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CHA 2 Exam 1 | Comprehensive Questions and Answers Latest Updated 2024/2025 With 100% Verified Solutions What is another name for a type 1 hypersensitivity reaction? - Atopic Allergy What is the most common hypersensitivity reaction? - Type 1 During a type I hypersensitivity reaction, what antibodies are released? - IgE What do IgE antibodies release? - Histamine & other vasoactive agents How can allergens be taken in to the body? - Inhaled, ingested, injected Patients with allergies to shellfish may also react to? - Propodone Iodine Patients with allergies to avocados, bananas, strawberries, and other topical fruit may also be allergic to? - Latex Patients with allergies to egg, soy, or peanut may also be allergic to? - Propofol Patients with an allergy to penicillin may also be allergic to? - Bee venom What is the difference between the 1st and 2nd allergic response exposure? - 2nd exposure has a primary AND secondary phase What is the most common vasoactive amine? - Histamine (short acting biochemical) Where is angioedema most common during a dermatologic reaction? - Lips, face, tongue, larynx, and neck During what type of reaction does angioedema occur? - Severe type I hypersensitivity reaction
What are signs and symptoms of intestinal angioedema? - Severe pain, cramping, nausea, vomiting What are the most common meds to cause an angioedema reaction? - ACE inhibitors and NSAIDs When are patients most at risk for an allergic reaction with ACE inhibitors? - 1st 24hrs after 1st dose (but it can happen later) Angioedema s/s? - Possible laryngeal edema. Deep firm swelling of the eyes, face, lips, tongue, and neck. Difficulty speaking or drinking. Distortion of the face. Swollen nasal passages. Hives. What s/s of angioedema require immediate intervention? - Strider, unable to swallow, lump in their throat (give O2, steroids, etc.) How quickly does anaphylaxis occur? - Seconds to minutes What is the #1 reason patients die during an anaphylactic reaction? - Delay of Epinephrine S/S of anaphylaxis? - Feeling of apprehension, anxiety, swollen tongue, hives, feeling of doom, overall weakness, congestion, rhinorrhea, dyspnea, increased respiratory distress with wheezing and stridor, hypotension What is actively working in the body during an anaphylactic reaction? - Histamine and other mediators What is the nurse's priority during an anaphylactic reaction? - Assess & stabilize (be ready to incubate or perform emergency tracheotomy) What meds are used to treat an anaphylactic reaction? - Epi & corticosteroids What is rhinosinusitis? - Hay fever (reaction or airborne allergens)
What are examples of type III hypersensitivities? - Rheumatoid arthritis, serum sickness, vasculitis, system lupus erythmatosus What type of reaction is a type IV hypersensitivity reaction? - Delayed reaction aka cell mediated immune response What cells are working in a type IV hypersensitivity reaction? - T cells are reactive (sensitive from previous exposure) When does a type IV hypersensitivity reaction occur? - Hours to days after exposure What are s/s of a type IV hypersensitivity reaction? - Edema, induration, ischemia, tissue damage to the site What are examples of type IV hypersensitivity reactions? - PPD test for TB, contact dermatitis, poison ivy, skin rashes, local response to insect sting, tissue transplant rejections, and sarcoidosis How long do type IV hypersensitivity reactions usually last for? - 5-7 days What can you do to treat/prevent type IV hypersensitivity reactions? - Corticosteroids and avoid the source of the reaction What should you immediately do as a nurse if your patient is showing signs of an allergic reaction? - Call a rapid response If a patient is having an allergic reaction to an IV drug or solution what should you do? - D/C the solution AND tubing and hang a bag of normal saline with NEW tubing (if patient doesn't have an IV, start one) What is the most common AIDS related malignancy? - Kaposi's sarcoma What is the risk with kaposi's sarcoma and AIDS? - Risk is related to do-infection with herpes
