Prep U for Brunner and Suddarth's Textbook of Medical Surgical Nursing, 13th Edition Chapter 36: Management of Patients With Immunodeficiency Disorders

A client with chronic mucocutaneous candidiasis, an autosomal recessive disorder, asks the nurse, "Will my children have this disease?" Which response by the nurse is appropriate?

"All of your children will be carriers of the recessive gene but may not develop the disease." pg. 990

A child has just been diagnosed with a primary immune deficiency. The parents state, "Oh, no. Our child has AIDS." Which response by the nurse would be most appropriate?

"Although AIDS is an immune deficiency, your child's condition is different from AIDS." pg. 994

A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching?

"I can eat whatever I want as long as it's low in fat." pg. 995

The nurse is caring for a young client who has agammaglobulinemia. The nurse is teaching the family how to avoid infection at home. Which statement by the family indicates that additional teaching is needed?

"I can take my child to the beach, as long as we play in the sand rather than swim in the water." pg. 995

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.

"Your immune system was most likely affected by an underlying disease process." pg. 994

A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response?

"It is a hyperimmune response to something in the environment that is usually harmless." pg. 1030

A client with rheumatoid arthritis informs the nurse that since he has been in remission and not having any symptoms, he doesn't need to take his medication any longer. What is the best response by the nurse?

"It is important that you continue to take your medication to avoid an acute exacerbation." pg. 1056

A nurse is reviewing treatment options with parents of an infant born with severe combined immunodeficiency disease (SCID). The nurse recognizes that the parents understand the teaching based on which statement?

"We could have our 10-year-old daughter tested, as the ideal stem cell donor is a human leukocyte antigen-identical sibling." pg. 992

The nurse is working with a parent whose child has just been diagnosed with selective immunoglobulin A deficiency. The parent asks the nurse, "Does this mean that my child is going to die?" How should the nurse respond?

"Your child has a mild genetic immune deficiency caused by a lack of immunoglobulin A, a type of antibody that protects against infections of the lining the mouth and digestive tract." pg. 987

When a nurse infuses gamma globulin intravenously, the rate should not exceed

3 mL/min. pg. 991

A nurse educator is preparing to discuss immunodeficiency disorders with a group of fellow nurses. What would the nurse identify as the most common secondary immunodeficiency disorder?

AIDS pg. 994

A nurse is working in a pediatric clinic. After giving a hepatitis B immunization to an infant, the parent asks what kind of protection this provides for the child. What is the nurse's best response? Active acquired immunity, which lasts many years or a lifetime Active acquired immunity, which is temporary Passive acquired immunity, which lasts many years or a lifetime Passive acquired immunity, which is temporary

Active acquired immunity, which lasts many years or a lifetime Active acquired immunity refers to immunologic defenses developed by the person's own body. This immunity typically lasts many years or even a lifetime. Passive acquired immunity is temporary immunity transmitted from a source outside the body that has developed immunity through previous disease or immunization.

A client is given a dose of ketorolac, a nonsteroidal anti-inflammatory drug for complaints of abdominal pain. Ten minutes after receiving the medication, the client's eyes, lips, and face begin to swell, and the nurse hears stridor. What priority measure should the nurse prepare to do?

Administer epinephrine. pg. 1037

A client has been having joint pain and swelling in the left foot and is diagnosed with rheumatoid arthritis. The symptoms began suddenly without any identifiable cause, and the client has significant joint destruction. What type of disease is this considered?

Autoimmune pg. 1054

A client is prescribed antihistamines, and asks the nurse about administration and adverse effects. The nurse should advise the client to avoid:

Avoid alcohol pg. 1041

What treatment option does the nurse anticipate for the patient with severe combined immunodeficiency disease (SCID)?

Bone marrow transplantation pg. 992

A treatment option for severe combined immune deficiency (SCID) includes

a stem cell transplant. pg. 992

More than 50% of individuals with this disease develop pernicious anemia:

Common variable immunodeficiency (CVID) pg. 990

A client received 2 units of packed red blood cells while in the hospital with rectal bleeding. Three days after discharge, the client experienced an allergic response and began to itch and break out with hives. What type of reaction does the nurse understand could be occurring?

Delayed hypersensitivity response pg. 1038

A client calls the clinic and asks the nurse if using oxymetazoline nasal spray would be alright to relieve the nasal congestion he is experiencing due to seasonal allergies. What instructions should the nurse provide to the client to avoid complications?

Do not overuse the medication as rebound congestion can occur. pg. 1040

When administering intravenous gamma globulin infusion, the nurse recognizes that which of the following complaints, if reported by the client, may indicate an adverse effect of the infusion?

Flank pain pg. 991

A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder?

For their immunosuppressant effects pg. 982

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?

IV gamma globulin administration pg. 992

Nursing students are reviewing information about the various types of primary immunodeficiencies. The students demonstrate understanding of the material when they identify which of the following as an example of a primary immunodeficiency involving B-lymphocyte dysfunction?

