The Immune System

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A woman comes into the hospital emergency room complaining that she is having problems swallowing and her neck is swelling. She was involved in an automobile accident a couple days ago, but only bruised her neck. What could be the problem?

She is suffering from Hashimoto's thyroiditis.

Harmful or disease-causing microorganisms are called ________.

pathogens

Which of the following is/are not a part of the innate immune defenses?

Inflammation;
Natural killer (NK) cells;
Fever;
T CELLS

What constitutes the body's first line of defense against disease?

intact skin and mucous membranes

T OR F: Cellular ingestion and destruction of particulate matter is called phagocytosis.

TRUE

T OR F: The respiratory burst produced by some macrophages releases free radicals.

TRUE

T OR F: The directional movement of cells in response to chemicals is called chemotaxis.

TRUE

T OR F: Fever is seldom beneficial because it speeds up the cellular metabolic rate and will not allow antigen-antibody reactions to occur.

FALSE

Which of the following is not a function of the inflammatory response?

disposes of cellular debris and pathogens;
sets the stage for repair processes;
prevents the spread of the injurious agent to nearby tissue;
REPLACES INJURED TISSUES WITH CONNECTIVE TISSUE

The redness and heat of an inflamed area are due to a local hyperemia caused by ________.

vasodilation

Which of the following statements regarding NK cells is a false or incorrect statement?

NK cells are present in the blood, spleen, lymph nodes, and red bone marrow;
NK cells attack cancer cells and virus-infected body cells;
NK cells attack cells that display abnormal MHC antigens;
NK CELLS ARE A TYPE OF NEUTROPHIL.

The process whereby neutrophils and other white blood cells are attracted to an inflammatory site is called ________.

chemotaxis

Which of the following is the correct sequence of events in phagocytosis?

chemotaxis, adherence, ingestion, digestion, killing

________ predominate at the sites of chronic infections.

Macrophages

Interferons ________.

interfere with viral replication within cells

Which of the following is a part of the second line of defense against microorganisms?

phagocytes

Cancer cells and virus-infected body cells can be killed before activation of adaptive immunity by

natural killer cells

Complement proteins and antibodies coat a microorganism and provide binding sites, enabling macrophages and neutrophils to phagocytize the organism. This phenomenon is termed ________.

opsonization

Innate immune system defenses include ________.

phagocytosis

Phagocyte mobilization involves ________.

mainly neutrophil and macrophage migration into inflamed areas

Fever ________.

production is regulated by chemicals that reset the body's thermostat to a higher setting

Natural killer (NK) cells ________.

can kill cancer cells before the immune system is activated

Select the correct statement about complement.

An adaptive immune mechanism is often involved in directing complement to its target.

Toll-like receptors (TLRs) trigger the release of ________ to attract white blood cells to the scene.

cytokines

What is the role of interferon in defense against disease?

protects cells that have not yet been infected by viruses

________ cells can lyse and kill cancer cells and virus-infected body cells before the immune system is activated.

Natural Killer

______refers to a group of at least 20 plasma proteins that normally circulate in an inactive state and are a major mechanism for destroying foreign substances in the body.

Complement

Proinflammatory signals include all of the following except:

leukotrienes;
histamines;
ANTIBODIES;
prostaglandins

____________ is the final step of phagocyte mobilization.

Chemotaxis

Which of the following is a role of interferons (IFNs)?

IFNs help the body combat viral infections.

Which of the following is an effect of complement activation?

opsonization

Pyrogens induce __________.

fever

Cellular immunity is attributed to the action of:

T cells

Which of the following is NOT a nonspecific internal defense against disease?

T CELLS;
NK cells;
inflammation;
phagocytes

Which defense mechanism results in redness, heat, pain, and swelling?

Inflammation

Which antimicrobial protein is produced by a virus-infected cell?

interferon

A physician orders Tylenol for a temperature greater than 101 degrees F. The patient's temperature is 100.4 F. What is the rationale for not medicating a fever of 100.4 F?

A mild or moderate fever is an adaptive response that seems to benefit the body. Bacteria need large amounts of zinc and iron to multiply. During fever, the liver and spleen sequester iron and zinc that bacteria need to multiply.

When the white blood cell count is depressed, the classic signs of infection such as redness, heat, and swelling are not manifested. In this case, should the nurse avoid administering aspirin?

Yes, aspirin should be avoided because aspirin would disguise a fever that would indicate infection.

T OR F: Substances capable of triggering the adaptive immune system and provoking an immune response are called antigens.

TRUE

Small molecules that bind with self-proteins to produce antigenic substances are called ________.

haptens

Which of the following is characteristic of complete antigens?

