CH 16 Concepts of Inflammation and Immunity (Inflammation)

A patient visits the doctor's office because of a suspected ingrown toenail. The toenail is red and painful, and the side of the toenail exudes pus upon pressure. Which stage of inflammation is the patient primarily experiencing?

Stage 2 The presence of pus is a classic sign of stage II of the inflammatory process.

In the presence of significant infection in the body, which form of neutrophils will the nurse expect to be most abundant in the white blood cell count (WBC) differential?

labeled 3 When the body is experiencing a significant infection, the mature segmented neutrophils (labeled 4) are depleted from the blood. In response, the bone marrow releases band neutrophils (labeled 3) prematurely. Therefore band neutrophils become more abundant than segmented neutrophils in the circulating blood. Promyelocytes (labeled 1) and metamyelocytes (labeled 2) are premature forms found only in the bone marrow, so they will not be seen on the WBC in the setting of infection.

A patient in an acute-care hospital setting calls the nurse because she notices a small area of redness around her IV cannula. The patient is concerned that she has developed a life-threatening blood infection. What can the nurse tell the patient to calm her fears?

1. "Redness is a hallmark of inflammation, and inflammation is not always accompanied by infection." Redness is a classical sign of inflammation. Although inflammation may be accompanied by an infection, an infection is not always present when inflammation is present. The redness could have several causes, including irritation of the skin by the cannula, a reaction to the infused medication, or a mild infection.

What does the nurse infer from the situation when a patient develops tenderness and inflammation in the area over the kidneys a month after kidney transplantation?

1. Acute Rejection Development of tenderness and inflammation over the kidneys post-transplant is a consequence of acute rejection. The natural killer cells and the cytolytic T-cells are responsible for the inflammatory response in the patient.

The nurse recalls that which type of leukocyte releases histamine and heparin in areas of tissue damage

1. Basophil Basophils secrete histamine and heparin in areas of tissue damage. Heparin inhibits blood and protein clotting. Histamine constricts small veins, thereby inhibiting blood flow and decreasing venous return.

A patient is having a type I hypersensitivity reaction to peanuts. Which immune cells would the nurse expect to be highly activated during this process?

1. Basophils Basophils are highly reactive during allergic and hypersensitivity reactions because of the presence of IgE on their surfaces.

Which cells present in the human body are considered non-self cells? Select all that apply.

1. Cancer Cells 5. Infected Body Cells Cancer cells and infected body cells are considered to be non-self cells. Recognizing a cell as self cell or a non-self cell is important for the body to initiate an immune response toward the non-self cells.

What is the function of a monocyte during inflammation?

1. Destruction of bacteria and cellular debris During inflammation, monocytes destroy bacteria and cellular debris.

Which are the primary differences between an inflammatory response and an antibody-mediated immunity (AMI) or cell-mediated immunity (CMI) response? Select all that apply.

1. Inflammation is an immediate response, whereas AMI and CMI are delayed responses. 2. Inflammation is a short-term response, whereas AMI and CMI are long-term responses. Inflammation is an immediate and short-term, nonspecific, localized response to invasion with a foreign organism or to injury. AMI and CMI are delayed, long-term, specific responses to infection.

Which statements about stage II of the inflammatory response are correct? Select all that apply.

1. Neutrophils attack and destroy organisms. 4. There is an increased number of circulatory neutrophils. 5. Pus contains dead white blood cells (WBCs), necrotic tissue, and fluids. Pus formation occurs in the second stage of inflammation. A healthy person produces enough neutrophils to keep pace with the invasion. Neutrophils attack and destroy the organisms. Exudate released at the site of injury in the form of pus contains dead WBCs, necrotic tissue, and fluids that escape from damaged cells.

In the process of phagocytosis, which substance coats the target cell to increase contact of the immune cell with the target cell?

1. Opsonins During the adherence phase of phagocytosis, opsonins coat the target cell in order to increase contact of the phagocytic cell with its target.

A patient has been diagnosed with lung inflammation due to COPD, but the alveolar macrophage levels are still relatively low. Which immune function will be decreased in this patient?

1. Phagocytosis One of the primary activities of macrophages is phagocytosis. Without the presence of alveolar macrophages, phagocytosis will be greatly reduced.

