Immunity

A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of? Oral candida Chronic diarrhea Anorexia Nausea and vomiting

Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of acquired immune deficiency syndrome (AIDS) can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.

The nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout? penicillamine prednisone methotrexate colchicine

Colchicine is prescribed for the treatment of an acute attack of gout.

Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia all have the same type of symptoms. may feel as if their symptoms are not taken seriously. will eventually lose their ability to walk. rarely respond to treatment.

Because clients present with widespread symptoms that are often vague in nature, health care providers may misdiagnose them. Clients feel as though people are not listening to them. Nurses need to provide support and encouragement. Symptoms of disease vary from client to client and respond to different treatments. Clients do not lose their ability to walk.

A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find? Urine specific gravity of 1.010 Hypokalemia Hypernatremia Proteinuria

Hypokalemia Electrolyte imbalances such as decreased sodium, potassium, calcium, magnesium, and chloride typically result from profuse diarrhea. A urine specific gravity of 1.010 would indicate dilute urine. The client with severe diarrhea most likely would be dehydrated, leading to a high urine specific gravity. Proteinuria may suggest renal dysfunction and would not be associated with severe diarrhea unless the client was developing renal failure.

A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis? "My finger joints are oddly shaped." "I have trouble with my balance." "My legs feel weak." "I have pain in my hands."

Joint abnormalities are the most obvious manifestations of rheumatoid arthritis. A systemic disease, rheumatoid arthritis attacks all connective tissue. Although muscle weakness may occur from limited use of the joint where the muscle attaches, such weakness isn't the most obvious sign of rheumatoid arthritis; also, it occurs only after joint abnormalities arise. Subcutaneous nodules in the hands, although common in rheumatoid arthritis, are painless. The disease may cause gait disturbances, but these follow joint abnormalities.

The nurse is reviewing various medications with a client that can be used to treat allergic disorders. What medication will the nurse identify as an intranasal corticosteroid? cromolyn sodium fexofenadine fluticasone zileuton

Fluticasone is an example of an intranasal corticosteroid. Cromolyn sodium is a mast cell stabilizer. Zileuton is a leukotriene-receptor inhibitor. Fexofenadine is a second-generation antihistamine.

Pannus

The inflammatory synovial tissue found in rheumatoid joints that covers the articular cartilages that progressively destroys the underlying articular cartilages; also found in other chronic granulomatous disease, including tuberculosis. See also: corneal pannus. 2. The cornea in trachoma. See also: corneal pannus

Zileuton

a leukotriene-receptor inhibitor.

urticaria

allergic reaction of the skin characterized by the eruption of pale red, elevated patches called wheals or hives

common variable immunodeficiency (CVID)

another type of B lymphocyte deficiency. In thisdisorder, the production of one or more of the immunoglobulin types is decreased and theantibody response to infections is impaired. It generally develops around the age of 10-20.The symptoms vary among affected people. Most people with this disorder have frequentinfections, and some also will experience anemia and rheumatoid arthritis. Many people also develop cancer.

rheumatic disease

any disease or condition involving the musculoskeletal system

Peyer's patches

any of several lymph nodes in the walls of the intestines near the junction of the ileum and colon.

ankylosing spondylitis (AS)

inflammatory response that causes degenerative changes in the spinal vertebrae; sacroiliac joints; connective tissues such as tendons and ligaments in the hips, shoulders, knees, feet, and ribs; and tissues of the lungs, eyes, and heart valves

MoAbs

monoclonal antibodies; the growth and production of targeted antibodies for specific pathologic organisms. May block ability of cell to initiate apoptosis, reproduce, or invade surrounding tissue.

Kardex

A type of card file that summarizes information found in the medical record-drugs, treatments, diagnoses, routine care measures, equipment, and special needs

A client reports to a health care provider's office for intradermal allergy testing. Before testing, the nurse provides client teaching. Which client statement indicates a need for further education? "If I notice tingling in my lips or mouth, gargling may help the symptoms." "I may experience itching and irritation at the site of the testing." "The test may be mildly uncomfortable." "I'll go directly to the pharmacy with my EpiPen prescription."

"If I notice tingling in my lips or mouth, gargling may help the symptoms."

A patient has been diagnosed with an allergy to peanuts. What is a priority for this patient to carry at all times? A medical alert bracelet An oral airway An H1 blocker An EpiPen

An EpiPen

The nurse is planning teaching for a client with gout. Which topics will the nurse include in the teaching? Select all that apply. Limiting exercise Avoiding purine-rich foods Restricting the intake of water Decreasing alcohol intake Weight loss

Avoiding purine-rich foods

The development of a positive HIV antibody test following initial infection generally occurs in which timeframe? 8 weeks 10 weeks 6 weeks 4 weeks

Development of a positive HIV antibody test generally occurs within 4 weeks and with few exceptions by 6 months.

A client has been having joint pain and swelling in the left foot and is diagnosed with rheumatoid arthritis. The symptoms began suddenly without any identifiable cause, and the client has significant joint destruction. What type of disease is this considered? A cause-and-effect relationship Autoimmune An alloimmunity disorder An exacerbation of a previous disorder

Diseases are considered autoimmune disorders when they are characterized by unrelenting, progressive tissue damage without any verifiable etiology. The client did not have a previous disorder that has caused an exacerbation. An alloimmunity describes an immune response that is waged against transplanted organs and tissues that carry non self antigens. Because there is no identifiable cause, there can be no effect.

What type of immunoglobulin does the nurse recognize that promotes the release of vasoactive chemicals such as histamine when a client is having an allergic reaction? IgE IgG IgA IgM

IgE promotes the release of vasoactive chemicals such as histamine and bradykinin in allergic, hypersensitivity, and inflammatory reactions. IgG neutralizes bacterial toxins and accelerates phagocytosis. IgA interferes with the entry of pathogens through exposed structures or pathways. IgM agglutinates antigens and lyses cell walls.

A nurse is reviewing the dietary history of a client who has experienced anaphylaxis. What would the nurse identify as a common cause of anaphylaxis? Select all that apply. Milk Eggs Chicken Shrimp Beef

Milk Eggs Shrimp Common food causes of anaphylaxis include peanuts, tree nuts, shellfish, fish, milk, eggs, soy, and wheat. Beef and chicken are not common causes.

An adult client has had mumps when the client was a child. The client had a titer prior to entering nursing school and shows immunity. What type of immunity does this reflect? Passive immunity Artificially acquired active immunity Natural passive immunity Naturally acquired active immunity

Naturally acquired active immunity

A 20-year-old client cut a hand while replacing a window. While reviewing the complete blood count (CBC) with differential, the nurse would expect which cell type to be elevated first in an attempt to prevent infection in the client's hand? Monocytes B cells Eosinophils Neutrophils

Neutrophils (polymorphonuclear leukocytes [PMNs]) are the first cells to arrive at the site where inflammation occurs. Eosinophils and basophils, other types of granulocytes, increase in number during allergic reactions and stress responses.

A client has had a splenectomy after sustaining serious internal injuries in a motorcycle accident, including a ruptured spleen. Following removal of the spleen, the client will be susceptible to: anemia because the spleen produces red blood cells. bleeding because the spleen synthesizes vitamin K. infection because the spleen removes bacteria from the blood. acidosis because the spleen maintains acid-base balance.

One function of the spleen is to remove bacteria from circulation; therefore, the client will be more susceptible to infection.

The nurse is teaching a client about allergic rhinitis and its triggers. What is the most common trigger for the respiratory allergic response? mold spores plant pollen dust mites animal dander

Plant pollen (from trees, grass, and other plants) causes the most common form of allergic rhinitis, which is known as hay fever. Animal dander, dust mites, and mold spores can be triggers, but are not the most common causes.

A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse knows which body fluid is not a means of transmission? Semen Urine Blood Breast milk

Urine

Cutaneous

pertaining to the skin

How long after possible HIV exposure must a healthcare worker begin antiviral treatment?

72 hours

The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.) Dyspnea owing to fibrotic cardiac tissue Butterfly-shaped rash on the face Decreased ventilation owing to lung scarring Productive cough Dysphagia owing to hardening of the esophagus

Dyspnea owing to fibrotic cardiac tissue Decreased ventilation owing to lung scarring Dysphagia owing to hardening of the esophagus The changes within the body, although not visible directly, are vastly more important than the visible changes. The left ventricle of the heart is involved, resulting in heart failure. The esophagus hardens, interfering with swallowing. The lungs become scarred, impeding respiration. Digestive disturbances occur because of hardening (sclerosing) of the intestinal mucosa. Progressive kidney failure may occur.

Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS? Iron and zinc Gluten Liquids Sucrose

Liquids The nurse should encourage clients with AIDS to consume liquids in order to help replace fluid and electrolyte losses. Gluten and sucrose may increase the complication of malabsorption. Large doses of iron and zinc should be avoided because they can impair immune function.

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about? Methylprednisolone Celecoxib Methotrexate Mercaptopurine azathioprine

Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction. Mercaptopurine azathioprine is a cytotoxic drug.

The nurse is caring for a client with ankylosing spondylitis (AS). Which medication will the nurse expect to be prescribed for this client? Antibiotics Nonsteroidal anti-inflammatory drugs (NSAIDs) Anticoagulants Oral corticosteroids

NSAIDs are the first-line therapy for treating all spondyloarthropathies. Antibiotics and anticoagulants are not used to treat AS. Corticosteroid injections may be used for periodic flares; however, oral and long-term use of steroids is not recommended.

scleroderma

Scleroderma is a progressive disease that affects the skin and connective tissue (includingcartilage, bone, fat, and the tissue that supports the nerves and blood vessels throughout thebody). There are two major forms of the disorder. The type known as localized sclerodermamainly affects the skin. Systemic scleroderma, which is also called systemic sclerosis, affectsthe smaller blood vessels and internal organs of the body.

The nurse is working in an allergy clinic with a client with tuberculosis. What other reaction is a type IV hypersensitivity disorder? atopic dermatitis anaphylaxis allergic rhinitis contact dermatitis

Tuberculosis and contact dermatitis are type IV hypersensitivity reactions. Anaphylaxis, allergic rhinitis, and atopic dermatitis are type I hypersensitivity reactions.

ataxia-telangiectasis (A-T, Louis-Bar syndrome)

a rare, genetic neurological disorder of childhood that progressively destroys part of the motor control area of the brain, leading to a lack of balance and coordination. Also affects the immune system and increases the risk of leukemia and lymphoma in affected individuals.

Atopy

refers to IgE-mediated diseases, such as allergic rhinitis, that have a genetic component

Hapten

small molecule that has to bind to a larger molecule to form an antigen

A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer? "Pace yourself and rest frequently, especially after activities." "Do all your chores in the evening, when pain and stiffness are least pronounced." "Do all your chores in the morning, when pain and stiffness are least pronounced." "Do all your chores after performing morning exercises to loosen up."

