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Exam (elaborations)

Chapter 15- Introduction to the Immune Response and Inflammation

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Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing process 1.Which of the following is considered the body's first line of barrier defense? A) Mast cells B) Mucous membranes C) Skin D) T cells Ans: C Response: The skin is the first line of barrier defense. The skin acts as a physical barrier to protect the internal tissues and organs of the body. Mast cells are part of cellular defense; they are found in the respiratory and gastrointestinal tracts and are fixed basophils that do not circulate. Mucous membranes are a barrier defense that line the areas of the body that are exposed to external influences but do not have the benefit of skin protection. T cells are part of the immune response and provide cell-mediated immunity. Activation of a T-cell by a nonself-cell results in responses that destroy foreign cells. Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process 2.Which of the following patients has lost a barrier defense that renders him at high risk for infection? A) A 68-year-old male who has prostrate cancer B) A 24-year-old male who has second-degree burns over one-third of his body C) A 13-year-old who as chickenpox D) A 72-year-old male with bacterial pneumonia Ans: B Response: A burn patient loses the protective barrier of the skin and is at risk for infection. In a second-degree burn the glands of the skin secrete chemicals that destroy many pathogens and also the normal flora that live on the skin. A cancer patient has decreased cellular defenses. The patients with chickenpox and pneumonia both have a diminished immune defense, along with the prostate cancer patient, but are at less risk for infection than the burn patient. Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Communication and documentation 3.A nurse is reviewing the results of a complete blood count on a patient who is diagnosed with an acute infection. Which of the following will the nurse expect to see elevated? A) Basophil count B) Eosinophil count C) Hematocrit D) Neutrophil count Ans: D This study source was downloaded by from CourseH on :09:04 GMT -05:00 Page 1 This study resource was shared via CourseH Chapter 15: Introduction to the Immune Response and Inflammation Response: During an acute infection, the neutrophils are rapidly produced in response to the interleukins released by active white blood cells. They move to the site of insult to attack the foreign substance. Eosinophils are often increased in an allergic response and basophils would only increase with generalized bone marrow stimulation. The hematocrit is increased in polycythemia. Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process 4.A nurse is explaining to a new mother why she is not alarmed by her daughter's temperature of 102ºF. Which of the following statements would be the nurse's best response? A) “A fever actually increases the efficiency of the immune and inflammatory responses.” B) “Neutrophils release pyrogen, a fever-causing substance, that helps act as a catalyst for the body's inflammatory and immune responses.” C) “Leukotrienes activated by arachidonic acid attract neutrophils to start the process of fighting inflammation.” D) “Inflammation causes the activation of a chemical called Hageman factor that initiates a process to bring more blood to the injured area and allows white blood cells to escape into the tissues.” Ans: A Response: The best response by the nurse would be that a fever actually increases the efficiency of the immune and inflammatory responses. While the other three statements are correct, they are technical and include terminology that a new mother may not understand or even care about. If the appropriate response does not suffice and the

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