NCLEX Exam: Immunologic Disorders (25 Items)

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This nursing exam covers Immunologic Disorders. Test your knowledge with this 25-item exam. Get that perfect score in your NCLEX or NLE exams with this questionnaire.

Topics

  • Immunologic Disorders

Guidelines

  • Read each question carefully and choose the best answer.
  • You are given one minute per question. Spend your time wisely!
  • Answers and rationales are given below. Be sure to read them.
  • If you need more clarifications, please direct them to the comments section.

Questions

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Immunologic Disorders (25 Items)

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Immunologic Disorders (25 Items)

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1. For Mikael who is diagnosed of having allergic rhinitis, which nursing intervention is the most appropriate?

A. Encouraging the client to use nasal saline sprays
B. Discouraging nose blowing before administering nasal medication
C. Advising use of bronchodilator regularly, even if having no symptoms
D. Instructing the client to carry epinephrine with him at all times

2. Which intervention should Nurse John Joe discuss with Elena who has an allergic disorder and is requesting information for allergy symptom control? (Select all that apply.)

A. Instructing the client to refrain from using air conditioning or humidifiers in the house
B. Instructing the client to use curtains instead of pull shades over windows
C. Instructing the client to cover the mattress with a hypoallergenic cover
D. Instructing the client to wear a mask when cleaning
E. Instructing the client to avoid using sprays, powders, and perfumes
F. Instructing the client to change detergents frequently

3. Which intervention should the nurse implement when caring for a client diagnosed with Pneumocystis carinii pneumonia related to acquired immunodeficiency syndrome who is crying over the loss of friends and family members because they will not talk to him anymore?

A. Advising the client not to worry, and telling him everything will be alright
B. Asking the health care provider for a psychiatric consult to assess the client’s mental functioning
C. Sitting down and listening to the client’s concerns and frustrations
D. Telling the client that the friends probably were not true friends anyway

4. For Aubrey Anne who has allergies, which client statement indicates that the nurse’s teaching about her condition has be successful?

A. “I don’t need to wear any type of mask when I’m cleaning my house.”
B. “I should stay in the house when there;s a low pollen count outside.”
C. “I should avoid any types of spray, powders, and perfumes.”
D. “I can wear any type of clothing that I want to as long as I wash it first.”

5. Mr. Mc Princeton who is diagnosed with rheumatoid arthritis (RA) complains about joints that always hurt, saying, “I just feel like staying in bed all day.” Which discharge instruction would be aimed at maintaining as such function as possible?

A. “Refrain from exercise because it only aggravates the disease process.”
B. “Apply elastic bandages to all joints to increase the pain threshold.”
C. “Maintain a supine position most of the day to prevent the stress of weight bearing.”
D. “Promote aquatic (water) exercises to enhance joint mobility.”

6. Nurse Vince sustained a dirty needle stick injury. Which diagnostic test would be ordered on a client?

A. Enzyme-linked immunosorbent assay (ELISA)
B. SUDS screening test
C. Antibody titers
D. Skin biopsy for Kaposi’s sarcoma

7. After the first injection of an immunotherapy program, the nurse notices a large, red wheal on the client’s arm, coughing, and expiratory wheezing. Which intervention should the nurse implement first?

A. Notifying the health care provider immediately
B. Administering I.M. epinephrine per protocol
C. Beginning oxygen by way of nasal cannula
D. Starting an I.V. line for medication administration

8. Slater is using a steroidal cream for allergic dermatoses. Which intervention should Nurse Rachel implement for the client?

A. Applying an occlusive dressing over the inflamed area afterward
B. Washing hands before and after applying the cream
C. Avoiding washing the inflamed area before applying the cream
D. Using alcohol to clean the inflamed area before applying the cream

9. Which clinical manifestation would cause the nurse to suspect that the client is diagnosed with systemic lupus erythematosus?

A. Joint edema and tenderness
B. Red, burning, tearing eyes
C. Chest tightness with wheezing on expiration
D. Fever and night sweats

10. April is diagnosed with systemic lupus erythematosus. Which instruction would be included in the teaching plan for the client?

A. “Wear large-brimmed hats when exposed to the sun.”
B. “Use tanning beds instead of sunbathing outside.”
C. “Remove all rugs, curtains, and dust-collecting items in home.”
D. “Carry injectable epinephrine at all times in case of exacerbation.”

11. Which discharge instruction would be included in the care plan for a client diagnosed with atopic dermatitis?

A. “Take weekly baths to avoid hydrating the skin.”
B. “Add humidity to the dry air caused by dry heat during the winter.”
C. “Keep the room temperature between 78° and 80° F.”
D. “Apply hot or cold therapy to affected joints.”

12. Theon was stung by a bee now exhibits redness and edema in the hand and forearm. The nurse’s actions would be based on which scientific rationale?

