NUR-631 Final Exam QUESTIONS AND ANSWERS WITH RATIONALES / NUR 631 FINAL EXAM QUESTIONS LATEST REAL EXAM QUESTIONS

NUR-631 Final Exam QUESTIONS AND ANSWERS WITH RATIONALES / NUR 631 FINAL EXAM QUESTIONS LATEST REAL EXAM QUESTIONS In which structure does B lymphocytes mature and undergo changes that commit them to becoming B cells? Thymus gland Regional lymph nodes Bone marrow Spleen - ANSWER- ANS: C RATIONALE: B lymphocytes mature and become B cells in specialized (primary) lymphoid organs—the thymus gland for T cells and the bone marrow for B cells. Neither regional lymph nodes nor the spleen are involved in changing B lymphocytes into B cells. An individual's acquired immunity is dependent on the function of which cells? (Select all that apply.) T lymphocytes B lymphocytes Macrophages Opsonins Neutrophils - ANSWER- ANS: A, B, C RATIONALE: T lymphocytes, B lymphocytes, macrophages, and dendritic cells are involved in acquired immunity. Opsonins are molecules that tag microorganisms for destruction by cells of the inflammatory system; these cells are primarily neutrophils. Neutrophils are white blood cells. The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulins? IgE IgG IgM T cells - ANSWER- ANS: A RATIONALE: Type I reactions are mediated by antigen-specific IgE and the products of tissue mast cells. The most common allergies (e.g., pollen allergies) are type I reactions. In addition, most type I reactions occur against environmental antigens and are therefore allergic. Hay fever allergy is not mediated by IgG, IgM, or T cells. During an IgE-mediated hypersensitivity reaction, which leukocyte is activated? a. Neutrophils b. Monocytes c. Eosinophils d. T lymphocytes - ANSWER- ANS: C RATIONALE: Of the options provided, only eosinophils are activated during IgEmediated hypersensitivity reactions. During an IgE-mediated hypersensitivity reaction, what causes bronchospasm? a. Bronchial edema caused by the chemotactic factor of anaphylaxis b. Bronchial edema caused by binding of the cytotropic antibody c. Smooth muscle contraction caused by histamine bound to H1 receptors d. Smooth muscle contraction caused by histamine bound to H2 receptors - ANSWER- ANS: C RATIONALE: During an IgE-mediated hypersensitivity reaction, smooth muscle contraction caused by histamine bound to H1 receptors results in bronchospasms. The bronchospasm is not caused by edema or by histamine binding to H2 receptors. A patient is having an IgE-mediated hypersensitivity reaction. What action by the healthcare professional is best? a. Give the patient an antihistamine. b. Prepare to give the patient a blood transfusion. c. Ask the patient is he/she is having pain at the site. d. Apply warm, moist heat to the affected area. - ANSWER- ANS: A RATIONALE: Histamine is the most potent mediator in an IgE-mediated hypersensitivity reaction (Type 1). Histamine bound to H2 results in the degranulation of mast cells with the release of histamine. Blocking histamine receptors with antihistamines can control some type I responses. The healthcare professional would not need to give the patient blood; warm; moist heat; or ask about pain. A student asks about the mechanism that results in type II hypersensitivity reactions. What description by the professor is best? a. Antibodies coat mast cells by binding to receptors that signal its degranulation, followed by a discharge of preformed mediators. b. Antibodies bind to soluble antigens that were released into body fluids, and the immune complexes are then deposited in the tissues. c. Cytotoxic T lymphocytes or lymphokine-producing helper T 1 cells directly attack and destroy cellular targets. d. Antibodies bind to the antigens on the cell surface. - ANSWER- ANS: D RATIONALE: The mechanism that results in a type II hypersensitivity reaction begins with antibody binding to tissue-specific antigens or antigens that have attached to particular tissues. The cell can be destroyed by antibody IgG or IgM and activation of the complement cascade through the classical pathway. How are target cells destroyed in a type II hypersensitivity reaction? a. Tissue damage from mast cell degranulation b. Antigen-antibody complexes deposited in vessel walls c. Cytotoxic T lymphocytes attack the cell directly. d. Natural killer cells - ANSWER- ANS: D RATIONALE: The mechanism that results in a type II hypersensitivity reaction involves a subpopulation of cytotoxic cells that are not antigen specific (natural killer [NK] cells). Antibody on the target cell is recognized by Fc receptors on the NK cells, which releases toxic substances that destroy the target cell. Tissue damage from mast cell degranulation occurs in type I hypersensitivity reactions. Antigen-antibody complexes are active in type III hypersensitivity responses. Cytotoxic lymphocytes are involved