Chapter 17 Inflammation and Immunity PDF

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Chapter17:InflammationandImmunity MULTIPLECHOICE 1.Thestudentnurselearnsthatthemostimportantfunctionofinflammationandimmunityiswhichpurpose? a.Destroyingbacteriabeforedamageoccurs b.Preventinganyentryofforeignmaterial c.Providingprotectionagainstinvadingorganisms d.Regulatingtheprocessofself-tolerance ANS:C Thepurposeofinflammationandimmunityistoprovideprotectiontothebodyagainstinvadingorganisms, whethertheyarebacterial,viral,protozoal,orfungal.Thesesystemseliminate,destroy,orneutralizethe offendingagents.Thecellsoftheimmunesystemaretheonlycellsthatcandistinguishselffromnon-self. Thisfunctionisgeneralizedandincorporatesdestroyingbacteria,preventingentryofforeigninvaders,and regulatingself-tolerance. DIF:Remembering/KnowledgeREF:289 KEY:Immunity|inflammation|infectioncontrol MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 2.Anurseisassessinganolderclientforthepresenceofinfection.Theclientstemperatureis97.6F(36.4C). Whatresponsebythenurseisbest? a.Assesstheclientformorespecificsigns. b.Concludethataninfectionisnotpresent. c.Documentfindingsandcontinuetomonitor. d.Requestthattheproviderorderbloodcultures. ANS:A Becauseolderadultshavedecreasedimmunefunction,includingreducedneutrophilfunction,fevermaynot bepresentduringanepisodeofinfection.Thenurseshouldassesstheclientforspecificsignsofinfection. Documentationneedstooccur,butamorethoroughassessmentcomesfirst.Bloodculturesmayormaynotbe neededdependingontheresultsoffurtherassessment. DIF:Applying/ApplicationREF:291 KEY:Infection|inflammation|immunity|olderadult|nursingassessment MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:HealthPromotionandMaintenance 3.Aclientistakingprednisonetopreventtransplantrejection.Whatinstructionbythenurseismost important? a.Avoidlargecrowdsandpeoplewhoareill. b.Checkover-the-countermedsforacetaminophen. c.Takethismedicineexactlyasprescribed. d.Youhaveahigherriskofdevelopingcancer. ANS:A Prednisone,likeallsteroids,decreasesimmunefunction.Theclientshouldbeadvisedtoavoidlargecrowds andpeoplewhoareill.Prednisonedoesnotcontainacetaminophen.Allclientsshouldbetaughttotake medicationsexactlyasprescribed.Ahigherriskforcancerisseenwithdrugsfromthecalcineurininhibitor category,suchastacrolimus(Prograf). DIF:Understanding/ComprehensionREF:301 KEY:Inflammation|immunity|infectioncontrol|clientteaching MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies 4.Aclinicnurseisworkingwithanolderclient.Whatassessmentismostimportantforpreventinginfections

