Med Surg - Chapter 17 - Principles of Inflammation and Immunity

What are causes of acute rejection? Select all that apply. 1 Scarring and fibrosis formation 2 Lysis of organ cells by cytotoxic T-cells 3 Blood vessel necrosis of the new organ 4 Blood vessel occlusion in the new organ 5 Chronic ischemia caused by vessel injury

2 Lysis of organ cells by cytotoxic T-cells 3 Blood vessel necrosis of the new organ Acute rejection occurs due to blood vessel necrosis of the transplanted organ and cytotoxic/cytolytic T-cell and natural killer (NK) cell-mediated lysis of the transplanted organ cells. Blood vessel occlusion leads to hyperacute rejection. Scarring, fibrosis, and chronic ischemia lead to chronic rejection.

Which cells are involved in the general inflammation process? Select all that apply. 1 Eosinophils 2 Neutrophils 3 Basophils 4 Natural killer cells 5 Macrophages 6 Cytotoxic T-cells

1 Eosinophils 2 Neutrophils 3 Basophils 5 Macrophages The leukocytes involved in inflammation are neutrophils, macrophages, eosinophils, and basophils. Neutrophils and macrophages use phagocytosis to destroy and eliminate foreign invaders. Basophils and eosinophils release chemicals that act on blood vessels to cause tissue-level responses that help neutrophil and macrophage actions. Natural killer cells nonselectively attack non-self cells, especially body cells that have undergone mutation and become malignant. Cytotoxic T-cells selectively attack and destroy non-self cells, including virally infected cells, grafts, and transplanted organs.

What side effects are expected in the patient who has just undergone organ transplant and is prescribed cyclosporine? Select all that apply. 1 Hirsutism 2 Hepatoxicity 3 Hyperglycemia 4 Hypomagnesemia 5 Gingival hyperplasia

1 Hirsutism 2 Hepatoxicity 5 Gingival hyperplasia Cyclosporine is an immunosuppressant and is prescribed to prevent transplant rejection in a patient who has undergone organ transplantation. It promotes hair epithelial cell proliferation causing hirsutism, and it causes hepatotoxicity by forming reactive oxygen radicals. Cyclosporine also causes gingival hyperplasia by increasing the deposition of collagen and extracellular matrix. Cyclosporine does not cause hyperglycemia or hypomagnesemia.

Which immunoglobulin (Ig) antibody is found abundantly in secretions but has very low circulating levels? 1 IgA 2 IgG 3 IgE 4 IgD

1 IgA IgA is the antibody found in high concentrations in secretions but its concentration in the plasma is very low. IgG is a major circulating antibody. The concentration of IgE is variable in the plasma and is not usually present in secretions. IgD is found in low concentrations in the plasma and is not secreted.

The nurse recalls that which condition is associated with inflammation that occurs with infection? 1 Otitis media 2 Blister formation 3 Allergic rhinitis 4 Myocardial infarction

1 Otitis media An example of inflammation that occurs through infection is otitis media. Myocardial infarction is associated with inflammation. However, this inflammation is not caused by infection. Blister formation is an example of inflammation that occurs without infection. Allergic rhinitis is an example of inflammation that occurs from the invasion of noninfectious microorganisms.

A patient who received a kidney transplant reports a gradual decline of renal function despite being compliant with drug therapy. What may be the causes? Select all that apply. 1 Scarring and fibrosis formation 2 Blood vessel necrosis of the new organ 3 Blood vessel occlusion in the new organ 4 Lysis of organ cells by cytotoxic T-cells 5 Chronic ischemia caused by vessel injury

1 Scarring and fibrosis formation 5 Chronic ischemia caused by vessel injury The patient has suffered chronic rejection. Among the events that lead to the gradual reduction of renal function are scarring and fibrosis of the transplanted kidney, and chronic ischemia. Blood vessel necrosis and lysis of organ cells by cytotoxic T-cells are seen in acute rejection. Blood vessel occlusion occurs in hyperacute rejection.

What is the process of making antigens less effective before administering them into the body for therapeutic purposes? 1 Lysis 2 Attenuation 3 Phagocytosis 4 Immunization

2 Attenuation Attenuation is the process of making an antigen less effective in order to administer it for therapeutic purposes. Lysis is the process of destroying the cell membrane of the antigen, which in turn, weakens it. Phagocytosis is associated with engulfing and destruction of an invading organism. Immunization is the process of acquiring artificial immunity.

