Chapter 19.
Nursing Care of Patients With Immune Disorders
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1. Urticaria is classified as what type of hypersensitivity reaction? Type 1
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2. B cells is the defective cell in hypogammaglobulinemia
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3. A patient who receives IV penicillin for an infection is at risk for developing serum sickness
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4. The nurse is caring for a patient with idiopathic autoimmune hemolytic anemia. include Assist with
ambulation in the plan of care for this patient
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5. Pt had a portion of stomach removed. Monitor for Numbness and tingling, weakness, and glossitis to detect
a vitamin B12 deficiency
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6. The nurse recognizes that the patient is at increased risk of infection due to the inability to replace IgA
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7. The nurse is caring for a patient who is stung by a wasp. A Hives manifestation would happen if allergic
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8. The nurse is caring for a patient with a severe allergic reaction. Subcutaneous via epinephrine would be
ordered
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9. Diphenhydramine (Benadryl) is administered secondarily to control the itching?
____ 11. Wear a mask when mowing the lawn for a patient has a history of allergies to pollen.
____ 12. Cover heating ducts with filters for a patient who is allergic to dust.
____ 13. Use relaxation techniques for a patient that is experiencing an episode of urticaria.
____ 14. Hemolytic anemia is An antigenantibody reaction is causing destruction of red blood cells
____ 17. Thyroid hormone production increases with Hashimotos thyroiditis.
____ 18. What differentiates urticaria from angioedema? It lasts a shorter period of time.
____ 19. Monitor for restlessness for a patient with angioedema.
____ 20. Assess for a decrease in urine output for a patient with chronic serum sickness
____ 21. Spend extra time with the patient, allowing verbalization of feelings.
____ 22. Provide activity every 2 hours for a patient with severe ankylosing spondylitis.
____ 23. Humoral immunity is affected in hypogammaglobulinemia?
____ 24. The nurse is reinforcing teaching on chloroquine side effects for a patient with Lupus. the patient needs to
report Blurred vision
____ 25. An increase in vitamin B12 levels and decrease in number of enlarged red blood cells indicates to the
nurse that the treatment for pernicious anemia has been successful
____ 26. Idiopathic autoimmune hemolytic anemia.
____ 27. A 20-year-old Hispanic woman is most likely to exhibit signs and symptoms of Lupus.
____ 28. Potential triggers allergic rhinitis. Dust. Pet Dander. Ragweed
____ 29. Most common irritants causing contact dermatitis. Poison Ivy. Poison Oak
____ 30. Include Use cool washcloths over affected area to ease itching. Keep fingernails short. Take baths with
an oatmeal solution. Use oil-in-water lubricants for skin dryness. in the patients teaching plan for a
nursing diagnosis of Risk for Impaired Skin Integrity due to contact dermatitis
____ 31. a patient diagnosed with Hashimotos thyroiditis who has progressed to hypothyroidism with a goiter need to.
Eat a soft diet.
During low-energy periods, use antiembolism stockings.
Increase activity slowly.
____ 32. Examples of type I hypersensitivity reactions:
Allergic rhinitis
Anaphylaxis
Angioedema
____ 33. possible side effects with a patient prescribed a corticosteroid for lupus
Increased weight
Facial hair
Moon face
Mood changes
____ 34. Plan of Care for a patient with ankylosing spondylitis
Activity as tolerated; up with assistance
Administer Remicade today
Tylenol #3 every 4 hours prn pain
Physical therapy daily
____ 35. Interventions for a patient with Lupus.
Report foamy urine to physician.
Use a daily personal schedule to plan activities to reduce fatigue.
Eat a balanced diet.
____ 36. Causes of an autoimmune disorder.
Viral infections
Drugs
Hormones
37. The nurse should stay at the bedside with a patient for the first fifteen minutes of any blood transfusion to
detect signs of a reaction.
38. A patient is receiving a transfusion of packed red blood cells. Ten minutes after the infusion begins, the
patient reports low back pain and a headache. Place the actions in order (15) of importance of performance.
A. 5 Start the new 0.9% normal saline infusion.
B. 4 Prepare a new 0.9% normal saline infusion.
C. 3 Notify the physician stat.
D. 2 Stop the blood infusion.
E. 1 Obtain vital signs and assess patient.
