NUR 631 TEST BANK-with 100% verified solutions-2024-2025.docx, Exams of Nursing

Download NUR 631 TEST BANK-with 100% verified solutions-2024-2025.docx and more Exams Nursing in PDF only on Docsity! NUR 631 TEST BANK-with 100% verified solutions-2024- 2025 The single best defining description of the classical pathway of complement activation is: A It acts as a cascade B It produces a C5 convertase C In generates the membrane attack complex (MAC) D It results in the splitting of C3 into C3a and C3b E It utilizes complement component C1r 2. The single best defining feature of a lymphocyte is that it is: A A type of leukocyte B A cell that is specialized to produce cytokines C Present in the circulation D Antigen-specific E Able to undergo cell proliferation 3. The characteristic that best defines the acquired immune response IMMUNOLOGY[dse1] From Medical Microbiology & Immunology Examination & Board Review, 6th ed., 2000 W. Levinson & E. Jawetz Directions (Questions 387-474): Select the ONE lettered answer that is BEST in each question. 387. Which category of hypersensitivity BEST describes hemolytic disease of the newborn caused by Rh incompatibility? A. atopic or anaphylactic B. cytotoxic C. immune complex D. delayed 388. The principal difference between cytotoxic (type II) and immune complex (type III) hypersensitivity is A. the class (isotype) of antibody. B. the site where antigen-antibody complexes are formed. C. the participation of complement. D. the participation of T cells. 389. A child stung by a bee experiences respiratory distress within minutes and lapses into unconsciousness. This reaction is probably mediated by D. complement components will not be matched. 395. Bone marrow transplantation in immunocompromised patients presents which major problem? A. potentially lethal graft-versus-host disease B. high risk of T cell leukemia C. inability to use a live donor D. delayed hypersensitivity 396. What is the role of class II MHC proteins on donor cells in graft rejection? A. They are the receptors for interleukin-2, which is produced by macrophages when they attack the donor cells. B. They are recognized by helper T cells, which then activate cytotoxic T cells to kill the donor cells. C. They induce the production of blocking antibodies that protect the graft. D. They induce IgE which mediates graft rejection. 397. Grafts between genetically identical individuals (i.e., identical twins) A. are rejected slowly as a result of minor histocompatibility antigens. B. are subject to hyperacute rejection. C. are not rejected, even without immunosuppression. D. are not rejected if a kidney is grafted, but skin grafts are rejected. 398. Penicillin is a hapten in both humans and mice. To explore the hapten-carrier relationship, a mouse was injected with penicillin covalently bound to bovine serum albumin and, at the same time, with egg albumin to which no penicillin was bound. Of the following, which one will induce a secondary response to penicillin when injected into the mouse 1 month later? A. penicillin B. penicillin bound to egg albumin C. egg albumin D. bovine serum albumin 399. AIDS is caused by a human retrovirus that kills A. B lymphocytes. B. lymphocyte stem cells. C. CD4-positive T lymphocytes. D. CD8-positive T lymphocytes. 400. Chemically-induced tumors have tumor-associated transplantation antigens that A. are always the same for a given carcinogen. B. are different for two tumors of different histologic type even if induced by the same carcinogen. C. are very strong antigens. D. do not induce an immune response. 401. Polyomavirus (a DNA virus) causes tumors in "nude mice" (nude mice do not have a thymus, because of a genetic defect) but not in normal mice. the BEST interpretation is that A. macrophages are required to reject polyomavirus-induced tumors. B. natural killer cells can reject polyomavirus-induced tumors without help from T lymphocytes. C. T lymphocytes play an important role in the rejection of polyomavirus-induced tumors. D. B lymphocytes play no role in rejection of polyomavirus-induced tumors. 402. C3 is cleaved to form C3a and C3b by C3 convertase. C3b is involved in all of the following EXCEPT A. altering vascular permeability. B. promoting phagocytosis. C. forming alternative-pathway C3 convertase. D. forming C5 convertase. 403. After binding to its specific antigen, a B lymphocyte may switch its A. immunoglobulin light-chain isotype. B. immunoglobulin heavy-chain class. C. variable region of the immunoglobulin heavy chain. D. constant region of the immunoglobulin light chain. A. decreased resistance to viral infections. B. increased hypersensitivity reactions. C. increased frequency of cancer. D. decreased resistance to Neisseria bacteremia. 