Chapter 13: Altered Immune Responses and Transplantation

Cells in the transplanted bone marrow are attacking the host tissue.--Rationale The patient's symptoms are characteristic of graft-versus-host-disease (GVHD) in which transplanted cells mount an immune response to the host's tissue. GVHD is not a type I allergic response or an atopic reaction, and it differs from transplant rejection in that the graft rejects the host rather than the host rejecting the graft.

Ten days after receiving a bone marrow transplant, a patient develops a skin rash on the palms of the hand and soles of the feet, jaundice, and diarrhea. What does the nurse suspect is occurring with this patient? -The patient is experiencing a type I allergic reaction. -An atopic reaction is causing the patient's symptoms. -The patient is experiencing rejection of the bone marrow. -Cells in the transplanted bone marrow are attacking the host tissue.

Type IV Rationale Type IV is related to cell-mediated immunity. It is a delayed hypersensitivity reaction. Tissue damage occurs in delayed hypersensitivity reactions. It requires 24 to 48 hours for a response to occur. Type I, Type II, and Type III are immediate reactions and are a part of humoral immunity.

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

Avoid eating or drinking products with grapefruits while taking this medication.--Rationale A substance in grapefruit and grapefruit juice prevents metabolism of these drugs. Consuming grapefruit or grapefruit juice while using tacrolimus could increase its toxicity. Tacrolimus can be taken with food or on an empty stomach; there is no specification. The medication does have significant side effects, including nephrotoxicity, that the patient should be taught. A flu-like syndrome occurs during the first few days of treatment when taking monoclonal antibodies, not tacrolimus, because of cytokine release.

The nurse is administering tacrolimus to a patient. Which information about this medication would the nurse be sure to include during patient education? -Take this medication on an empty stomach. -This medication has very few side effects. -Avoid eating or drinking products with grapefruits while taking this medication. -Flu-like symptoms will develop in the first few days of treatment.

Cytokines Rationale A cell-mediated immune response triggers the differentiation of T helper cells into T cytotoxic cells, which produce cytokines. IgE is an immunoglobulin and is produced during humoral immunity. Cell-mediated response does not affect the number of bacteria in the body. Macrophages are types of white blood cells (WBC) that identify and ingest antigens containing foreign material.

The nurse is caring for a patient who had an exposure to poison ivy, which initiated a cell-mediated immune response. The production of what type of cell is increased as a result of this response? -IgE -Bacteria -Cytokines -Macrophages

Multiple sclerosis Rationale 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.

The nurse is caring for a patient who is being treated with β-interferon. The nurse determines that the patient is being treated for which disease? -Multiple sclerosis -Multiple myeloma -Hairy cell leukemia -Renal cell carcinoma

Secondary immunodeficiency-- Rationale Secondary immunodeficiencymost commonly is caused by immunosuppressive drugs, such as corticosteroids. It also can be caused by diabetes mellitus, severe infection, malnutrition, and chronic stress, all of which are present in this patient. Major histocompatibility, primary immunodeficiency, and acute hypersensitivity reaction are not possible for this patient. Histocompatibility occurs when the human leukocyte antigen (HLA) system of the donor is not compatible with the recipient's HLA genes. Primary immunodeficiency is rare and includes phagocytic defects, B cell deficiency, T cell deficiency, or a combination of B cell and T cell deficiency. Acute hypersensitivity reaction is an anaphylactic type allergic reaction to an antigen.

The nurse is caring for a patient with diabetes that also has a severe lung infection requiring the administration of corticosteroids and antibiotics. The patient also has a diminished appetite. What condition should the nurse monitor this patient closely for? -Major histocompatibility -Primary immunodeficiency -Secondary immunodeficiency -Acute hypersensitivity reaction

"Have you been taking methyldopa?" Rationale: Hemolytic anemia can occur from the administration of methyldopa. It is not caused by pregnancy, iron supplements, or a history of myocardial infarction.

The nurse is caring for a patient with hemolytic anemia. What questions asked by the nurse when obtaining a history would be most significant to this disease process? - "Are you pregnant?" - "Have you ever had a heart attack?" - "Have you been taking methyldopa?" - "Are you taking any iron supplements?"

Antibodies are produced, Involves B lymphocyte cells, Examples include anaphylactic shock and transfusion reaction.--Rationale Humoral immunity involves B lymphocyte cells and produces antibodies. Examples include anaphylactic shock, atopic diseases, transfusion reaction, and bacterial infections. The other responses reflect cell-mediated immunity. Humoral immunity does not involve T lymphocytes and macrophages (cell-mediated immunity does). Cancer cell destruction and graft rejection are examples of cell-mediated immunity.

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

Kiwifruit, Potatoes, Avocados, Tomatoes Rationale Kiwifruit, potatoes, avocados, and tomatoes can cause latex-food syndrome. Pineapples and pears are not associated with this syndrome.

