CH. 13 NCLEX QUESTIONS

1. A patient who is receiving an IV antibiotic develops wheezes and dyspnea. In which order should the nurse implement these prescribed actions? (Put a comma and a space between each answer choice [A, B, C, D, E]). a. Discontinue the antibiotic. b. Give diphenhydramine IV. c. Inject epinephrine IM or IV. d. Prepare an infusion of dopamine. e. Apply 100% oxygen using a nonrebreather mask.

ANS:A, E, C, B, D

4. An older adult patient who is having an annual checkup 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. Incidence of cancer-associated infections in older adults d. Impact of poor nutrition on immune function in older adults

a. Consequences of aging on cell-mediated immunity

1. The nurse provides discharge instructions to a patient who has an immune deficiency involving the T lymphocytes. Which health screening should the nurse include in the teaching plan for this patient? a. Screening for cancers b. Screening for allergies c. Screening for antibody deficiencies d. Screening for autoimmune disorders

a. Screening for cancers

13. Ten days after receiving a bone marrow transplant, a patient develops a skin rash. What should the nurse suspect is the cause of the rash? a. The donor T cells are attacking the patient's skin cells. b. The patient needs treatment to prevent hyperacute rejection. c. The patient's antibodies are rejecting the donor bone marrow. d. The patient is experiencing a delayed hypersensitivity reaction.

a. The donor T cells are attacking the patient's skin cells.

21. Immediately after the nurse administers an intradermal injection of an allergen on the forearm, the patient reports itching at the site, weakness, and dizziness. What action should the nurse take first? a. Apply antiinflammatory cream. b. Place a tourniquet above the site. c. Administer subcutaneous epinephrine. d. Reschedule the patient's other allergen tests.

b. Place a tourniquet above the site.

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. "I need to be monitored closely for development of cancer." b. "After a couple of years, I will be able to stop taking the cyclosporine." c. "If I develop acute rejection episode, I will need additional types of drugs." d. "The drugs are combined to inhibit different ways the kidney can be rejected."

b. "After a couple of years, I will be able to stop taking the cyclosporine."

11. Which statement by a patient would alert the nurse to a risk for decreased immune function? a. "I had a chest x-ray 6 months ago." b. "I had my spleen removed after a car accident." c. "I take one baby aspirin every day to prevent stroke." d. "I usually eat eggs or meat for at least two meals a day."

b. "I had my spleen removed after a car accident."

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

b. "I will take oral antihistamines before going to work."

22. A clinic patient reports experiencing an allergic reaction to an unknown allergen several weeks ago. Which action is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/VN)? a. Perform a focused physical assessment. b. Administer a cutaneous scratch skin test. c. Obtain the health history from the patient. d. Review diagnostic study results with the patient.

b. Administer a cutaneous scratch skin test.

19. A patient in the health care provider's office for allergen testing using the cutaneous scratch method develops itching and swelling at the skin site. Which action should the nurse plan to take first? a. Monitor the patient's edema. b. Administer a dose of epinephrine. c. Obtain a prescription for oral antihistamines. d. Assess the patient's use of new skin products.

b. Administer a dose of epinephrine.

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

b. Administration of immunosuppressant medications

2. Which example should the nurse use to explain an infant's "passive immunity" to a new mother? a. Vaccinations b. Breastfeeding c. Stem cells in peripheral blood d. Exposure to communicable diseases

b. Breastfeeding

8. The nurse taking a health history learns that the patient, who has worked in rubber tire manufacturing, has allergic rhinitis and multiple food allergies. Which action by the nurse is correct? a. Recommend that the patient use latex gloves in preventing blood-borne pathogen contact. b. Document the patient's history and teach about clinical manifestations of a type I latex allergy. c. Encourage the patient to carry an epinephrine kit in case a type IV allergic reaction to latex develops. d. Tell the patient to use oil-based hand creams to decrease contact with natural proteins in latex gloves.

b. Document the patient's history and teach about clinical manifestations of a type I latex allergy.

14. A 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 expect to administer? a. Corticosteroids b. Gamma globulin c. Hepatitis B vaccine d. Fresh frozen plasma

b. Gamma globulin

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

b. IgE

12. Which patient should the nurse assess first? a. Patient with urticaria after receiving an IV antibiotic b. Patient who is sneezing after subcutaneous immunotherapy c. Patient who has graft-versus-host disease and severe diarrhea d. Patient with multiple chemical sensitivities with muscle stiffness

b. Patient who is sneezing after subcutaneous immunotherapy

6. Which information about intradermal skin testing should the nurse teach 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."

c. "Plan to wait in the clinic for 20 to 30 minutes after the testing."

18. The charge nurse is assigning semiprivate rooms for new admissions. Which patient could safely be assigned as a 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 with an anaphylactic reaction d. A patient with graft-versus-host disease

c. A patient with an anaphylactic reaction

20. A patient is anxious and reports difficulty breathing after being stung by a wasp. What is the nurse's priority action? a. Provide high-flow oxygen. b. Administer antihistamines. c. Assess the patient's airway. d. Remove the stinger from the site.

c. Assess the patient's airway.

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

c. Consult with the health care provider about giving a lower allergen dose.

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

c. Observe for swelling of the patient's lips and tongue.

24. 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 crossmatching are positive. d. Panel of reactive antibodies (PRA) percentage is low.

c. Results of patient-donor crossmatching are positive.

16. An older adult patient has a prescription for cyclosporine following a kidney transplant. Which information in the patient's health history has implications for planning patient teaching about the safe use of cyclosporine? a. The patient restricts salt to 2 grams per day. b. The patient eats green leafy vegetables daily. c. The patient drinks grapefruit juice every day. d. The patient drinks 3 to 4 quarts of fluid each day.

c. The patient drinks grapefruit juice every day.

25. 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. There is a 2-cm wheal at the site of the injection. d. The patient's symptoms did not improve in 2 months.

c. There is a 2-cm wheal at the site of the injection.

10. The nurse should assess the patient undergoing plasmapheresis for which clinical manifestation? a. Shortness of breath b. High blood pressure c. Transfusion reaction d. Extremity numbness

d. Extremity numbness

9. What instructions about plasmapheresis should the nurse include in the teaching plan for a patient diagnosed with systemic lupus erythematosus (SLE)? a. Plasmapheresis counteracts recovery of IgG production. b. Plasmapheresis removes eosinophils and basophils from the blood. c. Plasmapheresis decreases the damage to organs from T lymphocytes. d. Plasmapheresis prevents inflammatory mediators from injuring tissues.

d. Plasmapheresis prevents inflammatory mediators from injuring tissues.