Deck 14: Genetics, Altered Immune Responses, and Transplantation

Question 1

A patient who is employed as a laboratory technician is scheduled for surgery. While obtaining a health history from the patient, the nurse learns that the patient has a history of allergic rhinitis, asthma, and multiple food allergies. It is important that the nurse

A) encourage the patient to carry an epinephrine kit in case a type IV allergic reaction to latex develops.
B) document the patient's allergy history and be alert for any clinical manifestations of a type I latex allergy.
C) advise the patient to use oil-based hand creams to decrease contact with natural proteins in latex gloves.
D) recommend that the patient use vinyl gloves instead of latex gloves in preventing blood-borne pathogen contact.

Answer 1

document the patient's allergy history and be alert for any clinical manifestations of a type I latex allergy.

Question 2

An older patient at the clinic for an annual examination tells the nurse, "I don't understand why I need to have so many cancer screening tests now. I feel just fine!" The nurse will plan to teach the patient about the

A) decrease in antibody production associated with aging.
B) impact of poor nutrition on immune function in older people.
C) consequences of aging for cell-mediated immunity.
D) incidence of cancer-stimulating infections in older individuals.

Answer 2

consequences of aging for cell-mediated immunity.

Question 3

Immediately after the nurse administers an intracutaneous injection of an allergen on a patient's forearm, the patient complains of itching at the site and of weakness and dizziness. The nurse should first

A) apply a tourniquet above the injection site.
B) rub a local antiinflammatory cream on the site.
C) remind the patient to remain calm.
D) administer subcutaneous epinephrine.

Answer 3

apply a tourniquet above the injection site.

Question 4

In counseling a couple when the man has sickle cell disease, an autosomal-recessive disorder, and the woman has no gene for sickle cell disease, the nurse uses Punnett squares to show the couple that the probability of them having a child with sickle cell disease is

A) 0%.
B) 25%.
C) 50%.
D) 75%.

Question 5

After being bitten by an unknown insect, a patient allergic to wasp stings is brought to a clinic by a co-worker. Upon arrival the patient is anxious and having difficulty breathing. The first action by the nurse is to

A) administer high-flow oxygen.
B) maintain the patient's airway.
C) remove the stinger from the site.
D) have the patient lie down.

Question 6

A patient develops a severe angioedema involving the face, hands, and feet, with burning and stinging of the lesions. A significant risk factor for allergies that the nurse questions the patient about is

A) family history of allergic reactions.
B) living in an underdeveloped country.
C) a recent upper respiratory infection.
D) any exposure to fungal infections.

Question 7

The nurse obtains all this information about a patient who has been receiving immunotherapy for several months and is waiting in the clinic after receiving the allergen injection. Which information should the nurse communicate to the health care provider?

A) The patient's IgG level is increased.
B) The injection site is red and swollen.
C) There is a 3-cm wheal at the site of the allergen injection.
D) The patient's allergy symptoms have not improved.

Question 8

A young woman's mother has been diagnosed with BRCA gene-associated breast cancer. The patient asks the nurse, "Do you think I should be tested for the gene?" Which response by the nurse is most appropriate?

A) "You should decide first whether you are willing to have a double mastectomy."
B) "It depends on how you will feel if the test is positive for the BRCA gene."
C) "There are many things to consider before deciding to have genetic testing."
D) "In most cases, breast cancer is not caused by the BRCA gene."

Question 9

A patient with a severe allergic reaction receives epinephrine 1:10,000 0.5 ml IV. The next action that the nurse should take is to

A) start oxygen at 100% using a non-rebreather mask.
B) administer diphenhydramine (Benadryl) IV.
C) give a dose of cimetidine (Tagamet).
D) prepare an infusion of dopamine (Intropin).

Question 10

A patient is being evaluated for possible atopic dermatitis. The nurse will review the patient's laboratory values for the level of

A) IgE.
B) neutrophils.
C) basophils.
D) IgA.

Question 11

A patient who received a bone marrow transplant for treatment of leukemia develops a skin rash 10 days after the transplant. The nurse recognizes this reaction as an indication that the

A) donor T cells are attacking the patient's skin cells.
B) patient's circulating antibodies are rejecting the donor bone marrow.
C) patient is experiencing a delayed hypersensitivity reaction.
D) patient will need treatment to prevent graft-versus-host disease.

Question 12

A patient diagnosed with systemic lupus erythematosus (SLE) is scheduled for plasmapheresis. The nurse plans to teach the patient that plasmapheresis will

A) decrease the damage to organs caused by attacking T-lymphocytes.
B) remove antibody-antigen complexes from circulation.
C) prevent foreign antibodies from damaging various body tissues.
D) eliminate eosinophils and basophils from blood.

Question 13

A patient is treated at a clinic with an intramuscular (IM) injection of penicillin for a streptococcal throat infection. The patient's history reveals a prior penicillin injection with no allergic response. When the penicillin injection is administered, the nurse should tell the patient,

A) "You will need to wait in the clinic area for 20 minutes after the injection."
B) "Since you have taken penicillin before, there should be no problem this time."
C) "If you have a penicillin allergy, you will react immediately to the injection."
D) "Call if you develop any fever or skin rash in the next 24 to 48 hours."

