Chapter 18 Immune System Function, Assessment, and Therapeutic Measures

active immunity

acquired immunity, attributable to the presence of antibodies or of immune lymphoid cells formed in response to antigenic stimulus

anaphylactic

systemic reaction that produces life-threatening changes in the circulation and bronchioles; a sudden severe allergic reaction to an allergen

antibody

an immunoglobin molecule having a specific amino acid sequence that gives each antibody the ability to adhere to and interact only with the antigen that induced the synthesis

antigen

a protein marker on the surface of cells that identifies the type of cell

autoimmune

a condition in which the body does not recognize itself and the immune system attacks normal cells

cell-mediated immunity

production of lymphocytes by thymus in response to antigen exposure

humoral immunity

a.k.a. antibody-mediated immunity, involves antibody production

lymphocyte

cells present in the blood and lymphatic tissue that provide the main means of immunity for the body; white blood cells

neutrophil

granular leukocytes (white blood cells) having a nucleus with three to five lobes connected by threads of chromatin and cytoplasm containing very fine granules

passive immunity

reinforcement of the immune system with immune serum for such conditions as tetanus, diphtheria, and venomous snake bite

white blood cells

leukocytes; the body's primary defense against infection

1. The nurse taught a patient about vaccines. The nurse

would evaluate the patient as understanding the information

taught if the patient stated that a vaccine provides

which of these types of immunity?

1. "Naturally acquired passive immunity"

2. "Artificially acquired passive immunity"

3. "Naturally acquired active immunity"

4. "Artificially acquired active immunity"

4. Artificially acquired active immunity is provided by a vaccine.

2. Which of the following vaccines would the nurse correctly

recommend to be given annually during a teaching

session on health maintenance with an older patient?

1. Influenza

2. Pneumovax

3. Diphtheria tetanus

4. Polio

1. Older adults should receive an influenza vaccine.

3. The nurse is assisting with data collection on a patient.

Which of the following past surgeries found in the patient's

history would alert the nurse to possible immune

system dysfunction when planning care?

1. Splenectomy

2. Thyroidectomy

3. Pneumonectomy

4. Parathyroidectomy

1. A splenectomy may reduce immune function.

4. During data collection, the patient reports tenderness in

the cervical lymph nodes. The nurse recognizes that

enlarged and tender lymph nodes usually indicate which

of the following problems?

1. Cancer

2. Degeneration

3. Inflammation

4. Arthritis

3. Painful enlarged lymph nodes are associated with inflammation

and infection.

5. The nurse is caring for a patient with suspected HIV infection.

The nurse anticipates that which of the following

is a confirmation test that will be ordered to test for

HIV antibodies?

1. Murex SUDS

2. Western blot

3. Enzyme-linked immunosorbent assay

4. p24 antigen testing

2. For positive ELISA results, which may indicate HIV infection,

results must be confirmed by another test, usually the Western

blot.

Biaxin 200-mg oral suspension is ordered for a patient.

The nurse has 125 mg/5 mL available. How many

milliliters should the nurse give? Fill in the blank.

Answer: _______ mL

8 mL

200 mg 5 mL 125 mg = 8 mL

1. A baby is born temporarily immune to the diseases to which the mother is immune. The nurse would explain this to the mother as being which of the following types of immunity? 1. Naturally acquired passive immunity 2. Artificially acquired passive immunity 3. Naturally acquired active immunity 4. Artificially acquired active immunity

#1

2. Immunity to a disease after recovery is possible because the first exposure to the pathogen has stimulated the formation of which of the following? 1. Antigens 2. Memory cells 3. Complement 4. Natural killer cells

#2

3. Which of the following immunoglobulins is first produced during an acute infection? 1. IgG 2. IgM 3. IgE 4. IgD

#2

4. Which of the following is the function of macrophages and neutrophils? 1. Phagocytosis 2. Antibody production 3. Complement fixation 4. Suppression of autoimmunity

#1

5. The activation of B cells in humoral immunity is assisted by which of the following? 1. Cytotoxic T cells 2. Helper T cells 3. Suppressor T cells 4. Neutrophils

#2

6. Autoimmunity is defined as a phenomenon involving which of the following? 1. Production of endotoxins that destroy B lymphocytes. 2. Inability to differentiate self from nonself. 3. Overproduction of reagin antibody. 4. Depression of the immune response.

