Chapter 33: Introduction to the Immune System

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

a

A client has undergone treatment for urosepsis and received high doses of numerous antibiotics during the course of treatment. When planning the client's subsequent care, the nurse should be aware of what potential effect on the client's immune function? a. Bone marrow suppression b. Uncontrolled apoptosis c. Thymus atrophy d. Lymphoma

a Large doses of antibiotics can precipitate bone marrow suppression, affecting immune function. Antibiotics are not noted to cause apoptosis, thymus atrophy, or lymphoma.

Which of the following protective responses begin with the B lymphocytes? a. Humoral b. Phagocytic c. Cellular d. Recognition

a 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.

During a mumps outbreak at a local school, a patient, who is a school teacher, is exposed. She has previously been immunized for mumps. What type of immunity does she possess? a. Acquired immunity b. Natural immunity c. Phagocytic immunity d. Humoral immunity

a Acquired immunity usually develops as a result of prior exposure to an antigen through immunization. When the body is attacked by bacteria, viruses, or other pathogens, it has three means of defense. The first line of defense, the phagocytic immune response, involves the white blood cells (WBCs), which have the ability to ingest foreign particles. A second protective response is the humoral immune response, which begins when the B lymphocytes transform themselves into plasma cells that manufacture antibodies. The natural immune response system is rapid, nonspecific immunity present at birth.

During a mumps outbreak at a local school, a teacher has been exposed. The client has previously been immunized for mumps, and consequently possesses: a. acquired immunity. b. natural immunity. c. phagocytic immunity. d. humoral immunity.

a Acquired immunity usually develops as a result of prior exposure to an antigen, often through immunization. When the body is attacked by bacteria, viruses, or other pathogens, it has three means of defense. The first line of defense, the phagocytic immune response, involves the WBCs that have the ability to ingest foreign particles. A second protective response is the humoral immune response, which begins when the B lymphocytes transform themselves into plasma cells that manufacture antibodies. The natural immune response system is rapid, nonspecific immunity present at birth.

An infection control nurse is presenting an in-service reviewing the immune response. The nurse describes the clumping effect that occurs when an antibody acts like a cross-link between two antigens. What process is the nurse explaining? a. Agglutination b. Cellular immune response c. Humoral response d. Phagocytic immune response

a Agglutination refers to the clumping effect occurring when an antibody acts as a cross-link between two antigens. This takes place within the context of the humoral immune response, but is not synonymous with it. Cellular immune response, the immune system's third line of defense, involves the attack of pathogens by T-cells. The phagocytic immune response, or immune response, is the system's first line of defense, involving white blood cells that have the ability to ingest foreign particles.

Which of the following cell types are involved in humoral immunity? a. B lymphocytes b. Helper T lymphocyte c. Suppressor T lymphocyte d. Memory T lymphocyte

a B lymphocytes are involved in the humoral immune response. T lymphocytes are involved in cellular immunity.

A client with a history of dermatitis takes corticosteroids on a regular basis. The nurse should assess the client for which of the following complications of therapy? a. Immunosuppression b. Agranulocytosis c. Anemia d. Thrombocytopenia

a Corticosteroids such as prednisone can cause immunosuppression. Corticosteroids do not typically cause agranulocytosis, anemia, or low platelet counts.

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? a. effector T cells b. helper T cells c. suppressor T cells d. regulator T cells

a Effector T cells are killer (cytotoxic) cells.

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? a. They are activated on recognition of antigens and stimulate the rest of the immune system. b. They attack the antigen directly by altering the cell membrane and causing cell lysis. c. They have the ability to decrease B-cell production. d. They are responsible for recognizing antigens from previous exposure and mounting an immune response.

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

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? a. IgG b. IgA c. IgM d. IgD

a 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.

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? a. All options are correct. b. neutralization c. agglutination d. precipitation

a 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.

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

a 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.

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? a. interferons b. interleukins c. tumor necrosis factor d. colony-stimulating factor

a 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.

Which immunity type becomes active as a result of infection by a specific microorganism? a. naturally acquired active immunity b. artificially acquired active immunity c. naturally acquired passive immunity d. artificially acquired passive immunity

a Naturally acquired active immunity occurs as a direct result of an infection by a specific microorganism.

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

a Neutrophils and monocytes are phagocytes, cells that perform phagocytosis.

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

a 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 nurse is taking the health history of a newly admitted client. Which condition would place the client at risk for impaired immune function? a. Previous organ transplantation b. Surgical removal of the appendix c. Negative history for radiation therapy d. Surgical history of a partial gastrectomy

a Organ transplantaion requires immunosupressive drugs, which cause impaired immune function. Removal of the appendix or stomach would have no effect on the immune system. A positive history for radiation therapy would affect the immune system, but not a negative history.

