Adult Health Chapter 14 Normal and Altered Immune Responses

C When trying to determine whether a patient is at risk for latex allergy, the nurse can inquire about a history of allergy to avocados or bananas, which are both plant-based substances. Sulfa, penicillin, and shellfish are not associated with latex allergies.

During a preoperative assessment, the nurse would assess for latex allergy by asking the patient about allergy to which substance? A. Penicillin B. Sulfa C. Avocados D. Shellfish

B When caring for a patient undergoing plasmapheresis, the nurse should be observant for headache. Citrate toxicity is a common complication of plasmapheresis because citrate is used as an anticoagulant and may cause hypocalcemia, which in turn manifests as headache, paresthesias, and dizziness. Another common complication of plasmapheresis is hypotension caused by a vasovagal reaction or transient volume changes. Sneezing and conjunctivitis are not manifestations of citrate toxicity but are common symptoms of allergy.

A nurse is caring for a patient who is undergoing plasmapheresis for glomerulonephritis. The nurse should be observant for which symptoms indicating citrate toxicity? A. Sneezing B. Headache C. Hypertension D. Conjunctivitis

A Autoimmunity occurs when the body identifies self proteins as foreign substances, it causes cellular and tissue damage. Hypersensitivity is an exaggerated immune response to specific products. Immunodeficiency results from an incompetent immune system, which can be caused by pathogens, medications, and many other factors. Delayed hypersensitivity is a type of hypersensitivity reaction that takes 24 to 48 hours to occur.

A nurse is caring for a patient with systemic lupus erythematosus. The nurse understands that this disease is caused when the body identifies self proteins as foreign substances, triggering an immune response. What is this pathophysiologic condition called? A. Autoimmunity B. Hypersensitivity C. Immunodeficiency D. Delayed hypersensitivity

B IgA is the only immunoglobulin found in breast milk and colostrum. It provides passive acquired immunity to the baby. No other immunoglobulins are present in the breast milk. Passive acquired immunity in the baby is also provided by IgG, which crosses through the placenta and is present in the baby for at least 3 months. IgM and IgE are not present in the breast milk.

A nurse is teaching a new mother about the advantages of breastfeeding in protecting the baby against infections. Which immunoglobulin is present in breast milk that provides immunity against infections in the baby? A. IgG B. IgA C. IgM D. IgE

D IgM is responsible for primary immune response and forms antibodies to ABO blood antigens. IgE causes symptoms of allergic reactions. IgA lines mucous membranes and protects body surfaces. IgG is responsible for secondary immune responses.

A nursing instructor asks a group of nursing students which immunoglobulin forms antibodies to ABO blood antigens. Which student response is correct? A. IgE B. IgA C. IgG D. IgM

D, E Primary lymphoid organs are those where lymphocytes are formed and matured. The central lymphoid organs include the bone marrow and thymus gland. The spleen, tonsils, and lymph nodes are peripheral lymphoid organs.

A nursing instructor asks a student to identify the central lymphoid organs. Which are correct examples provided by the student nurses? Select all that apply. A. Spleen B. Tonsils C. Lymph nodes D. Bone marrow E. Thymus gland

B IgA is present in tears and colostrum. IgE and IgG are present in plasma and interstitial fluids. IgM is present in plasma. Text Reference - p. 206

A nursing instructor is lecturing on immunoglobulins. Which common immunoglobulin would the students expect to find in tears and colostrum? A. IgE B. IgA C. IgG D. IgM

C When administering immunotherapy, it is imperative to closely monitor the patient for any signs of an adverse reaction. The high risk and significant consequence of an adverse reaction supersede the need to assess the patient's fluid balance. Pain and changes in level of consciousness are not likely events when administering immunotherapy.

