chapter 16

Question 1

Chickenpox is an example of which of the following types of immunities?
a. Innate
b. Natural active
c. Artificial
d. Cell-mediated

Answer 1

B
Chickenpox is an example of natural active immunity.

Question 2

The nurse is caring for a client in the outpatient clinic who has an immune deficiency
involving the T-lymphocytes. Which of the following areas should the nurse teach the
client about the need for more frequent screening?
a. Allergies
b. Malignancy
c. Antibody deficiency
d. Autoimmune disorders

Answer 2

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 humoral immunity.

Question 3

Which of the following antibodies is involved with an anaphylactic reaction?
a. IgE
b. IgA
c. IgM
d. IgG

Answer 3

A
Serum IgE causes the symptoms of allergic reactions and is the antibody involved with an
anaphylactic reaction.

Question 4

The nurse encourages a new mother to breastfeed her infant, even for a short time, because
colostrum will provide the infant with which of the following types of immunity?
a. Innate
b. Active
c. Passive
d. Cell-mediated

Answer 4

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. Innate immunity is present at birth and occurs without
exposure to an antigen. Active immunity requires that the infant manufacture antibodies
after exposure to an antigen. Cell-mediated immunity is acquired through T-lymphocytes
and is a form of active immunity.

Question 5

The nurse is assessing a client for possible atopic dermatitis. Which of the following
laboratory values should the nurse review?
a. IgE
b. IgA
c. Basophils
d. Neutrophils

Answer 5

A
Serum IgE causes the symptoms of allergic reactions and is elevated in 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 client who has symptoms of atopic dermatitis.

Question 6

The nurse is conducting an annual health examination on an older adult client who states,
“I don’t understand why I need to have so many cancer screening tests now. I feel just
fine!” Based upon this statement, which of the following topics will the nurse include in
the clients’ teaching plan?
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

Answer 6

A
The primary impact of aging on immune function is on the activity of T cells, which are
responsible for tumour immunity. Antibody function is not impacted as much by aging and
does not protect against malignancy. Poor nutrition does contribute to decreased immunity,
but there is no evidence that it is a contributing factor for this client. Although some types
of cancers are associated with specific infections, this client does not have an active
infection.

Question 7

The nurse discusses the prevention and management of allergic reactions with a client who
is a beekeeper and has developed a hypersensitivity to bee stings. Which of the following
client statements indicates a need for additional teaching?

a. “I will plan to take oral antihistamines daily before going to work.”
b. “I will get a prescription for epinephrine and learn to self-inject it.”
c. “I should wear a Medic Alert bracelet indicating my allergy to bee stings.”
d. “I am going to need job retraining so that I can work in a different occupation.”

Answer 7

A
Since the client 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 client’s hypersensitivity reaction. The other client statements indicate a good
understanding of management of the problem.

Question 8

Which of the following instructions should the nurse include when teaching a client with
possible allergies about intradermal skin testing?
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 20–30 minutes after the testing.”
d. “Reaction to the testing will take about 48–72 hours to occur.”

Answer 8

C
Allergic reactions usually occur within minutes after injection of an allergen, and the client
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.

Question 9

The nurse is caring for a client who receives weekly immunotherapy and has missed the
previous appointment. Which of the following actions should the nurse implement when
the client comes for the next injection?
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 client’s sensitivity to the allergen with a repeat skin test.

Answer 9

C
Because there is an increased risk for adverse reactions after a client 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.

Question 10

The nurse is obtaining a health history from a client who works as a laboratory technician
and learns that the client has a history of allergic rhinitis, asthma, and multiple food
allergies. Which of the following actions is most important for the nurse to implement?
a. Encourage the client to carry an epinephrine kit in case a type IV allergic reaction
to latex develops.
b. Advise the client to use oil-based hand creams to decrease contact with natural
proteins in latex gloves.
c. Document the client’s allergy history and be alert for any clinical manifestations of
a type I latex allergy.
d. Recommend that the client use vinyl gloves instead of latex gloves in preventing
bloodborne pathogen contact.

Answer 10

C
The client’s allergy history and occupation indicate a risk for development of latex allergy,
and the nurse should be prepared to manage any symptoms that 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.

