Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
Chapter 13: Immune Responses and Transplantation
Harding: Lewis’s Medical-Surgical Nursing, 11th Edition
MULTIPLE CHOICE
1. The nurse provides discharge instructions to a patient who has an immune deficiency
involving the T lymphocytes. Which health screening should the nurse include in the teaching
plan for this patient?
a. Screening for cancers
b. Screening for allergies
c. Screening for antibody deficiencies
d. Screening for autoimmune disorders
ANS: A
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.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
2. Which example should the nurse use to explain an infant’s “passive immunity” to a new
mother?
a. Vaccinations
b. Breastfeeding
c. Stem cells in peripheral blood
NUdiseases
RSINGTB.COM
d. Exposure to communicable
ANS: B
Colostrum in breast milk 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. Stem cells are unspecialized cells used to repopulate a
person’s bone marrow after high-dose chemotherapy.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
3. A patient is being evaluated for possible atopic dermatitis. The nurse should expect elevation
of which laboratory value?
a. IgA
b. IgE
c. Basophils
d. Neutrophils
ANS: B
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 in body
secretions and would not be tested when evaluating a patient who has symptoms of atopic
dermatitis.
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
4. An older adult patient who is having an annual checkup 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. Incidence of cancer-associated infections in older adults
d. Impact of poor nutrition on immune function in older adults
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.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
5. A patient who collects honey to earn supplemental income has developed a hypersensitivity to
bee stings. Which statement by the patient would indicate a need for additional teaching?
a. “I need to find a different way to earn extra money.”
b. “I will take oral antihistamines before going to work.”
c. “I can get a prescription for epinephrine and learn to self-inject it.”
NURbracelet
B.COMmy allergy to bee stings.”
d. “I should wear a Medic-Alert
SINGTindicating
ANS: B
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.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
6. Which information about intradermal skin testing should the nurse teach 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.
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
7. The nurse reviewing a clinic patient’s medical record notes that the patient missed the
previous appointment for weekly immunotherapy. Which action by the nurse is appropriate?
a. Schedule an additional dose the following week.
b. Administer the scheduled dosage of the allergen.
c. Consult with the health care provider about giving a lower allergen dose.
d. Reevaluate 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.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
8. The nurse taking a health history learns that the patient, who has worked in rubber tire
manufacturing, has allergic rhinitis and multiple food allergies. Which action by the nurse is
correct?
a. Recommend that the patient use latex gloves in preventing blood-borne pathogen
contact.
b. Document the patient’s history and teach about clinical manifestations of a type I
latex allergy.
c. Encourage the patient to carry an epinephrine kit in case a type IV allergic reaction
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to latex develops.
d. Tell the patient to use oil-based hand creams to decrease contact with natural
proteins in latex gloves.
ANS: B
The patient’s allergy history and occupation indicate a risk of developing a latex allergy.
Teach the patient about symptoms that may occur. Epinephrine is not an appropriate treatment
for contact dermatitis that is caused by a type IV allergic reaction to latex. Using latex gloves
increases the chance of developing latex sensitivity. Oil-based creams will increase the
exposure to latex from latex gloves.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
9. What instructions about plasmapheresis should the nurse include in the teaching plan for a
patient diagnosed with systemic lupus erythematosus (SLE)?
a. Plasmapheresis counteracts recovery of IgG production.
b. Plasmapheresis removes eosinophils and basophils from the blood.
c. Plasmapheresis decreases the damage to organs from T lymphocytes.
d. Plasmapheresis prevents inflammatory mediators from injuring tissues.
ANS: D
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
Plasmapheresis is used in SLE to remove antibodies, antibody-antigen complexes, and
inflammatory mediators, such as complement, from the blood. T lymphocytes, foreign
antibodies, eosinophils, and basophils do not directly contribute to the tissue damage in SLE.
Immunosuppressive therapy is used to prevent recovery of IgG production.
DIF: Cognitive Level: Understand (comprehension)
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Planning
10. The nurse should assess the patient undergoing plasmapheresis for which clinical
manifestation?
a. Shortness of breath
b. High blood pressure
c. Transfusion reaction
d. Extremity numbness
ANS: D
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.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
11. Which statement by a patient would alert the nurse to a risk for decreased immune function?
a. “I had a chest x-ray 6 months ago.”
b. “I had my spleen removed after a car accident.”
c. “I take one baby aspirin every day to prevent stroke.”
NUforRSatIleast
B.C
d. “I usually eat eggs or meat
meals
NGTtwo
OMa day.”
