Patho Chapter 16 Disorders of the Immune Response
The CDC recommends routine testing for HIV of which groups of people? Select all that apply.
People who inject illicit drugs • People who exchange sex for money • People who have more than one sex partner
The surgeon is performing a kidney transplant on a client. The surgeon attaches the kidney and immediately notes that the kidney takes on a cyanotic, mottled appearance. The surgeon would interpret this as:
Hyperacute rejection
While undergoing a kidney transplant from a non-family member, the patients' transplanted kidney has just had the arterial clamps removed. The OR staff notice that the organ is turning purple with no urine output. When explaining to the family why they had to remove the donor kidney, the nurse will anticipate that the surgeon would likely include which statement?
Hyperacute rejection occurs because antibodies against HLA antigens are deposited in vessels causing necrosis.
The immune system typically responds to invaders of all types in our body. However, it can also cause tissue injury and disease. What is this effect called?
Hypersensitivity action
A patient with common variable immunodeficiency (CVID) is admitted to the hospital for treatment. Which of the following types of treatment will the nurse be administering to the patient?
IV immunoglobulin
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
Which of the following patients has the highest risk of contracting an opportunistic infection?
A patient who has had HIV for 3 years and has a CD4+ count of 50 cells/μL
Which of the following serves as the rationale for AIDS treatment with antiretroviral therapy?
Triple therapy with reverse transcriptase, protease, and fusion inhibitors
What is the leading cause of death for persons with HIV infection worldwide?
Tuberculosis
The nurse is teaching a group of college students about reducing the risk of HIV transmission during sexual relations. The nurse makes which of the following appropriate teaching points?
"If a person has a sexually transmitted disease (STD), there is an increased risk for HIV infection."
Which of the following would be the best treatment option to prevent perinatal transmission of HIV antibodies to a fetus from the HIV-positive mother?
Administration of zidovudine to the mother during pregnancy, labor, and delivery
The nurse is caring for a client who has just been diagnosed with AIDS. The client asks the nurse, "How long will I live?" Which of the following is an appropriate response by the nurse?
"AIDS is considered to be a chronic illness today."
When a patient who has been newly diagnosed with HIV asks, "What are the chances that I can be cured," which of the following is the nurse's most therapeutic response?
"Although there is no current treatment that provides a possible cure, there are ones that have successfully managed the infection."
When counseling a male patient with suspected HIV, the nurse informs him that if the enzyme-linked immunosorbent assay (ELISA) come back positive, then:
A second test known as the Western blot assay will be ordered to confirm positive HIV status
Which of the following statements about HIV/AIDS is true?
Accidental stick with a needle used on an HIV-infected patient carries little risk of infection.
The nurse is preparing to administer a unit of blood to a client. The client says that he is not sure he wants to give consent to receive the blood transfusion because he does not want to get AIDS from the blood. Select the best response from the nurse.
All blood is now tested for the AIDS virus, so the risk of getting AIDS from a blood transfusion is extremely low."
A client presents to the Urgent Care with erythematous, papular, and vesicular lesions associated with intense pruritus and weeping. The client states he was in the woods and thinks he may have come in contact with poison ivy .The reaction may be classified as:
Allergic contact dermatitis
A client with end-stage renal disease received a kidney transplant with a kidney donated by a family member. The client has been carefully monitored for signs of rejection. The physician informs the client that there has been a gradual rise in the serum creatinine over the last 5 months. What type of rejection does this depict?
Chronic rejection
In providing education to a sexually active 22-year-old female, which of the following would be most beneficial to discuss to decrease her risk for contracting HIV?
Consistent use of latex condoms with sexual activity
A client suspects they may have developed an allergic response to latex. What most common allergic response would the nurse expect to find?
Contact dermatitis
A male infant with X-linked (Bruton) agammaglobulinemia is typically diagnosed by which of the following?
Decreased serum immunoglobulin levels after age 9 months of age
The nurse has just administered a Mantoux test to a client. Select the reaction that best describes the anticipated response.
Delayed-type hypersensitivity
After several months on a waiting list, a 44-year-old male received a liver transplant 5 days ago. In the last 36 hours, he has developed a rash beginning on his palms and soles, along with abdominal pain and nausea. It has been determined by his care team that the immune response that is causing his symptoms originates not with his own compromised immune components but with those introduced with his new organ. This man's most likely medical diagnosis is:
Graft-versus-host-disease (GVHD)
The nurse is reviewing risk factors for a client to develop a type II (antibody-mediated) hypersensitivity reaction. These include: Select all that apply.
