Patho Ch. 12

Systemic lupus erythematosus is best characterized by which principle?

Most clients have antinuclear antibodies present in their blood. Clients diagnosed with systemic lupus erythematosus will most commonly have antinuclear antibodies in their blood. Lupus is primarily a disease of women and it is an autoimmune reaction.

Typical symptoms seen in the latent period of HIV infection include which of the following?

No signs or symptoms The primary phase is followed by a latent period during which the person has no signs or symptoms of illness.

An infant born to a woman with documented HIV will likely undergo which type of diagnostic testing?

HIV antibody testing 2 weeks after birth. Virologic assays that directly test for HIV are used in infants and children younger than 18 months who have exposure; HIV antibody tests are not used. RNA is a relatively new testing form for adults. Diagnosis of HIC-1 in children age 24 months or older relies on the HIV antibody or antigen/antibody tests.

The nurse is caring for an infant with DiGeorge syndrome. Which organ will be underdeveloped or absent?

thymus gland Infants born with DiGeorge syndrome usually have partial or complete failure of development of the thymus and parathyroid glands and have congenital defects of the head, neck, palate, and heart. In some children, the thymus is not absent but is extremely small and located outside of the mediastinum. None of the other organs listed are affected.

When a client who has been newly diagnosed with HIV asks, "What are the chances that I can be cured?," what is the nurse's most therapeutic response?

"Although there is no current treatment that provides a possible cure, there are ones that have successfully managed the infection." There is no cure for HIV infection. The medications that are currently available to treat HIV infection decrease the amount of virus in the body, but they do not eradicate HIV. After HIV infection is confirmed, a baseline evaluation should be done. This evaluation should include a complete history and physical examination and baseline laboratory tests including a complete blood count with differential. Routine follow-up care of a stable, asymptomatic person infected with HIV should include a history and physical examination along with CD4+ cell count and viral load testing every 3 to 4 months. People who are symptomatic may need to be seen more frequently. Therapeutic interventions are determined by the level of disease activity based on the viral load, the degree of immunodeficiency based on the CD4+ cell count, and the appearance of specific opportunistic infections.

While conducting client education at a public health clinic, a nurse teaches about sexually transmitted disease prevention. Included in the education is a segment on HIV/AIDS. Which statement from a client would indicate that more teaching is needed?

"Natural or lambskin condoms are as protective as latex condoms." Natural or lambskin condoms do not provide the same protection from HIV as latex because of the larger pores in the material. Only water-based lubricants should be used with condoms because petroleum (oil-based) products weaken the structure of the latex. Because there is no cure for HIV or AIDS, adopting risk-free or low-risk behavior is the best protection against the disease. Abstinence or a long-term, mutually monogamous sexual relationship between two uninfected partners is the best way to avoid HIV infection and other sexually transmitted diseases. Correct and consistent use of latex condoms can provide protection from HIV by not allowing contact with semen or vaginal secretions during intercourse.

A client was tested for HIV and received a positive result from the enzyme-linked immunosorbent assay (ELISA) followed by a negative Western blot test. The client asks the nurse what this means. What is the nurse's best response?

"The ELISA test gives some false positives, but the Western blot confirms you don't have HIV." Both the ELISA (or EIA) and Western blot tests search for antibodies in HIV infection. The Western blot is more specific and is used to confirm results from a positive ELISA. If the Western blot is negative, the client does not have HIV.

A college student has been called into the student health office because she tested positive for HIV on the enzyme-linked immunosorbent assay (ELISA). The student asks, "What is this Western blot assay going to tell you?" The best response by the health care provider is:

"The Western blot is a more sensitive assay that looks for the presence of antibodies to specific viral antigens." The Western blot is a more sensitive assay than the EIA that looks for the presence of antibodies to specific viral antigens. In the case of a false-positive EIA result, the Western blot test can identify the person as uninfected. Technologic advances have led to new forms of testing, such as the oral test, home testing kits, and the new rapid blood test. Oral fluids contain antibodies to HIV. In the late 1990s, the FDA approved the OraSure test. The OraSure uses a cotton swab, which is inserted into the mouth for 2 minutes, placed in a transport container with preservative, and then sent to a laboratory for EIA and Western blot testing.

A 24-year-old pregnant client presents to the clinic for her second prenatal visit. The results of her ELISA test are positive. Which statement by the nurse projects the best way to counsel this client?

"We will need to wait for the Western Blot results to confirm the diagnosis of HIV." The HIV antibody test procedure consists of screening with an enzyme immunoassay (EIA), also known as ELISA, followed by a confirmatory test, the Western blot assay, which is performed if the EIA is positive. Therefore, the nurse will inform the client that the Western Blot is the next step. The nurse does not need to notify the client's partner based on the screening test results, but public health regulations may require notification if diagnosis is confirmed. It is important the nurse reinforces that the client's confidentiality will be maintained. The ELISA would not be repeated and the nurse should not inform the client that the HIV diagnosis is confirmed.

