Module 6: Hypersensitivities, Infection, and Immune Deficiencies

Type I Feedback: Typical allergic responses are characterized as type I hypersensitivity reactions.

The patient is having a reaction to a bee sting. Which type of hypersensitivity reaction does the nurse expect to see documented in the patient s chart?

Alloimmune Feedback: Alloimmunity can be observed during immunologic reactions against transfusions, transplanted tissue, or the fetus during pregnancy.

The patient who has just undergone a kidney transplant starts to reject the new kidney. Which type of reaction is the patient experiencing?

type I hypersensitivities. Feedback: Skin test and food challenge are forms of allergy testing involving IgE-mediated reactions.

The physician has ordered a skin test and a food challenge. The nurse explains to the patient that these tests are to determine:

the stimulation of cytotoxic T cells.

Type IV hypersensitivity tissue effects are initiated by:

Alloimmune Feedback: Alloimmune reactions are induced when another person s tissues are introduced into the body.

What term will the nurse use to describe the process in which the heart transplant patient s body mounts an aggressive immune response?

Induration Feedback: The reaction site is infiltrated with T lymphocytes and macrophages, resulting in a clear hard center (induration) and a reddish surrounding area (erythema).

When a nurse checks the patient's PPD tuberculosis skin test, the area is hard and red. Which term should the nurse use to describe the hard area?

acquired immunodeficiency syndrome (AIDS). Feedback: As the number of functional T helper cells declines, the immune response becomes increasingly compromised and the clinical manifestations of HIV infection such as opportunistic infections and malignancies begin to appear. This signals the progression of HIV infection to AIDS.

When a person with HIV develops an opportunistic infection the result should be referred to as:

Deposition of immune complexes in the kidneys, brain, and heart Feedback: SLE is an autoimmune disease involving deposition of immune complexes in the kidneys, brain, heart, and other body systems.

When assessing a patient with systemic lupus erythematosus, the nurse understands that the symptoms are the result of which pathophysiological process?

appear to have no symptoms of infection (latency).

When assessing the patient with HIV, the nurse should remember that some individuals with HIV may:

arthralgia, anemia, and rash.

When assessing the patient with SLE, the nurse should expect to identify:

No antigens Feedback: An individual with type O blood has neither the A nor the B antigen

When explaining blood typing to patients, it is important for the nurse to discuss antigens and antibodies. A person with type O blood has which of the following antigens present on their red blood cells?

histamine. Feedback: When stimulated by cell injury or the presence of microorganisms, the mast cell releases preformed mediators such as histamine.

When mast cells degranulate, they release:

Alloimmune Feedback: Alloimmune responses involve reactions against the tissue of another individual. In this case, the mother produces antibodies against fetal red blood cells.

When the maternal immune system becomes sensitized against antigens expressed by the fetus, what type of immune reaction does the nurse expect to occur?

Anaphylaxis. Feedback: Anaphylaxis involves severe bronchoconstriction and hypotension, which can be life-threatening.

Which complication poses the greatest risk for a patient with a type I hypersensitivity reaction?

H1 and lung Feedback: H1 receptors are found on lungs and blood vessels. H2 receptors are found in the stomach to increase gastric secretions.

Which concepts should the nurse discuss together when teaching about histamine receptors?

Low levels of B cells Feedback: Bruton agammaglobulinemia has few or no circulating B cells, although T cell number and function are normal.

Which laboratory value is most consistent with Bruton agammaglobulinemia?

A patient with type O receiving blood from a person with type AB Feedback: Type O individuals, who have neither antigen but have both anti-A and anti-B antibodies, cannot accept blood from any of the other three types.

Which patient is most likely to have a transfusion reaction?

Universal blood recipient Feedback: A person with type AB blood is considered the universal recipient because they will not produce antibodies against any of the other blood types.

Which term is commonly associated with a person who has type AB blood?

Type II

Which type of hypersensitivity is associated with Graves disease?

Type III Feedback: Type III hypersensitivity reactions are caused by the formation of antigen-antibody (immune) complexes that later get deposited in vessel walls or extravascular tissue.

