Deck 16: Altered Immune Response and Transplantation

Question 1

The nurse is completing an assessment and health history with a client. Which of the following statements made by the client should 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 two 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."

Answer 1

"I had my spleen removed many years ago after a car accident."

Question 2

The nurse is caring for a client who has experienced Goodpasture's syndrome. Which of the following adverse effects should the nurse be aware of?

A)Thrombocytopenia
B)Leukopenia
C)Angioedema
D)Pulmonary hemorrhage

Answer 2

Pulmonary hemorrhage

Question 3

The nurse is admitting a client to hospital who has an acute rejection of an organ transplant. Which of the following clients is the most appropriate roommate?

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

Answer 3

A client who is recovering from an anaphylactic reaction to a bee sting

Question 4

Chickenpox is an example of which of the following types of immunities?

A)Innate
B)Natural active
C)Artificial
D)Cell-mediated

Question 5

Which of the following instructions should the nurse include when teaching a client 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 20-30 minutes after the testing."
D)"Reaction to the testing will take about 48-72 hours to occur."

Question 6

The nurse is assessing a client for possible atopic dermatitis. Which of the following laboratory values should the nurse review?

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

Question 7

Which of the following adverse effects is related to cyclosporine administration?

A)Nephrotoxicity
B)Aseptic necrosis
C)Peptic ulcer
D)Leukopenia

Question 8

The nurse is caring for a client who receives weekly immunotherapy and has missed the previous appointment. Which of the following actions should the nurse implement when the client comes for the next injection?

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 client's sensitivity to the allergen with a repeat skin test.

Question 9

The nurse is caring for a client who had a bone marrow transplant for treatment of leukemia and has developed a skin rash 10 days after the transplant. The nurse recognizes this reaction as an indication of which of the following?

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

Question 10

The nurse is conducting an annual health examination on an older adult client who states, "I don't understand why I need to have so many cancer screening tests now. I feel just fine!" Based upon this statement, which of the following topics will the nurse include in the clients' teaching plan?

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

The nurse encourages a new mother to breastfeed her infant, even for a short time, because colostrum will provide the infant with which of the following types of immunity?

A)Innate
B)Active
C)Passive
D)Cell-mediated

Question 12

The nurse is caring for a client in the outpatient clinic who has an immune deficiency involving the T-lymphocytes. Which of the following areas should the nurse teach the client about the need for more frequent screening?

A)Allergies
B)Malignancy
C)Antibody deficiency
D)Autoimmune disorders

Question 13

Which of the following antibodies is involved with an anaphylactic reaction?

A)IgE
B)IgA
C)IgM
D)IgG

Question 14

The nurse is admitting a client to the hospital with a diagnosis of an acute rejection of a kidney transplant. Which of the following actions should the nurse anticipate implementing?

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

Question 15

The nurse is teaching a client on immunosuppressant therapy after a kidney transplant about the post-transplant drug regimen. Which of the following statements by the client should alert the nurse that additional teaching is required?

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 tumours."
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 16

Which of the following adverse reactions should the nurse monitor when a client is undergoing plasmapheresis?

A)Shortness of breath
B)High blood pressure
C)Transfusion reactions
D)Hypotension and paresthesia

Question 17

The nurse discusses the prevention and management of allergic reactions with a client who is a beekeeper and has developed a hypersensitivity to bee stings. Which of the following client statements indicates a need for additional teaching?

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."

Question 18

A client diagnosed with systemic lupus erythematosus (SLE) is scheduled for plasmapheresis. Which of the following pathophysiological events should the nurse plan to teach the client about this procedure?

A)It eliminates eosinophils and basophils from blood.
B)It removes antibody-antigen complexes from circulation.
C)It prevents foreign antibodies from damaging various body tissues.
D)It decreases the damage to organs caused by attacking T-lymphocytes.

Question 19

The nurse is obtaining a health history from a client who works as a laboratory technician and learns that the client has a history of allergic rhinitis, asthma, and multiple food allergies. Which of the following actions is most important for the nursetoimplement?

A)Encourage the client to carry an epinephrine kit in case a type IV allergic reaction to latex develops.
B)Advise the client to use oil-based hand creams to decrease contact with natural proteins in latex gloves.
C)Document the client's allergy history and be alert for any clinical manifestations of a type I latex allergy.
D)Recommend that the client use vinyl gloves instead of latex gloves in preventing bloodborne pathogen contact.

Question 20

For early detection of an anaphylactic reaction in a client who has received allergen testing using the cutaneous scratch method, which of the following actions 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 21

After being stung by a wasp, a client is brought to the clinic by a coworker. Upon arrival the client is anxious and having difficulty breathing. Which of the following actions is priority for the nurse to implement?

A)Have the client lie down.
B)Assess the client's airway.
C)Administer high-flow oxygen.
D)Remove the stinger from the site.

Question 22

The nurse is caring for a client who is receiving an IV antibiotic and develops wheezes and dyspnea. In which order should the nurse implement these prescribed actions?

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

Question 23

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

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

Question 24

Immediately after the nurse administers an intradermal injection of an allergen on the forearm, a client complains of itching at the site and of weakness and dizziness. Which of the following actions is priority for the nurse to implement?

A)Remind the client 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 25

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

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

Question 26

To determine whether a client's angioedema has responded to prescribed therapies, which of the following actions 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 27

The nurse is caring for a client at an outpatient clinic who is experiencing an allergic reaction to an unknown allergen. Which of the following actions is most appropriate for the nurse to implement?

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