Patho Chapter 11

The employee health nurse is working with a nursing student who has just sustained a needlestick injury and has received a dose of hepatitis B immune globulin. The nurse is counseling the student about vaccination against hepatitis B. Which statement by the student indicates understanding?

"I need to start the hepatitis B vaccination series as soon as possible."

A client with infectious mononucleosis asks the nurse why the lymph nodes are enlarged. Which statement is the nurse's appropriate response?

"Your lymph nodes trap and destroy viruses."

A client is brought to the physician's office with a raised, red macular rash on the trunk and arms accompanied by a fever. A diagnosis of measles is made. Which type of immunity does this disease process provide?

Active natural immunity

The cells that mediate humoral immunity do so because they are capable of producing:

Antibodies Explanation: B lymphocytes (B cells) are the only cells capable of producing antibodies; therefore, they are the cells that mediate humoral immunity. B lymphocytes (B cells) differentiate into plasma cells that produce the needed immunoglobulins (antibodies) for responding to that particular antigen. Stem cells are undifferentiated cells. T helper cells differentiate into cytotoxic and other T-cell forms.

A nurse is caring for several clients with disorders of inflammatory responses. Which client pathophysiologic disease states may arise from this inflammatory response? Select all that apply.

Atherosclerosis Bronchial asthma Multiple sclerosis

The nurse knows that inflammation plays a key role in the pathogenesis of many common pathophysiologic states. Which diseases should be nurse include in the teaching plan for senior citizens? Select all that apply.

Atherosclerosis Coronary artery disease Non-insulin-dependent diabetes mellitus (NIDDM)

Which statements are true regarding humoral immunity? Select all that apply.

B lymphocytes (B cells) are vital to the functioning of this type of immunity. Two types of responses (primary and secondary) occur. The memory response occurs on subsequent exposures to the antigen.

Cell-mediated immunity is involved in resistance to infectious diseases caused by bacteria and some viruses. It is also involved in cell-mediated hypersensitivity reactions. Which of these does not cause a cell-mediated hypersensitivity reaction?

Blood transfusion Explanation: Activation of macrophages ensures enhanced phagocytic, metabolic, and enzymatic potential, resulting in more efficient destruction of infected cells. This type of defense is important against intracellular pathogens such as Mycobacterium species and Listeria monocytogenes. Contact dermatitis due to a poison ivy reaction or sensitivity to dyes is an example of delayed or cell-mediated hypersensitivity caused by hapten-carrier complexes. Blood transfusions do not cause hypersensitivity reactions by hapten-carrier complexes.

What is the term for a subset of cytokines that stimulate the production of large numbers of platelets, erythrocytes, lymphocytes, neutrophils, and monocytes, eosinophils, basophils, and dendritic cells?

Colony-stimulating factors (CSFs)

Once T helper cells are activated, they secrete which substance that activates and influences nearly all of the other cells of the immune system?

Cytokines

Which cells bind with major histocompatibility complex (MHC) class I molecules?

Cytotoxic T cells

Which findings are considered part of normal aging? Select all that apply.

Decrease in CD4+ count Decreased IL-2 level

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?

Decreased numbers and responsiveness of T lymphocytes

A clinical research study is evaluating cells that bridge both the innate and adaptive immune systems. A nurse has identified the dendritic cells (DCs) as a key component. Which statement validates this finding?

Dendritic cells (DCs) directly sense pathogens, capture foreign agents, and transport them to secondary lymphoid tissues. Once activated, they undergo a maturation process and function as antigen-presenting cells (APCs) capable of initiating adaptive immunity.

A client is experiencing a decrease in the number of circulating neutrophils (neutropenia) during an active bacterial infection. The nurse examines the client's lab results looking for which cytokines that is responsible for promoting growth and maturation of neutrophils during inflammatory reactions?

Granulocyte CSF (G-CSF)

A client receives an interleukin-2 (IL-2) infusion to treat cancer. Which response explains how this cytokine will affect the growth of cancer cells?

IL-2 stimulates growth of cytotoxic T lymphocytes.

A client comes to the clinic with reports of runny nose, itchy eyes, and congestion due to seasonal allergies. The nurse teaches the client about the allergic reaction. The nurse knows that teaching has been effective when the client identifies which CD4 helper T-cell cytokine as the cause of this Type I hypersensitivity reaction?

IL-4 Explanation: T cells produce IL-4, which induces differentiation toward the T2H subtype. The T2H cells direct B lymphocytes to switch class and produce the IgE antibodies and prime the mast cell, which causes an allergic or hypersensitivity response.

The nurse is assisting a new mother with breastfeeding. What does the nurse understand is a primary secretory immunoglobulin (Ig) that is found in the colostrum?

IgA

Which immunoglobulin is primarily found in secretions and has a primary function of providing local immunity on mucosal surfaces?

IgA

A client experiences an allergic reaction. Select the immunoglobulin that would bind to mast cells and release histamine.

