1. A woman has been diagnosed with breast cancer and is being treated
aggressively with a chemotherapeutic regimen. As a result of this
regimen, she has an inability to fight infection due to the fact that
her bone marrow is unable to produce a sufficient amount of
what?
A) Lymphocytes
B) Cytoblasts
C)
Antibodies
D) Capillaries
Ans: A
Feedback:
The white blood cells involved in
immunity (including lymphocytes) are produced in the bone marrow.
Cytoblasts are the protoplasm of the cell outside the nucleus.
Antibodies are produced by lymphocytes, but not in the bone marrow.
Capillaries are small blood vessels
2. During a mumps outbreak at a local school, a patient, who is a
school teacher, is exposed. She has previously been immunized for
mumps. What type of immunity does she possess?
A) Acquired
immunity
B) Natural immunity
C) Phagocytic immunity
D)
Humoral immunity
Ans: A
Feedback:
Acquired immunity usually develops as a
result of prior exposure to an antigen, often through immunization.
When the body is attacked by bacteria, viruses, or other pathogens, it
has three means of defense. The first line of defense, the phagocytic
immune response, involves the WBCs that have the ability to ingest
foreign particles. A second protective response is the humoral immune
response, which begins when the B lymphocytes transform themselves
into plasma cells that manufacture antibodies. The natural immune
response system is rapid, nonspecific immunity present at birth.
3. A gardener sustained a deep laceration while working and requires
sutures. The patient is asked about the date of her last tetanus shot,
which is over 10 years ago. Based on this information, the patient
will receive a tetanus immunization. The tetanus injection will allow
for the release of what?
A) Antibodies
B) Antigens
C)
Cytokines
D) Phagocytes
Ans: A
Feedback:
Immunizations activate the humoral
immune response, culminating in antibody production. Antigens are the
substances that induce the production of antibodies. Immunizations do
not prompt cytokine or phagocyte production.
4. An infection control nurse is presenting an inservice reviewing
the immune response. The nurse describes the clumping effect that
occurs when an antibody acts like a cross-link between two antigens.
What process is the nurse explaining?
A) Agglutination
B)
Cellular immune response
C) Humoral response
D) Phagocytic
immune response
Ans: A
Feedback:
Agglutination refers to the clumping
effect occurring when an antibody acts as a cross-link between two
antigens. This takes place within the context of the humoral immune
response, but is not synonymous with it. Cellular immune response, the
immune system’s third line of defense, involves the attack of
pathogens by T-cells. The phagocytic immune response, or immune
response, is the system’s first line of defense, involving white blood
cells that have the ability to ingest foreign particles.
5. A nurse has administered a child’s scheduled vaccination for
rubella. This vaccination will cause the child to develop which of the
following?
A) Natural immunity
B) Active acquired
immunity
C) Cellular immunity
D) Mild hypersensitivity
Ans: B
Feedback:
Active acquired immunity usually
develops as a result of vaccination or contracting a disease. Natural
immunity is present at birth and provides a nonspecific response to
any foreign invader. Immunizations do not activate the process of
cellular immunity. Hypersensitivity is not an expected outcome of immunization.
6. A patient with a history of dermatitis takes corticosteroids on a
regular basis. The nurse should assess the patient for which of the
following complications of therapy?
A) Immunosuppression
B)
Agranulocytosis
C) Anemia
D) Thrombocytopenia
Ans: A
Feedback:
Corticosteroids such as prednisone can
cause immunosuppression. Corticosteroids do not typically cause
agranulocytosis, anemia, or low platelet counts.
7. A nurse is planning the assessment of a patient who is exhibiting
signs and symptoms of an autoimmune disorder. The nurse should be
aware that the incidence and prevalence of autoimmune diseases is
known to be higher among what group?
A) Young adults
B)
Native Americans
C) Women
D) Hispanics
Ans: C
Feedback:
Many autoimmune diseases have a higher
incidence in females than in males, a phenomenon believed to be
correlated with sex hormones.
8. A 16-year-old has been brought to the emergency department by his
parents after falling through the glass of a patio door, suffering a
laceration. The nurse caring for this patient knows that the site of
the injury will have an invasion of what?
A) Interferons
B)
Phagocytic cells
C) Apoptosis
D) Cytokines
Ans: B
Feedback:
Monocytes migrate to injury sites and
function as phagocytic cells, engulfing, ingesting, and destroying
greater numbers and quantities of foreign bodies or toxins than
granulocytes. This occurs in response to the foreign bodies that have
invaded the laceration from the dirt on the broken glass.