A patient has begun immunotherapy for the treatment of intractable environmental allergies. When administering the patient's immunotherapy, what is the nurse's priority action? A. Monitor the patient's fluid balance B. Assess the patient's need for analgesia C. Monitor for signs and symptoms of an adverse reaction D. Assess the patient for changes in level of consciousness

A, C, D, E Some foods may cause an allergic reaction in people who are allergic to latex, because some proteins in rubber are similar to food proteins. This is referred to as latex-food syndrome. The most common of these foods include kiwi, banana, avocado, and chestnut. Apples do not cause latex-food syndrome. They do not contain proteins similar to those of rubber.

A patient has latex-food syndrome. The nurse recognizes that which foods may lead to an allergic response in the patient? Select all that apply. A. Kiwi B. Apple C. Banana D. Avocado E. Chestnut

B Skin testing is the preferred method for specific allergy testing. Enzyme linked-immunosorbent assay (ELISA) is performed in specific conditions when the patient cannot undergo skin allergy testing. A complete blood count (CBC) with differential helps determine the level of eosinophils, which are elevated in type I hypersensitivity reactions. However, CBC with differential does not help to identify the allergens. Testing bronchial secretions does not help in allergy testing, because bronchial secretions are not highly specific.

A patient presents with recurrent symptoms of allergy, specifically hives and rashes. What type of allergy test would the nurse expect to be performed on this patient? A. ELISA B. Skin testing C. CBC with differential D. Testing bronchial secretions

C In type II hypersensitivity reactions, cellular structures are destroyed. These reactions mostly involve the destruction of red blood cells, platelets, and leukocytes. When incompatible blood types are mixed, agglutination occurs. As a result, hemoglobin may be released into the urine and plasma, causing acute kidney failure. Type I, III, and IV are not responsible for ABO incompatibility reactions. Type I hypersensitivity reactions occur during allergic rhinitis and asthma. Type III hypersensitivity reactions occur in disease conditions like rheumatoid arthritis. Type IV reactions occur in contact dermatitis.

A patient undergoes ABO compatibility tests. When administering the patient a prescribed blood transfusion, the nurse monitors for what type of hypersensitivity reaction? A. Type I: IgE-mediated B. Type III: Immune-complex C. Type II: Cytotoxic and cytolytic D. Type IV: Delayed hypersensitivity

D The nurse should give immunotherapy at the hospital and closely monitor the patient for any adverse reactions. Immunotherapy may cause a severe anaphylactic reaction; therefore, the nurse should give immunotherapy only when emergency equipment is available. Immunotherapy should never be given in the home, because anaphylactic shock cannot be adequately treated at home. The patient should never be left alone after immunotherapy, because systemic reactions may occur.

A patient who has been receiving immunotherapy for the control of allergy symptoms requests a dose that can be taken at home. What is the most appropriate nursing response? A. Give immunotherapy to the patient that can be taken at home as requested. B. Give immunotherapy to the patient at home but explain that the patient will need to visit the hospital immediately afterward for testing. C. Give immunotherapy at the hospital and let the patient go home. D. Give immunotherapy at the hospital and closely monitor the patient.

D, E In immunotherapy, the offending allergen extract is administered either subcutaneously or sublingually. Titrated amounts of allergen extracts are administered subcutaneously once or twice a week, starting with a small dose and gradually increasing to a maintenance dosage. Sublingual immunotherapy is safer than subcutaneous immunotherapy because of a lower risk of adverse effects. During sublingual immunotherapy, the allergen extracts are taken under the tongue. The intravenous route of administration poses a danger of an immediate severe anaphylactic reaction. Oral and rectal routes are not used for immunotherapy.

A patient who is allergic to bee stings is scheduled for immunotherapy treatment. The nurse recalls that the immunotherapy can be given using what routes of administration? Select all that apply. A. IV B. Oral C. Rectal D. Sublingual E. Subcutaneous

B Transfusion reactions include type II (cytotoxic) reactions, in which agglutination and cytolysis occur. Type I hypersensitivity reactions are immunoglobulin E (IgE)-mediated reactions to specific allergens (e.g., exogenous pollen, food, drugs, or dust). Type III reactions are immune-complex reactions that occur secondary to antigen-antibody complexes. Type IV reactions are delayed cell-mediated immune response reactions.

