Chapter 35: Assessment of Immune Function Prep-U

When obtaining a health history from a patient with possible abnormal immune function, what question would be a priority for the nurse to ask? "Have you ever been treated for a sexually transmitted infection?" "Have you ever received a blood transfusion?" "Do you have abdominal pain or discomfort?" "When was your last menstrual period?"

"Have you ever received a blood transfusion?" Explanation: A history of blood transfusions is obtained, because previous exposure to foreign antigens through transfusion may be associated with abnormal immune function.

The nurse is instructing clients about the importance of taking the shingles vaccine. Which client would benefit from this vaccine? A 65-year-old client who had chicken pox when he was 12 years old A 24-year-old client who is pregnant A 17-year-old client who will be attending college and living in a dormitory A 32-year-old client who has never had chickenpox

A 65-year-old client who had chicken pox when he was 12 years old Explanation: Half of individuals living to age 65 years have had or will develop shingles and may not understand the potential seriousness and risk for complications. Nurses as client advocates should determine and provide health information regarding the shingles vaccine. The other clients are not candidates for the vaccine

A client has breast cancer. The nurse is concerned about a compromised immune system in this client for which reason? Excess circulating lymphocytes Excess circulating hemoglobin Deficient circulating antibodies Antineoplastic drug therapy

Antineoplastic drug therapy Explanation: Clients who receive chemotherapy are immunosuppressed. Antineoplastic drugs cause a compromised immune system. Breast cancer is not associated with an excess of lymphocytes, a deficiency of circulating antibodies, or an excess of hemoglobin.

Which of the following is a medical condition that is an example of a humoral immune response? Fungal infection Asthma Transplant rejection Parasitic infection

Asthma Explanation: Refer to Box 36-2 in the text.

Which of the following cell types are involved in humoral immunity? Helper T lymphocyte B lymphocytes Suppressor T lymphocyte Memory T lymphocyte

B lymphocytes Explanation: B lymphocytes are involved in the humoral immune response. T lymphocytes are involved in cellular immunity.

While taking the health history of a newly admitted client, the nurse reviews general lifestyle behaviors. What strategies would have a positive effect on the immune system? Humor, rigorous physical stress, and biofeedback Biofeedback, relaxation, and hypnosis Hypnosis, humor, and chronic illness Relaxation, intense competitive exercise, and humor

Biofeedback, relaxation, and hypnosis Explanation: Growing evidence indicates that strategies such as relaxation, imagery techniques, biofeedback, humor, hypnosis, and conditioning can positively influence a measurable immune system response. Intense or rigorous competitive exercise can cause negative effects on the immune system, especially if the environment is stressful while undergoing exercise.

A patient is being treated in the intensive care unit for sepsis related to ventilator-associated pneumonia. The patient is on large doses of three different antibiotics. What severe outcome should the nurse monitor for in the lab studies? Leukocytosis Rash Oral thrush Bone marrow suppression

Bone marrow suppression Explanation: Antibiotics, when given in large doses, can cause bone marrow suppression.

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

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

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? IgG IgM IgE IgA

IgE Explanation: 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.

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? IgD IgA IgG IgM

IgG Explanation: 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.

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? Interleukin-5 Monoclonal antibodies Interferon Erythropoietin

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

Which of the following is a center for immune cell proliferation? Pancreas Lymph node Liver Spleen

Lymph node Explanation: The lymph nodes remove foreign material from the lymph system before it enters the bloodstream. They are centers for immune cell proliferation.

A client is diagnosed with human immunodeficiency virus (HIV). After recovering from the initial shock of the diagnosis, the client expresses a desire to learn as much as possible about HIV and acquired immunodeficiency syndrome (AIDS). When teaching the client about the immune system, the nurse states that humoral immunity is provided by which type of white blood cell? Basophil Neutrophil Monocyte Lymphocyte

Lymphocyte Explanation: The lymphocyte provides humoral immunity — recognition of a foreign antigen and formation of memory cells against the antigen. Humoral immunity is mediated by B and T lymphocytes and can be acquired actively or passively. The neutrophil is crucial to phagocytosis. The basophil plays an important role in the release of inflammatory mediators. The monocyte functions in phagocytosis and monokine production.

