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Chickenpox is an example of which of the following types of immunities?
Which of the following antibodies is involved with an anaphylactic reaction?
The nurse encourages a new mother to breastfeed her infant, even for a short time, because colostrum will provide the infant with which of the following types of immunity?
Which of the following instructions should the nurse include when teaching a client with possible allergies about intradermal skin testing?
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A chest x-ray can suppress immune function.
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Which of the following adverse effects should the nurse be aware of in a client with Goodpasture’s syndrome?
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Which statement by a client on immunosuppressant therapy after a kidney transplant should alert the nurse that additional teaching is required?
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Which adverse effect is related to cyclosporine administration?
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What is the most appropriate action in treating a client admitted to the hospital with an acute rejection of a kidney transplant?
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What is the initial action for the nurse to take when a client is stung by a wasp and is experiencing difficulty breathing?
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What is the priority action for the nurse to implement when a client complains of itching at the site of an intradermal allergen injection?
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What is the most appropriate action for the nurse to take when caring for a client experiencing an allergic reaction to an unknown allergen?
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Which action should the nurse take first to determine if a client’s angioedema has responded to prescribed therapies?
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What question should the nurse ask to determine possible causes of a hemoglobin of 200 g/L and a hematocrit of 54%?
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Which laboratory test should the nurse monitor for a client receiving heparin?
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What does a low mean corpuscular volume (MCV) indicate?
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What lymph node finding should the nurse be most concerned about during physical assessment?
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What laboratory result should the nurse anticipate for a client with an intraoperative hemorrhage?
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What actions should the nurse include in the care plan for a neutropenic client?
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What should the nurse monitor in the care plan for a client with a 'shift to the left' in complete blood count results?
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What action should the nurse take before an ultrasound of the spleen for a client in a car accident?
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For which diagnostic test should the nurse obtain a signed consent form for a client with pancytopenia scheduled for testing?
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Which CBC information would be most important to communicate for a client with abdominal pain?
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Which of the following findings should the nurse identify as abnormal in a client's clotting study tests?
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Which of the following information should the nurse include when discussing the EIA test results with a client who tested positive for HIV antibodies?
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According to the World Health Organization (WHO) diagnostic criteria, which diagnosis should the nurse anticipate for a client admitted with Pneumocystis jiroveci pneumonia (PCP) and positive HIV testing?
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What action should the nurse implement for a client with a positive rapid-antibody test for HIV who is anxious and not attentive?
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What is the most appropriate response by the nurse to a client with AIDS expressing thoughts about dying?
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What information should the nurse include when teaching a pregnant woman with early chronic HIV infection?
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Which client exposure is most likely to require postexposure prophylaxis for the nurse?
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Which herb can enhance replication of HIV in clients?
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What factor is most important to consider when determining initiation of antiretroviral therapy (ART) for a client with a CD4+ cell count of 400/µL?
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Which client would be appropriate for teaching about antiretroviral therapy (ART) in an HIV clinic?
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When assessing an individual with early chronic HIV infection and a normal CD4+ count, which assessment should the nurse prioritize?
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Which test does the Canadian Blood Services utilize to detect HIV genetic material in blood?
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What is the best way to reduce the risk of HIV infection from injectable drug use?
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Which nursing action will be most helpful in assisting a young adult college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen?
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Which of the following goals is most appropriate for a client with HIV infection who has developed Mycobacterium avium complex infection?
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Which topic should the nurse include in the client teaching plan for a client with fat redistribution to the trunk after 7 years of HIV treatment?
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Which medication is most important to administer at the right time for an HIV-positive client hospitalized with Pneumocystis jiroveci pneumonia?
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Which test is used to evaluate the effectiveness of antiretroviral therapy (ART)?
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Which information about an HIV-positive client is most important for the nurse to address when planning care?
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What is the priority nursing intervention for an HIV-infected client with a CD4+ cell count of 800 cells per microliter and an undetectable viral load ten years after seroconversion?
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How soon after delivery of the baby can ART treatment be started for a pregnant client diagnosed with HIV?
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What is a priority information to include in a program to teach a community group about decreasing HIV infection incidence?
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What event is a client at an increased risk of developing after having an emergency splenectomy following an automobile accident?
