Patho 4 Immunological Health Problems
The nurse anticipates that a child with asthma caused by allergies will have which finding on a complete blood count (CBC) with differential report? 1. Eosinophils 21.9 2. White blood cells 10.9 3. Monocytes 4.0 4. Neutrophils 85.7
1. Eosinophils 21.9 Eosinophils are usually elevated in an allergic response. WBC, monocytes, and neutrophils are not involved in an allergic response. Specific knowledge of laboratory values is needed to answer the question. Review common lab values such as complete blood count (CBC) and differential if this question was difficult.
A female client who has recently been diagnosed with type 1 diabetes mellitus (DM) asks the nurse how she developed this because no one in her family is a diabetic. The nurse should respond that DM is an autoimmune disease characterized by which of the following? 1. Failure of the immune system to recognize self 2. Exacerbations and remissions 3. Accelerated production of killer T-cells 4. Immunosuppression and altered cortisol levels
1. Failure of the immune system to recognize self Type 1 diabetes is caused by the autoimmune destruction of pancreatic beta cells. Recognition of self as foreign is the definition of any autoimmune disease. Further explanation may be needed to explain that the immune system usually recognizes self and identifies what is foreign, targets foreign cells, and destroys them. Eliminate the options that do not relate to an autoimmune process. The critical word is autoimmune, not diabetes mellitus.
The nurse is working with a client who has been asymptomatic with HIV until recently, when he developed pneumocystis jiroveci pneumonia. The CD4 T-cell counts have dropped to below 200/mm^3 (Diagnostic Category 3). The nurse then assesses the client for the presence of what clinical problem that would also place this client in Clinical Category C? Select all that apply. 1. HIV encephalopathy 2. Persistent generalized lymphadenopathy 3. Chlamydia 4. Flulike symptoms of fever, sore throat, myalgia, and headache 5. Kaposi's sarcoma
1. HIV encephalopathy 5. Kaposi's sarcoma The classification system (1993 CDC recommendations) for HIV and AIDS lists several clinical problems that place an HIV-infected client into Clinical Category C. This is the most advanced category in which the client develops significant disease with neurological manifestations (HIV encephalopathy), opportunistic infections, cancers (Kaposi's sarcoma), and possibly HIV wasting syndrome. Select the problems seen in advanced AIDS.
A client is brought to the emergency department with anaphylaxis after taking a dose of penicillin. The nurse delivers care based on which nursing diagnosis that has highest priority? 1. Ineffective Breathing Pattern 2. Decreased Cardiac Output 3. Risk for Injury 4. Anxiety
1. Ineffective Breathing Pattern Because laryngeal spasms and bronchial constriction can occur with anaphylaxis, assessing the client's airway is top priority. The nurse should maintain and establish a patent airway first. Remember the ABCs (airway, breathing, and circulation). Cardiac output would come next, followed by risk for injury, and finally anxiety. Use the ABCs (airway, breathing, and circulation) and Maslow's hierarchy to prioritize. Recall that airway takes priority in life-threatening situations that do not involve cardiopulmonary resuscitation (which now uses CAB).
A 31-year-old female who has progressed to advanced AIDS is concerned about developing a secondary cancer. What diagnostic test should the nurse explain will probably be prescribed every 6 months? 1. Papanicolaou smear 2. Viral load 3. CD4 cell counts 4. CA 125 antigen level
1. Papanicolaou smear Cervical dysplasia is present in 40% of women with HIV. Cervical cancer often develops and is aggressive. Younger women die from the cervical cancer rather than from AIDS. Papanicolaou (PAP) smears every 6 months are recommended with aggressive treatment of any cervical dysplasia. CD4 cell counts and viral loads monitor the progression of AIDS but do not check for cancer. The CA 125 antigen is useful for detecting ovarian cancer. The question asks specifically for a diagnostic test for cancer, narrowing the options to 2. Recall which cancer is seen in women with AIDS.
The mother of a child with swollen lymph nodes is extremely afraid that the swelling means cancer. What is the best statement that the nurse could make to calm the mother? 1. "The finding is very alarming and could be serious, but you must remember it may be insignificant also." 2. "The lymph nodes filter foreign products and may only be swollen because of an infection.'' 3. "The lymph nodes will swell quite often and we may not ever know it." 4. "The lymph nodes are the major organ indicating a problem with the immune system"
2. "The lymph nodes filter foreign products and may only be swollen because of an infection.'' The mother is already alarmed enough, and the nurse should be careful with wording of the response. Describe the function of the lymph nodes to reassure the mother, such as "The lymph nodes filter foreign products and may only be swollen because of an infection." The other statements are either inaccurate or alarming, or both. The focus in this question is meeting the needs of the mother who is alarmed. Choose the response that best meets her needs for reassurance and yet gives correct information.
