Ch 13: Normal and Altered Immune Responses

Which changes occur in the immune system of a geriatric patient? Select all that apply. Thymic enlargement Bone marrow suppression Decrease in autoantibodies Decrease in cell-mediated immunity Decrease in primary antibody response Decreased delayed hypersensitivity reaction

Decrease in cell-mediated immunity Decrease in primary antibody response Decreased delayed hypersensitivity reaction Rationale: The changes in the immune system associated with aging include a decreased primary antibody response, decreased delayed hypersensitivity reaction, and decreased cell-mediated immunity. The thymus undergoes involution (shrinking) with aging. Bone marrow remains relatively unaffected by age. Autoantibodies increase with age.

Type IV hypersensitivity reaction:

Delayed Hypersensitivity

A nurse is assessing a patient who has developed eczematous skin lesions due to ingestion of nail polish remover today as well as several days ago. Which type of immunity reaction does the nurse suspect? IgE-mediated reaction Immune-complex reaction Cytotoxic and cytolytic reaction Delayed hypersensitivity reaction

Delayed hypersensitivity reaction Rationale: A delayed hypersensitivity reaction is a type of inflammatory reaction that is initiated by mononuclear leukocytes. The term "delayed" is used because a secondary cellular response appears 24 to 48 hours after the antigen exposure. The patient developed eczematous skin lesions on the second exposure, indicating the formation of memory cells to the antigen. The reaction between the memory cells and the antigens sensitizes the patient and results in skin lesions within 48 hours. This indicates a delayed hypersensitivity reaction. IgE-mediated reactions, immune-complex reactions, and cytotoxic and cytolytic reactions are immediate types of hypersensitivity reactions in which a response is seen within 12 minutes of an antigen challenge.

Which is a secondary immunodeficiency disorder? Diabetes mellitus Thymic hypoplasia Ataxia-telangiectasia Graft versus host disease

Diabetes mellitus Rationale: Secondary immunodeficiency disorders are more frequent and less severe than primary immunodeficiency disorders. Diabetes mellitus is an example of a secondary immunodeficiency disorder. Thymic hypoplasia (DiGeorge syndrome), ataxia-telangiectasia, and graft versus host disease are all primary immunodeficiency disorders.

What are the FIRST manifestations of systemic anaphylactic reaction?

Edema & Itching (site of exposure to antigen)

What is the Uniform Anatomical Gift Act responsible for? Procurement of donor organs Maintaining the organ donor registry Fair and consistent organ transplant laws Length of time a patient is on a transplant list

Fair and consistent organ transplant laws Rationale: The Uniform Anatomical Gift Act is responsible for fair and consistent transplant laws among all states. There are multiple reasons a patient may be on a transplant list, so the length of time can be attributed to other factors. The division of Organ Procurement and Transplant Network regulated by the US Department of Health and Human Services maintains the organ donor registry. The Uniform Anatomical Gift Act is not responsible for the actual procurement of the donor's organs.

A patient underwent a kidney transplant 24 hours ago. For which type of organ transplant rejection should the nurse closely monitor the patient? Acute Chronic Hyperacute Major histocompatibility antigen

Hyperacute Rationale: A hyperacute rejection occurs within 24 hours because the blood vessels are rapidly destroyed. A chronic rejection is a process that occurs over months or years. Major histocompatibility antigens are responsible for rejections; they are not rejections themselves. An acute rejection most commonly manifests in the first six months after a transplant.

Which immune response is an autoimmune disorder? Anaphylaxis Atopic reaction Hypersensitivity Contact dermatitis

Hypersensitivity Rationale: A hypersensitive reaction includes autoimmune diseases in which the body fails to recognize self-proteins and reacts against self-antigens. Anaphylaxis occurs when mediators are released systemically. Contact dermatitis is a delayed hypersensitivity reaction involving the skin. An atopic reaction is a sensitivity to environmental allergens.

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

IgA Rationale: IgA is present in tears and colostrum. IgE and IgG are present in plasma and interstitial fluids. IgM is present in plasma.

Type I hypersensitivity reaction:

IgE-Mediated

Immediate Hypersensitivity Reactions: 1) Name these types 2) How fast is the response after antigen exposure?

