Chapter 06: Adaptive Immunity My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 06: Adaptive Immunity

Test Bank

MULTIPLE CHOICE

1. Which of the following is responsible for initiating clonal selection?

a.

T cells

b.

B cells

c.

Antigens

d.

Lymphocytes

ANS: C

The lymphocytes remain dormant until an antigen initiates clonal selection.

T cells are part of the immune response, but do not initiate clonal selection.

B cells are antibodies.

Lymphocytes are released into the circulation as immature cells that react with antigens.

REF: p. 144

2. After teaching the students about B cells, which statement indicates teaching was successful? B cells are originally derived from cells of the:

a.

Bone marrow

b.

Lymph nodes

c.

Gut-associated lymphoid tissue

d.

Thymus

ANS: A

B cells are derived from the bone marrow.

B cells are derived from the bone marrow, not the lymph nodes.

B cells are derived from the bone marrow, not the gut-associated lymphoid tissue.

B cells are derived from the bone marrow, not the thymus.

REF: p. 147

3. A 6-year-old female is diagnosed with a bacterial infection of the respiratory system. Which of the following will most likely try to fight the antigen?

a.

Antibodies

b.

Cytotoxic T cells

c.

Self-antigens

d.

Helper T cells

ANS: A

Antibodies are produced by plasma cells that mature from lymphocytes, called B lymphocytes (B cells), in response to an antigen.

Antibodies are produced by plasma cells that mature from lymphocytes, called B lymphocytes (B cells), in response to an antigen. Cytotoxic T cells do not respond to antigens.

Antibodies are produced by plasma cells that mature from lymphocytes, called B lymphocytes (B cells), in response to an antigen. Self-antigens do not respond to antigens.

Antibodies are produced by plasma cells that mature from lymphocytes, called B lymphocytes (B cells), in response to an antigen. Helper T cells do not respond to antigens.

REF: p. 147 | p. 149

4. When the immunoglobulin crosses the placenta, what type of immunity does the fetus receive?

a.

Active

b.

Passive

c.

Innate

d.

Cell-mediated

ANS: B

Maternal antibodies that pass across the placenta into the fetus before birth provide passive systemic immunity.

Maternal antibodies that pass across the placenta into the fetus before birth provide passive systemic immunity, not active immunity.

Maternal antibodies that pass across the placenta into the fetus before birth provide passive systemic immunity, not innate immunity.

Maternal antibodies that pass across the placenta into the fetus before birth provide passive systemic immunity, not cell-mediated immunity.

REF: p. 145

5. An immunologist has isolated a molecule from the human body to study. It is found to react with antibodies on B cells. Further testing reveals that the molecule is large and chemically diverse. What type of molecule is the immunologist studying?

a.

Antigen

b.

Immunogen

c.

Epitope

d.

Paratope

ANS: A

Antibodies react with antigens.

Antibodies react with antigens, not immunogen.

Antibodies react with antigens, not epitopes.

Antibodies react with antigens, not paratopes.

REF: p. 147

6. Which statement indicates a correct understanding of antibodies? The most abundant class of antibody in the serum is:

a.

IgG

b.

IgM

c.

IgA

d.

IgE

ANS: A

IgG is the most abundant class of immunoglobulins, constituting 80% to 85% of the immunoglobulins in the blood.

IgG is the most abundant class of immunoglobulins, not IgM.

IgG is the most abundant class of immunoglobulins, not IgA.

IgG is the most abundant class of immunoglobulins, not IgE.

REF: p. 147

7. The predominant antibody of a typical primary immune response is:

a.

IgG

b.

IgM

c.

IgA

d.

IgE

ANS: B

IgM is the largest immunoglobulin and is the first antibody produced during the initial, or primary, response to antigen.

IgM, not IgG, is the largest immunoglobulin and is the first antibody produced during the initial, or primary, response to antigen.

IgM, not IgA, is the largest immunoglobulin and is the first antibody produced during the initial, or primary, response to antigen.

IgM, not IgE, is the largest immunoglobulin and is the first antibody produced during the initial, or primary, response to antigen.

REF: p. 147

8. An immunology nurse is caring for a patient. While planning care, which principle will the nurse remember? The primary role of IgA1 is to prevent infections in the:

a.

Blood

b.

Kidneys

c.

Lungs

d.

Mucous membranes

ANS: A

IgA1 is found predominantly in the blood.

IgA1 is found predominantly in the blood, not the kidneys.

