Question 1

A patient who is employed as a laboratory technician is scheduled for surgery. While obtaining a health history from the patient, the nurse learns that the patient has a history of allergic rhinitis, asthma, and multiple food allergies. It is important that the nurse

Accepted Answer

The patient'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 in unlikely.

Question 2

An older patient at the clinic for an annual examination tells the nurse, "I don't understand why I need to have so many cancer screening tests now. I feel just fine!" The nurse will plan to teach the patient about the

Accepted Answer

The primary impact of aging on immune function is on the activity of T cells, which are responsible for tumor 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 patient. Although some types of cancer are associated with specific infections, this patient does not have an active infection.

Question 3

Immediately after the nurse administers an intracutaneous injection of an allergen on a patient's forearm, the patient complains of itching at the site and of weakness and dizziness. The nurse should first

Accepted Answer

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 patient should be reassured, but this is not an adequate initial nursing action.

Question 4

In counseling a couple when the man has sickle cell disease, an autosomal-recessive disorder, and the woman has no gene for sickle cell disease, the nurse uses Punnett squares to show the couple that the probability of them having a child with sickle cell disease is

Accepted Answer

When one parent has no gene for an autosomal-recessive disorder, the children will not display the characteristics of the disorder, although the children will be carriers of sickle cell trait.

Question 5

After being bitten by an unknown insect, a patient allergic to wasp stings is brought to a clinic by a co-worker. Upon arrival the patient is anxious and having difficulty breathing. The first action by the nurse is to

Accepted Answer

The initial action with any patient with difficulty breathing is to assess and maintain the airway. The other actions are also part of the emergency management protocol for anaphylaxis, but the priority is airway maintenance.

Question 6

A patient develops a severe angioedema involving the face, hands, and feet, with burning and stinging of the lesions. A significant risk factor for allergies that the nurse questions the patient about is

Accepted Answer

A genetic predisposition to develop allergic reactions exists, although the specific allergy may be different in individual family members. Living in an underdeveloped country, upper respiratory infections, and fungal infections are not risk factors for allergic reactions.

Question 7

The nurse obtains all this information about a patient who has been receiving immunotherapy for several months and is waiting in the clinic after receiving the allergen injection. Which information should the nurse communicate to the health care provider?

Accepted Answer

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 to 2 years to achieve an effect, an improvement in the patient's symptoms is not expected after a few months.

Question 8

A young woman's mother has been diagnosed with BRCA gene-associated breast cancer. The patient asks the nurse, "Do you think I should be tested for the gene?" Which response by the nurse is most appropriate?

Accepted Answer

Although presymptomatic testing for genetic disorders allows patients to take action (such as mastectomy) to prevent the development of some genetically caused disorders, patients also need to consider that test results in their medical file may impact insurance, employability, etc. Telling a patient that a decision about mastectomy should be made before testing implies that the nurse has made a judgment about what the patient should do if the test is positive. Although the patient may need to think about her reaction if the test is positive, other issues (e.g., insurance) also should be considered. Although most breast cancers are not caused by the BRCA gene, the patient with the gene has a markedly increased risk for breast cancer.

Question 9

A patient with a severe allergic reaction receives epinephrine 1:10,000 0.5 ml IV. The next action that the nurse should take is to

Accepted Answer

After administration of epinephrine, the nurse should maximize oxygenation by administration of high-flow oxygen. The other actions are also appropriate, but oxygenation is the priority.

Question 10

A patient is being evaluated for possible atopic dermatitis. The nurse will review the patient's laboratory values for the level of

Accepted Answer

Serum IgE causes the symptoms of allergic reactions and is elevated in type 1 hypersensitivity disorders. 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 patient who has symptoms of atopic dermatitis.

Question 11

A patient who received a bone marrow transplant for treatment of leukemia develops a skin rash 10 days after the transplant. The nurse recognizes this reaction as an indication that the

Accepted Answer

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. Graft-versus-host disease cannot be prevented once it has occurred.

Question 12

A patient diagnosed with systemic lupus erythematosus (SLE) is scheduled for plasmapheresis. The nurse plans to teach the patient that plasmapheresis will

Accepted Answer

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 13

A patient is treated at a clinic with an intramuscular (IM) injection of penicillin for a streptococcal throat infection. The patient's history reveals a prior penicillin injection with no allergic response. When the penicillin injection is administered, the nurse should tell the patient,

Accepted Answer

Allergic reactions usually occur within minutes after injection of an allergen, and the patient will be monitored for about 20 minutes after the penicillin is given. Once a patient has been initially exposed to an allergen such as penicillin, an allergic reaction may occur with any subsequent exposure. Although allergic reactions may occur immediately, they can occur several hours after exposure to the allergen. A fever or skin rash occurring in 24 to 48 hours is not typical of a penicillin reaction.

Question 14

The nurse encourages a new mother to breastfeed her infant, even for a short time, because colostrum will provide the infant with

Accepted Answer

Colostrum provides passive immunity through antibodies from the mother that protects the infant for a few months; however, memory cells are not retained, so the protection is not permanent. Active immunity requires that the infant manufacture antibodies after exposure to an antigen. Innate immunity occurs without exposure to an antigen and provides species-specific immunity and nonspecific immunity.

Question 15

A patient seen in the outpatient clinic has an immune deficiency involving the T-lymphocytes. The nurse should teach the patient about the need for more frequent screening for

Accepted Answer

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 16

The nurse discusses the prevention and management of allergic reactions with a beekeeper who has developed a hypersensitivity to bee stings. The nurse identifies a need for additional teaching when the patient states,

Accepted Answer

Corticosteroids have many systemic effects and are used chronically only when there is no alternative. The other statements by the patient are correct and indicate that teaching about these topics has been understood.

Question 17

A patient who receives weekly "allergy shots" at a clinic missed the previous appointment. When the patient comes for the next injection, the nurse should

Accepted Answer

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.

Question 18

To prevent anaphylaxis after a patient has received allergen testing using the cutaneous scratch method, the nurse should initially monitor the patient's

Accepted Answer

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 19

The nurse will monitor a patient who is undergoing plasmapheresis for

Accepted Answer

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.

Question 20

While the nurse is obtaining an assessment and health history from a patient, which statement by the patient will alert the nurse to a possible immunodeficiency disorder?

Accepted Answer

Splenectomy increases the risk for septicemia from bacterial infections. The patient's protein intake is good and should improve immune function. Walking with friends may reduce stress and improve immune function. A chest radiography does not have enough radiation to suppress immune function.

Quiz 14: Genetics, Altered Immune Responses, and Transplantation