A. Baking soda is the best treatment for the edema from a bee sting.
B. Hypersensitivity is possible; the client may need to buy an anti-sting kit.
C. The client should not worry; people cannot develop an allergy to bee stings.
D. The client need regular checkups to obtain immunotherapy.

13. Which condition would Nurse Jade suspect when a client complains of a runny nose, itching and burning eyes, and sneezing since visiting a friend who had a cat in the home?

A. Anaphylaxis
B. Bronchitis
C. Allergic rhinitis
D. Asthma

14. During the past 6 months, a client diagnosed with acquired immunodeficiency syndrome has had chronic diarrhea and has lost 18 pounds. Additional assessment findings include tented skin turgor, dry mucous membranes, and listleness. Which nursing diagnosis focuses attention on the client’s most immediate problem?

A. Deficient fluid volume related to diarrhea and abnormal fluid loss
B. Imbalanced nutrition: less than body requirements related to nausea and vomiting
C. Disturbed thought processes related to central nervous system effects of disease
D. Diarrhea related to the disease process and acute infection

15. For a male client who has acquired immunodeficiency syndrome with chronic diarrhea, anorexia, a history of oral candidiasis, and weight loss, which dietary instruction would be included in the teaching plan?

A. “Follow a low-protein, high-carbohydrate diet.”
B. “Eat three large meals per day.”
C. “Include unpasteurized dairy products in the diet.”
D. “Follow a high-protein, high-calorie diet.”

16. Nurse Mary Jean is assisting in administering immunizations at a health care clinic. The nurse understands that an immunization will provide:

A. Protection from all disease
B. Innate immunity from disease
C. Natural immunity from disease
D. Acquired immunity from disease

17. Nurse Ruffa is providing dietary instructions to the client with systemic lupus erythematosus. Which of the following dietary items would the nurse instruct the client to avoid?

A. Cantaloupe
B. Turkey
C. Broccoli
D. Steak

18. A client with acquired immunodeficiency syndrome has a respiratory infection from Pneumocystis jiroveci and a nursing diagnosis of Impaired Gas Exchange written in the plan of care. Which of the following indicates that the expected outcome of care has not yet been achieved?

A. Client has clear breath sounds
B. Client now limits his fluid intake
C. Client expectorates secretions easily
D. Client is free of complaints of shortness of breath

19. Human Papilloma Virus in AIDS patients is manifested as:

A. Cough, evening fever, night sweats, weight loss and anemia
B. Persistent fever, tachypnoea, hypoxia, cyanosis and tachycardia.
C. Genital warts, flat warts, skin warts, neoplasm of cervix, vagina and penis
D. Watery diarrhea, abdominal pain, nausea and vomiting

20. A client is diagnosed with oral candidiasis. Nurse Tina knows that this condition in AIDS is treated with:

A. Trimethoprim + sulfamethoxazole
B. Fluconazole
C. Acyclovir
D. Zidovudine

21. The decision to begin antiretroviral therapy is based on:

A. The CD4 cell count
B. The plasma viral load
C. The intensity of the patient’s clinical symptoms
D. All of the above

22. Which client problem relating to altered nutrition is a consequence of AIDS?

A. Increased appetite
B. Decreased protein absorption
C. Increased secretions of digestive juices
D. Decreased gastrointestinal absorption

23. As a knowledgeable nurse, you know that the primary goals of antiretroviral therapy (ART) include all, EXCEPT:

A. Reduce HIV-associated morbidity and prolong the duration and quality of survival
B. Restore and preserve immunologic function
C. Maximally and durably suppress plasma HIV viral load
D. Elimination of HIV entirely from the body

24. Which is the most common HIV-related neurological complication?

A. Tuberculosis
B. Kaposi’s sarcoma
C. Toxoplasmosis
D. Lymphoma

25. A client with pemphigus is being seen in the clinic regularly. The nurse plans care based on which of the following descriptions of this condition?

A. The presence of tiny red vesicles
B. An autoimmune disease that causes blistering in the epidermis
C. The presence of skin vesicles found along the nerve caused by a virus
D. The presence of red, raised papules and large plaques covered by silvery scales

Answers and Rationale

Here are the answers for this exam. Gauge your performance by counter checking your answers to those below. If you have any disputes or clarifications, please direct them to the comments section.

1. Answer: A. Encouraging the client to use nasal saline sprays

For the client with allergic rhinitis, saline nasal sprays may be helpful in soothing mucous membranes, softening crusted secretions, and removing irritants. To achieve maximum relief, the client should blow the nose before administering any medication into the nasal cavity. The client diagnosed with asthma, not allergic rhinitis, may use bronchodilators. Carrying epinephrine would be appropriate for the client with an allergy to insect stings or certains foods such as shellfish.

