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CHA2 Exam 1 | Comprehensive Questions and Answers Latest Updated 2024/2025 With 100% Verified Solutions 3 components of immunity - Inflammation, Cellular-Mediated, Antibody-Mediated What are the 3 types of granulocytes - Neutrophils, Eosinophils, Basophils This type of leukocyte is the first to arrive at an injured area - Neutrophils What is the job of neutrophils? - Phagocytize bacteria and foreign material Normal neutrophil percentage - 50-70% Select the statement that is true of neutrophils: A. Neutrophils are produced in the thymus. B. Neutrophils provide the "first wave" of attack in the inflammatory process. C. Neutrophils are few in numbers, fewer than other types of leukocytes. D. Neutrophils are the oxygen-carrying cells in the blood. - B. Why would we see "bands" on a WBC differential? - Bands are the immature neutrophils. To keep up with the need for neutrophils, the bone marrow releases more but are in immature form (banded) These leukocytes are released during an allergic reaction and parasitic infections - Eosinophils Normal percentage of eosinophils - 1-3%
What is the role of basophils? - Release histamine, heparin, and other chemicals that act on blood vessels Normal percentage of basophils - 1% The nurse explains that with the exposure to an antigen, the initiator of the inflammatory response is the presence of histamine, which is released by the: A. basophils. B. neutrophils. C. eosinophils. D. monocytes. - A. What is the role of monocytes? (macrophages) - - Phagocytize foreign material
- Process/present antigen
- Secrete cytokines for immune system control Normal percentage of lymphocytes - 25-30% How to determine Absolute Neutrophil Count (ANC) - (WBC total) x (Neutrophils + Bands) = ANC Antibody-mediated immunity is associated with cells - B Cellular immunity is associated with cells - T Explain the process of anti-body mediated immunity - 1. B cell comes in contact with antigen on cell well or is presented with pathogen by macrophage
- B cell becomes activated and sensitized
- Converts into plasma cell or memory cell
- Plasma cell secretes immunoglobulins to destroy antigen (IgG, IgA, IgM, IgD, IgE)
- Memory cells do not produce antibodies; but remain
Local (cardinal) signs of inflammation - Swelling, pain, warmth/heat, erythema, loss of function Vascular response of inflammation - Brief vasoconstriction; Chemical mediators released - vasodilation and increased capillary permeability Cellular response of inflammation - Response of the cells of the immune system - WBCs What is SIRS? (Systemic Inflammatory Response Syndrome) - - Generalized inflammatory response
- Seen with shock states (severe decrease in tissue perfusion and oxygenation) A client's complete blood count (CBC) with differential has the following values. Which value indicates to the nurse that the client is having some type of allergic reaction? A. Total white blood cell (WBC) count 100% B. Eosinophils 11% C. Lymphocytes 38% D. Neutrophils 66% - B. Normally, eosinophils compose only 1% to 2% of the total white blood cell population. This value rises in response to an allergic reaction of any type. Markers of inflammation - C Reactive Protein (CRP) Erythrocyte Sedimentation Rate (ESR) Anti-Nuclear Antibody (ANA) Rheumatoid Factor (RF) When evaluating the lab results for a patient with joint pain, which lab test may indicate the diagnosis of rheumatoid arthritis?
