Ch 42: Nursing Care of a Family when a Child has an Immune Disorder

c) IgE Pg. 1171 Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening.

1. When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect stings, the nurse integrates knowledge that this response is related to which immunoglobulin? a) IgG b) IgM c) IgE d) IgA

d) The UAP takes a rectal temperature on the client Pg. 1171 Precautions must be taken to protect the client from infection. The RN would intervene if the UAP takes a rectal temperature because this increases the client's risk for infection. The client should not receive rectal suppositories as well. The RN would ensure meticulous oral care is provided and encourage appropriate and adequate nutrition. Delivering a meal tray, wearing a mask when entering the room, and assisting the client to ambulate in the room are all appropriate actions by the UAP.

16. The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for a pediatric client with an immune disorder receiving a stem cell transplant. Which action by the UAP will cause the RN to intervene? a) The UAP wears a mask when entering the client's room b) The UAP places a lunch tray in the client's room c) The UAP assists the client to ambulate in the room d) The UAP takes a rectal temperature on the client

c) Screening for HIV Pg. 1178 No screening mandate has been put forth for HIV, but all pregnant women should be encouraged to undergo this test. Prophylactic treatment would be initiated only once the woman has been screened. Screening for STIs and ensuring proper nutrition are also part of health promotion for women in this age group, but they are of lower priority than identifying HIV-positive individuals.

19. The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. What would be a priority recommendation in this setting? a) Prophylactic treatment for HIV b) Proper nutrition c) Screening for HIV d) Screening for sexually transmitted infections (STIs)

Allergen

A substance that causes an allergic reaction

Overactive

Allergy or hypersensitivity

IgE

Immunoglobulin involved in immediate hypersensitivity reactions It exists bound to mast cells on tissue surfaces When contacted by an antigen, cellular granules are released It is associated with allergy and parasitic infections

IgG

Immunoglobulin that is the most frequently occurring antibody in plasma During secondary response, it is the major immunoglobulin to be synthesized It freely diffuses into extravascular spaces to contact antigens In prenatal life, it diffuses across the placenta to supply passive immune protection to the fetus until the infant can effectively produce immunoglobulins It has the major responsibility for neutralizing bacterial toxins and in activating phagocytosis (destruction of bacteria)

Classification I: intermediate (hypersensitivity reaction)

Hypersensitivity reaction Mechanism: IgE attached to surface of mast cell triggers release of intracellular granules from mast cells on contact with antigens Involved cell: IgE Effect: allergies, asthma, atopic dermatitis, anaphylaxis

Classification IV: delayed (hypersensitivity reaction)

Hypersensitivity reaction Mechanism: T-cells combine with antigen to induce inflammatory reactions by direct cell involvement or the release of lymphokines Involved cell: T lymphocyte Effect: contact dermatitis, transplant graft reaction

Classification III: immune complex disease (hypersensitivity reaction)

Hypersensitivity reaction Mechanism: antigen-antibody complexes precipitate; complement is activated, leading to inflammatory response Involved cell: IgG or IgE Effect: rheumatoid arthritis, transplant graft reaction

IgM

Immunoglobulin effective in agglutinating antigens as well as lysing cell walls Discovered early in the course of an infection in the bloodstream as it is the first response to pathogenic antigens

Immunity

The ability of an organism to resist a particular infection or toxin by the action of specific antibodies or sensitized white blood cells

T lymphocytes

Originate in bone marrow and mature in thymus; react to viruses, fungi, & parasites and other antigens; 3 types

B lymphocytes

Originate in the bone marrow where they develop from plasma or memory cells; major function is to produce antibodies or immunoglobulins; recognize, bind to, and destroy antigens

Bone marrow Thymus Lymph nodes Spleen Liver Tonsils Blood

System organs

Immunodeficiency

Underactive or nonfunctional

Immunogen

A substance that induces immune response

Antigen

A toxin or other foreign substance which induces an immune response in the body, especially the production of antibodies

Autoimmune

Abnormal or excessive response against own cells

c) An elimination diet Pg. 1192 The food diary may identify foods the child does not tolerate well, but it lacks the objectivity of the elimination diet. Skin testing usually involves whole proteins and will not test for reactions to food breakdown products. A raw food diet does not apply to allergy identification.