The nurse is educating a patient with a latex allergy about which foods to avoid that may trigger latex-food syndrome. Which foods should the nurse include? Select all that apply. -Pears -Kiwifruit -Potatoes -Avocados -Tomatoes -Pineapples

Active--Rationale Active immunity is exposure to a pathogen to cause an antigen response; this type of immunity can be gained by immunization. Innate immunity is present at birth; another term for this type of immunity is natural. Passive immunity crosses the placenta or through the colostrum.

The nurse is educating an older adult patient about immunizations. Which type of immunity is provided by immunizations? -Innate -Active -Natural -Passive

Type II: Cytotoxic--Rationale A classic type II reaction occurs when a recipient receives ABO-incompatible blood from a donor. An example of a Type I-IgE-mediated reaction would be anaphylaxis. A Type III reaction would be seen more with autoimmune disorders (such as systemic lupus erythematosis). A Type IV reaction is contact dermatitis.

The nurse is monitoring a patient who has a past history of blood transfusion reactions. What hypersensitivity reaction does the nurse determine this patient is at risk for? --Type I: IgE-mediated --Type II: Cytotoxic --Type III: Immune-complex. --Type IV: Delayed hypersensitivity.

"The bone marrow will change with age."--Rationale The functions of the immune system decline with advancing age, but bone marrow remains relatively unaffected. If the nurse states that bone marrow changes with aging, this indicates a lack of understanding. Thymic involution occurs with aging due to the decreased functional activity of the thymus. Older people are more susceptible to infections because the function of the immune system declines with increasing age. Both T and B cells show deficiencies in activation with increasing age due to reduced immune activity in the body.

The nurse is performing an assessment on an older adult patient. Which statement regarding age-related changes within the immune system indicate a lack of understanding on the part of the nurse? -"Thymic involution occurs with aging." -"The bone marrow will change with age." -"Older adults are more susceptible to infections." -"Both T and B cells show deficiencies in activation."

The patient is presently taking antihistamines for urticaria.----Rationale Unfortunately, skin testing cannot be done on patients who cannot stop taking drugs that suppress the histamine response or patients with food allergies. A respiratory infection, travel outside of the country, and a previous patch tests are not reasons to cancel the skin patch test.

The nurse is preparing to administer a skin patch test to a patient with suspected contact allergies. After gathering a health history, what situation prevents the nurse from administering the skin test? -The patient had a previous skin patch test 5 years ago. -The patient is presently taking antihistamines for urticaria. -The patient travelled outside of the country within the month. -The patient had an upper respiratory infection 1 week previously.

"Complement system is involved in IgE-mediated hypersensitivity reactions."--Rationale IgE-mediated hypersensitivity reaction is a type I hypersensitivity reaction that is provoked by reexposure to a specific type of antigen called an allergen. Asthma is an example of an IgE-mediated hypersensitivity reaction because it is caused by repeated exposure to an allergen. Complement system is not involved in IgE-mediated hypersensitivity reactions. Histamine and mast cells are the mediators of injury in IgE-mediated hypersensitivity reactions. Exogenous pollen, food, and dust are the antigens associated with IgE-mediated hypersensitivity reactions.

The nurse is providing education to a client with an IgE-mediated hypersensitivity reaction. What statement made by the patient indicates that further education is required? -"Asthma is an example of an IgE-mediated hypersensitivity reaction." -"Complement system is involved in IgE-mediated hypersensitivity reactions." -"Histamine and mast cells are the mediators of injury in IgE-mediated hypersensitivity reactions." -"Exogenous pollen, food, and dust are the antigens associated with IgE-mediated hypersensitivity reactions."

"The lower doses of my medications can prevent rejection and minimize the side effects." Rationale 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.

The nurse is providing education to a patient with a recent organ transplant and is discussing immunosuppressive therapy. What statement made by the patient indicates that teaching has the desired outcome? -"Taking more than one medication will put me at risk for developing allergies." -"My drug dosages will be lower because the medications enhance each other." -"I will be more prone to malignancies because I will be taking more than one drug." -"The lower doses of my medications can prevent rejection and minimize the side effects."

This patient has a higher risk than the general population for developing ankylosing spondylitis--Rationale The possession of a particular HLA allele does not mean that the person will necessarily develop the associated disease—only that the relative risk is greater than in the general population. The patient has not developed ankylosing spondylitis already and may not ever develop it. The patient already has had genetic testing for ankylosing spondylitis.

The nurse is reviewing the genetic testing results of a patient and observes 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? --This patient already has developed ankylosing spondylitis. --This patient will develop ankylosing spondylitis at some point in his or her lifetime. --This patient has a higher risk than the general population for developing ankylosing spondylitis. --Further testing is needed to discover the degree of risk the patient has for developing ankylosing spondylitis.

