Nokea
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.
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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.
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.
The nurse is caring for a patient who is receiving an IV antibiotic and develops wheezes and dyspnea. In which order should the nurse implement these prescribed actions?
- A. Discontinue the antibiotic infusion.
- B. Give diphenhydramine IV.
- C. Inject epinephrine IM.
- D. Start 100% oxygen using a nonrebreather mask.
Correct Answer: A,D,C,B
Rationale: The nurse should initially discontinue the antibiotic, since it is the likely cause of the allergic reaction. Next, oxygen delivery should be maximized, followed by treatment of bronchoconstriction with epinephrine administered IM or IV. Diphenhydramine will work more slowly than epinephrine, but will help prevent progression of the reaction.
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.
Which information about a patient who is receiving immunotherapy and has just received an allergen injection is most important to communicate to the health care provider?
- A. The patient's IgG level is increased.
- B. The injection site is red and swollen.
- C. The patient's allergy symptoms have not improved.
- D. There is a 3-cm wheal at the site of the allergen injection.
Correct Answer: D
Rationale: A local reaction larger than quarter size may indicate that a decrease in the allergen dose is needed. An increase in IgG indicates that the therapy is effective. Redness and swelling at the site are not unusual. Because immunotherapy usually takes 1-2 years to achieve an effect, an improvement in the patient's symptoms is not expected after a few months.