Mismatched blood transfusion reaction • Hemolytic disease of the newborn due to ABO or Rh incompatibility
A theory that has been postulated to describe the mechanisms by which infectious agents or other foreign substances trigger an immune response against autoantigens is known as what?
Molecular mimicry
Which of the following is least likely to contribute to the spread of HIV infection?
Mosquitoes
Systemic lupus erythematosus is best characterized by which one of the following?
Most patients have antinuclear antibodies present in their blood.
Which disorder does the nurse know is considered to be an autoimmune disease?
Myasthenia gravis
The nurse is assessing a client who has AIDS and has the opportunistic infection toxoplasmosis. In view of this diagnosis, the nurse performs a focused assessment on which of the following body systems?
Nervous
Which one of the following is a common opportunistic infection in patients who have AIDS?
Pneumocystis jiroveci
Which one of the following is the main effect of HIV infection?
Poor helper T-cell function
A nurse is caring for a child who has had a history of recurrent severe infections that have been resistant to treatment with antibiotics. Which of the following disorders should be suspected in this child?
Primary immunodeficiency disorder (PID)
A person who develops AIDS 10 years after a primary infection of HIV is classified as which of the following types of progressors?
Typical progressor
Why is early diagnosis essential for an infant with severe combined immunodeficiency disorders (SCIDs)?
There is better opportunity for successful treatment.
The nurse is caring for a client who has just learned that he is HIV positive. The client asks the nurse how long he has been able to infect others. Select the best response by the nurse.
"You can infect others before the HIV antibody is detectable in your blood."
Therapeutic treatment for the HIV infection includes which of the following? Select all that apply.
• A combination of antiretroviral medications • Early recognition and treatment of opportunistic infections • Surveillance of HIV profile • Treatment of cognitive and affective disorders
Which of the following serves as recognition markers to aid in self-tolerance?
HLA antigens encoded by MHC genes
The school nurse is teaching a health class to a group of high school students. She is preparing a lecture on HIV/AIDS. The nurse would know to include what information about the transmission of AIDS in her lecture? (Select all that apply.)
• AIDS is transmitted through sexual contact. • AIDS is transmitted through blood-to-blood contact. • AIDS is transmitted from the mother to her unborn baby.
A patient has symptoms of an atopic reaction. Which of the following clinical manifestations would the nurse expect the patient to display? (Select all that apply.)
• Allergic rhinitis • Hives • Atopic dermatitis
Which of the following blood disorder(s) is probably an autoimmune disease? (Select all that apply.)
• Autoimmune hemolytic anemia • Idiopathic thrombocytopenic purpura • Autoimmune neutropenia and lymphopenia
A patient diagnosed with a primary immunodeficiency disorder has asked their siblings to be tested as possible stem cell donors. When discussing this procedure with their family, the nurse emphasizes that stem cells can be harvested from: Select all that apply.
• Bone marrow. • Peripheral blood.
Physical changes associated with lipodystrophy related to HIV infection include which of the following? Select all that apply.
• Buffalo hump • Breast enlargement • Increased abdominal girth
The nurse is caring for a client who is HIV positive and is newly diagnosed with Mycobacterium tuberculosis (TB). Which of the following symptoms does the nurse associate with TB? Select all that apply.
• Cough • Fever • Night sweats
A 21-year-old woman diagnosed with HIV/AIDS 4 years ago now presents with cytomegalovirus. The nurse explains to the woman that the infection is caused by a common organism that normally does not cause infection in someone with a healthy immune system. This type of infection is called what?
Opportunistic infection
A college student has been called into the student health office because she tested positive for HIV on the enzyme-linked immunosorbent assay (ELISA). The student asks, "What is this Western blot assay going to tell you?" The best response by the health care provider is:
The Western blot is a more sensitive assay that looks for the presence of antibodies to specific viral antigens."
The nurse understands that a positive ELISA test reported in a baby born to a woman who is HIV positive indicates which of the following?
The baby has antibodies from the mother and it is uncertain whether the baby is infected with HIV.
The treatment prescribed for an autoimmune disorder is primarily dependent upon what?
The current manifestations of the disease and the mechanisms that cause the disease process
Which HIV test is the most accurate in determining the presence of HIV antibodies and is the least expensive?
The enzyme-linked immunosorbent assay (ELISA)
Which of the following is correct regarding the diagnosis of an autoimmune disorder? Select all that apply.
