Chapter 36

19. A patient has been admitted with a phagocytic cell disorder and the nurse is reviewing the most common health problems that accompany these disorders. The nurse should identify which of the following? Select all that apply. A) Inflammatory bowel disease B) Chronic otitis media C) Cutaneous abscesses D) Pneumonia E) Cognitive deficits

Ans: B, C, D

11. The nurse is preparing to administer IVIG to a patient who has an immunodeficiency. What nursing guideline should the nurse apply? A) Do not exceed an infusion rate of 300 mL/hr. B) Slow the infusion rate if the patient exhibits signs of a transfusion reaction. C) Weigh the patient immediately after the infusion is complete. D) Administer pretreatment medications as ordered 30 minutes prior to infusion.

Ans: D

30. A home health nurse is reinforcing health education with a patient who is immunosuppressed and his family. What statement best suggests that the patient has understood the nurse's teaching? A) "My family needs to understand when I can go get the seasonal flu shot." B) "I need to know how to treat my infections in a home setting." C) "I need to understand how to give my platelet transfusions." D) "My family needs to understand that I'll probably need lifelong treatment."

Ans: D

36. A nurse is preparing to discharge a patient with an immunodeficiency. When preparing the patient for self-infusion of IVIG in the home setting, what education should the nurse prioritize? A) Sterile technique for establishing a new IV site B) Signs and symptoms of adverse reactions C) Formulas for calculating daily doses D) Technique for adding medications to the IVIG

Ans: B

14. A nurse is admitting an adolescent patient with a diagnosis of ataxia-telangiectasis. Which of the following nursing diagnoses should the nurse include in the patient's plan of care? A) Fatigue Related to Pernicious Anemia B) Risk for Constipation Related to Decreased Gastric Motility C) Risk for Falls Due to Loss of Muscle Coordination D) Disturbed Kinesthetic Sensory Perception Related to Vascular Changes

Ans: C

7. The nurse is caring for a patient who has a diagnosis of paroxysmal nocturnal hemoglobinuria. When planning this patient's care, the nurse should recognize the patient's heightened risk of what complication? A) Venous thromboembolism B) Acute respiratory distress syndrome (ARDS) C) Myocardial infarction D) Hypertensive urgency

Ans: A

15. A 20-year-old patient with an immunodeficiency is admitted to the unit with an acute episode of upper airway edema. This is the fifth time in the past 3 months that the patient has had such as episode. As the nurse caring for this patient, you know that the patient may have a deficiency of what? A) Interferons B) C1esterase inhibitor C) IgG D) IgA

Ans: B

17. The nurse is admitting a patient to the unit with a diagnosis of ataxia-telangiectasia. The nurse's assessment should reflect the patient's increased risk for what complication? A) Peripheral edema B) Cancer C) Anaphylaxis D) Gastrointestinal bleeds

Ans: B

27. The nurse is caring for a patient with an immunodeficiency who has experienced sudden malaise. The nurse's colleague states, "I'm pretty sure that it's not an infection, because the most recent blood work looks fine." What principle should guide the nurse's response to the colleague? A) Immunodeficient patients will usually exhibit subtle and atypical signs of infection. B) Infections in immunodeficient patients have a slower onset but a more severe course. C) Laboratory blood work is often inaccurate in immunodeficient patients. D) Immunodeficient patients do not develop symptoms of infection.

Ans: A

23. The nurse educator is differentiating primary immunodeficiency diseases from secondary immunodeficiencies. What is the defining characteristic of primary immunodeficiency diseases? A) They require IVIG as treatment. B) They are the result of intrauterine infection. C) They have a genetic origin. D) They are communicable.

Ans: C

29. A patient with a diagnosis of primary immunodeficiency informs the nurse that he has been experiencing a new onset of a dry cough and occasional shortness of breath. After determining that the patient's vital signs are within reference ranges, what action should the nurse take? A) Administer a nebulized bronchodilator. B) Perform oral suctioning. C) Assess the patient for signs and symptoms of infection. D) Teach the patient deep breathing and coughing exercises.

Ans: C

32. An immunocompromised patient is being treated in the hospital. The nurse's assessment reveals that the patient's submandibular lymph nodes are swollen, a finding that represents a change from the previous day. What is the nurse's most appropriate action? A) Administer a PRN dose of acetaminophen as ordered. B) Monitor the patient's vital signs q2h for the next 24 hours. C) Inform the patient's primary care provider of this finding. D) Implement standard precautions in the patient's care.

