C H A P T E R
47
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
1. Which type of immunity is the result of contact with the antigen through infection and is the longest lasting type of immunity?
a. Active innate immunity c. Active acquired immunity b. Passive innate immunity d. Passive acquired immunity 2. What accurately describes passive acquired immunity (select all that apply)?
a. Pooled gamma globulin b. Immunization with antigen c. Temporary for several months d. Immediate, lasting several weeks e. Maternal immunoglobulins in neonate
f. Boosters may be needed for extended protection 3. How does an antigen stimulate an immune response?
a. It is captured, processed, and presented to a lymphocyte by a macrophage.
b. It circulates in the blood, where it comes in contact with circulating lymphocytes.
c. It is a foreign protein that has antigenic determinants different from those of the body.
d. It combines with larger molecules that are capable of stimulating production of antibodies.
4. Which T lymphocytes are involved in direct attack and destruction of foreign pathogens?
a. Dendritic cells c. T helper (CD4) cells b. Natural killer cells d. T cytotoxic (CD8) cells 5. How does interferon help the body’s natural defenses?
a. Directly attacks and destroys virus-infected cells
b. Augments the immune response by activating phagocytes
c. Induces production of antiviral proteins in cells that prevent viral replication
d. Is produced by viral infected cells and prevents the transmission of the virus to adjacent cells 6. What is included in the humoral immune response?
a. Surveillance for malignant cell changes
b. Production of antigen-specific immunoglobulins c. Direct attack of antigens by activated B lymphocytes d. Releasing cytokines responsible for destruction of antigens 7. Where and into what do activated B lymphocytes differentiate?
a. Spleen; natural killer cells that destroy infected cells b. Bone marrow; plasma cells that secrete immunoglobulins c. Thymus; memory B-cells that retain a memory of the antigen
d. Bursa of Fabricius; helper cells that in turn activate additional B lymphocytes
8. Which immunoglobulin is responsible for the primary immune response and forms antibodies to ABO blood antigens?
a. IgA c. IgG
b. IgD d. IgM
9. Which immunoglobulins will initially protect a newborn baby of a breastfeeding mother (select all that apply)?
a. IgA d. IgG
b. IgD e. IgM
c. IgE
Altered Immune Responses
48 Chapter 14 Altered Immune Responses and Transplantation
10. Which characteristic describes immunoglobulin E (select all that apply)?
a. Assists in parasitic infections d. Assists in B-lymphocyte differentiation b. Responsible for allergic reactions e. Predominant in secondary immune response c. Present on the lymphocyte surface f. Protects body surfaces and mucous membranes 11. What are the important functions of cell-mediated immunity (select all that apply)?
a. Fungal infections d. Contact hypersensitivity reactions
b. Transfusion reactions e. Immunity against pathogens that survive outside cells c. Rejection of transplanted tissues
12. A 69-year-old woman asks the nurse whether it is possible to “catch” cancer because many of her friends of the same age have been diagnosed with different kinds of cancer. In responding to the woman, the nurse understands that what factor increases the incidence of tumors in older adults?
a. An increase in autoantibodies c. Decreased differentiation of T lymphocytes b. Decreased activity of the bone marrow d. Decreased size and activity of the thymus gland 13. What describes the occurrence of a type IV or delayed hypersensitivity transplant reaction?
a. Antigen links with specific IgE antibodies bound to mast cells or basophils releasing chemical mediators
b. Cellular lysis or phagocytosis through complement activation following antigen-antibody binding on cell surfaces c. Sensitized T lymphocytes attack antigens or release cytokines that attract macrophages that cause tissue damage d. Antigens combined with IgG and IgM too small to be removed by mononuclear phagocytic system deposit in
tissue and cause fixation of complement
14. What are examples of type I or IgE-mediated hypersensitivity reactions (select all that apply)?
a. Asthma f. Contact dermatitis
b. Urticaria g. Anaphylactic shock
c. Angioedema h. Transfusion reactions
d. Allergic rhinitis i. Goodpasture syndrome
e. Atopic dermatitis
15. Which type of hypersensitivity reaction occurs with rheumatoid arthritis and acute glomerulonephritis?
a. Type I or IgE-mediated hypersensitivity reaction b. Type II or cytotoxic hypersensitivity reaction
c. Type III or immune-complex mediated hypersensitivity reaction d. Type IV or delayed hypersensitivity reaction
16. For the patient with allergic rhinitis, which therapy should the nurse expect to be ordered first?
a. Corticosteroids c. Antipruritic drugs
b. Immunotherapy d. Sympathomimetic/decongestant drugs
17. A patient was given an IM injection of penicillin in the gluteus maximus and developed dyspnea and weakness within minutes following the injection. Which additional assessment findings indicate that the patient is having an anaphylactoid reaction (select all that apply)?
