Unit 1
A mother brings her child to the pediatric clinic because of irritability, loss of appetite, low-grade fever, pallor, and leg pain. Blood tests reveal anemia, thrombocytopenia, and an elevated leukocyte count with atypical lymphocytes. A diagnosis of acute lymphocytic leukemia (ALL) is confirmed with bone marrow studies. The child undergoes aggressive high-dose chemotherapy with plans for a possible stem cell transplant. Which of the following questions is most appropriate for the nurse to ask the mother?
"When your child was born, did you save the umbilical cord blood in a blood bank?" Stem cell transplants focus on correcting bone marrow failure, immunodeficiencies, hematologic defects and malignancies, and inherited errors of metabolism. Sources of the stem cells include bone marrow and umbilical cord blood, which replenish the recipient with a normal population of pluripotent stem cells. Stem cell transplants may be derived from the patient (autologous) or from a histocompatible donor (allogeneic). Autologous transplants are often used to replenish stem cells after high-dose chemotherapy or irradiation. Stem cell transplantation is considered appropriate front-line therapy for patients younger than 70 years. Umbilical cord blood from human leukocyte antigen-matched donors is a transplant option for children and carries less risk of graft-versus-host disease.
A client called the physician's office with symptoms of the common cold. The nurse educates the client on supportive treatment for symptoms and explains that the body's immune system is fighting the virus but will take approximately how long for a response?
1-2 weeks A primary immune response develops when the body encounters the antigen for the first time. The antigen comes in contact with various APCs including macrophages, DCs, and B lymphocytes. The antigen is processed by these cells in association with the MHC-II molecules on the cell's surface and then presented to the lymphocytes. The activated CD4+ helper T cells trigger B cells to proliferate and differentiate into clone plasma cells that produce antibody. The primary immune response takes 1 to 2 weeks, but once generated, detectable antibody continues to rise for several more weeks even though the infectious process has resolved.
A female client with a diagnosis of psoriatic arthritis is presently taking a course of prednisone for the control of symptoms related to inflammation. Which erythrocyte sedimentation rate (ESR) would indicate that the medication course has decreased the inflammation within normal limits?
10 mm/hr Increased sedimentation rate indicates inflammation and is used as a baseline and trend indicator in managing, for example, psoriatic arthritis. An individual who is diagnosed with psoriatic arthritis will have an initial ESR drawn. If the ESR is > 60 the person is diagnosed with a more severe condition than if the person had an elevated ESR of 40. Generally, the person is prescribed prednisone, and then at follow-up visits, the dose of prednisone will be gradually decreased, depending on the ESR and the person's symptoms.
The nurse is reviewing the client's laboratory report. Select the report that represents a normal value for leukocytes.
6500 cells/mL The number of leukocytes, or white blood cells, in the peripheral circulation normally ranges from 4500 to 10,500 cells/mL (4.5 to 10.5 × 109/L).
A mother brings her 5-month-old infant to the pediatrician for recurrent colds. The mother has never breastfed and the infant is fed iron-fortified formula. The mother asks, "My baby has been perfectly healthy up until last month--now it seems like she has been sick constantly. Why?" How should the physician respond?
"An infant gets immunity from the mother at birth and from breast milk; this provides protection from infection but wears off in approximately 3 to 6 months. An infant still needs time for his own immune system to mature." The infant's immune system is not yet mature. Passive immunity is immunity transferred from mother to fetus before birth. After birth, the neonate receives IgG antibodies from the mother in breast milk or colostrum. Therefore, infants are provided with some degree of protection from infection for approximately 3 to 6 months, giving their own immune systems time to mature.
A high school soccer player has just been diagnosed with mononucleosis. He tells the nurse he feels "OK" and really needs to play in the championship game this weekend. The most important information for the nurse to provide would be:
"Avoidance of contact sports for a minimum of 3 weeks after diagnosis is recommended." Most persons with infectious mononucleosis recover without incident. Although splenic rupture is rare, avoidance of contact sports for a minimum of 3 weeks after diagnosis is recommended.
The employee health nurse is working with a nursing student who has just sustained a needlestick injury and has received a dose of hepatitis B immune globulin. The nurse is counseling the student about vaccination against hepatitis B. Which statement by the student indicates understanding?
"I need to start the hepatitis B vaccination series as soon as possible." Some protection against infectious disease can be provided by the injection of hyperimmune serum, which contains high concentrations of antibodies for a specific disease, or immune serum or gamma globulin, which contains a pool of antibodies from many individuals, providing protection against many infectious agents. Passive immunity produces only short-term protection that lasts weeks to months.
A client stepped on a nail at work. The emergency room physician prescribes a tetanus "booster" shot. The client asks the nurse, "If I have already been vaccinated for tetanus why do I need to have another shot?" How should the nurse respond?
"The booster shot will stimulate your immune system's memory, causing an immediate rise in antibodies to protect you from an infection." The immunization process makes use of the primary and secondary immune responses. The initial vaccination causes production of both plasma cells and memory cells. The plasma cells destroy the invading organism or toxin, and the memory cells provide defense against future exposure. "Booster" immunizations produce an immediate antigen-antibody response that simulates an immediate rise in antibody levels.
A sixth grade science teacher asks the students to explain the role of cilia in the lower respiratory tract. Which student response is the best?
