Altered Immune Responses and
c. IgG d. IgM
9. Which immunoglobulins will initially protect a newborn baby of a breastfeeding mother (select all that apply)?
a. IgA b. IgD c. IgE d. IgG e. IgM
10. Which characteristic describes IgE (select all that apply)?
a. Assists in parasitic infections b. Responsible for allergic reactions c. Present on the lymphocyte surface d. Assists in B-lymphocyte differentiation e. Predominant in secondary immune response f. Protects body surfaces and mucous membranes
11. What are the important functions of cell-mediated immunity (select all that apply)?
a. Fungal infections b. Transfusion reactions
c. Rejection of transplanted tissues d. Contact hypersensitivity reactions
e. Immunity against pathogens that survive inside cells
12. A 69-yr-old woman asks the nurse whether it is possible to “catch” cancer because many of her friends of the same age have been diagnosed with different kinds of cancer. In responding to the woman, the nurse understands that which factor increases the incidence of tumors in older adults?
a. An increase in autoantibodies
b. Decreased activity of the bone marrow c. Decreased differentiation of T lymphocytes d. Decreased size and activity of the thymus gland
13. What describes the occurrence of a type IV or delayed hypersensitivity reaction?
a. Antigen links with specific IgE antibodies bound to mast cells or basophils releasing chemical mediators
b. Cellular lysis or phagocytosis through complement activation following antigen-antibody binding on cell surfaces
c. Sensitized T lymphocytes attack antigens or release cytokines that attract macrophages that cause tissue damage
d. Antigens combined with IgG and IgM too small to be removed by mononuclear phagocytic system deposit in tissue and cause fixation of complement
14. What are examples of type I or IgE-mediated hypersensitivity reactions (select all that apply)?
a. Asthma b. Urticaria c. Angioedema d. Allergic rhinitis e. Atopic dermatitis f. Contact dermatitis g. Anaphylactic shock h. Transfusion reactions
i. Goodpasture syndrome
15. Which type of hypersensitivity reaction occurs with rheumatoid arthritis and acute glomerulonephritis?
a. Type I or IgE-mediated hypersensitivity reaction b. Type II or cytotoxic hypersensitivity reaction
c. Type III or immune-complex–mediated hypersensitivity reaction d. Type IV or delayed hypersensitivity reaction
16. For the patient with allergic rhinitis, which therapy should the nurse expect to be ordered first?
a. Corticosteroids b. Immunotherapy c. Antipruritic drugs
d. Sympathomimetic/decongestant drugs
17. A patient was given an IM injection of penicillin in the gluteus maximus and developed dyspnea and weakness within minutes following the injection. Which additional assessment findings indicate that the patient is having an anaphylactic reaction (select all that apply)?
a. Wheezing b. Hypertension c. Rash on arms d. Constricted pupils e. Slowed strong pulse f. Feeling of impending doom
18. Priority Decision: The patient is admitted from a nearby park with an apparent anaphylactic reaction to a bee sting. He is experiencing dyspnea and hypotension with swelling at the site.
Number the following in the order of priority that the nurse should implement the actions for this patient.
_____ a. Remove the stinger _____ b. Ensure a patent airway
_____ c. Prepare to administer epinephrine _____ d. Start IV for fluid and medication access
_____ e. Anticipate intubation with severe respiratory distress
_____ f. Have diphenhydramine (Benadryl) and nebulized albuterol available 19. Which rationale describes treatment of atopic allergies with immunotherapy?
a. It decreases the levels of allergen-specific T helper cells.
b. It decreases the level of IgE so that it does not react as readily with an allergen.
c. It stimulates increased IgG to bind with allergen-reactive sites, preventing mast cell–bound IgE reactions.
d. It gradually increases the amount of allergen in the body until it is no longer recognized as foreign and does not elicit an antibody reaction.
20. A nurse develops contact dermatitis after wearing latex gloves. What accurately describes this?
a. This demonstrates a type I allergic reaction to natural latex proteins.
b. Use of powder-free latex gloves prevents the development of symptoms.
c. Use of oil-based hand cream when wearing gloves prevents latex allergy.
d. This demonstrates a type IV allergic reaction to chemicals used in the manufacture of latex gloves.