411. Natural killer cells are A. B cells that can kill without complement. B. cytotoxic T cells. C. increased by immunization. D. able to kill virus-infected cells without prior sensitization. 412. A positive tuberculin skin test (a delayed hypersensitivity reaction) indicates that A. a humoral immune response has occurred. B. a cell-mediated immune response has occurred. C. both the T and B cell systems are functional. D. only the B cell system is functional. 413. Reaction to poison ivy or poison oak is A. an IgG-mediated response. B. an IgE-mediated response. C. a cell-mediated response. D. an Arthus reaction. 414. A child disturbs a wasp nest, is stung repeatedly, and goes into shock within minutes, manifesting respiratory failure and vascular collapse. This is MOST likely to be due to A. systemic anaphylaxis. B. serum sickness. C. an Arthus reaction. D. cytotoxic hypersensitivity. 415. "Isotype switching" of immunoglobulin classes by B cells involves A. simultaneous insertion of VH genes adjacent to each CH gene. B. successive insertion of a single VH gene adjacent to different CH genes. C. activation of homologous genes on chromosome 6. D. switching of light-chain types (kappa and lambda). 416. Which one of the following pairs of genes is linked on a single chromosome? A. V gene for lambda chain and C gene for kappa chain B. C gene for gamma chain and C gene for kappa chain C. V gene for lambda chain and V gene for heavy chain D. C gene for gamma chain and C gene for alpha chain 417. Idiotypic determinants are located within A. hypervariable regions of heavy and light chains. B. constant regions of light chains. C. constant regions of heavy chains. D. the hinge region. 418. A primary immune response in an adult human requires approximately how much time to produce detectable antibody levels in the blood? A. 12 hours B. 3 days C. 1 week D. 3 weeks 419. The membrane IgM and IgD on the surface of an individual B cell A. have identical heavy chains but different light chains B. are identical except for their CH regions C. are identical except for their VH regions D. have different VH and VL regions enters the cells and activates them. 426. A patient with a central nervous system disorder is maintained on the drug methyldopa. Hemolytic anemia develops, which resolves shortly after the drug is withdrawn. This is MOST probably an example of A. atopic hypersensitivity. B. cytotoxic hypersensitivity. C. immune-complex hypersensitivity. D. cell-mediated hypersensitivity. 427. Which one of the following substances is NOT released by activated helper T cells? A. interleukin-1 B. gamma interferon C. interleukin-2 D. interleukin-4 428. A delayed hypersensitivity reaction is characterized by A. edema without a cellular infiltrate. B. an infiltrate composed of neutrophils. C. an infiltrate composed of helper T cells and macrophages D. an infiltrate composed of eosinophils. 429. Two dissimilar inbred strains of mice, A and B, are crossed to yield an F1 hybrid strain, AB. If a large dose of spleen cells from an adult A mouse is injected into an adult AB mouse, which one of the following is MOST likely to occur? An explanation of the answer to this question is given on p. 24. A. The spleen cells will be destroyed. B. The spleen cells will survive and will have no effect in the recipient. C. The spleen cells will induce a graft-versus-host reaction in the recipient. D. The spleen cells will survive and induce tolerance of strain A grafts in the recipient. 430. This question is based on the same strains of mice described in the previous question. If adult AB spleen cells are injected into a newborn B mouse, which one of the following is MOST likely to occur? An explanation of the answer to this question is given on p. 24. A. The spleen cells will be destroyed. B. The spleen cells will survive without any effect on the recipient. C. The spleen cells will induce a graft-versus-host reaction in the recipient. D. The spleen cells will survive and induce tolerance of strain A grafts in the recipient. 431. The minor histocompatibility antigens on cells A. are detected by reaction with antibodies and complement. B. are controlled by several genes in the major histocompatibility complex. C. are unimportant in human transplantation. D. induce reactions that can cumulatively lead to a strong rejection response. 432. Which one of the following is NOT true of class I MHC antigens? A. They can be assayed by a cytotoxic test that uses antibody and complement. B. They can usually be identified in the laboratory in a few hours. C. They are controlled by at least three gene loci in the major histocompatibility complex. D. They are found mainly on B cells, macrophages, and activated T cells. 