11. The nurse is discussing food allergies with parents of a young child, explaining that a very effective way to determine which foods a child may be allergic to is to implement: a) Allergy skin testing b) A food diary c) An elimination diet d) A raw food diet

Classification II: cytotoxic (hypersensitivity reaction)

Hypersensitivity reaction Mechanism: antigen-antibody reaction leading to antigen destruction; complement is activated Involved cell: IgG or IgM Effect: hemolytic anemia, transfusion reaction, erythroblastosis fetalis

IgA

Immunoglobulin found in external body secretions such as saliva, sweat, tears, mucus, bile, and colostrum It provides defense against pathogens on exposed mucosal surfaces, especially those of the gastrointestinal tract and respiratory tract, and works by preventing adherence of pathogens to mucosal cells

IgD

Immunoglobulin found in plasma It may be the receptor that binds antigens to lymphocyte surfaces but its true function is unclear

a) "We cannot go wrong with barbeque and french fries" Pg. 1189 The nurse needs to remind the parents that peanut oil might be a hidden ingredient in barbecue sauce. Baked goods can be hidden sources for peanut oil and peanuts. Hot chocolate may contain peanuts or peanut oil. Asian foods may contain hidden peanuts.

12. The nurse is teaching the parents of a 4-year-old client with a peanut allergy about dietary restrictions. Which response by the parents indicates a need for further teaching? a) "We cannot go wrong with barbeque and french fries" b) "Baked goods often contain hidden peanut ingredients" c) "We must be careful with Asian food" d) "Some hot chocolate mixes have peanuts"

a) Albuterol Pg. 1184 The nurse would expect to administer bronchodilation inhalation treatment (albuterol) if bronchospasm is present. Epinephrine, diphenhydramine, and/or corticosteroids are administered to reverse the allergic process.

2. The nurse is caring for a child who is having bronchospasm. The nurse would expect to administer what medication? a) Albuterol b) Epinephrine c) Diphenhydramine d) Corticosteroid

a) Peanuts c) Milk d) Eggs Pg. 1192 Allergies to eggs, peanuts, and milk are common in childhood. Cheerios are made of oats and are not known to be allergenic. Apples also are not allergenic, unlike bananas, which can cause problems for children who have latex allergies.

7. Food allergies have become more and more common in the last few decades. What are some common food allergies of childhood? Select all that apply. a) Peanuts b) Apples c) Milk d) Eggs e) Cheerios

b) Protease inhibitors Pg. 1176 The nurse understands that the child will be taking protease inhibitors as part of the three-drug regimen for HAART. Corticosteroids, cytotoxic agents, and DMARDs are typically used for the treatment of juvenile idiopathic arthritis (JIA).

8. The nurse is caring for a child undergoing highly active antiretroviral therapy (HAART) for HIV infection. The nurse is preparing to administer the prescribed medication. In addition to the nucleoside analog reverse transcriptase inhibitors (NRTIs) and the nonnucleoside analog reverse transcriptase inhibitors (NNRTIs), the nurse is cognizant that the child will be taking which additional medication as part of the three-drug regimen? a) Cytotoxic drugs b) Protease inhibitors c) Corticosteroids d) Disease-modifying antirheumatic drugs (DMARDs)

a) Ineffective protection related to impaired humoral defenses Pg. 1175 The child with a primary immunodeficiency lacks the necessary immune responses that provide protection from infection. Therefore, the priority nursing diagnosis would be ineffective protection. Imbalanced nutrition and risk for delayed growth and development may be appropriate, but these would not be the priority. Acute pain would be more appropriate for a child with juvenile idiopathic arthritis.