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inthisclient? a.Assessingvaccinationrecordsforboostershotneeds b.Encouragingtheclienttoeatanutritiousdiet c.Instructingtheclienttowashminorwoundscarefully d.Teachinghandhygienetopreventthespreadofmicrobes ANS:A Olderadultsmayhaveinsufficientantibodiesthathavealreadybeenproducedagainstmicrobestowhichthey havebeenexposed.Therefore,olderadultsneedboostershotsformanyvaccinationstheyreceivedasyounger people.Anutritiousdiet,properwoundcare,andhandhygienearerelevantforallpopulations. DIF:Understanding/ComprehensionREF:291 KEY:Immunity|inflammation|olderadult|vaccinations MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:HealthPromotionandMaintenance 5.Aclienthasalegwoundthatisinthesecondstageoftheinflammatoryresponse.Forwhatmanifestation doesthenurseassess? a.Noticeablerubor b.Purulentdrainage c.Swellingandpain d.Warmthatthesite ANS:B Duringthesecondphaseoftheinflammatoryresponse,neutrophiliaoccurs,producingpus.Rubor(redness), swelling,pain,andwarmtharecardinalsignsofthegeneralinflammatoryprocess. DIF:Remembering/KnowledgeREF:295 KEY:Inflammation|immunity|inflammatoryresponse|nursingassessment MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:ReductionofRiskPotential 6.Anursingstudentlearningaboutantibody-mediatedimmunitylearnsthatthecellwiththemostdirectrolein thisprocessbeginsdevelopmentinwhichtissueororgan? a.Bonemarrow b.Spleen c.Thymus d.Tonsils ANS:A TheBcellistheprimarycellinantibody-mediatedimmunityandisreleasedfromthebonemarrow.These cellsthentraveltootherorgansandtissues,knownasthesecondarylymphoidtissuesforBcells. DIF:Remembering/KnowledgeREF:295 KEY:Immunity|inflammation|antibody-mediatedimmunity|Bcell|bonemarrow MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 7.Thenurseunderstandsthatwhichtypeofimmunityisthelongestacting? a.Artificialactive b.Inflammatory c.Naturalactive d.Naturalpassive ANS:C Naturalactiveimmunityisthemosteffectiveandlongestactingtypeofimmunity.Artificialandnatural passivedonotlastaslong.Inflammatoryisnotatypeofimmunity. DIF:Remembering/KnowledgeREF:299

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KEY:Immunity|inflammation|antibody-mediatedimmunity MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 8.Thenurseworkingwithclientswhohaveautoimmunediseasesunderstandsthatwhatcomponentofcellmediatedimmunityistheproblem? a.CD4+cells b.CytotoxicTcells c.Naturalkillercells d.SuppressorTcells ANS:D SuppressorTcellshelppreventhypersensitivitytoonesowncells,whichisthebasisforautoimmunedisease. CD4+cellsarealsoknownashelper/inducercells,whichsecretecytokines.Naturalkillercellshavedirect cytotoxiceffectsonsomenon-selfcellswithoutfirstbeingsensitized.SuppressorTcellshaveaninhibitory actionontheimmunesystem.CytotoxicTcellsareeffectiveagainstselfcellsinfectedbyparasitessuchas virusesorprotozoa. DIF:Remembering/KnowledgeREF:296 KEY:Immunity|inflammation|cell-mediatedimmunity MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 9.Aclienthasbeenondialysisformanyyearsandnowisreceivingakidneytransplant.Theclient experienceshyperacuterejection.Whattreatmentdoesthenursepreparetofacilitate? a.Dialysis b.High-dosesteroidadministration c.Monoclonalantibodytherapy d.Plasmapheresis ANS:A Hyperacuterejectionstartswithinminutesoftransplantationandnothingwillstoptheprocess.Theorganis removed.Iftheclientsurvives,heorshewillhavetoreturntodialysistreatment.Steroids,monoclonal antibodies,andplasmapheresisareineffectiveagainstthistypeofrejection. DIF:Applying/ApplicationREF:300 KEY:Immunity|inflammation|rejection|hyperacuterejection|transplantation MSC:IntegratedProcess:NursingProcess:Analysis NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 10.Anurseisassessingaclientforacuterejectionofakidneytransplant.Whatassessmentfindingrequiresthe mostrapidcommunicationwiththeprovider? a.Bloodureanitrogen(BUN)of18mg/dL b.Cloudy,foul-smellingurine c.Creatinineof3.9mg/dL d.Urineoutputof340mL/8hr ANS:C Acreatinineof3.9mg/dLishigh,indicatingpossibledysfunctionofthekidney.Thisisapossiblesignof rejection.TheBUNisnormal,asistheurineoutput.Cloudy,foul-smellingurinewouldprobablyindicatea urinarytractinfection. DIF:Analyzing/AnalysisREF:300 KEY:Immunity|inflammation|acuterejection|transplantation|nursingassessment MSC:IntegratedProcess:CommunicationandDocumentation NOT:ClientNeedsCategory:PhysiologicalIntegrity:ReductionofRiskPotential 11.Thenurseworkinginanorgantransplantationprogramknowsthatwhichindividualistypicallythebest donorofanorgan?

