PNE 105 Ch. 33 Intro to Immune System. PrepU, Med-Surg.

A client undergoing a skin test has been intradermally injected with a disease-specific antigen on the inner forearm. The client becomes anxious because the area begins to swell. What advice should the nurse give to calm the client?

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

Which is the most important guideline for a nurse caring for immunosuppressed clients?

Follow the guidelines of the agency for controlling infections. Explanation: The nurse should follow agency guidelines for controlling infectious diseases or protecting the client who is immunosuppressed.

A client has been diagnosed with AIDS and tuberculosis (TB). A nursing student asks the nurse why the client's skin test for TB is negative if the client's physician has diagnosed TB. The nurse's correct reply is which of the following?

The client's immune system cannot mount a response to the skin test.

When obtaining a health history from a patient with possible abnormal immune function, what question would be a priority for the nurse to ask?

"Have you ever received a blood transfusion?" Explanation: A history of blood transfusions is obtained, because previous exposure to foreign antigens through transfusion may be associated with abnormal immune function.

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

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

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

All options are correct

A client requires ongoing treatment and infection-control precautions because of an inherited deficit in immune function. The nurse should recognize that this client most likely has what type of immune disorder?

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

A nurse is reviewing the immune system before planning an immunocompromised client's care. How should the nurse characterize the humoral immune response?

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

An individual's exposure to an airborne pathogen has prompted an immune response that includes both cellular and humoral components. Which of the following activities is most closely associated with the humoral immune response?

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

A client has undergone treatment for urosepsis and received high doses of numerous antibiotics during the course of treatment. When planning the client's subsequent care, the nurse should be aware of what potential effect on the client's immune function?

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

A client's health care provider suspects the client has developed an immune system disorder. What will most likely be the first test ordered?

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

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

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

A client's current immune response involves the direct destruction of foreign microorganisms. This aspect of the immune response may be performed by what cells?

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

A client is being treated for cancer and the nurse has identified the nursing diagnosis of Risk for Infection Due to Protein Losses. Protein losses inhibit immune response in what way?

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

A nurse is planning a client's care and is relating it to normal immune response. During what stage of the immune response should the nurse know that antibodies or cytotoxic T cells combine and destroy the invading microbes?

Effector stage Explanation: In the effector stage, either the antibody of the humoral response or the cytotoxic (killer) T cell of the cellular response reaches and couples with the antigen on the surface of the foreign invader. The coupling initiates a series of events that in most instances results in total destruction of the invading microbes or the complete neutralization of the toxin. This does not take place during the three preceding stages.

A client's natural immunity is enhanced by processes that are inherent in the physical and chemical barriers of the body. What is a chemical barrier that enhances natural immunity?

Gastric secretions

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

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

At 39 weeks' gestation, a pregnant client visits the physician for a scheduled prenatal checkup. The physician determines that the fetus has developed an infection in utero and sends the client for an emergency cesarean delivery. The client is very concerned about the health of her unborn child. Based on knowledge of the immune system, the delivery room nurse explains about which immunoglobulin that will be increased in the fetus at the time of birth and will be actively fighting the infection?

IgG Explanation: IgG composes 75% of total immunoglobulin. It appears in serum and tissues, assumes a major role in bloodborne and tissue infections, and crosses the placenta.

A client has had a splenectomy after sustaining serious internal injuries in a motorcycle accident, including a ruptured spleen. Following removal of the spleen, the client will be susceptible to:

Infection because the spleen removes bacteria from the blood.

A patient has enlarged lymph nodes in his neck and a sore throat. This inflammatory response is an example of a cellular immune response whereby:

Lymphocytes migrate to areas of the lymph node. Explanation: Recognition of antigens as foreign, or non-self, by the immune system is the initiating event in any immune response. Recognition involves the use of lymph nodes and lymphocytes for surveillance. Lymph nodes are widely distributed internally throughout the body and in the circulating blood, as well as externally near the body's surfaces. They continuously discharge small lymphocytes into the bloodstream. These lymphocytes patrol the tissues and vessels that drain the areas served by that node.

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

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

Which type of cell is capable of directly killing invading organisms and producing cytokines?

