Chapter 18. Immune System Function, Assessment, and Therapeutic Measures My Nursing Test Banks

Chapter 18. Immune System Function, Assessment, and Therapeutic Measures

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse determines that a patient has long-term immunity against a disease. Which part of the immune system should the nurse recognize is responsible for this patients long-term immunity?
a. IgE
b. IgG
c. Mast cells
d. Plasma cells
____ 2. The nurse is reviewing the immune system prior to discussing the actions with a patient. What type of cell should the nurse identify that is involved in cell-mediated immunity and has a cytotoxic action on tumor cells?
a. Lysosomes
b. Memory cells
c. Natural killer cells
d. Histocompatibility cells
____ 3. The nurse is caring for a patient who is experiencing an immune response involving B and T cells. Which type of immunity is the patient demonstrating?
a. Passive immunity
b. Humoral immunity
c. Acquired immunity
d. Cell-mediated immunity
____ 4. A patient is experiencing an immune response that involves the T lymphocytes. For which types of immunity should the nurse plan care for this patient?
a. Passive immunity
b. Humoral immunity
c. Acquired immunity
d. Cell-mediated immunity
____ 5. The nurse is preparing an injection for an individual who requires passive immunity. In which situation would passive immunity be indicated?
a. For permanent immunity against a disease
b. To overcome an allergic reaction that is relatively mild
c. To have ready-made antibodies after an exposure to pathogens
d. As a booster dose to stimulate the production of specific antibodies
____ 6. The nurse notes that a patients eosinophil level is elevated. For which health problem should the nurse plan care for this patient?
a. Cancer
b. Allergic reactions
c. Acute viral infections
d. Autoimmune diseases
____ 7. The nurse is administering medications to a patient. Which medications should the nurse understand is being given to suppress C-reactive protein levels?
a. Aspirin and steroids
b. Antibiotics and diuretics
c. Epinephrine and antihistamines
d. Antihypertensives and antineoplastic agents
____ 8. The nurse is caring for a patient being tested for rheumatoid arthritis. In reviewing laboratory values, which should the nurse recognize as being diagnostic of rheumatoid arthritis?
a. C-reactive protein = 12 mg/L
b. Rheumatoid factor is negative.
c. White blood cells = 6000/mm3
d. Antinuclear antibody test is negative.
____ 9. The nurse has contributed to a staff education program on immunity. Which participant response indicates a correct understanding of the type of immunity that protects newborns for the first 3 months of life as a result of maternal transmission of IgG?
a. Active natural immunity occurs.
b. Passive natural immunity occurs.
c. Active artificial immunity occurs.
d. Passive artificial immunity occurs.
____ 10. The nurse is reinforcing teaching to a person who has tested positive for HIV. Which test should the nurse explain is done to confirm the diagnosis of HIV?
a. Western blot
b. Rheumatoid factor
c. Antinuclear antibodies
d. Immunoglobulin assay
____ 11. The nurse is reinforcing teaching to a person being tested for HIV in a clinic. Which test should the nurse explain is done first in HIV testing?
a. ELISA test
b. Western blot test
c. Viral load studies
d. Rheumatoid factor test
____ 12. The nurse has contributed to an educational program for staff members. Which statement made by a staff member indicates a correct understanding of how passive immunity is provided?
a. Having an acute disease.
b. Administration of a toxoid.
c. Administration of a vaccine.
d. Administration of immunoglobulin.
____ 13. The nurse provides care to older adults. What should the nurse recognize as being more likely to occur in an older adult than in a younger adult?
a. High fevers
b. Fewer infections
c. More autoimmune disorders
d. Greater antibody production
____ 14. The nurse has administered prescribed allergen injections twice a week for several weeks to an individual with a bee sting allergy. The patient misses three appointments. What action should the nurse take on the patients next visit?
a. Consult physician to confirm the dosage to be given.
b. Administer the same dosage as was given at the last visit.
c. Administer the dosage as originally prescribed for that visit.
d. Tell the patient that the entire immunotherapy schedule needs to be restarted.
____ 15. The nurse is caring for a patient with an infection. Which immunoglobulin should the nurse understand is produced first when an infection occurs?
a. IgD
b. IgE
c. IgG
d. IgM
____ 16. During data collection, the nurse learns the patient is allergic to shellfish. Which precautions should be implemented during the patients hospitalization?
a. The patient should be placed in a private room.
