Unit 7 - Immunity

Question 1

Function of immune system:

• protect body from _____ _____
• identify, destroy potentially harmful _____
• remove _____ _____

Answer 1

• protect body from foreign antigens
• identify, destroy potentially harmful cells
• remove cellular debris

Question 2

_____ is the primary defense

Answer 2

skin

Question 3

Leukocytes:

• primary cells in both nonspecific, specific _____ _____
• derived from _____ _____ in _____ _____
• attack, destroy anything _____ (to include cancer cells)
• can move through _____ spaces
• normal number =
• leukocytes in presence of infection =

Answer 3

• primary cells in both nonspecific, specific immune responses
• derived from stem cells in bone marrow
• attack, destroy anything foreign (to include cancer cells)
• can move through tissue spaces
• normal number = 4,500 - 10,000 cells/mm^3
• leukocytes in presence of infection = > 10,000/mm^3

Question 4

Definition:

decrease in number of circulating leukocytes

Answer 4

leukopenia

Question 5

Leukopenia:

• when bone marrow activity _____
• when leukocyte destruction _____

Answer 5

• suppressed

- increases

Question 6

3 Types of leukocytes:

Answer 6

• granulocytes
• monocytes
• lymphocytes

Question 7

Granulocytes:

• _____-_____% of total leukocytes
• derive from _____ _____ _____ of bone marrow
• _____ life span
• key role during _____ _____, infection

Answer 7

• 60-80% of total leukocytes
• derive from myeloid stem cells of bone marrow
• short life span
• key role during acute inflammation, infection

Question 8

3 types of granulocytes

Answer 8

• neutrophils
• eosinophils
• basophils

Question 9

describe neutrophils

Answer 9

first responder

Question 10

Segmented neutrophils (or _____ ) are _____ forms and usually account for approximately _____ of total leukocytes. _____ are immature neutrophils and usually comprise _____ of leukocytes.

Answer 10

segs
mature
55%
Bands
5%

Question 11

Increased neutrophils seen in _____ infections

Answer 11

bacterial

Question 12

a _____ _____ refers to the presence of increased proportions of younger, less well differentiated neutrophils and neutrophil-precursor cells in the blood. This generally reflects early of premature release of _____ _____ from the bone marrow, the site where _____ are generated. A severe neutrophilia with left shifts is referred to as a _____ _____.

Answer 12

Left shift
myeloid cells
neutrophils
leukemoid reaction

Question 13

How do you measure granulocytes

Answer 13

CBC

Question 14

Type of granulocyte:

- certain allergic diseases and some asthma patients

Answer 14

eosinophils

Question 15

Type of granulocyte:

- associated with allergic reactions, also contain some histamine

Answer 15

Basophils

Question 16

Monocytes:

• _____-_____% of circulation leukocytes
• _____ leukocytes
• derive from _____ _____ of bone marrow
• migrate to _____, mature into _____, remain until activated
• _____cytes

Answer 16

• 2-3% of circulation leukocytes
• largest leukocytes
• derive from myeloid stem cells of bone marrow
• migrate to tissues, mature into macrophages, remain until activated
• histocytes

Question 17

4 Types of monocytes:

• _____ cells - in the liver
• _____ macrophages
• _____ - in the brain
• activate immune response against _____ infections

Answer 17

• kupffer cells - in the liver
• alveolar macrophages
• micoglia - in the brain
• activate immune response against chronic infections

Question 18

The client who has only a slight elevated in temperature in response to pneumonia is an example of a _____ in the expected immune response. The other clients are demonstrating an expected immune response as evidence by redness, swelling, and induration.

Answer 18

decline

Question 19

Human _____ engulf the weakened vaccine virus as if it is dangerous and _____ stimulate the immune system to attack it.