A client who has developed kidney failure is discussing options with the health care provider for treatment. What does the nurse understand that kidney failure is associated with? a. A deficiency in circulating lymphocytes b. A deficiency in phosphorus c. Decreased amount of WBCs d. Increased amount of macrophages

a Renal failure is associated with a deficiency in circulating lymphocytes.

A client's health care provider suspects the client has developed an immune system disorder. What will most likely be the first test ordered? a. CBC with differential b. blood chemistry c. complete blood count (CBC) d. liver enzyme studies

a The differential count measures the different types of white blood cells and compares their amounts to the total count. It is usually done by a machine (automated differential) but it can be done by a technologist who hand-counts the cells using a microscope (manual differential). This test would be ordered if the provider suspects something abnormal in the immune system.

A client undergoing a skin test has been intradermally injected with a disease-specific antigen on the inner forearm. The client becomes anxious because the area begins to swell. What advice should the nurse give to calm the client? a. Assure the client that this is a normal reaction. b. Advise the client to use prescribed analgesics. c. Apply ice packs to reduce the swelling. d. Gently rub the swollen area to accelerate the blood flow.

a The nurse should assure the client that this is a normal reaction. When disease-specific antigens are injected, the injection area swells as a result of the client developing antibodies against the antigen introduced. The nurse should also keep in mind that the client is not necessarily actively infectious if the test results are positive.

Which is the most important guideline for a nurse caring for immunosuppressed clients? a. Follow the guidelines of the agency for controlling infections. b. Ensure a balanced and varied diet. c. Maintain a serene atmosphere. d. Uplift the morale of such clients.

a The nurse should follow agency guidelines for controlling infectious diseases or protecting the client who is immunosuppressed.

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? a. An antibody b. An antigen c. A bacteria d. A virus

a 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.

A client has been diagnosed with breast cancer and is being treated aggressively with a chemotherapeutic regimen. As a result of this regimen, the client has an inability to fight infection because bone marrow is unable to produce a sufficient amount of: a. lymphocytes. b. cytoblasts. c. antibodies. d. capillaries.

a The white blood cells involved in immunity (including lymphocytes) are produced in the bone marrow. Cytoblasts are the protoplasm of the cell outside the nucleus. Antibodies are produced by lymphocytes, but not in the bone marrow. Capillaries are small blood vessels

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? a. Lymphocytes b. Cytoblasts c. Antibodies d. Capillaries

a 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.

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. a. intestines b. lungs c. stomach d. kidneys e. brain

a, b 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.

An older client doesn't understand why advancing age increases susceptibility to illness. What will be included in the nurse's explanation? Select all that apply. a. The body's number of T-cell lymphocytes decreases with age. b. The amount of antibody produced in response to most foreign antigens decreases with age. c. The body's number of B-cell lymphocytes decreases with age. d. The body's lymphoid tissue decreases with age.

a, b The body's number of T-cell lymphocytes decreases with age, which may be the result of gradual degeneration of the thymus gland. This change decreases the activity of the immune system, which increases the older client's risk for immunity-related problems. The amount of antibody produced in response to most foreign antigens decreases with age. Older adults should have an annual influenza vaccine and a pneumococcal vaccine repeated.

What types of cells are the primary targets of the healthy immune system? Select all that apply. a. infectious cells b. foreign cells c. cancerous cells d. typical cells

a, b, c The immune system's primary targets are infectious, foreign, or cancerous cells.

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.) a. Vitamin D deficiency is associated with increased risk of common cancers. b. Vitamin D deficiency is associated with increased risk of autoimmune disease. c. Vitamin D deficiency is associated with increased risk of congenital anomalies. d. Vitamin D deficiency is associated with increased risk of inflammatory disorders. e. Vitamin D deficiency is associated with increased risk of celiac disease.

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

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? a. Eosinophils b. Neutrophils c. B cells d. Monocytes

b

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

b 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.

The nurse should recognize a client's risk for impaired immune function if the client has undergone surgical removal of which of the following? a. Thyroid gland b. Spleen c. Kidney d. Pancreas

b A history of surgical removal of the spleen, lymph nodes, or thymus may place the client at risk for impaired immune function. Removal of the thyroid, kidney, or pancreas would not directly lead to impairment of the immune system.

A patient is admitted with an infected leg, and the nurse notes an increase in his white blood cell (WBC) count. The nurse is aware that, during the immune response, pathogens are engulfed by WBCs that ingest foreign particles. What is this process known as? a. Apoptosis b. Phagocytosis c. Antibody response d. Cellular immune response

b During the first mechanism of defense, WBCs, which have the ability to ingest foreign particles, move to the point of attack, where they engulf and destroy the invading agents. This is known as phagocytosis. The action described is not apoptosis, antibody response, or a cellular immune response.

