Altered Immune Responses and Transplantation & HIV

The nurse is discussing human immunodeficiency virus (HIV) prevention with a patient who has a history of substance abuse but is unsure if he or she is able to stop using drugs. Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission? Select all that apply. 1 Using sterile equipment to inject drugs. 2 Cleaning equipment used to inject drugs. 3 Educate the patient to wear gloves when self-injecting. 4 Not sharing equipment used to prepare and inject drugs. 5 Not having sexual intercourse while under the influence of drugs.

1 2 4 5

What is the mode of action of cyclophosphamide? 1 Cross-links DNA 2 Blocks purine synthesis 3 Inhibits purine synthesis 4 Prevents the activation of T-cells

1 Cross-links DNA

A nurse, having identified nursing diagnoses for a patient who has tested positive for human immunodeficiency virus, determines that the highest risk is: 1 Hyperthermia 2 Social isolation 3 Impaired memory 4 Sexual dysfunction

1 Hyperthermia

The nurse is comparing cell-mediated immunity and humoral immunity. Which of these are characteristics of humoral immunity? Select all that apply. 1 Antibodies are produced. 2 Involves B lymphocyte cells. 3 Involves T lymphocyte cells and macrophages. 4 Examples include anaphylactic shock and transfusion reaction. 5 Examples include destruction of cancer cells and graft rejection

1 Antibodies are produced. 2 Involves B lymphocyte cells. 4 Examples include anaphylactic shock and transfusion reaction.

A patient develops an allergic rash on the arms and subsequent shortness of breath during the administration of intravenous gentamicin. What should be the immediate nursing intervention to ensure safety of the patient? Select all that apply. 1 Call the health care provider. 2 Discontinue infusion of gentamicin. 3 Decrease the infusion rate of gentamicin. 4 Measure the respiratory rate again after 15 minutes. 5 Check body temperature.

1 Call the health care provider. 2 Discontinue infusion of gentamicin.

A nurse is teaching at a health fair about immunizations. How will this nurse educate the people at the fair about the benefits of immunization? Select all that apply. 1 It can help control the spread of infections within the community. 2 It can prevent disability and death from certain infectious diseases. 3 It helps in building a short-term immunity. 4 It reduces and can possibly eliminate diseases like polio. 5 It should be given with immunosuppressive therapy to reduce the side effects

1 It can help control the spread of infections within the community. 2 It can prevent disability and death from certain infectious diseases. 4 It reduces and can possibly eliminate diseases like polio.

A nurse is attending to a patient who is receiving a blood transfusion. The nurse finds that the patient has developed chills and is shivering. What actions should the nurse take? Select all that apply. 1 Stop the blood transfusion immediately. 2 Switch off the air conditioner to increase the room temperature. 3 Administer intravenous medications as prescribed to prevent kidney failure. 4 Discard the donor blood. 5 Administer paracetamol immediately after the transfusion is completed.

1 Stop the blood transfusion immediately. 3 Administer intravenous medications as prescribed to prevent kidney failure.

As part of an awareness program for high school students on acquired immunodeficiency syndrome (AIDS), a public nurse is giving information about routes of transmission. What information should the nurse provide to students regarding the routes of transmission? Select all that apply. 1 A person can be infected by having intercourse with one stable partner. 2 A person can be infected by donating a pint of whole blood. 3 A person can be infected even if a condom is used each time there is sexual intercourse. 4 A person can be infected if sexual contact is limited to those without human immunodeficiency virus (HIV) antibodies. 5 A person can get infected while hugging or shaking hands with a person infected with HIV

1 A person can be infected by having intercourse with one stable partner. 3 A person can be infected even if a condom is used each time there is sexual intercourse. 4 A person can be infected if sexual contact is limited to those without human immunodeficiency virus (HIV) antibodies.

A patient with acquired immunodeficiency syndrome (AIDS) has come to the hospital without any improvement in condition in spite of antiretroviral therapy. On assessment, the nurse learns that the patient was noncompliant with the therapy. What are the next appropriate nursing actions? Select all that apply. 1 Assess the need for a change in the medication regimen. 2 Avoid discussing the patient's status with other people. 3 Instruct the patient to avoid adjusting dosages, even if the medications interfere with the patient's work schedule. 4 Determine if the patient experienced any adverse effects of the medications. 5 Determine whether the patient understands the need for treatment compliance.

1 Assess the need for a change in the medication regimen. 4 Determine if the patient experienced any adverse effects of the medications. 5 Determine whether the patient understands the need for treatment compliance.

One month after delivering a baby, a mother was infected with human immunodeficiency virus (HIV) due to intercourse with a stranger. She came to the hospital to seek medical advice and HIV testing. Enzyme immunoassay (EIA) and Western blot tests revealed that she was HIV-positive. What should be advised to the mother? Select all that apply. 1 Avoid breastfeeding. 2 Extract breast milk with a breast pump. 3 Have the baby immunized. 4 Get Bacille Calmette Guerin (BCG) vaccination (mother). 5 Baby will need antiretroviral drugs.

