Disorders of the Immune System

These flashcards cover key vocabulary and concepts related to disorders of the immune system.

1. A licensed practical nurse (LPN) is monitoring a patient receiving an intravenous antibiotic. The patient suddenly reports feeling short of breath and has visible swelling of the lips. What is the priority nursing action?

• A. Administer a sedative to calm the patient.

• B. Stop the infusion immediately.

• C. Document the findings in the electronic health record.

• D. Check the patient's temperature.

Correct Answer: B. Stop the infusion immediately.

Rationale: The patient is exhibiting signs of anaphylaxis/angioedema, a Type I hypersensitivity. The priority is to remove the offending agent (the antibiotic) before proceeding with other interventions like airway management or medications.

2. A patient with systemic lupus erythematosus (SLE) asks the LPN why they need to wear sunscreen even on cloudy days. What is the best response?

• A. "Sunlight causes a type of infection that SLE patients are prone to."

• B. "Ultraviolet (UV) light can trigger an exacerbation or 'flare' of SLE symptoms."

• C. "Sunscreen prevents the development of type IV hypersensitivity."

• D. "Sunscreen helps the body produce Vitamin D which cures SLE."

Correct Answer: B. "Ultraviolet (UV) light can trigger an exacerbation or 'flare' of SLE symptoms."

Rationale: Photosensitivity is a common feature of SLE. UV exposure can cause skin rashes and systemic inflammatory responses, leading to a flare-up of the disease.

3. Which assessment finding in a patient with a known allergy to peanuts should the LPN report to the Register Nurse (RN) immediately as a sign of angioedema?

• A. Itchy, red welts on the trunk.
• B. A mild headache.
• C. Swelling of the tongue and throat.
• D. Dryness of the skin.

Correct Answer: C. Swelling of the tongue and throat.

Rationale: Angioedema involves swelling of the deeper submucosal or subcutaneous tissues. Swelling of the tongue and throat is a medical emergency because it can lead to airway obstruction.

4. An LPN is teaching a patient how to use an epinephrine auto-injector. Which instruction is correct?

• A. "Inject the medication into the center of the buttock."
• B. "Hold the injector in place for at least 10 seconds after triggering."
• C. "Rub the area vigorously for 5 minutes after injection."
• D. "Only use the injector if you lose consciousness."

Correct Answer: B. "Hold the injector in place for at least 10 seconds after triggering."

Rationale: Epinephrine should be administered into the outer thigh. Holding it in place ensures the full dose is delivered. The patient should seek emergency care immediately regardless of symptom severity.

5. A patient presents with a "butterfly rash" across the bridge of the nose and cheeks. The LPN recognizes this as a characteristic sign of which condition?

• A. Urticaria
• B. Type IV Hypersensitivity
• C. Systemic Lupus Erythematosus (SLE)
• D. Anaphylactic shock

Correct Answer: C. Systemic Lupus Erythematosus (SLE)

Rationale: The malar or butterfly rash is a classic clinical manifestation of SLE, a multisystem autoimmune disorder.

6. A patient is diagnosed with Urticaria. What is the primary characteristic the LPN expects to observe during assessment?

• A. Deep tissue swelling around the eyes.
• B. Raised, itchy welts (hives) on the skin.
• C. Scaly, silver patches on the elbows.
• D. Fluid-filled blisters that crust over.

Correct Answer: B. Raised, itchy welts (hives) on the skin.

Rationale: Urticaria is the medical term for hives, which are triggered by histamine release causing itchy, raised wheals.

7. A patient has a positive skin test for a delayed hypersensitivity reaction. The LPN knows this reaction is mediated by:

• A. Antibodies
• B. T cells
• C. B cells
• D. Neutrophils

Correct Answer: B. T cells

Rationale: Type IV hypersensitivity is a delayed-type reaction mediated by T cells rather than antibodies (unlike Type I).

8. Which of the following patients is at the highest risk for developing an autoimmune disorder like SLE?

• A. A 65-year-old male.
• B. A 25-year-old female.
• C. A 10-year-old male.
• D. An 80-year-old female.

Correct Answer: B. A 25-year-old female.

Rationale: SLE primarily affects women of childbearing age (typically between ages 15 and 45).

9. A patient is experiencing anaphylaxis. In addition to respiratory distress, which vital sign change would the LPN expect to see?

• A. Hypertension
• B. Bradycardia
• C. Hypotension
• D. Hyperthermia

Correct Answer: C. Hypotension

Rationale: Severe systemic histamine release during anaphylaxis causes widespread vasodilation, leading to a significant drop in blood pressure (shock).