A client is admitted with cellulitis and experiences a consequent increase in white blood cell count. During what process will pathogens be engulfed by white blood cells that ingest foreign particles? a. Apoptosis b. Phagocytosis c. Antibody response d. Cellular immune response

b During the first mechanism of defense, white blood cells, which have the ability to ingest foreign particles, move to the point of attack, where they engulf and destroy the invading agents. This is known as phagocytosis. The action described is not apoptosis (programmed cell death) or an antibody response. Phagocytosis occurs in the context of the cellular immune response, but it does not constitute the entire cellular response.

Our bodies contain a variety of immunoglobulins. Which of these immunoglobulins is found in sweat, tears, mucus, and bile? a. IgG b. IgA c. IgM d. IgE

b 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.

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? a. An 80-year-old man who is debilitated from Clostridium difficile-related diarrhea b. A 68-year-old woman who is being treated for chronic myeloid leukemia (CML) c. A 60-year-old man with motor and sensory deficits resulting from an ischemic stroke d. A 36-year-old woman who is in danger of developing sepsis after suffering full-thickness burns

b 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.

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

b 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.

All the following items are related to cancer. Which does not affect the immune system? a. Altered production of lymphocytes b. Diagnostic tests for cancer c. Radiation treatment d. Chemotherapy

b Immunosuppression contributes to the development of cancers; however, cancer itself is immunosuppressive. Diagnostic tests do not cause cancer. Radiation and chemotherapy decrease immune competency.

A 16-year-old has been brought to the emergency department by his parents after falling through the glass of a patio door, suffering a laceration. The nurse caring for this client knows that the site of the injury will have an invasion of what? a. Interferons b. Phagocytic cells c. Apoptosis d. Cytokines

b Monocytes migrate to injury sites and 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. Cytokines are the various proteins that mediate the immune response. These do not migrate to injury sites.

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? a. Previous organ transplantation b. Surgical removal of the appendix c. History of radiation therapy d. Surgical history of a splenectomy

b 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.

The nurse is assessing a client's risk for impaired immune function. What assessment finding should the nurse identify as a risk factor for decreased immunity? a. The client takes a beta blocker for the treatment of hypertension. b. The client is under significant psychosocial stress. c. The client had a pulmonary embolism 18 months ago. d. The client has a family history of breast cancer.

b Stress is a psychoneuroimmunologic factor that is known to depress the immune response. Use of beta blockers, a family history of cancer, and a prior PE are significant assessment findings, but none represents an immediate threat to immune function.

A nurse is explaining how the humoral and cellular immune responses should be seen as interacting parts of the broader immune system rather than as independent and unrelated processes. What aspect of immune function best demonstrates this? a. The movement of B cells in and out of lymph nodes b. The interactions that occur between T cells and B cells c. The differentiation between different types of T cells d. The universal role of the complement system

b T cells interact closely with B cells, indicating that humoral and cellular immune responses are not separate, unrelated processes, but rather branches of the immune response that interact. Movement of B cells does not clearly show the presence of a unified immune system. The differentiation between types of T cells and the role of the complement system does not directly suggest a single immune system.

Which condition is associated with impaired immunity relating to the aging client? a. Increase in humoral immunity b. Breakdown and thinning of the skin c. Decrease in inflammatory cytokines d. Increase in peripheral circulation

b The aging process stimulates changes in the immune system. Age-related changes in many body systems also contribute to impaired immunity. Changes such as poor circulation, as well as the breakdown of natural mechanical barriers such as the skin, place the aging immune system at even greater disadvantage against infection. As the immune system undergoes age-associated alterations, its response to infections progressively deteriorates. Humoral immunity declines and the number of inflammatory cytokines increase with age.

A gerontologic nurse is caring for an older adult client who has a diagnosis of pneumonia. What age-related change increases older adults' susceptibility to respiratory infections? a. Atrophy of the thymus b. Bronchial stenosis c. Impaired ciliary action d. Decreased diaphragmatic muscle tone

c As a consequence of impaired ciliary action due to exposure to smoke and environmental toxins, older adults are vulnerable to lung infections. This vulnerability is not the result of thymus atrophy, stenosis of the bronchi, or loss of diaphragmatic muscle tone.

