NUR 372 Exam 4 Questions and Correct
Answers, With Complete Solution, 207 Q&A.
2024/2025.
neutrophils
- phagocytes of early inflammation that destroy bacteria
- 55-70%
lymphocytes
- B and T cells
- 20-40%
monocytes
- macrophages: initiators of the inflammatory response, digest and destroy
microorganisms and debris
- dendritic cells: phagocytes that present processed antigens to other immune cells
- 2-5%
eosinophils
- phagocytes that destroy allergens and parasitic infections
- 1-4%
basophils
- release heparin as an anticoagulant and histamine during early inflammatory response
- 0.5-1%
leukopenia
- total WBC < 4000
- indicates drug toxicity, autoimmune disease, bone marrow failure, overwhelming
infection
leukocytosis
- total WBC > 10000
- indicates inflammation, infection, some malignancies, trauma, dehydration, stress,
steroid use, thyroid storm
- splenectomy will cause persistent leukocytosis
- older adult clients can have severe bacterial infection without leukocytosis
neutropenia
- neutrophils < 2000
- indicates viral infections, overwhelming bacterial infections, chemo radiation
- will be at increased risk of infection
- precautions: restrict visitors, live plants, fresh fruits/vegetables, no rectal temps or IM
injections
left shift
- increase of immature neutrophils that occur with acute infections
- acute infections cause neutrophil production to increase so fast that immature
neutrophils, which are not capable of phagocytosis, are released
dendritic cells
,- type of monocyte
- antigen presenting cells: captures and engulfs antigens producing the major
histocompatibility complex molecule, which identifies the antigen to help B and T cells in
recognition and response
mast cells
- found in skin and lining of the respiratory and GI tracts
-release heparin and histamine during early inflammatory response
- responsible for allergic reactions including anaphylaxis
B cells
- humoral immune response: defends through circulating antibodies
- plasma cells secrete antibodies after the first exposure to the antigen
- memory cells are restimulated by the same antigen and mount specific antigen-
antibody response
T cells
- cellular mediated immune response, defend by cell to cell contact
- helper (CD4) activate macrophages, B cells, cytotoxic T and NK cells
- cytotoxic (CD8) respond to foreign cells
- suppressor cells are activated by helper T cells when immune response is no longer
needed
- natural killer cells target virus infected and tumor cells
primary immune dysfunction
- congenital
- immune system that is deficient or is limited in its ability to function
secondary immune dysfunction
- always acquired
- secondary to another disease process or exposure to medications or chemicals
- ex HIV, radiation, chemotherapy, malnutrition, or burns
excessive immune response
- if the immune system is initiated inappropriately or it overreacts, autoimmunity or
hypersensitivity occurs
- autoimmune disorders occur when antibodies are formed to attack normal healthy self
cells
- hypersensitivity reaction is an overreactive response to a foreign antigen
- degree of reaction ranging to uncomfortable to fatal
type I hypersensitivity reaction
- most common type
- results from an increased release of IgE to an antigen that causes histamine and all of
the other vasoactive related WBCs to be released
- allergens can be inhaled, ingested, injected, or contacted
- onset is within one hour
- ex anaphylaxis
type I hypersensitivity medical management
- allergy testing
- avoidance of triggers
- antihistamines, decongestants, steroids, bronchodilators, epinephrine IM for severe
reactions
, type I hypersensitivity nursing management
- monitor respiratory function, BP, HR
- remove allergen, O2 100% via nonrebreather, elevate HOB, medication
administration, have resuscitation equipment available, stay with patient
- teaching: how to avoid allergen exposure, s/s of initial reaction, use of epipen, medic
alert bracelet/pendant
allergy testing
- patient prep: discontinue steroids and antihistamines prior
- procedure: ambu bag, oxygen, IV start kit, epi/benadryl
- follow up care: post procedure meds, driver
type II hypersensitivity reaction
- subtype 1 (complement and antibody mediated cell destruction): destroys cells, led by
IgM and IgG antibodies, ex blood transfusion reactions
- subtype 2 (complement and antibody mediated inflammation): Goodpasture's
syndrome leads to deposits of IgG on the basement membranes of lungs and kidneys
- subtype 3 (antibody mediated cellular dysfunction): myasthenia gravis results in
autoantibodies attaching to ACh receptors on neuromuscular endplates
type III hypersensitivity reaction
- mediated by the formation of antigen antibody complexes
- systemic: lupus erythematosus, rheumatoid arthritis, serum sickness
- local: arthus reaction
- treatment: remove offending agent, symptomatic treatment, epinephrine or
corticosteroids
type IV hypersensitivity reaction
- delayed reaction
- ex poison ivy, Mantoux test for TB, latex allergy (can also be type I)
- treatments: steroid skin creams, antihistamines, epinephrine, IV corticosteroids
contact precautions
- clean hands, gown, gloves
- ex MRSA, VRE, lice, RSV
droplet precautions
- clean hands, mask, eye protection
- ex flu, pertussis, meningitis
airborne precautions
- clean hands, N95
- ex TB, measles, varicella
MRSA
- result of decades of unnecessary antibiotic use
- resistant to penicillin, cephalosporin, carbapenem
- treatment: vancomycin
MRSA s/s
- pneumonia
- skin and soft tissue infections
- surgical site infections
- bloodstream infections
Answers, With Complete Solution, 207 Q&A.
