Med-Surg Test 1

Cell-Mediated Immunity

- Initiated through specific antigen recognition by T cells -immunity against pathogens that survive inside of cells (viruses & bacteria). -fungal infections -rejection of transplanted tissues -contact hypersensitivity reactions -Tumor immunity

Type IV Hypersensitivity Reaction

-Delayed hypersensitivity reactions -Ex: transplant rejection, tubercular caseous necrosis, contact dermatitis.

Type 1 Hypersensitivity Reaction

-IgE mediated -Ex: Asthma, allergic rhinitis, atopic dermatitis, anaphylactic shock, urticaria, angioedema

Type III Hypersensitivity Reaction

-Immune-Complex Reaction -Local or systemic -Immediate or delayed -Ex: Systemic lupus erythematosus, acute glomerulonephritis, and rheumatoid arthritis.

IgM

-Primary immune response -antibodies against ABO blood antigens

IgD

-present on lymphocyte surface -assists in differentiation of B lymphocytes

Nursing considerations for a pt undergoing skin tests to identify allergens.

-pt should never be left alone -Assess for anaphylactic reactions. -Extract can be removed if severe reaction occurs -anti-inflammatory topical cream is applied to the site -Tourniquet can be applied if on arm. -Subq injection of dpi may be necessary.

The reasons newborns are protected for the first 6 months of life from bacterial infections is because the maternal transmission of A. IgG B. IgA C. IgM D. IgE

A. IgG

The most common cause of secondary immunodeficiencies is A. drugs B. stress C. malnutrition D. human immunodeficiency virus

A. drugs

The nurse is alerted to possible anaphylactic shock immediately after a pt has received intramuscular penicillin by the development of A. edema and itching at the injection site B. Sneezing and itching of the nose and eyes. C. A wheal-and flare reaction at the injection site D. Chest tightness and production of thick sputum

A. edema and itching at the injection site

Emerging infections can affect health care by (Select ALL that apply) A. revealing antibiotic resistance B. generating scientific discoveries C. creating a strain on limited resources D. challenging established medical traditions E. limiting travel options for nursing personnel.

A. revealing antibiotic resistance B. generating scientific discoveries C. creating a strain on limited resources D. challenging established medical traditions

For which of the following individuals is genetic carrier screening indicated? A. A pt with a history of type 1 diabetes B. A pt with a family history of sickle cell disease C. A pt whose mother and sister died of breast cancer D. A pt who has a long-standing history of iron-deficiency anemia

B. A pt with a family history of sickle cell disease

In a person having an acute rejection of a transplanted kidney, which of the following would help the nurse understand the course of events (Select ALL that apply). A. a new transplant should be considered B. Acute rejection can be treated with OKT3 C. Acute rejection usually leads to chronic rejection D. Corticosteroids are the most successful drugs used to treat acute rejection. E. Acute rejection is common after a transplant and can be treated with drug therapy.

B. Acute rejection can be treated with OKT3E. Acute rejection is common after a transplant and can be treated with drug therapy.

A pt's hemoglobin and hematocrit have necessitated a transfusion of packed RBS's. Shortly after the first unit of packed RBC's is hung, the pt develops S&S of a transfusion reaction. Which of the following hypersensitivity reactions has the pt experienced? A. Type I B. Type II C. Type III D. Type IV

B. Type II

A pt is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse explains that plasmapheresis is used in her treatment to A. remove T lymphocytes in her blood that are producing anti-nuclear antibodies B. remove normal particles in her blood that are being damaged by autoantibodies. C. exchange her plasma that contains antinuclear antibodies with a substitute fluid. D. replace viral-damaged cellular components of her blood with replacement whole blood.

C. exchange her plasma that contains antinuclear antibodies with a substitute fluid.

One function of cell-mediated immunity is A. formation of antibodies B. activation of the complement system C. surveillance for malignant cell changes. D. opsonization of antigens to allow phagocytosis by neutrophils

C. surveillance for malignant cell changes.

Association between HLA antigens and diseases is most commonly found in what disease conditions? A. Malignancies B. Infectious diseases C. Neurologic diseases D. Autoimmune disorders

D. Autoimmune disorders

Ten days after receiving a bone marrow transplant, a pt has developed a skin rash on his palms and soles, jaundice, and diarrhea. What is the most likely etiology of these clinical manifestations? A. The pt is experiencing a type I allergic reaction. B. an atopic reaction is causing the pt's symptoms. C. The pt is experiencing rejection of the bone marrow. D. Cells in the transplanted bone marrow are rejecting the host tissue.

