Chapter 23: Immunity

Primary preventions

Immunizations, avoid high risk behaviors, adequate nutrition, exercise, infenction control measures

Allergic Rhinitis

"Hay fever", may also be associated with foods, atopic dermatitis or asthma- typically seasonal Symptoms: inflamed nasal passages, itchy, red, water eyes

localized hypersensitivity

*atopic* reactions: Sneezing, itching, watery discharge, fatigue, no fever If from the house, typically worse at night.

The nurse is reviewing the laboratory report of four clients. Which does the nurse suspect to have acquired immunodeficiency syndrome (AIDS)? 1 Client A - 3000 cells/mm 2 Client B - 5000 cells/mm 3 Client C - 7000 cells/mm 4 Client D - 9000 cells/mm

1 The normal lymphocyte count is between 5000 and 10,000 cells/mm 3. A client with AIDS is leukopenic and has a lymphocyte count less than 3500 cells/mm 3. Therefore, client A has AIDS. Clients B, C, and D have normal lymphocyte counts.

What are the symptoms of tuberculosis? Select all that apply. 1 Fatigue 2 Nausea 3 Weight gain 4 Low-grade fever 5 Increased appetite

1, 2, 4 Tuberculosis is an infectious respiratory disease caused by Mycobacterium tuberculosis. The symptoms of tuberculosis are fatigue, nausea, low-grade fever, weight loss, and anorexia.

10 warning signs of PI

1. 4+ ear infections in past yr 2. 2+ sinus infections in past yr 3. 2+ ineffective antibiotics 4. 2+ pneumonias 5. failure to thrive 6. recurrent deep skin or organ abcess 7. persistent thrush or fungal infection 8. need for IV antibiotic 9. 2+ deep seated infections (septicemia) 10. family hx of PI

Which autoimmune disease is directly related to the client's central nervous system? 1 Rheumatic fever 2 Multiple sclerosis 3 Myasthenia gravis 4 Goodpasture syndrome

2 Multiple sclerosis is a central nervous system-specific autoimmune disease. Rheumatic fever is related to the heart. Myasthenia gravis is a muscle-related autoimmune disease. Goodpasture syndrome is a kidney-related autoimmune disease.

Which client organ is protected by microglial cells? 1 Lung 2 Liver 3 Brain 4 Kidney

3 Microglial cells are macrophages present in the brain. The lungs are protected by alveolar macrophages. The liver is protected by Kupffer cells. Mesangial cells are present in the kidneys.

Which type of cytokine is used to treat anemia related to chronic kidney disease? 1 α-Interferon 2 Interleukin-2 3 Interleukin-11 4 Erythropoietin

4 Erythropoietin is used to treat anemia related to chronic kidney disease. α-Interferon is used to treat hairy cell leukemia or malignant melanoma. Interleukin-2 is used to treat metastatic renal carcinoma. Interleukin-11 is used to prevent thrombocytopenia after chemotherapy.

Which type of immune preparation, made from donated blood, contains antibodies that provide passive immunity? 1 Toxoid 2 Killed vaccine 3 Live attenuated vaccine 4 Specific immune globulin

4 Specific immune globulins contain a high concentration of antibodies directed at specific antigens. Toxoid vaccines contain a bacterial toxin that has been changed to a nontoxic form. Killed vaccines contain killed microbes or isolated microbes. Live attenuated vaccines are composed of live microbes that have been weakened or rendered completely avirulent.

Which virus can cause encephalitis in adults and children? 1 Rubella virus 2 Parvovirus 3 Rotaviruses 4 West Nile virus

4 The West Nile virus causes encephalitis. German measles is caused by rubella. Gastroenteritis is caused by parvovirus. Rotavirus also causes gastroenteritis.

Which diseases can be transmitted from client to client by droplet infection? Select all that apply. 1 Scabies 2 Shingles 3 Measles 4 Pertussis 5 Diphtheria

4, 5 Pertussis and diphtheria are infectious diseases that are known to be transmitted by droplet infection. Shingles and measles are infectious diseases that are known to be transmitted by air. Scabies is an infectious disease that is transmitted by direct contact.

vitamins for immunity

A & D

IgM

Remains in the blood and efficiently kills bacteria; largest of the immunoglobulins; first antibody produced with a primary response

Acquired immunity is

Antigen specific. Can be passive or active. Learned after birth

what produces immunoglobin or antibodies?

B lymphacytes in the presence of antigens

lymphoid progenitor cells

B lymphocytes (which become memory B cells), mature T lymphocytes, and natural killer cells

Lymphoid progenitor cells

B lymphocytes, T lymphocytes , natural killer cells

Immune organs aka lymphoid organs

Bone marrow, thymus gland spleen, tonsils, adenoids, appendix

Chronic leads to

Destruction of body tissue, abnormal organ growth, change in organ function.

Epítopes

Markers on foreign antigens cause immune response in individuals

Clinical management

Monitor immune function. Nutrition, prevent opportunistic infections,drug therapy

Active acquired obtained by

Natural ( disease) artificial ( vaccination) produce antibodies

Myeloid progenitor cells

Neutrophils, monocytes, eosinophils, basophils and mast cells

Immunity

Normal physiological response to microorganisms & proteins as well as conditions associated with an inadequate or excessive immune response

B lymphocytes become

Plasma or memory B cells

Diagnostic tests

Primary testing: basic blood work up. C-reactive protein. Allergy testing

3 primary functions

Protects body from invasion or microorganisms and other antigens

Clinical management

Remove exposure, airway support

All cells are derived from

Stem cells in bone marrow

Report of frequent infections Report of poor wound healing Fatigue Malaise Weight loss Poorly Nourished Chronic Wounds Enlarged Lymph Nodes Opportunistic Infection

Suppressed Immune Functioning Symptoms and Clinical Findings:

immunocompromised (immunodeficiency)

Suppressed responses are referred to as ___, lost ability to remove cells that mutate. (increased risk of getting sick, cancer)

immunity

The normal physiologic response to microorganisms and proteins as well as conditions associated with an inadequate or excessive immune response.

cancer, infection

The two major types of problems that result from suppressed immune response are:

IgG, skin test

allergy testing

antibodies

are secreted by b lymphocytes:

hyperimmune response ex

asthma attack

lymphoid organs

bone marrow, thymus gland, spleen, tonsils, adenoids, and appendix

T lymphocytes

differentiation on exposure to a foreign antigen- stimulate activation of other leukocytes.

clonal diversity

maturation of lymphocytes

B lymphocyte maturation

occur in the liver during mid fetal life and in the bone marrow during late fetal life and after birth

passive acquired immunity

occurs by the introduction of performed antibodies-either from an artificial route or from a natural route

phagocytes, natural killer T lymphocytes, granulocytes, macrophages

second line of defense:

elderly immune systems

shrinking of thymus gland therefore decrease T lymphocytes, fewer immunoglobulins, a delayed hypersensitivity rxn, and increase in auto antibodies. B lymphocytes decrease at 60 yrs of age

first line of defense

skin boundary surfaces to include mucous membranes, enzymes, natural microbial flora, and complement proteins

risk factors for suppressed immune response

young and old, non immunized, poor nutrition, pollutants, smoking, chronic illness, treatments, genetics, substance abuse, pregnancy

exaggerated immune response risk factors

SLE occurs more in women and African Americans. genetics, and environmental or medication exposure

3 primary protective functions of the immune response

1. Protects the body from invasion of microorganisms and other antigens 2. Removes dead or damaged tissues and cells 3. Recognizes and removes cell mutations that have demonstrated abnormal cell growth and development

A nurse is teaching a client about human immunodeficiency virus (HIV). What are the various ways HIV is transmitted? Select all that apply. 1 Mosquito bites 2 Sharing syringe needles 3 Breastfeeding a newborn 4 Kissing the infected partner 5 Anal intercourse

2, 3, 5 Fluids such as blood and semen are highly concentrated with HIV. HIV may be transmitted parenterally by sharing needles and postnatally through breast milk. HIV may also be transmitted through anal intercourse. HIV is not transmitted by mosquito bites or kissing.

Which influenza vaccine is administered by way of the intranasal route? 1 Fluarix 2 Fluvirin 3 FluMist 4 Fluzone

3 FluMist is given intranasally. Fluarix, Fluvirin, and Fluzone are also influenza vaccines administered via the intramuscular route.

A nurse is caring for a 13-year-old child who has an external fixation device on the leg. What is the nurse's priority goal when providing pin care? 1 Easing pain 2 Minimizing scarring 3 Preventing infection 4 Preventing skin breakdown

3 Pin sites provide a direct avenue for organisms into the bone. Pin care will not ease pain. Some scarring will occur at the pin insertion site regardless of pin site care. Skin has a tendency to grow around the pin, rather than break down, as long as infection is prevented.

Which type of hypersensitivity reaction is associated with rheumatoid arthritis? 1 Delayed 2 Cytotoxic 3 IgE-mediated 4 Immune-complex

4 Rheumatoid arthritis is an autoimmune disorder associated with an immune-complex type of hypersensitivity reaction. Contact dermatitis caused by poison ivy is associated with a delayed type of hypersensitivity reaction. Goodpasture's syndrome is associated with a cytotoxic type of hypersensitivity reaction. Asthma is associated with an IgE-mediated type of hypersensitivity reaction.