"Pace yourself and rest frequently, especially after activities." A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace oneself during daily activities. Telling the client to do chores in the morning is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Telling the client to do all chores after performing morning exercises or in the evening is incorrect because the client should pace oneself and take frequent rests rather than doing all chores at once.

Palindromic rheumatism (gout)

is acute, recurrent attacks of inflammation in or near one or several joints

Cromolyn sodium

mast cell stabilizer

A patient asks the nurse if it would be all right to take an over-the-counter antihistamine for the treatment of a rash. What should the nurse educate the patient is a major side effect of antihistamines? Palpitations Diarrhea Sedation Anorexia

Antihistamines are the major class of medications prescribed for the symptomatic relief of allergic rhinitis. The major side effect is sedation, although H1 antagonists are less sedating than earlier antihistamines.

A client with rheumatoid arthritis reports disrupted sleep because of pain and stiffness. Which recommendations will the nurse make to help the client achieve restful sleep? Select all that apply. Use relaxation exercises. Create a quiet sleep environment. Take pain medications four hours before sleep. Avoid caffeine before bedtime. Establish a set time to sleep every night.

Clients need restful sleep so that they can cope with pain, minimize physical fatigue, and deal with the changes related to having a chronic disease. In clients with acute disease, sleep time is frequently reduced and fragmented by prolonged awakenings. Recommendations to improve sleep include using relaxation exercises, establishing a set time to sleep, avoiding caffeine before bedtime, and creating a quiet sleep environment. Pain medications should be taken closer to sleep time so that they can work effectively for someone experiecing pain and stiffness due to rheumatoid disease.

A client with allergic rhinitis is prescribed a mast cell stabilizer. Which would the nurse expect to be used? Cromolyn sodium Diphenhydramine Cetirizine Zafirlukast

Cromolyn sodium Cromolyn sodium is a mast cell stabilizer. Zafirlukast is a leukotriene-receptor antagonist. Cetirizine is a second-generation antihistamine. Diphenhydramine is a first-generation antihistamine.

Which type of immunity becomes active as a result of infection by a specific microorganism? Naturally acquired active immunity Artificially acquired active immunity Artificially acquired passive immunity Naturally acquired passive immunity

Naturally acquired active immunity occurs as a result of an infection by a specific microorganism. Artificially acquired active immunity results from the administration of a killed or weakened microorganism or toxoid. Passive immunity develops when ready-made antibodies are given to a susceptible individual.

A client has had a "stuffy nose" and obtained an oxymetazoline nasal spray. What education should the nurse provide to the client in order to prevent "rebound congestion"? Be sure to use the nasal spray for at least 10 days to ensure the stuffiness is gone. Drink plenty of fluids. Only use the nasal spray for 3 to 4 days once every 12 hours. Use the medication every 4 hours to prevent congestion from recurring.

Only use the nasal spray for 3 to 4 days once every 12 hours. Adrenergic agents, which are vasoconstrictors of mucosal vessels, are used topically in nasal (oxymetazoline [Afrin]) and ophthalmic (brimonidine [Alphagan P]) formulations in addition to the oral route (pseudoephedrine [Sudafed]). The topical route (drops and sprays) causes fewer side effects than oral administration; however, the use of drops and sprays should be limited to a few days to avoid rebound congestion.

The nurse is caring for a client with palindromic rheumatism. The nurse knows that this type of rheumatism can lead to which diagnosis? Rheumatoid arthritis Systemic lupus erythematosus Scleroderma Fibromyalgia

Palindromic rheumatism is an uncommon variety of recurring and acute arthritis and periarthritis that in some may progress to rheumatoid arthritis (RA) but is characterized by symptom-free periods of days to months. Because of this, the nurse should plan care that would be similar to the client with RA. The symptoms of palindromic rheumatism are not similar to those of scleroderma, fibromyalgia, or systemic lupus erythematosus.

What education should the nurse provide to the patient taking long-term corticosteroids? The patient should take the medication only as needed and not take it unnecessarily. The patient should not stop taking the medication abruptly and should be weaned off of the medication. The patient should discontinue using the drug immediately if weight gain is observed. Corticosteroids are relatively safe drugs with very few side effects.

Patients who receive high-dose or long-term corticosteroid therapy must be cautioned not to stop taking the medication suddenly. Doses are tapered when discontinuing this medication to avoid adrenal insufficiency (Addison's disease).

Which acts as a potent vasoconstrictor and causes bronchial smooth muscle to contract? Prostaglandin Serotonin Platelet-activating factor Bradykinin

Serotonin acts as a potent vasoconstrictor and causes contraction of bronchial smooth muscle. Bradykinin is a polypeptide with the ability to cause increased vascular permeability, vasodilation, hypotension, and contraction of many types of smooth muscle, such as the bronchi. Prostaglandin is a polypeptide that stimulates nerve fibers and causes pain. Platelet-activating factor is responsible for initiating platelet aggregation and leukocytes, as well as vasodilation and increased capillary permeability.

The nurse is teaching a client after a medication allergic reaction has occurred. What is the most important action for the nurse to teach the client to take to prevent anaphylaxis? Carry an emergency kit. Undergo desensitization treatment. Wear a medical alert bracelet. Avoid potential allergens.

Strict avoidance of potential allergens is the most important preventive measure for the patient at risk for anaphylaxis. People who have experienced food, medication, idiopathic, or exercise-induced anaphylactic reactions should always carry an emergency kit containing epinephrine for injection to prevent the onset of the reaction upon exposure, but avoiding potential allergens is more important. Desensitization, based on controlled anaphylaxis with a gradual release of mediators, is an effective treatment option, but it is more important to avoid allergic triggers. The medical alert bracelet will assist those rendering aid to the patient who has experienced an anaphylactic reaction, but it's better to avoid the reaction in the first place.

The nurse is working with a colleague who has a delayed hypersensitivity (type IV) allergic reaction to latex. Which statement describes the clinical manifestations of this reaction? Symptoms are localized to the area of exposure, usually the back of the hands. Symptoms occur within minutes after exposure to latex. Symptoms can be eliminated by changing glove brands. Symptoms worsen when hand lotion is applied before donning latex gloves.

Symptoms are localized to the area of exposure, usually the back of the hands. Clinical manifestations of a delayed hypersensitivity reaction are localized to the area of exposure. Clinical manifestations of an irritant contact dermatitis can be eliminated by changing glove brands or using powder-free gloves. With an irritant contact dermatitis, avoid use of hand lotion before donning gloves; this may worsen symptoms, as lotions may leach latex proteins from the gloves. When clinical manifestations occur within minutes after exposure to latex, which is described as a latex allergy, an immediate hypersensitivity (type I) allergic reaction has occurred.

Nursing assessment findings reveal joint swelling and tenderness and a butterfly rash on the face. The nurse suspects which of the following? Scleroderma Fibromyalgia Systemic lupus erythematous Ankylosing spondylitis

Systemic lupus erythematous The butterfly rash is a unique skin manifestation of systemic lupus erythematous. Other clinical manifestations include joint swelling and tenderness, pain on movement, and morning stiffness. The disease can affect all body systems.

The nurse is educating a client about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms to report. Which COX-2 inhibitor is the nurse educating the client about? Ibuprofen Piroxicam Celecoxib Tolmetin sodium

The COX-2 inhibitor celecoxib (Celebrex) is associated with an increased risk of cardiovascular events, including myocardial infarction and stroke.

Which joint is most commonly affected in gout? Metatarsophalangeal Ankle Tarsal area Knee

The metatarsophalangeal joint of the big toe is the most commonly affected joint (90% of clients); this is referred to as podagra. The wrists, fingers, and elbows are less commonly affected. The tarsal area, ankle, and knee are not the most commonly affected in gout.

Which statement accurately reflects current stem cell research? Stem cell transplantation cannot restore immune system functioning. Clinical trials are underway only in clients with acquired immune deficiencies. Stem cell transplantation has been performed in the laboratory only. The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells.

The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells. The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells. Stem cells comprise only a small portion of all types of bone marrow cells. Research conducted with mouse models has demonstrated that once the immune system has been destroyed experimentally, it can be completely restored with the implantation of just a few purified stem cells. Stem cell transplantation has been carried out in human subjects with certain types of immune dysfunction, such as severe combined immunodeficiency. Clinical trails are underway in clients with a variety of disorders with an autoimmune component, including systemic lupus erythematosus, rheumatoid arthritis, scleroderma, and multiple sclerosis.

After teaching a client how to self-administer epinephrine, the nurse determines that the teaching plan has been successful when the client demonstrates which action? Pushes down on the grey release cap to administer the medication Maintains pressure on the auto-injector for about 30 seconds after insertion Jabs the autoinjector into the outer thigh at a 90-degree angle Avoids massaging the injection site after administration

To self-administer epinephrine, the client should remove the autoinjector from its carrying tube, grasp the unit with the black tip (injecting end) pointed downward, form a fist around the device, and remove the gray safety release cap. Then the client should hold the black tip near the outer thigh and swing and jab firmly into the outer thigh at a 90-degree angle until a click is heard. Next, the client should hold the device firmly in place for about 10 seconds, remove the device, and massage the site for about 10 seconds.

When assessing the skin of a client with allergic contact dermatitis, the nurse would most likely expect to find irritation at which area? Dorsal aspect of the hand Ankles Plantar aspects of the feet Lower arms

With allergic contact dermatitis, irritation is most common on the dorsal aspects of the hand. Irritant, phototoxic, and photoallergic types of contact dermatitis are commonly seen on the hands and lower arms.

Kaposi sarcoma (KS) is diagnosed through computed tomography. biopsy. visual assessment. skin scraping.

biopsy KS is diagnosed by biopsy of the suspected lesions. Prognosis depends on the extent of the tumor, the presence of other symptoms of HIV infection, and the CD4+ count.

Lymphopenia

deficiency of lymphocytes in the blood

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? prevention of joint deformity detection of systemic complications strategies for remaining active disease-modifying antirheumatic drug therapy

strategies for remaining active The goals of osteoarthritis disease management are to decrease pain and stiffness and improve joint mobility. Strategies for remaining active are the most important client focus. The detection of complications, disease-modifying antirheumatic drugs management, and prevention of joint deformity are considerations, but not the most important priorities for the client.

HIV is harbored within which type of cell? Lymphocyte Erythrocyte Platelet Nerve

Lymphocyte Because HIV is harbored within lymphocytes, a type of white blood cell, any exposure to infected blood results in significant risk of infection. HIV infection is not harbored in platelets, erythrocytes, or nerve cells.

A client with a history of gout experiences an attack every 2 to 3 months despite losing weight and stopping all alcohol intake. Which question will the nurse ask when assessing this client? "Have you increased your intake of fat-soluble vitamins?" "Are you taking frequent rest periods throughout the day?" "Are you taking the medication as prescribed?" "Have you reduced the amount of daily exercise?"

"Are you taking the medication as prescribed?" Medication adherence is critical but poor among clients prescribed urate lowering therapies for gout. Between acute episodes, the client feels well and may abandon medications and preventive behaviors, which may result in an acute attack. Asking about medication adherence is the appropriate. Exercise, fat-soluble vitamins, and rest periods will not increase the risk of having an attack of gout.