Ans: C

37. A home health nurse will soon begin administering IVIG to a new patient on a regular basis. What teaching should the nurse provide to the patient? A) The need for a sterile home environment B) Complementary alternatives to IVIG C) Expected benefits and outcomes of the treatment D) Technique for managing and monitoring daily fluid intake

Ans: C

20. A nurse is caring for a patient with a phagocytic cell disorder. The patient states, "My specialist says that I will likely be cured after I get my treatment tomorrow." To what treatment is the patient most likely referring? A) Treatment with granulocyte-macrophage colony-stimulating factor (GM-CSF) B) Hematopoietic stem cell transplantation C) Treatment with granulocyte colony-stimulating factor (G-CSF) D) Brachytherapy

Ans: B

16. A patient with Wiskott-Aldrich syndrome is admitted to the medical unit. The nurse caring for the patient should prioritize which of the following? A) Protective isolation B) Fresh-frozen plasma administration C) Chest physiotherapy D) Nutritional supplementation

Ans: A

2. A patient is admitted for the treatment of a primary immunodeficiency and intravenous immunoglobulin (IVIG) is ordered. What should the nurse monitor for as a potential adverse effect of IVIG administration? A) Anaphylaxis B) Hypertension C) Hypothermia D) Joint pain

Ans: A

3. A nurse is admitting a patient with an immunodeficiency to the medical unit. In planning the care of this patient, the nurse should assess for what common sign of immunodeficiency? A) Chronic diarrhea B) Hyperglycemia C) Rhinorrhea D) Contact dermatitis

Ans: A

31. A nurse is preparing to administer a scheduled dose of IVIG to a patient who has a diagnosis of severe combined immunodeficiency disease (SCID). What medication should the nurse administer prior to initiating the infusion? A) Diphenhydramine B) Ibuprofen C) Hydromorphone D) Fentanyl

Ans: A

35. A home health nurse is caring for a patient who has an immunodeficiency. What is the nurse's priority action to help ensure successful outcomes and a favorable prognosis? A) Encourage the patient and family to be active partners in the management of the immunodeficiency. B) Encourage the patient and family to manage the patient's activity level and activities of daily living effectively. C) Make sure that the patient and family understand the importance of monitoring fluid balance. D) Make sure that the patient and family know how to adjust dosages of the medications used in treatment.

Ans: A

39. Family members of an immunocompromised patient have asked the nurse why antibiotics are not being given to the patient in order to prevent infection. How should the nurse best respond? A) "Using antibiotics to prevent infections can cause the growth of drug-resistant bacteria." B) "If an antibiotic is given to prevent a bacterial infection, the patient is at risk of a viral infection." C) "Antibiotics can never prevent an infection; they can only cure an infection that is fully developed." D) "Antibiotics cannot resolve infections in people who are immunocompromised."

Ans: A

9. Patient teaching regarding infection prevention for the patient with an immunodeficiency includes which of the following guidelines? A) Cook all food thoroughly. B) Refrain from using creams or emollients on skin. C) Maintain contact only with individuals who have recently been vaccinated. D) Take OTC vitamin supplements consistently.

Ans: A

26. The nurse is applying standard precautions in the care of a patient who has an immunodeficiency. What are key elements of standard precautions? Select all that apply. A) Using appropriate personal protective equipment B) Placing patients in negative-pressure isolation rooms C) Placing patients in positive-pressure isolation rooms D) Using safe injection practices E) Performing hand hygiene

Ans: A, D, E

10. A nurse has admitted a patient diagnosed with severe combined immunodeficiency disease (SCID) to the unit. The patient's orders include IVIG. How will the patient's dose of IVIG be determined? A) The patient will receive 25 to 50 mg/kg of body weight. B) The dose will be determined by the patient's response. C) The dose will be determined by body surface area. D) The patient will receive a one-time bolus followed by 100- to 150-mg doses.

Ans: B

24. A nurse has created a plan of care for an immunodeficient patient, specifying that care providers take the patient's pulse and respiratory rate for a full minute. What is the rationale for this aspect of care? A) Respirations affect heart rate in immunodeficient patients. B) These patients' blunted inflammatory responses can cause subtle changes in status. C) Hemodynamic instability is one of the main complications of immunodeficiency. D) Immunodeficient patients are prone to ventricular tachycardia and atrial fibrillation.

