Lewis Chapter 14: Altered Immune Responses and Transplantation

D

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

Grapefruit contains a chemical substance that interferes with the metabolism of tacrolimus, causing drug toxicity events. Jackfruit, dragon fruit, and passion fruit do not interfere with the metabolism of these medications. Text Reference - p. 223

After a successful organ transplant, a patient began receiving immunosuppressive therapy, specifically tacrolimus (Prograf), methylprednisolone (Solu-Medrol), and mycophenolate mofetil (CellCept). Which food should the nurse instruct the patient to avoid during this therapy? 1 Jackfruit 2 Grapefruit 3 Dragon fruit 4 Passion fruit

ANS: B 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

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? a. Corticosteroids b. Gamma globulin c. Hepatitis B vaccine d. Fresh frozen plasma

D

If a person is heterozygous for a given gene, it means that the person: A. is a carrier for a genetic disorder B. is affected by the genetic disorder C. has two identical allels for the gene D. has two different allels for the gene

C

A father who has an X-linked recessive disorder and a wife with a normal genotype will: A. pass the carrier state to his make child B. pass the carrier state to all of his children C. pass the carrier state to his female child D. not pass on the genetic mutation to any of is children

2

The nurse is monitoring a patient who has a past history of blood transfusion reactions. A transfusion reaction is an example of which of these hypersensitivity reactions? 1 Type I: IgE-mediated 2 Type II: Cytotoxic 3 Type III: Immune-complex. 4 Type IV: Delayed hypersensitivity.

When trying to determine whether a patient is at risk for latex allergy, the nurse can inquire about a history of allergy to avocados or bananas, which are both plant-based substances. Sulfa, penicillin, and shellfish are not associated with latex allergies. Text Reference - p. 216

During a preoperative assessment, the nurse would assess for latex allergy by asking the patient about allergy to which substance? 1 Penicillin 2 Sulfa 3 Avocados 4 Shellfish

2 Cell-mediated immunity 3 Hypersensitivity response 4 Humoral immune response

On initial assessment of an older patient, the nurse knows to look for certain types of diseases because which immunologic response decrease with age? 1 Autoimmune response 2 Cell-mediated immunity 3 Hypersensitivity response 4 Humoral immune response

1 With aging, autoantibodies increase, which lead to autoimmune diseases (e.g., systemic lupus erythematosis, acute glomerulonephritis, rheumatoid arthritis, hypothyroidism). Cell-mediated immunity decreases with decreased thymic output of T cells and decreased activation of both T and B cells. There is a decreased or absent delayed hypersensitivity reaction. Immunoglobulin levels decrease and lead to a suppressed humoral immune response in older adults. Text Reference - p. 208

On initial assessment of an older patient, the nurse knows to look for certain types of diseases because which immunologic response increases with age? 1 Autoimmune response 2 Cell-mediated immunity 3 Hypersensitivity response 4 Humoral immune response

A

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

D

In a type 1 hypersensitivity reaction, the primary immunologic disorder appears to be: A. binding of IgG to an antigen on the cell surface B. deposit of antigen-antibody complexes in small vessels C. release of cytokines to interact with specific antigens D. release of chemical mediators from IgE-bound mast cells and basophils

C

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

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

Ten days after receiving a bone marrow transplant, a patient develops a skin rash. What would the nurse suspect is the cause of this patient's skin rash? a. The donor T cells are attacking the patient's skin cells. b. The patient's 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.

ANS: C 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 who had an anaphylactic reaction.

The charge nurse is assigning rooms for new admissions. Which patient would be the most appropriate roommate for a patient who has acute rejection of an organ transplant? a. A patient who has viral pneumonia b. A patient with second-degree burns c. A patient who is recovering from an anaphylactic reaction to a bee sting d. A patient with graft-versus-host disease after a recent bone marrow transplant

D

The function of 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 substances C. bind antigens and stimulate natural killer cell activation D. capture antigens by phagocytosis and present them to lymphocytes

ANS: C Angioedema is characterized by swelling of the eyelids, lips, and tongue. Wheal and flare lesions, clear nasal drainage, and hypotension and tachycardia are characteristic of other allergic reactions.