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a.Child b.Identicaltwin c.Parent d.Same-sexsibling ANS:B Therecipientsimmunesystemrecognizesdonatedtissuesasnon-selfexceptinthecaseofanidenticaltwin, whosegeneticmakeupisidenticaltotherecipient. DIF:Remembering/KnowledgeREF:300 KEY:Immunity|inflammation|transplantation|rejection MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 12.Anolderadulthasamildtemperature,nightsweats,andproductivecough.Theclientstuberculintest comesbacknegative.Whatactionbythenurseisbest? a.Recommendapneumoniavaccination. b.Teachtheclientaboutviralinfections. c.Telltheclienttorestanddrinkplentyoffluids. d.Treattheclientasifheorshehastuberculosis(TB). ANS:D Duetoanage-relateddecreaseincirculatingTlymphocytes,theolderadultmayhaveafalselynegativeTB test.WithsignsandsymptomsofTB,thenursetreatstheclientasifheorshedoeshaveTB.Apneumonia vaccinationisnotwarrantedatthistime.TBisnotaviralinfection.Theclientshouldrestanddrinkplentyof fluids,butthisisnotthebestanswerasitdoesnotaddressthepossibilitythattheclientsTBtestcouldbea falsenegative. DIF:Applying/ApplicationREF:291 KEY:Respiratorysystem|respiratorydisorder|laboratoryvalues|olderadult MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:HealthPromotionandMaintenance 13.Aclientreceivingmuromonab-CD3(OrthocloneOKT3)asksthenursehowthedrugworks.What responsebythenurseisbest? a.ItincreasestheeliminationofTlymphocytesfromcirculation. b.Itinhibitscytokineproductioninmostlymphocytes. c.ItpreventsDNAsynthesis,stoppingcelldivisioninactivatedlymphocytes. d.Itpreventstheactivationofthelymphocytesresponsibleforrejection. ANS:A Muromonab-CD3(OrthocloneOKT3)isamonoclonalantibodythatworkstoincreasetheeliminationofT lymphocytesfromcirculation.Thecorticosteroidsbroadlyinhibitcytokineproductioninmostleukocytes, resultingingeneralizedimmunosuppression.Themainactionofallantiproliferatives(suchasazathioprine [Imuran])istoinhibitsomethingessentialtoDNAsynthesis,whichpreventscelldivisioninactivated lymphocytes.Calcineurininhibitorssuchascyclosporine(Sandimmune)stoptheproductionandsecretionof interleukin-2,whichthenpreventstheactivationoflymphocytesinvolvedintransplantrejection. DIF:Understanding/ComprehensionREF:301 KEY:Immunesystem|immunity|immunosuppressants|patienteducation MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies MULTIPLERESPONSE 1.Forapersontobeimmunocompetent,whichprocessesneedtobefunctionalandinteractappropriatelywith eachother?(Selectallthatapply.) a.Antibody-mediatedimmunity b.Cell-mediatedimmunity