Reduce response

Antihistamine, sympathomimetic, mast cell stabilizater, immunosuppressive therapy, anti inflammatory agents

Remove exposure (if possible) Airway support (if anaphylaxis occurs) Pharmacotherapy Reduce response (Antihistamine, Sympathomimetic, Mast cell stabilizer, Immunosuppressive therapy, Anti-inflammatory agents) Symptomatic relief (Antipruritic, Decongestant, Analgesics)

Collaborative Care: Exaggerated Immune Response? WHAT DO YOU DO?

altered immunity

Conditions in which immune responses are either suppressed or exaggerated

Allergic symptoms Pain Fatigue Fever Allergic Response Autoimmune Disorders

Exaggerated Immune Functioning Symptoms and Clinical Findings:

Scaffold

IN MHC presents foreign antigen to immune cells. Empty MCH introduced in organs transplants

Altered immunity

Immune responses are suppressed or exaggerated

Passive acquired immunity

Obatianed by preformed antibodies thru natural (placenta, breast milk) artificial (immunoglobulins)

RBC and WBC Fluorescent antinuclear antibody C-reactive protein (CRP) Erythrocyte sedimentation rate (ESR) Allergy testing Genetic testing Rheumatoid factors (RFs) Western blot test TORCH antibody panel Organ function tests

Primary Testing for Immune Disorders:

3 primary functions

Recognizes and removes cell mutations that have demonstrated abnormal cell growth & development

3 primary functions

Removes dead or damaged cells

Major histocompability complex

Surface proteins (MHC) divided into 2 classes. Class I: found on all cells class II: on specialized cells differing self vs non self

Pharmacotherapy

Symptomatic relief; antipruritic, decongestant, analgesic

women

__ are more prone to deficient immune systems (10:1)

type IV (cell-mediated rxn)

delayed rxn without antibodies that involves macrophages and lymphocytes without complement system. ex: contact dermatitis

ex of active immunity

immunizations

t cells

memory cells

systemic hypersensitivity

*anaphylactic* responses, generally life threatening: Widespread edema, vascular shock (widespread vasodilation), difficulty breathing *FIRST* establish airway, then IV access and administration of epinephrine.

Which diseases are caused by viruses? Select all that apply. 1 Mumps 2 Tetanus 3 Measles 4 Hepatitis B 5 Diphtheria

1, 3, 4 Mumps is a swelling of the parotid glands caused by a virus. Measles is a highly contagious viral disease characterized by rash and high fever. Hepatitis B (a serious liver infection) is caused by a virus. Tetanus is caused by Clostridium tetani and diphtheria is caused by Corynebacterium diphtheriae. Both are gram-positive bacilli bacterial strains.

A nurse is teaching parents of toddlers about why children receiving specific medications should not receive varicella vaccines. Which medication will be included in the discussion? 1 Insulin 2 Steroids 3 Antibiotics 4 Anticonvulsants

2 Steroids have an immunosuppressive effect. It is thought that resistance to certain viral diseases, including varicella, is greatly decreased when a child takes steroids regularly. There is no known correlation between varicella and insulin. Because varicella is a viral disease, antibiotics will have no effect. There is no known correlation between varicella and anticonvulsants.

Which sexually transmitted disease is caused by a virus? 1 Syphilis 2 Gonorrhea 3 Genital warts 4 Chlamydial infection

3 Genital warts are caused by a sexually transmitted virus. Bacteria cause syphilis, gonorrhea, and chlamydial infections.

Hodgkin's and Non-Hodgkins Lymphoma

Cancer of the lymphatics system- arises from B or T cells. Symptoms: swollen lymph nodes, abdominal pain, persistent fatigue, fever and chills, night sweats, weight loss

MHC proteins

act to differentiate cells of the self/host from foreign proteins

cells easily susceptibe to phagocytic activity

antigen antibody complexes because of rough surface

specificity of lymphocytes

as a person is challenged by the presence of antigens in life they become specific--- this process is called clonal selection

where are neutrophils present

blood

rheumatoid factor

blood test to determine presence of antibodies against immunoglobulins and is evaluated in combination with other blood test

Immune system

body-wide, complex, interrelated group of cells, tissues, and organs that work within a dynamic communication network to protect the body from attacks by foreign antigens, typically proteins

active acquired immunity

develops after the introduction of a foreign antigen resulting in the formation of antibodies or sensitized T lymphoctes

helper t cells

encourage other t cells and activate B lymphocytes.

Anaphylaxis

exaggerated allergic response to foods, medications, stings, and exercise Symptoms: sneezing, hives, itching, diarrhea, breathing and circulation issues

third line of defense

from antibodies derived from B lymphocytes and T lymphocytes resulting from learned or acquired specific immunity

Type 1 Diabetes Mellitus

hyperglycemia as a result of the B cells in the pancreas either not producing enough insulin because the immune system has attached and destroyed the insulin-producing cells.

IgM

immunoglobulin that remains in the blood to kill bacteria- *first responder*

primary activities of activation of complement system

increase bacterial suscptibility to phagocytosis, lysing some types of bacteria and foreign antigens, producing chemotactic substances, increasing vascular perm, and increasing smooth muscle contraction.

HIV

leads to primary destruction of CD4+ T cells (helper T cells), leaving the person with an immune deficiency and a diminishing ability to fight infection. Symptoms: destruction of lymph nodes and lymph organs

allergy testing on skin

looks at allergens affect on the the skin

Epitopes

markers on foreign antigens that cause the immune response in individuals

epitopes

markers on foreign antigens that cause the immune response in individuals

microchimerism

mixing of cells of different origins-- happens in mother and fetus

autoimmune disorder

occur when the immune system attacks and destroys health cells following a breakdown of what has been termed "Self-tolerant"

common variable immunodeficiency

one of the most prevalent PI; manifest with a defect in antibody formation following a defect in B lymphocytes that interferes with ability to differentiate cells into plasma cells

bone marrow, thymus, spleen, tonsils, adenoids, appendix

organs of the immune system:

innate immunity

present at birth; provides nonspecific response not considered antigen specific

acquired immunity

protection that is gained after birth either actively or passively

IgA

protects entrances into the body; found in high concentrations in body fluids (tears, saliva, and secretions of the respiratory and GI tracts(

TORCH antibody panel

searches for presence of antibodies to cytomegalovirus, HSV, rubela, and toxoplasmosis

self-marker scaffold

the empty MHC scaffold which are the individuals tissue type or human leukocyte antigen

immunity

the normal physiological response to microorganisms and proteins as well as conditions associated with an inadequate or excessive immune response.

ELISA and confirmatory Western blot tests

used for HIV diagnosis

CRP

used to determine inflammation in the body-- does not diagnose

Which autoantigens are responsible for the development of Crohn's disease? 1 Crypt epithelial cells 2 Thyroid cell surface 3 Basement membranes of the lungs 4 Basement membranes of the glomeruli

1 Crypt epithelial cells are considered to be the autoantigens responsible for Crohn's disease. Thyroid cell surfaces are autoantigens responsible for Hashimoto's thyroiditis. The pulmonary and glomerular basement membranes act as autoantigens responsible for Goodpasture syndrome.

Which cells are affected in DiGeorge syndrome? 1 T-cells 2 B-cells 3 Monocytes 4 Polymorphonuclear cells

1 DiGeorge syndrome is a primary immune deficiency disorder in which T-cells are affected. The B-cells are affected in Bruton's X-linked agammaglobulinemia; common variable hypogammaglobulinemia; and selective IgA, IgM, and IgG deficiency. Monocytes and polymorphonuclear cells are affected in chronic granulomatous disease and Job syndrome.

A nurse is providing dietary teaching for a client with celiac disease. Which foods should the nurse teach the client to avoid when following a gluten-free diet? Select all that apply. 1 Rye 2 Oats 3 Rice 4 Corn 5 Wheat

1, 2, 5 Rye, oats, and wheat should be avoided because they are irritating to the gastrointestinal mucosa. Gluten is not found in rice or corn; therefore, these items do not have to be avoided.

Which conditions result in humoral immunity? Select all that apply. 1 Tuberculosis 2 Atopic diseases 3 Bacterial infection 4 Anaphylactic shock 5 Contact dermatitis

2, 3, 4 Atopic diseases, bacterial infections, and anaphylactic shock are disease conditions that trigger humoral immunity. Tuberculosis and contact dermatitis result in cell-mediated immunity.

A child who recently returned from a three-day camping trip over spring vacation is brought to the clinic after a rash, chills, and low-grade fever develop. What are the most important data for the nurse to assess when taking the child's history? Select all that apply. 1 Date of return to school 2 Sports played on camping trip 3 Tendency to allergic reactions 4 Duration of signs and symptoms 5 Recent exposure to poison oak or ivy

3, 4, 5 It is important to know whether the signs and symptoms are related to a history of allergies, a communicable infection contracted during the trip, or some other factor. The nurse must gather information regarding the duration of signs and symptoms because they could be related to a variety of factors that may or may not be linked to the camping trip. It is important to determine whether the child was exposed to a known allergen so appropriate treatment may be initiated. It is not necessary to know when the child is expected back in school; this information is unrelated to the situation. The child's problem is also unrelated to sports activities.

According to the Healthcare Personnel Vaccination Recommendations, what meningococcal conjugate vaccine dose should a nurse administer to a 12-year-old with an HIV infection? 1 Single initial dose and a booster dose 3 years later 2 Single initial dose and a booster dose 5 years later 3 Single initial dose and a booster dose 7 years later 4 Two initial doses and a booster dose at 16 years old

4 A 12-year-old with HIV would require two primary meningococcal conjugate vaccine delivered two months apart initially and a booster dose at the age of 16 years old. The client would require two initial doses, not a single initial dose, and a booster at 16 years old, not 3, 5, or 7 years later.

