Hes adaptive quizzess: immunity
Which medication class helps to prevent human immunodeficiency virus (HIV) incorporating its genetic material into the client's cell? 1 Entry inhibitors 2 Protease inhibitors 3 Integrase inhibitors 4 Reverse transcriptase inhibitors
3 Integrase inhibitors Integrase inhibitors such as raltegravir and dolutegravir bind with integrase enzymes and prevent HIV from incorporating its genetic material into the host (client's) cell. Entry inhibitors prevent the binding of HIV. Protease inhibitors prevent the protease enzyme from cutting HIV proteins into the proper lengths needed to allow viable virions to assemble. Reverse transcriptase inhibitors inhibit the action of reverse transcriptase
Which manifestations may indicate a client has systemic lupus erythematosus (SLE)? Select all that apply. a) percaditis b) esophagitis c) fibrotc skin d) discoid lesion e) pleural effusions
a) percaditis d) discoid lesion (sore w/ inflammation and scarring) e) pleural effusions
Which action should the nurse take when caring for a client who is suspected as having the Ebola virus? 1 Consider cohorting the client 2 Wear a face mask and gown at all times 3 Follow standard and droplet precautions 4 Avoid contact with all body fluids and discharges
4 Avoid contact with all body fluids and discharges
A client has colorectal cancer and is receiving cetuximab. Which process does cetuximab inhibit? 1 Proteasome activity 2 BCR-ABL tyrosine kinase (TK) 3 Anaplastic lymphoma kinase 4 Epidermal growth factor receptors (EGFRs)
4 Epidermal growth factor receptors (EGFRs) Cetuximab is an EGFR-tyrosine TK inhibitor that acts by inhibiting EGFRs in clients with colorectal cancer. Bortezomib inhibits proteasome activity in clients with multiple myeloma. Dasatinib acts by inhibiting BCR-ABL TK in clients with chronic myeloid leukemia. Crizotinib acts by inhibiting anaplastic lymphoma kinase (ALK) in clients with locally advanced or metastatic non-small cell lung cancer that is ALK positive.
While reviewing a client's laboratory reports, the nurse finds a neutrophil count of 12,000/mm3. Which condition may be present in this client? 1 Influenza 2 Pneumonia 3 Immunosuppression 4 Autoimmune disorder
2) penumonia normal leukocyte count is 5,000-10,000 a count of 12,000 indicate infection which could be the pheumonia or inflammation viral may happen when neutrophil count is low immunosupression and autoimmune disorder may result from a decreased leukocyte count
A client with tuberculosis is prescribed rifampin. What does the nurse teach the client about this medication? Select all that apply. 1 "Avoid drinking alcohol while you are on this drug." 2 "Report immediately if you find a yellow appearance to the skin." 3 "Wear a protective clothing and sunscreen when going out in sunlight." 4 "Your soft contact lenses will become permanently stained with this drug." 5 "Immediately consult your physician if you find reddish orange tinge in your urine."
1 "Avoid drinking alcohol while you are on this drug." 2 "Report immediately if you find a yellow appearance to the skin." 4 "Your soft contact lenses will become permanently stained with this drug." Rifampin is an antitubercular drug that kills slow-growing organisms residing in the caseating granulomas. Rifampin may cause liver damage, so alcohol should be avoided as it potentiates liver damage. Yellow appearance to the skin is a sign of liver failure. Therefore, a client on rifampin therapy is taught to report the presence of any yellowing of the skin. Rifampin permanently stains soft contact lenses and therefore the client is made aware to avoid wearing them while on the medication. Pyrazinamide causes photosensitivity reactions and therefore a client on that drug therapy is advised to wear protective clothing and sunscreen when going outdoors. The nurse should inform the client that rifampin changes the color of body secretions, which is normal and harmless.
What should the nurse explain as the reason a client prescribed corticosteroid therapy for a chronic health problem develops frequent infections? 1 "They affect antigen-antibody immunity." 2 "They enhance the inflammatory process." 3 "The medication makes the white blood cells work harder." 4 "They increase the number of inflammatory chemicals in the blood."
