Lewis - Chapter 13: Altered Immune Responses
and Transplantation| Questions with 100%
Correct Answers
Association between HLA antigens and disease is most commonly found in what disease
condition?
A. malignancies
B. infectious disease
C. neurologic diseases
D. autoimmune disorders - ✔️✔️D
Rationale: Most of the human leukocyte antigen (HLA)-associated diseases are classified as
autoimmune disorders. Examples of associations between HLA types and disease include (1) that
of HLA-B27 with ankylosing spondylitis, (2) those of HLA-DR2 and HLA-DR3 with systemic
lupus erythematosus (SLE), and (3) those of HLA-DR3 and HLA-DR4 with diabetes mellitus.
A patient is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse
explains that plasmapheresis is used in her treatment to:
A. remove T lymphocytes in her blood that are producing antinuclear antibodies
B. remove normal particles in her blood that are being damaged by autoantibodies
C. exchange her plasma that contains antinuclear antibodies with a substitute fluid
D. replace viral-damaged cellular components of her blood with replacement whole blood -
✔️✔️C
Rationale: The rationale for performing therapeutic plasmapheresis in patients with autoimmune
disorders such as SLE is to remove pathologic substances (i.e., antinuclear antibodies) from
plasma.
The most common cause of secondary immunodeficiencies is:
A. drugs
B. stress
C. malnutrition
D. human immunodeficiency virus - ✔️✔️A
Rationale: Drug-induced immunosuppression is the most common cause of secondary
immunodeficiency disorders.
Which of the following accurately describes rejection following transplantation?
A. hyperacute rejection can be treated with OKT3
B. acute rejections can be treated with sirolimus or tacrolimus
C. chronic rejection can be treated with tacrolimus or cyclosporine
D. hyperacute rejection can usually be avoided is crossmatching if done before the
transplantation - ✔️✔️D
Rationale: A positive crossmatch indicates that the recipient has cytotoxic antibodies to the
donor's antigens and is an absolute contraindication to transplantation. If transplanted, the organ
would undergo hyperacute rejection.
,In a person having an acute rejection of a transplanted kidney, which of the following would help
the nurse understand the course of events (select all that apply):
A. a new transplant could be considered
B. acute rejection can be treated with OKT3
C. acute rejection usually leads to chronic rejection
D. corticosteroids are the most successful drug used to treat acute rejection
E. Acute rejection is common after a transplant and can be treated with drug therapy - ✔️✔️B, E
Rationale: Acute rejection is treatable and does not usually necessitate replacement
transplantation. Monoclonal antibodies such as muromonab-CD3 (Orthoclone OKT3) are used
for preventing and treating acute rejection episodes. Calcineurin inhibitors are the most effective
immunosuppressants available to treat organ rejection. It is not uncommon to have at least one
acute rejection episode, especially with organs from deceased donors. These episodes are usually
reversible with additional immunosuppressive therapy that may include increased corticosteroid
doses or polyclonal or monoclonal antibodies.
If a person is heterozygous for a given gene, it means that the person:
A. is a carrier for a genetic disorder
B. is affected by the genetic disorder
C. has two identical allels for the gene
D. has two different allels for the gene - ✔️✔️D
A father who has an X-linked recessive disorder and a wife with a normal genotype will:
A. pass the carrier state to his make child
B. pass the carrier state to all of his children
C. pass the carrier state to his female child
D. not pass on the genetic mutation to any of is children - ✔️✔️C
The nurse creates a plan of care for a patient who has had an allergic reaction to a bee sting.
What is the priority expected outcome for this patient?
A. Verbalizing comfort
B. Maintaining a clear and patent airway
C. Being free of signs and symptoms of infection
D. Demonstrating self-administration of epinephrine - ✔️✔️B.
This patient is at risk for development of an anaphylactic reaction. Maintaining a clear and patent
airway is a priority outcome with a patient who has sustained a bee sting and has a known allergy
to bees. Comfort and being free of signs and symptoms of infection are important after ensuring
airway patency and breathing. Although the demonstration of self-administered epinephrine is
likely valuable for the allergic patient, immediately after the bee sting is not the best time to
engage in education because a delay in the administration of epinephrine could result.
Text Reference - p. 214
A patient who has been receiving immunotherapy for the control of allergy symptoms requests a
dose that can be taken at home. What is the most appropriate nursing response?
A. Give immunotherapy to the patient that can be taken at home as requested.
, B. Give immunotherapy to the patient at home but explain that the patient will need to visit the
hospital immediately afterward for testing.