Answer 19

macrophages

antigens

Question 20

Lymphocytes:

• derive from _____ _____ _____ of bone marrow
• _____-_____% of circulating leukocytes
• _____, _____ cells of specific responses
• constantly circulate, monitoring for _____ _____

Answer 20

• derive from lymphoid stem cells of bone marrow
• 20-40% of circulating leukocytes
• effector, regulator cells of specific responses
• constantly circulate, monitoring for cancerous cells

Question 21

Lymphocytes:

• _____ cells
• stay _____, sometimes for years
• activate immediately when exposed to _____ _____
• proliferate _____, intense immune response
• responsible for _____ _____

Answer 21

• memory cells
• stay inactive, sometimes for years
• activate immediately when exposed to same antigen
• proliferate rapidly, intense immune response
• responsible for acquired immunity

Question 22

2 types of lymphocytes

Answer 22

T cells

B cells

Question 23

T Cells:

• mature in _____
• on contact with _____ (antigen presenting cells), mature into active _____T cells, _____ T cells, or _____ T cells

Answer 23

• mature in thymus
• on contact with APCs (antigen presenting cells), mature into active helper T cells, cytotoxic T cells, or memory T cells

Question 24

B cells:

• mature in _____ _____
• on contact with _____, activated and mature into _____ cells of _____ cells
• create _____ after antigen encountered

Answer 24

• mature in bone marrow
• on contact with antigen, activated and mature into plasma cells of memory cells
• create antibodies after antigen encountered

Question 25

Natural Killer cells: - in _____, lymph nodes, bone marrow, _____ - _____% of circulating lymphocytes - immune _____, resistance to _____ - destruction of _____ _____ cells

Answer 25

- in spleen, lymph nodes, bone marrow, blood - 15% of circulating lymphocytes - immune surveillance, resistance to infection - destruction of early malignant cells

Question 26

Antigens: primary immune response - B cell produces antibodies to _____ _____ _____ - _____ react specifically to that antigen - takes _____ days

Answer 26

- B cell produces antibodies to eliminate extracellular antigens - antibodies react specifically to that antigen - takes ~3 days

Question 27

Antigens: secondary immune response | - subsequent encounters with an _____ _____ _____ cell

Answer 27

- subsequent encounters with an antigen trigger memory cell

Question 28

When an antigen is encountered in the body, two major groups of cells—_____ and _____—generate an effective immune response. _____ are recognized by a specific receptor on a lymphocyte, and an immune response is generated by those lymphocytes. Depending on the antigen itself and the type of immune cell activated by contact with the antigen, two separate but overlapping immune responses may occur. The _____, or humoral branch of the immune system, mainly eliminates extra- cellular antigens, such as bacteria, bacterial toxins, and free viruses, through the production of _____ (molecules that bind with the antigen and inactivate it). Antibodies are found in serum, body fluids, and certain tissues. When an individual is first exposed to an antigen, the B lymphocyte system begins to produce antibodies that react specifically to that antigen It takes approximately _____ days for this process, known as the _____ _____ _____, to occur. Subsequent encoun-ters with the antigen trigger memory cells, and the result is a secondary immune response within _____ hours.

Answer 28

``` lymphocytes APCs APCs B cell antibodies 3 primary immune response 24 ```

Question 29

5 Classes of antibodies (immunoglobulins)

Answer 29

``` IgM IgG IgA IgD IgE ```

Question 30

Which antibody: | responsible for primary immunity

Answer 30

IgM

Question 31

Which antibody: | major immunoglobulin

Answer 31

igG

Question 32

Which antibody: | protects mucous membranes

Answer 32

igA

Question 33

Which antibody: | role unknown

Answer 33

igD

Question 34

Which antibody: | increases during allergic reactions, anaphylaxis

Answer 34

igE

Question 35

In regard to newborn and infant immunity, _____ is the only immunoglobulin that crosses the placental barrier. Because of this, a newborn's level of IgG is similar to that of the mother. The maternal IgG disappears by the time the infant is _____ months old. IgA and IgE (are, are not) present at birth. Infants and children have differing amounts of some immunoglobulins.

Answer 35

IgG 6-8 are not

Question 36

Nursing interventions to support antibiotic therapy include encouraging an adequate fluid intake, monitoring for manifestations of an allergic reaction, assessing renal and hepatic function, and assessing vital signs. A baseline _____ is appropriate for _____ medication.