1 "They affect antigen-antibody immunity." Corticosteroids reduce the number of circulating T-cells and suppress cell-mediated immunity. They also interfere with immunoglobulin G (IgG) production and reduce antibody-antigen binding. Corticosteroids suppress the inflammatory process, block the movement of white blood cells, and disrupt the synthesis of a variety of inflammatory chemicals.
A client has been prescribed tacrolimus for immunosuppressant therapy. Which drug safety alert should the nurse mention? 1 Do not consume grapefruit or grapefruit juice. 2 Take acetaminophen before taking tacrolimus. 3 Once-a-day doses should be taken at bedtime (at least initially). 4 The client should make sure to report any vivid or bizarre dreams.
1 Do not consume grapefruit or grapefruit juice.
The nurse has administered lymphocyte immunoglobulin to a client. Which side effects are most likely to occur? Select all that apply. 1 Leukopenia 2 Peptic ulcer 3 tachycardia 4 Serum sickness 5 Urinary infection
1 Leukopenia 3 tachycardia 4 Serum sickness Lymphocyte immunoglobulin is an immunosuppressant directed against T-lymphocytes. Tachycardia, leukopenia, and serum sickness are side effects associated with lymphocyte immunoglobulin therapy. Peptic ulcers may occur when corticosteroids are injected. A urinary infection may occur when an immunosuppressant such as belatacept is administered.
Which leukocyte values should be assessed to determine the adequacy of a client's response to inflammation? Select all that apply. 1 Monocytes 2 Neutrophils 3 Plasma cells 4 T-helper cells 5 Macrophages
1 Monocytes 2 Neutrophils 5 Macrophages In response to inflammation, monocytes destroy bacteria and cellular debris; neutrophils ingest and phagocytize microorganisms and foreign protein; and macrophages destroy bacteria and cellular debris. Plasma cells are a part of antibody-mediated immunity and secrete immunoglobulins in response to the presence of a specific antigen. T-helper cells are a part of cell-mediated immunity and enhance immune activity through the secretion of various factors, cytokines, and lymphokines.
While assessing a client with acquired immunodeficiency syndrome (AIDS), the nurse suspects that the client has developed cryptococcosis. Which clinical manifestations support the nurse's suspicion of a cryptococcosis infection? Select all that apply. 1 Seizures 2 Dyspnea 3 Blurred vision 4 Neurologic deficits 5 Enlarged lymph nodes
1 Seizures 3 Blurred vision 4 Neurologic deficits Seizures, neurologic problems/deficits, and blurred vision are the manifestations of cryptococcosis. Cryptococcosis is a debilitating meningitis and can be a widely spread infection in clients who have AIDS. It is caused by Cryptococcus neoformans. Histoplasmosis is a respiratory infection caused by Histoplasma capsulatum, which progresses to widespread infection in a client with AIDS. The symptoms of histoplasmosis are dyspnea and enlarged lymph nodes.
Why would a primary healthcare provider recommend that a client with acquired immunodeficiency syndrome (AIDS) and Kaposi's sarcoma (KS) wear hats and long sleeves? 1 To maintain a normal appearance 2 To reduce pain 3 To promote healing 4 To prevent infection
1 To maintain a normal appearance Clients with KS lesions may be advised to wear hats, makeup, or long sleeves to maintain a normal appearance. Pain associated with KS lesions is treated with analgesics and comfort measures. Modified burrow's solution soaks may promote healing in some clients with KS. The cleaning and dressing of KS lesions will prevent infections.
the nurse is caring for a hospitalized immunosuppressed client. Which interventions will be beneficial for safe and effective care of this client? Select all that apply. 1 Advise the client to eat raw fruits daily 2 Avoid using supplies from common areas 3 Encourage activity at an appropriate level 4 Use alcohol-based hand rubs before touching the client 5 Change gauze-containing wound dressing on alternative days
2 Avoid using supplies from common areas 3 Encourage activity at an appropriate level 4 Use alcohol-based hand rubs before touching the client Supplies from common areas should not be used for neutropenic clients to prevent contracting infection. Physical activity at a level appropriate for client's condition should be encouraged to promote health. Alcohol-based hand rubs should be used before touching the client to decrease the risk of infection. Immunosuppressed clients should avoid eating raw fruits and vegetables; they should eat low-bacteria diet. Gauge-containing wound dressings should be changed on a daily basis, not on alternative days, to prevent infection
A client is treated with methyldopa for hypertension. For which side effect should the nurse monitor the client? 1 Xerostomia 2 Hemolytic anemia 3 Thrombocytopenia 4 Lupus-like syndrome
2 Hemolytic anemia Methyldopa is used in the treatment of hypertension. It can be a precipitating factor in an autoimmune disease such as hemolytic anemia. Scopolamine transdermal, an anticholinergic, may cause dry mouth or xerostomia. Chemotherapy drugs, such as mycophenolate mofetil and azathiprine, can cause thrombocytopenia. Procainamide is an anti-arrhythmic agent that can induce the formation of antinuclear antibodies and cause a lupus-like syndrome.