Secondary Immune Response-- Rationale IgG is responsible for the secondary immune response. IgM is responsible for the primary immune response. IgA lines mucous membranes. IgE is responsible for causing allergic reactions.

The nurse is teaching a group of adults about immunoglobulins. What is the function of IgG? -Primary immune response -Lining mucous membranes -Secondary immune response -Causing an allergic response

Bananas, Kiwis, Tomatoes Rationale Foods containing proteins similar to the rubber proteins in latex include bananas, kiwis, tomatoes, avocados, chestnuts, water chestnuts, guavas, hazelnuts, potatoes, peaches, grapes, and apricots. Wax beans, Bing cherries, spinach, plums, liver, peas, cashews, oranges, and green beans do not pose a risk for patients with latex allergy.

The nurse is teaching a patient with a newly diagnosed latex allergy about foods that may result in latex-food syndrome. Which foods should the patient be taught to avoid? -Plums, liver, peas -Bananas, kiwis, tomatoes -Cashews, oranges, green beans -Wax beans, Bing cherries, spinach

Cell-mediated immunity-- Rationale Cell-mediated immunity involves various cells, including natural killer cells. The natural killer cells are responsible for identifying "self" and "nonself" tissues, which sometimes results in rejection of grafts and transplants. Innate immunity is present after birth. It involves a nonspecific 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.

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? - Innate immunity - Passive immunity - Humoral immunity - Cell-mediated immunity

Pets in the home, Reaction to medications, Over-the-counter medications, Patient lifestyle and stress level. --Rationale Pets in the homes may trigger an allergic reaction in a patient with asthma. Certain medications, including over-the-counter medications, may trigger an allergic reaction. Patient lifestyle and stress levels associated with that lifestyle may contribute to an allergic reaction. The patient may be anxious about the possible encounter with an allergic trigger such as a pet when working as a visiting nurse. Nutrition is unlikely to exacerbate asthma.

The nurse working in the allergist's office is completing a health care screening of a patient with asthma. The patient works as a visiting nurse and must enter homes and states he or she has anxiety. Which are likely contributory factors to the patient's asthma? Select all that apply. -Nutrition -Pets in the homes -Reaction to medications -Over-the-counter medications -Patient lifestyle and stress level

Fair and consistent organ transplant laws Rationale The Uniform Anatomical Gift Act is responsible for fair and consistent transplant laws among all states. There are multiple reasons a patient may be on a transplant list, so the length of time can be attributed to other factors. The division of Organ Procurement and Transplant Network regulated by the US Department of Health and Human Services maintains the organ donor registry. The Uniform Anatomical Gift Act is not responsible for the actual procurement of the donor's organs.

What is the Uniform Anatomical Gift Act responsible for? - Procurement of donor organs - Maintaining the organ donor registry - Fair and consistent organ transplant laws - Length of time a patient is on a transplant list

Cross-links DNA Rationale: Cyclophosphamide is a cytotoxic agent used as an immunosuppressant. It acts by cross-linking the DNA strands, which leads to cell injury followed by cell death. This action of cyclophosphamide decreases the number and activity of T-cells. Azathioprine blocks the synthesis of purine, thereby inhibiting B-cell and T-cell proliferation. Mycophenolate acid acts by inhibiting purine synthesis. Belatacept is a drug that inactivates T-cells.

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

Activation of natural killer cells and macrophages Rationale:Interferon-beta activates natural killer cells, inhibits viral replication, and has antiproliferative effects on tumor cells. Granulocyte-macrophage colony-stimulating factor (GM-CSF) is responsible for the proliferation and differentiation of monocytes. G-CSF stimulates the proliferation and differentiation of neutrophils. Production of red blood cells in the bone marrow is the function of erythropoietin.

What is the primary function of interferon-beta? -Proliferation and differentiation of monocytes -Proliferation and differentiation of neutrophils -Production of red blood cells in the bone marrow -Activation of natural killer cells and macrophages

Activation of natural killer cells and macrophages Rationale Interferon-beta activates natural killer cells, inhibits viral replication, and has antiproliferative effects on tumor cells. Granulocyte-macrophage colony-stimulating factor (GM-CSF) is responsible for the proliferation and differentiation of monocytes. G-CSF stimulates the proliferation and differentiation of neutrophils. Production of red blood cells in the bone marrow is the function of erythropoietin.

