NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WI, Exams of Nursing

Download NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WI and more Exams Nursing in PDF only on Docsity! NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ The nurse provides discharge instructions to a patient who has an immune deficiency involving the T lymphocytes. Which screening should the nurse include in the teaching plan for this patient? a. Screening for allergies b. Screening for malignancy c. Antibody deficiency screening d. Screening for autoimmune disorders ANS: B Cell-mediated immunity is responsible for the recognition and destruction of cancer cells. Allergic reactions, autoimmune disorders, and antibody deficiencies are mediated primarily by B lymphocytes and humoral immunity. A new mother expresses concern about her baby developing allergies and asks what the health care provider meant by "passive immunity." Which example should the nurse use to explain this type of immunity? a. Early immunization b. Bone marrow donation c. Breastfeeding her infant d. Exposure to communicable diseases ANS: C Colostrum provides passive immunity through antibodies from the mother. These antibodies protect the infant for a few months. However, memory cells are not retained, so the protection is not permanent. Active immunity is acquired by being immunized with vaccinations or having an infection. It requires that the infant has an immune NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ response after exposure to an antigen. Cell-mediated immunity is acquired through T lymphocytes and is a form of active immunity. A patient is being evaluated for possible atopic dermatitis. The nurse expects elevation of which laboratory value? a. IgE b. IgA c. Basophils d. Neutrophils ANS: A Serum IgE is elevated in an allergic response (type 1 hypersensitivity disorders). The eosinophil level will be elevated rather than neutrophil or basophil counts. IgA is located in body secretions and would not be tested when evaluating a patient who has symptoms of atopic dermatitis. An older adult patient who is having an annual check-up tells the nurse, "I feel fine, and I don't want to pay for all these unnecessary cancer screening tests!" Which information should the nurse plan to teach this patient? a. Consequences of aging on cell-mediated immunity b. Decrease in antibody production associated with aging c. Impact of poor nutrition on immune function in older people d. Incidence of cancer-stimulating infections in older individuals ANS: A NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ 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. 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. The nurse teaches a patient diagnosed with systemic lupus erythematosus (SLE) about plasmapheresis. What instructions about plasmapheresis should the nurse include in the teaching plan? a. Plasmapheresis will eliminate eosinophils and basophils from blood. b. Plasmapheresis will remove antibody-antigen complexes from circulation. c. Plasmapheresis will prevent foreign antibodies from damaging various body tissues. d. Plasmapheresis will decrease the damage to organs caused by attacking T lymphocytes. Plasmapheresis is used in SLE to remove antibodies, antibody-antigen complexes, and complement from blood. T lymphocytes, foreign antibodies, eosinophils, and basophils do not directly contribute to the tissue damage in SLE. NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ 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 ANS: D 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. Which statement by a patient would alert the nurse to a possible immunodeficiency disorder? a. "I take one baby aspirin every day to prevent stroke." b. "I usually eat eggs or meat for at least 2 meals a day." c. "I had my spleen removed many years ago after a car accident." d. "I had a chest x-ray 6 months ago when I had walking pneumonia." ANS: C Splenectomy increases the risk for septicemia from bacterial infections. The patient's protein intake is good and should improve immune function. Daily aspirin use does not affect immune function. A chest x-ray does not have enough radiation to suppress immune function. NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ Which patient should the nurse assess first? a. Patient with urticaria after receiving an IV antibiotic b. Patient who has graft-versus-host disease and severe diarrhea c. Patient who is sneezing after having subcutaneous immunotherapy d. Patient with multiple chemical sensitivities who has muscle stiffness ANS: C Sneezing after subcutaneous immunotherapy may indicate impending anaphylaxis and assessment and emergency measures should be initiated. The other patients also have findings that need assessment and intervention by the nurse, but do not have evidence of life-threatening complications. Ten days after receiving a bone marrow transplant, a patient develops a skin rash. What would the nurse suspect is the cause of this patient's skin rash? a. The donor T cells are attacking the patient's skin cells. b. The patient's antibodies are