10. An LPN is reviewing the plan of care for a patient with SLE. Which nursing diagnosis should be the priority during an acute flare-up?

• A. Disturbed body image.
• B. Risk for impaired skin integrity.
• C. Fatigue related to chronic inflammation.
• D. Ineffective tissue perfusion related to vasculitis.

Correct Answer: D. Ineffective tissue perfusion related to vasculitis.

Rationale: While fatigue and skin integrity are important, SLE can cause organ damage via vasculitis. Monitoring and maintaining tissue perfusion to vital organs is the physiological priority.

11. A patient reports a rash that appeared 48 hours after using a new laundry detergent. The LPN identifies this as which type of hypersensitivity?

• A. Type I (Immediate)
• B. Type II (Cytotoxic)
• C. Type III (Immune complex)
• D. Type IV (Delayed)

Correct Answer: D. Type IV (Delayed)

Rationale: Reactions that occur 24 to 72 hours after exposure (like contact dermatitis) are classified as Type IV delayed hypersensitivity.

12. What is the primary physiological mechanism behind an autoimmune disorder?

• A. Complete absence of the immune system.
• B. Overproduction of red blood cells.
• C. Failure to distinguish "self" from "non-self."
• D. Destruction of all white blood cells.

Correct Answer: C. Failure to distinguish "self" from "non-self."

Rationale: Autoimmune disorders occur when the immune system loses its tolerance to the body's own tissues and begins to attack them.

13. A patient in the clinic is prescribed a medication to treat his SLE. Which class of medication is commonly used to reduce inflammation and suppress the immune response in SLE?

• A. Antibiotics
• B. Corticosteroids
• C. Diuretics
• D. Anticoagulants

Correct Answer: B. Corticosteroids

Rationale: Corticosteroids (like prednisone) are frequently used to manage SLE by reducing inflammation and suppressing the overactive immune system.

14. When educating a patient about anaphylaxis, which history item is most significant?

• A. Previous episodes of mild hay fever.
• B. A history of childhood asthma.
• C. A previous minor reaction to the same allergen.
• D. Family history of heart disease.

Correct Answer: C. A previous minor reaction to the same allergen.

Rationale: A previous reaction, even if minor, indicates sensitivity. Subsequent exposures can lead to a much more severe Type I reaction, including anaphylaxis.

15. An LPN is assisting with the admission of a patient with suspected SLE. Which symptom should the nurse expect the patient to report?

• A. Joint pain and stiffness.
• B. Increased energy levels.
• C. Weight gain.
• D. Improved vision.

Correct Answer: A. Joint pain and stiffness.

Rationale: Polyarthralgia (joint pain) and morning stiffness are very common symptoms in patients with SLE.

16. Which of the following is an example of Type I hypersensitivity?

• A. Tuberculosis skin test reaction.
• B. Allergic rhinitis (hay fever).
• C. Graft-versus-host disease.
• D. Contact dermatitis from nickel.

Correct Answer: B. Allergic rhinitis (hay fever).

Rationale: Allergic rhinitis is an IgE-mediated immediate reaction, making it Type I.

17. An LPN is monitoring a patient after an intramuscular injection of epinephrine. Which effect indicates the medication is working?

• A. Increased heart rate and bronchodilation.
• B. Decreased blood pressure and increased swelling.
• C. Sedation and slowed respirations.
• D. Decreased urine output.

Correct Answer: A. Increased heart rate and bronchodilation.

Rationale: Epinephrine acts on alpha and beta receptors to cause vasoconstriction (to raise BP) and bronchodilation (to open airways), and it often increases the heart rate.

18. A patient is diagnosed with systemic angioedema. The LPN hears high-pitched, inspiratory sounds over the upper airway. Which term should the LPN use to document this finding?

• A. Wheezing
• B. Crackles
• C. Stridor
• D. Rhonchi

Correct Answer: C. Stridor

Rationale: Stridor is a high-pitched sound heard on inspiration that indicates upper airway obstruction, which is a life-threatening complication of angioedema.

19. A patient with SLE is experiencing a flare-up. Which laboratory value is most commonly elevated during an inflammatory response in SLE?

• A. Hemoglobin
• B. Erythrocyte Sedimentation Rate (ESR)
• C. Glucose
• D. Sodium

Correct Answer: B. Erythrocyte Sedimentation Rate (ESR)

Rationale: ESR and C-reactive protein (CRP) are markers of systemic inflammation and are typically elevated during SLE exacerbations.