What is the primary function of interferon-beta? -Proliferation and differentiation of monocytes -Proliferation and differentiation of neutrophils -Production of red blood cells in the bone marrow -Activation of natural killer cells and macrophages

Applying a tourniquet above the site of the test--Rationale An intradermal skin test is performed on a patient's arm, so a tourniquet is applied immediately to stop the spread of the allergen from the site and to decrease the severity of the anaphylactic reaction. Elevating the patient's legs will reduce the risk of hypotension, but it is not the priority intervention to reduce allergy symptoms. A supine position will help keep the airway open if the patient loses consciousness, but placing the patient in supine position is not the priority intervention to reduce severity of allergic reaction. The nurse should notify the primary health care provider in case of a severe allergic reaction, but only after applying a tourniquet.

What is the priority nursing intervention for a patient who is developing severe symptoms of anaphylactic reaction during intradermal skin testing? -Elevating the legs of the patient -Moving the patient to a supine position -Notifying the primary health care provider -Applying a tourniquet above the site of the test

To elicit an immune response Rationale An antigen is a substance that elicits an immune response. Antigens do not provide immunity or promote homeostasis. An antigen does not directly protect the body; instead, it stimulates the immune system to produce antibodies.

What is the role of an antigen in the immune system? -To provide immunity -To promote homeostasis -To elicit an immune response -To protect the body against microorganisms

Autoimmune response--Rationale 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.

When assessing an older adult patient, the nurse should observe for characteristics of certain types of diseases due to what type of immunologic response that increases with age? - Autoimmune response - Cell-mediated immunity -Hypersensitivity response -Humoral immune response

Bone Marrow Rationale: Lymphocytes are produced in the bone marrow. The spleen is a peripheral lymph organ and is the primary site for filtering foreign antigens from the blood. The thymus gland is involved in the differentiation and maturation of T lymphocytes. The tonsils are a peripheral lymphoid organ.

Where are lymphocytes produced? -Spleen -Tonsils -Bone marrow -Thymus gland

Assess the patient's respiratory status--Rationale Maintaining a patient airway is crucial, and the patient's respiratory status should be assessed first since an obstructed airway poses the most immediate threat to the patient's life when he or she is having an anaphylactic reaction. Administering epinephrine, establishing IV access, and administering antihistamine can happen once the patient's respiratory status has been assessed.

Which action is most important when caring for a patient who is having a possible anaphylactic reaction? -Establish intravenous (IV) access. -Assess the patient's respiratory status. -Administer epinephrine to the patient. -Administer antihistamine to the patient.

B lymphocytes--Rationale B lymphocytes are involved in humoral immunity. Natural killer cells are involved in cell-mediated immunity. Neutrophils are mature white blood cells. T lymphocytes are involved in cell-mediated immunity.

Which cells are involved in humoral immunity? -Neutrophils -T lymphocytes -B lymphocytes -Natural killer cells

B- cells Rationale 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.

Which cells differentiate into plasma cells upon activation? -B-cells -T-cells -Dendritic cells -Natural killer cells

Mononuclear phagocytes--Rationale Mononuclear phagocytes capture, process, and present an antigen to the lymphocytes. B lymphocytes differentiate into plasma cells, which produce antibodies. Cytokines act as messengers between different cell types. T lymphocytes are primarily responsible for immunity to intracellular viruses, tumor cells, and fungi.

Which cells play a critical role in capturing, processing, and presenting an antigen to lymphocytes? -Cytokines -T lymphocytes -B lymphocytes -Mononuclear phagocytes

Decrease in cell-mediated immunity, Decrease in primary antibody response, Decreased delayed hypersensitivity reaction--Rationale The changes in the immune system associated with aging include a decreased primary antibody response, decreased delayed hypersensitivity reaction, and decreased cell-mediated immunity. The thymus undergoes involution (shrinking) with aging. Bone marrow remains relatively unaffected by age. Autoantibodies increase with age.

Which changes occur in the immune system of a geriatric patient? Select all that apply. Select all that apply -Thymic enlargement -Bone marrow suppression -Decrease in autoantibodies -Decrease in cell-mediated immunity -Decrease in primary antibody response -Decreased delayed hypersensitivity reaction

Defense, Surveillance, Homeostasis--Rationale The functions of the normal immune response include defense, homeostasis, and surveillance. Sepsis is the result of a serious infection, and mobilization is not part of the normal immune response.

Which functions does the nurse know are part of the normal immune response? Select all that apply. -Sepsis -Defense -Mobilization -Surveillance -Homeostasis

IgG--Rationale The serum concentration of IgG is 78%, which is the highest of these immunoglobulins. IgA has a serum concentration of 15%. IgD has a serum concentration of 1%. IgE has a serum concentration of 0.002%.

Which immunoglobulin has the highest total serum concentration? -IgA -IgD -IgE -IgG

Anxiety reducing drugs Rationale Anxiety-reducing drugs are used to treat MCS disorder. Psychotherapy is used to treat MCS disorder, but it is not itself a medication. ACE inhibitors and calcium channel blockers are used to treat cardiac disorders.