"These little hairs move germs trapped in mucous toward the throat so the body can cough them out." Also in the lower respiratory tract, hair-like structures called cilia protrude through the epithelial cells. The synchronous action of the cilia moves many microbes trapped in the mucous toward the throat. The physiologic responses of coughing and sneezing further aid in their removal from the body. Chemical defenses against trapped microbes include the following: lysozyme, which is a hydrolytic enzyme capable of cleaving the walls of bacterial cells; complement, which binds and aggregates bacteria to increase their susceptibility to phagocytosis or disrupt their lipid membrane; and members of the collectin family of surfactant proteins in the respiratory tract. The best-defined function of the surfactants is their ability to opsonize pathogens, including bacteria and viruses, and to facilitate phagocytosis by innate immune cells such as macrophages
A patient comes to the clinic with a runny nose and scratchy throat. The nurse is evaluating the white blood cell count, which shows an elevated number of white blood cells and an increased percentage of eosinophils. Which of the following is the most likely cause of the symptoms?
Allergic reaction Eosinophils increase in number during allergic reactions and parasitic infections.
The cells that mediate humoral immunity do so because they are capable of producing:
Antibodies B lymphocytes (B cells) are the only cells capable of producing antibodies; therefore, they are the cells that mediate humoral immunity. B lymphocytes (B cells) differentiate into plasma cells that produce the needed immunoglobulins (antibodies) for responding to that particular antigen. Stem cells are undifferentiated cells. T helper cells differentiate into cytotoxic and other T-cell forms.
The globulins that make up part of the plasma of the blood have three distinct purposes. What are the gamma globulins?
Antibodies of the immune system There are three types of globulins: the alpha globulins that transport bilirubin and steroids, the beta globulins that transport iron and copper, and the gamma globulins that constitute the antibodies of the immune system. Alpha globulins transport bilirubin and steroids. Beta globulins transport iron and copper. Autoantibodies are immunoglobulins that recognize an antigen on that person's own tissue.
Substances foreign to the host that can stimulate an immune response are known as:
Antigens Antigens are foreign substances that stimulate an immune response. Antibodies are innate and will adapt to the antigen. MHC proteins aid in the identification process of host cells. Cytokines are signaling molecules of the immune system.
The nurse is reviewing the laboratory results of a newborn. The infant has anemia, thrombocytopenia, and granulocytopenia (pancytopenia). Based on these results, the nurse anticipates the diagnosis of which type of anemia?
Aplastic anemia Aplastic anemia develops when the multipotent stem cells fail to grow and provide cells for differentiation. The result is concomitant anemia, thrombocytopenia, and granulocytopenia (pancytopenia).
The cloning of the genes for most of the hematopoietic growth factors has been accomplished. The recombinant proteins that are produced are used in a wide range of clinical problems. What diseases have these proteins been used to fight?
Aplastic anemia and the anemia of kidney failure The genes for most hematopoietic growth factors have been cloned, and their recombinant proteins have been generated for use in a wide range of clinical problems. They are used to treat bone marrow failure caused by chemotherapy or aplastic anemia, the anemia of kidney failure and cancer, hematopoietic neoplasms, infectious diseases such as AIDS, and congenital and myeloproliferative disorders. Autoimmune disorders, Parkinson disease, and Huntington disease are not anemic disorders, so the recombinant proteins have not been used in the treatment of these diseases.
A client asks, "What do these basophils and mast cells do in the body?" The health care provider responds that they:
Are involved when you have an allergic reaction The basophil, which is a blood cell, is related to the connective tissue mast cell that contains similar granules. Both the basophils and mast cells are thought to be involved in allergic and hypersensitivity reactions. These cells do not stiffen the cell membranes. In parasitic infections, the eosinophils use surface markers to attach themselves to the parasite and then release hydrolytic enzymes that kill it. Lymphocytes migrate through the peripheral lymphoid organs, where they recognize antigens and participate in immune responses.
Major histocompatibility complex (MHC) molecules, with human leukocyte antigens (HLAs), are markers on all nucleated cells and have an important role in:
Avoiding transplant rejections MHC and HLA markers are unique for each individual, except possibly for identical twins. Tissue and organ transplantation success is dependent on how closely matched the MHC molecules and HLAs are on the donor and recipient. MHC molecules and HLAs are not involved in transport or viral replication. Red blood cells do not have a nucleus and thus do not have HLA or MHC molecules on the surface.
Which of the following types of lymphocyte is involved with humoral-mediated immunity?
B lymphocytes B lymphocytes differentiate to form antibody-producing plasma cells and are involved in humoral-mediated immunity. T lymphocytes (helper T cells) activate other cells in the immune system and are involved in cell-mediated immunity. NKCs participate in innate or natural immunity.
Select the type of lymphocyte that matures in the bone marrow.
B lymphocytes B lymphocytes mature in the bone marrow and are essential for humoral or antibody-mediated immunity. The T lymphocytes mature in the thymus. Macrophages are part of the monocytic phagocyte system and are in almost all tissues and are the mature form of monocytes. Cytotoxic T cells are involved in cell-mediated immunity.
A patient comes to the clinic following exposure to chicken pox. The patient states he had chicken pox as a child but was worried about getting sick again. Which of the following statements best explains humoral-mediated immunity to the patient?
B lymphocytes (B cells) in the body produce antibodies to fight infections. Once exposed, the cells retain memory and are able to quickly fight off pathogens during re-exposure and prevent the disease from reoccurring. The B lymphocytes (B cells) differentiate to form antibody-producing plasma cells that retain memory and are involved in humoral-mediated immunity.
Which of the following types of white blood cells are related to the connective tissue mast cells and respond in allergic and hypersensitivity reactions?
Basophils The basophil is related to connective tissue mast cell because they contain similar granules and are believed to be involved in allergic and hypersensitivity reactions. Neutrophils, granulocytes, and B lymphocytes are not identified as being similar to mast cells.
