Lewis's Medical Surgical Nursing Test Bank 11th Edition [Harding]
Chapter 13 - Immune Responses and Transplantation
1. The nurse provides discharge instructions to a patient who has an immune
deficiency involving the T lymphocytes. Which screening should the nurse
include in the teaching plan for this patient?
A. Screening for allergies
B. Screening for malignancy
C. Antibody deficiency screening
D. Screening for autoimmune disorders
Answer: B
Explanation: T lymphocytes are responsible for cell-mediated immunity, which includes
immune surveillance and the destruction of cancer cells. Therefore, screening for malignancy
is a priority for patients with T-cell deficiencies.
2. A new mother expresses concern about her baby developing allergies and asks
what the health care provider meant by passive immunity. Which example
should the nurse use to explain this type of immunity?
A. Early immunization
B. Bone marrow donation
C. Breastfeeding her infant
D. Exposure to communicable diseases
Answer: C
Explanation: Passive immunity is acquired by receiving antibodies from another source, such
as through breastfeeding, where the infant receives maternal antibodies. This provides
temporary protection but does not stimulate the infant's own immune memory.
3. A patient is being evaluated for possible atopic dermatitis. The nurse expects
elevation of which laboratory value?
A. IgE
B. IgA
C. Basophils
D. Neutrophils
Answer: A
,Explanation: Atopic dermatitis is a type I hypersensitivity reaction mediated by
immunoglobulin E (IgE). Elevated serum IgE levels are commonly associated with allergic
conditions like atopic dermatitis.
4. An older adult patient who is having an annual check-up tells the nurse, I feel
fine, and I don't want to pay for all these unnecessary cancer screening tests!
Which information should the nurse plan to teach this patient?
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
Answer: A
Explanation: Aging primarily affects T-cell function (cell-mediated immunity), which is
crucial for immune surveillance and identifying and destroying cancer cells. This decline
increases cancer risk, justifying the need for screening.
5. A patient who collects honey to earn supplemental income has developed a
hypersensitivity to bee stings. Which statement, if made by the patient, would
indicate a need for additional teaching?
A. I need to find another way to earn extra money.
B. I will get a prescription for epinephrine and learn to self-inject it.
C. I will plan to take oral antihistamines daily before going to work.
D. I should wear a Medic-Alert bracelet indicating my allergy to bee stings.
Answer: C
Explanation: Oral antihistamines are not sufficient to prevent or treat a severe systemic
allergic reaction (anaphylaxis) to bee stings. The patient requires immediate epinephrine in
case of a sting, not premedication with antihistamines.
6. Which teaching should the nurse provide about intradermal skin testing to a
patient with possible allergies?
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 to 30 minutes after the testing.
D. Reaction to the testing will take about 48 to 72 hours to occur.
Answer: C
,Explanation: Allergic reactions to intradermal testing can occur rapidly. Patients must be
monitored for 20-30 minutes post-testing for signs of anaphylaxis. Antihistamines should be
avoided beforehand as they can suppress reactions.
7. The nurse, who is reviewing a clinic patients medical record, notes that the
patient missed the previous appointment for weekly immunotherapy. Which
action by the nurse is most appropriate?
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 patients sensitivity to the allergen with a repeat skin test.
Answer: C
Explanation: Missing a scheduled immunotherapy dose increases the risk of an adverse
reaction. The nurse should consult the provider about potentially reducing the dose to ensure
patient safety.
8. While obtaining a health history from a patient, the nurse learns that the patient
has a history of allergic rhinitis and multiple food allergies. Which action by the
nurse is most appropriate?
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 patients 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
blood-borne pathogen contact.
Answer: C
Explanation: Patients with a history of multiple allergies, especially to foods, are at increased
risk for a type I (immediate) latex allergy. The nurse should document this risk and monitor
for signs of a reaction.
9. The nurse teaches a patient diagnosed with systemic lupus erythematosus (SLE)
about plasmapheresis. What instructions about plasmapheresis should the nurse
include in the teaching plan?
A. Plasmapheresis will eliminate eosinophils and basophils from blood.
B. Plasmapheresis will remove antibody-antigen complexes from circulation.
, C. Plasmapheresis will prevent foreign antibodies from damaging various body
tissues.
D. Plasmapheresis will decrease the damage to organs caused by attacking T
lymphocytes.
Answer: B
Explanation: Plasmapheresis is used in SLE to remove pathogenic components from the
blood, including autoantibodies, immune complexes, and complement, which contribute to
tissue damage.
10. The nurse is caring for a patient undergoing plasmapheresis. The nurse should
assess the patient for which clinical manifestation?
A. Shortness of breath
B. High blood pressure
C. Transfusion reaction
D. Numbness and tingling
Answer: D
Explanation: Citrate, used as an anticoagulant during plasmapheresis, can bind calcium and
cause hypocalcemia, leading to symptoms like numbness and tingling (paresthesia).
11. Which statement by a patient would alert the nurse to a possible
immunodeficiency disorder?
A. I take one baby aspirin every day to prevent stroke.
B. I usually eat eggs or meat for at least 2 meals a day.
C. I had my spleen removed many years ago after a car accident.
D. I had a chest x-ray 6 months ago when I had walking pneumonia.
Answer: C
Explanation: The spleen is a key lymphoid organ. Its removal (splenectomy) increases the
risk for severe bacterial infections, indicating a potential immunodeficiency.
12. Which patient should the nurse assess first?
A. Patient with urticaria after receiving an IV antibiotic
B. Patient who has graft-versus-host disease and severe diarrhea
C. Patient who is sneezing after having subcutaneous immunotherapy
D. Patient with multiple chemical sensitivities who has muscle stiffness
Answer: C
Chapter 13 - Immune Responses and Transplantation
1. The nurse provides discharge instructions to a patient who has an immune
deficiency involving the T lymphocytes. Which screening should the nurse
include in the teaching plan for this patient?
