Question 1

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

A)   allergies.
B)   malignancy.
C)   antibody deficiency.
D)   autoimmune disorders. B

Question 2

To determine whether a patient's angioedema has responded to prescribed therapies, which action should the nurse take first?

Accepted Answer

A)   Ask about any clear nasal discharge.
B)   Obtain blood pressure and heart rate.
C)   Check for swelling of the lips and tongue.
D)   Assess extremities for wheal and flare lesions. C

Question 3

When caring for a clinic patient who is experiencing an allergic reaction to an unknown allergen, which nursing activity is most appropriate for the RN to delegate to an LPN/LVN?

Accepted Answer

A)   Perform a focused physical assessment.
B)   Obtain the health history from the patient.
C)   Teach the patient about the various diagnostic studies.
D)   Administer skin testing by the cutaneous scratch method. D

Question 4

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

A)   donor T cells are attacking the patient's skin cells.
B)   patient's antibodies are rejecting the donor bone marrow.
C)   patient is experiencing a delayed hypersensitivity reaction.
D)   patient will need treatment to prevent hyperacute rejection.

Question 5

Which information about patient and donor tissue typing results for a patient who needs a kidney transplant is most important for the nurse to communicate to the health care provider?

Accepted Answer

A)   Patient is Rh positive and donor is Rh negative.
B)   Six antigen matches are present in HLA typing.
C)   Results of patient-donor cross matching are positive.
D)   Panel of reactive antibodies ( PRA )  percentage is low.

Question 6

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

Accepted Answer

A)   remind the patient to remain calm.
B)   administer subcutaneous epinephrine.
C)   apply a tourniquet above the injection site.
D)   rub a local anti-inflammatory cream on the site.

Question 7

After teaching a patient on immunosuppressant therapy after a kidney transplant about the posttransplant drug regimen, the nurse determines that additional teaching is needed when the patient says,

Accepted Answer

A)   "If I develop an acute rejection episode, I will need to have other types of drugs given IV."
B)   "I need to be monitored closely because I have a greater chance of developing malignant tumors."
C)   "After a couple of years, it is likely that I will be able to stop taking the calcineurin inhibitor."
D)   "The drugs are given in combination because they inhibit different aspects of transplant rejection."

Question 8

For early detection of an anaphylactic reaction in a patient who has received allergen testing using the cutaneous scratch method, which action should the nurse take first?

Accepted Answer

A)   Check blood pressure and pulse rate.
B)   Auscultate the lung sounds bilaterally.
C)   Monitor pupil size and reaction to light.
D)   Assess the arm at the site of the skin testing.

Question 9

A patient whose mother has been diagnosed with BRCA gene-related breast cancer asks the nurse, "Do you think I should be tested for the gene?" Which response by the nurse is most appropriate?

Accepted Answer

A)   "In most cases, breast cancer is not caused by the BRCA gene."
B)   "It depends on how you will feel if the test is positive for the BRCA gene."
C)   "There are many things to consider before deciding to have genetic testing."
D)   "You should decide first whether you are willing to have a double mastectomy."

Question 10

A patient seen at the clinic with atopic dermatitis has a history of multiple allergies and several previous anaphylactic reactions. Which type of testing for allergens will the nurse anticipate for this patient?

Accepted Answer

A)   Serum IgE-level test
B)   Cutaneous scratch test
C)   Intracutaneous skin test
D)   Radioallergosorbent test (RAST)

Question 11

A patient seeks medical care after sharing needles for heroin injection with a friend who has hepatitis B. To provide immediate protection from infection, the nurse expects to administer

Accepted Answer

A)   corticosteroids.
B)   gamma globulin.
C)   hepatitis B vaccine.
D)   fresh frozen plasma.

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

A)   eliminate eosinophils and basophils from blood.
B)   remove antibody-antigen complexes from circulation.
C)   prevent foreign antibodies from damaging various body tissues.
D)   decrease the damage to organs caused by attacking T-lymphocytes.

Question 13

A pregnant patient with a family history of cystic fibrosis (CF) asks for information about genetic testing. The most appropriate action by the nurse is to

Accepted Answer

A)   refer the patient to a qualified genetic counselor.
B)   ask the patient why genetic testing is important to her.
C)   remind the patient that genetic testing has many social implications.
D)   tell the patient that cystic fibrosis is an autosomal-recessive disorder.

Question 14

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

Accepted Answer

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.

Question 15

Which information about a patient who is receiving immunotherapy and has just received an allergen injection is most important to communicate to the health care provider?

Accepted Answer

A)   The patient's IgG level is increased.
B)   The injection site is red and swollen.
C)   The patient's allergy symptoms have not improved.
D)   There is a 3-cm wheal at the site of the allergen injection.

Question 16

In counseling a couple in which the man has an autosomal recessive disorder, and the woman has no gene for the disorder, the nurse uses Punnett squares to show the couple that the probability of their having a child with the disorder is

Accepted Answer

A)   0%.
B)   25%.
C)   50%.
D)   75%.

Question 17

A patient has a new prescription for cyclosporine after having a kidney transplant. Which information in the patient's health history has the most implications for planning patient teaching about the medication at this time?

Accepted Answer

A)   The patient restricts salt to treat prehypertension.
B)   The patient drinks 3 to 4 quarts of fluids every day.
C)   The patient has many concerns about the effects of cyclosporine.
D)   The patient has a glass of grapefruit juice every day for breakfast.

Question 18

While obtaining a health history from the patient who works as a laboratory technician, 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

A)   encourage the patient to carry an epinephrine kit in case a type IV allergic reaction to latex develops.
B)   advise the patient to use oil-based hand creams to decrease contact with natural proteins in latex gloves.
C)   document the patient's allergy history and be alert for any clinical manifestations of a type I latex allergy.
D)   recommend that the patient use vinyl gloves instead of latex gloves in preventing blood-borne pathogen contact.

Question 19

A man with mild hemophilia asks the nurse, "Will my children be hemophiliacs?" Which response by the nurse is appropriate?

Accepted Answer

A)   "All of your children will be at risk for hemophilia."
B)   "Hemophilia is a multifactorial inherited condition."
C)   "Only your male children are at risk for hemophilia."
D)   "Your female children will be carriers for hemophilia."

Question 20

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

Accepted Answer

A)   innate immunity.
B)   active immunity.
C)   passive immunity.
D)   cell-mediated immunity.

Exam 14: Genetics, Altered Immune Responses, and Transplantation