1 Avoid breastfeeding. 3 Have the baby immunized.

Which cells differentiate into plasma cells upon activation? 1 B-cells 2 T-cells 3 Dendritic cells 4 Natural killer cells

1 B-cells are a type of lymphocyte that differentiates into plasma cells upon activation. Lymphocytes from bone marrow migrate to the thymus to differentiate into T-cells. Dendritic cells are antigen-presenting cells whose function is to capture the antigen and present it to the T-lymphocytes. Natural killer cells are large lymphocytes containing many granules in their cytoplasm.

An HIV patient is on long-term antiretroviral therapy (ART). Of what side effects of the antiretroviral therapy should the nurse instruct the patient to be aware? 1 Lipodystrophy 2 Nausea 3 Vomiting 4 Diarrhea

1 Lipodystrophy HIV-infected patients on antiretroviral therapy may develop a metabolic disorder called lipodystrophy, which is the deposition of fat in the abdomen, upper back, and breasts. There may simultaneously be a loss of fat in the arms, legs, and face. Nausea, vomiting, and diarrhea are short-term side effects of ART, and tend to subside with regular use. Text Reference - p. 243

A nurse is counseling a patient diagnosed with human immunodeficiency virus (HIV). The nurse understands that patients with HIV need vaccines to protect them from other infectious diseases. Which vaccines should the nurse advise the patient to take to comply with the recommended immunization schedule for a patient with HIV? Select all that apply. 1 Tetanus 2 Hepatitis B 3 Influenza 4 Pneumococcal vaccines 5 Measles-mumps-rubella (MMR) 6 Hepatitis C

1 Tetanus 2 Hepatitis B 3 Influenza 4 Pneumococcal vaccines

A human immunodeficiency virus (HIV) patient recently is started on antiretroviral therapy, but does not fully understand the purpose of the medication. The nurse would explain to the patient that the goals of the antiretroviral therapy are which of the following? Select all that apply. 1 To decrease the viral load 2 To cure the HIV disease 3 To stop the HIV disease from progressing 4 To prevent transmission of the HIV disease 5 To maintain or increase the CD4 cell counts 6 To prevent HIV-related opportunistic infections

1 To decrease the viral load 4 To prevent transmission of the HIV disease 5 To maintain or increase the CD4 cell counts 6 To prevent HIV-related opportunistic infections

When caring for a patient with a known latex allergy, the nurse would monitor the patient closely for a cross-sensitivity to which foods (select all that apply)? 1. Grapes 2.Oranges 3.Bananas 4.Potatoes 5. Tomatoes

1,3,4,5. Because some proteins in rubber are similar to food proteins, some foods may cause an allergic reaction in people who are allergic to latex. The most common of these foods are bananas, avocados, chestnuts, kiwi fruit, tomatoes, water chestnuts, guava, hazelnuts, potatoes, peaches, grapes, and apricots.

A nursing instructor is evaluating a student nurse's statements regarding IgE-mediated hypersensitivity reaction. Which statement indicates the need for correction? 1"Asthma is an example of an IgE-mediated hypersensitivity reaction." 2"Complement system is involved in IgE-mediated hypersensitivity reactions." 3"Histamine and mast cells are the mediators of injury in IgE-mediated hypersensitivity reactions." 4"Exogenous pollen, food, and dust are the antigens associated with IgE-mediated hypersensitivity reactions."

2 "Complement system is involved in IgE-mediated hypersensitivity reactions."

Which cytokine is used in the treatment of multiple sclerosis? 1 Interferon-alpha 2 Interferon-beta 3 Interleukin-2 4 Interleukin-11

2 Interferon-beta

A nurse is assessing an older adult patient admitted to the hospital for acute pneumonia. The patient's condition rapidly deteriorates due to a decreased immune response. What are the primary factors responsible for decreased immunity in older adult patients? Select all that apply. 1 Bone marrow 2 Thymus shrinkage 3 Increased T lymphocytes 4 Increased B lymphocytes 5 Decreased immunoglobulin levels

2 Thymus shrinkage 5 Decreased immunoglobulin levels

A patient with AIDS has been put on antiretroviral therapy and has been taking the medications for four weeks. During the one-month follow-up visit, what findings will help the nurse identify whether the patient is responding to the treatment? Select all that apply. 1 80% drop in viral load 2 90% drop in viral load 3 CD4 T cell count above 14% 4 CD4 T cell count above 400 cells /µL 5 3-unit drop in viral load on a log scale

2 90% drop in viral load 3 CD4 T cell count above 14% 5 3-unit drop in viral load on a log scale

