LEWIS MED-SURG CH 14 EXAM REVIEW SOLUTION 2022
The nurse provides discharge instructions to a patient who has an immune
deficiency involving the T
... [Show More] lymphocytes. Which screening should the nurse include in
the teaching plan for this patient?
a. Screening for allergies
b. Screening for malignancy
c. Antibody deficiency screening
d. Screening for autoimmune disorders - ANS: B
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
A new mother expresses concern about her baby developing allergies and asks what
the health care provider meant by "passive immunity." Which example should the
nurse use to explain this type of immunity?
a. Early immunization
b. Bone marrow donation
c. Breastfeeding her infant
d. Exposure to communicable diseases - ANS: C
Colostrum 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. It requires that the infant has an
immune response after exposure to an antigen. Cell-mediated immunity is acquired
through T lymphocytes and is a form of active immunity
A patient is being evaluated for possible atopic dermatitis. The nurse expects
elevation of which laboratory value?
a. IgE
b. IgA
c. Basophils
d. Neutrophils - ANS: A
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
located 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 check-up 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. Impact of poor nutrition on immune function in older people
d. Incidence of cancer-stimulating infections in older individuals - ANS: A
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, if made by the patient, would
indicate a need for additional teaching?
a. "I need to find another way to earn extra money."
b. "I will get a prescription for epinephrine and learn to self-inject it."
c. "I will plan to take oral antihistamines daily before going to work."
d. "I should wear a Medic-Alert bracelet indicating my allergy to bee stings." - ANS: C
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 teaching should the nurse provide about intradermal skin testing 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." - ANS: C
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, who is reviewing a clinic patient's medical record, notes that the patient
missed the previous appointment for weekly immunotherapy. Which action by the
nurse is most appropriate?
a. Schedule an additional dose that week.
b. Administer the usual dosage of the allergen.
c. Consult with the health care provider about giving a lower allergen dose.
d. Re-evaluate the patient's sensitivity to the allergen with a repeat skin test. - ANS:
C
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... [Show Less]