433. An antigen found in relatively high concentration in the plasma of normal fetuses and a high proportion of patients with progressive carcinoma of the colon is A. viral antigen. B. carcinoembryonic antigen. C. alpha-fetoprotein. D. heterophil 434. An antibody directed against the idiotypic determinants of a human IgG antibody would react with A. the Fc part of the IgG. B. an IgM antibody produced by the same plasma cell that produced the IgG. C. all human kappa chains. D. all human gamma chains. D. have the same haplotype. 441. Cytotoxic T cells induced by infection with virus A will kill target cells A. from the same host infected with any virus. B. infected by virus A and identical at class I MHC loci of the cytotoxic T cells. C. infected by virus A and identical at class II MHC loci of the cytotoxic T cells. D. infected with a different virus and identical at class I MHC loci of the cytotoxic cells. E. infected with a different virus and identical at class II MHC loci of the cytotoxic cells. 442. Antigen-presenting cells that activate helper T cells must express which one of the following on their surfaces? A. IgE B. gamma interferon C. class I MHC antigens D. class II MHC antigens 443. Which one of the following does NOT contain C3b? A. classic-pathway C5 convertase B. alternative-pathway C5 convertase C. classic-pathway C3 convertase D. alternative-pathway C3 convertase 444. Which one of the following is NOT true regarding the alternative complement pathway? A. It can be triggered by infectious agents in absence of antibody. B. It does not require C1, C2, or C4. C. It cannot be initiated unless C3b fragments are already present. D. It has the same terminal sequence of events as the classic pathway. 445. In setting up a complement fixation test for antibody, the reactants should be added in what sequence? (Ag = antigen; Ab = antibody; C = complement; EA = antibody-coated indicator erythrocytes.) A. Ag + EA + C/wait/ + patient's serum B. C + patient's serum + EA/wait/ + Ag C. Ag + patient's serum + EA/wait/ + C D. Ag + patient's serum + C/wait/ + EA 446. Proteins from two samples of animal blood, A and B, were tested by the double- diffusion (Ouchterlony) test in agar against antibody to bovine albumin. Which sample(s) contain horse blood? An explanation of the answer to this question is given on p[dse2] . 24. A. sample A B. sample B C. both samples D. neither sample 447. Complement lyses cells by A. enzymatic digestion of the cell membrane. B. activation of adenylate cyclase. C. insertion of complement proteins into the cell membrane. D. inhibition of elongation factor 2. 448. Graft and tumor rejection are mediated primarily by A. non-complement-fixing antibodies. B. phagocytic cells. C. helper T cells. D. cytotoxic T cells. D. zero. 455. Which one of the following statements BEST explains the relationship between inflammation of the heart (carditis) and infection with group A beta-hemolytic streptococci? A. Streptococcal antigens induce antibodies cross-reactive with heart tissue. B. Streptococci are polyclonal activators of B cells. C. Streptococcal antigens bind to IgE on the surface of heart tissue and histamine is released. D. Streptococci are ingested by neutrophils that release proteases that damage heart tissue. 456. Your patient became ill 10 days ago with a viral disease. Laboratory examination reveals that the patient's antibodies against this virus have a high ratio of IgM to IgG. What is your conclusion? A. It is unlikely that the patient has encountered this organism previously. B. The patient is predisposed to IgE-mediated hypersensitivity reactions. C. The information given is irrelevant to previous antigen exposure. D. It is likely that the patient has an autoimmune disease. 457. If you measure the ability of cytotoxic T cells from an HLA-B27 person to kill virus X- infected target cells, which one of the following statements is CORRECT? A. Any virus X-infected target cell will be killed. B. Only virus X-infected cells of HLA-B27 type will be killed. C. Any HLA-B27 cell will be killed. D. No HLA-B27 cell will be killed. 458. You have a patient who makes autoantibodies against his own red blood cells, leading to hemolysis. Which one of the following mechanisms is MOST likely to explain the hemolysis? A. Perforins from cytotoxic T cells lyse the red cells. B. Neutrophils release proteases that lyse the red cells. C. Interleukin-2 binds to its receptor on the red cells, which results in lysis of the red cells. D. Complement is activated, and membrane attack complexes lyse the red cells. 459. Your patient is a child who has no detectable T or B cells. This immunodeficiency is most probably the result of a defect in A. the thymus. B. the bursal equivalent. C. T cell-B cell interaction. D. stem cells originating in the bone marrow. 