Deck 12: Nursing Care of People With Altered Immunity

Question 1

A person tells the nurse, 'I had this rheumatoid arthritis pain under control, but then I learned I might lose my job'. Which of the following should the nurse say in response to this person?

A)'The pain will inevitably get worse'.
B)'You need to find a job more suited to your condition'.
C)'Stress can cause an exacerbation of the arthritis'.
D)'Have you considered going on disability?'

Answer 1

'You need to find a job more suited to your condition'.

Question 2

A person is found to be allergic to several foods from the food allergy testing. Which of the following should be done next to help this person?

A)Undergo patch testing.
B)Perform skin prick testing.
C)Undergo intradermal testing of the allergens with a negative response to prick testing.
D)Eliminate allergic foods from diet.

Answer 2

Eliminate allergic foods from diet.

Question 3

A person is prescribed a monoclonal antibody after an allograft. Which of the following should be done for this person?

A)Premedicate with hydrocortisone.
B)Encourage the person to have a chest x-ray one day after the first dose.
C)Closely observe the person for 24 hours following the initial dose.
D)Instruct the person that side effects from the medication are rare and minor.

Answer 3

Premedicate with hydrocortisone.

Question 4

A differential diagnosis for a person is food allergies. The nurse escorts the person into an examination room and begins to ask questions about what the person has most recently eaten. Which of the following has the nurse observed about this person?

A)Hives
B)Obesity
C)Malnutrition
D)Anorexia

Question 5

A person is diagnosed with a type IV hypersensitivity response. What will the person most likely need treatment with?

A)Antihistamines
B)Adrenaline
C)Plasmapheresis
D)Endotracheal intubation

Question 6

An adolescent asks the nurse about sexual practices and the risk of contracting HIV. Which of the following should the nurse instruct this person?

A)There is no such thing as safe sex.
B)Always use a condom.
C)The only totally safe sex is no sex.
D)Be sure to be tested for HIV every 6 months.

Question 7

An HIV-positive person is being treated with Nystatin suspension for oral thrush. Teaching by the nurse should include which of the following side effects?

A)'There are few side effects associated with the medication to treat thrush'.
B)'Nausea, vomiting and diarrhoea are common side effects'.
C)'Bone marrow depression can develop as a side effect'.
D)'Anaemia is a common side effect'.

Question 8

Before a bone marrow transplant, a person is prescribed ganciclovir. Which of the following should be included in the instructions to the person about this medication? It will:

A)reduce the likelihood of bacterial infections.
B)prevent the development of herpes pneumonia.
C)prevent the development of cytomegalovirus (CMV)pneumonia.
D)reduce the risk of an opportunistic systemic fungal.

Question 9

Which of the following conditions is an autoimmune disorder?

A)Osteoarthritis
B)Phenylketonuria
C)Non-insulin dependent (type 2)diabetes mellitus
D)Systemic lupus erythematosus (SLE)

Question 10

A person who received a kidney transplant 6 months prior is demonstrating an alteration in his blood urea nitrogen (BUN)level. The nurse realises that this person is demonstrating:

A)an acute tissue rejection.
B)evidence of improved kidney functioning.
C)an allergic response.
D)a functional decline as an early indicator of rejection.

Question 11

An HIV-positive person comes into the clinic complaining of increasing pain in his feet and legs. The nurse realises that this person is demonstrating a(n):

A)reaction to the antiviral medications.
B)nervous system manifestation of the disease.
C)secondary peripheral vascular disease.
D)minor opportunistic infection of the lower limbs.

Question 12

A person is demonstrating signs of anaphylactic shock. Which of the following should the nurse do first to assist this person?

A)Assess the respiratory rate and pattern.
B)Maintain an airway.
C)Insert an oropharyngeal airway.
D)Position in high Fowler's.

Question 13

A person tells the nurse, 'I get stomach pains and diarrhoea every time I drink milk'. This person is a type ________ allergic response.

A)I
B)II
C)III
D)IV

Question 14

Which is the most widely used screening test for HIV?

A)ELISA
B)IgE serum levels
C)CD4 cell count
D)HIV viral load test

Question 15

An HIV-positive person is not adhering to the prescribed medication therapy. Which of the following actions by the nurse will best improve compliance and long-term treatment of the disease process?

A)Discuss why the person is not adhering to the medication schedule.
B)Suggest that the person take the medication first thing in the morning to prevent nausea.
C)Refer the person to a social worker so that lower-cost medications can be obtained.
D)Confront the person about the noncompliant behaviour.

Question 16

A person is recovering from a skin graft where the skin of a pig is sutured to the person's ear. Which type of graft is this?

A)Xenograft
B)Allograft
C)Autograft
D)Isograft

Question 17

During the physical assessment of a person, the nurse wants to include the person's immunity function. Which of the following techniques would provide the nurse with the best information?

A)Auscultation of the heart
B)Palpation of the abdomen
C)Percussion of the lungs
D)Assessment of skin colour, temperature and moisture