Question 11

A client diagnosed with systemic lupus erythematosus (SLE) is scheduled for
plasmapheresis. Which of the following pathophysiological events should the nurse plan to
teach the client about this procedure?
a. It eliminates eosinophils and basophils from blood.
b. It removes antibody-antigen complexes from circulation.
c. It prevents foreign antibodies from damaging various body tissues.
d. It decreases the damage to organs caused by attacking T-lymphocytes.

Answer 11

B
Plasmapheresis is used in SLE to remove antibodies, antibody-antigen complexes, and
complement from blood. T-lymphocytes, foreign antibodies, eosinophils, and basophils do
not contribute to the tissue damage in SLE.

Question 12

Which of the following adverse reactions should the nurse monitor when a client is
undergoing plasmapheresis?
a. Shortness of breath
b. High blood pressure
c. Transfusion reactions
d. Hypotension and paresthesia

Answer 12

D
Hypotension and paresthesia may occur as the result of plasmapheresis. Citrate is used as
an anticoagulant and may cause hypocalcemia, which may manifest as headache,
paresthesias, and dizziness. The other clinical manifestations are not associated with
plasmapheresis.

Question 13

The nurse is completing an assessment and health history with a client. Which of the
following statements made by the client should 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 two 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.”

Answer 13

C
Splenectomy increases the risk for septicemia from bacterial infections. The client’s
protein intake is good and should improve immune function. Daily Aspirin use does not
impact immune function. A chest x-ray does not have enough radiation to suppress
immune function.

Question 14

The nurse is caring for a client who had a bone marrow transplant for treatment of
leukemia and has developed a skin rash 10 days after the transplant. The nurse recognizes
this reaction as an indication of which of the following?
a. Donor T cells are attacking the client’s skin cells.
b. The client’s antibodies are rejecting the donor bone marrow.
c. The client is experiencing a delayed hypersensitivity reaction.
d. The client will need treatment to prevent hyperacute rejection.

Answer 14

A
The client’s history and symptoms indicate that the client is experiencing graft-versus-host
disease, in which the donated T cells attack the client’s tissues. The history and symptoms
are not consistent with rejection or delayed hypersensitivity.

Question 15

The nurse is caring for a client who has experienced Goodpasture’s syndrome. Which of
the following adverse effects should the nurse be aware of?
a. Thrombocytopenia
b. Leukopenia
c. Angioedema
d. Pulmonary hemorrhage

Answer 15

D
Goodpasture’s syndrome is a rare disorder involving the lungs and the kidneys. An
antibody-mediated autoimmune reaction occurs involving the glomerular and alveolar
basement membranes. The circulating antibodies combine with tissue antigen to activate
the complement system which causes deposits of IgG to form along the basement
membranes of the lungs or the kidneys. This reaction may result in pulmonary hemorrhage
and glomerulonephritis.

Question 16

The nurse is teaching a client on immunosuppressant therapy after a kidney transplant
about the post-transplant drug regimen. Which of the following statements by the client
should alert the nurse that additional teaching is required?
a. “If I develop an acute rejection episode, I will need to have other types of drugs
given IV.”
b. “I need to be monitored closely because I have a greater chance of developing
malignant tumours.”
c. “After a couple of years, it is likely that I will be able to stop taking the calcineurin
inhibitor.”
d. “The drugs are given in combination because they inhibit different aspects of
transplant rejection.”

Answer 16

C
The calcineurin inhibitor will need to be continued for life. The other client statements are
accurate and indicate that no further teaching is necessary about those topics.

Question 17

Which of the following adverse effects is related to cyclosporine administration?
a. Nephrotoxicity
b. Aseptic necrosis
c. Peptic ulcer
d. Leukopenia

Answer 17

A
Nephrotoxicity is the most severe adverse effect of cyclosporine. Aseptic necrosis, peptic
ulcer, and leukopenia are all adverse effects of the use of corticosteroids, for example,
prednisone.

Question 18

The nurse is admitting a client to the hospital with a diagnosis of an acute rejection of a
kidney transplant. Which of the following actions should the nurse anticipate
implementing?
a. Administration of immunosuppressant medications
b. Insertion of an arteriovenous graft for hemodialysis
c. Placement of the client on the transplant waiting list
d. Drawing blood for human leukocyte antigen (HLA) and ABO compatibility
matching

Answer 18

A
Acute rejection is treated with the administration of additional immunosuppressant drugs
such as corticosteroids. Because acute rejection is reversible, there is no indication that the
client will require another transplant, hemodialysis, or HLA/ABO testing.