a. Wheezing d. Constricted pupils
b. Hypertension e. Slowed strong pulse
c. Rash on arms f. Feeling of impending doom
18. Priority Decision: The patient is admitted from a nearby park with an apparent anaphylactic reaction to a bee sting.
He is experiencing dyspnea and hypotension with swelling at the site. Number the following actions in the order of priority that the nurse should implement for this patient.
_______ a. Provide oxygen _______ b. Remove the stinger _______ c. Ensure a patent airway
_______ d. Prepare to administer epinephrine _______ e. Start IV for fluid and medication access _______ f. Position patient flat with the legs elevated
_______ g. Anticipate intubation with severe respiratory distress
_______ h. Have diphenhydramine (Benadryl) and nebulized albuterol available
Chapter 14 Altered Immune Responses and Transplantation 49 19. Which rationale describes treatment of atopic allergies with immunotherapy?
a. It decreases the levels of allergen-specific T helper cells.
b. It decreases the level of IgE so that it does not react as readily with an allergen.
c. It stimulates increased IgG to bind with allergen-reactive sites, preventing mast cell–bound IgE reactions.
d. It gradually increases the amount of allergen in the body until it is no longer recognized as foreign and does not elicit an antibody reaction.
20. Which description about a nurse who develops a contact dermatitis from wearing latex gloves is accurate?
a. This demonstrates a type I allergic reaction to natural latex proteins.
b. Use powder-free latex gloves to prevent the development of symptoms.
c. Use an oil-based hand cream when wearing gloves to prevent latex allergy.
d. This demonstrates a type IV allergic reaction to chemicals used in the manufacture of latex gloves.
21. A 28-year-old male Gulf War veteran tells the nurse he gets a headache, sore throat, shortness of breath, and nausea when his girlfriend wears perfume and when he was painting her apartment. He is afraid he has cancer. What does the nurse suspect may be the patient’s problem?
a. He has posttraumatic stress disorder.
b. He has multiple chemical sensitivities.
c. He needs to wear a mask when he paints.
d. He is looking for an excuse to break up with his girlfriend.
22. Although the cause of autoimmune disorders is unknown, which factors are believed to be present in most conditions (select all that apply)?
a. Younger age d. Initiation of autoreactivity by triggers b. Male gender e. Frequent viruses throughout the lifetime c. Inheritance of susceptibility genes
23. Why is plasmapheresis indicated in the treatment of autoimmune disorders?
a. Obtain plasma for analysis and evaluation of specific autoantibodies b. Decrease high lymphocyte levels in the blood to prevent immune responses
c. Remove autoantibodies, antigen-antibody complexes, and inflammatory mediators of immune reactions d. Add monocytes to the blood to promote removal of immune complexes by the mononuclear phagocyte system 24. Before the patient receives a kidney transplant, a crossmatch test is ordered. What does a positive crossmatch
indicate?
a. Matches tissue types for a successful transplantation b. Determines paternity and predicts risk for certain diseases c. Establishes racial background and predicts risk for certain diseases
d. Cytotoxic antibodies to the donor contraindicate transplanting this donor’s organ 25. What is the most common cause of secondary immunodeficiency disorders?
a. Chronic stress c. Drug-induced immunosuppression
b. T-cell deficiency from HIV d. Common variable hypogammaglobulinemia 26. Which characteristics are seen with acute transplant rejection (select all that apply)?
a. Treatment is supportive
b. Only occurs with transplanted kidneys c. Organ must be removed when it occurs
d. The recipient’s T cytotoxic lymphocytes attack the foreign organ
e. Long-term use of immunosuppressants necessary to combat the rejection f. Usually reversible with additional or increased immunosuppressant therapy
27. The patient is experiencing fibrosis and glomerulopathy a year after a kidney transplant. Which type of rejection is occurring?
a. Acute c. Delayed
b. Chronic d. Hyperacute
50 Chapter 14 Altered Immune Responses and Transplantation
CASE STUDY Allergy
Patient Profile
M.W., a 54-year-old male patient, has been diagnosed as having chronic allergic rhinitis. His health care provider pre- scribed oral antihistamines for control of his symptoms, which has not been completely effective. He is to undergo skin testing to identify specific allergens.