A patient's low hemoglobin and hematocrit have necessitated a transfusion of packed red blood cells (RBCs). Shortly after the first unit of RBCs starts to infuse, the patient develops signs and symptoms of a transfusion reaction. Which type of hypersensitivity reaction has the patient experienced? A. Type I B. Type II C. Type III D. Type IV

B The immune system is tolerant of the body's own molecules and is nonresponsive to self-antigens; therefore, the student nurse saying this indicates the need for further teaching. An antigen is a substance that elicits an immune response by binding to specific immune receptors present on the body's surface. Large polysaccharides, lipoproteins, and nucleic acids can also act as antigens. All of the body's cells have antigens on their surface that are unique to that person and enable the body to recognize itself.

A registered nurse is evaluating a student nurse after teaching about antigens and immune responses. Which statement from the student nurse indicates the need for further teaching? A. "An antigen is a substance that elicits an immune response." B. "The immune system is responsive to the body's own self-antigens." C. "Large polysaccharides, lipoproteins, and nucleic acids can act as antigens." D. "All of the body's cells have antigens on their surface that are unique to that person."

D Dendritic cells capture antigens at the sites of contact with the external environment. Dendritic cells transport an antigen until it encounters a T cell with specificity for the antigen. Dendritic cells activate the immune response. IL-7 promotes growth of T and B cells. IL- 9 enhances T cell survival and mast cell activation. IL-8 facilitates chemotaxis of neutrophils and T cells.

A student nurse learns that dendritic cells are an important component of the immune system and are found in the skin and the lining of the nose, the lungs, the stomach, and the intestine. What is the function of dendritic cells? A. They promote growth of T and B cells. B. They enhance T cell survival and mast cell activation. C. They cause chemotaxis of neutrophils and T cells. D. They capture antigens at the sites of contact with the external environment.

B Grapefruit contains a chemical substance that interferes with the metabolism of tacrolimus, causing drug toxicity events. Jackfruit, dragon fruit, and passion fruit do not interfere with the metabolism of these medications.

After a successful organ transplant, a patient began receiving immunosuppressive therapy, specifically tacrolimus, methylprednisolone, and mycophenolate mofetil. Which food should the nurse instruct the patient to avoid during this therapy? A. Jackfruit B. Grapefruit C. Dragon fruit D. Passion fruit

A A wheal-and-flare reaction is a reaction that occurs in response to an allergen. The reaction occurs in minutes or hours and is usually not dangerous. This reaction serves a diagnostic purpose as a means of demonstrating allergic reactions to specific allergens during skin tests. The classic example of a wheal-and-flare reaction is a mosquito bite. Wheal-and-flare reactions are characterized by a pale wheal containing edematous fluid.

An instructor is teaching about wheal-and-flare reactions. Which statement made by the student nurse indicates the need for correction? A. "A wheal-and-flare reaction is very dangerous." B. "A wheal-and-flare reaction can serve a diagnostic purpose." C. "A mosquito bite is an example of a wheal-and-flare reaction." D. "A wheal-and-flare reaction is characterized by a pale wheal containing edematous fluid."

D The patient's symptoms are characteristic of graft-versus-host-disease (GVHD) in which transplanted cells mount an immune response to the host's tissue. GVHD is not a type I allergic response or an atopic reaction, and it differs from transplant rejection in that the graft rejects the host rather than the host rejecting the graft.

Ten days after receiving a bone marrow transplant, a patient develops a skin rash on the palms of the hand and soles of the feet, jaundice, and diarrhea. What is the most likely etiology of these clinical manifestations? A. The patient is experiencing a type I allergic reaction. B. An atopic reaction is causing the patient's symptoms. C. The patient is experiencing rejection of the bone marrow. D. Cells in the transplanted bone marrow are attacking the host tissue.

A IgA is found in breast milk and colostrum. It lines mucous membranes and protects body surfaces. IgM is found in plasma, and is responsible for the primary immune response. It also produces antibodies against ABO blood antigens. IgG is found in plasma and interstitial fluid. It is responsible for secondary immune response. IgD is found in plasma. It helps in the differentiation of B lymphocytes.

