Chapter 33 34 35

An experienced medical nurse has provided care for patients who have immunodeficiencies that are primary, as well as for patients who have secondary immunodeficiencies. Which of the following individuals is most clearly exhibiting secondary immunodeficiency? A woman whose diagnosis of sepsis is attributable to her recent chemotherapy An elderly resident of a long-term care facility who has been diagnosed with the Norwalk virus A child who had an allergic reaction to a scheduled immunization A man who developed deep vein thrombosis (DVT) after being immobilized during recovery from orthopedic surgery

A woman whose diagnosis of sepsis is attributable to her recent chemotherapy Explanation: Secondary immunodeficiencies affect the normal immune system of the patient, resulting in increased susceptibility to infection and certain types of cancer. Chemotherapy is an example of a factor that can precipitate this susceptibility. Development of postoperative DVT and allergic reactions are not example of secondary immunodeficiency. Infection often results from a secondary immunodeficiency, but not every infection is attributable to this factor.

What types of cells are the primary participants in immune response? Select all that apply. T-cell lymphocytes B-cell lymphocytes leukocytes monocytes

B-cell and T-cell lymphocytes are the primary participants in the immune response.

When the body is in contact with an allergen, this lymphocyte, located in the respiratory and intestinal mucosa, triggers the release of histamine. Choose that lymphocyte. Ig A Ig D Ig E Ig G

IgE lymphocytes bind together to an allergen and trigger basophils to release chemical mediators such as histamine and leukotrienes.

The nurse is performing a physical assessment for a patient at the clinic and palpates enlarged inguinal lymph nodes on the left. What should the nurse document? (Select all that apply.) Location Size Consistency Reports of tenderness Temperature

Location Size Consistency Reports of tenderness Explanation: The anterior and posterior cervical, supraclavicular, axillary, and inguinal lymph nodes are palpated for enlargement; if palpable nodes are detected, their location, size, consistency, and reports of tenderness on palpation are noted. Joints are assessed for tenderness, swelling, increased warmth, and limited range of motion.

A patient with a recent diagnosis of HIV infection has expressed to the nurse that he is motivated to learn as much about his disease as possible. The patient has heard and read about the role of the different T cells, but is unclear of their roles in the immune response. Which of the following roles of T cells should the nurse identify? Select all that apply. Stimulating the immune system Secreting cytokines Directly attacking antigens Activating other T cells Producing antibodies

Stimulating the immune system Secreting cytokines Directly attacking antigens Activating other T cells Explanation: There are diverse types of T cells, and they perform functions such as stimulating the immune system, activating other T cells, secreting cytokines (helper T cells), and attacking antigens (killer T cells). T cells do not produce antibodies.

The nurse is preparing to infuse gamma-globulin intravenously (IV). When administering this drug, the nurse knows the speed of the infusion should not exceed what rate? 1.5 mL/min 3 mL/min 6 mL/min 10 mL/min

The nurse should administer the IV infusion at a slow rate, not to exceed 3 mL/min, usually at 100-200 mL/h.

What treatment option does the nurse anticipate for the patient with severe combined immunodeficiency disease (SCID)? Bone marrow transplantation Antibiotics Radiation therapy Removal of the thymus gland

Treatment options for SCID include stem cell and bone marrow transplantation.

he spleen acts as a filter for old red blood cells, holding a reserve of blood in case of hemorrhagic shock. It is also an area where lymphocytes can concentrate. It can become enlarged (splenomegaly) in certain hematologic disorders and cancers. To assess an enlarged spleen, the nurse would palpate the area of the:

Upper left quadrant of the abdomen.

The nurse practitioner treating a patient with allergic rhinitis decides pharmacologic therapy would be helpful. Which of the following is she most likely to prescribe? Sudafed Afrin Allegra Rhinocort

Allegra is the only antihistamine choice. Sudafed and Afrin are over-the-counter, and Rhinocort is a corticosteroid.

A patient is on highly active antiretroviral therapy (HAART) for the treatment of HIV. What does the nurse know would be an adequate CD4 count to determine the effectiveness of treatment for a patient per year? 1 mm3 to 10 mm3 10 mm3 to 20 mm3 20 mm3 to 45 mm3 50 mm3 to 150 mm3

An adequate CD4 response for most patients on HAART is an increase in CD4 count in the range of 50 mm3 to 150 mm3 per year, generally with an accelerated response in the first 3 months.

The nurse is evaluating a client's readiness for allergy skin testing. The nurse determines that the testing will need to be postponed when it is revealed that the client took which classification of medication the night before? Anti-inflammatory Anticoagulant Antihistamine Antidepressant

Antihistamines and corticosteroids suppress skin test reactivity and should be stopped at least 48 hours before testing, some experts state 72 hours to 96 hours before testing. It is best to check with the primary care provider regarding the use of antihistamines and corticosteroids and false negatives can occur during the skin testing.

A patient developed an infection while on vacation in Central America and is now taking the antibiotic chloramphenicol (Chloromycetin). What should the patient be monitored for when taking this drug? Eosinophilia Neutropenia Aplastic anemia Hypoprothrombinemia

Aplastic anemia Explanation: The effects of chloramphenicol on the immune system include leukopenia and aplastic anemia.

Which microorganism is known to cause retinitis in people with HIV/AIDS? Cytomegalovirus Cryptococcus neoformans Mycobacterium avium Pneumocystis carinii

Cytomegalovirus is a species-specific herpes virus. C. neoformans is a fungus that causes an opportunistic infection in clients with HIV/AIDS. M. avium is an acid-fast bacillus that commonly causes a respiratory illness. P. carinii is an organism that is thought to be protozoan but believed to be a fungus based on its structure.

A client is prescribed didanosine (Videx) as part of his highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client? "You should take the drug with an antacid." "It doesn't matter if you take this drug with or without food." "Be sure to take this drug about 1/2 hour before or 2 hours after you eat." "When you take this drug, eat a high-fat meal immediately afterwards."

Didanosine should be taken 30 to 60 minutes before or 2 hours after meals. Other antiretroviral agents, such as abacavir, emtricitabine, or lamivudine can be taken without regard to meals. High-fat meals should be avoided when taking amprenavir. Atazanavir should be taken with food and not with antacids.

During the immune response, cytotoxic cells bind to invading cells, destroy the targeted invader, and release lymphokines to remove the debris. Which type of T-cell lymphocyte is cytotoxic? effector T cells helper T cells suppressor T cells regulator T cells

Effector T cells are killer (cytotoxic) cells.

Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? Histamine Bradykinin Serotonin Prostaglandin

Histamine Explanation: When cells are damaged, histamine is released. Bradykinin is a polypeptide that stimulates nerve fibers and causes pain. Serotonin is a chemical mediator that acts as a potent vasoconstrictor and bronchoconstrictor. Prostaglandins are unsaturated fatty acids that have a wide assortment of biologic activities.

Histamine release in anaphylaxis causes which of the following? Nasal congestion Feeling of impending doom Urinary urgency Stomach cramps

Histamine release causes sweating, sneezing, shortness of breath, and NASAL CONGESTION. Feelings of impending doom are related to activation of IgE and subsequent release of chemical mediators. Urinary urgency and stomach cramps occur from smooth muscle contractions of intestines and bladder.

Histamine release in anaphylaxis causes which of the following?