Natural killer cells

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

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

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

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

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

Phagocytic cells Explanation: Monocytes migrate to injury sites and function as phagocytic cells, engulfing, ingesting, and destroying greater numbers and quantities of foreign bodies or toxins than granulocytes. This occurs in response to the foreign bodies that have invaded the laceration from the dirt on the broken glass. Interferon, one type of biologic response modifier, is a nonspecific viricidal protein that is naturally produced by the body and is capable of activating other components of the immune system. Apoptosis, or programmed cell death, is the body's way of destroying worn out cells such as blood or skin cells or cells that need to be renewed. Cytokines are the various proteins that mediate the immune response. These do not migrate to injury sites.

The nurse is taking the health history of a newly admitted client. Which condition would place the client at risk for impaired immune function?

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

Which condition is associated with impaired immunity relating to the aging client?

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

The nurse should recognize a client's risk for impaired immune function if the client has undergone surgical removal of which of the following?

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

A nurse is taking the health history of a newly admitted client. Which of the following conditions would NOT place the client at risk for impaired immune function?

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

The nurse is assessing a client's risk for impaired immune function. What assessment finding should the nurse identify as a risk factor for decreased immunity?

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

A nurse is planning the assessment of a client who is exhibiting signs and symptoms of an autoimmune disorder. The nurse should be aware that the incidence and prevalence of autoimmune diseases is known to be higher among what group?

Women.

During a mumps outbreak at a local school, a teacher has been exposed. The client has previously been immunized for mumps, and consequently possesses:

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

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

effector T cells

Decades ago, before the role of the tonsils and adenoids was better understood, it was typical after repeated bouts with tonsillitis to have a tonsillectomy and adenoidectomy. Today it is understood that the tonsils and adenoids are lymphoid tissues that:

filter bacteria from tissue fluid.

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

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

Immunocompetence is the ability of the immune system to cooperatively protect a person from external invaders and the body's own altered cells. Immunocompetence is maintained by white blood cells and:

lymphoid tissue.

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

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

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

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

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

a.) infectious cells c.) foreign cells d.) cancerous cells Explanation: The immune system's primary targets are infectious, foreign, or cancerous cells.

Proteins formed when cells are exposed to viral or foreign agents that are capable of activating other components of the immune system are referred to as:

interferons. Explanation: Interferons are biologic response modifiers with nonspecific viricidal proteins. Antibodies are protein substances developed by the body in response to and that interact with a specific foreign substance. Antigens are substances that induce formation of antibodies. Complement refers to a series of enzymatic proteins in the serum that, when activated, destroy bacteria and other cells

A client who has developed kidney failure is discussing options with the health care provider for treatment. What does the nurse understand that kidney failure is associated with?

A deficiency in circulating lymphocytes

Which of the following is a age-related change associated with the immune system?

Decreased antibody production. Explanation: Age-related changes associated with the immune response include decreased antibody production, suppressed phagocytic immune response, and a failure of immune system to differentiate "self" from "nonself."

A client with a history of dermatitis takes corticosteroids on a regular basis. The nurse should assess the client for which of the following complications of therapy?

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

A client is taking immunosuppressive medications to prevent the rejection of a transplanted kidney. Which adverse effect(s) should the nurse closely monitor in this client?

Respiratory or urinary system infections.

An emergency department (ED) nurse has provided care for many patients who have primary and secondary diagnoses of immune dysfunction. Which of the following patients likely has the highest risk of a disruption to normal immune functioning?

A man who has recently completed medical treatment for prostate cancer.

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

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

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

Antibodies or An antibody. Explanation: Immunizations activate the humoral immune response, culminating in antibody production. Antigens are the substances that induce the production of antibodies. Immunizations do not prompt cytokine or phagocyte production.

A client developed an infection while on vacation in Central America and is now taking the antibiotic chloramphenicol. What should the client be monitored for when taking this drug?

Aplastic anemia

A patient is being treated in the intensive care unit for sepsis related to ventilator-associated pneumonia. The patient is on large doses of three different antibiotics. What severe outcome should the nurse monitor for in the lab studies?

Bone marrow suppression Explanation: Antibiotics, when given in large doses, can cause bone marrow suppression.

Which condition is associated with impaired immunity relating to the aging client?

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

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

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

A nurse has admitted a client who has been diagnosed with urosepsis. What immune response predominates in sepsis?

Humoral Explanation: Most immune responses to antigens involve both humoral and cellular responses, although only one predominates. For example, during transplantation rejection, the cellular response predominates, whereas in the bacterial pneumonias and sepsis, the humoral response plays the dominant role. Neither mitigated nor nonspecific cell response is predominant in this situation.

