Immunity PrepU
Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? Histamine Bradykinin Serotonin Prostaglandin
Correct response: Histamine Explanation: When cells are damaged, histamine is released. Bradykinin is a polypeptide that stimulates nerve fibers and causes pain. Serotonin is a chemical mediator that acts as a potent vasoconstrictor and bronchoconstrictor. Prostaglandins are unsaturated fatty acids that have a wide assortment of biologic activities.
A 16-year-old girl tells the nurse that her friend has genital warts and asks the nurse how to make sure that she does not get them. Which of the following should the nurse recommend? "Get the human papillomavirus vaccine." "If your male partner doesn't have genital warts, you will not get them." "Douching will help to prevent them." "Have the Norplant system implanted in your arm."
Correct response: "Get the human papillomavirus vaccine." Explanation: Human papillomavirus (HPV) is a DNA virus also called genital warts and is a sexually transmitted infection (STI). A vaccine is now available to prevent this disease. Male partners with HPV may or may not have lesions. Women should avoid douching to prevent STIs, as they remove normal protective bacteria in the vagina and increases the risk of getting some STIs. The Norplant system is a contraceptive method and does not prevent STIs.
A client is administered mycophenolate to prevent rejection of the transplanted heart. It is recommended that the client have a CBC drawn weekly. The client asks the nurse the reason for the weekly CBC. What is the nurse's best response? "The weekly CBC is routine and prescribed for all clients." "The weekly CBC assesses for the development of bleeding." "The weekly CBC assesses for the development of infection." "The weekly CBC assesses for changes in your blood's oxygen-carrying capacity."
Correct response: "The weekly CBC assesses for the development of infection." Explanation: The weekly CBC is to assess for infection, neutropenia, and thrombocytopenia. Stating to the client that the CBC is routine is a belittling response that does not provide client education. The weekly CBC is not indicated to assess for bleeding or a decrease in erythrocytes.
A client is informed that his white blood cell count is low and that he is at risk for the development of infections. The client asks, "Where do I make new white blood cells?" What is the best response by the nurse? "White blood cells are produced in the plasma." "White blood cells are produced in the thymus gland." "White blood cells are produced in the lymphatic tissue." "White blood cells are produced in the bone marrow."
Correct response: "White blood cells are produced in the bone marrow." Explanation: White blood cells (leukocytes) are produced in the bone marrow. They are not produced in the plasma, thymus gland, or the lymphatic tissue.
The nurse is explaining to a client how an antigen previously encountered elicits a much faster immune response because the body's immune cells "remember" previous encounters with the antigen. The nurse is describing the function of what cells? T cells lymphocytes monocytes B cells
Correct response: B cells Explanation: After being activated, the B cells form memory cells that will produce antibodies for immediate release in the future if the antigen is encountered again. Although lymphocytes, monocytes, and T cells will then join in the battle to destroy the antigen, they do not produce memory cells as the B cells do.
The nurse is caring for a client receiving antiviral medications to treat HIV. What laboratory study should the nurse monitor most closely to determine the effectiveness of the medications? CD4 count CBC with differential P24 antigen test Liver function studies
Correct response: CD4 count Explanation: HIV attacks the helper T cells (CD4 cells) within the immune system. Monitoring T cell count would indicate how effective the drug is at controlling the virus. CBC with differential does not include a T cell count. P24 antigen tests confirm the presence of the virus but do not indicate the severity of the disease; it is either positive or negative. Liver function studies are not indicated unless liver function is damaged by the disease.
A young man presents reporting diarrhea, fecal urgency, and weight loss. His stool is light-colored and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and reports pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which diagnosis would his care team first suspect? Crohn disease Ulcerative colitis Diverticulitis Colon cancer
Correct response: Crohn disease Explanation: Crohn disease, like ulcerative colitis, causes diarrhea, fecal urgency, weight loss, and systemic symptoms such as erythema nodosum and arthritis. Unlike ulcerative colitis, it also causes steatorrhea but is not as likely to cause blood in the stool. The granulomatous "skip" lesions confirm the diagnosis of Crohn disease. Neither diverticulitis nor colon cancer would cause this combination of symptoms and signs.