Which type of hypersensitivity reaction is characterized by the formation of antigen-antibody complexes deposited on vessel walls or in extravascular tissues?

stimulate the production of thyroid hormone. Feedback: Hyperthyroidism in Graves disease is caused by the production of autoantibodies that mimic the effects of thyroid-stimulating hormone.

Graves disease is an autoimmune disease caused by autoantibodies that:

Secondary Feedback: Primary (congenital) immune deficiency is caused by a genetic defect, whereas secondary (acquired) immune deficiency is caused by another condition, such as cancer, infection, or normal physiologic changes, such as aging.

A cancer patient develops an immune deficiency due to the course of the disease. This immune deficiency would be identified as which type?

Most patients do not live past the age of 5. Feedback: Children with this deficiency develop serious, life-threatening infections and usually die before the age of 5 years.

A child has bare lymphocyte syndrome. What is the prognosis for this patient?

no antibodies against A or B antigen. Feedback: A person with type AB blood has no anti-A or anti-B antibodies. If they did, they would destroy their own red blood cells.

A nurse is caring for a patient with type AB blood. Which principle does the nurse understand about this patient? This patient is likely to have:

Rhinorrhea, watery eyes, and pruritus Feedback: Rhinorrhea, watery eyes, and pruritus (itching) are all common manifestations of allergic rhinitis.

A nurse is conducting a physical assessment on a patient. Which symptoms would indicate to the nurse that the patient experienced a type I hypersensitivity reaction?

H2 receptors Feedback: H2 receptors are found on the cells lining the stomach. The presence of histamine will increase gastric acid secretion.

A nurse is describing histamine receptors. Histamine receptors that stimulate gastric acid secretion in the stomach are which?

B lymphocytes and complement Feedback: Primary immune deficiencies are classified into five groups based on which principal component of the immune or inflammatory systems is defective: defects of B lymphocytes, T lymphocytes, both B and T lymphocytes (combined), phagocytes, or complement.

A nurse is describing primary immune deficiency. Which primary deficiencies should the nurse include?

CD4 receptor Feedback: HIV inserts its genetic material by binding to the CD4 receptor on the helper T cell.

A nurse is describing the pathophysiology of the HIV infection. An important point is that HIV inserts genetic material by binding to which structure of the helper T-cell?

Type II

Graves disease is associated with which type of hypersensitivity reaction?

The inability to produce major histocompatibility complex molecule Feedback: The bare lymphocyte syndrome is an immune deficiency characterized by an inability of lymphocytes and macrophages to produce major histocompatibility complex (MHC) class I or class II molecules.

A nurse is discussing the pathophysiology of bare lymphocyte deficiency. Which of the following should the nurse include?

allergic response to become worse. Feedback: With each subsequent exposure, the atopic individual produces larger quantities of IgE.

A nurse is providing care to an atopic patient. Which principle should the nurse use to guide nursing care? Repeated exposure to an allergen in an atopic individual will cause the:

helper T cells. Feedback: CD8 receptors are found on cytotoxic T cells. CD4 receptors are found on T helper cells. HIV does not attach to other viruses. Plasma cells do not have CD4 receptors.

A nurse is teaching student nurses how human immunodeficiency virus (HIV) attacks the body. An essential teaching point is that HIV attaches to CD4 receptors found on:

Common variable immune deficiency

A nurse wants to teach about the most common primary immune deficiency condition. Which of the following should the nurse describe?

Type II Feedback: Type II hypersensitivity reactions involve the formation of antibodies that attack the bodys own tissues.

A patient had a hypersensitivity reaction involving the formation of antibodies against tissue-specific antigen. Which type of hypersensitivity reaction did the patient experience?

Septicemia Feedback: Bruton agammaglobulinemia results in repeated infections, such as otitis media, streptococcal sore throat, and conjunctivitis, and more serious conditions, such as septicemia.

A patient has Bruton agammaglobulinemia. For which condition should the nurse be vigilant?

Low calcium levels and tetany Feedback: Low blood calcium levels cause the development of tetany or involuntary rigid muscular contraction.

