Immunity chapter 13

Bone Marrow

Produces RBC's, WBC, and platelets

The patient is admitted from a nearby park with an apparent anaphylactic reaction to a bee sting. He is experiencing dyspnea and hypotension with swelling at the site. Number the following in the order of priority that the nurse should implement the actions for this patient. a. _______ remove the stinger b. _______ Ensure a patent airway c. _______ prepare to admin epinephrine d. _______ start IV for fluid and Medication access e. _______ Anticipate intubation with severe distress f. _______ Have diphenhydramine(Benadryl) and nebulized albuterol available

a. 3 b. 1 c. 5 d. 4 e. 2 f. 6

Which characteristic describes immunoglobulin E (select all that apply)? a. Assists in parasitic infections b. Responsible for allergic reactions c. Present on the lymphocyte surface d. Assists in B-lymphocyte differentiation e. Predominant in secondary immune response f. Protects body surfaces and mucous membranes

a. Assists in parasitic infections b. Responsible for allergic reactions

What are examples of type I or IgE-mediated hypersensitivity reactions (select all that apply)? a. Asthma b. Urticaria c. Angioedema d. Allergic rhinitis e. Atopic dermatitis f. Contact dermatitis g. Anaphylactic shock h. Transfusion reactions i. Goodpasture syndrome

a. Asthma b. Urticaria c. Angioedema d. Allergic rhinitis e. Atopic dermatitis g. Anaphylactic shock

What are the important functions of cell-mediated immunity (select all that apply)? a. Fungal infections b. Transfusion reactions c. Rejection of transplanted tissues d. Contact hypersensitivity reactions e. Immunity against pathogens that survive inside cells

a. Fungal infections c. Rejection of transplanted tissues d. Contact hypersensitivity reactions e. Immunity against pathogens that survive inside cells

Which immunoglobulins will initially protect a newborn baby of a breastfeeding mother (select all that apply)? a. IgA b. IgD c. IgE d. IgG e. IgM

a. IgA d. IgG

How does an antigen stimulate an immune response? a. It is captured, processed, and presented to a lymphocyte by a macrophage. b. It circulates in the blood, where it comes in contact with circulating lymphocytes. c. It is a foreign protein that has antigenic determinants different from those of the body. d. It combines with larger molecules that are capable of stimulating production of antibodies.

a. It is captured and processed by a macrophage and then presented to lymphocytes

A pt was given an IM injection of penicillin in the gluteus maximus & developed dyspnea & weakness within minutes following the injection. Which additional assessment findings indicate that the pt is having an anaphylactoid reaction (SATA)? a. Wheezing b. Hypertension c. Rash on arms d. Constricted pupils e. Slowed strong pulse f. Feeling of impending doom

a. Wheezing f. Feeling of impending doom

In a person having an acute rejection of a transplanted kidney, what would help the nurse understand the course of events (select all that apply)? a. A new transplant should be considered. b. Acute rejection can be treated with OKT3. c. Acute rejection usually leads to chronic rejection. d. Corticosteroids are the most successful drugs used to treat acute rejection. e. Acute rejection is common after a transplant and can be treated with drug therapy.

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

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

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

Where and into what do activated B lymphocytes differentiate? a. Spleen; natural killer cells that destroy infected cells b. Bone marrow; plasma cells that secrete immunoglobulins c. Thymus; memory B-cells that retain a memory of the antigen d. Bursa of Fabricius; helper cells that in turn activate additional B lymphocytes

b. Bone marrow; plasma cells that secrete immunoglobulins

The patient is experiencing fibrosis and glomerulopathy a year after a kidney transplant. Which type of rejection is occurring? a. Acute b. Chronic c. Delayed d. Hyperacute

b. Chronic

A 38-year-old male veteran tells the nurse he gets a headache, sore throat, shortness of breath, and nausea when his girlfriend wears perfume and when he was painting her apartment. He is afraid he has cancer. What does the nurse suspect may be the patient's problem? a. He has posttraumatic stress disorder. b. He has multiple chemical sensitivities. c. He needs to wear a mask when he paints. d. He is looking for an excuse to break up with his girlfriend.

b. He has multiple chemical sensitivities.

