Chapter 18: The Child with an Immunologic Alteration
The nurse is caring for a child with HIV currently taking zidovudine. Which statement by the parent would be the most concerning?
"Zidovudine decreases the chance my child will transmit HIV to others."
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.
- Acute otitis media, one episode every 3 to 4 weeks over the past year. - Recurrent deep abscess of the thigh - Oral thrush, persistent over the past 6 to 7 months
After teaching a class of nursing students about acquired immunodeficiency, the instructor determines that the teaching was effective when the students identify what as a contributing factor? Select all that apply.
- Cancer - Immunosuppressive drugs - Malnutrition
A 7-year-old girl has been battling leukemia and receiving radiation therapy. She is highly susceptible to infections, and the nurse recognizes that this is because she is experiencing secondary immunodeficiency. What factors cause secondary immunodeficiency? Select all that apply.
- Cancer - Radiation therapy - Severe stress - Malnutrition
A nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread? Select all that apply.
- Exposure to blood and body fluids through sexual contact - Sharing contaminated needles - Transfusion of contaminated blood - Perinatally from mother to fetus - Through breastfeeding
The nurse is caring for a client with HIV who is receiving Ziagen (abacavir) for treatment. What signs and symptoms will require the nurse to notify the physician? Select all that apply.
- Muscle weakness - Shortness of breath - Rash - Unusual bleeding
The nurse is planning a program for community members that focus on the 2020 National Health Goals for allergies and immunologic functioning. What content should the nurse include in this program? Select all that apply.
- Promote following safe sexual practices. - Discourage the use of intravenous substances. - Discuss the role of sexual relations in HIV transmission. - Encourage parents to discuss the air quality in the schools with the school district.
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.
- Shrimp - Peanuts - Eggs
A 9-year-old child with a known peanut allergy has an allergic reaction right after eating potato chips with his classmates served from a large bowl during a party. After the child has been cared for, what action is most important for the nurse to initiate? A. A further investigation of the potato chips. B. Asking if the child is allergic to potatoes. C. Washing the serving bowl with soap and hot water. D. Asking the child if this reaction happens often.
C. For children with allergies to peanuts or other nuts, an anaphylactic reaction can occur with exposure to nut oils, surfaces contaminated with nuts, shell fragments, or cooking and serving utensils used previously for nut products. The bowl needs to be washed well.
A child with primary immune deficiency is about to receive an infusion of IVIG. What is the most appropriate premedication to minimize the reaction?
Diphenhydramine Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.
The most accurate screening test for the presence of HIV antigen in young children is:
PCR PCR tests directly for the HIV antigen. ELISA and the Western blot test detect the presence of HIV antibodies. The CD4 count is used as a measure of disease status and progression
The nurse is administering the drug cyclophosphamide (Cytoxan) to a child who has severe systemic lupus erythematosis (SLE). What body system is the nurse most concerned with adverse effects immediately after administration of this drug?
Renal Cyclophosphamide (Cytoxan) is a cytotoxic drug that interferes with normal function of DNA by alkylation, and is given for treatment of severe SLE. The medication is very nephrotoxic; therefore, the nurse must provide adequate hydration and have child void frequently during and after infusion to decrease risk of hemorrhagic cystitis.
A nurse is providing dietary interventions for a 12-year-old with a shellfish allergy. Which response indicates a need for further teaching?
"He will likely outgrow this." Older children and adolescents with allergic reactions to fish, shellfish, and nuts usually continue to have that concern as a life-long problem
The nursing instructor has completed a presentation on normal immune function. Which statement by a student would suggest a need for further education?
"Humoral immunity is generally functional at birth."
The nursing instructor has completed a presentation on normal immune function. Which statement by a student would suggest a need for further education?
"Humoral immunity is generally functional at birth." Normal immune function is a complex process involving phagocytosis (process by which phagocytes swallow up and break down microorganisms), humoral immunity (immunity mediated by antibodies secreted by B cells), cellular immunity (cell-mediated immunity controlled by T cells), and activation of the complement system. Cellular immunity is generally functional at birth, and as the infant is exposed to various substances over time, humoral immunity develops.
The nursing instructor has completed a presentation on normal immune function. Which statement by a student would suggest a need for further education?
"Humoral immunity is generally functional at birth." Normal immune function is a complex process involving phagocytosis (process by which phagocytes swallow up and break down microorganisms), humoral immunity (immunity mediated by antibodies secreted by B cells), cellular immunity (cell-mediated immunity controlled by T cells), and activation of the complement system. Cellular immunity is generally functional at birth, and as the infant is exposed to various substances over time, humoral immunity develops.
The nurse has completed an education session with parents of children diagnosed with food allergies. Which statement by a parent would indicate a need for additional education?
"If we need to use the EpiPen® we will need to notify her physician's office the next business day."
The nurse has completed an education session with parents of children diagnosed with food allergies. Which statement by a parent would indicate a need for additional education?
"If we need to use the EpiPen® we will need to notify her physician's office the next business day." If an EpiPen® is used, the child still needs immediate medical attention. EpiPens should be carried with the patient at all times. When administering an EpiPen, the grey safety cap should not be removed until immediately prior to using. Medical alert bracelets or necklaces should be worn by all children with severe allergies
The parents of a 10-year-old with HIV have never told their child that he has the virus. The child asks the nurse why he is "on so many medications." What action should the nurse take?
The nurse should encourage the child to talk with his parents about his medications
An HIV positive woman has asked about breastfeeding her son. What response by the nurse is appropriate?
"Breastfeeding will increase your child's risk of contracting HIV." HIV can be transmitted by breastfeeding. A newborn who received the recommended plan of drug treatment has a reduced risk for contracting the infection. Contracting HIV is not an absolute for this infant. The client should be discouraged from breastfeeding. Breastfeeding does provide immunity when the mother is free of infection but not in this scenario. Telling the mother that this is not a good idea is not the best response as it does not take advantage of the opportunity to provide education and improve client outcomes.
The nurse is caring for a 6-month-old infant with Wiskott-Aldrich syndrome. Which teaching does the nurse provide the parent?
"Do not insert anything in the rectum."
The parents of an adolescent tell the nurse, "Our child seems to have allergy symptoms every time we visit our favorite cafe. I don't understand since the only allergy indicated in the testing was to eggs?" How should the nurse respond?
"Does your child get a whipped cream or foam topping on their favorite drink?"
The parents of an adolescent tell the nurse, "Our child seems to have allergy symptoms every time we visit our favorite cafe. I don't understand since the only allergy indicated in the testing was to eggs?" How should the nurse respond?
"Does your child get a whipped cream or foam topping on their favorite drink?" Albumin, globulin, ovalbumin should be avoided if allergic to eggs. Some foam toppings for drinks contain these substances and would cause an allergic reaction to the person allergic to eggs. This would be important information to ascertain from the family as they would likely not be aware of this.
The parents of an adolescent tell the nurse, "Our child seems to have allergy symptoms every time we visit our favorite cafe. I don't understand since the only allergy indicated in the testing was to eggs?" How should the nurse respond?
"Does your child get a whipped cream or foam topping on their favorite drink?" Albumin, globulin, ovalbumin should be avoided if allergic to eggs. Some foam toppings for drinks contain these substances and would cause an allergic reaction to the person allergic to eggs. This would be important information to ascertain from the family as they would likely not be aware of this.
To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant?
"Has she ever had penicillin before?"
To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant?
"Has she ever had penicillin before?" Penicillin is a drug frequently involved in allergic reactions. The reaction occurs after the child has first been sensitized to the drug
To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant?
"Has she ever had penicillin before?" Penicillin is a drug frequently involved in allergic reactions. The reaction occurs after the child has first been sensitized to the drug.
The parent of a school-age child comments to the nurse, "Every time my child eats enchiladas at our local Mexican restaurant he gets a rash. It just doesn't make sense to me." How should the nurse respond?