A patient has DiGeorge syndrome. For which findings should the nurse assess?

Thymus Feedback: DiGeorge syndrome (congenital thymic aplasia or hypoplasia and diminished parathyroid gland development) is caused by the lack or partial lack of the thymus.

A patient has DiGeorge syndrome. Which organ should the nurse discuss when describing the pathophysiology of this disease?

Cold temperatures Feedback: Immune complexes precipitate at temperatures below normal body temperature, particularly in the tips of the fingers, toes, and nose for patients with Raynauds phenomenon.

A patient has Raynauds phenomenon. Which situation does the nurse advise the patient to avoid?

IgM. Feedback: Wiskott-Aldrich syndrome is an X-linked recessive disorder, in which IgM antibody production is greatly depressed. IgA is the predominant antibody in mucosal membrane secretions.

A patient has Wiskott-Aldrich syndrome. Which immunoglobulin would the nurse expect to be low?

Decreased IgM and bleeding Feedback: Wiskott-Aldrich syndrome is an X-linked recessive disorder, where IgM antibody production and platelets are depressed.

A patient has Wiskott-Aldrich syndrome. Which typical assessment findings should the nurse monitor for in this patient?

Gamma globulin injection Feedback: When immunocompromise is due to B-lymphocyte deficiencies and associated hypo- or agammaglobulinemia, the administration of gamma globulins can temporarily restore immune function.

A patient has a B-lymphocyte deficiency. Which treatment will the nurse prepare to give?

T and B lymphocytes. Feedback: Combined deficiencies result from defects that directly affect the development of both T and B lymphocytes.

A patient has a combined immune deficiency. Which important principle should the nurse remember? A patient with a combined immune deficiency lacks:

Neisseria. Feedback: Deficiencies of terminal components of the complement cascade (C5, C6, C7, C8, or C9 deficiencies) are associated with increased infections with only one group of bacteria those of the genus Neisseria (Neisseria meningitides or N. gonorrhoeae).

A patient has a complement deficiency of C5 and C7. The nurse should monitor this patient for infections caused by:

C3.

A patient has a complement deficiency. Which patient will the nurse assess for the most severe type of deficiency? A patient with a deficiency in:

Primary Feedback: Primary (congenital) immune deficiency is caused by a genetic defect, whereas secondary (acquired) immune deficiency is caused by another condition, such as cancer, infection, or normal physiologic changes, such as aging.

A patient has a congenital disorder that affects IgA cells. This is which type of immune deficiency?

Type IV Feedback: Type IV reactions are the only hypersensitivity responses mediated by T cells.

A patient has a hypersensitivity reaction mediated by Tc cells. A nurse recalls that this type of hypersensitivity reaction is called:

Complement and phagocytes Feedback: Primary immune deficiencies are classified into five groups: defects of B lymphocytes, T lymphocytes, both B and T lymphocytes (combined), phagocytes, or complement.

A patient has a primary immune deficiency. In this case which are deficient?

Type IV Feedback: Type III is an immune complex-mediated reaction. Type IV is cell-mediated and is a delayed reaction.

A patient has a severe rash due to contact with poison ivy. Which type of reaction did this patient experience?

Wiskott-Aldrich syndrome Feedback: Wiskott-Aldrich syndrome is an X-linked recessive disease characterized by decreased IgM production. Individuals with this disorder are especially susceptible to viruses and encapsulated bacteria.

A patient has an immunodeficiency disorder from an X-linked recessive disease characterized by decreased IgM production. Which diagnosis will the nurse observe documented on the chart?

Kidneys

A patient has glomerulonephritis. Which organ assessment is priority?

This treatment is only temporary. Feedback: This type of treatment helps the person; it does not cause the condition to worsen (exacerbation). The administration of gamma globulins can temporarily restore immune function (although these antibodies are only effective for 3 to 4 weeks).

A patient has hypogammaglobulinemia from a B cell immune deficiency disorder. What should the nurse teach the patient about gamma globulin injections for this condition?

