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Chapter 11- Innate and Adaptive Immunity
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1.
The nurse knows which of the following statements listed below relative to a client with malignant melanoma treated with alpha interferon (IFN-a) is accurate? Alpha interferon (IFN-a)
A)
will kill certain microorganisms that may help spread the cancer.
B)
plays an important role in the modulation of the inflammatory response.
C)
helps keep all the blood levels at a higher level.
D)
controls the migration of leukocytes to their primary site.
Ans:
B
Feedback:
IFNs are cytokines that primarily protect the host against viral infections and play a role in the modulation of the inflammatory response.
2.
The nurse knows which of the following statements listed below is accurate regarding the functions and nature of cytokines relative to a variety of pathologies?
A)
?A particular cytokine can have varied effects on different systems, a fact that limits their therapeutic use.?
B)
?Cytokine production is constant over time, but effects are noted when serum levels cross a particular threshold.?
C)
?Most cytokines are produced by granular leukocytes, and different cells are capable of producing the same cytokine.?
D)
?Cytokine actions are self-limiting, in that activation of one precludes activation of other cytokines with similar actions.?
Ans:
A
Feedback:
Because cytokines can mediate diverse effects due to their pleiotropic properties, they can have significant side effects. Cytokine production is brief, not constant, and production does not normally take place in granulocytes. Activation of a cytokine does not necessarily limit other similar cytokines, and additive effects are not uncommon.
3.
The nurse knows that a drug in a category identified as a colony-stimulating factor (CSF) helps
A)
cells engulf and digest microbes that want to attach to cell membranes and destroy normal cell function.
B)
produce cells that will be the first responder cells to protect against cancer formation.
C)
stimulate the person's immune system so that he or she can kill his or her own cancer cells.
D)
stimulate bone marrow to produce large numbers of mature cells such as platelets and erythrocytes.
Ans:
D
Feedback:
CSFs participate in hematopoiesis by stimulating bone marrow pluripotent stem and progenitor or precursor cells to produce large numbers of mature platelets, erythrocytes, lymphocytes, neutrophils, and monocytes.
4.
Which of the following individual situations listed below best exemplifies the processes of innate immunity?
A)
A child who has experienced heat and swelling of his skinned knuckle
B)
An adult who complains of itching and is sneezing because he is allergic to pollen
C)
A client whose blood work indicates increased antibody titers during an acute illness
D)
A client who has experienced rejection of a donor liver after transplantation
Ans:
A
Feedback:
In a skinned knuckle, one of the body's main innate defenses, the skin, is breached. The heat and swelling that accompany a breach in the skin are inflammatory responses, part of the body's innate immune defenses. Allergies are an inappropriate adaptive response mediated by immunoglobulin E; antibody titers increase during illness in response to the infection; and transplanted organs are rejected because the organ is recognized as foreign. These are all aspects of specific, acquired immunity.
5.
The nurse knows which of the following components listed below is needed for long-lasting immunity in a client with a diagnosis of sepsis without the causative agent identified?
A)
Neutrophils
B)
Lymphocytes
C)
Colony-stimulating factors
D)
Natural killer cells
Ans:
B
Feedback:
Lymphocytes provide lifelong immunity and an antigen-specific response to harmful microorganisms. Neutrophils, macrophages, and natural killer cells do not provide this.
6.
A client has been identified as having an excess of macrophage inhibitory factor, causing the client to have inhibited movement and activity of macrophages. Which of the following processes listed below would the health care team member expect to remain unaffected?
A)
Amplification of the immune response
B)
Destruction of virus-infected or tumor cells
C)
Initiation of adaptive immunity
D)
Specificity and memory of the immune response
Ans:
D
Feedback:
Specificity and memory are the defining characteristics of the adaptive immune system, and macrophages do not perform this particular role. Amplification of the immune response, destruction of virus-infected or tumor cells, and initiation of adaptive immunity are all components of macrophage activity.
7.
A client who has a diagnosis of an autoimmune disease asks his nurse why it is that his immune system does not attack all of the cells that make up his body. Which of the following aspects of pathogen recognition in the innate immune system listed below would underlie the nurse's response?
A)
Normal host cells excrete inhibitory proteins that are detected by natural killer cells.
B)
Intraepithelial lymphocytes and natural killer cells possess specific, highly diverse receptors.
C)
Pattern recognition receptors (PRRs) ensure that cells are correctly identified.
D)
Leukocytes possess pathogen-associated molecular patterns (PAMPs)
Ans:
C
Feedback:
PRRs recognize the structure of invaders and thus prevent activation by healthy somatic cells, though neither intraepithelial lymphocytes nor natural killer cells possess the high level of specification and diversity of receptors associated with the adaptive immune system. Host cells do not excrete inhibitory proteins, and PAMPs exist on pathogens, not on leukocytes.