A recent immigrant enters the emergency department with a roundworm infection. Which white blood cell type would the nurse expect to be most active in this patient? 1 Basophils 2 Eosinophils 3 Neutrophils 4 Tissue mast cells

2 Eosinophils Eosinophils are very active against parasitic infestations such as roundworm. Although other white blood cells such as basophils, neutrophils, and tissue mast cells may be active due to the presence of the infection, eosinophils are the primary cells involved in combatting parasitic infections.

Lymphocytes provide cell-mediated immunity through a variety of T-cells. What is the function of suppressor T-cells? 1 Recognize self cells versus non-self cells and secrete lymphokines. 2 Prevent hypersensitivity on exposure to non-self cells or proteins. 3 Destroy cells that contain a processed antigen's human leukocyte antigen. 4 Destroy unhealthy or abnormal self cells, cancer cells, and virally infected body cells.

2 Prevent hypersensitivity on exposure to non-self cells or proteins. Cell-mediated immunity is provided by different types of T-cells and natural killer (NK) cells. Suppressor T-cells prevent hypersensitivity on exposure to non-self cells or proteins which help to prevent immune overreactions. Helper T-cells recognize self cells versus non-self cells and secrete lymphokines. Cytotoxic T-cells destroy cells that contain a processed antigen's human leukocyte antigen. NK cells destroy unhealthy or abnormal self cells, cancer cells, and virally infected body cells.

In what stage of inflammation is there an increased number of circulating neutrophils and exudate formed? 1 Stage I 2 Stage II 3 Stage III 4 Stage IV

2 Stage II During stage II of inflammation, there is an increased number of circulating neutrophils and exudate formed. Stage I is characterized by a vascular response that starts the changes in blood vessels. During stage III, tissue repair and replacement occur. There is no stage IV of inflammation.

Which immunoglobulin (Ig) antibody binds to basophils and is involved in causing antigen-antibody mediated hypersensitivity reactions? 1 IgA 2 IgG 3 IgE 4 IgD

3 IgE The IgE antibody binds to basophils and is involved in causing antigen-antibody mediated hypersensitivity reactions. IgA is helpful in preventing gastrointestinal, urinary, and respiratory infections. IgG provides long-term immunity against invading microorganisms. IgD is co-expressed with IgM and acts as a receptor on unsensitized B-lymphocytes.

Which cells of the immune system are similar because they engulf foreign cells through phagocytosis? 1 Basophils and neutrophils 2 Mast cells and eosinophils 3 Neutrophils and macrophages 4 Eosinophils and macrophages

3 Neutrophils and macrophages Neutrophils and macrophages are the primary cells that are involved in phagocytosis. Eosinophils and basophils release vasoactive chemicals, and mast cells and basophils have IgE binding sites. However, they do not perform phagocytosis of foreign organisms or debris.

A patient presents in the emergency department with dysphagia, periorbital edema, lilac eyelid rash (DM), and severe muscle weakness. Which disease is consistent with these assessment findings? 1 Ankylosing spondylitis 2 Polymyalgia rheumatica 3 Polymyositis/dermatomyositis 4 Reiter's syndrome

3 Polymyositis/dermatomyositis Dysphagia, periorbital edema, lilac eyelid rash (DM), and severe muscle weakness along with malignant neoplasms in an older patient are signs and symptoms of polymyositis/dermatomyositis. Ankylosing spondylitis, polymyalgia rheumatic, and Reiter's syndrome do not produce all these symptoms.

Which statement should be included when a student nurse is discussing the action of interleukin-1? 1 "Interleukin-1 induces cell death." 2 "Interleukin-1 participates in graft rejection." 3 "Interleukin-1 stimulates the liver to produce fibrinogen." 4 "Interleukin-1 stimulates the production of prostaglandins."

4 "Interleukin-1 stimulates the production of prostaglandins." Interleukin-1 is a pro-inflammatory cytokine that stimulates the production of prostaglandins. Tumor necrosis factor is a pro-inflammatory cytokine that induces cell death and participates in graft rejection. Interleukin-6 is a pro-inflammatory cytokine that stimulates the liver to produce fibrinogen.

A patient has been brought to the emergency department (ED) after being bitten by a poisonous snake. What is the nature of protection that the nurse provides when injecting the patient with antivenom? 1 Natural active immunity 2 Artificial active immunity 3 Natural passive immunity 4 Artificial passive immunity

4 Artificial passive immunity Antivenom contains antibodies produced from snake venom that work against that same snake venom. Because the patient does not have active acquired immunity against the snake venom, the nurse injects antivenom to inactivate the antigen which provides artificial passive immunity. Natural active immunity occurs when an antigen enters the body without human assistance and the body responds by making antibodies against that antigen. Natural passive immunity is acquired by the passage of antibodies from a mother to her baby either through breast milk or placental transfer. Artificial active immunity is acquired through vaccination or immunization.

