Immune System Problem Quiz Questions!

Methotrexate is teratogenic and should not be used in patients who are pregnant. The physician will need to discuss use of contraception during the time the patient is taking methotrexate. The other patient information may require further patient assessment or teaching but does not indicate that methotrexate may be contraindicated for the patient.

Pentamidine can cause fatal hypoglycemia, so the low blood glucose level indicates a need for a change in therapy. The low blood pressure suggests that the IV infusion rate may need to be slowed. The other responses indicated need for independent nursing actions (such as obtaining a new IV site and encouraging oral intake) but are not associated with pentamidine infusion

Patients with severe immunodeficiency may be unable to produce an immune response, so a negative TB skin test does not completely rule out a TB diagnosis for this patient. The next steps in diagnosis are a chest x-ray and sputum culture. Teaching about INH and follow-up TB testing may be required, depending on the x-ray and sputum culture results

Both naproxen (an NSAID) and prednisone (a corticosteroid) can cause gastrointestinal bleeding and the stool appearance indicated that there may be blood present in the stool. A stool specimen should be checked for occult blood. Also, it is likely that patient needs to start taking aproton-pump inhibitor such as pantopraxole (Protonix) to reduce gastric acid secretion. The other symptoms are common in patients with RA and will require assessments and interventions, but do not indicated that therapy needs to be altered.

Epinephrine given 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 generally is administered using a non-rebreather mask at 90%-100% Fio2 Albuterol may also be used to decrease airway narrowing, but would not be the first therapy used for anaphylaxis. An IV access will take longer to establish and should not be the first intervention.

Viral load testing measures the amount of HIV genetic material in the blood, so a decrease in viral load indicates that the ART is effective. The lymphocyte count is used to assess the impact of HIV on immune function but will not directly measure the effectiveness of antiretroviral therapy. The ELISA and Western blot tests monitor for the presence of antibodies to HIB, so these will be positive after the patient is infected with HIV even if drug therapy is effective

Drug therapy for HIV infection requires taking multiple medications on a very consistent schedule. Failure to take the medications consistently can lead to mutations and the emergence of more virulent forms of the virus. Although the other data indicate the need for further assessments or interventions, they will not affect the decision to initiate antiretroviral therapy for this patient.

Albuterol is the most rapid acting of the medications listed. Corticosteroids are helpful in prevention of allergic reactions, but are not as rapid acting. Cromolyn is used as a prophylactic medication to prevent

A high number of patients with SLE develop nephropathy, so an increase in BUN may indicate a need for a change in therapy or for further diagnostic testing such as creatinine clearance test or renal biopsy. The other laboratory results are not unusual in patients with SLE.

To be most effective, cyclosporine must be mixed and administered following 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 (CCU) float nurse and new orientee would not have experience with this medication

Supplying bleach solution to patients who are at risk for HIV infection can be done by staff members with health assistant education. Pre-operative/post-operative test counseling may be done by non-RN personnel with specialized training; however, an RN would be better prepared to answer questions that are likely to be asked by at-risk individuals. Education and community assessment are RN-level skills.

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/contact precautions or visitor restrictions for opportunistic infections. Hot or spicy foods are not usually well tolerated by patients with oral or esophageal fungal infections.

Taking antiretroviral medications such as indinavir on a rigid time schedule is essential for effective treatment of HIV infection and to avoid development of drug resistant-strains of the virus. The other medications should also be given within the time frame indicated in the hospital policy (usually within 30 minutes of the scheduled time).

Collecting data used to evaluate the therapeutic and adverse effects of medications is included in LPN/LVN education and scope of practice. Assessment, planning, and teaching are more complex skills that will require RN education. Assistance with hygiene and activities of daily living should be delegated to the nursing assistants.

The varicella (chickenpox) vaccine is a live-virus vaccine and should not be administered to patients who are receiving immunosuppressive medications such as prednisone. The other medical orders are appropriate. Prednisone dose should be tapered gradually when patients have been on long-term steroid therapy, but tapering is not necessary for short-term prednisone use. CRP levels are not the most specific test for monitoring treatment but are inexpensive and frequently used. High does of NSAIDs such as ibuprofen are more likely to cause side effects such as gastrointestinal bleeding but are
useful in treating the joing pain associated with SLE exacerbations

Administration of oral medication is appropriate for LPN education and scope of practice. Oral care should be delegated to a nursing assistant. Teaching and assessment are more complex RN-level interventions.

Individuals with allergic reactions to these fruits have a high incidence of latex allergy. More information and/or testing is needed to determine whether the new employee has a latex allergy, which might affect ability to provide direct patient care. The other findings would be important to include in documenting the employee’s health history, but would not affect ability to provide patient care. Focus: Prioritizat

The staff member who is most knowledgeable about the regulations regarding HIV prophylaxis and obtaining a patient’s HIV status and/or patient HIV testing is the occupational health nurse. Doing unauthorized HIV testing or asking the patient yourself would be unethical. The nurse manager is not responsible for obtaining this information (unless the manager is also in charge of occupational health).

Nausea and vomiting are common adverse effects of interferon alfa-2a, but continued vomiting should be reported to the physician because dehydration may occur. The medication may be given by either the subcutaneous or intramuscular route. Flu-like symptoms such as a mild temperature elevation, headache, muscle aches, and anorexia are common after initiating therapy but tend to decrease over time.

Patients taking immunosuppressive medications are at increased risk for development of cancer. A non-tender swelling or lump may indicate the patient has lymphoma. The other data indicate that the patient is experiencing common side effects of the immunosuppressive medications.