D. Cells in the transplanted bone marrow are rejecting the host tissue. (host-versus-graft-disease)

In a type I hypersensitivity reaction, the primary immunologic disorder appears to be A. binding of IgG to an antigen on a cell surface. B. Deposit of antigen-antibody complexes in small vessels C. release of cytokines to interact with specific antigens D. release of chemical mediator from IgE-bound mast cells and basophils

D. release of chemical mediator from IgE-bound mast cells and basophils

When caring for a pt with a known latex allergy, the nurse would monitor the pt closely for a cross-sensitivity to which of the following foods (Select ALL that apply). A. Grapes B. Oranges C. Bananas D. Potatoes E. Tomatoes

Grapes, Bananas, Potatoes, Tomatoes (Also avocados, chestnuts, kiwi, water chestnuts, guava, hazelnuts, peaches, and apricots) Due to similar protiens

Plasmapheresis

The removal of plasma (separated from the blood) containing components causing or thought to cause disease, then replaced with fluids, fresh-frozen plasma, or albumin.

A nurse is monitoring a client who developed facial edema after receiving a medication. Which white blood cells stimulated the edema? a. basophils b. eosinophils c. monocytes d. neutrophils

a. basophils R: responsible for releasing histamine

While obtaining a health history, a nurse learns that a client is allergic to bee stings. When obtaining this client's medication history, the nurse should determine if the client keeps which med on hand? a. diphenhydramine (Benadryl) b. pseudoephedrine (Sudafed) c. guaifenesin (robitussin) d. loperamide (Imodium)

a. diphenhydramine (Benadryl)

This type of reaction most commonly occurs with kidney transplants, the organ must be immediately removed, and it is irreversible. a. hyperacute b. acute c. chronic

a. hyperacute

Which type of WBC is the most numerous? a. neutrophil b. lymphocyte c. eosinophil d. basophil

a. neutrophil (65%) Lymphocytes are next, eosinophils (2%), then basophils

Which of the following statements made by the nurse is most appropriate in teaching pt interventions to minimize the effects of seasonal allergic rhinitis? a. You will need to get of your pets. b. You should sleep in an air-conditioned room. c. You would do best to stay indoors during the winter months. d. You will need to dust your house with a dry feather duster twice a week.

b. You should sleep in an air-conditioned room.

This type of reaction most commonly occurs when the recipient's T-cytotoxic lymphocytes attack the foreign organ, it is usually reversible with additional or increased immunosuppressant therapy, and long-tern use of therapy is necessary to combat the rejection. a. hyperacute b. acute c. chronic

b. acute

When administering a blood transfusion to a client with multiple traumatic injuries, the nurse monitors closely for evidence of a transfusion reaction. Shortly after the transfusion begins, the client complains of chest pain, nausea, and itching. When urticaria, tachycardia, and hypotension develop, the nurse stops the transfusion and and notifies the physician. The nurse suspects which type of hypersensitivity reaction? a. Type I (immediate, anaphylactic) b. type II (cytolytic, cytoxic) c. Type III (immune complex) d. Type IV (cell-mediated, delayed)

b. type II (cytolytic, cytoxic)

Which nonpharmacologic interventions should a nurse include in a care plan for a client who has moderate rheumatoid arthritis? Select ALL that apply: a. massaging inflamed joints b. avoiding ROM exercise c. applying splints to inflamed joints d. using assistive devices at all times e. selecting clothing that has Velcro fasteners f. applying moist heat to joints

c. applying splints to inflamed joints e. selecting clothing that has Velcro fasteners f. applying moist heat to joint

This type of reaction most commonly occurs when there is infiltration of the organ with B and T lymphocytes, treatment is supportive and the recipient is placed on the transplant list again. a. hyperacute b. acute c. chronic

c. chronic

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important? a. immediately stop the transfusion, infuse dextrose 5% in water, and call physician b. slow the transfusion and monitor the client closely c. stop the transfusion, notify the blood bank, and administer antihistamines d. immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank.

d. immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a. serum potassium level of 4.9 mEq/L b. serum sodium level of 135 mEq/L c. temperature of 99.2F d. urine output of 20 mL/hour

d. urine output of 20 mL/hour

Humoral Immunity

-Antibody mediated immunity -think plasma cells/B cells -uses all the immunoglobulins (Igs)

Teach a pt about allergen recognition and control.