Cytokines that stimulate bone marrow pluripotent stem and progenitor or precursor cells to produce large numbers of platelets, erythrocytes, lymphocytes, neutrophils, and monocytes, eosinophils, basophils, and dendritic cells are known as:
Colony-stimulating factors (CSFs) Colony-stimulating factors (CSFs) are cytokines that stimulate bone marrow pluripotent stem and progenitor or precursor cells to produce large numbers of platelets, erythrocytes, lymphocytes, neutrophils, monocytes, eosinophils, basophils, and dendritic cells. Chemokines are cytokines that stimulate the migration and activation of immune and inflammatory cells. Antibodies are immunoglobulins. NK cells are a class of lymphocytes that recognize infected and stressed cells and respond by killing these cells.
A lactation nurse visits a new mother after delivery of her first child and encourages the mother to breastfeed her infant, even for a short time. Which statement made by the nurse correctly explains the importance of breastfeeding?
Colostrum will provide the infant with passive immunity for several months to diseases to which the mother has immunity. After birth, the neonate receives IgG antibodies from the mother in breast milk or colostrum. Therefore, infants are provided with some degree of protection from infection for approximately 3 to 6 months, giving their own immune systems time to mature. IgA is primarily a secretory Ig that is found in saliva, tears, colostrum (i.e., first milk of a nursing mother), and bronchial, gastrointestinal, prostatic, and vaginal secretions. Its primary function is in local immunity on mucosal surfaces. IgA prevents the attachment of viruses and bacteria to epithelial cells.
The nurse's review of a client's laboratory results indicates that inflammation is absent and platelet levels are low. Which test was performed to provide the platelet count?
Complete blood count The complete blood count provides the number and characteristics of red blood cells, leukocytes, and platelets. Hematocrit is simply the percentage of RBCs and sedimentation rate indicates inflammation. Bone marrow aspiration is used to examine the stem cells.
Which of the types of T cells is responsible for destroying pathogens by punching holes in their cell membrane and by secreting cytokines/lymphokines?
Cytotoxic T cells Cytotoxic T cells destroy the pathogens. Regulatory T cells suppress immune response. Memory T cells are derived from normal T cells. The principal cells of the adaptive immune system are the T and B lymphocytes and antigen-presenting cells. T lymphocytes differentiate into helper T and regulatory T cells and cytotoxic T cells and provide cell-mediated immunity. CD4+ helper T cells serve as a trigger for the immune response and are essential for the differentiation of B cells into antibody-producing plasma cells and the differentiation of T lymphocytes into CD8+ cytotoxic T cells.
A nurse is evaluating laboratory results of a patient diagnosed with a parasitic infection. The tests reveal a large group of cells that are membrane bound with granules in their cytoplasm that are aiding in the destruction of the parasite. Which of the following cells is the nurse evaluating?
Eosinophil People who have helminthic parasites will have an increase in eosinophils in their complete blood count. The specific cytoplasmic granules of the eosinophils stain red with the acidic dye eosin. In parasitic infections, the eosinophils use surface markers to attach themselves to the parasite and then release hydrolytic enzymes that kill it.
Leukocytes consist of three categories of cells that have different roles in the inflammatory and immune responses. Which of the following leukocytes is correctly matched with its function?
Eosinophils—allergic reactions Eosinophils, a type of granulocyte, increase in number during allergic reactions. Lymphocytes (agranulocytes) consist of three cell types that are not phagocytes but do have an important role in the immune response. Basophils and mast cells release heparin and histamine in response to allergens. Monocytes and macrophages are phagocytes that engulf antigens.
A 16-year-old male client who has been diagnosed with infectious mononucleosis asks the health care provider what caused the condition. The best response would be:
Epstein-Barr virus (EBV) EBV is the usual causative factor that results in the development of infectious mononucleosis. People with HIV may be at more risk for contacting mononucleosis. EBV may contribute to lymphoproliferative disorders, such as non-Hodgkin lymphoma.
A child diagnosed with acute lymphocytic leukemia undergoes aggressive high-dose chemotherapy and is scheduled for an autologous stem cell transplant. Which treatments would the nurse anticipate administering? Select all that apply.
Erythropoietin (EPO) to stimulate red blood cell production Granulocyte colony-stimulating factor (G-CSF) to promote the proliferation of all neutrophils Thrombopoietin (TPO) to stimulate platelet development Macrophage colony-stimulating factor (M-CSF) to increase macrophage colonies. Many cytokines stimulate the growth and production of new blood cells. CSFs promote the growth of hematopoietic cell colonies. The CSFs that act on committed progenitor cells include EPO; TPO; GM-CSF, which stimulates progenitors for granulocytes, monocytes, erythrocytes, and megakaryocytes; G-CSF, which promotes the proliferation of neutrophils; and M-CSF, which induces macrophage colonies. Growth factors are used to increase peripheral stem cells for transplantation and to accelerate cell proliferation after bone marrow engraftment. Administration of a flu vaccine is contraindicated with immunosuppression.
Select the statement that best describes the effectiveness of vaccination in the elderly population.
Experimental evidence suggests that vaccination is less successful in inducing immunization in older persons than in younger adults. Elderly persons tend to be more susceptible to infections, have more evidence of autoimmune and immune complex disorders than younger persons, and have a higher incidence of cancer. Experimental evidence suggests that vaccination is less successful in inducing immunization in older persons than in younger adults. However, the effect of altered immune function on the health of elderly persons is clouded by the fact that age-related changes or disease may affect the immune response.
The laboratory finds IgA in a sample of cord blood from a newborn infant. This finding is important because it signifies what?