A. Elevated hemoglobin B. Low sodium and magnesium C. Elevated anti-nuclear antibody (ANA) D. Low erythrocyte sedimentation rate (ESR) - C. Type I hypersensitivity reactions pathophysiology... - - B cells produce IgE in response to an antigen
- Basophils and eosinophils are stimulated
- Histamine and SRSA released
- Reaction!! Type I hypersensitivity reaction diagnostic tests/results? - CBC with WBC differential - eosinophil elevation Serum IgE - elevated RAST test Skin testing Immediate treatment for Anaphylaxis - ABCs! - Oxygen, intubation possibly STOP drug if it may be the cause IV access Epinephrine Injection (0.2-0.5mg or 0.5mL) Antihistamines The nurse plans to assess the client with type I hypersensitivity for which clinical manifestation? A. Poison ivy
B. Gastric distress C. Hypotension D. Infection E. Osteoporosis - A, B, D, E Not C - Hypertension is an adverse effect of prednisone. During this type of reaction, the body makes autoantibodies directed against self cells that have a foreign protein attached - Type II - Cytotoxic Reaction Blood transfusion reactions are an example of what type of hypersensitivity reaction? - Type II: Cytotoxic Reaction During this type of reaction, excess antigens cause immune complexes to form. These complexes are deposited in tissue or small blood vessels; leads to inflammation and destruction of tissues - Type III - Immune Complex Reaction Rheumatoid arthritis, lupus, and glomerulonephritis are all examples of what type of hypersensitivity reaction? - Type III: Immune Complex Reaction During this type of reaction, sensitized T cells attack antigens and release cytokines. Macrophages attracted to the area leading to tissue inflammation and destruction - Type IV - Delayed Hypersensitivity Reactions
Hypersensitivity reaction to bacteria (TB test), poison ivy reaction, and rejection of transplanted tissue are all examples of what type of hypersensitivity reaction? - Type IV: Delayed Hypersensitivity Reaction This type of reaction is an autoantibody reaction; "turns on" the action of the affected organ - Type V: Stimulatory Reaction The nursing instructor asks the student nurse to explain a type IV hypersensitivity reaction. Which statement by the student best describes type IV hypersensitivity? A. "It is a reaction of immune globulin (Ig)G with the host cell membrane or antigen." B. "The reaction of sensitized T-cells with antigen and release of lymphokines activate macrophages and induce inflammation." C. "It results in release of mediators, especially histamine, because of the reaction of IgE antibody on mast cells." D. "An immune complex of antigen and antibodies is formed and deposited in the walls of blood vessels." - B. Which of the following is the most common cause of secondary immunodeficiency? A. Stress B. Medications C. Malnutrition D. Human immunodeficiency virus - B Explain the pathophysiology of HIV - - Enters CD4 cells through knobs (GP 120 proteins)
Intermediate phase of HIV / Stage 2 - CD4 200-
- Opportunistic infections may develop (candida albicans and oral hairy leukoplakia)
- Chronic symptoms become worse Late stage of HIV / Stage 3 - AIDS of CD4 <
- Opportunistic infection
- Wasting syndrome
- HIV encephalopathy may develop Best way to determine appropriate treatment for HIV once confirmed? - HIV phenotype and genotype testing Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/μL b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs - C - The nurse should assess the patient for dehydration and hypovolemia. The other patients also will require assessment and possible interventions, but do not require immediate action to prevent complications such as hypovolemia and shock The client who has engaged in needle-sharing activities has developed a flu-like infection. An HIV antibody test is negative. Which statement best describes the scientific rationale for this finding? A: The client is fortunate not to have contracted HIV from an infected needle. B: The client must be repeatedly exposed to HIV before becoming infected. C: The client may be in the primary infection phase of an HIV infection. D: The antibody test is negative because the client has a different flu virus. - C: The primary phase of infection ranges
from being asymptomatic to severe flu-like symptoms, but during this time, the test may be negative although the individual is infected with HIV. Which statements accurately describe HIV infection (select all that apply)? a. Untreated HIV infection has a predictable pattern of progression. b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c. Untreated HIV infection can remain in the early chronic stage for a decade or more. d. Untreated HIV infection usually remains in the early chronic stage for 1 year or less. e. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low - A, B, C - The typical course of untreated HIV infection follows a predictable pattern. However, treatment can significantly alter this pattern, and disease progression is highly individualized. Late chronic infection is another term for acquired immunodeficiency syndrome (AIDS). The median interval between untreated HIV infection and a diagnosis of AIDS is about 11 years. The nurse is monitoring the effectiveness of antiretroviral therapy (ART) for a 56-year-old man with acquired immunodeficiency syndrome (AIDS). What laboratory study result indicates the medications have been effective? a. Increased viral load b. Decreased neutrophil count c. Increased CD4+ T cell count d. Decreased white blood cell count - C - Antiretroviral therapy is effective if there are decreased viral loads and increased CD4+ T cell counts. The nurse on a medical floor is caring for clients diagnosed with AIDS. Which client should be seen first? A. The client who has flushed, warm skin with tented turgor. B. The client who states the staff ignores the call light. C. The client whose vital signs are T 99.9˚F, P 101, R 26, and BP 110/68.