A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response? "It is a hyperimmune response to something in the environment that is usually harmless." "It is a muted response to something in the environment." "It is a harmless reaction to something in the environment." "It means you are very sensitive to something inside of yourself."

"It is a hyperimmune response to something in the environment that is usually harmless." An allergic disorder is characterized by a hyperimmune response to weak antigens that usually are harmless. The antigens that can cause an allergic response are called allergens.

The nurse tells the client that if exposure to an allergen occurs around 8:00 AM, then the client should expect a mild or moderate reaction by what time?

10:00 AM Mild and moderate reactions begin within 2 hours of exposure.

Which term refers to an incomplete antigen? Hapten Antibody Allergen Antigen

A hapten is an incomplete antigen. An allergen is a substance that causes manifestations of allergy. An antigen is a substance that induces the production of antibodies. An antibody is a protein substance developed by the body in response to and interacting with a specific antigen.

Fibromyalgia

A neurosensory disorder characterized by widespread muscle pain, joint stiffness, and fatigue. The condition is chronic (ongoing), but pain comes and goes and moves about the body. The disorder is often misdiagnosed or unrecognized and is and often complicated by mood and anxiety disorders.

Which allergic reaction is potentially life threatening? None of the listed allergic reactions is potentially life threatening. urticaria angioedema contact dermatitis

Angioedema is potentially life threatening. Medical management would include intubation, subcutaneous epinephrine, and aminophylline in severe reactions.

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following? Antibodies to HIV are present in his blood. Antibodies to HIV are not present in his blood. He is immune to HIV. He has not been infected with HIV.

Antibodies to HIV are not present in his blood.

Which of the following cell types are involved in humoral immunity? Helper T lymphocyte B lymphocytes Suppressor T lymphocyte Memory T lymphocyte

B lymphocytes are involved in the humoral immune response. T lymphocytes are involved in cellular immunity.

The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer? Diphenhydramine Nizatidine Cimetidine Omeprazole

Certain medications are categorized by their action at these receptors. Diphenhydramine (Benadryl) is an example of an antihistamine, a medication that displays an affinity for H1 receptors. Cimetidine (Tagamet) and nizatidine (Axid) target H2 receptors to inhibit gastric secretions in peptic ulcer disease.

Tophi

Crystals of monosodium urate that may appear as chalky outcroppings on the skin of the ear, or may occur in tendons or joints in

A client with an allergic disorder calls the nurse and asks what treatment is available for allergic disorders. The nurse explains to the client that there is more than one treatment available. What treatments would the nurse tell the client about? Sublingual-swallow immunotherapy (SLIT) Desensitization Sublingual-topical immunotherapy (STIT) Resensitization

Desensitization is a form of immunotherapy in which a person receives weekly or twice-weekly injections of dilute but increasingly higher concentrations of an allergen without interruption. SLIT is a form of desensitization therapy. Options C and D are distractors for this question.

A client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which activities might bring on an acute attack? high carbohydrate intake eating organ meats and sardines frequently drinking coffee frequently ingesting salicylates

During an acute attack, high-purine foods are avoided, including organ meats, gravies, meat extracts, anchovies, herring, mackerel, sardines, and scallops. The other listed factors do not worsen attacks.

A nurse is taking health history from a new client, which includes asking about a history of blood transfusions. This is important for which reason? Exposure to foreign antigens may cause altered immune function. Blood products cause lower antibody titers. Blood products cause a high risk for exposure to HIV. Blood products cause a high risk for hepatitis B.

Exposure to foreign antigens may cause altered immune function. A history of blood transfusions is obtained because previous exposure to foreign antigens through transfusion may be associated with abnormal immune function. There is only a small risk for HIV transmission from transfusions received after 1985. The risk for exposure to hepatitis B from blood transfusions is extremely small.

Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? Prostaglandin Histamine Serotonin Bradykinin

Histamine When cells are damaged, histamine is released. Bradykinin is a polypeptide that stimulates nerve fibers and causes pain. Serotonin is a chemical mediator that acts as a potent vasoconstrictor and bronchoconstrictor. Prostaglandins are unsaturated fatty acids that have a wide assortment of biologic activities.

A client with severe combined immunodeficiency is to receive a hematopoietic stem cell transplant. What would the nurse expect to be started? Antibiotic therapy Anticoagulation Chest physiotherapy Immunosuppressive agents

Immunosuppressive agents For a client undergoing a hematopoietic stem cell transplant, immunosuppression is started to ensure engraftment of depleted bone marrow. Antibiotic therapy may or may not be indicated. Chest physiotherapy would be appropriate for clients with ataxia-telangiectasis who have chronic lung disease. Anticoagulation would not be used.

Which points should be included in the medication teaching plan for a client taking adalimumab? The client should continue taking the medication if fever occurs. It is important to monitor for injection site reactions. The medication is administered intramuscularly. The medication is given at room temperature.

It is important to monitor for injection site reactions when taking adalimumab. The medication is injected subcutaneously and must be refrigerated. The medication should be withheld if fever occurs.

A patient presents to a clinic on May 1 and tells the nurse practitioner that he had a 1-month sexual relationship with a friend who did not disclose that he was HIV positive. The relationship ended last week. The nurse tells the patient that after infection with HIV, the immune system responds by making antibodies against the virus; therefore the patient should expect this to happen by: May 20 June 5 May 8 July 1

June 5 An antibody response to an HIV infection usually occurs 4 to 6 weeks after exposure.

The nurse teaches the client that reducing the viral load will have what effect? Longer survival Shorter time to AIDS diagnosis Longer immunity Shorter survival

Longer survival

A nurse comes to the employee health center for evaluation and is diagnosed with allergic contact dermatitis related to latex. What manifestation would the nurse most likely exhibit? Laryngeal edema Rhinitis Angioedema Blistering

Manifestations associated with allergic contact dermatitis related to latex include blisters, pruritus, erythema, swelling, and crusting or other skin lesions. Laryngeal edema, rhinitis, and angioedema would be noted with a latex allergy.

The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find? early morning stiffness joint pain that increases with rest subcutaneous nodules small joint involvement

Osteoarthritis is characterized by early morning stiffness that decreases with activity. Large joints are usually involved with osteoarthritis. Joint pain is a constant with osteoarthritis. Clients with rheumatoid arthritis have subcutaneous nodules.

PIDDs

Primary immune deficiency diseases; Genetic, typically diagnosed in infancy or adolescence. Prevent body from developing normal immune responses. May affect phagocytic function, B cells, T-cells, or complement system. 5 x more common in males.

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease? Ankylosing spondylitis Raynaud's phenomenon Reiter's syndrome Sjögren's syndrome

Raynaud's phenomenon

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease? Ankylosing spondylitis Reiter's syndrome Sjögren's syndrome Raynaud's phenomenon

Raynaud's phenomenon Blanching of fingers on exposure to cold is associated with Raynaud's phenomenon.

A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include?

Rheumatoid nodules usually are nontender, movable, and evident over bony prominences, such as the elbow or the base of the spine. The nodules are not reddened.

Which of the following is the most frequent route of exposure to a latex allergy? Parenteral Mucosal Cutaneous Inhalation

Routes of exposure to latex products can be cutaneous, percutaneous, mucosal, parenteral, or aerosol. Allergic reactions are more likely with parenteral or mucous membrane exposure but can also occur with cutaneous contact or inhalation. The most frequent source of exposure is cutaneous, which usually involves the wearing of natural latex gloves.

Which of the following disorders is characterized by an increased autoantibody production? Scleroderma Rheumatoid arthritis (RA) Systemic lupus erythematosus (SLE) Polymyalgia rheumatic

SLE is an immunoregulatory disturbance that results in increased autoantibody production. Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

The nurse knows the best strategy for latex allergy is antihistamines. epinephrine from an emergency kit. avoidance of latex-based products. corticosteroids.

The best strategy available for latex allergy is to avoid latex-based products, but this is often difficult because of their widespread use. Antihistamines and an emergency kit containing epinephrine should be provided to these clients, along with instructions about emergency management of latex allergy.

The nurse is preparing to infuse gamma-globulin intravenously (IV). When administering this drug, the nurse knows the speed of the infusion should not exceed what rate? 1.5 mL/min 10 mL/min 3 mL/min 6 mL/min

The nurse should administer the IV infusion at a slow rate, not to exceed 3 mL/min, usually at 100-200 mL/h.

The nurse is performing a health history with a new client in the clinic. What is the most common reason for a client to seek medical attention for arthritis? pain stiffness weakness joint swelling

The symptom that most commonly causes a person to seek medical attention is pain. Other common symptoms include joint swelling, limited movement, stiffness, weakness, and fatigue.

Decades ago, before the role of the tonsils and adenoids was better understood, it was typical after repeated bouts with tonsillitis to have a tonsillectomy and adenoidectomy. Today it is understood that the tonsils and adenoids are lymphoid tissues that: eliminate cancer cells. increase the efficacy of antibiotics. program T lymphocytes. filter bacteria from tissue fluid.

The tonsils and adenoids filter bacteria from tissue fluid. Because they are exposed to pathogens in the oral and nasal passages, they can become infected and locally inflamed.

Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? Subchondral bone Pannus Tophi Joint effusion

Tophi Tophi, when problematic, are surgically excised. Subchondral bone refers to a bony plate that supports the articular cartilage. Pannus refers to newly formed synovial tissue infiltrated with inflammatory cells. Joint effusion refers to the escape of fluid from the blood vessels or lymphatic vessels into the joint cavity.

A client that is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication does the nurse expect that the client will take for the treatment of this infection? Trimethoprim-sulfamethoxazole Amphotericin B Nystatin Fluconazole

Trimethoprim-sulfamethoxazole To prevent and treat Pneumocystis pneumonia, trimethoprim-sulfamethoxazole (Bactrim, Septra) is prescribed. The other medications are antifungals and used to treat candidiasis.

A client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications? activity restrictions dietary restrictions common adverse effects loading-dose schedule

common adverse effects The most common adverse effects of NSAIDs are related to the GI tract: nausea, vomiting, diarrhea, and constipation. GI bleeding, which in some cases is severe, has been reported with the use of these drugs. Use of NSAIDs does not pose significant dietary or activity restrictions nor is there a loading-dose schedule.

The nurse is reviewing various medications with a client that can be used to treat allergic disorders. What medication will the nurse identify as an intranasal corticosteroid? zileuton fexofenadine cromolyn sodium fluticasone

fluticasone Fluticasone is an example of an intranasal corticosteroid. Cromolyn sodium is a mast cell stabilizer. Zileuton is a leukotriene-receptor inhibitor. Fexofenadine is a second-generation antihistamine.