"Has your child ever been tested for a peanut allergy?"
The parent of a school-age child comments to the nurse, "Every time my child eats enchiladas at our local Mexican restaurant he gets a rash. It just doesn't make sense to me." How should the nurse respond?
"Has your child ever been tested for a peanut allergy?" Enchilada sauce is an unexpected food that may contain a form of peanuts (such as peanut oil) that may be causing an allergic reaction in the child.
The parent of a school-age child comments to the nurse, "Every time my child eats enchiladas at our local Mexican restaurant he gets a rash. It just doesn't make sense to me." How should the nurse respond?
"Has your child ever been tested for a peanut allergy?" Explanation: Enchilada sauce is an unexpected food that may contain a form of peanuts (such as peanut oil) that may be causing an allergic reaction in the child.
A nurse is conducting a physical examination of a 12-year-old girl with suspected systemic lupus erythematosus (SLE). How would the nurse best interview the girl?
"Have you noticed any hair loss or redness on your face?"
A nurse is conducting a physical examination of a 12-year-old girl with suspected systemic lupus erythematosus (SLE). How would the nurse best interview the girl?
"Have you noticed any hair loss or redness on your face?" Alopecia and the characteristic malar rash (butterfly rash) on the face are common clinical manifestations of SLE. Rhinorrhea, wheezing, and an enlarged spleen are not hallmark manifestations of SLE. Petechiae and purpura are more commonly associated with hematological disorders, not SLE.
A nurse is conducting a physical examination of a 12-year-old girl with suspected systemic lupus erythematosus (SLE). How would the nurse best interview the girl?
"Have you noticed any hair loss or redness on your face?" Alopecia and the characteristic malar rash (butterfly rash) on the face are common clinical manifestations of SLE. Rhinorrhea, wheezing, and an enlarged spleen are not hallmark manifestations of SLE. Petechiae and purpura are more commonly associated with hematological disorders, not SLE
The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching?
"I can use the egg white when baking, but not the yolk."
The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching?
"I can use the egg white when baking, but not the yolk." The parents must understand that their child cannot consume any part of an egg in any form. The other statements are accurate.
The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching?
"I can use the egg white when baking, but not the yolk." The parents must understand that their child cannot consume any part of an egg in any form. The other statements are accurate.
The nurse is providing discharge teaching to the client with myasthenia gravis. Which statements by the parents of the client demonstrate knowledge of proper care? Select all that apply.
"If my child shows signs of an upper respiratory infection I will contact our physician right away." "We love to take family vacations to Florida, but we will have to find a new vacation spot." "I picked up our child's medical alert bracelet today." Anticholinergic drugs should be given 30 to 45 minutes before meals, on time and exactly as ordered. Difficulty swallowing may occur from a myasthenic crisis. Infections can exacerbate the disease so the physician should be notified immediately if signs of infection are present. Heat can also exacerbate symptoms so avoidance of high temperatures is important. A medical alert bracelet is helpful for when the family is not present.
The mother of a child with myasthenia gravis inquires about thymus gland removal. She reports she has read that this is a possible cure for her child. What response by the nurse is indicated?"
"Removal of this gland may not improve your child's symptoms." Myasthenia gravis is an autoimmune condition. It is characterized by progressive weakness and fatigue. There is not cure. Removal of the thymus gland is recommended by some professionals but the thymus gland and its relationship to this disease are not clear. Removal of the gland may not improve the child's condition
The parents are concerned their child with atopic dermatitis is having an allergic reaction to diphenhydramine because the child became "sleepy and has a dry throat" after receiving the medication. Which education provided to the parents by the nurse is most important?
"Side effects, such as drowsiness and dryness, do not indicate an allergy."
The nurse is speaking with a teenager who has requested HIV testing. Which is the best statement by the nurse regarding HIV testing?
"The ELISA method detects antibodies so a person may have a false negative test for up to six months after exposure. ELISA method detects only antibodies, so the test may remain negative for several weeks up to 6 months (false-negative) after exposure. A false-positive may result with autoimmune disease. The ELISA test requires serial testing. HIV test results are confidential.
The nurse is speaking with a teenager who has requested HIV testing. Which is the best statement by the nurse regarding HIV testing?
"The ELISA method detects antibodies so a person may have a false negative test for up to six months after exposure. ELISA method detects only antibodies, so the test may remain negative for several weeks up to 6 months (false-negative) after exposure. A false-positive may result with autoimmune disease. The ELISA test requires serial testing. HIV test results are confidential
The nurse is speaking with a teenager who has requested HIV testing. Which is the best statement by the nurse regarding HIV testing?
"The ELISA method detects antibodies so a person may have a false negative test for up to six months after exposure."
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?
"The best way is to eliminate the food from the diet and then look for improvement."
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?
"The best way is to eliminate the food from the diet and then look for improvement." 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.
The nurse is providing instructions to the parents of a child with a severe peanut allergy. Which statement by the parents indicates a need for further teaching about the use of an epinephrine auto-injector?
"The epinephrine auto-injector should be jabbed into the upper arm."
The nurse is providing instructions to the parents of a child with a severe peanut allergy. Which statement by the parents indicates a need for further teaching about the use of an epinephrine auto-injector?
"The epinephrine auto-injector should be jabbed into the upper arm." An epinephrine auto-injector should be jabbed into the outer thigh, as this is a larger muscle, at a 90 degree angle, not into the upper arm. The other statements are correct.
The nurse is providing instructions to the parents of a child with a severe peanut allergy. Which statement by the parents indicates a need for further teaching about the use of an epinephrine auto-injector?
"The epinephrine auto-injector should be jabbed into the upper arm." An epinephrine auto-injector should be jabbed into the outer thigh, as this is a larger muscle, at a 90 degree angle, not into the upper arm. The other statements are correct
The nurse is administering Viramune (nevirapine) to an adolescent client diagnosed with HIV. The client asks the nurse how this medication helps fight the HIV. How should the nurse respond?
"The medication disrupts the virus life cycle of HIV. This prevents the disease from progressing."
A child with primary immune deficiency is about to receive an infusion of IVIG. What is the most appropriate premedication to minimize the reaction?
Diphenhydramine
Susie is a 3-year-old with a history of neonatal transmission of HIV and recent diagnosis of AIDS, as manifested by M. tuberculosis infection. To date, Susie has been relatively healthy with few illnesses associated with high fever; she has been developing appropriately and is at the 5th percentile for height and weight. Susie is at risk for all of the following diagnoses. Prioritize the order of urgency of these diagnoses based on the scenario provided.
-Altered family coping related to new presentation of significant illness -Altered comfort related to severity of new illness -Inadequate adherence to medication regimen related to side effects -Inadequate nutrition related to side effects of medication -Delayed growth and development related to frequent infections Because Susie has been relatively healthy since she was diagnosed with HIV, the change in her status is likely to cause changes in family coping mechanisms and dynamics that will have implications for the entire family. Next, the nurse needs to address the specific symptoms of the child. With the increased degree of illness and altered coping strategies, the child may have more difficulty with medication adherence, as well as other complications of AIDS-related illness and treatment, such as poor nutritional intake and delayed growth and development
The nurse is observing a child demonstrate the use of an Epipen. The nurse determines that the child has performed the procedure correctly. Place the steps in the proper sequence that was demonstrated by the child.
-Grasps Epipen with black tip pointing downward -Forms a fist around the Epipen -Pulls off the gray safety release -Jabs the Epipen firmly into the outer thigh at a 90-degree angle -Holds Epipen in place for 10 seconds -Massages site for 10 seconds after removing Epipen The steps to using an Epipen are as follows: Grasp the Epipen or Epipen Jr. with the black tip pointing downward, forming a fist; with the other hand, pull off the gray safety release; swing and jab the Epipen firmly into the outer thigh at a 90-degree angle and hold firmly there for 10 seconds; remove the Epipen and massage the thigh for 10 seconds.