A parent has brought a child to the clinic for a wellness check. While talking with the nurse, the parent asks the nurse to suggest a diet that will maximize the immune function of growing children. What dietary pattern should the nurse suggest? Diet rich in iron, zinc, and vitamin E Diet rich in potassium, magnesium, and sodium Moderate diet that is balanced and varied Diet rich in amino acids and essential fatty acids

Moderate diet that is balanced and varied Explanation: The best dietary advice to maximize immune function in healthy people is to eat a moderate diet that is balanced and varied, because the optimum amount and proportion of nutrients required are yet unknown. Recent studies indicate that the availability of one nutrient may impair or enhance the action of another nutrient in immune system functioning. Although it is necessary to include vitamins, amino acids, essential fatty acids, and electrolytes in the diet of growing children, excessive amounts are not advisable.

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

Natural immunity Explanation: 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 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? B cells Eosinophils Neutrophils Monocytes

Neutrophils Explanation: 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.

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

Nonsteroidal anti-inflammatory drugs in large doses Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs), in large doses, inhibit prostaglandin synthesis or release. NSAIDs 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 nurse is teaching a community group about healthy lifestyles. A participant asks about how to maintain a healthy immune system. The nurse informs the group that which factor will positively affect the immune system? Residential exposure to radiation Rigorous, competitive exercise Strong family and community connections Poor nutritional status

Strong family and community connections Explanation: Strong family and community ties will have a positive effect on the immune system. Rigorous or competitive exercise, usually considered a positive lifestyle factor, can be a physiologic stressor and cause negative effects on immune response. Any form of radiation can have a negative effect on the immune system, as can poor nutritional status.

A nurse is caring for a client with multiple sclerosis. Client education about the disease process includes which explanation about the cause of the disorder? The immune system recognizes one's own tissues as "foreign." Regulatory mechanisms fail to halt the immune response. Excess cytokines cause tissue damage. The immune system recognizes one's own tissues as "self."

The immune system recognizes one's own tissues as "foreign." Explanation: The immune system's recognition of one's own tissues as "foreign" rather than self is the basis of many autoimmune disorders, including multiple sclerosis. When regulatory mechanisms fail to halt the immune response or excess cytokines are produced, pathology occurs (e.g., allergies, hypersensitivity).

The spleen acts as a filter for old red blood cells, holding a reserve of blood in case of hemorrhagic shock. It is also an area where lymphocytes can concentrate. It can become enlarged (splenomegaly) in certain hematologic disorders and cancers. To assess an enlarged spleen, the nurse would palpate the area of the: Upper mediastinum. Upper left quadrant of the abdomen. Lower margin around the liver. Lower right abdomen.

Upper left quadrant of the abdomen. Explanation: The spleen is located to the left of the stomach, in the upper left of the abdomen. It plays an important role in the immune system

A client has undergone a kidney transplant. The nurse is concerned about a compromised immune system in this client for which reason? Use of anti-rejection drugs Deficient circulating antibodies Excess circulating hemoglobin Excess circulating lymphocytes

Use of anti-rejection drugs Explanation: Clients who receive a kidney transplant must take immunosuppressant drugs to prevent rejection of the transplant. These drugs cause a compromised immune system. Renal transplant is not associated with excess lymphocytes, deficient circulating antibodies, or excess hemoglobin.

What types of cells are the primary targets of the healthy immune system? Select all that apply. foreign cells cancerous cells infectious cells typical cells

infectious cells foreign cells cancerous cells Explanation: The immune system's primary targets are infectious, foreign, or cancerous cells.