A laboratory report shows that a client tested positive for human epidermal growth factor (HER), and a medical report reveals the presence of advanced breast cancer. Which medication would be used to treat this condition? 1 Erlotinib 2 Lapatinib 3 Rituximab
2 Lapatinib HER-2 is overexpressed in clients with advanced breast cancer. Lapatinib inhibits epidermal growth factor-r (EGFR)-tyrosine kinase (TK) and binds HER-2. Erlotinib is an EFGR-TK inhibitor prescribed to treat non-small cell lung cancer and advanced pancreatic cancer. Rituximab and tositumomab are administered to treat non-Hodgkin's lymphoma.
The laboratory report of a client reveals the presence of 350 cells/mm3 (350 cells/uL) of CD4+ T-cell count. According to the Centers for Disease Control and Prevention (CDC), which stage of human immunodeficiency virus (HIV) disease is present in the client? 1 Stage 1 2 Stage 2 3 Stage 3 4 stage 4
2 Stage 2 According to the CDC, human immunodeficiency disease is divided into four stages. A client with a CD4+ T-cell count between 200 and 499 cells/mm3 (499 cells/uL) is in the second stage of HIV disease. A client with a CD4+ T-cell count of greater than 500 cells/mm3 (500 cells/uL) is in the first stage of HIV disease. A client with a CD4+ T-cell count of less than 200 cells/mm3 (200 cells/uL) is in the third stage of HIV disease. The fourth stage of HIV disease indicates confirmed HIV infection with no information regarding CD4+ T-cell counts.
Which symptoms are observed in a client with Sjögren's syndrome? Select all that apply. 1 Angioedema 2 Tooth decay 3 Corneal ulcers 4 Vaginal dryness 5 Pulmonary hemorrhage
2 Tooth decay 3 Corneal ulcers 4 Vaginal dryness A client with Sjögren's syndrome (SS) may have antigens specific to certain tissue types, such as HLA-DRW52, HLA-DR3, and HLA-B8. Sjögren's syndrome may lead to autoimmune destruction of the lacrimal, salivary, and vaginal mucus-producing glands. Insufficient saliva decreases digestion of carbohydrates, which may promote tooth decay. Insufficient tears cause inflammation and ulceration of the cornea. Vaginal dryness increases the risk for infection and causes painful sexual intercourse. Angioedema occurs with a type I hypersensitivity reaction that may occur within seconds after exposure to the allergen. Clients with Goodpasture syndrome may have lung and kidney problems. Pulmonary hemorrhage is associated with this syndrome.
During an acquired immunodeficiency syndrome (AIDS) education class a client states, "Vaseline works great when I use condoms." Which conclusion about the client's knowledge of condom use can the nurse draw from this statement? 1 An understanding of safer sex 2 An ability to assume self-responsibility 3 Ignorance related to correct condom use 4 Ignorance concerning the transmission of human immunodeficiency virus (HIV)
3 Ignorance related to correct condom use Vaseline (petroleum jelly) breaks down condom integrity and will increase the risk for condom failure. Using Vaseline instead of a water-soluble lubricant shows a lack of knowledge about condom use, a form of safer sex. Although the person is attempting to be responsible, there is a lack of knowledge and the behavior is unsafe. Condom use shows the client has some understanding about the transmission of HIV.