The nurse is caring for a client who has a low level of T lymphocytes. The nurse plans care for a client with: Decreased immune response Decreased hematocrit Anemia Infection
Correct response: Decreased immune response Explanation: T lymphocytes differentiate to form CD4+ helper T cells, which serve to orchestrate the immune response. A client with low levels of T lymphocytes will have decreased immune response, which the nurse should consider when planning the client's care.
The treatment of HIV/AIDS is complicated because different drugs act on different stages of the replication cycle of the virus. Therefore, treatment includes combinations of two, three, or more drugs. What is this treatment called? DHHS treatment Anti-AIDS treatment HAART treatment HEELP treatment
Correct response: HAART treatment Explanation: Because different drugs act on different stages of the replication cycle, optimal treatment includes a combination of at least two to three drugs, often referred to as HAART [highly active antiretroviral therapy]. The goal of HAART is sustained suppression of HIV replication, resulting in an undetectable viral load and an increasing CD4+ cell count. The other treatments are not used in the treatment of HIV/AIDS.
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 activation of immune responsiveness Increase in susceptibility to infections Higher incidence of cancer Weakened response to vaccinations Decrease in autoimmune disorders
Correct response: Increase in susceptibility to infections Higher incidence of cancer Weakened response to vaccinations Explanation: As we age, the ability of the immune system to protect the body from pathogenic organisms and environmental toxins declines as a result of an overall decline in immune responsiveness. This results from changes in both cell-mediated and humoral immune responses. As a result, older adults are more susceptible to infections, have more evidence of autoimmune and immune complex disorders, and have a higher incidence of cancer than do younger people. In addition, the immune system of older adults is less likely to respond appropriately to immunization. As a result, older adults have a weakened response to vaccination. Older adults also frequently have many comorbid conditions that impair normal immune function and compromise the immune response.
A 78-year-old male client begins an immunosuppressant therapy for his rheumatoid arthritis. The nurse is concerned because this client is at greater risk for what complication, compared with younger adults using the same treatment modality? Falls Infections Mental status changes Self-care deficit
Correct response: Infections Explanation: Immunosuppressants are used for the same purposes and produce similar therapeutic and adverse effects in older adults as in younger adults. Because older adults often have multiple disorders and organ impairments, it is especially important that drug choices, dosages, and monitoring tests be individualized. In addition, infections occur more commonly in older adults, and this tendency is increased with immunosuppressant therapy.
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? Eosinophils Neutrophils B cells Monocytes
Correct response: 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.
Typical symptoms seen in the latent period of HIV infection include which of the following? Skin lesions Gastrointestinal problems No signs or symptoms Night sweats
Correct response: No signs or symptoms Explanation: The primary phase is followed by a latent period during which the person has no signs or symptoms of illness.
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 any signs of bleeding. Observe and report signs and symptoms of infection. Report if the child has 2 to 3 loose stools in a day. Do not immunize the child with inactive or live viruses.
Correct response: Observe and report signs and symptoms of infection. Explanation: The thymus is essential to the development of the immune system because it is responsible for the production of mature, immunocompetent T lymphocytes.
A nurse is providing education to pregnant women diagnosed with HIV. Which statement indicates the need for further teaching? Pregnancy will accelerate the progression of the disease. It is not safe to breastfeed my baby, so I will use formula. Antiretroviral treatment is effective in reducing maternal-fetal transmission. My health care provider may want me to have a cesarean birth.
Correct response: Pregnancy will accelerate the progression of the disease. Explanation: Of the nearly 1,000,000 people in the United States infected with HIV, 25% are female. There isn't any research showing pregnancy accelerates the progression of the disease. Women with HIV should not breastfeed, because they could transmit the virus to the baby via the breastmilk. Early use of antiretroviral medications are effective in reducing transmission, and a cesarean birth may be scheduled to reduce potential transmission to the newborn.
