Chapter 36: Management of Patients With Immunodeficiency Disorders

What treatment option does the nurse anticipate for the patient with severe combined immunodeficiency disease (SCID)? a) Removal of the thymus gland b) Radiation therapy c) Bone marrow transplantation d) Antibiotics

Bone marrow transplantation Explanation: Treatment options for SCID include stem cell and bone marrow transplantation.

The nurse is preparing a teaching plan for a client with an immunodeficiency. Which of the following would the nurse emphasize as most important? a) Incorporation of treatment regimens into daily patterns b) Frequent and thorough handwashing c) Adherence to prophylactic medication administration d) Identifying the signs and symptoms of infection

Frequent and thorough handwashing Explanation: Although identifying the signs and symptoms of infection, adherence to medication prophylaxis, and incorporation of treatment regimens into daily patterns are important, the most important aspect is frequent and thorough handwashing to prevent infection. If infection is prevented, signs and symptoms will not develop and medications would not necessarily be needed.

A majority of patients with CVID develop which type of anemia? a) Sickle cell b) Hemolytic c) Macrocytic d) Pernicious

Pernicious Explanation: A majority of patients with CVID develop pernicious anemia. The majority of patients with CVID do not develop the other types of anemia.

Loren Fawcett, an 18-year-old college student, arrived at your ED presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. After stabilizing Loren, you speak with her family and assuring them that she will recover. What type of hypersensitivity did Loren exhibit? a) Type II b) Type IV c) Type III d) Type I

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

The nurse is caring for a patient with an immunodeficiency disorder. What cardinal symptoms of immunodeficiency does the nurse recognize while caring for this patient? (Select all that apply.) a) Poor response to the treatment with antibiotics b) Nonproductive cough c) Vomiting d) Chronic diarrhea e) Chronic or recurrent severe infections

• Poor response to the treatment with antibiotics • Chronic or recurrent severe infections • Chronic diarrhea Correct Explanation: Regardless of the underlying cause, the cardinal symptoms of immunodeficiency include chronic or recurrent and severe infections, infections caused by unusual organisms or by organisms that are normal body flora, poor response to standard treatment for infections, and chronic diarrhea.

A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder? a) So the client has strong drug therapy b) Because an autoimmune disease is a neoplastic disease c) For their immunosuppressant effects d) To decrease the body's risk of infection

For their immunosuppressant effects Explanation: Drug therapy using anti-inflammatory and immunosuppressive agents is the mainstay for alleviating symptoms. Some antineoplastic (cancer) drugs also are used for their immunosuppressant effects. Antineoplastic drugs do not decrease the body's risk of infection; an autoimmune disease is not a neoplastic disease. Drugs are not ordered just so the client has strong drug therapy.

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

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

A patient is scheduled to receive an intravenous immunoglobulin (IVIG) infusion. He asks the nurse about the infusion's administration and its adverse effects. Which of the following choices should the nurse instruct this patient to report immediately? a) Mouth sores b) Tickle in the throat c) Sneezing d) Constipation

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

Telangiectasia is the term that refers to a) Vascular lesions caused by dilated blood vessels b) Difficulty swallowing c) Uncoordinated muscle movement d) Inability to understand the spoken word

Vascular lesions caused by dilated blood vessels Explanation: Telangiectasia is the term that refers to vascular lesions caused by dilated blood vessels. Ataxia-telangiectasia is an autosomal-recessive disorder affecting both T-cell and B-cell immunity. Receptive aphasia is an inability to understand the spoken word. Dysphagia refers to difficulty swallowing.

A nurse is preparing to give a client an infusion of gamma globulin. The nurse knows to stop the infusion if the client experiences which of the following symptoms? Choose all that apply. a) Tightness in the chest b) Fatigue c) Flank pain d) Shaking chills e) Hunger

• Flank pain • Shaking chills • Tightness in the chest Explanation: Adverse reactions can include reports of flank and back pain, shaking chills, dyspnea, and tightness in the chest, as well as headache, fever, and local reaction at the infusion site.

Tyler Harris, a 5-year-old male, is a client in the pediatric unit of the hospital where you practice nursing. Tyler is recovering from an anaphylactic reaction to an allergen which brought him to the ED. In your first assessment of Tyler for your shift, he presents with a periorbital accumulation of blood, a common occurrence in children. What type of allergic reaction presents "allergic shiners"? a) Type IV b) Type I c) Type II d) Type III

Type I Explanation: Less severe localized hypersensitivity Type I responses can include areas under the eyes, referred to as "allergic shiners," which are due to accumulation of blood around the orbit of the eye.

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

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

The nurse is preparing to administer the recommended dose of intravenous gamma-globulin for a 60-kg male patient. How many grams will the nurse administer? a) 90 g b) 60 g c) 30 g d) 15 g

30 g Correct Explanation: The optimal dose is determined by the patient's response. In most instances, an IV dose of 200-800 mg/kg of body weight is administered every 3-4 weeks to ensure adequate serum levels of immunoglobulin G (IgG).

Tyler Harris, a 5-year-old male, has recovered from an anaphylactic reaction which brought him to the ED 3 weeks ago. Tyler has begun sensitivity testing to determine the allergen which caused his anaphylactic reaction. In scratch testing, which part of the body is more sensitive to allergens? a) Back b) Chest c) Upper arm d) Forearm

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

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

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

A nursing instructor is discussing immunodeficiency disorders with students. The instructor tells the class that immunodeficiency disorders are caused by defects or deficiencies in which of the following? Choose all that apply. a) B and T lymphocytes b) Neurologic system c) Phagocytic cells d) The complement system e) Immune system

• The complement system • B and T lymphocytes • Phagocytic cells Explanation: Immunodeficiency disorders may be caused by a defect in or a deficiency of phagocytic cells, B lymphocytes, T lymphocytes, or the complement system.