ROSENTHAL: LEHNE’S PHARMACOTHERAPEUTICS
FOR ADVANCED PRACTICE NURSES AND
PHYSICIAN ASSISTANTS
A patient who breastfeeds her infant asks the nurse about the immunity the infant
receives from breast milk. What does the nurse tell the patient about immunity
through breastfeeding?
a. "The immunity protects the infant from hypersensitivity reactions."
b. "The immunity provides phagocytes to help the infant fight infections."
c. "The immunity results from the transfer of IgA through the breast milk."
d. "The immunity protects the infant from respiratory and gastrointestinal (GI)
microbes." - ANSWER-ANS: C
IgA crosses breast milk and, in the GI tract, where it is not absorbed, provides
passive immunity to
microbes. Infants do not receive protection from hypersensitivity reactions through
breast milk.
Phagocytes are not transmitted through breast milk. Infants are not protected from
respiratory
microbes via breast milk. DIF: Cognitive Level: Analysis REF: p. 574TOP: Nursing
Process:
Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic
Adaptation
A nurse is caring for a patient infected with the human immunodeficiency virus(HIV).
Which finding would most concern the nurse?
a. High level of macrophages
b. Low neutrophil count
c. Low red blood cell (RBC) count
d. Very low helper T lymphocyte count - ANSWER-ANS: D
The nurse understands that this patient may be vulnerable to opportunistic
infections, especially if
there were an indication of the HIV conversion to acquired immunodeficiency
syndrome (AIDS).
A very low helper T lymphocyte count would most concern the nurse, because the
helper T cells are essential to the immune system, and people with AIDS have a low
or deficient count. A high level of macrophages could indicate an inflammatory
response. A low RBC count may indicate anemia. A low neutrophil count can be
caused by multiple conditions, but a high count most likely indicates an infection.
DIF: Cognitive Level: Analysis REF: p. 572TOP: Nursing Process: Evaluation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
,A nurse is teaching a nursing student about a specific acquired immunity system.
Which statement by the student indicates a need for further teaching?
a. "Cell-mediated immunity and humoral immunity are both types of specific acquired
immune responses."
b. "Each exposure to an antigen causes a faster, more intense response."
c. "Immune responses occur only after exposure to a foreign substance."
d. "The skin is a factor in specific acquired immunity." - ANSWER-ANS: D
The skin is a physical barrier that confers natural immunity. It is not a factor in
specific acquired immunity. Cell-mediated and humoral immunity are both types of
specific acquired immunity. In specific acquired immunity, each exposure to an
antigen evokes a more intense response more
quickly. Specific acquired immunity occurs only after initial exposure to an antigen.
DIF: Cognitive Level: Analysis REF: p. 571TOP: Nursing Process: Assessment
MSC: NCLEX Client
Needs Category: Physiologic Integrity: Physiologic Adaptation
A patient has a Type IV hypersensitivity (delayed-type hypersensitivity) response to
an infection. The nurse understands which two types of cells are necessary for this
response?
a. Antigen-presenting cells and mast cells
b. Cytolytic T lymphocytes and target cells
c. Immunoglobulin cells and dendritic cells
d. Infected macrophages and CD4 helper T cells - ANSWER-ANS: D
The object of Type IV hypersensitivity (delayed-type hypersensitivity) is to rid the
body of bacteria that replicate within macrophages. The macrophage activates the
CD4 cell, which in turn activates the macrophage. The other cells listed are not a
part of this response. DIF: Cognitive Level:
Application REF: p. 578TOP: Nursing Process: Assessment MSC: NCLEX Client
Needs Category:
Physiologic Integrity: Physiologic Adaptation
A nurse is reviewing the immune system with a group of nursing students. One
student asks about the difference between cell-mediated immunity and humoral
immunity. What should the nurse reply?
a. "Humoral immunity does not involve helper T cells in the immune response."
b. "Humoral immunity does not have a role in hypersensitivity reactions."
c. "Humoral immunity requires cytolytic T cells that attack antigens directly."
d. "Humoral immunity uses cells produced by B lymphocytes in the immune
response." - ANSWER-ANS: D
Humoral immunity refers to immunity mediated by antibodies, which are produced by
B lymphocytes. Helper T cells have an essential role in antibody production by B
cells. The antibody immunoglobulin E plays a role in hypersensitivity reactions.
