Chapter 34: Immunologic Disorders
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. What is responsible for initiating the inflammatory response in addition to immunoglobulin E
(IgE)?
a.
Eosinophils
b.
Lymphocytes
c.
Basophils
d.
Neutrophils
2. Where are histamine-releasing mast cells located?
a.
Circulating in the blood
b.
Circulating in the lymph
c.
Attached to organ tissue
d.
Embedded in the bone marrow
3. What is true concerning passive-acquired immunity?
a.
Antibodies are acquired from outside the host and instilled in the host.
b.
Antibodies are manufactured in response to a disease in the host.
c.
Antibodies are innately acquired because of being born a human being.
d.
Antibodies are cell mediated inside the host.
4. A nurse is alerted by the laboratory regarding a patient’s complete blood count that shows a
large shift to the left. What should the nurse assess this to mean about cell level count?
a.
Neutrophils have dropped by 10%.
b.
Basophils have increased by 25%.
c.
Neutrophils have increased by 25%.
d.
Neutrophils have increased by 60%.
5. Which symptom should a nurse recognize as being pertinent to a possible diagnosis of
systemic lupus erythematosus (SLE)?
a.
Butterfly rash of the face
b.
Protruding abdomen
c.
Thinning hair
d.
Bloody diarrhea
6. A hospitalized patient has been prescribed dexamethasone (Decadron) for an allergic reaction.
Which teaching instruction should the patient be given with discharge relative to this drug?
a.
Report blurry vision.
b.
Take the medication on an empty stomach.
c.
Do not operate heavy machinery.
d.
Take this medication with meals.
7. A patient taking dexamethasone (Decadron) reports insomnia. What is the best information to
provide this patient regarding administration of this medication?
a.
Take with milk.
b.
Take at breakfast.
c.
Dissolve in fruit juice.
d.
Take at bedtime.
8. What should a nurse include when developing a plan of care for a patient with human
immunodeficiency virus (HIV)?
a.
Careful aseptic technique to prevent infection
b.
Instruction to limit fluids to prevent congestive heart failure
c.
Oral alcohol rinses to control mouth infections
d.
Selections of high-fat foods in the daily diet
9. An 11-year-old girl is diagnosed with idiopathic thrombocytopenic purpura (ITP). Which
parental statement helps the nurse evaluate that teaching is successful?
a.
“Our daughter can still be involved in gymnastics.”
b.
“When our daughter’s hemoglobin falls below 3.5, she’ll need blood.”
c.
“Our daughter will need genetic counseling before she marries.”
d.
“Our daughter should avoid drugs containing sulfonamides.”
10. A nurse is preparing a patient for a liver and spleen scan. Which intervention is most
important to implement before the procedure?
a.
Prepare the biopsy site with a clean field.
b.
Check for any allergies to contrast media.
c.
Explain the procedure to the patient’s family.
d.
Have the patient eat a complete regular diet.
11. After a bone marrow transplant, a patient is placed on a protocol of chemotherapy and
radiation and the nursing diagnosis of risk for injury is added. Which nursing assessment
should cause the nurse concern?
a.
Increased urine output
b.
Decreasing bilirubin levels
c.
Increasing blood pressure
d.
Increasing abdominal girth
12. A patient diagnosed with leukemia has had a bone marrow transplant and has completed
chemotherapy. What is the greatest risk for this patient while healthy bone marrow is growing
back?
a.
Infection and bleeding
b.
Hypertension and headache
c.
Oliguria and urinary retention
d.
Dyspnea and wheezing
13. What is most appropriate for a nurse to include when preparing discharge plans for a patient
with SLE?
a.
Need to consume 2 L of fluid daily
b.
Close monitoring of daily blood glucose level
c.
Use of daily sunscreens with a sun protection factor (SPF) higher than 15
d.
Careful concern for certain food allergies
14. A nurse is caring for a patient with thrombotic thrombocytopenic purpura who is having
plasmapheresis every day. Which assessment alerts the nurse of a complication?
a.
Hypotension
b.
Seizure activity
c.
Diarrhea
d.
