Introduction to the Immune

1.

The body’s first-line barrier defense is considered to be what?
A)
Mast cells
B)
Mucous membranes
C)
Skin
D)
T cells
Ans:
C

Feedback:

The skin is the first line of barrier defense. It acts as a physical barrier to protect the internal tissues and organs of the body. Mast cells are part of cellular defense. They are found in the respiratory and GI tracts and are fixed basophils that do not circulate. Mucous membranes are a barrier defense that line the areas of the body that are exposed to external influences but do not have the benefit of skin protection. T cells are part of the immune response and provide cell-mediated immunity. Activation of a T cell by a non–self-cell results in responses that destroy foreign cells.

2.

The nurse recognizes what patient has lost a barrier defense increasing his risk for infection?
A)
A 68-year-old man diagnosed with prostate cancer
B)
A 24-year-old man diagnosed with partial thickness burns
C)
A 13-year-old boy diagnosed with chickenpox
D)
A 72-year-old man diagnosed with bacterial pneumonia
Ans:
B

Feedback:

A burn patient loses the protective barrier of the skin and is at risk for infection. In a partial thickness burn, the glands of the skin secrete chemicals that destroy many pathogens and also the normal flora that live on the skin. A cancer patient has decreased cellular defenses. The patient with chickenpox and the patient with pneumonia both have a diminished immune defense along with the prostate cancer patient but still are at less risk for infection than the burn patient.

3.

After 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?
A)
Basophil count
B)
Eosinophil count
C)
Hematocrit
D)
Neutrophil count
Ans:
D

Feedback:

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. Basophils would only increase with generalized bone marrow stimulation. The hematocrit level is increased in polycythemia.

4.

A new mother calls the clinic and tells the nurse her toddler has a temperature of 102ºF. How does the nurse explain why the mother should not be alarmed?
A)
“A fever is the body’s way of fighting an infection and supporting the body’s immune system.”
B)
“Neutrophils release pyrogen, a fever-causing substance, which helps act as a catalyst for the body’s inflammatory and immune responses.”
C)
“Leukotrienes activated by arachidonic acid attract neutrophils to start the process of fighting inflammation.”
D)
“Inflammation causes the activation of a chemical called Hageman factor that initiates a process to bring more blood to the injured area and allows white blood cells to escape into the tissues.”
Ans:
A

Feedback:

The best response by the nurse would be that a fever actually increases the efficiency of the immune and inflammatory responses, helping the body to fight the infection. While the other three statements are correct, they are more technical and include terminology that a new mother may not understand or even care about. If the appropriate response does not suffice and the mother still has questions, the nurse would then go into more detail and use the rationale from the other options to explain in greater detail.

5.

A patient presents to the emergency department with an infected wound on his left forearm. The nurse explains the inflammatory response caused by the injury will occur in what sequence?
A)
Heat, pain, redness, swelling
B)
Swelling, pain, redness, heat
C)
Redness, swelling, heat, pain
D)
Pain, redness, swelling, heat
Ans:
C

Feedback:

The inflammatory response will begin with redness in the direct line of the infected wound. Next, swelling will occur because of the fluid that leaks into the tissue as a result of the change in capillary permeability. The heat can be detected due to the increased blood flow to the area. Pain will be felt due to the activation of fibers by histamine and the kinin system as well as stretching of the tissue caused by the edema.

6.

The patient with AIDS asks the nurse why his cytotoxic T cells are so important. What is the nurse’s best response to explain the actions of cytotoxic T cells?
A)
Cells that are programmed to identify specific proteins or antigens
B)
Cells that can either destroy a foreign cell or mark it for aggressive destruction
C)
Cells that respond to chemical indicators of immune activity and stimulate other lymphocytes to be more aggressive and responsive
D)
Cells that respond to rising levels of chemicals associated with an immune response to suppress or slow the reaction
Ans:
B

Feedback:

Effector or cytotoxic T cells either destroy a foreign cell or make it available for aggressive destruction. Cells that identify specific proteins or antigens are B cells. Cells that respond to chemical indicators to stimulate other cells are helper T cells. Cells that suppress or slow the reaction are suppressor T cells.

7.