Histamine release causes sweating, sneezing, shortness of breath, and nasal congestion.

Which immunoglobulin assumes a major role in bloodborne and tissue infections? IgA IgG IgM IgD

IgG Explanation: IgG assumes a major role in bloodborne and tissue infections. IgA protects against respiratory, gastrointestinal, and genitourinary infections. IgM appears as the first immunoglobulin produced in response to bacterial and viral infections. IgD possibly influences B-lymphocyte differentiation.

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 IgA IgM IgD

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.

What does the nurse understand will result if the patient has a deficiency in the normal level of complement? Increased susceptibility to infection Decrease in vascularity to the extremities Development of congestive heart failure Risk of stroke

Increased susceptibility to infection Explanation: The complement system is an integral part of the immune system, and deficiencies in normal levels of complement result in increased susceptibility to infectious diseases and immune-mediated disorders.

What specific drug group has both antiviral and anti-proliferative actions? Interferons Interleukins Monoclonal antibodies Hematopoietic growth factors

Interferons Explanation: Interferons are chemicals that are secreted by cells that have been invaded by viruses and possibly by other stimuli. The interferons prevent viral replication and also suppress malignant cell replication and tumor growth. Therefore Options B, C, and D are incorrect.

Which group of mediators initiates the inflammatory response? Leukotrienes Lymphokines Mast cells Prostaglandins

Leukotrienes are a group of chemical mediators that initiate the inflammatory response. Lymphokines are substances released by sensitized lymphocytes when they contact specific organs. Mast cells are connective tissue that contains heparin and histamine in their granules. Prostaglandins are unsaturated fatty acids that have a wide assortment of biologic activity.

A woman has been diagnosed with breast cancer and is being treated aggressively with a chemotherapeutic regimen. As a result of this regimen, she has an inability to fight infection due to the fact her bone marrow is unable to produce a sufficient amount of what? Lymphocytes Cytoblasts Antibodies Capillaries

Lymphocytes Explanation: The white blood cells involved in immunity are produced in the bone marrow. Like other blood cells, lymphocytes are generated from stem cells, which are undifferentiated cells. Descendants of stem cells become lymphocytes, the B lymphocytes and the T lymphocytes. B lymphocytes mature in the bone marrow and then enter the circulation. T lymphocytes move from the bone marrow to the thymus, where they mature into several kinds of cells with different functions. Cytoblasts are the protoplasm of the cell outside the nucleus. Capillaries are small blood vessels. Antibodies are protein substances that respond to the presence of an antigen. Antibodies are found in normal circulation.

A client is prescribed montelukast as part of his treatment plan for an allergic disorder. The nurse understands that this drug belongs to which class? Mast cell stabilizer Nonsedating antihistamine Corticosteroid Leukotriene-receptor antagonist

Montelukast is classified as a leukotriene-receptor antagonist. Cromolyn sodium is a mast cell stabilizer. Cetirizine, loratadine, and fexofenadine are nonsedating antihistamines. Beclomethasone, budesonide, dexamethasone, flunisolide, fluticasone, and triamcinolone are corticosteroids.

A 20-year-old client cut a hand while replacing a window. While reviewing the complete blood count (CBC) with differential, the nurse would expect which cell type to be elevated first in an attempt to prevent infection in the client's hand? Eosinophils Neutrophils B cells Monocytes

Neutrophils Explanation: Neutrophils (polymorphonuclear leukocytes [PMNs]) are the first cells to arrive at the site where inflammation occurs. Eosinophils and basophils, other types of granulocytes, increase in number during allergic reactions and stress responses.

Which medication classification is known to inhibit prostaglandin synthesis or release? Nonsteroidal anti-inflammatory drugs in large doses Antibiotics (in large doses) Adrenal corticosteroids Antineoplastic agents

Nonsteroidal anti-inflammatory drugs in large doses Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs), in large doses, inhibit prostaglandin synthesis or release. NSAIDs include aspirin and ibuprofen. Antibiotics in large doses are known to cause bone marrow suppression. Adrenal corticosteroids and antineoplastic agents are known to cause immunosuppression.

The parents of a 3-year-old boy have just been informed that allergy testing suggests their son has multiple food allergies. When providing health education for this family, what subject should the nurse prioritize? Alternative nutritional delivery systems Coping strategies for the lifestyle changes that their son's diagnosis necessitates The appropriate use of antihistamines in pediatric patients Possible sources of food allergens and strategies for avoiding offending foods

Possible sources of food allergens and strategies for avoiding offending foods Explanation: A teaching priority for individuals with food allergies surrounds the accurate identification and avoidance of possible allergens. Coping strategies are also likely relevant but avoiding allergens is a priority. Antihistamine use is secondary, and alternative nutritional delivery systems are almost never indicated.

A patient who has developed kidney failure is discussing options with the physician for treatment. What does the nurse understand that kidney failure is associated with?

Renal failure is associated with a deficiency in circulating lymphocytes

An older adult patient who is postmenopausal informs the nurse that she believes she has developed another urinary tract infection (UTI). The nurse understands that postmenopausal females are at greater risk for UTIs. What risk factors do female patients in this age group have? (Select all that apply.) Residual urine Urinary incontinence Estrogen deficiency Decreased function of the thyroid gland Dry mucous membranes of the vagina

Residual urine Urinary incontinence Estrogen deficiency

Which of the following occurs when the antigen-antibody molecule is coated with a sticky substance what also facilitates phagocytosis? Opsonization Agglutination Antigenic determinant Complement

Some antibodies assist in removal of offending organisms through OPSONIZATION. In this process, the antigen-antibody molecule is coated with a sticky substance that also facilitates phagocytosis. One antibody can act as a cross-link between two antigens, causing them to bind or clump together. This clumping effect, referred to as agglutination, helps clear the body of the pathogen by facilitating phagocytosis. The portion of the antigen involved in binding with the antibody is referred to as the antigenic determinant. Circulating plasma proteins, known as complement, are made in the liver and other sites and activated when an antibody connects with its antigen.

A nurse is taking the health history of a newly admitted client. Which of the following conditions would NOT place the client at risk for impaired immune function? Previous organ transplantation Surgical removal of the appendix History of radiation therapy Surgical history of a splenectomy

Surgical removal of the appendix Explanation: Removal of the appendix would have no direct effect on the immune system. Organ transplantaion requires immunosupressive drugs, which cause impaired immune function. Radiation therapy destroys lymphocytes. The spleen is an important part of the immune system, and removal of it increases the client's risk for poor immune function.

A client has discussed therapy for HIV-positive status. The goal of antiretroviral therapy is to:

The goal of antiretroviral therapy is to keep the CD4 cell count above 350/mm3 and bring the viral load to a virtually undetectable level. This level is no more than 500 or 50 copies,

The lower the client's viral load,

The lower the client's viral load, the longer the time to AIDS diagnosis and the longer the survival time. The key goal of antiretrovial therapy is to achieve and maintain durable viral suppression.

Which of the following is a center for immune cell proliferation? Lymph node Spleen Pancreas Liver

The lymph nodes remove foreign material from the lymph system before it enters the bloodstream. They are centers for immune cell proliferation.