Cytolytic T cells do not produce
antibodies; they are key players in cellular immunity. DIF: Cognitive Level: Analysis
REF: p. 571TOP: Nursing Process: Assessment MSC: NCLEX Client Needs
Category: Physiologic
Integrity: Physiologic Adaptation
A nurse is caring for a patient who has undergone organ transplantation. Because
the sequence
,of amino acids in the major histocompatibility complex (MHC) molecules of the donor
is
different from that of the patient, the nurse will expect to administer which class of
drugs?
a. Antibiotics
b. Antihistamines
c. Immune globulins
d. Immunosuppressants - ANSWER-ANS: D
The MHC molecules from one individual are recognized as foreign by the immune
system of another individual; therefore, when an attempt is made to transplant
organs between individuals who are not identical twins, immune rejection of the
transplant is likely. Immunosuppressants are
given to counter this response. Antibiotics are used to destroy bacteria.
Antihistamines block
hypersensitivity reactions. Immune globulins are given to confer passive immunity
when specific acquired immunity has not yet developed a response. DIF: Cognitive
Level: Application REF: p. 576TOP: Nursing Process: Planning MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
A nurse is teaching a group of nursing students about antibodies. The nurse
correctly explains which type of response is triggered when antigens bind to
antibodies on mast cells or basophils?
a. Acquired immune response
b. Autoimmune response
c. Hypersensitivity reaction
d. Transplant rejection - ANSWER-ANS: C
When antigens bind to antibodies on mast cells and basophils, chemical mediators
of hypersensitivity reactions are released. Although hypersensitivity is an acquired
response, mast cells and basophils do not play a role in other acquired responses.
An autoimmune response occurs when the immune system fails to discriminate
between self and nonself. Transplant rejection
occurs when the MHC molecules of the donor are different from those of the patient.
DIF: Cognitive Level: Analysis REF: p. 573TOP: Nursing Process: Evaluation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
Which statement is true about helper T cells?
a. They are useful but are not essential to immune responses.
b. They do not play a role in antibody production.
c. They have highly specific receptors to antigens on their surface.
d. They prevent CD4 molecules from attaching to antigens. - ANSWER-ANS: C
Helper T cells have highly specific cell surface receptors that recognize individual
antigens. Helper T cells play an essential role in several functions of the immune
response. They have an essential role in the production of antibodies by B cells.
They carryCD4 molecules on their surface and are
also referred to as CD4 cells. DIF: Cognitive Level: Analysis REF: p. 572TOP:
Nursing Process:
Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic
Adaptation
, A nurse is teaching a group of nursing students about immunoglobulins. Which
statement by a student indicates a need for further teaching?
a. "IgD provides a first line of defense against microbes entering the body through
the lungs."
b. "IgE plays a role in hypersensitivity reactions and responses to parasites."
c. "IgG and IgM participate in the complement response to promote target-cell lysis."
d. "Neonatal immunity is the result of IgG crossing the placenta." - ANSWER-ANS: A
IgD serves as a receptor for antigen recognition on B cells, which is the only place it
is found. IgE
is involved in hypersensitivity responses and responses to parasites. IgG and IgM
are involved in
complement responses. IgG crosses the placenta and confers passive immunity on
the fetus. DIF:
Cognitive Level: Analysis REF: p. 576TOP: Nursing Process: Assessment MSC:
NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
A nurse is discussing the role of antibodies in the complement system with a group
of nursing
students. Which statement by a student is correct?
a. "Antibodies activate the complement cascade by turning on the alternative
pathway."
b. "Antibodies that are free in solution can activate the complement system."
c. "Antibodies flag target cells to be lysed by membrane attack complexes."
d. "Antibody receptors are nonspecific to antigenic determinants." - ANSWER-ANS:
C
Lysis of target cells that have been tagged with antibodies is the most dramatic effect
of the complement system. Antibodies activate the complement cascade by turning
on the classical pathway. C1 cannot bind with free antibodies. Antibody receptors
are specific to antigen
determinants .DIF: Cognitive Level: Analysis REF: p. 578TOP: Nursing Process:
Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic
Adaptation
A provider has ordered intravenous promethazine [Phenergan] for an adult patient
postoperatively to prevent nausea and vomiting (N/V). What will the nurse do?
a. Administer the drug at a rate of 25 mg/minute or more to achieve maximum
effects.
b. Contact the provider to suggest using dimenhydrinate [Dramamine] instead.
c. Ensure that the IV is infusing freely through a large-bore needle.
d. Monitor the patient closely for cardiac dysrhythmias. - ANSWER-ANS: C
Promethazine can cause severe local tissue injury if it extravasates into tissues, so
the medication should be administered in an IV that is flowing freely through a large-
bore needle. The drug should be administered at a rate of 25 mg/minute or less.
