Immunology

A client will be receiving a hepatitis B vaccination series prior to employment in a dialysis center. What type of immunity will this provide?

Artificially acquired active immunity

A 36-year-old client is in the clinic for an annual physical. The clientasks the nurse, "Should I get a flu shot?" Which is the best response by the nurse?

"The flu shot is recommended for all people over 6 months of age."

The nurse is discussing Varicella immunization with a mother of a 13-month-old. The mother is reluctant to vaccinate because she feels it is "not necessary." Which comment by the nurse will be most persuasive for immunization?

"Children not immunized are at risk if exposed to the disease."

A female client reports that her mother-in-law was just diagnosed with cervical cancer and asks the nurse about her own risk. Which response by the nurse is correct?

"If you had the human papillomavirus (HPV) vaccine, your risk is greatly reduced."

he parents ask why the baby must have the Hib vaccine. How does the nurse respond?

"This vaccine protects against serious bacterial infections, such as meningitis."

A client with an allergic disorder calls the nurse and asks what treatment is available for allergic disorders. The nurse explains to the client that there is more than one treatment available. What treatments would the nurse tell the client about?

Desensitization is another option. Desensitization is a form of immunotherapy in which a person receives weekly or twice-weekly injections of dilute but increasingly higher concentrations of an allergen without interruption. SLIT is a form of desensitization therapy.

A client with acquired immune deficiency syndrome (AIDS) reports diarrhea after every meal. What is the nurse's best response?

Diarrhea may subside when the client avoids residue, lactose, fat, and caffeine

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find?

ESR - ESR shows inflammation associated with RA. Red blood cell count and C4 complement component are decreased.

Which type of lymphocyte is responsible for cellular immunity?

T-cells

There are some infections for which the mother does not provide antibodies to the fetus. What infection is the fetus not protected from?

The fetus does not receive immunity to rubella, cytomegalovirus (CMV), varicella, or measles. If the woman encounters these pathogens during her pregnancy, fetal infection may ensue.

Your client is about to have a skin test for an allergic disorder. What critical instruction should the nurse give this client?

The nurse should instruct the client to avoid taking prescribed or over-the-counter antihistamine or cold preparations for at least 48 to 72 hours before a skin test because this reduces the potential for false-negative test results

A nurse is providing care to a child with HIV who is prescribed therapy with a nucleoside reverse transcriptase inhibitor. What would the nurse expect to administer?

Zidovudine

A patient with a history of chronic cough is suspected of having pulmonary tuberculosis. Which vaccination is used to prevent the condition?

For the prevention of pulmonary tuberculosis (TB) in high-risk populations such as health care workers, infants, and children in endemic areas, a BCG vaccination is given. The MMR vaccine is used for preventing measles, mumps, and rubella. The DPT vaccine is used for the prevention of diphtheria, pertussis, and tetanus. IPV is an inactivated polio virus used to prevent polio.

What is a contraindication to an MMR booster for an adolescent female?

Pregnancy

An older adult tells the nurse, "My friend just developed shingles and has a lot of pain. Is there a way for me to protect myself from it?" Which of the following is an appropriate response from the nurse?

"Get a Zostavax vaccination." Herpes zoster is the viral infection caused by the varicella zoster virus. The first infection is called chickenpox. When there is a recurrence it is called shingles. The virus is believed to remain dormant in the nerve root until the client has a decline in cellular immunity when the virus will replicate. The pain is often described as throbbing, burning, or stabbing. The best prevention is a vaccine for adults age 60 and older.`

An adult client received the annual influenza vaccine yesterday afternoon and has now presented back to the clinic reporting malaise. The client's oral temperature is 37.4°C (99.3°F). What is the nurse's best action?

Explain that vaccines often cause a mild immune response and have the client self-monitor

A nurse is taking a health history on a new family at the pediatric clinic. Which information is the priority information to gather for a complete history database?

Immunization record

A nurse is receiving post-exposure prophylaxis for hepatitis B. What would the nurse most likely receive?

Hepatitis B immune globulin would be used for post-exposure prophylaxis for hepatitis B.

A pediatric client's caregiver states, "I will never give my child vaccinations." What is the prioritynursing response?

"Help me understand your thoughts about vaccinations."

A pregnant patient asks the nurse if it is all right for her take the varicella immunization for entrance into nursing school. What is the best response by the nurse?

"It is not recommended that pregnant women take the live virus. You should wait until after your child is born."

