Chapter 35: Assessment of Immune function

A nursing instructor is giving a lecture on the immune system. The instructor's discussion on phagocytosis will include: A.) neutrophils and monocytes. B.) plasma cells and memory cells. C.) regulator T cells and helper T cells. D.) lymphokines and suppressor T cells.

Answer: A.) neutrophils and monocytes.

What type of immunoglobulin does the nurse recognize that promotes the release of vasoactive chemicals such as histamine when a client is having an allergic reaction? A.) IgG B.) IgA C.) IgM D.) IgE

Answer: D.) IgE Rationale: IgE promotes the release of vasoactive chemicals such as histamine and bradykinin in allergic, hypersensitivity, and inflammatory reactions. IgG neutralizes bacterial toxins and accelerates phagocytosis. IgA interferes with the entry of pathogens through exposed structures or pathways. IgM agglutinates antigens and lyses cell walls.

A patient has enlarged lymph nodes in his neck and a sore throat. This inflammatory response is an example of a cellular immune response whereby: A.) Antibodies reside in the plasma B.) Antibodies are released into the bloodstream C.) B-lymphocytes respond to a specific antigen D.) Lymphocytes migrate to areas of the lymph node

Answer: D.) Lymphocytes migrate to areas of the lymph node Rationale: Recognition of antigens as foreign, or non-self, by the immune system is the initiating event in any immune response. Recognition involves the use of lymph nodes and lymphocytes for surveillance. Lymph nodes are widely distributed internally throughout the body and in the circulating blood, as well as externally near the body's surfaces. They continuously discharge small lymphocytes into the bloodstream. These lymphocytes patrol the tissues and vessels that drain the areas served by that node.

What is the function of the thymus gland? A.) Produce stem cells B.) Programs B lymphocytes to become regulator or effector B cells. C.) Develop the lymphatic system D.) Programs T lymphocytes to become regulator or effector T cells.

Answer: D.) Programs T lymphocytes to become regulator or effector T cells. Rationale: The thymus gland is located in the neck below the thyroid gland. It extends into the thorax behind the top of the sternum. The thymus gland produces lymphocytes during fetal development. It may be the embryonic origin of other lymphoid structures such as the spleen and lymph nodes. After birth, the thymus gland programs T lymphocytes to become regulator or effector T cells. The thymus gland becomes smaller during adolescence but retains some activity throughout the life cycle. Options A, B, and C are incorrect.

While taking the health history of a newly admitted client, the nurse asks for a list of the client's current medications. Which of the following medication classifications would place the client at risk for impaired immune function? A.) Antimetabolites B.) Antihypertensives C.) Inotropics D.) Pancreatic enzymes

Answer: A.) Antimetabolites Rationale: Antimetabolites can cause leukopenia, eosinoplilia, aplastic bone marrow, and pancytopenia. The other choices do not directly affect the immune system.

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.) Eosinophils B.) Neutrophils C.) B cells D.) Monocytes

Answer: B.) Neutrophils

This type of T lymphocyte is responsible for altering the cell membrane and initiating cellular lysis. Choose the T lymphocyte. A.) Helper T cell B.) Suppressor T cell C.) Cytotoxic T cell D.) Memory T cell

Answer: C.) Cytotoxic T cell Rationale: The cytotoxic T cells (also known as killer T cells) attack the antigen directly and release cytotoxic enzymes and cytokines.

A client will be receiving a hepatitis B vaccination series prior to employment in a dialysis center. What type of immunity will this provide? A.) Forced immunity B.) Naturally acquired active immunity C.) Passive immunity D.) Artificially acquired active immunity

Answer: D.) Artificially acquired active immunity

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.) Macrophages B.) Helper T cells C.) B cells D.) Cytotoxic T cells

Answer: D.) Cytotoxic T cells

Which assessment should be completed if immune dysfunction is suspected in the neurosensory system? A.) Ataxia B.) Hematuria C.) Urinary frequency D.) Burning upon urination

Answer: A.) 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.

Which of the following cell types are involved in humoral immunity? A.) B lymphocytes B.) Helper T lymphocyte C.) Suppressor T lymphocyte D.) Memory T lymphocyte

Answer: A.) B lymphocytes Rationale: B lymphocytes are involved in the humoral immune response. T lymphocytes are involved in cellular immunity.