A nurse is caring for a client who is suspected of having HIV. Which of the following diagnostic tests and laboratory values are used to confirm HIV infection? (Select all that apply.) A. Western blot B. Indirect immunofluorescence assay C. CD4+ T-lymphocyte count D. CD4+ T-lymphocyte percentage of total lymphocytes E. Cerebrospinal fluid (CSF) analysis - A, B A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient? a. "The EIA test will need to be repeated to verify the results." b. "A viral culture will be done to determine the progression of the disease." c. "It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)." d. "The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed." - A - After an initial positive EIA test, the EIA is repeated before more specifictesting such as the Western blot is done A 25-year-old male patient has been diagnosed with HIV. The patient does not want to take more than one antiretroviral drug. What reasons can the nurse tell the patient about for taking more than one drug? A. Together they will cure HIV. B. Viral replication will be inhibited. C. They will decrease CD4+ T cell counts. D. It will prevent interaction with other drugs - B - The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance that is a major problem with monotherapy A 52-year-old female patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection?
a. Cough, diarrhea, headaches, blurred vision, muscle fatigue d. Night sweats, fatigue, fever, and persistent generalized lymphadenopathy c. Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpes d. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea - D - Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure. The nurse has just taken a report and is preparing for the day's activities. Which client with AIDS should be seen first? A. The client with Kaposi's sarcoma B. The client with oral leukoplakia C. The client with vaginal candidiasis D. The client with Pneumocystis carinii pneumonia - D - Pneumocystis carinii pneumonia often causes airway closure and alterations in oxygen perfusion A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/L. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient meets the criteria for a diagnosis of an acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year." - C - Development of PCP meets the diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection. The client infected with HIV might be prescribed several medications to control replication of the AIDS virus. The combination of drug therapy is known by the abbreviation: A. ELISA
A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/μL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patient's social support system c. Potential medication side effects d. Patient's ability to comply with ART schedule - D - Drug resistance develops quickly unless the patient takes ART medications on a strict, regular schedule. The other information is also important to consider, but patients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen? a. "Set up" a drug pillbox for the patient every week. b. Give the patient a video and a brochure to view and read at home. c. Tell the patient that the side effects of the drugs are bad but that they go away after a while. d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances. - D
- The best approach to improve adherence to a treatment regimen is to learn about the patient's life and assist with problem solving within the confines of that life A pregnant woman who was tested and diagnosed with HIV infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? A. "The baby will probably be infected with HIV." B. "Only an abortion will keep your baby from having HIV." C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." D. "The duration and frequency of contact with the organism will determine if the baby gets HIV infection." - C - On average, 25% of infants born to women with untreated HIV will be born with HIV. Therisk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. During HIV infection
a. the virus replicates mainly in B-cells before spreading to CD4+ T cells. b. infection of monocytes may occur, but antibodies quickly destroy these cells. c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ Tcells. d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication - C - Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of CD4+ T cells (i.e., T helper cells or CD4+ T lymphocytes). The patient with AIDS has raised, dark purple lesions on the trunk of the body. The nurse anticipates which of the following procedures may be done to confirm that the lesions are due to Kaposi's sarcoma? A. enzyme-linked immunosorbent assay (ELISA) B. Western blot C. Skin biopsy D. Lung tissue sampling - C. Graft from the patient's own body (skin graft) - Autograft Transplant of tissue from two different individuals of same species (such as kidney, bone marrow) - Allograft Transplant of tissue from an individual with the same genotype as the recipient (identical twins) - Isograft Transplant of tissue between two different species - Heterograft Contraindications to donation of organs include.. - Severe, current infections Actively spreading cancer (except brain cancer)
B. A multigravida woman who had multiple blood transfusions after a difficult delivery. C. A middle-aged man with hypertension and a 25 pack-year smoking history D. A young woman with history of Type I diabetes mellitus. - B.