Indicate the first step involved in the disposal of sharp wastes of a client with acquired immunodeficiency syndrome (AIDS). 1 Place tape over the container 2 Place the container in a paper bag 3 Place the waste in a puncture-resistant container 4 Pour a 1:10 bleach solution in the container
3 Place the waste in a puncture-resistant container The sharp wastes of a client with AIDS should first be placed in a puncture-resistant container and labelled. Then a 1:10 bleach solution should be poured into the container for disinfection. Next the container should be taped to prevent leakage. The container should be then placed into a paper bag and subsequently disposed of in the regular trash.
While caring for a client with an intravenous cannula, the nurse assesses the site and finds that it red, swollen, and warm with purulent drainage near the insertion site. Which nursing intervention provides client comfort? 1 Slowing the infusion rate temporarily 2 Elevating the extremity slightly above level 3 Applying cold and warm compresses frequently 4 Cleaning the site with alcohol by expressing the drainage
4 Cleaning the site with alcohol by expressing the drainage A client with redness, swelling, and warmth with purulent drainage at the insertion site may have an infection. The nurse should clean the site immediately with alcohol and express any drainage to minimize infection. Slowing the infusion is not recommended because it may lead to a systemic spread of the infection. Elevating the extremity may help in phlebitis, with thrombosis, or with ecchymosis and hematoma. Application of cold and warm compresses may reduce the pain in a client with thrombophlebitis. Test-Taking Tip: Maintaining a hygienic and aseptic condition is essential to reduce the incidence and spread of the infection.
A client undergoing corticosteroid therapy is admitted with a peptic ulcer, osteoporosis, and hypertension. Which medication may have caused this condition? 1 Everolimus 2 Azathioprine 3 Mycophenolate acid 4 Methylprednisolone
4 Methylprednisolone Methylprednisolone is a corticosteroid that suppresses inflammatory responses and inhibits both cytokine production and T-cell activation. This drug may cause a peptic ulcer, osteoporosis, and hypertension. Everolimus may cause urinary tract infections, hyperlipidemia, and peripheral edema. Azathioprine may cause bone marrow suppression, neutropenia, and thrombocytopenia. Mycophenolate acid may cause diarrhea, neutropenia, and increased incidence of malignancies.
The nurse teaches a group of clients that nutritional support of natural defense mechanisms indicates the need for a diet high in what nutrient or nutrients? 1 Essential fatty acids 2 Dietary cellulose and fiber 3 Tryptophan, an amino acid 4 Vitamins A, C, E, and selenium
4 Vitamins A, C, E, and selenium Vitamins A, C, E, and selenium stimulate the immune system. The role of fatty acids in natural defense mechanisms is uncertain. Dietary cellulose and fiber have no known effect on natural defense mechanisms. Tryptophan has no known effect on natural defense mechanisms.
A primary healthcare provider has prescribed isoniazid to a client with tuberculosis. Which instruction by the nurse will be most beneficial to the client? 1 "You should take the drug on an empty stomach." 2 "Your soft contact lenses will be stained permanently." 3 "You must use an additional method of contraception." 4 "You need to drink at least 8 ounces of water with the medication."
1 "You should take the drug on an empty stomach." Isoniazid is used as first-line drug therapy for tuberculosis. Absorption of the drug from the gastrointestinal tract can be prevented or slowed by the presence of food and antacids, so the client should be instructed to take the drug on an empty stomach. Staining of bodily fluids is commonly associated with rifampin. Rifampin reduces the effectiveness of oral contraceptives, so an additional method of contraception is required for any female client prescribed this drug who also uses birth control pills. The instruction to drink at least 8 ounces of water with the medication would be beneficial fora client who has been prescribed pyrazinamide.
The laboratory results of a client with a pulmonary hemorrhage and glomerulonephritis reveal the presence of IgG antibodies. Which type of hypersensitivity reaction should a nurse suspect? 1 Cytotoxic reaction 2 Immediate reaction 3 Immune-complex reaction 4 Delayed hypersensitivity reaction
1 Cytotoxic reaction A client with a pulmonary hemorrhage and glomerulonephritis with deposits of IgG antibodies in the lungs and kidneys may have Goodpasture's syndrome. This reaction is a type 2 cytotoxic reaction that involves the lungs and kidneys. Immediate reactions are type 1 hypersensitivity reactions that include IgE antibody reactions. Immune-complex reactions such as systemic lupus erythematosus and rheumatoid arthritis are type 3 hypersensitivity reactions that include IgG and IgM antibodies. Delayed hypersensitivity reactions are type 4 reactions that involve cytokine and cytotoxic T-cell mediated immunity.