Intense headache
15. A nurse assesses a neutrophil count of 900/mm3 in a patient with acute leukemia. What should
the nurse anticipate initiating?
a.
A high-protein diet
b.
Increased doses of steroids
c.
Compromised host precautions
d.
Injections of blood-building medication
16. A nurse is caring for a patient in the last stages of leukemia and is aware that the patient is at
risk from the bacteria of his own body. Which is an example of internal bacteria?
a.
Beta-hemolytic streptococci
b.
Streptococcus pneumoniae
c.
Streptococcus viridans
d.
Pseudomonas aeruginosa
17. The nursing staff of an oncology unit cautions visitors to be free of infections before visiting
patients. What can chemotherapy and decreased bone marrow production cause in these
patients?
a.
Hemorrhage
b.
Neutropenia
c.
Edema
d.
Hypovolemia
18. A 24-year-old woman is admitted to the hospital for a complete medical examination. Her
current complaints are indicative of SLE. Which symptom would indicate this diagnosis?
a.
Recent weight gain of 10 lb
b.
Difficulty breathing in the morning
c.
Frequent episodes of diarrhea
d.
Musculoskeletal pain in the hands
19. What is the primary function in the immune process of the spleen?
a.
Filter microorganisms from the blood.
b.
Store lymphocytes used to fight infections.
c.
Produce additional RBCs fired blood cells).
d.
Stimulate WBC production.
20. Which laboratory result for a patient with acute leukemia should alert the nurse to the fact that
the drug protocols are not effective?
a.
Decreased prothrombin time
b.
Platelet count lower than 50,000/mm3
c.
Negative Western blot result
d.
Neutrophils 50% to 62%
21. Which observation by a nurse indicates a patient’s acceptance of the diagnosis of acute
leukemia?
a.
Plans a 14-day cruise in 2 weeks
b.
States that he will be fine in a few months
c.
Asks for educational material about acute leukemia
d.
Rests after a chemotherapy session
22. A skin test shows redness and swelling a few days after injection. What type of
hypersensitivity reaction should the nurse document?
a.
I
b.
II
c.
III
d.
IV
23. The nursing staff decides on a nursing diagnosis of “Imbalanced nutrition: less than body
requirements for a patient with leukemia.” Which goal is most realistic for this patient?
a.
To gain 5 lb, eat foods high in calories at each meal.
b.
To avoid nausea, eat slowly, and eat small meals.
c.
To consume all food at every meal, offer three large meals.
d.
To maintain a stable weight, eat small meals, and avoid vomiting.
24. A patient has undergone bone marrow transplant. Which injection should the nurse anticipate
this patient will receive to help stabilize the immune response and prevent rejection?
a.
Dexamethasone (Decadron)
b.
Filgrastim (Neupogen)
c.
Zidovudine (Retrovir)
d.
Nevirapine (Viramune)
25. What type of bone marrow transplant uses the patient’s own bone marrow?
a.
Allergenic
b.
Allogeneic
c.
Peripheral blood stem cell
d.
Autologous
26. Which human immunity is an example of innate immunity?
a.
Hoof-and-mouth disease
b.
Measles
c.
Rabies
d.
Mange
27. Which nursing action should be implemented when performing skin testing?
a.
Select an 18-gauge needle.
b.
Inject 1 mL intradermally.
c.
Check the site in 2 to 3 days for swelling.
d.
Wrap the site with a pressure dressing.
MULTIPLE RESPONSE
28. What are the four distinct stages of the inflammatory process?
a.
Dolor
b.
Rubor
c.
Tumor
d.
Calor
e.
Rumor
29. A nurse explains that in autoimmune diseases, the body identifies its own proteins as foreign
matter and sets out to destroy itself. Which are examples of autoimmune diseases? (Select all
that apply.)
a.
SLE
b.
Type 1 diabetes mellitus (DM)
c.
Rheumatoid arthritis (RA)
d.
Osteoarthritis
e.
Pancreatitis
COMPLETION
30. A nurse explains that early in life, lymphocytes migrate from the marrow of the bones to the
_____, in which they mature into T cells.
31. Cells in the bone marrow that are capable of developing into RBCs, WBCs, or platelets are
the _____ cells.