Which viral infection will cause the nurse to observe for warts? 1 Pox virus 2 Rhabdovirus 3 Epstein-Barr virus 4 Papillomavirus

4 Warts are caused by papillomavirus. Pox viruses cause smallpox. Rhabdovirus causes rabies. Epstein-Barr causes mononucleosis and Burkitt's lymphoma.

Which preparations use toxoids but not live viruses? Select all that apply. 1 Rotarix 2 Varivax 3 M-M-R II 4 PEDIARIX 5 DAPTACEL

4, 5 PEDIARIX consists of diphtheria and tetanus toxoids plus inactivated bacterial components of pertussis, inactive viral antigen of hepatitis B, and inactivated poliovirus vaccine. DAPTACEL is a preparation consisting of toxoids plus inactive bacterial and viral components of diphtheria and tetanus toxoids and acellular pertussis vaccine. Rotarix, Varivax, and M-M-R II are preparations containing live viruses.

Acquired immunity

Can be active or passive

secondary immunodeficiency

a loss of immune functioning (in a person with previously normal immune status) as a result of illness or treatment.

primary immunodeficiency

a situation in which the *entire immune defense system is inadequate* and the individual is missing some, if not all, of the components necessary for complete immune response. *RED FLAGS of this DISEASE:* 4+ ear infections/year 2+ sinus infections/year 2+ months on antibiotics/year failure of infant to gain weight deep skin abscesses persistent thrush in mouth fungal infections family history

second line of defense

activity of phagocytes, natrual killer T lymphocytes, granulocytes, and macrophages that provide innate nonspecific immunity

Systemic Lupus Erythematosus

affects multiple body organs and systems including joints, skin, kidneys, blood cells, brain, heart, and lungs- cells attack themselves with periods of flare and remission (No Cure) Symptoms: butterfly rashes that spread across the face

hypersensitive

antigen/antibody exaggerated responses are referred to as __ (allergies, autoimmune, body attacks itself) *patient becomes more sensitive with subsequent encounters*

dendritic cells

assert control from initiation to termination of the immune response - look for foreign antigens and alert lymphocytes to the presence of injury or infection.

Past medical history Family history Genetic history Current medications Allergies to medications or other substances Lifestyle behaviors Occupation Social environment

assessment history:

sneezing watery eyes nasal congestion rashes swelling shock

assessment of exaggerated immune response:

abnormal vital signs undernourished weight loss malaise impaired wound healing inflammation and infection of CNS

assessment of suppressed immune function:

cytotoxic t cells

attack and kill antigens directly- prefer virus or mutilated cells that have become cancerous *killer cells*

liver, bone marrow

b lymphocytes process and mature in the __ during mid-fetal life and in the __ ___ after birth.

Foreign antigens

bacteria, viruses, parasites, or fungi; pollen; foods; bee, snake, or spider venom; vaccines; transfusions; transplanted tissues

Helper T cells (CD4 cells)

comprise 75% of all T lymphocytes and act as mediators and directly encourage other T cells and help activate B lymphocytes

Acquired immunity

develops after the introduction of a foreign antigen resulting in the formation of antibodies or sensitized T lymphocytes; may be obtained artificially through the immune response to an immunization, or it may be obtained naturally through the immune response to exposure to infectious pathogens (such as chicken pox)

cytotoxic t cells

directly kill foreign antigens and may kill cells of the self

B cells

engulf antigen and create more IgG and create immune response known as humoral immunity

primary immunodeficiency

entire immune defense system is inadequate and the individual is missing some if not all the components necessary for a complete immune response.

ELISA

enzyme linked immunosorbent assay- determines blood levels of IgG

neutrophils

first line of defense.

skin (mucous membranes, enzymes, natural microbial flora, complement proteins)

first line of defense:

IgD

found within the cell membrane of B lymphocytes

MHC proteins

function to differentiate cells of the self from foreign proteins. Provides a scaffold that presents the foreign antigen to the immune cells

young immune systems

immature lymphocyte function (particularly T lymphocyte deficiency). newborns rely on maternal protection due to high levels of immunoglobulin in colostrum. have hypogammagloulinemia

type I (IgE-mediated or atopic)

immediate allergic rxn w/ mast cells involved. ex: seasonal allergies or anaphylaxis

intentional (secondary) immunodeficiency

intentionally suppress immune system through medications. ex. organ transplant

secondary immunodeficiency

loss of immune functioning as result of illness or treatment

thymus

maturation of t lymphocytes occurs in the __.

foreign antigens

may be a whole cell, virus, bacterium, MHC marker protein, or small poriton of a larger foreign protein

ESR

monitor inflammatory or cancerous diseases, RA, and other autoimmune diseases and TB

Passive acquired immunity

occurs by the introduction of preformed antibodies - either from an artificial route, such as a transfusion of immunoglobulin (Ig), or from a natural route, such as from a mother to her fetus through placental blood transference or through colostrum transfer during breast-feeding

passive acquired immunity

occurs by the introduction of preformed antibodies- either from an artificial route such as transfusion of immunoglobulins or from natural route such as mother to her fetus

T lymphocyte maturation

occurs in the thymus gland

Immunity

physiological process that provides an individual with protection or defense from disease; allows one to be resistant to a particular disease or condition

dendritic cells

potent cells that assert control from initiation to termination of the immune response. Have a sentinel function as they look for antigens and alert lymphocytes of presence of injury or infection

blood tests C-Reactive Protein (CRP, determine inflammation) Erythrocyte Sedimentation Rate (ESR)

primary diagnostic testing:

IgG

primary immunoglobin in the blood that may enter tissue spaces, cross the placenta, coats antigen for more effective and efficient presentation for an immune response, and bind to macrophages and neutrophils for increased phagocytosis

vaccination avoiding high-risk behaviors healthy diet exercise Vit A and D

primary prevention of immunity

B lymphocytes (immunoglobulin)

responsible for the body's response to bacteria and humoral immunity

Immunoglobin primary responsibility

responsible for the bodys response to invading baceria and viruses that provide the humoral immunity component of the immune response

gender (women) race genetics exposure to allergens

risk factors of exaggerated immune response

elders chronically ill cancer patients high risk behavior pregnancy

risk factors of suppressed immune response

where are macrophages present

stored in connective tissue, the spleen and liver, and lining of the GI and resp tracts. Most effective phagocyte

suppressor T cells

suppress function of both helper and cytotoxic T cells in order to prevent hyperimmune responses

supressor t cells

suppress the function of both helper and cytotoxic t cells in order to prevent hyperimmune responses.

scope of immunity

suppressed immune response<--optimal immune response--> exaggerated immune response

complement system

system including 25 major proteins that enhance immune response, responsible for dilation and leaking of fluid from vascular system leading to redness and swelling during inflammation.

What is the function of a client's natural killer cells? 1 Secrete immunoglobulins in response to the presence of a specific antigen 2 Heighten selectively and destroy non-self cells, including virally infected cells 3 Enhance immune activity through secretion of various factors, cytokines, and lymphokines 4 Attack non-selectively on non-self cells, especially mutated and malignant cells

4 Natural killer cells attack non-selectively on non-self cells, especially body cells that have undergone mutation and become malignant. Plasma cells secrete immunoglobulins in response to the presence of a specific antigen. Cytotoxic T-cells attack selectively and destroy non-self cells, including virally infected cells. Helper T-cells enhance immune activity through secretion of various factors, cytokines, and lymphokines.

A client asks the nurse what advantage breast-feeding holds over formula feeding. What major group of substances in human milk are of special importance to the newborn and cannot be reproduced in a bottle formula? 1 Amino acids 2 Gamma globulins 3 Essential electrolytes 4 Complex carbohydrates

2 The antibodies in human milk provide the infant with immunity against all or most of the pathogens that the mother has encountered. Amino acids and essential electrolytes are present in commercial formulas. Complex carbohydrates are not required by the infant.

IgD

immunoglobulin found in cell membrane of B lymphocytes

B and T lymphocytes

produced in large number in fetal development

IgE

responsible for all allergy symptoms and increases the presence of parasitic worms; normally found in trace amounts

t lymphocyte response

responsible for cell mediated immunity

elderly

the __ experience a shrinking of the thymus, resulting in immunodeficiency.

A client with localized redness and swelling due to a bee sting reports intense local pain, a burning sensation, and itching. What would be the most appropriate nursing action? 1 Applying cold compresses to the affected area 2 Ensuring the client keeps the skin clean and dry 3 Monitoring for neurological and cardiac symptoms 4 Advising the client to launder all clothes with bleach

1 A client with a bee sting may have localized redness, swelling, pain, and itching due to an allergic reaction. The nurse should apply cold compresses to the affected area to reduce the pain in the client. A client with Candida albicans infection should keep his or her skin clean and dry to prevent further fungal infections. A client with a Borrelia burgdorferi infection may suffer from cardiac, arthritic, and neurologic manifestations. Therefore the nurse has to monitor for these symptoms. Direct contact may transmit a Sarcoptes scabiei infection; the nurse should make sure that the client's clothes are bleached to prevent the transmission of the infection.

Which bacteria colonies are commonly found in a client's large intestine? 1 Escherichia coli 2 Neisseria gonorrhoeae 3 Staphylococcus aureus 4 Haemophilus influenzae

1 Escherichia coli are bacteria that are part of the normal flora in the large intestine. Neisseria gonorrhoeae causes gonorrhea and pelvic inflammatory disease. Staphylococcus aureus secretes toxins that damage cells and causes skin infections, pneumonia, urinary tract infections, acute osteomyelitis, and toxic shock syndrome. Haemophilus influenzae causes nasopharyngitis, meningitis, and pneumonia.

