Which information indicates the nurse has a correct understanding of bradykinin? Select all that apply.
Bradykinin can induce pain.
Bradykinin increases vascular permeability.
Bradykinin causes smooth muscle cell contraction.
An antigen produces an allergic response in a client. Which term should the nurse use to describe this antigen?
A client receiving antibiotics is experiencing perineal discomfort when urinating. Which microorganism should the nurse suspect is causing this client’s problem?
A nurse is talking about a very small antigen that must combine with larger molecules to produce an immune response in a client. What is the nurse describing?
A client inhales a microorganism that causes an infection. Which term should the nurse use to describe the inhalation of the microorganism?
Portal of Entry
A client has an immune deficiency. While the nurse is taking the history, which finding will be typical?
Frequent, severe infection
During the assessment, the nurse discovers a client has recurrent Neisseria menigitides Infection. Which deficiency does the nurse suspect?
Which term should the nurse use to describe the process of "gluing" bacteria with antibodies to promote phagocytosis of the microorganisms?
A nurse is teaching about the crystalline fragment (Fc) portion of the antibody. Which information should the nurse include in the teaching session? Select all that apply.
Activates the complement system
The nurse is caring for a client after an accident. Which interventions should be included in the client’s care plan to prevent contracture of tissue at the site of injury? Select all that apply
Placing the client in a proper position
Performing range-of-motion exercises
The nurse is reviewing the laboratory reports of four clients who each underwent an appendectomy for appendicitis. Which client is at the highest immediate risk for wound dehiscence?
Client A: Increase in white blood cell count.
A nurse administers a skin test for tuberculosis. The nurse reads the results of the skin test based on which type of hypersensitivity reaction?
A client has type A blood. Which type of blood can the nurse administer to this client? Select all that apply.
Which findings will the nurse observe in a client with local inflammation of the eye? Select all that apply.
A client sprains the left ankle. Before assessing the client for the classic signs of inflammation, the nurse remembers which cell type is responsible for the changes?
A client has an infection and the neutrophil level is elevated. Which function are the neutrophils providing for the client?
A client asks what it means when a healthcare professional expresses concern about the client's CD4/CD8 ratio. How should a nurse explain this ratio to the client?
These numbers refer to types of immune cells. CD4 refers to T-helper cells and CD8 refers to cytotoxic T cells.
A client has a reaction to a liver transplant. Which term will the nurse use to describe this event?
A client has gastroenteritis from eating spinach contaminated with E. coli. While planning care, the nurse should remember that the severity of the client's illness is determined by which characteristic of the bacteria?
The nurse is caring for a client with arthritis who is scheduled for knee replacement surgery. After reviewing the client’s medical history, the nurse finds that the client is at risk for delayed wound healing. Which medication did the nurse find in the client’s medical history?
A nurse is describing a type of microorganism that must depend on the permissive host to replicate. Which type of microorganism is the nurse discussing?
A nurse is asked about the primary function of plasmin in the body. What is the nurse's best response?
It degrades blood clots
When should the nurse chart that the client has fibrinous exudate?
When thick, clotted exudate, from severe inflammation, occurs
The nurse is teaching safety measures to a client with systemic lupus erythematosus (SLE). Which client statement indicates effective learning? Select all that apply.
I should avoid sun exposure
"I should take nonsteroidal anti-inflammatory drugs."
A client with arthritis has a malar rash, oral ulcers, seizures, and a discoid rash. Which class of medication should be included in the client’s prescriptions to provide effective treatment?
What are the primary protective agents involved when a client is invaded by extracellular microbes?
Which information from the nurse indicates a correct understanding of the difference between primary and secondary immunodeficiency disorders?
Primary immunodeficiencies are congenital, whereas secondary immunodeficiencies are acquired
For a client with Graves disease, which type of hypersensitivity reaction should guide nursing care?
A nurse is providing wound care and observes that the client is healing normally and is in the proliferative phase of wound healing. What will the nurse observe?
A client has an infection in the lungs that caused an immune response. Which cells in the client's body will produce antibodies?
Which information indicates successful client teaching regarding the main function of the humoral immune response?
Production of antibodies
When a client's mast cells degranulate, which substance is released?
A client is admitted to the hospital with an infection producing endotoxins. When the nurse checks the culture and sensitivity test, which type of microorganism will the nurse observe?
Which information indicates the nurse has a correct understanding of major histocompatibility complex (MHC) class I molecules? Select all that apply.
These molecules team up with T-cytotoxic cells.
These molecules present endogenous antigens.