b. The kitchen should use dedicated equipment for all of the patients food preparation.
c. Iodine-based skin preparations should be replaced with different bactericidal cleansers.
d. The patients allergy should be noted on the medical record and communicated clearly to all caretakers.
____ 17. The nurse is reviewing the immune system with a patient newly diagnosed with an autoimmune disorder. What should the nurse explain as the purpose of antibodies?
a. They destroy foreign antigens.
b. Work on many different antigens
c. Are specific according to blood type
d. Attach to antigens to label them for destruction
____ 18. A patient prescribed corticosteroids for arthritis is surprised to learn of an immune disorder. What should the nurse explain as the reason for the patient not demonstrating typical signs of immune dysfunction?
a. The arthritis is masking the normal immune response.
b. The corticosteroids are causing the thymus gland to malfunction.
c. The arthritis is interfering with the function of immunoglobulins.
d. Corticosteroids are impacting normal immune response functioning.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 19. The nurse is assisting in the preparation of a teaching plan for an older patient. What information about maintaining a healthy immune system should the nurse recommend be included in this plan? (Select all that apply.)
a. Get a pneumovax vaccine yearly.
b. Obtain a varicella booster every 3 years.
c. Get a diphtheria and tetanus booster every 10 years.
d. Avoid people with colds or other infectious illnesses.
e. Get an influenza vaccine yearly before influenza season.
f. Obtain vaccination against hepatitis B if infection risk is moderate to high.
____ 20. The nurse is caring for a patient with anemia. Which laboratory results should the nurse identify as being consistent with this diagnosis? (Select all that apply.)
a. RDW = 12% in a 28-year-old female
b. MCV = 72/mm3 in a 19-year-old female
c. WBC = 7 109/L in a 39-year-old male
d. RBC = 4.4 1012/L in a 31-year-old male
e. WBC = 5.2 109/L in a 22-year-old female
f. RBC = 5.7 1012/L in a 43-year-old female
____ 21. The nurse has contributed to an educational program for staff members on immunity and classes of antibodies. Which statements indicate that the staff member understandings information about classes of antibodies? (Select all that apply.)
a. IgG crosses the placenta.
b. IgA is found in breast milk.
c. IgD is found on natural killer cells.
d. IgG provides short-term immunity.
e. IgE is not involved in allergic reactions.
f. IgM is found in blood and lymph drainage.
____ 22. The nurse is providing care for a patient who is to start receiving immunotherapy for severe environmental allergies. Which information should the nurse reinforce for patient and family education? (Select all that apply.)
a. You will have to have shots about once a month for the treatment to work.
b. After the first shot, well be able to teach you how to give your own allergy shots at home.
c. You will need to remain in the clinic for half an hour after your shot in case you have any reaction.
d. The shots have medicine that helps slow down your immune system so you arent sick all the time.
e. Reactions can occur up to 24 hours after the injection, so it is important to watch for any problems.
f. Small amounts of things you are allergic to are being given in the shot so your body can become less sensitive to them.
____ 23. The nurse is caring for a patient with an immune disorder. Which classifications of medication should the nurse expect to be prescribed for this patient? (Select all that apply.)
a. Antibiotics
b. Epinephrine
c. Anticoagulants
d. Antihistamines
e. Corticosteroids
____ 24. A patient develops anaphylactic shock in response to eating something that has caused an allergic response in the past. What physiologic changes should the nurse expect to observe in this patient? (Select all that apply.)
a. Weak pulse
b. Muscle pain
c. Stomach cramps
d. Nausea and vomiting
e. Drop in blood pressure
____ 25. While hospitalized it is discovered that a patient has an allergy to latex. What should this patients discharge instructions include? (Select all that apply.)
a. Wear a medical alert bracelet.
b. Carry an epinephrine auto-injector.
c. Restrict the intake of dairy products.
d. Restrict exercise to 30 minutes each day.
e. Avoid consuming green leafy vegetables.
____ 26. While collecting data the nurse suspects that a patient is experiencing an immune disorder. What data did the nurse use to come to this conclusion? (Select all that apply.)
a. Rash
b. Fever
c. Joint pain
d. Muscle cramps
e. Swollen glands