Ibuprofen affects the immune system by causing thrombocytopenia. hemolytic anemia. pancytopenia. neutropenia.

neutropenia. Explanation: Ibuprofen causes leukopenia and neutropenia. Phenylbutazone causes pancytopenia. Cefuroxime sodium causes thrombocytopenia and hemolytic anemia.

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

neutrophils and monocytes. Explanation: Neutrophils and monocytes are phagocytes, cells that perform phagocytosis.

Which of the following is accurate regarding acquired immunity? Select all that apply. A nonspecific immunity present at birth Can develop by contracting a disease An immunologic response acquired during life but not present at birth Also know as innate immunity Usually develops as a result of exposure to an antigen through immunization

An immunologic response acquired during life but not present at birth Usually develops as a result of exposure to an antigen through immunization Can develop by contracting a disease Explanation: Acquired immunity is a immunologic responses acquired during life but not present at birth, and usually develops as a result of exposure to an antigen through immunization (vaccination) or by contracting a disease, both of which generate a protective immune response. Natural (innate) immunity is a nonspecific immunity present at birth that provides protection against an infectious agent without ever encountering it before.

Activation of a natural immunity response is enhanced by physical and chemical barriers. Which of the following is a physical barrier, which the nurse knows can be altered by illness, nutrition, or lifestyle? Mucus Cilia of the respiratory tract Acidic gastric secretions Enzymes in saliva

Cilia of the respiratory tract Explanation: Cilia are considered a physical barrier, along with intact skin and mucous membranes

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? Helper T cells Macrophages Cytotoxic T cells B cells

Cytotoxic T cells Explanation: 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.

The nurse is aware that the phagocytic immune response, one of the body's responses to invasion, involves the ability of cells to ingest foreign particles. Which of the following engulfs and destroys invading agents? Basophils Macrophages Eosinophils Neutrophils

Macrophages Explanation: Macrophages move toward the antigen and destroy it. Eosinophils are only slightly phagocytic.

The nurse is taking the health history of a newly admitted client. Which condition would place the client at risk for impaired immune function? Surgical history of a partial gastrectomy Negative history for radiation therapy Surgical removal of the appendix Previous organ transplantation

Previous organ transplantation Explanation: Organ transplantation requires immunosuppressive drugs, which cause impaired immune function. Removal of the appendix or stomach would have no effect on the immune system. A positive history for radiation therapy would affect the immune system, but not a negative history.

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? Serum, which depletes the body's store of immunoglobulins Plasma, which depletes the body's store of calcitonin Plasma, which depletes the body's store of catecholamines Serum, which depletes the body's store of glucagon

Serum, which depletes the body's store of immunoglobulins Explanation: 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).

An older adult client, who leads a sedentary lifestyle, and a younger client, who has a very stressful and active lifestyle, require a vaccine against a particular viral disorder. The nurse knows that in one of these clients, the vaccine will be less effective. In which client is the vaccine more likely to be less effective and why? The older client because of age The younger client because of age The older client because of lifestyle The younger client because of lifestyle

The older client because of age Explanation: Vaccines are less effective in an older adult than in a younger adult because the activity of the immune system declines with the aging process. The lifestyle or gender of the client does not have great implications on the effectiveness of a vaccine.

The nurse is caring for a patient in the hospital who is receiving a vitamin D supplement. What does the nurse understand is the importance of supplementation with this vitamin? (Select all that apply.) Vitamin D deficiency is associated with increased risk of congenital anomalies. Vitamin D deficiency is associated with increased risk of common cancers. Vitamin D deficiency is associated with increased risk of autoimmune disease. Vitamin D deficiency is associated with increased risk of inflammatory disorders. Vitamin D deficiency is associated with increased risk of celiac disease.

Vitamin D deficiency is associated with increased risk of common cancers. Vitamin D deficiency is associated with increased risk of autoimmune disease. Vitamin D deficiency is associated with increased risk of inflammatory disorders. Explanation: Vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, and inflammatory disorders.

