Ch 6 -- Innate Immunity: Inflammation & Wound Healing -- Patho

A public health nurse is teaching the community about health promotion. Which information

should the nurse include for innate immunity? Innate immunity is gained:

a. following an illness.

b. at birth.

c. via injection of specific antibodies.

d. in adulthood.

ANS: B

Innate immunity is present at birth. It is not dependent on illness or injection.

REF: p. 134

Which statement indicates teaching was successful regarding collectins? Collectins are

produced by the:

a. kidneys.

b. bowel.

c. lungs.

d. integument.

ANS: C

Collectins are produced by the lungs. Collectins are not associated with the kidneys, bowel, or

integumentary system.

REF: p. 135

A 20-year-old male received a knife wound to the arm during an altercation. Which of the

following types of immunity was compromised?

a. Innate immunity

b. Inflammatory response

c. Adaptive immunity

d. Specific immunity

ANS: A

The epithelial cells of the skin are a part of innate immunity. The inflammatory response is

not a type of immunity. Adaptive immunity is represented by the normal flora of the bowel.

Specific immunity is a type of adaptive immunity and is not associated with a break in skin

integrity.

REF: pp. 134-135

Biochemical secretions that trap and kill microorganisms include:

a. hormones.

b. neurotransmitters.

c. earwax.

d. gastric acid.

ANS: C

Epithelial cells secrete several substances that protect against infection, including earwax.

Hormones do not contain biochemical secretions that trap and kill microorganisms.

Neurotransmitters carry important messages, and gastric acid helps break down food into its

component parts, but neither contains biochemical secretions.

REF: p. 135

A 25-year-old female presents to her primary care provider reporting vaginal discharge of a

white, viscous, and foul-smelling substance. She reports that she has been taking antibiotics

for the past 6 months. Which finding will the nurse most likely see on the microorganism

report?

a. Clostridium difficile overgrowth

b. Decreased Lactobacillus

c. Streptococcus overgrowth

d. Decreased Candida albicans

ANS: B

Diminished colonization with Lactobacillus that occurs as a result of prolonged antibiotic

treatment increases the risk for vaginal infections, such as vaginosis. Clostridium difficile and

Candida albicans occur in the colon, not the vagina. Streptococcus overgrowth will occur in

the mouth.

REF: p. 136

When an aide asks the nurse about the purpose of the inflammatory process, how should the

nurse respond?

a. To provide specific responses toward antigens.

b. To lyse cell membranes of microorganisms.

c. To prevent infection of the injured tissue.

d. To create immunity against subsequent tissue injury.

ANS: C

One purpose of the inflammatory process is to prevent infection and further damage by

contaminating microorganisms. Specific response toward antigens is a part of the complement

system that assists in the inflammatory response, but not its purpose. Lysis of cell membranes

is part of the process of phagocytosis, which removes foreign material. Immunity cannot be

achieved against future tissue injury.

REF: p. 137

A child fell off a swing and scraped his right knee. The injured area becomes painful. What

else will the nurse observe upon assessment?

a. Vasoconstriction at injured site

b. Decreased RBC concentration at injured site

c. Pale skin at injured site

d. Edema at injured site

ANS: D

Increased vascular permeability and leakage of fluid out of the vessel cause edema at the site

of injury. Vasodilation occurs, bringing increased RBCs to the site and causing redness.

REF: p. 137

A nurse recalls the mast cell, a major activator of inflammation, initiates the inflammatory

response through the process of:

a. chemotaxis.

b. endocytosis.

c. degranulation.

d. opsonization.

ANS: C

Degranulation of mast cells is a major cellular component of inflammation. Chemotaxis is the

process of white cell migration. Endocytosis and opsonization are parts of phagocytosis but

are not factors in mast cell response.

REF: pp. 144-145

Which of the following individuals would be at greatest risk for an opportunistic infection?

a. 18-year-old with diabetes

b. 70-year-old with congestive heart failure

c. 24-year-old who is immunocompromised

d. 30-year-old with pneumonia

ANS: C

Opportunistic microorganisms can cause disease if the individual's defenses are

compromised. Diabetes, congestive heart failure, and pneumonia are not associated with

immunocompromised disorders.

REF: p. 137

The directional migration of leukocytes along a chemical gradient is termed:

a. chemotaxis.

b. endocytosis.

c. margination.

d. diapedesis.

ANS: A

Chemotaxis is the process by which leukocytes undergo directed migration. Endocytosis is a

form of engulfment and a part of phagocytosis. Margination occurs when leukocytes adhere to

endothelial cells in the walls of vessels. Diapedesis is the emigration of the cells through cell

junctions that have loosened in response to inflammatory mediators.