21. A 32-yr-old male veteran tells the nurse he gets a headache, sore throat, shortness of breath, and nausea when his girlfriend wears perfume and when he was painting her apartment. He is afraid he has cancer. What does the nurse suspect may be the patient's problem?
a. He has posttraumatic stress disorder.
b. He has multiple chemical sensitivities.
c. He needs to wear a mask when he paints.
d. He is looking for an excuse to break up with his girlfriend.
22. Although the cause of autoimmune disorders is unknown, which factors are believed to be present in most conditions (select all that apply)?
a. Younger age b. Male gender
c. Inheritance of susceptibility genes d. Initiation of autoreactivity by triggers e. Frequent viruses throughout the lifetime
23. Why is plasmapheresis indicated in the treatment of autoimmune disorders?
a. To obtain plasma for analysis and evaluation of specific autoantibodies
b. To decrease high lymphocyte levels in the blood to prevent immune responses
c. To remove autoantibodies, antigen-antibody complexes, and inflammatory mediators of immune reactions
d. To add monocytes to the blood to promote removal of immune complexes by the mononuclear phagocyte system
24. Before the patient receives a kidney transplant, a crossmatch test is ordered. What does a positive crossmatch indicate?
a. Paternity and predicts risk for certain diseases b. Tissue type match for a successful transplantation c. Racial background and predicts risk for certain diseases
d. Cytotoxic antibodies to the donor, which contraindicate transplanting this donor's organ 25. What is the most common cause of secondary immunodeficiency disorders?
a. Chronic stress
b. T-cell deficiency from HIV
c. Drug-induced immunosuppression
d. Common variable hypogammaglobulinemia
26. Which characteristics are seen with acute transplant rejection (select all that apply)?
a. Treatment is supportive
b. Only occurs with transplanted kidneys c. Organ must be removed when it occurs
d. The recipient's T cytotoxic lymphocytes attack the foreign organ
e. Long-term use of immunosuppressants necessary to combat the rejection f. Usually reversible with additional or increased immunosuppressant therapy
27. The patient is experiencing fibrosis and glomerulopathy a year after a kidney transplant. Which type of rejection is occurring?
a. Acute b. Chronic c. Delayed d. Hyperacute
28. What are the most common immunosuppressive agents initially used to prevent rejection of transplanted organs?
a. Cyclosporine, sirolimus, and muromonab-CD3 b. Prednisone, polyclonal antibodies, and cyclosporine c. Azathioprine, mycophenolate mofetil, and sirolimus d. Tacrolimus, prednisone, and mycophenolate mofetil
29. The patient has received a bone marrow transplant. Soon after the transplant there is a rash on the patient's skin. She says her skin is itchy and she has severe abdominal pain. What best summarizes what is happening to the patient and how she will be treated?
a. Graft rejection occurring; treat with different immunosuppressive agents b. Dry skin and nausea are side effects of immunosuppressants; decrease the dose
c. Transplanted bone marrow is attacking her tissue; prevent with immunosuppressive agents d. Dry skin from the dry air and nausea from the food in the hospital; treat with humidifier and
home food
Case Study
Allergy
(©deeepblue/iStock/Thinkstock)
Patient Profile
M.W., a 70-yr-old male patient, has been diagnosed with chronic allergic rhinitis. His health care provider prescribed oral antihistamines for control of his symptoms, which have not been completely effective. He is to undergo skin testing to identify specific allergens.
Subjective Data
• Itching of eyes, nose, and throat
• Stuffy nose, head congestion Objective Data
• Clear nasal drainage; reddened eyes and lacrimation Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What assessments of M.W. should be included by the nurse?
2. What immunoglobulins and chemical mediators are involved in M.W.'s allergic reaction?
3. Describe the procedure the nurse uses to perform the skin testing. What results indicate a positive response?
4. Safety: What precautions should be taken by the nurse during skin testing?
5. Patient-Centered Care: How do antihistamines act to relieve allergic symptoms? What information should the nurse include in teaching M.W. about using the antihistamines?
6. Patient-Centered Care: Skin testing indicates M.W. has an allergy to household dust. What information should the nurse include in teaching M.W. to control his exposure to this allergen?
7. M.W. is to begin immunotherapy. What would be the advantages and disadvantages of using sublingual immunotherapy?
8. Safety: What precautions does the nurse use during the subcutaneous administration of the allergen extract?
9. Priority Decision: Based on the assessment data provided, what are the priority nursing diagnoses? Are there any collaborative problems?