A patient has been exposed to a pathogen during an outbreak of a nosocomial (hospital-acquired) infection. The patient's immune system has responded appropriately to the virus, and the response has included the production of memory B cells. These particular B cells will have what effect? The patient will have a more pronounced immune response to the virus during future exposure. B cells will be able to produce antibodies without the assistance of T cells. The patient will have life-long immunity to the specific virus. The patient's B cells will have the ability to directly ingest the virus during a subsequent exposure.

The patient will have a more pronounced immune response to the virus during future exposure. Explanation: When an antigenic message is carried back to a lymph node, specific clones of the B lymphocyte are stimulated to enlarge, divide, proliferate, and differentiate into plasma cells capable of producing specific antibodies to the antigen. Other B lymphocytes differentiate into B-lymphocyte clones with a memory for the antigen. These memory B cells are responsible for the more exaggerated and rapid immune response in a person who is repeatedly exposed to the same antigen. They do not confer the ability to produce antibodies without T-cell assistance if this ability did not previously exist. B cells do not participate in phagocytosis, and the presence of memory B cells does not necessarily confer life-long immunity.

Which test indicates the quantity of allergen necessary to evoke an allergic reaction?

The serum-specific IgE test, formerly known as RAST, is a radioimmunoassay that measures allergen-specific IgE. It indicates the quantity of allergen necessary to evoke an allergic reaction. Provocative testing involves the direct administration of the suspected allergen to the sensitive tissue such as the conjunctiva. The scratch test does not indicate the quantity of allergen.

A client who is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication will the client take for the treatment of this infection?

To prevent and treat Pneumocystis pneumonia, trimethoprim-sulfamethoxazole (Bactrim, Septra) is prescribed. The other medications are antifungals and used to treat candidiasis.

Which immunity type becomes active as a result of infection by a specific microorganism?

You Selected: naturally acquired active immunity

Agammaglobulinemia

is a disorder marked by an almost complete lack of immunoglobulins or antibodies.

Panhypoglobulinemia

is a general lack of immunoglobulins in the blood.

Common adverse effects associated with the administration of zidovudine and other NRTIs include

nausea, abdominal pain and diarrhea

The body has several mechanisms to fight disease, one of which is sending chemical messengers. The messengers released by lymphocytes, monocytes, and macrophages have differing roles in the immune response. Which messenger helps in cellular repair in small doses yet destroys healthy tissue in excessive doses? tumor necrosis factor colony-stimulating factors interferons interleukins

tumor necrosis factor Explanation: Research has found that tumor necrosis factor (TNF) helps in cellular repair when administered in small doses. Excess amounts destroy healthy tissue. Consequently, TNF and TNF inhibitors are used to regulate various autoimmune and inflammatory disorders.

hyperimmunoglobulinemia

white blood cells cannot initiate an inflammatory response to an infectious organism.

Which of the following accurately describes effector or cytotoxic T-cells? Cells that are programmed to identify specific proteins or antigens Cells that can either destroy a foreign cell or mark it for aggressive destruction Cells that respond to chemical indicators of immune activity and stimulate other lymphocytes to be more aggressive and responsive Cells that respond to rising levels of chemicals associated with an immune response to suppress or slow the reaction

Cells that can either destroy a foreign cell or mark it for aggressive destruction Explanation: Effector or cytotoxic T-cells either destroy a foreign cell or make it available for aggressive destruction. Cells that identify specific proteins or antigens are B-cells. Cells that respond to chemical indicators to stimulate other cells are Helper T-cells. Cells that suppress or slow the reaction are Suppressor T-cells.

A patient has enlarged lymph nodes in his neck and a sore throat. This inflammatory response is an example of a cellular immune response whereby: Antibodies reside in the plasma Antibodies are released into the bloodstream B-lymphocytes respond to a specific antigen Lymphocytes migrate to areas of the lymph node

Lymphocytes migrate to areas other than those programmed to become plasma cells.

Which of the following disorders is characterized by an increased autoantibody production? Systemic lupus erythematosus (SLE) Scleroderma Rheumatoid arthritis (RA) Polymyalgia rheumatic

Systemic lupus erythematosus (SLE) Explanation: SLE is an immunoregulatory disturbance that results in increased autoantibody production. Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

The nursing instructor is discussing the development of human immunodeficiency disease (HIV) with the students. What should the instructor inform the class about helper T cells? They are activated on recognition of antigens and stimulate the rest of the immune system. They attack the antigen directly by altering the cell membrane and causing cell lysis. They have the ability to decrease B-cell production. They are responsible for recognizing antigens from previous exposure and mounting an immune response.

They are activated on recognition of antigens and stimulate the rest of the immune system. Explanation: Helper T cells are activated on recognition of antigens and stimulate the rest of the immune

This type of T lymphocyte is responsible for altering the cell membrane and initiating cellular lysis. Choose the T lymphocyte. Helper T cell Suppressor T cell Cytotoxic T cell Memory T cell

Cytotoxic T cell Explanation: The cytotoxic T cells (also known as killer T cells) attack the antigen directly and release cytotoxic enzymes and cytokines.

According to nursing research by Campbell et al., about 65% of patients identified with anaphylaxis who were seen in the emergency department were discharged to home. Of those 65%, one-third were prescribed self-injectable epinephrine. Patient teaching for use of an EpiPen must be included with discharge instructions. Select all the teaching points that apply. Grasp the EpiPen with the black tip pointing downward. Form a fist around the unit. Hold black tip near outer thigh. Jab firmly at a 45 degree angle to get maximum penetration. Hold for 5 seconds and massage injection area for 5 seconds. Call 911 before injecting epinephrine.

Grasp the EpiPen with the black tip pointing downward. Form a fist around the unit. Hold black tip near outer thigh.

Which is a primary chemical mediator of hypersensitivity? Serotonin Bradykinin Histamine Heparin

Histamine is a primary chemical mediator of hypersensitivity. Secondary mediators include serotonin, heparin, and bradykinin.

This type of T lymphocyte is responsible for altering the cell membrane and initiating cellular lysis. Choose the T lymphocyte. Helper T cell Suppressor T cell Cytotoxic T cell Memory T cell

The cytotoxic T cells (also known as killer T cells) attack the antigen directly and release cytotoxic enzymes and cytokines.

A client is scheduled to begin immunotherapy. The nurse would explain that the client will receive injections initially at which interval

Typically, immunotherapy begins with very small amounts and gradually increases, usually at WEEKLY intervals until a maximum tolerated dose is attained. Then maintenance booster injections are administered at 2- to 4-week intervals, frequently for a period of several years.

While monitoring the patient's eosinophil level, the nurse suspects a definite allergic disorder when seeing an eosinophil value of what percentage of the total leukocyte count? 1% to 3% 3% to 4% 5% to 10% 15% to 40%

15% to 40% Explanation: Eosinophils, which are granular leukocytes, normally make up 0% to 3% of the total number of WBCs (Fischbach & Dunning, 2009). A level between 5% and 15% is nonspecific but does suggest allergic reaction. Higher percentages of eosinophils are considered to represent moderate to severe eosinophilia. Moderate eosinophilia is defined as 15% to 40% eosinophils and may be found in patients with allergic disorders.