Mononuclear Phagocytes

-Include monocytes in blood and macrophages found throughout body -Capture, process, and present antigens to lymphocytes to initiate an immune response -Capture antigens by phagocytosis

Alpha interferons and Beta Interferons

-Inhibit viral replication -activate Nk -Antiproliferation effects on tumor cells

Tumor Necrosis Factor (TNF)

-Promotes immune and inflammatory response -kills tumor cells -responsible for weight loss -associated with chronic inflammation and cancer

Cytokines

-Secreted by WBC and other factors -messengers between cell types -tells cells to change proliferation, differentiation, secretion, or activity - Cause: *Chronic Inflammation(arthritis) *Autoimmune disease *Sepsis

Thymus

-Thymus gland shrinks with age Differentiation and proliferation of T lymphocytes

Dentritic cells

-activate immune response -capture antigens at sites of contact with external environment -Transport the antigen until it meets a T cell with specificity for that antigen

Y-Interferon(Y-IFN)

-activate macrophage, neutrophils, and Nk -inhibits viral replication

Lymphocytes

-made in bone marrow -migrate to peripheral organs -differentiate into B and T lymphocytes Types: T Cytotoxic cells T helper Cells T cells:70%-80% B cells:10%-20% Nk(natural killer): less than 10%

Which type of Immunity is the result of contact with the antigen through infection and is the longest lasting type of immunity? a. Innate Immunity b Natural active acquired immunity c. Artificial active acquired immunity d. Artificial passive acquired immunity

b. Natural Active acquired immunity is a result of exposure to the antigen via infection and the longest lasting type of immunity.

What is included in the humoral immune response? a. Surveillance for malignant cell changes b. Production of antigen-specific immunoglobulins c. Direct attack of antigens by activated B lymphocytes d. Releasing cytokines responsible for destruction of antigens

b. Production of antigen-specific immunoglobulins TERM ENGLISH

what accurately describes artificial passive acquired immunity(select all the apply)? a. Gamma Globulin injection b. immunization with antigen c. Immediate effect, lasting a short time d. boosters may be needed for extended protection

A,C: Artificial passive acquired immunity is received from injection of gamma globulin, provides immediate immunity, and may last for several weeks or months.

A patient has had a kidney transplant. The nurse knows that monitoring which of the following would have the highest priority? A. Fluid volume B. Electrolytes C. Complete blood count D. Temperature

A. Fluid volume

A patient with a sore throat and rhinitis has an elevated level of IgG in the blood. The nurse explains that the patient's symptoms are most likely caused by: 1. An initial viral infection. 2. A re-infection by bacteria. 3. An allergy. 4. Exposure to toxic fumes.

Answer: 2 Rationale: IgG is the primary antibody found in a secondary immune response.

A patient with end-stage renal disease is being evaluated for a kidney transplant from a living-related donor. Results of histocompatibility testing that indicate an absolute contraindication to transplantation is: a. Only 4-HLA match. b. ABO blood antigen match. c. ABO compatibility and negative antibody crossmatch. d. HLA-identical match and positive antibody crossmatch.

Answer: d Rationale: A crossmatch uses serum from the recipient mixed with donor lymphocytes to test for any pre-formed anti-HLA antibodies to the potential donor organ. A positive crossmatch indicates that the recipient has cytotoxic antibodies to the donor and is an absolute contraindication to transplantation.

A patient waiting for a kidney transplant asks the nurse to explain the difference between a negative and positive crossmatch. Which statement by the nurse would be the most accurate response? A. "A negative crossmatch means that both the donor and recipient are Rh negative, and the transplant is safe." B. "A negative crossmatch means that no preformed antibodies are present and the transplant would be safe." C. "A positive crossmatch means the blood type is the same between donor and recipient, and the transplant is safe." D. "A positive crossmatch means that both the donor and the recipient have antigens that are similar, and the transplant would be safe."