Which of the following protective responses begin with the B lymphocytes? A.) Humoral B.) Phagocytic C.) Cellular D.) Recognition

Answer: A.) Humoral Rationale: A second protective response, the humoral immune response, begins with the B lymphocytes, which can transform themselves into plasma cells that manufacture antibodies. The first line of defense, the phagocytic immune response, involves the white blood cells (WBCs; granulocytes and macrophages), which have the ability to ingest foreign particles. The third mechanism of defense, the cellular immune response, also involves T lymphocytes, which can turn into special cytotoxic (or killer) T cells that can attack the pathogens. Recognition of antigens as foreign, or nonself, by the immune system is the initiating even in any immune response.

The nurse understands that which cells circulate throughout the body looking for virus-infected cells and cancer cells? A.) Natural killer cells B.) Cytokines C.) Interleukins D.) Interferons

Answer: A.) Natural killer cells Rationale: Natural killer cells are lymphocyte-like cells that circulate throughout the body looking for virus-infected cells and cancer cells. Cytokines are chemical messengers released by lymphocytes, monocytes, and macrophages. Interleukins carry messages between leukocytes and tissues that form blood cells. Interferons are chemicals that primarily protect cells from viral infections.

The body has several mechanisms to fight disease, one of which is sending chemical messengers. The messengers released by lymphocytes, monocytes, and macrophages have differing roles in the immune response. Which messenger enables cells to resist viral replication and slow viral replication? A.) interferons B.) interleukins C.) tumor necrosis factor D.) colony-stimulating factor

Answer: A.) interferons Rationale: Interferons are chemicals that primarily protect cells from viral invasion. They enable cells to resist viral infection and slow viral replication. They have been used as adjunctive therapy in the treatment of AIDS. Interferons also have been used to treat some forms of cancer such as leukemia because they stimulate NK cell activity. Interferon is administered parenterally because digestive enzymes destroy its protein structure.

A nurse is taking health history from a new client, which includes asking about a history of blood transfusions. This is important for which reason? A.) Blood products cause lower antibody titers. B.) Exposure to foreign antigens may cause altered immune function. C.) Blood products cause a high risk for exposure to HIV. D.) Blood products cause a high risk for hepatitis B.

Answer: B.) Exposure to foreign antigens may cause altered immune function. Rationale: A history of blood transfusions is obtained because previous exposure to foreign antigens through transfusion may be associated with abnormal immune function. There is only a small risk for HIV transmission from transfusions received after 1985. The risk for exposure to hepatitis B from blood transfusions is extremely small.

During which stage of the immune response does the circulating lymphocytes containing the antigenic message return to the nearest lymph node? A.) Recognition B.) Proliferation C.) Response D.) Effector

Answer: B.) 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.

Which condition is associated with impaired immunity relating to the aging client? A.) Antibody production increases B.) Renal function decreases C.) Skin becomes thicker D.) Incidence of autoimmune disease decreases

Answer: B.) 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.

A nurse is taking the health history of a newly admitted client. Which of the following conditions would NOT place the client at risk for impaired immune function? A.) Previous organ transplantation B.) Surgical removal of the appendix C.) History of radiation therapy D.) Surgical history of a splenectomy

Answer: B.) Surgical removal of the appendix Rationale: Removal of the appendix would have no direct effect on the immune system. Organ transplantation requires immunosuppressive drugs, which cause impaired immune function. Radiation therapy destroys lymphocytes. The spleen is an important part of the immune system, and removal of it increases the client's risk for poor immune function.

A client arrives at the clinic and reports a very sore throat as well as a fever. A rapid strep test returns a positive result and the client is given a prescription for an antibiotic. How did the streptococcal organism gain access to the client to cause this infection? A.) From being outside in the cold weather and decreasing resistance B.) Through the mucous membranes of the throat C.) Through the skin D.) Breathing in airborne dust

Answer: B.) Through the mucous membranes of the throat Rationale: In a streptococcal throat infection, the streptococcal organism gains access to the mucous membranes of the throat.

