Chapter 11: Innate and Adaptive Immunity

A mother brings her 5-month-old infant to the pediatrician for recurrent colds. The mother has never breast-fed and the infant is fed iron-fortified formula. The mother asks, "My baby has been perfectly healthy up until last month—now it seems like she has been sick constantly. Why?" How should the physician respond?

"An infant gets immunity from the mother at birth and from breast milk; this provides protection from infection but wears off in approximately 3 to 6 months. An infant still needs time for his own immune system to mature."

A nurse is teaching a new mother diagnosed with HIV about the transfer of the infection to her newborn. The mother begins to cry and states, "It's too late, the lab tests on my baby are already positive for HIV." How should the nurse respond?

"Just because the test is positive for HIV does not mean your baby is infected with the virus."

A pregnant client who has HIV asks the nurse if her baby will have the disease. The best response would be:

"The baby will test positive for the HIV antibody test result, although the child may not necessarily be infected with the virus."

A client stepped on a nail at work. The emergency room physician prescribes a tetanus "booster" shot. The client asks the nurse, "If I have already been vaccinated for tetanus why do I need to have another shot?" How should the nurse respond?

"The booster shot will stimulate your immune system's memory, causing an immediate rise in antibodies to protect you from an infection."

A sixth-grade science teacher asks the students to explain the role of cilia in the lower respiratory tract. Which student response is best?

"These little hairs move germs trapped in mucus toward the throat so the body can cough them out."

A client with infectious mononucleosis asks the nurse why the lymph nodes are enlarged. Which statement is the nurse's appropriate response?

"Your lymph nodes trap and destroy viruses."

A client called the physician's office with symptoms of the common cold. The nurse educates the client on supportive treatment for symptoms and explains that the body's immune system is fighting the virus but will take approximately how long for a response?

1-2 weeks

Which client is at the greatest risk for developing an intracellular pathogen infection?

A client with AIDS who has a decreased CD4+ TH1 count

Substances foreign to the host that can stimulate an immune response are known as:

ANTIGENS

The nurse is administering a measles, mumps, and rubella (MMR) vaccination to a pediatric client. When the nurse explains immunity to the mother, which type of immunity will she explain that this vaccination provides?

Active artificial immunity

A client is brought to the physician's office with a raised, red macular rash on the trunk and arms accompanied by a fever. A diagnosis of measles is made. Which type of immunity does this disease process provide?

Active natural immunity

An immunocompromised client is exposed to varicella (chickenpox virus). The client has not had the varicella vaccine and has never had the disease. What intervention should the nurse anticipate to prevent this client from developing varicella?

Administer varicella zoster immune globulin (VZIG).

The cells that mediate humoral immunity do so because they are capable of producing:

Antibodies

The nurse knows that inflammation plays a key role in the pathogenesis of many common pathophysiologic states. Which diseases should be nurse include in the teaching plan for senior citizens? Select all that apply.

Atherosclerosis Coronary artery disease Non-insulin-dependent diabetes mellitus (NIDDM)

Select the type of lymphocyte that matures in the bone marrow.

B lymphocytes

A pregnant client asks the nurse when the immune system develops in the fetus. The best response is:

Beginning at 5 to 6 weeks as the fetal liver becomes active in hematopoiesis

An infectious disease nurse is researching T-cells to determine which cells control replication of intracellular bacteria. Which cells should the nurse begin investigating?

CD8 cells

A client receiving chemotherapy has leukopenia. Which type of medication would promote long-term improvement in the client's immune response?

Colony-stimulating factor (CSF)

Which of the types of T cells is responsible for destroying pathogens by punching holes in their cell membrane and by secreting cytokines/lymphokines?

Cytotoxic T cells

A nurse who works in a long-term care facility has observed the high incidence of infectious illnesses among the older adults who reside there. What is the best explanation for a diminished immune capacity in older adults?

Decreased numbers and responsiveness of T lymphocytes

A clinical research study is evaluating cells that bridge both the innate and adaptive immune systems. A nurse has identified the dendritic cells (DCs) as a key component. Which statement validates this finding?

Dendritic cells (DCs) directly sense pathogens, capture foreign agents, and transport them to secondary lymphoid tissues. Once activated, they undergo a maturation process and function as antigen-presenting cells (APCs) capable of initiating adaptive immunity.

Which cells block the entry of microbes and destroy them by secreting antimicrobial enzymes, proteins, and peptides within the mucous membrane linings of the gastrointestinal, respiratory, and urogenital tract?