The mature plasma cell secretes immunoglobulins. The nurse recalls that which immunoglobulin is found in breast milk and colostrum? A. IgA B. IgM C. IgG D. IgD

D Type IV is related to cell-mediated immunity. It is a delayed hypersensitivity reaction. Tissue damage occurs in delayed hypersensitivity reactions. It requires 24 to 48 hours for a response to occur. Type I, Type II, and Type III are immediate reactions and are a part of humoral immunity.

The nurse differentiates between the types of hypersensitivity reactions and recognizes that which type is related to cell-mediated immunity? A. Type I B. Type II C. Type III D. Type IV

B During a skin patch test, the patch of allergen is applied to intact skin for 48 to 72 hours. During this time period, the allergen penetrates the skin and will produce a positive reaction if allergies are present. Applying the patch for 2 hours, 5 minutes, or 10 minutes is not sufficient for the allergen to move through intact skin and elicit a reaction.

The nurse is administering a skin patch test to a patient with suspected contact allergies. How long should the nurse inform the patient that he or she must wear the patch? A. 2 hours B. 48 hours C. 5 minutes D. 10 minutes

C A cell-mediated immune response triggers the differentiation of T helper cells into T cytotoxic cells, which produce cytokines. IgE is an immunoglobulin and is produced during humoral immunity. Cell-mediated response does not affect the number of bacteria in the body. Macrophages are types of white blood cells (WBC) that identify and ingest antigens containing foreign material.

The nurse is caring for a patient who had an exposure to poison ivy which initiated a cell-mediated immune response. The production of what type of cell is increased as a result of this response? A. IgE B. Bacteria C. Cytokines D. Macrophages

B A classic type II reaction occurs when a recipient receives ABO-incompatible blood from a donor. An example of a Type I-IgE-mediated reaction would be anaphylaxis. A Type III reaction would be seen more with autoimmune disorders (such as systemic lupus erythematosis). A Type IV reaction is contact dermatitis.

The nurse is monitoring a patient who has a past history of blood transfusion reactions. A transfusion reaction is an example of which of these hypersensitivity reactions? A. Type I: IgE-mediated B. Type II: Cytotoxic C. Type III: Immune-complex. D. Type IV: Delayed hypersensitivity

A β-Interferon is used in treating multiple sclerosis. Cytokines instruct cells to alter their proliferation, differentiation, secretion, or activity. Cytokines play an important role in hematopoiesis. α-interferon is used to treat multiple myeloma, hairy cell leukemia, and renal cell carcinoma.

The nurse recalls that interferons may be used in the treatment of certain diseases. What is the clinical use of β-Interferon? A. As a treatment for multiple sclerosis B. As a treatment for multiple myeloma C. As a treatment for hairy cell leukemia D. As a treatment for renal cell carcinoma

D Contact dermatitis caused by the chemicals used in the manufacturing process of latex gloves is a type IV hypersensitivity reaction. It is a delayed reaction. It occurs within 6 to 48 hours. Type II and Type III are not types of latex allergies. A Type I allergic reaction is related to the natural rubber latex proteins and occurs within minutes of contact with the proteins.

The nurse recalls that there are two types of latex allergies. Which allergic reaction is caused by chemicals used in the manufacturing process of latex gloves? A. Type II B. Type III C. Type I D. Type IV

D In this emergency situation, the ABCs (airway, breathing, circulation) are being followed. For hypotension the patient should be placed in a recumbent position with the legs elevated and epinephrine will continue to be administered every two to five minutes and fluids will be administered with vasopressors. Diphenhydramine is an antihistamine used to treat allergy symptoms. Nitroprusside is a vasodilator and would not be used now. Anticipating a tracheostomy may occur with ongoing patient monitoring.

