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?

Accepted Answer

Splenectomy increases the risk for septicemia from bacterial infections. The client's protein intake is good and should improve immune function. Daily Aspirin use does not impact immune function. A chest x-ray does not have enough radiation to suppress immune function.

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?

Accepted Answer

Goodpasture's syndrome is a rare disorder involving the lungs and the kidneys. An antibody-mediated autoimmune reaction occurs involving the glomerular and alveolar basement membranes. The circulating antibodies combine with tissue antigen to activate the complement system which causes deposits of IgG to form along the basement membranes of the lungs or the kidneys. This reaction may result in pulmonary hemorrhage and glomerulonephritis.

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?

Accepted Answer

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

Question 4

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

Accepted Answer

Chickenpox is an example of natural active immunity.

Question 5

Which of the following instructions should the nurse include when teaching a client with possible allergies about intradermal skin testing?

Accepted Answer

Allergic reactions usually occur within minutes after injection of an allergen, and the client will be monitored for at least 20 minutes for anaphylactic reactions after the testing.
Medications that might modify the response, such as antihistamines, should be avoided before allergy testing. There is no reason to be NPO for skin testing. Results with intradermal testing occur within minutes.

Question 6

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

Accepted Answer

Serum IgE causes the symptoms of allergic reactions and is elevated in type 1 hypersensitivity disorders. The eosinophil level will be elevated, rather than neutrophil or basophil counts. IgA is located in body secretions and would not be tested when evaluating a client who has symptoms of atopic dermatitis.

Question 7

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

Accepted Answer

Nephrotoxicity is the most severe adverse effect of cyclosporine. Aseptic necrosis, peptic ulcer, and leukopenia are all adverse effects of the use of corticosteroids, for example, prednisone.

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?

Accepted Answer

Because there is an increased risk for adverse reactions after a client misses a scheduled dose of allergen, the nurse should check with the health care provider before administration of the injection. A skin test is used to identify the allergen and would not be used at this time. An additional dose for the week may increase the risk for a reaction.

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?

Accepted Answer

The client's history and symptoms indicate that the client is experiencing graft-versus-host disease, in which the donated T cells attack the client's tissues. The history and symptoms are not consistent with rejection or delayed hypersensitivity.

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?

Accepted Answer

The primary impact of aging on immune function is on the activity of T cells, which are responsible for tumour immunity. Antibody function is not impacted as much by aging and does not protect against malignancy. Poor nutrition does contribute to decreased immunity, but there is no evidence that it is a contributing factor for this client. Although some types of cancers are associated with specific infections, this client does not have an active infection.

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?

Accepted Answer

Colostrum provides passive immunity through antibodies from the mother; these antibodies protect the infant for a few months. However, memory cells are not retained, so the protection is not permanent. Innate immunity is present at birth and occurs without exposure to an antigen. Active immunity requires that the infant manufacture antibodies after exposure to an antigen. Cell-mediated immunity is acquired through T-lymphocytes and is a form of active immunity.

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?

Accepted Answer

Cell-mediated immunity is responsible for the recognition and destruction of cancer cells. Allergic reactions, autoimmune disorders, and antibody deficiencies are mediated primarily by humoral immunity.

Question 13

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

Accepted Answer

Serum IgE causes the symptoms of allergic reactions and is the antibody involved with an anaphylactic reaction.

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?

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 client will require another transplant, hemodialysis, or HLA/ABO testing.

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?

Accepted Answer

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

Question 16

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

Accepted Answer

Hypotension and paresthesia may occur as the result of plasmapheresis. Citrate is used as an anticoagulant and may cause hypocalcemia, which may manifest as headache, paresthesias, and dizziness. The other clinical manifestations are not associated with plasmapheresis.

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?

Accepted Answer

Since the client is at risk for bee stings and the severity of allergic reactions tends to increase with added exposure to allergen, taking oral antihistamines will not adequately control the client's hypersensitivity reaction. The other client statements indicate a good understanding of management of the problem.

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?

Accepted Answer

Plasmapheresis is used in SLE to remove antibodies, antibody-antigen complexes, and complement from blood. T-lymphocytes, foreign antibodies, eosinophils, and basophils do not contribute to the tissue damage in SLE.

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?

Accepted Answer

The client's allergy history and occupation indicate a risk for development of latex allergy, and the nurse should be prepared to manage any symptoms that occur. Epinephrine is not an appropriate treatment for contact dermatitis that is caused by a type IV allergic reaction to latex. Oil-based creams will increase the exposure to latex from latex gloves. Vinyl gloves are appropriate to use when exposure to body fluids is unlikely.

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?

Accepted Answer

The initial symptoms of anaphylaxis are itching and edema at the site of the exposure. Hypotension, tachycardia, dilated pupils, and wheezes occur later. Rapid administration of epinephrine when excessive itching or swelling at the skin site is observed can prevent the progression to anaphylaxis.

Quiz 16: Altered Immune Response and Transplantation