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Which information about patient and donor tissue typing results for a patient who needs a kidney transplant is most important for the nurse to communicate to the health care provider?
- A. Patient is Rh positive and donor is Rh negative.
- B. Six antigen matches are present in HLA typing.
- C. Results of patient-donor crossmatching are positive.
- D. Panel of reactive antibodies (PRA) percentage is low.
Correct Answer: C
Rationale: Positive crossmatching is an absolute contraindication to kidney transplantation, since hyperacute rejection will occur after the transplant. The other information indicates that the tissue match between the patient and potential donor is acceptable.
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The nurse is assessing a patient for possible atopic dermatitis. Which of the following laboratory values should the nurse review?
- A. IgE
- B. IgA
- C. Basophils
- D. Neutrophils
Correct Answer: A
Rationale: Serum IgE causes the symptoms of allergic reactions and is elevated in type 1 hypersensitivity disorders. The eosinophil level will be elevated, rather than neutrophil or basophil counts. IgA is located in body secretions and would not be tested when evaluating a patient who has symptoms of atopic dermatitis.
The nurse is admitting a patient to the hospital with a diagnosis of acute rejection of a kidney transplant. Which of the following actions should the nurse anticipate implementing?
- A. Administration of immunosuppressant medications
- B. Insertion of an arteriovenous graft for hemodialysis
- C. Placement of the patient on the transplant waiting list
- D. Drawing blood for human leukocyte antigen (HLA) and ABO compatibility
Correct Answer: A
Rationale: Acute rejection is treated with the administration of additional immunosuppressant drugs such as corticosteroids. Because acute rejection is reversible, there is no indication that the patient will require another transplant, hemodialysis, or HLA/ABO testing.
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.
The nurse is caring for a patient in the outpatient clinic who has an immune deficiency involving the T-lymphocytes. Which of the following areas should the nurse teach the patient about the need for more frequent screening?
- A. Allergies
- B. Malignancy
- C. Antibody deficiency
- D. Autoimmune disorders
Correct Answer: B
Rationale: Cell-mediated immunity is responsible for the recognition and destruction of cancer cells. Allergic reactions, autoimmune disorders, and antibody deficiencies are mediated primarily by humoral immunity.
Which of the following instructions should the nurse include when teaching a patient with possible allergies about intradermal skin testing?
- A. Do not eat anything for about 6 hours before the testing.'
- B. Take an oral antihistamine about an hour before the testing.'
- C. Plan to wait in the clinic for 20-30 minutes after the testing.'
- D. Reaction to the testing will take about 48-72 hours to occur.'
Correct Answer: C
Rationale: Allergic reactions usually occur within minutes after injection of an allergen, and the patient will be monitored for at least 20 minutes for anaphylactic reactions after the testing. Medications that might modify the response, such as antihistamines, should be avoided before allergy testing. There is no reason to be NPO for skin testing. Results with intradermal testing occur within minutes.