Brunner Review Ch. 31

A nurse is developing a teaching plan for a community presentation on smoking cessation. Based on current research regarding the effects of cigarette smoking on the immune system, which alterations in immune function can be attributed to smoking and should be included in the teaching presentation? Select all that apply. a. Decreased T-cell function b. Decreased natural killer cells c. Increased risk of infection d. Increased white blood cell count e. Decreased IgE antibody production

A, B, C, & D Rationale: Smoking causes an increased white blood cell count (indicating inflammation), an elevated T-cell count (with decreased function), decreased antibody production (IgG, IgA, IgM), increased IgE (allergic response), and fewer natural killer cells (increased risk for infection) in the immune system.

Which immunoglobulin assumes a major role in bloodborne and tissue infections? a. IgD b. IgA c. IgG d. IgM

C. IgG Rationale: IgG assumes a major role in bloodborne and tissue infections. IgA protects against respiratory, gastrointestinal, and genitourinary infections. IgM appears as the first immunoglobulin produced in response to bacterial and viral infections. IgD possibly influences B-lymphocyte differentiation.

Which medication classification is known to inhibit prostaglandin synthesis or release? a. Adrenal corticosteroids b. Antibiotics (in large doses) c. Antineoplastic agents d. Nonsteroidal anti-inflammatory drugs (in large doses)

D. Nonsteroidal anti-inflammatory drugs (in large doses) Rationale: Nonsteroidal anti-inflammatory drugs include aspirin and ibuprofen. Antibiotics in large doses are known to cause bone marrow suppression. Adrenal corticosteroids and antineoplastic agents are known to cause immunosuppression.

A 6-year-old client is diagnosed with a viral infection of the respiratory system. Which will most likely be trying to fight the antigen? a. Interferons b. B cells c. Complements d. Self-antigens

A. Interferons Rationale: Interferon, one type of biologic response modifier, is a nonspecific viricidal protein that is naturally produced by the body and is capable of activating other components of the immune system. Interferons have antiviral and antitumor properties. In addition to responding to viral infection, interferons are produced by T lymphocytes, B lymphocytes, and macrophages in response to antigens. They are thought to modify the immune response by suppressing antibody production and cellular immunity.

Which response is a humoral immune response? a. Intracellular infections b. Anaphylaxis c. Delayed hypersensitivity d. Transplant rejection

B. Anaphylaxis Rationale: Anaphylaxis is an example of a humoral response. Cellular responses include transplant rejection, intracellular infections, and delayed hypersensitivity

A nurse is teaching a client about the side effects of ibuprofen. The client's learning is determined to be effective based on which statement by the patient describing the drug's effect on the immune system? a. "Ibuprofen can cause pancytopenia, which is a decrease in all of my blood cells." b. "Ibuprofen can cause thrombocytopenia; I will need to watch for bruising and bleeding." c. "Ibuprofen can cause neutropenia, which can increase my risk of infection." d. "Ibuprofen can cause hemolytic anemia, which will make me feel tired and short of breath."

C. "Ibuprofen can cause neutropenia, which can increase my risk of infection." Rationale: Ibuprofen causes leukopenia and neutropenia.

A 34-year-old client is diagnosed with chronic hepatitis C. Testing reveals that the client is a candidate for treatment. The nurse anticipates that which therapy could be used to treat the client's condition? a. Monoclonal antibodies b. Erythropoietin c. Interferon d. Interleukin-5

C. Interferon Rationale: Interferons are used to treat immune-related disorders (e.g., multiple sclerosis) and chronic inflammatory conditions (e.g., chronic hepatitis).

Ibuprofen affects the immune system by causing a. neutropenia. b. hemolytic anemia. c. pancytopenia. d. thrombocytopenia.

A. Neutropenia Rationale: Ibuprofen causes leukopenia and neutropenia. Phenylbutazone causes pancytopenia. Cefuroxime sodium causes thrombocytopenia and hemolytic anemia.

