Immunology
A 28-year-old patient arrives in the ED after eating shellfish. The nurse notes facial swelling, wheezing, BP 82/48, HR 128, SpO₂ 89%. What is the nurse’s priority intervention?
A. Administer IV diphenhydramine
B. Prepare for intubation
C. Administer intramuscular epinephrine
D. Start IV corticosteroids
C. Administer intramuscular epinephrine
A 55-year-old patient reports fatigue, weight gain, constipation, and cold intolerance. Labs show:
TSH 9.2 mIU/L
Free T4 0.6 ng/dL
How should the nurse interpret these lab results?
A. Primary hyperthyroidism
B. Secondary hypothyroidism
C. Primary hypothyroidism
D. Tertiary hyperthyroidism
C.
Rationale:
High TSH + low T4 = primary hypothyroidism
Pituitary is trying to stimulate a failing thyroid
A patient undergoing chemotherapy reports fatigue and shortness of breath. Labs:
Hemoglobin 7.4 g/dL
Hematocrit 22%
What is the nurse’s priority concern?
A. Infection
B. Bleeding
C. Impaired oxygen delivery
D. Fluid volume overload
C
Rationale:
Low hemoglobin = ↓ oxygen-carrying capacity
Fatigue and dyspnea reflect tissue hypoxia
A patient receiving chemotherapy has:
Absolute neutrophil count (ANC): 420 cells/mm³
Temperature: 38.3°C (101°F)
What should the nurse do FIRST?
A. Administer acetaminophen
B. Notify the provider
C. Obtain a stool sample
D. Encourage oral fluids
B
Rationale:
Neutropenic fever is a medical emergency
Requires immediate broad-spectrum antibiotics
Which order is correct?
A. Insulin → fluids → potassium
B. Fluids → insulin → potassium
C. Potassium → insulin → fluids
D. Insulin → potassium → fluids
B
You cannot safely give insulin until you fix circulation, and you cannot safely replace potassium until insulin starts moving it into cells.
THE ICU BOUNCER STORY
Fluids = open the doors (fix circulation)
Insulin = tell glucose to go inside
Potassium = follow insulin carefully so the heart doesn’t crash
Doors first → people move → crowd control
A 24-year-old woman with systemic lupus erythematosus (SLE) presents with joint pain, fatigue, and a facial rash. Labs show:
ANA positive
Elevated ESR
Creatinine 2.1 mg/dL
Which complication is the nurse most concerned about?
A. Skin infection
B. Lupus nephritis
C. Osteoarthritis
D. Iron-deficiency anemia
B
Rationale:
Elevated creatinine + SLE = kidney involvement
Lupus nephritis can progress to renal failure
The nurse teaches a patient prescribed levothyroxine. Which statements indicate understanding?
☐ “I will take this medication every morning on an empty stomach.”
☐ “I should stop taking this if my symptoms improve.”
☐ “It may take several weeks to feel better.”
☐ “I will take this medication with calcium supplements.”
☐ “This medication may need to be taken for life.”
Take on empty stomach
Takes weeks to feel effects
May be lifelong therapy
Rationale: Calcium interferes with absorption
A patient with thrombocytopenia has a platelet count of 28,000/mm³.
What is the nurse’s priority?
A. Encourage ambulation
B. Implement bleeding precautions
C. Administer aspirin
D. Perform deep tissue massage
B
Platelets <50,000 = bleeding risk
<30,000 = high risk for spontaneous bleeding
A patient with leukemia starts chemotherapy. 24 hours later labs show:
Potassium: 6.1 mEq/L
Phosphorus: high
Calcium: low
Uric acid: high
These findings indicate risk for which life-threatening complication?
A. Hemorrhage
B. Acute kidney injury
C. Sepsis
D. Anaphylaxis
B
Rationale: Tumor lysis releases intracellular contents → renal failure
Which insulin order should the nurse question?
A. IV regular insulin for DKA
B. Insulin glargine at bedtime
C. Sliding-scale insulin only for type 1 diabetes
D. Insulin lispro before meals
C
Type 1 patients must have basal insulin
Sliding-scale alone = DKA risk
Cellular immunity comes into play when _________ is/are activated by an antigen.
A. B cells
B. T cells
C. NK cells
B. T Cells
A patient with Graves’ disease is prescribed methimazole.
Which assessment finding requires immediate provider notification?
A. Mild nausea
B. Weight gain
C. Sore throat and fever
D. Cold intolerance
C.
Rationale:
Methimazole can cause agranulocytosis
Fever + sore throat = possible life-threatening infection
A patient with septic shock develops:
Oozing from IV sites
Platelets: 42,000
PT/PTT: prolonged
D-dimer: elevated
Which pathophysiologic process explains this condition?