A patient who is a sex worker is complaining of rapid weight loss, oral thrush, nonproductive cough, progressive shortness of breath, fever, night sweats, and fatigue. Her chest x-ray shows interstitial infiltrates, and a blood test reveals that her CD4+ count is 140 cells/μL. She is taking medication for acquired immunodeficiency syndrome (AIDS). What measures can improve the health of this patient? Select all that apply. 1 Bacille Calmette Guerin (BCG) vaccine to prevent tuberculosis 2 Adherence to current medications 3 Antibiotics for the pneumonia 4 Adequate oxygenation 5 Antifungal medication

2 Adherence to current medications 4 Adequate oxygenation 5 Antifungal medication

A patient currently taking emtricitabine, asks the nurse how this medication helps with the patient's human immunodeficiency virus (HIV) infection. The nurse would explain that it: 1 Prevents the binding of the HIV to cells, which prevents HIV entry into the cell. 2 Inserts DNA into the HIV DNA chain and blocks further development of the HIV DNA chain. 3 Inhibits the action of the reverse transciptase enzyme, so that DNA is no longer converted to RNA. 4 Binds with the integrase enzyme, which prevents HIV from incorporating its genetic material into the host cell.

2 Inserts DNA into the HIV DNA chain and blocks further development of the HIV DNA chain.

A patient was given 500 mL of O-negative blood after proper cross-matching. Later, it was found that the blood donor was human immunodeficiency virus-(HIV) positive. After two weeks, the patient complained of fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and diffuse rash. What could be the possible reason for these symptoms? Select all that apply. 1 Flu 2 Seroconversion 3 Mononucleosis 4 Acute HIV infection 5 Guillain-Barré syndrome

2 Seroconversion 4 Acute HIV infection

A 27-year-old patient came to a clinic for a pregnancy test because she had missed her last menstrual period. Despite the use of a condom, the test was positive. She had no other sexual partners. What information should be given to this patient by the attending nurse? Select all that apply. 1 Discuss antiretroviral therapy (ART). 2 Tell her that failure of condoms is possible. 3 Offer access to voluntary HIV-antibody testing. 4 Advise her that she can choose abortion if she wants. 5 Advise her to get her partner tested for human immunodeficiency virus (HIV).

2 Tell her that failure of condoms is possible. 3 Offer access to voluntary HIV-antibody testing. 4 Advise her that she can choose abortion if she wants.

A patient with O-positive blood is transfused with AB-positive blood. Which hypersensitivity reaction does the nurse anticipate the patient will experience? 1 IgE-mediated reaction 2 Immune-complex reaction 3 Cytotoxic and cytolytic reaction 4 Delayed hypersensitivity reaction

3 Cytotoxic and cytolytic reaction

Which cytokine is used in the treatment of Kaposi sarcoma? 1Filgrastim 2Sargramostim 3Interferon-alpha 4Interferon-beta

3 Interferon-alpha

A patient who has a history of having multiple sexual partners underwent HIV testing through enzyme immunoassay (EIA). The test was negative. How should the nurse explain the test result to the patient? 1 The patient does not have HIV infection. 2 The test might give a false-negative report. 3 The test should be repeated at three weeks, six weeks, and three months. 4 The patient is HIV positive, but the viral load is not detectable.

3 The test should be repeated at three weeks, six weeks, and three months. An enzyme immunoassay (EIA) test for HIV is highly sensitive, but a negative result in a person with high risk behavior does not necessarily indicate an absence of HIV infection. The test should be repeated at three weeks, six weeks, and three months. The test is unlikely to give a false-negative result, so the nurse should not disclose this to the patient. The viral load may not be enough to be detected, but the nurse should not tell a patient who tested negative that he or she is HIV positive. Text Reference - p. 236

The nurse differentiates between the types of hypersensitivity reactions and recognizes that which type is related to cell-mediated immunity? 1 Type I 2 Type II 3 Type III 4 Type IV

4 Type IV

A human immunodeficiency virus (HIV)-infected patient asks the nurse, "I've heard about opportunistic diseases in HIV-infected people. What does that mean? I already have the HIV infection." Which response by the nurse is correct? 1 "These diseases are usually benign." 2 "Opportunistic diseases only occur at the end stages of HIV infection." 3 "Unfortunately, opportunistic diseases are not treatable if they occur." 4 "These are caused by organisms that do not cause severe disease in those with functioning immune system

4 "These are caused by organisms that do not cause severe disease in those with functioning immune system Opportunistic diseases generally do not occur in the presence of a functioning immune system. Organisms that do not cause severe disease in people with functioning immune systems can cause debilitating, disseminated, and life-threatening infections during this stage. Several opportunistic diseases may occur at the same time, compounding the difficulties of diagnosis and treatment. Advances in HIV treatment have decreased the occurrence of opportunistic diseases. These diseases can occur early in the process of HIV infection and sometimes are used to diagnose the presence of HIV. Text Reference - p. 234

Which organ produces lymphocytes? 1Spleen 2Tonsils 3Thymus 4Bone marrow

4 Bone marrow Production of lymphocytes takes place in the bone marrow. The spleen is responsible for filtering foreign antigens that enter the bloodstream. Tonsils are lymphoid tissue that act as a first-line defense against ingested or inhaled pathogens. The thymus produces mature T-lymphocytes.