The patient with an allergy to bee stings was just stung by a bee. After administering oxygen, removing the stinger, and administering epinephrine, the nurse notices the patient is hypotensive. What should be the nurse's first action? A. Administer intravenous (IV) diphenhydramine B. Administer nitroprusside as soon as possible C. Anticipate tracheostomy with laryngeal edema D. Place the patient recumbent and elevate the legs

C Plasmapheresis removes plasma that contains autoantibodies (usually IgG class) and antigen-antibody complexes to remove the pathologic substances in the plasma without causing anemia. Plateletpheresis removes platelets from normal individuals for use by patients with low platelet counts. Apheresis is used to collect stem cells from peripheral blood; it does not cure autoimmune disease.

The patient with an autoimmune disease will be treated with plasmapheresis. What should the nurse teach the patient about this treatment? A. It will gather platelets for use later when needed. B. It will cause anemia because it removes whole blood and red blood cells (RBCs) that are damaged. C. It will remove the immunoglobulin G (IgG) autoantibodies and antigen complexes from the plasma. D. It will remove the peripheral stem cells to cure the autoimmune disease.

A Cyclophosphamide is a cytotoxic agent used as an immunosuppresant. It acts by cross-linking the DNA strands, which leads to cell injury followed by cell death. This action of cyclophosphamide decreases the number and activity of T-cells. Azathioprine blocks the synthesis of purine, thereby inhibiting B-cell and T-cell proliferation. Mycophenolate acid acts by inhibiting purine synthesis. Belatacept is a drug that inactivates T-cells.

What is the mode of action of cyclophosphamide? A. Cross-links DNA B. Blocks purine synthesis C. Inhibits purine synthesis D. Prevents the activation of T-cells

D Interferon-beta activates natural killer cells, inhibits viral replication, and has antiproliferative effects on tumor cells. Granulocyte-macrophage colony-stimulating factor (GM-CSF) is responsible for the proliferation and differentiation of monocytes. G-CSF stimulates the proliferation and differentiation of neutrophils. Production of red blood cells in the bone marrow is the function of erythropoietin.

What is the primary function of interferon-beta? A. Proliferation and differentiation of monocytes B. Proliferation and differentiation of neutrophils C. Production of red blood cells in the bone marrow D. Activation of natural killer cells and macrophages

B Multiple sclerosis is associated with inflammation and demyelination of the neurons in the brain and the spinal cord. Interferon-beta prevents inflammation and demyelination of neurons and used in the treatment of multiple sclerosis. Interferon-alpha is used in the treatment of hepatitis B and C, malignant melanoma, and renal cell carcinoma. Interleukin-2 is used in the treatment of metastatic melanoma and metastatic renal cell carcinoma. Interleukin-11 prevents thrombocytopenia after chemotherapy.

Which cytokine is used in the treatment of multiple sclerosis? A. Interferon-alpha B. Interferon-beta C. Interleukin-2 D. Interleukin-11

D Production of lymphocytes takes place in the bone marrow. The spleen is responsible for filtering foreign antigens that enter the bloodstream. Tonsils are lymphoid tissue that act as a first-line defense against ingested or inhaled pathogens. The thymus produces mature T-lymphocytes.

Which organ produces lymphocytes? A. Spleen B. Tonsils C. Thymus D. Bone marrow

D

Which statement by the patient who has had an organ transplant would indicate that the patient understands the teaching about the immunosuppressive medications? A. "My drug dosages will be lower because the medications enhance each other." B. "Taking more than one medication will put me at risk for developing allergies." C. "I will be more prone to malignancies because I will be taking more than one drug." D. "The lower doses of my medications can prevent rejection and minimize the side effects."

D Because immunosuppressants work at different phases of the immune response, lower doses of each drug can be used to produce effective immunosuppression while minimizing side effects. The use of several medications is not because they enhance each other, and does not increase the risk of allergies or malignancies.

Which statement by the patient who has had an organ transplant would indicate that the patient understands the teaching about the immunosuppressive medications? A. "My drug dosages will be lower because the medications enhance each other." B. "Taking more than one medication will put me at risk for developing allergies." C. "I will be more prone to malignancies because I will be taking more than one drug." D. "The lower doses of my medications can prevent rejection and minimize the side effects."