B. "A negative crossmatch means that no preformed antibodies are present and the transplant would be safe." (A crossmatch uses serum from the recipient mixed with donor lymphocytes to test for any preformed antibodies to the potential donor organ. A positive crossmatch indicates that the recipient has cytotoxic antibodies to the donor and is an absolute contraindication to transplantation. A negative crossmatch indicates that no preformed antibodies are present and it is safe to proceed with transplantation.)

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

c. "Plan to wait in the clinic for 20 to 30 minutes after the testing." Allergic reactions usually occur within minutes after injection of an allergen, and the patient will be monitored for at least 20 minutes for anaphylactic reactions after the testing. Medications that might modify the response, such as antihistamines, should be avoided before allergy testing. There is no reason to be NPO for skin testing. Results with intradermal testing occur within minutes.

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

c. Check for swelling of the patient's lips and tongue. Angioedema is characterized by swelling of the eyelids, lips, and tongue. Wheal and flare lesions, clear nasal drainage, and hypotension and tachycardia are characteristic of other allergic reactions.

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

c. Consult with the health care provider about giving a lower allergen dose.

When a patient has orders to receive sirolimus and cyclosporine, which administration rule applies? A. They should be administered simultaneously. B. They cannot be administered within 4 hours of each other. C. They should be administered in separate veins. D. They cannot be administered within 6 hours of each other.

B. They cannot be administered within 4 hours of each other.

Signs and symptoms of acute rejection that the nurse should teach the patient to observe for include: A. tachycardia and headache B. fever and painful transplant site C. severe hypotension and weight loss D. recurrent history of urinary tract infections and oral yeast infections

B. fever and painful transplant site

Signs and symptoms of chronic rejection of the kidney are caused by: A. recurrence of the original kidney disease B. gradual occlusion of the renal blood vessels C. T-cytoxic cell attack on the foreign kidney D. destruction of kidney tissue by sensitized antibodies

B. gradual occlusion of the renal blood vessels

Why is plasmapheresis indicated in the treatment of autoimmune disorders? a. Obtain plasma for analysis and evaluation of specific autoantibodies b. Decrease high lymphocyte levels in the blood to prevent immune responses c. Remove autoantibodies, antigen-antibody complexes, and inflammatory mediators of immune reactions d. Add monocytes to the blood to promote removal of immune complexes by the mononuclear phagocyte system

C

Which information about patient and donor tissue typing results for a patient who needs a kidney transplant is most important for the nurse to communicate to the health care provider? A. Patient is Rh positive and donor is Rh negative. B. Six antigen matches are present in HLA typing. C. Results of patient-donor cross matching are positive. D. Panel of reactive antibodies (PRA) percentage is low.

C. Results of patient-donor cross matching are positive.

Two hours after a kidney transplant, the nurse obtains all of the following data when assessing the patient. Which information is most important to communicate to the health care provider? A. The urine output is 900 to 1100 mL/hr. B. The blood urea nitrogen (BUN) and creatinine levels are elevated. C. The patient's central venous pressure (CVP) is decreased. D. The patient has level 8 (on a 10-point scale) incisional pain.

C. The patient's central venous pressure (CVP) is decreased.

Which immunosuppressant selectively acts against cytotoxic T cells without affecting other types of immune cells? A. corticosteroids B. azathioprine C. cyclosporine D. OKT3

C. cyclosporine

A nurse is teaching diet recommendations to a client who had a kidney transplant and is taking cyclosporine. Which of the following recommendations should the nurse include in the teaching? A. decrease protein rich foods B. drink grapefruit juice C. take a magnesium supplement D. restrict intake of bananas and raisins

C. take a magnesium supplement

The reason newborns are protected for the first 3 months of life from bacterial infections is because of the maternal transmission of a. IgG. b. IgA. c. IgM. d. IgE.

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

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

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

On initial assessment of an older patient, the nurse knows to look for certain types of diseases because which immunologic response increases with age? a. Autoimmune response b. Cell-mediated immunity c. Hypersensitivity response d. Humoral immune response

Correct answer: a Rationale: With aging, autoantibodies increase, which lead to autoimmune diseases (e.g., systemic lupus erythematosus, 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.