The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level?
1300/mm3 The number of CD4 T lymphocytes in the blood helps to determine the effectiveness of antiretroviral therapy. Normal is 1500/mm3 in the infant, so anything below that number may indicate that the therapy is not effective.
The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level?
1300/mm3 The number of CD4 T lymphocytes in the blood helps to determine the effectiveness of antiretroviral therapy. Normal is 1500/mm3 in the infant, so anything below that number may indicate that the therapy is not effective.
A child is experiencing intestinal cramping, diarrhea, and mucosal lesions. Which allergens would the nurse suspect are triggering these responses? (Select all that apply.) A. Pears B. Strawberries C. Apples D. Pollen E. Wheat F. Grass
B. Strawberries E. Wheat
The nurse is caring for an infant exposed to HIV. The polymerase chain reaction (PCR) test was negative at birth. The nurse tells the mother that the child should be tested again at what age?
4 to 7 weeks
The nurse is providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which food?
Bananas
A child with recurrent infections, facial edema, hypertension and delayed growth in height is seen in the pediatrician's office. Which question would be most important for the nurse to ask the mother? A. "What medications are being taken by your child?" B. "When did this current infection begin?" C. "Are your other children shorter than usual?" D. "Is your child having headaches?"
A. Facial edema, hypertension, recurrent infections, and delayed growth in height are some of the clinical manifestations of excess steroid administered systemically.
Parents rush their 7-year-old child to a free standing emergency clinic because of the child's having been stung by several bees; the child is having rapid, labored breathing. What is the priority action by the nurse when the child gets into the examining room? A. Administer oxygen using a nasal cannula. B. Obtain a complete health history from the parents. C. Place a tourniquet distal to the area where the bee stings are. D. Get the code cart located down the hall in the locked treatment room.
A. Initially, the nurse maintains an adequate airway by administering oxygen and assisting with aerosol treatments and intubation as necessary.
An adolescent female with systemic lupus erythematosus (SLE) is trying to learn how to live with her illness. What teaching by the nurse is priority? A. Use protection against the sun whenever she is outside, regardless of the season. B. Maintain a high-protein diet to maintain healthy skin integrity and muscle fibers. C. Plan her schedule so she gets at least 10 hours of solid, deep sleep each night. D. Keep a diary so she can document her thoughts and feelings as she adjusts.
A. Using protection against the sun whenever she is outside, regardless of the season, is a must to avoid triggers that cause exacerbations.
It is important for the parents of a child who has had a severe allergic reaction to either peanuts or tree nuts to talk to their health care provider about whether the child should have medication available at school in case of an unanticipated exposure to nuts. Epinephrine is now available and easy to use in a device known as the ____________.
ANS: EpiPen The EpiPen is an auto-inject that can be given through the child's clothing. After the injection is given, the pen should be held in place for 10 seconds so that all medication can be delivered.
_________________________ is a chronic, multisystem, autoimmune disease characterized by inflammation of the connective tissue.
ANS: Systemic lupus erythematosus SLE SLE varies in severity and is marked by remission and exacerbations. Although the etiology is unknown, genetic, hormonal, environmental, and immune response factors are likely to be responsible.
The nurse observes a red butterfly-shaped rash that spreads across the child's cheeks and nose. This assessment finding is characteristic of which condition? a. Systemic lupus erythematosus (SLE) b. Rheumatic fever c. Kawasaki disease d. Anaphylactic reaction
ANS: A Feedback A A red, flat or raised malar "butterfly" rash over the cheeks and bridge of the nose is a clinical manifestation of SLE. B A major manifestation of rheumatic fever is erythema marginatum, which appears as red skin lesions spread peripherally over the trunk. C An erythematous rash, induration of the hands and feet, and erythema of the palms and soles are manifestations of Kawasaki disease. D Initial symptoms of anaphylaxis include severe itching and rapid development of erythema.
The nurse is planning care for an adolescent with AIDS. The priority nursing goal is to a. Prevent infection. b. Prevent secondary cancers. c. Restore immunologic defenses. d. Identify source of infection.
ANS: A Feedback A As a result of the immunocompromise that is associated with HIV infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the child's normal developmental needs. B Preventing secondary cancers is not currently possible. C Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication preventing further deterioration. D Case finding is not a priority nursing goal.
The nurse is providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which food?
Bananas The nurse should instruct children and their families to avoid foods with a known cross-reactivity to latex, such as bananas
Which statement is true regarding how infants acquire immunity? a. The infant acquires humoral and cell-mediated immunity in response to infections and immunizations. b. The infant acquires maternal antibodies that ensure immunity up to 12 months age. c. Active immunity is acquired from the mother and lasts 6 to 7 months. d. Passive immunity develops in response to immunizations.
ANS: A Feedback A Infants acquire long-term active immunity from exposure to antigens and vaccines. Immunity is acquired actively and passively. B The term infant's passive immunity is acquired from the mother and begins to dissipate during the first 6 to 8 months of life. C Passive immunity is acquired from the mother. D Active immunity develops in response to immunizations.
Which suggestion is appropriate to teach a mother who has a preschool child who refuses to take the medications for HIV infection? a. Mix medications with chocolate syrup or follow with chocolate candy. b. Mix the medications with milk or an essential food. c. Skip the dose of medication if the child protests too much. d. Mix the medication in a syringe, hold the child down firmly, and administer the medication.
ANS: A Feedback A Liquid forms of HIV medications may be foul tasting or have a gritty texture. Chocolate will help to make these foods more palatable and is liked by most children. B Medications should be mixed with nonessential foods. C Doses of medication should never be skipped. D Fighting with the child or using force should be avoided. A nonessential food that will make the taste of the medication more palatable for the child should be the correct action. The administration of medications for the child with HIV becomes part of the family's everyday routine for years.
What is the primary nursing concern for a hospitalized child with HIV infection? a. Maintaining growth and development b. Eating foods that the family brings to the child c. Consideration of parental limitations and weaknesses d. Resting for 2 to 3 hours twice a day
ANS: A Feedback A Maintaining growth and development is a major concern for the child with HIV infection. Frequent monitoring for failure to thrive, neurologic deterioration, or developmental delay is important for HIV-infected infants and children. B Nutrition, which contributes to a child's growth, is a nursing concern; however, it is not necessary for family members to bring food to the child. C Although an assessment of parental strengths and weaknesses is important, it will be imperative for health care providers to focus on the parental strengths, not weaknesses. This is not as important as the frequent assessment of the child's growth and development. D Rest is a nursing concern, but it is not as high a priority as maintaining growth and development. Rest periods twice a day for 2 to 3 hours may not be appropriate.
What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population? a. Perinatal transmission b. Sexual abuse c. Blood transfusions d. Poor handwashing
ANS: A Feedback A Perinatal transmission accounts for the highest percentage (91%) of HIV infections in children. Infected women can transmit the virus to their infants across the placenta during pregnancy, at delivery, and through breastfeeding. B Cases of HIV infection from sexual abuse have been reported; however, perinatal transmission accounts for most pediatric HIV infections. C Although in the past some children became infected with HIV through blood transfusions, improved laboratory screening has significantly reduced the probability of contracting HIV from blood products. D Poor handwashing is not an etiology of HIV infection.
A nurse in a well-child clinic is teaching parents about their child's immune system. Which statement by the nurse is correct? a. The immune system distinguishes and actively protects the body's own cells from foreign substances. b. The immune system is fully developed by 1 year of age. c. The immune system protects the child against communicable diseases in the first 6 years of life. d. The immune system responds to an offending agent by producing antigens.
ANS: A Feedback A The immune system responds to foreign substances, or antigens, by producing antibodies and storing information. Intact skin, mucous membranes, and processes such as coughing, sneezing, and tearing help maintain internal homeostasis. B Children up to age 6 or 7 years have limited antibodies against common bacteria. The immunoglobulins reach adult levels at different ages. C Immunization is the basis from which the immune system activates protection against some communicable diseases. D Antibodies are produced by the immune system against invading agents, or antigens.
