Exam (elaborations)
(Med-Surg) Lewis - Chapter 13: Altered Immune Responses And Transplantation – Qs & As
(Med-Surg) Lewis - Chapter 13: Altered Immune Responses And Transplantation – Qs & As
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(Med-Surg) Lewis - Chapter 13: Altered ImmuneResponses And Transplantation – Qs & As
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 - 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 - 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 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 - 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 -
ANS: A
The primary impact of aging on immune function is on T cells, which are
important for immune surveillance and tumor immunity. Antibody function
is not affected as much by aging. Poor nutrition can also contribute to
decreased immunity, but there is no evidence that it is a contributing factor
for this patient. Although some types of cancer are associated with specific
infections, this patient does not have an active infection.
A patient who collects honey to earn supplemental income has developed a
hypersensitivity to bee stings. Which statement, if made by the patient,
would indicate a need for additional teaching?
a. "I need to find another way to earn extra money."
b. "I will get a prescription for epinephrine and learn to self-inject it."
c. "I will plan to take oral antihistamines daily before going to work."
d. "I should wear a Medic-Alert bracelet indicating my allergy to bee
stings." ✔️Ans - ANS: C
Because the patient is at risk for bee stings and the severity of allergic
reactions tends to increase with added exposure to allergen, taking oral
antihistamines will not adequately control the patient's hypersensitivity
reaction. The other patient statements indicate a good understanding of
management of the problem
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." ✔️Ans
- ANS: C
, 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 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. ✔️Ans - ANS: C
Because there is an increased risk for adverse reactions after a patient
misses a scheduled dose of allergen, the nurse should check with the health
care provider before administration of the injection. A skin test is used to
identify the allergen and would not be used at this time. An additional dose
for the week may increase the risk for a reaction.
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. ✔️Ans - ANS: C
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.
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