Dimenhydrinate is indicated for motion sickness, not postoperative N/V. Cardiac
dysrhythmias were a concern with two antihistamines no longer on the market,
astemizole and terfenadine. DIF: Cognitive Level: Application REF: p. 601TOP:
Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
FOR ADVANCED PRACTICE NURSES AND
PHYSICIAN ASSISTANTS
A patient who breastfeeds her infant asks the nurse about the immunity the infant
receives from breast milk. What does the nurse tell the patient about immunity
through breastfeeding?
a. "The immunity protects the infant from hypersensitivity reactions."
b. "The immunity provides phagocytes to help the infant fight infections."
c. "The immunity results from the transfer of IgA through the breast milk."
d. "The immunity protects the infant from respiratory and gastrointestinal (GI)
microbes." - ANSWER-ANS: C
IgA crosses breast milk and, in the GI tract, where it is not absorbed, provides
passive immunity to
microbes. Infants do not receive protection from hypersensitivity reactions through
breast milk.
Phagocytes are not transmitted through breast milk. Infants are not protected from
respiratory
microbes via breast milk. DIF: Cognitive Level: Analysis REF: p. 574TOP: Nursing
Process:
Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic
Adaptation
A nurse is caring for a patient infected with the human immunodeficiency virus(HIV).
Which finding would most concern the nurse?
a. High level of macrophages
b. Low neutrophil count
c. Low red blood cell (RBC) count
d. Very low helper T lymphocyte count - ANSWER-ANS: D
The nurse understands that this patient may be vulnerable to opportunistic
infections, especially if
there were an indication of the HIV conversion to acquired immunodeficiency
syndrome (AIDS).
A very low helper T lymphocyte count would most concern the nurse, because the
helper T cells are essential to the immune system, and people with AIDS have a low
or deficient count. A high level of macrophages could indicate an inflammatory
response. A low RBC count may indicate anemia. A low neutrophil count can be
caused by multiple conditions, but a high count most likely indicates an infection.
DIF: Cognitive Level: Analysis REF: p. 572TOP: Nursing Process: Evaluation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
,A nurse is teaching a nursing student about a specific acquired immunity system.
Which statement by the student indicates a need for further teaching?
a. "Cell-mediated immunity and humoral immunity are both types of specific acquired
immune responses."
b. "Each exposure to an antigen causes a faster, more intense response."
c. "Immune responses occur only after exposure to a foreign substance."
d. "The skin is a factor in specific acquired immunity." - ANSWER-ANS: D
The skin is a physical barrier that confers natural immunity. It is not a factor in
specific acquired immunity. Cell-mediated and humoral immunity are both types of
specific acquired immunity. In specific acquired immunity, each exposure to an
antigen evokes a more intense response more
quickly. Specific acquired immunity occurs only after initial exposure to an antigen.
DIF: Cognitive Level: Analysis REF: p. 571TOP: Nursing Process: Assessment
MSC: NCLEX Client
Needs Category: Physiologic Integrity: Physiologic Adaptation
A patient has a Type IV hypersensitivity (delayed-type hypersensitivity) response to
an infection. The nurse understands which two types of cells are necessary for this
response?
a. Antigen-presenting cells and mast cells
b. Cytolytic T lymphocytes and target cells
c. Immunoglobulin cells and dendritic cells
d. Infected macrophages and CD4 helper T cells - ANSWER-ANS: D
The object of Type IV hypersensitivity (delayed-type hypersensitivity) is to rid the
body of bacteria that replicate within macrophages. The macrophage activates the
CD4 cell, which in turn activates the macrophage. The other cells listed are not a
part of this response. DIF: Cognitive Level:
Application REF: p. 578TOP: Nursing Process: Assessment MSC: NCLEX Client
Needs Category:
Physiologic Integrity: Physiologic Adaptation
A nurse is reviewing the immune system with a group of nursing students. One
student asks about the difference between cell-mediated immunity and humoral
immunity. What should the nurse reply?
a. "Humoral immunity does not involve helper T cells in the immune response."
b. "Humoral immunity does not have a role in hypersensitivity reactions."
c. "Humoral immunity requires cytolytic T cells that attack antigens directly."
d. "Humoral immunity uses cells produced by B lymphocytes in the immune
response." - ANSWER-ANS: D
Humoral immunity refers to immunity mediated by antibodies, which are produced by
B lymphocytes. Helper T cells have an essential role in antibody production by B
cells. The antibody immunoglobulin E plays a role in hypersensitivity reactions.