The clinic nurse suspects the client is having a genetically determined hypersensitivity to common environmental allergens since the client is experiencing which clinical manifestations? Select all that apply.

-Hives (urticaria) -Runny nose -Wheezes Localized, inherited allergic reactions mediated by IgE are known as atopic reactions, such as urticaria (hives). Atopic reactions are immediate (not delayed such as type IV poison ivy rash). Infections are not part of type I hypersensitivity. Autoimmune reactions are in response to antigens, not allergens.

A 30-year-old male knows that he contracted HIV a month ago. Place the following steps in the order of the progression of the disease, starting with what he could expect first if he does not receive treatment.

-There is a rapid increase in viral replication, which leads to very high viral loads. -Viral symptoms such as fatigue, lymphadenopathy, headaches, and gastrointestinal disturbances and the CD4+ T-cell count begins to fall. -There is a period (up to 10 years) of being symptom-free as CD4+ T cells decrease. -CD4+ T-cell count is 200 cells/μL, confirming the diagnosis of AIDS. -The risk of opportunist infection is highest. -Death When an individual in first infected with HIV, the viral load will increase significantly, and even reach 1 million copies/mL. This will lead to viral symptoms and a decrease in the CD4+ T-cell count. This is the primary phase of an HIV infection. The next phase is the latent phase, in which the individual may be symptom-free for up to a decade while the CD4+ count falls. Once the CD4+ count reaches 200 cells/μL, this indicates a diagnosis of AIDS and then the risk for an opportunistic infection is the highest. Without treatment, the result is death.

What is the length of time from infection with HIV to seroconversion?

1 to 3 months The point at which an infected person converts from being negative for the presence of HIV antibodies in the blood to being positive is called seroconversion. Seroconversion typically occurs within 1 to 3 months after exposure to HIV but can take up to 6 months.

What is the minimum number of antiretroviral medications used in highly active antiretroviral therapy (HAART), also known as combined antiretroviral therapy (CAR)?

3 HAART uses a combination on three to four antiretroviral medications to target HIV. This number is to target HIV at different stages or replication.

The molecules that are recognized as foreign on allografts are called:

Alloantigens The molecules that are recognized as foreign on allografts are called alloantigens. Rejection of allografts is a response to MHC molecules, which are so polymorphic that no two individuals are likely to express the same MHC molecules. Autoantigens are what is found to be reactive in autoimmune diseases. Antigens is a general term.

A client with common variable immunodeficiency (CVID) who is also deficient in IgA is being treated with IV immunoglobulin (IV Ig) in the hospital. For which sign/symptom should the nurse closely monitor the client during treatment?

Anaphylaxis Anaphylaxis to IgA in the IV Ig has been reported in people with CVID who are deficient in IgA. IgA-depleted IVIg is available, and its use has greatly reduced this risk.

Following a spider bite she received while camping, a 20-year-old woman presented to the emergency department with rash, edema, and fever and was subsequently diagnosed with serum sickness. Which statement best describes the physiologic rationale for the broad systemic effects of this event?

Antigen-antibody complexes have been deposited in a variety of locations throughout the body. Serum sickness is characterized by the deposition of antigen-antibody complexes in blood vessels, joints, heart, and kidney tissue. The deposited complexes activate complement, increase vascular permeability, and recruit phagocytic cells, all of which can promote focal tissue damage and edema. Serum sickness is not synonymous with an Arthus reaction. Antibody binding to specific target cell receptors, causing a change in cell function, is characteristic of antibody-mediated cellular dysfunction. Serum sickness is not associated with the activation of the complement system.

A client has been admitted to the hospital for the treatment of HIV infection, which has recently progressed to overt AIDS. Which nursing action should the nurse prioritize when providing care for this client?

Astute infection control and respiratory assessments Although all of the cited assessments and interventions may be of some value, infection control and the early identification of potential respiratory infections are paramount in the care of clients with AIDS.

Combined immunodeficiency (CID) is distinguished by low, not absent, T-cell function. These diseases are usually associated with other disorders and arise from diverse genetic causes. Which of the following diseases is considered a CID?

Ataxia-telangiectasia Ataxia-telangiectasia is a complex syndrome of neurologic, immunologic, endocrinologic, hepatic, and cutaneous abnormalities. Pierre Robin syndrome, Angelman syndrome, and Adair-Dighton syndrome are not immunologic deficiencies.

A client with end-stage renal disease received a kidney transplant with a kidney donated by a family member. The client has been carefully monitored for signs of rejection. The physician informs the client that there has been a gradual rise in the serum creatinine over the last 5 months. What type of rejection does this depict?