A nurse is assessing a patient who has developed eczematous skin lesions due to ingestion of nail polish remover today as well as several days ago. Which type of immunity reaction does the nurse suspect? 1 IgE-mediated reaction 2 Immune-complex reaction 3 Cytotoxic and cytolytic reaction 4 Delayed hypersensitivity reaction

4 Delayed hypersensitivity reaction

The nurse understands that personal protective equipment helps to prevent the spread of infection and protects the health care professional from contracting infection. What would the nurse wear to prevent the spread of infection when disconnecting IV fluid tubing from the IV access port? 1 A cap 2 An isolation gown 3 Shoe covers 4 Gloves

4 Gloves When disconnecting IV fluid tubing, the nurse may come in contact with blood. Therefore, personal protective equipment such as gloves should be used. This also helps the nurse avoid an infection by not touching contaminated items or surfaces. Caps, gowns, and boots are not required when removing IV tubing. Text Reference - p. 230

Which technique is associated with removal of white blood cells from the body? 1 Apheresis 2 Plateletpheresis 3 Plasmapheresis 4 Leukocytapheresis

4 Leukocytapheresis Leukocytapheresis is a process that involves removal of white blood cells from the body. In cases of chronic myelogenous leukemia, this technique involves removal of leukemic cells. Separation of blood components followed by isolation of one or more components is called apheresis. Plateletpheresis is separation of platelets from the blood. Plasmapheresis involves separation of plasma from whole blood.

An 82-year-old woman is brought to her physician by her daughter with complaints of some confusion. What testing should the nurse suggest for this patient? A. Urinalysis B. Sputum culture C. Red blood cell count D. White blood cell count

A

Transmission of HIV from an infected individual to another most commonly occurs as a result of a.unprotected anal or vaginal sexual intercourse. b.low levels of virus in the blood and high levels of CD4+ T cells. c.transmission from mother to infant during labor and delivery and breastfeeding. d.sharing of drug-using equipment, including needles, syringes, pipes, and straws.

A

Which antibiotic-resistant organisms cannot be killed by normal hand soap? a.Vancomycin-resistant enterococci b.Methicillin-resistant Staphylococcus aureus c.Penicillin-resistant Streptococcus pneumoniae d.β-Lactamase-producing Klebsiella pneumoniae

A

The nurse cares for a patient that had an asthma attack due to an unknown allergen. Which immunoglobulin is primarily responsible for allergic reactions? A. IgE B. IgG C. IgM D. IgA

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

The mature plasma cell secretes immunoglobulins. The nurse recalls that which immunoglobulin is found in breast milk and colostrum? A IgA B IgM C IgG D IgD

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

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

A Rationale: Drug-induced immunosuppression is the most common cause of secondary immunodeficiency disorders.

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

A Rationale: Immunoglobulin G (IgG) crosses the placental membrane and provides the newborn with passive acquired immunity for at least 3 months. Infants also may obtain some passive immunity from immunoglobulin A (IgA) in breast milk and colostrum.

The nurse is alerted to possible anaphylactic shock immediately after a patient has received intramuscular penicillin by the development of: A. edema and itching at the injection site B. sneezing and itching of the nose and eyes C. a wheal-and-flare reaction at the injection site D. chest tightness and production of thick sputum

A Rationale: Initial symptoms include edema and itching at the site of the exposure to the allergen.

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

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

A nurse is preparing the discharge plan of a patient who is allergic to latex. What foods should the nurse ask the patient to avoid? Select all that apply. A. Tomatoes B. Leafy vegetables C. Avocados D. Potatoes E. Milk

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

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

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

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

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

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

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

When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? A. "I will need to isolate any tissues I use so as not to infect my family." B. "I will notify all of my sexual partners so they can get tested for HIV." C. "Unprotected sexual contact is the most common mode of transmission." D. "I do not need to worry about spreading this virus to others by sweating at the gym."

A. "I will need to isolate any tissues I use so as not to infect my family."

The HIV-infected patient is taught health promotion activities including good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale behind these interventions that the nurse knows? A. Delaying disease progression B. Preventing disease transmission C. Helping to cure the HIV infection D. Enabling an increase in self-care activities

A. Delaying disease progression

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

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

The nurse teaches a patient about drug therapy after a kidney transplant. Which statement by the patient would indicate a need for further instructions? a. "After a couple of years, it is likely that I will be able to stop taking the cyclosporine." b. "If I develop an acute rejection episode, I will need to have other types of drugs given IV." c. "I need to be monitored closely because I have a greater chance of developing malignant tumors." d. "The drugs are given in combination because they inhibit different ways the kidney can be rejected."

