Deck 40: Review of Body Defenses and the Immune System

Question 1

The infection control (IC)nurse has completed teaching newly hired nurses about the innate body defenses.Which statements by one of the participants would indicate the need for further instruction? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"Fever is one of the process barriers we can expect our clients to demonstrate."
B)"Complement is a component of the adaptive immune response."
C)"I should try to keep my client's skin and mucous membranes intact."
D)"Dendritic cells are part of the nervous system involved in keeping the immune system strong."
E)"Phagocytes are cells that kill invading bacteria."

Answer 1

"Complement is a component of the adaptive immune response."
"Dendritic cells are part of the nervous system involved in keeping the immune system strong."

Question 2

Which properties are common to both the cell-mediated and humoral immune systems? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Recognition of common pathogenic features in bacterial cell walls
B)Both depend on the response of helper T cells.
C)Memory: the ability to mount a more rapid attack on a foreign antigen because of previous exposure
D)Specificity: the ability to react with molecules bearing a specific marker
E)Both react in the same way regardless of the nature of the offending agent.

Answer 2

Memory: the ability to mount a more rapid attack on a foreign antigen because of previous exposure
Specificity: the ability to react with molecules bearing a specific marker

Question 3

A client says,"I overheard my doctor tell the medical students that I don't have effective immune surveillance.What does that mean?" How should the nurse respond?

A)"I'll get the doctor to come talk to you about what you heard."
B)"I'm certain that the doctor was not talking about you."
C)"Your immune system is not identifying and removing pathogens from your system."
D)"Your body is working against itself."

Answer 3

"Your immune system is not identifying and removing pathogens from your system."

Question 4

A client with a disorder of the plasma cells has a deficiency in which part of the immune system?

A)Antigens that produce a diffuse immune response
B)Monocytes that are found in an exudate
C)Activated B lymphocytes that produce immunoglobulins specific to an antigen
D)Macrophages that devour bacteria

Question 5

What is the purpose of the normal flora of the skin?

A)They control pathogens by competing with them for nutrients and space.
B)They phagocytize pathogens.
C)They secrete substances that kill pathogens.
D)They makes the skin more acidic during times of stress,which discourages pathogen growth.

Question 6

A postmastectomy client tells the nurse,"The doctor says my arm is so swollen because of lymph fluid.How much lymph fluid do we have?" How should the nurse respond?

A)"Not very much.Most of your swelling is due to your cancer."
B)"The normal amount of lymph fluid in the body is about 3 liters."
C)"The lymph fluid is part of your blood,so it is hard to determine how much you have."
D)"Everyone is different.Some people have lots of lymph fluid and some have very little."

Question 7

During assessment of a client's infection site,the nurse determines that the site is warm to the touch.How should the nurse explain this warmth to the client?

A)"Infection causes fluid overload in your body,so the infected site gets warm and red."
B)"Your lymphatic system has shut down to keep the infection from spreading,so the site gets warm and red."
C)"The little vessels around your infection are leaking,so the area gets warm and red."
D)"Your body is sending extra blood and white cells to the site to fight the infection."

Question 8

A client says,"The doctor says I have a problem with the fluid in my lymph system backing up.Where does lymph fluid come from?" How should the nurse respond?

A)"Lymph is a byproduct of the production of urine."
B)"Lymph fluid is made in your stomach from the fluid you drink."
C)"Lymph fluid comes from the liquid part of your blood."
D)"Lymph is created in your lungs from the water you breathe in with air."

Question 9

A client asks,"Why does the infection in my finger make it so red?" What is the nurse's best response?

A)"When you have an infection,your body sends more blood to the area."
B)"Your blood vessels in that area are leaky."
C)"You don't get rid of fluid as quickly when you are sick,so you develop a fluid overload."
D)"Your fingers are small and a long way from your heart,so the lymph drainage is not as good."

Question 10

A client has been diagnosed with cancer.The nurse plans an assessment based on the awareness that cancer can spread through which component of the lymphatic system?

A)Lymph vessels
B)Tonsils
C)Thymus gland
D)Spleen

Question 11

A client asks,"Why does my leg swell when I have an infection?" How should the nurse respond?

A)"The fever from your infection causes you to drink more,and you become fluid overloaded."
B)"The infection causes the little vessels in your leg to become leaky,and fluid seeps out of your blood."
C)"The infection causes your lymphatic system to get blocked up so it doesn't drain."
D)"When you have an infection,more blood goes to your leg,causing it to swell."