2. Answer: C, D, E

Using hypoallergenic covers and cosmetics will help reduce the chance of n allergic attack, wearing mask while cleaning will help decrease the amount of dust entering the lungs, and avoiding sprays, powders, and perfumes will help decrease the chance of an allergic attack. The client should use air conditioning and humidifiers. Drapes, curtains, blinds, and carpets should be removed. The client should not change detergents or soaps.

3. Answer: C. Sitting down and listening to the client’s concerns and frustrations

Crying is evidence that the client is beginning to express concerns to the nurse. In response, active, nonjudgmental listening would most appropriate because is aids in the development of a trusting relationship. Advising the client not to worry or saying that everything will be alright provides false reassurance, which does not help the client cope. Further assessment is needed to determine whether a psychiatric consult should be considered. Telling the client that the friends were not true friends discounts the client’s feeling and hinders the development of a therapeutic relationship.

4. Answer: C. “I should avoid any types of spray, powders, and perfumes.”

The goal of teaching a client with allergies focuses on avoidance of the offending agent, and other triggers. The client with allergy problems should reduce any exposure to pollen (including avoiding barns, weeds, dry leaves, and grass), fumes, odors, sprays, powders, and perfumes. The client also should wear a mask when cleaning the house or working in the yard and stay inside when the pollen counts are high, not low. Any fabrics that cause itching should be avoided.

5. Answer: D. “Promote aquatic (water) exercises to enhance joint mobility.”

Water exercises are excellent because water promotes buoyancy, which eases joint movement. Persons with RA should maintain an active exercise program to strengthen and preserve muscle movement. Heat or cold applications, which promote circulation and reduce swelling, may help relieve pain, but elastic bandage wraps most likely would not be helpful.

6. Answer: B. SUDS screening test

SUDS screening test results are available in 30 to 60 minutes. The test is performed on a client to determine if the health care worker with a dirty needle stick injury should begin antiretroviral treatment. ELISA test results indicate exposure to or infection with human immunodeficiency virus (HIV), but the test does not diagnose acquired immunodeficiency syndrome (AIDS). Antibody titers would not be appropriate to determine whether the health care worker has been exposed to HIV or hepatitis. Kaposi’s sarcoma is usually associated with AIDS but not immediately after a needle stick.

7. Answer: B. Administering I.M. epinephrine per protocol

Immediately on noticing the client’s sign and symptoms, the nurse would determine that the client is experiencing anaphylaxis to the injection. The first action is to give 0.2 to 0.5 ml of 1:1,000 epinephrine I.M. Notifying the health care provider, beginning oxygen administration, and starting an I.V. line follow after the initial injection of epinephrine is administered.

8. Answer: B. Washing hands before and after applying the cream

The inflamed area is prone to infection. Before applying medication to it, the inflamed area and the hands should be washed. After application, the medication should be washed off the hands so that it will not be transferred to the eyes, skin, or other areas. The inflamed area usually id left open air, or a light gauze dressing — not an occlusive dressing — is used. The inflamed area should be cleaned with water, not alcohol.

9. Answer: A. Joint edema and tenderness

Clinical features of systemic lupus erythematosus involve multiple body systems. When the musculoskeletal system is involved, the client exhibits joint tenderness, edema, and morning stiffness. Eyes that are red, burning, and tearing are commonly associated with allergic rhinitis (i.e., hay fever). Chest tightness and wheezing on expiration are associated with allergic asthma. Fever and night sweats are manifestations of acquired immunodeficiency syndrome.

10. Answer: A. “Wear large-brimmed hats when exposed to the sun.”

The client diagnosed with systemic lupus erythematosus needs to modify his lifestyle. This includes avoiding sun and ultraviolet light exposure, especially between the hours of 10 a.m. and 4 p.m. The client also should wear tightly woven clothing. Regardless of of the source, exposure to ultraviolet light, even by means of tanning beds, should be strictly avoided. Removing all dust-collecting items in the home is appropriate for client diagnosed with asthma. Carrying injectable epinephrine is appropriate for a client who is allergic to insect stings or certain foods.

11. Answer: B. “Add humidity to the dry air caused by dry heat during the winter.”

Atopic dermatitis is an inflammatory condition involving a skin reaction to irritants or allergens. Adding humidity to the dry air caused by dry heat during the winter helps keep the skin hydrated and helps prevent itching and scratching. Daily bathing is necessary to hydrate the skin. The room temperature should be maintained between 68° and 70°F (20° and 21.1°C). Applying heat or cold therapy to affected joints is appropriate for a client diagnosed with rheumatoid arthritis.