The nurse is reviewing the client's medications. What antihistamines are contraindicated for a client with narrow-angle glaucoma? Select all that apply. diphenhydramine loratadine cetirizine brompheniramine fexofenadine

diphenhydramine loratadine cetirizine brompheniramine Explanation: Diphenhydramine, loratadine, brompheniramine, and cetirizine are antihistamines contraindicated with clients with narrow-angle glaucoma. The antihistamines have the potential to induce angle closure. Fexofenadine should be used cautiously in patients with hepatic or renal impairment.

Immunocompetence is the ability of the immune system to cooperatively protect a person from external invaders and the body's own altered cells. Immunocompetence is maintained by white blood cells and: antibodies. cytokines. the compliment system. lymphoid tissue.

lymphoid tissue. Explanation: The immune system is a collection of specialized white blood cells and lymphoid tissues that maintain immunocompetence. The function of these structures is assisted and supported by the activities of natural killer cells, antibodies, and nonantibody proteins such as cytokines and the complement system.

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

Renal function decreases Explanation: 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 client with an autoimmune disorder asks, "Why is autoimmune disease more prevalent in the women in my family?" Which response will the nurse make to this client? "It's because you take better care of your family than yourself." "There is not enough evidence to prove this." "Women have more stress than men and it weakens immunity." "It's believed to be caused by the differences in the sex hormones."

"It's believed to be caused by the differences in the sex hormones." Explanation: There are differences in the immune system functions of men and women. Research has revealed that sex hormones are integral signaling modulators of the immune system and the presence of autoimmune disease. Sex hormones play definitive roles in lymphocyte maturation, activation, and synthesis of antibodies and cytokines. Even though some autoimmune diseases are genetically linked, overall men do not have stronger genes than women. There is no evidence that the client relinquishes self-care for family care. Even though stress influences immunity, there is no evidence that women have more stress than men.

A client undergoing a skin test has been intradermally injected with a disease-specific antigen on the inner forearm. The client becomes anxious because the area begins to swell. Which technique may be used to decrease anxiety in this client? Assure the client that this is a normal reaction Apply ice packs to reduce the swelling Gently rub the swollen area to accelerate blood flow Advise the client to use prescribed analgesics

Assure the client that this is a normal reaction Explanation: The nurse should assure the client that this is a normal reaction. When disease-specific antigens are injected, the injection area swells as a result of the client developing antibodies against the antigen that is introduced. The nurse should also keep in mind that the client is not necessarily actively infectious if the test result is positive. Rubbing the area gently or even applying ice packs may only aggravate the swelling. The swollen area should be left open to heal by itself. The nurse should await the physician's instructions before advising the client to use any prescribed analgesics.

A school nurse is talking about infection with a high school health class. What would be the nurse's best explanation of the process of phagocytosis? Engulfment and digestion of bacteria and foreign material Removal of bacteria and dead blood cells from circulation Release of chemicals to destroy bacteria and foreign material Conversion of memory cells to plasma cells

Engulfment and digestion of bacteria and foreign material Explanation: Phagocytosis is the process of engulfing and digesting bacteria and foreign materials. It does not involve the release of chemicals or conversion of memory cells to plasma cells. The macrophages in the spleen remove bacteria and dead blood cells from circulation.

What type of cytokine will attract neutrophils and monocytes to remove debris? Lymphokines Regulator T cells Cytotoxic T cells Suppressor T cells

Lymphokines Explanation: Lymphokines, a type of cytokine, attract cells when they detect antigens and direct B-cell lymphocytes to multiply and mature. Cytotoxic T cells bind to invading cells, destroy the targeted invader by altering their cellular membrane and intracellular environment, and stimulate the release of chemicals called lymphokines. Suppressor T cells limit or turn off the immune response in the absence of continued antigenic stimulation. Regulator T cells are made of up of helper and suppressor cells.

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

Naturally acquired active immunity Explanation: 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? The injection area swells if the client has developed antibodies against the antigen. The injection area will become painful with in duration if the client has antibodies against the antigen. The client will have a productive cough. The injection area will break out in a fine macular rash.

