Chapter 47: Nursing Care of the Child With an Alteration in Immunity/Immunologic Disorder

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The nurse is caring for a 6-month-old boy with Wiskott-Aldrich syndrome. The nurse teaches the parents which of the following: a) "Don't encourage a pacifier due to possible oral malformation" b) "Do not use a sponge bath for light cleaning" c) "Don't use a tub bath for daily cleansing" d) "Do not insert anything in the rectum"

"Do not insert anything in the rectum" Explanation: Children with Wiskott-Aldrich syndrome should not be given rectal suppositories or temperatures since these children are at a high risk for bleeding. Tub baths are not contraindicated. Pacifi ers are not contraindicated in Wiskott-Aldrich but should be kept as sanitary as possible to avoid oral infections.

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?"

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

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. Explanation: 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.

When treating allergies in a child, the nurse is aware that the classification for the drug of choice to control itching, sneezing, and rhinorrhea is:

Antihistamines Explanation: Antihistamines block histamine release and as a result control itching, sneezing, and rhinorrhea.

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." Children with Wiskott-Aldrich syndrome should not be given rectal suppositories or temperatures since these children are at a high risk for bleeding. Tub baths are not contraindicated. Pacifiers are not contraindicated in Wiskott-Aldrich but should be kept as sanitary as possible to avoid oral infections.

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.

When evaluating parents' understanding of atopic dermatitis, which of the following statements would you want to hear them voice? a) "Flare-ups of lesions are not uncommon following therapy." b) "Hydrocortisone cream may lead to kidney disease." c) "Atopic dermatitis follows a streptococcal infection." d) "Atopic dermatitis turns to asthma later in life."

"Flare-ups of lesions are not uncommon following therapy." Explanation: Atopic dermatitis may recur when the child is re-exposed to the substance to which he or she is allergic.

To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant? a) "What do you give her to alleviate itching?" b) "Do you have a telephone to call us immediately if she develops trouble breathing?" c) "Is there any family history of allergy to penicillin?" d) "Has she ever had penicillin before?"

"Has she ever had penicillin before?" Explanation: Penicillin is a drug frequently involved in allergic reactions. The reaction occurs after the child has first been sensitized to the drug.

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 providing dietary interventions for a 12-year-old with a shellfish allergy. Which of the following responses indicates a need for further teaching? a) "Wheezing is a sign of a severe reaction" b) "We must order carefully when dining out" c) "He will likely outgrow this" d) "He must avoid lobster and shrimp"

"He will likely outgrow this" Correct Explanation: Older children and adolescents with allergic reactions to fish, shellfish, and nuts usually continue to have that concern as a life-long problem. The other statements are correct

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 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."

A child's mother asks the nurse how likely it is the child will develop asthma because the child's father has asthma. Which response by the nurse is most appropriate?

"Immune responses can be genetic and run in the family." Explanation: The nurse's most appropriate response is to explain that there are familial tendencies with allergic responses but not all family members manifest the symptoms in the same way. For example, if the father has asthma, the child may have allergic rhinitis. Asthma cannot be prevented by avoiding allergens; however, asthma symptoms can be managed by avoiding allergens.

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."

The nurse is providing instructions to the parents of a child with a severe peanut allergy. Which of the following statements by the parents indicates a need for further teaching about the use of the EpiPen Jr.?

"The EpiPen Jr. should be jabbed into the upper arm" Correct Explanation: The EpiPen Jr. 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 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." Explanation: 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 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 13-year-old is being evaluated for lupus. The teen asks who is at risk for this condition. What information can be provided by the nurse? Select all that apply.

-"Females are at a higher risk than males." -"Excessive sun exposure is linked to the development of lupus." -"Some clients will have had a recent infection." Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder that affects both humoral and cellular immunity. SLE can affect any organ system, so the onset and course of the disease are quite variable. There are some identified risk factors including female gender. Groups such African Americans or those of Asian descent have a higher incidence of lupus. Hispanics are not at an increased risk. Family history does have a role in this condition. A recent infection may be reported by some diagnosed with the condition.