An adult male client is admitted to the hospital with symptoms of pneumonia. He has not improved clinically and has not responded well to antibiotics. When the sputum culture and sensitivity (C&S) and chest x-ray (CXR) results are available, a diagnosis of pneumocystis jiroveci pneumonia is made. The nurse should conclude that this client has which of the following? 1. Recent infection by HIV 2. AIDS 3. Tuberculosis 4. An infection of unknown origin
2. AIDS Pneumocystis jiroveci pneumonia is the most common opportunistic infection associated with AIDS. The fungus responsible is not pathogenic in individuals with a normal immune system. Opportunistic infections are likely to be seen when the CD4 cell count falls below 200/mm3 in the more advanced stages of AIDS. This infection would not occur in clients with tuberculosis, recent HIV infection, or infection of unknown origin. Analyze the signs and symptoms and decide what disease is being described. Note this infection is associated with immunocompromised individuals. Next determine whether this finding would occur in late or early stages.
A client in an allergy clinic asks the nurse why some allergic reactions affect only a small area while a reaction that occurred in the past involved "my whole body and my breathing.'' The nurse offers which of the following as examples of reactions that could cause systemic immune responses? Select all that apply. 1. Extreme redness and swelling to the arm after being bitten by ants 2. Anaphylaxis after ingesting a certain food such as shellfish 3. Developing symptoms of systemic latex allergy 4. Severe bronchoconstriction and wheezing after playing football in the grass 5. Sprained ankle becoming swollen, bruised, and painful
2. Anaphylaxis after ingesting a certain food such as shellfish 3. Developing symptoms of systemic latex allergy 4. Severe bronchoconstriction and wheezing after playing football in the grass A nonspecific inflammatory response is evoked by any injury and is of short duration, occurring before the immune response is established. It is usually local and produces inflammation. In some cases, local injuries result in systemic manifestations that usually begin in hours or days generated by the release of cytokines causing fever, lethargy, and metabolic changes. Anaphylaxis, systemic allergies, and bronchoconstriction are indicative of system reactions; swelling to the arm and a sprained ankle are examples of localized inflammation. The critical word in the question is systemic. Separate local from systemic reactions and choose the options that are systematic.
The health care provider tells a sexually active 16-year-old female with flulike symptoms that a negative enzyme-linked immunosorbent assay (ELISA) will need to be repeated in several weeks. When the client asks the nurse why the second test is necessary, what is the best explanation by the nurse? 1. The first test may be inaccurate. 2. Antibodies do not always show up initially. 3. The test is sensitive and can give false positives. 4. It is standard practice.
2. Antibodies do not always show up initially. The symptoms in the question are consistent with early HIV infection. The enzyme-linked immunosorbent assay (ELISA) test may be negative upon initial testing and positive at the time of seroconversion, which takes 6 weeks to 6 months after infection. This time period when the antibodies are negative is called the seroconversion window, and virally infected individuals may have negative antibody tests. To answer this question accurately, it is necessary to know commonly performed diagnostic tests for the immune system. It is also helpful to know factors that will interfere with accurate diagnostic results-in this case, time after exposure to develop antibodies.
A client experiences an anaphylactic reaction after taking the first dose of a newly prescribed antibiotic. The client history reveals that the client had taken the antibiotic once before without a problem. The nurse's explanation to the client will be based on what knowledge about the hypersensitivity response? 1. Histamine precursor causes anaphylaxis and a life-threatening situation. 2. IgE antibodies destroy mast cells, releasing substances that cause hypotension and vascular collapse. 3. Cell-mediated response, or delayed hypersensitivity, is caused by sensitized T lymphocytes and can lead to tissue injury. 4. Massive numbers of red blood cells are lysed because of an incompatibility with the medication that requires discontinuing the medication.
2. IgE antibodies destroy mast cells, releasing substances that cause hypotension and vascular collapse. Type I hypersensitivity reactions are caused by widespread antigen-antibody reactions such as anaphylaxis. This person has been sensitized by a prior exposure to the antigen and formed IgE antibodies, which reacted during a subsequent exposure. The anaphylactic response is usually immediate and leads to an antigen-antibody complex that causes the release of histamine and other substances. Lysis of massive numbers of red blood cells because of an incompatibility describes what occurs with a blood transfusion reaction and possibly some medications. The explanation that cell-mediated response is caused by sensitive T lymphocytes describes a Type IV delayed hypersensitivity. The statement that histamine precursor causes anaphylaxis is false. Review hypersensitivity reactions. This client situation clearly gives a history of past exposure to the antigen and an anaphylactic response this time.
