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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.
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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 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.
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.
The nurse is caring for a patient who receives weekly immunotherapy and has missed the previous appointment. Which of the following actions should the nurse implement when the patient comes for the next injection?
- A. Schedule an additional dose that week.
- B. Administer the usual dosage of the allergen.
- C. Consult with the health care provider about giving a lower allergen dose.
- D. Re-evaluate the patient's sensitivity to the allergen with a repeat skin test.
Correct Answer: C
Rationale: Because there is an increased risk for adverse reactions after a patient misses a scheduled dose of allergen, the nurse should check with the health care provider before administration of the injection. A skin test is used to identify the allergen and would not be used at this time. An additional dose for the week may increase the risk for a reaction.
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.