What is the recommended daily dosage of vitamin D for patients taking chronic steroid therapy to prevent osteoporosis?___ mg

400 mg Rheumatoid arthritis is treated with steroids, which have anti-inflammatory and immunosuppressive effects. Chronic steroid therapy causes numerous side effects, including osteoporosis. To prevent osteoporosis and maintain bone density, 400 mg of vitamin D is recommended along with 1200 mg to 1500 mg of calcium.

A patient is at risk for developing tetanus. Which type of immunity would be helpful in preventing its development? 1 Natural active 2 Artificial active 3 Natural passive 4 Artificial passive

2 Artificial active Artificial active immunity (vaccinations and immunizations) is required to prevent tetanus as its effects are long-lasting. Natural active immunity and natural passive immunity do not help in preventing tetanus. Artificial passive immunity is helpful in treating rather than prevention, and its effects are short-lived and immediate.

Which drug would be a part of the rescue therapy for a patient who had acute rejection of a transplanted kidney? 1 Tacrolimus 2 Basiliximab 3 Azathioprine 4 Cyclosporine

2 Basiliximab Rescue therapy is used to treat acute rejection of grafts Monoclonal and polyclonal antibodies are the mainstay of the therapy. Basiliximab is a monoclonal antibody and is a part of the recue therapy. Tacrolimus and cyclosporine are calcineurin inhibitors and are used as maintenance therapy. Azathioprine is an antiproliferative and is a part of the maintenance therapy.

Which syndrome is characterized by the presence of rheumatoid nodules in the lungs? 1 Felty's syndrome 2 Caplan's syndrome 3 Sjogren's syndrome 4 Carpal tunnel syndrome

2 Caplan's syndrome Caplan's syndrome is characterized by the presence of rheumatoid nodules in the lungs. Felty's syndrome is characterized by leukopenia and hepatosplenomegaly. Dryness of the eyes, mouth, and vagina is a characteristic feature of Sjogren's syndrome. Carpal tunnel syndrome is caused by the compression of the median nerve in the wrist.

Which immunoglobulin (Ig) antibodies are involved in complement pathway activation? Select all that apply. 1 IgA 2 IgG 3 IgE 4 IgD 5 IgM

2 IgG 5 IgM Antibodies IgG and IgM are both responsible for activating the classic complement pathway. IgA, IgE, and IgD have no role in complement pathway activation. IgA helps in preventing infection in the upper and lower respiratory tracts, the GI tract, and the genitourinary tract. IgE is associated with antibody-mediated hypersensitivity reactions. IgD acts as a receptor on unsensitized B-lymphocytes.

A patient who received a kidney transplant is taking cyclosporine, azathioprine, and prednisolone. What are the risk factors associated with the use of these drugs in the patient? Select all that apply. 1 Hypertrichosis 2 Fungal infection 3 Bacterial infection 4 Cancer development 5 Thrombotic disorders

2 Fungal infection 3 Bacterial infection 4 Cancer development Cyclosporine, azathioprine, and prednisolone are used for maintenance therapy after kidney transplantation. Their use is associated with an increased risk of fungal infection, bacterial infection, and cancer development. They are not associated with hypertrichosis or thrombotic disorders.

When teaching student nurses about innate immunity, the nurse practitioner lists the inflammatory response as one of the components of innate immunity. What other parts of innate immunity should the nurse practitioner include in the teaching? Select all that apply. 1 Skin 2 Antibodies 3 Lymphocytes 4 Memory cells 5 Natural killer cells

1 Skin 5 Natural killer cells Skin forms a barrier to prevent infiltration of foreign organisms, and natural killer cells target foreign cells for destruction. Both of these are part of innate immunity. Lymphocytes, antibodies, and memory cells are all part of antibody-mediated immunity rather than innate immunity.

A patient is prescribed a vaccine for the prevention of rabies. What does the nurse tell the patient about this method of providing immunity? 1 The antibodies are produced in another person or animal. 2 The antigen that triggers antibody production also causes the disease. 3 Although it lasts for many years, a smaller dose may have to be repeated. 4 A small amount of specific antigen is placed as a vaccination into the patient.

1 The antibodies are produced in another person or animal. The antibodies were produced in another person or animal; the patient is receiving artificial passive immunity. Artificial active immunity involves placing a small amount of specific antigen as a vaccination into a person; this type of immunity lasts for many years; however, a smaller dose may have to be repeated. Natural active immunity occurs when the antigen that triggers antibody production also causes the disease. In this case, the person does not become ill after a second exposure to the same antigen.