Chapter 18. Immune System Function, Assessment, and Therapeutic Measures
Answer Section

MULTIPLE CHOICE

1. ANS: B
IgG provides long-term immunity following a vaccine or illness recovery. A. IgE is responsible for allergic reactions. C. Mast cells contribute to inflammation. D. Plasma cells respond to foreign antigens.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

2. ANS: C
Cytotoxic, or killer, T cells (CD8) are able to lyse cells such as cancer cells. A. B. D. These cells do not have a cytotoxic action on tumor cells.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

3. ANS: B
Humoral immunity involves primarily B cells but is assisted by T cells. A. C. D. These types of immunity do not use both B and T cells.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

4. ANS: D
Cell-mediated immunity involves T cells. A. B. C. These types of immunity involve other types of cells.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

5. ANS: C
Artificially acquired passive immunity involves injection of preformed antibodies; this may help prevent disease after exposure to a pathogen. A. B. D. These situations are not appropriate for the injection of an antibody.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

6. ANS: B
Eosinophils elevate with type I hypersensitivity reactions such as allergic rhinitis or anaphylaxis. A. C. D. Eosinophils do not elevate in cancer, acute viral infections, or with autoimmune diseases.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

7. ANS: A
A normal C-reactive protein level is less than10 mg/L; an elevated level is present in rheumatoid arthritis, cancer, and systemic lupus erythematosus (SLE). This level is suppressed by aspirin and steroids. B. C. D. These medications are not used to suppress C-reactive protein levels.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Analysis

8. ANS: A
A normal C-reactive protein level is less than 10 mg/L; an elevated level is present in rheumatoid arthritis, cancer, and systemic lupus erythematosus (SLE). B. D. Antinuclear antibody (ANA) and rheumatoid factor are positive in the presence of rheumatoid arthritis. C. This is a normal white blood cell (WBC) count, which measures immune function.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

9. ANS: B
One form of naturally acquired passive immunity includes placental transmission of antibodies from mother to fetus. D. Artificially acquired passive immunity involves injection of preformed antibodies; this may help prevent disease after exposure to a pathogen such as the hepatitis B virus. A. Active immunity means that the person produces his or her own antibodies. C. Artificially acquired active immunity occurs as the result of a vaccine that stimulates production of antibodies and memory cells.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

10. ANS: A
Western blot is used as a confirmation test for HIV. D. Immunoglobulin assays are completed to determine the presence of an infection. B. C. These are tests done to determine the presence of rheumatoid arthritis.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

11. ANS: A
Antibodies in the patients blood are tested for HIV antigen test plates. Positive ELISA results may indicate HIV infection, but results must be confirmed by another test. B. This test is often used to confirm a diagnosis of HIV. C. Viral load studies are completed to determine the percentage of viral infection that is present. D. Rheumatoid factor test is used to confirm rheumatoid arthritis.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

12. ANS: D
Artificially acquired passive immunity involves injection of preformed antibodies. Antibodies are made up of immunoglobulins. A. B. C. These do not explain how passive immunity is provided.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

13. ANS: C
The efficiency of the immune system decreases with age, so older people are more susceptible to infections and autoimmune disorders. A. Older patients are unlikely to experience high fevers. B. Infections might be increased because of altered immunity. D. Antibody production is altered with aging.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

14. ANS: A
It is important that the patient does not miss an allergen injection dose. If this happens, the allergen strength may need to be reduced, so the physician should be consulted. B. C. The same dose given on the last visit might be too strong since the patient missed three injections. D. The physician will determine the immunotherapy schedule. This is beyond the nurses scope of practice.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