Which medication is used to treat multiple chemical sensitivity (MCS) disorder? -Psychotherapy -ACE inhibitors -Anxiety-reducing drugs -Calcium channel blockers

Place the patient in a private room, Advise the patient to avoid people who are sick, Advise the patient to report any symptoms of acute illness--Rationale The patient should be placed in a private room and be advised to avoid people who are sick. The patient should also report any symptoms of acute illness. The consumption of fresh fruits and vegetables may introduce pathogens to the patient; this action should be discouraged. Encouraging the patient to reduce his or her daily fluid intake is not advised unless otherwise indicated, because the patient needs the fluid intake for adequate perfusion and kidney function.

Which nursing interventions should be implemented when caring for a patient who is taking immunosuppressive therapy? Select all that apply. -Place the patient in a private room -Advise the patient to avoid people who are sick -Encourage the patient to reduce daily fluid intake -Encourage consumption of fresh fruits and vegetables -Advise the patient to report any symptoms of acute illness

Skin, Lymph Nodes, Bronchial Tissue, GI tract Rationale The lymph nodes, bronchial tissue, skin, and gastrointestinal tract contain lymphoid tissue and are considered central or peripheral organs of the immune system. The kidneys and heart are not considered central or peripheral immune system organs

Which organs contain lymphoid tissue and are considered central or peripheral organs of the immune system? Select all that apply. Select all that apply -Skin -Heart -Kidneys -Lymph nodes -Bronchial tissue -Gastrointestinal tract

Monocytes produce antibodies on exposure to foreign substances. Rationale The mononuclear phagocyte system includes monocytes in the blood 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. They do have a role in phagocytosis and have a role in stimulation of development of T and B cells. Monocytes do not stimulate natural killer cell activation.

Which statement about monocytes in the immune response is true? -Monocytes do not engage in phagocytosis. -They bind antigens and stimulate natural killer cell activation. -Monocytes produce antibodies on exposure to foreign substances. -Monocytes do not have a role in stimulation of the production of T and B lymphocytes

"You should sleep in an air-conditioned room."--Rationale 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.

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

cell-mediated Rationale The rejection of transplanted tissue is an example of a cell-mediated immune response. The immune response occurs with a specific recognition by T cells. Innate immunity is present at birth. Humoral immunity is an antibody immunity. Acquired immunity is the development of immunity.

Which type of immunity causes the rejection of transplanted tissue? -Innate -Humoral -Acquired -Cell-mediated

Innate Rationale Innate immunity is present at birth. Passive immunity results from the introduction of antibodies from another organism, as in from a mother to her fetus. Acquired immunity can be either passive or active. Active immunity is the result of exposure to a pathogen in order to develop immunity to it, as in the case of vaccination.

Which type of immunity is present at birth? -Active -Innate -Passive -Acquired

Passive-artificial-Rationale The patient receives passive-artificial immunity when given an immune globulin, because exposure via blood products is considered passive-artificial. Passive and active immunity are two types of immunity, not one type. Active-natural immunity occurs when a patient has natural contact with the antigen. Active-artificial immunity occurs when a patient is immunized with an antigen, for instance via vaccine.

Which type of immunity occurs when a patient receives a hepatitis B immune globulin injection? -Active-natural -Passive-active -Active-artificial -Passive-artificial

"These injections should only be administered in a setting where emergency equipment and drugs are available."--

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? -"I would, but it is illegal for nurses to administer injections outside of a medical setting." -"These injections should only be administered in a setting where emergency equipment and drugs are available." -"Just make sure you have epinephrine in an injectable syringe provided along with the allergy injections." -"Allergy shots are not usually effective; it is safer and more effective to control allergies by avoiding allergens."

Administer the drug over 2 or more hours.----Rationale The most important nursing intervention when administering mycophenolate mofetil is to infuse this medication over 2 or more hours. Giving the drug slowly helps to decrease the side effects. The drug should never be given as an IV bolus and should always be reconstituted in D 5W. Thereafter, the nurse may educate the patient about the gastrointestinal side effects.

A nurse is administering mycophenolate mofetil as a part of triple immunosuppressive therapy for a posttransplant patient. Which is the most important nursing intervention? -Give large doses as intravenous (IV) bolus. -Reconstitute the drug in normal saline. -Administer the drug over 2 or more hours. -Educate the patient about gastrointestinal side effects.

Cytotoxic and cytolytic reaction--Rationale In cytotoxic reaction, the antibodies produced by the immune response bind to the antigens on the patient's own cell surfaces. In Graves' disease, antibodies are produced that bind to the thyroid-stimulating hormone receptor, causing excessive stimulation of the receptor. This excessive stimulation causes excessive production of thyroid hormone. Therefore a cytotoxic reaction is suspected in a patient who shows symptoms of Graves' disease. IgE-mediated reaction may be suspected in patients with asthma. Immune-complex reaction may be suspected in patients with rheumatoid arthritis. Delayed hypersensitivity reaction may be suspected in patients with contact dermatitis caused by poison ivy.