IgE Explanation: IgE responds to allergic exposures and parasitic infections. IgA is the primary defense against local infections in mucosal tissues. IgG protects against bacteria, toxins, and viruses and activates the complement system. IgD acts as an antigen receptor for initiating the B cells.

Which immunoglobulin (Ig) is the most abundant of circulating antibodies?

IgG

A nurse is reviewing labs for a client newly diagnosed with a bacterial infection. In determining if the client is experiencing a primary immune response, the nurse looks for which type of antibody produced from activated immature B cells?

IgM

The nurse is reviewing the functions of immunoglobulins and determines which immunoglobulin is associated with its correct action?

IgM, the first antibody to be produced by a developing fetus.

A client tells the nurse she is at risk to prematurely deliver her baby and is concerned that the baby does not have a developed immune system. The best response would be:

Infants born prematurely may be deficient immunity. Explanation: The largest amount of IgG crosses the placenta during the last weeks of pregnancy and is stored in fetal tissues; therefore, infants born prematurely may be deficient

Select the phases that make up the reaction of the complement system.

Initial activation, amplification of inflammation, membrane attack response

A client comes to the emergency room concerned about infection after being cut on the hand by a piece of glass; the skin surrounding the wound is red, warm and painful. After assisting with suture insertion, the nurse develops discharge instructions to include which information on the body's natural defenses? Select all that apply.

Innate immunity is the body's first line of defense. The epithelial layers of the skin provide innate immunity. Redness, heat, pain and swelling are part of the normal inflammatory process.

A hospital client with a diagnosis of sepsis is in need of a specific response to microorganisms and a long-lasting immunity to the pathogens in question. Which component of the client's immune system is most able to meet these criteria?

Lymphocytes

Innate immunity, also called natural or native immunity, consists of mechanisms that respond specifically to which potential threat?

Microbes

A blood smear is being examined and a stain has been added that will identify granulocytes. Which cell types will be visible with the stain? Select all that apply.

Neutrophil Eosinophil Basophil

The process by which microbes are coated to allow for more efficient recognition by phagocytes is known as:

Opsonization Explanation: Opsonization is the coating of particles with proteins, lectins, and complement to make them more attractive for phagocytes to recognize them as a foreign pathogen. Immunization is the process of acquiring the ability to respond to an antigen after its administration by vaccine. Immunity is protection from disease and, more specifically, infectious disease. Memory response occurs on second or subsequent exposures to the antigen

Which of the following helps the innate immune system differentiate between body cells and foreign substances?

Pattern recognition receptors identify structures not shared by body tissues.

A college student has received a tetanus booster shot. This immunization confers protection by way of what immune process?

Secondary humoral response

A client has been identified as having an excess of macrophage inhibitory factor, causing the client to have inhibited movement and activity of macrophages. Which process should the health care team expect to remain unaffected?

Specificity and memory of the immune response

Which statement explains how T lymphocytes and B lymphocytes differ?

T lymphocytes mature in the thymus gland; B lymphocytes mature in the bone marrow.

A client experiencing severe neck pain and fever comes to the emergency room and is diagnosed with bacterial meningitis. Knowing that the client's immune system is fighting the infection, the infectious disease nurse correctly identifies which pathway as the activation of the complement system?

The classical Explanation: The classical pathway is initiated by an antigen-antibody complex (either IgG or IgM mediated), which causes a specific reactive site on the antibody to be "uncovered" so that it can bind directly to the C1 molecule in the complement system. Once C1 is activated, a "cascade" of sequential reactions is set in motion. Initially, a small amount of enzyme is produced, but with activation of successive complement proteins successively increasing, concentrations of proteolytic enzymes are produced.

A teenager has been exposed to a person infected with chicken pox. After 2 weeks, the client has not contracted the virus. How is this possible? Select all that apply.

The client was vaccinated for chickenpox. The client was previously exposed to chickenpox.

The nurse is explaining the quality of pleiotropism that is possessed by many cytokines. The quality of pleiotropism implies that such cytokines:

are able to act on different types of cells.

Which cells block the entry of microbes and destroy them by secreting antimicrobial enzymes, proteins, and peptides within the mucous membrane linings of the gastrointestinal, respiratory, and urogenital tract?

epithelial

Immunologically active sites on antigens are recognized as:

epitopes

A client is being treated for lupus, an autoimmune disease. The nurse is teaching the client how the immune system normally differentiates between self and non-self (foreign peptides). The nurse knows teaching has been effective when the client correctly identifies which molecule as the self-recognition protein?

major histocompatibility complex (MHC)

A student asks, "What does cell-mediated immunity mean to the client?" The instructor responds, "This means:

the body is trying to defend itself against intracellular microbe invasion by engulfing and destroying the microbe."

Following delivery, the parents have chosen to have their infant's cord blood frozen. A blood test is performed on the cord blood and found to contain IgM antibodies. The nurse interprets this to mean:

the infant has been exposed to an intrauterine infection.