460. The role of the macrophage during an antibody response is to A. make antibody. B. lyse virus-infected target cells. C. activate cytotoxic T cells. D. process antigen and present it. 461. The structural basis of blood group A and B antigen specificity is A. a single terminal sugar residue. B. a single terminal amino acid. C. multiple differences in the carbohydrate portion. D. multiple differences in the protein portion. 462. Complement can enhance phagocytosis because of the presence on macrophages and neutrophils of receptors for A. factor D. B. C3b. C. C6. D. properdin. 463. The main advantage of passive immunization over active immunization is that A. it can be administered orally. B. it provides antibody more rapidly. C. antibody persists for a longer period. D. it contains primarily IgM. 464. On January 15, a patient developed an illness suggestive of influenza, which lasted 1 week. A. They are found on the surface of both B and T cells. B. They have a high degree of polymorphism. C. They are involved in the presentation of antigen by macrophages. D. They have a binding site for CD4 proteins. 471. Which one of the following statements concerning immunoglobulin allotypes is CORRECT? A. Allotypes are found only on heavy chains. B. Allotypes are determined by class I MHC genes. C. Allotypes are confined to the variable regions. D. Allotypes are due to genetic polymorphism within a species. 472. Each of the following statements concerning immunologic tolerance is correct EXCEPT: A. Tolerance is not antigen-specific; i.e., paralysis of the immune cells results in a failure to produce a response against many antigens. B. Tolerance is more easily induced in T cells than in B cells. C. Tolerance is more easily induced in neonates than in adults. D. Tolerance is more easily induced by simple molecules than by complex ones. 473. Each of the following statements concerning a hybridoma cell is correct EXCEPT: A. The spleen cell component provides the ability to form antibody. B. The myeloma cell component provides the ability to grow indefinitely. C. The antibody produced by a hybridoma cell is IgM, because heavy-chain switching does not occur. D. The antibody produced by a hybridoma cell is homogeneous; i.e., it is directed against a single epitope. 474. Each of the following statements concerning haptens is correct EXCEPT: A. A hapten can combine with (bind to) an antibody. B. A hapten cannot induce an antibody by itself; rather, it must be bound to a carrier protein to be able to induce antibody. C. In both penicillin-induced anaphylaxis and poison ivy, the allergens are haptens. D. Haptens must be processed by CD8+ cells to become immunogenic. Answers (Questions 387-474): 387. D 388. B 389. A 390. D 391. C 392. B 393. C 394. C 395. A 396. B 397. C 398. D 399. C 400. B 401. C 402. A 403. B 404. D 405. B 406. C 407. C 408. C 409. B 410. D 411. D 412. B 413. C 414. A 415. B 462. B 463. B 464. A 465. A 466. D 467. C 468. D 469. A 470. A 471. D 472. A 473. C 474. D Directions (Questions 475-535): Select the ONE lettered option that is MOST closely associated with the numbered items. Each lettered option may selected once, more than one, nor not at all. Questions 475-480 A. T cells B. B cells C. Macrophages D. B cells and macrophages E. T cells, B cells, and macrophages 475. Major source of interleukin-1 476. Acted on by interleukin-1 477. Major source of interleukin-2 478. Express class I MHC markers 479. Express class II MHC markers 480. Express surface immunoglobulin Questions 481-484 A. Primary antibody response B. Secondary antibody response 481. Appears more quickly and persists longer 482. Relatively richer in IgG 483. Relatively richer in IgM 484. Typically takes 7-10 days for antibody to appear Questions 485-488 A. Blood group A B. Blood group O C. Blood groups A and O D. Blood group AB 485. People with this type have circulating anti-A antibodies. 486. People with this type have circulating anti-B antibodies. 487. People with this type are called "universal donors." 488. People with this type are called "universal recipients." Questions 489-494 A. Variable region of light chain B. variable region of heavy chain C. Variable regions of light and heavy chains D. Constant region of heavy chain E. Constant regions of light and heavy chains 489. Determines immunoglobulin class 490. Determines allotypes 491. Determines idiotypes 492. Binding of IgG to macrophages 493. Fixation of complement by IgG 494. Antigen-binding site B. Precipitin test C. Immunofluorescence D. Enzyme immunoassay 506. Concentration of IgG in serum 507. Surface IgM on cells in a bone marrow smear 508. Growth hormone in serum 509. Type A blood group antigen on erythrocytes Questions 510-513 A. IgA B. IgE C. IgG D. IgM 510. Present in highest concentration in serum 511. Present in highest concentration in secretions 512. Present in lowest concentration in serum 513. Contains 10 heavy and 10 light chains Questions 514-517 In this double diffusion (Ouchterlony) assay, the center well contains antibody against whole human serum. The peripheral (numbered) wells contain one of the following proteins[dse4] : A. Human serum albumin at low concentration B. Human serum albumin at high concentration C. Human serum transferrin D. Sheep serum albumin 514. Which protein is present in well No. 1? 