Chapter 32 Management of Patients With Immune Deficiency Disorders
1. A teenager is diagnosed with cellulitis of the right knee and fails to respond to oral antibiotics.
He then develops osteomyelitis of the right knee, prompting a detailed diagnostic
workup that reveals a phagocytic disorder. This patient faces an increased risk of what
complication?
A) Thrombocytopenia
B) HIV/AIDS
C) Neutropenia D) Hemophilia Ans: C
Feedback:
Patients with phagocytic cell disorders may develop severe neutropenia. None of the other
listed health problems is a common complication of phagocytic disorders.
2. A patient is admitted for the treatment of a primary immunodeficiency and intravenous
immunoglobulin (IVIG) is ordered. What should the nurse monitor for as a potential adverse
effect of IVIG administration?
A) Anaphylaxis
B) Hypertension C) Hypothermia D) Joint pain Ans: A
Feedback:
Potential adverse effects of an IVIG infusion include hypotension, flank pain, chills,
and tightness in chest, terminating with a slightly elevated body temperature and anaphylactic
reaction. Hypertension, hypothermia, and joint pain are not usual adverse effects of IVIG.
3. A nurse is admitting a patient with an immunodeficiency to the medical unit. In planning the
care of this patient, the nurse should assess for what common sign of immunodeficiency?
A) Chronic diarrhea B) Hyperglycemia C) Rhinorrhea
D) Contact dermatitis
Ans: A
,Feedback:
The cardinal symptoms of immunodeficiency include chronic or recurrent severe infections,
infections caused by unusual organisms or organisms that are normal body flora, poor
response to treatment of infections, and chronic diarrhea. Hyperglycemia, rhinorrhea, and
contact dermatitis are not symptoms the patient is likely to exhibit.
4. A young couple visits the nurse practitioner stating that they want to start a family. The
husband states that his brother died of a severe infection at age 6 months. He says he never
knew what was wrong but his mother had him undergo ìblood testingî as a child. Based on
these statements, what health problem should the nurse practitioner suspect? A) Severe
neutropenia
B) X-linked agammaglobulinemia
C) Drug-induced thrombocytopenia
D) Aplastic anemia
Ans: B
Feedback:
There is no evidence of drug-induced thrombocytopenia or aplastic anemia. The child would
have only suffered from severe neutropenia if there was evidence of bacterial or fungal
infections. The fact the mother of this individual had him tested for gamma- globulin as a
child would indicate that his sibling had X-linked agammaglobulinemia. More than 10% of
patients with X-linked agammaglobulinemia are hospitalized for infection at less than 6
months of age. Since the condition is X-linked it is important for the couple to undergo
genetic testing.
, 5. The parents of a 1-month-old infant bring their child to the pediatrician with symptoms of
congestive heart failure. The infant is ultimately diagnosed with DiGeorge syndrome. What
will prolong this infant's survival?
A) Stem cell transplantation
B) Long-term antibiotics
C) Chemotherapy
D) Thymus gland transplantation
Ans: D
Feedback:
Transplantation of fetal thymus, postnatal thymus, or human leukocyte antigen (HLA)-
matched bone marrow has been used for permanent reconstitution of T-cell immunity in
infants with DiGeorge syndrome. Antibiotics and chemotherapy do not address the etiology of
the infant's disease. Stem cell transplantation is not a common treatment modality.
1. A teenager is diagnosed with cellulitis of the right knee and fails to respond to oral antibiotics.
He then develops osteomyelitis of the right knee, prompting a detailed diagnostic
workup that reveals a phagocytic disorder. This patient faces an increased risk of what
complication?
A) Thrombocytopenia
B) HIV/AIDS
C) Neutropenia D) Hemophilia Ans: C
Feedback:
Patients with phagocytic cell disorders may develop severe neutropenia. None of the other
listed health problems is a common complication of phagocytic disorders.
2. A patient is admitted for the treatment of a primary immunodeficiency and intravenous
immunoglobulin (IVIG) is ordered. What should the nurse monitor for as a potential adverse
effect of IVIG administration?
A) Anaphylaxis
B) Hypertension C) Hypothermia D) Joint pain Ans: A
Feedback:
Potential adverse effects of an IVIG infusion include hypotension, flank pain, chills,
and tightness in chest, terminating with a slightly elevated body temperature and anaphylactic
reaction. Hypertension, hypothermia, and joint pain are not usual adverse effects of IVIG.
3. A nurse is admitting a patient with an immunodeficiency to the medical unit. In planning the
care of this patient, the nurse should assess for what common sign of immunodeficiency?
A) Chronic diarrhea B) Hyperglycemia C) Rhinorrhea
D) Contact dermatitis
Ans: A
,Feedback:
The cardinal symptoms of immunodeficiency include chronic or recurrent severe infections,
infections caused by unusual organisms or organisms that are normal body flora, poor
response to treatment of infections, and chronic diarrhea. Hyperglycemia, rhinorrhea, and
contact dermatitis are not symptoms the patient is likely to exhibit.
4. A young couple visits the nurse practitioner stating that they want to start a family. The
husband states that his brother died of a severe infection at age 6 months. He says he never
knew what was wrong but his mother had him undergo ìblood testingî as a child. Based on
these statements, what health problem should the nurse practitioner suspect? A) Severe
neutropenia
B) X-linked agammaglobulinemia
C) Drug-induced thrombocytopenia
D) Aplastic anemia
Ans: B
Feedback:
There is no evidence of drug-induced thrombocytopenia or aplastic anemia. The child would
have only suffered from severe neutropenia if there was evidence of bacterial or fungal
infections. The fact the mother of this individual had him tested for gamma- globulin as a
child would indicate that his sibling had X-linked agammaglobulinemia. More than 10% of
patients with X-linked agammaglobulinemia are hospitalized for infection at less than 6
months of age. Since the condition is X-linked it is important for the couple to undergo
genetic testing.
, 5. The parents of a 1-month-old infant bring their child to the pediatrician with symptoms of
congestive heart failure. The infant is ultimately diagnosed with DiGeorge syndrome. What
will prolong this infant's survival?
A) Stem cell transplantation
B) Long-term antibiotics
C) Chemotherapy
D) Thymus gland transplantation
Ans: D
Feedback:
Transplantation of fetal thymus, postnatal thymus, or human leukocyte antigen (HLA)-
matched bone marrow has been used for permanent reconstitution of T-cell immunity in
infants with DiGeorge syndrome. Antibiotics and chemotherapy do not address the etiology of
the infant's disease. Stem cell transplantation is not a common treatment modality.