rejecting the donor bone marrow. c. The patient is experiencing a delayed hypersensitivity reaction. d. The patient will need treatment to prevent hyperacute rejection. The patient's history and symptoms indicate that the patient is experiencing graft-versus- host disease, in which the donated T cells attack the patient's tissues. The history and symptoms are not consistent with rejection or delayed hypersensitivity An adolescent patient seeks care in the emergency department after sharing needles for heroin injection with a friend who has hepatitis B. To provide immediate protection from infection, what medication will the nurse administer? NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ The charge nurse is assigning rooms for new admissions. Which patient would be the most appropriate roommate for a patient who has acute rejection of an organ transplant? a. A patient who has viral pneumonia b. A patient with second-degree burns c. A patient who is recovering from an anaphylactic reaction to a bee sting d. A patient with graft-versus-host disease after a recent bone marrow transplant ANS: C Treatment for a patient with acute rejection includes administration of additional immunosuppressants, and the patient should not be exposed to increased risk for infection as would occur from patients with viral pneumonia, graft-versus-host disease, and burns. There is no increased exposure to infection from a patient who had an anaphylactic reaction. A patient who has received allergen testing using the cutaneous scratch method has developed itching and swelling at the skin site. Which action should the nurse take first? a. Administer epinephrine. b. Apply topical hydrocortisone. c. Monitor the patient for lower extremity edema. d. Ask the patient about exposure to any new lotions or soaps. ANS: A The initial symptoms of anaphylaxis are itching and edema at the site of the exposure. Hypotension, tachycardia, dilated pupils, and wheezes occur later. Rapid administration of epinephrine when excessive itching or swelling at the skin site is observed can prevent NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ the progression to anaphylaxis. Topical hydrocortisone would not deter an anaphylactic reaction. Exposure to lotions and soaps does not address the immediate concern of a possible anaphylactic reaction. The nurse should not wait and observe for edema. The nurse should act immediately in order to prevent progression to anaphylaxis. 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. ANS: B 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. Immediately after the nurse administers an intracutaneous injection of an allergen on the forearm, a patient complains of itching at the site and of weakness and dizziness. What action should the nurse take first? a. Remind the patient to remain calm. b. Administer subcutaneous epinephrine. c. Apply a tourniquet above the injection site. d. Rub a local antiinflammatory cream on the site. ANS: C Application of a tourniquet will decrease systemic circulation of the allergen and should NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ be the first reaction. A local antiinflammatory cream may be applied to the site of a cutaneous test if the itching persists. Epinephrine will be needed if the allergic reaction progresses to anaphylaxis. The nurse should assist the patient to remain calm, but this is not an adequate initial nursing action. A clinic patient is experiencing an allergic reaction to an unknown allergen. Which action is most appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Perform a focused physical assessment. b. Obtain the health history from the patient. c. Teach the patient about the various diagnostic studies. d. Administer skin testing by the cutaneous scratch method. ANS: D LPN/LVNs are educated and licensed to administer medications under the supervision of an RN. RN-level education and the scope of practice include assessment of health history, focused physical assessment, and patient teaching. 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. NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ A. IgG B. IgA C. IgM D. IgE A In a type 1 hypersensitivity reaction, the primary immunologic disorder appears to be: A. binding of IgG to an antigen on the cell surface B. deposit of antigen-antibody complexes in small vessels C. release of cytokines to interact with specific antigens D. release of chemical mediators from IgE-bound mast cells and basophils D The nurse is altered 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 A 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 injectible syringe NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ provided with his extract C. avoiding the allergens is a much more effective way of controlling allergens, and allergy shots are not usually effective D. immunotherapy should only be administered in a setting where emergency equipment and drugs are available D Association between HLA antigens and disease is most commonly found in what disease condition? A. malignancies B. infectious disease C. neurologic diseases D. autoimmune