B Seasonal allergic rhinitis most commonly is caused by pollens from trees, weeds, and grasses. Airborne allergies can be controlled by sleeping in an air-conditioned room, daily damp dusting, covering the mattress and pillows with hypoallergenic covers, and wearing a mask outdoors. It is not necessary to get rid of pets because pet dander does not contribute to seasonal allergies. It is not necessary to stay indoors during the winter. Daily damp dusting is recommended, not dry feather dusting.

Which statement made by the nurse is most appropriate in teaching patient interventions to minimize the effects of seasonal allergic rhinitis? A. "You will need to get rid of your pets." B. "You should sleep in an air-conditioned room." C. "You would do best to stay indoors during the winter months." D. "You will need to dust your house with a dry feather duster twice a week.

D Leukocytapheresis is a process that involves removal of white blood cells from the body. In cases of chronic myelogenous leukemia, this technique involves removal of leukemic cells. Separation of blood components followed by isolation of one or more components is called apheresis. Plateletpheresis is separation of platelets from the blood. Plasmapheresis involves separation of plasma from whole blood.

Which technique is associated with removal of white blood cells from the body? A. Apheresis B. Plateletpheresis C. Plasmapheresis D. Leukocytapheresis

D Albuterol is an antihistamine used to treat urticaria. Patients with urticaria may develop an infection in the bronchi that causes bronchoconstriction. Antihistamines are ineffective in preventing bronchoconstriction, so the primary health care provider prescribes epinephrine, a decongestant, to relieve bronchoconstriction. Antihistamines reduce inflammation, pruritus, and edema effectively.

A patient has urticaria and is on albuterol therapy. Why does the primary health care provider prescribe epinephrine after assessing the patient on the follow-up visit? A. The patient has inflammation. B. The patient has persistent pruritus. C. The patient has edema at the neck. D. The patient has bronchoconstriction.

C A systemic anaphylactic reaction starts with edema and itching at the site of exposure to the antigen. Shock can develop rapidly with rapid, weak pulse, hypotension, dilated pupils, dyspnea, and possible cyanosis. The wheal-and-flare reaction occurs with a localized anaphylactic reaction, such as a mosquito bite.

A 21-year-old student has taken amoxicillin once as a child for an ear infection. The patient is given an injection of Penicillin V and develops a systemic anaphylactic reaction. What manifestations would be seen first? A. Dyspnea B. Dilated pupils C. Itching and edema D. Wheal-and-flare reaction

B B Anaphylactic reactions occur suddenly in hypersensitive patients after exposure to the offending allergen. They may occur after parenteral injection of drugs (especially antibiotics) or blood products, and after insect stings. The cardinal principle in management is speed in recognition of signs and symptoms of an anaphylactic reaction, maintenance of a patent airway, prevention of spread of the allergen by using a tourniquet, administration of drugs, and treatment for shock.

A nurse has just been asked by a friend to administer allergy shots at home to save money by avoiding office visits. Which response by the nurse is most appropriate? A. "I would, but it is illegal for nurses to administer injections outside of a medical setting." B. "These injections should only be administered in a setting where emergency equipment and drugs are available." C. "Just make sure you have epinephrine in an injectable syringe provided along with the allergy injections." D. "Allergy shots are not usually effective; it is safer and more effective to control allergies by avoiding allergens."

C The most important nursing intervention when administering mycophenolate mofetil is to infuse this medication over 2 or more hours. Giving the drug slowly helps to decrease the side effects. The drug should never be given as an IV bolus and should always be reconstituted in D5W. Thereafter, the nurse may educate the patient about the gastrointestinal side effects.

A nurse is administering mycophenolate mofetil as a part of triple immunosuppressive therapy for a posttransplant patient. Which is the most important nursing intervention? A. Give large doses as intravenous (IV) bolus. B. Reconstitute the drug in normal saline. C. Administer the drug over 2 or more hours. D. Educate the patient about gastrointestinal side effects.