CHAPTER 27: IMMUNOLOGIC ALTERATIONS My Nursing Test Banks

CHAPTER 27: IMMUNOLOGIC ALTERATIONS

MULTIPLE CHOICE

1.The three primary functions of the immune system are to prevent or ameliorate infections, maintain homeostasis, and to:

a.

promote phagocytosis

c.

prevent or ameliorate allergies

b.

produce white blood cells

d.

recognize self from nonself

ANS: D

Feedback

A

Incorrect. The three primary functions of the immune system are to prevent or ameliorate infections, maintain homeostasis, but not to promote phagocytosis.

B

Incorrect. The three primary functions of the immune system are to prevent or ameliorate infections, maintain homeostasis, but not to produce white blood cells.

C

Incorrect. The three primary functions of the immune system are to prevent or ameliorate infections, maintain homeostasis, but not to prevent or ameliorate allergies.

D

Correct. The three primary functions of the immune system are to prevent or ameliorate infections, maintain homeostasis, and recognize self from nonself.

PTS: 1 REF: p. 952 Brief Overview of Immune System Function

OBJ: Cognitive Level: Knowledge

2.At what age does a childs immune system mature?

a.

1 to 2 years

c.

7 to 10 years

b.

3 to 6 years

d.

11 to 14 years

ANS: B

Feedback

A

Incorrect. A childs immune system matures by 3 to 6 years of age.

B

Correct. A childs immune system matures by 3 to 6 years of age.

C

Incorrect. A childs immune system matures by 3 to 6 years of age.

D

Incorrect. A childs immune system matures by 3 to 6 years of age.

PTS: 1 REF: p. 952 Brief Overview of Immune System Function

OBJ: Cognitive Level: Knowledge

3.The processes of immunity are classified in which of the following ways?

a.

innate or acquired

c.

class A and class B

b.

rapid and long-term

d.

grade I and grade II

ANS: A

Feedback

A

Correct. The processes of immunity used by the body are classified as either innate (natural) or acquired. Innate or natural immunity consists of many factors relatively nonspecific. These include physical barriers such as skin, mucous membranes, and cough reflex. Natural immunity also includes nonspecific immune cells such as phagocytes and lymphocytes. Acquired immunity is a specific immunity, triggered then a person has had prior contact with a foreign agent. This activates the humoral system (B lymphocytes) and the cell-mediated system (T lymphocytes).

B

Incorrect. The processes of immunity used by the body are not classified as rapid and long-term.

C

Incorrect. The processes of immunity used by the body are not classified as class A and class B.

D

Incorrect. The processes of immunity used by the body are not classified as grade I and grade II.

PTS: 1 REF: p. 953 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Comprehension

4.What is the bodys main defense against viruses?

a.

T lymphocytes

c.

interferon

b.

B lymphocytes

d.

interleukin

ANS: A

Feedback

A

Correct. The bodys main defense against viruses is the T lymphocytes which direct and regulate the immunologic response by secreting lymphokines.

B

Incorrect. The bodys main defense against viruses is not the B lymphocytes.

C

Incorrect. The bodys main defense against viruses is not interferons.

D

Incorrect. The bodys main defense against viruses is not interleukins.

PTS: 1 REF: p. 953 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Knowledge

5.The chemical mediators or messages communicating throughout the immune processes are:

a.

interferon

c.

cytokines or interleukin

b.

helper T cells or T lymphocytes

d.

B lymphocytes

ANS: C

Feedback

A

Incorrect. The chemical mediators or messages communicating throughout the immune processes are cytokines or interleukins.

B

Incorrect. The chemical mediators or messages communicating throughout the immune processes are cytokines or interleukins.

C

Correct. The chemical mediators or messages communicating throughout the immune processes are cytokines or interleukins. These include the lymphokines, produced by the lymphocytes, and the monokines, produced by monocytes and macrophages.

D

Incorrect. The chemical mediators or messages communicating throughout the immune processes are cytokines or interleukins.

PTS: 1 REF: p. 954 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Comprehension

6.Where are the B lymphocytes produced?

a.

bone marrow

c.

spleen

b.

thymus gland

d.

liver

ANS: A

Feedback

A

Correct. B lymphocytes are produced in the bone marrow; hence, the designation of B lymphocytes.

B

Incorrect. T lymphocytes are produced in the thymus gland.