A client arrives at the orthopedic clinic and reports suspecting a stress fracture of the right foot. The physician orders an x-ray with negative results. What does the nurse understand that these negative results can mean? protein-rich foods carbohydrates purine-rich foods fluid intake

purine-rich foods Clients with gout should be advised to have adequate protein with the limitation of purine-rich foods to avoid contributing to the underlying problem. The diet should also be relatively high in carbohydrates and low in fats because carbohydrates increase urate excretion and fats retard it. A high fluid intake is recommended because it helps increase the excretion of uric acid.

A patient with a history of allergies comes to the clinic for an evaluation. The following laboratory test findings are recorded in a patient's medical record: Total serum IgE levels: 2.8 mg/mL White blood cell count: 5,100/cu mmEosinophil count: 4%Erythrocyte sedimentation rate: 20 mm/hThe nurse identifies which result as suggesting an allergic reaction? Erythrocyte sedimentation rate Serum IgE level Eosinophil count White blood cell count

Normally, serum IgE levels are below 1.0 mg/mL. The patient's level is significantly elevated suggesting allergic reaction. The other values are within normal parameters.

A client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which activities might bring on an acute attack? frequently ingesting salicylates frequently drinking coffee eating organ meats and sardines high carbohydrate intake

eating organ meats and sardines

A client is experiencing painful joints and changes in the lungs, heart, and kidneys. For which condition will the nurse schedule this client for diagnostic tests? Heart disease Metabolic disorders Autoimmune disorders Vascular diseases

A hallmark of inflammatory rheumatic diseases is autoimmunity, where the body mistakenly recognizes its own tissue as a foreign antigen. Although focused in the joints, inflammation and autoimmunity also involve other areas. The blood vessels (vasculitis and arteritis), lungs, heart, and kidneys may be affected by the autoimmunity and inflammation. It is unlikely that the client's array of symptoms is being caused by heart disease, vascular diseases, or metabolic disorders.

A nurse is collecting objective data for a client with AIDS. The nurse observes white plaques in the client's oral cavity, on the tongue, and buccal mucosa. What does this finding indicate? coccidioidomycosis candidiasis Kaposi's sarcoma hairy leukoplakia

Candidiasis is a yeast infection caused by the Candida albicans microorganisms. It may develop in the oral, pharyngeal, esophageal, or vaginal cavities or in folds of the skin. It is often called thrush when located in the mouth. Inspection of the mouth, throat, or vagina reveals areas of white plaque that may bleed when mobilized with a cotton-tipped swab. Kaposi's sarcoma is a purple lesion and is an opportunistic cancer. Hairy leukoplakia is also an indication of oral cancer. Coccidioidomycosis causes diarrhea in the immunosuppressed client.

Which condition is associated with impaired immunity relating to the aging client? Renal function decreases Skin becomes thicker Incidence of autoimmune disease decreases Antibody production increases

Decreased renal circulation, filtration, absorption, and excretion contribute to the risk for urinary tract infections. Antibody production decreases, the skin becomes thinner, and the incidence of autoimmune disease increases with age.

A client is diagnosed with severe combined immunodeficiency (SCID). What would the nurse expect to integrate into the client's plan of care? Preparation for bone marrow transplantation Administration of antifungal agents Administration of granulocyte colony-stimulating factors Preparation for a thymus graft

For a client with severe combined immunodeficiency (SCID), the nurse would include in the plan of care preparing the client for a bone transplant. Antifungal agents are used to treat chronic mucocutaneous candidiasis. Granulocyte-stimulating factors would be used to treat immunodeficiency related to phagocytic dysfunction. A thymus graft would be used to treat DiGeorge syndrome.

A nurse works in an employee health department of a hospital. She was asked to treat a staff nurse who was exposed to blood from a patient with an HIV infection. The nurse practitioner instituted a PEP protocol that includes which of the following actions? Select all that apply. Initiate postexposure testing after 4 weeks. Continue HIV medications for 4 weeks postexposure. Finish postexposure testing at 6 months. Start prophylaxis medications between 3 to 6 hours after exposure. Practice safe sex for 2 weeks (time for HIV medications to reach a satisfactory blood level).

Initiate postexposure testing after 4 weeks Continue HIV medications for 4 weeks postexposure Finish postexposure testing at 6 months.

A nurse is teaching a client who is allergic to ragweed. What season does the nurse advise the client to expect an increase in symptoms? late spring early fall early summer early spring

Ragweed has a seasonal occurrence in early fall. Tree pollen and mold spore levels rise in the spring. Rose and grass pollen is prevalent in the summer.

A client has begun sensitivity testing to determine the allergen which caused an anaphylactic reaction 3 weeks ago. In scratch testing, which part of the body is more sensitive to allergens? chest forearm upper arm back

The scratch or prick test involves scratching the skin and applying a small amount of the liquid test antigen to the scratch. The tester applies one allergen per scratch over the client's forearm, upper arm, or back. The back is more sensitive than the arms.

COX-2 inhibitors

A newer class of NSAIDS that block the effects of a specific part of the pathway that produces prostaglandins. Increase the risk of clots and heart attacks but have fewer GI side effects than tradition NSAIDS.

When obtaining a health history from a patient with possible abnormal immune function, what question would be a priority for the nurse to ask? "Have you ever been treated for a sexually transmitted infection?" "Have you ever received a blood transfusion?" "Do you have abdominal pain or discomfort?" "When was your last menstrual period?"

"Have you ever received a blood transfusion?" A history of blood transfusions is obtained, because previous exposure to foreign antigens through transfusion may be associated with abnormal immune function.

A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching? "I can eat whatever I want as long as it's low in fat." "I won't go to see my nephew right after he gets his vaccines." "I stopped smoking last year; this year I'll quit drinking alcohol." "I won't go to see my sister while she has a cold."

"I can eat whatever I want as long as it's low in fat." The client requires additional teaching if he states that he can eat whatever he wants. Immunosuppressed clients should avoid raw fruit and vegetables because they may contain bacteria that could increase the risk of infection; foods must be thoroughly cooked. Avoiding people who are sick, products containing alcohol, and people who have just received vaccines are appropriate actions for an immunosuppressed client.

An older adult with rheumatoid arthritis says exercise was not effective. Which response will the nurse make to learn the reason for the failure of this treatment approach? "Does exercise usually work for you?" "Why do you think the exercise didn't work?" "What types of exercise were you doing?" "Do you think you are too old to exercise?"

In an older adult with rheumatoid arthritis, exercise programs may not be instituted or may be ineffective because the client expects results too quickly or fails to appreciate the effectiveness of a program of exercise. Strength training is encouraged in the older adult with chronic diseases. The other questions will not help the nurse understand what type of exercise was used and what it was not effective for the client.

A patient has enlarged lymph nodes in his neck and a sore throat. This inflammatory response is an example of a cellular immune response whereby: Antibodies reside in the plasma B-lymphocytes respond to a specific antigen Lymphocytes migrate to areas of the lymph node Antibodies are released into the bloodstream

Lymphocytes migrate to areas of the lymph node Recognition of antigens as foreign, or non-self, by the immune system is the initiating event in any immune response. Recognition involves the use of lymph nodes and lymphocytes for surveillance. Lymph nodes are widely distributed internally throughout the body and in the circulating blood, as well as externally near the body's surfaces. They continuously discharge small lymphocytes into the bloodstream. These lymphocytes patrol the tissues and vessels that drain the areas served by that node.

A client with common variable immunodeficiency (CVID) comes to the ED reporting tingling and numbness in the hands and feet, muscle weakness, fatigue, and chronic diarrhea. An assessment reveals abdominal tenderness, weight loss, and loss of reflexes. A gastric biopsy shows lymphoid hyperplasia of the small intestine and spleen as well as gastric atrophy. Based on these findings, what common secondary problem has this client developed? Pernicious anemia Hyperthyroidism Gastric ulcer Sickle cell anemia

More than 50% of clients with CVID develop pernicious anemia. Lymphoid hyperplasia of the small intestine and spleen and gastric atrophy, which is detected by biopsy of the stomach, are common findings. Gastrointestinal malabsorption may occur.

What is the most common cause of anaphylaxis? NSAIDs Penicillin Opioids Radiocontrast agent

Penicillin is the most common pharmacological cause of anaphylaxis and accounts for about 75% of fatal anaphylactic reactions in the United States each year. Opioids, NSAIDs, and radiocontrast agents are some of the medications that are frequently reported as causing anaphylaxis.

Which adverse effect(s) should the nurse closely monitor in a client who has secondary immunodeficiencies due to immunosuppressive therapy? Depression, memory impairment, and coma Cardiac dysrhythmias and heart failure Rheumatoid arthritis Respiratory or urinary system infections

Respiratory or urinary system infections Secondary immunodeficiencies occur as a result of underlying disease processes or the treatment of these disorders, including administration of immunosuppressive agents. Abnormalities of the immune system affect both natural and acquired immunity. Because immunodeficiencies result in a compromised immune system and pose a high risk for infection, careful assessment of the client's immune status is essential. The nurse assesses and monitors the client for signs and symptoms of infection.

What is the priority intervention for a client who has been admitted repeatedly with attacks of gout? Insert a Foley catheter Place client on bed rest Assess diet and activity at home Increase fluids

Clients with gout need to be educated about dietary restrictions in order to prevent repeated attacks. Foods high in purine need to be avoided, and alcohol intake has to be limited. Stressful activities should also be avoided. The nurse should assess to determine what is stimulating the repeated attacks of gout. The other interventions are not appropriate for a client with this problem.

A client is scheduled to receive an intravenous immunoglobulin (IVIG) infusion. The client asks the nurse about the infusion's administration and its adverse effects. Which condition should the nurse instruct this client to report immediately?

Continually assess the client for adverse reactions; be especially aware of complaints of a tickle or lump in the throat, which could be the precursor to laryngospasm that precedes bronchoconstriction.

The body has several mechanisms to fight disease, one of which is sending chemical messengers. The messengers released by lymphocytes, monocytes, and macrophages have differing roles in the immune response. Which messenger enables cells to resist viral replication and slow viral replication? interferons interleukins tumor necrosis factor colony-stimulating factor

Interferons are chemicals that primarily protect cells from viral invasion. They enable cells to resist viral infection and slow viral replication. They have been used as adjunctive therapy in the treatment of AIDS. Interferons also have been used to treat some forms of cancer such as leukemia because they stimulate NK cell activity. Interferon is administered parenterally because digestive enzymes destroy its protein structure.

A laboring mother asks the nurse if the baby will have immunity to some illnesses when born. What type of immunity does the nurse understand that the newborn will have? Passive immunity transferred by the mother Naturally acquired active immunity There is no immunity passed down from mother to child. Artificially acquired active immunity

Passive immunity transferred by the mother Passive immunity develops when ready-made antibodies are given to a susceptible person. The antibodies provide immediate but short-lived protection from the invading antigen. Newborns receive passive immunity to some diseases for which their mothers have manufactured antibodies. Naturally acquired active immunity occurs as a direct result of infection by a specific micro organism. An example is the immunity to measles that develops after the initial infection. Not all invading microorganisms produce a response that gives lifelong immunity. Artificially acquired immunity is obtained by receiving a killed or weakened microorganism or toxoid.

