Chapter 6: Innate Immunity: Inflammation and Wound Healing

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1

A public health nurse is teaching the community about health promotion. Which information should the nurse include for innate immunity? Innate immunity is gained:

a. following an illness

b. at birth

c. via injection of specific antibodies

d. in adulthood

b. at birth

2

Which statement indicates teaching was successful regarding collectins? Collectins are produced by the:

a. kidneys

b. bowel

c. lungs

d. integument

c. lungs

3

A 20-year-old male received a knife wound to the arm during an altercation. Which of the following types of immunity was compromised?

a. innate immunity

b. inflammatory response

c. adaptive immunity

d. specific immunity

a. innate immunity

4

Biochemical secretions that trap and kill microorganisms include:

a. hormones

b. neurotransmitters

c. earwax

d. gastric acid

c. earwax

5

A 25-year-old female presents to her primary care provider reporting vaginal discharge of a white, viscous, and foul-smelling substance. She reports that she has been taking antibiotics for the past 6 months. Which finding will the nurse most likely see on the microorganism report?

a. Clostridium difficile overgrowth

b. Decreased Lactobacillus

c. Streptococcus overgrowth

d. Decreased Candida albicans

b. Decreased Lactobacillus

6

When an aide asks the nurse what is a purpose of the inflammatory process, how should the nurse respond?

a. To provide specific responses toward antigens

b. To lyse cell membranes of microorganisms

c. To prevent infection of the injured tissue

d. To create immunity against subsequent tissue injury

c. To prevent infection of the injured tissue

7

A child fell off the swing and scraped the right knee. The injured area becomes painful. What else will the nurse observe upon assessment?

a. vasoconstriction at the injured site

b. decreased RBC concentration at the injured site

c. pale skin at the injured site

d. edema at the injured site

d. edema at the injured site

8

A nurse recalls the mast cell, a major activator of inflammation, initiates the inflammatory response through the process of:

a. chemotaxis

b. endocytosis

c. degranulation

d. opsonization

c. degranulation

9

Which of the following individuals would be at greatest risk for an opportunistic infection?

a. 18-year-old with diabetes

b. 70-year-old with congestive heart failure

c. 24-year-old who is immunocompromised

d. 30-year-old with pneumonia

c. 24-year-old who is immunocompromised

10

The directional migration of leukocytes along a chemical gradient is termed:

a. chemotaxis

b. endocytosis

c. margination

d. diapedesis

a. chemotaxis

11

A 20-year-old male shoots his hand with a nail gun while replacing roofing shingles. Which of the following cell types would be the first to aid in killing bacteria to prevent infection in his hand?

a. eosinophils

b. neutrophils

c. leukotrienes

d. monocytes

b. neutrophils

12

The predominant phagocyte of early inflammation is the:

a. eosinophil

b. neutrophil

c. lymphocyte

d. macrophage

b. neutrophil

13

A 25-year-old female experiences a headache and takes aspirin for relief. A nurse recalls aspirin relieves the headache by:

a. decreasing leukotriene production

b. increasing histamine release

c. decreasing prostaglandin production

d. increasing platelet-activating factor

c. decreasing prostaglandin production

14

Which factor will help the nurse differentiate leukotrienes from histamine?

a. site of production

b. vascular effect

c. chemotactic ability

d. time of release

d. time of release

Leukotrienes are released slower and longer than histamine.

15

A 25-year-old male is in a car accident and sustains a fracture to his left femur with extensive soft tissue injury. The pain associated with the injury is related to:

a. histamine and serotonin

b. kinins and prostaglandins

c. vasoconstriction

d. immune complex formation

b. kinins and prostaglandins

Prostaglandins cause increased vascular permeability, neutrophil chemotaxis, and pain by direct effects on nerves. Kinins also promote pain.

16

The complement, clotting, and kinin systems share which of the following characteristics?

a. activation of a series of proenzymes

b. phagocytosis initiation

c. granulocyte production

d. activated by interferon

a. activation of a series of proenzymes

The complement system, the clotting system, and the kinin system are normally in inactive forms, but can activate in a series as proenzymes and are involved in the inflammatory process.

17

Which statement indicates teaching was successful regarding the classical pathway of the complement system? The classic pathway of the complement system is activated by:

a. histamine

b. antigen-antibody complexes

c. leukotrienes

d. prostaglandins

b. antigen-antibody complexes

The classic pathway of the complement system is activated by antibodies of the immune system.