C

Incorrect. B lymphocytes are not produced in the spleen.

D

Incorrect. B lymphocytes are not produced in the liver.

PTS: 1 REF: p. 953 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Application

7.The final major component of the immune response, complement, accomplishes which of the following things?

a.

facilitates vasodilation and increased circulation

b.

amplifies immune response and facilitates phagocytosis

c.

boosts the production of hemoglobin and oxygen to cells

d.

carries white blood cells (WBCs) quickly into areas of infection

ANS: B

Feedback

A

Incorrect. Complement does not facilitate vasodilation and increased circulation.

B

Correct. The final major component of the immune response is complement, activated by the onset of the immune response or chemical markers on a pathogen surface. Complement amplifies the immune response and complements antibody activity by facilitating phagocytosis by macrophages or attacking the pathogens cell membranes.

C

Incorrect. Complement does not boost the production of hemoglobin and oxygen to cells.

D

Incorrect. Complement does not carry white blood cells (WBCs) quickly into areas of infection.

PTS: 1 REF: p. 954 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Application

8.Which of the following best defines autoimmunity?

a.

the immediate response to a foreign protein

b.

immunity that is built into the bodys defense system

c.

start-up system to fight invaders that does not require conscious effort

d.

identification of self as foreign and mounting of immune response

ANS: D

Feedback

A

Incorrect. Autoimmunity is not defined as the immediate response to a foreign protein.

B

Incorrect. Autoimmunity is not defined as immunity that is built into the bodys defense system.

C

Incorrect.Autoimmunity is not defined as a start-up system to fight invaders that does not require conscious effort

D

Correct. Autoimmunity is defined as identification of self as foreign and mounting of immune response.

PTS: 1 REF: p. 954 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Comprehension

9.Which of the following groups of children are most likely to suffer from juvenile rheumatoid arthritis (JRA)?

a.

African American

c.

Caucasian

b.

Asian

d.

Native American

ANS: D

Feedback

A

Incorrect. African American children are least likely to suffer from JRA.

B

Incorrect. Asian children are least likely to suffer from JRA.

C

Incorrect. Caucasian children are not most likely to suffer from JRA.

D

Correct. Native American children are most likely to suffer from JRA.

PTS: 1 REF: p. 955 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Comprehension

10.What percentage of children satisfactorily recover from juvenile rheumatoid arthritis with no functional limitations?

a.

33%

c.

66%

b.

40%-50%

d.

80%-90%

ANS: D

Feedback

A

Incorrect. 80%-90% of children satisfactorily recover from juvenile rheumatoid arthritis with no functional limitations.

B

Incorrect. 80%-90% of childrensatisfactorily recover from juvenile rheumatoid arthritis with no functional limitations.

C

Incorrect. 80%-90% of children satisfactorily recover from juvenile rheumatoid arthritis with no functional limitations.

D

Correct. 80%-90% of children satisfactorily recover from juvenile rheumatoid arthritis with no functional limitations.

PTS: 1 REF: p. 955 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Knowledge

11.What are the classic symptoms of juvenile rheumatoid arthritis (JRA)

a.

severe joint pain that varies from sharp to burning pain

b.

morning immobility, stiffness, and joint pain

c.

swollen joints that are irregular in shape

d.

nighttime pain that causes difficulty sleeping

ANS: B

Feedback

A

Incorrect. The classic symptoms of JRA are not severe joint pain that varies from sharp to burning pain.

B

Correct. The classic symptoms of JRA are morning immobility, stiffness, and joint pain.

C

Incorrect. The classic symptoms of JRA are not swollen joints that are irregular in shape. These are the symptoms of rheumatoid arthritis, not JRA.

D

Incorrect. The classic symptoms of JRA are not nighttime pain that causes difficulty sleeping. This symptom may indicate growing pains or pain because the long bones grow faster than the attached muscles and typically occurs at night.

PTS: 1 REF: p. 955 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Application

12.The diagnostic criteria for juvenile rheumatoid arthritis (JRA) include:

a.

onset before age 16

c.

loss of feeling or motion

b.

duration of at least 2 weeks

d.

subnormal temperature

ANS: A

Feedback

A

Correct. The diagnostic criteria for JRA includes onset before 16 years of age; arthritis of at least 6 weeks duration; a defined subtype (by onset characteristics); and exclusion of other conditions.