An experiment is designed to determine specific cell types involved in cell-mediated immune response. The experimenter is interested in finding cells that attack the antigen directly by altering the cell membrane and causing cell lysis. Which cells should be isolated? a. Cytotoxic T cells b. Macrophages c. Helper T cells d. B cells

A. Cytotoxic T cells Rationale: Cytotoxic T cells (killer T cells) attack the antigen directly by altering the cell membrane and causing cell lysis (disintegration) and by releasing cytolytic enzymes and cytokines. Lymphokines can recruit, activate, and regulate other lymphocytes and white blood cells. These cells then assist in destroying the invading organism

Which stage of the immune response occurs when the differentiated lymphocytes function in either a humoral or a cellular capacity? a. Response stage b. Effector stage c. Proliferation stage d. Recognition stage

A. Response stage Rationale: In the response stage, the differentiated lymphocytes function in either a humoral or a cellular capacity. Recognition of antigens as foreign or non-self by the immune system is the initiating event in any immune response. In the proliferation stage, the circulating lymphocytes containing the antigenic message return to the nearest lymph node. In the effector stage, either the antibody of the humoral response of the cytotoxic T cell of the cellular response reaches and connects with the antigen on the surface of the foreign invader.

Which type of cell is capable of directly killing invading organisms and producing cytokines? a. Natural killer cells b. Null lymphocytes c. Cytotoxic T cells d. Memory cells

A. Natural killer cells Rationale: Natural killer cells defend against microorganisms and some types of malignant cells. Null lymphocytes also combat organisms, but they destroy antigens already coated with antibody. Memory cells are responsible for recognizing antigens from previous exposure and mounting an immune response. Cytotoxic T cells attack an antigen directly by altering the cell membrane and causing cell lysis and by releasing cytolytic enzymes and cytokines

Which condition is associated with impaired immunity relating to the aging client? a. Increase in humoral immunity b. Increase in peripheral circulation c. Breakdown and thinning of the skin d. Decrease in inflammatory cytokines

C. Breakdown and thinning of the skin Rationale: The aging process stimulates changes in the immune system. Age-related changes in many body systems also contribute to impaired immunity. Changes such as poor circulation, as well as the breakdown of natural mechanical barriers such as the skin, place the aging immune system at even greater disadvantage against infection. As the immune system undergoes age-associated alterations, its response to infections progressively deteriorates. Humoral immunity declines and the number of inflammatory cytokines increase with age.

At 39 weeks' gestation, a pregnant client visits the physician for a scheduled prenatal checkup. The physician determines that the fetus has developed an infection in utero and sends the client for an emergency cesarean delivery. The client is very concerned about the health of her unborn child. Based on knowledge of the immune system, the delivery room nurse explains about which immunoglobulin that will be increased in the fetus at the time of birth and will be actively fighting the infection? a. IgM b. IgD c. IgG d. IgA

C. IgG Rationale: IgG composes 75% of total immunoglobulin. It appears in serum and tissues, assumes a major role in bloodborne and tissue infections, and crosses the placenta.

Proteins formed when cells are exposed to viral or foreign agents that are capable of activating other components of the immune system are referred to as a. antigens. b. antibodies. c. interferons. d. complements.

C. Interferons Rationale: Interferons are biologic response modifiers with nonspecific viricidal proteins. Antibodies are protein substances developed by the body in response to and that interact with a specific foreign substance. Antigens are substances that induce formation of antibodies. Complement refers to a series of enzymatic proteins in the serum that, when activated, destroy bacteria and other cells.

Which is an action of cytotoxic T cells? a. Directly attack foreign antigens b. Produce circulating antibodies c. Decrease B-cell activity to a level at which the immune system is compatible with life d. Lyse cells infected with virus

D. Lyse cells infected with virus Rationale: Cytotoxic T cells play a role in graft rejection. B cells are lymphocytes important in producing circulating antibodies. Suppressor T cells are lymphocytes that decrease B-cell activity to a level at which the immune system is compatible with life. Helper T cells are lymphocytes that attack antigens directly.

Which adverse effect should the nurse closely monitor in a client who takes immunosuppressive drugs? a. Respiratory or urinary system infections b. Heart failure, infusion reactions, and life-threatening infections c. Depression, memory impairment, and coma d. Rheumatoid arthritis

A. Respiratory or urinary system infections Rationale: When taking drugs to suppress the immune system, the client is vulnerable to an increased risk of infection, especially in the respiratory or urinary systems. Depression, memory impairment, and coma are dose-related effects of cytokines, which are biologic response modifiers. Heart failure, infusion reactions, and life-threatening infections are possible adverse effects of taking infliximab, which minimizes inflammation. In addition, cytokines and infliximab are not immunosuppressive drugs. Moreover, immunosuppressive drugs are not known to cause rheumatoid arthritis.