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Which assessment should the nurse anticipate when noting numerous petechiae in a client?
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Which laboratory result should be of most concern when reviewing data for an older-adult client?
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What action should the nurse implement following a bone marrow aspiration from the left posterior iliac crest on a client with pancytopenia?
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Which assessment finding should the nurse anticipate in a client with chronic iron-deficiency anemia?
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Study Notes
Immune Response and Transplantation
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Types of Immunity:
- Innate immunity: present at birth, occurs without exposure to an antigen
- Natural active immunity: occurs when the body produces antibodies in response to an antigen, e.g., chickenpox
- Artificial immunity: induced by a vaccine or immune serum
- Cell-mediated immunity: involves T-lymphocytes, responsible for tumour immunity
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Immune Deficiency Disorders:
- T-lymphocyte deficiency: increased risk of malignancy
- B-lymphocyte deficiency: impaired antibody production
- Combined immunodeficiency: impaired both cell-mediated and humoral immunity
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Allergic Reactions:
- Anaphylaxis: severe, life-threatening allergic reaction
- IgE: involved in anaphylactic reactions
- Atopic dermatitis: type 1 hypersensitivity disorder, associated with elevated IgE levels
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Transplantation:
- Graft-versus-host disease: occurs when donated T cells attack the client's tissues
- Immunosuppressant therapy: used to prevent rejection of transplanted organs
- Cyclosporine: nephrotoxicity is a major adverse effect
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Plasmapheresis:
- Removes antibodies, antibody-antigen complexes, and complement from blood
- Used to treat systemic lupus erythematosus (SLE) and other autoimmune disorders
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Bone Marrow Transplant:
- Graft-versus-host disease: occurs when donated T cells attack the client's tissues
- Immunosuppressant therapy: used to prevent rejection of transplanted bone marrow
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Post-Transplant Care:
- Monitor for acute rejection
- Administer immunosuppressant medications
- Client education: importance of adhering to medication regimen and monitoring for signs of rejection### Angioedema and Allergic Reactions
- Angioedema is characterized by swelling of the eyelids, lips, and tongue.
- Wheal and flare lesions, clear nasal drainage, and hypotension and tachycardia are characteristics of other allergic reactions.
- To determine whether a client's angioedema has responded to prescribed therapies, the nurse should first check for swelling of the lips and tongue.
Kidney Transplant and Tissue Typing
- Positive crossmatching is an absolute contraindication to kidney transplantation, as it will lead to hyperacute rejection.
- The nurse should communicate the results of client-donor crossmatching to the healthcare provider.
Immunotherapy and Allergen Injection
- A local reaction larger than quarter size may indicate that a decrease in the allergen dose is needed.
- The nurse should communicate the size of the wheal at the site of the allergen injection to the healthcare provider.
Infection and HIV
- After an initial positive enzyme immunoassay (EIA) for HIV antibodies, the EIA is repeated before more specific testing such as the Western blot is done.
- The nurse should include information about the need for retesting to confirm the results when discussing the test results with the client.
- Development of Pneumocystis jiroveci pneumonia (PCP) meets the diagnostic criterion for AIDS.
- The nurse should anticipate a diagnosis of late chronic infection or AIDS in a client with PCP.
Nursing Care and HIV
- When a client is anxious and does not appear to hear what the nurse is saying, the nurse should first retest to confirm the results of the HIV test.
- The nurse should assess the client's psychosocial status before taking any other action when the client expresses concerns about dying.
- Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use antiretroviral therapy (ART) during pregnancy.
- The nurse should teach the client about the need to follow a stringent ART schedule to prevent drug resistance.
HIV and Herbs
- Some herbs, such as echinacea, should not be used by clients with HIV because they can enhance the replication of HIV.
HIV and Antiretroviral Therapy (ART)
- The nurse should consider the client's ability to comply with the ART schedule when determining whether to initiate therapy.
- Drug resistance develops quickly unless the client takes ART medications on a stringent schedule.
- The nurse should teach the client about the importance of taking ART medications as scheduled.
HIV and CD4+ Count
- Persistent generalized lymphadenopathy is common in the early stage of chronic HIV infection.