A patient has received a vaccination for shingles. Which test allows the nurse to determine the effectiveness of the vaccination? 1 Antibody level 2 White blood cell count 3 Absolute neutrophil count 4 White blood cell differential

1 Antibody level Antibody levels in the blood rise in response to vaccination to the specific antigen in the vaccine. An absolute neutrophil count determines the actual number of circulating mature neutrophils. A white blood cell (WBC) count determines the total number of circulating WBCs. A WBC differential count shows the number and percentage of the different types of circulating WBCs.

Which cells present in the human body are considered non-self cells? Select all that apply. 1 Cancer cells 2 B-lymphocytes 3 T-lymphocytes 4 Natural killer cells 5 Infected body cells

1 Cancer cells 5 Infected body cells Cancer cells and infected body cells are considered to be non-self cells. Recognizing a cell as self cell or a non-self cell is important for the body to initiate an immune response toward the non-self cells. B-lymphocytes and T-lymphocytes contribute to the immune system of the body. Natural killer are special cells which help in cell-mediated immunity. They are most effective on unhealthy or abnormal self cells.

What is the function of a monocyte during inflammation? 1 Destruction of bacteria and cellular debris 2 Release of histamine and heparin in areas of tissue damage 3 Nonspecific ingestion and phagocytosis of microorganisms 4 Nonspecific recognition of foreign proteins and microorganisms

1 Destruction of bacteria and cellular debris During inflammation, monocytes destroy bacteria and cellular debris. Basophils releases histamine and heparin in areas of tissue damage. The function of neutrophils is nonspecific ingestion and phagocytosis of microorganisms. The function of macrophages is nonspecific recognition of foreign proteins and microorganisms.

What kind of immunoglobulin helps in the prevention of respiratory tract infections? 1 Immunoglobulin A 2 Immunoglobulin E 3 Immunoglobulin G 4 Immunoglobulin M

1 Immunoglobulin A Immunoglobulin A, abbreviated as IgA, is an antibody that is present in high concentrations in the secretions of mucous and membranes of the intestinal mucosa. These help in preventing infections in the respiratory tract, gastrointestinal tract, and genitourinary tract. Immunoglobulin E, or IgE, is present in variable concentrations in the blood and is associated with antibody-mediated hypersensitivity reactions. Immunoglobulin G, or IgG, comprises 75% of the immunoglobulin present in human serum. It is produced particularly during secondary immune responses to provide sustained, long-term immunity against invading microorganisms. Immunoglobulin M, or IgM, is the first antibody to appear in primary immune responses and indicates that an infection has been acquired recently.

In the process of phagocytosis, which substance coats the target cell to increase contact of the immune cell with the target cell? 1 Opsonins 2 Histamine 3 Serotonin 4 Leukotriene

1 Opsonins During the adherence phase of phagocytosis, opsonins coat the target cell in order to increase contact of the phagocytic cell with its target. Histamine, serotonin, and leukotrienes are all substances that are released from basophils during an inflammatory action. They bind to host cells to activate them, not the cell that is targeted for destruction.

What are the body's defense mechanisms to prevent organisms from entering? Select all that apply. 1 Skin 2 Sweat glands 3 Normal skin flora 4 Skin pigmentation 5 Mucous membranes

1 Skin 3 Normal skin flora 5 Mucous membranes Natural defense mechanisms that help in preventing organisms from invading the body are intact skin, normal skin flora, and intact mucous membranes. Sweat gland activity is associated with temperature regulation rather than keeping invading organisms at bay. Skin pigmentation is not a defense mechanism for microorganisms.

Which statements about how the immune system is organized are correct? Select all that apply. 1 The immune system is located in the bone marrow. 2 The immune system is influenced by many systems. 3 All immune system cells mature in the bone marrow. 4 Some immune cells mature in the body after leaving the bone marrow. 5 Mature immune system cells circulate through the blood to different body sites.

2 The immune system is influenced by many systems. 4 Some immune cells mature in the body after leaving the bone marrow. 5 Mature immune system cells circulate through the blood to different body sites. The immune system is influenced by the nervous system, the endocrine system, and the gastrointestinal system. Most immune cells mature in the bone marrow, but a few mature in the body after leaving the bone marrow. Mature immune system cells travel to different body sites to carry out specific functions once they are released into the bloodstream. The immune system is not located in any one body part.

