Immunity

An inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity is: 1) Wiskott-Aldrich syndrome. 2) Severe combined immunodeficiency syndrome (SCIDS). 3)Acquired immunodeficiency syndrome. 4) Fanconi syndrome.

#2) Sever combined immunodeficiency syndrome (SCIDS) Feedback: Severe SCIDS is a genetic disorder that results in deficits of both humoral and cellular immunity. Acquired immunodeficiency syndrome is not inherited. Wiskott-Aldrich syndrome is an X-linked recessive disorder with selected deficiencies of T and B lymphocytes. Fanconi syndrome is a hereditary disorder of red cell production.

What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population? 1) Correct Perinatal transmission 2) Sexual abuse 3) Blood transfusions 4) Poor hand washing

1) Perinatal transmission Feedback: Perinatal transmission accounts for the highest percentage (91%) of HIV infections in children. Infected women can transmit the virus to their infants across the placenta during pregnancy, at delivery, and through breastfeeding. Cases of HIV infection from sexual abuse have been reported; however, perinatal transmission accounts for most pediatric HIV infections. In the past some children became infected with HIV through blood transfusions; however, improved laboratory screening has significantly reduced the probability of contracting HIV from blood products. Poor hand washing is not an etiology of HIV infection.

After being stung by a wasp, a patient is brought to the clinic by a co-worker. Upon arrival the patient is anxious and having difficulty breathing. The first action that the nurse should take is to 1) have the patient lie down. 2) Correct assess the patient's airway. 3) administer high-flow oxygen. 4) remove the stinger from the site.

2) assess the patient's airway. Feedback: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.

When caring for a clinic patient who is experiencing an allergic reaction to an unknown allergen, which nursing activity is most appropriate for the RN to delegate to an LPN/LVN? 1) Perform a focused physical assessment. 2) Obtain the health history from the patient. 3)Teach the patient about the various diagnostic studies. 4) Administer skin testing by the cutaneous scratch method.

4) Administer skin testing by the cutaneous scratch method. Response: 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 discusses the prevention and management of allergic reactions with a beekeeper who has developed a hypersensitivity to bee stings. The nurse identifies a need for additional teaching when the patient states, A) "I am going to need job retraining so that I can work in a different occupation." B) "I will get a prescription for epinephrine and learn to self-inject it." C) "I should wear a Medic Alert bracelet indicating my allergy to bee stings." D) "I am going to need job retraining so that I can work in a different occupation."

A) "I am going to need job retraning so that I can work in a different occupation" Feedback: Since 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 school nurse is informed that a child with human immunodeficiency virus (HIV) will be attending school soon. Which is an important nursing intervention? A) Carefully follow universal precautions. B) Determine how the child became infected. C) Inform the parents of the other children. D) Reassure other children that they will not become infected.

A) Carefully follow universal precautions Feedback: Universal precautions are necessary to prevent further transmission of the disease. It is not the role of the nurse to determine how the child became infected. Informing the parents of other children and reassuring other children that they will not become infected is a violation of the child's right to privacy.

A patient is being evaluated for possible atopic dermatitis. The nurse will review the patient's laboratory values for the level of Selected Answer: Incorrect basophils. Answers: A) IgE. B) IgA. C) basophils. D) neutrophils.

A) IgE Feedback: Serum IgE causes the symptoms of allergic reactions and is elevated in 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 62-year-old patient who is having an annual check-up tells the nurse, "I don't understand why I need to have so many cancer screening tests now. I feel just fine!" The nurse will plan to teach the patient about the 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.

A) consequences of aging on cell-mediated immunity. Feedback: The primary impact of aging on immune function is on the activity of T cells, which are responsible for tumor immunity. Antibody function is not impacted as much by aging and does not protect against malignancy. Poor nutrition does 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.

A patient who is receiving an IV antibiotic develops wheezes and dyspnea. In which order should the nurse implement these prescribed actions? a. Discontinue the antibiotic infusion. b. Give diphenhydramine (Benadryl) IV. c. Inject epinephrine (Adrenalin) IM or IV. d. Prepare an infusion of dopamine (Intropin). e. Start 100 % oxygen using a nonrebreather mask.

A, E, C, B, D The nurse should initially discontinue the antibiotic, since it is the likely cause of the allergic reaction. Next, oxygen delivery should be maximized, followed by treatment of bronchoc

Which condition is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T-cells? 1) Wiskott-Aldrich syndrome 2)Idiopathic thrombocytopenic purpura (ITP) 3)Acquired immunodeficiency syndrome (AIDS) 4) Severe combined immunodeficiency disease

Acquired immunodeficiency syndrome (AIDS)

A young child with human immunodeficiency virus is receiving several antiretroviral drugs. The purpose of these drugs is to: 1) Cure the disease. 2) Delay disease progression. 3)Prevent spread of disease. 4)Treat Pneumocystis jiroveci pneumonia.

Answer : Delay disease progression Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system, and delay disease progression. At this time cure is not possible. These drugs do not prevent the spread of the disease. Pneumocystis jiroveci prophylaxis is accomplished with antibiotic

The nurse is planning care for an adolescent with acquired immunodeficiency syndrome. The priority nursing goal is to: 1) Correct Prevent infection. 2) Prevent secondary cancers. 3) Restore immunologic defenses. 4) Identify source of infection.