A patient was seen in the clinic 3 days previously for allergic rhinitis and was given a prescription for a corticosteroid nasal spray. The patient calls the clinic and tells the nurse that the nasal spray is not working. What is the best response by the nurse? "You may be immune to the effects of this medication and will need something else in its place." "I am sorry that you are feeling poorly but this is the only medication that will work for your problem." "The full benefit of the medication may take up to 2 weeks to be achieved." "You need to come back to the clinic to get a different medication since this one is not working for you."

Patients must be aware that full benefit of corticosteroid nasal sprays may not be achieved for several days to 2 weeks.

A client is prescribed an oral corticosteroid for 2 weeks to relieve asthma symptoms. The nurse educates the client about side effects, which include hypoglycemia. diuresis. adrenal suppression. hypotension.

The nurse should instruct the client that side effects of oral corticosteroid therapy include adrenal suppression, fluid retention, weight gain, glucose intolerance, hypertension, and gastric irritation.

The nurse is talking with a group of teens about transmission of human immunodeficiency virus (HIV). What body fluids does the nurse inform them will transmit the virus? Select all that apply. blood urine breast milk vaginal secretions semen

There are only four known body fluids through which HIV is transmitted: blood, semen, vaginal secretions, and breast milk. HIV may be present in saliva, tears, and conjunctival secretions, but transmission of HIV through these fluids has not been implicated. HIV is not found in urine, stool, vomit, or sweat.

A client is informed of having a low white blood cell count and that the client is at risk for the development of infections. The client asks, "Where do I make new white blood cells?" What is the best response by the nurse? "White blood cells are produced in the bone marrow." "White blood cells are produced in the thymus gland." "White blood cells are produced in the plasma." "White blood cells are produced in the lymphatic tissue."

White blood cells (leukocytes) are produced in the bone marrow. They are not produced in the plasma, thymus gland, or the lymphatic tissue.

Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia? Widespread chronic pain Butterfly facial rash Heberden's nodes Jaw locking

Widespread chronic pain The most common finding associated with fibromyalgia is widespread and chronic pain, as clients experience an increased sensitivity to pain signals. Heberden's nodes are associated with osteoarthritis. Jaw locking is a manifestation of temporomandibular joint dislocation. A butterfly facial rash is associated with systemic lupus erythematosus.

Which is the leading cause of disability and pain in the elderly? Rheumatoid arthritis (RA) Scleroderma Systemic lupus erythematosus (SLE) Osteoarthritis (OA)

The client requires further teaching if the client states, "I will gargle to help alleviate tingling in the lips or mouth." Allergy testing introduces potentially irritating substances to the client. Tingling in the mouth, lips, or throat indicates the onset of a severe reaction and the need for immediate medical intervention. The testing may cause irritation and itching at the test site. The health care provider may order an epinephrine pen (EpiPen) for the client to self-administer epinephrine if the client experiences an allergic reaction away from the office setting.

A client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit? type IV type II type I type III

There are four types of hypersensitivity responses, three of which are immediate. This is an example of Type I, atopic or anaphylactic, which is mediated by immunoglobulin E (IgE) antibodies.

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic? the fact that it is a mutated virus originally thought to be bovine in nature means of transmission cure rate HIV-1 is more prevalent than HIV-2 subtypes

Two HIV subtypes have been identified: HIV-1 and HIV-2. HIV-1 mutates easily and frequently, producing multiple substrains that are identified by letters from A through O. HIV-2 is less transmittable, and the interval between initial infection with HIV-2 and development of AIDS is longer. HIV-1 is more prevalent in the United States and in the rest of the world. Western Africa is the primary site of infection with HIV-2. There is no cure for HIV/AIDS; hence, no cure rate. The virus is thought to be a mutation of a simian virus. Transmission of the virus is not a characteristic.

A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer? furosemide calcium gluconate aspirin colchicine

A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The health care provider orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide is a diuretic; it is not used to relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps; it is not used to treat gout.

The nurse is teaching a group of health care workers about latex allergies. What reaction will the nurse teach the workers to be most concerned about with laryngeal edema? IgE-mediated hypersensitivity IgG antibodies allergic contact irritant contact

A type I, IgE-mediated hypersensitivity can cause severe reaction symptoms such as laryngeal edema and bronchospasm. Irritant and allergic contact dermatitis result in more localized skin reactions. IgG antibodies are important in fighting viral and bacterial infections.

A client being treated for an allergy has been prescribed antihistamines. The Kardex of this client reads as follows:Age: 32; Profession: Carpenter; Lifestyle & diet: Lives alone, average smoker, nonalcoholic, no food preferences, practices yoga; Medical history: Suffers from hay fever, recent urinary tract infection that has been treated successfully.What information from the Kardex is likely to have the greatest implication in educating the client about antihistamine administration? The client's age The client's smoking habit The client's medical history The client's profession

The client's profession Most antihistamines cause drowsiness, so the nurse should advise the client not to operate machinery or perform tasks that require alertness when taking antihistamines. Since the client is not an older adult, his age has no implications on the therapy. The recent urinary tract infection will have no implications either. Antihistamines are not administered to clients with disorders of the lower respiratory tract. In addition, smoking does not affect the effectiveness of the antihistamine therapy.

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find? Increased albumin levels Elevated erythrocyte sedimentation rate Increased C4 complement Increased red blood cell count

The erythrocyte sedimentation rate (ESR) may be elevated, particularly as the disease progresses. ESR shows inflammation associated with RA. Red blood cell count and C4 complement component are decreased. Serum protein electrophoresis may disclose increased levels of gamma and alpha globulin but decreased albumin.

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? "Monitor your body temperature." "Exposure to sunlight will help control skin rashes." "Corticosteroids may be stopped when symptoms are relieved." "There are no activity limitations between flare-ups."

The nurse should instruct the client to monitor body temperature. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Clients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. Abruptly stopping corticosteroids can cause adrenal insufficiency, a potentially life-threatening situation.

A nurse is working in a dermatology clinic with clients who have allergies. What is the most important chemical mediator involved in the allergic response? leukotrienes prostaglandins histamine serotonin

The pathophysiology of an allergic response involves a chain of events that includes responses from lymphocytes, IgE, mast cells, and basophils. All chemical mediators are participants in the response cycle, but histamine is the most important protein involved. Activated by a mast cell, it increases vessel permeability.

A client receiving antiretroviral therapy reports "not urinating enough." What is the nurse's best action? Encourage the client to drink more fluids. Assess liver function tests. Administer fluids 100 mL/hour IV. Assess blood urea nitrogen and creatinine.

Assess blood urea nitrogen and creatinine. Adverse effects associated with antiretroviral therapy include potential nephrotoxicity. Assessing blood urea nitrogen and creatinine for clients who have decreased urination is appropriate. The other answers will not assist the nurse in determining the client's problem, which should be assessed before intervention are administered.

A client with acquired immune deficiency syndrome (AIDS) reports diarrhea after every meal. What is the nurse's best response? Reduce food intake. Increase the intake of iron and zinc. Avoid residue, lactose, fat, and caffeine. Encourage large, high-fat meals.

Avoid residue, lactose, fat, and caffeine. Diarrhea may subside when the client avoids residue, lactose, fat, and caffeine. Although eating may seem to cause diarrhea, the client must understand that limiting the intake of food to control diarrhea only exacerbates wasting. The client will tolerate a low-fat, high-carbohydrate, soft or liquid diet better than large, high-fat meals. The client should be advised to avoid large doses of iron and zinc because they can impair the functioning of the immune system.

The nurse administers an injection to a client with AIDS. When finished, the nurse attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse? Call the lab to draw the nurse's blood. Fill out a risk management report. Report the incident to the supervisor. Obtain counseling.

Because post exposure protocols can reduce the risk of HIV infection if initiated promptly, nurses must immediately report any needlestick or sharp injury to a supervisor. Obtaining counseling will occur after all other procedures are adhered to. The lab will draw blood from the client if required for documentation and other blood transmitted disorders.

Which condition is associated with impaired immunity relating to the aging client? Increase in peripheral circulation Breakdown and thinning of the skin Decrease in inflammatory cytokines Increase in humoral immunity

Breakdown and thinning of the skin The aging process stimulates changes in the immune system. Age-related changes in many body systems also contribute to impaired immunity. Changes such as poor circulation, as well as the breakdown of natural mechanical barriers such as the skin, place the aging immune system at even greater disadvantage against infection. As the immune system undergoes age-associated alterations, its response to infections progressively deteriorates. Humoral immunity declines and the number of inflammatory cytokines increase with age.

Which is usually the most important consideration in the decision to initiate antiretroviral therapy? Western blotting assay HIV RNA CD4+ counts ELISA

CD4+ (Helper T-cell) counts

A client is admitted to the hospital with a diagnosis of pneumonia. The client informs the nurse of having several drug allergies. The physician has ordered an antibiotic as well as several other medications for cough and fever. What should the nurse do prior to administering the medications? Give the client one medicine at a time and observe for allergic reactions. Call the pharmacy and let them know the client has several drug allergies. Administer the medications that the physician ordered. Consult drug references to make sure the medicines do not contain substances which the client is hypersensitive.

Clear identification of any substances to which the client is allergic is essential. The nurse must consult drug references to verify that prescribed medications do not contain substances to which the client is hypersensitive. Administering the medications or giving one at a time may cause the client to have an allergic reaction. The nurse may call the pharmacy but still maintains responsibility for the medications administered.

All the following items are related to cancer. Which does not affect the immune system? Radiation treatment Altered production of lymphocytes Diagnostic tests for cancer Chemotherapy

Diagnostic tests for cancer Immunosuppression contributes to the development of cancers; however, cancer itself is immunosuppressive. Diagnostic tests do not cause cancer. Radiation and chemotherapy decrease immune competency.

A client is admitted with cellulitis and experiences a consequent increase in white blood cell count. During what process will pathogens be engulfed by white blood cells that ingest foreign particles? Phagocytosis Cellular immune response Apoptosis Antibody response

During the first mechanism of defense, white blood cells, which have the ability to ingest foreign particles, move to the point of attack, where they engulf and destroy the invading agents. This is known as phagocytosis. The action described is not apoptosis (programmed cell death) or an antibody response. Phagocytosis occurs in the context of the cellular immune response, but it does not constitute the entire cellular response.

Which blood test confirms the presence of antibodies to HIV? Reverse transcriptase p24 antigen Erythrocyte sedimentation rate (ESR) Enzyme immunoassay (EIA)

EIA and Western blotting identify and confirm the presence of antibodies to HIV. ESR is an indicator of the presence of inflammation in the body. p24 antigen test is a blood test that measures viral core protein. Reverse transcriptase is not a blood test. Rather, it is an enzyme that transforms single-stranded RNA into double-stranded DNA.