The nurse is meeting with the mother of an 11-year-old girl to provide decision making support and education regarding human papillomavirus (HPV) vaccination. The mother states, "I am confused about why my 11 year old needs to be protected from a sexually transmitted infection. She is so young and not sexually active. Why does she need the vaccination now?" What is the nurse's bestresponse?

"The vaccination helps to prevent cervical cancer in adult women. It works better if she has it before she becomes sexually active. Let's talk about some of the concerns you have about the vaccination"

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 assesses for the development of infection." The weekly CBC is to assess for infection, neutropenia, and thrombocytopenia.

The nurse is precepting a graduate nurse and preparing to give infant immunizations. The preceptor asks the graduate, "Infant injections should only be given in which muscle?" What is the best response by the graduate nurse?

"vastus lateralis"

Place the following in the sequence of the progression of HIV/AIDS on a cellular level.1)The HIV virus is uncoded.2)HIV attaches to the receptors on the CD4+ cell.3)DNA synthesis occurs by reverse transcription.4)Transcription of the DNA to form a single-strand messenger RNA.

2, 1, 3, 4

A woman with systemic lupus erythematosus is interested in preconception counseling to discuss her desire to get pregnant. The nurse explains that it would be best if she is symptom-free or in remission for how long before getting pregnant?

6 months

A nurse is caring for a client who has undergone organ transplant surgery. The client asks the nurse what antibodies are. What is the best response by the nurse?

A protein substance that the body produces in response to an antigen

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

Although this phenomenon is not well understood, increasing proportions of lymphocytes become unresponsive with age, and CD4+ T lymphocytes are the most severely affected

The nurse is helping the parents of a toddler identify foods that are causing allergic symptoms in the child. Which strategy should the nurse encourage the parents to use?

An elimination diet is a traditional method to detect food allergens. Parents feed the child only foods that rarely cause allergy, such as rice, lamb, carrots, peas, and sweet potatoes, for about 7 days. Then they add, one by one, at 2- to 3-day intervals, foods that are suspected of causing allergy.

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

Naturally acquired passive immunity

What types of cells are the primary participants in immune response?

B and T cells

The nurse educator is teaching a class of community leaders about immunologic agents. To minimize the concern regarding adverse effects of vaccinations, the nurse should include which mild reactions in the teaching plan?

Chills and fever

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?

Cilia are considered a physical barrier, along with intact skin and mucous membranes.

The nurse is caring for a client being discharged following kidney transplantation. The client is ordered mofetil to prevent organ rejection. Which nursing instruction is essential regarding medication use?

Contact the health care provider at first signs of an infection. Mofetil is an organ rejection medication that diminishes the body's ability to identify and eliminate pathogens (immunosuppressant). Identifying symptoms of infection at an early state is helpful in treating the infection. This medication is administered on an empty stomach. Typically, capsules would not be opened dispensing medication at one time. Antacids may decrease the absorption of the medication.

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?

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 client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated?

Immunoglobulin E (IgE) is involved with an allergic reaction.

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?

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.

A group of students are reviewing information about immune modulators in preparation for a test. The students demonstrate understanding of the material when they identify what as an immune stimulant?

Interferons and interleukins are immune stimulants; monoclonal antibodies, interleukin receptor antagonists, and T- and B-cell suppressors are immune suppressants.

A student nurse is taking microbiology and reviewing various types of cells. From which cell type are granulocytes derived?

Myeloid stem cells

The nurse is preparing to administer the rotavirus vaccine to an infant. The nurse would expect to administer this vaccine by which route?

Oral

The nurse is taking the health history of a newly admitted client. Which condition would place the client at risk for impaired immune function?

Organ transplantaion requires immunosupressive drugs, which cause impaired immune function.

what are primary, secondary, tertiary, and quaternary care?

Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Immunizations are an example of primary health promotion. Secondary health promotion and illness prevention focus on screening for early detection of disease, with prompt diagnosis and treatment of any found. Tertiary health promotion and illness prevention begin after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate clients to a maximum level of functioning. The term chronic is not related to health promotion.

The nurse is providing education to a client recently diagnosed with psoriasis. The client questions the nurse about the potential for curing the condition. What response by the nurse is mostappropriate?

Psoriasis is a chronic condition. It may be managed with lifestyle changes and medications. There is no permanent cure. Periods of remission are followed by exacerbations, which can be triggered by stress, infection, or environmental factors.