10. A nurse is preparing a plan of care for a child with a primary immunodeficiency. Which nursing diagnosis is the priority? a) Ineffective protection related to impaired humoral defenses b) Risk for delayed growth and development related to chronic illness c) Imbalanced nutrition, less than body requirements related to poor appetite d) Acute pain related to inflammatory processes

b) A client with human immunodeficiency virus (HIV) whose temperature is 102.2°F (39°C) Pg. 1175-1176 Of the immunologic disorders, HIV infection is the most serious. This client is also exhibiting an unexpected manifestation, which could indicate an infection. The clients with serum sickness and dermatitis are exhibiting expected findings and would be seen last. The client newly diagnosed needs to be seen second to have the medication started and receive education.

13. Which client will the nurse assess first after receiving shift report? a) A client with serum sickness stating, "I just feel bad all over" b) A client with human immunodeficiency virus (HIV) whose temperature is 102.2°F (39°C) c) A client with contact dermatitis who has blisters and mild edema on the lower extremities d) A client newly diagnosed with allergic rhinitis prescribed loratadine 10 mg

d) Determining if her throat itches Pg. 1192 Asking if the child's throat itches is most important because this aids in determining airway patency, which is always the priority. Asking about a rash, nausea, or abdominal pain can be done after the nurse is certain the child's airway is not jeopardized.

15. The school nurse is walking through the lunchroom when one of the children says she started to feel strange after trading lunches with a friend. Which assessment would be most important? a) Asking if she has abdominal pain b) Asking if she has a rash anywhere c) Checking if she has any nausea d) Determining if her throat itches

b) "Maternal antibodies crossed the placenta and that prevented infections until now" Pg. 1175 IgA deficiency does not have a specific treatment, is usually found when evaluating other illnesses, and is associated with allergies. However, the nurse's most appropriate response to the parents' question about why the infant was not diagnosed sooner is to explain how maternal antibodies prevent manifestation of the deficiency until the infant is approximately 4 months old.

35. The parents of a 5-month-old infant diagnosed with humoral IgA deficiency question the nurse about why the infant was not diagnosed sooner. Which response by the nurse most appropriate? a) "This is associated with allergies, which may not be noted prior to 5 months" b) "Maternal antibodies crossed the placenta and that prevented infections until now" c) "There is no treatment or cure specific for IgA deficiency in children" d) "IgA deficiency is usually found when evaluating for another illness"

b) Exposure to allergen d) Rapid immune response c) Vasodilation e) Bronchoconstriction a) Circulatory response Pg. 1179-1180 Anaphylaxis typically is a very rapid response to exposure to an allergen. Vasodilation leads to potential circulatory collapse. Bronchospasm occurs simultaneously with other system reactions, also contributing to the life-threatening possibility.

20. Place in correct order the steps in the anaphylactic response. a) Circulatory collapse b) Exposure to allergen c) Vasodilation d) Rapid immune response e) Bronchoconstriction

a) Wheezing b) Serum sickness d) Urticaria Pg. 1192 A child with a severe penicillin allergy might very likely show symptoms such as wheezing, urticaria, and serum sickness. True drug allergies most commonly affect the dermatologic, immunologic, hemolytic, and respiratory systems.

25. The nurse receives a call from a parent whose toddler received a prescription for amoxicillin one teaspoon every 8 hours. The child has received 2 doses and the parent is noticing unusual symptoms. Which symptoms may indicate a severe penicillin allergy? Select all that apply. a) Wheezing b) Serum sickness c) Incontinence d) Seizures d) Urticaria

b) Bone marrow c) Spleen d) Liver e) Thymus Pg. 1171 The major organs of the immune system are the thymus, liver, bone marrow, spleen, tonsils, lymph nodes, and blood. The gallbladder assists with digestion.

9. The nurse is educating an immunocompromised child about the organs that assist in the immune process. The nurse recognizes teaching was effective when the child identifies which organs? Select all that apply. a) Gall bladder b) Bone marrow c) Spleen d) Liver e) Thymus

a) Pregnancy will accelerate the progression of the disease Pg. 1177 Of the nearly 1,000,000 people in the United States infected with HIV, 25% are female. There isn't any research showing pregnancy accelerates the progression of the disease. Women with HIV should not breastfeed, because they could transmit the virus to the baby via the breastmilk. Early use of antiretroviral medications are effective in reducing transmission, and a cesarean birth may be scheduled to reduce potential transmission to the newborn.