8.
A 60-year-old male client with an acute viral infection is receiving interferon therapy. The physician is teaching the family of the client about the diverse actions of the treatment and the ways that it differs from other anti-infective therapies. Which of the following teaching points listed below should the physician least likely include?
A)
?Interferon can help your father's unaffected cells adjacent to his infected cells produce antiviral proteins that can stop the spread of the infection.?
B)
?Interferon can help limit the replication of the virus that's affecting your father.?
C)
?Interferon helps your father's body recognize infected cells more quickly.?
D)
?Interferon can bolster your father's immune system through the stimulation of natural killer cells that attack viruses.?
Ans:
D
Feedback:
Interferons can activate macrophages in the fight against viral invaders, but they are not noted to stimulate the action of natural killer cells. Answers A, B, and C all capture elements of the action of interferons.
9.
Which of the following phenomena would be least likely to result in activation of the complement system?
A)
Recognition of an antibody bound to the surface of a microbe
B)
Increase in tissue blood flow and capillary permeability, so fluids/proteins can leak into the area
C)
Activation of toll-like receptors (TLRs) on complement proteins
D)
Direct recognition of microbial proteins
Ans:
C
Feedback:
Toll-like receptors are not associated with the complement system. The complement system may be activated by antibody recognition, mannose binding, or microbial protein recognition.
10.
A nurse is providing care for a client who is immunocompromised following chemotherapy. The nurse knows which of the following characterizations of the adaptive immune system listed below is responsible for the client's disruption in his normal immune function?
A)
Epitopes on antigens are recognized by immunoglobulin receptors following presentation by accessory cells.
B)
Haptens combine to form epitopes that stimulate the response of regulatory and effector cells.
C)
Effector cells orchestrate the immune response of regulatory cells toward an antigen.
D)
Accessory cells such as macrophages are engulfed by regulatory cells, stimulating effector cells.
Ans:
A
Feedback:
In the adaptive immune response, accessory cells present antigen epitopes to receptors, initiating the immune response of lymphocytes. Epitopes may combine to form haptens, and regulatory cells orchestrate effector cells. Regulatory cells do not engulf accessory cells.
11.
The nurse knows the cells primarily programmed to remove the invading organisms and remember the antigen to respond rapidly during the next exposure are
A)
CD4 and CD8 cells.
B)
natural killer (NK) cells and macrophages.
C)
T and B lymphocytes.
D)
white blood cells and platelets.
Ans:
C
Feedback:
T and B lymphocytes are unique in that they are the only cells in the body capable of recognizing specific antigens present on the surfaces of microbial agents and other pathogens.
12.
A 53-year-old female hospital patient has received a kidney transplant following renal failure secondary to hypertension. As part of the teaching while she was on the organ wait list, she was made aware that she would need to take antirejection drugs for the rest of her life. Which aspect of the immune system underlies this necessity?
A)
The lack of identifiable major histocompatibility complex (MHC) molecules will stimulate the innate immune response.
B)
Donor organ antibodies will be identified as foreign and stimulate an immune response.
C)
Antirejection drugs will stimulate the production of familiar MHC molecules.
D)
MHC molecules will never develop in the cells of the donor organ, and effector cells will be continually stimulated.
Ans:
D
Feedback:
The lack of familiar MHC molecules will stimulate an immune response by effector cells in the absence of antirejection drugs. An innate immune response is not central to the response, but rather the adaptive immune system. Lack of known MHC molecules, not foreign antibodies, accounts for the immune response, and familiar MHC molecules will not be produced by the donor kidney cells.
13.
A client has been inhaling viruses periodically while on a cross-country flight. Which of the following situations listed below would most likely result in the stimulation of the client's T lymphocytes and adaptive immune system?
A)
Presentation of a foreign antigen by a familiar immunoglobulin
B)
Recognition of a foreign major histocompatibility complex (MHC) molecule
C)
Recognition of a foreign peptide bound to a self-major histocompatibility complex (MHC) molecule
D)
Cytokine stimulation of a T lymphocyte with macrophage or dendritic cell mediation
Ans:
C
Feedback:
The stimulation of T cells requires the recognition of a foreign peptide bound to a self-major histocompatibility complex (MHC) molecule. Immunoglobulins do not play an antigen-presenting role, and foreign MHC molecules and cytokines do not stimulate the adaptive immune system.
14.
Three days ago, a mother delivered her full-term infant who had been identified as having an in utero infection. The infant is receiving antibiotic and phototherapy, and the mother is breast-feeding. Which of the following types of immunoglobulins could most reasonably be expected to predominate in the infant's immune system?