The mother of an HIV-positive infant who is 2 months old questions the nurse about which childhood immunizations her child will be able to receive. Which immunizations should an HIV-positive child be able to receive according to the American Academy of Pediatrics recommendation for immunizing infants who are HIV positive? Select all that apply. a. Hepatitis B b. DTaP c. MMR d. IPV e. HIB
ANS: A, B, D, E Feedback Correct Routine immunizations are appropriate. Incorrect The MMR vaccination is not given at 2 months of age. If it were indicated, CD4+ counts are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+counts. Only IPV should be used for HIV-infected children.
Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS)? Select all that apply. a. Give supplemental vitamins as prescribed. b. Yearly influenza vaccination should be avoided. c. Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed. d. Notify the physician if the child develops a cough or congestion. e. Missed doses of antiretroviral medication do not need to be recorded.
ANS: A, C, D Feedback Correct The parents should be taught that supplemental vitamins will be prescribed to aid in nutritional status. Bactrim is administered to prevent the opportunistic infection of Pneumocystis pneumonia. The physician should be notified if the child with AIDS develops a cough and congestion. Incorrect The yearly influenza vaccination is recommended and any missed doses of antiretroviral medication need to be recorded and reported.
A young child with HIV is receiving several antiretroviral drugs. The purpose of these drugs is to a. Cure the disease. b. Delay disease progression. c. Prevent the spread of disease. d. Treat Pneumocystis carinii pneumonia.
ANS: B Feedback A At this time, cure is not possible. B Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system, and delay disease progression. C These drugs do not prevent the spread of the disease. D Pneumocystis carinii prophylaxis is accomplished with antibiotics.
What is the primary nursing concern for a child having an anaphylactic reaction? a. Identifying the offending allergen b. Ineffective breathing pattern c. Increased cardiac output d. Positioning to facilitate comfort
ANS: B Feedback A Determining the cause of an anaphylactic reaction is important to implement the appropriate treatment, but the primary concern is the airway. B Laryngospasms resulting in ineffective breathing patterns is a life-threatening manifestation of anaphylaxis. The primary action is to assess airway patency, respiratory rate and effort, level of consciousness, oxygen saturation, and urine output. C During anaphylaxis, the cardiac output is decreased. D During the acute period of anaphylaxis, the nurse's primary concern is the child's breathing. Positioning for comfort is not a primary concern during a crisis.
The Center for Disease Control (CDC, 2009) recommendation for immunizing infants who are HIV positive is a. Follow the routine immunization schedule. b. Routine immunizations are administered; assess CD4+ counts before administering the MMR and varicella vaccinations. c. Do not give immunizations because of the infant's altered immune status. d. Eliminate the pertussis vaccination because of the risk of convulsions.
ANS: B Feedback A Routine immunizations are appropriate; however, CD4+ cell counts should be assessed before administering the MMR and varicella vaccines to establish adequate immune system function. B Routine immunizations are appropriate. CD4+ cells are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+ counts. Only inactivated polio virus (IPV) should be used for HIV-infected children. C Immunizations are given to infants who are HIV positive. D The pertussis vaccination is not eliminated for an infant who is HIV positive.
What is the drug of choice the nurse should administer in the acute treatment of anaphylaxis? a. Diphenhydramine b. Histamine inhibitor (cimetidine) c. Epinephrine d. Albuterol
ANS: C Feedback A Although diphenhydramine may be indicated, epinephrine is the first drug of choice in the immediate treatment of anaphylaxis. B Although a histamine inhibitor such as cimetidine may be indicated, epinephrine is the first drug of choice in immediate treatment of anaphylaxis. C Epinephrine is the first drug of choice in immediate treatment of anaphylaxis. Treatment must be initiated immediately because it may only be a matter of minutes before shock occurs. D Albuterol is not usually indicated for treatment of anaphylaxis.
Which statement by a mother about antiretroviral agents for the management for her 5-year-old child with acquired immunodeficiency syndrome (AIDS) indicates that she has a good understanding? a. "When my child's pain increases, I double the recommended dosage of antiretroviral medication." b. "Addiction is a risk, so I only use the medication as ordered." c. "Doses of the antiretroviral medication are selected on the basis of my child's age and growth." d. "By the time my child is an adolescent she will not need her antiretroviral medications any longer."
ANS: C Feedback A Antiretroviral medications are not administered for pain relief. Doubling the recommended dosage of any medication is not appropriate without an order from the physician. B Addiction is not a realistic concern with antiretroviral medications. C Doses of antiretroviral medication to treat HIV infection for infants and children are based on individualized age and growth considerations. D Antiretroviral medications are still needed during adolescence. Doses for adolescents are based on pubertal status by Tanner staging.
Children receiving long-term systemic corticosteroid therapy are most at risk for a. Hypotension b. Dilation of blood vessels in the cheeks c. Growth delays d. Decreased appetite and weight loss
ANS: C Feedback A Hypertension is a clinical manifestation of long-term systemic steroid administration. B Dilation of blood vessels in the cheeks is associated with an excess of topically administered steroids. C Growth delay is associated with long-term steroid use. D Increased appetite and weight gain are clinical manifestations of excess systemic corticosteroid therapy.
Which intervention is appropriate for a child receiving high doses of steroids? a. Limit activity and receive home schooling. b. Decrease the amount of potassium in the diet. c. Substitute a killed virus vaccine for live virus vaccines. d. Monitor for seizure activity.
ANS: C Feedback A Limiting activity and home schooling are not routine for a child receiving high doses of steroids. B The child receiving steroids is at risk for hypokalemia and needs potassium in the diet. C The child on high doses of steroids should not receive live virus vaccines because of immunosuppression. D Children on steroids are not typically at risk for seizures.
What should the nurse include in a teaching plan for the mother of a toddler who will be taking prednisone for several months? a. The medication should be taken between meals. b. The medication needs to be discontinued because of the risks associated with long-term usage. c. The medication should not be stopped abruptly. d. The medication may lower blood glucose, so the mother needs to observe for signs of hypoglycemia.
ANS: C Feedback A Prednisone should be taken with food to minimize or prevent gastrointestinal bleeding. B Although there are adverse effects from long-term steroid use, the medication must not be discontinued without consulting a physician. Acute adrenal insufficiency can occur if the medication is withdrawn abruptly. The dosage needs to be tapered. C The dosage must be tapered before the drug is discontinued to allow the gradual return of function in the pituitary-adrenal axis. D The medication puts the child at risk for hyperglycemia.
What is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T cells? a. Wiskott-Aldrich syndrome b. Idiopathic thrombocytopenic purpura c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease
ANS: C Feedback A Wiskott-Aldrich syndrome is not a viral illness. B Idiopathic thrombocytopenic purpura is not a viral illness. C Acquired immune deficiency is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+ T cells. D Severe combined immunodeficiency disease is not a viral illness.
Which organs and tissues control the two types of specific immune functions? a. The spleen and mucous membranes b. Upper and lower intestinal lymphoid tissue c. The skin and lymph nodes d. The thymus and bone marrow
ANS: D Feedback A Both the spleen and mucous membranes are secondary organs of the immune system that act as filters to remove debris and antigens and foster contact with T lymphocytes. B Gut-associated lymphoid tissue is a secondary organ of the immune system. This tissue filters antigens entering the gastrointestinal tract. C The skin and lymph nodes are secondary organs of the immune system. D The thymus controls cell-mediated immunity (cells that mature into T lymphocytes). The bone marrow controls humoral immunity (stem cells for B lymphocytes).
A nurse is teaching parents about the importance of immunizations for infants because of immaturity of the immune system. The parents demonstrate that they understand the teaching if they make which statement? a. "The spleen reaches full size by 1 year of age." b. "IgM, IgE, and IgD levels are high at birth." c. "IgG levels in the newborn infant are low at birth." d. "Absolute lymphocyte counts reach a peak during the first year."