IgE-mediated reactions immune-complex reactions cytotoxic reactions cytolytic reactions 12 minutes

Which immunoglobulin has the highest total serum concentration? IgA IgD IgE IgG

IgG Rationale: The serum concentration of IgG is 78%, which is the highest of these immunoglobulins. IgA has a serum concentration of 15%. IgD has a serum concentration of 1%. IgE has a serum concentration of 0.002%.

Type III hypersensitivity reaction:

Immune-Complex

Which type of immunity is present at birth? Active Innate Passive Acquired

Innate Rationale: Innate immunity is present at birth. Passive immunity results from the introduction of antibodies from another organism, as in from a mother to her fetus. Acquired immunity can be either passive or active. Active immunity is the result of exposure to a pathogen in order to develop immunity to it, as in the case of vaccination.

A patient with atopic dermatitis asks the nurse why they have this. What is the best response by the nurse? Select all that apply. It is an inherited skin disorder. It may manifest as shortness of breath. It is caused by environmental allergens. It is associated with a negative skin test. It is represented by localized wheal and flare.

It is an inherited skin disorder. It is caused by environmental allergens. Rationale: Atopic dermatitis is a chronic, inherited skin disorder. It is caused by several environmental allergens, which are difficult to identify. Although the patient has a positive skin test and elevated levels of IgE, it is not characterized by a localized wheal and flare. This is more indicative of a type I reaction. It is not associated with shortness of breath.

A nurse is teaching at a health fair about immunizations. How will this nurse educate the people at the fair about the benefits of immunization? Select all that apply. It helps in building a short-term immunity. It reduces and can possibly eliminate diseases like polio. It can prevent disability and death from certain infectious diseases. It can help control the spread of infections within the community. It should be given with immunosuppressive therapy to reduce the side effects.

It reduces and can possibly eliminate diseases like polio. It can prevent disability and death from certain infectious diseases. It can help control the spread of infections within the community. Rationale: Artificial active acquired immunization is obtained from vaccinations. Immunization helps to control the spread of infections. It prevents disability and death from infectious diseases and reduces the risk of diseases like polio by producing immunity against them. Immunity developed through immunization takes time to develop but is usually long-lasting. Also, immunization should not be given with immunosuppressive therapy, because it may prove fatal

A patient has taken amoxicillin once as a child for an ear infection. When given an injection of Penicillin V, the patient develops a systemic anaphylactic reaction. What manifestations would be seen first? Dyspnea Dilated pupils Itching and edema Wheal-and-flare reaction

Itching and edema Rationale: 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.

The nurse is educating a patient with a latex allergy about which foods to avoid that may trigger latex-food syndrome. Which foods should the nurse include? Select all that apply. Pears Kiwifruit Potatoes Avocados Tomatoes Pineapples

Kiwifruit Potatoes Avocados Tomatoes Rationale: Foods containing proteins similar to the rubber proteins in latex include bananas, kiwis, tomatoes, avocados, chestnuts, water chestnuts, guavas, hazelnuts, potatoes, peaches, grapes, and apricots.

A patient with chronic myelogenous leukemia has an overabundance of white blood cells (WBC). What procedure should the nurse prepare to educate the patient about? Apheresis Plateletpheresis Plasmapheresis Leukocytapheresis

Leukocytapheresis 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 statement about monocytes in the immune response is true? Monocytes do not engage in phagocytosis. They bind antigens and stimulate natural killer cell activation. Monocytes produce antibodies on exposure to foreign substances. Monocytes do not have a role in stimulation of the production of T and B lymphocytes.

Monocytes produce antibodies on exposure to foreign substances. Rationale: The mononuclear phagocyte system includes monocytes in the blood macrophages found throughout the body. Mononuclear phagocytes have a critical role in the immune system. They are responsible for capturing, processing, and presenting the antigen to the lymphocytes. They do have a role in phagocytosis and have a role in stimulation of development of T and B cells. Monocytes do not stimulate natural killer cell activation.