ANS: A Cyclosporine, a calcineurin inhibitor, will need to be continued for life. The other patient statements are accurate and indicate that no further teaching is necessary about those topics.

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

ANS: A Serum IgE is elevated in an allergic response (type 1 hypersensitivity disorders). The eosinophil level will be elevated rather than neutrophil or basophil counts. IgA is located in body secretions and would not be tested when evaluating a patient who has symptoms of atopic dermatitis.

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

ANS: A The initial symptoms of anaphylaxis are itching and edema at the site of the exposure. Hypotension, tachycardia, dilated pupils, and wheezes occur later. Rapid administration of epinephrine when excessive itching or swelling at the skin site is observed can prevent the progression to anaphylaxis. Topical hydrocortisone would not deter an anaphylactic reaction. Exposure to lotions and soaps does not address the immediate concern of a possible anaphylactic reaction. The nurse should not wait and observe for edema. The nurse should act immediately in order to prevent progression to anaphylaxis.

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

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

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

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

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

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

The nurse teaches a patient diagnosed with systemic lupus erythematosus (SLE) about plasmapheresis. What instructions about plasmapheresis should the nurse include in the teaching plan? a. Plasmapheresis will eliminate eosinophils and basophils from blood. b. Plasmapheresis will remove antibody-antigen complexes from circulation. c. Plasmapheresis will prevent foreign antibodies from damaging various body tissues. d. Plasmapheresis will decrease the damage to organs caused by attacking T lymphocytes.

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

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

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

An adolescent patient seeks care in the emergency department after sharing needles for heroin injection with a friend who has hepatitis B. To provide immediate protection from infection, what medication will the nurse administer? a. Corticosteroids b. Gamma globulin c. Hepatitis B vaccine d. Fresh frozen plasma

ANS: B The patient should first receive antibodies for hepatitis B from injection of gamma globulin. The hepatitis B vaccination series should be started to provide active immunity. Fresh frozen plasma and corticosteroids will not be effective in preventing hepatitis B in the patient

Which teaching should the nurse provide about intradermal skin testing to a patient with possible allergies? a. "Do not eat anything for about 6 hours before the testing." b. "Take an oral antihistamine about an hour before the testing." c. "Plan to wait in the clinic for 20 to 30 minutes after the testing." d. "Reaction to the testing will take about 48 to 72 hours to occur."

ANS: C Allergic reactions usually occur within minutes after injection of an allergen, and the patient will be monitored for at least 20 minutes for anaphylactic reactions after the testing. Medications that might modify the response, such as antihistamines, should be avoided before allergy testing. There is no reason to be NPO for skin testing. Results with intradermal testing occur within minutes.

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

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

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

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

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

ANS: C Because the patient is at risk for bee stings and the severity of allergic reactions tends to increase with added exposure to allergen, taking oral antihistamines will not adequately control the patient's hypersensitivity reaction. The other patient statements indicate a good understanding of management of the problem

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

ANS: C Because there is an increased risk for adverse reactions after a patient misses a scheduled dose of allergen, the nurse should check with the health care provider before administration of the injection. A skin test is used to identify the allergen and would not be used at this time. An additional dose for the week may increase the risk for a reaction.

A new mother expresses concern about her baby developing allergies and asks what the health care provider meant by "passive immunity." Which example should the nurse use to explain this type of immunity? a. Early immunization b. Bone marrow donation c. Breastfeeding her infant d. Exposure to communicable diseases

ANS: C Colostrum provides passive immunity through antibodies from the mother. These antibodies protect the infant for a few months. However, memory cells are not retained, so the protection is not permanent. Active immunity is acquired by being immunized with vaccinations or having an infection. It requires that the infant has an immune response after exposure to an antigen. Cell-mediated immunity is acquired through T lymphocytes and is a form of active immunity.

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

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

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

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

Which statement by a patient would alert the nurse to a possible immunodeficiency disorder? a. "I take one baby aspirin every day to prevent stroke." b. "I usually eat eggs or meat for at least 2 meals a day." c. "I had my spleen removed many years ago after a car accident." d. "I had a chest x-ray 6 months ago when I had walking pneumonia."

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

While obtaining a health history from a patient, the nurse learns that the patient has a history of allergic rhinitis and multiple food allergies. Which action by the nurse is most appropriate? a. Encourage the patient to carry an epinephrine kit in case a type IV allergic reaction to latex develops. b. Advise the patient to use oil-based hand creams to decrease contact with natural proteins in latex gloves. c. Document the patient's allergy history and be alert for any clinical manifestations of a type I latex allergy. d. Recommend that the patient use vinyl gloves instead of latex gloves in preventing blood-borne pathogen contact.