When assessing a patient, the nurse notices an area of inflammation on the skin. The nurse would likely be less concerned about the potential for infection in the presence of what other skin abnormalities? Select all that apply.

1. Rash 4. Intact Blister A rash is usually the body's response to an allergen rather than an infectious agent. A blister is usually the body's response to a minor burn or a sheering force rather than an infectious agent. Because neither of these conditions break the skin barrier, they are less likely to develop an infection.

When teaching student nurses about INNATE immunity, the nurse practitioner lists the inflammatory response as one of the components of innate immunity. What other parts of innate immunity should the nurse practitioner include in the teaching? Select all that apply.

1. Skin 5. Natural Killer Cells Skin forms a barrier to prevent infiltration of foreign organisms, and natural killer cells target foreign cells for destruction. Both of these are part of innate immunity.

What is the nurse's understanding of a normal neutrophil count in the older adult experiencing inflammation?

1. The activity of the neutrophils is reduced. The nurse understands that the activity of the neutrophils in an older adult is reduced in the presence of inflammation. It does not mean the neutrophils eradicated the microbe.

What are the functions of leukocytes? Select all that apply.

1. They destroy foreign invaders. 3. They help with complement activation. 4. They produce antibodies against invaders. 5. They help in recognizing self versus non-self. Leukocytes destroy foreign invaders, cell debris, and abnormal self cells. They also produce antibodies against foreign invaders and help in complement activation. Leukocytes are additionally responsible for recognizing self versus non-self cells. Leukocytes produce cytokines to increase specific leukocyte activity.

A patient with allergic rhinitis has a differential white blood cell count showing an increase in the number of circulating eosinophils. What does the nurse teach the patient about the function of eosinophils?

1. They release vasoactive amines. There is an increase in the number of eosinophils during an allergic response. Eosinophil granules contain certain enzymes that degrade vasoactive chemicals released by other leukocytes.

A registered nurse is helping a student nurse understand the inflammatory response. Which statement by the student nurse indicates a need for further training?

2. "Monocytes have the same activity as macrophages; they just reside in the blood rather than in tissues." Monocytes primarily reside in the blood in an immature form. This immature form has limited activity. Once they move into tissues, they mature into active macrophages. Therefore, monocytes and macrophages do not have the same activity.

A patient comes in with complaints of a runny nose; sneezing; itchy, watery eyes; and a sore throat. The patient demands that the physician prescribe an antibiotic, even though a throat culture came back negative for bacteria. What should the nurse say to the patient in this situation?

2. "Your symptoms are likely a reaction to an air-borne allergen, not a bacterial infection. An antibiotic would not help your symptoms, and they may make you resistant to antibiotics in the future." A runny nose; sneezing; itchy, watery eyes; and a sore throat are all classic symptoms of an allergic reaction to an air-borne allergen. Although they may also be the body's response to a bacterial or viral infection, the throat culture ruled out a bacterial infection, and antibiotics are not effective against viral infections.

What is the process of making antigens less effective before administering them into the body for therapeutic purposes?

2. Attenuation Attenuation is the process of making an antigen less effective in order to administer it for therapeutic purposes.

A recent immigrant enters the emergency department with a roundworm infection. Which white blood cell type would the nurse expect to be most active in this patient?

2. Eosinophils Eosinophils are very active against parasitic infestations such as roundworm.

While looking through patient charts, the nurse studies pictures taken from a blood smear. Which cells would the nurse expect to appear as immature cells rather than mature cells? Select all that apply.

2. Monocytes 4. Tissue Mast Cells 5. Band Neutrophils Immature cells that circulate in the blood include monocytes, tissue mast cells, and band neutrophils.

Which patient is most likely to experience an excessive inflammatory response that results in tissue damage rather than tissue healing even with timely and appropriate treatment by the medical staff?

2. Patient B In Patient B, the damaged heart tissue is non-dividing tissue, so the inflammatory process has to go beyond its typical role to replace the damaged tissue without the help of the tissue itself. This ultimately results in the formation of scar tissue, which does not function in the same manner as healthy cardiac tissue.

A patient with joint inflammation asks the nurse what causes the symptoms being experienced. Which explanations does the nurse offer? Select all that apply.