A patient is on highly active antiretroviral therapy (HAART) for the treatment of HIV. What does the nurse know would be an adequate CD4 count to determine the effectiveness of treatment for a patient per year? 1 mm3 to 10 mm3 10 mm3 to 20 mm3 20 mm3 to 45 mm3 50 mm3 to 150 mm3

50 mm3 to 150 mm3 Explanation: An adequate CD4 response for most patients on HAART is an increase in CD4 count in the range of 50 mm3 to 150 mm3 per year, generally with an accelerated response in the first 3 months.

Nursing students have learned that removal of what specific organs may place the patient at risk for impaired immune function?

A history of surgical removal of the spleen, lymph nodes, or thymus may place the patient at risk for impaired immune function. Removal of the lung, colon, or pancreas would not lead to impairment of the immune system.

Which of the following protective responses begin with the B lymphocytes?

A second protective response, the HUMORAL IMMUNE response, begins with the B lymphocytes, which can transform themselves into plasma cells that manufacture antibodies. The first line of defense, the phagocytic immune response, involves the white blood cells (WBCs; granulocytes and macrophages), which have the ability to ingest foreign particles. The third mechanism of defense, the cellular immune response, also involves T lymphocytes, which can turn into special cytotoxic (or killer) T cells that can attack the pathogens. Recognition of antigens as foreign, or nonself, by the immune system is the initiating even in any immune response.

Which diagnostic test measures HIV RNA in the plasma?

A viral load test measures the quantity of HIV RNA in the blood. Enzyme immunoassay (EIA) is a blood test that can determine the presence of antibodies to HIV in the blood or saliva; it is also referred to as an enzyme-linked immunosorbant assay (ELISA). A Western blotting assay is a blood test that identifies antibodies to HIV and is used to confirm the results of an EIA (ELISA) test.

A client with a history of IV drug use is HIV-positive. The client has been following an antiretroviral medication regimen faithfully and is doing well, attending college to get a social work degree, and focused on a bright future. In regular CD counts, what factor will indicate that this client has progressed from HIV to AIDS? CD count CD count >200/mm CD count >100/mm

CD count A CD (T-cell) count of less than 500/mm indicates immune suppression; a CD (T-cell) count of 200/mm or less is an indicator of AIDS.

Which is usually the most important consideration in the decision to initiate antiretroviral therapy?

CD4+ counts

Which of the following is the most frequent route of exposure to a latex allergy? Cutaneous Inhalation Mucosal Parenteral

Cutaneous Explanation: Routes of exposure to latex products can be cutaneous, percutaneous, mucosal, parenteral, or aerosol. Allergic reactions are more likely with parenteral or mucous membrane exposure but can also occur with cutaneous contact or inhalation. The most frequent source of exposure is cutaneous, which usually involves the wearing of natural latex gloves.

Upon reviewing the results of a complete blood count on a patient who is diagnosed with an acute infection what will the nurse expect to see elevated? Basophil count Eosinophil count Hematocrit Neutrophil count

During an acute infection, the neutrophils are rapidly produced in response to the interleukins released by active white blood cells. They move to the site of insult to attack the foreign substance. Eosinophils are often increased in an allergic response and basophils would only increase with generalized bone marrow stimulation. The hematocrit is increased in polycythemia.

The nurse is caring for a female patient who has an exacerbation of lupus erythematosus. What does the nurse understand is the reason that females tend to develop autoimmune disorders more frequently than men? Androgen tends to enhance immunity. Estrogen tends to enhance immunity. Testosterone tends to enhance immunity. Leukocytes are increased in females.

Estrogen tends to enhance immunity. Explanation: Autoimmune disorders tend to be more common in women because estrogen tends to enhance immunity. Androgen, on the other hand, tends to be immunosuppressive.

Immunoglobulins (also known as antibodies) promote the destruction of invading cells in various ways, using different mechanisms. Which mechanism is used by immunoglobulins to destroy pathogenic antigens?

Immunoglobulins bind with antigens and promote the destruction of invading cells in one of two ways. First, immunoglobulins may hinder antigens physically by (1) neutralizing their toxins; (2) linking them together in a process called agglutination and (3) causing them to precipitate, or become solid. Second, antibodies can facilitate the destruction of antigens with other mechanisms; for example, those performed by nonantibody proteins such as the complement system and cytokines.

In which process is the antigen-antibody molecule coated with a sticky substance that facilitates phagocytosis? Opsonization Apoptosis Agglutination Immunoregulation

In the process of opsonization, the antigen-antibody molecule is coated with a sticky substance that facilitates phagocytosis. Apoptosis is programmed cell death that results from the digestion of DNA by endonucleases. Agglutination is the clumping effect that occurs when an antibody acts as a cross-link between two antigens. Immunoregulation is a complex system of checks and balances that regulates or controls immune responses.

Lymphoid tissues, which perform a function within the immune response, are found throughout the body. While the thymus gland, tonsils and adenoids, spleen, and lymph nodes are lymphoid tissues, where else in the body can lymphoid tissues be found? Select all that apply. intestines lungs stomach kidneys brain

Lymphoid tissue also is found on alveolar membranes in the LUNGS, mucous membranes of the INTESTINES, and in the lining of the sinusoids of the LIVER.

The nurse is aware that the phagocytic immune response, one of the body's responses to invasion, involves the ability of cells to ingest foreign particles. Which of the following engulfs and destroys invading agents? Eosinophils Macrophages Basophils Neutrophils

Macrophages move toward the antigen and destroy it. Eosinophils are only slightly phagocytic.

A middle-aged woman will soon begin treatment for a gastric tumor that has just been discovered by endoscopy. The woman's natural killer (NK) cells are already actively opposing the tumor cells, because the tumor cells lack "self" markers of major histocompatibility complex (MHC) class I. This aspect of the patient's immune response is characteristic of: Active immunity Humoral immunity Phagocytic immunity Natural immunity

The action of NK cells is a component of natural immunity.

Which of the following indicates that a client with HIV has developed AIDS?

The immune system becomes compromised. The CD4 T-cell count drops below 200 cells and develops one of the opportunistic diseases, such as Pneumocystis carinii pneumonia, candidiasis, cytomegalovirus, or herpes simplex.

A client is taking immunosuppressive medications to prevent the rejection of a transplanted kidney. Which adverse effect(s) should the nurse closely monitor in this client? respiratory or urinary system infections depression, memory impairment, and coma rheumatoid arthritis heart failure

When taking medications to suppress the immune system, clients have an increased risk of infection, especially in the respiratory or the urinary system.

The body has several mechanisms to fight disease, one of which is sending chemical messengers. The messengers released by lymphocytes, monocytes, and macrophages have differing roles in the immune response. Which messenger enables cells to resist viral replication and slow viral replication? interferons interleukins tumor necrosis factor colony-stimulating factor

interferons Explanation: Interferons are chemicals that primarily protect cells from viral invasion. They enable cells to resist viral infection and slow viral replication. They have been used as adjunctive therapy in the treatment of AIDS. Interferons also have been used to treat some forms of cancer such as leukemia because they stimulate NK cell activity. Interferon is administered parenterally because digestive enzymes destroy its protein structure.

A client has ankylosing spondylitis (AS), an inflammatory joint disease.The client has been receiving treatment for AS since the age of 14 years. In addition to having AS, the client has recently developed primary immune deficiency disorder and receives immunoglobulin infusions weekly. Which type of immunity develops from receiving immunoglobulin treatments? passive immunity naturally acquired active immunity artificially acquired active immunity Immunity does not develop after receiving immunoglobulin treatments.

passive immunity Explanation: Passive immunity develops when ready-made antibodies are given to a susceptible person. Ready-made antibodies are obtained from the serum of another organism, either animal or human. Immune serum globulin, also called gamma globulin or immunoglobulin, is recovered from pooled human plasma.

