Lewis Chapter 16: Altered Immune Response and Transplantation Flashcards
Which of the following statements made by the nurse is most appropriate in teaching patient interventions to minimize the effects of seasonal allergic rhinitis?
A. “You will need to get rid of your pets.”
B. “You should sleep in an air-conditioned room.”
C. “You would do best to stay indoors during the winter months.”
D. “You will need to dust your house with a dry feather duster twice a week.”
B. Seasonal allergic rhinitis is most commonly caused by pollens from trees, weeds, and grasses. Airborne allergies can be controlled by sleeping in an air-conditioned room, daily damp dusting, covering the mattress and pillows with hypoallergenic covers, and wearing a mask outdoors.
Ten days after receiving a bone marrow transplant, a patient has developed a skin rash on their palms and soles, jaundice, and diarrhea. Which of the following is the most likely etiology of these clinical manifestations?
A. The patient is experiencing a type I allergic reaction.
B. An atopic reaction is causing the patient’s symptoms.
C. The patient is experiencing rejection of the bone marrow.
D. Cells in the transplanted bone marrow are rejecting the host tissue.
D. The patient’s symptoms are characteristic of graft-versus-host (GVH) disease, in which transplanted cells mount an immune response to the host’s tissue. GVH is not a type I allergic response or an atopic reaction, and it differs from transplant rejection in that the graft rejects the host rather than the host rejecting the graft.
The nurse is caring for a patient with a low hemoglobin and hematocrit and is preparing for a transfusion of packed red blood cells (PRBCs). Shortly after the first unit of PRBCs is hung, the patient develops signs and symptoms of a transfusion reaction. Which of the following hypersensitivity reactions has the patient experienced?
A. Type I
B. Type II
C. Type III
D. Type IV
B. Transfusion reactions are characterized as a type II (cytotoxic) reaction in which agglutination and cytolysis occur.
The nurse is caring for a patient that has begun immunotherapy for the treatment of intractable environmental allergies. When administering the patient’s immunotherapy, which of the following interventions is the nurse’s priority action?
A. Monitoring the patient’s fluid balance.
B. Assessing the patient’s need for analgesia.
C. Assessing the patient for changes in level of consciousness.
D. Monitoring for signs and symptoms of an adverse reaction.
D. When administering immunotherapy, it is imperative to closely monitor the patient for any signs of an adverse reaction. The high risk and significant consequence of an adverse reaction supersede the need to assess the patient’s fluid balance, whereas pain and changes in level of consciousness are not likely events when administering immunotherapy.
Which of the following statements regarding passive acquired immunity is true?
A. The body synthesizes antibodies to an antigen.
B. Immunity is developed immediately and is long-lasting.
C. Immunity is developed immediately and is short-lived.
D. Immunity is developed slowly and is long-lasting.
C. Passive acquired immunity has immediate effect, but because antibodies are not synthesized by the host, memory cells are not retained and immunity is short-lived.
When caring for a patient with a known latex allergy, the nurse would monitor the patient closely for a cross-sensitivity to which of the following foods? (Select all that apply.)
A. Grapes
B. Oranges
C. Bananas
D. Potatoes
E. Tomatoes
A, C, D, E.
Because some proteins in rubber are similar to food proteins, some foods may cause an allergic reaction in people who are allergic to latex. The most common of these foods are bananas, avocados, chestnuts, kiwi, tomatoes, water chestnuts, guava, hazelnuts, potatoes, peaches, grapes, and apricots.
What is the function of monocytes in immunity?
a. They stimulate the production of T and B lymphocytes.
b. They produce antibodies on exposure to foreign substances.
c. They bind antigens and stimulate natural killer cell activation.
d. They capture antigens by phagocytosis and present them to lymphocytes.
D.
Which of the following is a function of cell-mediated immunity?
a. Formation of antibodies
b. Activation of the complement system
c. Surveillance for malignant cell changes
d. Opsonization of antigens to allow phagocytosis by neutrophils
C.
Which immunoglobulin from maternal transmission protects newborns in the first 3 to 6 months of life from bacterial infections?
a. IgG
b. IgA
c. IgM
d. IgE
A.
Which primary immunological disorder typically occurs in a type I hypersensitivity reaction?
a. Binding of IgG to an antigen on a cell surface
b. Deposit of antigen–antibody complexes in small vessels
c. Release of lymphokines to interact with specific antigens
d. Release of chemical mediators from IgE-bound mast cells and basophils
D.
Which response alerts the nurse that a possible anaphylactic shock reaction may be occurring immediately after a client has received an intramuscular penicillin injection?
a. Edema and itching at the injection site
b. Sneezing and itching of the nose and eyes
c. A wheal-and-flare reaction at the injection site
d. Chest tightness and production of thick sputum
A.
Which is the most appropriate response when a person requests a friend who is a nurse to administer his allergy shot?
a. It is illegal for nurses to administer injections outside of a medical setting.
b. The nurse is qualified to do it if the friend has epinephrine in an injectable syringe provided with his extract.
c. Avoiding the allergens is a more effective way of controlling allergies, and allergy shots are not usually effective.
d. Immunotherapy should be administered only in a setting where emergency equipment and medications are available.
D.
Association between HLA antigens and diseases is most commonly found in what disease conditions?
a. Malignancies
b. Infectious diseases
c. Neurological diseases
d. Autoimmune disorders
D.
A client is undergoing plasmapheresis for treatment of SLE. What effect does plasmapheresis have?
a. Removes T lymphocytes in the client’s blood that are producing antinuclear antibodies
b. Removes normal particles in the client’s blood that are being damaged by autoantibodies
c. Exchanges the client’s plasma that contains antinuclear antibodies with a substitute fluid
d. Replaces viral-damaged cellular components of the client’s blood with replacement whole blood
C.
What is the most common cause of secondary immunodeficiencies?
a. Medications
b. Stress
c. Malnutrition
d. Human immunodeficiency virus
A.
Which of the following accurately describes rejection after transplantation?
a. Hyperacute rejection can be treated with mycophenolate mofetil.
b. Acute rejection can be treated with sirolimus or tacrolimus.
c. Chronic rejection can be treated with tacrolimus or cyclosporin.
d. Hyperacute rejection can usually be avoided if crossmatching is done before transplantation.
D.
Which of the following does the nurse understand regarding acute rejection of a transplanted lung? (Select all that apply.)
a. A new transplant should be considered immediately.
b. Acute rejection can be treated with high-dose corticosteroids.
c. Acute rejection always leads to chronic rejection.
d. Acute rejection is treated with muromonab-CD3.
e. Acute rejection is common after a transplant and is treated with augmentation of immunosuppression.
B, E.
Which of the following statements best describes cardiac death in a deceased donor?
a. Severe brain damage; coma has progressed to a state of wakefulness without detectable awareness
b. Irreversible loss of all functions of the entire brain, including the brainstem
c. Devastating and irreversible brain injuries (not complete brain death) from trauma or intracranial bleeding; complete cessation of the heartbeat may have occurred, and after subsequent cardiac resuscitation, irreversible brain injury results from a long period of lack of oxygen
d. Inability to be awakened; fails to respond normally to pain or light, does not have sleep–wake cycles, and does not take voluntary actions
C.
Which symptom may occur with the presence of allergies? Select all that apply. One, some, or all responses may be correct.
A. Chest tightness
B. Vomiting
C. Weight loss
D. Fatigue
E. Food intolerances
A, B, D, E.
Which area of the body would the nurse prepare when caring for a patient scheduled for allergy testing? Select all that apply. One, some, or all responses may be correct.
A. Face
B. Trunk
C. Buttocks
D. Arms
D.