Chronic rejection Chronic rejection involves immune-mediated inflammatory injury to a graft that occurs over a prolonged period. It is most often due to the inability to maintain adequate immunosuppression necessary to control residual circulating antigraft T lymphocytes or antibodies. Hyperacute rejection occurs almost immediately after vascular reperfusion to graft tissue occurs. Acute rejection and acute antibody-mediated rejection occur days to weeks after implantation.

All antiretroviral medications interfere with some stage of the HIV life cycle. What stage do protease inhibitors prevent?

Cleavage of the polyprotein chain into the individual proteins that will be used to make new virus By binding to the protease enzyme and inhibiting its function, protease inhibitors prevent cleavage of the polyprotein chain into individual proteins. Virions are still released into the body, but they are immature and noninfectious.

In providing education to a sexually active 22-year-old female, which topic would be most beneficial to discuss to decrease her risk for contracting HIV?

Consistent use of latex condoms with sexual activity The use of latex condoms is the best defense against contacting HIV. Natural or lambskin condoms and oil-based lubricants are not recommended. As an educator you should not place your values on the client, and advising an already sexually active female to practice abstinence is not the best choice.

Which gastrointestinal disorder is commonly associated with acquired immunodeficiency syndrome (AIDS)?

Diarrhea The most common gastrointestinal disorder associated with HIV/AIDS is diarrhea, with more than two stools a day. Diarrhea occurs in 75% of cases. Colitis can occur when the CD4 count drops below 50 cells/mm3. Crohn disease and ulcerative colitis are not strictly associated with the development of AIDS.

The nurse is reviewing the medical record for laboratory blood work that would indicate if a client is HIV infected. The nurse reviews which lab test?

ELISA enzyme-linked immunosorbent assay The antibody test procedure consists of screening with an enzyme immunoassay (EIA), also know as enzyme-linked immunosorbent assay (ELISA).

The nurse is caring for a pregnant woman who is infected with HIV. What is an important nursing intervention for this client?

Education about medication compliance Women who receive antiretroviral therapy who also have a viral load of less than 1000 copies/mL have very low rates of perinatal transmission. One caveat to antiretroviral therapy in pregnancy is that efavirenz cannot be used during the first trimester because it is a teratogen. HIV can be transmitted through breast-feeding.

Which serves as a recognition marker to aid in self-tolerance?

HLA antigens encoded by MHC genes The immune system must be able to differentiate foreign antigens from self-antigens in a process called self-tolerance. It is the HLAs (human leukocyte antigen) encoded by major histocompatibility complex (MHC) genes that serve as recognition markers of self and non-self for the immune system. To elicit an immune response, an antigen must first be processed by an antigen-presenting cell (APC), such as a macrophage, which then presents the antigenic determinants along with an MHC II molecule to a CD4+ helper T cell.

A client is suffering from the effects of the opportunistic infection, Cryptosporidium parvum. An important nursing intervention would be to encourage which action?

Hydration Cryptosporidium parvum has clinical features ranging from mild diarrhea to severe, watery diarrhea with a loss of up to several liters per day. Hydration is an important consideration.

A client with common variable immunodeficiency (CVID) is admitted to the hospital for treatment. Which type of treatment will the nurse be administering to the client?

IV immunoglobulin Treatment methods for CVID are similar to those used for other primary humoral immunodeficiencies, with IVIg being the mainstay of therapy.

The nurse is providing care for a client whose abrupt-onset hypersensitivity reaction was stimulated by an antigen challenge. The nurse should understand that this reaction is:

IgE-mediated. Type I, IgE-mediated, hypersensitivity reactions respond to antigen challenge and are often referred to as simple allergic reactions. Type II, antibody-mediated, hypersensitivity reactions are involved in mismatched blood transfusions and hemolytic disease of newborns where antibodies are targeted against the cell surface. Type III, complement-mediated disorders can be generalized if the immune complexes are formed in the circulation and deposited in many organs, or localized to a particular organ, such as the kidney, joints, or small blood vessels of the skin. Type IV, cell-mediated reactions occur against viruses, bacteria, or exogenous antigens. A type I hypersensitivity response is also known as an immediate hypersensitivity response due to the speed of onset.

A nurse caring for a client who has undergone an organ transplant. Advances in which process has made organ transplants a reality?

Immunology The nurse understands that advances in immunogenetics have made organ transplants a reality.

Which is a characteristic finding in AIDS?

Kaposi sarcoma People with AIDS have a high incidence of certain malignancies, especially Kaposi sarcoma, a malignancy of the endothelial cells that line small blood vessels throughout the body.

Which medication is used in the treatment of HIV to prevent cleavage of the polyprotein chain into individual proteins?