ANS: B
Splenectomy increases the risk for septicemia from bacterial infections. The patient’s protein
intake is good and should improve immune function. Daily aspirin use does not affect immune
function. A chest x-ray does not have enough radiation to suppress immune function.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
12. Which patient should the nurse assess first?
a. Patient with urticaria after receiving an IV antibiotic
b. Patient who is sneezing after subcutaneous immunotherapy
c. Patient who has graft-versus-host disease and severe diarrhea
d. Patient with multiple chemical sensitivities with muscle stiffness
ANS: B
Sneezing after subcutaneous immunotherapy may indicate impending anaphylaxis and
assessment and emergency measures should be initiated. The other patients also have findings
that need assessment and intervention by the nurse, but do not have evidence of
life-threatening complications.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients
TOP: Nursing Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
13. Ten days after receiving a bone marrow transplant, a patient develops a skin rash. What
should the nurse suspect is the cause of the rash?
a. The donor T cells are attacking the patient’s skin cells.
b. The patient needs treatment to prevent hyperacute rejection.
c. The patient’s antibodies are rejecting the donor bone marrow.
d. The patient is experiencing a delayed hypersensitivity reaction.
ANS: A
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.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
14. A patient seeks care in the emergency department after sharing needles for heroin injection
with a friend who has hepatitis B. To provide immediate protection from infection, what
medication will the nurse expect to administer?
a. Corticosteroids
b. Gamma globulin
c. Hepatitis B vaccine
d. Fresh frozen plasma
ANS: B
The patient should first receive antibodies for hepatitis B from injection of gamma globulin.
The hepatitis B vaccination series should be started to provide active immunity. Fresh frozen
plasma and corticosteroids will
hepatitis B in the patient.
NUnot
RSbe
INeffective
GTB.CinOpreventing
M
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
15. The nurse teaches a patient about drug therapy after a kidney transplant. Which statement by
the patient would indicate a need for further instructions?
a. “I need to be monitored closely for development of cancer.”
b. “After a couple of years, I will be able to stop taking the cyclosporine.”
c. “If I develop acute rejection episode, I will need additional types of drugs.”
d. “The drugs are combined to inhibit different ways the kidney can be rejected.”
ANS: B
Cyclosporine, a calcineurin inhibitor, will need to be continued for life. The other patient
statements are accurate and indicate that no further teaching is necessary about those topics.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
16. An older adult patient has a prescription for cyclosporine following a kidney transplant.
Which information in the patient’s health history has implications for planning patient
teaching about the safe use of cyclosporine?
a. The patient restricts salt to 2 grams per day.
b. The patient eats green leafy vegetables daily.
c. The patient drinks grapefruit juice every day.
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
d. The patient drinks 3 to 4 quarts of fluid each day.
ANS: C
Grapefruit juice can increase the toxicity of cyclosporine. The patient should be taught to
avoid grapefruit juice. Normal fluid and sodium intake or eating green leafy vegetables will
not affect cyclosporine levels or renal function.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
17. A patient is admitted to the hospital with acute rejection of a kidney transplant. Which
intervention will the nurse expect for this patient?
a. Testing for human leukocyte antigen (HLA) match
b. Administration of immunosuppressant medications
c. Insertion of an arteriovenous graft for hemodialysis
d. Placement of the patient on the transplant waiting list
ANS: B
Acute rejection is treated with the administration of additional immunosuppressant drugs such
as corticosteroids. Because acute rejection is potentially reversible, there is no sign that the
patient will need another transplant or hemodialysis. There is no need to repeat HLA testing.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
18. The charge nurse is assigning semiprivate rooms for new admissions. Which patient could
safely be assigned as a roommate for a patient who has acute rejection of an organ transplant?
a. A patient who has viral pneumonia
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b. A patient with second-degree
burns
c. A patient with an anaphylactic reaction
d. A patient with graft-versus-host disease
ANS: C
There is no increased exposure to infection from a patient who had an anaphylactic reaction.
Treatment for a patient with acute rejection includes administration of additional
immunosuppressants and the patient should not be exposed to increased risk for infection as
would occur from patients with viral pneumonia, graft-versus-host disease, and burns.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Multiple Patients
MSC: NCLEX: Safe and Effective Care Environment
TOP: Nursing Process: Planning
19. A patient in the health care provider’s office for allergen testing using the cutaneous scratch
method develops itching and swelling at the skin site. Which action should the nurse plan to
take first?
a. Monitor the patient’s edema.
b. Administer a dose of epinephrine.
c. Obtain a prescription for oral antihistamines.
d. Assess the patient’s use of new skin products.