15. ANS: D
IgM is produced first in an infection. A. IgD are antigen-specific receptors on B lymphocytes. B. IgE are important in allergic reactions. C. IgG crosses the placenta to provide passive immunity in newborns.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

16. ANS: D
It is important to clearly communicate patient allergies, so necessary precautions can be taken. C. It is not necessary to exchange the povidone-iodine solution found in procedural kits for a non-iodine-based bactericidal cleanser. A. The patient does not need a private room. B. Shellfish is not a common ingredient in numerous foods, so dedicated equipment is not required.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

17. ANS: D
Antibodies are also called immunoglobulins (Ig) or gamma globulins and are glycoproteins produced by plasma cells in response to foreign antigens. Antibodies attach to antigens to label them for destruction. A. They do not themselves destroy foreign antigens. B. Each antibody is specific for only one antigen. C. There are five classes of human antibodies, designated by letter names: IgG, IgA, IgM, IgD, and IgE. They are not specific according to blood type.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

18. ANS: C
If the immune system is suppressed or functioning abnormally, this normal inflammatory response may not occur. Thus, the patient may have only a low-grade fever with none of the other signs of inflammation or infection. Corticosteroids can mask or impact normal immune response functioning. A. B. C. These are not reasons why the patient is not demonstrating typical signs of an immune disorder.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Analysis

MULTIPLE RESPONSE

19. ANS: C, D, E, F
The immune system is less effective with age, so avoiding those with infections is helpful. Immunizations for older adults include diphtheria tetanus booster every 10 years, pneumovax once in a lifetime, influenza vaccine yearly, and hepatitis B vaccine if medium to high risk for exposure to hepatitis B. A. A Pneumovax vaccine is not needed every year. B. A varicella booster is not needed every 3 years.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

20. ANS: D, E
The normal number of red blood cells per mm of blood for a man is 4.7 to 6.1 1012/L; for a female is 4.2 to 5.4 1012/L; low values indicate anemia. Mean corpuscular volume (MCV) and red blood cell distribution width (RDW) are used to help determine the cause of anemia. B. This value is low and indicative of anemia. A. This is normal. C. E. WBC count is indicative of immune function and is not used to determine the presence of anemia.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

21. ANS: A, B, F
IgA is found in breast milk. IgG crosses the placenta. IgM is found in blood and lymph fluid. D. IgG produces long-term immunity after vaccination or illness. C. IgD is found on B cells. E. IgE is involved in allergic reactions.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

22. ANS: C, F
B. When administering the allergen injection, it is important to understand that an anaphylactic reaction can occur. A physician and emergency equipment should be readily available. C. The patient should be observed following the injection for about 20 to 30 minutes to detect a reaction. D. F. Immunotherapy is used to help desensitize a patient and involves injecting small amounts of an extract of the allergen. A. The subcutaneous injections are given once or twice a week initially with a very dilute preparation. E. The patient and family should be taught that a reaction could occur up to 24 hours after the injection and how to respond if it does occur.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

23. ANS: A, B, D, E
Medications are one of the primary treatment options for immune disorders. General categories of these medications include epinephrine, corticosteroids, antihistamines, histamine (H2) blockers, decongestants, mast cell stabilizers, antivirals, antibiotics, immunosuppressants, interferon, leukotriene antagonists, and hormone therapy. C. Anticoagulants are not prescribed for immune disorders.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

24. ANS: A, E
Anaphylactic shock is an allergic reaction, but massive in response. It is characterized by loss of plasma from capillaries as an effect of histamine and a sudden drop in the intravascular blood volume and blood pressure. B. C. D. Muscle pain, stomach cramps, and nausea and vomiting are not physiologic changes to anaphylactic shock.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

25. ANS: A, B
Patients who are allergic to latex should wear a medical alert bracelet and carry an epinephrine auto-injector. C. D. E. These interventions are not necessary for the patient with an allergy to latex.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

26. ANS: A, B, C, E
Common signs and symptoms present with immune disorders include fever, fatigue, joint pain, swollen glands, weight loss, and rash. D. Muscle cramps are not associated with an immune disorder.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

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