Lewis 4th ed: Ch 16 Altered Immune Response Flashcards
Chickenpox is an example of which of the following types of immunities?
a. innate
b. natural active
c. artificial
d. cell-mediated
b. Natural active
The nurse is caring for a client in the outpatient clinic that has an immune deficiency involving the T-lymphocytes. Which of the following areas should the nurse teach the client about the need for more frequent screening?
a. allergies
b. malignancy
c. antibody deficiency
d. autoimmune disorders
b. malignancy
• Why? T-lymphocytes are a key component of cell-mediated immunity, which is responsible for recognizing and destroying abnormal cells, including cancer (malignancy) cells. • When there is a deficiency in T-cells, the body loses its ability to effectively detect and eliminate cancerous cells, increasing the risk of malignancies. • Frequent screening is needed to catch malignancies early in immunocompromised individuals.
Why Not the Other Options?
1. (a) Allergies – Allergic reactions are primarily mediated by humoral immunity (B-cells and antibodies), not T-cells.
2. (c) Antibody Deficiency – Antibodies are produced by B-lymphocytes, which are part of humoral immunity, not T-cell-mediated immunity.
3. (d) Autoimmune Disorders – While T-cells are involved in immune regulation, autoimmune disorders are more related to dysregulation of both humoral and cell-mediated immunity rather than just T-cell deficiency.
Key Takeaway:
• T-lymphocytes = Cell-mediated immunity = Cancer surveillance
• B-lymphocytes = Humoral immunity = Antibodies and allergic reactions
• T-cell deficiency = Increased risk of malignancy → Needs frequent screening
Which of the following antibodies is involved with an anaphylactic reaction?
a. IgE
b. IgA
c. IgM
d. IgG
a. IgE
IgE causes the symptoms of allergic reactions and is the antibody involved in anaphylactic reaction.
The nurse encourages a new mother to breastfeed her infant, even for a short time, because colostrum will provide the infant with which of the following types of immunity?
a. Innate
b. Active
c. Passive
d. Cell-mediated
c. Passive
Colostrum provides passive immunity through antibodies from the mother; these antibodies protect the infant for a few months. However, memory cells are not retained, so the protection is not permanent. Innate immunity is present at birth and occurs without exposure to an antigen. Active immunity requires that the infant manufacture antibodies after exposure to an antigen. Cell-mediated immunity is acquired through T-lymphocytes and is a form of active immunity.
The nurse is assessing a client for a possible atopic dermatitis. Which of the following laboratory values should the nujrse review?
a. IgE
b. IgA
c. Basophils
d. Neutrophils
a. IgE
Serum IgE causes the symptoms of allergic reactions and is elevated in type 1 hypersensitivity disorders. The eosinophil level will be elevated, rather than neutrophil or basophil counts. IgA is located in body secretions and would not be tested when evaluating a client who has symptoms of atopic dermatitis.
The nurse is conducting an annual health examination on an older adult client who states “I don’t understand why i need to have so many cancer screening tests now, I feel just fine!” Based upon this statement, which of the following topics will the nurse include in the clients teaching plan?
a. Consequences of aging on cell-mediated immunity
b. Decrease in antibody production associated with aging
c. Impact of poor nutrition on immune function in older people.
d. Incidence of cancer-stimulating infections in older individuals.
a. Consequences of aging on cell-mediated immunity.
Key Points:
• The client is questioning why they need more frequent cancer screenings despite feeling fine.
• The nurse must explain the impact of aging on the immune system, specifically cell-mediated immunity.
• Why? As people age, their T-lymphocyte (T-cell) function declines, leading to weaker cell-mediated immunity. • T-cells play a key role in detecting and eliminating cancerous cells. When this function weakens, the risk of cancer increases. • This is why older adults require more cancer screenings, even if they feel fine.
Why Not the Other Options?