An experiment is designed to determine specific cell types involved in cell-mediated immune response. The experimenter is interested in finding cells that attack the antigen directly by altering the cell membrane and causing cell lysis. Which cells should be isolated? Macrophages Helper T cells B cells Cytotoxic T cells

Cytotoxic T cells Explanation: Cytotoxic T cells (killer T cells) attack the antigen directly by altering the cell membrane and causing cell lysis (disintegration) and by releasing cytolytic enzymes and cytokines. Lymphokines can recruit, activate, and regulate other lymphocytes and white blood cells. These cells then assist in destroying the invading organism.

Nursing students are reviewing various medications that can be used to treat allergic disorders. The students demonstrate understanding of the information when they identify which of the following as an intranasal corticosteroid? Cromolyn sodium Fluticasone Zileuton Fexofenadine

Fluticasone is an example of an intranasal corticosteroid. Cromolyn sodium is a mast cell stabilizer. Zileuton is a leukotriene-receptor inhibitor. Fexofenadine is a second-generation antihistamine.

Our bodies contain a variety of immunoglobulins. Which of these immunoglobulins is found in sweat, tears, mucus, and bile?

IgA Explanation: Five different types of immunoglobulins have been identified: IgE is present in small amounts and seems to be related to allergic responses and to the activation of mast cells. The first immunoglobulin released is M (IgM), and it contains the antibodies produced at the first exposure to the antigen. IgG, another form of immunoglobulin, contains antibodies made by the memory cells that circulate and enter the tissue; most of the immunoglobulin found in the serum is IgG. IgA is found in tears, saliva, sweat, mucus, and bile. It is secreted by plasma cells in the GI and respiratory tracts and in epithelial cells. These antibodies react with specific pathogens that are encountered in exposed areas of the body.

Which of the following protective responses begin with the B lymphocytes? Humoral Phagocytic Cellular Recognition

Humoral Explanation: A second protective response, the humoral immune response, begins with the B lymphocytes, which can transform themselves into plasma cells that manufacture antibodies. The first line of defense, the phagocytic immune response, involves the white blood cells (WBCs; granulocytes and macrophages), which have the ability to ingest foreign particles. The third mechanism of defense, the cellular immune response, also involves T lymphocytes, which can turn into special cytotoxic (or killer) T cells that can attack the pathogens. Recognition of antigens as foreign, or nonself, by the immune system is the initiating even in any immune response.

The nurse observes diffuse swelling involving the deeper skin layers in a client who has experienced an allergic reaction. The nurse would correctly document this finding as urticaria. contact dermatitis. pitting edema. angioneurotic edema.

The area of skin demonstrating ANGIONEUROTIC EDEMA may appear normal, but often has a reddish hue and does not pit. Urticaria (hives) is characterized as edematous skin elevations that vary in size, shape, and itch, which cause local discomfort. Contact dermatitis refers to inflammation of the skin caused by contact with an allergenic substance such as poison ivy. Pitting edema, the result of increased interstitial fluid, is associated with disorders such as congestive heart failure.

The nurse is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm³, and the client has been diagnosed with pneumocystis pneumonia. What does this indicate to the nurse? The client has converted from HIV infection to AIDS. The client has advanced HIV infection. The client's T4-cell count has decreased due to the pneumocystis pneumonia. The client has another infection present that is causing a decrease in the T4-cell count.

The client has converted from HIV infection to AIDS. Explanation: AIDS is the end stage of HIV infection. Certain events establish the conversion of HIV infection to AIDS: a markedly decreased T4 cell count from a normal level of 800 to 1200/mm³ and the development of certain cancers and opportunistic infections. The client does not have advanced HIV; they meet the criteria for the development of AIDS. The T4-cell count is not decreasing due to an infection.

A client with severe environmental allergies is scheduled for an immunotherapy injection. What should be included in teaching the client about this treatment? The client will be given a low dose of epinephrine before the treatment. The client will remain in the clinic to be monitored for 30 minutes following the injection. Therapeutic failure occurs if the symptoms to the allergen do not decrease after 3 months. The allergen will be given by the peripheral intravenous route.

The client will remain in the clinic to be monitored for 30 minutes following the injection. Explanation: Although severe systemic reactions are rare, the risk of systemic and potentially fatal anaphylaxis exists. Because of this risk, the client must remain in the office or clinic for at least 30 minutes after the injection and is observed for possible systemic symptoms. Therapeutic failure is evident when a client does not experience a decrease in symptoms within 12 to 24 months. Epinephrine is not given prior to treatment and the IV route is not used.

The thymus gland, a lymphoid tissue, programs T lymphocytes to become regulator or effector T cells. In which part of the life cycle does the thymus gland produce lymphocytes? fetal development after birth adolescence adulthood

fetal development Explanation: The thymus gland produces lymphocytes during fetal development. It may be the embryonic origin of other lymphoid structures such as the spleen and lymph nodes. After birth, the thymus gland programs T lymphocytes to become regulator or effector T cells. The thymus gland becomes smaller during adolescence but retains some activity throughout the life cycle.

A client with AIDS has become forgetful with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? distal sensory polyneuropathy (DSP) candidiasis AIDS dementia complex (ADC) cytomegalovirus (CMV)

AIDS dementia complex (ADC) Explanation: ADC, a neurologic condition, causes the degeneration of the brain, especially in areas that affect mood, cognition, and motor functions. Such clients exhibit forgetfulness, limited attention span, decreased ability to concentrate, and delusional thinking. DSP is characterized by abnormal sensations, such as burning and numbness in the feet and later in the hands. Candidiasis is a yeast infection that may develop in the oral, pharyngeal, esophageal, or vaginal cavities or in the folds of the skin. CMV infects the choroid and retinal layers of the eye, leading to blindness, and can also cause ulcers in the esophagus, colitis, diarrhea, pneumonia, and encephalitis.

The nurse is caring for a client whose most recent laboratory values reveal a neutrophil level of 21,000 mm3. When preparing to assess the client, the nurse should prioritize what assessment? Assessing the client for signs and symptoms of infection Assessing the client's activity level and functional status Assessing the client for indications of internal or external hemorrhage Assessing the client for signs of venous thromboembolism

Assessing the client for signs and symptoms of infection Explanation: Normal neutrophil levels range from 3,000 to 7,000 mm3. Levels rise in response to infection, so the nurse should monitor the client closely for signs and symptoms of infection. Increased neutrophil levels do not normally affect coagulation or energy levels.

A client has a known allergy to peanuts, meaning that the client's immune system has identified peanuts as a foreign invader and has produced specific cells to attack if the client should come in contact with peanuts again. The formation of these specific cells is known as: humoral response. cell-mediated response. inflammatory response. memory response.

humoral response. Explanation: The B-cell lymphocytes mature in the bone marrow and migrate to the spleen and other lymphoid tissues such as the lymph nodes. When stimulated by T cells, the B cells become either plasma or memory cells. Plasma cells produce antibodies. Formation of antibodies is called a humoral response.