A patient has a minor laceration on the left arm. What does the nurse know that will cause a patient to experience muscle and joint aches, a low-grade fever, and sleepiness when an inflammatory reaction is initiated?
A)
Bacterial toxins
B)
Interferon activity
C)
Leukotriene activity
D)
Phagocytosis
Ans:
C

Feedback:

The leukotrienes (autocoids activated through the kinin system) affect the brain to induce slow-wave sleep, believed to be an important energy conservation measure for fighting the invader. They also cause myalgia and arthralgia (muscle and joint pain)—common signs and symptoms of various inflammatory diseases, which also cause reduced activity and save energy. Interferons are released in response to viral infection. Phagocytosis destroys engulfed foreign material in the body. Bacterial toxins cause local reactions unless the infection is intense and the bacteria enter the bloodstream.

8.

What body defense needs to be reduced in the patient following organ transplantation?
A)
Major histocompatibility complex
B)
Barrier defenses
C)
Lymphoid tissues
D)
Eosinophils
Ans:
A

Feedback:

The major histocompatability complex is the genetic identification code carried on chromosomes and produces several proteins called histocompatibility antigens located on the cell membrane that allow the body to recognize cells that are self-cells. Cells without these proteins, such as those in a transplanted organ, are identified as foreign and are targeted for destruction so this defense must be minimized to prevent damage to the transplanted organ. Barrier defenses prevent entry of pathogens into the body. Lymphoid tissue creates cellular components of the mononuclear phagocyte system, differentiates T cells, and regulates actions of the immune system. Eosinophils respond to allergic responses. Barrier defenses, lymphoid tissue, and eosinophils are not involved in the transplant rejection process.

9.

The nurse is teaching a class on the inflammatory response for other nurses and discusses the role of factor XII or the Hageman factor. What substance does Hageman’s factor activate to cause kininogen to be converted to bradykinin?
A)
Arachidonic acid
B)
Prostaglandins
C)
Leukotrienes
D)
Kallikrein
Ans:
D

Feedback:

Hageman’s factor activates kallikrein, a substance found in the local tissues, which causes the precursor substance kininogen to be converted to bradykinin and other kinins. Bradykinin causes the release of arachidonic acid from the cell membrane. Arachidonic acid causes the release of other substances called autocoids, including prostaglandins, leukotrienes, and thromboxanes

10.

A patient who has received a heart transplant has been given an order for drugs that block T cell activity. What is the rationale behind this order?
A)
To manufacture antibodies to the foreign proteins
B)
To stimulate wound healing
C)
To combine with a complement to cause a massive inflammatory reaction
D)
To prevent an inflammatory reaction against the transplanted heart
Ans:
D

Feedback:

Effector or cytotoxic T cells are aggressive against non–self-cells, releasing cytokines that can either directly destroy a foreign cell or mark it for aggressive destruction. If the transplanted organ is attacked by cytokines, it will be destroyed, referred to as “organ rejection.” As a result, inhibition of these killer T cells is essential to continued organ function in the transplanted organ. Blocking T cells would not manufacture antibodies, stimulate wound healing, or trigger a massive inflammatory response.

11.

The nurse anticipates what generalized response to the patient’s cellular injury?
A)
Decreased pH
B)
Increased protein catabolism
C)
Inhibition of cell growth
D)
Inflammation
Ans:
D

Feedback:

The inflammatory response is the local reaction of the body to invasion or injury. Any insult to the body that injures cells or tissues sets of a series of events and chemical reactions known as the inflammatory response. Protein catabolism is the breakdown of protein into particles small enough to be carried into the cell and is an incorrect choice. Cellular injury does not inhibit cell growth or lower pH.

12.

The nurse takes a class to better understand the immune and inflammatory responses and learns what cells help to slow or suppress the immune response?
A)
Cytotoxic T cells
B)
Helper T cells
C)
Suppressor T cells
D)
B cells
Ans:
C

Feedback:

Suppressor T cells respond to rising levels of chemicals associated with an immune response to suppress or slow the reaction. Helper T cells respond to the chemical indicators of immune activity and stimulate other lymphocytes, including B cells, to be more aggressive. Cytotoxic T cells are aggressive against non–self-cells.

13.

The nurse plans care for patients with the knowledge that loss of body defenses can increase the patient’s risk for infection. What barrier defenses need to remain intact to prevent infection? (Select all that apply.)
A)
Skin
B)
Mucous membranes
C)
Gastric acid
D)
Leukocytes
E)
T cells
Ans:
A, B, C

Feedback:

The skin is the first line of barrier defense, creating a physical barrier to prevent pathogens from entering the internal tissues. Mucous membranes are another barrier defense protecting the area without skin protection (e.g., the respiratory tract, gastrointestinal tract, genitourinary tract). Gastric acids destroy many pathogens that are ingested or swallowed, preventing them from entering the bloodstream or internal organs. Leukocytes and T cells are cellular defenses and not barrier defenses.