18

A patient has researched bradykinin on the internet. Which information indicates the patient understands the functions of bradykinin? Bradykinin is involved in:

a. increasing vascular permeability

b. vasoconstricting blood vessels

c. stimulating the clotting system

d. increasing degradation of prostaglandins

a. increasing vascular permeability

Bradykinin increases vascular permeability.

19

After teaching the staff about the clotting system, which statement indicates teaching was successful? The end product of the clotting system is:

a. plasmin

b. fibrin

c. collagen

d. factor x

b. fibrin

The end product of the clotting system is fibrin.

20

A 5-year-old male is diagnosed with a bacterial infection. Cultures of the bacteria revealed lipopolysaccharides on the bacterial cell surface. Which of the complement pathways would be activated in this case?

a. classical pathway

b. lectin pathway

c. alternative pathway

d. kinin pathway

c. alternative pathway

The alternative pathway is activated by several substances found on the surface of infectious organisms, such as those containing lipopolysaccharides.

21

An 8-year-old female presents with edema of the cutaneous and mucosal tissue layers. Her mother reports that the condition is recurrent and seems to occur more often during stressful situations. The child is diagnosed with hereditary angioedema. Which of the following is deficient in this child?

a. C1 esterase inhibitor

b. Carboxypeptidase

c. Neutrophils

d. Plasmin

a. C1 esterase inhibitor

A genetic defect in C1 esterase inhibitor (C1 INH deficiency) results in hereditary angioedema.

22

A nurse is preparing to teach on the subject of opsonins. Which information should the nurse include? Opsonins are molecules that:

a. are composed of fatty acids

b. regulate inflammation

c. degranulate mast cells

d. enhance phagocytosis

d. enhance phagocytosis

Opsonins coat the surface of bacteria and increase their susceptibility to being phagocytized.

23

A 10-year-old male is diagnosed with a parasite. Which lab result should the nurse check for a response to the parasite?

a. monocytes

b. eosinophils

c. neutrophils

d. macrophages

b. eosinophils

Eosinophils serve as the body's primary defense against parasites.

24

A 65-year-old female is diagnosed with metastatic breast cancer. She has developed muscle wasting. Which of the following substances would be produced in large quantities to eliminate the tumor cells and cause muscle wasting?

a. interleukin-6

b. eosinophils

c. tumor necrosis factor

d. platelets

c. tumor necrosis factor

Tumor necrosis factor causes muscle wasting.

25

When phagocytes begin to stick avidly to capillary walls, which process is occurring?

a. margination

b. exudation

c. integration

d. emigration

a. margination

Both leukocytes and endothelial cells secrete substances that increase adhesion, or stickiness, causing the leukocytes to adhere more avidly to the endothelial cells in the walls of the capillaries and venules in a process called margination.

26

An infant develops a fever secondary to a bacterial infection. Which of the following most likely triggered the fever?

a. Interleukin-1

b. Interleukin-6

c. Interleukin-10

d. Interferons (INFs)

a. Interleukin-1

Interleukin-1 is responsible for fever production.

27

A 54-year-old male IV drug user is diagnosed with chronic hepatitis C. Testing revealed that he is a candidate for treatment. Which of the following could be used to treat his condition?

a. Interleukin-1

b. Interleukin-6

c. Interleukin-10

d. Interferons (INFs)

d. Interferons (INFs)

INFs are members of a family of cytokines that protect against viral infections.

28

A 35-year-old male is diagnosed with lobar pneumonia (lung infection). Which of the following exudates would be present in the highest concentration at the site of this advanced inflammatory response?

a. serous

b. purulent

c. hemorrhagic

d. fibrinous

d. fibrinous

Fibrinous exudates occur in the lungs of individuals with pneumonia.

29

During inflammation, the liver is stimulated to release plasma proteins, collectively known as:

a. opsonins

b. acute phase reactants

c. antibodies

d. phagolysosome

b. acute phase reactants

The synthesis of many plasma proteins by the liver is increased during inflammation. These proteins, which can be either proinflammatory or antiinflammatory in nature, are referred to as acute phase reactants.