14. A nurse is providing education to pregnant women diagnosed with HIV. Which statement indicates the need for further teaching? a) Pregnancy will accelerate the progression of the disease b) It is not safe to breastfeed my baby, so I will use formula c) Antiretroviral treatment is effective in reducing maternal-fetal transmission d) My health care provider may want me to have a cesarean birth

b) Antihistamine Pg. 1181 If the client has taken an antihistamine within the past 5 to 7 days, the skin testing appointment will need to be rescheduled because antihistamines will provide false results to the testing. When an allergen is introduced into the client's skin, the client, sensitive to the allergen, will respond with redness and a wheal at the site, due to the release of histamine by local mast cells. Inhibiting this histamine release will result in a false negative. If the client has taken a drug from the other classifications listed, the skin testing may proceed. These medications are able to be taken concurrently with allergy testing.

17. A client presents to the clinic for allergy testing. The nurse is reviewing current medications taken within the past 5 to 7 days. Which classification of medication, if taken by the client, will cause the nurse to reschedule the allergy testing appointment? a) Antipyretic b) Antihistamine c) Corticosteroid d) Antibiotic

a) Contact the health care provider to request treatment Pg. 1189-1191 Infants that feed poorly, are irritable, and have a weeping, crusty rash on the checks and neck may have atopic dermatitis (infantile eczema). The nurse should contact the health care provider to request treatment, which may include methods to avoid allergens. Although reducing exposure to identified allergens is important, a 3-month-old infant should not be eating peanuts, so this information would not be appropriate at this time.

18. The parents of a 3-month-old infant report concerns the infant is irritable, feeds poorly, and has a rash. The nurse notes weeping, crusty lesions on the infant's cheeks and neck. Which action by the nurse is most appropriate? a) Contact the health care provider to request treatment b) Instruct the parents to soak the lesions in mineral oil c) Advise the parents to change the infant's formula d) Encourage parents to avoid feeding the infant peanuts

d) Eggs e) Peanuts f) Shrimp Pg. 1190 Foods that should be avoided in children younger than 1 year of age include cow's milk, eggs, peanuts, tree nuts, sesame seeds, and fish and shellfish (i.e., shrimp). Carrots, potatoes, and bananas are not considered problematic.

3. A nurse is preparing a presentation for a group of new parents and is planning to discuss nutrition during the first year. As part of the presentation, the nurse is planning to address foods that should be avoided to reduce the risk of possible food allergies. Which foods would the nurse most likely include? Select all that apply. a) Carrots b) Potatoes c) Bananas d) Eggs e) Peanuts f) Shrimp

b) Encourage the child to wear a medical alert bracelet for penicillin Pg. 1192 Oral medications most likely to cause an allergic reaction include antibiotics, acetylsalicylic acid (aspirin), and NSAIDs. Children experiencing stridor, wheezing, and urticaria after taking a medication most likely have an allergy to that medication. The priority nursing action for discharge education is to prevent the child from being exposed to penicillin again, which could be accomplished by encouraging the child to wear a medical alert bracelet. Although children with atopic diseases are more likely to have medication allergies, requesting parents have the child evaluated is not a priority. Questioning the child about the amount of penicillin taken and educating parents about the side effects of penicillin is not a priority.

6. When providing discharge instructions to a child who was admitted to the hospital following stridor, wheezing, and urticaria after taking penicillin, which nursing action is priority? a) Educate the parents about possible side effects of penicillin in children b) Encourage the child to wear a medical alert bracelet for penicillin c) Question the child about the amount of penicillin that was taken d) Advise the parents to have their child evaluated for atopic diseases

c) "Limit your time outdoors depending upon the pollen count" Pg. 1180-1181, 1187 Rhinitis is usually related to an airborne antigen, and a child who reports allergy symptoms that only occur certain times of the year most likely has seasonal allergies. During that time, the child should remain indoors when pollen counts are high. Allergies to household dust mites and indoor pets will result in yearlong allergies; therefore, neither cleaning the mattress and carpets nor keeping the cat out of one's room is likely to help this child. Opening the windows allows environmental allergens to pass into the room via air circulation.