14.

What is the nurse referring to when discussing B-cell immunity when the B cells are programmed to identify specific proteins or antigens?
A)
T-cell immunity
B)
Autoimmunity
C)
Passive immunity
D)
Humoral immunity
Ans:
D

Feedback:

B cells are programmed to identify specific proteins, or antigens. They provide what is called “humoral immunity.” Autoimmunity occurs when the body attacks its own self-cells. Passive immunity is the transfer of antibodies from one person to another. Active immunity is immunity produced by the body in response to an organism.

15.

When antibodies and antigens react, they create an antigen–antibody complex. This structure reveals a new receptor site that activates a series of plasma proteins called what?
A)
Complement
B)
Neutralization of viral toxins
C)
Opsonization
D)
Histamine
Ans:
A

Feedback:

When the antigens and antibodies react, they form an antigen–antibody complex. This new structure reveals a new receptor site on the antibody that activates a series of plasma proteins in the body called “complement proteins.” Options B, C, and D are distracters for this question and are not involved in this process.

16.

The pharmacology instructor is discussing activated complement with the nursing students. What would the instructor tell the students that activated complement stimulates?
A)
Opsonization
B)
Chemotaxis
C)
Agglutination
D)
Phagocytosis
Ans:
B

Feedback:

Activated complement stimulates chemotaxis (movement of monocytes, neutrophils, basophils, and eosinophils toward the antigen) and the release of hydrolytic enzymes; actions that result in the destruction or inactivation of the invading antigen. Opsonization is the coating of the antigen so that it is more readily recognized by phagocytic cells. Agglutination is the clumping of cells. Phagocytosis is the destruction of pathogens or cells.

17.

The nursing instructor explains that future exposure to an antigen previously encountered elicits a much faster response as the result of what cells forming memory cells?
A)
T cells
B)
Lymphocytes
C)
Monocytes
D)
B cells
Ans:
D

Feedback:

After being activated, the B cells form memory cells that will produce antibodies for immediate release in the future if the antigen is encountered again. Although lymphocytes, monocytes, and T cells will then join in the battle to destroy the antigen, they do not produce memory cells as the B cells do.

18.

When explaining the immune response the nursing instructor explains the role of neutrophils as doing what?
A)
Phagocytosis
B)
Producing memory cells
C)
Marking cells for destruction
D)
Initiating an immune response
Ans:
A

Feedback:

Neutrophils engulf and digest foreign material through the process of phagocytosis. B cells produce memory cells. Cytoxic T cells mark cells for destruction. Basophils initiate the immune response.

19.

What specific drug group has both antiviral and antiproliferative actions?
A)
Interferons
B)
Interleukins
C)
Monoclonal antibodies
D)
Hematopoietic growth factors
Ans:
A

Feedback:

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. Therefore, options B, C, and D are incorrect.

20.

Tumor necrosis factors (TNF) participate in the inflammatory response of the human body. What do they cause in the inflammatory response?
A)
Enhancing macrophage activity
B)
Tumor regression
C)
Binding of target cells
D)
Delaying or stopping macrophage migration
Ans:
B

Feedback:

TNF, a cytokine, is a chemical released by macrophages that inhibits tumor growth and can cause tumor regression. It also works with other chemicals to make the inflammatory and immune responses more aggressive and efficient. Therefore, options A, C, and D are incorrect.

21.

Stressors are a variety of factors that have long been thought to have an important connection with the immune response. What could the nurse classify as a stressor? (Select all that apply.)
A)
Trauma
B)
Foreign cells
C)
Viruses
D)
Extremes of environmental conditions
E)
Self-cells
Ans:
A, B, C, D

Feedback:

The term “stressors” can include bacteria, viruses, other foreign pathogens or non–self-cells, trauma, and exposure to extremes of environmental conditions. Self-cells are not considered a stressor on the body.

22.

