Immunology Questions
The nurse is planning care in the home for a client with rheumatoid arthritis. What instruction(s) should the nurse include in the plan of care? Select all that apply. 1. Ensure the home environment is safe. 2, Teach the nursing assistant to allow extra time in the evening for hygiene or other procedures. 3. Collaborate with occupational therapists for specialized equipment. 4. Identify the exercise regimen planned by physical therapist. 5. Provide nursing assistance for ADLs.
1,3,4,5 The nurse should collaborate with occupational therapists for specialized equipment, identify the exercise regimen planned by physical therapist, provide nursing assistance for ADLs, and ensure the home environment is safe. The nurse should teach the nursing assistant to allow extra time in the morning, not the evening, for hygiene or other procedures.
There are major differences between primary and secondary immunodeficiencies. Select the most accurate statement the nurse would use to explain the cause of a secondary immunodeficiency. 1. "Your immune system was most likely affected by an underlying disease process." 2. "Your condition will predispose you to frequent and recurring infections." 3. "You will now be more likely to develop cancer in the future." 4. "Your diagnosis was inherited."
1. A secondary immunodeficiency is the result of an underlying disease process or the treatment of a disorder. It is not genetically inherited. Some examples of a secondary immunodeficiency are chronic stress and diabetes mellitus.
Which assessment should be completed if immune dysfunction is suspected in the neurosensory system? 1. Ataxia 2. Hematuria 3. Urinary frequency 4. Burning upon urination
1. Ataxia should be assessed when immune dysfunction in the neurosensory system is suspected. Hematuria, discharge, and frequency of and burning upon urination are associated with the genitourinary system.
A client with a discoid facial rash caused by systemic lupus erythematosus (SLE) asks why a urine sample is needed. Which response will the nurse make to the client? 1. "The lupus can affect your kidney function." 2. "The medication you take can affect your bladder." 3. "The test will determine how long you will have the rash." 4. "It is a routine test done on everyone."
1. Nephritis as a result of SLE, also referred to as lupus nephritis, occurs due to a buildup of antibodies and immune complexes that cause damage to the nephrons. Early detection allows for prompt treatment so that renal damage can be prevented. Serum creatinine levels and urinalysis are used in screening for renal involvement. Urinalysis is not a routine test done on every client. The urinalysis is not being used to determine if the client's medication is affecting the bladder. The urinalysis will not determine the length of time the client will have the rash.
A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, what should the laboratory results reveal? 1. Hyperproteinuria 2. Hyperuricemia 3. Glucosuria 4. Ketonuria
2. Gout is caused by hyperuricemia (increased serum uric acid).
The nurse is aware that the phagocytic immune response, one of the body's responses to invasion, involves the ability of cells to ingest foreign particles. Which of the following engulfs and destroys invading agents? 1. Eosinophils 2. Macrophages 3. Basophils 4. Neutrophils
2. Macrophages move toward the antigen and destroy it. Eosinophils are only slightly phagocytic.
Chronic illnesses may contribute to immune system impairment in various ways. Renal failure is associated with 1. decreased bone marrow function. 2. deficiency in circulating lymphocytes. 3. altered production of white blood cells. 4. increased incidence of infection.
2. Renal failure is associated with a deficiency in circulating lymphocytes. Diabetes mellitus is associated with increased incidence of infection. Chemotherapy causes decreased bone marrow function. Leukemia is associated with altered production of white blood cells.
The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful? 1. "The symptoms are primarily localized to the skin but may involve the joints." 2. "The belief is that it is an autoimmune disorder with an unknown trigger." 3. "This disorder is more common in men in their thirties and forties than in women." 4. "SLE has very specific manifestations that make diagnosis relatively easy."
2. Systemic lupus erythematosus is believed to be an autoimmune disorder but the triggering mechanism is not known. The disorder is more common in women than in men, most with the disorder in the 3rd or 4th decade of life. The disease is considered the "great imitator" because the clinical signs resemble many other conditions. SLE is a diffuse connective tissue disease that affects multiple body systems.
The presence of crystals in synovial fluid obtained from arthrocentesis is indicative of 1. inflammation. 2. gout. 3. infection. 4. degeneration.
2. The presence of crystals is indicative of gout, whereas the presence of bacteria is indicative of infective arthritis.
A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis? 1. Sputum specimen for acid fast bacillus 2. Urine specimen for culture and sensitivity 3. Stool specimen for ova and parasites 4. Blood specimen for electrolyte studies
3. A stool specimen for ova and parasites will give a definitive diagnosis. The organism is spread by the fecal-oral route from contaminated water, food, or human or animal waste. Those infected can lose from 10 to 20 L of fluid per day. Losing this magnitude of fluid quickly leads to dehydration and electrolyte imbalances.
A patient asks the nurse if it would be all right to take an over-the-counter antihistamine for the treatment of a rash. What should the nurse educate the patient is a major side effect of antihistamines? 1. Diarrhea 2. Palpitations 3. Sedation 4. Anorexia
3. Antihistamines are the major class of medications prescribed for the symptomatic relief of allergic rhinitis. The major side effect is sedation, although H1 antagonists are less sedating than earlier antihistamines.