Which stage of the immune response occurs when the differentiated lymphocytes function in either a humoral or a cellular capacity? A.) Recognition stage B.) Proliferation stage C.) Response stage D.) Effector stage

Answer: C.) 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 immunity becomes active as a result of infection by a specific microorganism? A.) Naturally acquired active immunity B.) Artificially acquired active immunity C.) Naturally acquired passive immunity D.) Artificially acquired passive immunity

Answer: A.) 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.

The nurse is administering a skin test for detection of exposure to tuberculosis. How would the nurse determine if the client was exposed to tuberculosis? A.) The client will have a productive cough. B.) The injection area swells if the client has developed antibodies against the antigen. C.) The injection area will become painful with in duration if the client has antibodies against the antigen. D.) The injection area will break out in a fine macular rash.

Answer: B.) The injection area swells if the client has developed antibodies against the antigen.

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

Answer: 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.

The nurse is teaching a client who has been diagnosed with Hashimoto's thyroiditis. Which statement correctly describes the process of autoimmunity? A.) The normal protective immune response attacks the body, damaging tissues. B.) The body produces inappropriate or exaggerated responses to specific antigens. C.) The body overproduces immunoglobulins. D.) A deficiency results from improper development of immune cells or tissues.

Answer: A.) The normal protective immune response attacks the body, damaging tissues. Rationale: Autoimmunity happens when the normal protective immune response paradoxically turns against or attacks the body, leading to tissue damage. It is not an immune deficiency. An exaggerated immune response describes a hypersensitivity. An overproduction of immunoglobulins is the definition of gammopathies.

A client is admitted to the hospital with a diagnosis of pneumonia. The client informs the nurse that he has several drug allergies. The physician has ordered an antibiotic as well as several other medications for cough and fever. What should the nurse do prior to administering the medications? A.) Administer the medications that the physician ordered. B.) Call the pharmacy and let them know the client has several drug allergies. C.) Consult drug references to make sure the medicines do not contain substances which the client is hypersensitive. D.) Give the client one medicine at a time and observe for allergic reactions.

Answer: C.) Consult drug references to make sure the medicines do not contain substances which the client is hypersensitive. Rationale: Clear identification of any substances to which the client is allergic is essential. The nurse must consult drug references to verify that prescribed medications do not contain substances to which the client is hypersensitive. Administering the medications or giving one at a time may cause the client to have an allergic reaction. The nurse may call the pharmacy but still maintains responsibility for the medications administered.

The nurse is caring for a client recovering from a major burn. Burns affect the immune system by causing a loss of large amounts of which of the following? A.) Serum, which depletes the body's store of immunoglobulins B.) Plasma, which depletes the body's store of catecholamines C.) Plasma, which depletes the body's store of calcitonin D.) Serum, which depletes the body's store of glucagon

Answer: A.) Serum, which depletes the body's store of immunoglobulins Rationale: Major burns cause impaired skin integrity and compromise the body's first line of defense. Loss of large amounts of serum occurs with burn injuries and depletes the body of essential proteins, including immunoglobulins. Loss of serum or plasma does not deplete the body of catecholamines (adrenal gland), calcitonin (thyroid gland), or glucagon (pancreas).

A client is treated in the clinic for a sexually transmitted infection, and the nurse suspects that the client is at risk for HIV. The physician determines that the client should be tested for the virus. What responsibility does the nurse have? A.) The nurse ensures a written consent is obtained prior to testing. B.) The nurse should send the client to have the blood drawn without informing him about the specific screening test. C.) The nurse will call the client with the results of the test. D.) The nurse will inform the client that the results will have to be reported to the Centers for Disease Control and Prevention (CDC).

Answer: A.) The nurse ensures a written consent is obtained prior to testing. Rationale: The nurse ensures that a written consent is obtained before testing for human immunodeficiency virus (HIV) and keeps the results of HIV testing confidential. The client should never be tested without his knowledge. The physician will review the results when the client comes in for a follow-up visit. It is not necessary for the nurse to report results to the CDC.

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 clinical trials have only been attempted in clients with acquired immune deficiencies, but plans are underway to begin human cloning using embryonic stem cells." D.) "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."

Answer: D.) "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." 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.