1. (b) Decrease in antibody production associated with aging
• While B-cells and antibody production also decline with age, they are part of humoral immunity, not cell-mediated immunity, which is more directly linked to cancer risk.
2. (c) Impact of poor nutrition on immune function in older people
• Poor nutrition can weaken immunity, but it’s not the primary reason for increased cancer screenings in aging adults.
3. (d) Incidence of cancer-stimulating infections in older individuals
• Certain infections (e.g., HPV, hepatitis) can increase cancer risk, but the main issue in aging is declining immune surveillance of cancerous cells.
Key Takeaways:
• Aging weakens cell-mediated immunity (T-cells), reducing the body’s ability to fight cancer.
• Older adults need more cancer screenings due to increased cancer risk.
• This is why the nurse should educate the client about aging’s impact on cell-mediated immunity.
The nurse discusses the prevention and management of allergic reactions with a client who is a beekeeper and has developed a hypersensitivity to bee stings. Which of the following client statements indicates a need for additional teaching?
a. “I will plan to take oral antihistamines daily before going to work”
b. “I will get a prescription for epinephrine and learn to self-inject it”
c. “I should wear a Medic Alert bracelet indicating my allergy to bee stings”
d. “I am going to need job retraining so that i can work in a different occupation”
a. “I will plan to take oral antihistamines daily before going to work”
Since the client is at risk for bee stings and the severity of allergic reactions tends to increase with added exposure to allergen, taking oral antihistamines will not adequately control the client’s hypersensitivity reaction. The other client statements indicate a good understanding of management of the problem.
Which of the following instructions should the nurse include when teaching a client with possible allergies about intradermal skin testing?
a. “do not eat anything for about 6 hours before the testing”
b. “take an oral antihistamine about an hour before testing”
c. “plan to wait in the clinic for 20-30 minutes after the testing”
d. “reaction to the testin giwll take about 48-72 hours to occur”
c. “plan to wait in the clinic for 20-30 minutes after the testing”
The nurse is obtaining a health history from a client who works as a laboratory technician and learns that the client has a history of allergic rhinitis, asthma, and multiple food allergies. Which of the following actions is most important for the nurse to implement?
a. encourage the client to carry an epinephrine kit in case type IV allergic reaction to latex develops.
b. Advise the client to use oil-based hand crease to decrease contact with natural proteins in latex gloves.
c. Document the client’s allergy history and be alert for any clinical manifestations of a type I latex allergy.
d. Recommend that the client use vinyl gloves instead of latex gloves in preventing bloodborne pathogen contact.
c. Document the client’s allergy history and be alert for any clinical manifestations of a type I latex allergy.
The client’s history and occupation indicate a risk for development of latex allergy, and the nurse should be prepared to manage any symptoms that occur. Epinephrine is not an appropriate treatment for contact dermatitis that is caused by a type IV allergic reaction to latex. Oil-based creams will increase the exposure to latex from latex gloves. Vinyl gloves are appropriate to use when exposure to body fluids is unlikely.
A client diagnosed with systemic lupus erythematosus is scheduled for plasmapheresis. Which of the following pathophysiological events should the nurse plan to teach the client about this procedure?
a. It eliminates eosinophils and basophils from blood.
b. It removes antibody-antigen complexes from circulation.
c. It prevents foreign antibodies from damaging various body tissues.
d. It decreases the damage to organs caused by attacking T-lymphocytes.
b. It removes antibody-antigen complexes from circulation.
Understanding Plasmapheresis and Its Role in Systemic Lupus Erythematosus (SLE)
What is Plasmapheresis?
Plasmapheresis (also called therapeutic plasma exchange) is a procedure that removes plasma (the liquid part of blood) from the body, filters out harmful substances, and then returns the cleaned plasma or a plasma substitute back into the body.
Why is Plasmapheresis Used in Lupus (SLE)?
Systemic lupus erythematosus (SLE) is an autoimmune disease where the body’s immune system produces harmful antibodies that attack healthy tissues. This leads to inflammation, tissue damage, and organ dysfunction.