ANS: B
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
Rapid administration of epinephrine when excessive itching or swelling at the skin site is
observed can prevent the progression to anaphylaxis. The initial symptoms of anaphylaxis are
itching and edema at the site of the exposure. The nurse should not wait and assess for
development of more edema. Hypotension, tachycardia, dilated pupils, and wheezes occur
later. Exposure to skin products does not address the immediate concern of a possible
anaphylactic reaction.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
20. A patient is anxious and reports difficulty breathing after being stung by a wasp. What is the
nurse’s priority action?
a. Provide high-flow oxygen.
b. Administer antihistamines.
c. Assess the patient’s airway.
d. Remove the stinger from the site.
ANS: C
The initial action with any patient with difficulty breathing is to assess and maintain the
airway. The patient’s symptoms of anxiety and difficulty breathing may have other causes
than anaphylaxis, so additional assessment is warranted. The other actions are part of the
emergency management protocol for anaphylaxis, but the priority is airway assessment and
maintenance.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
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MSC: NCLEX: Physiological Integrity
21. Immediately after the nurse administers an intradermal injection of an allergen on the forearm,
the patient reports itching at the site, weakness, and dizziness. What action should the nurse
take first?
a. Apply antiinflammatory cream.
b. Place a tourniquet above the site.
c. Administer subcutaneous epinephrine.
d. Reschedule the patient’s other allergen tests.
ANS: B
Application of a tourniquet will decrease systemic circulation of the allergen and should be
the first reaction. The other actions may occur, but the tourniquet application slows the
allergen progress into the patient’s system, allowing treatment of the anaphylactic response. A
local antiinflammatory cream may be applied to the site of a cutaneous test for persistent
itching. Epinephrine will be needed if the allergic reaction progresses to anaphylaxis. Other
testing may be delayed and rescheduled after development of anaphylaxis.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
22. A clinic patient reports experiencing an allergic reaction to an unknown allergen several
weeks ago. Which action is appropriate for the registered nurse (RN) to delegate to a licensed
practical/vocational nurse (LPN/VN)?
a. Perform a focused physical assessment.
b. Administer a cutaneous scratch skin test.
c. Obtain the health history from the patient.
d. Review diagnostic study results with the patient.
ANS: B
LPN/VNs are educated and licensed to administer medications under the supervision of an
RN. RN-level education and the scope of practice include assessment of health history,
focused physical assessment, and teaching about study results.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation
TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
23. The health care provider asks the nurse to evaluate whether a patient’s angioedema has
responded to prescribed therapies. Which assessment should the nurse perform?
a. Obtain the patient’s blood pressure and heart rate.
b. Question the patient about any clear nasal discharge.
c. Observe for swelling of the patient’s lips and tongue.
d. Assess the patient’s extremities for wheal and flare lesions.
ANS: C
Angioedema is characterized by swelling of the eyelids, lips, and tongue. Wheal and flare
lesions, clear nasal drainage, and hypotension and tachycardia are characteristic of other
allergic reactions.
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DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
24. A nurse has obtained donor tissue typing information about a patient who is waiting for a
kidney transplant. Which results should be reported to the transplant surgeon?
a. Patient is Rh positive and donor is Rh negative.
b. Six antigen matches are present in HLA typing.
c. Results of patient–donor crossmatching are positive.
d. Panel of reactive antibodies (PRA) percentage is low.
ANS: C
Positive crossmatching is an absolute contraindication to kidney transplantation because a
hyperacute rejection will occur after the transplant. The other information shows that the
tissue match between the patient and potential donor is acceptable.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
25. A patient who is receiving immunotherapy has just received an allergen injection. Which
assessment finding is most important to communicate to the health care provider?
a. The patient’s IgG level is increased.
b. The injection site is red and swollen.
c. There is a 2-cm wheal at the site of the injection.
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
d. The patient’s symptoms did not improve in 2 months.
ANS: C
A local reaction larger than quarter size may indicate that a decrease in the allergen dose is
needed. An increase in IgG shows 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.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
OTHER
1. A patient who is receiving an IV antibiotic develops wheezes and dyspnea. In which order
should the nurse implement these prescribed actions? (Put a comma and a space between
each answer choice [A, B, C, D, E]).
a. Discontinue the antibiotic.
b. Give diphenhydramine IV.
c. Inject epinephrine IM or IV.
d. Prepare an infusion of dopamine.
e. Apply 100% oxygen using a nonrebreather mask.
ANS:
A, E, C, B, D
The nurse should initially discontinue
antibiotic
N RSINtheGT
B.C Mbecause it is the likely cause of the
allergic reaction. Next, oxygenUdelivery
should beOmaximized, followed by treatment of
bronchoconstriction with epinephrine administered IM or IV. Diphenhydramine will work
more slowly than epinephrine but will help prevent progression of the reaction. Because the
patient currently does not have evidence of hypotension, the dopamine infusion can be
prepared last.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
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