ANS: C The patient's allergy history and occupation indicate a risk of developing a latex allergy. The nurse should be prepared to manage any symptoms that may occur. Epinephrine is not an appropriate treatment for contact dermatitis that is caused by a type IV allergic reaction to latex. Oil-based creams will increase the exposure to latex from latex gloves. Vinyl gloves are appropriate to use when exposure to body fluids is unlikely.

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

ANS: C Treatment for a patient with acute rejection includes administration of additional immunosuppressants, and the patient should not be exposed to increased risk for infection as would occur from patients with viral pneumonia, graft-versus-host disease, and burns. There is no increased exposure to infection from a patient who had an anaphylactic reaction.

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

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

An older adult patient has a prescription for cyclosporine following a kidney transplant. Which information in the patient's health history has the most implications for planning patient teaching about the medication at this time? a. The patient restricts salt to treat prehypertension. b. The patient drinks 3 to 4 quarts of fluids every day. c. The patient has many concerns about the effects of cyclosporine. d. The patient has a glass of grapefruit juice every day for breakfast.

ANS: D Grapefruit juice can increase the toxicity of cyclosporine. The patient should be taught to avoid grapefruit juice. High fluid intake will not affect cyclosporine levels or renal function. Cyclosporine may cause hypertension, and the patient's many concerns should be addressed, but these are not potentially life-threatening problems.

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

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

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

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

The mother does not want her child to have any extra immunizations for diseases that no longer occur. What teaching about immunization should the nurse provide this mother? A. There is currently no need for those older vaccines. B. There is a reemergence of some of the infections, such as pertussis. C. There is no longer an immunization available for some of those diseases. D. The only way to protect your child is to have the federally required vaccines.

B

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

B

The patient has vancomycin-resistant enterococci (VRE) infection in a surgical wound. What infection precautions should the nurse use to best prevent transmission of the infection to the nurse, other patients, staff, and those outside the hospital? A. Droplet precautions B. Contact precautions C. Airborne precautions D. Standard precautions

B

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

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

The mature plasma cell secretes immunoglobulins. The nurse recalls that which immunoglobulin is found in plasma, and is responsible for produces antibodies against ABO blood antigens ? A IgA B IgM C IgG D IgD

B IgM

The mature plasma cell secretes immunoglobulins. The nurse recalls that which immunoglobulin is found in plasma, and is responsible for the primary immune response ? A IgA B IgM C IgG D IgD

B IgM

Antiretroviral drugs are used to a.cure acute HIV infection. b.decrease viral RNA levels. c.treat opportunistic diseases. d.decrease pain and symptoms in terminal disease.

B decrease viral RNA levels.

On initial assessment of an older patient, the nurse knows to look for certain types of diseases because which immunologic response decrease with age? A. Autoimmune response B. Cell-mediated immunity C. Hypersensitivity response D. Humoral immune response

B, Cell-mediated immunity C Hypersensitivity response D Humoral immune response

In a person having an acute rejection of a transplanted kidney, which of the following would help the nurse understand the course of events (select all that apply): A. a new transplant could be considered B. acute rejection can be treated with OKT3 C. acute rejection usually leads to chronic rejection D. corticosteroids are the most successful drug used to treat acute rejection E. Acute rejection is common after a transplant and can be treated with drug therapy

B, E Rationale: Acute rejection is treatable and does not usually necessitate replacement transplantation. Monoclonal antibodies such as muromonab-CD3 (Orthoclone OKT3) are used for preventing and treating acute rejection episodes. Calcineurin inhibitors are the most effective immunosuppressants available to treat organ rejection. It is not uncommon to have at least one acute rejection episode, especially with organs from deceased donors. These episodes are usually reversible with additional immunosuppressive therapy that may include increased corticosteroid doses or polyclonal or monoclonal antibodies.

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

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

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

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

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

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

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

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

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

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

The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? A. Presence of HIV antibodies B. CD4+ T cell count below 200/µL C. Presence of oral hairy leukoplakia D. White blood cell count below 5000/µL

B. CD4+ T cell count below 200/µL

The nurse was accidently stuck with a needle used on an HIV-positive patient. After reporting this, what care should this nurse first receive? A. Personal protective equipment B. Combination antiretroviral therapy C. Counseling to report blood exposures D. A negative evaluation by the manager

B. Combination antiretroviral therapy

A 25-year-old male patient has been diagnosed with HIV. The patient does not want to take more than one antiretroviral drug. What reasons can the nurse tell the patient about for taking more than one drug? A. Together they will cure HIV. B. Viral replication will be inhibited. C. They will decrease CD4+ T cell counts. D. It will prevent interaction with other drugs.