12. Answer: B. Hypersensitivity is possible; the client may need to buy an anti-sting kit.

The client is demonstrating sign of a moderate reaction to the bee sting and may be hypersensitive and should have access to an anti-sting kit in the event he is stung again. The use of baking soda is ineffective in controlling the client’s reaction. People can develop an allergy to bee stings. Immunotherapy is prescribed only when immunoglobulin E hypersensitivity to specific inhalant allergens (e.g., house dust, pollens) that the client is unable to avoid is demonstrated.

13. Answer: C. Allergic rhinitis

The client most likely is suffering from allergic rhinitis, an allergic reaction to inhaled airborne allergens. In this case, the friend’s cat triggered the client’s symptoms. Anaphylaxis is an acute, life-threatening allergic reaction marked by rapidly progressive urticaria and respiratory distress. Bronchitis and asthma produce symptoms in the lower respiratory tract, such as expiratory wheezing and chest tightness.

14. Answer: A. Deficient fluid volume related to diarrhea and abnormal fluid loss

Based on the client’s assessment findings, the most immediate problem is dehydration because of chronic diarrhea. The nursing diagnosis of deficient fluid volume is the priority, and interventions are geared to improving the client’s fluid status. Although imbalanced nutrition, disturbed thought processes, and diarrhea are involved, they assume a lower priority at this time.

15. Answer: D. “Follow a high-protein, high-calorie diet.”

Dietary instructions should include the need for a high-protein, high-calorie diet. The patient should be taught to eat small, frequent meals and include low-microbial foods, such as pasteurized dairy products, washed and peeled fruits and vegetables, and well-cooked meats.

16. Answer: D. Acquired immunity from disease

Acquired immunity can occur by receiving an immunization that causes antibodies to a specific pathogen to form. Natural (innate) immunity is present at birth. No immunization protects the client from all diseases.

17. Answer: D. Steak

The client with systemic lupus erythematosus (SLE) is at risk for cardiovascular disorders such as coronary artery disease and hypertension. The client is advised of lifestyle changes to reduce these risks, which include smoking cessation and prevention of obesity and hyperlipidemia. The client is advised to reduce salt, fat, and cholesterol intake.

18. Answer: B. Client now limits his fluid intake

The status of the client with a diagnosis of Impaired gas exchange would be evaluated against the standard outcome criteria for this nursing diagnosis. These would include the client stating that breathing is easier and is coughing up secretions effectively, and has clear breath sounds. The client should not limit fluid intake because fluids are needed to decrease the viscosity of secretions for expectoration.

19. Answer: C. Genital warts, flat warts, skin warts, neoplasm of cervix, vagina and penis

Dermatologic human papillomavirus (HPV) infection in HIV patients manifests as both anogenital and nongenital skin disease. Cutaneous HPV-related disease in nongenital skin is also increased in HIV-positive patients, in the form of benign common warts, epidermodysplasia verruciformis-like skin lesions, and nonmelanoma skin cancers.

20. Answer: B. Fluconazole

Oral candidiasis usually responds to topical treatments such as clotrimazole troches and nystatin suspension (nystatin “swish and swallow”). Systemic antifungal medication such as fluconazole or itraconazole may be necessary for oropharyngeal infections that do not respond to these treatments.

21. Answer: D. All of the above

A person’s CD4 count is an important factor in the decision to start ART. A low or falling CD4 count indicates that HIV is advancing and damaging the immune system. A rapidly decreasing CD4 count increases the urgency to start ART. Regardless of CD4 count, there is greater urgency to start ART when a person has a high viral load or any of the following conditions: pregnancy, AIDS, and certain HIV-related illnesses and co infections.

22. Answer: B. Decreased protein absorption

Often the complications of the acquired immunodeficiency syndrome (AIDS) have a negative impact on nutritional status. Weight loss and protein depletion are commonly seen among the AIDS population.

23. Answer: D. Elimination of HIV entirely from the body.

Eradication of HIV infection cannot be achieved with available antiretroviral (ARV) regimens even when new, potent drugs are added to a regimen that is already suppressing plasma viral load below the limits of detection of commercially available assays.

24. Answer: C. Toxoplasmosis

Toxoplasmosis is the most common central nervous system infection in patients with the acquired immunodeficiency syndrome (AIDS) who are not receiving appropriate prophylaxis. This infection has a worldwide distribution and is caused by the intracellular protozoan parasite, Toxoplasma gondii.

25. Answer: B. An autoimmune disease that causes blistering in the epidermis

Pemphigus is an autoimmune disease that causes blistering in the epidermis. The client has large flaccid blisters (bullae). Because the blisters are in the epidermis, they have a thin covering of skin and break easily, leaving large denuded areas of skin. On initial examination, clients may have crusting areas instead of intact blisters. Option A describes eczema, option C describes herpes zoster, and option D describes psoriasis.

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