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PORTH'S ESSENTIALS OF PATHOPHYSIOLOGY CHAPTER 12 DISORDERS OF THE IMMUNE RESPONSE TEST BANK
Typology: Exams
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While teaching about HIV/AIDS to a group of high school seniors, the school health nurse will begin by explaining the basic facts. Which information will this likely include? A. Like all viruses, HIV is a genetic material made from DNA with long molecules that carry genetic information. B. HIV is different from other viruses since it is a retrovirus that selectively attacks the body's immune cells. C. There are two types of HIV, but the one that is endemic to the U.S. is HIV type 2. D. HIV type 1 for some reason rarely develops into full-blown AIDS. B As part of her prenatal education, a 29-year-old woman who is pregnant with her first child is receiving teaching from her primary care provider. Which statement by the woman reflects an accurate understanding of HIV transmission? A. "I know my baby is safe from HIV while in the womb, but the delivery will place him or her at real risk." B. "It's discouraging to know that my breast milk can pass on HIV to my baby." C. "I know it's possible, but it's comforting that the chances of my child contracting my HIV are actually very low." D. "I'm relieved to learn that a caesarean delivery will protect my baby from being born HIV positive." B A potential donor is angry at the personal nature of the questions about HIV risk factors that he is required to answer at a blood collection center, and states that simple blood testing should suffice. How can the nurse at the center best respond? A. "There are some very uncommon subtypes of the HIV virus that are not detectable by current testing methods." B. "There's a chance that persons who are asymptomatic but HIV positive can have their antibodies missed by serum testing." C. "There's a period shortly after someone is infected with HIV when blood tests might still be negative." D. "Even though blood tests are completely accurate, the high stakes of blood donation and transfusion mean that double measures are appropriate." C A 19 year-old intravenous drug user was exposed to the HIV virus 3 weeks ago and is experiencing a rapid proliferation in viral load. Which statement best captures an aspect of the process of HIV replication that underlies this proliferation? A. Free HIV RNA is able to attach to the cell coat of CD4+ cells. B. The cytoplasm of CD4+ cells provides a protected environment for the replication of RNA by HIV. C. Expression of reverse transcriptase by CD4+ cells allows replication of HIV cells
rather than new lymphocytes. D. HIV is able to change its RNA into DNA to allow for replication by CD4+ cells D A person who has been diagnosed with HIV infection 12 years ago and still has a CD4+ cell count of 800 cells/μL and a low viral load is considered to be in which clinical group? A. Rapid progressor B. Typical progressor C. Delayed progressor D. Long-term nonprogressor Answer: D Rationale: There is a subset of slow progressor, called the long-term nonprogressor, who account for 1% of all HIV infections. These people have been infected for at least 8 years, are antiretroviral naïve, have high CD4+ cell counts, and usually have very low viral loads. They are being investigated to determine how they maintain viral suppression of HIV. Which client would be considered to be in the latent period of HIV infection? BA. 16- year-old prostitute who has open sores on her labia that drain purulent secretions. B. 33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his axilla and cervical neck region for the past 4 months. C. 45-year-old alcohol abuser who is reporting excessive vomiting of blood that started 2 weeks ago. D. 24-year-old college student who has developed a chronic cough that will not go away, even after taking two courses of antibiotics. B We have an expert-written solution to this problem! A 39-year-old female with HIV has been characterized as a typical progressor by her care team, and is experiencing an increase in her manifestations and complaints as her CD4+ count declines. Which health problem would her care team most likely attribute to a cause other than her HIV? A. Her recent diagnosis of bacterial pneumonia B. Her esophagitis that has been linked to herpes simplex infection C. Her decreased bone density and recent fractures D. Her increasing confusion and disorientation C A 48-year-old man who has been HIV positive for 6 years has just learned that he has been diagnosed with Kaposi sarcoma (KS). Which fact most accurately conveys an aspect of his diagnosis? A. An opportunistic Epstein-Barr virus underlies the man's KS. B. He is likely to have lesions on his skin, mouth, or GI tract. C. Intense pain was probably his first manifestation of KS D. Heterosexual contact most likely underlies his HIV and subsequent KS. B When counseling a male client with suspected HIV, the nurse informs him that if the enzyme-linked immunosorbent assay (ELISA) comes back positive, then: A. no further testing is required since this confirms HIV infection. B. a second test known as the Western blot assay will be ordered to confirm positive HIV status.