Subjective Data
• Itching of eyes, nose, and throat
• Stuffy nose, head congestion Objective Data
• Clear nasal drainage; reddened eyes and lacrimation
Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What assessments of M.W. should be included by the nurse?
2. What immunoglobulins and chemical mediators are involved in M.W.’s allergic reaction?
3. Describe the procedure the nurse uses to perform the skin testing. What results indicate a positive response?
4. What precautions should be taken by the nurse during skin testing?
5. How do antihistamines act to relieve allergic symptoms? What information should the nurse include in teaching M.W. about using the antihistamines?
6. Skin testing indicates M.W. has an allergy to household dust. What information should the nurse include in teaching M.W. to control his exposure to this allergen?
7. M.W. is to begin immunotherapy. What would be the advantages and disadvantages of using sublingual immunotherapy?
8. What precautions does the nurse use during the subcutaneous administration of the allergen extract?
9. Priority Decision: Based on the assessment data provided, what are the priority nursing diagnoses? Are there any collaborative problems?
28. What are the most common immunosuppressive agents used to prevent rejection of transplanted organs?
a. Cyclosporine, sirolimus, and muromonab-CD3 b. Prednisone, polyclonal antibodies, and cyclosporine c. Azathioprine, mycophenolate mofetil, and sirolimus d. Tacrolimus, prednisone, and mycophenolate mofetil
29. The patient has received a bone marrow transplant. Soon after the transplant there is a rash on the patient’s skin. She says her skin is itchy and she has severe abdominal pain. What best summarizes what is happening to the patient and how she will be treated?
a. Graft rejection occurring; treat with different immunosuppressive agents b. Dry skin and nausea are side effects of immunosuppresants; decrease the dose
c. Transplanted bone marrow is rejecting her tissue; prevent with immunosuppressive agents
d. Dry skin from the dry air and nausea from the food in the hospital; treat with humidifier and home food
C H A P T E R
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved. 51
15
1. To what is the increase in emerging and untreatable infections attributed (select all that apply)?
a. The evolution of new infectious agents b. Use of antibiotics to treat viral infections
c. Human population encroachment into wilderness areas d. Transmission of infectious agents from humans to animals
e. An increased number of immunosuppressed and chronically ill people
2. The three antibiotic-resistant bacteria that are of most current concern in North America are ____________________, ____________________, and ____________________.
3. What are the recommended measures to prevent the transmission of health care–associated infections (HAIs) (select all that apply)?
a. Empty bedpans as soon as possible d. Use personal protective equipment b. Limit fresh flowers in patient rooms e. Hand washing or alcohol-based sanitizing c. Remove urinals from bedside tables f. Have patients wear sandals in the shower
4. A patient with diarrhea has been diagnosed with Clostridium difficile. Along with standard precautions, which kind of transmission-based precautions will be used when the nurse is caring for this patient?
a. Droplet precautions c. Isolation precautions b. Contact precautions d. Airborne precautions
5. A 78-year-old patient has developed Haemophilus influenzae. In addition to standard precautions, what should the nurse use to protect herself and other patients when working within 3 feet of the patient?
a. Mask c. Gloves
b. Gown d. Shoe covers
6. An 82-year-old male patient with pneumonia who is in the intensive care unit (ICU) is beginning to have decreased cognitive function. What should the nurse first suspect as a potential cause of this change?
a. Fatigue c. ICU psychosis
b. Infection d. Medication allergy
7. The nurse realizes that the patient understands the teaching about decreasing the risk for antibiotic-resistant infection when the patient says which of the following?
a. “I know I should take the antibiotic for one day after I feel better.”
b. “I want an antibiotic ordered for my cold so I can feel better sooner.”
c. “I always save some pills because I get the illness again after I first feel better.”
d. “I will follow the directions for taking the antibiotic so I will get over this infection.”
8. In each of the following situations identify which option has the highest risk for human immunodeficiency virus (HIV) transmission?
a. Transmission to women OR to men during sexual intercourse
b. Hollow-bore needle used for vascular access OR used for IM injection c. First 2 to 6 months of infection OR 1 year after infection
d. Perinatal transmission from HIV-infected mothers taking antiretroviral therapy OR HIV-infected mothers using no therapy
e. A splash exposure of HIV-infected blood on skin with an open lesion OR a needle-stick exposure to HIV-infected blood