LACHARITY 3 - Immunologic Problems Flashcards
When scheduling a patient for skin testing for allergies, which information is
most important for the allergy clinic nurse to include in patient teaching?
1. Avoid taking antihistamines before the skin testing.
2. Skin testing may be done with an intradermal injection.
3. Swelling and itching may occur at the site of the skin testing.
4. Patient will need to wait in the clinic for 20 minutes after the testing.
Ans: 1 Because antihistamine use before skin testing may prevent a reaction
to an allergen, it is important that no antihistamine be taken before arriving
for the skin testing, or the testing will have to be rescheduled. The other
information may also be included, but it is not as important as avoiding any
antihistamine before the skin testing takes place. Focus: Prioritization.
Which finding will be most important for the nurse to report to the health
care provider about a patient who is taking prednisone chronically after an
organ transplant?
1. Multiple arm bruises
2. Sodium level of 146 mEq/dL (146 mmol/L)
3. Blood glucose of 110 mg/dL (6.1 mmol/L)
4. Black-colored stools
Ans: 4 Dark green or black stools may indicate gastrointestinal bleeding, a
possible adverse effect of oral steroid use, and further assessment and
treatment are needed. Although thinning of the skin, electrolyte disturbances,
and changes in glucose metabolism also occur with steroids, bruising and
mild changes in sodium or glucose level do not require treatment. Focus:
Prioritization.
When the occupational health nurse is teaching unlicensed assistive
personnel (UAP) about bloodborne pathogen exposure and human
immunodeficiency virus (HIV) risk, which information is most important to
emphasize?
1. Occupational transmission of HIV from patients to health care workers is
relatively rare.
2. Occupational exposure to HIV-containing fluids should be reported
immediately to the supervisor.
3. Treatment for occupational exposure to HIV may include use of
antiretroviral medications.
4. Postexposure treatment will include HIV testing at baseline and at several
intervals after the exposure.
Ans: 2 Centers for Disease Control and Prevention guidelines indicate that if
postexposure prophylaxis is to be used, antiretroviral drugs should be started
as soon as possible, preferably within hours of the exposure. It is important
that staff understand that reporting the possible exposure is a priority so that
so that rapid assessment and treatment can be initiated. The other statements
are also true but will not impact on the efficacy of any needed treatment.
Focus: Prioritization
A patient in the allergy clinic who has a rash has received diphenhydramine
50 mg PO. Which patient information is most indicative of a need for action
by the nurse?
1. The patient is preparing to drive home.
2. The patient reports itching at the site of the rash.
3. The patient has a history of constipation.
4. The patient states, “My mouth feels so very dry!”
Ans: 1 Sedation is a common effect of the first-generation antihistamines, and
patients should be cautioned against driving when taking medications such
as diphenhydramine. Itching of the rash is expected with an allergic reaction.
The patient should be taught about how to manage common antihistamine
side effects such as constipation and oral dryness, but these side effects are
not safety concerns. Focus: Prioritization.
After change-of-shift report, which newly admitted patient should the nurse
assess first?
1. A patient with human immunodeficiency virus (HIV) whose CD4 count is
45 mm 3 (45 cells/mcL)
2. A patient with acute kidney transplant rejection who has a scheduled dose
89of prednisone due
3. A patient with graft-versus-host disease who has frequent liquid stools
4. A patient with hypertension who has angioedema after receiving lisinopril
Ans: 4 Because angioedema may cause airway obstruction, this patient
should be assessed for any difficulty breathing, and treatment should be
started immediately. The other patients also will need to be assessed as
quickly as possible, but the patient with potential airway difficulty will need
the most rapid care. Focus: Prioritization.
A few minutes after the nurse has given an intradermal injection of an
allergen to a patient who is undergoing skin testing for allergies, the patient
reports feeling anxious, short of breath, and dizzy. Which action included in
the emergency protocol should the nurse take first?