Which cells play a critical role in capturing, processing, and presenting an antigen to lymphocytes? Cytokines T lymphocytes B lymphocytes Mononuclear phagocytes

Mononuclear phagocytes Rationale: Mononuclear phagocytes capture, process, and present an antigen to the lymphocytes. B lymphocytes differentiate into plasma cells, which produce antibodies. Cytokines act as messengers between different cell types. T lymphocytes are primarily responsible for immunity to intracellular viruses, tumor cells, and fungi.

Patient is infected with chickenpox, MMR, etc.:

Natural-Active

Transplacental and colostrum transfer from mother to child (ex: maternal immunoglobulins passed to baby):

Natural-Passive

Which type of immunity occurs when a patient receives a hepatitis B immune globulin injection? Active-natural Passive-active Active-artificial Passive-artificial

Passive-artificial Rationale: The patient receives passive-artificial immunity when given an immune globulin, because exposure via blood products is considered passive-artificial. Passive and active immunity are two types of immunity, not one type. Active-natural immunity occurs when a patient has natural contact with the antigen. Active-artificial immunity occurs when a patient is immunized with an antigen, for instance via vaccine.

Who should not be given immunizations?

Patients on Immunosuppressive therapy

After assessing a patient with delayed hypersensitivity reaction, the nurse suspects that the patient has contact dermatitis. Which symptoms support the nurse's conclusion? Select all that apply. Pruritic lesions Generalized skin lesions Erythematous skin lesions Skin lesions away from the area exposed to allergen Skin lesions covered with papules, vesicles, and bullae

Pruritic lesions Erythematous skin lesions Skin lesions covered with papules, vesicles, and bullae Rationale: Contact dermatitis is a delayed type of hypersensitivity reaction in which the patient, if exposed to the same allergen for the second time, develops hypersensitivity reactions. Contact dermatitis is characterized by pruritic, erythematous lesions covered with papules, vesicles, and bullae. The skin lesions will be localized to the area that was exposed to the allergen.

The nurse is caring for a patient with diabetes that also has a severe lung infection requiring the administration of corticosteroids and antibiotics. The patient also has a diminished appetite. What condition should the nurse monitor this patient closely for? Major histocompatibility Primary immunodeficiency Secondary immunodeficiency Acute hypersensitivity reaction

Secondary immunodeficiency Rationale: Secondary immunodeficiency most commonly is caused by immunosuppressive drugs, such as corticosteroids. It also can be caused by diabetes mellitus, severe infection, malnutrition, and chronic stress, all of which are present in this patient. Major histocompatibility, primary immunodeficiency, and acute hypersensitivity reaction are not possible for this patient. Histocompatibility occurs when the human leukocyte antigen (HLA) system of the donor is not compatible with the recipient's HLA genes. Primary immunodeficiency is rare and includes phagocytic defects, B cell deficiency, T cell deficiency, or a combination of B cell and T cell deficiency. Acute hypersensitivity reaction is an anaphylactic type allergic reaction to an antigen.

Which organs contain lymphoid tissue and are considered central or peripheral organs of the immune system? Select all that apply. Skin Heart Kidneys Lymph nodes Bronchial tissue Gastrointestinal tract

Skin Lymph nodes Bronchial tissue Gastrointestinal tract Rationale: The lymph nodes, bronchial tissue, skin, and gastrointestinal tract contain lymphoid tissue and are considered central or peripheral organs of the immune system. The kidneys and heart are not considered central or peripheral immune system organs.

The nurse is comparing primary and secondary immune deficiencies. Which of these are potential causes of secondary immune deficiencies? Select all that apply. Stress Malnutrition Job syndrome Corticosteroid drugs Graft-versus-host disease Acquired immunodeficiency syndrome (AIDS)

Stress Malnutrition Corticosteroids Acquired immunodeficiency syndrome (AIDS) Rationale: Stress, malnutrition, corticosteroid drugs, and AIDS are causes of secondary immunodeficiency disorders. Job syndrome and graft-versus-host disease are causes of primary immunodeficiency disorders.

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? They promote growth of T and B cells. They cause chemotaxis of neutrophils and T cells. They enhance T cell survival and mast cell activation. They capture antigens at the sites of contact with the external environment.