ANS: D Feedback A The spleen reaches its full size during adulthood. B IgM, IgE, and IgD are normally in low concentration at birth. IgM, IgE, IgA, and IgD do not cross the placenta. C The term newborn infant receives an adult level of IgG as a result of transplacental transfer from the mother. D Absolute lymphocyte counts reach a peak during the first year.
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.
Acute otitis media, one episode every 3 to 4 weeks over the past year. Recurrent deep abscess of the thigh Oral thrush, persistent over the past 6 to 7 months 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 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.
school-aged child has a bee-sting allergy. When the child is stung by a bee during a school recess, assuming that all of the following interventions are covered by school protocol, which initial intervention by the school nurse would be most appropriate?
Administer epinephrine immediately. Epinephrine counteracts histamine release to decrease bronchospasm and difficulty breathing.
A child with a known allergy to bees, is stung while on the playground at school. The school nurse is the first to arrive and notes the child is wheezing and begins vomiting. What will the nurse do first?
Administer epinephrine.
The nurse is caring for a child who is receiving naproxen for treatment of juvenile idiopathic arthritis. What interventions should the nurse include in this client's care plan?
Administer the medication with food Monitor lab results for an increase in liver enzymes Monitor renal labs for a decrease in renal function Naproxen is a nonsteroidal anti-inflammatory drugs (NSAID) that acts by inhibiting prostaglandin synthesis. Side effects include GI upset or bleeding (administering with food helps prevent GI side effects); decreased liver and renal function. Extended release preparations cannot be crushed as this disrupts the extended release action. Muscle strength is not typically affected by naproxen.
The nurse is reviewing the health records of an 18-year-old with Guillain-Barré syndrome (GBS). The nurse anticipates finding what information in the client's health history?
An upper respiratory viral infection GBS is a disorder in which an immune response within the body attacks the peripheral nervous system but does not usually affect the brain or spinal cord. GBS is believed to be an autoimmune condition that most commonly is triggered by a previous viral or bacterial infection, usually described as an upper respiratory tract infection or an acute gastroenteritis with fever, and is more commonly seen in adults rather than children
A nurse is assisting with skin testing for allergies in a 14-year-old girl. What should the nurse do to ensure an accurate test?
Be certain that the child has not received an antihistamine in the past 8 hours. Skin testing is done to detect the presence of IgE in the skin, or to isolate an antigen (allergen) to which the IgE is responding or to which a child is sensitive. When an allergen is introduced into the child's skin and the child is sensitive to that allergen, a wheal or flare response will appear at the site of the test from the release of histamine, which leads to local vasodilation. Because this reaction appears quickly, the test should be read in 20 minutes, not 40 minutes. Systemic or aerosol administration of an antihistamine will inhibit the flare response, so be certain the child has not received these drugs for 8 hours before skin testing. Because intracutaneous injections are given just below the epidermal layer of skin (not in the muscle), they are almost painless; thus, no anesthetic is needed.
The nurse is caring for a child who is beginning to show signs and symptoms of anaphylaxis. Which intervention would be the priority?
Assessing patency of the airway The priority nursing intervention is to assess patency of the airway and breathing. If the child is stable, the next step would be to obtain a brief history of allergen exposure. If epinephrine is required, it would be administered prior to diphenhydramine. Corticosteroids would be used to prevent late-onset reactions.
A nursing student correctly identifies the inability to distinguish self from nonself, causing the immune system to carry out immune responses against normal cells:
Autoimmunity Autoimmunity results from an inability to distinguish self from nonself, causing the immune system to carry out immune responses against normal cells and tissue. Delayed hypersensitivity is when T-lymphocyte activity occurs without an accompanying humoral response. Immunity is the ability to destroy like antigens. An allergen is any mediating substance that when released causes tissue injury and allergic symptoms.
What therapeutic management for the patient with systemic lupus erythematosus (SLE) would the nurse expect to include? A. A high-protein, low-sodium diet. B. Corticosteroids to control inflammation. C. Gold salts to suppress the inflammatory process. D. An exercise regimen to build up muscle strength and endurance.
B. Corticosteroids to control inflammation is the current primary mode of therapy.
The school nurse is discussing prevention of Human Immunodeficiency Virus (HIV) transmission with some adolescents. Which is appropriate to include? A. The virus is easily transmitted. B. The virus is only transmitted through blood. C. Intravenous drug users should not share needles. D. Condoms should be used for homosexual sex.
C. HIV is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus.
The school nurse is concerned about a recent outbreak of chickenpox in the school. There are two children at the school who are immunodeficient as a result of chemotherapy. Based on the nurse's knowledge of immunizations and immunocompromised states, what should the nurse recommend? A. Nothing; no precautions necessary. B. Administration of acyclovir (Zovirax) to minimize symptoms of chickenpox. C. Administration of varicella-zoster immune globulin (VZIG) to prevent chickenpox. D. Temporarily stopping chemotherapy to allow the children's immune systems to recover.
C. Varicella-zoster immune globulin (VZIG) is an antibody to the virus that causes chickenpox. Administration of VZIG can prevent the development of the disease.
After teaching a class of nursing students about acquired immunodeficiency, the instructor determines that the teaching was effective when the students identify what as a contributing factor? Select all that apply.
Cancer Immunosuppressive drugs Malnutrition Factors contributing to secondary (acquired) immunodeficiency include severe systemic infection, cancer, renal disease, radiation therapy, severe stress, malnutrition, immunosuppressive therapy, and aging.
Which fungal infection are HIV-exposed infections particularly at risk of contracting?
Candida
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?
Contact the health care provider to request treatment.
The nurse is assessing a child with a complex medical history that includes fatigue, Raynaud phenomenon, anemia and photosensitivity. The nurse should anticipate that this child may require which treatment?
Corticosteroid therapy This child's symptoms are consistent with systemic lupus erythematosus (SLE), which is usually treated with corticosteroids. Antiretrovirals, IVIG and phototherapy are of no benefit in the treatment of SLE.
The nurse is assessing a child with a complex medical history that includes fatigue, Raynaud phenomenon, anemia and photosensitivity. The nurse should anticipate that this child may require which treatment?
Corticosteroid therapy This child's symptoms are consistent with systemic lupus erythematosus (SLE), which is usually treated with corticosteroids. Antiretrovirals, IVIG and phototherapy are of no benefit in the treatment of SLE
A child is being discharged home on a regimen of oral corticosteroids. What information is most important for the nurse to explain to the parents? A. Reduce the dosage as quickly as possible so dependence on the medication is avoided. B. Any new cuts should be washed with soap and water then covered with a bandage. C. All spurts of energy and increased appetite are interpreted as a positive response. D. If the child becomes ill, notify the physician who ordered the medication.
D. If the child becomes ill, the physician who ordered the medication should be notified because of the increased stress. Supplemental glucocorticoids might be necessary during times of increased stress to prevent adrenal insufficiency.
The nurse is preparing to administer IVIG to a child who has not received the medication before. What medication should the nurse expect to administer prior to the infusion?
Diphenhydramine Premedication with diphenhydramine or acetaminophen may be indicated in children who have never received IVIG, have not had an infusion in more than 8 weeks, have had a recent bacterial infection, have a history of serious infusion-related adverse reactions, or are diagnosed with agammaglobulinemia or hypogammaglobulinemia. Aspirin, ibuprofen and prednisone would not routinely be administered prior to IVIG.
The nurse is preparing to administer IVIG to a child who has not received the medication before. What medication should the nurse expect to administer prior to the infusion?
Diphenhydramine Premedication with diphenhydramine or acetaminophen may be indicated in children who have never received IVIG, have not had an infusion in more than 8 weeks, have had a recent bacterial infection, have a history of serious infusion-related adverse reactions, or are diagnosed with agammaglobulinemia or hypogammaglobulinemia. Aspirin, ibuprofen and prednisone would not routinely be administered prior to IVIG
The nurse is caring for a child who is receiving an intravenous immunoglobulin treatment. The client calls the nurse and reports she vomited. What action should be completed first?