Fetal reaction to exposure to an intrauterine infection Cord blood does not normally contain IgM or IgA. If present, these antibodies are of fetal origin and represent exposure to intrauterine infection.
A patient being treated for polymyalgia rheumatica (PMR) comes to the clinic for a follow-up visit. The current erythrocyte sedimentation rate (ESR) rate has decreased from 60 mm/hour to 30 mm/hour and the patient is afebrile, denies any headaches, and reports a decrease in joint pain and fatigue. Based on these findings, the nurse anticipates which of the following changes to the treatment plan?
Gradually decrease the current dosage of prednisone and repeat ESR in 2 weeks. The ESR is a screening test for monitoring the fluctuations in the clinical course of a disease such as PMR. Symptoms of this inflammatory disorder include fatigue, fever, pain, and headache, which are all a result of the systemic effects of cytokine release. An individual who is diagnosed with PMR will have an initial ESR drawn. If the ESR is >60, the person is diagnosed with a severe PMR. Generally, the person is prescribed prednisone, and then at follow-up visits, the dose of prednisone will be gradually decreased depending on the ESR and the person's symptoms.
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 (Neupogen) 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.
A patient who has received chemotherapy has a steadily decreasing white blood cell count. The nurse anticipates administering which of the following to increase the neutrophil count?
Granulocyte colony-stimulating factor Administration of granulocyte colony-stimulating factor promotes the proliferation of all neutrophils.
A client has recently received a pneumococcal vaccine and the client's B cells are consequently producing antibodies. Which of the following cells may enhance this production of antibodies?
Helper T cells Among T lymphocytes are a subset of T cells called helper T cells, which help B lymphocytes produce antibodies. Natural killer cells as well as regulatory and cytotoxic T cells do not perform this function.
An essential property of the immune system is self-regulation. An immune response that is not adequate can lead to immunodeficiency, while an immune response that is excessive can lead to conditions from allergic responses all the way to autoimmune diseases. Which of these is not an example of a breakdown of the self-regulation of the immune system?
Huntington disease Self-regulation is an essential property of the immune system. An inadequate immune response may lead to immunodeficiency, but an inappropriate or excessive response may lead to conditions varying from allergic reactions to autoimmune diseases. All answers are autoimmune diseases except for Huntington disease.
A client with acute leukemia has developed gout. The nurse is aware that this results from:
Hyperuricemia Hyperuricemia occurs as the result of increased proliferation or increased breakdown of purine nucleotides secondary to leukemic cell death that results from chemotherapy. It may increase before and during treatment. Prophylactic therapy with allopurinol, a drug that inhibits uric acid synthesis, is routinely administered. Diet will contribute to gout.
A patient receives an interleukin-2 (IL-2) infusion to treat cancer. Which of the following responses explains how this cytokine will affect the growth of cancer cells?
IL-2 stimulates growth of cytotoxic T lymphocytes. Cytokines are small proteins used by the innate and adaptive immune systems to communicate with each other. IL-2 is a growth factor for activated T cells produced by macrophages. IL-2 activates cytotoxic T lymphocytes and natural killer cells. These cells destroy abnormal cells.
A client experiences an allergic reaction. Select the immunoglobulin that would bind to mast cells and release histamine.
IgE IgE responds to allergic exposures and parasitic infections. IgA is the primary defense against local infections in mucosal tissues. IgG protects against bacteria, toxins, and viruses and activates the complement system. IgD acts as an antigen receptor for initiating the B cells.
Which of the following immunoglobulins (Ig) is released in response to allergy or parasitic infections?
IgE IgG is responsible for antiviral, antitoxin, and antibacterial responses. IgA is found in body secretions and helps with local immunity on mucosal surfaces. IgM is the first antibody developed by an infant. IgE is secreted in response to inflammation and allergy and is released in the presence of parasitic infection. IgD helps B cells mature.
A nurse is reviewing labs for a client newly diagnosed with a bacterial infection. In determining if the client is experiencing a primary immune response, the nurse looks for which type of antibody produced from activated immature B cells?
IgM IgM is the first antibody to be produced by the developing fetus and by immature B lymphocytes
The nurse is reviewing the functions of immunoglobulins and determines which of the following as a correct action?
IgM/first to challenge the antigen The correct actions are as follows: IgM is the first circulating immunoglobulin to appear in response to an antigen. IgA prevents the attachment of viruses and bacteria to epithelial cells. IgE is involved in inflammation, allergic responses, and combating parasitic infections. It binds to mast cells and basophils. IgD serves as an antigen receptor for initiating the differentiation of B cells.
A nurse is caring for a child diagnosed with DiGeorge Syndrome with thymic hypoplasia. Which immune response would the nurse anticipate in this child?
Increased risk of infection The thymus is essential to the development of the immune system because it is responsible for the production of mature, immunocompetent T lymphocytes. Mature, immunocompetent T-helper and T-cytotoxic cells leave the thymus in 2 to 3 days and enter the peripheral lymphoid tissues through the bloodstream. Without a thymus, infections would occur frequently. These T cells recognize foreign antigens and build an immune response. Therefore, with thymic hypoplasia, there is a risk for increased infection (not reduced infection or no change). Obviously there is an antigen response.
Natural killer cells are specialized lymphocytes that are one of the major parts of which immunity?
Innate The major components of innate immunity are the skin and mucous membranes; phagocytic cells (mainly neutrophils and macrophages); specialized lymphocytes called NK cells; and several plasma proteins, including the proteins of the complement system. Adaptive, humoral, and cell-mediated immunities do not use NK cells.