They capture antigens at the sites of contact with the external environment. Rationale: 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.

The nurse is reviewing the genetic testing results of a patient and observes that the patient has a human leukocyte antigen (HLA) allele that is positive for ankylosing spondylitis. Which of these statements is true about the HLA antigens and disease conditions? This patient already has developed ankylosing spondylitis. This patient will develop ankylosing spondylitis at some point in his or her lifetime. This patient has a higher risk than the general population for developing ankylosing spondylitis. Further testing is needed to discover the degree of risk the patient has for developing ankylosing spondylitis.

This patient has a higher risk than the general population for developing ankylosing spondylitis. Rationale: The possession of a particular HLA allele does not mean that the person will necessarily develop the associated disease—only that the relative risk is greater than in the general population. The patient has not developed ankylosing spondylitis already and may not ever develop it. The patient already has had genetic testing for ankylosing spondylitis.

What is the role of an antigen in the immune system? To provide immunity To promote homeostasis To elicit an immune response To protect the body against microorganisms

To elicit an immune response Rationale: An antigen is a substance that elicits an immune response. Antigens do not provide immunity or promote homeostasis. An antigen does not directly protect the body; instead, it stimulates the immune system to produce antibodies.

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

Type IV Rationale: 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.

A mosquito bite is an example of?

Wheel-and-Flare (localized anaphylactic reaction)

Plasma cells produce:

antibodies

The nurse is caring for a patient with hemolytic anemia. What questions asked by the nurse when obtaining a history would be most significant to this disease process? "Are you pregnant?" "Have you ever had a heart attack?" "Have you been taking methyldopa?" "Are you taking any iron supplements?"

"Have you been taking methyldopa?" Rationale: Hemolytic anemia can occur from the administration of methyldopa. It is not caused by pregnancy, iron supplements, or a history of myocardial infarction.

The nurse is performing an assessment on an older adult patient. What age related changes to the immune system does the nurse anticipate will occur? "Thymic involution occurs with aging." "The bone marrow keeps on changing with age." "Older people are more susceptible to infections." "Both T and B cells show deficiencies in activation."

"The bone marrow keeps on changing with age." Rationale: The functions of the immune system decline with advancing age, but bone marrow remains relatively unaffected. Thymic involution occurs with aging due to the decreased functional activity of the thymus. Older people are more susceptible to infections because the functions of the immune system decline with increasing age. Both T and B cells show deficiencies in activation with increasing age due to reduced immune activity in the body.

The nurse is providing education to a patient with a recent organ transplant and is discussing immunosuppressive therapy. What statement made by the patient indicates that teaching has the desired outcome? "Taking more than one medication will put me at risk for developing allergies." "My drug dosages will be lower because the medications enhance each other." "I will be more prone to malignancies because I will be taking more than one drug." "The lower doses of my medications can prevent rejection and minimize the side effects."

"The lower doses of my medications can prevent rejection and minimize the side effects." Rationale: 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.

T lymphocytes are primarily responsible for immunity to:

-intracellular viruses -tumor cells -fungi

Type II (Cytotoxic) 1) Antigens? 2) Antibodies involved? 3) Complement involved? 4) Mediators of injury? 5) Examples? 6) Skin test used?

1) Cell surface of RBCs; Cell basement membrane 2) IgG, IgM 3) Yes 4) Complement lysis; Macrophages in tissues 5) Transfusion reaction; Goodpasture syndrome; Immune thrombocytopenic purpura; Graves' disease 6) None

Type III (Immune-Complex) 1) Antigens? 2) Antibodies involved? 3) Complement involved? 4) Mediators of injury? 5) Examples? 6) Skin test used?

1) Extracellular fungal, viral, bacterial 2) IgG; IgM 3) Yes 4) Neutrophils; Complement lysis; Monocytes; macrophages; Lysosomal enzymes 5) Systemic lupus erythematosus; Rheumatoid arthritis; Acute glomerulonephritis 6) Erythema and edema in 3-8 hrs

Delayed hypersensitivity reaction: 1) What type of reaction is it? 2) What initiates it? 3) Why is called "delayed"? 4) What is indicated if a patient develops eczematous skin lesions on 2nd exposure to an antigen?