A male client taking penicillamine calls the clinic and tells the nurse that he is seeing double and his eyes are "drooping closed." What is the best response by the nurse?

Rare but serious adverse effects are myasthenia gravis syndrome and obliterative bronchiolitis. Penicillamine should be discontinued at the first sign of ptosis or diplopia or exertional dyspnea, cough, or wheezing. These symptoms should be reported immediately.

The nurse caring for a child with a skin allergy recognizes that the highest priority in the treatment for skin allergies is aimed at:

Reducing swelling and relieving itching

A nurse is working in a support group for clients with acquired immunodeficiency syndrome (AIDS). Which point is most important for the nurse to stress?

employ safe-sex practicies

Prior to discharge is an appropriate time to evaluate the client's status for preventative measures such as immunizations and Rh status. Which test would the nurse ensure has been conducted to evaluate the Rh negative mother?

The indirect Coombs' test is an antibody screen that will indicate whether or not the woman has been sensitized to the Rh positive blood of her infant. A positive result indicates the sensitization has occurred and this can cause complications for future pregnancies.

A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram?

The nurse should be alert for pruritus and urticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye.

When teaching a client with rheumatoid arthritis (RA), which factor does the nurse explain is an underlying cause of this disease?

The pathogenesis of RA can be viewed as an aberrant immune response that leads to synovial inflammation and destruction of the joint architecture. Approximately 70%-80% of people with the disease have a substance called rheumatoid factor, which is an autologous (self-produced) antibody that causes joint destruction.

A client is to receive a typhoid vaccine. The nurse would prepare to administer this vaccine in which site?

The typhoid vaccine is administered subcutaneously, often into the fatty tissue of the upper arm.

A nurse teaches new parents that the best way to help prevent infections in the newborn is which method?

breastfeeding A major source of IgA, which helps in immunity, is human breast milk

Immunologically active sites on antigens are recognized as:

epitopes

A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route?

oral

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

pain control

What is a common opportunistic infection in AIDS clients?

pneumocystis pneumonia (PCP)

The placenta is the site where antibodies in the mother's blood pass into the fetal circulation. These antibodies give passive immunity to the fetus for several common childhood diseases. There are some infections for which the mother does not provide antibodies to the fetus. What infection is the fetus not protected from?

rubella

A female HIV-positive patient with a high CD4 count has been taking nevirapin (Viramune) for 9 weeks. What clinical manifestations indicate to the nurse that the patient is having complications from this medication?

severe, life-threatening and in some cases fatal hepatotoxicity, particularly in the first 18 weeks, has been reported in patients treated with nevirapine.

The pediatric nurse knows that there are a number of anatomic and physiologic differences between children and adults. Which statement about the immune systems of infants and young children is true?

Infants and young children are more susceptible to infection due to the immature responses of their immune systems

A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which statement would be the nurse's best answer?

Infants born of HIV-positive women test positive for HIV antibodies at birth because these have crossed the placenta. An accurate disease status cannot be determined until the antibodies fade at about 18 months. Testing positive for HIV antibodies does not mean the infant has AIDS.

The parent asks the nurse, "What are tonsils good for anyway?" What is the best response by the nurse?

Tonsils and adenoids filter bacteria from tissue fluid. Because they are exposed to pathogens in the oral cavity, they can become infected and locally inflamed.

Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur?

Type 1A diabetes is thought to be an autoimmune disorder resulting from a genetic predisposition (i.e., diabetogenic genes); an environmental triggering event, such as an infection; and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen.

A nurse observing a client receiving treatment with pyridostigmine for myasthenia gravis notices the client clenching the jaw, salivating excessively, and experiencing muscle weakness, rigidity, and spasm. The nurse interprets these as indicating which of the following?

cholinergic crisis - Symptoms of cholinergic crisis include severe abdominal cramping, diarrhea, excessive salivation, muscle weakness, rigidity and spasm, and clenching of the jaw.

The nurse is assisting with the development of a program to administer flu shots to a group of senior citizens. What type of prevention does this program reflect?

Primary prevention

A 48-year-old man who has been HIV positive for 6 years has just learned that he has been diagnosed with Kaposi sarcoma (KS). Which fact most accurately conveys an aspect of his diagnosis?

The lesions of KS can be found on the skin and in the oral cavity, gastrointestinal tract, and the lungs. More than 50% of people with skin lesions also have gastrointestinal lesions.