A. Excessive clotting followed by bleeding
B. Vitamin K deficiency
C. Bone marrow suppression
D. Autoimmune platelet destruction
A
DIC = clotting factors consumed → bleeding
Labs show both clotting & bleeding abnormalities
A patient receiving immune checkpoint inhibitors reports:
New-onset diarrhea
Abdominal pain
Elevated liver enzymes
Which complication is the nurse most concerned about?
A. Chemotherapy-induced nausea
B. Opportunistic infection
C. Immune-related adverse reaction
D. Tumor progression
C
Immunotherapy can cause autoimmune-like organ damage
GI + liver involvement = red flag
A patient receiving chemotherapy has the following labs:
WBC: 1,200
ANC: 420
Temperature: 38.3°C (101°F)
Which condition is the nurse MOST concerned about?
A. Sepsis
B. Anaphylaxis
C. Febrile neutropenia
D. Bone marrow suppression
C
ANC <500 + fever = febrile neutropenia
This is an oncologic emergency
Infection signs may be minimal
You are caring for a patient who has had an organ transplant. She is asking you about rejection and medications used to prevent it. In answering her question, you base your response on your knowledge that (select all that apply):
A.Immunosuppressive therapy is helpful in slowing the process of graft rejection.
B.Tissue rejection usually occurs within 2 to 4 days of transplantation.
C.Antigenic determinants on the cells lead to graft rejection via the immune process.
D.Infection is a threat to the patient receiving immunosuppressive therapy.
A, C, D
A patient with pituitary adenoma has labs:
TSH: low
T4: low
After treatment, T4 improves but TSH remains low.
What is the best interpretation of this trend?
A. Treatment is ineffective
B. Thyroid gland is failing
C. Pituitary dysfunction persists
D. Patient is developing hyperthyroidism
C
In secondary hypothyroidism, TSH may stay low despite adequate hormone replacement
15 minutes after starting PRBCs, the patient develops:
Fever
Chills
Back pain
Hypotension
What is the nurse’s FIRST action?
A. Slow the infusion
B. Stop the transfusion
C. Administer antipyretics
D. Notify the provider
B
STOP transfusion immediately
Everything else comes after
A patient with metastatic cancer reports:
New onset back pain
Leg weakness
Urinary retention
This presentation suggests:
A. Hypercalcemia
B. Tumor lysis syndrome
C. Spinal cord compression
D. Peripheral neuropathy
C
The nurse identifies febrile neutropenia. What is the nurse’s FIRST action?
A. Administer antipyretics
B. Start broad-spectrum antibiotics
C. Obtain blood cultures
D. Place the patient in reverse isolation
C
Cultures FIRST, then antibiotics
A 39-year-old patient with untreated Graves’ disease arrives in the ED with:
Temp: 40.2°C (104.4°F)
HR: 152 bpm
BP: 168/92
Agitation, tremors, diarrhea
Which finding is most concerning and indicates a life-threatening complication?
A. Diarrhea
B. Tremors
C. Hyperthermia
D. Weight loss
C
Thyroid storm = medical emergency
Hyperthermia + tachycardia + CNS changes = impending cardiovascular collapse
Labs:
Cortisol: Low
ACTH: High
Sodium: Low
Potassium: High
BP: 86/52
These findings indicate:
A. Secondary adrenal insufficiency
B. Primary adrenal insufficiency
C. SIADH
D. Cushing syndrome
B
Low cortisol + HIGH ACTH = primary
Aldosterone loss → ↓ Na, ↑ K, hypotension
Findings:
Bleeding from IV sites
Petechiae
Platelets: 28,000
PT/PTT prolonged
D-dimer elevated
Which statement best explains what is happening?
A. Excess clotting factor production
B. Simultaneous clotting and bleeding
C. Autoimmune platelet destruction
D. Bone marrow failure
B
A patient with acute leukemia just started chemotherapy 24 hours ago.
Current labs:
K⁺: 6.2
Phosphorus: 5.8
Calcium: 7.1
Uric acid: 9.5
Creatinine rising
ECG: peaked T waves
Which condition is the nurse MOST concerned about?
A. Sepsis
B. Tumor lysis syndrome
C. DIC
D. Acute rejection
B
↑ K, ↑ Phos, ↓ Ca, ↑ uric acid = TLS
Occurs after chemo from massive cell breakdown
Which patient should the nurse assess FIRST?
A. Patient with SLE and joint pain
B. Patient with HIV and CD4 of 480
C. Patient receiving chemo with ANC 380 and fever
D. Patient with seasonal allergies and wheezing
C
Febrile neutropenia = life-threatening