Which drug treats hay fever by preventing leukotriene synthesis? 1 Zileuton 2 Cromolyn sodium 3 Chlorpheniramine 4 Diphenhydramine

1 Zileuton [1] [2] is a leukotriene antagonist drug; this substance prevents the synthesis of leukotrienes and helps in managing and preventing hay fever. Cromolyn sodium stabilizes mast cells and prevents the opening of mast cell membranes in response to allergens binding to immunoglobulin E.. Chlorpheniramine and diphenhydramine are antihistamines and prevent the binding of histamine to receptor cells and decrease allergic manifestations.

A nurse is teaching a health class about human immunodeficiency virus (HIV). Which basic methods are used to reduce the incidence of HIV transmission? Select all that apply. 1 Using condoms 2 Using separate toilets 3 Practicing sexual abstinence 4 Preventing direct casual contacts 5 Sterilizing the household utensils

1, 3 HIV is found in body fluids such as blood, semen, vaginal secretions, breast milk, amniotic fluid, urine, feces, saliva, tears, and cerebrospinal fluid. Therefore a client should use condoms to prevent contact between the vaginal mucus membranes and semen. Practicing sexual abstinence is the best method to prevent transmission of the virus. The HIV virus is not transmitted by sharing the same toilet facilities, casual contacts such as shaking hands and kissing, or by sharing the same household utensils.

A mother with the diagnosis of acquired immunodeficiency syndrome (AIDS) states that she has been caring for her baby even though she has not been feeling well. What important information should the nurse determine? 1 If she has kissed the baby 2 If the baby is breast-feeding 3 When the baby last received antibiotics 4 How long she has been caring for the baby

2 Epidemiologic evidence has identified breast milk as a source of human immunodeficiency virus (HIV) transmission. Kissing is not believed to transmit HIV. When the baby last received antibiotics is unrelated to transmission of HIV. HIV transmission does not occur from contact associated with caring for a newborn.

A child is found to be allergic to dust. The nurse is preparing a teaching plan for the parents. What should the nurse include in the plan? 1 Housework must be done by professional housecleaners. 2 Damp-dusting the house will help limit dust particles in the air. 3 The condition must be accepted because dust cannot be limited. 4 The house must be redecorated because the environment must be dust free.

2 Although dust cannot be avoided completely, use of a damp cloth helps eliminate the quantity of airborne particles that might be inhaled. Hiring professional housecleaners is unnecessary and unrealistic. There are ways to limit the quantity of airborne particles. Redecorating will not eliminate dust; it is part of our environment

The echoviruses can cause which diseases in clients? Select all that apply. 1 Parotitis 2 Gastroenteritis 3 Mononucleosis 4 Aseptic meningitis 5 Burkitt's lymphoma

2, 4 Echoviruses cause gastroenteritis and aseptic meningitis. Parotitis is caused by mumps. Burkitt's lymphoma and mononucleosis are caused by the Epstein-Barr virus.

Which leukocytes should the nurse include when teaching about antibody-mediated immunity? Select all that apply. 1 Monocyte 2 Memory cell 3 Helper T cell 4 B-lymphocyte 5 Cytotoxic T cell

2, 4 Memory cells and B-lymphocytes are involved in antibody-mediated immunity. Monocytes are involved in inflammation. Helper T cells and cytotoxic T cells are involved in cell-mediated immunity.

Which medications act by binding with integrase enzyme and prevent human immunodeficiency virus (HIV) from incorporating its genetic material into the client's cell? Select all that apply. 1 Ritonavir 2 Nelfinavir 3 Tenofovir 4 Raltegravir 5 Elvitegravir

4, 5 Raltegravir and elvitegravir are integrase inhibitors. They act by binding with integrase enzyme and prevent HIV from incorporating its genetic material into the client's cell. Ritonavir and nelfinavir are protease inhibitors. They act by preventing the protease enzyme from cutting HIV proteins into the proper lengths needed to allow viable virions to assemble and bud out from the cell membrane. Tenofovir is a nucleotide reverse transcriptase inhibitor. It acts by combining with reverse transcriptase enzyme to block the process needed to convert HIV ribose nucleic acid into HIV deoxyribose nucleic acid.

IgE

immunoglobulin responsible for allergy symptoms, parasitic worms

Innate immunity

natural or native; the immunity present at birth; provides nonspecific response not considered antigen specific

myeloid progenitors

neutrophils, monocytes, eosinophils, basophils, and mast cells

phagocytes

recognize and ingest foreign antigens as they enter the body (macrophages (more active) and neutrophils)

phagocytes

responsible for recognizing and ingesting foreign antigens as tehy enter the body. Macrophages and neutrophils are the primary phagocytes. involved in first line of defense

ex of passive immunity

transfusion of Ig or from mother to her fetus through placental blood transference/through colostrum in breast feeding

Which vaccine is administrated through the intranasal route? 1 Rotavirus vaccine 2 Influenza (live) vaccine 3 Varicella virus vaccine 4 Human papillomavirus vaccine

2 Influenza (live) vaccine is administered through the intranasal route. The rotavirus vaccine is administered orally. The varicella virus vaccine is given as a subcutaneous injection. The human papillomavirus vaccine is given as intramuscular injection.

Which organ-specific autoimmune disorder is associated with a client's kidney? 1 Graves' disease 2 Addison's disease 3 Goodpasture syndrome 4 Guillain-Barré syndrome

3 Goodpasture syndrome is an autoimmune disorder associated with the client's kidney. Graves' disease and Addison's disease are autoimmune disorders associated with the endocrine system. Guillain-Barré syndrome is an autoimmune disorder associated with the central nervous system.

A client is admitted to the hospital with a diagnosis of acute Guillain-Barré syndrome. Which assessment is priority? 1 Urinary output 2 Sensation to touch 3 Neurologic status 4 Respiratory exchange

4 The respiratory center in the medulla oblongata can be affected with acute Guillain-Barré syndrome because the ascending paralysis can reach the diaphragm, leading to death from respiratory failure. Although urinary output, sensation to touch, and neurologic status are important, none of them are the priority.

IgE blood test

measures amount of IgE i blood-- higher levels associated with more severe allergic response

adverse effect of treatment (secondary immunodeficiency)

the treatment of cancer reduces the number of WBC

antibodies (b lymphocytes and t lymphocytes)

third line of defense:

Which cytokine is used to treat multiple sclerosis? 1 β-Interferon 2 Interleukin-2 3 Erythropoietin 4 Colony-stimulating factor

1 β-Interferon is a cytokine used to treat multiple sclerosis. Interleukin-2 is used to treat metastatic melanoma. Erythropoietin is a cytokine used to treat anemia related to chemotherapy. Colony-stimulating factor is a cytokine used to treat chemotherapy-induced neutropenia.

Which are examples of a type IV hypersensitivity reaction? Select all that apply. 1 Poison ivy allergic reaction 2 Sarcoidosis 3 Myasthenia gravis 4 Rheumatoid arthritis 5 Systemic lupus erythematosus

1, 2 Sarcoidosis and poison ivy reactions are examples of type IV hypersensitivity reactions. In type IV hypersensitivity, the inflammation is caused by a reaction of sensitized T cells with the antigen and the resultant activation of macrophages due to lymphokine release. Myasthenia gravis is an example of a type II or cytotoxic hypersensitivity reaction. Rheumatoid arthritis and systemic lupus erythematosus are examples of type III immune complex-mediated reactions.

Which vaccine is administered orally in children? 1 MMR vaccine 2 Rotavirus vaccine 3 Live influenza vaccine 4 Meningococcal conjugate vaccine (MCV4)

2 Rotavirus vaccines are generally administered orally because these live viruses should replicate in the gut of the infant. MMR vaccines are generally administered subcutaneously in the upper region of the arm. Live influenza vaccines are administered nasally. Meningococcal conjugate vaccines (MCV4) are administered intramuscularly in the deltoid region.

Which autoimmune disease affects the central nervous system? 1 Uveitis 2 Celiac disease 3 Multiple sclerosis 4 Goodpasture syndrome

3 Multiple sclerosis is an autoimmune disease that affects the central nervous system. Uveitis is an autoimmune disease that affects the eyes. Celiac disease is an autoimmune disease that affects the gastrointestinal System. Goodpasture syndrome is an autoimmune disease that affects the kidneys.

Which hypersensitivity reaction may occur in a newborn with hemolytic disease? 1 Type I 2 Type II 3 Type III 4 Type IV

2 Hemolytic disease in a pregnant woman may result in erythroblastosis fetalis, a type II hypersensitivity reaction. Type I reactions involve immunoglobulin E (IgE)-mediated reactions such as anaphylaxis and wheal-and-flare reactions. Type III reactions are immune complex reactions such as rheumatoid arthritis or systemic lupus erythematosus. Type IV reactions are delayed hypersensitivity reactions such as contact dermatitis.

A father asks the nurse about the immunization schedule for his 15-month-old toddler, who is being treated for acute lymphoid leukemia. What vaccine is contraindicated for a child undergoing chemotherapy? 1 Hib (influenza) 2 Hep B (hepatitis B) 3 MMR (measles, mumps, rubella) 4 DTaP (diphtheria, tetanus, acellular pertussis)

3 The MMR vaccine contains attenuated live virus and should not be administered to a child undergoing chemotherapy because of the compromise of the child's immune system. There are no contraindications to administering the Hib vaccine, Hep B vaccine, or DTaP vaccine to a child who is immunosuppressed.

