Chapter 38-agents that affect immunity

Question 1

When teaching the client about his prescribed immune globulin, the nurse recognizes the client understands the instructions when he comments:

Answer 1

“This will give me passive immunity.”-This is an example of passive immunity.

Question 2

The nurse recognizes which of the following drugs is used as an immunosuppressant agent in small doses and as an antineoplastic agent in large doses?

Answer 2

methotrexate- Methotrexate and cyclophosphamide are used as immunosuppressant agents in small doses and as antineoplastic agents in large doses.

Question 3

The Vaccine Injury Compensation Act requires that a written record of vaccines be maintained of all the following information EXCEPT:

Answer 3

injection site of vaccination-This is not required information according to this legislation; however, most health care facilities require this information to be documented on facility records.

Question 4

When administering antivenin to a client bitten by a rattlesnake, the nurse should:

Answer 4

observe the client for pain, swelling, or shortness of breath.- These are manifestations indicating more antivenin may be needed.

Question 5

The nurse monitors a young child following routine immunizations for which of the following indications of a severe reaction?

Answer 5

high-pitched, shrill crying-This indicates a severe neurological reaction.

Question 6

A client unable to take cyclosporine oral solution is prescribed the IV form. The nurse anticipates the IV dose should be:

Answer 6

one third of the oral dose.

Question 7

The nurse working in the well-baby clinic prepares to administer immunizations to a 4-month-old infant, including:

Answer 7

DTaP #2, Hib #2, IPV #2, PCV #2.

Question 8

Lysozymes are enzymes that:

Answer 8

attack the cell walls of bacteria.

Question 9

A client is diagnosed with an autoimmune disease. The nurse would anticipate the use of what classification of drug to treat this client?

Answer 9

immunosuppressant agents-This classification of agents is used to treat autoimmune diseases.

Question 10

When providing a client with active immunization, the nurse will need to administer an:

Answer 10

antigen- An antigen must be administered to provide active immunity.

Question 11

A 12-month-old child is scheduled to receive his immunizations according to the Recommended Childhood and Adolescent Immunization Schedule. The nurse prepares:

Answer 11

Hib #3, IPV #3, MMR #1, Varicella #1, PCV #4, and yearly influenza.

Question 12

A renal transplant client is prescribed azathioprine to prevent rejection. The nurse should:

Answer 12

monitor the client’s uric acid level.- This is a chemical derivative of 6-mercaptopurine that can increase uric acid levels

Question 13

A liver transplant client is prescribed azathioprine and allopurinol. The nurse understands that when these two agents are used together:

Answer 13

the dose of the azathioprine is reduced to one fourth to one third of the normal dose.-

Question 14

The nurse working in the clinic has what drug available when administering vaccines?

Answer 14

epinephrine

Question 15

The nurse working in the well-baby clinic is preparing to immunize a 15-month-old toddler by preparing which site?

Answer 15

vastus lateralis muscle -This is the site used for IM injections for infants and young children because it is the largest muscle in these children.

Question 16

According to the “Recommended Childhood and Adolescent Immunization Schedule, 2006,” individuals should receive how many doses of measles, mumps, and rubella (MMR)?

Answer 16

two- The first MMR is given between 12 to 18 months, and the second is given at 4 to 6 years (prior to entering school).

Question 17

A child is receiving a maintenance dose of azathioprine following his bone marrow transplant. The recommended maintenance dose is 1–3 mg/kg/day. What is the maximum this child weighing 44 pounds should receive?

Answer 17

60 mg/day-44 pounds divided by 2.2 = 20 kg; multiplied by 1 = 20 mg; 20 kg multiplied by 3 = 60 mg. So the maximum dose for this child would be 60 mg/day.

Question 18

Following a bone marrow transplant, a client weighing 132 pounds is prescribed tacrolimus. The recommended dose range for tacrolimus is 0.05–0.1 mg/kg/day. The recommended minimum dose for this client is:

Answer 18

3 mg/day- 132 pounds divided by 2.2 = 60; multiplied by 0.05 = 3 mg/day.

Question 19

For clients receiving immunosuppressants, the priority goal of nursing care is:

Answer 19

prevention of infection.-This is the priority goal of nursing care for clients receiving immunosuppressant agents.

Question 20

This is the priority goal of nursing care for clients receiving immunosuppressant agents.

Answer 20

assess the client’s mouth and gums.- Cyclosporine can cause gum hyperplasia, so gum condition or oral mucous membranes should be assessed.

Question 21

After teaching a client prescribed oral cyclosporine following his heart transplant, the nurse recognizes client understanding of the instructions when he responds:

Answer 21

“I can dilute my medication in chocolate milk or orange juice.”

Question 22

The nurse would prepare to administer basiliximab by which route?

Answer 22

IV

Question 23

Which of the following is the means of transmission for H1N1 virus?

Answer 23

respiratory droplets

Question 24

Which of the following is true concerning Anthrax vaccine?

Answer 24

It is administered IM.

Question 25

Which of the following individuals should receive the hepatitis B immunization series? Select all that apply.

Answer 25

a. mortician
b. nurse
d. prostitute
f. users of illicit injectable drugs
- -These are individuals with high risk of exposure to this bloodborne infection.

Question 26

The nurse recognizes which of the following as immunosuppressants used to prevent organ rejection following transplantation? Select all that app

Answer 26

a. cyclosporine
b. daclizumab
c. muromonab-CD3
e. myophenolate mofetil HCl
f. basiliximab

Question 27

When caring for a client receiving an immunosuppressant agent, the nurse should report which of the following values? Select all that apply.

Answer 27

a. leukocyte count of 15,000 cells/mm3
b. leukocyte count of 1,300 cells/mm3
c. neutrophil count 450 cells/mm3

Question 28

The nurse is preparing to administer scheduled immunizations to a 5-year-old prior to beginning kindergarten. The nurse should administer which of the following? Select all that apply.

Answer 28

a. Varicella #2
b. IVP #5
c. MMR #2
d. DTaP #5

Question 29

The client receiving cyclosporine would be monitored for which of the following? Select all that apply.

Answer 29

b. opportunistic infections
c. renal dysfunction
d. hirsutism
e. acne

Question 30

Which of the following information provided by the nurse recruit is correct concerning Gaucher’s disease? Select all that apply.

Answer 30

a. There are three types of the disease primarily differentiated by absence or presence of brain involvement.
b. It is the most common genetic disorder affecting the Jewish population of eastern European descent.
c. Harmful quantities of glucocerebroside accumulate in some areas of the body.
d. The client may present with S/S of thrombocytopenia.
e. The client is susceptible to pathological fractures.