disorders D A patient is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse explains that plasmapheresis is used in her treatment to: A. remove T lymphocytes in her blood that are producing antinuclear antibodies B. remove normal particles in her blood that are being damaged by autoantibodies C. exchange her plasma that contains antinuclear antibodies with a substitute fluid D. replace viral-damaged cellular components of her blood with replacement whole blood C The most common cause of secondary immunodeficiencies is: NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ A. drugs B. stress C. malnutrition D. human immunodeficiency virus A Which of the following accurately describes rejection following transplantation? A. hyperacute rejection can be treated with OKT3 B. acute rejections can be treated with sirolimus or tacrolimus C. chronic rejection can be treated with tacrolimus or cyclosporine D. hyperacute rejection can usually be avoided is crossmatching if done before the transplantation D In a person having an acute rejection of a transplanted kidney, which of the following would help the nurse understand the course of events (select all that apply): A. a new transplant could be considered B. acute rejection can be treated with OKT3 C. acute rejection usually leads to chronic rejection D. corticosteroids are the most successful drug used to treat acute rejection E. Acute rejection is common after a transplant and can be treated with drug therapy B, E NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ available. Immunotherapy should never be given in the home as anaphylactic shock cannot be adequately treated at home. The patient should never be left alone after immunotherapy, as systemic reactions may occur. 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? 1 Monitor the patient's fluid balance 2 Assess the patient's need for analgesia 3 Monitor for signs and symptoms of an adverse reaction 4 Assess the patient for changes in level of consciousness 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 nurse is caring for a patient with systemic lupus erythematosus. The nurse understands that this disease is caused when the body identifies self proteins as foreign substances, triggering an immune response. What is this pathophysiological condition called? 1 Autoimmunity 2 Hypersensitivity 3 Immunodeficiency 4 Delayed hypersensitivity Autoimmunity occurs when the body identifies self proteins as foreign substances, it NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ 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. While undergoing a cerebral computed tomography (CT) scan, a contrast dye is injected. After administering a few mL of contrast media, the health care provider assesses the patient and immediately stops the infusion. What reasons could have led the health care provider to discontinue the contrast dye? Select all that apply. 1 Nasal discharge 2 Sneezing 3 Dyspnea 4 Rapid, weak pulse 5 Hypotension Anaphylaxis is a significant adverse reaction that is life threatening in response to the iodinated dye that was used as a contrast. As anaphylaxis is manifested by respiratory distress, a rapid weak pulse, hypotension, and shock, counteractive measures must be implemented immediately. Nasal discharge and sneezing are not associated with contrast dye-related complications; these are minor manifestations of atopic reactions. After a successful organ transplant, a patient began receiving immunosuppressive therapy, specifically tacrolimus (Prograf), methylprednisolone (Solu-Medrol), and mycophenolate mofetil (CellCept). Which food should the nurse instruct the patient to avoid during this therapy? 1 Jackfruit NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ 2 Grapefruit 3 Dragon fruit 4 Passion fruit Grapefruit contains a chemical substance that interferes with the metabolism of tacrolimus, causing drug toxicity events. Jackfruit, dragon fruit, and passion fruit do not interfere with the metabolism of these medications. A patient undergoes ABO compatibility tests. When administering the patient a prescribed blood transfusion, the nurse monitors for what type of hypersensitivity reaction? 1 Type I: IgE-mediated 2 Type III: Immune-complex 3 Type II: Cytotoxic and cytolytic 4 Type IV: Delayed hypersensitivity 3 In type II hypersensitivity reactions, cellular structures are destroyed. These reactions mostly involve the destruction of red blood cells, platelets, and leukocytes. When incompatible blood types are mixed, agglutination occurs. As a result, hemoglobin may be released into the urine and plasma, causing acute kidney failure. Type I, III, and IV are not responsible for ABO incompatibility reactions. Type I hypersensitivity reactions occur during allergic rhinitis and asthma. Type III hypersensitivity reactions occur in disease conditions like rheumatoid arthritis. Type IV reactions occur in contact dermatitis. NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ The patient should be instructed to avoid chemicals known to trigger symptoms. Creating a chemical- and odor-free environment is the most appropriate treatment to prevent symptoms related to chemical sensitivity. Narcotic drugs, antianxiety drugs, and antidepressant drugs are used only to treat the symptoms temporarily. These drugs do not desensitize the patient toward the chemicals. 