Which type of hypersensitivity reaction will occur when the client's T cytotoxic cells are involved as the mediators of injury? 1 Type I 2 Type II 3 Type III 4 Type IV

4 Type IV hypersensitivity reaction will occur when the T cytotoxic cells are involved as the mediators of injury. Type I IgE-mediated reaction will occur when histamine is involved as the mediators of injury. Type II cytotoxic reaction will occur when complement lysis is the mediator of injury. Type III immune complex reaction will occur when neutrophils are involved as the mediators of injury.

The nurse is reviewing blood screening tests of the immune system of a client with acquired immunodeficiency syndrome (AIDS). What does the nurse expect to find? 1 A decrease in CD4 T cells 2 An increase in thymic hormones 3 An increase in immunoglobulin E 4 A decrease in the serum level of glucose-6-phosphate dehydrogenase

1 The human immunodeficiency virus (HIV) infects helper T-cell lymphocytes; therefore 300 or fewer CD4 T cells per cubic millimeter of blood or CD4 cells accounting for less than 20% of lymphocytes is suggestive of AIDS. The thymic hormones necessary for T-cell growth are decreased. An increase in immunoglobulin E is associated with allergies and parasitic infections. A decrease in the serum level of glucose-6-phosphate dehydrogenase is associated with drug-induced hemolytic anemia and hemolytic disease of the newborn.

Which vaccination is given to young children to provide protection against tetanus and diphtheria but not pertussis? 1 Td 2 DT 3 DTaP 4 Tdap

2 DT is given to children to provide protection from both tetanus and diphtheria. Td is used as a booster dose to protect adolescents and adults from tetanus and diphtheria. DTaP is given to children to provide protection from tetanus, diphtheria, and acellular pertussis. Tdap is used as a booster dose to protect adolescents and adults from tetanus, diphtheria, and acellular pertussis.

A nurse is reviewing the laboratory reports of four clients. Which client's laboratory report indicates acquired immunodeficiency syndrome (AIDS)? 1 Client 1, CD4 count, 750 cells/mm 2 Client 2, CD4 count, 550 cells/mm 3 Client 3, CD4 count, 175 cells/mm 4 Client 4, CD4 count, 450 cells/mm

3 The diagnosis of AIDS requires that the person should be HIV positive and have either a CD4+ T-cell count of less than 200 cells/mm 3 (200 cells/uL) or less than 14% or an opportunistic infection. Therefore client 3, with a CD4+ T-cell count of less than 200 cells/mm 3 (200 cells/uL) and who is HIV positive, is having AIDS-defining illness. A healthy client usually has at least 800 to 1000 CD4+ T-cells per cubic millimeter (mm 3) of blood. This number is reduced in the client with HIV disease. Client 1, with a CD4+ T-cell count of 750 cells/mm 3 and HIV positive, does not have AIDS. Client 2, with a CD4+ T-cell count of 550 cells/mm 3 and HIV positive, does not have AIDS. Client 4, having a CD4+ T-cell count of 450 cells/mm 3 and HIV positive does not have AIDS.

lymphocytes

specificity to a certain antigen: on re-exposure, to the same antigen, the person will have a more rapid and efficient immune response (MEMORY cells)

fluorescent antinuclear antibody test

standard in evaluation of potential autoimmune diseases

Which vaccine may cause intussusception in children? 1 Rotavirus 2 Hepatitis 3 Measles, mumps, and rubella 4 Diphtheria, tetanus, and pertussis

1 Rotavirus vaccines very rarely cause intussusception, a form of bowel obstruction in which the bowel telescopes in on itself. Hepatitis vaccines can cause anaphylactic reactions. The measles, mumps, and rubella vaccine may cause thrombocytopenia. The diphtheria, tetanus, and pertussis vaccine carries a small risk of causing acute encephalopathy, convulsions, and a shock-like state.

A nurse is caring for a client who is human immunodeficiency virus (HIV) positive. Which complication associated with this diagnosis is most important for the nurse to teach prevention strategies? 1 Infection 2 Depression 3 Social isolation 4 Kaposi sarcoma

1 The client has a weakened immune response. Instructions regarding rest, nutrition, and avoidance of unnecessary exposure to people with infections help reduce the risk for infection. Clients can be taught cognitive strategies to cope with depression, but the strategies will not prevent depression. The client may experience social isolation as a result of society's fears and misconceptions; these are beyond the client's control. Although Kaposi sarcoma is related to HIV infection, there are no specific measures to prevent its occurrence.

During the neurologic assessment of a client with a tentative diagnosis of Guillain-Barré syndrome, what does the nurse expect the client to manifest? 1 Diminished visual acuity 2 Increased muscular weakness 3 Pronounced muscular atrophy 4 Impairment in cognitive reasoning

2 Muscular weakness with paralysis results from impaired nerve conduction because the motor nerves become demyelinated. Diminished visual acuity usually is not a problem; motor loss is greater than sensory loss, with paresthesia of the extremities being the most frequent sensory loss. Demyelination occurs rapidly early in the disease, and the muscles will not have had time to atrophy; this can occur later if rehabilitation is delayed. Only the peripheral nerves are involved; the central nervous system is unaffected.

A teenager with allergies is using oxymetazoline nasal spray. What effect should the nurse assess the client for if more than the recommended dose is taken? 1 Nasal polyps 2 Ringing in the ears 3 Bleeding tendencies 4 Increased nasal congestion

4 With frequent and continued use, oxymetazoline can cause rebound congestion of mucous membranes. Nasal polyps may be associated with allergies but are unrelated to nasal spray use. Ringing in the ears (tinnitus) is not associated with oxymetazoline, although this medication may cause hypotension, tachycardia, and dizziness. Bleeding tendencies are related to inadequate clotting mechanisms, which are not associated with the use of this nasal spray.

Which process does the IgD immunoglobulin support? 1 Manifestation of allergic reactions 2 Protection of the body's mucous surfaces 3 Differentiation of the B-lymphocytes 4 Provision of the primary immune response

3 IgD is present on the lymphocyte surface; this immunoglobulin differentiates B-lymphocytes. IgE causes symptoms of allergic reactions by adhering to mast cells and basophils. IgE also helps to defend the body against parasitic infections. IgA lines the mucous membranes and protects the body surfaces. IgM provides the primary immune response.

type II (tissue specific/cytotoxic rxn)

immediate response involving IgG & IgM antibodies and macrophages that involves complement system. ex: autoimmune stuff

glucose regulation nutrition stress infection fatigue tissue integrity inflammation

immunity interrelated concepts:

The parents of an infant ask a nurse why their baby is not receiving the measles, mumps, and rubella (MMR) vaccine at the same time that other immunizations are being given. What explanation should the nurse give about why the MMR vaccine is administered at 12 to 15 months of age? 1 There is an increased risk of side effects in infants. 2 Maternal antibodies provide immunity for about 1 year. 3 It interferes with the effectiveness of vaccines given during infancy. 4 There are rare instances of these infections occurring during the first year of life.

2 Maternal antibodies to measles, mumps, and rubella infection persist in the infant until approximately 15 months of age. Side effects are no more common among infants than in toddlers. The measles vaccination does not interfere with the effectiveness of other vaccines. Although the measles, mumps, and rubella do occasionally occur after the administration of the MMR vaccine during the first year of life, the vaccine is not given during this time because of the presence of maternal antibodies.

Which is the first antibody formed after exposure to an antigen? 1 IgA 2 IgE 3 IgG 4 IgM

4 IgM (immunoglobulin M) is the first antibody formed by a newly sensitized B-lymphocyte plasma cell. IgA has very low circulating levels and is responsible for preventing infection in the upper and lower respiratory tracts, and the gastrointestinal and genitourinary tracts. IgE has variable concentrations in the blood and is associated with antibody-mediated hypersensitivity reactions. IgG is heavily expressed on second and subsequent exposures to antigens to provide sustained, long-term immunity against invading microorganisms.

The nurse is caring for a client who is receiving azathioprine, cyclosporine, and prednisone before receiving a kidney transplant. What does the nurse identify as the purpose of these drugs? 1 Stimulate leukocytosis 2 Provide passive immunity 3 Prevent iatrogenic infection 4 Reduce antibody production

4 These drugs suppress the immune system, decreasing the body's production of antibodies in response to the new organ, which acts as an antigen. These drugs decrease the risk of rejection. These drugs inhibit leukocytosis. These drugs do not provide immunity; they interfere with natural immune responses. Because these drugs suppress the immune system, they increase the risk of infection.

IgG

immunoglobulin that crosses the placenta and participates in phagocytosis

IgA

immunoglobulin that protects entrances to the body

Why would a client with acquired immunodeficiency syndrome (AIDS) be prescribed diphenoxylate hydrochloride? 1 To manage pain 2 To manage diarrhea 3 To manage candidal esophagitis 4 To manage behavioral problems

2 Diphenoxylate hydrochloride is an antidiarrheal drug prescribed to clients with AIDS to manage frequent diarrhea experienced by a client with AIDS. Opioid analgesics such as tramadol are used to manage pain. Ketoconazole can be used to treat candidal esophagitis associated with AIDS. Behavioral problems are managed with psychotropic drugs.

