Title: ASN 210 W3 INFLAMMATION IMMUNITY
Course: 16SP-ASN-210-GH1A1-ADV NUR THROUGH LIFESPAN I

Q: The student nurse learns that the most important function of inflammation and immunity is which purpose?
- Destroying bacteria before damage occurs
- Preventing any entry of foreign material
- Providing protection against invading organisms
- Regulating the process of self-tolerance
A: Providing protection against invading organisms
If right: 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.
If wrong: 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.

Q: A nurse is assessing an older client for the presence of infection. The client’s temperature is 97.6° F (36.4° C). What response by the nurse is best?
- Assess the client for more specific signs.
- Conclude that an infection is not present.
- Document findings and continue to monitor.
- Request that the provider order blood cultures.
A: Assess the client for more specific signs.
If right: 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.
If wrong: 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.

Q: A client is taking prednisone to prevent transplant rejection. What instruction by the nurse is most important?
- “Avoid large crowds and people who are ill.”
- “Check over-the-counter meds for acetaminophen.”
- “Take this medicine exactly as prescribed.”
- “You have a higher risk of developing cancer.”
A: “Avoid large crowds and people who are ill.”
If right: 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).
If wrong: 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).

Q: A clinic nurse is working with an older client. What assessment is most important for preventing infections in this client?
- Assessing vaccination records for booster shot needs
- Encouraging the client to eat a nutritious diet
- Instructing the client to wash minor wounds carefully
- Teaching hand hygiene to prevent the spread of microbes
A: Assessing vaccination records for booster shot needs
If right: 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.
If wrong: 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.

Q: A client has a leg wound that is in the second stage of the inflammatory response. For what manifestation does the nurse assess?
- Noticeable rubor
- Purulent drainage
- Swelling and pain
- Warmth at the site
A: Purulent drainage
If right: 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.
If wrong: 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.

Q: 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?
- Bone marrow
- Spleen
- Thymus
- Tonsils
A: Bone marrow
If right: 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.
If wrong: 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.

Q: The nurse understands that which type of immunity is the longest acting?
- Artificial active
- Inflammatory
- Natural active
- Natural passive
A: Natural active
If right: 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.
If wrong: 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.

Q: The nurse working with clients who have autoimmune diseases understands that what component of cell-mediated immunity is the problem?
- CD4+ cells
- Cytotoxic T cells
- Natural killer cells
- Suppressor T cells
A: Suppressor T cells
If right: Suppressor T cells help prevent hypersensitivity to one’s 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.
If wrong: Suppressor T cells help prevent hypersensitivity to one’s 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.

Q: 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?
- Dialysis
- High-dose steroid administration
- Monoclonal antibody therapy
- Plasmapheresis
A: Dialysis
If right: 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.
If wrong: 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.

Q: A nurse is assessing a client for acute rejection of a kidney transplant. What assessment finding requires the most rapid communication with the provider?
- Blood urea nitrogen (BUN) of 18 mg/dL
- Cloudy, foul-smelling urine
- Creatinine of 3.9 mg/dL
- Urine output of 340 mL/8 hr
A: Creatinine of 3.9 mg/dL
If right: 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.
If wrong: 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.

Q: The nurse working in an organ transplantation program knows that which individual is typically the best donor of an organ?
- Child
- Identical twin
- Parent
- Same-sex sibling
A: Identical twin
If right: The recipient’s immune system recognizes donated tissues as non-self except in the case of an identical twin, whose genetic makeup is identical to the recipient.
If wrong: The recipient’s immune system recognizes donated tissues as non-self except in the case of an identical twin, whose genetic makeup is identical to the recipient.

Q: An older adult has a mild temperature, night sweats, and productive cough. The client’s tuberculin test comes back negative. What action by the nurse is best?
- Recommend a pneumonia vaccination.
- Teach the client about viral infections.
- Tell the client to rest and drink plenty of fluids.
- Treat the client as if he or she has tuberculosis (TB).
A: Treat the client as if he or she has tuberculosis (TB).
If right: 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 client’s TB test could be a false negative.
If wrong: 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 client’s TB test could be a false negative.

Q: A client receiving muromonab-CD3 (Orthoclone OKT3) asks the nurse how the drug works. What response by the nurse is best?
- “It increases the elimination of T lymphocytes from circulation.”
- “It inhibits cytokine production in most lymphocytes.”
- “It prevents DNA synthesis, stopping cell division in activated lymphocytes.”
- “It prevents the activation of the lymphocytes responsible for rejection.”
A: “It increases the elimination of T lymphocytes from circulation.”
If right: 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.
If wrong: 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.

Q: For a person to be immunocompetent, which processes need to be functional and interact appropriately with each other? <b>(Select all that apply.)</b>
- Antibody-mediated immunity
- Cell-mediated immunity
- Inflammation
- Red blood cells
- White blood cells
A: Antibody-mediated immunity; Cell-mediated immunity; Inflammation
If right: 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.
If wrong: 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.

Q: A student nurse is learning about the types of different cells involved in the inflammatory response. Which principles does the student learn? <b>(Select all that apply.)</b>
- Basophils are only involved in the general inflammatory process.
- Eosinophils increase during allergic reactions and parasitic invasion.
- Macrophages can participate in many episodes of phagocytosis.
- Monocytes turn into macrophages after they enter body tissues.
- Neutrophils can only take part in one episode of phagocytosis.
A: Eosinophils increase during allergic reactions and parasitic invasion.; Macrophages can participate in many episodes of phagocytosis.; Monocytes turn into macrophages after they enter body tissues.; Neutrophils can only take part in one episode of phagocytosis.
If right: 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 <i>both</i> the general inflammatory response and allergic or hypersensitivity responses.
If wrong: 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 <i>both</i> the general inflammatory response and allergic or hypersensitivity responses.

Q: The nurse assesses clients for the cardinal signs of inflammation. Which signs/symptoms does this include? <b>(Select all that apply.)</b>
- Edema
- Pulselessness
- Pallor
- Redness
- Warmth
A: Edema; Redness; Warmth
If right: The five cardinal signs of inflammation include redness, warmth, pain, swelling, and decreased function.
If wrong: The five cardinal signs of inflammation include redness, warmth, pain, swelling, and decreased function.

Q: Which are steps in the process of making an antigen-specific antibody? <b>(Select all that apply.)</b>
- Antibody-antigen binding
- Invasion
- Opsonization
- Recognition
- Sensitization
A: Antibody-antigen binding; Invasion; Recognition; Sensitization
If right: 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.
If wrong: 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.

Q: The student nurse is learning about the functions of different antibodies. Which principles does the student learn? <b>(Select all that apply.)</b>
- IgA is found in high concentrations in secretions from mucous membranes.
- IgD is present in the highest concentrations in mucous membranes.
- IgE is associated with antibody-mediated hypersensitivity reactions.
- IgG comprises the majority of the circulating antibody population.
- IgM is the first antibody formed by a newly sensitized B cell.
A: IgA is found in high concentrations in secretions from mucous membranes.; IgE is associated with antibody-mediated hypersensitivity reactions.; IgG comprises the majority of the circulating antibody population.; IgM is the first antibody formed by a newly sensitized B cell.
If right: 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.
If wrong: 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.

Q: A client’s white blood cell count is 7500/mm<sup>3</sup>. Calculate the expected range for this client’s neutrophils. (<i>Record your answer using whole numbers separated with a hyphen; do not use commas.</i>)<i> </i>______/mm<sup>3</sup>
Feedback: 4125-5625/mm^3 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/mm^3 to 5625/mm^3.