chapter 13

Gamma globulin 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.

14. 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? Corticosteroids Gamma globulin Hepatitis B vaccine Fresh frozen plasma

B Cell-mediated immunity is responsible for the recognition and destruction of cancer cells.

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

Numbness and tingling Numbness and tingling may occur as the result of the hypocalcemia caused by the citrate used to prevent coagulation.

10. The nurse is caring for a patient undergoing plasmapheresis. The nurse should assess the patient for which clinical manifestation? Shortness of breath High blood pressure Transfusion reaction Numbness and tingling

C Splenectomy increases the risk for septicemia from bacterial infections.

11. 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.

C Sneezing after subcutaneous immunotherapy may indicate impending anaphylaxis and assessment and emergency measures should be initiated.

12. 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

A The patients history and symptoms indicate that the patient is experiencing graft-versus-host disease, in which the donated T cells attack the patients tissues.

13. Ten days after receiving a bone marrow transplant, a patient develops a skin rash. What would the nurse suspect is the cause of this patients skin rash? A. The donor T cells are attacking the patients skin cells. B. The patients 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.

A Cyclosporine, a calcineurin inhibitor, will need to be continued for life.

15. 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.

C 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. Active immunity is acquired by being immunized with vaccinations or having an infection. It requires that the infant has an immune response after exposure to an antigen. Cell-mediated immunity is acquired through T lymphocytes and is a form of active immunity.

2. 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

IgE Serum IgE is elevated in an allergic response (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 patient who has symptoms of atopic dermatitis.

3. A patient is being evaluated for possible atopic dermatitis. The nurse expects elevation of which laboratory value? IgE IgA Basophils Neutrophils

C Allergic reactions usually occur within minutes after injection of an allergen, and the patient 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.

6. 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.

Consult with the health care provider about giving a lower allergen dose. Because there is an increased risk for adverse reactions after a patient misses a scheduled dose of allergen, the nurse should check with the health care provider before administration of the injection.

7. The nurse, who is reviewing a clinic patients medical record, notes that the patient missed the previous appointment for weekly immunotherapy. Which action by the nurse is most appropriate? Schedule an additional dose that week. Administer the usual dosage of the allergen. Consult with the health care provider about giving a lower allergen dose. Re-evaluate the patients sensitivity to the allergen with a repeat skin test.

C The patients allergy history and occupation indicate a risk of developing a latex allergy. The nurse should be prepared to manage any symptoms that may occur.

8. 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 patients 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.

B Plasmapheresis is used in SLE to remove antibodies, antibody-antigen complexes, and complement from blood.

9. 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.