A client with a diagnosis of polyarteritis nodosa asks the nurse for information about this disorder. What information should the nurse include in the response? 1 Clients with this disease have an excellent prognosis. 2 The disorder affects males and females in equal numbers. 3 The disorder is considered one of hypersensitivity, and the exact cause is unknown. 4 Clients with this disease have problems with only the kidneys and the retina of the eyes.

3 An autoimmune response plays a role in the development of polyarteritis, although drugs and infections may precipitate it. The disorder often is fatal, usually as a result of heart or renal failure. Men are affected three times more often than women. Arteriolar pathology can affect any organ or system.

Which leukocyte releases vasoactive amines during a client's allergic reactions? 1 Neutrophil 2 Monocyte 3 Eosinophil 4 Macrophage

3 Eosinophils release vasoactive amines during allergic reactions to limit the extent of the allergic reactions. Neutrophils are phagocytes and increase in inflammation and infection. Monocytes are involved in the destruction of bacteria and cellular debris. Macrophages are involved in nonspecific recognition of foreign protein and microorganisms.

The nurse suspects that a client with inhalation anthrax is in the fulminant stage of the disease. Which symptom supports the nurse's conclusion? 1 Fever 2 Dry cough 3 Hematemesis 4 Mild chest pain

3 Inhalation anthrax is a bacterial infection caused by Bacillus anthracis. This disease has two stages of illness, the prodromal stage and the fulminant stage. The symptom of the fulminant stage is hematemesis. The symptoms of the prodromal stage are fever, dry cough, and mild chest pain.

When taking the blood pressure of a client who has acquired immunodeficiency syndrome (AIDS), what must the nurse do? 1 Don clean gloves. 2 Use barrier techniques. 3 Put on a mask and gown. 4 Wash hands thoroughly.

4 Because this procedure does not involve contact with blood or secretions, additional protection other than washing the hands thoroughly is not indicated. Donning clean gloves and using barrier techniques are necessary only when there is risk of contact with blood or body fluid. A mask and gown are indicated only if there is a danger of secretions or blood splattering on the nurse (for example, during suctioning).

active acquired immunity

immunity protection that is developed after the introduction of a foreign antigen resulting in the formation of antibodies or sensitized T lymphocytes.

acquired immunity

immunity protection that is gained after birth either actively or passively.

What type of hypersensitivity reaction is the cause of systemic lupus erythematosus? 1 Type I 2 Type II 3 Type III 4 Type IV Systemic lupus erythematosus is an example of an immune complex-mediated, or type III, hypersensitive reaction.

3 Anaphylaxis is an example of a type I or immediate hypersensitive reaction. Cytotoxic or type II hypersensitive reactions can result in conditions such as myasthenia gravis and Goodpasture syndrome. Graft rejection and sarcoidosis are conditions that are caused by delayed or type IV hypersensitivity reactions.

type III (immune complex mediated)

immediate rxn involving IgG & IgM antibodies and neutrophils. has complement system participation. ex: SLE

innate immunity

immunity present at birth, nonspecific response not considered antigen specific

Which client is most likely to develop IgE antibodies? 1 A client with pollen allergy 2 A client undergoing a poison ivy reaction 3 A client with bacterial infection 4 A client undergoing a blood transfusion

1 A client with a pollen allergy develops IgE antibodies that may result in an anaphylactic reaction. A client with poison ivy develops delayed hypersensitivity, which is mediated by T lymphocytes. A client with a bacterial infection develops IgG and IgM antibodies. A client undergoing blood transfusion may develop IgG and IgM type II hypersensitivity reactions.

Why would a client with acquired immunodeficiency syndrome (AIDS) be administered pregabalin? 1 To reduce neuropathic pain 2 To reduce cognitive difficulty 3 To reduce swallowing difficulty 4 To reduce muscle and joint pain

1 Pregabalin is indicated for neuropathic pain based on its mechanism of interference with nerve signaling. Clients with AIDS generally exhibit emotional and behavioral changes, which can be managed with appropriate antidepressants and anxiolytics. AIDS clients who experience difficulty swallowing may have candidal esophagitis; this condition can be managed with antifungal mediations such as fluconazole or amphotericin B. Traditional analgesics are used to manage joint and muscle pain.

A primary healthcare provider has prescribed pyrazinamide to a client with tuberculosis. Which instruction by the nurse will be beneficial to the client? Select all that apply. 1 Avoid drinking alcoholic beverages." 2 "Drink at least 8 ounces of water with the medication." 3 "Your soft contact lenses will be stained permanently." 4 "Darkening of the urine is normal while you are using this drug." 5 "Be sure to report any changes in vision such as diminished color perception."

1, 2 A client undergoing pyrazinamide therapy may require extra fluids to help prevent uric acid formation from precipitating and causing gout or kidney problems. Therefore the client should drink at least 8 ounces of water with the medication. The client should also avoid alcoholic beverages, which could potentiate liver toxicity. Staining is a common problem with rifampin, not pyrazinamide. The client should also report any darkening of urine because this may be a sign of liver toxicity or damage. The client should report any vision changes if he or she is taking etambutol.

A nurse has just administered an immunization injection to a 2-month-old infant. What instructions should the nurse give the parent if the infant has a reaction? 1 Give aspirin for pain; if swelling at the injection site develops, call the healthcare provider. 2 Apply heat to the injection site for the first day after the injection; apply ice if the arm is inflamed. 3 Give acetaminophen for fever; call the healthcare provider if the child exhibits marked drowsiness or seizures. 4 Apply ice to the injection site if soreness develops; call the healthcare provider if the child comes down with a fever.

3 Fever is a common reaction to immunizations, and acetaminophen may be given to minimize discomfort. A central nervous system reaction is rare and requires notification of the healthcare provider. Aspirin should not be given to infants and children because it is linked to Reye syndrome. Infants do not tolerate the application of ice, which will increase discomfort. Fever is a common reaction to the immunizations; it is not necessary to notify the healthcare provider.

Which type of immunity is acquired through the transfer of colostrum from the mother to the child? 1 Natural active immunity 2 Artificial active immunity 3 Natural passive immunity 4 Artificial passive immunity

3 Natural passive immunity is acquired through the transfer of colostrum from the mother to the child. Natural active immunity is acquired when there is a natural contact with an antigen through a clinical infection. Artificial active immunity is acquired through immunization with an antigen. Artificial passive immunity is acquired by injecting serum from an immune human.

A client reports disturbed sleep due to itching caused by an allergy. Which medication would be prescribed to help the client sleep well and treat the allergic symptoms? 1 Cetirizine 2 Fexofenadine 3 Desloratadine 4 Chlorpheniramine

4 Chlorpheniramine [1] [2] is an antihistamine that helps to manage allergic symptoms by preventing vasodilation and decreasing allergic symptoms. Sedation is a side effect of chlorpheniramine; therefore this drug is prescribed to clients experiencing sleep issues due to allergic symptoms. Cetirizine effectively blocks histamine from binding to receptors and has less sedating potential. Fexofenadine and desloratadine are also less sedating antihistamine drugs.

An injured client with an open wound is brought to the hospital. The doctor asks the nurse to administer a tetanus toxoid injection. Which standard of the nursing practice as defined by the American Nurses Association does the nurse follow? 1 Diagnosis 2 Evaluation 3 Assessment 4 Implementation

4 The nurse will administer the tetanus as per the doctor's regime. The American Nurses Association identifies this standard of nursing practice as implementation. Diagnosis refers to analysis of the client's biological and psychosocial data to find out the relevant issues and problems. Evaluation is the procedure of assessing the desired outcomes of treatment. Assessment is done at the very beginning when the nurse collects the data about the client to make an accurate diagnosis.

What functions of leukocytes are involved in inflammation? Select all that apply. 1 Destruction of bacteria and cellular debris 2 Selective attack and destruction of non-self cells 3 Release of vasoactive amines during allergic reactions 4 Secretion of immunoglobulins in response to a specific antigen 5 Enhancement of immune activity through secretion of various factors, cytokines, and lymphokines

1, 3 Leukocytes such as monocytes and eosinophils are involved in inflammation. Their functions include the destruction of bacteria and cellular debris and the release of vasoactive amines during allergic reactions to limit these reactions. Helper/inducer T-cells and cytotoxic cells selectively attack and destroy non-self cells and secrete immunoglobulins in response to the presence of a specific antigen. B-lymphocytes, or plasma cells, secrete immunoglobulins in response to the presence of a specific antigen. Helper/inducer T-cells are involved in cell-mediated immunity, enhancing immune activity through the secretion of various factors, cytokines, and lymphokines.

A client who has been living in another country for 10 years is undergoing diagnostic testing to identify the causative organisms of the infection that has been acquired. When caring for this client, what should the nurse recall about active immunity? 1 Protein antigens are formed in the blood to fight invading antibodies. 2 Protein substances are formed within the body to neutralize antigens. 3 Blood antigens are aided by phagocytes in defending the body against pathogens. 4 Sensitized lymphocytes from an immune donor act as antibodies against invading pathogens.

2 Active immunity occurs when the individual's cells produce antibodies in response to an agent or its products; these antibodies will destroy the agent (antigen) should it enter the body again. Antigens do not fight antibodies; they trigger antibody formation that in turn attacks the antigen. Antigens are foreign substances that enter the body and trigger antibody formation. Sensitized lymphocytes do not act as antibodies.