A nurse is assessing a patient with a diagnosis of Graves' disease. Which hypersensitivity reaction does the nurse determine will occur in this patient? -IgE-mediated reaction -Immune-complex reaction -Cytotoxic and cytolytic reaction -Delayed hypersensitivity reaction

Patient B has angioedema.--Rationale Angioedema is a localized cutaneous lesion involving deeper layers of the skin and the submucosa. Swelling in the body parts indicates that patient B has angioedema. Elevated IgE levels and a positive skin test indicates that patient A has atopic dermatitis, not asthma. Excessive secretions of viscoid and mucus and bronchial smooth muscle constriction indicate that patient D has asthma, not urticaria. A cutaneous reaction characterized by pink, raised, edematous, pruritic areas indicates that patient C has urticaria, not atopic dermatitis.

A nurse is assessing four patients who have hypersensitivity reactions. What does the nurse infer from these findings? -Patient A has asthma. -Patient D has urticaria. -Patient B has angioedema. -Patient C has atopic dermatitis.

Headache--Rationale When caring for a patient undergoing plasmapheresis, the nurse should be observant for headache. Citrate toxicity is a common complication of plasmapheresis because citrate is used as an anticoagulant and may cause hypocalcemia, which in turn manifests as headache, paresthesias, and dizziness. Another common complication of plasmapheresis is hypotension caused by a vasovagal reaction or transient volume changes. Sneezing and conjunctivitis are not manifestations of citrate toxicity but are common symptoms of allergy.

A nurse is caring for a patient who is undergoing plasmapheresis for glomerulonephritis. The nurse should be observant for which symptoms indicating citrate toxicity? -Sneezing -Headache -Hypertension -Conjunctivitis

Autoimmunity--Rationale Autoimmunity occurs when the body identifies self proteins as foreign substances and 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.

A nurse is caring for a patient with systemic lupus erythematosus. What is the pathophysiologic response that the disease has on the patient? -Autoimmunity -Hypersensitivity -Immunodeficiency -Delayed hypersensitivity

Document the allergies in the patient's medical record.--Because health professionals wear latex gloves when caring for patients, the nurse should first document any allergies in the patient's medical record so that the information is available to all health care providers. Following that, the nurse can also report this information to the primary healthcare provider. Placing an Epi-Pen at the bedside is not appropriate at this time. The nurse does not yet have enough information to determine if the patient should consult a dietitian.

A nurse is conducting a new patient admission assessment. The patient reports having allergies to eggs, nuts, and latex. What is the priority action by the nurse? -Place an Epi-Pen at the patient's bedside. -Obtain an order for a consult with the dietician. -Document the allergies in the patient's medical record. -Notify the primary health care provider of the patient's allergies.

Erythema, Edema at the site--Rationale Systemic lupus erythematosus is a type III hypersensitivity reaction in which erythema and edema appear within 3 to 8 hrs after performing a skin test. Wheal and flare appear in type I hypersensitivity reaction. Itching is present usually in atopic reactions. Skin lesions with bullae are seen during acute dermatitis.

A nurse is performing a skin test on a patient with systemic lupus erythematosus. What are conditions that the nurse is likely to find during this test? Select all that apply. -Erythema -Wheal and flare -Itching at the site -Edema at the site -Skin lesions with bullae

Bone Marrow, Thymus Gland Rationale Primary lymphoid organs are those where lymphocytes are formed and matured. The central lymphoid organs include the bone marrow and thymus gland. The spleen, tonsils, and lymph nodes are peripheral lymphoid organs.

A nursing instructor asks a student to identify the central lymphoid organs. Which are correct examples provided by the student nurses? Select all that apply. Select all that apply -Spleen -Tonsils -Lymph nodes -Bone marrow -Thymus gland

IgA Rationale IgA is present in tears and colostrum. IgE and IgG are present in plasma and interstitial fluids. IgM is present in plasma.

A nursing instructor is lecturing on immunoglobulins. Which common immunoglobulin would the students expect to find in tears and colostrum? - IgE - IgA - IgG - IgM

Artificially acquired active immunity.. Rationale 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.

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

Concern about pain from the skin test.--Rationale The possible pain the child is about to experience is a likely cause of the parent's anxiety. There is no information in the question to suggest the child is hungry, the parent is late to work, or the child disturbing others in the waiting room.

A parent brought his or her child to the allergist office for skin testing for suspected allergies. The child is crying, and the parent is fidgeting while trying to comfort the child. What is the most likely cause of anxiety in the parent? --The child is hungry. --The parent is late for work. -Concern about pain from the skin test. --The parent is concerned about the child disturbing others in the waiting room.