C. Give immunotherapy at the hospital and let the patient go home.
D. Give immunotherapy at the hospital and closely monitor the patient. - ✔️✔️D.
The nurse should give immunotherapy at the hospital and closely monitor the patient for any
adverse reactions. Immunotherapy may cause a severe anaphylactic reaction; therefore, the nurse
should give immunotherapy only when emergency equipment is available. Immunotherapy
should never be given in the home as anaphylactic shock cannot be adequately treated at home.
The patient should never be left alone after immunotherapy, as systemic reactions may occur.
TEST-TAKING TIP: Do not worry if you select the same numbered answer repeatedly, because
there usually is no pattern to the answers.
Text Reference - p. 216
A patient has begun immunotherapy for the treatment of intractable environmental allergies.
When administering the patient's immunotherapy, what is the nurse's priority action?
A. Monitor the patient's fluid balance
B. Assess the patient's need for analgesia
C. Monitor for signs and symptoms of an adverse reaction
D. Assess the patient for changes in level of consciousness - ✔️✔️C.
When administering immunotherapy, it is imperative to closely monitor the patient for any signs
of an adverse reaction. The high risk and significant consequence of an adverse reaction
supersede the need to assess the patient's fluid balance. Pain and changes in level of
consciousness are not likely events when administering immunotherapy.
Text Reference - p. 215
A nurse is caring for a patient with systemic lupus erythematosus. The nurse understands that
this disease is caused when the body identifies self proteins as foreign substances, triggering an
immune response. What is this pathophysiological condition called?
A. Autoimmunity
B. Hypersensitivity
C. Immunodeficiency
D. Delayed hypersensitivity - ✔️✔️A.
Autoimmunity occurs when the body identifies self proteins as foreign substances, it causes
cellular and tissue damage. Hypersensitivity is an exaggerated immune response to specific
products. Immunodeficiency results from an incompetent immune system, which can be caused
by pathogens, medications, and many other factors. Delayed hypersensitivity is a type of
hypersensitivity reaction that takes 24 to 48 hours to occur.
Text Reference - p. 217
While undergoing a cerebral computed tomography (CT) scan, a contrast dye is injected. After
administering a few mL of contrast media, the health care provider assesses the patient and
immediately stops the infusion. What reasons could have led the health care provider to
discontinue the contrast dye? Select all that apply.
A. Nasal discharge
and Transplantation| Questions with 100%
Correct Answers
Association between HLA antigens and disease is most commonly found in what disease
condition?
A. malignancies
B. infectious disease
C. neurologic diseases
D. autoimmune disorders - ✔️✔️D
Rationale: Most of the human leukocyte antigen (HLA)-associated diseases are classified as
autoimmune disorders. Examples of associations between HLA types and disease include (1) that
of HLA-B27 with ankylosing spondylitis, (2) those of HLA-DR2 and HLA-DR3 with systemic
lupus erythematosus (SLE), and (3) those of HLA-DR3 and HLA-DR4 with diabetes mellitus.
A patient is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse
explains that plasmapheresis is used in her treatment to:
A. remove T lymphocytes in her blood that are producing antinuclear antibodies
B. remove normal particles in her blood that are being damaged by autoantibodies
C. exchange her plasma that contains antinuclear antibodies with a substitute fluid
D. replace viral-damaged cellular components of her blood with replacement whole blood -
✔️✔️C
Rationale: The rationale for performing therapeutic plasmapheresis in patients with autoimmune
disorders such as SLE is to remove pathologic substances (i.e., antinuclear antibodies) from
plasma.
The most common cause of secondary immunodeficiencies is:
A. drugs
B. stress
C. malnutrition
D. human immunodeficiency virus - ✔️✔️A
Rationale: Drug-induced immunosuppression is the most common cause of secondary
immunodeficiency disorders.
Which of the following accurately describes rejection following transplantation?
A. hyperacute rejection can be treated with OKT3
B. acute rejections can be treated with sirolimus or tacrolimus
C. chronic rejection can be treated with tacrolimus or cyclosporine
D. hyperacute rejection can usually be avoided is crossmatching if done before the
transplantation - ✔️✔️D
Rationale: A positive crossmatch indicates that the recipient has cytotoxic antibodies to the
donor's antigens and is an absolute contraindication to transplantation. If transplanted, the organ
would undergo hyperacute rejection.