A child is undergoing skin testing for allergies. About 10 minutes after a scratch test with an allergen, the child develops signs and symptoms of anaphylaxis. The nurse prepares to administer epinephrine subcutaneously. The child weighs 88 pounds. The nurse would administer which dosage of epinephrine? a) 0.2 mg b) 0.4 mg c) 0.8 mg d) 1 mg

0.4 mg Explanation: The child weighs 88 pounds or 40 kg. The dose of epinephrine is 0.01 mg/kg. So for a child weighing 40 kg, the nurse would give 0.4 mg.

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 Explanation: 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 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 which of the following medications? a) Abacavir b) Ritonavir c) Lamivudine d) Zidovudine

Abacavir Explanation: A fatal hypersensitivity reaction may occur with abacavir. Ritonavir is a protease inhibitor, not a nucleoside analogue reverse transcriptase inhibitor. This drug is not associated with a fatal hypersensitivity reaction. This drug is not associated with a fatal hypersensitivity reaction.

A 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? a) Immediately transport the child to the local hospital. b) Administer epinephrine immediately. c) Apply a warm compress to the site of the bee sting. d) Notify the child's mother.

Administer epinephrine immediately. Explanation: 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 providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which of the following foods? a) Blueberries b) Pomegranate c) Banana d) Pumpkin

Banana Explanation: The nurse should instruct children and their families to avoid foods with a known cross-reactivity to latex, such as bananas.

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 is providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which food?

Bananas Explanation: The nurse should instruct children and their families to avoid foods with a known cross-reactivity to latex, such as bananas.

A child with primary immune deficiency is about to receive an infusion of IVIG. Which of the following is the most appropriate premedication to minimize the reaction? a) Ibuprofen b) Solu-Medrol c) Ketorolac d) Diphenhydramine

Diphenhydramine Explanation: Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.

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.

Which of the following would best identify foods to which a child is allergic? a) Hyposensitivity testing b) Elimination diet c) Corticosteroid challenge testing d) Complete dietary protein restriction

Elimination diet Explanation: 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) 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.

The first time a child with hypersensitivity to stinging insects is stung, the reaction is usually anaphylactic shock and, if not immediately treated, death. a) True b) False

False Explanation: The first time a child is stung, the total reaction is probably only local edema at the site. The second time, generalized urticaria, pruritus, and edema may develop. The third time, symptoms may progress to wheezing and dyspnea. The next time, the reaction could be so severe that shock and death result. The progression of symptoms may be slower than this (involving 10 to 12 stings) if the stings occur far apart; if the stings are received close together (1 or 2 days apart, or even 3 weeks apart), the progression to fatal symptoms may occur as early as the second or third exposure

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.

The nurse is administering the prescribed intravenous immunoglobulin to a 10-year-old boy. Which of the following would be most important for the nurse to do? a) Have epinephrine available. b) Administer with food. c) Monitor for signs of Cushing syndrome. d) Monitor urine for glucose.

Have epinephrine available. Explanation: The nurse should have epinephrine available during the infusion in case of an adverse reaction. Monitoring urine for glucose would be appropriate when corticosteroids are being given. Intravenous immunoglobulin does not need to be administered with food because it is being given as an intravenous infusion. Monitoring for signs of Cushing syndrome would be appropriate when corticosteroids are given.

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. Involving school-age children in education related to their allergy helps them play an active role in their own care. Involving the child in teaching also helps to plan nursing care that meets QSEN competencies and also best meets the family's needs. Although advising parents the child may benefit from skin testing of other allergies, informing the child's school of the peanut allergy, and offering information about community support groups are important, involving the child in education is the best method to prevent exposure to the allergen.

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?

Kaposi sarcomas observed on the skin Explanation: 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.

A group of nursing students are reviewing information about the immune system. The students demonstrate understanding of the information when they identify which of the following being produced by the thymus? a) Stem cells b) Lymphocyte T cells c) White blood cells d) Antibodies

Lymphocyte T cells Explanation: 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 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.

What advice would be most appropriate for the child with a stinging-insect allergy?

Obtain a Medic-Alert bracelet so the presence of the allergy can be identified easily. Explanation: Stinging-insect allergy can lead to anaphylactic shock. Alerting health care personnel to the possibility of an insect sting is important

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 most accurate screening test for the presence of HIV antigen in young children is a) Western blot b) PCR c) CD4 count d) ELISA

PCR Explanation: 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.