9. A man was scratched by an old tool and developed a virulent
staphylococcus infection. In the course of the man’s immune response,
circulating lymphocytes containing the antigenic message returned to
the nearest lymph node. During what stage of the immune response did
this occur?
A) Recognition stage
B) Proliferation
stage
C) Response stage
D) Effector stage
Ans: B
Feedback:
The recognition stage of antigens as
foreign by the immune system is the initiating event in any immune
response. The body must first recognize invaders as foreign before it
can react to them. In the proliferation stage, the circulating
lymphocyte containing the antigenic message returns to the nearest
lymph node. Once in the node, the sensitized lymphocyte stimulates
some of the resident dormant T and B lymphocytes to enlarge, divide,
and proliferate. In the response stage, the differentiated lymphocytes
function either in a humoral or a cellular capacity. In the effector
stage, either the antibody of the humoral response or the cytotoxic
(killer) T cell of the cellular response reaches and connects with the
antigen on the surface of the foreign invader.
10. A patient with cystic fibrosis has received a double lung
transplant and is now experiencing signs of rejection. What is the
immune response that predominates in this situation?
A)
Humoral
B) Nonspecific
C) Cellular
D) Mitigated
Ans: C
Feedback:
Most immune responses to antigens
involve both humoral and cellular responses, although only one
predominates. During transplantation rejection, the cellular response
predominates over the humoral response. Neither a mitigated nor
nonspecific cell response is noted in this situation.
11. A patient is being treated for bacterial pneumonia. In the first
stages of illness, the patient’s dyspnea was accompanied by a high
fever. Currently, the patient claims to be feeling better and is
afebrile. The patient is most likely in which stage of the immune
response?
A) Recognition stage
B) Proliferation
stage
C) Response stage
D) Effector stage
Ans: D
Feedback:
The immune response culminates with the
effector stage, during which offending microorganisms are killed by
the various actions of the immune system. The patient’s improvement in
health status is likely the result of this final stage in the immune response.
12. The nurse is providing care for a patient who has multiple
sclerosis. The nurse recognizes the autoimmune etiology of this
disease and the potential benefits of what treatment?
A) Stem
cell transplantation
B) Serial immunizations
C)
Immunosuppression
D) Genetic engineering
Ans: A
Feedback:
Clinical trials using stem cells are
under way in patients with a variety of disorders having an autoimmune
component, including multiple sclerosis. Immunizations and genetic
engineering are not used to treat multiple sclerosis.
Immunosuppression would exacerbate symptoms of MS.
13. A patient’s injury has initiated an immune response that involves
inflammation. What are the first cells to arrive at a site of
inflammation?
A) Eosinophils
B) Red blood cells
C)
Lymphocytes
D) Neutrophils
Ans: D
Feedback:
Neutrophils are the first cells to
arrive at the site where inflammation occurs. Eosinophils increase in
number during allergic reactions and stress responses, but are not
always present during inflammation. RBCs do not migrate during an
immune response. Lymphocytes become active but do not migrate to the
site of inflammation.
14. A nurse is planning a patient’s care and is relating it to normal
immune response. During what stage of the immune response should the
nurse know that antibodies or cytotoxic T cells combine and destroy
the invading microbes?
A) Recognition stage
B) Proliferation
stage
C) Response stage
D) Effector stage
Ans: D
Feedback:
In the effector stage, either the
antibody of the humoral response or the cytotoxic (killer) T cell of
the cellular response reaches and couples with the antigen on the
surface of the foreign invader. The coupling initiates a series of
events that in most instances results in total destruction of the
invading microbes or the complete neutralization of the toxin. This
does not take place during the three preceding stages.
15. The nurse should recognize a patient’s risk for impaired immune
function if the patient has undergone surgical removal of which of the
following?
A) Thyroid gland
B) Spleen
C) Kidney
D) Pancreas
Ans: B
Feedback:
A history of surgical removal of the
spleen, lymph nodes, or thymus may place the patient at risk for
impaired immune function. Removal of the thyroid, kidney, or pancreas
would not directly lead to impairment of the immune system.
16. A nurse is admitting a patient who exhibits signs and symptoms of
a nutritional deficit. Inadequate intake of what nutrient increases a
patient’s susceptibility to infection?
A) Vitamin B12
B)
Unsaturated fats
C) Proteins
D) Complex carbohydrates
Ans: C
Feedback:
Depletion of protein reserves results in
atrophy of lymphoid tissues, depression of antibody response,
reduction in the number of circulating T cells, and impaired
phagocytic function. As a result, the patient has an increased
susceptibility to infection. Low intake of fat and vitamin B12affects
health, but is not noted to directly create a risk for infection. Low
intake of complex carbohydrates is not noted to constitute a direct
risk factor for infection.