The injection area swells if the client has developed antibodies against the antigen. Explanation: The injection area swells if the client has developed antibodies against the antigen. The client is not necessarily actively infectious if the test results are positive. Although a productive cough is one of the symptoms of active tuberculosis, it may also indicate other diseases and disorders. The area should not be painful, and the client should not break out with a rash.

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

The normal protective immune response attacks the body, damaging tissues. Explanation: 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.

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

IgG Explanation: 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.

A child is brought to the clinic with a rash and is subsequently diagnosed with measles. The parent reports also having had measles as a young child. What type of immunity to measles develops after the initial infection? Artificially acquired passive immunity Naturally acquired passive immunity Artificially acquired active immunity Naturally acquired active immunity

Naturally acquired active immunity Explanation: Immunity to measles that develops after the initial infection is an example of naturally acquired active immunity. Artificially acquired active immunity results from the administration of a killed or weakened microorganism or toxoid (attenuated toxin), whereas passive immunity develops when ready-made antibodies are given to a susceptible client.

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? "Stem cell transplantation has been discontinued based on concerns about safety, efficacy, resource allocation, and human cloning." "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." "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." "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."

"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." Explanation: 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.

A client is diagnosed with rheumatoid arthritis. When teaching the client and family about rheumatoid arthritis, the nurse should provide which information? Clients with autoimmune disorders may have false-negative but not false-positive serologic tests. Autoimmune disorders include connective tissue (collagen) disorders. Advanced medical intervention can cure most autoimmune disorders. Autoimmune disorders are distinctive, aiding differential diagnosis.

Autoimmune disorders include connective tissue (collagen) disorders. Explanation: Connective tissue disorders are considered autoimmune disorders. Clients with autoimmune disorders may have either false-positive or false-negative serologic tests for syphilis. Other common laboratory findings in these clients include Coombs-positive hemolytic anemia, thrombocytopenia, leukopenia, immunoglobulin excesses or deficiencies, antinuclear antibodies, antibodies to deoxyribonucleic acid and ribonucleic acid, rheumatoid factors, elevated muscle enzymes, and changes in acute phase-reactive proteins. No cure exists for autoimmune disorders; treatment centers on controlling symptoms. Autoimmune disorders aren't distinctive; they share common features, making differential diagnosis difficult.

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

Breakdown and thinning of the skin Explanation: 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.

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

Programs T lymphocytes to become regulator or effector T cells. Explanation: 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.

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

The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells. Explanation: 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 nursing students are learning about the immune system in their anatomy and physiology class. What would these students learn is a component of the immune system? Red blood cells Cytokines Lymphoid tissues Stem cells

Lymphoid tissues Explanation: The immune system actually is a collection of specialized white blood cells and lymphoid tissues that cooperate to protect a person from external invaders and the body's own altered cells. The function of these structures is assisted and supported by the activities of natural killer cells, antibodies, and nonantibody proteins such as cytokines and the complement system. Red blood cells and stem cells are not part of the immune system.

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? Breathing in airborne dust Through the skin From being outside in the cold weather and decreasing resistance Through the mucous membranes of the throat

Through the mucous membranes of the throat Explanation: In a streptococcal throat infection, the streptococcal organism gains access to the mucous membranes of the throat.

A client is diagnosed with an immune system disorder caused by a congenital alteration in the proper development of immune cells. The nurse is aware that this immune system disorder is classified as which type? primary immune deficiency hypersensitivity autoimmune deficiency gammopathy

primary immune deficiency Explanation: Primary immune deficiencies result from the improper development of immune cells or tissues. These disorders are usually congenital or inherited. The terms autoimmune disease or autoimmune disorder, not autoimmune deficiency, are used to refer broadly to improper function of the immune system, not specifically disorders with a congenital basis. Hypersensitivity is an overreaction of the immune system to an antigen. Gammopathy relates to an overproduction of immunoglobulins.