One of the key issues in SLE is the formation of antibody-antigen complexes (immune complexes) that accumulate in tissues and cause damage.
Plasmapheresis helps by:
✔ Removing these immune complexes from circulation
✔ Reducing inflammation and preventing further organ damage
✔ Decreasing the severity of lupus flares
Correct Answer: (b) It removes antibody-antigen complexes from circulation
• This is the main reason plasmapheresis is used in lupus. It clears out the harmful immune complexes that contribute to inflammation and tissue damage.
Why Not the Other Options?
1. (a) It eliminates eosinophils and basophils from blood ❌
• Plasmapheresis does not target specific white blood cells like eosinophils and basophils. These cells are involved in allergic reactions, not lupus.
2. (c) It prevents foreign antibodies from damaging various body tissues ❌
• Lupus is not caused by foreign antibodies but by the body’s own immune system attacking itself. Plasmapheresis removes autoantibodies, not foreign ones.
3. (d) It decreases the damage to organs caused by attacking T-lymphocytes ❌
• T-lymphocytes are part of cell-mediated immunity. While they play a role in lupus, plasmapheresis mainly removes circulating immune complexes and antibodies, not T-cells.
Key Takeaways:
• Plasmapheresis = Plasma exchange (removing and replacing plasma).
• Main purpose in lupus = Removes harmful antibody-antigen complexes.
• Helps reduce lupus symptoms and prevent organ damage.
• Does not affect specific immune cells like eosinophils, basophils, or T-cells.
This treatment is usually reserved for severe lupus cases, especially those affecting the kidneys (lupus nephritis) or causing life-threatening complications.
The nurse is completing an assessment and health history with a client. Which of the following statements made by the client should alert the nurse to a possible immunodeficiency disorder?
a. “i take one baby aspirin every day to prevent stroke”
b. “I usually eat eggs or meat for at least 2 meals a day”
c. “I had my spleen removed many years ago after a car accident”
d. “I had a chest x-ray 6 months ago when i had walking pneumonia”
c. “I had my spleen removed many years ago after a car accident”
Splenectomy increases the risk for septicemia from bacterial infections. The client’s protein intake is good and should improve immune function. Daily aspirin use does not impact immune function. A chest x-ray does not have enough radiation to suppress immune function.
The nurse is caring for a client that has experienced Goodpasture’s syndrome. Which of the following adverse effects should the nurse be aware of?
a. Thrombocytopenia
b. Leukopenia
c. Angioedema
d. Pulmonary hemmorhage
d. Pulmonary hemorrhage
Goodpasture’s syndrome is a rare disorder involving the lungs and kidneys. An antibody-mediated autoimmune reaction occurs involving the glomerular and alveolar basement membranes. The circulating antibodies combine with tissue antigen to activate the complement system which causes deposits of IgG to form along the basement membranes of the lungs or the kidneys. This reaction may result in pulmonary hemorrhage and glomerulonephritis.
The nurse is teaching a client on immunosuppressant therapy after a kidney transplant about the post transplant drug regimen. Which of the following statements by the client should alert the nurse that additional teaching is required?
a. “If i develop an acute rejection episode, I will need to have other types of drugs given IV”
b. “I need to be monitored closely because I have a greater chance of developing malignant tumours”
c. “After a couple of years, it is likely that i will be able to stop taking the calcineurin inhibitor”
d. “the drugs are given in combination because they inhibit different aspects of transplant rejection”
c. “After a couple of years, it is likely that i will be able to stop taking the calcineurin inhibitor”
The calcineurin inhibitor will need to be continued for life. The other client statements are accurate and indicate that no further teaching is necessary about those topics.