Which disease conditions involve a cytotoxic hypersensitivity reaction? Select all that apply. 1 Graves' disease 2 Contact dermatitis 3 Myasthenia gravis 4 Rheumatoid arthritis 5 Immune thrombocytopenic purpura
1 Graves' disease 3 Myasthenia gravis 5 Immune thrombocytopenic purpura Graves' disease, myasthenia gravis, and immune thrombocytopenic purpura involve cytotoxic reactions. Rheumatoid arthritis and contact dermatitis are examples of immune complex and delayed hypersensitivity reactions, respectively.
What should the nurse identify as responses to the release of histamine during a type I rapid hypersensitivity reaction? Select all that apply. 1 Pruritus 2 Erythema 3 Fibrotic changes 4 Nasal mucus secretion 5 Conjunctival mucus secretion
1 Pruritus 2 Erythema 4 Nasal mucus secretion 5 Conjunctival mucus secretion Histamine causes itching or pruritus, erythema, and nasal and conjunctival mucus secretion. Fibrotic changes occur with type III immune complex reactions.
The nurse performs a skin test on a client who has a mosquito bite. The client shows wheal and flare reaction post-skin test. Which type of hypersensitivity reaction most likely has occurred? 1 Type 1 2 Type II 3 Type III 4 Type IV
1 Type 1 Type I is an IgE-mediated hypersensitivity reaction that causes wheal and flare response. This reaction is characterized by a pale wheal containing edematous fluid surrounded by a red flare from the hyperemia. Type II is a cytotoxic hypersensitivity reaction that involves IgG and IgM antibodies but does not show any wheal and flare response. Type III hypersensitivity reaction is an immune complex-mediated reaction that involves erythema and edema in 3 to 8 hours. Type IV is a delayed hypersensitivity reaction that involves erythema and edema in 24-48 hours. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.
Which body system should the nurse focus on when assessing a client with suspected Goodpasture's syndrome? 1 Renal 2 Neurologic 3 Cardiovascular 4 Musculoskeletal
1) renal Goodpasture's syndrome is an autoimmune disorder in which autoantibodies attack the glomerular basement membrane and neutrophils. One organ with the most damage is the kidneys. A person with the disorder may have kidney problems which manifests as glomerulonephritis that may rapidly progress to complete kidney failure. Goodpasture's syndrome does not affect the neurologic, cardiovascular, or musculoskeletal systems.
A client has received ABO-incompatible blood from a donor by mistake. Which type of hypersensitivity reaction will occur in the client? 1 Type I 2 Type II 3 Type III 4 type IV
2 Type II
The nurse is caring for a client on antiretroviral therapy who has Pneumocystis jiroveci pneumonia. Which action is priority? 1 Assisting the client in eating and drinking 2 Maintaining fluid balance in the client 3 Providing adequate oxygenation for the client 4 Encouraging the client to perform breathing exercise
3 Providing adequate oxygenation for the client Pneumocystis jiroveci pneumonia may cause difficulty in breathing; therefore the client should be provided adequate oxygenation. A client with human immunodeficiency virus and mouth lesions may need assistance in eating and drinking. An important nursing concern in a client with dehydration is maintaining fluid balance. Encouraging regular breathing exercises may be incorporated when the client is stable and is not the priority.
A client reports hair loss, joint pain, and a facial rash. The nurse documents the presence of a butterfly rash on the face in the client's medical record. Which disorder does the nurse suspect? 1 Scleroderma 2 Angioedema 3 Rheumatoid arthritis 4 Systemic lupus erythematosus
4 Systemic lupus erythematosus Systemic lupus erythematosus is an autoimmune connective tissue disorder characterized by joint pain, alopecia, and rashes on the face. A characteristic butterfly rash is a major skin manifestation of systemic lupus erythematosus. Scleroderma is a chronic, inflammatory, autoimmune connective tissue disease characterized by hardening of the skin. Angioedema is the diffuse swelling of the eyes and lips. Rheumatoid arthritis is an inflammatory autoimmune disease process that affects primarily the synovial joints. The primary symptom of rheumatoid arthritis is painful swollen joints.