B

Incorrect. The diagnostic criteria for JRA includes arthritis of at least 6 weeks duration.

C

Incorrect. The diagnostic criteria for JRA does not include loss of feeling or motion.

D

Incorrect. The diagnostic criteria for JRA does not include subnormal temperature.

PTS: 1 REF: p. 955 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Application

13.Which of the following laboratory results would the nurse most likely find reported on a child who has juvenile rheumatoid arthritis?

a.

increased erythrocyte sedimentation rate (ESR)

b.

decreased C-reactive protein

c.

decreased white blood cell count (WBC)

d.

increased hemoglobin

ANS: A

Feedback

A

Correct. Increased erythrocyte sedimentation rate (ESR) is a common lab finding in a child with JRA. Tests reflecting inflammation are used in JRA; however, there are no specific diagnostic laboratory tests.

B

Incorrect. An elevated C-reactive protein would be seen in JRA.

C

Incorrect. An increased WBC would be seen in JRA.

D

Incorrect. Decreased hemoglobin would be seen in JRA.

PTS:1REF:p. 957 Immunologic Alterations

OBJ: Cognitive Level: Comprehension

14.You are the nurse giving discharge instructions to the caregivers of a child with juvenile rheumatoid arthritis who is going home from the hospital. The caregivers ask about physical activities. Which of the following activities would be best for this child?

a.

swimming and golf

c.

wrestling and karate

b.

football and basketball

d.

ice hockey and skateboarding

ANS: A

Feedback

A

Correct. The best activities for a child with JRA would be swimming and golf. Exercise maintains or increases range of motion and improves strength and endurance. However, high impact and contact sports should be avoided.

B

Incorrect. Football and basketball should be avoided because they are contact sports.

C

Incorrect. Wrestling and karate should be avoided because they are contact sports.

D

Incorrect. Ice hockey, a contact sport, and skateboarding, a high impact sport, should be avoided.

PTS: 1 REF: p. 959 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Application

15.The nurse has given the family of a child with juvenile rheumatoid arthritis instructions on nutrition and diet. Which of the following reports given by the family a week later on what they have been serving will best indicate that they followed the nurses instructions?

a.

Our child does not like much of anything except sweets, so we serve a lot of sweet foods.

b.

We have increased the amount of olive oil in our childs otherwise balanced diet.

c.

We serve less beef and pork and more eggs and fish such as salmon for protein.

d.

We provide 3 to 4 servings of protein each day as part of a balanced diet that is low in fat and low in sodium.

ANS: D

Feedback

A

Incorrect. Serving mostly sweets will cause weight gain and lack of proper nutrients.

B

Incorrect. Olive oil is a monounsaturated fat which is preferred to a saturated fat but is not an indication that the child is eating a well balanced diet.

C

Incorrect. We serve less beef and pork and more eggs and fish such as salmon for protein does not indicate that they followed the nurses instructions.

D

Correct. When the family reports that they have been serving 3 to 4 servings of protein each day as part of a balanced diet that is low in fat and sodium, this indicates they have understood the nurses instructions. It is important for the diet of a child with JRA to include well balanced meals, avoidance of weight gain, calcium intake of 3-4 servings daily, and low fat, low sodium intake if on corticosteroids.

PTS: 1 REF: p. 958 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Application

16.Which of the following is the first-line treatment for juvenile rheumatoid arthritis?

a.

corticosteroids

b.

nonsteroidal anti-inflammatory drugs (NSAIDs)

c.

slow-acting antirheumatic drugs (SAARDs)

d.

hydrochloroquine

ANS: B

Feedback

A

Incorrect. For years corticosteroids were commonly used to slow the inflammatory process to relieve pain, maintain function, and promote normal growth and development. However, there are many adverse side effects with these drugs, and they are not the first-line treatment.

B

Correct. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for JRA. Not only do they decrease inflammation by decreasing production of the inflammatory substance prostaglandin, but they are also antipyretic, helping decrease fever.

C

Incorrect. Slow-acting antirheumatic drugs (SAARDs), such as sulfasalazine, may be used in combination with NSAIDs to control inflammation, but are not the first-line treatment.

D

Incorrect. Hydrochloroquine, an anti-malarial drug, has been used to treat JRA but is not the first-line treatment.