These molecules present virus-infected and potentially malignant cells
Which action by the new nurse will cause the charge nurse to intervene?
Giving type AB blood to a person with type O blood
The nurse caring for a client with poorly controlled diabetes mellitus gives priority to assessment for postoperative wound infection. What is the best rationale for the nurse's actions?
Hyperglycemia suppresses the activity of macrophages.
A nurse is teaching the staff about Russell bodies and neurofibrillary tangles. An accumulation of which nutrient contributes to the formation of these conditions?
A client is infected with a superantigen. Which pathophysiologic response does the nurse expect in the client?
Excessive cytokine production and proliferation of Th cells
When should the nurse chart that the client has serous exudate?
When watery exudate, containing few cells and not much protein occurs
A client has an infection. Which cells provide long-term phagocytosis against infectious agents?
The nurse is inspecting a client's abdominal incision the day after surgery. What does the nurse expect to observe?
A nurse is teaching about the clotting system. Which information should the nurse include?
The extrinsic pathway is activated by tissue factor
A nurse is teaching about the functions of macrophages. Besides phagocytosis, which information should the nurse include in the teaching session? Select all that apply
Activation of fibroblasts
Release of growth factor
Promotion of collagen formation
Stimulation of new blood vessel growth
A client has to be treated for an infection that produces endotoxins. The nurse is caring for which client?
A man with an Escherichia coli infection
A nurse is caring for an older adult client. Which age-related factors affecting mechanisms of self-defense will the nurse consider when planning care for this client?
Autoantibodies are increased
After interacting with a client, the nurse believes the client has a risk of delayed wound healing due to impaired collagen synthesis and fibroblast proliferation. Which statement made by the client supports the nurse’s conclusion?
"I’m a vegetarian, but I rarely eat beans or legumes."
A client is infected with a parasite. Which immunoglobulin will be most elevated when the nurse reviews the laboratory results?
A client has a parasite infestation. Which inflammatory cell or protein will substantially damage the parasite?
A client breaks the first line of defense against infection. The next response the nurse should consider involves which mechanism?
A woman presents with diminished colonization of Lactobacillus, which the primary healthcare provider diagnoses as vaginosis. Which finding will be typical when the nurse takes the history?
Prolonged antibiotic treatment
A client has an asphyxial injury that caused total deprivation of oxygen. Which term should the nurse use to describe this finding?
A nurse is describing class-switch. Which immune cell is primarily involved with this process?
Which nursing assessment data increase the client's risk for wound dehiscence?
5'3" tall with weight 189 lb
A nurse is teaching the staff about the human immunodeficiency virus (HIV). Which area (see diagram) should the nurse choose to illustrate the substance that combines with the CD4 molecule?
Area 2 ( yellow ball on stick on outer surface of virus)
Which events induce active immunity in a client? Select all that apply.
Exposure to the flu virus (antigen)
Obtaining a pneumonia vaccine/immunization
A nurse is asked by a coworker what an immature macrophage is called. How should the nurse respond?
A child developed hives soon after eating homemade strawberry jam. The child's mother states, "I don't understand what happened. He didn't break out last month when I made this jam." Which information should the nurse consider before answering?
Last month, antibodies against antigens normally in strawberries bound to mast cells, making the child sensitized. More jam today caused these mast cells to degranulate and release mast cell products.
A client with arthritis has severe inflammation in the knee, along with fever and anxiety. During the follow-up visit, the nurse finds that the client still has inflammation and swelling in the knee, but the fever and anxiety have subsided. Which medication does the nurse anticipate finding in the client’s prescription?
How should a nurse support a hospitalized client's first line of defense against microorganisms?
While reviewing the laboratory reports of a client with otitis media, the nurse finds that the client has no circulating B cells and a normal number of T cells. Which condition will the nurse expect to see written in the client’s medical record?
A nurse is asked about the characteristics of natural killer (NK) cells. How should the nurse reply?
NK cells can recognize protein changes on a cell's surface associated with viruses or cancer.
A client has cancer. While planning care, the nurse recalls that which type of immunity primarily attacks cancer?
A client has an X-linked recessive immunodeficiency disease characterized by decreased immunoglobulin M (IgM) production. Which medical diagnosis will the nurse observe written in the chart?
A nurse is teaching a client about the major function of Th17 cells. Which information from the client indicates successful teaching?
Activation of macrophages is the major function.
While assessing a client, the nurse observes a raised scar at the site of injury. What does the nurse suspect to be the cause of this scarring pattern?
Increase in collagen levels
After reviewing the history of a client with recurrent infection, the nurse finds that the client has impaired adaptive immunity. Which finding supports the nurse’s conclusion?