In which response do T lymphocytes have a role? a. Transplant rejection b. Bacterial phagocytosis and lysis c. Allergic hay fever and asthma d. Anaphylaxis

A. Transplant rejection Rationale: Most immune responses to antigens involve both humoral and cellular responses, although one usually predominates. For example, during transplant rejection, the cellular response involving T cells predominates, whereas in bacterial pneumonias and sepsis, the humoral response involving B cells plays the dominant protective role. Transplant rejection and graft-versus-host disease are cellular response roles of T cells. Anaphylaxis is a humoral response role of B lymphocytes. Allergic hay fever and asthma, as well as bacterial phagocytosis and lysis, are humoral response roles of B lymphocytes.

A 25-year-old client receives a knife wound to the leg in a hunting accident. Which type of immunity was compromised? a. Passive immunity b. Natural immunity c. Specific immunity d. Adaptive immunity

B. Natural immunity Rationale: Natural immunity, which is nonspecific, provides a broad spectrum of defense against and resistance to infection. It is considered the first line of host defense following antigen exposure, because it protects the host without remembering prior contact with an infectious agent.

A 38-year-old client has begun to suffer from rheumatoid arthritis and is being assessed for disorders of the immune system. The client works as an aide at a facility that cares for children infected with AIDS. Which is the most important factor related to the client's assessment? a. Age b. Home environment c. Diet d. Use of other drugs

D. Use of other drugs Rationale: The nurse needs to review the client's drug history. These data will help her to assess the client's susceptibility to illness because certain past illnesses and drug use, such as corticosteroids, suppress the inflammatory and immune responses. The client's age, home environment, and diet do not have any major implications during assessment because they do not indicate the client's susceptibility to illness.

A client comes into the emergency department reporting difficulty walking and loss of muscle control in the arms. Once the nurse begins the physical examination, which assessment should be completed if an immune dysfunction in the neurosensory system is suspected? a. Review the urinalysis report for hematuria b. Assess joint mobility using passive range of motion. c. Assess for hepatosplenomegaly by measuring abdominal girth d. Assess for ataxia using the finger-to-nose test and heel-to-shin test

D Rationale: Ataxia should be assessed when suspecting immune dysfunction in the neurosensory system. Joint movement, a urinalysis results positive for hematuria , and measuring abdominal girth are not used to assess for issues with the neurosensory system in relation to immune dysfunction.

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? a. B cells b. Eosinophils c. Neutrophils d. Monocytes

C. Neutrophils Rationale: 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.

During which stage of the immune response does the circulating lymphocytes containing the antigenic message return to the nearest lymph node? a. Proliferation b. Response c. Recognition d. Effector

A. Proliferation Rationale: During the proliferation phase, the circulating lymphocytes containing the antigenic message return to the nearest lymph node. Once in the node, the sensitized lymphocytes stimulate some of the resident dormant T and B lymphocytes to enlarge, divide, and proliferate. In the recognition stage, the immune system distinguishes an invader as foreign, or non-self. In the response stage, the changed lymphocytes function either in a humoral or cellular fashion. In the effector stage, either the antibody of the humoral response or the cytotoxic T cell of the cellular response reaches and couples with the antigen on the surface of the foreign invader.

In which process is the antigen-antibody molecule coated with a sticky substance that facilitates phagocytosis? a. Apoptosis b. Immunoregulation c. Agglutination d. Opsonization

D. Opsonization Rationale: In the process of opsonization, the antigen-antibody molecule is coated with a sticky substance that facilitates phagocytosis. Apoptosis is programmed cell death that results from the digestion of DNA by endonucleases. Agglutination is the clumping effect that occurs when an antibody acts as a cross-link between two antigens. Immunoregulation is a complex system of checks and balances that regulates or controls immune responses.

Chronic illnesses may contribute to immune system impairment in various ways. Renal failure is associated with... a. altered production of white blood cells. b. increased incidence of infection. c. decreased bone marrow function. d. deficiency in circulating lymphocytes.

D. deficiency in circulating lymphocytes Rationale: Renal failure is associated with a deficiency in circulating lymphocytes. Diabetes mellitus is associated with increased incidence of infection. Chemotherapy causes decreased bone marrow function. Leukemia is associated with altered production of white blood cells.

