Question 1 See full question
A client undergoing a skin test has been intradermally injected with a
disease-specific antigen on the inner forearm. The client becomes
anxious because the area begins to swell. Which technique may be
used to decrease anxiety in this client?
You Selected:
• Assure the client that this is a normal reaction
Correct response:
• Assure the client that this is a normal reaction
Explanation
:
The nurse should assure the client that this is a normal reaction.
When disease-specific antigens are injected, the injection area swells
as a result of the client developing antibodies against the antigen
that is introduced. The nurse should also keep in mind that the client
is not necessarily actively infectious if the test result is positive.
Rubbing the area gently or even applying ice packs may only
aggravate the swelling. The swollen area should be left open to heal
by itself. The nurse should await the physician's instructions before
advising the client to use any prescribed analgesics.
Reference:
• Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook
of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott
Williams & Wilkins, 2017,
Question 2 See full question
Ibuprofen affects the immune system by causing
You
Selected:
• neutropenia.
Correct response:
• neutropenia.
Explanation
:
Ibuprofen causes leukopenia and neutropenia. Phenylbutazone causes
pancytopenia. Cefuroxime sodium causes thrombocytopenia and
hemolytic anemia.
Reference:
, • Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of
Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters
Kluwer, 2018, Chapter 35: Assessment of Immune Function,
Table 35-5, p. 1019.
Chapter 35: Assessment of Immune Function - Page 1019
Question 3 See full question
An elderly client is diagnosed with a respiratory infection. While
reviewing age-related changes in the immune system, the nurse
identifies which of the following as having contributed to this client's
infection?
You Selected:
• Impaired ciliary action from exposure to environmental toxins
Correct response:
• Impaired ciliary action from exposure to environmental toxins
Explanation:
Impaired ciliary action from exposure to smoke and environmental
toxins contributes to impaired clearance of pulmonary secretions and
an increased incidence of respiratory infections in the elderly. Failure
of the immune system to differentiate "self" from "non-self" leads
to an increase incidence of autoimmune diseases. Decreased
phagocytosis by the liver's Kupffer cells leads to increased incidence
and severity of hepatitis B. Decreased sensation and slowing of
reflexes leads to increased risk of skin injury, skin ulcers, abrasions,
burns, and other trauma.
Reference:
• Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of
Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters
Kluwer, 2018, Chapter 35: Assessment of Immune Function,
Table 35-4, p. 1015.
Chapter 35: Assessment of Immune Function - Page 1015
Question 4 See full question
A client has been diagnosed with AIDS and tuberculosis (TB). A
nursing student asks the nurse why the client's skin test for TB is
negative if the client's physician has diagnosed TB. The nurse's
correct reply is which of the following?
You Selected:
• The client's immune system cannot mount a response to the
skin test.
, Correct response:
A client undergoing a skin test has been intradermally injected with a
disease-specific antigen on the inner forearm. The client becomes
anxious because the area begins to swell. Which technique may be
used to decrease anxiety in this client?
You Selected:
• Assure the client that this is a normal reaction
Correct response:
• Assure the client that this is a normal reaction
Explanation
:
The nurse should assure the client that this is a normal reaction.
When disease-specific antigens are injected, the injection area swells
as a result of the client developing antibodies against the antigen
that is introduced. The nurse should also keep in mind that the client
is not necessarily actively infectious if the test result is positive.
Rubbing the area gently or even applying ice packs may only
aggravate the swelling. The swollen area should be left open to heal
by itself. The nurse should await the physician's instructions before
advising the client to use any prescribed analgesics.
Reference:
• Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook
of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott
Williams & Wilkins, 2017,
Question 2 See full question
Ibuprofen affects the immune system by causing
You
Selected:
• neutropenia.
Correct response:
• neutropenia.
Explanation
:
Ibuprofen causes leukopenia and neutropenia. Phenylbutazone causes
pancytopenia. Cefuroxime sodium causes thrombocytopenia and
hemolytic anemia.
Reference:
, • Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of
Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters
Kluwer, 2018, Chapter 35: Assessment of Immune Function,
Table 35-5, p. 1019.
Chapter 35: Assessment of Immune Function - Page 1019
Question 3 See full question
An elderly client is diagnosed with a respiratory infection. While
reviewing age-related changes in the immune system, the nurse
identifies which of the following as having contributed to this client's
infection?
You Selected:
• Impaired ciliary action from exposure to environmental toxins
Correct response:
• Impaired ciliary action from exposure to environmental toxins
Explanation:
Impaired ciliary action from exposure to smoke and environmental
toxins contributes to impaired clearance of pulmonary secretions and
an increased incidence of respiratory infections in the elderly. Failure
of the immune system to differentiate "self" from "non-self" leads
to an increase incidence of autoimmune diseases. Decreased
phagocytosis by the liver's Kupffer cells leads to increased incidence
and severity of hepatitis B. Decreased sensation and slowing of
reflexes leads to increased risk of skin injury, skin ulcers, abrasions,
burns, and other trauma.
Reference:
• Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of
Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters
Kluwer, 2018, Chapter 35: Assessment of Immune Function,
Table 35-4, p. 1015.
Chapter 35: Assessment of Immune Function - Page 1015
Question 4 See full question
A client has been diagnosed with AIDS and tuberculosis (TB). A
nursing student asks the nurse why the client's skin test for TB is
negative if the client's physician has diagnosed TB. The nurse's
correct reply is which of the following?
You Selected:
• The client's immune system cannot mount a response to the
skin test.
, Correct response:
