Immunity and Metabolism LVL 2

An older adult tells the nurse, "My friend just developed shingles and has a lot of pain. Is there a way for me to protect myself from it?" How should the nurse respond?

"Ask your healthcare provider about a herpes zoster vaccine." Herpes zoster is the viral infection caused by the varicella zoster virus. The first infection is called chickenpox. When there is a recurrence it is called shingles. The virus is believed to remain dormant in the nerve root until the client has a decline in cellular immunity when the virus will replicate. The pain is often described as throbbing, burning, or stabbing. The best prevention is a vaccine for adults age 60 and older. Antivirals will lessen the severity at the time but will not prevent infection.

The nurse has just finished administering the DTaP vaccine to a 2-month-old and is educating the parent about immunization. Which statement is accurate?

"Bring her back for the second dose when she is 4 months old." DTaP is given as a series of five injections—at 2, 4, and 6 months; between 15 and 18 months; and between 4 and 6 years. A TdaP booster is needed by 11 to 12 years. There are common side effects such as fever and redness and swelling at the injection site as well as other less common reactions such as seizures. The "T" in the vaccine stands for tetanus.

A student states, "It seems like helper T cells do a lot more than just 'help' the cellular immunity process". Which response listed below best conveys an aspect of the role of CD4+ helper T cells in immunity?

"Helper T cells play a major role in stimulating and regulating the whole process." Helper T cells are central to the regulation, proliferation, and stimulation of the immune system. They do not play a central role in antigen presentation or early hematopoiesis, however. Their absence would not result in incorrect antibody production, but rather insufficient or absent immune response.

Which client has an absolute neutrophil count (ANC) that is critically low and the standard of care would recommend placement on neutropenic precautions?

37-year-old client with leukemia being treated with chemotherapy with ANC of 400 (0.40 x 109/L). Neutrophils constitute the majority of blood leukocytes and play a critical role in host defense mechanisms against infection. The ANC is supposed to be 1000/μL and if the ANC is <500 cells mm3 the person is generally put on neutropenic precautions in the hospital to protect him or her from the environment. A client on long-term steroids for rheumatoid arthritis with WBC of 7000/μL has a normal WBC count; a client with prostate cancer receiving radiation therapy with neutrophil count of 2000/μL has a normal neutrophil count; a client with renal failure receiving Epogen for anemia with hemoglobin level of 9.7 g/dL is associated with RBCs and not neutrophils.

A person with type A blood who exhibits the D antigen would be considered to have which blood type?

A+ Persons who express the D antigen are designated Rh positive. This client would be considered to have A+ blood type. A- and AB- would indicate a lack of the D antigen, whereas O+ has the D antigen but is not a type A blood, as it lacks the A antigen.

The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a co-morbidity of multiple sclerosis, so the nurse knows the stress test will be drug-induced. What drug will be used to dilate the coronary arteries?

Diazepam Drugs such as adenosine (Adenocard), dipyridamole (Persantine), or dobutamine (Dobutrex) may be administered singularly or in combination by the IV route. The drugs dilate the coronary arteries, similar to the vasodilation that occurs when a person exercises to increase the heart muscle's blood supply. The other options would not dilate the coronary arteries.

A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?

Facial erythema, pericarditis, pleuritis, fever, and weight loss. An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, (the classic butterfly rash). SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE.

A client diagnosed with sepsis has a critically low neutrophil count. The nurse expects which drug or drug class to be used to stimulate white blood cell production?

Granulocyte CSF (G-CSF) such as filgrastim. Granulocyte CSF (G-CSF) promotes growth and maturation of neutrophils consumed in inflammatory reactions. In clinical practice, recombinant CSF is being used to increase the success rates of bone marrow transplantations and neutropenia. The availability of recombinant CSFs and cytokines offers the possibility of several clinical therapies where stimulation or inhibition of the immune response or cell production is desirable.

Adult strabismus is almost always of the paralytic variety. What is a cause of adult strabismus?

Graves disease Paralytic strabismus is uncommon in children, but accounts for nearly all cases of adult strabismus. It can be caused by infiltrative processes, including Graves disease, myasthenia gravis, stroke, and direct optical trauma. The other diseases have nothing to do with adult strabismus.

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?

IgE 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.

Which of the following reflect the pathophysiology of cutaneous signs of HIV disease?

Immune function deterioration Cutaneous signs may be the first manifestations of HIV, appearing in more than 90% of HIV-infected patients as immune function deteriorates. Common complaints include pruritus, folliculitis, and chronic actinic dermatitis. Cutaneous signs of HIV disease correlate to low CD4 counts. Cutaneous signs of HIV disease appear as immune function deteriorates.

For a client with Hodgkin disease who has developed neutropenia, what is an appropriate nursing intervention to include in the care plan?