S/s of Kaposi's sarcoma? - Small purplish/brown raised lesions on skin and mucous membranes (usually not painful or itchy. May also see lesions in lymph nodes, mouth, throat, intestinal tract, and lungs) How do you diagnose kaposi's sarcoma? - Biopsy of a lesion What is important about mucositis and AIDS? - Sores occur in mucous membranes especially the mouth and GI tract (check mouth regularly for sores) What can help prevent mucositis? - Cryotherapy (ice water or chips) What medications work against opportunistic infections in HIV? - Antiretroviral Do antiretrovirals kill the infections? - No, they only inhibit viral replication Why is mono-therapy dangerous for patients with HIV? - It promotes drug resistance What therapy is standard for HIV/AIDS? - Combination antiretroviral therapy (cART) What is important to teach about cART therapy? - Patients must take it 90% of the time & as prescribed Is it possible to determine if an HIV strain has developed drug resistance? - Yes What happens when a strain of HIV becomes resistant to a specific drug? - Once resistant it's stored forever (archived) What are examples of cART drug therapy? - -Nucleotide Reverse Transcriptase Inhibitors (NRTIs) -Abacavir (Ziagen) -Didanoise (Videx EC) -Emtricitabine (Emtriva) -Lamivudine (Epivir)
Who does rheumatoid arthritis impact more? - Women Review Rheumatoid arthritis Charts 18-7, 18-8, and 18-9 - What are the primary problems patients with myasthenia gravis face? - Muscle weakness & respiratory issues What is Guillain-Barre syndrome? - Acute inflammation leading to demyelination of peripheral nerve What is demyelination? - Myelin sheath is wearing away so electrical signal dont stay in spinal cord and some escapes What does demyelinization result in? - Leads to motor weakness and altered sensory function When does Guillain-Barre Syndrome occur? - After illness, trauma, surgery, pregnancy, immunization Symptoms usually occur 1-2 weeks after event What do nurses need to avoid giving if a patient has Guillain-Barré syndrome? - Do not give the flu shot S/S of Guillain-Barre Syndrome - -Ascending weakness (moves upward) -May affect respiratory muscles and cranial nerves -Respiratory depression -Facial weakness, dysphagia -Decreases reflexes, ataxia, paresthesias -Labile BP, tachycardia or bradycardia, dysrhythmias What treatment is used for Guilin-barre syndrome? - -Frequently assessing ABCs -PT/OT -Cardiac monitoring - observe/treat dysrhythmias
-May need mechanical ventilation What complications do patients with guillain-barre face? - Hypoxia, aspiration, pneumonia, UTI's, DVT, skin breakdown (other complications related to immobility) What medications are used to treat Guillain-Barré syndrome? - Plasma exchange & IV immunoglobulins What is occurring in the body when a patient has Lupus (SLE)? - Immune complexes lodge in blood vessels causing inflammation, damage, & destruction What is SLE? - Systemic lupus erythematosus (SLE) is a chronic inflammatory disease In what disease are autoimmune complexes attracted to glomeruli? - Lupus (SLE) What does Lupus cause? - Vasculitis and glomerulonephritis What happens to joints in Lupus? - Arthralgia and arthritis What are the 2 main classifications of Lupus? - -Discoid lupus erythematosus (DLE) -Systemic lupus erythematosus (SLE) What is lupus characterized by? - Like Rheumatoid arthritis it's characterized by spontaneous remissions & exacerbations is lupus fatal? - It can be What part of the body are immune complexes most attracted to in lupus? - Most attracted to glomeruli of kidneys (some degree of kidney involvement aka lupus nephritis which is the leading cause of death in Lupus)
How does a person acquire natural active immunity? - being exposed to an antigen and developing antibodies (once they have got the disease) What is an example of natural, passive immunity? - antibodies passed from mother to fetus via the placenta, or through breastmilk what is the effect of steroid use on the immune system? - works as an anti-inflammatory and immunosuppressant which puts the pt. at increased risk for infections what 3 systems work together to ensure immunocompetency? - inflammation, cell-mediated and antibody mediated immune systems all work together to provide immunity which 2 types of T cells work together to keep a balance in the immune system? - T