1. Start oxygen at 6 L/min using a face mask.
2. Obtain IV access with a large-bore IV catheter.
3. Give epinephrine 0.5 mg intramuscularly.
4. Administer albuterol per nebulizer mask.
Ans: 3 World Allergy Organization guidelines indicate that intramuscular
epinephrine should be the initial drug for treatment of anaphylaxis. Giving
epinephrine rapidly at the onset of an anaphylactic reaction may prevent or
reverse cardiovascular collapse as well as airway narrowing caused by
bronchospasm and inflammation. Oxygen use is also appropriate, but oxygen
delivery will be effective only if airways are open. Albuterol may also be
administered to decrease airway narrowing but would not be the first
therapy used for anaphylaxis. IV access will take longer to establish and
should not be the first intervention. Focus: Prioritization
The nurse manager in a public health department is implementing a plan to
reduce the incidence of infection with human immunodeficiency virus (HIV)
in the community. Which nursing action will be delegated to unlicensed
assistive personnel (UAP) working for the agency?
1. Supplying injection drug users with sterile injection equipment such as
needles and syringes
2. Interviewing patients about behaviors that indicate a need for annual HIV
testing
3. Teaching high-risk community members about the use of condoms in
preventing HIV infection
4. Assessing the community to determine which population groups to target
for education
Ans: 1 Supplying sterile injection supplies to patients who are at risk for HIV
infection can be done by staff members with UAP education. Assessing for
96high-risk behaviors, education, and community assessment are RN-level
skills. Focus: Delegation.
The nurse is supervising a student nurse who is caring for a patient with
human immunodeficiency virus (HIV). The patient has severe esophagitis
caused by Candida albicans. Which action by the student requires the most
rapid intervention by the nurse?
1. Putting on a mask and gown before entering the patient’s room
2. Giving the patient a glass of water after administering the prescribed oral
nystatin suspension
3. Suggesting that the patient should order chile con carne or chicken soup for
the next meal
4. Placing a “No Visitors” sign on the door of the patient’s room
Ans: 2 Nystatin should be in contact with the oral and esophageal tissues as
long as possible for maximum effect. The other actions are also inappropriate
and should be discussed with the student but do not require action as
quickly. HIV-positive patients do not require droplet or contact precautions
or visitor restrictions to prevent opportunistic infections. Hot or spicy foods
are not usually well tolerated by p
The nurse is evaluating a patient with human immunodeficiency virus (HIV)
who is receiving trimethoprim–sulfamethoxazole (TMP-SMX) as a treatment
for Pneumocystis jiroveci pneumonia. Which information is most important to
communicate to the health care provider?
1. The patient reports a blistering rash.
2. The patient’s fluid intake is 2 L/day.
3. The patient’s potassium is 3.4 mg/dL (3.4 mmol/L).
4. The patient enjoys spending time outside in the sun.
Ans: 1 Because TMP-SMX can cause Stevens-Johnson syndrome (a life-
threatening skin condition), a blistering rash indicates a need to discontinue
the medication immediately. Two L/day of fluid is adequate to prevent
crystalluria and renal damage associated with TMP-SMX. TMP-SMX can
cause hyperkalemia; the nurse will report the potassium level to the provider,
but the low potassium level is not caused by the medication. Patient teaching
about photosensitivity is needed, but the nurse does not need guidance from
the provider to implement this action. Focus: Prioritization.
The nurse is working with a patient who has a new diagnosis of human
immunodeficiency virus (HIV) and who reports current use of injectable
heroin and methamphetamine. Which actions by the nurse are appropriate?
Select all that apply.
1. Refer the patient to a substance abuse treatment program.
2. Plan for the patient to participate in a needle exchange program.
3. Coordinate the patient’s schedule for directly observed antiretroviral drug
treatment.
4. Instruct the patient that ongoing injectable drug use is a contraindication
for antiretroviral therapy.
5. Provide patient education about the risk of transmitting HIV to others
when sharing needle
Ans: 1, 2, 3, 5 Current guidelines indicate that antiretroviral therapy for HIV
should be initiated as soon as possible after HIV diagnosis. Although ongoing
substance abuse is a risk factor for poor adherence, antiretroviral therapy can
be initiated when strategies to improve adherence are used. Strategies include
directly observing patients taking medications, needle exchange programs,
and referring patients for substance abuse treatment. Focus: Prioritization.