The health care provider asks the nurse whether a patient's angioedema has responded to prescribed therapies. Which assessment should the nurse perform? a. Ask the patient about any clear nasal discharge. b. Obtain the patient's blood pressure and heart rate. c. Check for swelling of the patient's lips and tongue. d. Assess the patient's extremities for wheal and flare lesions.

1 IgA is found in breast milk and colostrum. It lines mucous membranes and protects body surfaces. IgM is found in plasma, and is responsible for the primary immune response. It also produces antibodies against ABO blood antigens. IgG is found in plasma and interstitial fluid. It is responsible for secondary immune response. IgD is found in plasma. It helps in the differentiation of B lymphocytes. Text Reference - p. 206

The mature plasma cell secretes immunoglobulins. The nurse recalls that which immunoglobulin is found in breast milk and colostrum? 1 IgA 2 IgM 3 IgG 4 IgD

4 IgD

The mature plasma cell secretes immunoglobulins. The nurse recalls that which immunoglobulin is found in plasma, and helps in the differentiation of B lymphocytes ? 1 IgA 2 IgM 3 IgG 4 IgD

3 IgG

The mature plasma cell secretes immunoglobulins. The nurse recalls that which immunoglobulin is found in plasma, and interstitial fluid. It is responsible for secondary immune response ? 1 IgA 2 IgM 3 IgG 4 IgD

2 IgM

The mature plasma cell secretes immunoglobulins. The nurse recalls that which immunoglobulin is found in plasma, and is responsible for produces antibodies against ABO blood antigens ? 1 IgA 2 IgM 3 IgG 4 IgD

2 IgM

The mature plasma cell secretes immunoglobulins. The nurse recalls that which immunoglobulin is found in plasma, and is responsible for the primary immune response ? 1 IgA 2 IgM 3 IgG 4 IgD

D

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 much more effective way of controlling allergens, and allergy shots are not usually effective D. immunotherapy should only be administered in a setting where emergency equipment and drugs are available

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

A clinic patient is experiencing an allergic reaction to an unknown allergen. Which action is most appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Perform a focused physical assessment. b. Obtain the health history from the patient. c. Teach the patient about the various diagnostic studies. d. Administer skin testing by the cutaneous scratch method.

ANS: 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.

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

Anaphylactic reactions occur suddenly in hypersensitive patients after exposure to the offending allergen. They may occur after parenteral injection of drugs (especially antibiotics) or blood products, and after insect stings. The cardinal principle in management is speed in recognition of signs and symptoms of an anaphylactic reaction, maintenance of a patent airway, prevention of spread of the allergen by using a tourniquet, administration of drugs, and treatment for shock. Text Reference - p. 210

A nurse has just been asked by a friend to administer allergy shots at home to save money by avoiding office visits. Which response by the nurse is most appropriate? 1 "I would, but it is illegal for nurses to administer injections outside of a medical setting." 2 "These injections should only be administered in a setting where emergency equipment and drugs are available." 3 "Just make sure you have epinephrine in an injectable syringe provided along with the allergy injections." 4 "Allergy shots are not usually effective; it is safer and more effective to control allergies by avoiding allergens."

ANS: C Positive crossmatching is an absolute contraindication to kidney transplantation, since a hyperacute rejection will occur after the transplant. The other information indicates that the tissue match between the patient and potential donor is acceptable

A nurse has obtained donor tissue typing information about a patient who is waiting for a kidney transplant. Which results should be reported to the transplant surgeon? a. Patient is Rh positive and donor is Rh negative b. Six antigen matches are present in HLA typing c. Results of patient-donor cross matching are positive d. Panel of reactive antibodies (PRA) percentage is low

Autoimmunity occurs when the body identifies self proteins as foreign substances, it causes cellular and tissue damage. Hypersensitivity is an exaggerated immune response to specific products. Immunodeficiency results from an incompetent immune system, which can be caused by pathogens, medications, and many other factors. Delayed hypersensitivity is a type of hypersensitivity reaction that takes 24 to 48 hours to occur. Text Reference - p. 217

