Nokea
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.
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The nurse encourages a new mother to breastfeed her infant, even for a short time, because colostrum will provide the infant with which of the following types of immunity?
- A. Innate
- B. Active
- C. Passive
- D. Cell-mediated
Correct Answer: C
Rationale: Colostrum provides passive immunity through antibodies from the mother; these antibodies protect the infant for a few months. However, memory cells are not retained, so the protection is not permanent. Innate immunity is present at birth and occurs without exposure to an antigen. Active immunity requires that the infant manufacture antibodies after exposure to an antigen. Cell-mediated immunity is acquired through T-lymphocytes and is a form of active immunity.
The nurse is obtaining a health history from a patient who works as a laboratory technician and learns that the patient has a history of allergic rhinitis, asthma, and multiple food allergies. Which of the following actions is most important for the nurse to implement?
- A. Encourage the patient to carry an epinephrine kit in case a type IV allergic reaction to latex develops.
- B. Advise the patient to use oil-based hand creams to decrease contact with natural proteins in latex gloves.
- C. Document the patient's allergy history and be alert for any clinical manifestations of a type I latex allergy.
- D. Recommend that the patient use vinyl gloves instead of latex gloves in preventing bloodborne pathogen contact.
Correct Answer: C
Rationale: The patient's allergy history and occupation indicate a risk for development of latex allergy, and the nurse should be prepared to manage any symptoms that occur. Epinephrine is not an appropriate treatment for contact dermatitis that is caused by a type IV allergic reaction to latex. Oil-based creams will increase the exposure to latex from latex gloves. Vinyl gloves are appropriate to use when exposure to body fluids is unlikely.
The nurse discusses the prevention and management of allergic reactions with a patient who is a beekeeper and has developed a hypersensitivity to bee sting. Which of the following patient statements indicates a need for additional teaching?
- A. I will plan to take oral antihistamines daily before going to work.'
- B. I will get a prescription for epinephrine and learn to self-inject it.'
- C. I should wear a Medic Alert bracelet indicating my allergy to bee stings.'
- D. I am going to need job retraining so that I can work in a different occupation.'
Correct Answer: A
Rationale: Since the patient is at risk for bee stings and the severity of allergic reactions tends to increase with added exposure to allergen, taking oral antihistamines will not adequately control the patient's hypersensitivity reaction. The other patient statements indicate a good understanding of management of the problem.
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 caring for a patient at an outpatient clinic who is experiencing an allergic reaction to an unknown allergen. Which of the following actions is most appropriate for the nurse to implement?
- A. Perform a focused physical assessment.
- B. Obtain the health history from the patient.
- C. Teach the patient about the various diagnostic studies.
- D. Prioritize care based on the presenting symptoms, starting with vital sign interpretation.
Correct Answer: D
Rationale: The immediate priority is to determine the status of the patient. After the allergic reaction is treated, an assessment of health history, focused physical assessment, and patient teaching could follow.