Protease inhibitor Protease inhibitors bind to the protease enzymes and prevent cleavage of the polyprotein chain into individual proteins, resulting in incomplete, immature viruses. The other treatment options do not work on the polyprotein chains.

A client with cirrhosis has just received a liver transplant. Tissue rejection can be best prevented by what means?

Suppression of CD8+ cytotoxic T cells T-cell-mediated graft rejection is called cellular rejection and is induced by two mechanisms: destruction of graft cells by CD8+ cytotoxic T cells and delayed hypersensitivity reactions triggered by CD4+ helper T cells. Neutrophil, complement, and macrophages are nonspecific inflammatory cells.

The nurse is caring for a client who is positive for the human immunodeficiency virus (HIV). Which precaution will the nurse take to reduce occupational exposure to the virus?

Take universal precautions, because they are used for all client care situations where exposure to blood and body fluids is possible. Universal blood and body fluid precautions should be used in encounters with all clients in the health care setting. These precautions involve the nurse protecting oneself from exposure to all clients' blood and body fluids using gloves, eye protection, or gowns depending on the risk for exposure. Because HIV is transmitted via direct exposure to blood and body fluids, the nurse takes the same precautions as for a client who does not have HIV. Actions such as double gloving or posting special precaution signage are not needed.

The nurse is caring for a client who is diagnosed with Pneumocystis jiroveci pneumonia (PCP). Which interventions will the nurse implement?

Universal precautions In people with healthy immune systems, PCP does not cause infection or disease. Universal Blood and Body Fluid Precautions should be used in encounters with all people in the health care setting.

The nurse is caring for a client with common variable immunodeficiency (CVID) disorder. Which clinical manifestation of the disorder is common with this client?

Viral pneumonia Clinical manifestations of CVID can begin at any time of life and most commonly include recurrent bacterial and viral infections of the respiratory tract.

Which client would be diagnosed with wasting syndrome?

client with AIDS, fever, diarrhea, and significant involuntary weight loss A client diagnosed with wasting syndrome (an AIDS-defining illness) would have chronic fever, diarrhea, and a significant involuntary weight loss (usually more than 10%) without an opportunistic infection. Pneumonia, Kaposi sarcoma, and herpes simplex and candidiasis are all opportunistic infection.

The nurse is preparing to administer a unit of blood to a client. The client says that he is not sure he wants to give consent to receive the blood transfusion because he does not want to get HIV/AIDS from the blood. How will the nurse respond?

"All blood is now tested for HIV, so the risk of getting HIV/AIDS from a blood transfusion is extremely low." Some transfusions of whole blood, plasma, platelets, or blood cells before 1985 resulted in the transmission of HIV. Since 1985, all blood donations in the United States have been screened for HIV, so this is no longer a transmission risk; however, infection can occur from transfused blood that was screened for HIV antibody and found negative because the donor was recently infected and still in the window period.

A client describes himself as being "devastated" after hearing that his HIV test has come back positive. Which response by the nurse is most appropriate?

"It's entirely normal to feel that way. We are going to try our best to help you get all the support you need." The nurse's best response is to validate the client's statement and to affirm a commitment to support him. It is presumptuous to conclude that by saying he is "devastated" he means that he is ashamed or afraid. Similarly, it is presumptuous for the nurse to claim that he or she knows how the client is feeling.

The nurse is teaching a group of college students about reducing the risk of HIV transmission during sexual relations. The nurse makes which appropriate teaching point?

"If a person has a sexually transmitted disease (STD), there is an increased risk for HIV infection." Sexual contact is the most frequent mode of HIV transmission. This includes vaginal, oral, and anal sex. The HIV-infected person is infectious even when no symptoms are present and before seroconversion. People with other sexually transmitted diseases (STDs) are at increased risk for HIV. Natural or lambskin condoms do not provide the same protection from HIV as latex because of the larger pores in the material.

A 5-year-old child is experiencing itchy, watery eyes and an increased respiratory rate with some inspiratory wheezes. He has been outside playing in the yard and trees. The mother asks, "Why does he get like this?" The health care worker's best response is:

"This is what we call a type I hypersensitivity reaction and usually occurs a few minutes after exposure to his allergen. It is primarily caused by mast cells in his body." The immediate response to allergen exposure is mast cell degranulation and release of mediators such as histamine and acetylcholine. Monocytes respond as part of the acute immune response. There is no truth to this being an anaphylactic reaction. Showers may help, but the underlying cause is the mast cell degranulation and the release of preformed mediators.

The nurse is caring for a client who has just learned that he is HIV positive. The client asks the nurse how long he has been able to infect others. Select the best response by the nurse.

"You can infect others before the HIV antibody is detectable in your blood." The HIV-infected person is infectious even when no symptoms are present. The point at which an infected person converts from being negative for presence of HIV antibodies in the blood to being positive is called seroconversion. The time after infection and before seroconversion is known as the window period. During the window period, a person's HIV antibody test result will be negative, but the infected person may still transmit the virus.

