Nokea
The nurse is conducting an annual health examination on an older adult patient who states, 'I don't understand why I need to have so many cancer screening tests now. I feel just fine!' Based upon this statement, which of the following topics will the nurse include in the patients' teaching plan?
- A. Consequences of aging on cell-mediated immunity
- B. Decrease in antibody production associated with aging
- C. Impact of poor nutrition on immune function in older people
- D. Incidence of cancer-stimulating infections in older individuals
Correct Answer: A
Rationale: The primary impact of aging on immune function is on the activity of T cells, which are responsible for tumour immunity. Antibody function is not impacted as much by aging and does not protect against malignancy. Poor nutrition does contribute to decreased immunity, but there is no evidence that it is a contributing factor for this patient. Although some types of cancers are associated with specific infections, this patient does not have an active infection.
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The nurse is caring for a patient who has experienced Goodpasture's syndrome. Which of the following adverse effects should the nurse be aware of?
- A. Thrombocytopenia
- B. Leukopenia
- C. Angioedema
- D. Pulmonary hemorrhage
Correct Answer: D
Rationale: Goodpasture's syndrome is a rare disorder involving the lungs and the kidneys. An antibody-mediated autoimmune reaction occurs involving the glomerular and alveolar basement membranes. The circulating antibodies combine with tissue antigen to activate the complement system which causes deposits of IgG to form along the basement membranes of the lungs or the kidneys. This reaction may result in pulmonary hemorrhage and glomerulonephritis.
The nurse is teaching a patient on immunosuppressant therapy after a kidney transplant about the post-transplant drug regimen. Which of the following statements by the patient should alert the nurse that additional teaching is required?
- A. If I develop an acute rejection episode, I will need to have other types of drugs given IV.'
- B. I need to be monitored closely because I have a greater chance of developing malignant tumours.'
- C. After a couple of years, it is likely that I will be able to stop taking the calcineurin inhibitor.'
- D. The drugs are given in combination because they inhibit different aspects of transplant rejection.'
Correct Answer: C
Rationale: The calcineurin inhibitor will need to be continued for life. The other patient statements are accurate and indicate that no further teaching is necessary about those topics.
The nurse is admitting a patient to hospital who has acute rejection of an organ transplant. Which of the following patients is the most appropriate roommate?
- A. A patient who has viral pneumonia
- B. A patient with second-degree burns
- C. A patient who is recovering from an anaphylactic reaction to a bee sting
- D. A patient with graft-versus-host disease after a recent bone marrow transplant
Correct Answer: C
Rationale: Treatment for a patient with acute rejection includes administration of additional immunosuppressants, and the patient should not be exposed to increased risk for infection as would occur from patients with viral pneumonia, graft-versus-host disease, and burns. There is no increased exposure to infection from a patient with anaphylaxis.
Which of the following adverse effects is related to cyclosporine administration?
- A. Nephrotoxicity
- B. Aseptic necrosis
- C. Peptic ulcer
- D. Leukopenia
Correct Answer: A
Rationale: Nephrotoxicity is the most severe adverse effect of cyclosporine. Aseptic necrosis, peptic ulcer, and leukopenia are all adverse effects of the use of corticosteroids, for example, prednisone.
Which of the following adverse reactions should the nurse monitor when a patient is undergoing plasmapheresis?
- A. Shortness of breath
- B. High blood pressure
- C. Transfusion reactions
- D. Hypotension and paresthesia
Correct Answer: D
Rationale: Hypotension and paresthesia may occur as the result of plasmapheresis. Citrate is used as an anticoagulant and may cause hypocalcemia, which may manifest as headache, paresthesias, and dizziness. The other clinical manifestations are not associated with plasmapheresis.