Ans: B

28. A nurse is caring for a patient who has an immunodeficiency. What assessment finding should prompt the nurse to consider the possibility that the patient is developing an infection? A) Uncharacteristic aggression B) Persistent diarrhea C) Pruritis (itching) D) Constipation

Ans: B

4. A young couple visits the nurse practitioner stating that they want to start a family. The husband states that his brother died of a severe infection at age 6 months. He says he never knew what was wrong but his mother had him undergo ìblood testingî as a child. Based on these statements, what health problem should the nurse practitioner suspect? A) Severe neutropenia B) X-linked agammaglobulinemia C) Drug-induced thrombocytopenia D) Aplastic anemia

Ans: B

40. A 6-month-old infant has been diagnosed with X-linked agammaglobulinemia and the parents do not understand why their baby did not develop an infection during the first months of life. The nurse should describe what phenomenon? A) Cell-mediated immunity in infants B) Passive acquired immunity C) Phagocytosis D) Opsonization

Ans: B

8. A patient diagnosed with common variable immune deficiency (CVID) has been admitted to the acute medicine unit. When reviewing this patient's laboratory findings, the nurse should prioritize what values? A) Creatinine and blood urea nitrogen (BUN) B) Hemoglobin and vitamin B12 C) Sodium, potassium and magnesium D) D-dimer and c-reactive protein

Ans: B

1. A teenager is diagnosed with cellulitis of the right knee and fails to respond to oral antibiotics. He then develops osteomyelitis of the right knee, prompting a detailed diagnostic workup that reveals a phagocytic disorder. This patient faces an increased risk of what complication? A) Thrombocytopenia B) HIV/AIDS C) Neutropenia D) Hemophilia

Ans: C

13. A patient with a diagnosis of common variable immunodeficiency begins to develop thick, sticky, tenacious sputum. The patient has a history of episodes of pneumonia at least one time per year for the last 10 years. What does the nurse suspect the patient is developing? A) Pulmonary edema B) A pulmonary neoplasm C) Bronchiectasis D) Emphysema

Ans: C

18. The nurse is working with the interdisciplinary team to care for a patient who has recently been diagnosed with severe combined immunodeficiency disease (SCID). What treatment is likely of most benefit to this patient? A) Combined radiotherapy and chemotherapy B) Antibiotic therapy C) Hematopoietic stem cell transplantation (HSCT) D) Treatment with colony-stimulating factors (CSFs)

Ans: C

21. A patient's primary immunodeficiency disease is characterized by the inability of white blood cells to initiate an inflammatory response to infectious organisms. What is this patient's most likely diagnosis? A) Chronic granulomatous disease B) Wiskott-Aldrich syndrome C) Hyperimmunoglobulinemia E syndrome D) Common variable immunodeficiency

Ans: C

33. A nurse caring for a patient who has an immunosuppressive disorder knows that continual monitoring of the patient is critical. What is the primary rationale behind the need for continual monitoring? A) So that the patient's functional needs can be met immediately B) So that medications can be given as ordered and signs of adverse reactions noted C) So that early signs of impending infection can be detected and treated D) So that the nurse's documentation can be thorough and accurate

Ans: C

12. IVIG has been ordered for the treatment of a patient with an immunodeficiency. Which of the following actions should the nurse perform before administering this blood product? A) Ensure that the patient has a patent central line. B) Ensure that the IVIG is appropriately mixed with normal saline. C) Administer furosemide before IVIG to prevent hypervolemia. D) Weigh the patient before administration to verify the correct dose.

Ans: D

22. A nurse educator is explaining that patients with primary immunodeficiencies are living longer than in past decades because of advances in medical treatment. This increased longevity is associated with an increased risk of what? A) Chronic obstructive pulmonary disease B) Dementia C) Pulmonary fibrosis D) Cancer

Ans: D

25. A nurse is providing health education regarding self-care to a patient with an immunodeficiency. What teaching point should the nurse emphasize? A) The importance of aggressive treatment of acne B) The importance of avoiding alcohol-based cleansers C) The need to keep fingernails and toenails closely trimmed D) The need for thorough oral hygiene

Ans: D

34. A nurse is planning the care of a patient who requires immunosuppression to ensure engraftment of depleted bone marrow during a transplantation procedure. What is the most important component of infection control in the care of this patient? A) Administration of IVIG B) Antibiotic administration C) Appropriate use of gloves and goggles D) Thorough and consistent hand hygiene

Ans: D

38. The home health nurse is assessing a patient who is immunosuppressed following a liver transplant. What is the most essential teaching for this patient and the family? A) How to promote immune function through nutrition B) The importance of maintaining the patient's vaccination status C) How to choose antibiotics based on the patient's symptoms D) The need to report any slight changes in the patient's health status

Ans: D

5. The parents of a 1-month-old infant bring their child to the pediatrician with symptoms of congestive heart failure. The infant is ultimately diagnosed with DiGeorge syndrome. What will prolong this infant's survival? A) Stem cell transplantation B) Long-term antibiotics C) Chemotherapy D) Thymus gland transplantation

Ans: D

6. A patient who has received a heart transplant is taking cyclosporine, an immunosuppressant. What should the nurse emphasize during health education about infection prevention? A) Eat a high-calorie, high-protein diet. B) Limit physical activity in order to conserve energy. C) Take prophylactic antibiotics as ordered. D) Perform frequent handwashing.

Ans: D