21. The nurse is caring for a child who reports constant rhinitis during the spring months. Which education will the nurse to provide to the child? a) "Clean the mattresses and sweep carpets frequently to eliminate dust mites" b) "Open the window in your room to promote ventilation" c) "Limit your time outdoors depending upon the pollen count" d) "Do not allow the cat in your room. Wash your hands after playing with the cat"

a) Oral candidiasis (thrush), persistent over the past 6 to 7 months c) Acute otitis media, one episode every 3 to 4 weeks over the past year e) Recurrent deep abscess of the thigh Pg. 1176-1187 Warning signs associated with primary immunodeficiency include four or more new episodes of acute otitis media in 1 year, recurrent deep skin or organ abscesses, persistent oral candidiasis (thrush) or skin candidiasis after 1 year of age. A history of infections requiring IV antibiotics to heal and two or more episodes of pneumonia in 1 year are also warning signs.

22. The nurse is reviewing the medical history of a 4-year-old child. What would the nurse identify as potentially indicative of a primary immunodeficiency? Select all that apply. a) Oral candidiasis (thrush), persistent over the past 6 to 7 months b) Pneumonia last spring; resolved with antibiotics c) Acute otitis media, one episode every 3 to 4 weeks over the past year d) Infected laceration requiring IV antibiotic 2 months ago; healed e) Recurrent deep abscess of the thigh

a) IgG Pg. 1173 IgG is the most frequent antibody in plasma and is the major immunoglobin to be synthesized during the secondary response. IgG represents about 75% of all serum antibodies. Most of the newborn's IgG is transferred via the placenta to the fetus. The infant develops passive immunity to antigens in which the mother has developed antibodies. The infant begins to manufacture IgG after about 6 months of age. IgG reaches 50% of its adult level at 1 year of age and full adult level at age 7 years. IgD is only found in about 1% of plasma. Its function is to signal for B cells to be activated. IgA protects the mucous membranes against the invasion of microbes. IgM is the first antibody to respond to infection.

23. Which immunoglobulin occurs most frequently in plasma and is the major immunoglobulin synthesized during secondary response? a) IgG b) IgA c) IgM d) IgD

b) "The best way is to eliminate the food from the diet and then look for improvement" Pg. 1192-1193 Food allergies are best identified by eliminating a suspected food from the diet and observing whether symptoms improve. After a time of improvement, the food is reintroduced and if the child is allergic to the food, the symptoms will return. Skin testing with either a patch or intracutaneous injection is ineffective for determining food allergies. Serum antibody levels can be measured but are not specific in helping to determine food allergies.

33. The mother of a child with a possible food allergy asks the nurse for information about how to test for it. Which response by the nurse would be most appropriate? a) "Skin testing using a patch is probably the easiest method" b) "The best way is to eliminate the food from the diet and then look for improvement" c) "We can check the level of antibodies in the blood to confirm the allergy" d) "We can inject an extract of the food under the skin and see if there is a reaction"

d) Kaposi sarcomas observed on the skin Pg. 1175-1176 Presence of Kaposi's sarcoma in a child with HIV indicates progression to category C, or AIDS. Hepatomegaly, enlarged lymph nodes, and crackles (a sign of pneumonia) indicate category A, or mildly symptomatic HIV. Although all these signs will be present if the child has progressed to AIDS, Kaposi sarcomas are not typically observed in HIV status.