Reactivity with an antibody

Which of the following is not characteristic of the adaptive immune system?

IT IS SPECIFIC FOR A GIVEN ORGAN;
It has memory;
It is systemic;
It is antigen-specific.

Which of the following statements is incorrect or false?

CLASS II MHC MOLECULES APPEAR ONLY ON THE SURFACE OF ANTIGEN-PRESENTING CELLS, THYMIC CELLS, AND T CELLS THAT HAVE BEEN ACTIVATED BY EXPOSURE TO ANTIGENS;
Class 1 MHC molecules are built into the plasma membranes of all body cells;
Haptens lack immunogenicity unless attached to protein carriers;
MHC proteins are the cell's identity markers.

Immunocompetence ________.

is the ability of individual cells to recognize a specific antigen by binding to it

Select the correct statement about antigens.

One antigen may have many different antigenic determinants and may therefore cause the formation of more than one antibody.

Which of the following does not serve as an antigen-presenting cell?

Macrophages;
NATURAL KILLER CELLS;
Dendritic cells;
B cells

T OR F: Some immunocompetent cells will never be called to service in our lifetime.

TRUE

T OR F: Adaptive immunity is provided only by lymphocytes that secrete antibodies.

FALSE

T OR F: Somatic recombination by B cells allows each B cell to form its own unique antibody genes.

TRUE

T OR F: Antigens can be complete or incomplete.

TRUE

T OR F: It is our genes, not antigens, that determine what specific foreign substances our immune system will be able to recognize and resist.

TRUE

B lymphocytes develop immunocompetence in the ________.

bone marrow

________ determine(s) what specific foreign substances our adaptive immune system will be able to recognize and resist.

Our genes

Which of the statements below does not describe antigens?

The parts of antigen molecules that initiate immune responses are called epitopes or antigenic determinants;
Antigens exhibit immunogenicity and reactivity;
Antigens can include proteins, nucleic acids, lipoproteins, glycoproteins, and certain large polysaccharides;
ANTIGENS ONLY COME FROM MICROBES

Which of the following statements is a false or incorrect statement?

T cells and B cells become fully immunocompetent when they bind with recognized antigens;
The lymphoid organs where lymphocytes become immunocompetent are called primary lymph organs. All other lymphoid organs are referred to as secondary lymphoid organs;
It is our genes, not antigens, that determine what specific foreign substances our immune system will be able to recognize and resist;
AFTER BECOMING IMMUNOCOMPETENT, THE NAIVE T CELLS AND B CELLS ARE EXPORTED TO THE BONE MARROW WHERE THE ENCOUNTERS WITH ANTIGENS OCCUR

T cells achieve self-tolerance in the _______.

thymus

Choose the true statement regarding the primary versus the secondary immune response.

A primary response results when naïve lymphocytes are activated, while a secondary response is a result of activating memory cells.

___________ immunity protects a baby who is fed breast milk.

Natural passive

Which of the following does NOT describe the adaptive immune response?

It is specific;
IT OCCURS IMMEDIATELY AFTER THE BODY IS CHALLENGED BY FOREIGN MATERIAL;
It is systemic;
It has memory.

What mobilizes the adaptive defenses and provokes an immune response?

antigens

Which cells engulf antigens and present fragments of them on their own surfaces where they can be recognized by cells that will deal with them?

dendritic cells

T OR F: Soluble proteins secreted by plasma cells are called antibodies.

TRUE

Which of the following is characteristic of antibodies?

composed of heavy and light polypeptide chains

Which of the following is associated with passive immunity?

passage of IgG antibodies from a pregnant mother to her fetus

The antibody molecule is held together by ________ bonds.

disulfide

In clonal selection of B cells, which substance is responsible for determining which cells will eventually become cloned?

antigen

B cells respond to the initial antigen challenge by ________.

producing progeny cells that include plasma cells and memory cells

Monoclonal antibodies are used for the diagnosis of all of the following except ________.

JUVENILE DIABETES;
pregnancy;
rabies;
hepatitis

Select the correct statement about active and passive immunity.

Active and passive humoral immunity are both mechanisms of adaptive immunity that use antibodies.

Clonal selection of B cells ________.

results in the formation of plasma cells

The primary immune response ________.

has a lag period while B cells proliferate and differentiate into plasma cells

Select the correct statement about the function of antibodies.

Complement fixation is the main mechanism by which antibodies provide protection.

Which of the following is true about the number of binding sites per functional antibody unit?

IgM contains 10 binding sites.

Antibody functions include all of the following except ________.