#2

7. Which of the following is used to determine the presence of inflammation? Select all that apply. 1. IgM assay CD4+ count Western blot C-reactive protein (CRP) Erythrocyte sedimentation rate (ESR)

(4, 5) C-reactive protein and erythrocyte sedimentation

rate test for inflammation. (1, 2, 3) are incorrect. (1) IgM

is an immunoglobulin. (2) CD4 is indicative of immune

function and is decreased in cancer, HIV, AIDS, or immunosuppression.

(3) Western blot is used to detect

HIV antigens.

8. A mother brings her children into the clinic, and the children are diagnosed with chickenpox. The mother had chickenpox as a child. Which of the following state ments should the nurse include in the patient teaching? 1. "Because you have an active natural immunity to chick enpox, you can take care of the children at home." 2. "You will need to wear a mask while caring for the children to prevent contamination." 3. "You will need to get a booster chickenpox vaccina tion to ensure that you don't get reinfected." 4. "Because you've had chickenpox before and your children are now ill, you should monitor yourself for signs or symptoms of shingles for the next 2 weeks."

8. (1) This mother has a naturally acquired active immunity

to chickenpox and can care for the children without

a mask or a booster vaccine. (2, 3, 4) are incorrect.

9. Which of the following may stimulate antibody produc tion? Select all that apply. Cold virus Plant pollen Transplanted organ Bacterial toxins Measles vaccine

9. (1, 2, 4, 5) Cold virus, plant pollen, bacterial toxins,

or vaccines can all stimulate the formation of antibodies.

(3) Transplanted organs stimulate cellmediated

immunity, which does not involve the production

of antibodies.

10. The nurse is caring for a patient undergoing a biopsy. Which action is appropriate for the nurse to take? 1. Ask whether the patient has an iodine allergy. 2. Ensure that informed consent is obtained before the procedure. 3. Ask the patient about environmental allergies and the type of reaction that occurs. 4. Check eosinophil level on the laboratory report.

10. (2) A biopsy requires that the patient sign an informed

consent. (1) Iodine is not typically used in a biopsy, but

it is used in a computed tomography (CT) scan and

magnetic resonance imaging (MRI) scan. (3, 4) are

more appropriate when checking a patient with known

allergies.

11. While working with patients in an autoimmune disease clinic, the nurse recognizes that which of the following individuals is most likely to develop systemic lupus erythematosus? 1. A 38-year-old African American male who works in the construction industry 2. A 55-year-old white female who works as a medical secretary 3. A 19-year-old Asian female who is attending college 4. A 34-year-old Native American male who works as a lawyer

11. (3) Systemic lupus erythematosus (SLE), an autoimmune

disorder, tends to affect women eight times more

than men. In addition, Hispanic, Native American,

Asian, and African American women develop SLE two

to three times more than Caucasian women.

1.The nurse is reviewing the humoral immune response mechanism with a patient. What should the nurse explain when reviewing this mechanism?

1. T cells produce antibodies.2. B cells phagocytize the foreign antigen.3. T cells are stimulated by B cells and turn into plasma cells, which produce antibodies or memory cells.4. B cells are stimulated by T helper cells or macrophages and turn into plasma cells, which produce antibodies or memory cells.

#4

Humoral immunity is also called antibody-mediated immunity and involves antibody production. An antigen is recognized by B cells as being foreign. Helper T cells stimulate the activated B cell to proliferate and differentiate to become plasma cells, while other B cells become memory cells. This mechanism does not include the production of antibodies by T cells, phagocytizing foreign antigens by B cells, or T cells being stimulated by B cells and then turning into plasma cells that produce antibodies.

2.A 72-year-old patient is diagnosed with immune senescence. What effects should the nurse keep in mind when collecting data on this patient? Select all that apply.1. Decline in response to antigens2. Decreased body response to antibiotics3. Decrease in the size of the thymus gland4. Increased production of immature T cells5. Decrease in antibody response to foreign organism

1, 3 ,4 ,5

Significant changes occur in the immune system of the older adult. These changes are known as immune senescence, which refers to a decline in immune system function. Some specific changes include a decrease in the size of the thymus gland, an increased production of immature T cells, a decline in response to antigens, and antibody response to foreign organisms decreases. Immune senescence does not indicate a decreased body response to antibiotics.

3.The nurse is reviewing the immune system with a patient newly diagnosed with allergies. What should the nurse explain as the role of the thymus gland?

1. Maturates T cells2. Maturates B cells3. Maturates platelets4. Maturates red blood cells

1

T cells arise from the red bone marrow and then migrate to the thymus, where the thymic hormones bring about their maturation. The thymus gland does not mature B cells, platelets, or red blood cells.