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 Explanation: 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 instructing a group of women of childbearing age about HIV during pregnancy. Which of the following should be a priority recommendation in this setting? a) Proper nutrition b) Screening for HIV c) Prophylactic treatment for HIV d) Screening for STIs

Screening for HIV Explanation: 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

A newborn is found to have Di George syndrome and has misshaped ears, a small mandible, and an absent thymus. The nurse recognizes that this condition is associated with which of the following types of immunodeficiency disorders? a) B-lymphocyte deficiency b) Combined T- and B-lymphocyte deficiency c) T-lymphocyte deficiency d) Secondary immunodeficiency

T-lymphocyte deficiency Explanation: T-lymphocyte immunodeficiencies involve inadequate numbers or inadequate functioning of one or more types of T lymphocytes; this affects cell-mediated immunity and also, because of helper T-lymphocyte function, possibly humoral immunity as well. Di George syndrome is a chromosomal disorder in which there is deletion of a small piece of chromosome 22. This leads to not only a T cell defect but misshaped or low-set ears, smaller than usual mandible, absent thymus, neonatal tetany, and congenital heart disease

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

To establish whether the problem is truly a milk allergy in a child who is suspected of having this condition, milk should be reintroduced every 6 to 12 months. a) True b) False

True Explanation: To establish whether the problem is truly a milk allergy, milk should be reintroduced every 6 to 12 months. If the problem is a true milk allergy, signs will recur

What nursing instruction would best identify foods to which a child is allergic?

Thoughtful elimination of diet choices

The adoptive parents of a child who is 7 years old and HIV positive are concerned about telling their child about his condition. What information can be provided by the nurse?

When providing health information to a child of this age it should be simplistic and at the child's level of understanding. Explanation: When a child has a chronic condition they often realize that they have special concerns even before they are fully able to understand them. Information should be provided that is developmentally appropriate. Excessive information and details should be limited. Children who have this type of information may experience problems anger, depression and difficulty in school.

abacavir.

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 Signs and symptoms of an anaphylactic allergic reaction include nausea, anxiety, and itchy mouth. Diarrhea, rather than constipation, is a sign of an allergic reaction.

has polyarticular JIA. Explanation: 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.

The nursing diagnosis you anticipate that would best apply to a child with allergic rhinitis is a) risk for infection related to blocked eustachian tubes. b) disturbed self-esteem related to inherited tendency for illness. c) pain related to sinus edema and headache. d) ineffective tissue perfusion related to frequent nosebleeds.

pain related to sinus edema and headache. Correct Explanation: Many children with allergic rhinitis develop sinus headaches from edema of the upper airway

The nurse is preparing to administer intravenous immunoglobulin (IVIG) for a child who has not had an IVIG infusion in over 10 weeks. The nurse knows to first:

premedicate with acetaminophen or diphenhydramine. Explanation: Premedication with diphenhydramine or acetaminophen may be indicted in children who have never received intravenous immunoglobulin (IVIG), have not had an infusion in over 8 weeks, have had a recent bacterial infection, or have history of serious infusion-related adverse reactions. The nurse should first premedicate, and then obtain a baseline physical assessment. Once the infusion begins, the nurse should continually assess for adverse reaction

Which of the following treatments are common to both systemic lupus erythematosus and juvenile idiopathic arthritis? Select all that apply. a) Nonsteroidal antiinflammatories b) Corticosteroids c) Antipyretics d) Antirheumatics e) Antimalarial

• Corticosteroids • Nonsteroidal antiinflammatories Explanation: Antimalarials are specific to SLE; antirheumatics are specific to JIA. Antipyretics are not typically used for either disorder

Nursing students are reviewing the events involved in humoral immunity. They demonstrate understanding of the information when they identify which of the following as occurring with complement activation? Select all that apply. a) Smooth muscle relaxation b) Decreased vascular permeability c) Lysis of the foreign antigen d) Phagocytosis e) Chemotaxis

• Lysis of the foreign antigen • Chemotaxis • Phagocytosis Explanation: Complement activation results in increased vascular permeability, smooth muscle contraction, chemotaxis, phagocytosis, and lysis of the foreign antigen

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 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) "We can inject an extract of the food under the skin and see if there is a reaction." b) "Skin testing using a patch is probably the easiest method." c) "The best way is to eliminate the food from the diet and then look for improvement." d) "We can check the level of antibodies in the blood to confirm the allergy.