30

A 3-year-old is making play cakes in a sandbox and is eating the play cakes. The sand was also being used by cats as a litter box and was contaminated with toxoplasmosis. Which of the following would most likely also be present?

a. granuloma formation

b. degranulation

c. blood clots

d. exudate production

a. granuloma formation

Infections caused by bacteria such as toxoplasmosis can result in granuloma formation.

31

A 12-year-old male is fighting with another child when he receives a puncture wound from a pencil. The school nurse cleans and bandages the wound. After about 1 week, the wound would be in which phase of healing?

a. debridement

b. primary intention

c. resolution

d. maturation

c. resolution

Resolution occurs when repaired tissue is approaching close to normal.

32

The macrophage secretion that stimulates procollagen synthesis and secretion is:

a. angiogenesis factor

b. matrix metalloproteinase

c. vascular endothelial growth factor

d. transforming growth factor-beta

d. transforming growth factor-beta

Macrophages secrete transforming growth factor-beta to stimulate fibroblasts to secrete the collagen precursor procollagen.

33

A 30-year-old male was involved in a motor vehicle accident. The glass from the shattered window cut his face and neck. The scar, however, was raised and extended beyond the original boundaries of the wound. This pattern of scarring is caused by impaired:

a. nutritional status

b. collagen synthesis

c. epithelialization

d. contraction

b. collagen synthesis

Impaired production of collagen can cause surface overhealing, leading to a keloid or a hypertrophic scar.

34

The nurse is reviewing the lab data of a newly admitted patient. The nurse notes the patient had an erythrocyte sedimentation done, and the results are quite elevated. The nurse would focus the care plan on which of the following conditions?

a. anemia

b. infection

c. inflammation

d. electrolyte imbalance

c. inflammation

Common lab tests for inflammation measure levels of acute phase reactants. An increase in fibrinogen is associated with an increased erythrocyte sedimentation rate, which is considered a good indicator of an acute inflammatory response.

35

Healing by secondary intention would occur in which of the following patients? A patient with a:

a. sutured surgical wound

b. stage IV pressure ulcer

c. paper cut

d. sunburn

b. stage IV pressure ulcer

A patient with a stage IV pressure ulcer would heal by secondary intention.

36

The post-surgical patient is experiencing delayed wound healing. The dietician believes the delay is related to nutritional intake. A deficiency in which of the following substances could directly affect healing?

a. vitamin D

b. ascorbic acid

c. melanin

d. cholesterol

b. ascorbic acid

Most of the factors that interfere with the production of collagen in healing tissues are nutritional. Scurvy, for example, is caused by lack of ascorbic acid of the cofactors required for collagen formation by fibroblasts. The results of scurvy are poorly formed connective tissue and greatly impaired healing.

37

A nurse remembers the primary actions of the complement cascade include:

a. increased vascular permeability

b. vasoconstriction

c. chemotaxis

d. opsonization

e. cell killing

f. increased clotting

a. increased vascular permeability

c. chemotaxis

d. opsonization

e. cell killing

The actions of the complement cascade include increased vascular permeability, and vasodilation, chemotaxis, opsonization, and cell killing. It does not involve vasoconstriction or increased clotting.

38

The nurse is assessing a patient with a diagnosis of inflammation. The nurse would expect to find which of the following signs and symptoms consistent with acute inflammation?

a. heat

b. erythema

c. pain

d. swelling

e. exudates

f. loss of function

a. heat

b. erythema

c. pain

d. swelling

f. loss of function

The classic symptoms of acute inflammation include redness, (erythema), heat, swelling, pain, and loss of function. Exudates would indicate infection, not inflammation.

39

The nurse identified each of the following clinical manifestations of inflammation. Which would the nurse classify as a local response?

a. fever

b. redness

c. swelling

d. heat

e. pain

b. redness

c. swelling

d. heat

e. pain

Local manifestations of inflammation are the result of the vascular changes associated with the inflammatory process, including vasodilation, and increased capillary permeability. The symptoms include redness, heat, swelling, and pain.

40

Physical barriers that offer the body protection from damage and infection are located in the:

a. GI tract

b. genitourinary tract

c. respiratory tract

d. lymph system

e. hematopoietic system

a. GI tract

b. genitourinary tract

c. respiratory tract

The physical barriers that cover the external parts of the human body offer considerable protection from damage and infection. These barriers are composed of tightly associated epithelial cells of the skin and of the linings of the GI, gentiourinary, and respiratory tracts.