Monitoring temperature every 4 hours For a client with neutropenia, monitoring temperature every 4 hours is essential. If the client develops a fever, the client is considered to have an infection and is usually admitted to the hospital. Cultures of blood, urine, and sputum, as well as a chest x-ray, are obtained.

The granulocyte cell lines are derived from:

Myeloid stem cells Leukocyte development begins with the myeloid and lymphoid stem cells in the bone marrow. The granulocyte and monocyte cell lines derive from the myeloid stem cells and the lymphocytes from the lymphoid stem cells. Metamyelocytes mature to become mature neutrophils. Monoblasts are derived from monocytes.

Guillain-Barré syndrome is characterized by which form of neuron damage?

Polyneuropathy Polyneuropathies involve demyelination or axonal degeneration of multiple peripheral nerves that leads to symmetric sensory, motor, or mixed sensorimotor deficits. Guillain-Barre syndrome is an acute immune-mediated polyneuropathy.

A client develops fever and arthralgia 4 days after the administration of tetanus toxoid. What reaction to the vaccine is this?

Serum sickness Serum sickness presents several days after the administration of a vaccine with symptoms of urticaria, fever, arthralgia, and enlarged lymph nodes. The presence of fever and arthralgia after the administration of an immunization is not noted as an infectious process, anaphylaxis, or distress syndrome.

A client with myasthenia gravis is receiving continuous mechanical ventilation. When the high-pressure alarm on the ventilator sounds, what should the nurse do?

Suction the client's artificial airway. A high-pressure alarm on a continuous mechanical ventilator indicates an obstruction in the flow of gas from the machine to the client. The nurse should suction the client's artificial airway to remove respiratory secretions that could be causing the obstruction. The sounding of a ventilator alarm has no relationship to the apical pulse. Increasing the oxygen percentage and ventilating with a handheld mechanical ventilator wouldn't correct the airflow blockage.

A nurse, caring for a client with human immunodeficiency virus (HIV), reviews the client's differential WBC count. What type of WBC will the nurse check the level of?

T lymphocytes Lymphocytes (T cells, B cells, and natural killer cells) are WBCs that are the major components of the body's immune response. T cells are primarily responsible for cell-mediated immunity, whereas B cells are involved in antibody production.

To prevent meningococcal infections, the nurse would administer:

Vaccine Meningococcal infections would be prevented by a vaccine. A toxoid is a type of vaccine made from the toxins produced by the organism. Immune globulins and antivenin are examples of immune sera.

A client with suspected human immunodeficiency virus (HIV) has had two positive enzyme-linked immunosorbent assay (ELISA) tests. What diagnostic test would be run next?

Western Blot The ELISA test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. The test is repeated if results are positive. If results of a second ELISA test are positive, the Western blot is performed. A positive result on Western blot confirms the diagnosis; however, false-positive and false-negative results on both tests are possible. A polymerase chain reaction gives the viral load of the client. The T4/T8 ratio determines the status of T lymphocytes.

The nurse knows high incidences of infectious illnesses among the older adults who reside in a long-term care facility are most likely to have diminished immune capacity because of:

decreased numbers and responsiveness of T lymphocytes. Although this phenomenon is not well understood, increasing proportions of lymphocytes become unresponsive with age, and CD4+ T lymphocytes are the most severely affected. B lymphocytes recognize more antigens, not fewer, and expression of cytokines and their cellular receptors decreases.

The nurse is caring for a client who is to receive interleukins. What change in the client's status would most clearly suggest successful therapy?

increased numbers of natural killer cells When interleukins are administered, there are increases in the numbers of natural killer cells and lymphocytes, in cytokine activity, and in the number of circulating platelets. They do not affect leukocyte or C-reactive protein levels.

Immunocompetence is the ability of the immune system to cooperatively protect a person from external invaders and the body's own altered cells. Immunocompetence is maintained by white blood cells and:

lymphoid tissue. The immune system is a collection of specialized white blood cells and lymphoid tissues that maintain immunocompetence. The function of these structures is assisted and supported by the activities of natural killer cells, antibodies, and nonantibody proteins such as cytokines and the complement system.

A client has been seeing an allergist for 6 months for treatment of allergies. The client's allergies have been insufficiently controlled by symptomatic treatments and the physician has suggested desensitization. The anticipated outcome of desensitization is that repeated exposure to the:

weak antigen promotes the production of IgG, an antibody that blocks IgE so it cannot stimulate mast cells. Desensitization is a form of immunotherapy in which a person receives weekly or twice weekly injections of dilute but increasingly higher concentrations of an allergen without interruption. Repeated exposure to the weak antigen promotes the production of IgG, an antibody that blocks IgE so it cannot stimulate mast cells.

A client was diagnosed with human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). The nurse realizes that the client needs further teaching about the disease process based on which statement?