A client develops an immunodeficiency disorder after receiving chemotherapy for the treatment of lung cancer. The client asks the nurse if he was born with this deficiency. What is the nurse's best response?

"You have developed a secondary immunodeficiency disorder as a result of your chemotherapy." Secondary immunodeficiency disorders develop later in life as a result of other pathophysiologic states such as malnutrition, disseminated cancers; infection of the cells of the immune system, most notably with human immunodeficiency virus, and treatment with immunosuppressant drugs, such as chemotherapeutic agents, corticosteroids, or transplant rejection medications.

Shortly after being diagnosed with HIV, a client has begun highly active antiretroviral therapy (HAART). The client asks, "My doctor tells me that my viral load is going down. What does that mean?" The nurse's best response is:

"Your HAART medications are working to slow the progression of the disease." Antiviral therapies such as HAART are prescribed to slow the progression of AIDS and improve the overall quality of life and survival time of persons with HIV infection. Extension, not limitation, of the latent period is a goal. Minimizing transmission and preventing seroconversion are not normally achievable goals through drug therapy alone. The final 5% to 15% are long-term nonprogressors, who remain asymptomatic for 10 years or more after seroconversion, with stable CD4+ T-cell counts and low plasma HIV RNA levels.

Which statements are correct regarding the diagnosis of an autoimmune disorder? Select all that apply.

-Overlapping presentation of symptoms is common among this type of disorder. -Non-autoimmune diseases can present with autoimmune-like symptoms. -Effective history taking is vital to the diagnosis of autoimmune disorders. -Laboratory diagnostic testing aids in the diagnosis of auto immune disorders. Currently, there are more than 80 identified autoimmune disorders and many have overlapping presentations. In addition, many of the manifestations are nonspecific and are frequently seen in other disease processes that are not of autoimmune etiology. Diagnosis is therefore made based upon evidence of autoimmunity as indicated by history, as well as physical and serological findings. Each autoimmune disease is associated with certain clinical signs and laboratory findings that practitioners screen for during the diagnostic workup. Because the etiology of autoimmunity is multifactorial, it is unlikely that any one specific genetic testing alone will be able to determine a diagnosis with 100% certainty.

A client who had a kidney transplant 3 months ago is experiencing an organ rejection. The reaction would be classified as:

Acute rejection Acute rejection may occur within the first few days to weeks after transplantation, or it may occur suddenly months or even years later, after the discontinuation of immunosuppressants in the posttransplant period. Chronic rejection develops insidiously over months and years and may or may not be preceded by episodes of acute rejection. Hyperacute rejection occurs almost immediately after transplantation.

Which intervention would be the best treatment option to prevent perinatal transmission of HIV antibodies to a fetus from the HIV-positive mother?

Administration of zidovudine to the mother during pregnancy, labor, and delivery The administration of zidovudine has proven to be effective in lowering the perinatal transmission by two-thirds as compared to those who do not take the medications. Administration of zidovudine to the infant would not be therapeutic. Efavirenz, a fusion inhibitor, is contraindicated related to its teratogenic effects in the first trimester.

Select the statement that best describes autoimmune disease.

Autoimmune diseases represent a disruption in self-tolerance that results in damage to body tissues by the immune system. Autoimmune diseases represent a disruption in self-tolerance that results in damage to body tissues by the immune system. Autoimmunity results from a failure of tolerance. Autoimmune disorders may be triggered by environmental stimuli, such as infections, in a genetically predisposed individual. Overuse of antibiotics, however, does not lead to autoimmune diseases.

The early management recommendations for an asymptomatic person confirmed to have HIV antibodies would consist of which intervention?

Baseline screening for viral load and CD4+ counts In an asymptomatic person, a baseline evaluation should be done to include an evaluation of viral load, CD4 counts, and physical examination. Antivirals would not be started until symptomatic and certain criteria met. AIDS clients are not quarantined.

Which statement about acquired immunodeficiency syndrome (AIDS) is true?

Both B-cell and T-cell function are affected. The CD4+T cells are necessary for normal immune function. Among other functions, the CD4+T cell recognizes foreign antigens and helps activate antibody-producing B lymphocytes. In AIDS the CD4+T lymphocytes falls. People who are HIV positive are not diagnosed with AIDS until the CDC4+ cell count is less than 200 microliters of blood or develop an AIDS-defining illness. In 2009, the CDC determined that 61 percent of the new cases occurred in gay and bisexual men.

A 23-year-old HIV-positive woman in the United States with routinely low viral loads and robust CD4+ cell counts is planning to get pregnant. Which precaution would her health care provider eliminate from her care?

