Innate immunity: inflammation and wound healing

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.

Innate immunity is present at birth and does not require an illness.

Innate immunity is present at birth and does not require injection.

Innate immunity is present at birth.

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 produced by the lungs, not the kidneys.

Collectins are produced by the lungs, not the bowel.

Collectins are produced by the lungs, not the integument.

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.

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, but they do not contain biochemical secretions.

Gastric acid helps break down food into its component parts, but does not contain biochemical secretions.

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 occurs in the colon, not the vagina.

Streptococcus overgrowth will occur in the mouth.

Candida albicans occurs in the colon, not the vagina.

When an aide asks the nurse what is a 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, but this is not the purpose of the inflammatory response.

Immunity cannot be achieved against future tissue injury.

A child fell off the swing and scraped the 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, not vasoconstriction.

Increased RBCs come to the site, not fewer.

Redness occurs, not paleness, during inflammation.

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 is a part of phagocytosis and is not a factor in mast cell response.

Opsonization is part of phagocytosis and is not a factor in mast cell response.

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.

An 18-year-old with diabetes would not be immunocompromised and would not be at risk.

A 70-year-old with congestive heart failure would not be immunocompromised and would not be at risk.

A 30-year-old with pneumonia would not be immunocompromised and would not be at risk.

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.

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 to 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.

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 to 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.

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 inhibits prostaglandins; it does not affect leukotriene production.

Aspirin inhibits prostaglandins; it does not affect histamine release.

Aspirin does not play a role in the platelet activating factor; this is a leukotriene response.

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.

Leukotrienes and histamine are produced from mast cells.

Leukotrienes and histamine have similar vascular effects.

Leukotrienes and histamine have similar chemotactic ability.

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 and serotonin

b.

Kinins and prostaglandins

c.

Vasoconstriction

d.

Immune complex formation

ANS: B

Prostaglandins cause increased vascular permeability, neutrophil chemotaxis, and pain by direct effects on nerves. Kinins also promote pain.

Prostaglandins produce pain; histamine promotes vasodilation.

Prostaglandins produce pain, not vasoconstriction.

Prostaglandins produce pain, not the immune complex.

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.

The complement system, the clotting system, and the kinin system do not play a role in phagocytosis, but do play a role in the inflammatory response as proenzymes.

The complement system, the clotting system, and tje kinin system do not play a role in granulocyte production, but they function as proenzymes in the inflammatory response.

The complement system, the clotting system, and the kinin system are not activated by interferon, but are activated by enzymatic action.

Which statement indicates teaching was successful regarding the classic pathway of the complement system? The classic pathway of the complement system is activated by:

a.

Histamine

b.

Antigen-antibody complexes

c.

Leukotrienes

d.

Prostaglandins

ANS: B

The classic pathway of the complement system is activated by antibodies of the immune system.

The classic pathway of the complement system is activated by antibodies, not by histamine.

The classic pathway of the complement system is activated by antibodies, not by leukotrienes.

The classic pathway of the complement system is activated by antibodies, not by prostaglandins.

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.

Bradykinin increases vascular permeability; it does not promote vasoconstriction.

Bradykinin increases vascular permeability; it does not stimulate clotting.

Bradykinin promotes pain; thus, it does not degrade prostaglandins but supports them.

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

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 classic pathway but is independent of antibody. It is activated by several plasma proteins.

The kinin pathway is involved in coagulation.

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. Carboxypeptidase degrades kinins.

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

Plasmin is not associated with hereditary angioedema, but is associated with clots.

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 composed of fatty acids; they are antibodies.

Opsonins coat the surface of bacteria and increase their susceptibility to being phagocytized. They do not regulate inflammation; mast cells do.

Opsonins coat the surface of bacteria and increase their susceptibility to being phagocytized; they do not react with mast cells.

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 are not the body's primary defense against parasite; eosinophils are. Monocytes are phagocytic.

Neutrophils are phagocytic; they are not the body's defense against parasites.

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

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

d.

Platelets

ANS: C

Tumor necrosis factor causes muscle wasting.

Interleukin-6 stimulates growth and differentiation of blood cells.

Eosinophils are stimulated for parasites.

Platelets stimulate clotting.

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.

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 (INFs)

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.

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.

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.

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

a.

Opsonins

b.

Acute phase reactants

c.

Antibodies

d.

Phagolysosome

ANS: B

The synthesis of many plasma proteins by the liver is increased during inflammation. These proteins, which can be either proinflammatory or antiinflammatory 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.

Phagolysosome destroys bacterium.

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.

A 12-year-old male is fighting with another child when he receives a puncture wound from a pencil. The school nurse cleans and bandages the wound. After about 1 week, the wound would be in which phase of healing?

a.

Debridement

b.

Primary intention

c.

Resolution

d.

Maturation

ANS: C

Resolution occurs when repaired tissue is approaching close to normal.

Debridement is the scraping away of dead tissue and is not a phase of wound healing.

Primary intention is the stage of healing of wounds that are closely proximated.

Maturation is the result of severe wounds which would begin several weeks after injury and may take 2 years.

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.

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.

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.

Anemia would not result in an increased erythrocyte sedimentation rate.

An infection would result in an increase in white blood cell count, but not the erythrocyte sedimentation rate.

An electrolyte imbalance would not cause a rise in the sedimentation rate.

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 patient with a surgical wound would heal by primary intention.

A patient with a paper cut would heal by primary intention.

A patient with a sunburn would heal without needing either primary or secondary intention.

The post-surgical patient is experiencing delayed wound healing. The dietician 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.

Vitamin D deficiency will not directly affect healing; ascorbic acid does.

Melanin deficiency will not directly affect healing; ascorbic acid does.

Cholesterol deficiency will not directly affect healing; ascorbic acid does.