Leukemias are classified according to the predominant cell type. The myelogenous cell type of leukemia can:
Interfere with thrombocyte cell maturation Myelogenous leukemia interferes with maturation of all blood cells, including granulocytes, erythrocytes, and thrombocytes, in the bone marrow. Lymphocytic leukemia originates in the marrow and infiltrates the spleen, lymph nodes, and tissues. Lymphocytic leukemia has immature precursor B and T cells in the marrow. Chronic lymphocytic leukemia results from the malignant transformation of relatively mature B lymphocytes into immature ones.
Which type of macrophages are found in the liver?
Kupffer cells Rationale: Macrophages found in the liver are known as Kupffer cells. Histiocytes are macrophages found loose in connective tissue, and microglial cells are brain macrophages. Monocytes are referred to macrophages when they enter the tissues.
An obstetrics nurse is counselling an expectant mother. The mother is concerned about letting people hold her baby once it's born, fearing that the baby will get sick. What should the nurse explain to the mother?
Maternal immunoglobulins cross the placenta and protect the newborn early in life. Passive immunity is immunity transferred from another source. An infant receives passive immunity naturally from the transfer of antibodies from its mother in utero and through breast milk. Maternal IgG crosses the placenta and protects the newborn during the first few months of life. Innate immunity are not effective yet, and protection is unrelated to the amount of lymphoid tissue.
Innate immunity, also called natural or native immunity, consists of mechanisms that respond specifically to:
Microbes Innate immunity is the first line of defense against microbial invasion and is in place before infection. Inflammation and antibody production are responses to microbes after they have invaded the body. The innate immune system is able to identify non-self from self-cells.
A blood smear is being examined and a stain has been added that will identify granulocytes. Which cell types will be visible with the stain? Select all that apply.
Neutrophil Eosinophil Basophil The macrophage does not contain cytoplasmic granules, and neutrophils, eosinophils, and basophils do. The granules contain the mediators of the acute inflammatory response. Monocytes are not granulocytes.
Which of the following is the most common leukocyte in normal blood?
Neutrophilic granulocyte Neutrophilic granulocyte is the most common leukocyte in normal blood.
A teenager presents to the clinic with an infected wound from a bike accident. He asks, "How does my body fight off the germs in my scraped arm?" Which is the nurse's best response? "The cells that plays the central role related to the innate immune response to an infectious microorganism are:
Neutrophils Neutrophils are phagocytic cells that play a central role in innate immunity. Antibodies and B lymphocytes and T lymphocytes contribute exclusively to the adaptive immune response.
A nurse sends a blood sample to the lab for analysis. Assuming the sample is normal, the nurse anticipates which of the following white blood cells (WBCs) will account for the highest percentage?
Neutrophils Neutrophils constitute 55-65% of the total WBCs.
A patient is admitted to the hospital with an elevated temperature and flank pain. When reviewing the complete blood count (CBC), which of the following levels is the most important for the nurse to communicate to the health care provider?
Neutrophils 85% Neutrophils are very mobile and are the first cells to go to an area of tissue damage. The elevation in neutrophils indicates that the patient has an acute infection (such as pyelonephritis) that is causing the temperature elevation and flank pain.
When a white blood cell with differential count reveals an acute infection, which statement is correct regarding the client's neutrophils?
Neutrophils are the first white blood cell to elevate in an acute infection. Neutrophils constitute 55% to 65% of the total numbers of white blood cells and are primarily responsible for maintaining normal host defenses against invading fever producing bacteria and fungi, cell debris, and a variety of foreign substances. Eosinophils are white blood cells that are responsive in an allergic or parasitic infection.
The process by which microbes are coated to allow for more efficient recognition by phagocytes is known as:
Opsonization Opsonization is the coating of particles with proteins, lectins, and complement to make them more attractive for phagocytes to recognize them as a foreign pathogen. Immunization is the process of acquiring the ability to respond to an antigen after its administration by vaccine. Immunity is protection from disease and, more specifically, infectious disease. Memory response occurs on second or subsequent exposures to the antigen.
While explaining immunity to a client, the nurse responds, "The body's internal organs are protected from pathogens because:
Our mucosal tissue contains all the necessary cell components to fight a pathogen with an immune response." Secondary lymphoid tissues contain all the necessary cell components (i.e., T cells, B cells, macrophages, and dendritic cells) for an immune response. Because of the continuous stimulation of the lymphocytes in these tissues by microorganisms constantly entering the body, large numbers of plasma cells are evident. Immunity at the mucosal layers helps to exclude many pathogens and thus protects the vulnerable internal organs. Although cells of both the innate and adaptive immune systems communicate critical information by cell-to-cell contact, many interactions and effector responses depend on the secretion of short-acting soluble molecules called cytokines. The actions of cytokines are often pleiotropic and redundant. Pleiotrophism refers to the ability of a cytokine to act on different cell types.
A nurse working in an emergency department is assigned to triage the following patients. Which of the following patients should the nurse evaluate first?
Patient who has chemotherapy-induced neutropenia (decrease in neutrophil levels) and a temperature of 101.2°F Neutrophils are primarily responsible for maintaining normal host defenses against invading bacteria and fungi, cell debris, and a variety of foreign substances. The earliest sign of infection in a neutropenic patient is an elevation in temperature. A neutropenic patient with a fever is assumed to have an infection and is at risk for rapidly developing sepsis. Rapid assessment, cultures, and initiation of antibiotic therapy are needed. The other patients also require rapid assessment but not as urgently.
A mother of a child diagnosed with strep throat asks, "Why are the lymph nodes in my child's neck swollen?" The nurse will base her response knowing that dendritic cells help:
Phagocytose foreign agents/microbes and migrate them to regional lymph nodes Dendritic cells have the same function as macrophages—to initiate the adaptive immune response and present the processed antigen to T lymphocytes. Dendritic cells are found in skin tissue and transport antigens to lymph nodes. Dendritic cells do not dispose of normal metabolic waste products or control the inflammatory response.