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." Viramune (nevirapine) is a nonnucleoside analog reverse transcriptase inhibitor (NNRTIs) that binds to HIV-1 reverse transcriptase, blocking DNA polymerase activity and disrupting the virus life cycle. It's used for treatment of HIV-1 infection as part of a three-drug regimen.

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.

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.

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 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.

The nurse is providing education to a 16-year-old who has recently been diagnosed with myastenia gravis and her parents. What statements by the teen indicate an understanding of the information provided? Select all that apply.

-"It is important I avoid triggers." -"Getting a flu shot will be important." -"I am going to incorporate a short nap into my daily routine." Myasthenia gravis is an autoimmune condition characterized by weakness and fatigue. Management involves avoiding triggers such as stress and illness. Taking a flu shot will aid in avoidance of influenza which can be dangerous for someone with this disease. Fatigue is a concern and rest periods should be incorporated in to the teens schedule. There is no cure for the condition. There will need to be modifications in the teen's normal routine but attending public schools is possible.

A child with HIV, weighing 25 kg, is about to receive an infusion of IVIG. The recommended dose is 400 mg/kg/dose. The medication is available in a concentration of 50 mg/mL. What is the proper amount of infusion that the child will receive?

200 mL Explanation: The dose is calculated as 25 x 400 = 10,000 mg. Because the concentration is 50 mg/mL, calculate the volume as 10,000/50 = 200 mL.

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 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 will most likely be tested again at what age? a) 8 to 10 weeks b) 2 to 3 months c) 12 months d) 4 to 7 weeks

4 to 7 weeks Explanation: Virologic testing for HIV-exposed infants should be done with the polymerase chain reaction test at birth, at 4 to 7 weeks, and again at 8 to 16 weeks. Serologic testing is done at approximately 12 months of age to document disappearance of the HIV-1 antibody

Which nursing intervention is priority when caring for a child with HIV?

Administer prescribed medications. Explanation: 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.

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. 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 healthcare 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.

A child with primary immune deficiency is about to receive an infusion of IVIG. Which of the following is the most appropriate premedication to minimize the reaction? a) Ketorolac b) Diphenhydramine c) Ibuprofen d) Solu-Medrol

Diphenhydramine Explanation: Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.

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.

Eggs Shrimp Peanuts Explanation: 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.

Which of the following drugs should be available for emergency treatment of a child who goes into anaphylactic shock? a) Vistaril b) Morphine sulfate c) Meperidine d) Epinephrine

Epinephrine Explanation: Epinephrine (adrenaline) reverses the effects of histamine (severe bronchospasm and edema).

Question: Place in correct order the steps in the anaphylactic response.

Exposure to allergen Rapid immune response Vasodilation Bronchoconstriction Circulatory collapse Explanation: 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.

The nurse is administering the prescribed intravenous immunoglobulin to a 10-year-old boy. Which of the following would be most important for the nurse to do? a) Administer with food. b) Have epinephrine available. c) Monitor urine for glucose. d) Monitor for signs of Cushing syndrome.

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 Explanation: 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 IgG is the most frequent antibody in plasma and is the major immunoglobin to be synthesized during the secondary response.

A nursing instructor is preparing a teaching plan for a class about the immune response. When discussing the immune response, which of the following would the instructor describe as being primarily involved in a secondary immune response? a) IgE b) IgG c) IgA d) IgM

IgG Explanation: Only IgM and IgG are involved in primary and secondary immune responses. The main immunoglobulin produced in a secondary response is IgG. With a primary immune response, IgM antibodies peak at 14 days after an initial exposure to an antigen and then decline. This is followed by the production of IgG, which remains high for several weeks. IgE antibodies are involved in an immediate hypersensitivity reaction

When teaching about primary and secondary humoral responses, what should the nurse identify as the immunoglobin that is first to appear in the serum? a) IgM b) IgD c) IgE d) IgG

IgM Explanation: IgM is the first immunoglobin to appear in the serum with the primary and secondary humoral responses

A child is scheduled to undergo hyposensitization. The nurse understands that this therapy attempts to achieve which of the following? a) Blockage of histamine release b) An increased level of IgE c) Reduction in allergen exposure d) Increased concentration of IgG