Give her single-dose perinatal nevirapine Single-dose nevirapine is an appropriate alternative when zidovudine is not available. However, HAART containing zidovudine is readily available in the United States. Avoiding breast-feeding will reduce the client's chances of transmitting HIV to her infant. Because the risk of transmission is not zero, prophylaxis with trimethoprim-sulfamethoxazole will protect her infant from PCP until its serostatus is known.

One week after a client received a transplant the nurse notes that the skin shows a maculopapular rash on the hands and feet. The client reports itching and nausea. What is the likely cause of these manifestations?

Graft-versus-host disease Graft-versus-host disease is a serious condition in which the recipient is "attacked" by the graft cells. Three conditions are necessary for this to occur. The client must be immunologically compromised, the recipient's cells must secrete antigens that are not part of the donor cells, and the donor graft must contain cells that are immunologically capable of attacking the host cells. The condition is more likely to develop when there is not a close tissue match. Early signs include rash and itching, and progress to nausea, diarrhea, and liver disease. If gastrointestinal bleeding occurs, it indicates mucosal ulceration. The more severe the reaction, the lower the rate of survival.

The surgeon is performing a kidney transplant on a client. The surgeon attaches the kidney and immediately notes that the kidney takes on a cyanotic, mottled appearance. The surgeon would interpret this as:

Hyperacute rejection Hyperacute rejection occurs almost immediately after transplantation. In kidney transplants, it can often be seen at the time of surgery. As soon as blood flow from the recipient to the donor kidney begins, it takes on a cyanotic, mottled appearance. Acute rejection may occur within the first few days to weeks after transplantation, or it may occur suddenly months or even years later, after the discontinuation of immunosuppressants in the posttransplant period. Chronic rejection develops insidiously over months and years and may or may not be preceded by episodes of acute rejection.

The nurse is teaching a new mother about caring for her baby and reducing the risk for infection. On what principle does the nurse base the knowledge of passive immunity?

Infants are protected at birth from infection by maternal IgG. At birth, infants are protected from infection my maternal IgG antibodies that have crossed the placenta during fetal development. Infants are normally deficient in IgA, IgM, IgD, and IgE because immunoglobulins do not normally cross the placenta.

Type III hypersensitivity immune responses can be harmful when immune complex deposits in tissue cause which type of damage to tissues?

Inflammation Type III responses create immune complexes that are deposited in the affected tissues, activating an inflammatory response. Autoantibodies are involved with type II responses; cytotoxic cells are involved with type II and type IV responses. Immunoglobulins are released in response to B-cell activation of plasma cells, which does not occur as part of type III reactions.

A client has common variable immunodeficiency (CVID), a form of humoral primary immunodeficiency. Which alteration in serum levels would the nurse expect to see?

Low serum IgG levels Humoral primary immunodeficiency associated with impaired B-cell differentiation and antibody production is CVID. All clients have low serum IgG levels, but some present with low IgA and/or low IgM as well, resulting in impaired antibody response to specific infections and vaccine challenges.

Which cellular mediator is involved in the development of type I hypersensitivity reactions?

Mast cells Early in the immediate response to allergen exposure, mast cells degranulate and release mediators that include histamine and heparin. Plasma cells and monocytes respond as part of the acute immune response. Arachidonic acid is part of the late-phase response to the allergen.

A client has developed a type 1 hypersensitivity reaction. When should the nurse assess for a possible progressing response to the secondary or late-phase?

May occur 2 to 8 hours after the primary or initial-phase response and lasts for several days The secondary or late-phase response occurs about 2 to 8 hours after the primary or initial-phase response and lasts for several days. The primary or immediate-phase response usually occurs within 5 to 30 minutes of exposure to antigen and subsides within 60 minutes.

What would constitute a normal assessment finding in a neonate?

Minimal or absent levels of IgA and IgM IgA and IgM levels are normally low in the neonate because these immunoglobulins do not cross the placental barrier. An absence of plasma cells in the lymph nodes and spleen accompanies common variable immunodeficiency. An absence of mature B cells with normal T-cell levels and function, as well as undetectable levels of all immunoglobulins, is a pathologic finding in X-linked agammaglobulinemia.

A nurse is caring for a child who has had a history of recurrent severe infections that have been resistant to treatment with antibiotics. Which disorder should be suspected in this child?

Primary immunodeficiency disorder (PID) Children with PID often present with a history of recurrent, severe infections that are resistant to treatment. In fact, the average age of referral for immune testing after recurrent severe infection is about 6 months of age. The infections frequently involve the respiratory tract and are the result of organisms not traditionally seen in this population.

The nurse is caring for a client who has AIDS and suffers from wasting syndrome. What is the priority nursing consideration for this client?