PTS: 1 REF: p. 958 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Application

17.Which of the following is a medication that has been found to work in a completely new way in the treatment of juvenile rheumatoid arthritis?

a.

methotrexate (Rheumatrex)

c.

etanercept (Enbrel)

b.

hydrochloroquine (Aralen)

d.

sulfasalazine (Azulfidine)

ANS: C

Feedback

A

Incorrect. Methotrexate (Rheumatrex) is an antirheumatic and antineoplastic agent used in JRA. It is usually the first SAARD used.

B

Incorrect. Hydrochloroquine (Aralen) is an anti-malarial drug used to treat JRA. It decreases inflammation by decreasing the production of prostaglandin.

C

Correct. Etanercept (Enbrel) is a medication that has been found to work in a completely new way in the treatment of JRA. Etanercept works by interrupting the inflammatory process, by blocking the cytokine tumor necrosis factor.

D

Incorrect. Sulfasalazine (Azulfidine) is a slow acting antirheumatic drug (SAARDs) that acts as an antibiotic and anti-inflammatory drug.

PTS: 1 REF: p. 958 Rheumatological Autoimmune Inflammatory Diseases

OBJ: Cognitive Level: Application

18.The usual onset of systemic lupus erythematosus (SLE) is at which of the following ages or time periods?

a.

1 year

c.

before age 3

b.

2 years

d.

after age 5

ANS: D

Feedback

A

Incorrect. Although lupus can develop at any age, onset in childhood usually occurs after the age of 5 years.

B

Incorrect. Although lupus can develop at any age, onset in childhood usually occurs after the age of 5 years.

C

Incorrect. Although lupus can develop at any age, onset in childhood usually occurs after the age of 5 years.

D

Correct. Although lupus can develop at any age, onset in childhood usually occurs after the age of 5 years.

PTS:1REF:p. 960 Human Immunodeficienty Virus

OBJ: Cognitive Level: Comprehension

19.Which of the following is the telltale sign of systemic lupus erythematosus?

a.

polyarthritis

b.

butterfly-shaped macular rash over the bridge of the nose and cheeks

c.

large nodules

d.

fine irregular rash over the entire body, which fades with sleep or rest

ANS: B

Feedback

A

Incorrect. Polyarthritis is not the telltale sign of systemic lupus erythematosus.

B

Correct. Butterfly-shaped macular rash over the bridge of the nose and cheeks is the telltale sign of systemic lupus erythematosus.

C

Incorrect. Large nodules are not the telltale sign of systemic lupus erythematosus.

D

Incorrect. Fine irregular rash over the entire body, which fades with sleep or rest, is not the telltale sign of systemic lupus erythematosus.

PTS:1REF:p. 962 Human Immunodeficienty Virus

OBJ: Cognitive Level: Application

20.Which of the following groups is most affected by systemic lupus erythematosus?

a.

females

c.

children under 5

b.

Caucasians

d.

elderly over 65

ANS: A

Feedback

A

Correct. Females are most affected by systemic lupus erythematosus.

B

Incorrect. Caucasians are not most affected by systemic lupus erythematosus.

C

Incorrect. Children under 5 are not most affected by systemic lupus erythematosus.

D

Incorrect. Elderly over 65 are not most affected by systemic lupus erythematosus.

PTS:1REF:p. 962 Human Immunodeficienty Virus

OBJ: Cognitive Level: Comprehension

21.The nurse is working with a child who is in for diagnostic tests. The lab results for the childs antinuclear antibodies (ANA) come back positive. These results support which conclusion?

a.

It is unlikely that this is a case of systemic lupus erythematosus.

b.

The child has negative antibodies to DNA.

c.

The child likely has systemic lupus erythematosus.

d.

The childs kidneys are involved in one of the autoimmune disorders.

ANS: C

Feedback

A

Incorrect. If the childs ANA were negative, it is unlikely that this is a case of SLE.

B

Incorrect. Positive antibodies to DNA is one of the 12 diagnostic criteria for SLE. Since this child has negative antibodies to DNA, it means he or she does not have one of the 12 criteria. No conclusion can be drawn about the presence of absence of SLE,

C

Correct. Positive antinuclear antibodies (ANA) are one diagnostic criterion for systemic lupus erythematosus (SLE) Therefore, the child may have SLE. Diagnosis is made by history, physical exam, laboratory testing, and the presence of four of the twelve diagnostic criteria.