26. The nurse is caring for a child with HIV admitted to the pediatric unit. Which assessment finding would alert the nurse that the child has most likely progressed from HIV to AIDS? a) Enlarged lymph nodes felt with palpation b) Crackles noted in lower lobes of the lungs c) Hepatomegaly noted during percussion d) Kaposi sarcomas observed on the skin

a) It tends to occur more frequently in formula-fed infants b) Soap has a tendency to increase the pruritus c) The scalp and forehead are commonly affected Pg. 1190-1191 Atopic dermatitis is more problematic in the winter months when additional irritating clothing is present. Dermatitis tends to improve in the summer months. Atopic dermatitis is found more frequently in formula-fed infants. Sweating, heat, tight clothing, and contact irritants such as soap increase the pruritus. The common sites for lesions include the scalp, forehead, cheeks, neck, behind the ears, and extensor surfaces of the extremities. Skin testing is ineffective because the allergen causing the condition is often a food allergen.

31. A nurse is preparing a teaching plan for the parents of an infant with atopic dermatitis. Which topics are essential to ensure appropriate care? Select all that apply. a) It tends to occur more frequently in formula-fed infants b) Soap has a tendency to increase the pruritus c) The scalp and forehead are commonly affected d) Skin testing is the primary means for diagnosing the condition e) The condition is more problematic during the summer months

c) You may want to consider a cesarean birth Pg. 1176-1178 The pregnant client will be screened for HIV immediately to determine HIV status. If positive, it is helpful in planning in case the newborn needs immediate antiviral therapy. Though pregnancy does not appear to accelerate the progression of the disease, it can affect the birthing plan. To prevent the transmission of the disease through vaginal birth, a client may be offered a cesarean birth. An epidural may be discouraged due to the presence of thrombocytopenia associated with the disease process. There is no need for antibiotics because HIV is a virus. Unless born in distress, newborns are able to remain within their birth parent following the birth process.

24. A client in the fourth month of pregnancy has recently learned that the sexual partner is HIV-positive. The client agrees to be tested for the virus but asks, " If I am positive, how will it change my birth plan?" How will the nurse respond? a) You will be given antibiotics during labor to prevent transmission of HIV b) The newborn will be taken to the neonatal intensive care unit (NICU) right away c) You may want to consider a cesarean birth d) You may need to consider having an epidural for your labor analgesia

d) Zidovudine Pg. 1177 Children born to HIV-positive mothers should receive a 6-week course of zidovudine therapy. Lopinavir, ritonavir, and nevirapine are medications used for treatment of HIV-1 infections as part of a three-drug regimen.

27. The nurse is caring for a newborn whose mother is HIV positive. The nurse would expect to administer a 6-week course of which medication? a) Nevirapine b) Ritonavir c) Lopinavir d) Zidovudine

d) Administer prescribed medications Pg. 1176-1177 Although assisting with activities, assessing pain, and reviewing CD4 counts are all important, the priority when caring for a child with HIV is to administer prescribed medications. Prescribed medications prevent progressive deterioration of the immune system and provide prophylaxis against opportunistic infections.

28. Which nursing intervention is priority when caring for a child with HIV? a) Review laboratory CD4 counts daily b) Assist the child with daily activities c) Assess pain after invasive procedures d) Administer prescribed medications

b) Placental spread during pregnancy Pg. 1176-1178 Although it is decreasing in incidence, transmission of HIV from mother to child by placental spread is still the most common reason for childhood HIV infection in the United States. Children with hemophilia no longer have a high incidence of the disease because blood products are now screened for the virus. HIV is not transmitted by animals or through usual casual contact, such as shaking hands or kissing, or in households, day care centers, or schools. Infection via breast milk is possible but less likely than via placental spread.

29. A mother who is HIV positive is distraught when she learns that her 6-month-old baby is also HIV-positive. The child had undergone open heart surgery as a newborn and had received numerous blood transfusions. The nurse recognizes that the most likely means of transmission of the disease to this child was: a) The mother kissing the baby on the forehead b) Placental spread during pregnancy c) Blood transfusion products contaminated with the virus d) Breastfeeding

b) Stop the adolescent from continuing and review the appropriate site to use Pg. The site identified by the adolescent is incorrect. The nurse should stop the adolescent from using it and re-explain the steps for using an autoinjector, including the appropriate site. When using an epinephrine autoinjector, the person should grasp the autoinjector by the barrel (avoid placing thumb over the end), and, using firm pressure, apply the autoinjector to the outer aspect of the thigh until the autoinjector "clicks." The abdomen or upper arm are never used. Allowing the adolescent to administer the medication into the abdomen would be inappropriate.