A client's natural immunity is enhanced by processes that are inherent in the physical and chemical barriers of the body. What is a chemical barrier that enhances natural immunity? a. Cell cytoplasm b. Interstitial fluid c. Gastric secretions d. Cerebrospinal fluid

c Chemical barriers, such as mucus, acidic gastric secretions, enzymes in tears and saliva, and substances in sebaceous and sweat secretions, act in a nonspecific way to destroy invading bacteria and fungi. Not all body fluids are chemical barriers, however. Cell cytoplasm, interstitial fluid, and CSF are not normally categorized as chemical barriers to infection.

A nurse is reviewing a client's medication administration record in an effort to identify drugs that may contribute to the client's recent immunosuppression. What drug is most likely to have this effect? a. An antibiotic b. A nonsteroidal anti-inflammatory drug (NSAID) c. An antineoplastic d. An antiretroviral

c Chemotherapy affects bone marrow function, destroying cells that contribute to an effective immune response and resulting in immunosuppression. Antibiotics in large doses cause bone marrow suppression, but antineoplastic drugs have the most pronounced immunosuppressive effect. NSAIDs and antiretrovirals do not normally have this effect.

A client's current immune response involves the direct destruction of foreign microorganisms. This aspect of the immune response may be performed by what cells? a. Suppressor T cells b. Memory T cells c. Cytotoxic T cells d. Complement T cells

c Cytotoxic T cells (also called CD8 + cells) participate in the destruction of foreign organisms. Memory T cells and suppressor T cells do not perform this role in the immune response. The complement system does not exist as a type of T cell.

A nurse is admitting a client who exhibits signs and symptoms of a nutritional deficit. Inadequate intake of what nutrient increases a client's susceptibility to infection? a. Vitamin B12 b. Unsaturated fats c. Proteins d. Complex carbohydrates

c Depletion of protein reserves results in atrophy of lymphoid tissues, depression of antibody response, reduction in the number of circulating T cells, and impaired phagocytic function. As a result, the client has an increased susceptibility to infection. Low intake of fat and vitamin B12 affects health, but is not noted to directly create a risk for infection. Low intake of complex carbohydrates is not noted to constitute a direct risk factor for infection.

A nurse has been administering seasonal influenza vaccinations to the residents of a long-term care facility. One resident has refused the vaccinations, stating that he believes the vaccination to be a cause of influenza infection rather than a protection against it. The nurse's response to this resident should encompass which of the following facts about vaccination? a. Vaccination confers life-long immunity against influenza. b. A vaccine is directly cytotoxic to the influenza virus. c. Vaccination against influenza means that future exposure does not require an immune response. d. Vaccination prompts the body to produce antibodies against influenza.

c Exposure to attenuated virus, such as the influenza vaccine, prompts the production of antibodies against influenza. Immunity may be long-lasting, but is often not life-long. Re-exposure to influenza initiates a cascade of immune responses that are more rapid and capable of controlling the virus. Patients either eliminate the virus from their system or have a milder case of influenza. The vaccine prompts an immune response; it is not cytotoxic to the microorganism in question.

What immunoglobulin is present in small amounts and is thought to be related to allergic responses? a. IgM b. IgG c. IgE d. IgA

c 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.

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. a. Ig A b. Ig D c. Ig E d. Ig G

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

A nurse is planning the assessment of a client who is exhibiting signs and symptoms of an autoimmune disorder. The nurse should be aware that the incidence and prevalence of autoimmune diseases is known to be higher among what group? a. Young adults b. Native Americans/First Nations c. Women d. Hispanics

c Many autoimmune diseases have a higher incidence in females than in males, a phenomenon believed to be correlated with sex hormones.

A client requires ongoing treatment and infection-control precautions because of an inherited deficit in immune function. The nurse should recognize that this client most likely has what type of immune disorder? a. A primary immune deficiency b. A gammopathy c. An autoimmune disorder d. A rheumatic disorder

c Primary immune deficiency results from improper development of immune cells or tissues. These disorders are usually congenital or inherited. Autoimmune disorders are less likely to have a genetic component, though some have a genetic component. Overproduction of immunoglobulins is the hallmark of gammopathies. Rheumatic disorders do not normally involve impaired immune function.

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

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

An individual's exposure to an airborne pathogen has prompted an immune response that includes both cellular and humoral components. Which of the following activities is most closely associated with the humoral immune response? a. T cells directly attack the foreign pathogen. b. A circulating lymphocyte containing an antigenic message returns to the nearest lymph node. c. B lymphocytes produce antibodies that are specific to the pathogen. d. Granulocytes and macrophages engulf and destroy the invading agents.

c The humoral response is characterized by the production of antibodies by B lymphocytes in response to a specific antigen. T cells are more closely associated with cellular immunity, and the action of circulating lymphocytes containing antigenic messages is associated with the proliferation stage that precedes the humoral and cellular response. Phagocytic immunity is associated with the actions of granulocytes and macrophages.