B. Viral replication will be inhibited.

A 21-year-old student had taken amoxicillin once as a child for an ear infection. She is given an injection of Penicillin V and develops a systemic anaphylactic reaction. What manifestations would be seen first? A. Dyspnea B. Dilated pupils C. Itching and edema D. Wheal-and-flare reaction

C

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

C

The patient with diabetes mellitus has been ill for some time with a severe lung infection needing corticosteroids and antibiotics. The patient does not feel like eating. The nurse understands that this patient is likely to develop A. major histoincompatibility. B. primary immunodeficiency. C. secondary immunodeficiency. D. acute hypersensitivity reaction

C

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

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

One function of cell-mediated immunity is: A. formation of antibodies B. activation of the complement system C. surveillance for malignant cell changes D. opsonization of antigens to allow phagocytosis by neutrophils

C Rationale: One role of cell-mediated immunity is immune surveillance to detect any malignant changes in cells and then destroy them.

A patient is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse explains that plasmapheresis is used in her treatment to: A. remove T lymphocytes in her blood that are producing antinuclear antibodies B. remove normal particles in her blood that are being damaged by autoantibodies C. exchange her plasma that contains antinuclear antibodies with a substitute fluid D. replace viral-damaged cellular components of her blood with replacement whole blood

C Rationale: The rationale for performing therapeutic plasmapheresis in patients with autoimmune disorders such as SLE is to remove pathologic substances (i.e., antinuclear antibodies) from plasma.

Passive acquired immunity in the baby is also provided by ______________ which crosses through the placenta and is present in the baby for at least 3 months A IgA B IgM C IgG D IgD

C IgG

The mature plasma cell secretes immunoglobulins. The nurse recalls that which immunoglobulin is found in plasma, and interstitial fluid. It is responsible for secondary immune response ? A IgA B IgM C IgG D IgD

C IgG

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

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

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

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

A pregnant woman who was tested and diagnosed with HIV infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? A. "The baby will probably be infected with HIV." B. "Only an abortion will keep your baby from having HIV." C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." D. "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."

C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection."

The nurse is providing care for a patient who has been living with HIV for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A. A new onset of polycythemia B. Presence of mononucleosis-like symptoms C. A sharp decrease in the patient's CD4+ count D. A sudden increase in the patient's WBC count

C. A sharp decrease in the patient's CD4+ count

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

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

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

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

During a preoperative assessment, the nurse would assess for latex allergy by asking the patient about allergy to which substance? A. Penicillin B. Sulfa C. Avocados D. Shellfish

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

The nurse is providing education for a patient who is infected with the virus about transmission of human immunodeficiency virus (HIV) to another person. Which of these is a potential method of HIV transmission? Select all that apply. 1 Shaking hands and sharing eating utensils. 2 Unprotected anal or vaginal sexual intercourse. 3 Exposure to HIV-infected blood through needle stick. 4 Sharing of needles, syringes, pipes, and straws during drug use. 5 Transmission from mother to infant during labor and delivery and breastfeeding

Correct 2, 3, 4, 5 HIV can be transmitted as a result of contact with infected blood, semen, vaginal secretions, or breast milk. Transmission of HIV occurs through sexual intercourse with an infected partner, type of exposure to HIV-infected blood or blood products, and perinatal transmission during pregnancy, at delivery, or through breastfeeding. HIV is not spread through casual contact, such as shaking hands, hugging, or sharing utensils. Text Reference - p. 231

The nurse is providing teaching for a patient who has a new prescription for an antibiotic. Which statement by the patient indicates a need for further teaching? 1 "I will not skip doses of the antibiotic." 2 "I will take the medicine until it is finished." 3 "I will stop taking the antibiotic when my symptoms are better." 4 "I will not share this antibiotic with other members of my family."

Correct 3 "I will stop taking the antibiotic when my symptoms are better." Patients can contribute to antibiotic resistance development by skipping doses, not taking antibiotics for the full duration of prescribed therapy, or saving unused antibiotics "in case I need them later." Antibiotics should not be shared with other family members.

The nurse is reviewing the genetic testing results of a patient, and sees that the patient has a human leukocyte antigen (HLA) allele that is positive for ankylosing spondylitis. Which of these statements is true about the HLA antigens and disease conditions? 1 This patient already has developed ankylosing spondylitis. 2 This patient will develop ankylosing spondylitis at some point in his or her lifetime. 3 This patient has a higher risk than the general population for developing ankylosing spondylitis. 4 Further testing is needed to discover the degree of risk the patient has for developing ankylosing spondylitis

Correct3 This patient has a higher risk than the general population for developing ankylosing spondylitis.

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

D

The patient with an allergy to bee stings was just stung by a bee. After administering oxygen, removing the stinger, and administering epinephrine, the nurse notices the patient is hypotensive. What should be the nurse's first action? A. Administer IV diphenhydramine (Benadryl). B. Administer nitroprusside as soon as possible. C. Anticipate tracheostomy with laryngeal edema. D. Place the patient recumbent and elevate the legs

D

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

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

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

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

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

D Rationale: A positive crossmatch indicates that the recipient has cytotoxic antibodies to the donor's antigens and is an absolute contraindication to transplantation. If transplanted, the organ would undergo hyperacute rejection.