Discontinue the infusion.
The nurse is caring for a child who is receiving an intravenous immunoglobulin treatment. The client calls the nurse and reports she vomited. What action should be completed first?
Discontinue the infusion. Clients receiving intravenous immunoglobulin are at risk for anaphylaxis. Vomiting can signal an allergic response. The first action would be to stop the infusion. The remaining activities are appropriate for inclusion in the plan of care but are not of the highest priority.
The nurse is caring for a child who is receiving an intravenous immunoglobulin treatment. The client calls the nurse and reports she vomited. What action should be completed first?
Discontinue the infusion. Clients receiving intravenous immunoglobulin are at risk for anaphylaxis. Vomiting can signal an allergic response. The first action would be to stop the infusion. The remaining activities are appropriate for inclusion in the plan of care but are not of the highest priority
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.
Eggs Peanuts Milk
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.
Eggs Shrimp Peanuts 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.
The nurse is assessing a child who is experiencing renal complications as a result of lupus. Which finding is of the greatest concern?
Elevated blood pressure
The nurse is assessing a child who is experiencing renal complications as a result of lupus. Which finding is of the greatest concern?
Elevated blood pressure Renal complications may result from lupus. This may be accompanied by hypertension making monitoring of blood pressure of the highest importance.
The nurse is assessing a child who is experiencing renal complications as a result of lupus. Which finding is of the greatest concern?
Elevated blood pressure Renal complications may result from lupus. This may be accompanied by hypertension making monitoring of blood pressure of the highest importance.
The nurse is helping the parents of a toddler identify foods that are causing allergic symptoms in the child. Which strategy should the nurse encourage the parents to use?
Elimination diet
What would best identify foods to which a child is allergic?
Elimination diet Elimination diets involve adding foods slowly to a child's diet so foods to which the child is allergic can be identified.
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?
Encourage the child to wear a medical alert bracelet for penicillin.
Cyclophosphamide has been prescribed for a client. What considerations are indicated?
Encourage voiding with medication administration.
A nurse is caring for an infant whose mother is human immunodeficiency (HIV) positive. The nurse knows that which diagnostic test result will be positive even if the child is not infected with the virus?
Enzyme-linked immunosorbant assay (ELISA)
A nurse is caring for an infant whose mother is human immunodeficiency (HIV) positive. The nurse knows that which diagnostic test result will be positive even if the child is not infected with the virus?
Enzyme-linked immunosorbant assay (ELISA) The ELISA test will be positive in infants of HIV-infected mothers because of trans-placentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate in detecting true HIV infection in infants and toddlers than the polymerase chain reaction (PCR). The PCR test is positive in infected infants over the age of 1 month. The erythrocyte sedimentation rate would be ordered for an immune disorder initial workup or ongoing monitoring of autoimmune disease. Immunoglobulin electrophoresis would be ordered to test for immune deficiency and autoimmune disorders.
A nurse is caring for an infant whose mother is human immunodeficiency (HIV) positive. The nurse knows that which diagnostic test result will be positive even if the child is not infected with the virus?
Enzyme-linked immunosorbant assay (ELISA) The ELISA test will be positive in infants of HIV-infected mothers because of trans-placentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate in detecting true HIV infection in infants and toddlers than the polymerase chain reaction (PCR). The PCR test is positive in infected infants over the age of 1 month. The erythrocyte sedimentation rate would be ordered for an immune disorder initial workup or ongoing monitoring of autoimmune disease. Immunoglobulin electrophoresis would be ordered to test for immune deficiency and autoimmune disorders
Which drug should be available for emergency treatment of a child who goes into anaphylactic shock?
Epinephrine Epinephrine (adrenaline) reverses the effects of histamine (severe bronchospasm and edema).
A child is in the emergency department after a bee sting and experiencing bouts of nausea and vomiting. The client's blood pressure is 68/40; pulse is 48. The child is hypoxic and dyspneic. Which medication should the nurse prepare to give this client?
Epinephrine Epinephrine is the drug of choice to treat anaphylaxis.
The nurse on a pediatric unit finds a child having extreme shortness of breath, a swollen tongue, and urticaria on her face and neck. The nurse notices her lunch tray to have a half-eaten peanut butter and jelly sandwich. The client is allergic to peanuts. What is the first medication the nurse should be prepared to administer?
Epinephrine The child is demonstrating an anaphylactic reaction. While all of the medications may be necessary, the first medication to be administer is epinephrine to counteract the analphylaxis.
The nurse is monitoring the labs of a child admitted for an exacerbation of juvenile pauciarticular arthritis. Which lab result does the nurse expect to be elevated?
Erythrocyte sedimentation rate (ESR)
The nurse is monitoring the labs of a child admitted for an exacerbation of juvenile pauciarticular arthritis. Which lab result does the nurse expect to be elevated?
Erythrocyte sedimentation rate (ESR) The erythrocyte sedimentation rate (ESR) is an indicator of inflammation; it would likely be elevated during an exacerbation of arthritis. Immunoglobulin electrophoresis determines the level of individual immunoglobulins; it would not be elevated in an autoimmune disease. Lymphocyte immunophenotyping T-cell quantification measures T-cells; this would be used to monitor immunosuppressive disorders. The radioallergosorbent test measures minute quantities of IgE in the blood; it is used for asthma and food allergy testing.
The nurse is monitoring the labs of a child admitted for an exacerbation of juvenile pauciarticular arthritis. Which lab result does the nurse expect to be elevated?
Erythrocyte sedimentation rate (ESR) The erythrocyte sedimentation rate (ESR) is an indicator of inflammation; it would likely be elevated during an exacerbation of arthritis. Immunoglobulin electrophoresis determines the level of individual immunoglobulins; it would not be elevated in an autoimmune disease. Lymphocyte immunophenotyping T-cell quantification measures T-cells; this would be used to monitor immunosuppressive disorders. The radioallergosorbent test measures minute quantities of IgE in the blood; it is used for asthma and food allergy testing.
Place in correct order the steps in the anaphylactic response.
Exposure to allergen Rapid immune response Vasodilation Bronchoconstriction Circulatory collapse 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.
Place in correct order the steps in the anaphylactic response.
Exposure to allergen Rapid immune response Vasodilation Bronchoconstriction Circulatory collapse 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.
A nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread? Select all that apply.
Exposure to blood and body fluids through sexual contact Sharing contaminated needles Transfusion of contaminated blood Perinatally from mother to fetus Through breastfeeding HIV is spread by exposure to blood and other body fluids through sexual contact, sharing of contaminated needles for injection, transfusion of contaminated blood, perinatally from mother to fetus, and through breastfeeding.
A client was admitted to the medical unit for exacerbation (flare-up) of symptoms of systemic lupus erythematosis (SLE). When reviewing the client's chart the nurse notices that the he has a "butterfly rash." The nurse will assess for this rash on what area of the client's body?
Face A malar rash (a butterfly-shaped rash over the cheeks) is a common occurrence with SLE
The nurse is preparing to administer an intravenous immunoglobulin infusion. While reconstituting the product according the manufacturer's instructions, the nurse knows to take which step for proper preparation?
Gently roll the vial to mix the medication. The nurse knows not to shake the intravenous immunoglobulin, as this may lead to foaming and may cause the immunoglobulin protein to degrade. Reconstituted intravenous immunoglobulin can be refrigerated overnight but should be brought to room temperature prior to administration. The nurse does not need to reconstitute the medication 2 hours prior to administration
The nurse is administering the prescribed intravenous immunoglobulin to a 10-year-old boy. What step would be most important for the nurse to do?
Have epinephrine available.