C. he will be sent to an infectious disease physician for a tissue biopsy to confirm infection. D. if the second test, the Western blot, returns negative, he has not developed a case of full-blown AIDS. B We have an expert-written solution to this problem! After years of going to different physicians with vague symptoms, a 55-year-old client with a history of Hodgkin lymphoma has been diagnosed with a secondary immunodeficiency syndrome. The client asks the nurse what this means. The nurse knows that secondary immunodeficiency disorders may occur if which background information is available? Select all that apply. A. May be inherited as a sex-linked trait B. Usually develop later in life C. May be a result of chemotherapy being used to treat a cancer D. Can result from frequent recurring Staphylococcus aureus infections E. Can occur in clients taking corticosteroids daily. B, C, E A 2-year-old girl has had repeated ear and upper respiratory infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiologic origin of the child's recurrent infections? A. The child's immune system is unable to synthesize adequate immunoglobulin on its own. B. The child had a congenital absence of IgG antibodies, which her body is only slowly beginning to produce independently. C. The child was born with IgA and IgM antibodies, suggesting intrauterine infection. D. The child lacks the antigen presenting cells integral to normal B cell antibody production. A A nurse is providing care for a 17-year-old boy who has experienced recurrent sinus and chest infections throughout his life and presently has enlarged tonsils and lymph nodes. Blood work indicated normal levels of B cells and free immunoglobins but a lack of differentiation into normal plasma cells. The boy is currently receiving intravenous immunoglobulin (IVIg) therapy. What is the boy's most likely diagnosis? A. X-linked hypogammaglobulinemia B. Transient hypoglobulinemia C. Common variable immunodeficiency D. IgG subclass deficiency C An 8-week-old boy has been recently diagnosed with a severe combined immunodeficiency (SCID). His parents have performed a significant amount of research on the Internet and have brought a large amount of material to discuss with their care provider. Which statement best reflects an accurate understanding of their son's health situation? A. "We read that gene therapy could cure our son; we'd like you to look into that option." B. "Our son likely has a deficiency of B-lymphocytes and can't produce antibodies."
C. "We feel guilty, because dietary and environmental factors have been shown to contribute to SCID" D. "The antibodies that our son produces are mismatched to the infections that he was born with, and encounters." B A 1-year-old child who has experienced low platelet counts and bacterial susceptibility has been admitted to a pediatric medical unit of a hospital for treatment of Wiskott- Aldrich syndrome. The nurse who has admitted the child to the unit would anticipate which short-term and longer-term treatment plans? A. Transfusion of clotting factors XII and XIII and serum albumin; splenectomy B. Neutropenic precautions; fresh frozen plasma transfusions; treatment of gastrointestinal symptoms. C. Intravenous immunoglobulin (IVIg) treatment; thyroidectomy D. Treatment of eczema; management of bleeding; bone marrow transplant D A 4-year-old boy presents with a chronic cough and swollen lymph nodes. His records show that he has been given antibiotics several times in the past year with limited success, most recently for a liver abscess. He also has a recurring fungal skin condition. Which diagnosis is most likely the cause of this child's manifestations? A. Selective IgA deficiency B. A deficiency in IgG2 subclass antibodies C. Chronic granulomatous disease D. Ataxia-telangiectasia C When explaining to parents what is occurring when their child has an acute bronchial asthma attack, the nurse will emphasize that which mediator is primarily responsible for the bronchial constriction? A. Tree pollen B. Mold dust C. Histamine D. T-lymphocyte proliferation C A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which phenomenon best captures the rationale for allergy desensitization therapy? A. Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response. B. Allergens in large, regular quantities overwhelm the IgE antibodies that mediate the allergic response. C. Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response. D. Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies. D