Increased concentration of IgG Explanation: Hyposensitization works by increasing the plasma concentration of IgG antibodies. IgG acts to prevent or block IgE antibodies from coming into contact with the allergen. IgE levels are not increased. Antihistamines block the release of histamine. Environmental control helps to reduce exposure to potential allergens

A woman in her fourth month of pregnancy has recently learned that her sexual partner is HIV positive. She agrees to be tested for the virus but asks the nurse what early symptoms she should be looking for in herself. Which of the following should the nurse mention to the client? a) Mild, flu-like symptoms b) Genital warts c) Skin rash d) Vaginal discharge

Mild, flu-like symptoms Explanation: Unlike other sexually transmitted infections, HIV infection rarely begins with reproductive tract lesions. Instead, early symptoms are more subtle and often difficult to differentiate from those of other diseases or even from the symptoms of early pregnancy such as fatigue, anemia, diarrhea, and weight loss. The initial invasion of the virus may be accompanied by mild, flulike symptoms.

A nursing is providing education to pregnant women diagnosed with HIV. Which statement indicates the need for further teaching?

Pregnancy will accelerate the progression of the disease. Explanation: 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.

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 5 year old is hospitalized after an asthma attack at school. The child tells the nurse that the janitor had been 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 what? a) allergen b) macrophage c) immunogen d) antigen

allergen Explanation: 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.

When caring for a child experiencing anaphylactic shock, the most important nursing action would be to a) counteract hypertension. b) enhance the action of histamine. c) facilitate breathing. d) reverse sympathetic nervous system responses.

facilitate breathing. Explanation: The sudden release of histamine with an allergic reaction can cause severe bronchospasm, closing the airway.

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

• Recurrent deep abscess of the thigh • Oral thrush, persistent over the past 6 to 7 months • Acute otitis media, one episode every 3 to 4 weeks over the past year. Explanation: Warning signs associated with primary immunodeficiency include eight or more episodes of acute otitis media in 1 year (one episode every 3 to 4 weeks results in at least 12 episodes in the past year), recurrent deep skin or organ abscesses, persistent oral thrush or skin candidiasis after 1 year of age. A history of infections that do not clear with IV antibiotics or two or more episodes of pneumonia in 1 year would be considered warning signs.

The child has a peanut allergy and accidentally ate food that contained peanuts. Which of the following findings are clinical manifestations of anaphylaxis? Select all that apply. a) The child's pulse is 52 beats per minute b) The child states that his tongue feels "too big" for his mouth c) The child has developed hives on his face and trunk d) The child states that he feels like he might faint e) The child states he feels might "throw up"

• The child states he feels might "throw up" • The child states that his tongue feels "too big" for his mouth • The child states that he feels like he might faint • The child has developed hives on his face and trunk Explanation: The following are common signs and symptoms of anaphylaxis: tongue edema, urticaria, nausea, vomiting, and syncope. Typically, the child who has developed anaphylaxis will be tachycardic.

The nurse is preparing to administer the child's dose of intravenous immune globulin (IVIG). Which of the following activities by the nurse indicates the need for further education? Select all that apply. a) The nurse is prepared to give acetaminophen to the child b) The nurse is prepared to give diphenhydramine to the child c) The nurse is preparing to administer the medication ventrogluteal site as an intramuscular injection d) The nurse takes baseline vital signs and will monitor the vital signs during the infusion e) The nurse has mixed the medication with the child's intravenous antibiotic

• The nurse is preparing to administer the medication ventrogluteal site as an intramuscular injection • The nurse has mixed the medication with the child's intravenous antibiotic Explanation: 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 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 is providing family education about the administration of cyclosporine A. Which response by the family indicates a need for further teaching?

"The medication is best absorbed with the vitamin C in citrus juices." Explanation: Cyclosporine A should not be taken with grapefruit juice but it may be administered with dairy products. While this medication is being used, the patient needs to be monitored for signs of infection and adhere to the schedule for follow up blood tests to evaluate for complications.

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."

A nurse in the emergency department is examining an 18-month-old with lip edema, urticaria, stridor, and tachycardia. The nurse immediately suspects: a) anaphylaxis. b) systemic lupus erythematosus. c) severe polyarticular juvenile idiopathic arthritis. d) severe combined immunodeficiency.