-various preventive measure can help control allergy symptoms but the pt will never be completely desensitized or free of all symptoms. -identifying the allergen is key -elimination of allergen from diet if food -Stress management for asthma and urticaria -Environment control for airborn allergens: air-condition, damp dusting daily, covering mattresses with hypoallergenic covers, wearing a mask outside during work -avoid drug if allergen is drug -if insect sting, carry epi pen and tourniquet, alert bracelet.

Which of the following accurately describes rejection following transplantation? A. hyperacute rejection can be treated with OKT3 B. Acute rejection can be treated with sirolimus or tacrolimus C. chronic rejection can be treated with tacrolimus or cyclosporine D. Hyperacute reaction can usually be avoided if crossmatching is done before the transplantation.

D. Hyperacute reaction can usually be avoided if crossmatching is done before the transplantation.

Nursing considerations for a pt undergoing immune therapy

-Always anticipate adverse reactions (pruritus, urticaria, sneezing, laryngeal edema, and hypotension). -If reaction site is larger than a quarter, report to provider -emergency equipment and essential drugs should always be available. -good record keeping. -use extremity away from a joint -site should be rotated -aspirate for blood before injection -observe for 20 minutes -warn pt to watch for delayed reaction for up to 24 hours.

Type II Hypersensitivity Reaction

-Cytotoxic and Cytolytic Reactions -IgM -Ex: Hemolytic transfusion reactions, Goodpasture Syndrome

What is plasmapheresis used to treat?

-autoimmune diseases: SLE, glomerulonephritis, Goodpasture syndrome, myasthenia garvis, thrombocytopenic purpura, rheumatoid arthritis, and Guillain-Barre syndrome.

IgE

-causes symptoms of allergic reactions -parasitic protection

IgG

-crosses placenta -secondary immune response

Emergency management of anaphylactic shock

-enurse patent airway -admin. high flow 02 via non-rebreather mask -remove insect stinger if present -establish IV access -Epi, albuteraol, benadryl, corticosteroids -manage hypotension (elevate legs, fluids) -monitor

S&S of anaphylaxis

-headache, dizziness paresthesia, feeling of impending doom -pruritis, angioedema, erythema, urticaria -hoarseness, coughing, sensation of narrowed airway, wheezing, stridor, dyspnea, tachypnea, respiratory arrest -hypotension, dysthythmias, tachycardia, cardiac arrest -cramping, abdominal pain, N&V, diarrhea

What are complications of plasmapheresis?

-hypotension -citrate toxicity (caused by hypocalcemia - headache, paresthesias, and dizziness).

IgA

-lines mucous membranes and protects body surfaces. -passed through breast milk and colostrum

The nurse advises a friend who asks him to administer his allergy shots that A. it is illegal for nurses to administer injections outside of a medical setting. B. He is qualified to do it if the friend has epinephrine in an injectible syringe provided with his extract C. avoiding the allergens is a more effective way of controlling allergies, and allergy shots are not usually effective. D. Immunotherapy should only be administered in a setting where emergency equipment and drugs are available.

D. Immunotherapy should only be administered in a setting where emergency equipment and drugs are available.

A pt has begun immunotherapy for the treatment of intractable environmental allergies. When administering the pt's immunotherapy, which of the following is the nurse's priority action? A. Monitoring the pt's fluid balance B. Assessing the pt's need for analgesia C. Assessing the pt for changes in level of consciousness D. Monitoring for S&S of and adverse reaction

D. Monitoring for S&S of and adverse reaction

The function of the monocytes in immunity is related to their ability to A. stimulate the production of T and B lymphocytes B. produce antibodies on exposure to foreign substance C. bind antigens and stimulate natural killer cell activation. D. capture antigens by phagocytosis and present them to lymphocytes

D. capture antigens by phagocytosis and present them to lymphocytes

A nurse encourages a client with an immunologic disorder to eat a nutritionally balanced diet to promote optimal immunologic function. Which snacks have the greatest probability of stimulating autoimmunity? a. raisins and carrot sticks b. potato chips and chocolate milk shakes c. fruit salad and mineral water d. applesauce and saltine crackers

b. potato chips and chocolate milk shakes