A client has had a kidney transplant performed for end-stage kidney disease. What type of immune response that T-cell lymphocytes perform is related to this type of surgery? A cell-mediated response Activation of the complement system Stimulation of colony-stimulating factors Naturally acquired active immunity

A cell-mediated response Explanation: A cell-mediated response occurs when T cells survey proteins in the body, actively analyze the surface features, and respond to those that differ from the host by directly attacking the invading antigen. An example of a cell-mediated response is one that occurs when an organ is transplanted. The complement system cooperates with antibodies to attract phagocytes and coat antigens to make them more recognizable for phagocytosis and stimulate inflammation and is not related to the surgery. Colony-stimulating factors prompt the bone marrow to produce, mature, and promote the functions of blood cells. Naturally acquired active immunity is a direct result of infection by a specific microorganism.

The nurse is caring for a client with renal failure. Which factor indicates a compromised immune system? An excess of circulating hemoglobin An excess of circulating lymphocytes A deficiency of circulating antibodies A deficiency of circulating lymphocytes

A deficiency of circulating lymphocytes Explanation: Renal failure is associated with a deficiency in circulating lymphocytes, which make up a large part of the immune system. Renal failure is not associated with excess lymphocytes, deficient circulating antibodies, or excess hemoglobin.

The nurse understands that which cells circulate throughout the body looking for virus-infected cells and cancer cells? Cytokines Natural killer cells Interferons Interleukins

Natural killer cells Explanation: 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

A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response? "It is a hyperimmune response to something in the environment that is usually harmless." "It is a harmless reaction to something in the environment." "It means you are very sensitive to something inside of yourself." "It is a muted response to something in the environment."

"It is a hyperimmune response to something in the environment that is usually harmless." Explanation: An allergic disorder is characterized by a hyperimmune response to weak antigens that usually are harmless. The antigens that can cause an allergic response are called allergens.

T-cell and B-cell lymphocytes are the primary participants in the immune response. What do they do? T-cell and B-cell lymphocytes distinguish harmful substances and ignore those natural and unique to a person. T-cell and B-cell lymphocytes respond to the body's invasion by macrophages. T-cell and B-cell lymphocytes react to the body's lack of B12 . T-cell and B-cell lymphocytes distinguish harmful treatments from curative treatments.

T-cell and B-cell lymphocytes distinguish harmful substances and ignore those natural and unique to a person. Explanation: T-cell and B-cell lymphocytes are the primary participants in the immune response. They distinguish harmful substances and ignore those natural and unique to a person. Options B, C, and D are incorrect.

The anatomy and physiology instructor is explaining a cell-mediated response to the pre-nursing students. What actions would the instructor explain occur in a cell-mediated response? Toxins of invading antigens are neutralized. The invading antigens link together (agglutination). T-cell lymphocytes survey proteins in the body and attack the invading antigens. The invading antigens precipitate.

T-cell lymphocytes survey proteins in the body and attack the invading antigens. Explanation: During a cell-mediated response, T-cell lymphocytes survey proteins in the body, actively analyze the surface features, and respond to those that differ from the host by directly attacking the invading antigen. For example, a cell-mediated response occurs when an organ is transplanted. Immunoglobulins hinder the antigens physically by neutralizing their toxins through agglutination or by causing them to precipitate.

A 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. What is the most important factor related to the client's assessment? The client's home environment The client's diet The client's age The client's use of other drugs

The client's use of other drugs Explanation: The nurse needs to review the client's drug history. This data will help to assess the client's susceptibility to illness because certain past illnesses and drugs, 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 susceptibility to illness.

A client who is being treated for complications related to acquired immunodeficiency disorder syndrome (AIDS) is receiving interferon parenterally as adjunctive therapy. Why does the nurse understand this route is being used? The medication, given orally, will cause diarrhea. Digestive enzymes destroy its protein structure. The taste of the medication is not palatable. The medication will work more rapidly parenterally.

