Deck 14: Genetics, Altered Immune Responses, and Transplantation

Question 1

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

A) innate immunity.
B) active immunity.
C) passive immunity.
D) cell-mediated immunity.

Answer 1

passive immunity.

Question 2

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 will plan to take oral antihistamines daily before going to work."
B) "I will get a prescription for epinephrine and learn to self-inject it."
C) "I should wear a Medic Alert bracelet indicating my allergy to bee stings."
D) "I am going to need job retraining so that I can work in a different occupation."

Answer 2

"I will plan to take oral antihistamines daily before going to work."

Question 3

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

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

Answer 3

remove antibody-antigen complexes from circulation.

Question 4

In counseling a couple in which the man has an autosomal recessive disorder, and the woman has no gene for the disorder, the nurse uses Punnett squares to show the couple that the probability of their having a child with the disorder is

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

Question 5

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

Question 6

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

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

Question 7

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 take one baby aspirin every day to prevent stroke."
B) "I usually eat eggs or meat for at least 2 meals a day."
C) "I had my spleen removed many years ago after a car accident."
D) "I had a chest x-ray 6 months ago when I had walking pneumonia."

Question 8

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) "If I develop an acute rejection episode, I will need to have other types of drugs given IV."
B) "I need to be monitored closely because I have a greater chance of developing malignant tumors."
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 inhibit different aspects of transplant rejection."

Question 9

A patient whose mother has been diagnosed with BRCA gene-related breast cancer asks the nurse, "Do you think I should be tested for the gene?" Which response by the nurse is most appropriate?

A) "In most cases, breast cancer is not caused by the BRCA gene."
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) "You should decide first whether you are willing to have a double mastectomy."

Question 10

A 62-year-old patient who is having an annual check-up 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) consequences of aging on cell-mediated immunity.
B) decrease in antibody production associated with aging.
C) impact of poor nutrition on immune function in older people.
D) incidence of cancer-stimulating infections in older individuals.

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 antibodies are rejecting the donor bone marrow.
C) patient is experiencing a delayed hypersensitivity reaction.
D) patient will need treatment to prevent hyperacute rejection.

Question 12

A man with mild hemophilia asks the nurse, "Will my children be hemophiliacs?" Which response by the nurse is appropriate?

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

Question 13

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

Question 14

The nurse will monitor a patient who is undergoing plasmapheresis for

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

Question 15

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

Question 16

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) IgA.
C) basophils.
D) neutrophils.

Question 17

While obtaining a health history from the patient who works as a laboratory technician, 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) advise the patient to use oil-based hand creams to decrease contact with natural proteins in latex gloves.
C) document the patient's allergy history and be alert for any clinical manifestations of a type I latex allergy.
D) recommend that the patient use vinyl gloves instead of latex gloves in preventing blood-borne pathogen contact.

Question 18

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

Question 19

Which instruction will be included when teaching a patient with possible allergies about intradermal skin testing?

A) "Do not eat anything for about 6 hours before the testing."
B) "Take an oral antihistamine about an hour before the testing."
C) "Plan to wait in the clinic for 20 to 30 minutes after the testing."
D) "Reaction to the testing will take about 48 to 72 hours to occur."

Question 20

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

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

Question 22

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

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

Question 23

Which information about patient and donor tissue typing results for a patient who needs a kidney transplant is most important for the nurse to communicate to the health care provider?

A) Patient is Rh positive and donor is Rh negative.
B) Six antigen matches are present in HLA typing.
C) Results of patient-donor cross matching are positive.
D) Panel of reactive antibodies ( PRA ) percentage is low.

Question 24

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

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

Question 25

Which information about a patient who is receiving immunotherapy and has just received an allergen injection is most important to communicate to the health care provider?

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

Question 26

For early detection of an anaphylactic reaction in a patient who has received allergen testing using the cutaneous scratch method, which action should the nurse take first?

A) Check blood pressure and pulse rate.
B) Auscultate the lung sounds bilaterally.
C) Monitor pupil size and reaction to light.
D) Assess the arm at the site of the skin testing.

Question 27

To determine whether a patient's angioedema has responded to prescribed therapies, which action should the nurse take first?

A) Ask about any clear nasal discharge.
B) Obtain blood pressure and heart rate.
C) Check for swelling of the lips and tongue.
D) Assess extremities for wheal and flare lesions.

Question 28

After being stung by a wasp, a patient is brought to the clinic by a co-worker. Upon arrival the patient is anxious and having difficulty breathing. The first action that the nurse should take is to

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

Question 29

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

Question 30

A patient who is receiving an IV antibiotic develops wheezes and dyspnea. In which order should the nurse implement these prescribed actions? Put a comma and space between each solve choice (a, b, c, d, etc.) ____________________

A) Discontinue the antibiotic infusion.
B) Give diphenhydramine (Benadryl) IV.
C) Inject epinephrine (Adrenalin) IM or IV.
D) Prepare an infusion of dopamine (Intropin).
E) Start 100 % oxygen using a nonrebreather mask.