Hydrogen peroxide Feedback: Affected individuals with phagocytic deficiency have adequate myeloperoxidase and halide but lack the necessary hydrogen peroxide.

A patient has phagocytic deficiency. What component of the phagocytic process does the nurse suspect the patient is missing?

Sibling Feedback: Since each sibling receives one haplotype from each parent, they have the highest chance of sharing both.

A patient needs a kidney transplant. Which relative might share both HLA haplotypes, making him or her a good match for an organ transplant?

IgA deficiency Feedback: IgA deficiency results in recurrent infections of the mucosal membranes. The systems most commonly afflicted are the respiratory and gastrointestinal linings.

A patient presents with recurrent respiratory tract infections and chronic yeast infections of the gastrointestinal tract. Which immune disease does the nurse suspect the patient is experiencing?

Autoimmune Feedback: Alloimmune is associated with transplants. Systemic lupus erythematosus (SLE) is the most common, complex, and serious of the autoimmune disorders. Allergens cause an allergic immune response.

A patient with systemic lupus erythematosus asks the nurse what caused the disease. A nurse will identify the disease as which type?

Mast cells Feedback: During a type I hypersensitivity reaction, the presence of IgE stimulates mast cell degranulation releasing histamine.

An important point for the nurse to include in a presentation about hypersensitivity reactions is that histamine is released by which cells?

Macrophages

If a patient has a phagocyte deficiency, which cells will be affected?

Clumping and lysis of red blood cells Feedback: An individual with type O blood has anti-A antibodies. The result will be a transfusion reaction with agglutination and lysis of red blood cells.

If a transfusion of A-negative blood to an O-positive individual occurred, which result would the nurse expect?

vasodilation and increased vascular permeability. Feedback: Histamine causes vasodilation, increased vascular permeability, increased gastric secretions, and bronchoconstriction. Histamine from mast cells does not cause a decrease in gastric secretions or attract viruses. Nor does it cause it bronchodilation or activation of the complement cascade. Dehydration and opsonization are not associated with actions caused by allergic histamine.

The family of a patient with an allergic response wants to know more about the process. The nurse should identify that there are cells called "mast cells" that release histamine, and that the function of the histamine is to cause:

Urticaria Feedback: Anaphylaxis is a life-threatening allergic reaction. Urticaria is characterized by white fluid-filled blisters (wheals) surrounded by areas of redness (flares).

The nurse assesses the skin of a patient experiencing an allergic reaction. The nurse notes fluid-filled blisters surrounded by redness (hives). Which medical term should the nurse use to describe this finding?

Increased permeability Feedback: Binding histamine to H1 receptors on endothelial cells results in increased capillary permeability from endothelial cell retraction.

The nurse explains to the nursing student that histamine 1 receptor stimulation results in:

the donors immune cells attack the recipient. Feedback: Graft-versus-host disease (GVHD) occurs when the donor's immune cells attack the recipient.

The nurse explains to the patient that a graft versus host disease (GVHD) occurs when:

T helper cells Feedback: The virus that causes AIDS infects Th cells, causing their dysfunction and later death.

The nurse is analyzing the laboratory work of a patient with AIDS. The nurse should expect to observe very low levels of which blood component?

Thyroid Feedback: T cells attack thyroid cell-surface antigens, contributing to the destruction of the thyroid in autoimmune thyroiditis (Hashimoto Disease).

The nurse is assessing a patient with Hashimoto disease. On which organ should the nurse focus?

encapsulated bacteria. Feedback: B-lymphocyte deficiencies result in an increased susceptibility to infection, especially those caused by encapsulated bacteria.

The nurse is caring for a patient with B-lymphocyte deficiency. The nurse should protect the patient primarily from:

Type III hypersensitivity. Feedback: Raynaud phenomenon involves immune complex deposition in blood vessels and is therefore characterized as a type III hypersensitivity.

The nurse is caring for a patient with Raynaud phenomenon. Which type of hypersensitivity should the nurse expect to see documented in the patient s chart?

opportunistic infections. Feedback: Individuals with immunodeficiencies are at risk for infection from all sources, including microorganisms that normally would not cause disease.