20. What is the standard route for the emergency administration of epinephrine for anaphylaxis in a community setting?

• A. Oral (PO)
• B. Intramuscular (IM)
• C. Subcutaneous (SQ)
• D. Intradermal (ID)

Correct Answer: B. Intramuscular (IM)

Rationale: IM injection into the vastus lateralis (thigh) is the preferred route for rapid absorption during an anaphylactic emergency.

21. A patient with SLE asks about exercising. What is the best advice for the LPN to give?

• A. "Avoid all physical activity to prevent fatigue."
• B. "Engage in high-impact aerobics daily."
• C. "Alternate activities with rest periods to manage fatigue."
• D. "Only exercise if you have no pain at all."

Correct Answer: C. "Alternate activities with rest periods to manage fatigue."

Rationale: Patients with SLE should stay active but must balance activity with rest to manage the chronic fatigue associated with the disease.

22. Which term describes a reaction that results in tissue damage due to the immune system's overreaction?

• A. Immunity
• B. Homeostasis
• C. Hypersensitivity
• D. Prophylaxis

Correct Answer: C. Hypersensitivity

Rationale: Hypersensitivity is an exaggerated immune response to a perceived threat that causes harm to the host's own body.

23. A patient is worried about "passing on" SLE to her children. Which statement by the LPN is accurate regarding the cause of SLE?

• A. "It is caused exclusively by a single gene."
• B. "It is purely environmental and not related to genes."
• C. "The cause is unknown but involves a combination of genetic, hormonal, and environmental factors."
• D. "It is a contagious condition passed through contact."

Correct Answer: C. "The cause is unknown but involves a combination of genetic, hormonal, and environmental factors."

Rationale: SLE is complex and multifactorial; there is no single known cause, but genetics play a role in susceptibility.

24. An LPN is caring for a patient experiencing a mild allergic reaction (urticaria). Which medication class is typically given first to reduce itching and swelling?

• A. Antihistamines
• B. Anticoagulants
• C. Opioids
• D. Loop diuretics

Correct Answer: A. Antihistamines

Rationale: Antihistamines (like diphenhydramine) block the effects of histamine release, which is the primary cause of urticaria/hives.

25. Which system is NOT commonly affected by Systemic Lupus Erythematosus (SLE)?

• A. Renal (Kidneys)
• B. Musculoskeletal (Joints)
• C. Integumentary (Skin)
• D. Reproductive (Fertility levels)

Correct Answer: D. Reproductive (Fertility levels)

Rationale: While SLE affects the skin, kidneys, heart, and joints, it does not typically cause infertility, though pregnancy outcomes must be closely monitored.

26. A patient is being tested for a Type IV hypersensitivity. The LPN should explain that the results will be read in:

• A. 15 minutes
• B. 1 hour
• C. 48 to 72 hours
• D. One week

Correct Answer: C. 48 to 72 hours

Rationale: Type IV reactions are delayed and take several days to manifest, which is why TB skin tests are read after 48-72 hours.

27. In a patient with SLE, a nurse notes a decrease in urine output and peripheral edema. Which complication should the nurse suspect?

• A. Lupus nephritis
• B. Raynaud's phenomenon
• C. Pericarditis
• D. Anemia

Correct Answer: A. Lupus nephritis

Rationale: SLE often involves the kidneys (lupus nephritis), which can lead to renal failure, evidenced by decreased urine output and swelling.

28. An LPN is preparing a room for a patient with a history of severe latex allergy. Which action is most important?

• A. Ensure an extra blanket is available.
• B. Remove all latex-containing products from the room.
• C. Close the door to prevent airflow from the hallway.
• D. Provide a high-protein diet.

Correct Answer: B. Remove all latex-containing products from the room.

Rationale: Prevention is the best treatment for hypersensitivity. Using latex-free equipment is essential for patient safety.

29. Which of the following describes the role of the LPN in evaluating a patient with an autoimmune disorder?

• A. Independently changing the medication dosage.
• B. Documenting and reporting new symptoms or changes in condition to the RN/Provider.
• C. Diagnosing the specific type of autoimmune disease.
• D. Determining the underlying genetic sequence.

Correct Answer: B. Documenting and reporting new symptoms or changes in condition to the RN/Provider.

Rationale: The LPN's role involves assessment, monitoring, and reporting changes to the healthcare team.

30. A patient reports that after eating shellfish, she feels her throat "tightening." After ensuring she can breathe, the LPN should advise her to:

• A. Eat more shellfish to build tolerance.
• B. Avoid shellfish and carry an epinephrine-auto injector.
• C. Only eat shellfish in small amounts.
• D. Take an aspirin before eating shellfish.