Question 14

The nurse encourages a new mother to breastfeed her infant, even for a short time, because colostrum will provide the infant with

A) active immunity to many childhood illnesses for several years.
B) passive immunity to all childhood illnesses for several months.
C) passive immunity to diseases to which the mother has immunity.
D) innate immunity to diseases to which the mother is immune.

Question 15

A patient seen in the outpatient clinic has an immune deficiency involving the T-lymphocytes. The nurse should teach the patient about the need for more frequent screening for

A) malignancy.
B) allergies.
C) autoimmune disorders.
D) antibody deficiency.

Question 16

The nurse discusses the prevention and management of allergic reactions with a beekeeper who has developed a hypersensitivity to bee stings. The nurse identifies a need for additional teaching when the patient states,

A) "I am going to need job retraining so that I can work in a different occupation."
B) "I should wear a Medic Alert bracelet indicating my allergy to insect stings."
C) "I will learn to administer epinephrine so that I will be prepared if I am stung again."
D) "I can take maintenance doses of corticosteroids to prevent reactions to further stings."

Question 17

A patient who receives weekly "allergy shots" at a clinic missed the previous appointment. When the patient comes for the next injection, the nurse should

A) administer the usual dosage of the allergen.
B) re-evaluate the patient's sensitivity to the allergen with a skin test.
C) consult with the health care provider about giving a lower dose for this injection.
D) schedule an additional dose that week.

Question 18

To prevent anaphylaxis after a patient has received allergen testing using the cutaneous scratch method, the nurse should initially monitor the patient's

A) blood pressure and pulse.
B) pupil size and reaction to light.
C) arm at the site of the skin testing.
D) bilateral lung sounds.

Question 19

The nurse will monitor a patient who is undergoing plasmapheresis for

A) numbness and tingling.
B) high blood pressure.
C) shortness of breath.
D) transfusion reactions.

Question 20

While the nurse is obtaining an assessment and health history from a patient, which statement by the patient will alert the nurse to a possible immunodeficiency disorder?

A) "I had my spleen removed many years ago after a car accident."
B) "I usually eat eggs or meat for at least 2 meals every day."
C) "I enjoy walking several times a week with friends."
D) "I had a chest x-ray 6 months ago when I had pneumonia."

Question 21

When the nurse is admitting a patient who has acute rejection of an organ transplant, which of these already-admitted patients will be the most appropriate roommate?

A) A patient who has viral pneumonia
B) A patient with graft-versus-host disease after a recent bone marrow transplant
C) A patient who is recovering from an anaphylactic reaction to a bee sting
D) A patient with second degree burns

Question 22

A patient seen at the clinic with atopic dermatitis has a history of multiple allergies and several previous anaphylactic reactions. Which type of testing for allergens will the nurse anticipate for this patient?

A) Radioallergosorbent test (RAST)
B) Cutaneous scratch test
C) Intracutaneous skin test
D) Serum IgE-level test

Question 23

After teaching a patient on immunosuppressant therapy after a kidney transplant about the posttransplant drug regimen, the nurse determines that additional teaching is needed when the patient says,

A) "I need to be monitored closely because I have a greater chance of developing malignant tumors."
B) "If I develop an acute rejection episode, I will need to have other types of drugs given IV."
C) "After a couple of years, it is likely that I will be able to stop taking the calcineurin inhibitor."
D) "The drugs are given in combination because they act differently to inhibit cytokine production and lymphocyte activity."

Question 24

A patient is admitted to the hospital with acute rejection of a kidney transplant. The nurse will anticipate

A) placement of the patient on the transplant waiting list.
B) insertion of an arteriovenous graft for hemodialysis.
C) administration of immunosuppressant medications.
D) drawing blood for HLA and ABO compatibility matching.

Question 25

A patient has a new prescription for cyclosporine after having a kidney transplant. Which information in the patient's health history has the most implications for planning patient teaching about the medication at this time?

A) The patient drinks 3 to 4 quarts of fluids every day.
B) The patient restricts salt to treat prehypertension.
C) The patient likes to have orange or grapefruit juice for breakfast.
D) The patient has many concerns about the effects of cyclosporine.

Question 26

When caring for a clinic patient who is experiencing an allergic reaction to an unknown allergen, which nursing activity is most appropriate for the RN to delegate to an LPN/LVN?

A) Obtain the health history from the patient.
B) Perform a focused physical assessment.
C) Administer skin testing by the cutaneous scratch method.
D) Teach the patient about the various diagnostic studies.

Question 27

A man with mild hemophilia, a sex-linked recessive disorder, asks the nurse, "Will my children be hemophiliacs?" Which response by the nurse is appropriate?

A) "Only your male children are at risk for hemophilia."
B) "Your female children will be carriers for hemophilia."
C) "All of your children will be at risk for hemophilia."
D) "Hemophilia is a multifactorial inherited condition."

Question 28

A pregnant patient with a family history of cystic fibrosis (CF) asks for information about genetic testing. The most appropriate action by the nurse is to

A) refer the patient to a qualified genetic counselor.
B) remind the patient that genetic testing has many social implications.
C) tell the patient that cystic fibrosis is an autosomal-recessive disorder.
D) ask the patient why genetic testing is important to her.

Question 29

A patient seeks medical care after sharing needles for heroin injection with a friend who has hepatitis B. To provide immediate protection from infection, the nurse expects to administer

A) hepatitis B vaccine.
B) fresh frozen plasma.
C) corticosteroids.
D) gamma globulin.