17. A nurse has admitted a patient who has been diagnosed with
urosepsis. What immune response predominates in sepsis?
A)
Mitigated
B) Nonspecific
C) Cellular
D) Humoral
Ans: D
Feedback:
Most immune responses to antigens
involve both humoral and cellular responses, although only one
predominates. For example, during transplantation rejection, the
cellular response predominates, whereas in the bacterial pneumonias
and sepsis, the humoral response plays the dominant role. Neither
mitigated nor nonspecific cell response is noted in this situation.
18. A patient is admitted with cellulitis and experiences a
consequent increase in white blood cell count. The nurse is aware that
during the immune response, pathogens are engulfed by white blood
cells that ingest foreign particles. What is this process known
as?
A) Apoptosis
B) Phagocytosis
C) Antibody
response
D) Cellular immune response
Ans: B
Feedback:
During the first mechanism of defense,
white blood cells, which have the ability to ingest foreign particles,
move to the point of attack, where they engulf and destroy the
invading agents. This is known as phagocytosis. The action described
is not apoptosis (programmed cell death) or an antibody response.
Phagocytosis occurs in the context of the cellular immune response,
but it does not constitute the entire cellular response.
19. A nurse is reviewing a patient’s medication administration record
in an effort to identify drugs that may contribute to the patient’s
recent immunosuppression. What drug is most likely to have this
effect?
A) An antibiotic
B) A nonsteroidal anti-inflammatory
drug (NSAID)
C) An antineoplastic
D) An antiretroviral
Ans: C
Feedback:
Chemotherapy affects bone marrow
function, destroying cells that contribute to an effective immune
response and resulting in immunosuppression. Antibiotics in large
doses cause bone marrow suppression, but antineoplastic drugs have the
most pronounced immunosuppressive effect. NSAIDs and antiretrovirals
do not normally have this effect.
20. A patient requires ongoing treatment and infection-control
precautions because of an inherited deficit in immune function. The
nurse should recognize that this patient most likely has what type of
immune disorder?
A) A primary immune deficiency
B) A
gammopathy
C) An autoimmune disorder
D) A rheumatic disorder
Ans: C
Feedback:
Primary immune deficiency results from
improper development of immune cells or tissues. These disorders are
usually congenital or inherited. Autoimmune disorders are less likely
to have a genetic component, though some have a genetic component.
Overproduction of immunoglobulins is the hallmark of gammopathies.
Rheumatic disorders do not normally involve impaired immune function.
21. A neonate exhibited some preliminary signs of infection, but the
infant’s condition resolved spontaneously prior to discharge home from
the hospital. This infant’s recovery was most likely due to what type
of immunity?
A) Cytokine immunity
B) Specific
immunity
C) Active acquired immunity
D) Nonspecific immunity
Ans: D
Feedback:
Natural immunity, or nonspecific
immunity, is present at birth. Active acquired or specific immunity
develops after birth. Cytokines are proteins that mediate the immune
response; they are not a type of immunity.
22. A gerontologic nurse is caring for an older adult patient who has
a diagnosis of pneumonia. What age-related change increases older
adults’ susceptibility to respiratory infections?
A) Atrophy of
the thymus
B) Bronchial stenosis
C) Impaired ciliary
action
D) Decreased diaphragmatic muscle tone
Ans: C
Feedback:
As a consequence of impaired ciliary
action due to exposure to smoke and environmental toxins, older adults
are vulnerable to lung infections. This vulnerability is not the
result of thymus atrophy, stenosis of the bronchi, or loss of
diaphragmatic muscle tone.
23. A nurse is explaining the process by which the body removes cells
from circulation after they have performed their physiologic function.
The nurse is describing what process?
A) The cellular immune
response
B) Apoptosis
C) Phagocytosis
D) Opsonization
Ans: B
Feedback:
Apoptosis, or programmed cell death, is
the body’s way of destroying worn out cells such as blood or skin
cells or cells that need to be renewed. Opsonization is the coating of
antigen–antibody molecules with a sticky substance to facilitate
phagocytosis. The body does not use phagocytosis or the cellular
immune response to remove cells from circulation.
24. A patient is responding to a microbial invasion and the patient’s
differentiated lymphocytes have begun to function in either a humoral
or a cellular capacity. During what stage of the immune response does
this occur?