helpers & T suppressor (if balance is upset then there's a problem either too much immune response or not enough and can't fight disease off) how many stages of inflammation are there? What are they called? - 3, vasoactive, exudate (pus), repair/replacing what cell or component is most prelevant in the 1st stage of inflammation? What are the 3 functions? - macrophages they present antigens, phagocytosis and produce other inflammatory components what is a common clinical finding for a pt. that is in stage 2 inflammation? - exudate (made up of WBCs, necrotic tissue and fluid that escapes from damaged cell's is the inflammation process considered specific or not specific? - non-specific (acts the same regardless of the cause) chemical mediators do what during the first stage of inflammation? - increase the production of neutrophils and shorten the time it takes to produce WBCs to enhance the inflammatory process
allergic asthma, hay fever, allergic rhinosinusitis and anaphylaxis are examples of what type of hypersensitivity? - type 1 are allergies inherited? - they can be, not necessarily the exact same one but another allergy may occur from the source if a pt. states they have an allergy, what should the nurse ask the pt.? - what they are allergic too and what rxn they have autoimmune disorders are classified as what type of hypersensitivity? - type 3 immune complex what is the cause of type 2 hypersensitivity rxn? What is an example? - cytotoxic rxn myasthenia gravis is considered what type of disease and what is happening? - autoimmune, antibodies attaching to when someone has SLE what are s/s of complications during exacerbation? - fever, pneumonia, plural effusion, nephritis, fatigue Guillain-Barre is an autoimmune disease that can cause the most complications in what system? - respiratory RA is a chronic progressive disease what pt. education is important for self-management? - balance/rest w/ activity, don't overdo it what is an opportunistic infection? - infection that has does not affect healthy people but that are immunocompromised How does HIV decrease a pts. immune system? - by entering and taking over the CD4+T cells and the cell loses its innate abilities
-Innate versus adaptive What part of the immune system is always the same response? - Inflammation (burn & infection get same response) What does inflammation provide? - Immediate protection that is innate, natural, & non-transferable What are the 5 cardinal signs of inflammation? - Warmth, redness, swelling, pain, decreased functioning What is stage 1 of the inflammation response? - The vascular response What happens during stage 1 inflammation? - Histamine, serotonin, & kinins are released causing redness, warmth, increased nutrients, hyperemia, edema, and capillary leak (blood plasma) What is hyperemia and when does it occur in the inflammatory process? - Increased blood flow, stage 1 what do kinins do when released in response to inflammation? (3) - cause contraction of smooth muscle, vasodilation, and pain stimulation (small veins constrict, arteries dilate) When does stage 1 of inflammation occur? - 24-72 hours What's the primary cell in stage 1 inflammation and what does it secrete? - Macrophages secrete cytokines What is stage 2 of the inflammatory process? - Cellular exudate stage What occurs during stage 2 of inflammation? - Neutrophilia (neutrophils = phagocytosis), WBC secrete cytokines What mediators work during stage 2 of the inflammatory process? - Histamine, leukotrienes, prostaglandins, serotonin, & kinins
What happens initially in the inflammatory response? - Vasoconstriction (very short) What is stage 3 of the inflammatory process? - Tissue repair & replacement What occurs during stage 3 of the inflammatory process? - WBC's promote the formation of scar tissue (this is a patch and does not operate as muscle) What is angiogenesis and when does it occur in the inflammatory process? - New blood vessel growth, occurs in stage 3 What is humoral immunity? - Specific antibody mediated immunity What occurs during antibody mediated immunity? - B cells transform into plasma cells, which synthesize and secrete specific proteins called antibodies What do antigens/antibodies do during hemoral immunity? - Interact and destroy foreign protein What do B lymphocytes do? - produce antibodies What do B cells do? - Sensitize B lymphocytes Where do B cells start in the body? - Start as stem cells in bone marrow What is the antigen-antibody interaction? - Foreign protein or allergen causes immune response What cells have the most direct role in antibody mediated immunity? - B cells What are the 5 classes of immunoglobulins? - IgG, IgA, IgM, IgD, IgE