Question 19

The nurse is admitting a client to hospital who has an acute rejection of an organ transplant.
Which of the following clients is the most appropriate roommate?

a. A client who has viral pneumonia
b. A client with second-degree burns
c. A client who is recovering from an anaphylactic reaction to a bee sting
d. A client with graft-versus-host disease after a recent bone marrow transplant

Answer 19

C
Treatment for a client with acute rejection includes administration of additional
immunosuppressants, and the client should not be exposed to increased risk for infection
as would occur from clients with viral pneumonia, graft-versus-host disease, and burns.
There is no increased exposure to infection from a client with anaphylaxis.

Question 20

For early detection of an anaphylactic reaction in a client who has received allergen testing
using the cutaneous scratch method, which of the following actions should the nurse take
first?
a. Check blood pressure and pulse rate.
b. Auscultate the lung sounds bilaterally.
c. Monitor pupil size and reaction to light.
d. Assess the arm at the site of the skin testing.

Answer 20

D
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 the
progression to anaphylaxis.

Question 21

After being stung by a wasp, a client is brought to the clinic by a coworker. Upon arrival
the client is anxious and having difficulty breathing. Which of the following actions is
priority for the nurse to implement?
a. Have the client lie down.
b. Assess the client’s airway.
c. Administer high-flow oxygen.
d. Remove the stinger from the site.

Answer 21

B
The initial action with any client 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.

Question 22

Immediately after the nurse administers an intradermal injection of an allergen on the
forearm, a client complains of itching at the site and of weakness and dizziness. Which of
the following actions is priority for the nurse to implement?
a. Remind the client to remain calm.
b. Administer subcutaneous epinephrine.
c. Apply a tourniquet above the injection site.
d. Rub a local anti-inflammatory cream on the site.

Answer 22

C
Application of a tourniquet will decrease systemic circulation of the allergen and should
be the first reaction. A local anti-inflammatory 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 client to remain calm, but this is not
an adequate initial nursing action.

Question 23

The nurse is caring for a client at an outpatient clinic who is experiencing an allergic
reaction to an unknown allergen. Which of the following actions is most appropriate for
the nurse to implement?
a. Perform a focused physical assessment.
b. Obtain the health history from the client.
c. Teach the client about the various diagnostic studies.
d. Administer skin testing by the cutaneous scratch method.

Answer 23

D
The immediate priority is to administer skin testing by the cutaneous scratch method as the
client is experiencing an allergic reaction. After the allergic reaction is treated, an
assessment of health history, focused physical assessment, and client teaching could
follow.

Question 24

To determine whether a client’s angioedema has responded to prescribed therapies, which
of the following actions should the nurse take first?
a. Ask about any clear nasal discharge.
b. Obtain blood pressure and heart rate.
c. Check for swelling of the lips and tongue.
d. Assess extremities for wheal and flare lesions.

Answer 24

C
Angioedema is characterized by swelling of the eyelids, lips, and tongue. Wheal and flare
lesions; clear nasal drainage; and hypotension and tachycardia are characteristics of other
allergic reactions.

Question 25

Which information about client and donor tissue typing results for a client who needs a
kidney transplant is most important for the nurse to communicate to the health care
provider?
a. Client is Rh positive and donor is Rh negative.
b. Six antigen matches are present in HLA typing.
c. Results of client-donor crossmatching are positive.
d. Panel of reactive antibodies (PRA) percentage is low.

Answer 25

C
Positive crossmatching is an absolute contraindication to kidney transplantation, since
hyperacute rejection will occur after the transplant. The other information indicates that
the tissue match between the client and potential donor is acceptable.

Question 26

Which information about a client who is receiving immunotherapy and has just received
an allergen injection is most important to communicate to the health care provider?
a. The client’s IgG level is increased.
b. The injection site is red and swollen.
c. The client’s allergy symptoms have not improved.
d. There is a 3-cm wheal at the site of the allergen injection.

Answer 26

D
A local reaction larger than quarter size may indicate that a decrease in the allergen dose is
needed. An increase in IgG indicates that the therapy is effective. Redness and swelling at
the site are not unusual. Because immunotherapy usually takes 1–2 years to achieve an
effect, an improvement in the client’s symptoms is not expected after a few months.