Nutrition The wasting syndrome is an AIDS-defining illness and is common in people with HIV infection or AIDS. Wasting syndrome is characterized by involuntary weight loss of at least 10% of baseline. Treatment for wasting includes nutritional interventions.

The cell responsible for migrating to the site of an infection and enveloping invading microorganisms is:

Phagocyte The primary purpose of phagocytic cells is to migrate to the site of infection, aggregate around the affected tissue, envelop invading microorganisms or foreign substances, and generate microbicidal substances to kill the ingested pathogens. The other functions are not responsible for that function.

A client is admitted with recurrent infections and granulomatous lesions. The client also reports arthritis and shows signs of respiratory congestion. Which immunodeficiency does this client most likely have?

Phagocytic disorder Recurrent infections, along with granulomatous lesions, are thought to be due to persistence of viable microorganisms in impaired phagocytic cells. Complement disorders cause decreases in the rest of the inflammatory reactions. SCID and Wiskott-Aldrich are complement related.

What is the main effect of HIV infection?

Poor helper T-cell function Helper T cells are also known as CD4+ T cells. These CD4+ T cells are necessary for normal immune function and are the main target of HIV.

A 40 year-old male who has been HIV-positive for 6 years is experiencing a new increase in his viral load along with a corresponding decrease in his CD4+ count. Which aspect of his immune system is likely to remain most intact?

Presentation of major histocompatibility complex (MHC) molecules on body cells The expression of MHC on various cells of the body is not noted to be directly influenced by HIV. However, infected CD4+ cells are compromised in their ability to guide the action of NK cells, to direct phagocytic function of macrophages, and to present antigens that activate B cells.

What instruction will the nurse provide to a client with a new diagnosis of anaphylactic reaction to peanuts?

Routinely wear medical alert identification. Clients with anaphylaxis have type I hypersensitivity reactions that can be triggered by the presence of minute amounts of the antigen. They should always wear or carry medical alert identification. With history of anaphylaxis, they should also carry epinephrine syringes for emergency administration. Waiting until the client stops breathing would put the person at risk of sudden death. Hypersensitivity reactions do not decrease over time, but may become more severe.

Which regimen serves as the rationale for HIV/AIDS treatment with antiretroviral therapy?

combination therapy incorporating the five classes of antiretroviral drugs Because different drugs act on various stages of the replication cycle, optimal treatment includes a combination of drugs, including reverse transcriptase inhibitors, protease inhibitors, fusion/entry inhibitors, and integrase inhibitors, and multidrug combination products. Each type of agent attempts to interrupt viral replication at a different point.

A nurse has just learned that her child has a life-threatening complement disorder known as hereditary angioneurotic edema (HAE). Due to deficiency in C1-INH, the nurse needs to be prepared for which possible life-threatening clinical manifestation?

Swelling of the airway HAE is a rare, life-threatening complement disorder that results from deficiency of C1-inhibitor (HAE-C1-INH). It is an inherited autosomal dominant trait that causes mutation in the 11th chromosome. Deficiencies in C1-INH result in uncontrolled release of vasoactive substances that promote vascular permeability. The net result is development of tissue swelling in the subcutaneous tissues of the extremities, face/torso, or upper airway and GI tract. Laryngeal edema is a life-threatening manifestation that can lead to complete airway obstruction and death without interventions.

A nurse is caring for a child diagnosed with DiGeorge syndrome with thymic hypoplasia. Which immune response would the nurse anticipate in this child?

The child with thymic hypoplasia will be at increased risk of infection. The immune system is affected in 75% of children with DiGeorge syndrome as a result of thymic hypoplasia. Children with severe T-cell dysfunction are more prone to recurrent or chronic viral, fungal, and intracellular bacterial infections. Impaired helper T-cell function affects antigen presentation to B cells and subsequent antibody production. However, the size of the thymus does correlate directly with circulating T-cell counts, so the degree of hypoplasia is not the most important predictor of immune function. The child will not be at increased risk for allergy formation as less antibodies are produced.

The treatment prescribed for an autoimmune disorder is primarily dependent upon what?

The current manifestations of the disease and the mechanisms that cause the disease process Treatment of autoimmune disorders is dependent upon the magnitude of the presenting manifestations and underlying mechanisms of the disease process. Since in many cases the pathophysiologic mechanisms are not always known, treatment may be purely symptomatic. While corticosteroids are often use, they are not always the first line of treatment. The client's age and medical history can be factors in treatment choices but are not the primary consideration.

An infant has been born to a client who is HIV positive. What is the infant's most likely prognosis for developing AIDS?