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? 1 ELISA 2 Skin testing 3 CBC with differential 4 Testing bronchial secretions 2 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, as bronchial secretions are not highly specific. The patient with an autoimmune disease will be treated with plasmapheresis. What should the nurse teach the patient about this treatment? 1 It will gather platelets for use later when needed. NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ 2 It will cause anemia because it removes whole blood and red blood cells (RBCs) that are damaged. 3 It will remove the immunoglobulin G (IgG) autoantibodies and antigen complexes from the plasma. 4 It will remove the peripheral stem cells to cure the autoimmune disease 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. The nurse recalls that interferons may be used in the treatment of certain diseases. What is the clinical use of β-Interferon? 1 As a treatment for multiple sclerosis 2 As a treatment for multiple myeloma 3 As a treatment for hairy cell leukemia 4 As a treatment for renal cell carcinoma 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. A nurse is preparing the discharge plan of a patient who is allergic to latex. What foods should the nurse ask the patient to avoid? Select all that apply. NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ 1 Tomatoes 2 Leafy vegetables 3 Avocados 4 Potatoes 5 Milk 1,3, 4 Some of the proteins in rubber latex are similar to food proteins. The patient who is allergic to latex may also be allergic to foods that contain similar food proteins. Tomatoes, potatoes, and avocados should be avoided. Milk and leafy vegetables do not contain proteins similar to those found in latex. The nurse cares for a patient that had an asthma attack due to an unknown allergen. Which immunoglobulin is primarily responsible for allergic reactions? 1 IgE 2 IgG 3 IgM 4 IgA NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ Wearing a Medic Alert bracelet is important because it gives an indication to the health care provider about the patient's medical history. The patient should carry preinjectable epinephrine and a tourniquet. The patient should be taught the technique of applying a tourniquet and the method of self-injecting epinephrine in case of emergency. Methdilazine is an antipruritic agent that requires a prescription, and it should be used with great caution. Also, as it is antipruritic, it will not protect against insect sting. Calamine lotion is also antipruritic. It will help to relieve itching but will not act as a preventive measure for insect stings. A parent arrives at the pediatrician's office with a young patient who is to receive vaccines. The nurse would explain that the type of immunity rendered through the vaccination is what? 1 Artificially acquired passive immunity 2 Naturally acquired active immunity 3 Artificially acquired active immunity 4 Naturally acquired passive immunity 3 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. Which statement by the patient who has had an organ transplant would indicate that the patient understands the teaching about the immunosuppressive medications? NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ 1 "My drug dosages will be lower because the medications enhance each other." 2 "Taking more than one medication will put me at risk for developing allergies." 3 "I will be more prone to malignancies because I will be taking more than one drug." 4 "The lower doses of my medications can prevent rejection and minimize the side effects." 4 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 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? 1 Innate immunity 2 Passive immunity 3 Humoral immunity 4 Cell-mediated immunity Cell-mediated immunity involves various cells, including natural killer cells. The natural killer cells are responsible for identifying "self" and "non-self" tissues, which sometimes results in rejection of grafts and transplants. Innate immunity is present after birth. It involves a non-specific 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 NURS 104 QUESTIONS WITH ANSWERS :Altered Immune Responses and Transplantation QUESTIONS WITH ANSWERS 2023 A+ production and is responsible for allergic reactions. Text Reference - p. 208 On initial assessment of an older patient, the nurse knows to look for certain types of diseases because which immunologic response increases with age? 1 Autoimmune response 2 Cell-mediated immunity 3 Hypersensitivity response 4 Humoral immune response 1 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. The nurse is monitoring a patient who has a past history of blood transfusion reactions. A transfusion reaction is an example of which of these hypersensitivity reactions? 1 Type I: IgE- mediated 2 Type II: Cytotoxic 3 Type III: Immune-complex. 4 Type IV: Delayed hypersensitivity. 2