in type IV hypersensitivity responses. Graves disease (hyperthyroidism) is an example of which type II hypersensitivity reaction? a. Modulation b. Antibody-dependent cell-mediated cytotoxicity c. Neutrophil-mediated damage d. Complement-mediated lysis - ANSWER- ANS: A RATIONALE: The antibody reacts with the receptors on the target cell surface and modulates the function of the receptor by preventing interactions with their normal ligands, replacing the ligand and inappropriately stimulating the receptor or destroying the receptor. For example, in the hyperthyroidism (excessive thyroid activity) of Graves disease, autoantibody binds to and activates receptors for thyroid-stimulating hormone (TSH) (a pituitary hormone that controls the production of the hormone thyroxine by the thyroid). Graves disease is not a result of cell- mediated cytotoxicity, neutrophil-mediated damage, or complementmediated lysis. Immunoglobulin E (IgE) is associated with which type of hypersensitivity reaction? a. I b. II c. III d. IV - ANSWER- ANS: A RATIONALE: Hypersensitivity reactions have been divided into four distinct types: type I (IgE-mediated) hypersensitivity reactions, type II (tissue-specific) hypersensitivity reactions, type III (immune complex-mediated) hypersensitivity reactions, and type IV (cell-mediated) hypersensitivity reactions. A Rh-negative woman gave birth to a Rh-positive baby. When discussing Rho[D] immunoglobulin with her, what information should the healthcare professional provide? It provides protection against infection from poor immunity in the baby. It prevents alloimmunity and hemolytic anemia of the newborn. It provides necessary antibodies in case the mother doesn't breastfeed. It causes the intestinal tract of the newborn to produce antibodies. - ANSWERANS: B RATIONALE: Alloimmunity occurs when an individual's immune system reacts against antigens on the tissues of other members of the same species. This can occur when a woman is Rh-negative and gives birth to an Rh-positive baby, leading to hemolytic anemia of the newborn. Rho[D] immunoglobulin does not provide protection against infection, provide antibodies to a bottle-fed baby, or cause the intestine to produce antibodies. Which mother does the healthcare professional prepare to administer Rh immune globulin (Rho- GAM) to? a. Is Rh-positive and the fetus is Rh-negative b. Is Rh-negative and the fetus is Rh-positive c. Has type A blood and the fetus has type O d. Has type AB blood and the fetus has type B - ANSWER- ANS: B RATIONALE: Hemolytic disease of the fetus and newborn (HDFN) can occur only if antigens on fetal erythrocytes differ from antigens on maternal erythrocytes. Maternal-fetal incompatibility exists only if the mother and fetus differ in ABO blood type or if the fetus is Rh-positive and the mother is Rh-negative. The healthcare professional would plan to administer Rho-GAM to the mother who is Rh-negative whose baby is Rh positive. A patient has microcytic, hypochromic anemia. Which type of treatment or procedure does the healthcare professional discuss as a potential cure with the patient? a. Cord blood transplantation b. Scheduled infusion of gamma globulins c. Massive blood transfusions d. Repeated injections of Rho-GAM - ANSWER- ANS: A RATIONALE: Microcytic, hypochromic anemia is one manifestation of thalassemia. The only definitive cures for this disorder are allogeneic hematopoietic stem cell transplantation (HSCT) from a matched family or unrelated donor or cord blood transplantation from a related donor. Gamma globulins protect the body against infectious diseases. Blood transfusions can be used to correct low hemoglobin. Rho-GAM is used in postpartum women who are Rh-negative after delivering an Rh-positive baby to prevent development of maternal antibodies against the baby's blood. An infant was born with hemolytic disease of the fetus and newborn (HDFN). What treatment does the healthcare professional anticipate for this baby? Administration of intravenous fluids to dilute the blood Replacement transfusion of Rh-positive blood not contaminated with anti-Rh antibodies Performance of a splenectomy to prevent the destruction of abnormal erythrocytes Replacement transfusion of Rh-negative erythrocytes - ANSWER- ANS: B RATIONALE: If antigenic incompatibility of the mother's erythrocytes is not discovered in time to administer Rh immunoglobulin and the child is born with HDFN, then the treatment consists of exchange transfusions in which the neonate's blood is replaced with new Rh-positive blood that is not contaminated with anti-Rh antibodies. This treatment is administered during the first 24 hours of extrauterine life to prevent kernicterus. Kernicterus is not prevented by diluting the blood with IV fluids, splenectomy, or by giving Rh-negative blood.