Correct Answer: B. Avoid shellfish and carry an epinephrine-auto injector.

Rationale: Throat tightening suggests an impending Type I systemic reaction; strict avoidance and carrying emergency medication are critical.

31. SLE is described as a "multisystem" disorder. What does this mean for the patient?

• A. Only one organ is affected at a time.
• B. The disease can affect any organ or tissue in the body.
• C. It only affects the nervous system.
• D. It is a mental health condition with physical symptoms.

Correct Answer: B. The disease can affect any organ or tissue in the body.

Rationale: Systemic means it affects multiple organ systems throughout the body simultaneously or sequentially.

32. A patient with SLE has been taking long-term corticosteroids. Which side effect should the LPN monitor for?

• A. Lowered blood glucose.
• B. Decreased blood pressure.
• C. Increased risk for infection.
• D. Thickening of the skin.

Correct Answer: C. Increased risk for infection.

Rationale: Corticosteroids suppress the immune system, making the patient more susceptible to infections.

33. Which instruction should the LPN provide regarding skin care for an SLE patient with a rash?

• A. Cleanse the skin with harsh soaps to remove scales.
• B. Use mild, soap-free cleansers and pat the skin dry.
• C. Use hot water for all bathing.
• D. Apply scented lotions to the rash area.

Correct Answer: B. Use mild, soap-free cleansers and pat the skin dry.

Rationale: Skin with SLE is fragile. Using gentle products and avoiding rubbing helps maintain skin integrity.

34. An LPN notes that a patient’s hands turn blue and then white when exposed to cold. This finding, often associated with SLE, is called:

• A. Urticaria
• B. Raynaud’s phenomenon
• C. Angioedema
• D. Cyanosis

Correct Answer: B. Raynaud’s phenomenon

Rationale: Raynaud’s phenomenon involves vasospasm of small arteries, typically in the fingers/toes, and is a common secondary condition in SLE.

35. A student nurse asks why Type I hypersensitivity happens so fast. The LPN explains it is due to the rapid release of:

• A. Hemoglobin
• B. Histamine
• C. Calcium
• D. Iron

Correct Answer: B. Histamine

Rationale: In Type I reactions, IgE antibodies trigger mast cells to release histamine, which immediately causes vasodilation and smooth muscle contraction.

36. A patient with a history of lupus is planning a pregnancy. What is the most important advice?

• A. "SLE makes it impossible to conceive."
• B. "You should wait until your disease has been in remission for at least 6 months."
• C. "You must stop all medications immediately before trying to conceive."
• D. "SLE flares never happen during pregnancy."

Correct Answer: B. "You should wait until your disease has been in remission for at least 6 months."

Rationale: Pregnancy is safest when the disease is stable/in remission. Some medications may need adjustment via the provider.

37. A patient is experiencing angioedema. Which medication would the nurse expect to have readily available?

• A. Furosemide
• B. Epinephrine
• C. Warfarin
• D. Digoxin

Correct Answer: B. Epinephrine

Rationale: Epinephrine is the gold standard for treating severe allergic reactions involving the airway (angioedema) or circulation (anaphylaxis).

38. What is the characteristic of "remission" in a patient with SLE?

• A. The disease is completely cured.
• B. A period where symptoms are minimal or absent.
• C. The time when the disease is most contagious.
• D. A permanent loss of immune function.

Correct Answer: B. A period where symptoms are minimal or absent.

Rationale: SLE is chronic and characterized by "flares" (worsening symptoms) and "remissions" (quiet periods).

39. Which laboratory test measures for a specific antibody often found in patients with SLE?

• A. Complete Blood Count (CBC)
• B. Antinuclear Antibody (ANA)
• C. Prothrombin Time (PT)
• D. Potassium level

Correct Answer: B. Antinuclear Antibody (ANA)

Rationale: The ANA test is a common screening tool for SLE; a positive result indicates the presence of autoantibodies against the cell nucleus.

40. A patient asks why they feel so tired even when SLE is not in a "flare." The LPN explains:

• A. "The fatigue is likely due to lack of sleep."
• B. "Chronic inflammation from the autoimmune process can cause persistent fatigue."
• C. "You are probably just over-exercising."
• D. "Fatigue is not a symptom of SLE."

Correct Answer: B. "Chronic inflammation from the autoimmune process can cause persistent fatigue."

Rationale: Fatigue is one of the most common and debilitating symptoms reported by patients with SLE, even during periods of low disease activity.