CROSS-LINKING CELL-BOUND ANTIGENS ON RED BLOOD CELLS WHEN BLOOD TYPES ARE PROPERLY MATCHED;
targeting foreign cells so that complement proteins can cause cellular lysis;
binding and inactivating chemical toxins released by bacteria or other microorganisms;
linking soluble antigens together so that they fall out of solution

Which of the following is not a method by which antibodies work?

agglutinating and precipitating antigen;
enhancing phagocytosis;
neutralizing antigen;
ACTIVATING CYTOKINES

Pure antibody preparations specific for a single antigenic determinant are called ________ antibodies.

monoclonal

The antibody that becomes bound to mast cells and basophils and causes the cells to release histamine and other chemicals is ________.

IgE

A(n) ________ is a cell hybrid formed from the fusion of tumor cells and B lymphocytes.

hybridoma

________ is the most abundant class of antibodies in plasma.

IgG

________ are lymphocytes that directly kill virus infected cells.

T cytotoxic cells

Antigens bound to MHC II activate:

T helper cells

Why are children given vaccinations?

to develop antibodies against various diseases

Max is bitten by a rattlesnake while on a camping trip. His friends immediately apply ice packs to the bitten area to slow the spread of the protein-based toxin; they then rush him to an emergency facility. What treatment would be given, and what type of immunity did he receive/generate?

Max would be given anti-venom to the rattlesnake venom, thereby conferring passive immunity.

Class II MHC proteins are found on which of the following cell types?

antigen-presenting cells

Which class of MHC proteins presents exogenous antigens?

class II MHC proteins

Class I MHC proteins are recognized by which of the following cell types (that are destined to become T cells)?

CD8

Which of the following types of cells display protein fragments produced by the cancer within them?

all nucleated cells

Which major class of lymphocytes become cytotoxic T cells?

CD8

T OR F: A graft from a monkey to a human is an example of an allograft.

FALSE

T OR F: The mechanism of the "lethal hit" of cytotoxic T cells and NK cells involves a protein called perforin.

TRUE

T OR F: A given pathogen will provoke either a cell-mediated response or an antibody-mediated response but not both.

FALSE

T OR F: Monoclonal antibodies can be specific for several antigenic determinants.

FALSE

T OR F: Both T cells and B cells must accomplish double recognition: They must simultaneously recognize self and nonself to be activated.

FALSE

Which of the following is not a type of T cell?

regulatory;
helper;
ANTIGENIC;
cytotoxic

The only T cells that can directly attack and kill other cells are the ________.

cytotoxic cells

Which of the following does not respond to cell-mediated immunity?

PATHOGENS IN THE CNS;
intracellular pathogens that reside within host cells;
foreign tissue transplants;
some cancer cells

Regulatory T cells ________.

may function in preventing autoimmune reactions

Select the correct definition about tissue grafts.

Isografts are between identical twins.

________ are released by activated T cells and macrophages to mobilize immune cells and attract other leukocytes into the area.

Cytokines

Graft rejection may be caused by ________.

using a xenograft

Cytotoxic T cells ________.

are the only T cells that can directly attack and kill other cells

Helper T cells ________.

function in the adaptive immune system activation

Which of the following cells is the most critical cell in immunity?

helper T cell

Which statement is true about T cells?

Their proliferation is enhanced by interleukins 1 and 2.

________ are grafts taken from another animal species.

xenografts

________ cells are the only T lymphocytes that can directly attack and kill other cells.

Cytotoxic T cells

What occurs if a T cell binds to an antigen and the T cell does not receive a co-stimulatory signal?

The T cell enters a state of anergy.

_______ are lymphocytes that coordinate cellular and humoral immune responses.

T helper cells

Which class of tissue graft is the least likely to be accepted by a patient's body?

xenograft

Which is mismatched?

AIDS: T helper cells are destroyed by a virus;
Severe combined immunodeficiency syndrome (SCID): genetic defect resulting in a shortage of B and/or T cells;
Multiple sclerosis: autoimmune disorder;
IMMEDIATE HYPERSENSITIVITY: ALLERGIC CONTACT DERMATITIS

T OR F: Fever is one of the cardinal signs of inflammation.

FALSE

Which cell of the immune system is absolutely required for an adaptive immune response?

Helper T cell

What types of antigen are recognized by T cells?

processed fragments of protein antigens displayed on surfaces of body cells

A young girl requires a liver transplant due to failure of her liver to function. What is required for her to have a good prognosis, and what must be performed after the operation?

ABO and Rh typing must be performed, followed by MHC typing. Following surgery, she must receive immunosuppressive therapy to keep her body from rejecting the new liver as foreign tissue.