The nurse is caring for a patient with immunodeficiencies. The nurse should be particularly vigilant for:

Autoantibody activation of complement and subsequent destruction of target cells. Feedback: Neutrophils are attracted, bind to the tissues, and release toxic substances into the tissue, causing injury. Type II hypersensitivities involve the production of autoantibodies that target the body s own tissues in all three ways: stimulation of NK cells, opsonization of target cells, and activation of complement.

The nurse is concerned about the patient having tissue injury during type II hypersensitivity. Which mechanism provides the rationale for this concern?

Minute amounts of allergens are given in increasing amounts. Feedback: Minute quantities of the allergen to which the person is sensitive are injected in increasing doses over a prolonged period.

The nurse is explaining "desensitization therapy" to a patient with allergies. Which is a key component of thorough teaching?

helper T cells. Feedback: HIV infects and destroys the Th cell.

The nurse is explaining the pathophysiology of HIV (human immunodeficiencty virus) to a group of teenagers. An important point to make is that the HIV will attack:

Type IV Feedback: Because this reaction takes 24 to 72 hours to appear, it is a classic example of a type IV hypersensitivity reaction.

The nurse is interpreting a patient's positive tuberculin skin test. This finding is consistent with which type of hypersensitivity reaction?

Women, 20 to 40 years old Feedback: SLE, like most autoimmune diseases, occurs more often in women (approximately a 10:1 predominance of females), especially in the 20- to 40-year-old age group.

The nurse is planning a community teaching event about systemic lupus erythematosus (SLE). To which population should the teaching be primarily targeted?

The breakdown of tolerance Feedback: Autoimmune disease results from a breakdown of tolerance (body does not attack itself).

The nurse is planning a teaching plan for the patient with an autoimmune disease. Which mechanism should be included when discussing the development of an autoimmune disease?

Rh positive fetus and Rh negative mom Feedback: Rh negative moms with Rh positive fetuses result in life-threatening hemolytic disease of the newborn.

The nurse is planning care for a newborn. Which consideration warrants intervention in order to prevent hemolytic disease?

Antibody-dependent cell-mediated cytotoxicity involves natural killer cells

The nurse is teaching the patient with a Type II reaction about how this process affects cells. Which information should the nurse include?

delayed response. Feedback: A key feature of type IV hypersensitivities is that manifestations of the reactions are usually delayed by 24 to 72 hours.

The patient has a type IV hypersensitivity reaction. In planning care for this patient, the nurse should consider that this type of reaction is related to:

preformed antibodies that react immediately with the graft. Feedback: Hyperacute rejection is an immediate reaction to the graft caused by the presence of preformed antibodies to the transplanted tissue. In most cases these antibodies are present from previous transplantation or transfusion.

The patient is experiencing hyperacute allograft rejection. The nurse explains to the patient s family that this type of rejection is the result of:

Hypogammaglobulinemia Feedback: The results are lower levels of circulating immunoglobulins (hypogammaglobulinemia) or occasionally totally or nearly absent immunoglobulins (agammaglobulinemia).

While checking laboratory results, the nurse notices that a patient has low levels of antibodies. What term should the nurse use to describe this condition?

type I hypersensitivity. Feedback: Type I hypersensitivities result in mast cell degranulation, and problems are caused by the effects of histamine and other inflammatory mediators. In type II, III, and IV reactions, the body begins to recognize self-antigen as foreign.

While reading about autoimmunity, the nurse should question the statement that "autoimmunity can result from":

AIDS Feedback: AIDS is acquired immunodeficiency syndrome. Allergy, autoimmunity, and alloimmunity are considered hypersensitivity reactions.

While reviewing a patient's chart, the nurse sees the term "immunodeficiency." Which disorder is most commonly associated with immunodeficiency?

IgE Feedback: Large amounts of IgE are produced during type I hypersensitivity reactions.

While reviewing a patients' immunological profile, which immunoglobulin does the nurse expect to see elevated if the patient has a type I hypersensitivity reaction?