30. After teaching an adolescent how to use an epinephrine autoinjector, the nurse observes the adolescent attempting to self-administer the medication. The adolescent indicates the site to be used, pointing to the abdomen just below the umbilicus. Which action should the nurse take next? a) Explain that that site is used only if another site is not available b) Stop the adolescent from continuing and review the appropriate site to use c) Allow the adolescent to administer the autoinjector at the site indicated d) Tell the adolescent to choose the upper arm instead of the abdomen

2 mL Pg. 1181 To determine the rate, use weight in kilograms. Then, multiply 0.01 mg/kg by 20 kg to determine the appropriate milligrams, which is 0.2 mg. Next, multiply 0.2 mg by 10 ml to determine the appropriate milliliters, which is 2 ml.

32. The nurse is caring for a child who weighs 44 lb (20 kg) experiencing an anaphylactic reaction. The health care provider has prescribed an epinephrine 0.01 mg/kg injection. Epinephrine is supplied at 1 mg in 10 mL. How many milliliters will the nurse administer? Record your answer using a whole number.

d) "It is important to determine how disruptive the symptoms are to the child" Pg. 1187-1189 Management of allergic rhinitis (hay fever) can be challenging, and the side effects of testing and treatment can be costly and painful. The decision on initiation and type of treatment is geared to the individual child and family—in particular, how much the disease interferes with the child's activities and self-esteem. The child is the only one to convey the severity of the symptoms and if the child is willing to maintain therapy. It is the therapeutic effect—not the side effects—which determines if the treatment is beneficial.

34. The nurse is instructing a parent who is questioning when treatment for pediatric allergic rhinitis (hay fever) begins. Which nursing statement is accurate? a) "The health care provider will assess the child's willingness to maintain therapy" b) "The health care provider will determine the severity of the child's symptoms" c) "Side effects of antihistamines determine if treatment is beneficial" d) "It is important to determine how disruptive the symptoms are to the child"

d) Serum blood testing Pg. 1170-1181 When there is a deficiency of immunocompetent cells, an assessment will focus on analysis of blood components, particularly white blood cells, T cells, and immunoglobulin levels. The results of these tests will indicate the need to additional testing. A stem cell analysis would be completed if a stem cell transplant was indicated. This test helps determine compatibility. A bone marrow biopsy is done to determine if the bone marrow is healthy and making normal amounts of blood cells. A lumbar puncture is done to collect cerebrospinal fluid for diagnostic testing. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system.

4. A pediatric client is admitted to the hospital. The primary health care provider suspects a problem with the child's immune system. The nurse anticipates preparing this client for which test initially? a) Lumbar puncture b) Stem cell analysis c) Bone marrow biopsy d) Serum blood testing

c) "It is to help prevent transmission of the disease to your infant" Pg. 1178 A goal of therapy during pregnancy is to maintain the CD4 cell count at greater than 500 cells/mm3by administering oral zidovudine, which helps halt maternal/fetal transmission dramatically along with one or more protease inhibitors, such as ritonavir or indinavir, in conjunction with a nucleoside reverse transcriptase inhibitor (NRTI). Kaposi sarcoma is normally treated with chemotherapy. Women may need a platelet transfusion close to birth to restore coagulation ability. This medication has no affect on the fetus's growth and development.

5. The nurse is working with a pregnant client who is HIV positive and has been prescribed oral zidovudine. Which statement by the nurse explains the primary rationale for taking this medication? a) "This medication will help to restore your coagulation ability before labor" b) "This will help halt the growth of your Kaposi sarcoma" c) "It is to help prevent transmission of the disease to your infant" d) "Zidovudine will help stimulate your fetus's growth during pregnancy"