• Overlapping presentation of symptoms is common among this type of disorder. • Non-autoimmune diseases can present with autoimmune like symptoms. • Effective history taking is vital to the diagnosis of autoimmune disorders. • Laboratory diagnostic testing aids in the diagnosis of auto immune disorders.
Members of an AIDS support group who have more advanced cases are sharing some of their recent health problems with a member who has just been diagnosed. Which of the members' statements is most accurate?
"As people with HIV live longer, more of us are eventually succumbing to the cancers that are associated with HIV"
Which of the following is a known trigger for many autoimmune disorders?
A viral infection
Some members of the population are so sensitive to certain antigens that they react within minutes by developing itching, hives, and skin erythema, followed shortly thereafter by bronchospasm and respiratory distress. What is this near immediate reaction commonly known as?
Anaphylactic reaction
A patient with common variable immunodeficiency (CVID) who is also deficient in IgA is being treated with IV immunoglobulin (IV Ig) in the hospital. For which of the following should the nurse closely monitor the client during treatment?
Anaphylaxis
Which of the following statements from a group of young adults demonstrates the need for further teaching related to HIV and prevention of the spread?
"Having oral sex is one way I can prevent passing on HIV to my partner."
As part of her prenatal education, a 29 year-old woman who is pregnant with her first child is receiving teaching from her primary care provider. Which of the following statements by the woman reflects an accurate understanding of HIV transmission?
"It's discouraging to know that my breast milk can pass on HIV to my baby."
A patient who was tested for HIV received a positive result from the enzyme-linked immunosorbent assay (ELISA) followed by a negative Western blot test asks the nurse what this means. Which of the following is the nurse's best response?
"The ELISA test gives some false positives, but the Western blot confirms you don't have HIV."
(see full question) A potential donor is angry at the personal nature of the questions about HIV risk factors that he is required to answer at a blood collection center, and states that simple blood testing should suffice. How can the nurse at the center best respond?
"There's a period shortly after someone is infected with HIV when blood tests might still be negative."
A school nurse is teaching high school students about HIV and AIDS in the context of the school's sexual health curriculum. Which of the students' following statements would the nurse most likely want to correct or clarify?
"They have to take a blood sample from you in order to test you for AIDS."
A 5-year-old child is experiencing itchy, watery eyes and an increased respiratory rate with some inspiratory wheezes. He has been outside playing in the yard and trees. The mother asks, "Why does he get like this?" The health care worker's best response is:
"This is what we call a type I hypersensitivity reaction and usually occurs a few minutes after exposure to his allergen. It is primarily caused by mast cells in his body."
A patient will be receiving a bone graft from an unrelated individual. Which of the following types of graft does the nurse inform the patient that he or she will be receiving?
Allograft
A child has experienced a "bee-sting" while at the park. The health care provider is walking by and notices the child has swelling around the eyes, lips, and face in general. What priority assessment should the nurse make at this time?
Assess and establish an open airway.
Which of the following types of a hypersensitivity reaction involves failure of the development of self-tolerance?
Autoimmune reaction
Which of the following statements about opportunistic pathogen infection in AIDS is true?
Becoming infected with an opportunistic pathogen is one requirement for the diagnosis of AIDS.
A diagnosis of acquired immunodeficiency syndrome (AIDS) is identified when the CD4+ T cell count reaches which level?
Below 200 cells/μL
Which one of the following is an AIDS-defining condition?
CD4+ count less than 200 cells/microliter of blood
A patient is diagnosed with a mild case of an autoimmune disorder and is beginning a treatment regimen. Which of the following is the mainstay of treatment with an autoimmune disorder?
Corticosteroids and immunosuppressants
While teaching about HIV/AIDS to a group of high school seniors, the school health nurse will begin by explaining the basic facts which will likely include which of the following information?
HIV is different from other viruses since it is a retrovirus that selectively attacks the body's immune cells.
When explaining what is occurring when their child has an acute bronchial asthma attack, the nurse will emphasize that which mediator is primarily responsible for the bronchial constriction?
Histamine
A client is suffering from the effects of the opportunistic infection, Cryptosporidium parvum. An important nursing intervention would be to encourage which of the following?
Hydration
The nurse is teaching a new mother about caring for her baby and reducing the risk for infection. On which of the following does the nurse base the knowledge of passive immunity?
Infants are protected at birth from infection by maternal IgG.
A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy?
Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies.