The nurse is working with a client with allergies. What will the nurse use to confirm allergies and decrease the risk of anaphylaxis? 1. nasal smear 2. peripheral blood smears 3. intradermal testing 4. punch biopsy
3. The diagnosis of anaphylaxis risk is determined by prick and intradermal skin testing. Skin testing of patients who have clinical symptoms consistent with a type I, IgE-mediated reaction has been recommended. A nasal smear, punch biopsy, and peripheral blood smear would not be used for allergy testing.
The nurse administers an injection to a client with AIDS. When finished, the nurse attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse? 1. Call the lab to draw the nurse's blood. 2. Fill out a risk management report. 3. Obtain counseling. 4. Report the incident to the supervisor.
4. Because post exposure protocols can reduce the risk of HIV infection if initiated promptly, nurses must immediately report any needlestick or sharp injury to a supervisor. Obtaining counseling will occur after all other procedures are adhered to. The lab will draw blood from the client if required for documentation and other blood transmitted disorders.
A client has had a "stuffy nose" and obtained an oxymetazoline nasal spray. What education should the nurse provide to the client in order to prevent "rebound congestion"? 1. Drink plenty of fluids. 2. Be sure to use the nasal spray for at least 10 days to ensure the stuffiness is gone. 3. Use the medication every 4 hours to prevent congestion from recurring. 4. Only use the nasal spray for 3 to 4 days once every 12 hours.
4. Adrenergic agents, which are vasoconstrictors of mucosal vessels, are used topically in nasal (oxymetazoline [Afrin]) and ophthalmic (brimonidine [Alphagan P]) formulations in addition to the oral route (pseudoephedrine [Sudafed]). The topical route (drops and sprays) causes fewer side effects than oral administration; however, the use of drops and sprays should be limited to a few days to avoid rebound congestion.
A hospital nurse has experienced percutaneous exposure to an HIV-positive client's blood because of a needlestick injury. The nurse has informed the supervisor and identified the client. What action should the nurse take next? 1. Apply a hydrocolloid dressing to the wound site. 2. Flush the wound site with chlorhexidine. 3. Follow up with the nurse's primary care provider. 4. Report to the emergency department or employee health department.
4. After initiating the emergency reporting system, the nurse should report as quickly as possible to the employee health services, the emergency department, or other designated treatment facility. Flushing is recommended, but chlorhexidine is not used for this purpose. Applying a dressing is not recommended. Following up with the nurse's own primary provider would require an unacceptable delay.
A nurse is preparing a presentation to a local community group about allergic disorders. Which medication would the nurse include as the most common cause of anaphylaxis? 1. Iodine contrast agent 2. Aspirin 3. Morphine 4. Penicillin
4. Although aspirin, morphine (an opioid) and radiocontrast agents such as iodine can cause anaphylaxis, penicillin is the most common cause of anaphylaxis, accounting for about 75% of fatal anaphylactic reactions in the United States each year.
A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client? 1. Use volume expanders in case blood is needed. 2. Sign a refusal of blood transfusion form so the client will not receive the transfusion. 3. Ask people to donate blood. 4. Bank autologous blood.
4. Banking autologous blood that is self-donated is the safest option for the client. Signing the refusal form does not give the client any information about the options that are available and places the client at risk. Directed donor blood may be no safer than blood collected from public donors. Those who support this belief say that directed donors may not reveal their high-risk behaviors that put the potential recipient at risk for blood-borne pathogens such as HIV.
The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer? 1. Nizatidine 2. Omeprazole 3. Cimetidine 4. Diphenhydramine
4. Certain medications are categorized by their action at these receptors. Diphenhydramine (Benadryl) is an example of an antihistamine, a medication that displays an affinity for H1 receptors. Cimetidine (Tagamet) and nizatidine (Axid) target H2 receptors to inhibit gastric secretions in peptic ulcer disease.
A client has had a splenectomy after sustaining serious internal injuries in a motorcycle accident, including a ruptured spleen. Following removal of the spleen, the client will be susceptible to: 1. acidosis because the spleen maintains acid-base balance. 2. bleeding because the spleen synthesizes vitamin K. 3. anemia because the spleen produces red blood cells. 4. infection because the spleen removes bacteria from the blood.
4. One function of the spleen is to remove bacteria from circulation; therefore, the client will be more susceptible to infection.
What is the function of the thymus gland? 1. Produce stem cells 2. Programs B lymphocytes to become regulator or effector B cells. 3. Develop the lymphatic system 4. Programs T lymphocytes to become regulator or effector T cells.
4. The thymus gland is located in the neck below the thyroid gland. It extends into the thorax behind the top of the sternum. The thymus gland produces lymphocytes during fetal development. It may be the embryonic origin of other lymphoid structures such as the spleen and lymph nodes. After birth, the thymus gland programs T lymphocytes to become regulator or effector T cells. The thymus gland becomes smaller during adolescence but retains some activity throughout the life cycle. Options A, B, and C are incorrect.