Answers: Prevent infection. Response Feedback: As a result of the immunocompromise that is associated with human immunodeficiency virus infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the child's normal developmental needs. Restoring immunologic defenses is not currently possible. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication, preventing further deterioration. Case finding is not a priority nursing goal.

A patient diagnosed with systemic lupus erythematosus (SLE) is scheduled for plasmapheresis. The nurse plans to teach the patient that plasmapheresis will Answers: A) eliminate eosinophils and basophils from blood. B) remove antibody-antigen complexes from circulation. C) prevent foreign antibodies from damaging various body tissues. D) decrease the damage to organs caused by attacking T-lymphocytes.

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

The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement, sequencing from the highest priority to the lowest. A. Notify the practitioner. B. Stop the transfusion. C. Take the vital signs. D. Maintain a patent intravenous (IV) line with normal saline.

B,C,D,A

After teaching a patient on immunosuppressant therapy after a kidney transplant about the posttransplant drug regimen, the nurse determines that additional teaching is needed when the patient says, A) "If I develop an acute rejection episode, I will need to have other types of drugs given IV." B) "I need to be monitored closely because I have a greater chance of developing malignant tumors." C) "After a couple of years, it is likely that I will be able to stop taking the calcineurin inhibitor." D) "The drugs are given in combination because they inhibit different aspects of transplant rejection."

C) "After a couple of years, it is likely that I will be able to stop taking the calcineurin inhibitor."

When the nurse is admitting a patient who has acute rejection of an organ transplant, which of these already admitted patients will be the most appropriate roommate? 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

C) A patient who is recovering from an anaphylactic reaction to a bee sting Feedback: 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 with anaphylaxis.

A patient who receives weekly immunotherapy at a clinic missed the previous appointment. When the patient comes for the next injection, the nurse should 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.

C) consult with the health care provider about giving a lower allergen dose. Feedback: 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.

Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS) (Select all that apply)? 1) Give supplemental vitamins as prescribed. 2) Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed. 3) Notify the physician if the child develops a cough or congestion. 4) Yearly influenza vaccination should be avoided.

Correct :1,2,3 : Give supplemental vitamins as prescribed. Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed. Notify the physician if the child develops a cough or congestion. The parents should be taught that supplemental vitamins will be prescribed to aid in nutritional status. Bactrim is administered to prevent the opportunistic infection of Pneumocystis jiroveci pneumonia. The physician should be notified if the child with AIDS develops a cough and congestion. The yearly influenza vaccination is recommended, and any missed doses of antiretroviral medication need to be recorded and reported.

While the nurse is obtaining an assessment and health history from a patient, which statement by the patient will 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)Correct "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."

D) "I had my spleen removed many years ago after a car accident. Response Feedback: 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 impact on immune function. A chest x-ray does not have enough radiation to suppress immune function.

A patient seen at the clinic with atopic dermatitis has a history of multiple allergies and several previous anaphylactic reactions. Which type of testing for allergens will the nurse anticipate for this patient? A) Serum IgE-level test B) Cutaneous scratch test C) Intracutaneous skin test D) Correct Radioallergosorbent test (RAST)

D) Radioallergosorbent test (RAST) Feedback: RAST is an in vitro test for hypersensitivity to specific allergens that is used when patients are likely to have anaphylactic reactions to other forms of skin testing. Cutaneous scratch testing or intracutaneous testing is more likely to cause anaphylaxis. Serum IgE level is elevated in atopic reactions but is not diagnostic for specific allergens.

The nurse will monitor a patient who is undergoing plasmapheresis for A) shortness of breath. B) high blood pressure. C) transfusion reactions. D) numbness and tingling.

D) numbness and tingling. Feedback: 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.

A patient has a new prescription for cyclosporine after having 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.

The patient has a glass of grapefruit juice every day for breakfast. Feedback:Grapefruit juice can increase the cyclosporine to toxic levels. The patient should be taught to avoid grapefruit juice. High fluid intake will not impact 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.

Which immunization should be given with caution to children infected with human immunodeficiency virus? 1) Influenza 2) Varicella 3) Pneumococcus 4) Inactivated poliovirus

Varicella Feedback: The children should be carefully evaluated before giving live viral vaccines such as varicella, measles, mumps, and rubella. The child must be immunocompetent and not have contact with other severely immunocompromised individuals. Influenza, pneumococcus, and inactivated poliovirus are not live vaccines.

A patient is admitted to the hospital with acute rejection of a kidney transplant. The nurse will anticipate A) administration of immunosuppressant medications. B) insertion of an arteriovenous graft for hemodialysis. C) placement of the patient on the transplant waiting list. D) drawing blood for human leukocyte antigen (HLA) and ABO compatibility matching.

administration of immunosuppressant medications. Feedback: Acute rejection is treated with the administration of additional immunosuppressant drugs such as corticosteroids. Because acute rejection is reversible, there is no indication that the patient will require another transplant, hemodialysis, or HLA/ABO testing.

Several complications can occur when a child receives a blood transfusion. An immediate sign or symptom of an air embolus is: 1) Chills and shaking. 2) Nausea and vomiting. 3) Irregular heart rate. 4) Sudden difficulty in breathing.

sudden 4) difficulty breathing Feedback: Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Air emboli should be avoided by carefully flushing all tubing of air before connecting to the patient. Chills, shaking, nausea, and vomiting are associated with hemolytic reactions. Irregular heart rate is associated with electrolyte disturbances and hypothermia.