What is the likely reason that the nurse would observe a decreased number of mature neutrophils in a patient's laboratory report? 1 Impaired functioning of erythropoietin 2 Impaired functioning of thrombopoietin 3 Impaired functioning of granulocyte colony-stimulating factor 4 Impaired functioning of granulocyte-macrophage colony-stimulating factor

3 Impaired functioning of granulocyte colony-stimulating factor Impaired functioning of the granulocyte colony-stimulating factor can result in a decreased number of mature neutrophils. Erythropoietin is a growth factor that increases growth and differentiation of erythrocytes. Thrombopoietin is a growth factor that increases growth and differentiation of platelets. Granulocyte-macrophage colony-stimulating factor is a growth factor that increases growth and maturation of myeloid stem cells.

Which inflammatory conditions are not caused by an infection? Select all that apply. 1 Meningitis 2 Pneumonia 3 Joint sprains 4 Osteoarthritis 5 Blister formation

3 Joint sprains 4 Osteoarthritis 5 Blister formation Joint sprains, blister formation, and osteoarthritis are examples of inflammation that is not caused by an infection. Osteoarthritis (also called degenerative joint disease) it is the progressive deterioration of bone and joint cartilage. Meningitis is inflammation of the meninges and pneumonia is inflammation of the lung parenchyma; both conditions are caused by an infection.

What type of immunity does a baby acquire from its mother through breastfeeding? 1 Natural active 2 Artificial active 3 Natural passive 4 Artificial passive

3 Natural passive Natural passive immunity occurs when a mother transmits preformed antibodies to her baby through breast milk. Natural active immunity is acquired after an antigen enters a person's body. Artificial active immunity is acquired through vaccination or immunization. Artificial passive immunity is acquired by injecting a person with antibodies obtained from animals or other human beings.

Which type of immunity occurs when antibodies pass from a mother to her fetus? 1 Natural active immunity 2 Artificial active immunity 3 Natural passive immunity 4 Artificial passive immunity

3 Natural passive immunity Natural passive immunity occurs when antibodies are passed from a mother to her fetus through the placenta. Natural active immunity occurs when the person is exposed to a live pathogen, develops the disease, and becomes immune because of the primary immune response. Artificial active immunity is the immunity that is induced by a vaccine. Artificial passive immunity is a condition in which high levels of human antibodies specific for a pathogen or toxin are transferred to nonimmune individuals.

Where are various types of body cells, including the cells involved in inflammation and immune response, produced in the human body? 1 Spleen 2 Pancreas 3 Lymph nodes 4 Bone marrow

4 Bone marrow Bone marrow produces immature stem cells which may mature to form red blood cells (RBCs) and white blood cells (WBCs). The spleen is a secondary lymphoid organ that acts as a filter for blood as a part of the immune system. The pancreas is an important organ of the digestive system and the endocrine system. Lymph nodes are secondary lymphoid organs that are the major sites for production of T-cells and B-cells.

What is the key function of neutrophils? 1 Release vasoactive amines during allergic reactions 2 Help in recognition of foreign proteins and microorganisms 3 Release histamine and heparin in areas of tissue damage 4 Help in nonspecific ingestion and phagocytosis of microorganisms

4 Help in nonspecific ingestion and phagocytosis of microorganisms Neutrophils help in nonspecific ingestion and phagocytosis of microorganisms and foreign particles. Vasoactive amines are released by eosinophils during allergic reactions. Macrophages, not neutrophils, are responsible for the recognition of foreign proteins. Basophils release heparin and histamine in areas of tissue damage.

What functional age-related change in the older adult occurs during the immune component of inflammation? 1 There is a decline in natural antibodies. 2 There is a decreased response to antigens. 3 There is a decrease in circulating T-lymphocytes. 4 Leukocytosis does not occur during acute infection.

4 Leukocytosis does not occur during acute infection. Leukocytosis does not occur during acute infection in the older adult in the immune component of inflammation. A decline in natural antibodies and a decreased response to antigens occur during the immune component of antibody-mediated immunity. In the older adult, there is a decrease in the numbers of circulating T-lymphocytes that occur in the immune component of cell-related immunity, not inflammation.

A patient has a final check-up with the nurse after a long recovery from a gunshot wound. If the patient experiences long-term or permanent decreased functionality at the site of the wound, what would the nurse expect to find upon inspection of the wound site? 1 Scab 2 Blisters 3 Redness 4 Scar tissue

4 Scar tissue Scar tissue occurs when the healthy cells are not able to divide adequately to cover the damaged area. This results in loss of normal tissue function and permanent decreased functionality. A scab, redness, or blisters are signs of incomplete healing and would most likely not be present at this final checkup.