REF: p. 147

A 20-year-old male shoots his hand with a nail gun while replacing roofing shingles. Which

of the following cell types would be the first to aid in killing bacteria to prevent infection in

his hand?

a. Eosinophils

b. Neutrophils

c. Leukotrienes

d. Monocytes

ANS: B

Neutrophils are the predominant phagocytes in the early inflammatory site, arriving within

6-12 hours after the initial injury. Eosinophils help limit and control inflammation.

Leukotrienes are activators of the inflammatory response. Monocytes enter much later and

replace leukocytes.

REF: p. 146

The predominant phagocyte of early inflammation is the:

a. eosinophil.

b. neutrophil.

c. lymphocyte.

d. macrophage

ANS: B

Neutrophils are the predominant phagocytes in the early inflammatory site, arriving within

6-12 hours after the initial injury. Eosinophils help limit and control inflammation, but they

are not the prominent phagocyte. Lymphocytes are part of the innate immune response.

Macrophages kill microorganisms.

REF: p. 146

A 25-year-old female experiences a headache and takes aspirin for relief. A nurse recalls

aspirin relieves the headache by:

a. decreasing leukotriene production.

b. increasing histamine release.

c. decreasing prostaglandin production.

d. increasing platelet-activating factor.

ANS: C

Aspirin is a prostaglandin inhibitor. Aspirin is not associated with leukotriene production,

histamine release, or platelet-activating factor.

REF: p. 145

Which factor will help the nurse differentiate leukotrienes from histamine?

a. Site of production

b. Vascular effect

c. Chemotactic ability

d. Time of release

ANS: D

Leukotrienes are released slower and longer than histamine. Both leukotrienes and histamine

are produced by mast cells, and they have similar vascular effects and chemotactic abilities.

REF: p. 145

A 25-year-old male is in a car accident and sustains a fracture to his left femur with extensive

soft tissue injury. The pain associated with the injury is related to:

a. histamine.

b. prostaglandins.

c. vasoconstriction.

d. immune complex formation.

ANS: B

Prostaglandins cause increased vascular permeability, neutrophil chemotaxis, and pain by

direct effects on nerves. Histamine promotes vasodilation. Prostaglandins are not associated

with vasoconstriction or the immune complex formation.

REF: p. 145

The complement, clotting, and kinin systems share which of the following characteristics?

a. Activation of a series of proenzymes

b. Phagocytosis initiation

c. Granulocyte production

d. Activated by interferon

ANS: A

The complement system, the clotting system, and the kinin system are normally in inactive

forms but can activate in a series as proenzymes and are involved in the inflammatory

process. This system is not associated with phagocytosis, granulocyte production, or the

activation of interferon.

REF: p. 138

Which statement indicates teaching was successful regarding the classical pathway of the

complement system? The classical pathway of the complement system is activated by:

a. histamine.

b. antigen-antibody complexes.

c. leukotrienes.

d. prostaglandins.

ANS: B

The classical pathway of the complement system is activated by antibodies of the immune

system, not by histamine, leukotrienes, or prostaglandins.

REF: p. 139

A patient has researched bradykinin on the Internet. Which information indicates the patient

understands the functions of bradykinin? Bradykinin is involved in:

a. increasing vascular permeability.

b. vasoconstricting blood vessels.

c. stimulating the clotting system.

d. increasing degradation of prostaglandins.

ANS: A

Bradykinin increases vascular permeability. It is not associated with vasoconstriction,

stimulating the clotting system, or increasing degradation of prostaglandins.

REF: p. 141

After teaching the staff about the clotting system, which statement indicates the teaching was

successful? The end product of the clotting system is:

a. plasmin.

b. fibrin.

c. collagen.

d. factor X.

ANS: B

The end product of the clotting system is fibrin. Plasmin activates the complement cascade.

Collagen plays a factor in wound healing. Factor X is a first step in the clotting system.

REF: p. 139

A 5-year-old male is diagnosed with a bacterial infection. Cultures of the bacteria revealed

lipopolysaccharides on the bacterial cell surface. Which of the complement pathways would

be activated in this case?

a. Classical pathway

b. Lectin pathway

c. Alternative pathway

d. Kinin pathway

ANS: C

The alternative pathway is activated by several substances found on the surface of infectious

organisms, such as those containing lipopolysaccharides. The classical pathway is primarily

activated by antibodies that are proteins of the acquired immune system. The lectin pathway is

similar to the classical pathway but is independent of antibody. It is activated by several

plasma proteins. The kinin pathway is involved in coagulation.

REF: p. 139

An 8-year-old female presents with edema of the cutaneous and mucosal tissue layers. Her

mother reports that the condition is recurrent and seems to occur more often during stressful

situations. The child is diagnosed with hereditary angioedema. Which of the following is

deficient in this child?

a. C1 esterase inhibitor

b. Carboxypeptidase

c. Neutrophils

d. Plasmin

ANS: A

A genetic defect in C1 esterase inhibitor (C1 INH deficiency) results in hereditary

angioedema. Hereditary angioedema is due to C1 esterase inhibitor, not neutrophils.