A) The recognition stage
B) The effector
stage
C) The response stage
D) The proliferation stage
Ans: C
Feedback:
In the response stage, the
differentiated lymphocytes function in either a humoral or a cellular
capacity. In the effector stage, either the antibody of the humoral
response or the cytotoxic (killer) T cell of the cellular response
reaches and connects with the antigen on the surface of the foreign
invader. In the recognition stage, the recognition of antigens as
foreign, or non-self, by the immune system is the initiating event in
any immune response. During the proliferation stage the circulating
lymphocytes containing the antigenic message return to the nearest
lymph node.
25. A nurse is reviewing the immune system before planning an
immunocompromised patient’s care. How should the nurse characterize
the humoral immune response?
A) Specialized cells recognize and
ingest cells that are recognized as foreign.
B) T lymphocytes are
assisted by cytokines to fight infection.
C) Lymphocytesare
stimulated to become cells that attack microbes directly.
D)
Antibodies are made by B lymphocytes in response to a specific antigen.
Ans: D
Feedback:
The humoral response is characterized by
the production of antibodies by B lymphocytes in response to a
specific antigen. Phagocytosis and direct attack on microbes occur in
the context of the cellular immune response.
26. A patient is undergoing testing to determine the overall function
of her immune system. What test can be performed to evaluate the
functioning of the patient’s cellular immune system?
A)
Immunoglobulin testing
B) Delayed hypersensitivity skin
test
C) Specific antibody response
D) Total serum globulin assessment
Ans: B
Feedback:
Cellular (cell-mediated) immunity tests
include the delayed hypersensitivity skin test, since this immune
response is specifically dependent on the cellular immune response.
Each of the other listed tests assesses functioning of the humoral
immune system.
27. Diagnostic testing has revealed a deficiency in the function of a
patient’s complement system. This patient is likely to have an
impaired ability to do which of the following?
A) Protecting the
body against viral infection
B) Marking the parameters of the
immune response
C) Bridging natural and acquired immunity
D)
Collecting immune complexes during inflammation
Ans: C
Feedback:
Complement has three major physiologic
functions: defending the body against bacterial infection, bridging
natural and acquired immunity, and disposing of immune complexes and
the byproducts associated with inflammation. Complement does not mark
the parameters of the immune response; complement does not collect
immune complexes during inflammation.
28. A patient’s current immune response involves the direct
destruction of foreign microorganisms. This aspect of the immune
response may be performed by what cells?
A) Suppressor T
cells
B) Memory T cells
C) Cytotoxic T cells
D)
Complement T cells
Ans: C
Feedback:
Cytotoxic T cells (also called CD8 +
cells) participate in the destruction of foreign organisms. Memory T
cells and suppressor T cells do not perform this role in the immune
response. The complement system does not exist as a type of T cell.
29. A nurse is explaining how the humoral and cellular immune
responses should be seen as interacting parts of the broader immune
system rather than as independent and unrelated processes. What aspect
of immune function best demonstrates this?
A) The movement of B
cells in and out of lymph nodes
B) The interactions that occur
between T cells and B cells
C) The differentiation between
different types of T cells
D) The universal role of the
complement system
Ans: B
Feedback:
T cells interact closely with B cells,
indicating that humoral and cellular immune responses are not
separate, unrelated processes, but rather branches of the immune
response that interact. Movement of B cells does not clearly show the
presence of a unified immune system. The differentiation between types
of T cells and the role of the complement system do not directly
suggest a single immune system.
30. A nurse is caring for a patient who has had a severe
antigen/antibody reaction. The nurse knows that the portion of the
antigen that is involved in binding with the antibody is called
what?
A) Antibody lock
B) Antigenic sequence
C)
Antigenic determinant
D) Antibody channel
Ans: C
Feedback:
The portion of the antigen involved in
binding with the antibody is referred to as the antigenic determinant.
This portion is not known as an antibody lock, antigenic sequence, or
antibody channel.
31. A patient is being treated for cancer and the nurse has
identified the nursing diagnosis of Risk for Infection Due to Protein
Losses. Protein losses inhibit immune response in which of the
following ways?
A) Causing apoptosis of cytokines
B)
Increasing interferon production
C) Causing CD4+ cells to
mutate
D) Depressing antibody response
Ans: D
Feedback:
Depletion of protein reserves results in
atrophy of lymphoid tissues, depression of antibody response,
reduction in the number of circulating T cells, and impaired
phagocytic function. This specific nutritional deficit does not cause
T-cell mutation, an increase in the production of interferons, or
apoptosis of cytokines.
32. A patient is vigilant in her efforts to “take good care of
herself” but is frustrated by her recent history of upper respiratory
infections and influenza. What aspect of the patient’s lifestyle may
have a negative effect on immune response?
A) The patient works
out at the gym twice daily.
B) The patient does not eat red
meats.
C) The patient takes over-the-counter dietary
supplements.