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

Correct answer: b Rationale: Seasonal allergic rhinitis is most commonly 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.

A patient's low hemoglobin and hematocrit have necessitated a transfusion of packed red blood cells (RBCs). Shortly after the first unit of RBCs starts to infuse, the patient develops signs and symptoms of a transfusion reaction. Which type of hypersensitivity reaction has the patient experienced? a. Type I b. Type II c. Type III d. Type IV

Correct answer: b Rationale: Transfusion reactions are characterized as a type II (cytotoxic) reaction in which agglutination and cytolysis occur. Type I hypersensitivity reactions are IgE-mediated reactions to specific allergens (e.g., exogenous pollen, food, drugs, or dust). Type III reactions are immune-complex reactions that occur secondary to antigen-antibody complexes. Type IV reactions are delayed cell-mediated immune response reactions.

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

Correct answer: c Rationale: *Secondary immunodeficiency is most commonly caused by immunosuppressive drugs, such as corticosteroids*. It can also be caused by diabetes mellitus, severe infection, malnutrition, and chronic stress, all of which are present in this patient. The other options are not possible for this patient. Histoincompatibility 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.

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

Correct answer: c Rationale: A systemic anaphylactic reaction starts with edema and itching at the site of exposure to the antigen. Shock can rapidly develop 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.

One function of cell-mediated immunity is a. formation of antibodies. b. activation of the complement system. c. surveillance for malignant cell changes. d. opsonization of antigens to allow phagocytosis by neutrophils.

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

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

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

What is the most common cause of secondary immunodeficiency disorders? a. Chronic stress b. T-cell deficiency from HIV c. Drug-induced immunosuppression d. Common variable hypogammaglobulinemia

c. Drug-induced immunosuppression

How does interferon help the body's natural defenses? a. Directly attacks and destroys virus-infected cells b. Augments the immune response by activating phagocytes c. Induces production of antiviral proteins in cells that prevent viral replication d. Is produced by viral infected cells and prevents the transmission of the virus to adjacent cells

c. Induces production of antiviral proteins in cells that prevent viral replication

Although the cause of autoimmune disorders is unknown, which factors are believed to be present in most conditions (select all that apply)? a. Younger age b. Male gender c. Inheritance of susceptibility genes d. Initiation of autoreactivity by triggers e. Frequent viruses throughout the lifetime

c. Inheritance of susceptibility genes d. Initiation of autoreactivity by triggers

Which rationale describes treatment of atopic allergies with immunotherapy? a. It decreases the levels of allergen-specific T helper cells. b. It decreases the level of IgE so that it does not react as readily with an allergen. c. It stimulates increased IgG to bind with allergen-reactive sites, preventing mast cell-bound IgE reactions. d. It gradually increases the amount of allergen in the body until it is no longer recognized as foreign and does not elicit an antibody reaction.

c. It stimulates increased IgG to bind with allergen-reactive sites, preventing mast cell-bound IgE react

Why is plasmapheresis indicated in the treatment of autoimmune disorders? a. Obtain plasma for analysis and evaluation of specific autoantibodies b. Decrease high lymphocyte levels in the blood to prevent immune responses c. Remove autoantibodies, antigen-antibody complexes, and inflammatory mediators of immune reactions d. Add monocytes to the blood to promote removal of immune complexes by the mononuclear phagocyte system

c. Remove autoantibodies, antigen-antibody complexes, and inflammatory mediators of immune reactions

What describes the occurrence of a type IV or delayed hypersensitivity transplant reaction? a. Antigen links with specific IgE antibodies bound to mast cells or basophils releasing chemical mediators b. Cellular lysis or phagocytosis through complement activation following antigen-antibody binding on cell surfaces c. Sensitized T lymphocytes attack antigens or release cytokines that attract macrophages that cause tissue damage d. Antigens combined with IgG and IgM too small to be removed by mononuclear phagocytic system deposit in tissue and cause fixation of complement

c. Sensitized T lymphocytes attack antigens or release cytokines that attract macrophages that cause tissue damage