IgA deficiency pg. 987

A client with severe combined immunodeficiency is to receive a hematopoietic stem cell transplant. Which of the following would the nurse expect to be started?

Immunosuppressive agents pg. 992

The nurse is aware that the most prevalent cause of immunodeficiency worldwide is

Malnutrition pg. 994

A nurse is preparing an in-service presentation about primary immunodeficiencies. When describing these conditions, which of the following would the nurse need to integrate into the presentation?

Most cases are typically diagnosed in infancy pg. 987

Ataxia-telangiectasia is a disorder characterized by the following. Choose all that apply.

Neurologic symptoms that usually occur before 5 years of age IgA deficiency in 40% of individuals pg. 992

A client with common variable immunodeficiency (CVID) comes to the ED reporting 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 client developed?

Pernicious anemia pg. 988

A majority of clients with CVID develop which type of anemia?

Pernicious pg. 990

Which adverse effect(s) should the nurse closely monitor in a client who has secondary immunodeficiencies due to immunosuppressive therapy?

Respiratory or urinary system infections pg. 994

A mother brings her young child to the clinic for an evaluation of an infection. The mother states, "He's been taking antibiotics now for more than 2 months and still doesn't seem any better. It's like he's always sick." During the history and physical examination, which of the following would alert the nurse to suspect a primary immunodeficiency?

Ten ear infections in the past year pg. 989

Reproductive health education for women who are HIV-positive includes recommending which of the following contraceptives?

The female condom pg. 1000

A 64-year-old male client, who leads a sedentary life-style, and a 31-year-old female client, who has a very stressful and active life-style, require a vaccine against a particular viral disorder. As the nurse, you would know that in one of these clients the vaccine will be less effective. In which client is the vaccine more likely to be less effective and why? The male client because of his age The male client because of his life-style The female client because of her age The female client because of her life-style

The male client because of his age Vaccines are less effective in an older adult than in a younger adult because the activity of the immune system declines with the aging process. The lifestyle or gender of the client does not have great implications on the effectiveness of a vaccine. Reference:

T-cell deficiency occurs when which gland fails to develop normally during embryogenesis?

Thymus pg. 992

A client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit?

Type I pg. 1032

Telangiectasia is the term that refers to

Vascular lesions caused by dilated blood vessels pg. 992

The nurse is admitting a client to the unit with a diagnosis of ataxia-telangiectasia. A clinical manifestation is telangiectasia. The nurse would recognize that the client is exhibiting telangiectasia when assessing the presence of what?

Vascular lesions caused by dilated blood vessels pg. 992

Which assessment finding would the nurse expect to document for a client with ataxia-telangiectasis?

Vascular lesions pg. 992

The majority of patient with primary immunodeficiency are in which age group?

Younger than 20 pg. 987

Which allergic reaction is potentially life threatening?

angioedema pg. 1048

A client has begun sensitivity testing to determine the allergen which caused an anaphylactic reaction 3 weeks ago. In scratch testing, which part of the body is more sensitive to allergens?

back pg. 1035

A nurse knows that more than 50% of clients with CVID develop the following disorder.

pernicious anemia pg. 990

Ataxia refers to

uncoordinated muscle movement. pg. 992

A nurse is assessing a client with a primary immunodeficiency. Afterward the nurse documents that the client displayed ataxia. The nurse makes this documentation because the client has

uncoordinated muscle movements. pg. 992

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.

• Shaking chills • Flank pain • Tightness in the chest pg. 991

The nurse is teaching the client who has an immunodeficiency disorder how to avoid infection at home. Which statement indicates that additional teaching is needed?

"I will be sure to eat lots of fresh fruits and vegetables every day." pg. 995

A client presents to the clinic with complaints that he began to itch and break out in hives after taking an aspirin this morning. What medication does the nurse anticipate administering that blocks histamine receptors?

Diphenhydramine pg. 1047

A nursing instructor is giving a lecture on the immune system. The instructor's discussion on phagocytosis will include: neutrophils and monocytes. plasma cells and memory cells. regulator T cells and helper T cells. lymphokines and suppressor T cel

Neutrophils and monocytes are phagocytes, cells that perform phagocytosis.

A patient is suspected to have an immunodeficiency disorder. The physician orders a nitroblue tetrazolium reductase (NTR) test to diagnose this patient. What does the nurse suspect that this disorder is related to?

Phagocytic cells pg. 988

A client is diagnosed with common variable immunodeficiency (CVID). When assessing the client for possible infection, which of the following would the nurse identify as a least likely cause?

Pneumocystis jiroveci pneumonia pg. 990

A client is scheduled to receive an intravenous immunoglobulin (IVIG) infusion. The client asks the nurse about the infusion's administration and its adverse effects. Which condition should the nurse instruct this client to report immediately?

Tickle in the throat pg. 991

When the nurse administers intravenous gamma-globulin infusion, she recognizes that which symptom, if reported by the client, may indicate an adverse effect of the infusion?

Tightness in the chest pg. 991