Angioedema--Rationale Angioedema is a localized cutaneous lesion similar to urticaria, but involving deeper layers of the skin and submucosa. The principal areas of involvement include the eyelids, lips, tongue, larynx, hands, feet, GI tract, and genitalia. Swelling usually begins in the face and then progresses to the airways and other parts of the body. Dilation and engorgement of the capillaries secondary to the release of histamine cause the diffuse swelling. Welts are not apparent as in urticaria. The outer skin appears normal or has a reddish hue. The lesions may burn, sting, or itch and can cause acute abdominal pain if in the GI tract. The swelling may occur suddenly or over several hours and usually lasts for 24 hours. Atopic dermatitis is a chronic, inherited skin disorder characterized by exacerbations and remissions. It is caused by several environmental allergens. There is no evidence to indicate the patient has a laceration.

A patient began taking an angiotensin converting enzyme inhibitor 3 days ago and arrives in the Emergency Department with swelling of the lips and tongue. What does the nurse suspect the patient is experiencing? -Urticaria -Angioedema -Atopic dermatitis -A laceration to the tongue

Call the health care provider, Discontinue infusion of gentamicin-- Rationale The nurse should immediately stop the infusion because the patient may be susceptible to an allergic reaction. The nurse should stop the infusion of medicine and notify the health care provider. Decreasing the flow rate is not an appropriate action in this case. This could be an emergency situation, so reassessing after 15 minutes is not a wise thing to do. Instead, the nurse should continuously monitor the vital signs of the patient. Checking body temperature is not the priority.

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. -Check body temperature. -Call the health care provider. -Discontinue infusion of gentamicin. -Decrease the infusion rate of gentamicin. -Measure the respiratory rate again after 15 minutes.

Collecting the first voided urine--Rationale: When a patient has or is suspected of having a blood transfusion reaction, urine should be collected to be tested for hemoglobinuria. When red blood cells are destroyed in large numbers, as they are in a hemolytic reaction, excess hemoglobin is filtered by the kidneys and excreted in the urine. Taking a blood sample, measuring the oxygenation level, or starting an infusion of 0.9% sodium chloride may be additional nursing actions to be performed after the infusion is stopped; the pulse and blood pressure are measured, and the primary healthcare provider is called.

A patient experiences a hemolytic reaction to a blood transfusion. The nurse stops the infusion, assesses the pulse and blood pressure, and calls the primary health care provider. What additional action is important for the nurse to perform? - Taking a blood sample - Collecting the first voided urine - Measuring the oxygenation level -Starting an infusion of 0.9% sodium chloride

Type IV----Rationale Contact dermatitis caused by the chemicals used in the manufacturing process of latex gloves is a type IV hypersensitivity reaction. It is a delayed reaction. It occurs within 6 to 48 hours. Type II and Type III are not types of latex allergies. A Type I allergic reaction is related to the natural rubber latex proteins and occurs within minutes of contact with the proteins.

A patient has a latex allergy caused by chemicals that are used in manufacturing of the gloves used in hospitals. What type of allergy does the nurse educate the patient about? -Type I -Type II -Type III -Type IV

Monitor for signs and symptoms of an adverse reaction.--Rationale 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.

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

Itching and edema Rationale A systemic anaphylactic reaction starts with edema and itching at the site of exposure to the antigen. Shock can develop rapidly with rapid, weak pulse, hypotension, dilated pupils, dyspnea, and possible cyanosis. The wheal-and-flare reaction occurs with a localized anaphylactic reaction, such as a mosquito bite.

A patient has taken amoxicillin once as a child for an ear infection. When given an injection of Penicillin V, the patient develops a systemic anaphylactic reaction. What manifestations would be seen first? -Dyspnea -Dilated pupils -Itching and edema -Wheal-and-flare reaction

Acute rejection can be treated with muromonab-CD3, Repeated episodes of acute rejection can lead to chronic rejection.--Rationale It is not uncommon to have at least one acute rejection episode, especially with organs from deceased donors. These episodes usually are reversible with additional immunosuppressive therapy that may include increased corticosteroid doses or polyclonal or monoclonal antibodies. Monoclonal antibodies, such as muromonab-CD3, are used for preventing and treating acute rejection episodes. Acute rejection is treatable and usually does not require a new transplant. Calcineurin inhibitors are the most effective immunosuppressants available to treat organ rejection.

A patient is experiencing an acute rejection of a transplanted kidney. Which of these statements explain what is occurring due to the rejection? Select all that apply. Select all that apply -A new transplant will be needed. -Acute rejection can be treated with muromonab-CD3. -Repeated episodes of acute rejection can lead to chronic rejection. -Corticosteroids are the most successful drugs used to treat acute rejection. -Acute rejection is common after a transplant and can be treated with drug therapy.