What is the function of the thymus gland? Produces stem cells Programs B lymphocytes to become regulator or effector B cells Develops the lymphatic system Programs T lymphocytes to become regulator or effector T cells
Correct response: 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. The other options are incorrect.
Which cells are responsible for cell-mediated immunity? T cells B cells Neutrophils Immunoglobulins
Correct response: T cells Explanation: T cells provide cell-mediated immunity. B cells provide humoral immunity, which involves antibody or immunoglobulin production. Neutrophils are not associated with either cell-mediated or humoral immunity.
Reproductive health education for women who are HIV-positive includes recommending which of the following contraceptives? Oral estrogen contraceptives An intrauterine device (IUD) A diaphragm The female condom
Correct response: The female condom Explanation: The female condom, the first barrier method controlled by women, is the only proven, effective method to prevent the transmission of HIV and sexually transmitted infections (STI).
A client who is HIV positive has been prescribed antiretroviral drugs. The nurse explains the action of each antiretroviral drug and develops a schedule for the client's self-administration, including strong emphasis about rigidly adhering to the dosage, time and frequency of the administration of the drugs. Why is it important to adhere to the schedule of drug dosing developed for this client? To avoid overdosing on the drugs To avoid resistance to the drugs To maintain appropriate blood levels of the drugs To get the most benefit from the drugs
Correct response: To avoid resistance to the drugs Explanation: For clients with an established HIV status, the nurse explains the action of each antiretroviral drug and develops a schedule for the client's self-administration. This includes strong precautions about rigidly adhering to the dosage, time, and frequency of drug administration to avoid resistance. Adhering rigidly to the developed schedule is not to preclude overdosing, or to maintain appropriate blood levels, or to get the most benefit from the drugs.
When describing the use of vaccines to a local community group, what would the nurse include? Vaccines are used to provide active immunity. Vaccines promote the development of antigens. Vaccines can result in signs and symptoms of the full-blown disease. Vaccines are associated with severe reactions in children.
Correct response: Vaccines are used to provide active immunity. Explanation: Vaccines provide active immunity. They promote the formation of antibodies against a specific disease. The person experiences an immune response without having to suffer the full course of the disease. Severe reactions are rare.
The nurse knows high incidences of infectious illnesses among the older adults who reside in a long-term care facility are most likely to have diminished immune capacity because of: decreased numbers and responsiveness of T lymphocytes. decreased antigen recognition by B lymphocytes. over-expression of cytokines and receptors. altered function in peripheral lymphocytes.
Correct response: decreased numbers and responsiveness of T lymphocytes. Explanation: Although this phenomenon is not well understood, increasing proportions of lymphocytes become unresponsive with age, and CD4+ T lymphocytes are the most severely affected. B lymphocytes recognize more antigens, not fewer, and expression of cytokines and their cellular receptors decreases.
The nurse is explaining patterns of incidence and transmission of HIV to a group of adolescent girls. She explains that the risks for this population are much higher because of the possibility of both vertical and horizontal transmission. Horizontal transmission refers to transmission of the disease during: sexual contact. feeding with breast milk. the birthing process. pregnancy.
Correct response: sexual contact. Explanation: Horizontal transmission refers to person-to-person transfer of the virus. Transmission by feeding with breast milk, birthing, and pregnancy are all examples of vertical transmission.
The client who is 28 weeks gestation is at the obstetric (OB) clinic reviewing lab work. The human immunodeficiency virus (HIV) test is positive, and treatment is indicated. Which medication should the nurse expect to administer that will help to prevent transmission of the virus to the fetus? zidovudine fluvastatin dimenhydrinate disulfiram
Correct response: zidovudine Explanation: Zidovudine is an antiretroviral used to help to prevent the transmission of HIV infection to the neonate. The other medications are not appropriate for this client. Fluvastatin is an antilipemic used for hypercholesterolemia, dimenhydrinate is an antiemetic used for motion sickness, and disulfiram is an alcohol deterrent.