Digestive enzymes destroy its protein structure. Explanation: Interferon is administered parenterally because digestive enzymes destroy its protein structure. The medicine does not have an oral preparation.

A client with chronic renal failure has begun treatment with a colony-stimulating factor. What medication does the nurse anticipate administering to the client that will promote the production of blood cells? Epoetin alfa (Epogen) Etanercept (Enbrel) infliximab (Remicade) Adalimumab (Humira)

Epoetin alfa (Epogen) Explanation: Colony-stimulating factors are cytokines that prompt the bone marrow to produce, mature, and promote the functions of blood cells. CSFs enable stem cells in bone marrow to differentiate into specific types of cells such as leukocytes, erythrocytes, and platelets. Pharmacologic preparation of CSFs, such as epoetin alfa (Epogen), is used to promote the natural production of blood cells in people whose own hematopoietic functions have become compromised. The other medications in A, B, and D are tumor necrosis factor inhibitors.

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: Antibodies reside in the plasma B-lymphocytes respond to a specific antigen Antibodies are released into the bloodstream Lymphocytes migrate to areas of the lymph node

Lymphocytes migrate to areas of the lymph node Explanation: 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.

An elderly client is diagnosed with a respiratory infection. While reviewing age-related changes in the immune system, what would the nurse identify as having contributed to this client's infection? Failure of the immune system to differentiate "self" from "non-self" Impaired ciliary action from exposure to environmental toxins Decreased phagocytosis by the liver's Kupffer cells Decreased sensation and slowing of reflexes

Impaired ciliary action from exposure to environmental toxins Explanation: Impaired ciliary action from exposure to smoke and environmental toxins contributes to impaired clearance of pulmonary secretions and an increased incidence of respiratory infections in the elderly. Failure of the immune system to differentiate "self" from "non-self" leads to an increase incidence of autoimmune diseases. Decreased phagocytosis by the liver's Kupffer cells leads to increased incidence and severity of hepatitis B. Decreased sensation and slowing of reflexes leads to increased risk of skin injury, skin ulcers, abrasions, burns, and other trauma.

A laboring mother asks the nurse if the baby will have immunity to some illnesses when born. What type of immunity does the nurse understand that the newborn will have? Passive immunity transferred by the mother Artificially acquired active immunity Naturally acquired active immunity There is no immunity passed down from mother to child.

Passive immunity transferred by the mother Explanation: Passive immunity develops when ready-made antibodies are given to a susceptible person. The antibodies provide immediate but short-lived protection from the invading antigen. Newborns receive passive immunity to some diseases for which their mothers have manufactured antibodies. Naturally acquired active immunity occurs as a direct result of infection by a specific micro organism. An example is the immunity to measles that develops after the initial infection. Not all invading microorganisms produce a response that gives lifelong immunity. Artificially acquired immunity is obtained by receiving a killed or weakened microorganism or toxoid.

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

Respiratory or urinary system infections Explanation: 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.

The immune system is a complicated and intricate system that contains specialized cells and tissues that protect us from external invaders and our own altered cells. Which term is used to define any substances capable of inducing a specific immune response and of reacting with the products of that response? antigens lymphokines lymphocytes antibodies

antigens Explanation: Antigens, which are protein markers on cells, are substances capable of inducing a specific immune response and of reacting with the products of that response

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? tumor necrosis factor colony-stimulating factor interferons interleukins

interferons Explanation: 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.

An adult client has had mumps when the client was a child. The client had a titer prior to entering nursing school and shows immunity. What type of immunity does this reflect? Natural passive immunity Naturally acquired active immunity Artificially acquired active immunity Passive immunity

Naturally acquired active immunity Explanation: Naturally acquired active immunity occurs as a direct result of infection by a specific microorganism. An example is the immunity to measles that develops after the initial infection. Not all invading microorganisms produce a response that gives lifelong immunity. Artificially acquired immunity is obtained by receiving a killed or weakened microorganism or toxoid. Passive immunity is acquired when ready-made antibodies are given to a susceptible person.