A nurse is caring for a patient with systemic lupus erythematosus. The nurse understands that this disease is caused when the body identifies self proteins as foreign substances, triggering an immune response. What is this pathophysiological condition called? 1 Autoimmunity 2 Hypersensitivity 3 Immunodeficiency 4 Delayed hypersensitivity

1,3, 4 Some of the proteins in rubber latex are similar to food proteins. The patient who is allergic to latex may also be allergic to foods that contain similar food proteins. Tomatoes, potatoes, and avocados should be avoided. Milk and leafy vegetables do not contain proteins similar to those found in latex. Text Reference - p. 216

A nurse is preparing the discharge plan of a patient who is allergic to latex. What foods should the nurse ask the patient to avoid? Select all that apply. 1 Tomatoes 2 Leafy vegetables 3 Avocados 4 Potatoes 5 Milk

2 IgA is the only immunoglobulin found in breast milk and colostrum. It provides passive acquired immunity to the baby. No other immunoglobulins are present in the breast milk. Passive acquired immunity in the baby is also provided by IgG, which crosses through the placenta and is present in the baby for at least 3 months. IgM and IgE are not present in the breast milk. Text Reference - p. 206

A nurse is teaching a new mother about the advantages of breast-feeding in protecting the baby against infections. Which immunoglobulin is present in breast milk that provides immunity against infections in the baby? 1 IgG 2 IgA 3 IgM 4 IgE

3 Artificially acquired active immunity is the response to antigens that are artificially acquired by the body through vaccination. If the antigens are naturally introduced in the body, it is called naturally acquired active immunity. In passive immunity, the body receives antigens rather than synthesizing them. Text Reference - p. 204

A parent arrives at the pediatrician's office with a young patient who is to receive vaccines. The nurse would explain that the type of immunity rendered through the vaccination is what? 1 Artificially acquired passive immunity 2 Naturally acquired active immunity 3 Artificially acquired active immunity 4 Naturally acquired passive immunity

1,3,4 Wearing a Medic Alert bracelet is important because it gives an indication to the health care provider about the patient's medical history. The patient should carry preinjectable epinephrine and a tourniquet. The patient should be taught the technique of applying a tourniquet and the method of self-injecting epinephrine in case of emergency. Methdilazine is an antipruritic agent that requires a prescription, and it should be used with great caution. Also, as it is antipruritic, it will not protect against insect sting. Calamine lotion is also antipruritic. It will help to relieve itching but will not act as a preventive measure for insect stings. Text Reference - p. 214

A patient allergic to insect stings is going on a jungle trek. How will you instruct the patient to take precautionary measures? Select all that apply. 1 Carry preinjectable epinephrine and a tourniquet. 2 Take methdilazine (Tacaryl) orally as a preventive measure. 3 Wear a Medic Alert bracelet. 4 Learn how to self-inject epinephrine. 5 Apply calamine lotion topically as a preventive measure.

3 When administering immunotherapy, it is imperative to closely monitor the patient for any signs of an adverse reaction. The high risk and significant consequence of an adverse reaction supersede the need to assess the patient's fluid balance. Pain and changes in level of consciousness are not likely events when administering immunotherapy. Text Reference - p. 215

A patient has begun immunotherapy for the treatment of intractable environmental allergies. When administering the patient's immunotherapy, what is the nurse's priority action? 1 Monitor the patient's fluid balance 2 Assess the patient's need for analgesia 3 Monitor for signs and symptoms of an adverse reaction 4 Assess the patient for changes in level of consciousness

4, 5 The patient should be instructed to avoid chemicals known to trigger symptoms. Creating a chemical- and odor-free environment is the most appropriate treatment to prevent symptoms related to chemical sensitivity. Narcotic drugs, antianxiety drugs, and antidepressant drugs are used only to treat the symptoms temporarily. These drugs do not desensitize the patient toward the chemicals. TEST-TAKING TIP: Look for options that are similar in nature. If all are correct, either the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option. Text Reference - p. 216

A patient has developed multiple chemical sensitivities. What line of treatment would be appropriate for this patient? Select all that apply. 1 Start narcotic drugs. 2 Start antianxiety drugs. 3 Start antidepressants. 4 Avoid chemicals that may trigger symptoms. 5 Create an odor-free and chemical-free home and workplace.