A. Screening for allergies
B. Screening for malignancy
C. Antibody deficiency screening
D. Screening for autoimmune disorders
Answer: B
Explanation: T lymphocytes are responsible for cell-mediated immunity, which includes
immune surveillance and the destruction of cancer cells. Therefore, screening for malignancy
is a priority for patients with T-cell deficiencies.
2. A new mother expresses concern about her baby developing allergies and asks
what the health care provider meant by passive immunity. Which example
should the nurse use to explain this type of immunity?
A. Early immunization
B. Bone marrow donation
C. Breastfeeding her infant
D. Exposure to communicable diseases
Answer: C
Explanation: Passive immunity is acquired by receiving antibodies from another source, such
as through breastfeeding, where the infant receives maternal antibodies. This provides
temporary protection but does not stimulate the infant's own immune memory.
3. A patient is being evaluated for possible atopic dermatitis. The nurse expects
elevation of which laboratory value?
A. IgE
B. IgA
C. Basophils
D. Neutrophils
Answer: A
,Explanation: Atopic dermatitis is a type I hypersensitivity reaction mediated by
immunoglobulin E (IgE). Elevated serum IgE levels are commonly associated with allergic
conditions like atopic dermatitis.
4. An older adult patient who is having an annual check-up tells the nurse, I feel
fine, and I don't want to pay for all these unnecessary cancer screening tests!
Which information should the nurse plan to teach this patient?
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
Answer: A
Explanation: Aging primarily affects T-cell function (cell-mediated immunity), which is
crucial for immune surveillance and identifying and destroying cancer cells. This decline
increases cancer risk, justifying the need for screening.
5. A patient who collects honey to earn supplemental income has developed a
hypersensitivity to bee stings. Which statement, if made by the patient, would
indicate a need for additional teaching?
A. I need to find another way to earn extra money.
B. I will get a prescription for epinephrine and learn to self-inject it.
C. I will plan to take oral antihistamines daily before going to work.
D. I should wear a Medic-Alert bracelet indicating my allergy to bee stings.
Answer: C
Explanation: Oral antihistamines are not sufficient to prevent or treat a severe systemic
allergic reaction (anaphylaxis) to bee stings. The patient requires immediate epinephrine in
case of a sting, not premedication with antihistamines.
6. Which teaching should the nurse provide about intradermal skin testing to a
patient with possible allergies?
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 to 30 minutes after the testing.
D. Reaction to the testing will take about 48 to 72 hours to occur.
Answer: C
,Explanation: Allergic reactions to intradermal testing can occur rapidly. Patients must be
monitored for 20-30 minutes post-testing for signs of anaphylaxis. Antihistamines should be
avoided beforehand as they can suppress reactions.
7. The nurse, who is reviewing a clinic patients medical record, notes that the
patient missed the previous appointment for weekly immunotherapy. Which
action by the nurse is most appropriate?
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 patients sensitivity to the allergen with a repeat skin test.
Answer: C
Explanation: Missing a scheduled immunotherapy dose increases the risk of an adverse
reaction. The nurse should consult the provider about potentially reducing the dose to ensure
patient safety.
8. While obtaining a health history from a patient, the nurse learns that the patient
has a history of allergic rhinitis and multiple food allergies. Which action by the
nurse is most appropriate?
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 patients 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
blood-borne pathogen contact.
Answer: C
Explanation: Patients with a history of multiple allergies, especially to foods, are at increased
risk for a type I (immediate) latex allergy. The nurse should document this risk and monitor
for signs of a reaction.
9. The nurse teaches a patient diagnosed with systemic lupus erythematosus (SLE)
about plasmapheresis. What instructions about plasmapheresis should the nurse
include in the teaching plan?
A. Plasmapheresis will eliminate eosinophils and basophils from blood.
B. Plasmapheresis will remove antibody-antigen complexes from circulation.
, C. Plasmapheresis will prevent foreign antibodies from damaging various body
tissues.
D. Plasmapheresis will decrease the damage to organs caused by attacking T
lymphocytes.
Answer: B
Explanation: Plasmapheresis is used in SLE to remove pathogenic components from the
blood, including autoantibodies, immune complexes, and complement, which contribute to
tissue damage.
10. The nurse is caring for a patient undergoing plasmapheresis. The nurse should
assess the patient for which clinical manifestation?
A. Shortness of breath
B. High blood pressure
C. Transfusion reaction
D. Numbness and tingling
Answer: D
Explanation: Citrate, used as an anticoagulant during plasmapheresis, can bind calcium and
cause hypocalcemia, leading to symptoms like numbness and tingling (paresthesia).
11. Which statement by a patient would alert the nurse to a possible
immunodeficiency disorder?
A. I take one baby aspirin every day to prevent stroke.
B. I usually eat eggs or meat for at least 2 meals a day.
C. I had my spleen removed many years ago after a car accident.
D. I had a chest x-ray 6 months ago when I had walking pneumonia.
Answer: C
Explanation: The spleen is a key lymphoid organ. Its removal (splenectomy) increases the
risk for severe bacterial infections, indicating a potential immunodeficiency.
12. Which patient should the nurse assess first?
A. Patient with urticaria after receiving an IV antibiotic
B. Patient who has graft-versus-host disease and severe diarrhea
C. Patient who is sneezing after having subcutaneous immunotherapy
D. Patient with multiple chemical sensitivities who has muscle stiffness
Answer: C