D) The patient sleeps approximately 6 hours each night.
Ans: A
Feedback:
Rigorous exercise or competitive
exercise—usually considered a positive lifestyle factor—can be a
physiologic stressor and cause negative effects on immune response.
The patient’s habits around diet and sleep do not present obvious
threats to immune function.
33. The nurse is assessing a client’s risk for impaired immune
function. What assessment finding should the nurse identify as a risk
factor for decreased immunity?
A) The patient takes a beta
blocker for the treatment of hypertension.
B) The patient is
under significant psychosocial stress.
C) The patient had a
pulmonary embolism 18 months ago.
D) The patient has a family
history of breast cancer.
Ans: B
Feedback:
Stress is a psychoneuroimmunologic
factor that is known to depress the immune response. Use of beta
blockers, a family history of cancer, and a prior PE are significant
assessment findings, but none represents an immediate threat to immune function.
34. The nurse is completing a focused assessment addressing a
patient’s immune function. What should the nurse prioritize in the
physical assessment?
A) Percussion of the patient’s
abdomen
B) Palpation of the patient’s liver
C) Auscultation
of the patient’s apical heart rate
D) Palpation of the patient’s
lymph nodes
Ans: D
Feedback:
During the assessment of immune
function, the anterior and posterior cervical, supraclavicular,
axillary, and inguinal lymph nodes are palpated for enlargement. If
palpable nodes are detected, their location, size, consistency, and
reports of tenderness on palpation are noted. Because of the central
role of lymph nodes in the immune system, they are prioritized over
the heart, liver, and abdomen, even though these would be assessed.
35. A patient’s exposure to which of the following microorganisms is
most likely to trigger a cellular response?
A) Herpes
simplex
B) Staphylococcus aureus
C) Pseudomonas
aeruginosa
D) Beta hemolytic Streptococcus
Ans: A
Feedback:
Viral, rather than bacterial antigens,
induce a cellular response.
36. A patient was recently exposed to infectious microorganisms and
many T lymphocytes are now differentiating into killer T cells. This
process characterizes what stage of the immune response?
A)
Effector
B) Proliferation
C) Response
D) Recognition
Ans: B
Feedback:
In the proliferation stage, T
lymphocytes differentiate into cytotoxic (or killer) T cells, whereas
B lymphocytes produce and release antibodies. This does not occur in
the response, recognition, or effector stages.
37. The nurse knows that the response of natural immunity is enhanced
by processes that are inherent in the physical and chemical barriers
of the body. What is a chemical barrier that enhances the response of
natural immunity?
A) Cell cytoplasm
B) Interstitial
fluid
C) Gastric secretions
D) Cerebrospinal fluid
Ans: C
Feedback:
Chemical barriers, such as mucus, acidic
gastric secretions, enzymes in tears and saliva, and substances in
sebaceous and sweat secretions, act in a nonspecific way to destroy
invading bacteria and fungi. Not all body fluids are chemical
barriers, however. Cell cytoplasm, interstitial fluid, and CSF are not
normally categorized as chemical barriers to infection.
38. A nursing student is giving a report on the immune system. What
function of cytokines should the student describe?
A) Determining
whether a cell is foreign
B) Determining if lymphokines will be
activated
C) Determining whether the T cells will remain in the
nodes and retain a memory of the antigen
D) Determining whether
the immune response will be the production of antibodies or a
cell-mediated response
Ans: D
Feedback:
Separate subpopulations of helper T
cells produce different types of cytokines and determine whether the
immune response will be the production of antibodies or a
cell-mediated immune response. Cytokines do not determine whether
cells are foreign, determine if lymphokines will be activated, or
determine the role of memory T cells.
39. A patient has undergone treatment for septic shock and received
high doses of numerous antibiotics during the course of treatment.
When planning the patient’s subsequent care, the nurse should be aware
of what potential effect on the patient’s immune function?
A)
Bone marrow suppression
B) Uncontrolled apoptosis
C) Thymus
atrophy
D) Lymphoma
Ans: A
Feedback:
Large doses of antibiotics can
precipitate bone marrow suppression, affecting immune function.
Antibiotics are not noted to cause apoptosis, thymus atrophy, or lymphoma.
40. A patient’s recent diagnostic testing included a total lymphocyte
count. The results of this test will allow the care team to gauge what
aspect of the patient’s immunity?
A) Humoral immune
function
B) Antigen recognition
C) Cell-mediated immune
function
D) Antibody production
Ans: C
Feedback:
A total lymphocyte count is a test used
to determine cellular immune function. It is not normally used for
testing humoral immune function and the associated antigen–antibody.