T OR F: Anaphylactic shock can result from an immediate hypersensitivity where the allergen enters the blood.

TRUE

T OR F: A transfusion reaction is a subacute hypersensitivity to foreign red blood cells.

TRUE

Which of the following would be classified as a delayed hypersensitivity reaction?

allergic contact dermatitis

Select the correct statement about immunodeficiency.

The causative agent in acquired immune deficiency syndrome (AIDS) is a virus that recognizes CD4 proteins.

Which of the following is true of immediate hypersensitivities?

They involve IgE antibodies and the release of histamine from mast cells and basophils.

Delayed hypersensitivities ________.

include allergic contact dermatitis

Which of the following is not an autoimmune disease?

TYPE II DIABETES;
systemic lupus erythematosus;
multiple sclerosis;
glomerulonephritis

Which of the following is not a mechanism for the development of autoimmune disorders?

A SECOND EXPOSURE TO AN ALLERGEN;
Mutation followed by the appearance of membrane proteins not previously present;
Exposure of previously "hidden" self-antigens to the adaptive immune system;
Cross-reaction of antibodies formed against foreign antigens with self-antigens

________ is the most common type of immediate hypersensitivity.

Allergy

________ is an autoimmune disease that severely impairs renal function.

Glomerulonephritis

T OR F: MHC I proteins (major histocompatibility class I proteins) are found on most cells of the body.

TRUE

A 36-year-old man enters the hospital in an extremely debilitated condition. He has purple-brown skin lesions (a symptom of Kaposi's sarcoma) and a persistent cough. A physical examination reveals swollen lymph nodes, and laboratory tests find a very low lymphocyte count. Information taken during the personal history reveals that he has multiple sex partners with whom he frequently engages in unprotected sex. What is likely to be the man's problem and what is his prognosis?

He is probably suffering from AIDS. His outlook is poor once the disease has progressed to this advanced stage. There is no cure, and drug therapy has had limited short-term success.

Why does nursing care of a patient with acquired immune deficiency syndrome (AIDS) include monitoring of T lymphocyte counts?

A decrease in the number of T cells would make the patient more susceptible to infection and unusual cancers.

After receiving penicillin intravenously, a 32-year-old male patient has an anaphylactic reaction. The nurse understands that therapeutic management includes what critical items?

Maintaining an open airway because the bronchioles can constrict, making it difficult to breathe

Select the correct statement about the prevention of immune attack on "self."

Tolerance is developed during fetal life.

________ is a dangerous condition where the cytokines are released unchecked, making the capillaries very leaky and thus depleting blood fluids.

Septic shock or Sepsis

Which of the following best describes the immune system?

The diverse set of molecules and immune cells that are found in lymphoid tissue and fluids throughout the body.

Which of the following act as the first line of defense against foreign pathogens?

skin; mucous membranes

The two intrinsic defense systems have many components. Which of the following cell types is not a contributor to specific immunity?

NATURAL KILLER CELLS;
plasma cells;
B cells;
T cells

Which of the following is not a mechanical barrier to pathogen invasion?

mucus;
lysozyme in tears;
saliva;
INTERFERON

Macrophages are derived from _____.

monocytes

In order for some phagocytes to destroy certain pathogens they have ingested (like tuberculosis), _____ must be deployed.

the respiratory burst

___and ___ are the most common phagocytic cells in the blood.

Neutrophils; monocytes

What characteristic do all inflammatory chemicals share?

They are all vasodilators.

An increase in white blood cell number at sites of injury, which is characteristic of inflammation, is called ______.

leukocytosis

The process by which phagocytes exit capillaries and enter injured tissue is called _____.

diapedesis

Your hand has a scratch. What signals would indicate that the injury is inflammed?

Red, hot, swollen, painful

A patient has contracted the hepatitis C virus. Which of the following drug therapies might be affective?

Interferon

The basic mechanism employed by complement to fight bacterial infections is ____.

bacterial cell membrane lysis

The process of attaching complement proteins to the bacterial cell wall to enhance phagocytosis is called ______.

opsonization

What would be the body's response if the hypothalamus detected pyrogens?

an increase in body temperature set point

Which of the following materials or compounds would be the most highly immunogenic?

Nonself-antibody

The presence of ____ proteins makes it possible for our immune system to differentiate between our cells and those that are foreign.

MHC

The adaptive immune system involves three major cell types: antigen-presenting cells, T cells, which constitute ____ immunity, and B cells, which govern ____ immunity.

cell-mediated; humoral

______ become antigenic if they attach themselves to larger proteins.

Haptens

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