1) Inflammatory reaction 2) Mononuclear leukocytes 3) Because secondary cellular response appears 24-48 hours after antigen exposure 4) Formation of memory cells to the antigen

Type IV (Delayed Hypersensitivity) 1) Antigens? 2) Antibodies involved? 3) Complement involved? 4) Mediators of injury? 5) Examples? 6) Skin test used?

1) Intracellular; Extracellular 2) None 3) No 4) Cytokines; T cytotoxic cells 5) Contact dermatitis (poison ivy) 6) Erythema and edema in 24-48 hrs (TB test)

Type I (IgE mediated) 1) Antigens? 2) Antibodies involved? 3) Complement involved? 4) Mediators of injury? 5) Examples? 6) Skin test used?

1) Pollen, Food, Drugs, Dust 2) IgE 3) No 4) Histamine, Mast cells, Leukotrienes, Prostaglandins 5) Allergic rhinitis, Asthma, Atopic dermatitis, Urticaria, Angioedema 6) Wheel-and-Flare

Atopic dermatitis: 1) What kind of disorder is it? 2) Is it acute or chronic? 3) Can it be inherited? 4) What causes it? 5) What type of reaction is it?

1) Skin disorder 2) Chronic 3) Inherited 4) Environmental allergens 5) Type I (IgE-Mediated)

Goodpasture Syndrome: 1) What organs are involved? 2) What specific organ tissues are involved? 3) What may result in a patient with this disorder? 4) The priority assessments would include?

1) lungs; kidneys 2) glomerular & alveolar basement membranes 3) Pulmonary hemorrhage; Glomerulonephritis 4) lungs; kidneys

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

Activation of natural killer cells and macrophages Rationale: 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.

Which processes do cytokines instruct cells to alter? Select all that apply. Activity Secretion Proliferation Composition Differentiation

Activity Secretion Proliferation Differentiation Rationale: Cytokines act as messengers by instructing cells to alter secretion, differentiation, proliferation, and activity. Cells are unable to alter their compositions.

The nurse is comparing cell-mediated immunity and humoral immunity. Which of these are characteristics of humoral immunity? Select all that apply. Antibodies are produced. Involves B lymphocyte cells. Involves T lymphocyte cells and macrophages. Examples include anaphylactic shock and transfusion reaction. Examples include destruction of cancer cells and graft rejection.

Antibodies are produced. Involves B lymphocyte cells. Examples include anaphylactic shock and transfusion reaction. Rationale: Humoral immunity involves B lymphocyte cells and produces antibodies. Examples include anaphylactic shock, atopic diseases, transfusion reaction, and bacterial infections. The other responses reflect cell-mediated immunity. Humoral immunity does not involve T lymphocytes and macrophages (cell-mediated immunity does). Cancer cell destruction and graft rejection are examples of cell-mediated immunity.

Which medication is used to treat multiple chemical sensitivity (MCS) disorder? Psychotherapy ACE inhibitors Anxiety-reducing drugs Calcium channel blockers

Anxiety-reducing drugs Anxiety-reducing drugs are used to treat MCS disorder. Psychotherapy is used to treat MCS disorder, but it is not itself a medication. ACE inhibitors and calcium channel blockers are used to treat cardiac disorders.

Patient receives vaccines for chickenpox, MMR, etc.:

Artificial-Active

Injection of serum from infected person to non-infected person (ex: HepB injection)

Artificial-Passive

A parent arrives at the pediatrician's office with a child who is to receive vaccines. The nurse would explain that the type of immunity rendered through the vaccination is what? Naturally acquired active immunity Artificially acquired active immunity Naturally acquired passive immunity Artificially acquired passive immunity

Artificially acquired active immunity Rationale: Artificially acquired active immunity is the response to antigens that are artificially acquired by the body through vaccination. If the antigens are naturally introduced in the body, it is called naturally acquired active immunity. In passive immunity, the body receives antigens rather than synthesizing them.