The client has a T cell deficiency
A client has a low pH of urine and stomach contents. How should the nurse interpret these findings?
The first line of defense is working
The nurse is teaching about the molecular classes of immunoglobulins. Which examples should the nurse include in the teaching session? Select all that apply.
While reviewing the medical history of a client with X-linked immunodeficiency disorder, the nurse finds that the client has low immunoglobulin M (IgM) antibodies. Which complication should the nurse assess for in the client?
Which immunoglobulin should the nurse suspect is affected in a client who is experiencing dust allergies?
The parents of an infant with which condition will need the most complex teaching about protecting their infant from infection?
Severe combined immunodeficiencies (SCIDs)
A client with an upper respiratory tract infection has nasal congestion. During the assessment, the nurse finds that the client’s blood pressure is 120/80 mm Hg and rate of respiration is 15 breaths/minute. The nurse should check the client’s prescription for which category of medication to help with the congestion?
A client has an Arthus reaction after an injection. What will the nurse observe upon assessment of this client?
A nurse is preparing a teaching poster about routes of transmission for human immunodeficiency virus (HIV). Which routes should be included? Select all that apply.
Contact with infected blood
Breast-feeding by an infected mother
Sexual intercourse with an infected partner
Which information indicates the nurse has an accurate understanding of the process that confers long-lasting immunity against a specific organism?
Production of memory cells
Which information from the staff indicates successful teaching by the nurse for cytokines?
They include interleukins and interferons
Which term should the nurse use to describe a microorganism that does not infect people who have intact immune systems but does infect people who are immunosuppressed?
An opportunistic microorganism
After a client has a type 1 hypersensitivity response, which laboratory test result will the nurse find the most elevated?
The nurse anticipates that the client with which injury will be most at risk for developing chronic inflammation?
A wood splinter
The nurse is administering an immunization to a client. Which type of immunity will the client develop after the immunization?
While reviewing the medication history of a client, the nurse finds that the client is receiving long-term therapy with broad-spectrum antibiotics. Which complications does the nurse expect to find? Select all that apply
When a client is infected with a pathogen, which immune cells develop specificity for a specific antigen? Select all that apply.
A nurse is caring for a client with an alloimmune disease. The nurse is caring for which client?
An infant with hemolytic disease of the newborn
A client's Th1 cells are decreased. Which process will the nurse expect to occur?
Decreased cellular immunity
A nurse is teaching about the primary difference between adaptive immunity and innate immunity. Which type of cell or protein is primarily involved in the adaptive response?
A client has an organ transplant from another person. The client's body mounts an aggressive response against the organ transplanted. Which type of reaction did the client experience?
Confidence: Nailed itStatsIssue with this question?8.A nurse is teaching a wellness class about nutritional antioxidants. Which information from the class members indicates successful learning about which vitamin is an antioxidant?
A client is receiving monoclonal antibodies for treatment. How should the nurse interpret this finding?
The "best" single antibody has been cloned
A nurse administers an attenuated vaccination. Which type of vaccine did the nurse give to the client?
A live, weakened microorganism
A client requires a transplant. Which cells become a priority for the nurse to check?
Human leukocyte antigens (HLAs)
A client is having pain in an injured area. The nurse administers a nonsteroidal anti-inflammatory drug (NSAID). What is the rationale for the nurse's action?
NSAIDs block the synthesis of prostaglandins
A child who has a congenital immunodeficiency that impairs B lymphocyte function will have primarily a deficiency of which immune component?
Which laboratory test result will indicate to the nurse that the client had a secondary immune response?
Elevated IgG higher than IgM
A client who receives preformed antibodies from a donor develops which type of immunity?
A nurse is asked how an antibody can recognize an antigen. How should the nurse respond?
The Fab portions contain the receptors for antigens.
A nurse is describing cells of the cell-mediated immune response. Which types of cells should the nurse include? Select all that apply.
The nurse teaches a group of clients with acquired immunodeficiency syndrome (AIDS) about ways to protect themselves from infection. What is the rationale for the nurse's behavior?
HIV primarily infects and destroys T helper cells
Which cytokine deficiency does the nurse suspect is causing delayed wound healing in a client?
A client has poison ivy. Which type of reaction did the client experience?
A nurse is teaching about parasitic diseases. Which information should the nurse include in the teaching session?
They are rarely transmitted from human to human
Which term should the nurse use to describe the function of an antibody that inactivates or blocks the binding of an antigen to a client's cell receptor?
