Deck 14: Altered Immune Responses, and Transplantation

Question 1

The nurse provides discharge instructions to a patient who has an immune deficiency involving the T lymphocytes.Which screening should the nurse include in the teaching plan for this patient?

A) Screening for allergies
B) Screening for malignancy
C) Antibody deficiency screening
D) Screening for autoimmune disorders

Answer 1

Screening for malignancy

Question 2

Which patient should the nurse assess first?

A) Patient with urticaria after receiving an IV antibiotic
B) Patient who has graft-versus-host disease and severe diarrhea
C) Patient who is sneezing after having subcutaneous immunotherapy
D) Patient with multiple chemical sensitivities who has muscle stiffness

Answer 2

Patient who is sneezing after having subcutaneous immunotherapy

Question 3

Ten days after receiving a bone marrow transplant,a patient develops a skin rash.What would the nurse suspect is the cause of this patient's skin rash?

A) The donor T cells are attacking the patient's skin cells.
B) The patient's antibodies are rejecting the donor bone marrow.
C) The patient is experiencing a delayed hypersensitivity reaction.
D) The patient will need treatment to prevent hyperacute rejection.

Answer 3

The donor T cells are attacking the patient's skin cells.

Question 4

The nurse is caring for a patient undergoing plasmapheresis.The nurse should assess the patient for which clinical manifestation?

A) Shortness of breath
B) High blood pressure
C) Transfusion reaction
D) Numbness and tingling

Question 5

While obtaining a health history from a patient,the nurse learns that the patient has a history of allergic rhinitis and multiple food allergies.Which action by the nurse is most appropriate?

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 6

The nurse teaches a patient about drug therapy after a kidney transplant.Which statement by the patient would indicate a need for further instructions?

A) "After a couple of years, it is likely that I will be able to stop taking the cyclosporine."
B) "If I develop an acute rejection episode, I will need to have other types of drugs given IV."
C) "I need to be monitored closely because I have a greater chance of developing malignant tumors."
D) "The drugs are given in combination because they inhibit different ways the kidney can be rejected."

Question 7

Which statement by a patient would 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

An adolescent patient seeks care in the emergency department after sharing needles for heroin injection with a friend who has hepatitis B.To provide immediate protection from infection,what medication will the nurse administer?

A) Corticosteroids
B) Gamma globulin
C) Hepatitis B vaccine
D) Fresh frozen plasma

Question 9

Which teaching should the nurse provide about intradermal skin testing to a patient with possible allergies?

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 10

A patient who collects honey to earn supplemental income has developed a hypersensitivity to bee stings.Which statement,if made by the patient,would indicate a need for additional teaching?

A) "I need to find another way to earn extra money."
B) "I will get a prescription for epinephrine and learn to self-inject it."
C) "I will plan to take oral antihistamines daily before going to work."
D) "I should wear a Medic-Alert bracelet indicating my allergy to bee stings."

Question 11

A patient who is anxious and has difficulty breathing seeks treatment after being stung by a wasp.What is the nurse's priority action?

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 12

A patient who has received allergen testing using the cutaneous scratch method has developed itching and swelling at the skin site.Which action should the nurse take first?

A) Administer epinephrine.
B) Apply topical hydrocortisone.
C) Monitor the patient for lower extremity edema.
D) Ask the patient about exposure to any new lotions or soaps.

Question 13

A patient is admitted to the hospital with acute rejection of a kidney transplant.Which intervention will the nurse prepare for this patient?

A) Administration of immunosuppressant medications
B) Insertion of an arteriovenous graft for hemodialysis
C) Placement of the patient on the transplant waiting list
D) A blood draw for human leukocyte antigen (HLA) matching

Question 14

An older adult patient has a prescription for cyclosporine following 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 15

A patient is being evaluated for possible atopic dermatitis.The nurse expects elevation of which laboratory value?

A) IgE
B) IgA
C) Basophils
D) Neutrophils

Question 16

The charge nurse is assigning rooms for new admissions.Which patient would be the most appropriate roommate for a patient who has acute rejection of an organ transplant?

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 17

An older adult patient who is having an annual check-up tells the nurse,"I feel fine,and I don't want to pay for all these unnecessary cancer screening tests!" Which information should the nurse plan to teach this patient?

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 18

The nurse teaches a patient diagnosed with systemic lupus erythematosus (SLE)about plasmapheresis.What instructions about plasmapheresis should the nurse include in the teaching plan?

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

Question 19

The nurse,who is reviewing a clinic patient's medical record,notes that the patient missed the previous appointment for weekly immunotherapy.Which action by the nurse is most appropriate?

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 20

A new mother expresses concern about her baby developing allergies and asks what the health care provider meant by "passive immunity." Which example should the nurse use to explain this type of immunity?

A) Early immunization
B) Bone marrow donation
C) Breastfeeding her infant
D) Exposure to communicable diseases

Question 21

A clinic patient is experiencing an allergic reaction to an unknown allergen.Which action is most appropriate for the registered nurse (RN)to delegate to a licensed practical/vocational nurse (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 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.What action should the nurse take first?

A) Remind the patient to remain calm.
B) Administer subcutaneous epinephrine.
C) Apply a tourniquet above the injection site.
D) Rub a local antiinflammatory cream on the site.

Question 23

A nurse has obtained donor tissue typing information about a patient who is waiting for a kidney transplant.Which results should be reported to the transplant surgeon?

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

The health care provider asks the nurse whether a patient's angioedema has responded to prescribed therapies.Which assessment should the nurse perform?

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

Question 25

A patient who is receiving immunotherapy has just received an allergen injection.Which assessment finding 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 2-cm wheal at the site of the allergen injection.

Question 26

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 a space between each answer choice [A,B,C,D,E]).

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.