A nurse is reviewing a client's complete blood count (CBC) which indicates thrombocytopenia. Based on this result which action should the nurse include in the plan of care?
Place the client on bleeding precautions Thrombocytopenia is a decreased number of platelets, which places the patient at high risk for bleeding.
The nurse is caring for a client with leukemia that is having difficulty with blood clotting after having several transfusions with packed red blood cells. What does the nurse anticipate infusing for this client to assist with controlling the bleeding?
Platelets Thrombocytes, or platelets, are circulating cell fragments of the large megakaryocytes that are derived from the myeloid stem cell. They function to form the platelet plug to help control bleeding after injury to a vessel wall. Their cytoplasmic granules release mediators required for the blood coagulation process. Thrombocytes have a membrane but no nucleus, cannot replicate, and, if not used, last approximately 10 days in the circulation before the phagocytic cells of the spleen remove them.
Activating lymphocytes depends on which actions of antigens by macrophages?
Processing and displaying Macrophages engulf and process the antigen, then move it to the surface for display to a T lymphocyte. Macrophages do not completely destroy antigens; the T and B cells do the destruction after the processed antigen is presented. Memory cells remember the first encounter with a particular antigen and repeat the same response. Macrophages capture one antigen at a time, not in clusters or in groups.
A child's thymus gland is fully formed and proportionately larger than an adult's. Which of the following processes that contributes to immunity takes place in the thymus gland?
Proliferation of T cells Phenotypically immature T cells enter the thymus from the bone marrow and undergo maturation and thymic selection. B cells are not differentiated in the thymus, and NK cells result from the common lymphoid progenitor. The spleen filters antigens from the blood.
The nurse is planning care for a client with a diagnosis of primary immunodeficiency. Which of the following is a priority intervention to incorporate into the plan?
Protecting the client from infection The client with immunodeficiency has an absent or inadequate immune response. Cell-mediated, or cellular, immunity is mediated by the cytotoxic T lymphocytes (T cells) and functions in the elimination of intracellular pathogens. A lack of this response increases the client's risk of infection.
A client is being evaluated for atopic dermatitis possibly caused by a latex-related allergic reaction. The nurse will review which of the following labs to determine if an allergy is present?
Serum IgE IgE binds to mast cells and basophils and is involved in parasitic infections, allergic and hypersensitivity reactions. Serum IgE causes the symptoms of allergic reactions and is elevated in type 1 hypersensitivity disorders.
A 26-year-old female client has a neutrophil count of less than 500 ?L. The nurse would interpret this as
Severe neutropenia A moderate neutropenia diagnosis would be consistent with a count of 500 to 1000 ?L. Normal count would be 5000 to 10,000 ?L. Mild neutropenia would be 1000 ?L and severe neutropenia at less than 500 ?L.
A client with chronic myelogenous leukemia (CML) has been diagnosed with terminal blast crisis. Which clinical manifestations should the nurse focus the assessment on for this client? Select all that apply.
Shortness of breath and progressive dyspnea Headache and lethargy Increasing confusion The terminal blast crisis phase of CML represents evolution to acute leukemia and is characterized by an increasing number of myeloid precursors, especially blast cells, in the blood. With very high blast counts (>100,000 cells/μL), symptoms of leukostasis may occur. The high number of circulating leukemic blasts increases blood viscosity and predisposes to the development of leukoblastic emboli with obstruction of small blood vessels in the pulmonary and cerebral circulations. Occlusion of the pulmonary vessels leads to vessel rupture and infiltration of lung tissue, resulting in sudden shortness of breath and progressive dyspnea. Cerebral leukostasis leads to diffuse headache and lethargy, which can progress to confusion and coma.
The first physical line of defense in innate immunity is:
Skin and mucous membranes The first physical line of defense are the skin and mucous membranes, which prevent pathogens from entering. Plasma proteins, neutrophils, and specialized lymphocytes are examples of cellular level protection.
A client diagnosed with pancytopenia due to aplastic anemia is scheduled for which of the following treatments that can correct bone marrow deficiencies?
Stem cell transplant Aplastic anemia develops when the multipotent stem cells fail to grow and provide cells for differentiation. The result is concomitant anemia, thrombocytopenia, and granulocytopenia (pancytopenia). Potential cures for these and many other disorders use hematopoietic stem cells as part of the treatment. Stem cell transplants focus on correcting bone marrow failure, immunodeficiencies, hematologic defects and malignancies, and inherited errors of metabolism.
A student asks, "What does cell-mediated immunity mean to the client?" The instructor responds. "This means:
The body is trying to defend itself against intracellular microbe invasion by engulfing and destroying the microbe." Cell-mediated immunity, which defends against intracellular microbes such as viruses, is provided by cells called T lymphocytes. Some T lymphocytes activate phagocytes to destroy microbes that have been engulfed, whereas others kill any type of host cell that is harboring microbes.
A teenager has been exposed to a person infected with chicken pox. After two weeks, the client has not contracted the virus. How is this possible? Select all that apply.
The client was vaccinated for chicken pox. The client was previously exposed to chicken pox. Active immunity is acquired when the host mounts an immune response to an antigen either through the process of vaccination or from environmental exposure. It is called active immunity because it requires the host's own immune system to develop an immunological response including the development of memory. Passive immunity transferred from mother to fetus only lasts a few weeks to months following birth
Which of the following factors differentiates chronic leukemias from acute leukemias?