Which of the following adverse effects is related to cyclosporine administration?
a. Nephrotoxicity
b. Aseptic necrosis
c. Peptic ulcer
d. Leukopenia
a. Nephrotoxicity
Nephrotoxicity is the most severe adverse effect of cyclosporine. Aseptic necrosis, peptic ulcer, and leukopenia are all adverse effects of the us of corticosteroids - not cyclosporine.
The nurse is admitting a client to hospital who has an acute rejection of an organ transplant. Which of the following clients is the most appropriate roomate?
a. A client who has viral pneumonia.
b. A client with second-degree burns.
c. A client who is recovering from an anaphylactic reaction to a bee sting.
d. A client with graft-versus-host disease after a recent bone marrow transplant.
c. A client who is recovering from an anaphylactic reaction to a bee sting.
Treatment for a client with acute rejection includes administration of additional immunosuppressants, and the client should not be exposed to increases risk for infection as would occur from clients with viral pneumonia, graft-versus-host disease, and burns. There is no increased exposure to infection from a client with anaphylaxis.
The nurse is caring for a client at an outpatient clinic who is experiencing an allergic reaction to an unknown allergen. Which of the following actions is most appropriate for the nurse to implement?
a. Perform a focused physical assessment.
b. Obtain the health history from the client.
c. teach the client about various diagnostic studies.
d. administer skin testing by the cutaneous scratch method.
d. administer skin testing by the cutaneous scratch method.
The immediate priority is to administer skin testing by the cutaneous scratch method as the client is experiencing an allergic reaction. After the allergic reaction is treated, an assessment of health history, focused physical assessment, and client teaching could follow.
To determine whether a client’s angioedema has responded to prescribed therapies, which of the following actions should the nurse take first?
a. Ask about any clear nasal discharge.
b. Obtain blood pressure and heart rate.
c. Check for swelling of the lips and tongue.
d. Assess extremities for Wheal and flare lesions
c. Check for swelling of the lips and tongue.
Angioedema is characterized by swelling of the eyelids, lips, adn tongue. Wheal and flare lesions; clear nasal drainage; and hypotension and tachycardia are characteristics of other allergive reactions.
Which information about client and donor tissue typing results for a client who needs a kidney transplant is most important for the nurse to communicate to the health care provider?
a. Client is Rh positive and donor is Rh negative.
b. Six antigen matches are present in HLA typing.
c. Results of client-donor crossmatching are positive.
d. Panel of reactive antibodies percentage is low.
c. Results of client-donor crossmatching are positive.
Positive cross matching is an absolute contraindication to kidney transplantation, since hyperacute rejection will occur after the transplant.
Understanding Positive Crossmatching in Kidney Transplantation
A positive crossmatch means that the recipient’s immune system will immediately attack the donor kidney, making transplantation impossible due to the high risk of hyperacute rejection.
What is Crossmatching in Kidney Transplantation?
• Crossmatching is a compatibility test done before a kidney transplant.
• It determines whether the recipient has pre-formed antibodies against the donor’s tissue.
• The test mixes the recipient’s serum (which contains antibodies) with donor cells to see if a reaction occurs.
What Does a Positive Crossmatch Mean?
✔ A positive crossmatch = transplant is contraindicated (not safe).
✔ The recipient has pre-existing antibodies that will immediately attack the donor kidney.
✔ Leads to hyperacute rejection, which occurs within minutes to hours post-transplant and causes rapid graft failure.
Which information about a client who is receiving immunotherapy and has just received an allergen injection is most important to communicate to the health care provider?
a. The client’s IgG level is increased.
b. The injection site is red and swollen.
c. The client’s allergy symptoms have not improved.
d. There is a 3cm wheal at the site of the allergen injection.
d. There is a 3cm wheal at the site of the allergen injection.
A local reaction larger than quarter size may indicate that a decrease in the allergen dose is needed. An increase in IgG indicates that the therapy is effective. Redness and swelling at the site are not unusual. Because immunotherapy usually takes 1-2 years to achieve an effect, an improvement in the client’s symptoms is not expected after a few months.