4.A patient receives a series of skin tests to determine substances causing allergic responses. When the sites of these tests are evaluated, the nurse notes that many are red and have areas of induration. What should these results indicate to the nurse? Select all that apply.1. The patient has an active infection.2. The patient has antibodies to an antigen.3. The patient needs to start steroid therapy.4. The patient needs to have the tests repeated.5. The patient has been exposed to an organism.

1, 2 ,5

If erythema (redness) or induration (firmness) occurs at the site within a prescribed time frame, the test is positive. This means that the patient has either been exposed to an organism, has an active infection, or has developed antibodies that stimulate an immune response. The skin response does not mean that the patient needs to start steroid therapy or that the tests need to be repeated.

5.The nurse is planning care for an older patient. What should the nurse recall as changes that frequently occur within the immune system of an older adult? Select all that apply.1. An increase in immature T cells2. A decreased response to antigens3. A decrease in autoimmune diseases4. A decreased response to cancer cells5. An increase in the size of the thymus6. Decreased efficiency of the immune system

1 ,2 ,4 ,6

The efficiency of the immune system decreases with age. The thymus gland decreases in size, and there is an increased production of immature T cells and subsequent decline in response to antigens. Older people are more susceptible to infection and also to immune disorders, because their immune systems mistakenly perceive the body's own tissues as foreign and initiate their destruction. The incidence of cancer also increases, because malignant cells that once would have been quickly destroyed by the immune system live and proliferate.

6.While attending a family picnic, a child with a known allergy to bee stings is stung and develops flushing and shortness of breath. A dose of epinephrine is provided through the use of the child's EpiPen, and the child's breathing becomes more relaxed. Which of the following actions should the nurse take?

1. Allow the child to return to normal activity.2. Restrict play and observe the child for 2 hours.3. Instruct the family to seek immediate medical attention.4. Move all activities indoors to avoid the risk of additional bee stings.

3

The patient needs to be instructed that the EpiPen does not replace the need for immediate and continued medical attention, because the duration of the single dose of epinephrine varies from 1 to 4 hours. The child should not be permitted to return to normal activity. Restricting play for 2 hours is not sufficient. Moving activities indoors might be appropriate in the future; however, the child needs medical attention now.

7.The nurse is reviewing the function of the immune system. In what part of the lymphatic system should the nurse recognize that B cells and T cells carry out immune functions?

1. Spleen2. Thymus3. Lymph nodes4. Lymphatic vessels

1.

The spleen is the organ of the lymphatic system in which B and T cells carry out their immune function. The thymus, another lymphatic organ, functions mainly in childhood and atrophies with age. Lymphatic vessels return fluid to the circulatory system, and lymph nodes, usually grouped along lymph vessels, function to destroy foreign material.

8.The nurse is providing information at a health clinic on infectious disease prevention. How should the nurse explain the process of obtaining artificially acquired active immunity?

1. Through the injection of preformed antibodies2. Through disease-induced production of antibodies3. Through vaccine-induced production of antibodies4. Through placental transmission of antibodies from mother to fetus

#3

Artificially acquired active immunity occurs as a result of a vaccine that stimulates the production of antibodies and memory cells. Naturally acquired active immunity occurs when a person recovers from a disease and then has antibodies and memory cells specific for the pathogen that caused the disease. Passive immunity is acquired through placental transmission from mother to fetus, through breast milk, and through the injection of preformed antibodies in vaccines.

9.A patient's laboratory report indicates the presence of antinuclear antibodies, increased rheumatic factor and C-reactive protein, decreased CD8⁺ count, and deficiencies of specific complement proteins. While awaiting the physician's diagnosis, the nurse should recognize that these laboratory values are found in which of the following diseases?

1. Anaphylaxis2. Rheumatoid arthritis3. Hashimoto's thyroiditis4. Systemic lupus erythematosus

#4

Although systemic lupus erythematosus and rheumatoid arthritis are similar and have many of the same laboratory findings, the combination of antinuclear antibodies, increased rheumatic factor and C-reactive protein, decreased CD8⁺ count, and complement protein deficiencies strongly suggests systemic lupus erythematosus. These laboratory values do not indicate anaphylaxis or Hashimoto's thyroiditis.

10.A patient's immune response to an allergen has diminished. Which type of cell should the nurse consider as being the immune system's shutoff mechanism that is functioning in this patient?