The leukemic cells are more fully differentiated than in acute leukemias. In contrast to acute leukemias, chronic leukemias are malignancies involving proliferation of more fully differentiated myeloid and lymphoid cells. Down syndrome is associated with acute leukemias, and both acute leukemias and chronic leukemias involve systemic distribution of leukemic cells.
A newborn has been lethargic, is not nursing well, and is basically looking ill. Following lab tests, it has been found that the newborn has IgM present in his blood. How should the nurse interpret this finding?
The presence of IgM suggests the infant has a current infection. IgM is the first immunoglobulin to appear in response to antigen and is the first antibody type made by a newborn. This is diagnostically useful because the presence of IgM suggests a current infection in the infant by a specific pathogen. IgE is involved in inflammation, allergic responses, and combating parasitic infections. It binds to mast cells and basophils. The binding of antigen to mast cell- or basophil-bound IgE triggers these cells to release histamine and other mediators important in inflammation and allergies. IgA is found in saliva and tears, and is a primary defense against infections in mucosal tissues.
The nurse is reviewing the results of a client's complete blood count and differential. The results of this test will inform the nurse of what aspects of the client's current status? Select all that apply.
The proportion of each type of white cell in the client's blood The number of platelets that are present in each unit of blood
The nurse is explaining to a colleague the basis of a client's allergy to dust. What statement by the nurse most accurately describes antigens in this situation?
They are substances foreign to the host that can stimulate an immune response. Antigens are any molecule that can stimulate an immune response. Antibodies are polypeptides. Cytokines communicate critical information, and interferons disrupt viral multiplication.
A 6-year-old child is having a stem cell transplant using umbilical cord blood. What benefit does the nurse understand that this type of transplant will have for the child?
This type of transplant creates less risk of graft-versus host disease Umbilical cord blood from HLA-matched donors is a transplant option for children and carries less risk of graft-versus-host disease. Stem cell transplants focus on correcting bone marrow failure, immunodeficiencies, hematologic defects and malignancies, and inherited errors of metabolism. Sources of the stem cells include bone marrow and umbilical cord blood, which replenish the recipient with a normal population of pluripotent stem cells. Stem cell transplants may be derived from the client (autologous) or from a histocompatible donor (allogeneic). Autologous transplants are often used to replenish stem cells after high-dose chemotherapy or irradiation.
One of the self-regulatory actions of the immune system is to identify self-antigens and be nonreactive to them. Which term best describes this process of the immune system?
Tolerance The term tolerance is used to define the ability of the immune system to be nonreactive to self-antigens while producing immunity to foreign agents. All other responses have nothing to do with the recognition and tolerance to self-antigens.
A nurse conducting a health promotion education program on heat cramps states that muscle cramps that occur from fluid losses from heavy sweating should not be treated only with which of the following?
Water Muscle cramps from heat cramps occur due to salt depletion that occurs when fluid losses from heavy sweating are replaced by water alone.
A mother is diagnosed with a bacterial infection and is worried that her newborn infant will also contract the infection. Which of the following statements should the nurse include in the teaching plan for the client?
Your newborn has maternal IgG antibodies that were transferred through the placenta before birth, providing some protection from infection Passive immunity is immunity transferred from another source. The most common form of passive immunity is that conferred from mother to fetus. During fetal development, maternal IgG antibodies are transferred to the fetus via the placenta. After birth, the neonate also receives IgG antibodies from the mother in breast milk or colostrum. Therefore, infants are provided with some degree of protection from infection for approximately 3 to 6 months, giving their own immune systems time to mature.
The leukemia most commonly found in children and adolescents is recognized as:
Acute lymphocytic leukemia (ALL) Among children and adolescents, ALL is the most common type, accounting for 75% of leukemia cases. In adults 20 years of age and older, the most common types are CLL (38%) and AML (30%).
The health care provider suspects a client may have developed a leukemia that originates from the B cells. The provider would assess the client for:
Acute lymphocytic leukemia (ALL) and chronic lymphocytic leukemia (CLL) ALL and CLL originate from the B lymphocytes, while CML originates with the myeloid cells. AML originates from the myeloid precursor cells in the bone marrow.
A client has a lymphoma that carries a risk of CNS involvement. The nurse anticipates the health care provider will prescribe:
CNS prophylaxis Persons with lymphomas that carry a risk of CNS involvement usually receive CNS prophylaxis with high doses of chemotherapeutic agents or cranial irradiation. The other options would not benefit the client.
A nurse who works in a long-term care facility has observed the high incidence of infectious illnesses among the older adults who reside there. What is the best explanation for a diminished immune capacity in older adults?
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 explaining to the parents of a young child the mechanism of his allergic reaction. The nurse should explain the role of which leukocyte?
Eosinophil Eosinophils increase in number during allergic reactions and parasitic infections. It is thought that they release enzymes or chemical mediators that detoxify the agents associated with allergic reactions. Neutrophils, basophils, and macrophages are not directly involved in allergic reactions.
The nurse is aware that the only class of immunoglobulins to cross the placenta is:
IgG IgG is the only class of immunoglobulins to cross the placenta. Levels of maternal IgG decrease significantly during the first 3 to 6 months of life, while infant synthesis of immunoglobulins increases.
Which of the following immunoglobulins (Ig) is the most abundant of circulating antibodies?
IgG IgG makes up about 75% of the immunoglobulins. IgA is about 15%, IgM 10%, and IgE 0.004% of the total.
Which of the following is the main job of lymphocytes?
Immune reaction
A patient is admitted to the emergency department with a diagnosis of polycythemia. The nurse plans to assess for symptoms related to which of the following problems?