A person who is HIV-positive starts to exhibit signs of AIDS. The nurse would accurately interpret that the client now has an AIDS-defining illness after noting which of the following? Select all that apply. 1. Low viral load and a high white blood cell (WBC) count 2. Low CD4 count and symptoms of immunodeficiency 3. High white blood cell (WBC) count and anemia 4. High viral load and CD4 count below 200 cells/mm^3 5. Diagnosis of pneumocystis jiroveci pneumonia
2. Low CD4 count and symptoms of immunodeficiency 4. High viral load and CD4 count below 200 cells/mm^3 5. Diagnosis of pneumocystis jiroveci pneumonia A client with Category 3 (AIDS) will have a low CD4 count (less than 200 cells/mm3) and a high viral load, and may have an opportunistic infection. What is desired is to have a high CD4 count and a low viral load (which should normally be zero). The white blood cell count is not used in classifying HIV. Recall that for an option to be correct, everything in the option must be correct. Analyze each option completely, eliminating first the options that contain WBC counts.
A family member of a client with type O negative blood is concerned about the risk of allergic reaction when the client receives a needed transfusion. The nurse explain that which type of blood will be transfused to avoid an allergic reaction? 1. O+ 2. O- 3. AB+ 4. AB-
2. O- Remember the Rh (+ or -) must also match in addition to the type of blood (O in this case) matching. If antigens are present in the donor blood, which can interact with antibodies in the recipient's blood (a Type II hypersensitivity), hemolytic reaction follows. Type O negative blood can be given to any recipient (the "universal donor"). For all other types the blood given must match the client's blood type. Recall principles of safely administering a blood transfusion including the type and crossmatch needed before transfusing.
A child who was breastfed as an infant receives the varicella vaccine at age 18 months. The mother states, "But I've had the chickenpox." The nurse explains to the mother that the child will require a booster even though the child has experienced which types of immunity since birth? Select all that apply. 1. Active acquired, natural 2. Passive acquired, natural 3. Passive acquired, artificial 4. Active acquired, artificial 5. Passive artificial, permanent
2. Passive acquired, natural 4. Active acquired, artificial Immunizations offer actively acquired artificial immunity. This child will need a booster vaccination at approximately age 5 because active artificial immunity can wane. Breastfeeding a child would offer passively acquired natural immunity, which also does not last. Active acquired natural immunity occurs when the body produces antibodies or develops immune lymphocytes against specific antigens-in this case, chickenpox (varicella), when the client contracts the disease. Immune globulins offer passively acquired artificial immunity. Consider what immunologic mechanism occurs when a person recovers from a viral infection.
The public health nurse considers that which of the following individuals is at increased risk of being infected with the HIV virus? 1. Police officer who works the streets and responds to emergencies 2. Sexually active teenager 3. School nurse who examines children 4. Nurse working on a telemetry unit
2. Sexually active teenager A sexually active teenager, especially if the act is unprotected, is at highest risk. The police officer and nurse on the telemetry unit should be using standard precautions, which include gloves any time body secretions are encountered. Although either of these may encounter blood accidentally. the percentage is low. A school nurse should not be coming into contact with body secretions that would increase the risk factor. Consider the bloodborne transmission of the virus to analyze which person in the options is most likely to be exposed and unprotected.
In assessing a client with a suspected latex allergy, the nurse should ask which of the following questions? 1. "Are your hands usually moist or dry?" 2. "What drug allergies do you have?" 3. "Do the elastic bands in your underwear cause rash and itching?" 4. "What types of surgeries have you had?"
3. "Do the elastic bands in your underwear cause rash and itching?" Exposure to latex can be via skin, mucous membrane, inhalation, or internal tissue. The allergy can be a Type I or Type IV hypersensitivity reaction. Diagnosis is based on evidence of skin reaction after exposure. Most elastic bands contain latex, and would indicate dermal exposure to latex. The moistness or dryness of skin does not affect allergies to latex. Drug allergies do not affect latex allergy. If the client was previously exposed to latex during surgeries, this might be relevant, but is not a primary factor in determining latex allergy. Consider which option gives the best information in assessing for latex allergy. Do not be misled by options that sound good but assess for other problems.