Pathophysiology and Etiology of HIV: impairs the ability of infected T4 cells to recognize foreign antigens and stimulate B-cell lymphocytes

impairs the ability of infected T4 cells to recognize foreign antigens and stimulate B-cell lymphocytes

An infant is born to a mother who had no prenatal care during her pregnancy. What type of hypersensitivity reaction does the nurse understand may have occurred? Bacterial endocarditis Rh-hemolytic disease Lupus erythematosus Rheumatoid arthritis

Rh-hemolytic disease Explanation: A type II hypersensitivity, or cytotoxic, reaction, which involves binding either the IgG or IgM antibody to a cell-bound antigen, may lead to eventual cell and tissue damage. The reaction is the result of mistaken identity when the system identifies a normal constituent of the body as foreign and activates the complement cascade. Examples of type II reactions are myasthenia gravis, Goodpasture syndrome, pernicious anemia, hemolytic disease of the newborn, transfusion reaction, and thrombocytopenia.

stem cell

The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells. Stem cells comprise only a small portion of all types of bone marrow cells. Research conducted with mouse models has demonstrated that once the immune system has been destroyed experimentally, it can be completely restored with the implantation of just a few purified stem cells. Stem cell transplantation has been carried out in human subjects with certain types of immune dysfunction, such as severe combined immunodeficiency. Clinical trails are underway in clients with a variety of disorders with an autoimmune component, including systemic lupus erythematosus, rheumatoid arthritis, scleroderma, and multiple sclerosis.

What immunoglobulin is present in small amounts and is thought to be related to allergic responses? IgM IgG IgE IgA

IgE Explanation: Five different types of immunoglobulins have been identified: IgE is present in small amounts and seems to be related to allergic responses and to the activation of mast cells. The first immunoglobulin released is M (IgM), and it contains the antibodies produced at the first exposure to the antigen. IgG, another form of immunoglobulin, contains antibodies made by the memory cells that circulate and enter the tissue; most of the immunoglobulin found in the serum is IgG. IgA is found in tears, saliva, sweat, mucus, and bile. It is secreted by plasma cells in the GI and respiratory tracts and in epithelial cells. These antibodies react with specific pathogens that are

A client presents with itching, swelling, redness, and wheals of superficial skin layers. What is the most likely type of allergy this client is displaying? urticaria dermatitis medicamentosa contact dermatitis angioedema

Urticaria presents with itching, swelling, redness, and wheals of superficial skin layers. Dermatitis medicamentosa presents with sudden generalized bright red rash, itching, fever, malaise, headache, arthralgias. Contact dermatitis presents with itching, burning, redness, rash on contact with substance. Angioedema presents with itching, swelling, redness of deeper tissues and mucous membranes.

The nurse is caring for a patient in the hospital who is receiving a vitamin D supplement. What does the nurse understand is the importance of supplementation with this vitamin? (Select all that apply.) Vitamin D deficiency is associated with increased risk of common cancers. Vitamin D deficiency is associated with increased risk of autoimmune disease. Vitamin D deficiency is associated with increased risk of congenital anomalies. Vitamin D deficiency is associated with increased risk of inflammatory disorders. Vitamin D deficiency is associated with increased risk of celiac disease.

Vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, and inflammatory disorders (DiRosa, Malaguarnera, Nicoletti, et al., 2011).

The nurse is caring for a patient with an immunodeficiency disorder. What cardinal symptoms of immunodeficiency does the nurse recognize while caring for this patient? (Select all that apply.) Chronic diarrhea Nonproductive cough Chronic or recurrent severe infections Poor response to the treatment with antibiotics Vomiting

Chronic diarrhea Chronic or recurrent severe infections Poor response to the treatment with antibiotics

A patient is experiencing an allergic reaction to a dose of penicillin. What should the nurse look for in the patient's initial assessment? Dyspnea, bronchospasm, and/or laryngeal edema. Hypotension and tachycardia The presence and location of pruritus The severity of cutaneous warmth and flushing

Dyspnea, bronchospasm, and/or laryngeal edema. Explanation: Severe systemic, anaphylactic reactions have an abrupt onset with the same signs and symptoms described previously. These symptoms progress rapidly to bronchospasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension. Dysphagia (difficulty swallowing), abdominal cramping, vomiting, diarrhea, and seizures can also occur. Cardiac arrest and coma may follow.

A middle-aged woman will soon begin treatment for a gastric tumor that has just been discovered by endoscopy. The woman's natural killer (NK) cells are already actively opposing the tumor cells, because the tumor cells lack "self" markers of major histocompatibility complex (MHC) class I. This aspect of the patient's immune response is characteristic of: Active immunity Humoral immunity Phagocytic immunity Natural immunity

The action of NK cells is a component of natural immunity.

A client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit? type I type II type III type IV

type I There are four types of hypersensitivity responses, three of which are immediate. This is an example of Type I, atopic or anaphylactic, which is mediated by immunoglobulin E (IgE) antibodies.

The inflammatory response is an important nonspecific component of the immune system that is elicited in response to tissue injury or pathogens. A nurse is aware that dysfunctional inflammatory responses are responsible for numerous pathophysiological conditions. Which of the following patients most clearly exemplifies this? A 71-year-old woman who uses a quad cane because of mobility limitations brought on by rheumatoid arthritis A male patient who has begun chemotherapy after the discovery of colorectal cancer that has metastasized to his liver A woman who frequently experiences gastroesophageal reflux disease (GERD) after meals A 59-year-old man who has required the insertion of a urinary catheter because of urinary retention that resulted from benign prostatic hyperplasia (BPH)

A 71-year-old woman who uses a quad cane because of mobility limitations brought on by rheumatoid arthritis Explanation: Many diseases, such as arthritis, are the consequence of a dysfunctional inflammatory response. BPH, GERD, and cancer are not the result of inflammation.

While visiting the pediatric clinic with her 2 year old, a mother picks up a brochure about immunizations and asks about active and passive acquired immunity to childhood diseases. The nurse explains that immunizations are which of the following and why? Active acquired immunity, because the person's own body develops defenses Passive acquired immunity, because the defenses are developed from a substance given to the person Active acquired immunity, because the person develops defenses in response to a disease Passive acquired immunity, because the defenses are given to the person in the form of an immunization

Active acquired immunity, because the person's own body develops defenses Explanation: Active acquired immunity happens when the person's own body develops defenses. Passive acquired immunity happens when temporary immunity is transmitted from a source outside the body that has developed immunity through prior disease or immunization.

A hospital educator is reiterating the importance of Standard Precautions to a group of nursing students who will soon begin a clinical rotation on the unit. Which of the following statements best describes the application of Standard Precautions? Standard Precautions should be used when providing care for any patient who has a white blood cell (WBC) count of 10.8 × 109/L or greater. Standard Precautions should be applied in the care of any patient who has an actual or suspected primary or secondary immunodeficiency. Standard Precautions should be applied to patients regardless of diagnosis or presumed infectious status. Standard Precautions should be used in the care of any patient whose diagnosis is attributable to an infectious process.

Standard Precautions should be applied to patients regardless of diagnosis or presumed infectious status. Explanation: Standard Precautions incorporate the major features of Universal Precautions (designed to reduce the risk of transmission of bloodborne pathogens) and Body Substance Isolation (designed to reduce the risk of transmission of pathogens from moist body substances); they are applied to all patients in health care facilities regardless of their diagnosis or presumed infectious status.