Anaphylaxis. Explanation: Lip edema, urticaria, stridor, and tachycardia are common clinical manifestations of anaphylaxis.

When treating allergies in a child, the nurse is aware that the classification for the drug of choice to control itching, sneezing, and rhinorrhea is which of the following? a) Antihistamines b) Decongestants c) Antibiotics d) Corticosteroids

Antihistamines Explanation: Antihistamines block histamine release and as a result control itching, sneezing, and rhinorrhea.

A mother brings her 4-month-old infant to the doctor's office due to vesicular lesions that have appeared on the child's scalp and face. The mother says that the child will not stop scratching at the lesions and that she is concerned that he is having some kind of allergic reaction. Which of the following should the nurse recommend to the mother to help reduce pruritus in this child? a) Put the child on elimination diets b) Have the child retested for PKU c) Have the child undergo skin testing d) Apply wet dressings for 15 to 20 minutes, followed by moisturizer

Apply wet dressings for 15 to 20 minutes, followed by moisturizer Explanation: A major consideration in treatment of atopic dermatitis is aimed at reducing pruritus so children do not irritate lesions and cause secondary infections by scratching. Hydrating the skin by bathing or applying wet dressings (wet with tap water or Burrow's solution) for 15 to 20 minutes, followed by application of moisturizer such as Eucerin is helpful. Skin testing is usually ineffective because, although the allergen causing infantile atopic dermatitis may be pollen, dust or a mold spore; it is often a food allergen. Elimination diets can help identify an allergen, but do not directly help reduce pruritus; in any case, a 4-month-old should not be eating solid foods. Because untreated phenylketonuria (PKU) can lead to atopic dermatitis, children with infantile atopic dermatitis need to have a repeat test for PKU to be certain this is ruled out—however, this intervention does not directly reduce pruritus, either.

The parents of a child with juvenile idiopathic arthritis bring the child to the emergency department because the child is very drowsy and breathing heavily. The child also has been vomiting and complaining of ringing in her ears. The nurse suspects that the child is experiencing a toxic reaction to one of her medications. Which medication would the nurse suspect? a) Etanercept b) Aspirin c) Corticosteroid d) Methotrexate

Aspirin Explanation: The child is exhibiting signs and symptoms of aspirin toxicity. Corticosteroids would lead to signs and symptoms of Cushing syndrome as well as masking the signs of infection. Methotrexate would lead to changes in the white blood cell count, placing the child at risk for infection. Etanercept, like methotrexate, places the child at risk for infection. (less)

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 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? a) Gently roll the vial to mix the medication. b) Reconstitute the medication 2 hours prior to administration. c) Shake the vial vigorously to disperse the diluent. d) Store the reconstituted medication no longer than 4 hours in the refrigerator

Gently roll the vial to mix the medication. Explanation: The nurse knows not the 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 caring for a child who is receiving a skin test to determine the presence of allergies. A positive skin test for one particular allergen shows the mediation of which type of immune globulin?

IgE Explanation: Skin testing is done to detect the presence of IgE in the skin that responds to a particular allergen. IgM is part of the body's primary response, and IgG is part of the body's secondary response to infection. IgA is present in the mucous membranes of the body to fight against infection

Nursing students demonstrate correct understanding when they identify which immunoglobin as occurring most frequently in plasma and the major one to be synthesized during secondary response? a) IgD b) IgM c) IgG d) IgA

IgG Explanation: IgG is the most frequent antibody in plasma and is the major immunoglobin to be synthesized during the secondary response.

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 which of the following is the most likely means of transmission of the disease to this child? a) Placental spread during pregnancy b) Blood transfusion products contaminated with the virus c) The mother kissing the baby on the forehead d) Breastfeeding

Placental spread during pregnancy Explanation: 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. (less)

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 child has polyarticular JIA Explanation: 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.

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 which of the following? a) The child has polyarticular JIA b) The child has pauciarticular JIA c) The child is at risk for anaphylaxis d) The child has systemic JIA

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. a) humoral; viral b) humoral; bacterial c) killer; bacterial d) killer; viral

humoral; bacterial Explanation: 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 child has a peanut allergy and accidentally ate food that contained peanuts. Which clinical manifestations of anaphylaxis should the nurse expect to find? Select all that apply.