- The nurse should assess the client's lymph nodes when assessing an individual with early chronic HIV infection and a normal CD4+ count.
HIV and Blood Donation
- The Canadian Blood Services uses a nucleic acid amplification test (NAAT) to detect HIV genetic material in blood of potential donors.
Preventing HIV Infection
- Participation in needle and syringe exchange programs has been shown to control the rate of HIV infection.
- The nurse should inform the client that the best way to reduce the risk of HIV infection from drug use is to participate in a needle-exchange program.### HIV Infection and Care
- A client with a CD4+ cell count of 800 cells per microliter and an undetectable viral load is in the early chronic stage of HIV infection.
- At this stage, the body is able to produce enough CD4+ cells to maintain a normal CD4+ count.
- AIDS and opportunistic infections typically develop when the CD4+ count is much lower than normal.
- Priority nursing intervention at this stage is to encourage adequate nutrition, exercise, and sleep.
ART Treatment and Pregnancy
- Women infected with HIV should receive optimal ART immediately, regardless of pregnancy.
- ART treatment can be initiated while pregnant.
HIV Prevention and Education
- The most common way HIV is transmitted is through sexual contact.
- Education on preventing transmission between sexual partners is a priority.
- Other methods of transmission, such as perinatal transmission, needle sterilization, and blood transfusions, should also be addressed.
Prophylactic Measures for HIV Clients
- Vaccines recommended for HIV clients include hepatitis B, pneumococcal, and influenza.
- These vaccines are important for preventing other infections in HIV clients.
Hematological System
Splenectomy
- Splenectomy increases the risk of infection, especially with gram-positive bacteria.
- The risk of lymphedema, bleeding, and anemia is not increased after splenectomy.
Petechiae and Bleeding
- Petechiae are small, purplish-red lesions.
- Ecchymosis is bruising on the skin.
- Telangiectasia is small, focal red lesions.
- Purpura is a rash of purple, red, or brown spots on the skin or mucous membranes.
Laboratory Results
- A low WBC count indicates compromised immune function.
- A normal platelet count is around 400 ´ 109/L.
- A slight decrease in hemoglobin and hematocrit is not unusual in older clients.
Bone Marrow Aspiration
- A pressure dressing is used to cover the aspiration site after a bone marrow biopsy.
Anemia and Iron Deficiency
- Chronic iron deficiency anemia can cause loss of papillae on the tongue.
- Scleral jaundice is associated with hemolysis.
- Gum bleeding and tenderness occur with thrombocytopenia or neutropenia.
Polycythemia
- Polycythemia may cause visual abnormalities.
- A hemoglobin level of 200 g/L and a hematocrit of 54% indicate polycythemia.
Heparin and Coagulation
- aPTT testing is used to determine whether heparin is at a therapeutic level.
- FDP is useful in diagnosis of disseminated intravascular coagulation (DIC).
- PT and INR are used to test for therapeutic levels of warfarin.
Red Blood Cell Indices
- A low MCV indicates smaller-than-normal RBCs.
- Inadequate numbers of RBCs indicate anemia.
- Low levels of hemoglobin in RBCs result in a low MCH.
Lymph Nodes
- Enlarged and nontender nodes are most suggestive of malignancy.
- Firm nodes are an expected finding in an area of infection.
Hemorrhage and Hemoglobin
- Hemorrhage causes the release of more immature RBCs from the bone marrow into the circulation.
- The reticulocyte count is elevated after hemorrhage.
Neutropenia
- Neutropenic clients are at high risk for infection and sepsis.
- Monitoring temperature frequently is important in neutropenic clients.
Shift to the Left
- A shift to the left indicates that the number of immature polymorphonuclear neutrophils, or bands, is elevated.
- This is a sign of severe infection.
Ultrasound and Spleen
- The client is placed in a flat position before splenic ultrasound.
Pancytopenia and Bone Marrow Biopsy
- Bone marrow biopsy is a minor surgical procedure that requires a signed consent form.
Complete Blood Count
- An elevation in WBCs indicates that an abdominal infection may be the cause of the client's pain.
- Further diagnostic testing is needed in this case.
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Description
Take this quiz to test your knowledge on Chapter 16 of Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition, covering topics such as immune response and transplantation.