Administer epinephrine.--Rationale The nurse should administer epinephrine in response to an allergic reaction, which is indicated by the itching and swelling. A topical antihistamine will not be as effective. The assessment of a systemic rash can wait until the patient has received epinephrine to prevent further allergic response. IV access may be necessary, but only if the epinephrine is ineffective.

A patient is receiving allergy skin testing and has itching and swelling at the injection site. What intervention should the nurse prioritize? -Administer epinephrine. -Assess for systemic rash. -Establish intravenous (IV) access. -Apply a topical antihistamine to the injection site.

Skin Testing-- Rationale 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, because bronchial secretions are not highly specific.

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? -ELISA -Skin testing -CBC with differential -Testing bronchial secretions

Hyperacute Rationale A hyperacute rejection occurs within 24 hours because the blood vessels are rapidly destroyed. A chronic rejection is a process that occurs over months or years. Major histocompatibility antigens are responsible for rejections; they are not rejections themselves. An acute rejection most commonly manifests in the first six months after a transplant.

A patient underwent a kidney transplant 24 hours ago. For which type of organ transplant rejection should the nurse closely monitor the patient? -Acute -Chronic -Hyperacute -Major histocompatibility antigen

Cytotoxic and cytolytic reaction--Rationale If a patient receives blood from donors who have different blood types, he or she will show incompatible blood reactions. A patient who receives incompatible blood will experience a hemolytic transfusion reaction. Hemolytic transfusion reaction is a type of cytotoxic and cytolytic reaction in which antibodies immediately coat the foreign erythrocytes, causing agglutination. Neutrophils and macrophages phagocytize the agglutinated cells, the complement system is activated, and cell lysis occurs. Therefore the patient will experience a cytotoxic reaction. When a patient is exposed to exogenous pollen to which he or she is allergic, that patient will experience IgE-mediated reactions. When a patient is exposed to fungal, viral, or bacterial antigens, that patient will experience immune-complex reactions. Delayed hypersensitivity reaction is seen when a patient is exposed to poison ivy for the second time.

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

Leukocytapheresis Rationale 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.

A patient with chronic myelogenous leukemia has an overabundance of white blood cells (WBC). What procedure should the nurse prepare to educate the patient about? - Apheresis - Plateletpheresis - Plasmapheresis - Leukocytapheresis

The patient has bronchoconstriction.--Antihistamines like Albuterol are already effective in treating inflammation, puritis and edema. The albuterol therapy would not be effective in treating a bronchoconstriction in a patient with urticaria. Therefore the primary health care provider would prescribe epinephrine, a decongestant, to treat the bronchoconstriction.

A patient with urticaria is taking albuterol therapy. What clinical manifestation exhibited by the patient requires the health care provider to prescribe epinephrine? -The patient has inflammation. -The patient has persistent pruritus. -The patient has edema at the neck. -The patient has bronchoconstriction.

They capture antigens at the sites of contact with the external environment. Rationale 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.

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? -They promote growth of T and B cells. -They cause chemotaxis of neutrophils and T cells. -They enhance T cell survival and mast cell activation. -They capture antigens at the sites of contact with the external environment.

Pruritic lesions, Erythematous skin lesions, Skin lesions covered with papules, vesicles, and bullae-- Rationale Contact dermatitis is a delayed type of hypersensitivity reaction in which the patient, if exposed to the same allergen for the second time, develops hypersensitivity reactions. Contact dermatitis is characterized by pruritic, erythematous lesions covered with papules, vesicles, and bullae. The skin lesions will be localized to the area that was exposed to the allergen.

After assessing a patient with delayed hypersensitivity reaction, the nurse suspects that the patient has contact dermatitis. Which symptoms support the nurse's conclusion? Select all that apply. -Pruritic lesions -Generalized skin lesions -Erythematous skin lesions -Skin lesions away from the area exposed to allergen -Skin lesions covered with papules, vesicles, and bullae

"A wheal-and-flare reaction is very dangerous." Rationale A wheal-and-flare reaction is a reaction that occurs in response to an allergen. The reaction occurs in minutes or hours and is usually not dangerous. This reaction serves a diagnostic purpose as a means of demonstrating allergic reactions to specific allergens during skin tests. The classic example of a wheal-and-flare reaction is a mosquito bite. Wheal-and-flare reactions are characterized by a pale wheal containing edematous fluid.

An instructor is teaching about wheal-and-flare reactions. Which statement made by the student nurse indicates that further education is required? - "A wheal-and-flare reaction is very dangerous." - "A wheal-and-flare reaction can serve a diagnostic purpose." - "A mosquito bite is an example of a wheal-and-flare reaction." - "A wheal-and-flare reaction is characterized by a pale wheal containing edematous fluid."