Epithelial

Immunologically active sites on antigens are recognized as:

Epitopes

Select the statement that best describes the effectiveness of vaccination in the older adult population.

Experimental evidence suggests that vaccination is less successful in inducing immunization in older persons than in younger adults.

The laboratory finds IgA in a sample of cord blood from a newborn infant. This finding is important because it signifies what?

Fetal reaction to exposure to an intrauterine infection

A lactation nurse visits a new mother after delivery of her first child and encourages the mother to breast-feed her infant, even for a short time. Which statement made by the nurse correctly explains the importance of breast-feeding?

For several months, colostrum will provide the infant with passive immunity to diseases to which the mother has immunity.

A client is experiencing a decrease in the number of circulating neutrophils (neutropenia) during an active bacterial infection. The nurse examines the client's lab results looking for which cytokines that is responsible for promoting growth and maturation of neutrophils during inflammatory reactions?

Granulocyte CSF (G-CSF)

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

Granulocyte CSF (G-CSF) such as filgrastim

A nurse is administering penicillin to a client diagnosed with a streptococcal infection. The client later develops a systemic rash. Which could be considered a cause of this allergic reaction?

Hapten-carrier complexes

A client has recently received a pneumococcal vaccine and the client's B cells are consequently producing antibodies. Which cells may enhance this production of antibodies?

Helper T cells

A client with end-stage kidney disease is receiving a kidney donated by a family member. When caring for this client, what does the nurse know is the major target involved in organ transplant rejection?

Human leukocyte antigens (HLAs)

A client receives an interleukin-2 (IL-2) infusion to treat cancer. Which response explains how this cytokine will affect the growth of cancer cells?

IL-2 stimulates growth of cytotoxic T lymphocytes.

The nurse is assisting a new mother with breast-feeding. What does the nurse understand is a primary secretory Ig that is found in the colostrum?

IgA

Which immunoglobulin (Ig) is released in response to allergy or parasitic infections?

IgE

The nurse is aware that the only class of immunoglobulins to cross the placenta is:

IgG

Which immunoglobulin (Ig) is the most abundant of circulating antibodies?

IgG

Which immunoglobulin is the first circulating immunoglobulin to appear in response to an antigen and is the first antibody type made by a newborn?

IgM

A nurse is teaching a group of seniors about the decline of the immune system due to aging. Which topic should be included in the teaching plan regarding the immune response of older adults? Select all that apply.

Increase in susceptibility to infections Higher incidence of cancer Weakened response to vaccinations

A nurse is caring for a child diagnosed with DiGeorge syndrome with thymic hypoplasia. Which immune response would the nurse anticipate in this child?

Increased risk of infection

A client tells the nurse she is at risk to prematurely deliver her baby and is concerned that the baby does not have a developed immune system. The best response would be:

Infants born prematurely may have deficient immunity.

Select the phases that make up the reaction of the complement system.

Initial activation, amplification of inflammation, membrane attack response

A client being treated for a bacterial infection is improving and preparing for discharge. The nurse explains the disease process and functioning of the immune system to the client. Which cytokine is identified as responsible for decreasing the inflammatory immune response?

Interleukin-10 (IL-10)

Which event is part of the effector function of activated members of the complement system?

Localization of infection

A hospital client with a diagnosis of sepsis is in need of a specific response to microorganisms and a long-lasting immunity to the pathogens in question. Which component of the client's immune system is most able to meet these criteria?

Lymphocytes

What is a common source of interleukin-1 (IL-1), interleukin-6 (IL-6), and interleukin-12 (IL-12)?

Macrophages

A client is being treated for lupus, an autoimmune disease. The nurse is teaching the client how the immune system normally differentiates between self and non-self (foreign peptides). The nurse knows teaching has been effective when the client correctly identifies which molecule as the self-recognition protein?

Major histocompatibility complex (MHC)

An obstetrics nurse is counseling an expectant mother. The mother is concerned about letting people hold her baby once the baby is born, fearing that the infant will get sick. What should the nurse explain to the mother?

Maternal immunoglobulins cross the placenta and protect the newborn early in life.

A person has been exposed to a particular antigen and a now experiences a repeat exposure. What stimulates a quicker immune response?

Memory T cells

While caring for a pediatric client admitted with a viral infection, the nurse knows that which type of cell will be the child's primary defense against the virus?