A 36-year-old male who is positive for HIV antibodies notices purplish spots on his upper body. Which of the following terms is used to identify these areas as an opportunistic infection?
Kaposi's sarcoma
Which one of the following is often found in a patient with AIDS?
Kaposi's sarcoma
Which of the following is a characteristic indicator that an individual is in the latent phase of HIV?
Lack of symptoms
Manifestations of Kaposi sarcoma include which of the following?
Lesions of the skin and in the oral cavity, gastrointestinal tract, and lungs
A client has developed a type 1 hypersensitivity reaction. The nurse recognizes that a secondary or late-phase response
May occur 2 to 8 hours after the primary or initial-phase response and lasts for several days
An 8-week-old boy has been recently diagnosed with a severe combined immunodeficiency (SCID). His parents have performed a significant amount of research on the Internet and have brought a large amount of material to discuss with their care provider. Which of the following statements best reflects an accurate understanding of their son's health situation?
Our son likely has a deficiency of B-lymphocytes and can't produce antibodies."
The nurse is caring for an infant with DiGeorge syndrome. Which of the following organs does the nurse know will be underdeveloped or absent?
Parathyroid and thymus glands
Which of the following patients would be diagnosed with wasting syndrome?
Patient with HIV, fever, diarrhea, and significant involuntary weight loss
Which of the following is the priority intervention for a nurse caring for a patient with wasting syndrome from HIV?
Promote nutritional intake
Which of the following medications is used in the treatment of HIV to prevent cleavage of the polyprotein chain into individual proteins?
Protease inhibitor
What instruction will the nurse provide to a client with a new diagnosis of anaphylactic reaction to peanuts?
Routinely wear medical alert identification.
Select the most important organ to assess when considering acute graft versus host disease (GVHD).
Skin
The baby has antibodies from the mother and it is uncertain whether the baby is infected with HIV.
Triple therapy with reverse transcriptase, protease, and fusion inhibitors
Children born to mothers who are infected with HIV are considered uninfected if the children become HIV antibody negative after 18 months of age, have no other laboratory evidence of HIV infection, and have not met the surveillance case definition criteria for AIDS in children.
True
The type of hypersensitivity reaction that is dependent on IgE-mediated activation of mast cells and basophils and the subsequent release of chemical mediators of the inflammatory response is known as which of the following types of hypersensitivity reaction?
Type I
A client has developed a hypersensitivity reaction resulting in the formation and deposition of insoluble antigen-antibody complexes that cause serum sickness and acute glomerulonephritis. The nurse would document this as:
Type III hypersensitivity reaction
The nurse is caring for a client who is diagnosed with Pneumocystis jiroveci pneumonia (PCP). Which of the following interventions will the nurse implement?
Universal Precautions
What is the length of time from infection with the AIDS virus to seroconversion?
Up to six months
Which of the following is the most common mode of transmission of HIV?
Vaginal and anal intercourse
A patient in the primary or initial phase of a type I hypersensitivity reaction would most likely experience which of the following?
Vasodilation of the capillaries from the release of histamine
A client presents at the clinic complaining of unplanned weight loss of up to 10% of her body weight. She states that she has had diarrhea, more than twice a day. She goes on to say the she has fever and weakness that "just won't go away." After a complete history and physical, an enzyme-linked immunosorbent assay test is ordered. This order is based on what suspected diagnosis?
Wasting Syndrome
The nurse is administering an intramuscular medication to a client who has AIDS. Which of the following precautions will the nurse take when administering the medication?
Wear gloves
A 20-year-old male presents at the clinic complaining of severe fatigue, night sweats, and fever. While taking the client's history, he reports having multiple sexual partners and unprotected sex. HIV/AIDS is suspected. What diagnostic test would be ordered to confirm the diagnosis?
Western blot assay
Which one of the following is a common opportunistic infection in AIDS patients?
Which one of the following is a common opportunistic infection in AIDS patients?
The nurse is caring for a client who has lesions of Kaposi sarcoma (KS). The nurse understands that KS:
is a malignancy of the endothelial cells that line small blood vessels.
The nurse is reviewing the client's medical record for the results of a Western blot test with the understanding that:
the Western blot is used to confirm a diagnosis of HIV infection.
The nurse understands that the best way for a health care worker to protect against the transmission of HIV is to:
use universal precautions on all clients.
The nurse is teaching a group of parents about foods that commonly cause allergic reactions in children. The most important information to provide would be: Select all that apply.
• Milk • Shellfish • Eggs • Peanuts