What is the role of the plasma cell in the antigen-antibody response? 1 Makes an antigen harmless without destroying it 2 Produces antibodies against the sensitizing antigen 3 Produces antibodies after an exposure to a known antigen 4 Clumps antibody-antigens linkages together to form immune complexes

2 In the antigen-antibody response, once the B-cell is sensitized, it divides and forms a plasma cell, which produces antibodies against the sensitizing antigen. Inactivation or neutralization is the process of making an antigen harmless without destroying it. Memory cells produce antibodies after the next exposure to an antigen that is recognized by the body. Agglutination is the clumping of antigens linked with antibodies, forming immune complexes.

What is the mechanism of action of norepinephrine in managing anaphylaxis? 1 Norepinephrine blocks the effects of histamine 2 Norepinephrine inhibits the degranulation of mast cells 3 Norepinephrine increases blood pressure and cardiac output 4 Norepinephrine rapidly stimulates alpha- and beta-adrenergic receptors

3 Norepinephrine is a vasopressor that elevates the blood pressure and cardiac output in clients suffering from anaphylactic reactions. Diphenhydramine HCL blocks the effects of histamine on various organs. Corticosteroids such as dexamethasone prevent the degranulation of mast cells. Epinephrine works by rapidly stimulating alpha- and beta-adrenergic receptors.

The bacteria Clostridium botulinum causes which condition in a client? 1 Upper respiratory tract infection 2 Toxic shock syndrome 3 Urinary tract infection 4 Food poisoning with progressive muscle paralysis

4 Clostridium botulinum bacteria causes food poisoning with progressive muscle paralysis. Toxic shock syndrome is caused by the bacteria Staphylococcus aureus. Many viruses and bacteria can cause upper respiratory tract infection but Clostridium is not one of them. Klebsiella-Enterobacter organisms most likely cause urinary tract infections.

Which cytokine increases growth and maturation of myeloid stem cells? 1 Interleukin-2 2 Thrombopoietin 3 Granulocyte colony-stimulating factor 4 Granulocyte-macrophage colony-stimulating factor

4 Granulocyte-macrophage colony-stimulating factor is a cytokine that increases growth and maturation of myeloid stem cells. Interleukin-2 is a cytokine that increases growth and differentiation of T-lymphocytes. Thrombopoietin is a cytokine that increases growth and differentiation of platelets. Granulocyte colony-stimulating factor is a cytokine that increases numbers and maturity of neutrophils.

What finding in the client is a sign of allergic rhinitis? 1 Presence of high-grade fever 2 Reduced breathing through the mouth 3 Presence of pinkish nasal discharge 4 Reduced transillumination on the skin over the sinuses

4 Reduced transillumination on the skin overlying the sinuses indicates allergic rhinitis. This effect is caused by the sinuses becoming inflamed and blocked with thick mucoid secretions. Generally, fever does not accompany allergic rhinitis unless the client develops a secondary infection. In allergic rhinitis, the client is unable to breathe through the nose because it gets stuffy and blocked. Instead the client will resort to mouth breathing. Clients with allergic rhinitis will have clear or white nasal discharge.

(1) protect the body from invasion of microorganisms and other antigens (2) remove dead cells (3) recognize and remove cell mutations that have demonstrated abnormal growth

immune response fn: (3)

A client who underwent a physical examination reports itching after 2 days. Which condition should the nurse suspect? 1 Eczema 2 Hypersensitivity 3 Contact dermatitis 4 Anaphylactic shock

3 A client who is allergic to latex may experience an allergy after a physical examination with latex gloves. Itching is one of the clinical signs of latex allergy. Contact dermatitis is a delayed immune response that occurs 12 to 48 hours after exposure. Eczema is a skin condition that can be worsened with excessive drying. Hypersensitivity is an immediate allergic reaction that occurs due to chemicals that are used to make gloves. Anaphylactic shock is also an immediate allergic reaction that occurs due to natural rubber latex.

Which client has the highest risk for human immunodeficiency virus (HIV) infection? 1 A client who is involved in mutual masturbation 2 A client who undergoes voluntary prenatal HIV testing 3 A client who shares equipment to snort or smoke drugs 4 A client who engages in insertive sex with a non-infective partner

3 Clients who use equipment to snort (straws) and smoke (pipes) drugs are at the highest risk for becoming infected with HIV as their judgment may be impaired regarding the high-risk behaviors. Safe activities that prevent the risk of contracting HIV include mutual masturbation, masturbation, and other activities that meet the "no contact" requirements. A client who undergoes perinatal HIV voluntary testing may reduce the chances of getting infected. Insertive sex between partners who are not infected with HIV are not at risk of becoming infected with HIV.

A nurse who is caring for a 7-year-old child with acute glomerulonephritis assesses the child for cerebral complications. What signs and symptoms indicate cerebral involvement? 1 Headache, drowsiness, and vomiting 2 Generalized edema, anorexia, and restlessness 3 Anuria, temperature higher than 103° F (39.4° C), and confusion 4 Cardiac decompensation, heart rate of 114 beats/min, and vomiting

1 Headache, drowsiness, and vomiting may occur if the blood pressure remains increased and leads to cerebral edema. Drowsiness, not restlessness, will occur; generalized edema and anorexia are not specific to cerebral edema. Although fever and confusion may occur, anuria is not specific to cerebral edema. Although the pulse may be altered and vomiting may occur, cardiac decompensation is not related to cerebral involvement.

A nurse is caring for a client with Guillain-Barré syndrome. The nurse should prepare the client for what essential care related to rehabilitation? 1 Physical therapy 2 Speech exercises 3 Fitting with a vertebral brace 4 Follow-up on cataract progression

1 Rehabilitation needs for a client with Guillain-Barré syndrome focus on physical therapy and exercise for the lower extremities because of muscle weakness and discomfort. A client with Guillain-Barré syndrome does not need speech or swallowing exercises. A client with Guillain-Barré syndrome does not need vertebral support. Problems with cataracts are not associated with Guillain-Barré syndrome.

After assessing an older client's medical report, the nurse finds that the client is at an increased risk for bacterial and fungal infections. Which change in immune function may have occurred? 1 Decline in natural bodies 2 Reduction of neutrophil function 3 Decrease in circulating T-lymphocytes 4 Reduction of colony-forming B-lymphocytes

3 A decrease in circulating T-lymphocytes occurs with cell-mediated immunity, resulting in an increased risk of bacterial and fungal infections. A client would need booster shots for old vaccinations and immunizations when there is a decline in natural antibodies. A reduced neutrophil function may be an implication when neutrophil function is decreased. The older adult should receive immunizations, such as flu shots, when the number of colony-forming B-lymphocytes is diminished.

A nurse is caring for a client with acquired immunodeficiency syndrome (AIDS). What precautions should the nurse take when caring for this client? 1 Use standard precautions. 2 Employ airborne precautions. 3 Plan interventions to limit direct contact. 4 Discourage long visits from family members.

1 The Centers for Disease Control and Prevention (Canada: Public Health Agency of Canada) states that standard precautions should be used for all clients; these precautions include wearing of gloves, gown, mask, and goggles when there is risk for exposure to blood or body secretions. There is no indication that airborne precautions are necessary. Planning interventions to limit direct contact and discouraging long visits from family members will unnecessarily isolate the client.

A nurse instills an antibiotic ophthalmic ointment into a newborn's eyes. What condition does this medication prevent? 1 Herpetic ophthalmia 2 Retinopathy of prematurity 3 Ophthalmia neonatorum 4 Hemorrhagic conjunctivitis

3 Ophthalmia neonatorum is caused by gonorrheal and/or chlamydial infections present in the vaginal tract. It is preventable with the prophylactic use of an antibiotic ophthalmic ointment applied to the neonate's eyes. Herpes affects the neonate systemically. Retinopathy of prematurity (formerly retrolental fibroplasia) occurs as a result of prolonged exposure to a too-high oxygen concentration. Hemorrhagic conjunctivitis is usually caused by rapid expulsion of the fetus's head from the vagina.

complement system

works to enhance immune response and to help rid the body of antigen-antibody complexes. composed on 25 major proteins taht circulate in an inactive form in the blood and are engaged in a cascade of interactions when encounter an antigen-antibody complex. Responsible for redneess and swelling in inflammtory process

The parent of a newborn asks a nurse why, except for hepatitis B vaccine, the immunization schedule does not start until the infant is 2 months old. How should the nurse respond? 1 "A newborn's spleen can't produce efficient antibodies." 2 "Infants younger than 2 months are rarely exposed to infectious disease." 3 "The immunization will attack the infant's immature immune system and cause the disease." 4 "Maternal antibodies interfere with the development of active antibodies by the infant when immunized."

4 Passive antibodies received from the mother will be diminished by age 8 weeks and will no longer interfere with the development of active immunity to most communicable diseases. The spleen does not produce antibodies. Infants often are exposed to infectious diseases. The viruses in immunizations are inactivated or attenuated; they may cause irritability and fever but will not cause the related disease.

The nurse administers an initial dose of Haemophilus influenzae type b (Hib) vaccine to a 2-month-old infant. When should the nurse administer the final dose of the vaccine to the infant? 1 6-8 months of age 2 8-10 months of age 3 12-15 months of age 4 16-18 months of age

3 The Haemophilus influenzae type b (Hib) vaccine is administered in four doses, finishing at the age of 12-15 months. Following the first dose at 2 months, the second is administered at 4 months, and the third at 6 months. For the final dose, 6-8 months and 8-10 months would be too soon; 16-18 months would be too late.

The nurse educates a client on decreasing the risk of developing antibiotic-resistant infections. Which statement made by the nurse will be most significant? 1 "Wash your hands frequently." 2 "Do not skip any dose of your antibiotics." 3 "Save the unfinished antibiotics for later use." 4 "Stop taking the antibiotics when you feel better."