The nurse is caring for a group of patients, and one of the patients will be receiving interferon. What type of disease does the nurse determine the patient is being treated for? As a treatment for multiple sclerosis As a treatment for multiple myeloma As a treatment for hairy cell leukemia As a treatment for renal cell carcinoma

As a treatment for multiple sclerosis Rationale: 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.

A nurse is assessing a patient with Goodpasture syndrome. What assessment(s) should be a priority? Select all that apply. Assessing urine output Assessing lung sounds Assessing capillary refill Assessment of peripheral pulses Assessing oxygenation with a pulse oximeter

Assessing urine output Assessing lung sounds Rationale: Goodpasture syndrome is a disorder involving the lungs and kidneys. An antibody-mediated autoimmune reaction occurs involving the glomerular and alveolar basement membranes. The circulating antibodies combine with tissue antigen to activate the complement system, which causes deposits of IgG to form along the cell basement membranes of the lungs or kidneys. This reaction may result in pulmonary hemorrhage and glomerulonephritis. The priority assessments would include the lungs and the kidneys. Peripheral pulses and capillary refill would include cardiovascular indications of impairment, which is not representative of Goodpasture syndrome.

Allergic rhinitis is a common type I hypersensitivity, which is also known as what type of reaction? Atopic reaction Cytolytic reaction Immune complex reaction Delayed hypersensitivity reaction

Atopic reaction Allergic rhinitis is considered an atopic reaction. A delayed hypersensitivity reaction is a type IV reaction. A cytolytic reaction is a type II sensitivity. An immune complex reaction is a type III sensitivity.

When assessing an older adult patient, the nurse should observe for characteristics of certain types of diseases due to what type of immunologic response that increases with age? Autoimmune response Cell-mediated immunity Hypersensitivity response Humoral immune response

Autoimmune response Rationale: With aging, autoantibodies increase, which lead to autoimmune diseases (e.g., systemic lupus erythematosis, acute glomerulonephritis, rheumatoid arthritis, hypothyroidism). Cell-mediated immunity decreases with decreased thymic output of T cells and decreased activation of both T and B cells. There is a decreased or absent delayed hypersensitivity reaction. Immunoglobulin levels decrease and lead to a suppressed humoral immune response in older adults.

Which cells are involved in humoral immunity? Neutrophils T lymphocytes B lymphocytes Natural killer cells

B lymphocytes Rationale: B lymphocytes are involved in humoral immunity. Natural killer cells are involved in cell-mediated immunity. Neutrophils are mature white blood cells. T lymphocytes are involved in cell-mediated immunity.

Azathioprine blocks the synthesis of purine, thereby inhibiting:

B-cell and T-cell proliferation.

Which cells differentiate into plasma cells upon activation? B-cells T-cells Dendritic cells Natural killer cells

B-cells Rationale: B-cells are a type of lymphocyte that differentiates into plasma cells upon activation. Lymphocytes from bone marrow migrate to the thymus to differentiate into T-cells. Dendritic cells are antigen-presenting cells whose function is to capture the antigen and present it to the T-lymphocytes. Natural killer cells are large lymphocytes containing many granules in their cytoplasm.

Where are lymphocytes produced? Spleen Tonsils Bone marrow Thymus gland

Bone marrow Rationale: Lymphocytes are produced in the bone marrow. The spleen is a peripheral lymph organ and is the primary site for filtering foreign antigens from the blood. The thymus gland is involved in the differentiation and maturation of T lymphocytes. The tonsils are a peripheral lymphoid organ.

A deceased patient is brought to the emergency department. The family members reveal that the patient had multiple bee stings. Which pathologic mechanisms would have been responsible for death after bee stings? Select all that apply. Bronchial constriction Decreased peripheral circulation Decreased peripheral resistance Constriction of major blood vessels Respiratory acceleration and cardiac arrest

Bronchial constriction Decreased peripheral resistance Rationale: Hypersensitivity to a foreign substance can cause an anaphylactic reaction. In such cases, histamine is released, causing bronchial constriction, and there is a marked increase in capillary permeability and dilation of arterioles. This decreased peripheral resistance is associated with hypotension and inadequate circulation to major organs. Respiratory depression and cardiac arrest result from bronchial constriction and vascular collapse, and would be considered secondary reactions from bee stings. When dilation of arterioles occurs, arterioles dilate, capillary permeability increases, and eventually, vascular collapse occurs.