Carboxypeptidase degrades kinins. Plasmin is associated with clots.

REF: p. 141

A nurse is preparing to teach on the subject of opsonins. Which information should the nurse

include? Opsonins are molecules that:

a. are composed of fatty acids.

b. regulate inflammation.

c. degranulate mast cells.

d. enhance phagocytosis.

ANS: D

Opsonins coat the surface of bacteria and increase their susceptibility to being phagocytized.

Opsonins are not associated with fatty acids, the regulation of the inflammatory process, or

the degranulation of mast cells.

REF: p. 138

A 10-year-old male is diagnosed with a parasite. Which lab result should the nurse check for a

response to the parasite?

a. Monocytes

b. Eosinophils

c. Neutrophils

d. Macrophages

ANS: B

Eosinophils serve as the body's primary defense against parasites. Monocytes and neutrophils

are phagocytic. Macrophages are not active against parasites; they act as long-term defense

against infections.

REF: p. 146

A 65-year-old female is diagnosed with metastatic breast cancer. She has developed muscle

wasting. Which of the following substances would be produced in large quantities to eliminate

the tumor cells and cause muscle wasting?

a. Interleukin-6

b. Eosinophils

c. Tumor necrosis factor-alpha

d. Platelets

ANS: C

Tumor necrosis factor causes muscle wasting. Interleukin-6 stimulates growth and

differentiation of blood cells. Eosinophils are stimulated by parasites. Platelets stimulate

clotting.

REF: p. 144

When phagocytes begin to stick avidly to capillary walls, which process is occurring?

a. Margination

b. Exudation

c. Integration

d. Emigration

ANS: A

Both leukocytes and endothelial cells secrete substances that increase adhesion, or stickiness,

causing the leukocytes to adhere more avidly to the endothelial cells in the walls of the

capillaries and venules in a process called margination. Exudation is the process of pus

formation and does not result in stickiness. Integration occurs in cells but is not a major

function and does not lead to stickiness. Emigration is similar to diapedesis and is not

associated with increased stickiness.

REF: p. 147

An infant develops a fever secondary to a bacterial infection. Which of the following most

likely triggered the fever?

a. Interleukin-1

b. Interleukin-6

c. Interleukin-10

d. Interferons (IFNs)

ANS: A

Interleukin-1 is responsible for fever production. Interleukin-6 stimulates growth and

differentiation of blood cells. Interleukin-10 helps decrease the immune response. INFs are

members of a family of cytokines that protect against viral infections.

REF: p. 143, Figure 6-6

A 54-year-old male intravenous (IV) drug user is diagnosed with chronic hepatitis C. Testing

revealed that he is a candidate for treatment. Which of the following could be used to treat his

condition?

a. Interleukin-1

b. Interleukin-6

c. Interleukin-10

d. INFs

ANS: D

INFs are members of a family of cytokines that protect against viral infections. Interleukin-1

is responsible for fever production. Interleukin-6 stimulates growth and differentiation of

blood cells. Interleukin-10 helps decrease the immune response.

REF: p. 144

A 35-year-old male is diagnosed with lobar pneumonia (lung infection). Which of the

following exudates would be present in highest concentration at the site of this advanced

inflammatory response?

a. Serous

b. Purulent

c. Hemorrhagic

d. Fibrinous

ANS: D

Fibrinous exudates occur in the lungs of individuals with pneumonia. Serous fluid is watery

fluid, as in a blister. Purulent is characterized by an abscess, such as pus. Hemorrhagic occurs

when the exudates are filled with erythrocytes.

REF: p. 149

During inflammation, the liver is stimulated to release plasma proteins, collectively known as:

a. opsonins.

b. acute phase reactants.

c. antibodies.

d. phagolysosomes.

ANS: B

The synthesis of many plasma proteins by the liver is increased during inflammation. These

proteins, which can be either proinflammatory or anti-inflammatory in nature, are referred to

as acute phase reactants. Opsonins coat the surface of bacteria and increase their susceptibility

to being phagocytized. Antibodies are proteins of the immune system. Phagolysosomes

destroy bacteria.

REF: p. 149

A 3-year-old is making play cakes in a sandbox and is eating the play cakes. The sand was

also being used by cats as a litter box and was contaminated with toxoplasmosis. Which of the

following would most likely also be present?

a. Granuloma formation

b. Degranulation

c. Blood clots

d. Exudate production

ANS: A

Infections caused by bacteria such as toxoplasmosis can result in granuloma formation.