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

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

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

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

A client arrives at the clinic and reports a very sore throat as well as a fever. A rapid strep test returns a positive result and the client is given a prescription for an antibiotic. How did the streptococcal organism gain access to the client to cause this infection?

Through the mucous membranes of the throat

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

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

A nurse is explaining the process by which the body removes cells from circulation after they have performed their physiologic function. The nurse is describing what process?

Apoptosis

Which of the following cell types are involved in humoral immunity?

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

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

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

A gerontologic nurse is caring for an older adult client who has a diagnosis of pneumonia. What age-related change increases older adults' susceptibility to respiratory infections?

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

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

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

What specific drug group has both antiviral and anti-proliferative actions?

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

A client's injury has initiated an immune response that involves inflammation. What are the first cells to arrive at this client's site of inflammation?

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

A neonate exhibited some preliminary signs of infection, but the infant's condition resolved spontaneously prior to discharge home from the hospital. This infant's recovery was most likely due to what type of immunity?

Nonspecific immunity

Which medication classification is known to inhibit prostaglandin synthesis or release?

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

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

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

A client is admitted with cellulitis and experiences a consequent increase in white blood cell count. During what process will pathogens be engulfed by white blood cells that ingest foreign particles?

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

Nursing students have learned that removal of specific organs may place the patient at risk for impaired immune function. The students are taught that it is important, while taking the patient's health history, to ask the patient if he or she had surgical removal of what organ that may lead to impairment of the immune system?

Spleen

Which statement accurately reflects current stem cell research?

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

A 38-year-old client has begun to suffer from rheumatoid arthritis and is being assessed for disorders of the immune system. The client works as an aide at a facility that cares for children infected with AIDS. Which is the most important factor related to the client's assessment?

Use of other drugs. Explanation: The nurse needs to review the client's drug history. These data will help her to assess the client's susceptibility to illness because certain past illnesses and drug use, such as corticosteroids, suppress the inflammatory and immune responses. The client's age, home environment, and diet do not have any major implications during assessment because they do not indicate the client's susceptibility to illness.

An older adult has developed a sacral pressure ulcer. What should the nurse assess in order to ensure adequate wound healing and prevent poor outcomes for this client? Select all that apply. a.) Nutritional status b.) The client's ability to perform his or her own wound care c.) The amount of carbohydrates the client ingests d.) Quality of food ingested e.) Caloric intake

a.) Nutritional status. d.) Quality of food ingested. e.) Caloric intake.

A client's recent diagnostic testing included a total lymphocyte count. The results of this test will allow the care team to gauge what aspect of the client's immunity?

ell-mediated immune function Explanation: A total lymphocyte count is a test used to determine cellular immune function. It is not normally used for testing humoral immune function and the associated antigen-antibody.

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

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

Which type of cell is capable of recognizing and killing infected or stressed cells and producing cytokines?

Natural killer cells. Explanation: Natural killer cells are a class of lymphocytes that recognize infected and stressed cells and respond by killing these cells and by secreting macrophage-activating cytokine. Natural killer cells defend against microorganisms and some types of malignant cells. Null lymphocytes do not produce or active cytokine they are stimulated to attack tumor or viral infected cells. Memory cells are important to the immune system but produces memory B cells not cytokine. Cytotoxic -T cells leads to apoptosis ,causing death in infectious cells, however they do not produce cytokine.

A nurse is admitting a client who exhibits signs and symptoms of a nutritional deficit. Inadequate intake of what nutrient increases a client's susceptibility to infection?

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

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

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

What immunoglobulin is present in small amounts and is thought to be related to allergic responses?

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

A client undergoing a skin test has been intradermally injected with a disease-specific antigen on the inner forearm. The client becomes anxious because the area begins to swell. Which technique may be used to decrease anxiety in this client?

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

A nursing instructor is giving a lecture on the immune system. The instructor's discussion on phagocytosis will include:

neutrophils and monocytes.

A patient has been exposed to a pathogen during an outbreak of a nosocomial (hospital-acquired) infection. The patient's immune system has responded appropriately to the virus, and the response has included the production of memory B cells. These particular B cells will have what effect?

The patient will have a more pronounced immune response to the virus during future exposure.

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

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

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

Phagocytosis

A nurse is explaining how the humoral and cellular immune responses should be seen as interacting parts of the broader immune system rather than as independent and unrelated processes. What aspect of immune function best demonstrates this?

The interactions that occur between T cells and B cells.