ANS: A Acute rejection is treated with the administration of additional immunosuppressant drugs such as corticosteroids. Because acute rejection is potentially reversible, there is no indication that the patient will require another transplant or hemodialysis. There is no indication for repeat HLA testing.

A patient is admitted to the hospital with acute rejection of a kidney transplant. Which intervention will the nurse prepare for this patient? a. Administration of immunosuppressant medications b. Insertion of an arteriovenous graft for hemodialysis c. Placement of the patient on the transplant waiting list d. A blood draw for human leukocyte antigen (HLA) matching

ANS: A 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.

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

C

A patient 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 antinuclear 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

2 Skin testing is the preferred method for specific allergy testing. Enzyme linked-immunosorbent assay (ELISA) is performed in specific conditions when the patient cannot undergo skin allergy testing. A complete blood count (CBC) with differential helps determine the level of eosinophils, which are elevated in type I hypersensitivity reactions. However, CBC with differential does not help to identify the allergens. Testing bronchial secretions does not help in allergy testing, as bronchial secretions are not highly specific. Text Reference - p. 214

A patient presents with recurrent symptoms of allergy, specifically hives and rashes. What type of allergy test would the nurse expect to be performed on this patient? 1 ELISA 2 Skin testing 3 CBC with differential 4 Testing bronchial secretions

In type II hypersensitivity reactions, cellular structures are destroyed. These reactions mostly involve the destruction of red blood cells, platelets, and leukocytes. When incompatible blood types are mixed, agglutination occurs. As a result, hemoglobin may be released into the urine and plasma, causing acute kidney failure. Type I, III, and IV are not responsible for ABO incompatibility reactions. Type I hypersensitivity reactions occur during allergic rhinitis and asthma. Type III hypersensitivity reactions occur in disease conditions like rheumatoid arthritis. Type IV reactions occur in contact dermatitis. Text Reference - p. 211

A patient undergoes ABO compatibility tests. When administering the patient a prescribed blood transfusion, the nurse monitors for what type of hypersensitivity reaction? 1 Type I: IgE-mediated 2 Type III: Immune-complex 3 Type II: Cytotoxic and cytolytic 4 Type IV: Delayed hypersensitivity

ANS: C Because the patient 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 patient's hypersensitivity reaction. The other patient statements indicate a good understanding of management of the problem

A patient who collects honey to earn supplemental income has developed a hypersensitivity to bee stings. Which statement, if made by the patient, would indicate a need for additional teaching? a. "I need to find another way to earn extra money." b. "I will get a prescription for epinephrine and learn to self-inject it." c. "I will plan to take oral antihistamines daily before going to work." d. "I should wear a Medic-Alert bracelet indicating my allergy to bee stings."

The nurse should give immunotherapy at the hospital and closely monitor the patient for any adverse reactions. Immunotherapy may cause a severe anaphylactic reaction; therefore, the nurse should give immunotherapy only when emergency equipment is available. Immunotherapy should never be given in the home as anaphylactic shock cannot be adequately treated at home. The patient should never be left alone after immunotherapy, as systemic reactions may occur. TEST-TAKING TIP: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers. Text Reference - p. 216

A patient who has been receiving immunotherapy for the control of allergy symptoms requests a dose that can be taken at home. What is the most appropriate nursing response? 1 Give immunotherapy to the patient that can be taken at home as requested. 2 Give immunotherapy to the patient at home but explain that the patient will need to visit the hospital immediately afterward for testing. 3 Give immunotherapy at the hospital and let the patient go home. 4 Give immunotherapy at the hospital and closely monitor the patient.

