired immunity requires prior exposure to an antigen. After the initial exposure, any future exposures will result in the immune system remembering the antigen and attacking the invader. The two methods of developing acquired immunity include adaptive acquired and passive acquired. With adaptive acquired immunity, immunity is acquired actively by exposure to the antigen. With passive acquired immunity, immunity occurs by the passage of antibodies from one host to another. Acquired immunity involves cell-mediated immunity which is derived from T-cell responses and humoral immunity which is derived from B-cell responses.

A client presents at the clinic with an allergic disorder. The client asks the nurse what an allergic disorder means. What would be the nurse's best response? A. It is a muted response to something in the environment. B. It is a hyperimmune response to something in the environment that is usually harmless. C. It is a harmless reaction to something in the environment. D. It means you are very sensitive to something inside of yourself.

B. An allergic disorder is characterized by a hyperimmune response to weak antigens that usually are harmless. The antigens that can cause an allergic response are called allergens.

A client is admitted to the hospital with a diagnosis of pneumonia. The client informs the nurse of having several drug allergies. The physician has ordered an antibiotic as well as several other medications for cough and fever. What should the nurse do prior to administering the medications? A. Administer the medications that the physician ordered. B. Consult drug references to make sure the medicines do not contain substances which the client is hypersensitive. C. Call the pharmacy and let them know the client has several drug allergies. D. Give the client one medicine at a time and observe for allergic reactions.

B. Clear identification of any substances to which the client is allergic is essential. The nurse must consult drug references to verify that prescribed medications do not contain substances to which the client is hypersensitive. Administering the medications or giving one at a time may cause the client to have an allergic reaction. The nurse may call the pharmacy but still maintains responsibility for the medications administered.

The nurse is aware that during the immune response, pathogens are engulfed by white blood cells that ingest foreign particles. What is this process known as? A. Apoptosis B. Phagocytosis C. Antibody response D. Cellular immune response

B. During the first mechanism of defense, white blood cells, which have the ability to ingest foreign particles, move to the point of attack, where they engulf and destroy the invading agents. This is known as phagocytosis. The action described is not apoptosis (programmed cell death) or an antibody response. Phagocytosis occurs in the context of the cellular immune response, but it does not constitute the entire cellular response.

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? A. Passive immunity B. Naturally acquired active immunity C. Artificially acquired active immunity D. Natural passive immunity

B. 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.

Which type of immunity becomes active as a result of infection by a specific microorganism? A. Artificially acquired active immunity B. Naturally acquired active immunity C. Naturally acquired passive immunity D. Artificially acquired passive immunity

B. Naturally acquired active immunity occurs as a result of an infection by a specific microorganism. Artificially acquired active immunity results from the administration of a killed or weakened microorganism or toxoid. Passive immunity develops when ready-made antibodies are given to a susceptible individual.

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? A. Naturally acquired active immunity B. Passive immunity transferred by the mother C. Artificially acquired active immunity D. There is no immunity passed down from mother to child.

B. Passive immunity develops when ready-made antibodies are given to a susceptible person. The antibodies provide immediate but short-lived protection from the invading antigen. Newborns receive passive immunity to some diseases for which their mothers have manufactured antibodies. 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.

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? A. History of radiation therapy B. Surgical removal of the appendix C. Surgical history of a splenectomy D. Previous organ transplantation

B. Removal of the appendix would have no direct effect on the immune system. Organ transplantation requires immunosuppressive drugs, which cause impaired immune function. Radiation therapy destroys lymphocytes. The spleen is an important part of the immune system, and removal of it increases the client's risk for poor immune function.

The mother of a young child tells the nurse that when she was breastfeeding her baby, he never had any colds or infections but now that he is weaned, he seems to be sick all of the time. What should the nurse explain to the mother? 1. The breast milk provided passive immunity to the baby that he no longer is receiving. 2. The child should be immunized to prevent these common illnesses. 3. Some children are just prone to getting more infections than others. 4. Most babies won't get sick until they are past the age of 12 months.

Answer: 1 Explanation: 1. Passive immunity is a temporary immunity involving the transfer of antibodies from one individual to another or from some other source to an individual. An infant receives passive immunity both in utero and from breast milk. 2. There are no immunizations against many of these common illnesses. 3. This information is not accurate and should not be provided to the mother. 4. This information is not accurate and should not be provided to the mother.

The patient has developed a shift to the left. The nurse would expect which value on the complete blood count? 1. Increased bands 2. Increased eosinophils 3. Decreased lymphocytes 4. Increased monocytes

Answer: 1 Explanation: 1. When an infection exists and the body needs neutrophils, the production is increased, but many immature cells or bands are released. This release results in a shift to the left. 2. Eosinophils are not involved in the shift to the left. 3. A decrease in lymphocytes is not reported as a shift. 4. An increase in monocytes is not reported as a shift.

A patient tells the nurse that it seems like the only time she gets a cold is when she is under higher than normal stress. What information should the nurse provide? 1. You probably don't eat as well when you are under stress. 2. You probably don't rest and sleep as well when your stress is high. 3. Stress causes your body to have an autoimmune response. 4. Stress increases cortisol, which suppresses your immune system.

Answer: 4 Explanation: 1. This is an assumption on the nurse's part. There is no evidence that a change in nutrient intake exists. 2. This is an assumption on the nurse's part. There is no evidence that lack of sleep and rest exist. 3. Colds are not a result of an autoimmune response. 4. Cortisol has a direct suppressing effect on the immune system by inhibiting the production of interleukins, which stimulate T- and B-cell production and response

A patient tells the nurse that he thought he had a varicella vaccine as a child. His daughter has just developed varicella. What information should the nurse provide? Select all that apply. 1. Since you were vaccinated, you won't contract varicella from your daughter. 2. Your innate immunity will protect you from contracting this disease. 3. It is dangerous to give a second injection of vaccines. 4. You may need an injection to boost your immunity. 5. We can check your blood titer to check your immunity.

Answer: 4, 5 Explanation: 1. Vaccinations do not always provide lifelong immunity. 2. The immunity that this patient may have against varicella is not innate immunity. 3. There is no indication that a second injection of vaccines is dangerous if it is needed. 4. In some cases, there is need for a second injection. 5. Antibody titers can be compared to pre established norms to see if repeated immunizations are necessary.