A public health nurse is preparing an educational campaign to address a recent local increase in the incidence of HIV infection. The nurse should prioritize what intervention? Appropriate use of standard precautions Educational programs that focus on control and prevention Lifestyle actions that improve immune function Screening programs for youth and young adults

Educational programs that focus on control and prevention Until an effective vaccine is developed, preventing HIV by eliminating and reducing risk behaviors is essential. Educational interventions are the primary means by which behaviors can be influenced. Screening is appropriate, but education is paramount. Enhancing immune function does not p

A client suspected of having human immunodeficiency virus (HIV) has blood drawn for a screening test. What is the first test generally run to see if a client is, indeed, HIV positive? Enzyme-linked immunosorbent assay (ELISA) Schick Complete blood count (CBC) Western Blot

Enzyme-linked immunosorbent assay (ELISA) The ELISA test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. If the ELISA is positive twice then the Western Blot test is run. A CBC and a Schick test are not screening tests for HIV.

Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment? Past substance abuse Lack of social support Depression Active substance abuse

Past substance abuse Factors associated with nonadherence include active substance abuse, depression, and lack of social support, as well as neurocognitive impairment, low health literacy, stressful life events, high levels of alcohol consumption, homelessness, poverty, nondisclosure of HIV serostatus, denial, stigma, and inconsistent access to medications. Past substance abuse has not been implicated as a factor for noncompliance with antiretroviral treatment.

A client is diagnosed with severe combined immunodeficiency (SCID). What would the nurse expect to integrate into the client's plan of care? Administration of granulocyte colony-stimulating factors Preparation for a thymus graft Preparation for bone marrow transplantation Administration of antifungal agents

Preparation for bone marrow transplantation For a client with severe combined immunodeficiency (SCID), the nurse would include in the plan of care preparing the client for a bone transplant. Antifungal agents are used to treat chronic mucocutaneous candidiasis. Granulocyte-stimulating factors would be used to treat immunodeficiency related to phagocytic dysfunction. A thymus graft would be used to treat DiGeorge syndrome.

What is the function of the thymus gland? Programs T lymphocytes to become regulator or effector T cells Produces stem cells Programs B lymphocytes to become regulator or effector B cells Develops the lymphatic system

Programs T lymphocytes to become regulator or effector T cells The thymus gland is located in the neck below the thyroid gland. It extends into the thorax behind the top of the sternum. The thymus gland produces lymphocytes during fetal development. It may be the embryonic origin of other lymphoid structures such as the spleen and lymph nodes. After birth, the thymus gland programs T lymphocytes to become regulator or effector T cells. The thymus gland becomes smaller during adolescence but retains some activity throughout the life cycle. The other options are incorrect.

The nurse is beginning the physical examination of a client with fatigue. What documentation will the nurse provide to describe this general appraisal of the client's health? The client has palpable peripheral pulses in the upper extremities. The client appears mildly ill, listless, and disheveled. The client is alert and oriented to all spheres. The client has a blood pressure of 120/72 mm Hg.

The client appears mildly ill, listless, and disheveled. The beginning of the physical examination is a general appraisal of the client's health. The nurse notes whether the client appears healthy, acutely or mildly ill, malnourished, extremely tired, or listless. The next thing the nurse will do is obtain vital signs and then performs a more comprehensive examination.

A nurse is caring for a client with multiple sclerosis. Client education about the disease process includes which explanation about the cause of the disorder? Excess cytokines cause tissue damage. Regulatory mechanisms fail to halt the immune response. The immune system recognizes one's own tissues as "foreign." The immune system recognizes one's own tissues as "self."

The immune system's recognition of one's own tissues as "foreign" rather than self is the basis of many autoimmune disorders, including multiple sclerosis. When regulatory mechanisms fail to halt the immune response or excess cytokines are produced, pathology occurs (e.g., allergies, hypersensitivity).

The nurse is administering a skin test for detection of exposure to tuberculosis. How would the nurse determine if the client was exposed to tuberculosis? The injection area swells if the client has developed antibodies against the antigen. The injection area will break out in a fine macular rash. The client will have a productive cough. The injection area will become painful with in duration if the client has antibodies against the antigen.

The injection area swells if the client has developed antibodies against the antigen. The client is not necessarily actively infectious if the test results are positive. Although a productive cough is one of the symptoms of active tuberculosis, it may also indicate other diseases and disorders. The area should not be painful, and the client should not break out with a rash.

A nurse is teaching the parents of an infant about primary immunodeficiencies. Which statement verifies that the parents understand the teaching? "Girls are diagnosed with primary immunodeficiencies more often than boys." "My baby cannot survive into childhood with a diagnosis of primary immunodeficiency." "The majority of primary immunodeficiencies are diagnosed in infancy." "The primary immunodeficiency will disappear with age."

The majority of primary immunodeficiencies are diagnosed in infancy, with a male-to-female ratio of 5 to 1.

A client has begun to suffer from rheumatoid arthritis and is being assessed for disorders of the immune system. The client works as an aide at a facility that cares for children infected with AIDS. What is the most important factor related to the client's assessment? The client's home environment The client's use of other drugs The client's age The client's diet

The nurse needs to review the client's drug history. This data will help to assess the client's susceptibility to illness because certain past illnesses and drugs, such as corticosteroids, suppress the inflammatory and immune responses. The client's age, home environment, and diet do not have any major implications during assessment because they do not indicate susceptibility to illness.

The nurse teaches the client that the presence of crystals in the synovial fluid obtained from arthrocentesis confirms which disease process? Degeneration Inflammation Gout Infection

The presence of crystals is indicative of gout; the presence of bacteria is indicative of infective arthritis.

A client with an autoimmune disorder asks, "Why is autoimmune disease more prevalent in the women in my family?" Which response will the nurse make to this client? "It's because you take better care of your family than yourself." "It's believed to be caused by the differences in the sex hormones." "There is not enough evidence to prove this." "Women have more stress than men and it weakens immunity."

There are differences in the immune system functions of men and women. Research has revealed that sex hormones are integral signaling modulators of the immune system and the presence of autoimmune disease. Sex hormones play definitive roles in lymphocyte maturation, activation, and synthesis of antibodies and cytokines. Even though some autoimmune diseases are genetically linked, overall men do not have stronger genes than women. There is no evidence that the client relinquishes self-care for family care. Even though stress influences immunity, there is no evidence that women have more stress than men.

A 64-year-old male client, who leads a sedentary life-style, and a 31-year-old female client, who has a very stressful and active life-style, require a vaccine against a particular viral disorder. As the nurse, you would know that in one of these clients the vaccine will be less effective. In which client is the vaccine more likely to be less effective and why?

Vaccines are less effective in an older adult than in a younger adult because the activity of the immune system declines with the aging process. The lifestyle or gender of the client does not have great implications on the effectiveness of a vaccine.

A client is to self-administer intravenous immunoglobulin (IVIG) in the home. What is the client's first action? Prepare the IVIG solution. Take the premedication. Check his or her temperature. Check the IV device patency.

When administering intravenous immunoglobulin in the home, it is imperative to ensure that the IV access device is patent. This should be done first because if the device is not patent, it would be useless to prepare the solution, administer the premedication, or check vital signs. Unless the device is patent, the medication could not be given.

The nurse is aware that the most prevalent cause of immunodeficiency worldwide is: Chronic diarrhea Malnutrition Hypocalcemia Neutropenia

he most prevalent cause of immunodeficiency worldwide is severe malnutrition.

The nurse is instructing clients about the importance of taking the shingles vaccine. Which client would benefit from this vaccine? A 32-year-old client who has never had chickenpox A 24-year-old client who is pregnant A 17-year-old client who will be attending college and living in a dormitory A 65-year-old client who had chicken pox when he was 12 years old

A 65-year-old client who had chicken pox when he was 12 years old Half of individuals living to age 65 years have had or will develop shingles and may not understand the potential seriousness and risk for complications. Nurses as client advocates should determine and provide health information regarding the shingles vaccine. The other clients are not candidates for the vaccine

The nurse receives a phone call at the clinic from the family of a client with AIDS. They state that the client started "acting funny" and reported headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member? "The client may have cryptococcal meningitis and will need to be evaluated by the health care provider." "The client probably has a case of the flu and you should give acetaminophen." "The client probably has pneumocystis pneumonia and will need to be evaluated by the health care provider." "This is one of the side effects from antiretroviral therapy and will require changing the medication."

A fungal infection, Cryptococcus neoformans is another common opportunistic infection among clients with AIDS, and it causes neurologic disease. Cryptococcal meningitis is characterized by symptoms such as fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes, and seizures.

An older adult client who is postmenopausal informs the nurse that she believes she has developed another urinary tract infection (UTI). What risk factors do female clients in this age group have? Select all that apply.

For example, postmenopausal females are at a greater risk for urinary tract infections due to residual urine, urinary incontinence, and estrogen deficiency (Torine, 2011).

hich of the following indicates that a client with HIV has developed AIDS? Herpes simplex ulcer persisting for 2 months Severe fatigue at night Pain on standing and walking Weight loss of 10 lb over 3 months

Herpes simplex ulcer persisting for 2 months A diagnosis of AIDS cannot be made until the person with HIV meets case criteria established by the Centers for Disease Control and Prevention. The immune system becomes compromised. The CD4 T-cell count drops below 200 cells and develops one of the opportunistic diseases, such as Pneumocystis carinii pneumonia, candidiasis, cytomegalovirus, or herpes simplex.

A nursing instructor is giving a lecture on the immune system. The instructor's discussion on phagocytosis will include: plasma cells and memory cells. regulator T cells and helper T cells. lymphokines and suppressor T cells. neutrophils and monocytes.

Neutrophils and monocytes are phagocytes, cells that perform phagocytosis.

The nurse is beginning the physical examination of a client with fatigue. What documentation will the nurse provide to describe this general appraisal of the client's health? The client is alert and oriented to all spheres. The client has palpable peripheral pulses in the upper extremities. The client appears mildly ill, listless, and disheveled. The client has a blood pressure of 120/72 mm Hg.

The client appears mildly ill, listless, and disheveled. The beginning of the physical examination is a general appraisal of the client's health. The nurse notes whether the client appears healthy, acutely or mildly ill, malnourished, extremely tired, or listless. The next thing the nurse will do is obtain vital signs and then performs a more comprehensive examination.

What types of cells are the primary targets of the healthy immune system? Select all that apply. cancerous cells infectious cells foreign cells typical cells

The immune system's primary targets are infectious, foreign, or cancerous cells.

A client with ataxia-telangiectasia is admitted to the unit. The nurse caring for the client would expect to see what included in the treatment regimen? Thymus grafting IV gamma globulin administration Platelet administration Factor VIII administration

Treatment for ataxia-telangiectasia includes IV gamma globulin, antimicrobial therapy, and bone marrow transplantation. It does not include platelet administration, factor VIII administration, or thymus grafting.