The nurse is caring for a patient with newly diagnosed multiple sclerosis (MS). The patient asks why MS is called an autoimmune disease. What is the nurse’s best response?
A)
The body attacks its own cells because it responds to specific self-antigens to produce antibodies.
B)
A result of response to a cell that was invaded by bacteria, leading to antibody production to similar cells.
C)
Production of autoantibodies is a normal process that goes on all the time, but immunosuppression limits B-cell response.
D)
People with multiple sclerosis have a genetic predisposition to destroy autoantibodies.
Ans:
A

Feedback:

Autoimmune disease occurs when the body responds to specific self-antigens to produce antibodies or cell-mediated immune responses against its own cells. The actual cause of autoimmune disease is not known, but theories speculate that (1) it could be a result of response to a cell that was invaded by a virus, leading to antibody production to similar cells; (2) production of autoantibodies is a normal process that goes continuously, but in a state of immunosuppression, the suppressor T cells do not suppress autoantibody production; or (3) a genetic predisposition to develop autoantibodies is present.

23.

The nurse is caring for a patient with an acute infection that resulted in an immune reaction. What symptoms exhibited by the patient would the nurse recognize as being caused by interleukins? (Select all that apply.)
A)
Fever
B)
Joint pain
C)
Muscle pain
D)
Hyperactivity
E)
Insomnia
Ans:
A, B, C

Feedback:

Interleukins cause many of the symptoms associated with flu-like symptoms, all things that help the body to conserve energy including fever, joint pain (arthralgia), muscle pain (myalgia), and slow-wave sleep induction. Hyperactivity and insomnia are incorrect options.

24.

What immunoglobulin (Ig) is present in small amounts and is thought to be related to allergic responses?
A)
IgM
B)
IgG
C)
IgE
D)
IgA
Ans:
C

Feedback:

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). 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 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.

25.

Our bodies contain various immunoglobulins (Ig). Which of these immunoglobulins is found in sweat, tears, mucus, and bile?
A)
IgG
B)
IgA
C)
IgM
D)
IgE
Ans:
B

Feedback:

Five different types of immunoglobulins have been identified: 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. 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); 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. These antibodies react with specific pathogens that are encountered in exposed areas of the body.

26.

A 44-year-old man has come to the clinic with an exacerbated asthma attack, 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 there is most likely an allergic component based on a genetic predisposition. The specific allergen initiated by immunological mechanisms is usually mediated by what?
A)
Immunoglobulin A
B)
Immunoglobulin M
C)
Immunoglobulin G
D)
Immunoglobulin E
Ans:
D

Feedback:

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.

27.

Injury to a cell membrane causes the local release of histamine. What does histamine do?
A)
Stimulates pain perception
B)
Causes vasoconstriction
C)
Decreases capillary permeability
D)
Inhibits phagocytosis
Ans:
A

Feedback:

Pain comes from the activation of pain fibers by histamine and the kinin system, occurring any time a cell is injured. Histamine also causes vasodilation, increases capillary permeability, and facilitates phagocytosis.

28.

An adolescent comes to the free clinic with complaints of allergic rhinitis. The adolescent asks the nurse what makes his nose get so stuffy. What is the nurse’s best response?
A)
“The inside of the nose swells because of the dilation of the blood vessels.”
B)
“Allergies make the sinuses drain into the nasal passages and it stuffs them up.”
C)
“The inside of the nose swells closed because of drainage from the sinuses.”
D)
“Leukotrienes are attacking the mucous membranes of your nose and causing irritation.”
Ans:
A

Feedback:

Histamine is the major mediator of allergic reactions in the nasal mucosa. Tissue edema results from vasodilation and increased capillary permeability. Tissue edema is not caused by drainage from the sinuses or from leukotrienes.

29.

In a discussion about cancer, a student asks why the body does not phagocytize a tumor. What would be the instructor’s best response?
A)
“Sometimes tumor cells trick the T cells into allowing them to survive.”
B)
“Some tumor cells do not develop an antigen–antibody reaction.”
C)
“Some tumor cells develop a strong mast cell reaction.”
D)
“Tumor cells are too small to be seen by the immune system.”
Ans:
A

Feedback:

Neoplasms occur when mutant cells escape normal surveillance of the immune system and begin to grow and multiply. Aging reduces efficiency of the immune system; location of mutant cells can make it difficult for lymphocytes to get to them or that mass can grow so quickly that the tumor becomes too large for the immune system to deal with. Tumors can produce antibodies that cover antigen receptor sites on the tumor and prevent recognition by cytotoxic T cells, or a weak antigenic tumor may elicit a mild response from the immune system and tricks the T cells into allowing it to survive.