A patient develops an allergic rash on the arms and subsequent shortness of breath during the administration of intravenous gentamicin. What should be the immediate nursing intervention to ensure safety of the patient? Select all that apply. Check body temperature. Call the health care provider. Discontinue infusion of gentamicin. Decrease the infusion rate of gentamicin. Measure the respiratory rate again after 15 minutes.

Call the health care provider. Discontinue infusion of gentamicin. Rationale: The nurse should immediately stop the infusion because the patient may be susceptible to an allergic reaction. The nurse should stop the infusion of medicine and notify the health care provider. Decreasing the flow rate is not an appropriate action in this case. This could be an emergency situation, so reassessing after 15 minutes is not a wise thing to do. Instead, the nurse should continuously monitor the vital signs of the patient. Checking body temperature is not the priority.

Cyclophosphamide cross-links the DNA strands, which leads to:

Cell death and decreases number and activity of T-cells.

Which type of immunity causes the rejection of transplanted tissue? Innate Humoral Acquired Cell-mediated

Cell-mediated Rationale: The rejection of transplanted tissue is an example of a cell-mediated immune response. The immune response occurs with a specific recognition by T cells. Innate immunity is present at birth. Humoral immunity is an antibody immunity. Acquired immunity is the development of immunity.

The nurse recognizes that a patient is demonstrating signs of a transplant rejection after a renal transplant. Which phenomenon is responsible for the rejection of donor organs and tissue? Innate immunity Passive immunity Humoral immunity Cell-mediated immunity

Cell-mediated immunity Rationale: Cell-mediated immunity involves various cells, including natural killer cells. The natural killer cells are responsible for identifying "self" and "nonself" tissues, which sometimes results in rejection of grafts and transplants. Innate immunity is present after birth. It involves a nonspecific response through neutrophils and monocytes and is not responsible for graft rejections. Passive immunity results when antibodies are acquired by the body and not produced within. Humoral immunity involves immunoglobulin production and is responsible for allergic reactions.

The nurse is alerted to possible anaphylactic shock immediately after a patient has received intramuscular iron dextran by the development of which of the following? Select all that apply. Chest tightness Sneezing Itching at the injection site Blisters at the injection site Edema at the injection site Itching of the nose and eyes

Chest tightness Itching at the injection site Edema at the injection site Rationale: Symptoms of systemic anaphylactic shock include edema and itching at the site of exposure to the allergen, and chest tightness. Blisters at the injection site, itchiness of nose and eyes, and sneezing do not occur with anaphylaxis

A patient experiences a hemolytic reaction to a blood transfusion. The nurse stops the infusion, assesses the pulse and blood pressure, and calls the primary health care provider. What additional action is important for the nurse to perform? Taking a blood sample Collecting the first voided urine Measuring the oxygenation level Starting an infusion of 0.9% sodium chloride

Collecting the first voided urine Rationale: When a patient has or is suspected of having a blood transfusion reaction, urine should be collected to be tested for hemoglobinuria. When red blood cells are destroyed in large numbers, as they are in a hemolytic reaction, excess hemoglobin is filtered by the kidneys and excreted in the urine. Taking a blood sample, measuring the oxygenation level, or starting an infusion of 0.9% sodium chloride may be additional nursing actions to be performed after the infusion is stopped; the pulse and blood pressure are measured, and the primary healthcare provider is called.

What do Mononuclear phagocytes do to antigens?

capture, process, and present antigen to the lymphocytes.

Cyclophosphamide acts by

cross-linking the DNA strands

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

"A wheal-and-flare reaction is very dangerous." Rationale: 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.

The nurse is providing education to a client with an IgE-mediated hypersensitivity reaction. What statement made by the patient indicates that further education is required? "Asthma is an example of an IgE-mediated hypersensitivity reaction." "Complement system is involved in IgE-mediated hypersensitivity reactions." "Histamine and mast cells are the mediators of injury in IgE-mediated hypersensitivity reactions." "Exogenous pollen, food, and dust are the antigens associated with IgE-mediated hypersensitivity reactions."