TestBank-Medical-SurgicalNursing:ConceptsforInterprofessionalCollaborativeCare9e

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c.Inflammation d.Redbloodcells e.Whitebloodcells ANS:A,B,C Thethreeprocessesthatneedtobefunctionalandinteractwitheachotherforapersontobe immunocompetentareantibody-mediatedimmunity,cell-mediatedimmunity,andinflammation.Redand whitebloodcellsarenotprocesses. DIF:Remembering/KnowledgeREF:291 KEY:Immunity|inflammationMSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 2.Astudentnurseislearningaboutthetypesofdifferentcellsinvolvedintheinflammatoryresponse.Which principlesdoesthestudentlearn?(Selectallthatapply.) a.Basophilsareonlyinvolvedinthegeneralinflammatoryprocess. b.Eosinophilsincreaseduringallergicreactionsandparasiticinvasion. c.Macrophagescanparticipateinmanyepisodesofphagocytosis. d.Monocytesturnintomacrophagesaftertheyenterbodytissues. e.Neutrophilscanonlytakepartinoneepisodeofphagocytosis. ANS:B,C,D,E Eosinophilsdoincreaseduringallergicandparasiticinvasion.Macrophagesparticipateinmanyepisodesof phagocytosis.Monocytesturnintomacrophagesaftertheyenterbodytissues.Neutrophilsonlytakepartinone episodeofphagocytosis.Basophilsareinvolvedinboththegeneralinflammatoryresponseandallergicor hypersensitivityresponses. DIF:Remembering/KnowledgeREF:292 KEY:Inflammation|immunityMSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 3.Thenurseassessesclientsforthecardinalsignsofinflammation.Whichsigns/symptomsdoesthisinclude? (Selectallthatapply.) a.Edema b.Pulselessness c.Pallor d.Redness e.Warmth ANS:A,D,E Thefivecardinalsignsofinflammationincluderedness,warmth,pain,swelling,anddecreasedfunction. DIF:Remembering/KnowledgeREF:294 KEY:Inflammation|immunity|nursingassessment MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 4.Whicharestepsintheprocessofmakinganantigen-specificantibody?(Selectallthatapply.) a.Antibody-antigenbinding b.Invasion c.Opsonization d.Recognition e.Sensitization ANS:A,B,D,E Thesevenstepsintheprocessofmakingantigen-specificantibodiesare:exposure/invasion,antigen recognition,sensitization,antibodyproductionandrelease,antigen-antibodybinding,antibodybindingactions andsustainedimmunity.Opsonizationistheadherenceofanantibodytotheantigen,markingitfor destruction.

TestBank-Medical-SurgicalNursing:ConceptsforInterprofessionalCollaborativeCare9e

121

DIF:Remembering/KnowledgeREF:297 KEY:Immunity|inflammation|antibody-mediatedimmunity MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 5.Thestudentnurseislearningaboutthefunctionsofdifferentantibodies.Whichprinciplesdoesthestudent learn?(Selectallthatapply.) a.IgAisfoundinhighconcentrationsinsecretionsfrommucousmembranes. b.IgDispresentinthehighestconcentrationsinmucousmembranes. c.IgEisassociatedwithantibody-mediatedhypersensitivityreactions. d.IgGcomprisesthemajorityofthecirculatingantibodypopulation. e.IgMisthefirstantibodyformedbyanewlysensitizedBcell. ANS:A,C,D,E ImmunoglobulinA(IgA)isfoundinhighconcentrationsinsecretionsfrommucousmembranes. ImmunoglobulinE(IgE)isassociatedwithantibody-mediatedhypersensitivityreactions.Themajorityofthe circulatingantibodypopulationconsistsofimmunoglobulinG(IgG).Thefirstantibodyformedbyanewly sensitizedBcellisimmunoglobulinM(IgM).ImmunoglobulinD(IgD)istypicallypresentinlow concentrations. DIF:Remembering/KnowledgeREF:298 KEY:Immunity|inflammation|antibodies MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation SHORTANSWER 1.Aclientswhitebloodcellcountis7500/mm3.Calculatetheexpectedrangeforthisclientsneutrophils. (Recordyouranswerusingwholenumbersseparatedwithahyphen;donotusecommas.)______/mm3 ANS: 4125-5625/mm3 Thenormalrangeforneutrophilsis55%to75%ofthewhitebloodcellcount. 75000.55=4125 75000.75=5625 Sotherangewouldbeexpectedtobe4125/mm3to5625/mm3. DIF:Applying/ApplicationREF:292 KEY:Inflammation|immunity|whitebloodcellcount|neutrophils MSC:IntegratedProcess:NursingProcess:Analysis NOT:ClientNeedsCategory:PhysiologicalIntegrity:ReductionofRiskPotential...