2. Warmth is caused by increased vascularity in the tissues. 3. Redness is caused by increased vascularity in the tissues. 5. Edema is caused by the leakage of plasma into the tissues. Redness and warmth at the inflammatory site is due to increased vascularity in the area. Edema is due to the leakage of plasma at the inflammatory site.

The nurse is preparing a patient for discharge on postoperative day 1 after a modified radical mastectomy. Which instruction is most important for the nurse to include in this patient's discharge plan?

3. "Please report any increased redness, swelling, warmth, or pain to your health care provider." Instruction on increased signs and symptoms of inflammation could reveal signs of potential infection and is most important.

A patient enters the emergency department with first degree and partial thickness second degree burns due to sun overexposure. Intact blisters are present on the most severely burned areas. The patient complains of severe pain, rated 5 on a scale of 0 to 10. When the nurse is providing burn care instructions to the patient and caregiver, which statement should be included?

3. "The patient may exude pus from the most severely burned areas as the inflammatory process proceeds; this should not be mistaken as a sign of infection." The normal progression of the inflammatory response includes formation of pus, which contains dead white blood cells, necrotic tissue, and fluids from damaged cells. The formation of pus does not indicate the presence of infection, although it can be associated with infection. Itching and peeling are also normal signs of healing for sunburns and should not be mistaken for signs of infection.

Which statement accurately explains otitis media?

3. The inflammatory response is triggered by the invasion of foreign organisms. Inflammation is the process that occurs in response to invasion by organisms. In otitis media, it is bacteria. Macrophages and neutrophils are involved in inflammation; otitis media is an inflammation caused by infection.

The emergency department nurse is caring for four patients. Which patient will have the most widespread inflammatory response?

4. A child has a broken leg, chest contusions, and a dislocated shoulder from a motor vehicle accident. The child in the motor vehicle accident has multiple injuries to multiple parts of the body. This will result in a widespread, potentially whole-body inflammatory response.

A complete blood count with differential is performed in a patient with chronic sinusitis. Which finding does the nurse expect?

4. Basophils, 4% The normal count for basophils (basos) is 0.5%; an elevated count indicates inflammation, which is common with chronic sinusitis.

Where are various types of body cells, including the cells involved in inflammation and immune response, produced in the human body?

4. Bone Marrow Bone marrow produces immature stem cells which may mature to form red blood cells (RBCs) and white blood cells (WBCs). The spleen is a secondary lymphoid organ that acts as a filter for blood as a part of the immune system.

The nurse is administering a prescribed anti-inflammatory medication to a patient with rheumatoid arthritis. The mechanism of action of the drug is likely inhibition of which enzyme?

4. Cyclooxugenase Cyclooxygenase (COX) helps convert arachidonic acid (AA) into mediators that promote inflammatory responses in tissues. Therefore, many anti-inflammatory medications, including NSAIDs, function by inhibiting cyclooxygenase activation.

A patient is suffering from recurrent episodes of allergic manifestations. What elevated laboratory finding does the nurse assess?

4. Eosinophil count In an allergic response, there is typically an increase in the number of circulating eosinophils.

What is the key function of neutrophils?

4. Help in nonspecific ingestion and phagocytosis of microorganisms Neutrophils help in nonspecific ingestion and phagocytosis of microorganisms and foreign particles.

What functional age-related change in the older adult occurs during the immune component of inflammation?

4. Leukocytosis does not occur during acute infection. Leukocytosis does not occur during acute infection in the older adult in the immune component of inflammation. A decline in natural antibodies and a decreased response to antigens occur during the immune component of antibody-mediated immunity.

A patient has a final check-up with the nurse after a long recovery from a gunshot wound. If the patient experiences long-term or permanent decreased functionality at the site of the wound, what would the nurse expect to find upon inspection of the wound site?

4. Scar Tissue Scar tissue occurs when the healthy cells are not able to divide adequately to cover the damaged area. This results in loss of normal tissue function and permanent decreased functionality.

Secretion of histamine, serotonin, and kinins in the initial stage of inflammation causes constriction of the small veins and dilates the arteriole in the area of injury. This causes warmth and redness in the tissue. Which cells are responsible for this action?

4. Tissue Mast Cells The initial stage of the vascular inflammatory response involves blood vessels. The tissue mast cells present in the injured tissue secretes histamine, serotonin, and kinins. They constrict the small veins and dilate the arteriole which causes redness and warmth in the tissue.