Unit 1 Module 1: Body Defenses

Question 1

What type of cells are most commonly antigen presenting cells?

Answer 1

Macrophages, B cells, dendritic cells

Remember macrophages live in the tissues so they make a perfect cell to be an APC since they are out in the tissues can quickly pick up on an invader.

Question 2

A patient presents to the clinic with an allergic reaction. This can be verified by an elevated in which WBC type?

Answer 2

Eosinophils

Question 3

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 3

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

Question 4

Which of the top five Opportunistic infections are caused by a fungus?

Answer 4

cryptococcal meningitis and PCP pneumonia

The top 5 we need to know for this class are

• PCP pneumonia
• MAC
• cytomegalovirus
• cryptococcal meningitis
• Kaposi’s sarcoma

Question 5

erythema

Answer 5

Vasodilation causes increased blood flow

Question 6

What is the best test to determine if a patient has HIV infection in an individual who is believed to have been infected 1 year ago?

Answer 6

4th generation assay test

The CDC recommends this test because it can detect within 14 days the presence of p24 HIV protein.

Question 7

Which AIDS opportunistic infection causes blindness?

Answer 7

Cytomegalovirus

The top 5 we need to know for this class are

• PCP pneumonia
• MAC
• cytomegalovirus
• cryptococcal meningitis
• Kaposi’s sarcoma

Question 8

Which cells in the differential are immature cells and are elevated when there has been a “shift to the left”

Answer 8

stabs and bands

Question 9

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

Answer 9

lymphocytes

Question 10

margination

Answer 10

The action of leukocytes adhering to blood vessel walls

Question 11

WBC differential: slightly elevated WBC, high segs

Answer 11

inflammatory response (with a higher WBC overall, would be bacterial)

Question 12

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 12

mast cell degeneration

Question 13

phagocytosis

Answer 13

a cell (neutrophil or macrophage) ingests and disposes of foreign material or an invader

Question 14

When the body encounters something, it checks to see if it is “self” or “non-self”. What marker does the body read to recognize “self”?

Answer 14

Human leukocyte antigen (more generally: major histocompatibility complex)

Question 15

Opportunistic or pathogenic: Gastroenteritis

Answer 15

pathogenic

Question 16

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

Answer 16

T helper (CD4) cells

Question 17

The nurse is evaluating a patient’s wound on his ankle. The site is red, swollen and painful to move. What action should the nurse take?

Answer 17

Teach the patient how to keep the wound clean and dry (no sign of infection yet)

Question 18

WBC differential: high WBC, high stab/band neutrophils, normal segs, low lymphocytes

Answer 18

This can either be early in the infection or an overwhelming infection where more and more neutrophils are needed.

Question 19

_______________cells make antibodies, which are proteins that are produced in response to one particular antigen.

Answer 19

B

Question 20

HIV or AIDS: 36-year-old female recently diagnosed HIV positive with MAC (mycobacterium avium complex)

Answer 20

AIDS

It has to be CD4 less than 200 or AIDS defining illness.

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

HIV or AIDS: 44-year-old male with CD4 count of 160 being treated for oral candidiasis (thrush)

Answer 22

AIDS

It has to be CD4 less than 200 or AIDS defining illness.

Question 23

What enzymes are used in the process of HIV replication?

Answer 23

reverse transcriptase, integrase, protease

Question 24

A patient presents to the emergency department with pneumonia. The provider determines that the patient most likely has a [viral/bacterial/fungal] pneumonia because of elevated neutrophils.

Answer 24

bacterial

Question 25

A patient is fearful that he has been infected with HIV. The nurse recognizes that the first manifestations of HIV infection is/are:

Answer 25

Acute HIV infection looks like most viral infections with symptoms like fever, fatigue, night sweats, swollen lymph glands and muscle aches. The drop in CD4 cells to a significant amount and the opportunistic infections don't happen until the end of the disease process.

Question 26

Opportunistic or pathogenic: bacterial pneumonia

Answer 26

pathogenic

Question 27

Opportunistic or pathogenic: sinusitis

Answer 27

opportunistic

Question 28

Why does inflammation cause pain?

Answer 28

Increased fluid in the area puts pressure on nerve endings

Question 29

edema

Answer 29

Protein-rich fluid flows from vascular space into the tissues

Question 30

WBC differential: WBC 14,000, high monocytes

Answer 30

chronic infection -- the neutrophils can no longer manage the problem because it has gone on too long

Question 31

Why does inflammation cause impaired function?

Answer 31

Edema and pain

Question 32

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

Answer 32

MAC

Question 33

HIV or AIDS: 24-year-old female HIV positive with CD4 count of 250 and has invasive cervical cancer

Answer 33

AIDS It has to be CD4 less than 200 or AIDS defining illness.

Question 34

chemotaxis

Answer 34

the communication method that is used to call other cells to the site of injury

Question 35

Opportunistic or pathogenic: tuberculosis

Answer 35

pathogenic

Question 36

Opportunistic or pathogenic: Oral candidiasis

Answer 36

Opportunistic

Question 37

Which cell is considered the most critical to acquired immunity?

Answer 37

T helper cells (CD4) both direct the cell-mediated immunity as well as activate B cells for humoral immunity to produce antibodies.

Question 38

How does an HIV infection occur in the body?

Answer 38

HIV infects CD4 cells and uses the cell as a factory for more HIV cells

Question 39

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

Answer 39

lymphocytes, fibroblasts, macrophages

Question 40

Opportunistic or pathogenic: PCP/PJP pneumonia

Answer 40

opportunistic

Question 41

Which one of the five antibodies (immunoglobulins) is the first ones to be produced and the one that gives us long term protection?

Answer 41

IgM then IgG

Question 42

This is the type of cell that displays a fragment of the antigen on it's surface which makes it marked for recognition by T lymphocytes.

Answer 42

Antigen presenting cells (APC) is the type of cell. Macrophages are one type of APC. The MHC is the "barcode" type of designation that helps T cells know if it is "self" vs "nonself".

Question 43

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

Answer 43

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

Question 44

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 44

cancer Natural killer cells do surveillance in the body for cancer cells and eradicate them on their own.

Question 45

Opportunistic or pathogenic: Karposi's sarcoma

Answer 45

opportunistic

Question 46

A fellow nursing student was running to class and fell acquiring a leg injury. What s/s would you expect without infection?

Answer 46

- sharp pain - heat - tight skin - redness

Question 47

The 4th gen assay is positive but the HIV 1/HIV2 test is indeterminate. Which test would show positivity during the acute phase?

Answer 47

Nucleic acid test

Question 48

An HIV positive patient was started on new drug therapy for his HIV infection. What test would give the best indication if the drug therapy is effective?

Answer 48

Viral load * This gives the best idea of the change in the viral replication speed. The goal is to decrease viral replication to the point of undetectable.

Question 49

What cells are primarily responsible for the production of antibodies?

Answer 49

The B cells are the primary ones that produce antibodies. Although the T-cells give direction for B cells to start making antibodies.

Question 50

HIV or AIDS: 56-year-old diagnosed 10 years ago; now has a bacterial pneumonia

Answer 50

HIV It has to be CD4 less than 200 or AIDS defining illness. Bacterial pneumonia is pathogenic. PCP/fungal pneumonia is opportunistic.

Question 51

mast cells

Answer 51

cells made up of granular bags that live in the tissues and can release chemical signals.

Question 52

Opportunistic or pathogenic: Mycobacterium avium complex (MAC)

Answer 52

opportunistic