A)
IgA, IgM, IgD
B)
IgG, IgA, IgM
C)
IgE, IgG, IgD
D)
IgM, IgD, Igm
Ans:
B
Feedback:
Infants are born with IgG from transfer across the placenta, while IgA is found in colostrum. IgM is indicative of an in utero infection.
15.
A middle school student is scheduled to receive booster immunizations, and the father asks the nurse why the booster is necessary. What characteristic of the adaptive immune system listed below would provide the rationale for the nurse?s response?
A)
Some antibodies require a repeat of the primary immune response.
B)
Some antibodies have a duration measured in months rather than years.
C)
A secondary response causes a sharp rise in antibody levels.
D)
Antigen receptors on CD4+ cells require multiple exposures separated by time.
Ans:
C
Feedback:
Booster immunizations take advantage of the increase in antibodies that accompanies a repeat exposure. The primary immune response cannot be repeated, and antibodies survive beyond several months. Antigen receptors on CD4+ cells do not require multiple exposures.
16.
A student states, ?It seems like helper T cells do a lot more than just 'help' the cellular immunity process.? Which of the following responses listed below best conveys an aspect of the role of CD4+ helper T cells in immunity?
A)
?Without helper T cells, no antigens would be presented.?
B)
?Helper T cells play a major role in stimulating and regulating the whole process.?
C)
?Without helper T cells, the wrong antibodies would end up being produced.?
D)
?Helper T cells are key to the hematopoiesis that produces all the components of the immune system.?
Ans:
B
Feedback:
Helper T cells are central to the regulation, proliferation, and stimulation of the immune system. They do not play a central role in antigen presentation or early hematopoiesis, however. Their absence would not result in incorrect antibody production, but rather insufficient or absent immune response.
17.
A newly diagnosed HIV-positive adolescent has blood work drawn, which includes a CD8 T-cell count. The nurse knows which of the following functions of CD8 T cells listed below will assist the adolescent's immune system in fighting off the viral attack? Select all that apply.
A)
Release destructive enzymes
B)
Trigger intracellular programmed death
C)
Cause allergens to surround the virus
D)
Boost antigen?antibody response
E)
Remove foreign material from lymph before it enters the blood
Ans:
A, B
Feedback:
The primary function of cytotoxic T (CD8) cells is to monitor the activity of all cells in the body and destroy any that threaten the integrity of the body. The CD8 cells destroy target cells by releasing cytolytic enzymes, toxic cytokines, and pore-forming molecules or by triggering membrane molecules and intercellular apoptosis. Removal of foreign material from lymph before it enters the blood is the function of lymph nodes.
18.
A 10-year-old child with strep throat asks the nurse, ?why there are large bumps [lymph nodes] on my neck when my throat gets sore?? The nurse replies lymph nodes
A)
help your body fight off infections by allowing special cells (lymphocytes and macrophages) move through the lymph chain and engulf and destroy germs.
B)
bring in cells into the lymph node (your bump) to stop the germs from going anywhere else in the body.
C)
bring all kind of good cells to your throat so that they can wall the strep off and keep the germs from getting any food or water.?
D)
help your tonsils get bigger with cells that will bring immune cells into your throat to prevent any other infections.
Ans:
A
Feedback:
Lymphocytes and macrophages move slowly through the lymph nodes so that they can have adequate time to engulf microorganisms and interact with circulating antigens. The lymph nodes do not bring cells into the node to stop germs; do not bring cells to the throat to wall off strep; and do not enlarge the tonsil with immune cells.
19.
Which of the following situations can best be characterized as an example of passive immunity?
A)
A 6-month-old infant receives his scheduled immunization against measles, mumps, and rubella.
B)
A 9-year-old boy is immune to chicken pox after enduring the infection before 1 year.
C)
An 8-year-old girl recovers from a respiratory infection after intravenous antibiotic treatment.
D)
A 6-week-old infant receives antibodies from his mother's breast milk.
Ans:
D
Feedback:
Passive immunity involves the transfer of antibodies from an outside source, such as those from breast milk. Immunization and recovery from illness involve active immunity.
20.
The nurse knows high incidences of infectious illnesses among the older adults who reside in a long-term care facility are most likely to have diminished immune capacity because of
A)
decreased numbers and responsiveness of T lymphocytes.
B)
decreased antigen recognition by B lymphocytes.
C)
overexpression of cytokines and receptors.
D)
altered function in peripheral lymphocytes.
Ans:
A
Feedback:
Although this phenomenon is not well understood, increasing proportions of lymphocytes become unresponsive with age, and CD4+ T lymphocytes are the most severely affected. B lymphocytes recognize more antigens, not fewer, and expression of cytokines and their cellular receptors decreases.
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