,In a person having an acute rejection of a transplanted kidney, which of the following would help
the nurse understand the course of events (select all that apply):
A. a new transplant could be considered
B. acute rejection can be treated with OKT3
C. acute rejection usually leads to chronic rejection
D. corticosteroids are the most successful drug used to treat acute rejection
E. Acute rejection is common after a transplant and can be treated with drug therapy - ✔️✔️B, E
Rationale: Acute rejection is treatable and does not usually necessitate replacement
transplantation. Monoclonal antibodies such as muromonab-CD3 (Orthoclone OKT3) are used
for preventing and treating acute rejection episodes. Calcineurin inhibitors are the most effective
immunosuppressants available to treat organ rejection. It is not uncommon to have at least one
acute rejection episode, especially with organs from deceased donors. These episodes are usually
reversible with additional immunosuppressive therapy that may include increased corticosteroid
doses or polyclonal or monoclonal antibodies.
If a person is heterozygous for a given gene, it means that the person:
A. is a carrier for a genetic disorder
B. is affected by the genetic disorder
C. has two identical allels for the gene
D. has two different allels for the gene - ✔️✔️D
A father who has an X-linked recessive disorder and a wife with a normal genotype will:
A. pass the carrier state to his make child
B. pass the carrier state to all of his children
C. pass the carrier state to his female child
D. not pass on the genetic mutation to any of is children - ✔️✔️C
The nurse creates a plan of care for a patient who has had an allergic reaction to a bee sting.
What is the priority expected outcome for this patient?
A. Verbalizing comfort
B. Maintaining a clear and patent airway
C. Being free of signs and symptoms of infection
D. Demonstrating self-administration of epinephrine - ✔️✔️B.
This patient is at risk for development of an anaphylactic reaction. Maintaining a clear and patent
airway is a priority outcome with a patient who has sustained a bee sting and has a known allergy
to bees. Comfort and being free of signs and symptoms of infection are important after ensuring
airway patency and breathing. Although the demonstration of self-administered epinephrine is
likely valuable for the allergic patient, immediately after the bee sting is not the best time to
engage in education because a delay in the administration of epinephrine could result.
Text Reference - p. 214
A patient who has been receiving immunotherapy for the control of allergy symptoms requests a
dose that can be taken at home. What is the most appropriate nursing response?
A. Give immunotherapy to the patient that can be taken at home as requested.
, B. Give immunotherapy to the patient at home but explain that the patient will need to visit the
hospital immediately afterward for testing.
C. Give immunotherapy at the hospital and let the patient go home.
D. Give immunotherapy at the hospital and closely monitor the patient. - ✔️✔️D.
The nurse should give immunotherapy at the hospital and closely monitor the patient for any
adverse reactions. Immunotherapy may cause a severe anaphylactic reaction; therefore, the nurse
should give immunotherapy only when emergency equipment is available. Immunotherapy
should never be given in the home as anaphylactic shock cannot be adequately treated at home.
The patient should never be left alone after immunotherapy, as systemic reactions may occur.
TEST-TAKING TIP: Do not worry if you select the same numbered answer repeatedly, because
there usually is no pattern to the answers.
Text Reference - p. 216
A patient has begun immunotherapy for the treatment of intractable environmental allergies.
When administering the patient's immunotherapy, what is the nurse's priority action?
A. Monitor the patient's fluid balance
B. Assess the patient's need for analgesia
C. Monitor for signs and symptoms of an adverse reaction
D. Assess the patient for changes in level of consciousness - ✔️✔️C.
When administering immunotherapy, it is imperative to closely monitor the patient for any signs
of an adverse reaction. The high risk and significant consequence of an adverse reaction
supersede the need to assess the patient's fluid balance. Pain and changes in level of
consciousness are not likely events when administering immunotherapy.
Text Reference - p. 215
A nurse is caring for a patient with systemic lupus erythematosus. The nurse understands that
this disease is caused when the body identifies self proteins as foreign substances, triggering an
immune response. What is this pathophysiological condition called?
A. Autoimmunity
B. Hypersensitivity
C. Immunodeficiency
D. Delayed hypersensitivity - ✔️✔️A.
Autoimmunity occurs when the body identifies self proteins as foreign substances, it causes
cellular and tissue damage. Hypersensitivity is an exaggerated immune response to specific
products. Immunodeficiency results from an incompetent immune system, which can be caused
by pathogens, medications, and many other factors. Delayed hypersensitivity is a type of
hypersensitivity reaction that takes 24 to 48 hours to occur.
Text Reference - p. 217
While undergoing a cerebral computed tomography (CT) scan, a contrast dye is injected. After
administering a few mL of contrast media, the health care provider assesses the patient and
immediately stops the infusion. What reasons could have led the health care provider to
discontinue the contrast dye? Select all that apply.
A. Nasal discharge