"Complement system is involved in IgE-mediated hypersensitivity reactions." Rationale: IgE-mediated hypersensitivity reaction is a type I hypersensitivity reaction that is provoked by reexposure to a specific type of antigen called an allergen. Asthma is an example of an IgE-mediated hypersensitivity reaction because it is caused by repeated exposure to an allergen. Complement system is not involved in IgE-mediated hypersensitivity reactions. Histamine and mast cells are the mediators of injury in IgE-mediated hypersensitivity reactions. Exogenous pollen, food, and dust are the antigens associated with IgE-mediated hypersensitivity reactions.

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

Cross-links DNA Rationale: Cyclophosphamide is a cytotoxic agent used as an immunosuppressant. 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

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? IgE Bacteria Cytokines Macrophages

Cytokines Rationale: 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.

Type II hypersensitivity reaction:

Cytotoxic

A patient with O-positive blood is transfused with AB-positive blood. Which hypersensitivity reaction does the nurse anticipate the patient will experience? IgE-mediated reaction Immune-complex reaction Cytotoxic and cytolytic reaction Delayed hypersensitivity reaction

Cytotoxic and cytolytic reaction Rationale: If a patient receives blood from donors who have different blood types, he or she will show incompatible blood reactions. A patient who receives incompatible blood will experience a hemolytic transfusion reaction. Hemolytic transfusion reaction is a type of cytotoxic and cytolytic reaction in which antibodies immediately coat the foreign erythrocytes, causing agglutination. Neutrophils and macrophages phagocytize the agglutinated cells, the complement system is activated, and cell lysis occurs. Therefore the patient will experience a cytotoxic reaction. When a patient is exposed to exogenous pollen to which he or she is allergic, that patient will experience IgE-mediated reactions. When a patient is exposed to fungal, viral, or bacterial antigens, that patient will experience immune-complex reactions. Delayed hypersensitivity reaction is seen when a patient is exposed to poison ivy for the second time.

A nurse is assessing a patient with a diagnosis of Graves' disease. Which hypersensitivity reaction does the nurse determine will occur in this patient? IgE-mediated reaction Immune-complex reaction Cytotoxic and cytolytic reaction Delayed hypersensitivity reaction

Cytotoxic and cytolytic reaction Rationale: In cytotoxic reaction, the antibodies produced by the immune response bind to the antigens on the patient's own cell surfaces. In Graves' disease, antibodies are produced that bind to the thyroid-stimulating hormone receptor, causing excessive stimulation of the receptor. This excessive stimulation causes excessive production of thyroid hormone. Therefore a cytotoxic reaction is suspected in a patient who shows symptoms of Graves' disease. IgE-mediated reaction may be suspected in patients with asthma. Immune-complex reaction may be suspected in patients with rheumatoid arthritis. Delayed hypersensitivity reaction may be suspected in patients with contact dermatitis caused by poison ivy.

The reaction between the memory cells and the antigens sensitizes the patient and results in skin lesions within 48 hours. This indicates:

delayed hypersensitivity reaction

What are the 8 manifestations of systemic anaphylactic reaction?

edema @ site of exposure itching @ site of exposure shock rapid, weak pulse hypotension dilated pupils dyspnea cyanosis

Cytokines play an important role in:

hematopoiesis

Belatacept is a drug that:

inactivates T-cells

Mycophenolate acid acts by:

inhibiting purine synthesis.

What type of reaction would wheal-and-flare reactions occur?

localized anaphylactic reaction

Contact dermatitis is characterized by:

localized, pruritic, erythematous lesions covered w/ papules, vesicles, and bullae.

Cytokines act as:

messengers between different cell types.

α-interferon is used to treat

multiple myeloma hairy cell leukemia renal cell carcinoma

β-Interferon is used in treating:

multiple sclerosis

B lymphocytes differentiate into:

plasma cells

Cytokines instruct cells to alter their:

proliferation activity differentiation secretion

Azathioprine blocks:

synthesis of purine