IgA1 is found predominantly in the blood, not the lungs.

IgA1 is found predominantly in the blood, not the mucous membranes.

REF: p. 147

9. A 23-year-old pregnant female visits her primary care provider for her final prenatal checkup. The primary care provider determines that the fetus has developed an infection in utero. Which of the following would be increased in the fetus at birth?

a.

IgG

b.

IgA

c.

IgM

d.

IgD

ANS: C

IgM is synthesized early in neonatal life, and its synthesis may be increased as a response to infection in utero.

IgM, not IgG, is synthesized early in neonatal life, and its synthesis may be increased as a response to infection in utero.

IgM, not IgA, is synthesized early in neonatal life, and its synthesis may be increased as a response to infection in utero.

IgM, not IgD, is synthesized early in neonatal life, and its synthesis may be increased as a response to infection in utero.

REF: p. 149

10. Which portion of the antibody is responsible for the biologic functions of antibodies?

a.

Heavy chain

b.

Variable region

c.

Fc portion

d.

Epitope

ANS: C

The Fc portion is responsible for most of the functions of antibodies.

The Fc portion is responsible for most of the functions of antibodies, not the heavy chain.

The Fc portion is responsible for most of the functions of antibodies, not the variable region.

The Fc portion is responsible for most of the functions of antibodies, not the epitope.

REF: p. 149

11. An experiment is carried out to characterize newly discovered immunoglobulins. Specificity of the amino acids within the immunoglobulin could be determined by studying the:

a.

C region of the light chain

b.

C region of the H chain

c.

Complementary-determining region (CDR)

d.

Framework regions

ANS: C

The amino acid differences are clustered into three areas in the variable region. These three areas are called CDRs.

The amino acid differences are clustered into three areas in the variable region. These three areas are called CDRs, not the C region of the light chain.

The amino acid differences are clustered into three areas in the variable region. These three areas are called CDRs, not the C region of the H chain.

The amino acid differences are clustered into three areas in the variable region. These three areas are called CDRs, not the framework regions.

REF: p. 149

12. A 20-year-old female is applying for nursing school and is required to be tested for immunity against several illnesses. Testing that looks at which of the following would be the best to determine immunity?

a.

Culture and sensitivity

b.

Agglutination

c.

Precipitation

d.

Titer

ANS: D

The amount of antibody in a serum sample is referred to as the titer; a higher titer indicates more antibodies.

Culture and sensitivity determine the type of organism that causes an infection, and sensitivity identifies the antibody it is sensitive to.

The amount of antibody in a serum sample is referred to as the titer, not agglutination.

The amount of antibody in a serum sample is referred to as the titer, not precipitation.

REF: p. 155

13. A 10-year-old male is stung by a bee while playing in the yard. He experiences a severe allergic reaction and has to go to the ER. The nurse providing care realizes this reaction is the result of:

a.

Toxoids

b.

IgA

c.

IgE

d.

IgM

ANS: C

IgE is normally at low concentrations in the circulation. It has very specialized functions as a mediator of many common allergic responses.

IgE, not toxoids, is the mediator of common allergic response.

IgE, not IgA, is the mediator of common allergic response.

IgE, not IgM, is the mediator of common allergic response.

REF: p. 151

14. A 25-year-old female has sexual relations with her boyfriend. Later she is told that the boyfriend is infected with Neisseria gonorrhoeae. Testing reveals that she does not have the disease. How is it possible that she did not contract the disease?

a.

Antibodies covered sites of attachment.

b.

She was vaccinated against it.

c.

Platelets provided protection.

d.

IgE was released.

ANS: A

Some bacteria, such as Neisseria gonorrhoeae that causes gonorrhea, must attach to specific sites on urogenital epithelial cells. Antibodies may protect the host by covering sites on the microorganism that are needed for attachment, thereby preventing infection.

The patient did not contract the disease because antibodies covered sites of attachment, not because of vaccination.

The patient did not contract the disease because antibodies covered sites of attachment, not because of platelets.

The patient did not contract the disease because antibodies covered sites of attachment, not because of IgE release.

REF: p. 150

15. Which of the following characteristics is shared by both the secretory and systemic immune systems?

a.

Lymphocytic paths of migration

b.

Neutralization following antigen-antibody binding

c.

Timing of response

d.

Location of response

ANS: B

Direct effects result from the binding of antibody directly to a harmful antigen or infectious agent. These include inhibition of processes that are necessary for infection, such as the reaction of an infectious agent with a particular cell in the body or neutralization of harmful bacterial toxins.