Which assessment finding will indicate to the nurse that the client is having a life-threatening type I hypersensitivity reaction?
Wheezing, difficulty breathing, and hypotension
Which treatment should the nurse expect to be prescribed for a client with adenosine deaminase deficiency and low levels of IgM and IgA? Select all that apply
Transplantation of bone marrow
Transfusions of glycerol frozen-packed erythrocytes
Which terms can a nurse use to describe urticaria to another health professional? Select all that apply
Which information indicates the nurse has a correct understanding of a cytokine that has some anti-inflammatory effects?
A nurse is teaching about the role of C3b. Which information should the nurse include?
A camp nurse meets with a young male camper who states that he touched poison ivy accidentally but is perfectly fine. The camper seems to think that he is not allergic to poison ivy. What is the nurse's best response?
You will likely get an itchy blistering rash in the next few days. Let me check your hand every day this week
Which process in a client with a severe viral infection supports the nurse’s suspicion that the client has risk of cachexia?
Increase in tumor necrosis factor-alpha
After reviewing the laboratory reports of a client with a T cell deficiency, the nurse suspects that the client has acquired immunodeficiency syndrome. Which laboratory finding is consistent with this condition?
CD4+ cell levels are 150/mm3
Which complication will the nurse monitor for in a client who has been prescribed long-term antibiotic therapy?
Increased risk of Candida albicans infection
The nurse is caring for a client who has undergone bone marrow transplantation. After assessing the client, the nurse suspects that the client is at risk for graft-versus-host disease (GVHD). Which client statement supports the nurse’s conclusion?
"I always feel thirsty"
A nurse is teaching a prenatal class about antibodies that are present in a new mother’s colostrum. Which information should the nurse include in the teaching session? Select all that apply
The provide protection against gastrointestinal infection.
A nurse is asked what the difference is between monocytes and macrophages. How should the nurse respond?
Monocytes circulate in the blood, macrophages are found in tissues.
To help a client's wound heal, the nurse suggests eating foods high in vitamins A and C. What is the rationale for the nurse's action?
These vitamins are required for collagen synthesis.
A child with ill-fitting shoes developed a small blister that burst, releasing clear watery fluid. How should the school nurse document this type of exudate?
A client has an inappropriate, exaggerated response against a noninfectious environmental substance. Which term should the nurse use when reporting this condition to another healthcare professional?
A client has an inflammatory response. Upon assessment, the nurse finds edema in the client's foot. What caused the edema?
Which information indicates the nurse has a good understanding of pathogen-associated molecular patterns (PAMPs)?
PAMPs are molecules that are expressed by infectious agents, either found on their surface or released as soluble molecules
Confidence: Nailed itStatsIssue with this question?12.A nurse is teaching about the type of T-helper cell that is produced in greater numbers when a client has a multicellular parasite. Which T-helper cell is the nurse describing?
A client with a B-cell deficiency is receiving intravenous immune globulin. When the client asks about the drug therapy, how should the nurse respond?
You will need repeated treatments
A nurse is caring for a client with mycosis. The nurse is caring for which client?
A man with a fungal infection
A client's immune system activates interferons. Which type of organism should the nurse suspect is causing this reaction?
A client’s laboratory results indicate an increase in tumor necrosis factor α, interleukin 6, and prostaglandin. Which condition does the nurse expect to find in the client?
Which laboratory finding should the nurse use to evaluate the effectiveness of protease inhibitors prescribed for a client with a viral infection?
T helper cells =800/mm3
A client has chronic granulomatous disease. Which goal is priority for this client?
Which finding in the history will indicate to the nurse that the client may have a deficiency of humoral immune cells?
Recurrent bacterial infection
A nurse is caring for a client that had an organ transplant rejection. Which information indicates the nurse has a correct understanding of transplant rejection? Select all that apply.
White graft indicates hyperacute rejection
Acute rejection is a type IV hypersensitivity reaction.
While reviewing the laboratory reports of a newborn, the nurse finds that the newborn has α1-antitrypsin deficiency. Which test should be prescribed later in the child’s life to determine effects?
Pulmonary functioning test
Which clients will most likely have wound healing through secondary intention? Select all that apply
Client who has stage 4 pressure ulcer
Client with second-degree burns on the arm from hot oil
A nurse is teaching about HIV. Which area (see diagram) should the nurse choose to illustrate the structure that incorporates viral DNA into the client’s cell DNA?
Area 2- purple ball on edge of DNA
A client with an intestinal infection is receiving prolonged treatment with antibiotics. Which deficiencies are likely to occur in the client? Select all that apply.