"HIV only infects B cells." The retroviruses such as HIV have a unique mechanism of replication. After entry into the host cell, the viral RNA genome is first translated into DNA by a viral enzyme called reverse transcriptase. The viral DNA copy is then integrated into the host chromosome where it exists in a latent state, similar to the herpes viruses. Reactivation and replication require a reversal of the entire process. Some retroviruses lyse the host cell during the process of replication. In the case of HIV, the infected cells regulate the immunologic defense system of the host, and their lysis leads to a permanent suppression of the immune response.

The nurse is performing an assessment of a client in order to determine the functional status of the client's humoral immunity. What component of the client's immune function should the nurse prioritize?

B cells B cells provide humoral immunity. Suppressor T cells are involved with cell-mediated immunity. Natural killer cells are another type of lymphocyte that is not involved in either type of immunity. Lymphokine-activated killer cells are another type of lymphocyte that is not involved in either type of immunity.

A nurse observing a client receiving treatment with pyridostigmine for myasthenia gravis notices the client clenching the jaw, salivating excessively, and experiencing muscle weakness, rigidity, and spasm. The nurse interprets these as indicating which of the following?

Cholinergic crisis Symptoms of cholinergic crisis include severe abdominal cramping, diarrhea, excessive salivation, muscle weakness, rigidity and spasm, and clenching of the jaw. In acetylcholinesterase crisis a pronounced muscular weakness and respiratory paralysis caused by excessive acetylcholine, often a result of overmedication with anticholinesterase drugs. Hypertensive emergency includes retinal hemorrhage, increased intracranial pressure resulting in headache and/or vomiting, and kidney organ failure. Status epilepticus is a medical emergency and can be of different types and caused by brain trauma, infection, or stroke.

The treatment of HIV/AIDS is complicated because different drugs act on different stages of the replication cycle of the virus. Therefore, treatment includes combinations of two, three, or more drugs. What is this treatment called?

HAART treatment Because different drugs act on different stages of the replication cycle, optimal treatment includes a combination of at least two to three drugs, often referred to as HAART [highly active antiretroviral therapy]. The goal of HAART is sustained suppression of HIV replication, resulting in an undetectable viral load and an increasing CD4+ cell count. The other treatments are not used in the treatment of HIV/AIDS.

A client with human immunodeficiency virus (HIV) comes to the clinic and is experiencing white patches on the lateral border of the tongue. What type of lesions does the nurse document?

Hairy leukoplakia Hairy leukoplakia is a condition often seen in people who are HIV positive in which white patches with rough, hairlike projections form, typically on lateral border of the tongue. Aphthous stomatitis is typically a recurrent round or oval sore or ulcer on the inside of the lips and cheeks or underneath the tongue and is not associated with HIV. Erythroplakia describes a red area or red spots on the lining of the mouth and is not associated with HIV. Nicotine stomatitis is a white patch in the mouth caused by extreme heat from smoking.

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

Neutrophils Neutrophils (polymorphonuclear leukocytes [PMNs]) are the first cells to arrive at the site where inflammation occurs. Eosinophils and basophils, other types of granulocytes, increase in number during allergic reactions and stress responses.

A client is receiving anakinra for treatment of rheumatoid arthritis. The client is scheduled to have arthroscopic evaluation of the right knee. What is the priority nursing diagnosis for this client after the procedure?

Risk for infection Although all the nursing diagnoses may be appropriate, the priority would be risk for infection because the client is receiving anakinra, which suppresses the immune system and places the client at higher risk for infection following an invasive procedure.

A client with psoriasis visits the dermatology clinic. When inspecting the affected areas, the nurse expects to see which type of secondary lesion?

Scale A scale is the characteristic secondary lesion occurring in psoriasis. Although crusts, ulcers, and scars also are secondary lesions in skin disorders, they don't occur with psoriasis

After discussing the vaccine available for human papillomavirus with the mother of a 12-year-old female client, the mother agrees to have her daughter immunized. It is July when the nurse administers the first dose. The nurse would instruct the mother to bring the girl in for her second dose at which time?

September The vaccine for human papillomavirus is given in three intramuscular doses, with the initial dose followed by a second dose in 2 months, and a third dose in 6 months after the first dose. For this girl, the second dose would be given 2 months after July, which would be September.

A client has been diagnosed with pneumonia and admitted to the hospital for antibiotic therapy. What aspect of the client's current health status should the nurse prioritize when planning care?

The client's leukocyte count is 1210/µL (1.21 × 109/L The client's low leukocyte count suggest that he or she is immunocompromised. This has a significant effect on treatment. The client's nominally elevated potassium level has lesser consequences. Noncompliance is less of a concern in a hospital setting than in the community setting. The client's nutritional status must be addressed but immune status is a priority.