Unit 1, Mod 1: Body Defenses

Question 1

What marker does the body read to recognize “self”?

Answer 1

Human leukocyte antigen (HLA)

Question 2

A nurse is evaluating a pts wound.

Location: Ankle
Source: Scratched from gardening
Site: red, mildly swollen, painful to move, no discharge
Symptoms: afebrile

What action should the nurse take?

Answer 2

Teach the pt how to keep the wound clean and dry

Question 3

A patient presents to the emergency department with pneumonia. The provider determines that the patient most likely has a bacterial pneumonia because of which lab report finding?

Answer 3

Increased neutrophils, they are the first responders and are highly present during bacterial infections

Question 4

A patient has (seasonal) allergies and is starting to take an “anti-histamine” medication for the symptoms. Now that you understand pathophysiology, you now know that histamines are present because of:

Answer 4

Mast cell degradation, when mast cells break down they release substances such as histamines

Question 5

A patient has a rare immune disease that makes his natural killer cells not functional. The nurse recognizes that this patient is most at risk for what types of illness/disease?

Answer 5

Cancer, NK cells surveillance the body for cancer cells

Question 6

A fellow nursing student was running to class and fell acquiring a leg injury. Which of the following manifestations are expected after the injury due to inflammation?

Answer 6

the student complains of sharp pain when the site is touched and the student reports that her skin feels tight around the injury (edema)

Question 7

If a patient has chronic inflammation, what cells are present?

Answer 7

lymphocytes and fibroblasts

Question 8

Based on what you learned about systemic manifestations of inflammation and fever. What action should the nurse take for a 20-year patient who has a fever of 101 from a viral infection.

Answer 8

Allow the fever to go without treatment, if the pt is able to tolerate the metabolic burden on the body

Question 9

The nurse is assessing a client who has been having elevated temperatures. The client is shivering, states he is cold and is asking for a blanket. Understanding how a fever comes about, where is this client in the process?

Answer 9

The temperature is on it’s way up and has not yet hit the ‘set point’.

Shivering is the way the body is generating heat to raise the body temperature. This client is on the way up and had not yet reached the max temperature.

Question 10

What cells are primarily responsible for the production of antibodies?

Answer 10

B cells are the primary ones that produce antibodies.

Question 11

Which option below lists the first antibodies produced paired with the antibodies that give us long term protection?

Answer 11

IgM is the first responder and IgG is the long term protector

Question 12

The loss of what type of cell in cell mediated immunity would have the greatest impact on the immune system?

Answer 12

T helper (CD4) cells are key to coordinate and regulate the immune response.

Question 13

What type of cells most commonly function as antigen presenting cells?

Answer 13

Macrophages

Question 14

What is the benefit of memory cells in the immune system?

Answer 14

Quicker and more pronounced response the second time they encounter an invader.

Question 15

A patient presents to the emergency room with gastroenteritis and has an elevated WBC. What part of the WBC differential result will tell the provider that is it is most likely a viral infection as these cells will be increased?

Answer 15

lymphocytes, these are elevated with viral infections

Question 16

A patient presents to the clinic with an allergic reaction. Which cell types will be elevated on the WBC differential lab report?

Answer 16

Eosinophils, this will elevate with allergic reactions

Question 17

Which cells on a WBC differential lab report are immature cells and are elevated when there has been a “shift to the left”?

Answer 17

Stab/bands neutrophils. these are the immature cells and are on the WBC and in the “old fashioned” handwritten reports where listed to the far left, hence the term “shift to the left”. These indicate either a new infection or an overwhelming infection.

Question 18

Which of the following is the best diagnostic test to determine if an individual has HIV infection?

Answer 18

4th gen assay blood test

Question 19

What enzymes are used in the process of HIV replication?

Answer 19

Protease and integrase

Question 20

An HIV positive patient was started on new drug therapy to treat HIV infection. Which of the following tests provides the best indication that drug therapy is effective?

Answer 20

Viral load, this gives the best report of viral replication speed. The goal is to decrease viral replication till it is undetectable

Question 21

What implications might there be for an individual with HIV who has an “undetectable” viral load?

Answer 21

It decreases the risk of transmission of the virus to others as there is less virus replicating in the bloodstream.

Question 22

Which infection is most often seen when the patient’s CD4 cell count is below 50 cells/mm3?

Answer 22

PCP pneumonia and MAC

Question 23

Which AIDS opportunistic infection causes blindness?

Answer 23

Cytomegalovirus

Question 24

Which opportunistic infection is called by a fungus?

Answer 24

cryptococcal meningitis

Question 25

Which of the following patient’s would be considered to be in the acute HIV infection stage?

Answer 25

Found to be HIV positive by using the nucleic acid test.

This test will pick up on the acute HIV infection time frame when it is the HIV 1/HIV-2 test is indeterminate or negative.

Question 26

How would you interpret these results? What is a possible cause?

Elevated Stab/Band Neutrophils, elevated WBC (18,000)

Answer 26

Early Infection

The overall WBC is elevated. Normal is 5,000-10,000. The immature neutrophils (the stabs/bands) are elevated which means that the bone marrow is kicking out cells because they are needed. This can either be early in the infection or an overwhelming infection where more and more neutrophils are needed.

Question 27

How would you interpret these results? What is a possible cause?

Elevated WBC (11,900), elevated PMN/Segs.

Answer 27

Inflammatory response

The overall WBC is barely elevated. Only the mature neutrophils are elevated. This is most likely either a bacterial infection OR inflammation. You will see a bump in the WBC in the neutrophils when patients have an inflammatory response such as post surgery (first 24-48 hours—normal response) or if they have a deep vein thrombosis (DVT, blood clot). When there is an increase from inflammation is it not a huge increase, but a small elevation.

Question 28

How would you interpret these results? What is a possible cause?

Elevated WCB (14,000), elevated monocytes

Answer 28

Chronic infection

monocytes become elevated with chronic infections . The neutrophils can no longer manage the problem because it has gone on for too long.

Question 29

When reading a WBC differential, it is most important to take note of which percentages decrease. (most of the time)

Answer 29

False

Because a WBC differential lab report is based on percentages, if one number goes up then another number has to decrease.

Increased numbers have more significance than decreased numbers.