30.

What systems are activated by Hageman’s factor? (Select all that apply.)
A)
Kinin system
B)
Histamine release system
C)
Clotting cascade
D)
Plasminogen system
E)
Chemotaxis system
Ans:
A, C, D

Feedback:

Hageman’s factor is responsible for activating at least three systems in the body: the kinin system; the clotting cascade, which initiates blood clotting; and the plasminogen system, which initiates the dissolution of blood clots. Histamine release is stimulated by cell damage. Arachidonic acid activates some leukotrienes that have a property called chemotaxis, which is the ability to attract neutrophils and to stimulate them and other macrophages to be very aggressive.

31.

The nurse assesses the patient’s postoperative wound and determines that the wound is inflamed, most likely because of an infection, when noting what classic symptoms? (Select all that apply.)
A)
Heat around the site of the wound
B)
Redness around the site of the wound
C)
Increase in reports of pain
D)
Edema at the site of the wound
E)
Serosanguineous drainage from the wound
Ans:
A, B, C, D

Feedback:

Activation of the inflammatory response produces a characteristic clinical picture. Heat occurs because of the increased blood flow to the area. Swelling occurs because of the fluid that leaks into the tissues as a result of the change in capillary permeability. Redness is related to the increase in blood flow caused by the vasodilation. Pain comes from the activation of pain fibers by histamine and the kinin system.

32.

When assessing the patient with tissue injury, the nurse correlates signs and symptoms to the responses occurring within the patient’s body. Put the inflammatory responses in the order they will occur.
A)
Activation of Hageman’s factor
B)
Kininogen activates release of bradykinin
C)
Release of leukotrienes and prostaglandins
D)
Prekallikrein becomes kallikrein
E)
Release of arachidonic acid
Ans:
A, B, C, D, E

Feedback:

Tissue injury is followed by exposure of plasma to the injured cell, which results in activation of Hageman’s factor. This stimulates prekallikrein to become active kallikrein. Kininogen activates bradykinin. Arachidonic acid is released, which activates release of leukotrienes and prostaglandins.

33.

The patient tells the nurse she was reading about interferons on the Internet but still does not exactly understand what they do. What actions would the nurse describe as being performed by interferons? (Select all that apply.)
A)
Prevent viral replication
B)
Suppress malignant cell replication
C)
Suppress tumor growth
D)
Stimulate T and B cells to initiate an immune response
E)
Stimulate the body to produce more T cells
Ans:
A, B, C

Feedback:

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. Interleukins stimulate T and B cells to initiate an immune response and to produce more T cells.

34.

The nurse is caring for a patient waiting for a heart transplant. The patient’s spouse asks the nurse, “Why don’t they just choose any heart until the right heart can be found?” What is the nurse’s best response?
A)
The more closely the new heart matches the patient’s tissue, the less aggressive the immune reaction will be.
B)
When the body responds to specific self-antigens to produce antibodies against its own cells, a severe immune response results.
C)
Graft-versus-host disease would result making the patient very ill.
D)
The patient would need to have suppressor T cells infused daily to maintain the heart.
Ans:
A

Feedback:

Transplantation of foreign tissue (e.g., moving a heart from a donor to a sick patient) results in an immune reaction. Matching a donor’s human leukocyte antigen markers is important as closely as possible to those of the recipient because histocompatability is essential. The more closely the transplanted heart matches the recipient, the less aggressive the immune response will be to the donated tissue. Graft-versus-host disease occurs only in stem cell or bone marrow donations, not organ transplantation. Suppressor T cells cannot be transfused like blood because they must be produced by the body to function appropriately.

35.

The patient, recently diagnosed with HIV, is waiting for results of his lab work to determine his T cell count and says to the nurse, “What exactly is a T cell?” What is the nurse’s best response?
A)
“T cells are monocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body.”
B)
“T cells are neutrophils, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body.”
C)
“T cells are lymphocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body.”
D)
“T cells are basophils, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body.”
Ans:
C

Feedback:

T cells are lymphocytes, a type of white blood cells with large, varied nuclei that can be either T cells or B cells. T cells are not neutrophils, which are capable of moving outside the bloodstream and phagocytizing foreign material. Basophils are myelocytic leukocytes containing chemical substances important for initiating and maintaining an immune or inflammatory response. Monocytes are macrophages capable of phagocytizing an antigen and help to remove foreign material from the body.