A 16-year-old has been brought to the emergency department by his parents after falling through the glass of a storm door. The fall resulted in a 6 cm laceration of the right antecubital. The nurse caring for this patient knows that the site of the injury will have an invasion of what? Interferon Phagocytic cells Apoptosis Cytokines

Phagocytic cells Explanation: Monocytes also function as phagocytic cells, engulfing, ingesting, and destroying greater numbers and quantities of foreign bodies or toxins than granulocytes. This occurs in response to the foreign bodies that have invaded the laceration from the dirt on the broken glass. Interferon, one type of biologic response modifier, is a nonspecific viricidal protein that is naturally produced by the body and is capable of activating other components of the immune system. Apoptosis, or programmed cell death, is the body's way of destroying worn out cells such as blood or skin cells or cells that need to be renewed. Helper T cells are activated upon recognition of antigens and stimulate the rest of the immune system. When activated, helper T cells secrete cytokines that attract and activate B cells, cytotoxic T cells, natural killer cells, macrophages, and other cells of the immune system.

The nurse is conducting a community education program on allergies and anaphylactic reactions. The nurse determines that the participants understand the education when they make which statement about anaphylaxis? The most common cause of anaphylaxis is penicillin. Anaphylactoid (anaphylaxis-like) reactions are commonly fatal. The most common food item that causes anaphylaxis is chocolate. Systemic reactions include urticaria and angioedema.

The most common cause of anaphylaxis is penicillin. Explanation: The most common cause of anaphylaxis is penicillin, accounting for about 75% of fatal anaphylactic reactions in the United States. Although possibly severe, anaphylactoid reactions are rarely fatal. Food items that are common causes of anaphylaxis include peanuts, tree nuts, shellfish, fish, milk, eggs, soy, and wheat. Local reactions usually involve urticaria and angioedema at the site of the antigen exposure. Systemic reactions, which occur within about 30 minutes of exposure, involve cardiovascular, respiratory, gastrointestinal, and integumentary organ systems.

A nurse is reviewing the dietary history of a client who has experienced anaphylaxis. Which of the following would the nurse identify as a common cause of anaplhylaxis? Select all that apply? Milk Eggs Shrimp Beef Chicken

Common food causes of anaphylaxis include peanuts, tree nuts, shelfish, fish, milk, eggs, soy, and wheat. Beef and chicken are not common causes.

A patient arrives at the clinic and informs the nurse that she has a very sore throat as well as a fever. A rapid strep test returns a positive result and the patient is given a prescription for an antibiotic. How did the streptococcal organism gain access to the patient to cause this infection? Through the mucous membranes of the throat Through the skin Breathing in airborne dust From being outside in the cold weather and decreasing resistance

Through the mucous membranes of the throat Explanation: In a streptococcal throat infection, the streptococcal organism gains access to the mucous membranes of the throat.

The immune system is a complicated and intricate system that contains specialized cells and tissues that protect us from external invaders and our own altered cells. Which term is used to define any substances capable of inducing a specific immune response and of reacting with the products of that response? antigens antibodies lymphokines lymphocytes

antigens Explanation: Antigens, which are protein markers on cells, are substances capable of inducing a specific immune response and of reacting with the products of that response.

Telangiectasias

are vascular lesions caused by dilated blood vessels.

A gardener sustained a deep laceration while working and requires sutures. The patient is asked about the date of his last tetanus shot, which he tells the nurse was more than 10 years ago. Based on this information, the patient will receive a tetanus immunization. The tetanus injection will allow for the release of what? An antibody An antigen A bacteria A virus

An antibody Explanation: The structural part of the invading or attacking organism that is responsible for stimulating antibody production is called an antigen. For example, an antigen can be a small patch of proteins on the outer surface of the microorganism. Not all antigens are naturally immunogenic, and these must be coupled to other molecules to stimulate the immune response. A single bacterium or large molecule, such as diphtheria or tetanus toxin, may have several antigens, or markers, on its surface, thus inducing the body to produce a number of different antibodies. Bacteria are microorganisms. A virus is an organism that can cause disease.

The nurse is reviewing the medical record of a client who is positive for human immunodeficiency virus (HIV). The nurse notes that the client is classified as HIV asymptomatic based on which CD4+ T lymphocyte count? Less than 200/mm3 Between 200 to 350/mm3 Between 350 to 499/mm3 Greater than 500/mm3

A client is classified as HIV asymptomatic when the CD4+ T lymphocyte count is greater than 500/mm3. A person is considered HIV symptomatic when the CD4+ count is 200 to 499/mm3. A person is considered to have aquired immunodeficiency syndrome (AIDS) when the CD4+ count is less than 200/mm3.

A patient with common variable immunodeficiency (CVID) is extremely fatigued and not feeling well. What lab test does the nurse anticipate the patient will have to detect a common development related to the disease? Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) Blood urea nitrogen (BUN) and creatinine Glucose level B12 level

B12 level Explanation: More than 50% of patients with CVID develop pernicious anemia, a condition in which the body cannot make enough red blood cells due to an inability to absorb vitamin B12.

Which condition is associated with impaired immunity relating to the aging client? Antibody production increases Renal function decreases Skin becomes thicker Incidence of autoimmune disease decreases

Decreased renal circulation, filtration, absorption, and excretion contribute to the risk for urinary tract infections. Antibody production decreases, the skin becomes thinner, and the incidence of autoimmune disease increases with age.

A client is administered foscarnet to treat a case of CMV retinitis. Which adverse effect should the nurse closely monitor in the client? Electrolyte imbalances Hypotension Peripheral neuropathy Anemia

Electrolyte imbalances Explanation: Alterations in renal function, fever, nausea, electrolyte imbalances, and diarrhea are the most common adverse effects of foscarnet and should be closely monitored. The drug does not cause hypotension. On the other hand, peripheral neuropathy is an adverse effect of administering drugs such as didanosine and zalcitabine. Anemia is an adverse effect of administering zidovudine.

What intervention is a priority when treating a client with HIV/AIDS?

Fluid and electrolyte deficits are a priority in monitoring clients with HIV/AIDS, and assessment of fluid loss and electrolyte imbalance is essential. Skin integrity should be monitored but is a lower priority. Neurologic and psychological status should also be monitored, but this is not as high a priority as fluid and electrolyte imbalance.

An infant that is 10 hours postdelivery is observed to have tetanic contractions. What symptom does the nurse recognize can indicate DiGeorge syndrome? Chronic diarrhea Hypocalcemia Neutropenia Pernicious anemia

Hypocalcemia Explanation: Thymic hypoplasia, also known as DiGeorge syndrome, is associated with recurrent infections, hypoparathyroidism, hypocalcemia, tetany, convulsions, congenital heart disease, possible renal abnormalities, and abnormal facies.

Which immunoglobulin assumes a major role in bloodborne and tissue infections? IgA IgG IgM IgD

IgG assumes a major role in bloodborne and tissue infections. IgA protects against respiratory, gastrointestinal, and genitourinary infections. IgM appears as the first immunoglobulin produced in response to bacterial and viral infections. IgD possibly influences B-lymphocyte differentiation.