ANS: A 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. Topical hydrocortisone would not deter an anaphylactic reaction. Exposure to lotions and soaps does not address the immediate concern of a possible anaphylactic reaction. The nurse should not wait and observe for edema. The nurse should act immediately in order to prevent progression to anaphylaxis.

A patient who has received allergen testing using the cutaneous scratch method has developed itching and swelling at the skin site. Which action should the nurse take first? a. Administer epinephrine. b. Apply topical hydrocortisone. c. Monitor the patient for lower extremity edema. d. Ask the patient about exposure to any new lotions or soaps.

ANS: B The initial action with any patient with difficulty breathing is to assess and maintain the airway. The other actions also are part of the emergency management protocol for anaphylaxis, but the priority is airway maintenance.

A patient who is anxious and has difficulty breathing seeks treatment after being stung by a wasp. What is the nurse's priority action? a. Have the patient lie down. b. Assess the patient's airway. c. Administer high-flow oxygen. d. Remove the stinger from the site.

ANS: D A local reaction larger than quarter size may indicate that a decrease in the allergen dose is needed. An increase in IgG indicates that the therapy is effective. Redness and swelling at the site are not unusual. Because immunotherapy usually takes 1 to 2 years to achieve an effect, an improvement in the patient's symptoms is not expected after a few months

A patient who is receiving immunotherapy has just received an allergen injection. Which assessment finding is most important to communicate to the health care provider? a. The patient's IgG level is increased. b. The injection site is red and swollen. c. The patient's allergy symptoms have not improved. d. There is a 2-cm wheal at the site of the allergen injection.

Dendritic cells capture antigens at the sites of contact with the external environment. Dendritic cells transport an antigen until it encounters a T cell with specificity for the antigen. Dendritic cells activate the immune response. IL-7 promotes growth of T and B cells. IL- 9 enhances T cell survival and mast cell activation. IL-8 facilitates chemotaxis of neutrophils and T cells. Text Reference - p. 206

A student nurse learns that dendritic cells are an important component of the immune system and are found in the skin and the lining of the nose, the lungs, the stomach, and the intestine. What is the function of dendritic cells? 1 They promote growth of T and B cells. 2 They enhance T cell survival and mast cell activation. 3 They cause chemotaxis of neutrophils and T cells. 4 They capture antigens at the sites of contact with the external environment.

ANS: D Grapefruit juice can increase the toxicity of cyclosporine. The patient should be taught to avoid grapefruit juice. High fluid intake will not affect 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.

An older adult patient has a prescription for cyclosporine following 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? a. The patient restricts salt to treat prehypertension. b. The patient drinks 3 to 4 quarts of fluids every day. c. The patient has many concerns about the effects of cyclosporine. d. The patient has a glass of grapefruit juice every day for breakfast.

ANS: A The primary impact of aging on immune function is on T cells, which are important for immune surveillance and tumor immunity. Antibody function is not affected as much by aging. Poor nutrition can also contribute to decreased immunity, but there is no evidence that it is a contributing factor for this patient. Although some types of cancer are associated with specific infections, this patient does not have an active infection.

An older adult patient who is having an annual check-up tells the nurse, "I feel fine, and I don't want to pay for all these unnecessary cancer screening tests!" Which information should the nurse plan to teach this patient? a. Consequences of aging on cell-mediated immunity b. Decrease in antibody production associated with aging c. Impact of poor nutrition on immune function in older people d. Incidence of cancer-stimulating infections in older individuals

D

Association between HLA antigens and disease is most commonly found in what disease condition? A. malignancies B. infectious disease C. neurologic diseases D. autoimmune disorders

B, E

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 could be considered B. acute rejection can be treated with OKT3 C. acute rejection usually leads to chronic rejection D. corticosteroids are the most successful drug used to treat acute rejection E. Acute rejection is common after a transplant and can be treated with drug therapy

ANS: C Application of a tourniquet will decrease systemic circulation of the allergen and should be the first reaction. A local antiinflammatory cream may be applied to the site of a cutaneous test if the itching persists. Epinephrine will be needed if the allergic reaction progresses to anaphylaxis. The nurse should assist the patient to remain calm, but this is not an adequate initial nursing action.