The effect of the immune system is neutralization, not lymphocytic paths of migration.

The effect of the immune system is neutralization, not timing of response.

The effect of the immune system is neutralization, not location of response.

REF: p. 150

16. A patient has done research on monoclonal antibodies on the Internet. Which statement indicates a correct understanding? Pure monoclonal antibodies are produced by:

a.

T lymphocytes

b.

Bone marrow

c.

Laboratories

d.

Fetuses

ANS: C

Monoclonal antibodies are produced in the laboratory from one B cell that has been cloned; thus, the entire antibody is of the same class, specificity, and function.

Monoclonal antibodies are produced in the laboratory, not by T lymphocytes.

Monoclonal antibodies are produced in the laboratory, not by the bone marrow.

Monoclonal antibodies are produced in the laboratory, not by the fetus.

REF: p. 155

17. An experiment is designed to determine specific cell types involved in cell-mediated immune response. The experimenter is interested in finding cells that attack cells that have specific antigens. Which cells should be isolated?

a.

Lymphokine-producing cells

b.

Cytotoxic T cells

c.

Helper T cells

d.

Macrophages

ANS: B

Cell-mediated immunity is driven by T-cytotoxic (Tc) cells that attack antigens directly and destroy cells that bear foreign antigens.

Cell-mediated immunity is driven by T-cytotoxic (Tc) cells, not lymphokine-producing cells, that attack antigens directly and destroy cells that bear foreign antigens.

Cell-mediated immunity is driven by T-cytotoxic (Tc) cells, not helper T cells, that attack antigens directly and destroy cells that bear foreign antigens.

Cell-mediated immunity is driven by T-cytotoxic (Tc) cells, not macrophages, that attack antigens directly and destroy cells that bear foreign antigens.

REF: p. 144

18. Which of the following statements indicates more teaching is needed regarding secondary lymph organs? ________is/are a secondary lymph organ.

a.

The spleen

b.

Peyer patches

c.

Adenoids

d.

The liver

ANS: D

The liver is not a secondary lymph organ.

The spleen is a secondary lymphoid organ.

Peyer patches are a secondary lymph organ.

The adenoids are a secondary lymph organ.

REF: p. 155

19. After a patient is exposed to a specific antigen, B cells will differentiate into:

a.

B cytotoxic cells

b.

Clonal equivalents

c.

Plasma cells

d.

Bursal cells

ANS: C

The B cell differentiates into plasma cells.

The B cell differentiates into plasma cells, not B cytotoxic cells.

The B cell differentiates into plasma cells, not clonal equivalents.

The B cell differentiates into plasma cells, not bursal cells.

REF: p. 158

20. A macrophage was isolated and analyzed for major histocompatibility complex. Which of the following would be expected?

a.

MHC I only

b.

MHC II only

c.

MHC I and II

d.

Neither MHC I or MHC II

ANS: C

MCH I and II would be expected.

MCH I and II would be expected.

MCH I and II would be expected.

Both MCH I and II would be expected.

REF: p. 157

21. A cell that is produced in the thymus and interacts with MHC class II molecules would have which of the following surface proteins?

a.

CD4

b.

CD8

c.

Th1

d.

Superantigen

ANS: A

CD4-positive Th cells are restricted to interactions with cells presenting antigen by MHC class II molecules.

CD4-positive Th, not CD8, cells are restricted to interactions with cells presenting antigen by MHC class II molecules.

CD4-positive Th, not Th1, cells are restricted to interactions with cells presenting antigen by MHC class II molecules.

CD4-positive Th, not superantigen, cells are restricted to interactions with cells presenting antigen by MHC class II molecules.

REF: p. 158

22. A 6-month-old infant is brought to the pediatrician for recurrent colds. The child is fed formula, and the other family members have not been ill. The primary care provider tells the mother that the childs immune system is not yet competent, but will be about 60% of an adult system around age _____ months.

a.

3

b.

6

c.

9

d.

12

ANS: D

The child has an immune system of about 60% of the adult by age 12 months.

The child has an immune system of about 60% of the adult by age 12 months, not 3 months.

The child has an immune system of about 60% of the adult by age 12 months, not 6 months.

The child has an immune system of about 60% of the adult by age 12 months, not 9 months.

REF: p. 164

23. A 5-month-old child is admitted to the hospital with recurring respiratory infections. A possible cause of this condition is:

a.