The nurse advises a friend who asks him to administer his allergy shots that: A. it is illegal for nurses to administer injections outside of a medical setting B. he is qualified to do it if the friend has epinephrine in an injectible syringe provided with his extract C. avoiding the allergens is a much more effective way of controlling allergens, and allergy shots are not usually effective D. immunotherapy should only be administered in a setting where emergency equipment and drugs are available

D Rationale: Anaphylactic reactions occur suddenly in hypersensitive patients after exposure to the offending allergen. They may occur after an allergy shot (i.e., parenteral injection). The cardinal principle in therapeutic management is speed in (1) recognition of signs and symptoms of an anaphylactic reaction, (2) maintenance of a patent airway, (3) prevention of spread of the allergen by use of a tourniquet, (4) administration of drugs, and (5) treatment for shock.

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

D Rationale: Most of the human leukocyte antigen (HLA)-associated diseases are classified as autoimmune disorders. Examples of associations between HLA types and disease include (1) that of HLA-B27 with ankylosing spondylitis, (2) those of HLA-DR2 and HLA-DR3 with systemic lupus erythematosus (SLE), and (3) those of HLA-DR3 and HLA-DR4 with diabetes mellitus.

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

D Rationale: Type I hypersensitivity reactions occur only in susceptible persons who are highly sensitized to specific allergens. Immunoglobulin E (IgE) antibodies, produced in response to the allergen, have a characteristic property of attaching to mast cells and basophils.

The function of monocytes in immunity is related to their ability to: A. stimulate the production of T and B lymphocytes B. produce antibodies on exposure to foreign substances C. bind antigens and stimulate natural killer cell activation D. capture antigens by phagocytosis and present them to lymphocytes

D Rationale: The mononuclear phagocyte system includes monocytes in the blood and macrophages found throughout the body. Mononuclear phagocytes have a critical role in the immune system. They are responsible for capturing, processing, and presenting the antigen to the lymphocytes.

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

D IgD

A patient has developed multiple chemical sensitivities. What line of treatment would be appropriate for this patient? Select all that apply. A. Start narcotic drugs. B. Start anti-anxiety drugs. C. Start antidepressants. D. Avoid chemicals that may trigger symptoms. E. Create an odor-free and chemical-free home and workplace.

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

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

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

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

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

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

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

Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission? a.Using sterile equipment to inject drugs b.Cleaning equipment used to inject drugs c.Taking zidovudine (AZT, ZDV, Retrovir) during pregnancy d.Using latex or polyurethane barriers to cover genitalia during sexual contact

a. Using sterile equipment to inject drugs

Which statements accurately describe HIV infection (select all that apply)? a.Untreated HIV infection has a predictable pattern of progression. b.Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c.Untreated HIV infection can remain in the early chronic stage for a decade or more. d.Untreated HIV infection usually remains in the early chronic stage for 1 year or less. e.Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low.

a.Untreated HIV infection has a predictable pattern of progression. b.Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c.Untreated HIV infection can remain in the early chronic stage for a decade or more.

For which of the following individuals is genetic carrier screening indicated? A. A patient with a history of type 1 diabetes B. A patient with a family history of sickle cell disease C. A patient whose mother and sister died of breast cancer D. A patient who has a long-standing history of iron-deficiency anemia

b. Genetic carrier screening should be done in families with a history of sickle cell disease. Diabetes and iron-deficiency anemia are not amenable to any form of genetic testing, whereas a family history of breast cancer suggests the need for presymptomatic testing for estimating the patient's risk of developing breast cancer.

Opportunistic diseases in HIV infection a.are usually benign. b.are generally slow to develop and progress. c.occur in the presence of immunosuppression. d.are curable with appropriate drug interventions.

c. occur in the presence of immunosuppression

Screening for HIV infection generally involves a.laboratory analysis of blood to detect HIV antigen. b.electrophoretic analysis for HIV antigen in plasma. c.laboratory analysis of blood to detect HIV antibodies. d.analysis of lymph tissues for the presence of HIV RNA.

c.laboratory analysis of blood to detect HIV antibodies.

During HIV infection a.the virus replicates mainly in B-cells before spreading to CD4+ T cells. b.infection of monocytes may occur, but antibodies quickly destroy these cells. c.the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells. d.a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication.

c.the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells.

What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen? a."Set up" a drug pillbox for the patient every week. b.Give the patient a video and a brochure to view and read at home. c.Tell the patient that the side effects of the drugs are bad but that they go away after a while. d.Assess the patient's routines and find adherence cues that fit into the patient's life circumstances.

d.Assess the patient's routines and find adherence cues that fit into the patient's life circumstances