2024/2025.
neutrophils
- phagocytes of early inflammation that destroy bacteria
- 55-70%
lymphocytes
- B and T cells
- 20-40%
monocytes
- macrophages: initiators of the inflammatory response, digest and destroy
microorganisms and debris
- dendritic cells: phagocytes that present processed antigens to other immune cells
- 2-5%
eosinophils
- phagocytes that destroy allergens and parasitic infections
- 1-4%
basophils
- release heparin as an anticoagulant and histamine during early inflammatory response
- 0.5-1%
leukopenia
- total WBC < 4000
- indicates drug toxicity, autoimmune disease, bone marrow failure, overwhelming
infection
leukocytosis
- total WBC > 10000
- indicates inflammation, infection, some malignancies, trauma, dehydration, stress,
steroid use, thyroid storm
- splenectomy will cause persistent leukocytosis
- older adult clients can have severe bacterial infection without leukocytosis
neutropenia
- neutrophils < 2000
- indicates viral infections, overwhelming bacterial infections, chemo radiation
- will be at increased risk of infection
- precautions: restrict visitors, live plants, fresh fruits/vegetables, no rectal temps or IM
injections
left shift
- increase of immature neutrophils that occur with acute infections
- acute infections cause neutrophil production to increase so fast that immature
neutrophils, which are not capable of phagocytosis, are released
dendritic cells
,- type of monocyte
- antigen presenting cells: captures and engulfs antigens producing the major
histocompatibility complex molecule, which identifies the antigen to help B and T cells in
recognition and response
mast cells
- found in skin and lining of the respiratory and GI tracts
-release heparin and histamine during early inflammatory response
- responsible for allergic reactions including anaphylaxis
B cells
- humoral immune response: defends through circulating antibodies
- plasma cells secrete antibodies after the first exposure to the antigen
- memory cells are restimulated by the same antigen and mount specific antigen-
antibody response
T cells
- cellular mediated immune response, defend by cell to cell contact
- helper (CD4) activate macrophages, B cells, cytotoxic T and NK cells
- cytotoxic (CD8) respond to foreign cells
- suppressor cells are activated by helper T cells when immune response is no longer
needed
- natural killer cells target virus infected and tumor cells
primary immune dysfunction
- congenital
- immune system that is deficient or is limited in its ability to function
secondary immune dysfunction
- always acquired
- secondary to another disease process or exposure to medications or chemicals
- ex HIV, radiation, chemotherapy, malnutrition, or burns
excessive immune response
- if the immune system is initiated inappropriately or it overreacts, autoimmunity or
hypersensitivity occurs
- autoimmune disorders occur when antibodies are formed to attack normal healthy self
cells
- hypersensitivity reaction is an overreactive response to a foreign antigen
- degree of reaction ranging to uncomfortable to fatal
type I hypersensitivity reaction
- most common type
- results from an increased release of IgE to an antigen that causes histamine and all of
the other vasoactive related WBCs to be released
- allergens can be inhaled, ingested, injected, or contacted
- onset is within one hour
- ex anaphylaxis
type I hypersensitivity medical management
- allergy testing
- avoidance of triggers
- antihistamines, decongestants, steroids, bronchodilators, epinephrine IM for severe
reactions
, type I hypersensitivity nursing management
- monitor respiratory function, BP, HR
- remove allergen, O2 100% via nonrebreather, elevate HOB, medication
administration, have resuscitation equipment available, stay with patient
- teaching: how to avoid allergen exposure, s/s of initial reaction, use of epipen, medic
alert bracelet/pendant
allergy testing
- patient prep: discontinue steroids and antihistamines prior
- procedure: ambu bag, oxygen, IV start kit, epi/benadryl
- follow up care: post procedure meds, driver
type II hypersensitivity reaction
- subtype 1 (complement and antibody mediated cell destruction): destroys cells, led by
IgM and IgG antibodies, ex blood transfusion reactions
- subtype 2 (complement and antibody mediated inflammation): Goodpasture's
syndrome leads to deposits of IgG on the basement membranes of lungs and kidneys
- subtype 3 (antibody mediated cellular dysfunction): myasthenia gravis results in
autoantibodies attaching to ACh receptors on neuromuscular endplates
type III hypersensitivity reaction
- mediated by the formation of antigen antibody complexes
- systemic: lupus erythematosus, rheumatoid arthritis, serum sickness
- local: arthus reaction
- treatment: remove offending agent, symptomatic treatment, epinephrine or
corticosteroids
type IV hypersensitivity reaction
- delayed reaction
- ex poison ivy, Mantoux test for TB, latex allergy (can also be type I)
- treatments: steroid skin creams, antihistamines, epinephrine, IV corticosteroids
contact precautions
- clean hands, gown, gloves
- ex MRSA, VRE, lice, RSV
droplet precautions
- clean hands, mask, eye protection
- ex flu, pertussis, meningitis
airborne precautions
- clean hands, N95
- ex TB, measles, varicella
MRSA
- result of decades of unnecessary antibiotic use
- resistant to penicillin, cephalosporin, carbapenem
- treatment: vancomycin
MRSA s/s
- pneumonia
- skin and soft tissue infections
- surgical site infections
- bloodstream infections