When reviewing the laboratory test results of a client with X-linked agammaglobulinemia, which of the following would be most likely? Select all that apply. Absent B cells Leukopenia Low levels of IgM Pernicious anemia Hypocalcemia

X-linked agammaglobulinemia, a type of B-cell deficiency, is characterized by low or absent B cells in the peripheral blood and low or absent levels of IgG, IgM, IgA, IgD, and IgE. Hypocalcemia is associated with T-cell deficiencies. Leukopenia is associated with deficiencies of the complement system. Pernicious anemia is associated with common variable immunodeficiency (CVID), a second type of B-cell deficiency.

A nurse is monitoring a client who developed facial edema after receiving a medication. Which white blood cells stimulated the edema? Eosinophils Monocytes Basophils Neutrophils

The client's edema is related to an allergic reaction to the medication. Basophils are responsible for releasing histamine during an allergic reaction. Eosinophils' major function is phagocytosis of antigen-antibody complexes that are formed in allergic reactions. Monocytes and neutrophils are predominately phagocytic.

The nurse identifies a nursing diagnosis of ineffective airway clearance related to pneumocystis pneumonia and increased bronchial secretions for a client with AIDS. Which of the following would be appropriate for the nurse to include in the client's plan of care? Limit fluid intake to 1 1/2 to 2 liters per day. Encourage client to ambulate frequently in the halls. Assist with chest physiotherapy every 2 to 4 hours. Maintain the client in a supine or side-lying position.

The nurse should include interventions such as assisting with and/or performing chest physiotherapy every 2 to 4 hours to prevent stasis of secretions, assist the client to attain the semi- or high Fowler's position to facilitate breathing and airway clearance, allow for frequent rest periods to prevent excessive fatigue, and maintain a fluid intake of at least 3 liters per day unless contraindicated.

There are major differences between primary and secondary immunodeficiencies. Select the most accurate statement the nurse would use to explain the cause of a secondary immunodeficiency. "Your immune system was most likely affected by an underlying disease process." "You will now be more likely to develop cancer in the future." "Your diagnosis was inherited." "Your condition will predispose you to frequent and recurring infections."

Your immune system was most likely affected by an underlying disease process." A secondary immunodeficiency is the result of an underlying disease process or the treatment of a disorder. It is not genetically inherited. Some examples of a secondary immunodeficiency are chronic stress and diabetes mellitus.

A nurse is working in a pediatric clinic. After the nurse gives a hepatitis B immunization to an infant, the parent asks what kind of protection this provides for the child. What is the nurse's best response? Active acquired immunity, which is temporary Passive acquired immunity, which lasts many years or a lifetime Passive acquired immunity, which is temporary Active acquired immunity, which lasts many years or a lifetime

gActive acquired immunity, which lasts many years or a lifetime Universal childhood vaccination for hepatitis B prevention has been instituted in the United States, and this is generally done via active immunization. With active acquired immunity, the person's own body develops immunologic defenses. This immunity typically lasts many years or even a lifetime. Passive acquired immunity is temporary immunity transmitted from a source outside the body that has developed immunity through previous disease or immunization

A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis? Urine specimen for culture and sensitivity Stool specimen for ova and parasites Blood specimen for electrolyte studies Sputum specimen for acid fast bacillus

A stool specimen for ova and parasites will give a definitive diagnosis. The organism is spread by the fecal-oral route from contaminated water, food, or human or animal waste. Those infected can lose from 10 to 20 L of fluid per day. Losing this magnitude of fluid quickly leads to dehydration and electrolyte imbalances.

Which assessment should be completed if immune dysfunction is suspected in the neurosensory system? Ataxia Hematuria Burning upon urination Urinary frequency

Ataxia should be assessed when immune dysfunction in the neurosensory system is suspected. Hematuria, discharge, and frequency of and burning upon urination are associated with the genitourinary system.

A client who has AIDS reports having diarrhea after every meal, and wants to know what can be done to stop this symptom. What should the nurse advise? Increase intake of iron and zinc. Avoid fibrous foods, lactose, fat, and caffeine. Reduce food intake. Consume large, high-fat meals.

Avoid fibrous foods, lactose, fat, and caffeine. Diarrhea may subside when the client avoids fibrous foods, lactose, fat, and caffeine. Although eating may seem to cause diarrhea, the client must understand that limiting the intake of food to control diarrhea only exacerbates wasting. The client will tolerate a low-fat, high-carbohydrate, and soft or liquid diet better than large, high-fat meals. The client should be advised to avoid large doses of iron and zinc because they can impair the functioning of the immune system.

A child is brought to the clinic with a rash and is subsequently diagnosed with measles. The parent reports also having had measles as a young child. What type of immunity to measles develops after the initial infection? Naturally acquired active immunity Artificially acquired passive immunity Artificially acquired active immunity Naturally acquired passive immunity

Immunity to measles that develops after the initial infection is an example of naturally acquired active immunity. Artificially acquired active immunity results from the administration of a killed or weakened microorganism or toxoid (attenuated toxin), whereas passive immunity develops when ready-made antibodies are given to a susceptible client.

A client who has AIDS is being treated in the hospital and admits to having periods of extreme anxiety. What would be the most appropriate nursing intervention? Collaborate with the client's physician to obtain an order for hydromorphone. Increase the client's activity level. Give the client more control of her antiretroviral regimen. Teach the client guided imagery.

Measures such as relaxation and guided imagery may be beneficial because they decrease anxiety, which contributes to weakness and fatigue. Increased activity may be of benefit, but for other clients this may exacerbate feelings of anxiety or loss. Granting the client control has the potential to reduce anxiety, but the client is not normally given unilateral control of the ART regimen. Hydromorphone is not used to treat anxiety.

A client is diagnosed with multiple site cancers and has received whole-body irradiation. The nurse is concerned about a compromised immune system in this client for which reason? Radiation causes an excess of circulating hemoglobin. Radiation causes a deficiency of circulating hemoglobin. Radiation destroys lymphocytes. Radiation causes an excess of circulating lymphocytes.

Radiation destroys lymphocytes and decreases the ability to mount an effective immune response. Radiation is not associated with an excess of lymphocytes or an excess or deficiency of hemoglobin.

A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching? "I stopped smoking last year; this year I'll quit drinking alcohol." "I can eat whatever I want as long as it's low in fat." "I won't go to see my nephew right after he gets his vaccines." "I won't go to see my sister while she has a cold."

The client requires additional teaching if he states that he can eat whatever he wants. Immunosuppressed clients should avoid raw fruit and vegetables because they may contain bacteria that could increase the risk of infection; foods must be thoroughly cooked. Avoiding people who are sick, products containing alcohol, and people who have just received vaccines are appropriate actions for an immunosuppressed client.

This type of T lymphocyte is responsible for altering the cell membrane and initiating cellular lysis. Choose the T lymphocyte. Helper T cell Memory T cell Suppressor T cell Cytotoxic T cell

The cytotoxic T cells (also known as killer T cells) attack the antigen directly and release cytotoxic enzymes and cytokines.

The nurse is teaching a client who has been diagnosed with Hashimoto's thyroiditis. Which statement correctly describes the process of autoimmunity? A deficiency results from improper development of immune cells or tissues. The body produces inappropriate or exaggerated responses to specific antigens. The normal protective immune response attacks the body, damaging tissues. The body overproduces immunoglobulins.

The normal protective immune response attacks the body, damaging tissues. Autoimmunity happens when the normal protective immune response paradoxically turns against or attacks the body, leading to tissue damage. It is not an immune deficiency. An exaggerated immune response describes a hypersensitivity. An overproduction of immunoglobulins is the definition of gammopathies.

A client with acquired immune deficiency syndrome (AIDS) is brought to the clinic by a family member. The family member tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? Candidiasis Cytomegalovirus (CMV) AIDS dementia complex (ADC) Distal sensory polyneuropathy (DSP)

AIDS dementia complex, or ADC, is a neurologic condition that causes the degeneration of the brain, especially in areas that affect mood, cognition, and motor functions. Such clients exhibit forgetfulness, limited attention span, decreased ability to concentrate, and delusional thinking. DSP is characterized by abnormal sensations, such as burning and numbness in the feet and later in the hands. Candidiasis is a yeast infection that may develop in the oral, pharyngeal, esophageal, or vaginal cavities or in the folds of the skin. CMV infects the choroid and retinal layers of the eye, leading to blindness, and can also cause ulcers in the esophagus, colitis, diarrhea, pneumonia, and encephalitis.

A nurse educator is preparing to discuss immunodeficiency disorders with a group of fellow nurses. What would the nurse identify as the most common secondary immunodeficiency disorder? CVID DAF AIDS SCID

AIDS, the most common secondary disorder, is perhaps the best-known secondary immunodeficiency disorder. It results from infection with the human immunodeficiency virus (HIV). DAF refers to lysis of erythrocytes due to lack of decay-accelerating factor (DAF) on erythrocytes. CVID is a disorder that encompasses various defects ranging from IgA deficiency (in which only the plasma cells that produce IgA are absent) to severe hypogammaglobulinemia (in which there is a general lack of immunoglobulins in the blood). Severe combined immunodeficiency disease (SCID) is a disorder in which both B and T cells are missing.

A client is given a dose of ketorolac, a nonsteroidal anti-inflammatory drug for complaints of abdominal pain. Ten minutes after receiving the medication, the client's eyes, lips, and face begin to swell, and the nurse hears stridor. What priority measure should the nurse prepare to do? Assess the client's vital signs. Perform an electrocardiogram (ECG). Administer epinephrine. Intubate the client.

Administer epinephrine Anaphylaxis is a rapid and profound type I hypersensitivity response. A massive release of histamine causes vasodilation; increased capillary permeability; angioneurotic edema (acute swelling of the face, neck, lips, larynx, hands, feet, genitals, and internal organs); hypotension; and bronchoconstriction. A nurse must administer 0.2 mg of epinephrine subcutaneously to a client experiencing a severe allergic reaction. It is outside of the nurse's practice to intubate a client. Performing an ECG and assessing the vital signs delays the treatment of the client and can have negative outcomes.

The nurse is obtaining the medical history of a client with Crohn's disease. What medication would the nurse include when asking about what medications the client has taken for suppression of the inflammatory and immune response? Nonsteroidal anti-inflammatory Diuretics Corticosteroids Angiotensin-converting enzyme inhibitors (ACE-I)

Corticosteroids The nurse obtains a history of immunizations, recent and past infectious diseases, and recent exposure to infectious diseases. The nurse reviews the client's drug history because certain drugs, such as corticosteroids, suppress the inflammatory and immune responses. Nonsteroidal anti-inflammatory medication does not suppress the inflammatory and immune responses of Crohn's disease. An ACE-I prevents the conversion of angiotensin I to angiotensin II and does not suppress the inflammatory or immune response. Diuretics also do not suppress the immune response but help reduce excess fluid from the kidneys.