The 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: a. Upper mediastinum. b. Lower right abdomen. c. Upper left quadrant of the abdomen. d. Lower margin around the liver.

c The spleen is located to the left of the stomach, in the upper left of the abdomen. It plays an important role in the immune system.

A 44-year-old man has come to the clinic with an asthma exacerbation. He tells the nurse that his father and brother also suffer from asthma, as does his 15-year-old son. The nurse explains that this is an allergic response based on a genetic predisposition. The specific allergen initiated by immunological mechanisms is usually mediated by what? a. Immunoglobulin A b. Immunoglobulin M c. Immunoglobulin G d. Immunoglobulin E

d Allergic reactions characterized by the action of IgE antibodies and a genetic predisposition to allergic reactions are found in diseases like asthma. IgG is the most common immunoglobulin and is found in intravascular and intercellular compartments. IgA and IgM are found in mucous secretions.

A patient tells the nurse, "I can't believe I have ineffective immune function and am getting sick again. I exercise rigorously and compete regularly." What is the best response by the nurse? a. "Something must be seriously wrong. You should not be getting sick since you are so healthy." b. "Maybe you need to stop exercising so much. It can't be good for you." c. "It is possible that you are immunocompromised and may have HIV." d. "Rigorous exercise can cause negative effects on immune response."

d Although factors that are not consistent with a healthy lifestyle are predominately responsible for ineffective immune function, positive lifestyle factors can also negatively affect immune function and require assessment. For example, rigorous exercise or competitive exercise— usually considered a positive lifestyle factor—can be a physiologic stressor and cause negative effects on immune response (Walsh, Gleeson, Shephard, et al., 2011).

An emergency department (ED) nurse has provided care for many patients who have primary and secondary diagnoses of immune dysfunction. Which of the following patients likely has the highest risk of a disruption to normal immune functioning? a. A woman who was motivated to come to the ED because of a severe migraine b. A woman who presented for care for a complaint of vertigo c. A child who has just been treated for a greenstick fracture to her radius d. A man who has recently completed medical treatment for prostate cancer

d Cancer treatments, such as chemotherapy and radiotherapy, have a direct effect on the immune system. Health problems such as orthopedic trauma and neurological diseases are less likely to directly impair normal immune function.

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? a. Macrophages b. Helper T cells c. B cells d. Cytotoxic T cells

d 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.

A client is being treated for cancer and the nurse has identified the nursing diagnosis of Risk for Infection Due to Protein Losses. Protein losses inhibit immune response in what way? a. Causing apoptosis of cytokines b. Increasing interferon production c. Causing CD4+ cells to mutate d. Depressing antibody response

d Depletion of protein reserves results in atrophy of lymphoid tissues, depression of antibody response, reduction in the number of circulating T cells, and impaired phagocytic function. This specific nutritional deficit does not cause T-cell mutation, an increase in the production of interferons, or apoptosis of cytokines.

A 34-year-old client is diagnosed with chronic hepatitis C. Testing reveals that the client is a candidate for treatment. The nurse anticipates that which therapy could be used to treat the client's condition? a. Erythropoietin b. Interleukin-5 c. Monoclonal antibodies d. Interferon

d Interferons are used to treat immune-related disorders (e.g., multiple sclerosis) and chronic inflammatory conditions (e.g., chronic hepatitis).

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: a. Antibodies reside in the plasma b. Antibodies are released into the bloodstream c. B-lymphocytes respond to a specific antigen d. Lymphocytes migrate to areas of the lymph node

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

A client's injury has initiated an immune response that involves inflammation. What are the first cells to arrive at this client's site of inflammation? a. Eosinophils b. Red blood cells c. Lymphocytes d. Neutrophils

d Neutrophils are the first cells to arrive at the site where inflammation occurs. Eosinophils increase in number during allergic reactions and stress responses, but are not always present during inflammation. RBCs do not migrate during an immune response. Lymphocytes become active but do not migrate to the site of inflammation.

A nurse is reviewing the immune system before planning an immunocompromised client's care. How should the nurse characterize the humoral immune response? a. Specialized cells recognize and ingest cells that are recognized as foreign. b. T lymphocytes are assisted by cytokines to fight infection. c. Lymphocytes are stimulated to become cells that attack microbes directly. d. Antibodies are made by B lymphocytes in response to a specific antigen.

d The humoral response is characterized by the production of antibodies by B lymphocytes in response to a specific antigen. Phagocytosis and direct attack on microbes occur in the context of the cellular immune response.