515. Which protein is present in well No. 2? 516. Which protein is present in well No. 3? 517. Which protein is present in well No. 4? An explanation of the answer to this question is given on p. 24. Questions 518-521 A. Class I MHC proteins B. Class II MHC proteins 518. Involved in the presentation of antigen to CD4-positive cells 519. Involved in the presentation of antigen to CD8-positive cells 520. Involved in antibody responses to T-dependent antigens 521. Involved in target cell recognition by cytotoxic T cells Questions 522-525 A. Fab fragment of IgG B. Fc fragment of IgG 522. Contains an antigen-combining site 523. Contains hypervariable regions 524. Contains a complement-binding site 525. Is crystallizable Questions 522-525 A. Severe combined immunodeficiency disease (SCID) B. X-linked hypogammaglobulinemia 494. C 495. D 496. C 497. A 498. B 499. C 500. A 501. D 502. B 503. C 504. C 505. D 506. D 507. C 508. D 509. A 510. C 511. A 512. B 513. D 514. B 515. A 516. D 517. C 518. B 519. A 520. B 521. A 522. A 523. A 524. B 525. B 526. D 527. C 528. E 529. B 530. A 531. D 532. B 533. E 534. A 535. C Explanation of Question 429: Spleen cells from the adult donor A will recognize the B antigen on the recipient's cell as foreign. Spleen cells from the adult donor will contain mature CD4 and CD8 cells that will attack the recipient cells, causing a graft-versus-host reaction; therefore, answer C is correct. Because the recipient is tolerant to antigen A, the donor A spleen cells will not be destroyed; therefore, answer A is incorrect. Answer B is incorrect because, although the donor cells will survive, they will have an effect on the recipient. Answer D is incorrect because the recipient is already tolerant to antigen A. Explanation of Question 430: Because the donor AB spleen cells will not see any foreign antigen in the recipient, no graft-versus-host reaction will occur; therefore, answer C is incorrect. The immune cells of the newborn mouse do not have the capability to kill the donor cells; therefore, answer A is incorrect. Answer D is more correct than answer B because the donor cells will survive and induce tolerance to antigen A in the newborn recipient. Explanation of Question 446: There is a line of identity between sample A and bovine albumin, therefore, sample A is bovine albumin. There is a line of identity between sample B and horse albumin, therefore, sample B is horse albumin. The answer to the question is, therefore, B. Note that there is a spur formed between the wells containing sample A and horse albumin and between the wells containing sample B and bovine albumin. The spur indicates partial identity between the two proteins. Partial identity means that there are epitopes shared between the two albumins but that, because they are from different species, there are epitopes unique to each protein, also. A spur is formed by the interaction of the subset of antibodies in the anti-bovine serum with the unique epitopes in bovine albumin. The other lines are formed by the interaction of the subset of antibodies in the anti-bovine serum with the epitopes shared by the two albumins. Explanation of Questions 495-498: The center well contains antibody against whole human serum; therefore, well D must contain whole human serum because there are multiple lines representing some of the many proteins in whole human serum. There is a line of identity between well C and a protein in whole human serum and a line of partial identity with that same protein and well A. This indicates that well C contains human IgG and well A contains baboon IgG. The concept of partial identity is explained above in the discussion of question 446. There is a line of nonidentity between wells B and C; therefore, well B contains human transferrin, a protein immunologically distinct from human IgG. Explanation of Questions 514-517: There is a line of identity between wells 1 and 2; therefore, they contain human serum albumin (HAS). Note that the line of immunoprecipitate is very close to well 2. This line would not form if well 2 contained the high concentration of HAS because it would be a zone of antigen excess, and the line only forms in a zone of equivalence. Therefore, well 2 contains the low concentration and well 1 contains the high concentration of HAS. There is a line of partial identity between well 2 and 3, therefore, well 3 contains sheep serum albumin