Peds PrepU Quizzes Ch. 25

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." Explanation: 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.

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

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 Explanation: 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 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) Explanation: 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 child is diagnosed with a latex allergy. When developing the teaching plan for this child, the nurse would include what foods to avoid? Select all that apply.

Pineapples Cherries Bananas Explanation: Certain foods have shown a cross-sensitivity to latex and should be avoided. These include: pear, peach, passion fruit, plum, pineapple, kiwi, fig, grape, cherry, melon, nectarine, papaya, apple, apricot, banana, chestnut, carrot, celery, avocado, tomato, or potato.

Which nursing problems could be associated with a child with primary immunodeficiency? Select all that apply.

Risk for infection Altered skin integrity Delayed growth and development Explanation: All of these can be problems associated with immune system dysfunction. Fluid and electrolytes and GI function are not commonly associated with primary immunodeficiency.

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 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 administering Mestinon (pyridostigmine) to a client with myasthenia gravis. Which signs and symptoms would alert the nurse that the client may be receiving too high of a dose of the medication? Select all that apply.

Sweating Salivation Urinary incontinence Explanation: Mestinon (pyridostigmine) is a cholinergic neuromuscular blocking agent that is given for myasthenia gravis. It inhibits destruction of acetylcholine. Overdose of this medication may result in a cholinergic crisis, exhibited by sweating, salivation, and urinary incontinence.

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. 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 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 Explanation: 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.

Which treatments are common to both systemic lupus erythematosus and juvenile idiopathic arthritis? Select all that apply.

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

The nurse is performing the intake assessment on a child about to undergo allergy skin testing. Which statements by the parent would demonstrate to the nurse that the parent understands the procedure? Select all that apply.

-"I am a little nervous because I know my child could have a severe reaction during testing." -"We will be here in the exam room for quite a while I'm guessing." -"If my child is allergic to any of the substances there will be a raised red area at the reaction site." Explanation: Anaphylactic shock can occur with allergy skin testing. The skin testing procedure is time intensive and close observation is necessary during the testing as the client will be exposed to a number of allergans. A wheal response indicates allergy to the substance. Antihistamines must be stopped several days prior to testing because they will inhibit the results of the test. The child will react to the testing immediately or sometime during the testing process

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. Explanation: 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 administering IVIG. Which assessment findings would indicate a potential anaphylaxis? Select all that apply.

-The client's temperature is elevated one degree higher than it was prior to the administration of the IVIG. -The client appears increasingly nervous. -There are inspiratory wheezes heard with auscultation of the lung fields. Explanation: Frequent observations are indicated during the administration and following IVIG administration. The vital signs are observed for hypotension and temperature increases. Increased nervousness and anxiety should be monitored as they may signal anaphylaxis. In an allergic reaction the client's face is flushed and not pale.

The nurse is reviewing the immunization schedule with the parent of a child who is HIV positive. What information should the nurse provide? Select all that apply.

-Pneumococcal vaccination can be given. -The varicella vaccine should not be given if the child is symptomatic. -If the CD4 count is low, the measles, mumps, and rubella vaccine should not be given. Explanation: The nurse should emphasize that live vaccines should not be given to those infected with HIV. Children should receive routine immunizations according to the usual schedule with the killed virus vaccines, including pneumococcal and human papillomavirus vaccine. Symptomatic children should not receive the varicella vaccine, and those with low CD4 counts should not receive measles, mumps, and rubella vaccine.

The nurse is completing a care plan for a child who has recently had a bone marrow transplant. Which nursing interventions should the nurse include in the care plan? Select all that apply.

-Administer immunosuppressive medications as ordered. -Monitor the client for signs and symptoms of graft versus host disease. -Provide oral care at least every shift, but more often as needed. -Perform meticulous hand hygiene and ensure all visitors follow these precautions. Explanation: The client who has had a bone marrow transplant is at high risk for bone marrow rejection and must receive immunosuppressive medications as scheduled to prevent rejection. Protective isolation, not contact precautions, are followed to prevent infection in this immunocompromised client, as does hand hygiene. Oral hygiene prevents infections from beginning in the mouth. Graft versus host disease is an allergic reaction that can occur; early recognition is vital.

The nurse is planning to administer IVIG to a child for the first time. What actions related to this therapy are indicated? Select all that apply.

-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. Explanation: 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 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." Explanation: 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.

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 client needs to be monitored for signs of infection and adhere to the schedule for follow-up blood tests to evaluate for complications.

The young girl has been diagnosed with juvenile idiopathic arthritis (JIA) and has been prescribed methotrexate. Which statements by the child's parent indicates that adequate learning has occurred? Select all that apply.

-"We'll need to bring her back in for some lab tests after she starts methotrexate." -"Swimming sounds like a good exercise for her." -"A warm bath before bed might help her sleep better." Explanation: The child diagnosed with JIA 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 useful 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 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. Explanation: Nurses can help the nation achieve the 2020 National Health Goals for allergies and immunologic functioning by advocating for improved air quality in schools, initiating educational programs for children and adolescents that include teaching about the way HIV is transmitted, such as through sexual relations and unclean intravenous needles, and protective measures they can take to avoid contracting the disease, including safer sex practices and not using intravenous drugs. Explaining how certain foods promote food borne illnesses does not support the identified 2020 National Health Goals for allergies and immunologic functioning.

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?

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 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 Explanation: 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.

The nurse is preparing to administer IVIG to an adolescent. Prior to administration, which baseline lab values does the nurse need to review? Select all that apply.

BUN. Serum creatinine. Explanation: Prior to administering IVIG the nurse must assess baseline serum blood urea nitrogen (BUN) and creatinine, as acute renal insufficiency may occur as a serious adverse reaction

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 Explanation: Renal complications may result from lupus. This may be accompanied by hypertension making monitoring of blood pressure of the highest importance.

Cyclophosphamide has been prescribed for a client. What considerations are indicated?

Encourage voiding with medication administration. Explanation: Cyclophosphamide is a cytotoxic medication. It suppresses bone marrow activity. The child should be encouraged to void during and after administration to prevent hemorrhagic cystitis. The medication should be administered in the morning. Food intake does not have a bearing on the administration of this medication.

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) 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.

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 laboratory results of a child with juvenile arthritis are being evaluated. Which are consistent with this condition? Select all that apply.

Hemoglobin 9.3 mg/dL Erythrocyte sedimentation rate elevated Explanation: Juvenile arthritis is characterized by changes in laboratory results which include anemia and elevations in the erythrocyte sedimentation rate. A hemoglobin of 9.3 mg/dL is consistent with anemia and thus arthritis. A white blood cell count of 7.9 mg/dL is normal.

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.

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. Explanation: 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.

Anaphylaxis clinical manifestations

Lip edema, urticaria, stridor, and tachycardia

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 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 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 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.

The most accurate screening test for the presence of HIV antigen in young children is...

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.

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 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.

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. 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 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.

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