Natural killer (NK) cells

Which type of immunity is achieved by an infant from its mother through antibodies transferred in utero or in breast milk?

Naturally acquired passive immunity

A blood smear is being examined and a stain has been added that will identify granulocytes. Which cell types will be visible with the stain? Select all that apply.

Neutrophil Eosinophil Basophil

A teenager with an infected wound asks, "How does my body fight off the germs in my scraped arm?" Which response by the nurse correctly identifies the cells that play a central role to the innate immune response to an infectious microorganism?

Neutrophils

A child has a congenital condition in which the thymus gland is absent. What should the nurse include in the education of care of this client to the parents?

Observe and report signs and symptoms of infection.

The process by which microbes are coated to allow for more efficient recognition by phagocytes is known as:

Opsonization

A woman experiences a viral infection while pregnant. Which type of immunity does an infant have at birth against this infection?

Passive

The nurse is planning care for a client with a diagnosis of primary immunodeficiency. What is a priority intervention to incorporate into the plan?

Protecting the client from infection

A client is being evaluated for atopic dermatitis possibly caused by a latex-related allergic reaction. The nurse will review which lab results to determine if an allergy is present?

Serum IgE

A client has been identified as having an excess of macrophage inhibitory factor, causing the client to have inhibited movement and activity of macrophages. Which process should the health care team expect to remain unaffected?

Specificity and memory of the immune response

Which type of immunity provides a defense against intracellular microbes such as viruses?

T lymphocytes

Which statement explains how T lymphocytes and B lymphocytes differ?

T lymphocytes mature in the thymus gland; B lymphocytes mature in the bone marrow.

A client experiencing severe neck pain and fever comes to the emergency room and is diagnosed with bacterial meningitis. Knowing that the client's immune system is fighting the infection, the infectious disease nurse correctly identifies which pathway as the activation of the complement system?

The classical

A newborn has been lethargic, is not nursing well, and is basically looking ill. Following lab tests, it has been found that the newborn has IgM present in his blood. How should the nurse interpret this finding?

The presence of IgM suggests the infant has a current infection.

In an attempt to best explain the innate immune system to a class of first-year nursing students, the instructor should describe what characteristic?

The response of the innate immune system is rapid, usually within minutes to hours, and prevents the establishment of infection and deeper tissue penetration of microorganisms.

Select the response that correctly identifies B lymphocytes.

They are the only cells capable of producing antibodies.

Which is the main purpose of the complement system in the presence of invading microorganisms?

To attack and destroy antigens

A client seeks treatment in the clinic for exposure to poison ivy with a rash over the right arm and hand. The nurse is aware that what toxin is found in the oils on poison ivy that is responsible for eliciting an allergic reaction?

Urushiol

A client comes to the clinic with the following cardinal signs of inflammation: redness, heat, pain and swelling, following a laceration to the thigh. Which statement correctly explains the cause of swelling at the laceration site?

When activated, the complement protein C3 breaks into two fragments. The larger 3b fragment acts as an enzyme to cleave C5 into two components; the C5b fragment produces vasodilation and increases vascular permeability, causing edema.

The nurse is explaining the quality of pleiotropism that is possessed by many cytokines. The quality of pleiotropism implies that such cytokines:

are able to act on different types of cells.

The entrance of a microbe into an individual's vascular space has initiated opsonization. How will the health care provider explain this process that is critical in stopping the infiltration of the microbe through opsonization? Opsonization:

coats a microbe to activate phagocytosis recognition.

The most important function of the thymus is:

immune cell production and maturation.

The nurse working in a pediatric clinic knows that live vaccines are not recommended for clients with severe primary immunodeficiency disease (PIDD). Therefore, the nurse should question the health care provider before administering which live attenuated vaccine? Select all that apply.

measles, mumps, rubella (MMR) live bacterial Salmonella typhi Ty21a (LAIV BCG Ty21a) bacillus Calmette-Guerin (bCG)

While explaining immunity to a client, the nurse responds, "The body's internal organs are protected from pathogens because:

our mucosal tissue contains all the necessary cell components to fight a pathogen with an immune response."

A student asks, "What does cell-mediated immunity mean to the client?" The instructor responds, "This means:

the body is trying to defend itself against intracellular microbe invasion by engulfing and destroying the microbe."

Following delivery, the parents have chosen to have their infant's cord blood frozen. A blood test is performed on the cord blood and found to contain IgM antibodies. The nurse interprets this to mean:

the infant has been exposed to an intrauterine infection.