Lewis Med-Surg Ch 14
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1. The nurse provides discharge instruc- ANS: B
tions to a patient who has an immune Cell-mediated immunity is respon-
deficiency involving the T lymphocytes. sible for the recognition and de-
Which screening should the nurse in- struction of cancer cells. Allergic
clude in the teaching plan for this pa- reactions, autoimmune disorders,
tient? and antibody deficiencies are me-
diated primarily by B lymphocytes
a. Screening for allergies and humoral immunity
b. Screening for malignancy
c. Antibody deficiency screening
d. Screening for autoimmune disorders
2. A new mother expresses concern ANS: C
about her baby developing allergies Colostrum provides passive im-
and asks what the health care provider
munity through antibodies from
meant by "passive immunity." Which the mother. These antibodies pro-
example should the nurse use to ex- tect the infant for a few months.
plain this type of immunity? However, memory cells are not
retained, so the protection is not
a. Early immunization permanent. Active immunity is ac-
b. Bone marrow donation quired by being immunized with
c. Breastfeeding her infant vaccinations or having an infec-
d. Exposure to communicable diseases tion. It requires that the infant has
an immune response after expo-
sure to an antigen. Cell-mediat-
ed immunity is acquired through
T lymphocytes and is a form of
active immunity
3. A patient is being evaluated for pos- ANS: A
sible atopic dermatitis. The nurse ex- Serum IgE is elevated in an al-
pects elevation of which laboratory val- lergic response (type 1 hypersen-
ue? sitivity disorders). The eosinophil
level will be elevated rather than
a. IgE neutrophil or basophil counts. IgA
b. IgA is located in body secretions and
c. Basophils would not be tested when evaluat-
d. Neutrophils ing a patient who has symptoms of
atopic dermatitis
, Lewis Med-Surg Ch 14
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4. An older adult patient who is having ANS: A
an annual check-up tells the nurse, "I The primary impact of aging on im-
feel fine, and I don't want to pay for mune function is on T cells, which
all these unnecessary cancer screen- are important for immune surveil-
ing tests!" Which information should lance and tumor immunity. Anti-
the nurse plan to teach this patient? body function is not affected as
much by aging. Poor nutrition can
a. Consequences of aging on cell-medi- also contribute to decreased im-
ated immunity munity, but there is no evidence
b. Decrease in antibody production as- that it is a contributing factor for
sociated with aging this patient. Although some types
c. Impact of poor nutrition on immune of cancer are associated with spe-
function in older people cific infections, this patient does
d. Incidence of cancer-stimulating in- not have an active infection
fections in older individuals
5. A patient who collects honey to earn ANS: C
supplemental income has developed a Because the patient is at risk for
hypersensitivity to bee stings. Which bee stings and the severity of al-
statement, if made by the patient, would lergic reactions tends to increase
indicate a need for additional teaching? with added exposure to allergen,
taking oral antihistamines will not
a. "I need to find another way to earn adequately control the patient's
extra money." hypersensitivity reaction. The oth-
b. "I will get a prescription for epineph- er patient statements indicate a
rine and learn to self-inject it." good understanding of manage-
c. "I will plan to take oral antihistamines ment of the problem
daily before going to work."
d. "I should wear a Medic-Alert bracelet
indicating my allergy to bee stings."
6. Which teaching should the nurse pro- ANS: C
vide about intradermal skin testing to a Allergic reactions usually occur
patient with possible allergies? within minutes after injection of an
allergen, and the patient will be
a. "Do not eat anything for about 6 monitored for at least 20 minutes
hours before the testing." for anaphylactic reactions after
b. "Take an oral antihistamine about an the testing. Medications that might
, Lewis Med-Surg Ch 14
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hour before the testing." modify the response, such as anti-
c. "Plan to wait in the clinic for 20 to 30 histamines, should be avoided be-
minutes after the testing." fore allergy testing. There is no
d. "Reaction to the testing will take reason to be NPO for skin test-
about 48 to 72 hours to occur." ing. Results with intradermal test-
ing occur within minutes
7. The nurse, who is reviewing a clinic ANS: C
patient's medical record, notes that the Because there is an increased risk
patient missed the previous appoint- for adverse reactions after a pa-
ment for weekly immunotherapy. Which tient misses a scheduled dose of
action by the nurse is most appropri- allergen, the nurse should check
ate? with the health care provider be-
fore administration of the injection.
a. Schedule an additional dose that A skin test is used to identify the
week. allergen and would not be used at
b. Administer the usual dosage of the this time. An additional dose for the
allergen. week may increase the risk for a
c. Consult with the health care provider reaction.
about giving a lower allergen dose.
d. Re-evaluate the patient's sensitivity
to the allergen with a repeat skin test.
8. While obtaining a health history from a ANS: C
patient, the nurse learns that the patient The patient's allergy history and
has a history of allergic rhinitis and occupation indicate a risk of de-
multiple food allergies. Which action by veloping a latex allergy. The nurse
the nurse is most appropriate? should be prepared to manage
any symptoms that may occur. Ep-
a. Encourage the patient to carry an inephrine is not an appropriate
epinephrine kit in case a type IV allergic treatment for contact dermatitis
reaction to latex develops. that is caused by a type IV allergic
b. Advise the patient to use oil-based reaction to latex. Oil-based creams
hand creams to decrease contact with will increase the exposure to latex
natural proteins in latex gloves. from latex gloves. Vinyl gloves are
c. Document the patient's allergy histo- appropriate to use when exposure
ry and be alert for any clinical manifes- to body fluids is unlikely
tations of a type I latex allergy.
d. Recommend that the patient use
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