Which type of cell is capable of recognizing and killing infected or stressed cells and producing cytokines? a. Cytotoxic T cells b. Null lymphocytes c. Natural killer cells d. Memory cells

C. Natural killer cells Rationale: Natural killer cells are a class of lymphocytes that recognize infected and stressed cells and respond by killing these cells and by secreting macrophage-activating cytokine. Natural killer cells defend against microorganisms and some types of malignant cells. Null lymphocytes do not produce or active cytokine they are stimulated to attack tumor or viral infected cells. Memory cells are important to the immune system but produces memory B cells not cytokine. Cytotoxic -T cells leads to apoptosis ,causing death in infectious cells, however they do not produce cytokine.

During an annual examination, an older client tells the nurse, "I don't understand why I need to have so many cancer screening tests now. I feel just fine!" Based on knowledge of neoplastic disease and the aging immune system, what teaching should the nurse include in the client's plan of care? Select all that apply. A. Education about the importance of adhering to a recommended vaccine schedule should be initiated to boost the immune system function. B. Tumor cells may possess special blocking factors that coat tumor cells and prevent their destruction by killer T lymphocytes; therefore the body may not recognize the tumor as foreign and fail to destroy the malignant cells. Routine screening increases the chance of finding and treating cancer early. C. The increase in occurrence of autoimmune diseases with aging strongly suggests a predisposition toward various types of cancer due to the body's inability to differentiate between self and nonself. Routine screening increases the chance of finding and treating cancer early. D. Nutritional intake to support a competent immune response plays an important role in reducing the incidence of cancer. A healthy diet including protein, vitamins, minerals, and some fats can alter the risk of cancer development. E. The immune system is integrated with other psychophysiological processes and is regulated by the brain. Aging of the brain can have immunologic consequences and can affect neural and endocrine function increasing the risk of cancer development.

B, C, D Rationale: Large tumors can release antigens into the blood, and these antigens combine with circulating antibodies and prevent them from attacking the tumor cells. Furthermore, tumor cells may possess special blocking factors that coat tumor cells and prevent their destruction by killer T lymphocytes. During the early development of tumors, the body may fail to recognize the tumor antigens as foreign and subsequently fail to initiate destruction of the malignant cells. The incidence of autoimmune diseases also increases with age, possibly from a decreased ability of antibodies to differentiate between self and nonself. Failure of the surveillance system to recognize mutant or abnormal cells also may be responsible, in part, for the high incidence of cancer associated with increasing age. Vitamin D deficiency has been associated with increased risk of common cancers. Evidence shows that nutrition plays a role in the development of cancer and that diet and lifestyle can alter the risk of the development of cancer and other chronic diseases.

A nurse is explaining treatment options to a client diagnosed with an immune dysfunction. Which statement by the client accurately reflects the teaching about current stem cell research? a. "Stem cell transplantation has been discontinued based on concerns about safety, efficacy, resource allocation, and human cloning." b. "Currently, stem cell transplantation has only been performed in the laboratory, but future research with embryonic stem cell transplants for humans with immune dysfunction has been promising." c. "Stem cell transplantation has been carried out in humans with certain types of immune dysfunction, and clinical trials using stem cells are underway in clients with a variety of disorders with an autoimmune component." d. "Stem cell clinical trials have only been attempted in clients with acquired immune deficiencies, but plans are underway to begin human cloning using embryonic stem cells."

C Rationale: Research has shown that stem cells can restore an immune system that has been destroyed (Ko, 2012). Stem cell transplantation has been carried out in humans with certain types of immune dysfunction, such as severe combined immunodeficiency; clinical trials using stem cells are underway in clients with a variety of disorders having an autoimmune component, including systemic lupus erythematosus, rheumatoid arthritis, scleroderma, and multiple sclerosis. Research with embryonic stem cells has enabled investigators to make substantial gains in developmental biology, gene therapy, therapeutic tissue engineering, and the treatment of a variety of diseases (Ko, 2012). However, along with these remarkable opportunities, many ethical challenges arise, which are largely based on concerns about safety, efficacy, resource allocation, and human cloning.