Immediately after the nurse administers an intracutaneous injection of an allergen on the forearm, a patient complains of itching at the site and of weakness and dizziness. What action should the nurse take first? a. Remind the patient to remain calm. b. Administer subcutaneous epinephrine. c. Apply a tourniquet above the injection site. d. Rub a local antiinflammatory cream on the site.

3 IgG

Passive acquired immunity in the baby is also provided by ______________ which crosses through the placenta and is present in the baby for at least 3 months 1 IgA 2 IgM 3 IgG 4 IgD

This patient is at risk for development of an anaphylactic reaction. Maintaining a clear and patent airway is a priority outcome with a patient who has sustained a bee sting and has a known allergy to bees. Comfort and being free of signs and symptoms of infection are important after ensuring airway patency and breathing. Although the demonstration of self-administered epinephrine is likely valuable for the allergic patient, immediately after the bee sting is not the best time to engage in education because a delay in the administration of epinephrine could result. Text Reference - p. 214

The nurse creates a plan of care for a patient who has had an allergic reaction to a bee sting. What is the priority expected outcome for this patient? 1 Verbalizing comfort 2 Maintaining a clear and patent airway 3 Being free of signs and symptoms of infection 4 Demonstrating self-administration of epinephrine

A

The nurse is altered to possible anaphylactic shock immediately after a patient 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

ANS: D Numbness and tingling may occur as the result of the hypocalcemia caused by the citrate used to prevent coagulation. The other clinical manifestations are not associated with plasmapheresis.

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

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

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

1 β-Interferon is used in treating multiple sclerosis. Cytokines instruct cells to alter their proliferation, differentiation, secretion, or activity. Cytokines play an important role in hematopoiesis. α-interferon is used to treat multiple myeloma, hairy cell leukemia, and renal cell carcinoma. Text Reference - p. 208

The nurse recalls that interferons may be used in the treatment of certain diseases. What is the clinical use of β-Interferon? 1 As a treatment for multiple sclerosis 2 As a treatment for multiple myeloma 3 As a treatment for hairy cell leukemia 4 As a treatment for renal cell carcinoma

4 Cell-mediated immunity involves various cells, including natural killer cells. The natural killer cells are responsible for identifying "self" and "non-self" tissues, which sometimes results in rejection of grafts and transplants. Innate immunity is present after birth. It involves a non-specific response through neutrophils and monocytes and is not responsible for graft rejections. Passive immunity results when antibodies are acquired by the body and not produced within. Humoral immunity involves immunoglobulin production and is responsible for allergic reactions. Text Reference - p. 208

The nurse recognizes that a patient is demonstrating signs of a transplant rejection after a renal transplant. Which phenomenon is responsible for the rejection of donor organs and tissue? 1 Innate immunity 2 Passive immunity 3 Humoral immunity 4 Cell-mediated immunity

ANS: A Cyclosporine, a 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.

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."

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

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.

ANS: C 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. 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.

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

Plasmapheresis removes plasma that contains autoantibodies (usually IgG class) and antigen-antibody complexes to remove the pathologic substances in the plasma without causing anemia. Plateletpheresis removes platelets from normal individuals for use by patients with low platelet counts. Apheresis is used to collect stem cells from peripheral blood that does not cure autoimmune disease. Text Reference - p. 217

The patient with an autoimmune disease will be treated with plasmapheresis. What should the nurse teach the patient about this treatment? 1 It will gather platelets for use later when needed. 2 It will cause anemia because it removes whole blood and red blood cells (RBCs) that are damaged. 3 It will remove the immunoglobulin G (IgG) autoantibodies and antigen complexes from the plasma. 4 It will remove the peripheral stem cells to cure the autoimmune disease

A

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

D

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

ANS: C Sneezing after subcutaneous immunotherapy may indicate impending anaphylaxis and assessment and emergency measures should be initiated. The other patients also have findings that need assessment and intervention by the nurse, but do not have evidence of life-threatening complications.