D

Incorrect. Positive antinuclear antibodies (ANA) do not support the conclusion that the childs kidneys are involved in one of the autoimmune disorders.

PTS:1REF:p. 962 Human Immunodeficienty Virus

OBJ: Cognitive Level: Application

22.Which of the following statements by a caregiver of a child with systemic lupus erythematosus would indicate that the caregiver understood the nurses teachings?

a.

We dont give the child any milk or milk products.

b.

We protect our child from sunlight as much as possible.

c.

Our child is not allowed to play with other children.

d.

There is no gluten in any of the foods we serve our child.

ANS: B

Feedback

A

Incorrect. Avoidance of milk or milk products is not necessary for the child with SLE.

B

Correct. Exposure to sunlight can trigger a flare-up of symptoms; therefore, it should be avoided as much as possible. This statement indicates the caregivers have understood the nurses teachings.

C

Incorrect. SLE is an autoimmune disorder and is not contagious so the child can play with other children.

D

Incorrect. The child with SLE does not have a problem digesting gluten.

PTS:1REF:p. 964 Immunologic Alterations

OBJ: Cognitive Level: Application

23.Which of the following opportunistic infections is the most common acquired-immunodeficiency-syndrome-defining condition in infants up to 1 year of age?

a.

Pneumocystiscarinii pneumonia

c.

cytomegalovirus disease

b.

histoplasmosis

d.

cryptosporidiosis

ANS: A

Feedback

A

Correct. Pneumocystis carinii pneumonia is the most common acquired-immunodeficiency-syndrome (AIDS) defining condition in infants up to 1 year of age.

B

Incorrect. Histoplasmosis is not the most common AIDS defining condition in infants up to 1 year of age.

C

Incorrect. Cytomegalovirus disease is not the most common AIDS defining condition in infants up to 1 year of age.

D

Incorrect. Cryptosporidiosis is not the most common AIDS defining condition in infants up to 1 year of age.

PTS: 1 REF: p. 966 Brief Overview of Immune System Function

OBJ: Cognitive Level: Comprehension

24.Over 84% of newborn babies prenatally infected with human immunodeficiency virus (HIV) are of which of the following races?

a.

Caucasian and American Indian

c.

Asian

b.

African American and Hispanic

d.

Eskimo

ANS: B

Feedback

A

Incorrect. Over 84% of newborn babies prenatally infected with HIV are not Caucasian and American Indian.

B

Correct. Over 84% of newborn babies prenatally infected with HIV are African American and Hispanic demonstrating this disease disproportionately affects children of color.

C

Incorrect. Over 84% of newborn babies prenatally infected with HIV are not Asian.

D

Incorrect. Over 84% of newborn babies prenatally infected with HIV are not Eskimo.

PTS: 1 REF: p. 967 Brief Overview of Immune System Function

OBJ: Cognitive Level: Comprehension

25.The nurse working with pregnant women and new mothers in developed countries will advise these women to avoid:

a.

breastfeeding

c.

supplementing breast milk with formula

b.

sunlight

d.

exercising in any health clubs or gyms

ANS: A

Feedback

A

Correct. The nurse working with pregnant women and new mothers in developed countries will advise these women to avoid breastfeeding. If they have HIV, their infant may become infected through breast milk.

B

Incorrect. Sunlight has no relationship to the etiology of HIV.

C

Incorrect. The nurse will advise these women to avoid breastfeeding; therefore, supplementing breast milk with formula is not a logical choice.

D

Incorrect. Exercising in any health clubs or gyms has no relationship to the etiology of HIV.

PTS: 1 REF: p. 967 Brief Overview of Immune System Function

OBJ: Cognitive Level: Application

26.Which of the following groups of clients with human immunodeficiency virus (HIV) will the nurse find have the most severe symptoms?

a.

young adult women

c.

children diagnosed with HIV then young

b.

men diagnosed with HIV as adolescents

d.

middle-aged men

ANS: C

Feedback

A

Incorrect. Young adult women will not have the most severe symptoms.

B

Incorrect. Men diagnosed with HIV as adolescents will not have the most severe symptoms.

C

Correct. Children diagnosed with HIV when young will have the most severe symptoms.

D

Incorrect. Middle-aged men will not have the most severe symptoms.

PTS: 1 REF: p. 967 Brief Overview of Immune System Function

OBJ: Cognitive Level: Application

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