17.) Immune System Disorders

Front 1

1. The nurse is preparing a female patient with SLE for discharge. Which instructions should the nurse include in the teaching plan?

A. Exposure to sunlight will help control skin rashes.

B. No activity limitations are necessary between fl are-ups.

C. Monitor body temperature.

D. Corticosteroids may be stopped when symptoms are relieved.

Back 1

Correct answer: C

The patient should monitor her body temperature because fever can signal an exacerbation and should be reported to the practitioner. Option A is incorrect because sunlight and other sources of ultraviolet light may exacerbate the disease. Option B is incorrect because fatigue can cause a fl are-up of SLE, and patients should be encouraged to pace activities and plan for rest periods. Corticosteroids, Option D, must be gradually tapered because they can suppress the function of the adrenal gland. Abruptly stopping corticosteroids can cause adrenal insuffi ciency, a potentially life-threatening situation.

Front 2

2. A patient with rheumatoid arthritis has a history of long-term NSAID use and, consequently, has developed peptic ulcer disease. To treat this condition, the nurse should expect to administer:

A. cyanocobalamin (vitamin B12).

B. ticlopidine.

C. prednisone.

D. misoprostol.

Back 2

Correct answer: D

NSAIDs decrease prostaglandin synthesis. Misoprostol, a synthetic analog of prostaglandin, is used to treat and prevent NSAID-induced gastric ulcers. Cyanocobalamin (Option A) is used to treat vitamin B12 defi ciency. Ticlopidine (Option B) is an antiplatelet drug used to reduce the risk of stroke. Prednisone (Option C) is a glucocorticosteroid used to treat several infl ammatory disorders and may promote gastric ulcer development.

Front 3

3. The nurse is providing care for a patient with AIDS and Pneumocystis jiroveci pneumonia. The patient is receiving aerosolized pentamidine isethionate (Nebu-Pent). What’s the best evidence that the therapy is working?

A. A sudden gain in lost body weight

B. Whitening of lung fields on the chest X-ray

C. Improved patient vitality and activity tolerance

D. A febrile body temperature and development of leukocytosis

Back 3

Correct answer: C

P. jiroveci pneumonia is a protozoal infection of the lungs. Pentamidine isethionate is one drug used to treat this infection. Because a common manifestation of the infection is activity intolerance and loss of vitality, improvements in these areas suggest success of the therapy. Sudden weight gain (Option A), whitening of the lung fi elds on chest X-ray (Option B), and development of leukocytosis (Option D) aren’t evidence of therapeutic success.

Front 4

4. A patient with SLE who receives immunosuppressants develops a fever. The nurse should:

A. administer prescribed antipyretics.

B. place the patient in isolation.

C. apply cooling measures immediately.

D. help identify the cause.

Back 4

Correct answer: D Immunosuppressants impair the patient’s immunocompetence and predispose the patient to infection. Fever is a sign of infection; therefore, it’s important to discover the cause of the fever as soon as possible. Antipyretics (Option A) should be withheld until cultures have been obtained. Isolation (Option B) isn’t indicated unless the absolute neutrophil count is less than 1,000/mL. Cooling measures (Option C) may be indicated, but they don’t have priority over organism identification.

Front 5

5. Which finding distinguishes rheumatoid arthritis from osteoarthritis and gouty arthritis?

A. Crepitus with ROM

B. Symmetry of joint involvement

C. Elevated serum uric acid levels

D. Dominance in weight-bearing joints

Back 5

Correct answer: B

Rheumatoid arthritis is bilateral and symmetrical; by contrast, osteoarthritis and gouty arthritis are unilateral. Crepitus (Option A) is usually associated with osteoarthritis. Elevated serum uric acid levels (Option C) are common in patients with gouty arthritis; weight-bearing joint dominance (Option D), in those with osteoarthritis.

Front 6

6. A patient is admitted with acute bronchitis. During the admission interview, he tells the nurse he’s allergic to bananas. Based on this statement, he may also have an allergy to which drug or substance?

A. Iodine-containing drugs

B. Cephalosporins

C. Penicillins

D. Latex

Back 6

Correct answer:

D Patients who are allergic to certain cross-reactive foods–including apricots, avocados, bananas, cherries, chestnuts, grapes, kiwis, passion fruit, peaches, and tomatoes–may also be allergic to latex. When exposed to latex, they may have an allergic response similar to the one these foods produce. Patients with allergies to shellfi sh may be allergic to iodine-containing drugs (Option A). Hypersensitivity reactions to cephalosporins (Option B) are more common in patients with penicillin allergy. There’s no link between food allergies and penicillin (Option C).

Front 7

7. A patient with AIDS is prescribed zidovudine (Retrovir), 200 mg by mouth every 4 hours. When teaching the patient about this drug, the nurse should provide which instruction?

A. “Take zidovudine with meals.”

B. “Take zidovudine on an empty stomach.” C. “Take zidovudine every 4 hours around the clock.”

D. “Take OTC drugs to treat minor adverse reactions.”

Back 7

Correct answer: C

To be effective, zidovudine must be taken every 4 hours around the clock. Food doesn’t affect absorption of this drug, so the patient may take zidovudine either with food (Option A) or on an empty stomach (Option B). To avoid serious drug interactions, the patient should check with the physician before taking OTC medications (Option D).

Front 8

8. In a patient who has HIV infection, the CD4+ level is measured to determine the:

A. presence of opportunistic infections.

B. level of the viral load.

C. extent of immune system damage.

D. resistance to antigens.

Back 8

Correct answer: C

The CD4+ level in the blood of a patient with HIV infection is measured to determine the extent of damage to his immune system. Although the level does indicate his risk for developing an opportunistic infection, it doesn’t identify specifi c infections (Option A). Different diagnostic tests are used to determine the viral load level (Option B) and resistance to antigens (Option D).

Front 9

9. A 36-year-old patient complains of fatigue, weight loss, and a low-grade fever. He also has pain in his fi ngers, elbows, and ankles. Which condition is suspected?

A. Anemia

B. Leukemia

C. Rheumatic arthritis

D. SLE

Back 9

Correct answer: C

Fatigue, weight loss, and a low-grade fever are all early indications of many immune system diseases, including anemia (Option A), leukemia (Option B), and SLE (Option D). However, only rheumatic arthritis is associated with pain in the fi ngers, elbows, wrists, ankles, and knees.

Front 10

10. Which WBCs are involved in releasing histamine during an allergic reaction?

A. Basophils

B. Eosinophils

C. Monocytes

D. Neutrophils

Back 10

Correct answer: A

Basophils are involved in the release of histamine. The major function of eosinophils (Option B) is phagocytosis of antigen-antibody complexes that are formed in allergic reactions. Monocytes (Option C) and neutrophils (Option D) are predominately phagocytic.