The nurse concludes that medications taken by a client with AIDS are effective if, in addition to a viral load of 25,000, the client exhibits which of the following? 1. Rare occurrence of symptoms 2. Negative enzyme-linked immunosorbent assay (ELISA) 3. CD4 T lymphocyte count of 490 mm^3 4. White blood cell (WBC) count of 1,700 mm^3
3. CD4 T lymphocyte count of 490 Positive results of medication are indicated by a reduced viral load and a CD4 count above 350 mm^3. A client with AIDS will have exacerbations and remissions with opportunistic infections; therefore, symptoms may vary. With a diagnosis of AIDS, an enzyme-linked immunosorbent assay (ELISA) test would remain positive for antibodies. WBC of 1,700 shows neutropenia, which does not indicate improvement. Compare the desired response to the options. Determine what factors will not change even with the treatment.
The ambulatory care nurse concludes that the client who does which of the following is at highest risk of contact with the HIV virus? 1. Counsels HIV victims and their families 2. Works with athletes who perspire a lot 3. Collects blood donations via a mobile blood unit 4. Gives flu shots in a health care provider's office
3. Collects blood donations via a mobile blood unit Fluids containing blood or blood cells have been identified as a mode of transmission for HIV. Collecting blood, especially in a mobile unit (where the population is more diverse) is a risk for any health care worker. Appropriate gloving is essential. Counseling may require touch, which is not a form of transmission; perspiration has not been identified as a form of contact. Using retractable syringes and disposing of used needles appropriately reduces the risk for nurses giving intramuscular (IM) injections. Consider how the HIV virus is spread and which body fluid is known to contain the virus.
A mother of twins calls the office and speaks to the nurse about a rash that has developed on both children since taking an antibiotic prescribed 7 days ago. The twins also have edema of the face and neck, joint pain, and fever. What conclusion does the nurse draw about the problem and what is the appropriate nursing action? 1. Type I hypersensitivity reaction-get an order for diphenhydramine (Benadryl) and stop the medication. 2. Type II hypersensitivity reaction-monitor renal function after stopping the drug. 3. Type III hypersensitivity reaction (serum sickness) stop the drug and notify the pediatrician. 4. Type IV hypersensitivity reaction-get order to change to another drug and recommend calamine lotion for the rash.
3. Type III hypersensitivity reaction (serum sickness) stop the drug and notify the pediatrician. Serum sickness, a reaction a week after ingestion of a drug, is a Type III hypersensitivity reaction where formation of IgG or IgM antibody-antigen complexes occurs in the blood. The deposited immune complexes activate the inflammatory process causing focal tissue damage and edema. Urticaria, rash, extensive edema, and fever are usually temporary, resolving within a few days after the drug is stopped. Type I reactions occur within minutes of exposure to the antigen. Type II reactions involve IgG and IgM and cause hemolytic reactions. Type IV reactions are cell mediated reactions and are delayed from the contact with the antigen. The core issue of the question is that the clients have developed an adverse drug reaction. Recall that antibiotics can cause hypersensitivity reactions to determine the correct option.
The nurse would immediately asses for which symptom in a client suspected of having an anaphylactic reaction? 1. Elevated blood pressure of 180/94 2. Decreased apical pulse rate of 56 3. Onset of lung crackles 4. Onset of stridor or wheezing
4. Onset of stridor or wheezing A barking cough, wheezing, and stridor are clinical manifestations of the bronchoconstriction and airway edema that accompanies anaphylaxis. Lung crackles are not part of the clinical picture. The blood pressure is usually low (hypotension) because of vasodilation, rather than high. The pulse would be rapid (tachycardia) rather than slow. Remember that anaphylaxis results in a type of shock, so choose the option that fits assessment findings of a client in shock.
A client reports to the clinic with reports of itching and weeping along the back of her legs. Upon inspection, wheals are evident that appear to be poison ivy. The client states the symptoms developed 1 day after sitting in the car wearing shorts. She sat on the same seat as her husband, who had been working in a field of grass all day. The nurse concludes that the client is having which type of reaction? 1. Type I Hypersensitivity 2. Type II Hypersensitivity 3. Type III Hypersensitivity 4. Type IV Hypersensitivity
4. Type IV Hypersensitivity This type of contact dermatitis is commonly a delayed reaction and indicates Type IV hypersensitivity. This reaction is cell-mediated rather than antibody-mediated and is delayed 24 to 48 hours. Type I hypersensitivity reaction are immediate, within minutes of exposure. A Type II reaction is cytotoxic and reacts to cell-bound antigens. Type III reactions result from the formation of antibody-antigen immune complexes in the circulation. The clue in the question is the timing of the reaction. Only one hypersensitivity type happens in a delayed time frame.