A 6-year-old client is diagnosed with a viral infection of the respiratory system. Which will most likely be trying to fight the antigen? Interferons Complements Self-antigens B cells

Interferon, one type of biologic response modifier, is a nonspecific viricidal protein that is naturally produced by the body and is capable of activating other components of the immune system. Interferons have antiviral and antitumor properties. In addition to responding to viral infection, interferons are produced by T lymphocytes, B lymphocytes, and macrophages in response to antigens. They are thought to modify the immune response by suppressing antibody production and cellular immunity.

Which type of immunity becomes active as a result of infection by a specific microorganism? Naturally acquired active immunity Artificially acquired active immunity Naturally acquired passive immunity Artificially acquired passive immunity

Naturally acquired active immunity Explanation: Naturally acquired active immunity occurs as a result of an infection by a specific microorganism. Artificially acquired active immunity results from the administration of a killed or weakened microorganism or toxoid. Passive immunity develops when ready-made antibodies are given to a susceptible individual.

A nurse educator is giving a lecture on autoimmunity. Included in the lecture are current theories that explain the development of autoimmune disorders. Which theories would the educator include? Select all that apply. cross-antigen theory viral mutation theory diminished T-suppressor theory tissue mutation theory

cross-antigen theory viral mutation theory diminished T-suppressor theory Explanation: The educator would include cross-antigen theory (self-antigens that resemble foreign antigens cause T cells to misidentify natural cells and mount an immune attack), viral mutation theory (viruses alter T-cell receptors that are used to differentiate self from nonself), and diminished T-suppressor theory (reduced numbers of suppressor cells or a shortened life span because of aging and atrophy of the thymus gland alter immunoregulation). Tissue mutation theory is not a current theory that explains the development of autoimmune disorders.

The body has several mechanisms to fight disease, one of which is sending chemical messengers. The messengers released by lymphocytes, monocytes, and macrophages have differing roles in the immune response. Which messenger enables cells to resist viral replication and slow viral replication? interferons interleukins tumor necrosis factor colony-stimulating factorI

nterferons are chemicals that primarily protect cells from viral invasion. They enable cells to resist viral infection and slow viral replication. They have been used as adjunctive therapy in the treatment of AIDS. Interferons also have been used to treat some forms of cancer such as leukemia because they stimulate NK cell activity. Interferon is administered parenterally because digestive enzymes destroy its protein structure.

A mother has come to the emergency department (ED) with her 2-year-old who appears to be having a hypersensitivity reaction. The ED nurse knows that a hypersensitivity reaction may be characterized by an immediate reaction beginning within minutes of exposure to an antigen. What condition is an example of such a reaction? Anaphylactic reaction immediately following a bee sting Skin reaction from tape adhesive Hay fever Rheumatoid arthritis

Anaphylactic reaction immediately following a bee sting Explanation: Anaphylactic (type I) hypersensitivity is an immediate reaction mediated by IgE antibodies and requires previous exposure to the specific antigen. Type II reactions, or cytotoxic hypersensitivity, occur when the system mistakenly identifies a normal constituent of the body as foreign. Type III, or immune complex hypersensitivity, occurs as the result of two factors, the increased amount of circulating complexes and the presence of vasoactive amines. Type IV, or delayed-type hypersensitivity, occurs 24 to 72 hours after exposure to an allergen and is mediated by sensitized T-cells and macrophages.

A client has recently been diagnosed with rheumatoid arthritis, and is also receiving further testing for disorders of the immune system. The client works as an aide at a facility caring for children infected with AIDS. Which factors will hold significant implications during the client's assessment? Select all that apply. work environment history of immunizations and allergies use of other drugs age diet Her home environment

It is important for the nurse to obtain a history of past immunizations and infectious diseases, any allergies, and any recent exposure to infectious diseases. The nurse also needs to review the client's drug history. These data will help the nurse to assess the client's susceptibility to illness because certain past illnesses and drugs, such as corticosteroids, suppress the inflammatory and immune responses. The nurse should question the client about the practices that put her at risk for AIDS, such as her work environment. The client's age, home environment, and diet do not have any major implications during the assessment because they do not indicate the client's susceptibility to illness. work environment history of immunizations and allergies use of other drugs

A client has been diagnosed with HIV and has been placed on antiretroviral therapy. What does the nurse inform the client will be required for determining the progression of the disease as well as guiding drug therapy? The client will be required to stop medication for 2 weeks and then have laboratory studies drawn to determine if the antiretroviral therapy has cured the disease. Viral load and T4-cell counts will be performed every 2 to 3 months. More antiretroviral medication will be added every 2 to 3 months. The Western blot test will be monitored every 6 months to see if the virus is still present.

Viral load testing is used to guide drug therapy and follow the progression of the disease. Viral load tests and T4-cell counts may be performed every 2 to 3 months once it is determined that a person is HIV positive. The medication should be adhered to and not discontinued. There is no cure for the disease at this time. Antiretroviral therapy is not generally changed or added to without reason or lack of response. The Western blot is used for confirmation of the presence of the HIV virus

x A nurse is aware of the important role that interferons (IFNs) perform in the normal function of the immune system. As well, the nurse has provided care for patients who have benefited from interferon therapy. IFN therapy is most likely to be effective in the treatment of which of the following patients? An 80-year-old man who is debilitated from Clostridium difficile-related diarrhea A 68-year-old woman who is being treated for chronic myeloid leukemia (CML) A 60-year-old man with motor and sensory deficits resulting from an ischemic stroke A 36-year-old woman who is in danger of developing sepsis after suffering full-thickness burns

A 68-year-old woman who is being treated for chronic myeloid leukemia (CML) Explanation: IFNs are cytokines. They have antiviral and antitumor properties and can consequently be used in the treatment of neoplasms such as CML. Bacterial infections and neurological deficits are not responsive to interferon therapy.

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic? You Selected: HIV-1 is more prevalent than HIV-2 subtypes Correct response: HIV-1 is more prevalent than HIV-2 subtypes Explanation: Two HIV subtypes have been identified: HIV-1 and HIV-2. HIV-1 mutates easily and frequently, producing multiple substrains that are identified by letters from A through O. HIV-2 is less transmittable, and the interval between initial infection with HIV-2 and development of AIDS is longer. HIV-1 is more prevalent in the United States and in the rest of the world. Western Africa is the primary site of infection with HIV-2. There is no cure for HIV/AIDS; hence, no cure rate. The virus is thought to be a mutation of a simian virus. Transmission of the virus is not a characteristic.

HIV-1 is more prevalent than HIV-2 subtypes Explanation: Two HIV subtypes have been identified: HIV-1 and HIV-2. HIV-1 mutates easily and frequently, producing multiple substrains that are identified by letters from A through O. HIV-2 is less transmittable, and the interval between initial infection with HIV-2 and development of AIDS is longer. HIV-1 is more prevalent in the United States and in the rest of the world. Western Africa is the primary site of infection with HIV-2. There is no cure for HIV/AIDS; hence, no cure rate. The virus is thought to be a mutation of a simian virus. Transmission of the virus is not a characteristic.

A nursing instructor is giving a lecture on the immune system. The instructor's discussion on phagocytosis will include: neutrophils and monocytes. plasma cells and memory cells. regulator T cells and helper T cells. lymphokines and suppressor T cells.

Neutrophils and monocytes are phagocytes, cells that perform phagocytosis.