The nurse is caring for a client who has a diagnosis of human immunodeficiency virus (HIV). Part of this client's teaching plan is educating the client about his or her medications. What is essential for the nurse to include in the teaching of this client regarding medications? The use of condoms What vaccinations to have Side effects of drug therapy The action of each antiretroviral drug

Describing the side effects of drug therapy is essential, with the admonition to refrain from discontinuing any of the prescribed drugs without first consulting the prescribing physician. Although the client may want to know how the drugs work in general, the specific action of each antiretroviral drug is not essential information. Teaching about condoms and vaccinations may be appropriate, but these topics are not directly related to the client's HIV medications.

A client who is HIV positive is receiving highly active antiretroviral therapy (HAART) that includes a protease inhibitor (PI). The client comes to the clinic for a follow-up visit. Assessment reveals lipoatrophy of the face and arms. The client states, "I'm thinking the side effects of the drug are worse than the disease. Look what's happening to me." The nurse would most likely identify which nursing diagnosis as the priority? Deficient knowledge related to the effects of the disease Disturbed body image related to loss of fat in the face and arms Risk for impaired liver function related to drug therapy effects Risk for infection related to the immune system dysfunction

Disturbed body image related to loss of fat in the face and arms. The client is experiencing lipoatrophy, which results in a localized loss of subcutaneous fat in the face (manifested as sinking of the cheeks, eyes, and temples), arms, legs, and buttocks. These changes as well as his statement about the side effects of the drug being worse than the disease indicate that he is concerned about how he appears to others. Therefore, the nursing diagnosis of disturbed body image would be the priority. Deficient knowledge, risk for infection, and risk for impaired liver function may be applicable; however, they are not concerns at this time.

The nurse is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm3, and the client has been diagnosed with Pneumocystis pneumonia. What does this indicate to the nurse? The client's T4-cell count has decreased due to the Pneumocystis pneumonia. The client has advanced HIV infection. The client has another infection present that is causing a decrease in the T4-cell count. The client has converted from HIV infection to AIDS.

The client has converted from HIV infection to AIDS. AIDS is the end stage of HIV infection. Certain events establish the conversion of HIV infection to AIDS: a markedly decreased T4 cell count from a normal level of 800 to 1200/mm3 and the development of certain cancers and opportunistic infections. The client does not have advanced HIV; they meet the criteria for the development of AIDS. The T4-cell count is not decreasing due to an infection.

Which of the following is the first barrier method that can be controlled by the woman? Female condom Diaphragm IUD Birth control pills

The female condom has the distinction of being the first barrier method that can be controlled by the woman. The IUD may increase the risk for HIV transmission through an inflammatory foreign body response. The female condom is as effective in preventing pregnancy as other barrier methods, such as the diaphragm and the male condom. Birth control pills are not a barrier method.

A child has just been diagnosed with a primary immune deficiency. The parents state, "Oh, no. Our child has AIDS." Which response by the nurse would be most appropriate? "We need to do some more testing before we will know if your child's condition is AIDS." "Although AIDS is an immune deficiency, your child's condition is different from AIDS." "Your child does not have AIDS but this condition puts your child at risk for it later in life." "Your child's condition is extremely serious. Like AIDS, it will most likely be fatal."

"Although AIDS is an immune deficiency, your child's condition is different from AIDS. Primary immune deficiencies should be not be confused with AIDS. They are not the same condition. In addition, a primary immune disorder does not increase the child's risk for developing AIDS later in life. Primary immune deficiency diseases are serious, but they are rarely fatal and can be controlled. Testing will reveal the evidence of a primary immune disease, not AIDS. AIDS is classified as a secondary immunodeficiency.

A nurse is reviewing treatment options with parents of an infant born with severe combined immunodeficiency disease (SCID). The nurse recognizes that the parents understand the teaching based on which statement? "Hematopoietic stem cell transplantation cannot be performed until the age of 5 years." "The only treatment option is thymus gland transplantation." "We could have our 10-year-old daughter tested, as the ideal stem cell donor is a human leukocyte antigen-identical sibling." "We can ask our family members to donate blood for stem cell harvesting."

"We could have our 10-year-old daughter tested, as the ideal stem cell donor is a human leukocyte antigen-identical sibling." Treatment options for SCID include stem cell and bone marrow transplantation. Hematopoietic stem cell transplantation is the definitive therapy for SCID; the best outcome is achieved if the disease is recognized and treated early in life. The ideal donor is a human leukocyte antigen-identical sibling.

The nursing students are learning about the immune system in their anatomy and physiology class. What would these students learn is a component of the immune system? Cytokines Stem cells Red blood cells Lymphoid tissues

The immune system actually is a collection of specialized white blood cells and lymphoid tissues that cooperate to protect a person from external invaders and the body's own altered cells. The function of these structures is assisted and supported by the activities of natural killer cells, antibodies, and nonantibody proteins such as cytokines and the complement system. Red blood cells and stem cells are not part of the immune system.

A client diagnosed with human immunodeficiency virus (HIV) asks how the health care provider determines what his or her viral load is. What is the nurse's best response?

The health care provider can have a polymerase chain reaction test run. The p24 antigen test and polymerase chain reaction test measure viral loads. They are used to guide drug therapy and follow the progression of the disease. Options A, B, and C are incorrect, as these tests do not determine the client's viral load.

Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement? Hypertension Chest pain Behavioral changes Decreased cognitive ability

Hypertension is suggestive of renal damage in the client with systemic lupus erythematous.

A nurse is explaining treatment options to a client diagnosed with an immune dysfunction. Which statement by the client accurately reflects the teaching about current stem cell research? "Stem cell transplantation has been carried out in humans with certain types of immune dysfunction, and clinical trials using stem cells are underway in clients with a variety of disorders with an autoimmune component." "Stem cell clinical trials have only been attempted in clients with acquired immune deficiencies, but plans are underway to begin human cloning using embryonic stem cells." "Currently, stem cell transplantation has only been performed in the laboratory, but future research with embryonic stem cell transplants for humans with immune dysfunction has been promising." "Stem cell transplantation has been discontinued based on concerns about safety, efficacy, resource allocation, and human cloning."

"Stem cell transplantation has been carried out in humans with certain types of immune dysfunction, and clinical trials using stem cells are underway in clients with a variety of disorders with an autoimmune component." Research has shown that stem cells can restore an immune system that has been destroyed (Ko, 2012). Stem cell transplantation has been carried out in humans with certain types of immune dysfunction, such as severe combined immunodeficiency; clinical trials using stem cells are underway in clients with a variety of disorders having an autoimmune component, including systemic lupus erythematosus, rheumatoid arthritis, scleroderma, and multiple sclerosis. Research with embryonic stem cells has enabled investigators to make substantial gains in developmental biology, gene therapy, therapeutic tissue engineering, and the treatment of a variety of diseases (Ko, 2012). However, along with these remarkable opportunities, many ethical challenges arise, which are largely based on concerns about safety, efficacy, resource allocation, and human cloning.

The nurse is teaching a client about a recent order for loratadine to help with seasonal allergies. What client statements indicate no further teaching is required? Select all that apply. "Drinking two or three alcoholic drinks a week is okay." "Taking my medication on an empty stomach is a must." "It is recommended that I buy a humidifier for my bedroom." "Being careful driving is important after taking the medication." "Sucking on ice chips will help if my mouth is dry."

"Taking my medication on an empty stomach is a must." "Sucking on ice chips will help if my mouth is dry." "Being careful driving is important after taking the medication." "It is recommended that I buy a humidifier for my bedroom." Client education includes instructing the client to take the medication on an empty stomach to prevent food from interfering with absorption. Avoid alcohol because the medication can cause increased drowsiness. A side effect is dry mouth, and sucking on ice chips will help. Being careful when driving is important because the medication can cause drowsiness. Using a humidifier will help decrease the negative symptoms associated with humidity.

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. The client asks which of the tests ordered will determine positivity for the disorder. Which statement by the nurse is most accurate? "Tell me more about your concerns about this potential diagnosis." "The diagnosis won't be based on the findings of a single test but by combining all data found." "SLE is a very serious systemic disorder." "You should discuss that matter with your health care provider."

"The diagnosis won't be based on the findings of a single test but by combining all data found." There is no single test available to diagnose SLE. Therefore, the nurse should inform the client that diagnosis is based on combining the findings from the physical assessment and the laboratory tests results. Advising the client to speak with the health care provider, stating that SLE is a serious systemic disorder, and asking the client to express feelings about the potential diagnosis do not answer the client's question.

A client with a discoid facial rash caused by systemic lupus erythematosus (SLE) asks why a urine sample is needed. Which response will the nurse make to the client? "The lupus can affect your kidney function." "It is a routine test done on everyone." "The medication you take can affect your bladder." "The test will determine how long you will have the rash."

"The lupus can affect your kidney function." Nephritis as a result of SLE, also referred to as lupus nephritis, occurs due to a buildup of antibodies and immune complexes that cause damage to the nephrons. Early detection allows for prompt treatment so that renal damage can be prevented. Serum creatinine levels and urinalysis are used in screening for renal involvement. Urinalysis is not a routine test done on every client. The urinalysis is not being used to determine if the client's medication is affecting the bladder. The urinalysis will not determine the length of time the client will have the rash.

A nurse is caring for a client undergoing evaluation for possible immune system disorders. Which intervention will best help support the client throughout the diagnostic process? Assist the client with scheduling the procedures Educate the client about the diagnostic procedures and answer their questions about the possible diagnosis Encourage the client to ask the physician for information about treatment options for the possible diagnosis Accompany the client to the diagnostic tests

Educate the client about the diagnostic procedures and answer their questions about the possible diagnosis It is the nurse's role to counsel, educate, and support clients throughout the diagnostic process. Many clients may be extremely anxious about the results of diagnostic tests and the possible implications of those results for their employment, insurance, and personal relationships. This is an ideal time for the nurse to provide counseling and education.

A clinic nurse is caring for a client diagnosed with rheumatoid arthritis (RA). The client tells the nurse that she has not been taking her medication because she usually cannot remove the childproof medication lids. How can the nurse best facilitate the client's adherence to her medication regimen? Have a trusted family member take over the management of the client's medication regimen. Have the client approach her primary provider to explore medication alternatives. Encourage her to have her pharmacy replace the tops with alternatives that are easier to open. Encourage the client to store the bottles with their tops removed.

Encourage her to have her pharmacy replace the tops with alternatives that are easier to open The client's pharmacy will likely be able to facilitate a practical solution that preserves the client's independence while still fostering adherence to treatment. There should be no need to change medications, and storing open medication containers is unsafe. Delegating medications to a family member is likely unnecessary at this point and promotes dependence.

A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication? Since the medication is able to be obtained over the counter, it has few side effects. Inform the health care provider if there is ringing in the ears. Take the medication with food to avoid stomach upset. Take the medication on an empty stomach in order to increase effectiveness.

Ibuprofen is a nonsteroidal anti-inflammatory drug. The nurse should advise the patient to take NSAIDs with food to avoid stomach upset. Ibuprofen is available over the counter, but it still has side effects. Aspirin is known to cause ringing in the ears, not NSAIDs.