Which type of immunity becomes active as a result of infection by a specific microorganism? a. Artificially acquired active immunity b. Naturally acquired passive immunity c. Naturally acquired active immunity d. Artificially acquired passive immunity

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

Which condition is associated with impaired immunity relating to the aging client? a. Skin becomes thicker b. Incidence of autoimmune disease decreases c. Antibody production increases d. Renal function decreases

D. Renal function decreases Rationale: Decreased renal circulation, filtration, absorption, and excretion contribute to the risk for urinary tract infections. Antibody production decreases, the skin becomes thinner, and the incidence of autoimmune disease increases with age.

During a 12-month well-baby visit, a mother reports that the baby has been breastfed since birth and has never been ill. The mother is trying to convince her sister, who is currently pregnant, to breastfeed also and asks the nurse about the benefits of breastfeeding. The nurse explains the immune benefits of breastfeeding and provides the mother with pamphlets. The nurse determines the mother understands the teaching based on which statement? "a. Breastfeeding is beneficial because the dominant antibody IgG in breast milk assumes a major role in bloodborne and tissue infections." b. "Breastfeeding is beneficial because T lymphocytes found in breast milk are primarily responsible for cellular immunity." c. "Breastfeeding is beneficial because the dominant antibody IgA in breast milk acts by functioning as an antigen receptor in the mucosal membranes." d. "Breastfeeding is beneficial because the dominant antibody IgM in breast milk is the first immunoglobulin produced in response to bacterial and viral infections."

C. "Breastfeeding is beneficial because the dominant antibody IgA in breast milk acts by functioning as an antigen receptor in the mucosal membranes." Rationale: IgA composes 15% of total immunoglobulin. It appears in body fluids (blood, saliva, tears, breast milk, and pulmonary, gastrointestinal, prostatic, and vaginal secretions). It protects against respiratory, gastrointestinal, and genitourinary infections and passes to the neonate in breast milk for protection.

A 38-year-old client has been diagnosed with rheumatoid arthritis, an autoimmune disease. During the health history assessment. the nurse learns that the client works as an aide at a facility that cares for children infected with AIDS, does moderate cardiovascular exercises every other day, takes no medication, has no allergies, and eats mainly a vegetarian diet with fish and chicken one to two times each week. Which factor is the most important consideration in determining the status of the client's immune system? a. Environment b. Age c. Gender d. Diet

C. Gender Rationale: The immune system functions of men and women differ. For example, many autoimmune diseases have a higher incidence in females than in males, a phenomenon believed to be correlated with sex hormones. Autoimmune diseases tend to be more common in women because estrogen tends to enhance immunity. Androgen, on the other hand, tends to be immunosuppressive. Autoimmune diseases are a leading cause of death by disease in females of reproductive age.

Which statement accurately reflects current stem cell research? a. Stem cell transplantation cannot restore immune system functioning. b. Clinical trials are underway only in clients with acquired immune deficiencies. c. Stem cell transplantation has been performed in the laboratory only. d. The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells.

D. The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells. Rationale: The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells. Stem cells comprise only a small portion of all types of bone marrow cells. Research conducted with mouse models has demonstrated that once the immune system has been destroyed experimentally, it can be completely restored with the implantation of just a few purified stem cells. Stem cell transplantation has been carried out in human subjects with certain types of immune dysfunction, such as severe combined immunodeficiency. Clinical trails are underway in clients with a variety of disorders with an autoimmune component, including systemic lupus erythematosus, rheumatoid arthritis, scleroderma, and multiple sclerosis.

Which assessment should be completed if immune dysfunction is suspected in the neurosensory system? a. Hematuria b. Ataxia c. Urinary frequency d. Burning upon urination

B. Ataxia Rationale: Ataxia should be assessed when immune dysfunction in the neurosensory system is suspected. Hematuria, discharge, and frequency of and burning upon urination are associated with the genitourinary system

A nurse is caring for a client undergoing evaluation for possible immune system disorders. Which intervention will best help support the client throughout the diagnostic process? a. Assist the client with scheduling the procedures b. Encourage the client to ask the physician for information about treatment options for the possible diagnosis c. Educate the client about the diagnostic procedures and answer their questions about the possible diagnosis d. Accompany the client to the diagnostic tests

C. Educate the client about the diagnostic procedures and answer their questions about the possible diagnosis Rationale: It is the nurse's role to counsel, educate, and support clients throughout the diagnostic process. Many clients may be extremely anxious about the results of diagnostic tests and the possible implications of those results for their employment, insurance, and personal relationships. This is an ideal time for the nurse to provide counseling and education.