A nursing student correctly identifies what to be the most serious of all of the immunologic disorders?
Human immunodeficiency virus (HIV) Of the immunologic disorders, HIV infection is the most serious, not only because it is still fatal but also because its spread has been difficult to contain
The nurse is explaining to a parent some of the basic aspects of the immune system and its functions. She informs them that B cells, also known as _________ cells, will attack __________ antigens.
Humoral; bacterial B cells are also called humoral cells and typically attack bacterial organisms. Another term for T cells is killer cells, and they most commonly attack viral organisms.
The nurse is preparing educational materials for a group of new parents about allergic reactions. Which specific immunoglobulin should the nurse emphasize as being responsible for these types of reactions?
IgE
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?
IgE Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening.
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?
IgE Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening
Which immunoglobin occurs most frequently in plasma and is the major immunoglobulin synthesized during secondary response?
IgG
A child with systemic lupus erythematosus is receiving hydroxychloroquine sulfate. Which instruction would the nurse emphasize when teaching the child and parents about this drug?
Importance of yearly eye examinations When hydroxychloroquine is given, the child should have a fundoscopic eye exam and visual field testing every year. Corticosteroids need to be tapered gradually over time. Cyclosporine A should not be taken with grapefruit juice. Nonsteroidal anti-inflammatory agents should be given with food to decrease gastrointestinal upset
The nurse is caring for a school-age child recently diagnosed with an allergy to peanuts. Which nursing action is a priority?
Include the child when discussing foods that contain peanuts.
The mother of a child with myasthenia gravis has called the clinic and reports her child appears very anxious and the child's heart is beating very fast. What action by the nurse is indicated?
Instruct the child be brought to the emergency department promptly.
The most accurate screening test for the presence of HIV antigen in young children is
PCR PCR tests directly for the HIV antigen. ELISA and the Western blot test detect the presence of HIV antibodies. The CD4 count is used as a measure of disease status and progression.
The mother of a child with myasthenia gravis has called the clinic and reports her child appears very anxious and the child's heart is beating very fast. What action by the nurse is indicated?
Instruct the child be brought to the emergency department promptly. Myasthenia gravis is an autoimmune disorder that is characterized by weakness and fatigue. There is no cure. The disease may be aggravated by stress, exposure to extreme temperatures, and infections, resulting in a myasthenic crisis. Myasthenic crisis is a medical emergency with symptoms including sudden respiratory distress, dysphagia, dysarthria, ptosis, diplopia, tachycardia, anxiety, and rapidly increasing weakness. The symptoms reported are consistent with a crisis and prompt care is indicated. Waiting 24 hours to have the child seen by the physician is not appropriate. Questions about changes in routine and medication compliance may be asked but the first priority is to have the child seen
A group of nursing students are reviewing information about the immune system. The students demonstrate understanding of the information when they identify what as being produced by the thymus?
Lymphocyte T cells The thymus is responsible producing lymphocyte T cells. The bone marrow produces stem cells that are capable of differentiating into various blood cells. White blood cells arise from the stem cells in the bone marrow. Antibodies are formed by the B cells
The nurse is caring for a child with HIV. The doctor will most likely order which test to monitor the child's progress?
Lymphocyte immunophenotyping T-cell quantification
The nurse is caring for a child with HIV. The doctor will most likely order which test to monitor the child's progress?
Lymphocyte immunophenotyping T-cell quantification Lymphocyte immunophenotyping T-cell quantification is for ongoing monitoring of progressive depletion of CD4 T lymphocytes in HIV disease. The nurse would expect the physician to order a complement assay (C3 and C4) for ongoing monitoring of systemic lupus erythematosus. IgG subclasses measures the levels of the four subclasses of IgG and is used to determine immunodeficiencies. Immunoglobulin electrophoresis is ordered for immunodeficiency and autoimmune disorders, not to monitor systemic lupus erythematosus.
The nursing instructor is describing the events of anaphylaxis. Place the assessment findings in the order that they would occur from first to last.
Nausea, vomiting, diarrhea Urticaria, angioedema Bronchospasm Hypoxia Seizures Initially, a child may be nauseous, with vomiting and diarrhea, because of the sudden increase in gastrointestinal secretions produced by the stimulation of histamine. This is followed by urticaria and angioedema. Bronchospasm can become so severe the child becomes dyspneic and hypoxemic. Continued bronchospasm leads to hypoxia. As blood vessels dilate, the blood pressure and pulse rate fall. Seizures and death may follow as soon as 10 minutes after the allergen is introduced into the child's body.
What advice would be most appropriate for the child with a stinging-insect allergy?
Obtain a medical alert ID bracelet so the presence of the allergy can be identified easily. Stinging-insect allergy can lead to anaphylactic shock. Alerting health care personnel to the possibility of an insect sting is important.
What advice would be most appropriate for the child with a stinging-insect allergy?
Obtain a medical alert ID bracelet so the presence of the allergy can be identified easily. Stinging-insect allergy can lead to anaphylactic shock. Alerting health care personnel to the possibility of an insect sting is important.
While obtaining a health history on a 3-year-old child, the nurse finds what information a concern? Select all that apply.
Parents report the child as an infant had failure to thrive. Parents report the child has had recurrent bacterial infections. Parents report the child didn't start walking until 1 ½ years old. Parents report the child didn't sit up by herself until 9 months old. When collecting health history the nurse must be attuned to reports that may signal underlying conditions. A child who has experienced failure to thrive, repeated bacterial infections and developmental delays with regard to walking and sitting up presents the need for further investigation. These are consistent with an autoimmune disorder.
The nurse is caring for a child presenting with eye inflammation, knee pain, poor appetite and poor weight gain. The nurse is aware that this is which type of juvenile idiopathic arthritis?
Pauciarticular (oligoarticular) Pauciarticular or (oligoarticular) arthritis symptoms include involvement of four or fewer joints; quite often the knee is involved, eye inflammation, malaise, poor appetite, poor weight gain. Polyarticular involves five or more joints; frequently involves small joints and often affects the body symmetrically. Systemic includes joint involvement, fever and rash may be present at diagnosis. Rheumatic arthritis typically involves small joints.
A mother, who is HIV positive, is distraught when she learns that her 6-month-old baby is also human immunodeficiency virus (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:
Placental spread during pregnancy 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 that via placental spread
An infant born to a mother who was HIV positive was tested at birth and found to be negative. The infant is scheduled for follow-up testing. Which test would the nurse expect to be performed?
Polymerase chain reaction (PCR) test The PCR is the preferred test to determine HIV infection in infants over 1 month of age. The ELISA is positive in infants of HIV-infected mothers because of transplacentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate at detecting HIV infection in infants and toddlers than the PCR. The platelet count would provide no information about the infant's HIV status. CD4 counts would be used to monitor HIV infection but not to confirm whether the infant is positive or negative for the virus.
A nursing is teaching pregnant women with HIV about the possibility of infecting their fetuses. Which statement indicates the need for further teaching?
Pregnancy will definitely accelerate the progression of the disease.
The nurse is providing education regarding 2020 Health Goals to reduce the incidence of acquired immunodeficiency syndrome (AIDS) within the community. Which goal will the nurse choose as a primary prevention strategy?
Provide education to sexually active females about proper condom usage.
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?
Screening for HIV 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.
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?
Screening for HIV 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
The nurse is preparing to administer the child's dose of intravenous immune globulin (IVIG). Which actions should the nurse take? Select all that apply.
Take baseline vital signs and monitor the vital signs during the infusion Prepare to give acetaminophen to the child Prepare to give diphenhydramine to the child IVIG should be given only intravenously and should not be given as an intramuscular injection. IVIG cannot be mixed with other medications. The nurse should closely monitor the child's vital signs during the infusion of the IVIG. The child may require an antipyretic and/or an antihistamine during infusion to help with fever and chills.
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?
The best way is to eliminate the food from the diet and then look for improvement."