Increased blood viscosity Unregulated overproduction of the red cell mass is termed polycythemia, which causes a thickening of the blood and an increased risk of blood clots.
A person has been exposed to a particular antigen and a now experiences a repeat exposure. What stimulates a quicker immune response?
Memory T cells The memory T and B lymphocytes that are generated remain in the body for a longer time and can respond more rapidly during repeat exposures to an antigen related to their acquired memory.
A child has a congenital condition in which the thymus gland is absent. What should the nurse include in the education of care of this patient to the parents?
Observe and report signs and symptoms of infection. The thymus is essential to the development of the immune system because it is responsible for the production of mature, immunocompetent T lymphocytes.
Which of the following is the name of the fluid that remains after blood clots?
Serum Serum is the name of the fluid after blood clots.
Which of the following explains how T lymphocytes and B lymphocytes differ?
T lymphocytes mature in the thymus gland; B lymphocytes mature in the bone marrow. T lymphocytes mature in the thymus gland and provide cell-mediated immunity. T lymphocytes activate other lymphocytes and phagocytes. B lymphocytes mature in the bone marrow and are responsible for forming the antibodies that provide humoral immunity. Both are amplified by cytokines.
Stem cell transplantation has been shown to provide potential cures for diseases such as aplastic anemia and the leukemias. What are the sources of stem cells used for transplant?
Umbilical cord blood and bone marrow Sources of the stem cells include bone marrow and umbilical cord blood. All replenish the recipient with a normal population of pluripotent stem cells. Immature embryonic cells do not necessarily contain stem cells. Immature neural cells are not stem cells. Yellow bone marrow does not make blood cells, so it would not contain stem cells.
A patient seeks treatment in the clinic for exposure to poison ivy with a rash over the right arm and hand. The nurse is aware that what toxin is found in the oils on poison ivy that are responsible for eliciting an allergic reaction?
Urushiol Urushiol is a toxin found in the oils on poison ivy that is responsible for initiating an allergic reaction.
A nurse is reviewing laboratory data for an elderly patient. Which of the following laboratory values should the nurse be most concerned about?
White blood cell (WBC) count 3500/mL Normal WBC count is 4.8-10.8 × 103/µL. The total WBC count is not usually affected by aging, and the low WBC here would indicate that the patient's immune function may be compromised. The platelet count is normal for an older patient. The slight decrease in hemoglobin and hematocrit are not unusual for an older patient.
A nurse is reviewing the laboratory data for a hospitalized client. The nurse would be most concerned about which finding?
White blood cell (WBC) count of 2800/µL Leukocytes are crucial to our defense against disease. The low WBC count in this patient would indicate that the patient's immune function may be compromised and the underlying cause of the problem needs to be investigated.
The nurse is reviewing the complete blood count (CBC) and white blood cell (WBC) differential of a client admitted with lower right abdominal pain. Which laboratory results are the most important for the nurse to communicate to the health care provider?
White blood cells (WBCs) 18,500/µL Leukocytes are crucial to our defense against disease. The high WBC count in this would indicate that the patient has an inflammatory or infectious process ongoing, which may be the cause of the patient's pain, and that further diagnostic testing is needed.
The nurse is explaining the quality of pleiotropism that is possessed by many cytokines. The quality of pleiotropism implies that such cytokines:
are able to act on different types of cells. Pleiotropism refers to the ability of a cytokine to act on different cell types. However, they cannot act on every type of cell and do not perform multiple functions on the same cell.
A nurse on an oncology floor is treating a client who is anemic following chemotherapy. The drugs being administered are designed to increase the number of red blood cells in circulation. These drugs are likely agonists of:
cytokines. RBC production is directed by cytokines and growth factors. Lymphokines are used for communication between lymphocytes, and trophic and secondary hormones are too broad an answer to this question.
A nurse is caring for a newborn that has developed a low platelet count. Which of the following could be the cause?
Decreased thrombopoietin (TPO) TPO stimulates the differentiation of platelets.
What are the components of blood? (Select all that apply.)
Electrolytes Enzymes Blood is made up of plasma, plasma proteins, fixed elements or blood cells, and substances such as hormones, enzymes, electrolytes, and by-products of cellular waste. Ascites is an accumulation of intraperitoneal fluid containing large amounts of protein and electrolytes. Bile is a secretion of the liver that is stored in the gallbladder.
The entrance of a microbe into an individual's vascular space has initiated opsonization. How will the health care provider explain this process critical in stopping the infiltration of the microbe through opsonization? Opsonization:
Coats a microbe to activate phagocytosis recognition The coating of particles, such as microbes, is called opsonization, and the coating materials are called opsonins. The opsonin bound to the microbe then activates the phagocyte after attachment to a complementary receptor on the phagocyte. Opsonization does not involve stimulation by T cells, stimulation of the bone marrow, or the lysis of microbes by cytotoxic T cells.
A client's laboratory report shows the presence of the Philadelphia chromosome. The health care provider would recognize this as:
Chronic myelogenous leukemia (CML) The Philadelphia chromosome translocation is found in more than 90% of persons with chronic myelogenous leukemia and in some persons with acute leukemia.
Although the usual site for a bone marrow test is the posterior iliac crest, other sites include the anterior iliac crest and the sternum. What are the dangers of using the sternum for a bone marrow test in children?
Danger of perforating the mediastinum and heart Usually, the posterior iliac crest is used in all persons older than 12 to 18 months of age. Other sites include the anterior iliac crest, sternum, and spinous processes T10 through L4. The sternum is not commonly used in children because the cavity is too shallow, and there is danger of mediastinal and cardiac perforation.
