IMMUNITY/HIV: Lewis Ch 13: Immune Responses and Transplantation Flashcards
The nurse provides discharge instructions to a patient who has an immune deficiency involving the T lymphocytes. Which health screening should the nurse include in the teaching plan for this patient?
a. Screening for cancers
b. Screening for allergies
c. Screening for antibody deficiencies
d. Screening for autoimmune disorders
a. Screening for cancers
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.
Which example should the nurse use to explain an infant’s “passive immunity” to a new mother?
a. Vaccinations
b. Breastfeeding
c. Stem cells in peripheral blood
d. Exposure to communicable diseases
b. Breastfeeding
Colostrum in breast milk 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. Stem cells are unspecialized cells used to repopulate a person’s bone marrow after high-dose chemotherapy.
A patient is being evaluated for possible atopic dermatitis. The nurse should expect elevation of which laboratory value?
a. IgA
b. IgE
c. Basophils
d. Neutrophils
b. IgE
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 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 checkup 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. Incidence of cancer-associated infections in older adults
d. Impact of poor nutrition on immune function in older adults
a. Consequences of aging on cell-mediated immunity
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 by the patient would indicate a need for additional teaching?
a. “I need to find a different way to earn extra money.”
b. “I will take oral antihistamines before going to work.”
c. “I can get a prescription for epinephrine and learn to self-inject it.”
d. “I should wear a Medic-Alert bracelet indicating my allergy to bee stings.
b. “I will take oral antihistamines before going to work.”
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 information about intradermal skin testing should the nurse teach 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.”
c. “Plan to wait in the clinic for 20 to 30 minutes after the testing.”
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 reviewing a clinic patient’s medical record notes that the patient missed the previous appointment for weekly immunotherapy. Which action by the nurse is appropriate?
a. Schedule an additional dose the following week.
b. Administer the scheduled dosage of the allergen.
c. Consult with the health care provider about giving a lower allergen dose.
d. Reevaluate the patient’s sensitivity to the allergen with a repeat skin test.
c. Consult with the health care provider about giving a lower allergen dose.
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.
The nurse taking a health history learns that the patient, who has worked in rubber tire manufacturing, has allergic rhinitis and multiple food allergies. Which action by the nurse is correct?
a. Recommend that the patient use latex gloves in preventing blood-borne pathogen contact.
b. Document the patient’s history and teach about clinical manifestations of a type I latex allergy.
c. Encourage the patient to carry an epinephrine kit in case a type IV allergic reaction to latex develops
d. Tell the patient to use oil-based hand creams to decrease contact with natural proteins in latex gloves.
b. Document the patient’s history and teach about clinical manifestations of a type I latex allergy.
The patient’s allergy history and occupation indicate a risk of developing a latex allergy. Teach the patient about symptoms that may occur. Epinephrine is not an appropriate treatment for contact dermatitis that is caused by a type IV allergic reaction to latex. Using latex gloves increases the chance of developing latex sensitivity. Oil-based creams will increase the exposure to latex from latex gloves.
What instructions about plasmapheresis should the nurse include in the teaching plan for a patient diagnosed with systemic lupus erythematosus (SLE)?
a. Plasmapheresis counteracts recovery of IgG production.
b. Plasmapheresis removes eosinophils and basophils from the blood.
c. Plasmapheresis decreases the damage to organs from T lymphocytes.
d. Plasmapheresis prevents inflammatory mediators from injuring tissues.
d. Plasmapheresis prevents inflammatory mediators from injuring tissues.
Plasmapheresis is used in SLE to remove antibodies, antibody-antigen complexes, and inflammatory mediators, such as complement, from the blood. T lymphocytes, foreign antibodies, eosinophils, and basophils do not directly contribute to the tissue damage in SLE. Immunosuppressive therapy is used to prevent recovery of IgG production.
The nurse should assess the patient undergoing plasmapheresis for which clinical manifestation?
a. Shortness of breath
b. High blood pressure
c. Transfusion reaction
d. Extremity numbness
d. Extremity numbness
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 risk for decreased immune function?
a. “I had a chest x-ray 6 months ago.”
b. “I had my spleen removed after a car accident.”
c. “I take one baby aspirin every day to prevent stroke.”
d. “I usually eat eggs or meat for at least two meals a day.”
b. “I had my spleen removed after a car accident.”
Which patient should the nurse assess first?
a. Patient with urticaria after receiving an IV antibiotic
b. Patient who is sneezing after subcutaneous immunotherapy
c. Patient who has graft-versus-host disease and severe diarrhea
d. Patient with multiple chemical sensitivities with muscle stiffness
b. Patient who is sneezing after subcutaneous immunotherapy
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 should the nurse suspect is the cause of the rash?
a. The donor T cells are attacking the patient’s skin cells.
b. The patient needs treatment to prevent hyperacute rejection.
c. The patient’s antibodies are rejecting the donor bone marrow.
d. The patient is experiencing a delayed hypersensitivity reaction.
a. The donor T cells are attacking the patient’s skin cells.
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.
A 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 expect to administer?
a. Corticosteroids
b. Gamma globulin
c. Hepatitis B vaccine
d. Fresh frozen plasma
b. Gamma globulin
The patient should first receive antibodies for hepatitis B from injection of gamma globulin.
The hepatitis B vaccination series should be started to provide active immunity. Fresh frozen
plasma and corticosteroids will not be effective in preventing hepatitis B in the patient.
The nurse teaches a patient about drug therapy after a kidney transplant. Which statement by the patient would indicate a need for further instructions?
a. “I need to be monitored closely for development of cancer.”
b. “After a couple of years, I will be able to stop taking the cyclosporine.”
c. “If I develop acute rejection episode, I will need additional types of drugs.”
d. “The drugs are combined to inhibit different ways the kidney can be rejected.”
b. “After a couple of years, I will be able to stop taking the cyclosporine.”
Cyclosporine, a calcineurin inhibitor, will need to be continued for life. The other patient statements are accurate and indicate that no further teaching is necessary about those topics.