Deck 18: Immune System Function, Assessment, and Therapeutic Measures

Question 1

The nurse is preparing to administer diphenhydramine (Benadryl) 50 mg intravenously to a patient with severe allergies. Available is diphenhydramine (Benadryl) 25 mg/1 mL. How many mL will the nurse administer? Enter the numeral only.

Answer 1

2

Question 2

The nurse has administered prescribed allergen injections twice a week for several weeks to an individual with a bee sting allergy. The patient misses three appointments. What action should the nurse take during the patient's next visit?

A)Consult the physician to confirm the dosage to be given.
B)Administer the same dosage as was given at the last visit.
C)Administer the dosage as originally prescribed for that visit.
D)Tell the patient that the entire immunotherapy schedule needs to be restarted.

Answer 2

Consult the physician to confirm the dosage to be given.

Question 3

The nurse is assisting a health care provider with subcutaneous immunotherapy (SCIT). Which is a priority to have readily available?

A)Emergency equipment
B)Restraints
C)Antibiotic
D)Family contact information

Answer 3

Emergency equipment

Question 4

While collecting data, the nurse suspects that a patient is experiencing an immune disorder. Which data did the nurse use to come to this conclusion? (Select all that apply.)

A)Rash
B)Fever
C)Joint pain
D)Muscle cramps
E)Swollen glands

Question 5

The nurse is reviewing laboratory values for a patient and notes an absolute neutrophil count of 300 cells/µL. The nurse knows this result means the patient is experiencing which condition?

A)Anemia
B)Neutropenia
C)Thrombocytopenia
D)Leukopenia

Question 6

The nurse is taking a medication history for a newly admitted patient. The patient states he is allergic to levofloxacin (Levaquin). Which response by the nurse is most appropriate?

A)"We will be sure to add this to your chart so you never receive this medication."
B)"You need to wear a medical alert bracelet to show you have an allergy."
C)"What happens to you when you take the medication?"
D)"You can take the medication as long as you carry an EpiPen."

Question 7

The nurse is teaching a class for older adults regarding the importance of vaccinations. Which vaccine should the nurse suggest for this age group?

A)Meningococcal vaccine
B)Polio vaccine
C)Human papilloma virus (HPV) vaccine
D)Pneumococcal vaccine

Question 8

The nurse is working in a clinic when a patient presents with shortness of breath, wheezing, and hives. The nurse should plan to implement which order first?

A)Administer morphine IV
B)Administer epinephrine IV
C)Administer ketorolac (Toradol) IV
D)Administer furosemide (Lasix) IV

Question 9

The nurse is caring for a patient with a diagnosis of malaria. Which antibody would the nurse expect to see increased?

A)Immunoglobulin G (IgG)
B)IgM
C)IgA
D)IgE

Question 10

The nurse is reviewing laboratory results for a group of patients and notes a CD4 count of 120 cells/µL. For which patient would the nurse expect to see this result?

A)A patient with gastroenteritis
B)A patient with HIV
C)A patient with allergic rhinitis
D)A patient with atrial fibrillation

Question 11

The nurse is caring for a patient being tested for rheumatoid arthritis. In reviewing laboratory values, which should the nurse recognize as being diagnostic of rheumatoid arthritis?

A)C-reactive protein = 12 mg/L
B)Negative rheumatoid factor
C)White blood cells (WBC) = 6,000/mm³
D)Negative antinuclear antibody (ANA) test

Question 12

The nurse is caring for a group of patients. Which patient is at highest risk for developing systemic lupus erythematosus (SLE)?

A)An African American female
B)A Caucasian female
C)An Asian male
D)A Hispanic male

Question 13

The nurse is administering clindamycin (Cleocin) 300 mg in 100 mL of normal saline intravenously to run over 1 hour to a patient with an infection. At what rate will the nurse set the infusion pump? Enter the numeral only.

Question 14

The nurse is caring for a group of patients. Which patients should the nurse see first?

A)A patient with allergic rhinitis reporting frequent sneezing
B)A patient who had an anaphylactic reaction 2 days ago
C)A patient who just received an influenza vaccination
D)A patient receiving chemotherapy with a temperature of 103°F

Question 15

The nurse is caring for a patient with anemia. Which laboratory results should the nurse identify as being consistent with this diagnosis? (Select all that apply.)

A)Red blood cell distribution width (RDW) = 12% in a 28-year-old female
B)Mean corpuscular volume (MCV) = 72/mm³ in a 19-year-old female
C)WBC = 7 *10⁹/L in a 39-year-old male
D)RBC = 4.4 * 10¹²/L in a 31-year-old male
E)WBC = 5.2 * 10₉/L in a 22-year-old female
F)RBC = 5.7 * 10¹²/L in a 43-year-old female

Question 16

The nurse is reinforcing teaching to a person who has tested positive for HIV. Which test should the nurse explain is done to confirm the diagnosis of HIV?

A)Western blot
B)Rheumatoid factor
C)ANA
D)Immunoglobulin assay

Question 17

The nurse is caring for a group of patients. Which patient is at highest risk for developing a latex allergy?

A)A banker
B)A construction worker
C)A nurse
D)A computer technician

Question 18

The nurse is taking a health history of a patient who has a weakened immune system. Which does the nurse conclude contributed to weakening the immune system? (Select all that apply.)

A)Craniotomy
B)Parathyroidectomy
C)Knee replacement
D)Splenectomy
E)Rhinoplasty
F)Thymectomy

Question 19

The nurse is teaching the family of a child who is allergic to peanuts about important topics regarding the allergy. Which statements made by the parents indicate an understanding of the teaching? (Select all that apply.)

A)"I will make sure my child wears a medical alert bracelet at all times."
B)"I need to notify my child's school of the peanut allergy."
C)"I will be sure we seek medical care within hours after injecting the EpiPen."
D)"I will make sure my child consumes a minimal amount of food with peanuts."
E)"I am going to ensure my child carries an EpiPen at all times."

Question 20

The nurse is caring for a patient who reports enlarged, painful, and moveable preauricular lymph nodes, postauricular lymph nodes, and cervical lymph nodes. Which does the nurse infer from these findings?

A)Infection
B)Cancer
C)Liver failure
D)Thyroid disorder