The patient with an autoimmune disease will be treated with plasmapheresis. What should the nurse teach the patient about this treatment? a. It will gather platelets for use later when needed. b. It will cause anemia because it removes whole blood and RBCs are damaged. c. It will remove the IgG autoantibodies and antigen complexes from the plasma. d. It will remove the peripheral stem cells in order to cure the autoimmune disease. Why is plasmapheresis indicated in the treatment of autoimmune disorders? a. Obtain plasma for analysis and evaluation of specific autoantibodies b. Decrease high lymphocyte levels in the blood to prevent immune responses c. Remove autoantibodies, antigen-antibody complexes, and inflammatory mediators of immune reactions d. Add monocytes to the blood to promote removal of immune complexes by the mononuclear phagocyte system

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

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

Correct answer: c 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.

The patient has received a bone marrow transplant. Soon after the transplant there is a rash on the patient's skin. She says her skin is itchy and she has severe abdominal pain. What best summarizes what is happening to the patient and how she will be treated? a. Graft rejection occurring; treat with different immunosuppressive agents b. Dry skin and nausea are side effects of immunosuppressants; decrease the dose c. Transplanted bone marrow is attacking her tissue; prevent with immunosuppressive agents d. Dry skin from the dry air and nausea from the food in the hospital; treat with humidifier and home food

c. Transplanted bone marrow is attacking her tissue; prevent with immunosuppressive agents

Which type of hypersensitivity reaction occurs with rheumatoid arthritis and acute glomerulonephritis? a. Type I or IgE-mediated hypersensitivity reaction b. Type II or cytotoxic hypersensitivity reaction c. Type III or immune-complex mediated hypersensitivity reaction d. Type IV or delayed hypersensitivity reaction

c. Type III or immune-complex mediated hypersensitivity reaction

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

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

Association between HLA antigens and diseases is most commonly found in what disease conditions? a. Malignancies b. Infectious diseases c. Neurologic diseases d. Autoimmune disorders

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

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

Correct answer: d 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 of malignancies.

Before the patient receives a kidney transplant, a crossmatch test is ordered. What does a positive crossmatch indicate? a. Paternity and predicts risk for certain diseases b. Tissue type match for a successful transplantation b. Determines paternity and predicts risk for certain diseases c. Racial background and predicts risk for certain diseases d. Cytotoxic antibodies to the donor which contraindicate transplanting this donor's organ

d. Cytotoxic antibodies to the donor which contraindicate transplanting this donor's organ

A 69-year-old woman asks the nurse whether it is possible to "catch" cancer because many of her friends of the same age have been diagnosed with different kinds of cancer. In responding to the woman, the nurse understands that what factor increases the incidence of tumors in older adults? a. An increase in autoantibodies b. Decreased activity of the bone marrow c. Decreased differentiation of T lymphocytes d. Decreased size and activity of the thymus gland

d. Decreased size and activity of the thymus gland

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

Correct answer: d Rationale: In this emergency situation, the ABCs (airway, breathing, circulation) are being followed. For hypotension the patient should be placed in a recumbent position with the legs elevated, epinephrine will continue to be administered every 2-5 minutes, and fluids will be administered with vasopressors. Diphenhydramine is an antihistamine used to treat allergy symptoms. Anticipating a tracheostomy may occur with ongoing patient monitoring. Nitroprusside is a vasodilator and would not be used now.

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

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

Ten days after receiving a bone marrow transplant, a patient develops a skin rash on his palms and soles, jaundice, and diarrhea. What is the most likely etiology of these clinical manifestations? a. The patient is experiencing a type I allergic reaction. b. An atopic reaction is causing the patient's symptoms. c. The patient is experiencing rejection of the bone marrow. d. Cells in the transplanted bone marrow are attacking the host tissue.