Answer 36

electrocardiogram | antimalarial

Question 37

_____ carry messages for immune system function

Answer 37

cytokines

Question 38

Cytotoxic T lymphocytes: - attack _____ cells - responsible for rejection of _____

Answer 38

- attack malignant cells | - responsible for rejection of transplants

Question 39

Immunosuppressive agents _____ T cell development and activation. They are given concurrently with _____ and in combination with other immunosuppressants, and inhibit immune system activity and organ rejection. Nursing responsibilities include monitoring BUN and creatinine for evidence of _____ (kidney damage). The client should _____ grapefruit juice, which can raise cyclosporine levels by 50% to 200% and increase the risk of _____. Fluids should be _____ to maintain good hydration and urinary output. Ibuprofen is acceptable for immunosuppressive medications, but should not be taken with _____ agents.

Answer 39

``` inhibit glucocorticoids nephrotoxicity avoid toxicity increased cytotoxic ```

Question 40

Lymphoid system: - recover _____ for vascular system - protects bloodstream from _____ _____

Answer 40

- recover proteins for vascular system | - protects bloodstream from invading organism

Question 41

Lymph nodes: - most numerous elements of _____ system - filter foreign products of _____ - house, support ____ and _____

Answer 41

- most numerous elements of lymphoid system - filter foreign products of antigens - house, support lymphocytes and macrophages

Question 42

Spleen: - ______ lymphoid organ - filters _____ - _____ kinds of tissue - _____ pulp: lymphoid proliferation, immune surveillance - _____ pulp: blood filtration

Answer 42

- largest lymphoid organ - filters blood - two kinds of tissue - white pulp: lymphoid proliferation, immune surveillance - red pulp: blood filtration

Question 43

Thymus gland: - stimulates _____ - during fetal life, childhood, site for maturation differentiation of _____ lymphoid cells

Answer 43

- stimulates lymphopoiesis | - during fetal life, childhood, site for maturation differentiation of thymic lymphoid cells

Question 44

Bone marrow: | - produces, stores _____ stem cells

Answer 44

- produces, stores hematopoietic stem cells

Question 45

Lymphoid tissues: - _____ collections of lymphocytes, plasma cells, phagocytes - _____ _____: largest collection of immune cells

Answer 45

- diffuse collections of lymphocytes, plasma cells, phagocytes - peyer patches: largest collection of immune cells

Question 46

Tonsiles and adenoids: | - protect from inhaled, ingested _____ _____

Answer 46

- protect from inhaled, ingested foreign agents

Question 47

How can voiding create Barrier Protection? Voiding a sufficient quantity of urine is a form of barrier protection that helps the body to defend itself against microorganisms. The act of voiding flushes those organisms that might try to enter the body through the _____ _____. Intact skin is also a physiological barrier that helps defend the body against microorganisms. Occasional smoking does not defend the body from microorganisms; it destroys the _____ in the nose that helps to filter organisms. _____ the skin and a surgical _____ can both allow microorganisms to enter the body.

Answer 47

urinary meatus cilia Moisturizing incision

Question 48

Child's igG increases gradually until _____ years

Answer 48

7-8

Question 49

_____ is present in breastmilk, concentrated in colostrum

Answer 49

igA

Question 50

T/F: a newborn's level of igG is similar to that of the mother

Answer 50

T, because igG is the only immunoglobulin that crosses the placental barrier

Question 51

Are igA and IgE present at birth?

Answer 51

No

Question 52

As a person grows older, there is an overall _____ in the speed and strength of the immune response. The immune system does not quit working totally. There is a decrease in the number of _____ in circulation.

Answer 52

decrease | B cells

Question 53

4 types of allergic/hypersensitivity reactions: | - immediate hypersensitivity

Answer 53

Type 1

Question 54

4 types of allergic/hypersensitivity reactions: | - cytotoxic hypersensitivity

Answer 54

Type 2

Question 55

4 types of allergic/hypersensitivity reactions: | - immune complex reaction

Answer 55

Type 3

Question 56

4 types of allergic/hypersensitivity reactions: | - delayed-type hypersensitivity

Answer 56

Type 4

Question 57

Autoimmune diseases: - immune system loses ability to... - attacks... - examples: _____ (SLE), _____, _____

Answer 57

- immune system loses ability to distinguish self from others - attacks own body - examples: lupus (SLE), Rheumatoid arthritis, HIV

Question 58

Transplant reactions: | occurs minutes, hours after trasnplantation

Answer 58

hyperacute rejections

Question 59

Transplant reactions: | occurs in weeks after transplantation

Answer 59

acute rejection

Question 60

Transplant reactions: | occurs months after transplantation

Answer 60

chronic rejection

Question 61

Transplant reactions: - secondary deficiencies caused by trauma, cancer therapies - AIDS

Answer 61

impaired immune response

Question 62

Hypersensitivity reactions: | Can also affect bone marrow transplants, the new bone marrow can attack the _____ _____

Answer 62

host cells

Question 63

Prevalence: - Estimated _____-_____% of schoolchildren worldwide sensitized to one or more allergens - Prevalence _____ in U.S. - About _____% of U.S. population affected by autoimmune disease - Majority are _____ - _____ is the most common

Answer 63

- Estimated 40–50% of schoolchildren worldwide sensitized to one or more allergens - Prevalence increasing in U.S. - About 8% of U.S. population affected by autoimmune disease - Majority are female - Lupus is the most common

Question 64

T/F: Restricting fluids could cause respiratory secretions to thicken and hinder the client's ability to maintain a clear airway. Fluids should be encouraged.

Answer 64

T

Question 65

If drugs are discontinued, that can ______ the risk of organ rejection

Answer 65

increase

Question 66

_____ immune deficiencies are more prevalent than _____

Answer 66

secondary | primary

Question 67

T/F: children are at greater risk of allergies if parents have allergies

Answer 67

T

Question 68

_____ _____ have higher rates of transplant rejection

Answer 68

African Americans

Question 69

_____ _____ have increased prevalence of autoimmune disease

Answer 69

African Americans

Question 70

Influenza vaccine is administered annually to healthy individuals and should not be given to those with an allergy to _____. The pneumococcal vaccine is administered _____. Revaccination is only recommended in persons with _____ _____, those who have had _____, those with malignancies, and those with _____/_____.

Answer 70