The child states that his tongue feels "too big" for his mouth. The child has developed hives on his face and trunk. The child states he feels like he might "throw up". The child states that he feels like he might faint. The following are common signs and symptoms of anaphylaxis: tongue edema, urticaria, nausea, vomiting, and syncope. Typically, the child who has developed anaphylaxis will be tachycardic.

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?

You Selected: Discontinue the infusion. Correct response: Discontinue the infusion. Explanation: 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.

A nurse is providing care to a child with HIV who is prescribed therapy with a nucleoside reverse transcriptase inhibitor. Which of the following would the nurse expect to administer?

Zidovudine Explanation: Zidovudine is a nucleoside reverse transcriptase inhibitor. Nevirapine and efavirenz are classified as nonnucleoside reverse transcriptase inhibitors. Ritonavir is a protease inhibitor.

A young patient comes to the clinic with multiple symptoms of an infection. The nurse realizes that the patient has been seen in the clinic every month for the last 6 months for the same problems. Which body system does the nurse suspect is malfunctioning in this patient? a) gastrointestinal b) cardiovascular c) respiratory d) immune

immune Explanation: Disorders of the immune system include deficiencies of immune substances and function that affect the body's ability to ward off infection.

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 preparing to administer intravenous immunoglobulin (IVIG) for a child who has not had an IVIG infusion in over 10 weeks. The nurse knows to first: a) obtain baseline physical assessment. b) begin infusion slowly increasing to prescribed rate. c) assess for adverse reaction. d) premedicate with acetaminophen or diphenhydramine.

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

• Eggs • Milk • Peanuts Explanation: 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.

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 of the following would the nurse most likely include? Select all that apply.

• Eggs • Peanuts • Shrimp Explanation: Foods that should be avoided in children younger than 1 year of age include: cow's milk, eggs, peanuts, tree nuts, sesame seeds, kiwi fruit, and fish and shellfish (ie, shrimp). Carrots, potatoes, and oranges are not considered problematic. (less)

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

A child with primary immune deficiency is about to receive an infusion of IVIG. Which of the following is the most appropriate premedication to minimize the reaction? a) Solu-Medrol b) Diphenhydramine c) Ketorolac d) Ibuprofen

Diphenhydramine Explanation: Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.

Question: The nurse instructs a school-aged child who has a bee-sting allergy and his parents on proper use of the EpiPen. What is the order of steps that should be taken if the child is bit by a bee?

Grasp the EpiPen with your fist, with black tip pointing down. Remove gray safety cap. Place EpiPen against child's thigh, injecting solution. Hold syringe in place for 10 seconds. Explanation: These are the necessary steps for injecting the EpiPen. First, make sure to hold the device correctly. Then remove the cap. Next, place the injection tip against the thigh, either directly on the skin or on the clothing. Finally, hold the syringe in place for 10 seconds to make sure the content is injected properly.

A child is scheduled to undergo hyposensitization. The nurse understands that this therapy attempts to achieve which of the following? a) Blockage of histamine release b) Increased concentration of IgG c) An increased level of IgE d) Reduction in allergen exposure

The nurse is caring for a child with systemic lupus erythematosus. The doctor will most likely order which test to monitor the child's progress? a) Immunoglobulin electrophoresis b) Lymphocyte immunophenotyping T-cell quantification c) IgG subclasses d) Complement assay (C3 and C4)

Lymphocyte immunophenotyping T-cell quantification Explanation: 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 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. Primary prevention strategies focus on preventing a disease before it occurs, which includes condom usage to prevent being exposed to AIDS. Screening for the presence of AIDS is a secondary prevention strategy because it does not prevent an individual from contracting AIDS, but would allow for early identification. Improving air quality and reducing allergens are goals to prevent allergies.

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 which of the following?

Sexual contact Explanation: 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

After teaching a class of nursing students about acquired immunodeficiency, the instructor determines that the teaching was effective when the students identify which of the following as a contributing factor? Select all that apply. a) Immunosuppressive drugs b) Vitamin therapy c) Minor localized infection d) Malnutrition e) Cancer

• Cancer • Malnutrition • Immunosuppressive drugs Explanation: Factors contributing to secondary (acquired) immunodeficiency include severe systemic infection, cancer, renal disease, radiation therapy, severe stress, malnutrition, immunosuppressive therapy, and aging.