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? The nurse ensures a written consent is obtained prior to testing. The nurse will call the client with the results of the test. The nurse should send the client to have the blood drawn without informing him about the specific screening test. The nurse will inform the client that the results will have to be reported to the Centers for Disease Control and Prevention (CDC).

The nurse ensures a written consent is obtained prior to testing. Explanation: 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 client has been diagnosed with AIDS and tuberculosis (TB). A nursing student asks the nurse why the client's skin test for TB is negative if the client's physician has diagnosed TB. The nurse's correct reply is which of the following? The client's immune system cannot mount a response to the skin test. The skin test was improperly performed. The solution used for the skin test was probably outdated. The client has only mild TB, which is not enough to cause a reaction.

The client's immune system cannot mount a response to the skin test. Explanation: The inflammatory response is a major function of the immune system that is elicited in response to invading foreign material. A person with AIDS has a poorly functioning or non-functioning immune system that will not respond to the injected skin test. Any TB organisms should cause a reaction to the skin test in people with intact immune systems. The nurse cannot accurately speculate on how the skin test was performed or that the solution was outdated.

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. 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. 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. 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. Education about the importance of adhering to a recommended vaccine schedule should be initiated to boost the immune system function. 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.

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. 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. 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. Explanation: 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 working in a pediatric clinic. After the nurse gives a hepatitis B immunization to an infant, the parent asks what kind of protection this provides for the child. What is the nurse's best response? Passive acquired immunity, which is temporary Active acquired immunity, which is temporary Active acquired immunity, which lasts many years or a lifetime Passive acquired immunity, which lasts many years or a lifetime

Active acquired immunity, which lasts many years or a lifetime Explanation: Universal childhood vaccination for hepatitis B prevention has been instituted in the United States, and this is generally done via active immunization. With active acquired immunity, the person's own body develops immunologic defenses. This immunity typically lasts many years or even a lifetime. Passive acquired immunity is temporary immunity transmitted from a source outside the body that has developed immunity through previous disease or immunization.

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? Assess joint mobility using passive range of motion. Assess for ataxia using the finger-to-nose test and heel-to-shin test Review the urinalysis report for hematuria Assess for hepatosplenomegaly by measuring abdominal girth

Assess for ataxia using the finger-to-nose test and heel-to-shin test Explanation: 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.

The nurse is obtaining the medical history of a client with Crohn's disease. What medication would the nurse include when asking about what medications the client has taken for suppression of the inflammatory and immune response? Corticosteroids Diuretics Angiotensin-converting enzyme inhibitors (ACE-I) Nonsteroidal anti-inflammatory

Corticosteroids Explanation: The nurse obtains a history of immunizations, recent and past infectious diseases, and recent exposure to infectious diseases. The nurse reviews the client's drug history because certain drugs, such as corticosteroids, suppress the inflammatory and immune responses. Nonsteroidal anti-inflammatory medication does not suppress the inflammatory and immune responses of Crohn's disease. An ACE-I prevents the conversion of angiotensin I to angiotensin II and does not suppress the inflammatory or immune response. Diuretics also do not suppress the immune response but help reduce excess fluid from the kidneys.

The nurse is completing a physical assessment with an older adult client. Which findings indicate to the nurse that the client is experiencing age-related changes to the immune system? Select all that apply. Muscle cramps Pain with voiding Crepitus Diarrhea Skin tears

Diarrhea Skin tears Explanation: Age-related changes in many body systems contribute to impaired immunity. Decreased gastric secretions and motility lead to the proliferation of intestinal organisms that cause gastroenteritis and diarrhea. Thinning of the skin with less elasticity and loss of adipose tissue increases the risk of skin injuries and tears. Decreased kidney function and changes in lower urinary tract function increase the incidence of urinary tract infections. Crepitus is associated with osteoarthritis. Muscle cramps can be caused by a variety of conditions however they are not directly linked to age-related changes in immune function.