Following a spider bite she received while camping, a 20-year-old female presented to the emergency department with rash, edema, and fever and was subsequently diagnosed with serum sickness. Which statement best conveys the physiologic rationale for the broad systemic effects of this event? A. The woman is experiencing diffuse tissue necrosis as a consequence of an Arthus reaction. B. Antigen-antibody complexes have been deposited in a variety of locations throughout the body. C. Antibody binding to specific target cell receptors is bringing about a change in cell function. D. Deposited antibodies are activating her complement system. B A female dental assistant has developed signs and symptoms of a latex sensitivity, and is undergoing allergy testing as well as blood work. Which component of the assistant's blood work would most likely be the focus of her health care provider's analysis? A. Analysis of class II MHC antigens B. Serum IgE immunoassays C. Serum B-lymphocyte levels D. Serum CD8+ levels B While undergoing a kidney transplant from a non-family member, the client's transplanted kidney has just had the arterial clamps removed. The OR staff notices that the organ is turning purple with no urine output. When explaining to the family why they had to remove the donor kidney, the nurse will anticipate that the surgeon would likely include which statement? A. Obviously, there has been a mismatch during the human leukocyte antigens (HLA) testing. B. The circulating B and T lymphocytes are just doing their job. C. Hyperacute rejection occurs because antibodies against HLA antigens are deposited in vessels, causing necrosis. D. Previous exposure to the HLA antigens is responsible for the high titers of complement-fixing antibodies that cause the rejection. C After several months on a waiting list, a 44-year-old male received a liver transplant 5 days ago. In the last 36 hours, he has developed a rash beginning on his palms and soles, along with abdominal pain and nausea. It has been determined by his care team that the immune response that is causing his symptoms originates not with his own compromised immune components but with those introduced with his new organ. This man's most likely medical diagnosis is: A. Graft-versus-host-disease (GVHD) B. Acute transplant rejection C. Hyperacute organ rejection D. T-cell mediated graft rejection A We have an expert-written solution to this problem!
While volunteering in an HIV clinic in a big city, the nurse notices a new mom and her 6- month old child in the waiting room. Upon assessing the infant for possible HIV infection, the nurse will be assessing for which clinical manifestations of HIV infection? Select all that apply. A. Weighing him to determine if he is gaining 1.5 to 2 pounds/month. B. Observing to see if he can roll over from back to stomach. C. Lack the coordination to play with toys/stuffed animals. D. History of repeated episodes of bacterial pneumonia and ear infections. E. Listlessness and poor eye contact. A, C, D, E Which client is most likely to be a candidate for a thymus transplant as the treatment of choice to reconstitute T-cell immunity? A. A 12-year-old girl with a history of epilepsy and low IgG levels secondary to phenytoin use B. A 7-year-old boy with diagnosis of thymic aplasia whose blood work indicates absence of T cells C. A 6-year-old boy whose pre-B cells are incapable of translation to normal B cells D. A 9-year-old girl who has developed secondary cell-mediated immunodeficiency following a viral infection B Which clients are at increased risk for developing secondary hypogammaglobulinemia, a secondary humoral immunodeficiency? Select all that apply. A. client with burns covering more than 45% of the body B. malnourished child who only drinks cow's milk C. client with a history of anxiety and depression D. child allergic to furs, grass, and trees E. client with a history of seizures controlled by an antiepileptic A, B, E A health care provider has prescribed blood products for a trauma client with a history of selective immunoglobulin A deficiency (SIGAD) who is going into hypovolemic shock. Which blood product is most appropriate for the nurse to infuse? A. platelets from a single donor B. specially washed erythrocytes from normal donor C. fresh frozen plasma from multiple donors D. cryoprecipitate from pooled donors B