The nurse is preparing a care plan for a 3-year-old client diagnosed with severe combined immune deficiency. What is the primary goal for this client?
The client will remain free from infection. While all of these are goals for the client, the highest priority for the immunocompromised client is to remain free from infection since she is at a high risk for development of an infection. In the immunocompromised client any infection can be life threatening
The parents of a 10-year-old with HIV have never told their child that he has the virus. The child asks the nurse why he is "on so many medications." What action should the nurse take?
The nurse should encourage the child to talk with his parents about his medications Generally, children older than 6 years of age will eventually need to have their diagnosis disclosed to them in an age-appropriate manner. They begin to ask questions and often seem to sense that something is going on other than what they've been told so far. Encouraging discussion with the parents is the best first step
The parents of a 10-year-old with HIV have never told their child that he has the virus. The child asks the nurse why he is "on so many medications." What action should the nurse take?
The nurse should encourage the child to talk with his parents about his medications Generally, children older than 6 years of age will eventually need to have their diagnosis disclosed to them in an age-appropriate manner. They begin to ask questions and often seem to sense that something is going on other than what they've been told so far. Encouraging discussion with the parents is the best first step.
What nursing instruction would best identify foods to which a child is allergic?
Thoughtful elimination of diet choices
The nurse is working with a pregnant client with HIV who is receiving oral zidovudine. What is the primary rationale for this intervention?
To help prevent transmission of the disease to the fetus A goal of therapy during pregnancy is to maintain the CD4 cell count at greater than 500 cells/mm3 by administering oral zidovudine which helps halt maternal/fetal transmission dramatically along with one or more protease inhibitors, such as ritonavir (Norvir) or indinavir (Crixivan), in conjunction with an NRTI. If P. carinii pneumonia develops, a woman is treated with trimethoprim with sulfamethoxazole. Kaposi's sarcoma is normally treated with chemotherapy. Women may need a platelet transfusion close to birth to restore coagulation ability.
The nurse is working with a pregnant client with HIV who is receiving oral zidovudine. What is the primary rationale for this intervention?
To help prevent transmission of the disease to the fetus A goal of therapy during pregnancy is to maintain the CD4 cell count at greater than 500 cells/mm3 by administering oral zidovudine which helps halt maternal/fetal transmission dramatically along with one or more protease inhibitors, such as ritonavir (Norvir) or indinavir (Crixivan), in conjunction with an NRTI. If P. carinii pneumonia develops, a woman is treated with trimethoprim with sulfamethoxazole. Kaposi's sarcoma is normally treated with chemotherapy. Women may need a platelet transfusion close to birth to restore coagulation ability.
A 6-month-old boy has been admitted to the hospital with severe bloody diarrhea. The nurse notes petechiae and eczema with signs of secondary infection. As the nurse documents the boy's history, the parents report easy bruising and prolonged bleeding after circumcision. Based on these findings, the nurse suspects a diagnosis of:
Wiskott-Aldrich syndrome.
A nurse is providing care to a child with HIV who is prescribed therapy with a nucleoside reverse transcriptase inhibitor. What would the nurse expect to administer?
Zidovudine Zidovudine is a nucleoside reverse transcriptase inhibitor. Nevirapine and efavirenz are classified as nonnucleoside reverse transcriptase inhibitors. Ritonavir is a protease inhibitor.
The nurse is caring for a 4-year-old girl with HIV. The girl is taking nucleoside analogue reverse transcriptase inhibitors (NRTI) as part of a three-drug regimen. The nurse knows to monitor for signs of a fatal hypersensitivity reaction that can occur with:
abacavir.
A 5-year-old is hospitalized after an asthma attack at school. The child tells the nurse that the janitor was cleaning in the classroom prior to the attack and that a lot of dust was in the air. The dust that likely caused the attack is known as a (an):
allergen. Mediating substances that are released and cause tissue injury and allergic symptoms are called allergens. An antigen is any foreign substance capable of stimulating an immune response. An antigen that can be readily destroyed by an immune response is called an immunogen. Macrophages are mature white blood cells.
The nurse is discussing food allergies with parents of a young child. She explains that a very effective way to determine which foods a child may be allergic to is to implement:
an elimination diet. 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.
The nurse is educating a child with a peanut allergy about the signs and symptoms of an anaphylactic reaction. The nurse realizes additional teaching is needed when the child identifies which sign/symptom?
constipation
The nurse is caring for a child with juvenile idiopathic arthritis (JIA). There is involvement of five or more small joints and it is affecting the body symmetrically. This tells the nurse that the child:
has polyarticular JIA. Polyarticular JIA is defined by the involvement of five or more joints, frequently the small joints, and affects the body symmetrically. Pauciarticular JIAs is defined by the involvement of four or fewer joints. Systemic JIA presents with fever and rash in addition to join involvement at the time of diagnosis. The child with JIA is not at greater risk for anaphylaxis.
A mother, who is HIV positive, is distraught when she learns that her 6-month-old baby is also human immunodeficiency virus (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:
placental spread during pregnancy
A mother, who is HIV positive, is distraught when she learns that her 6-month-old baby is also human immunodeficiency virus (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:
placental spread during pregnancy 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 that via placental spread.
The nurse is explaining patterns of incidence and transmission of HIV to a group of adolescent girls. She explains that the risks for this population are much higher because of the possibility of both vertical and horizontal transmission. Horizontal transmission refers to transmission of the disease during:
sexual contact. Horizontal transmission refers to person-to-person transfer of the virus. Transmission by feeding with breast milk, birthing, and pregnancy are all examples of vertical transmission.
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?
• Acute otitis media, one episode every 3 to 4 weeks over the past year. • Recurrent deep abscess of the thigh • Oral thrush, persistent over the past 6 to 7 months 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 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.
The nurse is planning to administer IVIG to a child for the first time. What actions related to this therapy are indicated?
• After mixing, roll the vial of medication. • Store the vial in the refrigerator until use. • Promote hydration prior to administration. • Medicate with acetaminophen prior to administration. IVIG must be reconstituted. After the diluent is added to the powder, gently roll the vial between your hands to mix. Shaking will damage the medication. Reconstituted IVIG may be refrigerated overnight but should be brought to room temperature prior to infusion. Premedication with acetaminophen may be indicated in children who have never received IVIG. The child should be well hydrated prior to the administration. Adverse reactions should be monitored for within 15 minutes of the initiation of the infusion
The nurse is assessing children in a physician's office. Which children may have a primary immunodeficiency?
• Child diagnosed with six episodes of acute otitis media during the previous year • Child with oral thrush that is unresolved with treatment • Child admitted to the hospital three times within the last year with pneumonia • Child who has taken antibiotics for the last 3 months without evidence of clearing of the infection The following children may have a primary immunodeficiency: a child with a persistent case of oral candidiasis, a child who has been diagnosed with pneumonia at least twice during the previous year, and a child who has taken antibiotics for 2 months or longer with little effect
Food allergies have become more and more common in the last few decades. What are some common food allergies of childhood?
• Milk • Peanuts • Eggs 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.
The nurse is caring for a client with HIV who is receiving Ziagen (abacavir) for treatment. What signs and symptoms will require the nurse to notify the physician?
• Muscle weakness • Shortness of breath • Rash • Unusual bleeding Ziagen (abacavir) is a nucleoside analog reverse transcriptase inhibitor given as part of the drug treatment regimen for HIV. Muscle weakness, shortness of breath, headache, insomnia, rash, or unusual bleeding are side effects that must be reported to the physician.
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.
• Peanuts • Eggs • Shrimp 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.
A nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread?
• Perinatally from mother to fetus • Sharing contaminated needles • Transfusion of contaminated blood • Through breastfeeding • Exposure to blood and body fluids through sexual contact HIV is spread by exposure to blood and other body fluids through sexual contact, sharing of contaminated needles for injection, transfusion of contaminated blood, perinatally from mother to fetus, and through breastfeeding
