The nurse is caring for a client with a history of breast cancer who is receiving chemotherapy. Which side effect should the nurse monitor for?

Choice A reason: An IgE-mediated (Type I) hypersensitivity reaction, like anaphylaxis, occurs post-bee sting, with rapid onset of rash, shortness of breath, hypotension, and tachycardia. IgE antibodies trigger mast cell degranulation, releasing histamine, causing vasodilation, bronchoconstriction, and systemic symptoms, matching the client’s acute presentation.

Choice B reason: Cell-mediated (Type IV) hypersensitivity involves T-cells, causing delayed reactions like contact dermatitis, not rapid systemic symptoms. Bee sting reactions are immediate, driven by IgE, not T-cells. Rash, hypotension, and respiratory distress indicate anaphylaxis, not a delayed cell-mediated response.

Choice C reason: Autoimmune responses involve self-directed antibodies, as in lupus, not triggered by external allergens like bee stings. The client’s acute rash, hypotension, and respiratory distress suggest an IgE-mediated anaphylactic reaction, not an autoimmune process, which is unrelated to acute allergen exposure.

Choice D reason: Type II hypersensitivity involves antibody-mediated cytotoxicity, as in transfusion reactions, not allergen-induced systemic symptoms. Bee sting reactions are IgE-driven, causing immediate anaphylaxis with rash and hypotension, not cytotoxic damage, making Type II inappropriate for the client’s acute presentation.

Choice A reason: Hemoccult tests detect blood in sputum, indicating hemoptysis, a TB symptom, but do not confirm Mycobacterium tuberculosis infection. Sputum culture is required for definitive diagnosis, as hemoccult only identifies bleeding, which is nonspecific and can occur in other respiratory conditions.

Choice B reason: Chest x-ray or CT scans show pulmonary abnormalities like cavitary lesions in TB but are not confirmatory. Radiographic findings suggest TB but require microbiological confirmation via sputum culture, as similar patterns occur in other lung diseases, making imaging supportive but not diagnostic.

Choice C reason: Sputum culture positive for Mycobacterium tuberculosis is the gold standard for TB diagnosis. It directly identifies the pathogen, confirming active infection. Other tests like skin tests or imaging are suggestive but not definitive, as they cannot distinguish active TB from latent or other conditions.

Choice D reason: A positive PPD skin test indicates TB exposure or latent infection but does not confirm active disease. False positives occur with prior BCG vaccination or nontuberculous mycobacteria. Sputum culture is needed to verify active TB, making the skin test less definitive.