``` eggs once renal failure splenectomies HIV/AIDS ```

Question 71

Is a vaccine active or passive immunity

Answer 71

active

Question 72

is an injection of antibodies produced by another host active or passive imminuty

Answer 72

passive

Question 73

Receiving an immunization for rabies is an example of _____ _____ _____ _____. Receiving tetanus and immunoglobulin are also examples but would not be used in the case of an animal bite. Mother's breast milk is another example of _____ immunity, but would not be used in the case of an animal bite.

Answer 73

artificially acquired passive immunity | passive

Question 74

When the client has the disease, the body stimulates the process of _____ _____ _____. Receiving injections for rabies, tetanus, and gamma globulin are examples of _____ _____ _____ _____.

Answer 74

acquired active immunity | artificially acquired passive immunity

Question 75

Definition: | life threatening allergic reaction

Answer 75

anaphylaxis

Question 76

If the nurse observes a _____ reaction, the client will exhibit manifestations including temperature, increased pulse, tachypnea, and leukocytosis. Erythema, warmth, pain, edema, and functional impairment indicate a _____ reaction.

Answer 76

systemic | local

Question 77

Can you use live virus immunizations (ex. rubella) during pregnancy

Answer 77

No!

Question 78

A patch test assesses a 1-inch area impregnated with the _____, which is applied for 48 hours. Absence of a response indicates a _____ result. Positive responses are graded from mild (erythema in the exposed area) to severe (papules, vesicles, or ulcerations). Direct Coombs' test detects _____ in the client's RBC that damage and destroy the cells. This is used following a suspected transfusion reaction to detect antibodies coating the _____ _____. This is also part of the crossmatch of a blood type and crossmatch. Indirect Coombs' test detects the presence of circulating antibodies against _____. The eosinophil count is 1% to 4%, which is within normal range.

Answer 78

``` allergen negative antibodies transfused RBCs RBCs ```

Question 79

Nonsteroidal anti-inflammatory drugs (NSAIDS) are _____; keeping the client well hydrated will help prevent kidney damage. Taking the medication (with/without) food will decrease gastrointestinal (GI) irritation, but preventing kidney damage is more of a priority. Taking the medication on an empty stomach will _____ gastrointestinal (GI) irritation. Constipation (is/is not) an issue with NSAIDs.

Answer 79

nephrotoxic with increase is not