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.

You Selected: "The epinephrine auto-injector should be jabbed into the upper arm." Correct response: "The epinephrine auto-injector should be jabbed into the upper arm." Explanation: 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 monitoring the labs of a child admitted for an exacerbation of juvenile pauciarticular arthritis. Which lab result does the nurse expect to be elevated?

You Selected: Erythrocyte sedimentation rate (ESR) Correct response: Erythrocyte sedimentation rate (ESR) Explanation: 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.

A nurse is providing care to a child with HIV who is prescribed therapy with a nucleoside reverse transcriptase inhibitor. Which of the following would the nurse expect to administer? a) Nevirapine b) Ritonavir c) Efavirenz d) Zidovudine

The young girl has been diagnosed with JIA and has been prescribed methotrexate. Which of the following statements by the child's parent indicates that adequate learning has occurred? a) "She may start feeling better by next week." b) "She can take methotrexate with yogurt or chocolate milk." c) "Swimming sounds like a good exercise for her." d) "We'll need to bring her back in for some lab tests after she starts methotrexate." e) "A warm bath before bed might help her sleep better."

- "We'll need to bring her back in for some lab tests after she starts methotrexate." • "She may start feeling better by next week." Explanation: The child diagnosed with juvenile idiopathic arthritis should not take the oral form of methotrexate with dairy products. The approximate time to benefit from methotrexate is typically 3 to 6 weeks. The child will need blood tests to determine renal and liver function during treatment. Children with juvenile idiopathic arthritis usually find swimming to be auseful exercise for them because it helps maintain joint mobility without placing pressure on the joints. Sleep may be promoted by a warm bath at bedtime.

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 Correct Explanation: 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 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 An elimination diet is a traditional method to detect food allergens. Parents feed the child only foods that rarely cause allergy, such as rice, lamb, carrots, peas, and sweet potatoes, for about 7 days. Then they add, one by one, at 2- to 3-day intervals, foods that are suspected of causing allergy. When a food is introduced this way, the child must be encouraged to eat a lot of it that day. If symptoms occur, the food is then eliminated from the child's meals on a permanent basis. If no symptoms occur, the child can continue to eat the food. Hyposensitivity testing is unreliable with food allergies. Corticosteroids delay hypersensitivity reactions. It is difficulty to totally eliminate protein from the diet, and this is not a method to determine the cause of food allergies in the toddler.

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) IgM b) IgE c) IgG d) IgA

IgE Explanation: Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening.

Question: 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 below 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 Explanation: 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

IgE Explanation: Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening.

A nursing student correctly identifies the inability to distinguish self from nonself, causing the immune system to carry out immune responses against normal cells, as which of the following? a) autoimmunity b) allergen c) delayed hypersensitivity d) immunity

autoimmunity Explanation: 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.

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? a) Polymerase chain reaction (PCR) test b) CD4 counts c) Enzyme-linked immunosorbent assay (ELISA) d) Platelet count

Wiskott-Aldrich syndrome Explanation: Severe bloody diarrhea, petechiae, bruising, eczema with secondary infection, and prolonged bleeding episodes are signs and symptoms of Wiskott-Aldrich syndrome. Beta-thalassemia major would be manifested by signs of bleeding. von Willebrand's disease would be manifested by signs of bleeding. Severe combined immunodeficiency would be manifested by chronic diarrhea and failure to thrive, persistent thrush, and a history of severe infections beginning in infancy. (less)

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? a) "Tell me if you have noticed any new bruising or different color patterns on your skin" b) "Have you noticed any hair loss or redness on your face?" c) "Do you notice any wheezing when you breathe or a runny nose?" d) "Do you have any shoulder pain or abdominal tenderness?"

"Have you noticed any hair loss or redness on your face?" Explanation: 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

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 Explanation: 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 caring for a child who is beginning to show signs and symptoms of anaphylaxis. Which intervention would be the priority? a) Obtaining brief history of allergen exposure b) Assessing patency of the airway c) Administering IV diphenhydramine (Benadryl) d) Administering corticosteroids

Assessing patency of the airway Explanation: 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.

Question: 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 Explanation: 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.

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Chapter 47: Nursing Care of the Child With an Alteration in Immunity/Immunologic Disorder

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