Cytolytic T cells do not produce
antibodies; they are key players in cellular immunity. DIF: Cognitive Level: Analysis
REF: p. 571TOP: Nursing Process: Assessment MSC: NCLEX Client Needs
Category: Physiologic
Integrity: Physiologic Adaptation
A nurse is caring for a patient who has undergone organ transplantation. Because
the sequence
,of amino acids in the major histocompatibility complex (MHC) molecules of the donor
is
different from that of the patient, the nurse will expect to administer which class of
drugs?
a. Antibiotics
b. Antihistamines
c. Immune globulins
d. Immunosuppressants - ANSWER-ANS: D
The MHC molecules from one individual are recognized as foreign by the immune
system of another individual; therefore, when an attempt is made to transplant
organs between individuals who are not identical twins, immune rejection of the
transplant is likely. Immunosuppressants are
given to counter this response. Antibiotics are used to destroy bacteria.
Antihistamines block
hypersensitivity reactions. Immune globulins are given to confer passive immunity
when specific acquired immunity has not yet developed a response. DIF: Cognitive
Level: Application REF: p. 576TOP: Nursing Process: Planning MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
A nurse is teaching a group of nursing students about antibodies. The nurse
correctly explains which type of response is triggered when antigens bind to
antibodies on mast cells or basophils?
a. Acquired immune response
b. Autoimmune response
c. Hypersensitivity reaction
d. Transplant rejection - ANSWER-ANS: C
When antigens bind to antibodies on mast cells and basophils, chemical mediators
of hypersensitivity reactions are released. Although hypersensitivity is an acquired
response, mast cells and basophils do not play a role in other acquired responses.
An autoimmune response occurs when the immune system fails to discriminate
between self and nonself. Transplant rejection
occurs when the MHC molecules of the donor are different from those of the patient.
DIF: Cognitive Level: Analysis REF: p. 573TOP: Nursing Process: Evaluation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
Which statement is true about helper T cells?
a. They are useful but are not essential to immune responses.
b. They do not play a role in antibody production.
c. They have highly specific receptors to antigens on their surface.
d. They prevent CD4 molecules from attaching to antigens. - ANSWER-ANS: C
Helper T cells have highly specific cell surface receptors that recognize individual
antigens. Helper T cells play an essential role in several functions of the immune
response. They have an essential role in the production of antibodies by B cells.
They carryCD4 molecules on their surface and are
also referred to as CD4 cells. DIF: Cognitive Level: Analysis REF: p. 572TOP:
Nursing Process:
Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic
Adaptation
, A nurse is teaching a group of nursing students about immunoglobulins. Which
statement by a student indicates a need for further teaching?
a. "IgD provides a first line of defense against microbes entering the body through
the lungs."
b. "IgE plays a role in hypersensitivity reactions and responses to parasites."
c. "IgG and IgM participate in the complement response to promote target-cell lysis."
d. "Neonatal immunity is the result of IgG crossing the placenta." - ANSWER-ANS: A
IgD serves as a receptor for antigen recognition on B cells, which is the only place it
is found. IgE
is involved in hypersensitivity responses and responses to parasites. IgG and IgM
are involved in
complement responses. IgG crosses the placenta and confers passive immunity on
the fetus. DIF:
Cognitive Level: Analysis REF: p. 576TOP: Nursing Process: Assessment MSC:
NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
A nurse is discussing the role of antibodies in the complement system with a group
of nursing
students. Which statement by a student is correct?
a. "Antibodies activate the complement cascade by turning on the alternative
pathway."
b. "Antibodies that are free in solution can activate the complement system."
c. "Antibodies flag target cells to be lysed by membrane attack complexes."
d. "Antibody receptors are nonspecific to antigenic determinants." - ANSWER-ANS:
C
Lysis of target cells that have been tagged with antibodies is the most dramatic effect
of the complement system. Antibodies activate the complement cascade by turning
on the classical pathway. C1 cannot bind with free antibodies. Antibody receptors
are specific to antigen
determinants .DIF: Cognitive Level: Analysis REF: p. 578TOP: Nursing Process:
Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic
Adaptation
A provider has ordered intravenous promethazine [Phenergan] for an adult patient
postoperatively to prevent nausea and vomiting (N/V). What will the nurse do?
a. Administer the drug at a rate of 25 mg/minute or more to achieve maximum
effects.
b. Contact the provider to suggest using dimenhydrinate [Dramamine] instead.
c. Ensure that the IV is infusing freely through a large-bore needle.
d. Monitor the patient closely for cardiac dysrhythmias. - ANSWER-ANS: C
Promethazine can cause severe local tissue injury if it extravasates into tissues, so
the medication should be administered in an IV that is flowing freely through a large-
bore needle. The drug should be administered at a rate of 25 mg/minute or less.
Dimenhydrinate is indicated for motion sickness, not postoperative N/V. Cardiac
dysrhythmias were a concern with two antihistamines no longer on the market,
astemizole and terfenadine. DIF: Cognitive Level: Application REF: p. 601TOP:
Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