The infant can be HIV antibody positive by ELISA for up to 18 months of age without being actively infected with HIV. Infants born to HIV-infected women can be HIV antibody positive by ELISA for up to 18 months of age even though they are not infected with HIV. PCR testing for HIV DNA is used most often to diagnose HIV infection in infants younger than 18 months of age. Two positive PCR tests for HIV DNA are needed to diagnose a child with HIV infection. Children born to mothers with HIV infection are considered uninfected if they become HIV antibody negative after 6 months of age, have no other laboratory evidence of HIV infection, and have not met the surveillance-case-definition criteria for AIDS in children. It is possible for them to develop AIDS. Passive immunity is not likely to eradicate the virus.

When a client with a kidney transplant develops graft versus host disease, signs and symptoms develop first in which organ?

The skin, with pruritis and maculopapular rash When a client with a kidney transplant develops graft versus host disease, signs and symptoms develop first in the skin, coinciding with the engraftment of donor cells. People present with a pruritic, maculopapular rash that starts on the hands and feet but ultimately spreads over the entire body. The other symptoms occur in the gastrointestinal system with nausea, anorexia, diarrhea, and abdominal pain. Liver symptoms commonly occur, but they are frequently hard to differentiate from the liver involvement normally seen after transplantation.

A college student has just received a positive HIV test result. How can the nurse most accurately interpret and respond to this finding?

The student has HIV antigens and further testing should be done. The student has antigens against the HIV virus, which indicates that he has been exposed to the virus and further testing should be done to determine if the virus is present. Not all cases of HIV will develop into AIDS, nor does it mean he has AIDS.

What distinguishes primary immunodeficiency disorders from another disorder?

They are inherited abnormalities of immune function that render a person susceptible to diseases normally prevented by an intact immune system. Primary immunodeficiency disorders are inherited abnormalities of immune function that render a person susceptible to diseases normally prevented by an intact immune system. They can be classified as B-cell-mediated, T-cell mediated, or combined immunodeficiencies that affect all aspects of the humoral and cell-mediated immune response. B-cell-mediated immunodeficiency disorders affect antibody production and inhibit the ability of the immune system to defend against bacterial infections and toxins that circulate in body fluids or enter the body through the mucosal surface of the respiratory or gastrointestinal tract. T-cell-mediated immunodeficiency disorders result from defective expression of the T-cell receptor complex, defective cytokine production, and defects in T-cell activation.

The type of hypersensitivity reaction that is mediated by IgG or IgM antibodies directed against target antigens on specific host cell surfaces or tissues is also known as which type of hypersensitivity reaction?

Type II A type I hypersensitivity reaction is dependent on IgE-mediated activation of mast cells and basophils and the subsequent release of chemical mediators of the inflammatory response. Type II hypersensitivity reactions are mediated by IgG or IgM antibodies directed against target antigens on specific host cell surfaces or tissues and result in complement mediated phagocytosis and cellular injury. Type III hypersensitivity is caused by the formation of antigen-antibody immune complexes in the bloodstream, which are subsequently deposited in vascular epithelium or extravascular tissues and which activate the complement system and induce a massive inflammatory response. Type IV hypersensitivity involves tissue damage in which cell-mediated immune responses with sensitized T lymphocytes cause cell and tissue injury.

HIV is considered to be a retrovirus because:

it carries its genetic information in ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA). Like other retroviruses, HIV carries its genetic information in ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA). In the process of taking over the CD4+ T cell, the virus attaches to receptors on the CD4+ cell, fuses to and enters the cell, incorporates its RNA into the cell's DNA, and then uses the CD4+ cell's DNA to reproduce large amounts of HIV, which are released into the blood.

A client has developed a hypersensitivity reaction resulting in the diagnosis of serum sickness. In documentation, the nurse would categorize this reaction as which type of hypersensitivity reaction?

Type III hypersensitivity reaction Type III hypersensitivity reactions involve the formation and deposition of insoluble antigen-antibody complexes and are responsible for vasculitis (as seen in SLE or acute glomerulonephritis), systemic immune complex disease (serum sickness), and local immune complex disease (Arthus reaction). Type I hypersensitivity reactions are IgE-mediated reactions; type II (antibody-mediated) hypersensitivity reactions are mediated by IgG or IgM antibodies; and type IV hypersensitivity reactions involve cell-mediated rather than antibody-mediated immune responses.

A 67-year-old client diagnosed with myasthenia gravis will likely display which clinical manifestations as a result of autoantibodies ultimately blocking the action of acetylcholine, resulting in destruction of the receptors?

Weakness of the eye muscles, difficulty in swallowing and slurred speech, impaired gait. Myasthenia gravis ultimately results in destruction of receptors in the neuromuscular junction, leading to a decrease in neuromuscular function. Tremor of hands/arms, rigidity of the arms, and shuffling gait are signs/symptoms of Parkinson's disease. Short-term memory lapses, problems with orientation, and a lack of drive or initiative are signs/symptoms of Huntington disease. Facial droop, slurred speech, and weakness on one side of the body are classic signs/symptoms of CVA.