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

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

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."

4 Because immunosuppressants work at different phases of the immune response, lower doses of each drug can be used to produce effective immunosuppression while minimizing side effects. The use of several medications is not because they enhance each other, and does not increase the risk of allergies or malignancies. Text Reference - p. 221

Which statement by the patient who has had an organ transplant would indicate that the patient understands the teaching about the immunosuppressive medications? 1 "My drug dosages will be lower because the medications enhance each other." 2 "Taking more than one medication will put me at risk for developing allergies." 3 "I will be more prone to malignancies because I will be taking more than one drug." 4 "The lower doses of my medications can prevent rejection and minimize the side effects."

2 Seasonal allergic rhinitis most commonly is caused by pollens from trees, weeds, and grasses. Airborne allergies can be controlled by sleeping in an air-conditioned room, daily damp dusting, covering the mattress and pillows with hypoallergenic covers, and wearing a mask outdoors. It is not necessary to get rid of pets because pet dander does not contribute to seasonal allergies. It is not necessary to stay indoors during the winter. Daily damp dusting is recommended, not dry feather dusting. Text Reference - p. 209

Which statement made by the nurse is most appropriate in teaching patient interventions to minimize the effects of seasonal allergic rhinitis? 1 "You will need to get rid of your pets." 2 "You should sleep in an air-conditioned room." 3 "You would do best to stay indoors during the winter months." 4 "You will need to dust your house with a dry feather duster twice a week."

ANS: 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.

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."

ANS: C The patient's allergy history and occupation indicate a risk of developing a latex allergy. The nurse should be prepared to manage any symptoms that may 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.

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 patient's 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.

3, 4, 5 Anaphylaxis is a significant adverse reaction that is life threatening in response to the iodinated dye that was used as a contrast. As anaphylaxis is manifested by respiratory distress, a rapid weak pulse, hypotension, and shock, counteractive measures must be implemented immediately. Nasal discharge and sneezing are not associated with contrast dye-related complications; these are minor manifestations of atopic reactions. Text Reference - p. 214

While undergoing a cerebral computed tomography (CT) scan, a contrast dye is injected. After administering a few mL of contrast media, the health care provider assesses the patient and immediately stops the infusion. What reasons could have led the health care provider to discontinue the contrast dye? Select all that apply. 1 Nasal discharge 2 Sneezing 3 Dyspnea 4 Rapid, weak pulse 5 Hypotension

1 Allergic reactions are IgE-mediated and happen only in individuals who are susceptible to specific allergens. IgG, IgM, and IgA are other immunoglobulins that are responsible for various immune mechanisms other than allergy. IgG is the primary antibody found in a secondary immune response. It can move from the intravascular space to extra vascular space. IgM is a large molecule. It is the first type of antibody formed, and remains confined to the intravascular space. IgA are immunoglobulins found in breast milk; they render passive immunity. Text Reference - p. 209

he nurse cares for a patient that had an asthma attack due to an unknown allergen. Which immunoglobulin is primarily responsible for allergic reactions? 1 IgE 2 IgG 3 IgM 4 IgA

4, 5 The patient should receive the shingles (herpes zoster) vaccine, Pneumovax, and influenza. Meningococcal, Hib, and MMR vaccinations do not apply to this patient. Meningococcal vaccination is recommended for adults at risk (e.g., adults with anatomic or functional asplenia or persistent complement component deficiencies). Adults born before 1957 generally are considered immune to measles and mumps. Hib vaccination is considered only for adults with selected conditions (e.g., sickle cell disease, leukemia, human immunodeficiency virus [HIV] infection, or for those who have anatomic or functional asplenia) if they have not been vaccinated previously. Text Reference - p. 208

healthy 65-year-old man who lives at home is at the clinic requesting a "flu shot." When assessing the patient, what other vaccinations should the nurse ask the patient about receiving? Select all that apply. 1 Haemophilus influenzae type b (Hib) 2 Measles, mumps, and rubella (MMR) 3 Meningococcal 4 Shingles 5 Pneumonia