Degranulation is a part of mast cell destruction. Blood clots are not expected with chronic

inflammation. Exudate production is pus formation.

REF: p. 150

The macrophage secretion that stimulates procollagen synthesis and secretion is:

a. angiogenesis factor.

b. matrix metalloproteinase.

c. vascular endothelial growth factor.

d. transforming growth factor-beta

ANS: D

Macrophages secrete transforming growth factor-beta to stimulate fibroblasts to secrete the

collagen precursor procollagen. Angiogenesis factor supports the growth of new vessels.

Matrix metalloproteinase remodels proteins at the site of injury. Vascular endothelial growth

factors are also involved in vessel growth.

REF: p. 152

A 30-year-old male was involved in a motor vehicle accident. The glass from the shattered

window cut his face and neck. The scar, however, was raised and extended beyond the

original boundaries of the wound. This pattern of scarring is caused by impaired:

a. nutritional status.

b. collagen synthesis.

c. epithelialization.

d. contraction.

ANS: B

Impaired production of collagen can cause surface overhealing, leading to a keloid or a

hypertrophic scar. Nutritional deficiencies would lead to healing problems, but not extended

scarring. Necrosis or steroid use leads to impaired epithelialization. Impaired contraction

would lead to drawing of tissues, not raised.

REF: p. 153

The nurse is reviewing the lab data of a newly admitted patient. The nurse notes the patient

had an erythrocyte sedimentation done, and the results are quite elevated. The nurse would

focus the care plan on which of the following conditions?

a. Anemia

b. Infection

c. Inflammation

d. Electrolyte imbalance

ANS: C

Common laboratory tests for inflammation measure levels of acute phase reactants. An

increase in fibrinogen is associated with an increased erythrocyte sedimentation rate, which is

considered a good indicator of an acute inflammatory response. An elevated sedimentation

rate is not associated with anemia, infection, or an electrolyte imbalance.

REF: p. 149

Healing by secondary intention would occur in which of the following patients? A patient

with a:

a. sutured surgical wound.

b. stage IV pressure ulcer.

c. paper cut.

d. sunburn.

ANS: B

A patient with a stage IV pressure ulcer would heal by secondary intention. A surgical wound

and a paper cut would heal by primary intention. A patient with a sunburn would heal without

needing either primary or secondary intention.

REF: p. 152

The post-surgical patient is experiencing delayed wound healing. The dietitian believes the

delay is related to nutritional intake. A deficiency in which of the following substances could

directly affect healing?

a. Vitamin D

b. Ascorbic acid

c. Melanin

d. Cholesterol

ANS: B

Most of the factors that interfere with the production of collagen in healing tissues are

nutritional. Scurvy, for example, is caused by lack of ascorbic acid—one of the cofactors

required for collagen formation by fibroblasts. The results of scurvy are poorly formed

connective tissue and greatly impaired healing. Healing is not associated with vitamin D,

melanin, or cholesterol.

REF: p. 153

A nurse remembers that the primary actions of the complement cascade include: (select all

that apply)

a. increased vascular permeability.

b. vasoconstriction.

c. chemotaxis.

d. opsonization.

e. cell killing.

f. increased clotting

ANS: A, C, D, E

The actions of the complement cascade include increased vascular permeability and

vasodilation, chemotaxis, opsonization, and cell killing. They do not involve vasoconstriction

or increased clotting.

REF: pp. 138-139

The nurse is assessing a patient with a diagnosis of inflammation. The nurse would expect to

find which of the following signs and symptoms consistent with acute inflammation? (select

all that apply)

a. Heat

b. Erythema

c. Pain

d. Swelling

e. Paleness

f. Loss of function

ANS: A, B, C, D, F

The classic symptoms of acute inflammation include redness (erythema), heat, swelling, pain,

and loss of function. Paleness would indicate poor circulation, not inflammation.

REF: p. 137

The nurse identified each of the following clinical manifestations of inflammation. Which

would the nurse classify as a local response? (select all that apply)

a. Fever

b. Redness

c. Swelling

d. Heat

e. Pain

ANS: B, C, D, E

Local manifestations of inflammation are the result of the vascular changes associated with

the inflammatory process, including vasodilation and increased capillary permeability. The

symptoms include redness, heat, swelling, and pain. Fever is a symptom of infection.

REF: p. 149

Physical barriers that offer the body protection from damage and infection are located in the:

(select all that apply)

a. gastrointestinal tract.

b. genitourinary tract.

c. respiratory tract.

d. lymph system.

e. hematopoietic system.

ANS: A, B, C

The physical barriers that cover the external parts of the human body offer considerable

protection from damage and infection. These barriers are composed of tightly associated

epithelial cells of the skin and of the linings of the gastrointestinal, genitourinary, and

respiratory tracts.

REF: p. 135