2 Antibiotic-resistant infection develops when the hardiest bacteria survive and multiply. This may happen when a client stops taking an entire course of antibiotics, which leads to infections that are resistant to many antibiotics. Therefore a client should not skip any dose of an antibiotic. Hand washing is required to prevent infections; it is not related to antibiotic-resistant infections. Antibiotics should not be stopped even if the client has started feeling better; the full course of treatment should be taken. Non-compliance in taking the full course of prescribed antibiotics can lead to an antibiotic-resistant infection. It is dangerous to take the unfinished antibiotics at a later time; it may prove fatal if the antibiotics are outdated.

A nurse is monitoring a client who is having a computed tomography (CT) scan of the brain with contrast. Which response indicates that the client is having an untoward reaction to the contrast medium? 1 Pelvic warmth 2 Feeling flushed 3 Shortness of breath 4 Salty taste in the mouth

3 An untoward response to the iodinated dye used as a contrast is anaphylaxis, a life-threatening allergic response. Anaphylaxis is manifested by respiratory distress, hypotension, and shock; counteractive measures must be instituted. A feeling of warmth or flushing is an expected minor side effect. A salty taste is an expected minor side effect.

A client has a kidney transplant. The nurse should monitor for which assessment findings associated with rejection of the transplant? Select all that apply. 1 Fever 2 Oliguria 3 Jaundice 4 Polydipsia 5 Weight gain

1, 2, 5 Fever is a characteristic of the systemic inflammatory response to the antigen (transplanted kidney). Oliguria or anuria occurs when the transplanted kidney is rejected and fails to function. Weight gain can occur from fluid retention when the transplanted kidney fails to function or as a result of steroid therapy; this response must be assessed further. Jaundice is unrelated to rejection. Polydipsia is associated with diabetes mellitus; it is not a clinical manifestation of rejection.

multiple sclerosis

immune system attacks the nerve-insulating myelin sheaths and disrupts communication between nerves and muscles. Symptoms: blurred vision, blindness, muscle weakness, balance impairment, paresthesias, numbness, speech impediments, dizziness, hearing loss

A client who abused intravenous drugs was diagnosed with the human immunodeficiency virus (HIV) several years ago. What does the nurse explain to the client regarding the diagnostic criterion for acquired immunodeficiency syndrome (AIDS)? 1 Contracts HIV-specific antibodies 2 Develops an acute retroviral syndrome 3 Is capable of transmitting the virus to others 4 Has a CD4+T-cell lymphocyte level of less than 200 cells/µL (60%)

4 AIDS is diagnosed when an individual with human immunodeficiency virus (HIV) develops one of the following: a CD4+T-cell lymphocyte level of less than 200 cells/µL (60%), wasting syndrome, dementia, one of the listed opportunistic cancers (e.g., Kaposi sarcoma [KS], Burkitt lymphoma), or one of the listed opportunistic infections (e.g., Pneumocystis jiroveci pneumonia, Mycobacterium tuberculosis). The development of HIV-specific antibodies (seroconversion), accompanied by acute retroviral syndrome (flulike syndrome with fever, swollen lymph glands, headache, malaise, nausea, diarrhea, diffuse rash, joint and muscle pain) 1 to 3 weeks after exposure to HIV reflects acquisition of the virus, not the development of AIDS. A client who is HIV positive is capable of transmitting the virus with or without the diagnosis of AIDS.

A client has undergone scratch testing but the causative allergen is yet to be identified. What would be the next step to confirm a strongly suspected allergen? 1 Administer allergy shots 2 Begin intradermal testing 3 Request that a client take an oral food challenge 4 Begin radioallergosorbent testing

2 An intradermal test is administered when a strongly suspected allergen tests negative with the scratch test. A testing dose of sera is injected intradermally into the arm and any signs of allergy are observed to confirm the allergen. Allergy shots are a therapeutic method of reducing sensitivity to a known allergen when exposure cannot be avoided. An oral food challenge is done to confirm an ingested allergen if skin testing completely fails. Radioallergosorbent testing is useful to measure immunoglobulin E levels to ascertain the presence of an allergic reaction.

What causes medications used to treat AIDS to become ineffective? 1 Taking the medications 90% of the time 2 Missing doses of the prescribed medications 3 Taking medications from different classifications 4 Developing immune reconstitution inflammatory syndrome (IRIS)

2 The most important reason for the development of drug resistance in the treatment of AIDS is missing doses of drugs. When doses are missed, the blood drug concentrations become lower than what is needed to inhibit viral replication. The virus replicates and produces new particles that are resistant to the drugs. Taking the medications 90% of the time prevents medications from becoming ineffective. Taking medications from different classes prevents the drugs from becoming ineffective. Immune reconstitution inflammatory syndrome (IRIS) occurs when T-cells rebound with medication therapy and become aware of opportunistic infections.

A client who has acquired human immunodeficiency syndrome (HIV) develops bacterial pneumonia. On admission to the emergency department, the client's PaO 2 is 80 mm Hg. When the arterial blood gases are drawn again, the level is determined to be 65 mm Hg. What should the nurse do first? 1 Prepare to intubate the client. 2 Increase the oxygen flow rate per facility protocol. 3 Decrease the tension of oxygen in the plasma. 4 Have the arterial blood gases redone to verify accuracy.

2 This decrease in PaO 2 indicates respiratory failure; it warrants immediate medical evaluation. Most facilities have a protocol to increase the oxygen flow rate to keep oxygen saturation greater than 92%. The client PaO 2 of 65 mm Hg is not severe enough to intubate the client without first increasing flow rate to determine if the client improves. Decreasing the tension of oxygen in the plasma is inappropriate and will compound the problem. The PaO 2 is a measure of the pressure (tension) of oxygen in the plasma; this level is decreased in individuals who have perfusion difficulties, such as those with pneumonia. Having the arterial blood gases redone to verify accuracy is negligent and dangerous; a falling PaO 2 level is a serious indication of worsening pulmonary status and must be addressed immediately. Drawing another blood sample and waiting for results will take too long.

A 5-year-old-child is undergoing chemotherapy. The mother tells the nurse that the child is not up to date on the required immunizations for school. What is the best response by the nurse? 1 "By this time your child has developed sufficient antibodies to provide immunity." 2 "Maintaining current immunizations is critical. Make sure the series is completed." 3 "This isn't the best time to finish the immunizations, because your child's immune system is suppressed." 4 "It's important to complete the immunizations because your child needs to be protected from childhood diseases that could be fatal."

3 Chemotherapy compromises the immune system. The vaccines may be administered after the completion of the chemotherapy protocol, once the immune system has returned to its previous state. The child has not developed sufficient antibodies; booster immunizations are needed, but not at this time. Administering immunizations at this time could prove fatal.

The mother of an 8-year-old child with the diagnosis of acute poststreptococcal glomerulonephritis (APSGN) is concerned that a 4-year-old sibling may also have the disorder. What does the nurse recall when preparing to explain the cause of the disease process? 1 A systemic infection causing clots in the small renal tubules 2 A factor that is unknown and therefore is difficult to prevent 3 An immune complex disorder occurring after a group A β-hemolytic Streptococcus infection 4 An autosomal recessive trait, meaning that there is an increased probability that a sibling will also have the disease

3 The β-hemolytic Streptococcus immune complex becomes trapped in the glomerular capillary loop, causing acute poststreptococcal glomerulonephritis. APSGN is usually precipitated by a localized pharyngitis. Clots do not form in the small renal tubules with APSGN. Prevention depends on treating an individual with a group A β-hemolytic Streptococcus infection with antibiotics to eliminate the organism before an immune response can occur. APSGN is an acquired, not an inherited, disorder.

What does the nurse explain to a client that a positive diagnosis for human immunodeficiency virus (HIV) infection is based on? 1 Performance of high-risk sexual behaviors 2 Evidence of extreme weight loss and high fever 3 Identification of an associated opportunistic infection 4 Positive enzyme-linked immunosorbent assay (ELISA) and Western blot tests

4 Positive ELISA and Western blot tests confirm the presence of HIV antibodies that occur in response to the presence of the HIV. Performance of high-risk sexual behaviors places someone at risk but does not constitute a positive diagnosis. Evidence of extreme weight loss and high fever do not confirm the presence of HIV; these adaptations are related to many disorders, not just HIV infection. The diagnosis of just an opportunistic infection is not sufficient to confirm the diagnosis of HIV. An opportunistic infection (included in the Centers for Disease Control and Prevention surveillance case definition for acquired immunodeficiency syndrome [AIDS]) in the presence of HIV antibodies indicates that the individual has AIDS.

When preparing discharge teaching for a client who had a kidney transplant, in addition to a corticosteroid, the nurse expects what other medications to be prescribed to prevent kidney rejection? 1 Furosemide and sirolimus 2 Cefazolin and methotrexate 3 Methylprednisolone and phenytoin 4 Tacrolimus and mycophenolate mofetil

4 Standard triple therapy includes a corticosteroid prednisone (methylprednisolone), an antimetabolite (mycophenolate), and a calcineurin inhibitor (tacrolimus and cyclosporine). Although sirolimus is used for immunosuppression, furosemide is a diuretic. Neither of these medications are immunosupressives. Cefazolin is an antibiotic, and methotrexate is a folic acid antagonist used in cancer chemotherapy. Although methylprednisolone is used for immunosuppression, phenytoin is an antiseizure medication.