Correct answer: d 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.*

In a type I hypersensitivity reaction the primary immunologic disorder appears to be a. binding of IgG to an antigen on a cell surface. b. deposit of antigen-antibody complexes in small vessels. c. release of cytokines used to interact with specific antigens. d. release of chemical mediators from IgE-bound mast cells and basophils.

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

The nurse teaches a patient about drug therapy after a kidney transplant. Which statement by the patient would indicate a need for further instructions? a. "I need to be monitored closely for development of malignant tumors." b. "After a couple of years I will be able to stop taking the cyclosporine." c. "If I develop acute rejection episode, I will need additional types of drugs." d. "The drugs are combined to inhibit different ways the kidney can be rejected."

"After a couple of years I will be able to stop taking the cyclosporine. Cyclosporine, a calcineurin inhibitor, will need to be continued for life. The other patient statements are accurate and indicate that no further teaching is necessary about those topics.

When caring for a patient with a known latex allergy, the nurse would monitor the patient closely for a cross-sensitivity to which foods (select all that apply)? a. Grapes b. Oranges c. Bananas d. Potatoes e. Tomatoes

Corrects answers: a, c, d, e Rationale: Because some proteins in rubber are similar to food proteins, some foods may cause an allergic reaction in people who are allergic to latex. The most common of these foods are bananas, avocados, chestnuts, kiwi fruit, tomatoes, water chestnuts, guava, hazelnuts, potatoes, peaches, grapes, and apricots.

What accurately describes rejection following transplantation? a. Hyperacute rejection can be treated with OKT3. b. Acute rejection can be treated with sirolimus or tacrolimus. c. Chronic rejection can be treated with tacrolimus or cyclosporine. d. Hyperacute reaction can usually be avoided if crossmatching is done before the transplantation.

d. Hyperacute reaction can usually be avoided if crossmatching is done before the transplantation. (A positive crossmatch indicates that the recipient has cytotoxic antibodies to the donor's antigens and is an absolute contraindication to transplantation. If transplanted, the organ would undergo hyperacute rejection)

Which immunoglobulin is responsible for the primary immune response and forms antibodies to ABO blood antigens? a. IgA b. IgD c. IgG d. IgM

d. IgM

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

d. Numbness and tingling 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

For the patient with allergic rhinitis, which therapy should the nurse expect to be ordered first? a. Corticosteroids b. Immunotherapy c. Antipruritic drugs d. Sympathomimetic/decongestant drugs

d. Sympathomimetic/decongestant drugs

Which T lymphocytes are involved in direct attack and destruction of foreign pathogens? a. Dendritic cells b. Natural killer cells c. T helper (CD4) cells d. T cytotoxic (CD8) cells

d. T cytotoxic (CD8) cells

What are the most common immunosuppressive agents used to prevent rejection of transplanted organs? a. Cyclosporine, sirolimus, and muromonab-CD3 b. Prednisone, polyclonal antibodies, and cyclosporine c. Azathioprine, mycophenolate mofetil, and sirolimus d. Tacrolimus, prednisone, and mycophenolate mofetil

d. Tacrolimus, prednisone, and mycophenolate mofetil

Which characteristics are seen with acute transplant rejection (select all that apply)? a. Treatment is supportive b. Only occurs with transplanted kidneys c. Organ must be removed when it occurs d. The recipient's T cytotoxic lymphocytes attack the foreign organ e. Long-term use of immunosuppressants necessary to combat the rejection f. Usually reversible with additional or increased immunosuppressant therapy

d. The recipient's T cytotoxic lymphocytes attack the foreign organ e. Long-term use of immunosuppressants necessary to combat the rejection f. Usually reversible with additional or increased immunosuppressant therapy

Which description about a nurse who develops a contact dermatitis from wearing latex gloves is accurate? a. This demonstrates a type I allergic reaction to natural latex proteins. b. Use powder-free latex gloves to prevent the development of symptoms. c. Use an oil-based hand cream when wearing gloves to prevent latex allergy. d. This demonstrates a type IV allergic reaction to chemicals used in the manufacture of latex gloves.

d. This demonstrates a type IV allergic reaction to chemicals used in the manufacture of latex gloves.