1. Plasma cells2. Helper T cells3. B lymphocytes4. Suppressor T cells

#4

Suppressor T cells are believed to inhibit the immune response to just what is needed and no more. Plasma, helper T, and B lymphocytes are not considered the immune system's shutoff mechanism.

11.In response to questions about medical history, diet, and lifestyle, the patient reports taking prednisone for rheumatoid arthritis and several herbal preparations, including echinacea and licorice. For which potential complication should the nurse be aware when planning care for this patient?

1. Hemorrhage2. Hypertension3. Bone marrow depression4. Decreased immune response

#4

Corticosteroids, such as prednisone, suppress the immune response. Licorice, sometimes taken for its anti-inflammatory effects, produces additive effects when taken concurrently with corticosteroids, further decreasing the immune response. Bone marrow depression, often a cause of decreased immune response, is associated with antineoplastics and anti-infectives. Risk for hemorrhage and hypertension should

12.Place the following steps in order (1-6) as they occur in humoral immunity.

B cells recognize an antigen as foreign.

Macrophages or neutrophils phagocytize the antigen.

Helper T cells stimulate activated B cells to proliferate.

Complement activation leads to lysis of the cell and its death.

Some B cells become memory cells that will remember the antigen.

Antibodies produced by plasma cells bond to the antigen, forming an antigen-antibody complex.

1, 3 ,5 ,6 ,2 ,4

In antibody-mediated, or humoral, immunity, B cells recognize an antigen as foreign, and helper T cells stimulate the activated B cells to proliferate. Some of the B cells become memory cells that will remember the antigen and initiate a rapid response when the same antigen appears again. Antibodies produced by the plasma cells (B cells) bond to the antigen, forming an antigen-antibody complex that labels the antigen for phagocytosis by macrophages and neutrophils and stimulates complement fixation, which may lyse cells, such as foreign bacterial cells, resulting in their death.

13.During data collection on a patient who reports fatigue and vague joint pain, the nurse documents a reddened area over the bridge of the nose and hears a pericardial friction rub. What should the nurse ask the patient after reviewing the medical history?

1. "Is there a history of asthma or allergic rhinitis in your family?"2. "Has anyone in your family had systemic lupus erythematosus?"3. "Have you ever had any problems with your nails and nailbeds?"4. "Do you have any problems with diarrhea, or has any family member been diagnosed with an intestinal disorder?"

#2

The reddened skin over the bridge of the nose—"butterfly rash"—and possible pleural effusion suggest systemic lupus erythematosus. Because systemic lupus erythematosus is thought to be familial or to have a genetic component, it is appropriate to go back to medical history and confirm the information provided by the patient. The signs and symptoms do not suggest asthma or allergic rhinitis, Hashimoto's thyroiditis, or an intestinal disorder such as irritable bowel syndrome.

14.The nurse is reviewing the different classes of antibodies with a patient newly diagnosed with an immune disorder. Which of the following should the nurse instruct regarding the location of immunoglobulin IgA? Select all that apply.1. IgA is found in tears.2. IgA is found in urine.3. IgA is found in saliva.4. IgA is found in blood.5. IgA is found in lymph.

1 ,3

IgA is found in all secretions from mucous membranes, including tears and saliva. IgG and IgM are found in blood and lymph. There are no immunoglobins found in urine.

15.A school-age child is diagnosed with an allergy to peanuts. How should the nurse instruct the mother to ensure this child's safety?

1. Keep an epinephrine autoinjector in the home.2. Replace peanuts with peanut butter in the home.3. Cut the amount of peanuts used in cooking by one-half.4. Use reduced-fat peanut butter in the child's lunches.

1

Food is the most common trigger of anaphylaxis that can be fatal. Epinephrine is the drug of choice for acute reactions and the only medication shown to be lifesaving when administered promptly. The nurse should ensure that the mother has an epinephrine autoinjector. The child has an allergy to peanuts and cannot eat them in any form. Peanut butter is made from peanuts and could lead to an allergic reaction. Peanuts should not be in any of the child's food. Reduced-fat peanut butter is still made with peanuts.

16.A 68-year-old patient had a tetunus, diphtheria, and pertussis booster at age 63. What should the nurse instruct the patient about this vaccination?

1. Another booster is due now.2. The next booster would be due in 5 years.3. The next booster would be due in 2 years.4. There is no need to obain any future boosters.

2,

Tetanus, diphtheria, and pertussis booster is to be obtained every 10 years. If the patient received the booster at age 63, the next one would be needed at age 73, which would be in five years since the patient is 68 years old. Another booster is not due now. Receiving a booster in 2 years would be too soon.