A patient with newly diagnosed acquired immunodeficiency syndrome
(AIDS) has a 6-mm induration at 48 hours after a skin test for tuberculosis
(TB). Which action will the nurse anticipate taking next?
1. Arrange for a chest x-ray to check for active TB.
2. Tell the patient that the TB test results are negative.
3. Teach the patient about multidrug treatment for TB.
4. Schedule TB skin testing again in 12 months.
Ans: 1 According to National Institutes of Health guidelines, an induration
of 5 mm or greater indicates TB infection in patients with HIV and a chest
radiograph will be needed to determine whether the patient has active or
latent TB infection. Teaching about multidrug therapy is needed if the patient
has active TB, but latent TB is treated with a single drug (usually isoniazid)
only. Positive skin test results generally persist throughout the patient’s
lifetime and will not be repeated, although other tests such as follow-up chest
radiographs and sputum testing may be used to evaluate for effective TB
treatment. Focus: Prioritization.
The nurse is working in a hospice facility for patients with acquired
immunodeficiency syndrome (AIDS). The facility is staffed with LPNs/LVNs
and unlicensed assistive personnel (UAP). Which action will the nurse assign
to the LPN/LVN?
1. Assessing patients’ nutritional needs and individualizing diet plans to
improve nutrition
2. Collecting data about the patients’ responses to medications used for pain
and anorexia
3. Developing UAP training programs about how to lower the risk for
spreading infections
4. Assisting patients with personal hygiene and other activities of daily living
as needed
Ans: 2 The collection of data used to evaluate the therapeutic and adverse
effects of medications is included in LPN/LVN education and scope of
practice. Assessment, planning, and developing teaching programs are more
complex skills that require RN education. Assistance with hygiene and
activities of daily living should be delegated to the UAP. Focus: Assignment,
Delegation.
A patient who has received a kidney transplant has been admitted to the
medical unit with acute rejection and is receiving IV cyclosporine and
methylprednisolone. Which staff member is best to assign to care for this
patient?
1. RN who floated to the medical unit from the coronary care unit for the day
2. RN with 3 years of experience in the operating room who is orienting to the
medical unit
3. RN who has worked on the medical unit for 5 years and is working a
double shift today
914. Newly graduated RN who needs experience with IV medication
administration
Ans: 3 To be most effective, cyclosporine must be mixed and administered in
accordance with the manufacturer’s instructions, so the RN who is likely to
have the most experience with the medication should care for this patient or
monitor the new graduate carefully during medication preparation and
administration. The coronary care unit float nurse and the nurse who is new
97to the unit would not have experience with this medication. Focus:
Assignment.
The nurse is caring for a patient with rheumatoid arthritis who is taking
naproxen twice a day to reduce inflammation and joint pain. Which symptom
is most important to communicate to the health care provider?
1. Joint pain worse in the morning
2. Dry eyes bilaterally
3. Round and moveable nodules under the skin
4. Dark-colored stool
Ans: 4 Naproxen, a nonsteroidal anti-inflammatory drug, can cause
gastrointestinal bleeding, and the stool appearance indicates that blood may
be present in the stool. The health care provider should be notified so that
actions such as testing a stool specimen for occult blood and administering
proton pump inhibitors can be prescribed. The other symptoms are common
in patients with rheumatoid arthritis and require further assessment or
intervention, but they do not indicate that the patient is experiencing adverse
effects from the medications. Focus: Prioritization.
Which of these patients cared for by the nurse in the clinic presents the
highest risk for infection with human immunodeficiency virus (HIV) during
sexual intercourse?
1. Uninfected man who reports performing oral intercourse with an HIV-
infected woman
2. Uninfected man who is the receiver during anal intercourse with an HIV-
infected man
3. Uninfected woman who has had vaginal intercourse with an HIV-infected
man
4. Uninfected woman who has performed oral intercourse with an HIV-
infected woman
Ans: 2 Because anal intercourse allows contact of the infected semen with
mucous membrane and causes tearing of mucous membrane, there is a high
risk of transmission of HIV. HIV can be transmitted through oral or vaginal
intercourse as well but not as easily. Focus: Prioritization.