Question 12

The nurse has explained the process of phagocytosis to a client with an infected wound.The client is fascinated by the nurse's description of cells that eat other cells and asks,"Why don't they eat good cells,too?" How should the nurse respond?

A)"They do,but there are not enough phagocytic cells to kill enough good cells to make a person sick."
B)"The cells migrate to the infection before they start killing other cells."
C)"They don't eat good cells because of a process called chemotaxis."
D)"These cells can tell the difference between cells from the person's body and foreign cells."

Question 13

A client is prescribed ibuprofen for pain.The nurse is aware that this drug is designed to target which inflammatory mediator to reduce pain?

A)Histamine
B)Leukotrienes
C)Complement
D)Prostaglandins

Question 14

The school nurse is speaking to a group of children in middle school about preventing infection.How can the nurse best explain why it is so important for the children to keep from injuring their skin? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"Your skin cells are packed together tightly to keep germs out.If you disrupt that barrier,germs can get into your body."
B)"The sweat on your skin discourages germ growth.You don't want to damage the cells that produce sweat."
C)"You shed skin cells all the time,along with the germs on the skin."
D)"If you damage the skin's outer layer,it will never grow back."
E)"The deep layers of your skin have special cells that eat germs."

Question 15

A client has been stung by a bee.The site is warm,red,and swollen.Which agent does the nurse suspect to be the cause?

A)Histamine
B)Leukotrienes
C)Complement
D)Prostaglandins

Question 16

A key aspect of the specific immune system is:

A)recognition of common bacterial receptors.
B)complement.
C)memory.
D)phagocytes.

Question 17

Activation of the humoral immune system by an antigen results in the production of which substance?

A)Immunoglobulins (antibodies)specific for the antigen
B)Macrophages specific for the immunogen
C)Sensitized T lymphocytes
D)Sensitized natural killer (NK)cells

Question 18

A client is prescribed an antihistamine for an allergic reaction.The client asks,"Why am I getting this? What is a histamine anyway?" How can the nurse most accurately describe the action of histamine in the body?

A)"Histamine causes your blood vessels to dilate and leak.That is why you are swollen and itchy."
B)"Histamine stimulates production of the clotting parts of your blood.That is why you are blotchy."
C)"Histamine stimulates production of white blood cells to fight off infection.That is why you feel flushed."
D)"Histamine stimulates production of the red cells of your blood.That is why you are red."

Question 19

Which cells of the nonspecific body defense are phagocytic? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Mast cells
B)Macrophages
C)Dendritic cells
D)Neutrophils
E)Eosinophils

Question 20

Which option reflects a key aspect of the nonspecific body defense?

A)Recognition of antigens
B)Inflammation
C)Systemic response
D)Antibodies

Question 21

A client scheduled to undergo a lymph node biopsy asks,"If lymph nodes are so prone to cancer,why don't they just take them all out?" How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"Lymph nodes filter out all kinds of debris and are essential to our good health."
B)"The surgeon will probably take out a majority of the nodes in the region where the biopsy will be done."
C)"The cells that are in the lymph nodes actually help protect us from cancer."
D)"The lymph nodes make up one of our best defenses against infection."
E)"They usually do take out all the lymph nodes if the client has lymphoma."

Question 22

The health care providers and nurses caring for a group of clients with cancer have instituted a strict nutritional program with the goal of stimulating the clients' natural killer cells.How do these cells work? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)They phagocytize cancer cells.
B)The cells secrete chemical toxins that kill cancer cells.
C)They help to enhance inflammation.
D)They protect noncancerous cells from attack by viruses that cause cancer.
E)They modulate the adaptive immune response.

Question 23

The newly licensed nurse tells the supervisor,"I thought that interferons were medications,but I heard the doctor tell my client that his interferons were suppressed." How should the supervisor respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"Interferons are proteins produced in the body."
B)"Interferons can be produced to use as medications to fight cancer."
C)"The doctor probably said your client's immune system was depressed."
D)"Interferons help to stimulate other cells of the immune system."
E)"Interferons made by the body are the same as natural killer cells."

Question 24

A client is being given cytokines to stimulate the immune system.What response should the nurse expect from this drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Some cytokines will kill foreign organisms in the body.
B)The client's inflammatory response will be stimulated.
C)The client's immune system will be taken over by the cytokines.
D)The client's lymphatic system will shut down.
E)There will be fewer white blood cells in the client's blood.