Hypergammaglobulinemia

b.

Increased maternal IgG

c.

Immune insufficiency

d.

Decreased maternal antibody breakdown, resulting in hyposensitivity

ANS: C

Normal human infants are immunologically immature when born, with deficiencies in antibody production, phagocytic activity, and complement activity, especially components of alternative pathways.

Normal human infants are immunologically immature when born. They do not posses hypergammaglobulinemia.

Possessing increased maternal IgG would not lead to recurring infections.

The recurrent infections are due to decreased immunity, not maternal antibody breakdown.

REF: p. 164

24. Which patient will develop active immunity? A patient who:

a.

Has natural exposure to an antigen or receives an immunization

b.

Receives preformed antibodies or T cells from a donor

c.

Has T cells that become B cells

d.

Receives immunoglobulin

ANS: A

Active immunity occurs after either natural exposure to an antigen or after immunization.

Active immunity occurs after either natural exposure to an antigen or after immunization, not with preformed antibodies.

Active immunity occurs after either natural exposure to an antigen or after immunization, not when T cells become B cells.

Active immunity occurs after either natural exposure to an antigen or after immunization, not when the patient receives immunoglobulins.

REF: p. 144

25. A 16-year-old is bitten by a rabid dog while jogging in the park. Upon admission to the emergency department, the nurse will administer which of the following to help prevent infection?

a.

Cytotoxic T cells

b.

Helper T cells

c.

Macrophages

d.

Immune globulin

ANS: D

Unvaccinated individuals who are exposed to particular infectious agents often will be given immune globulins, which are prepared from individuals who already have antibodies against that particular pathogen.

The patient would be given immune globulin, not cytotoxic T cells.

The patient would be given immune globulin, not helper T cells.

The patient would be given immune globulin, not macrophages.

REF: p. 145

26. Self-antigens do not meet the requirements for immunogenicity because they lack which of the following?

a.

Foreignness

b.

Size

c.

Quantity

d.

Virulence

ANS: A

A self-antigen that fulfills all the criteria listed above except foreignness does not normally elicit an immune response.

A self-antigen fulfills all the criteria listed above except foreignness. They possess size.

A self-antigen fulfills all the criteria listed above except foreignness. They possess quantity.

Virulence is not a factor.

REF: p. 145

27. A patient has a disease state that results from the secretion of toxins by bacteria. Which medical diagnosis will the nurse see documented on the chart?

a.

Malaria

b.

Tetanus

c.

Smallpox

d.

Hepatitis

ANS: B

Some bacteria secrete toxins that harm individuals. For instance, specific bacterial toxins cause the symptoms of tetanus or diphtheria.

Tetanus, not malaria, is due to toxin secretion.

Tetanus, not smallpox, is due to toxin secretion.

Tetanus, not hepatitis, is due to toxin secretion.

REF: p. 150

MULTIPLE RESPONSE

1. While planning care for an elderly patient, the nurse remembers that increased age is associated with (select all that apply):

a.

Increased T cell function

b.

Decreased immune function

c.

Increased production of antibodies

d.

Decreased numbers of circulating immune complexes

e.

Decreased ability to fight infection

ANS: B, D, E

Increased age is associated with diminished T cell function, decreased immune function, diminished production of antibody responses, decreased circulating immune complexes, and decreased ability to fight infection.

REF: p. 164

2. When a patient asks about secondary lymph organs, how should the nurse respond? Secondary lymph organs include (select all that apply):

a.

Spleen

b.

Peyer patches

c.

Adenoids

d.

Liver

e.

Bone marrow

f.

Appendix

ANS: A, B, C, F

The secondary lymphoid organs include the spleen, lymph nodes, adenoids, tonsils, Peyer patches (intestines), and the appendix. The liver and bone marrow are not secondary lymph organs.

REF: p. 155

3. Direct effects of antibodies include (select all that apply):

a.

Neutralization

b.

Agglutination

c.

Precipitation

d.

Phagocytosis

e.

Division

ANS: A, B, C

Directly, antibodies can affect infectious agents or their toxic products by neutralization (inactivating or blocking the binding of antigen to receptors), agglutination (clumping insoluble particles that are in suspension), or precipitation (making a soluble antigen into an insoluble precipitate). Indirectly, antibodies activate components of innate resistance, including complement and phagocytes. Antibodies are generally a mixed population of classes, specificities, and capacity to provide the functions listed above.

REF: p. 150

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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