Question 1

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?

Accepted Answer

Treatment for a patient with acute rejection includes administration of additional immunosuppressants, and the patient should not be exposed to increased risk for infection as would occur from patients with viral pneumonia, graft-versus-host disease, and burns. There is no increased exposure to infection from a patient with anaphylaxis.

Question 2

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?

Accepted Answer

RAST is an in vitro test for hypersensitivity to specific allergens that is used when patients are likely to have anaphylactic reactions to other forms of skin testing. Cutaneous scratch testing or intracutaneous testing is more likely to cause anaphylaxis. Serum IgE level is elevated in atopic reactions but is not diagnostic for specific allergens.

Question 3

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,

Accepted Answer

The calcineurin inhibitor will need to be continued for life. The other patient statements are accurate and indicate that no further teaching is necessary about those topics.

Question 4

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

Accepted Answer

Acute rejection is treated with the administration of additional immunosuppressant drugs such as corticosteroids. Because acute rejection is reversible, there is no indication that the patient will require another transplant, hemodialysis, or HLA/ABO testing.

Question 5

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?

Accepted Answer

Grapefruit juice can increase the cyclosporine to toxic levels; the patient should be taught to avoid grapefruit juice. High fluid intake will not impact cyclosporine levels or renal function. Cyclosporine may cause hypertension, and the patient's many concerns should be addressed, but these are not potentially life-threatening problems.

Question 6

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?

Accepted Answer

LPN/LVNs are educated and licensed to administer medications under the supervision of an RN. RN-level education and the scope of practice includes assessment of health history, focused physical assessment, and patient teaching.

Question 7

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?

Accepted Answer

Because hemophilia is caused by a mutation of the X-chromosome, all female children of a man with hemophilia are carriers of the disorder and can transmit the mutated gene to their offspring. Sons of a man with hemophilia will not have the disorder. Hemophilia is caused by a genetic mutation and is not a multifactorial inherited condition.

Question 8

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

Accepted Answer

A genetic counselor is best qualified to address the multiple issues involved in genetic testing for a patient who is considering having children. Although genetic testing does have social implications, a pregnant patient will be better served by a genetic counselor who will have more expertise in this area. CF is an autosomal-recessive disorder, but the patient might not understand the implications of this statement. Asking why the patient feels genetic testing is important may imply to the patient that the nurse is questioning her value system regarding issues such as abortion.

Question 9

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

Accepted Answer

The patient should first receive antibodies for hepatitis B from injection of gamma globulin. The hepatitis B vaccination series should be started to provide active immunity. Fresh frozen plasma and corticosteroids will not be effective in preventing hepatitis B in the patient.

Quiz 14: Genetics, Altered Immune Responses, and Transplantation