What are the 3 main types of T cells in aquired immunity? - Cytotoxic (attack & destroy), helper, and suppressor What occurs in the myeloid pathway? - Stem cells are made in bone marrow, become specific (includes: WBC, RBC, Platelets, etc.) What are granulocytes? - neutrophils, eosinophils, basophils Where are mature neutrophils made? - bone marrow How long to mature neutrophils live? - 8-12 hours What percentage of WBC's are neutrophils? - 55-70% What cells are first to arrive at the site of an injury and how long does it take? - Neutrophils, 6-12hrs What do neutrophils do? - phagocytize bacteria Where do neutrophils originate? - Stem cells (before maturity) What's another name for neutrophils? - Granulocytes Why are mature neutrophils so important? - Immature can't phagocytize Most circulated neutrophils are what? - Segmented What can sepsis do to neutrophils? - Decrease the number of mature neutrophils causing a left shift (bandemia) Where are basophils made? - Bone marrow
What percentage of WBC's are basophils? - 1% Do basophils act specifically or non-specifically? - Non-specifically Where do basophils come from? - Myeloid stem cells What do basophils do? - Release basophils chemicals such as heparin, histamine, serotonin, kinins, and leukotrienes (inflammatory response) Where are eosinophils produced? - bone marrow What percentage of WBC's are eosinophils? - 1-2% What type of action do eosinophils have? - Phagocytic action like neutrophils What is the half life of eosinophils? - Half life of 12 days What are eosinophils most active against? - Parasitic larvae Eosinophils increase during what reaction? - Allergic reactions Where do mast cells originate? - Bone marrow How do mast cells look & function? - Similar to basophils & eosinophils Where do mast cells mature? - In tissue What do mast cells bind with? - IgE
What antibody is activated first? - IgM and then IgG What WBC's have the most important role in cell-mediated immunity? - T-cells How long can T cells live? - The life of a person What do T-cells account for? - Long-term immunity What's another name for T-cells? - Natural killer cells What do cytotoxic T cells do? - Attack foreign invaders by secreting cytolytic substances What are cytotoxic T cells most affective against? - Self cells infected by viruses or proteins Another name for helper T cells? - CD4+ What do CD4+ cells do? - Call other cells and stimulate antibody production What's another name for suppressor T-cells? - CD8+ What do suppressor T cells do? - Regulate CMI, inhibitory effect (prevent hypersensitivity) What is the normal balance of helper & suppressor cells? - 2:1 helper to suppressor (if unbalanced, incr. infection risk) What's another name for natural killer cells? - CD16+ (large lymphocytes)
What do natural killer cells do? - Direct cytotoxic effect on some non-self cells w/o needing to be sensitized, can seek & destroy non-self cells What are killer cells most effective against? - Cancer cells, viral infected cells, transplanted grafts What are cytokines? - chemical messengers produced in response to a stimulus Where are cytokines produced? - WBC & other tissues What lab shows the % of circulating leukocytes? - WBC's with differential Most circulating neutrophils are what? - Segmented (mature) What is an immature neutrophil? - Band cell What happens to neutrophils during sepsis? - Decrease in segmented cells (left shift) body can't keep up What is ANC? - absolute neutrophil count Absolute Neutrophil Count (ANC) equals? - Total WBC's x (neutrophils + bands) What does ANC show? - Risk of infection If ANC is low what may be needed? - Neutropenia precautions What cell is a continuous, instant, non specific protection against organisms? - Neutrophils What is normal ANC? - 1500+
