Nokea
A parent of a child who has been having frequent bouts of tonsillitis brings the child back to the clinic for another sore throat. The parent asks the nurse, 'What are tonsils good for anyway?' What is the best response by the nurse?
- A. They really do not have a function and should be removed.
- B. These tissues filter bacteria from tissue fluid.
- C. The tissue acts as an emergency reservoir of blood.
- D. The tissue removes blood and bacteria.
Correct Answer: B
Rationale: Tonsils and adenoids filter bacteria from tissue fluid. Because they are exposed to pathogens in the oral cavity, they can become infected and locally inflamed. The spleen acts as an emergency reservoir of blood and removes blood and bacteria, not the tonsils.
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A client asks the nurse about the importance of taking supplements to maximize immune function. The client is healthy and does not have any medical problems. What is the best information to give to the client?
- A. Instead of taking supplements, eat a lot of fruits and vegetables to maximize immune function.
- B. Adopt a vegetarian diet and omit all meats, and you will maximize immune function.
- C. You should take a variety of vitamin and mineral supplements to maximize immune function.
- D. Eating a moderate diet that is balanced and varied will maximize immune function.
Correct Answer: D
Rationale: Until more is known about nutrient interactions, the best dietary advice to maximize immune function in healthy people is to eat a moderate diet that is balanced and varied. Eating fruits and vegetables and a vegetarian lifestyle may be healthy choices but do not maximize immune function as a balanced diet will.
The nurse is caring for a client with a suspected diagnosis of HIV. The nurse is preparing to draw blood for a confirmatory diagnostic test on this client. What is the most important action that the nurse should perform before testing a client for HIV?
- A. Advise the client to avoid excess fluid intake.
- B. Advise the client to abstain from having intercourse.
- C. Advise the client to take off any ornaments and metallic objects.
- D. Obtain a written consent from the client.
Correct Answer: D
Rationale: It is important that the nurse obtain written consent from the client before performing an HIV test and keep the results of HIV test confidential. The nurse may not ask the client to avoid excess fluid intake or abstain from intercourse before the tests. The client also need not take off ornaments and metallic objects worn unless they are likely to interfere with the test results.
A client is informed of having a low white blood cell count and being at risk for the development of infections. The client asks, 'Where do I make new white blood cells?' What is the best response by the nurse?
- A. White blood cells are produced in the plasma.
- B. White blood cells are produced in the thymus gland.
- C. White blood cells are produced in the lymphatic tissue.
- D. White blood cells are produced in the bone marrow.
Correct Answer: D
Rationale: White blood cells (leukocytes) are produced in the bone marrow. They are not produced in the plasma, thymus gland, or the lymphatic tissue.
What type of immunoglobulin does the nurse recognize that promotes the release of vasoactive chemicals such as histamine when a client is having an allergic reaction?
- A. IgG
- B. IgA
- C. IgM
- D. IgE
Correct Answer: D
Rationale: IgE promotes the release of vasoactive chemicals such as histamine and bradykinin in allergic, hypersensitivity, and inflammatory reactions. IgG neutralizes bacterial toxins and accelerates phagocytosis. IgA interferes with the entry of pathogens through exposed structures or pathways. IgM agglutinates antigens and lyses cell walls.
A client has had a kidney transplant performed for end-stage kidney disease. What type of immune response that T-cell lymphocytes perform is related to this type of surgery?
- A. Activation of the complement system
- B. Stimulation of colony-stimulating factors
- C. A cell-mediated response
- D. Naturally acquired active immunity
Correct Answer: C
Rationale: A cell-mediated response occurs when T cells survey proteins in the body, actively analyze the surface features, and respond to those that differ from the host by directly attacking the invading antigen. An example of a cell-mediated response is one that occurs when an organ is transplanted. The complement system cooperates with antibodies to attract phagocytes and coat antigens to make them more recognizable for phagocytosis and stimulate inflammation and is not related to the surgery. Colony-stimulating factors prompt the bone marrow to produce, mature, and promote the functions of blood cells. Naturally acquired active immunity is a direct result of infection by a specific microorganism.