B11

The nurse is preparing to administer subcutaneous epinephrine hydrochloride (Adrenalin) 0.01 mg/kg to a child weighing 88 lb. How many milliliters of the medication will the nurse provide? (Numeric value only. Calculate to the10th decimal point.)

Ans: 0.40 mg Feedback: The nurse needs to first determine the patient's weight in kilograms by dividing the weight in pounds by 2.2 or 88 / 2.2 = 40 kg. Then the nurse is to multiply the dose of 0.01 mg by the weight or 0.01 mg × 40 kg = 0.40. The nurse is to provide the patient with 0.40 ml of the medication.

A newborn weighing 6.6 lb is prescribed zidovudine (ZDV) 2 mg/kg every 6 hours to reduce the risk of maternal transmission of HIV. The pharmacy prepares an infusion of 1,000 mg of the medication in 1 L of 0.9% normal saline. How many milliliters of the medication will the nurse infuse for each dose? (Numeric value only.)

Ans: 6 ml Feedback: The nurse needs to first determine the patient's weight in kilograms by dividing 6.6 lb by 2.2 or 6.6 / 2.2 = 3 kg. The nurse then needs to determine the amount of medication for each dose by multiplying 2 mg × 3 or 6 mg. If the infusion contains 1,000 mg/1,000 ml, then each milliliter contains 1 mg of medication. For a dosage of 6 mg, the nurse would infuse 6 ml.

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? A) Elimination diet B) Hyposensitivity testing C) Corticosteroid challenge testing D) Complete dietary protein restriction

Ans: A Feedback: 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.

A child is experiencing anaphylactic shock. Which nursing action is a priority? A) Facilitate breathing. B) Counteract hypertension. C) Enhance the action of histamine. D) Reverse sympathetic nervous system responses.

Ans: A Feedback: In anaphylactic shock, the child has symptoms caused by the stimulation of histamine. Bronchospasm can become so severe the child becomes dyspneic, hypoxemic, and then hypoxic. Facilitating breathing is the priority. The blood pressure falls in anaphylactic shock. A goal of therapy is to reverse parasympathetic nervous system responses.

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.) A) Promote following safe sexual practices. B) Discourage the use of intravenous substances. C) Discuss the role of sexual relations in HIV transmission. D) Explain how certain foods promote immunologic compromise. E) Encourage parents to discuss the air quality in the schools with the school district.

Ans: A, B, C, E Feedback: 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 immunologic compromise does not support the 2020 National Health Goals for allergies and immunologic functioning.

The nurse is teaching the parents of a child with multiple environmental allergies on ways to control allergens in the home. What should the nurse include in these instructions? (Select all that apply.) A) Remove all carpeting. B) Install a dehumidifier in the home. C) Consider having fish as pets instead of a dog or cat. D) Remove stuffed toys unless filled with synthetic material. E) Replace furniture with upholstered chairs and sofas for sitting.

Ans: A, B, D Feedback: Actions to control environmental allergens include removing all carpeting in the home, installing a dehumidifier, and only permitting stuffed toys filled with synthetic material. Fish and aquariums should be removed because they cause mold spores. Upholstered chairs and sofas should be replaced with wooden chairs and surfaces.

The nurse is caring for a child diagnosed with category B HIV. What should the nurse expect to review in this patient's medical history? (Select all that apply.) A) Pneumonia B) Herpes zoster C) Kaposi sarcoma D) Cardiomyopathy E) Positive tuberculosis test

Ans: A, B, D Feedback: In category B HIV, the patient will experience serious illnesses such as pneumonia, cardiomyopathy, and herpes zoster. Kaposi sarcoma and tuberculosis are associated with category C HIV.

The health care provider instructs the parents of a toddler with allergies to avoid secondary smoke. What teaching should the nurse provide to assist these parents? (Select all that apply.) A) Frequent smoke-free establishments. B) Declare the home and car smoke-free zones. C) Spray air freshener in the room after smoking. D) Ask individuals who smoke to smoke out of doors. E) Encourage family and friends to begin quit-smoking programs.

Ans: A, B, D, E Feedback: Guidelines to avoid secondary smoke include frequenting smoke-free establishments, declaring the home and car smoke-free zones, asking individuals who smoke to smoke out of doors, and encouraging family and friends to begin quit-smoking programs. Spraying air freshener in the room after smoking will not reduce the child's exposure to secondary smoke.

2. The nurse is reviewing the immunization schedule with the mother of a child who has HIV. What information should the nurse provide the mother about immunizations for this child? (Select all that apply.) A) Pneumococcal vaccination can be given. B) The child should receive live vaccines only. C) The human papillomavirus vaccine should not be given. D) The varicella vaccine should not be given if the child is symptomatic. E) If the CD4 count is low, the measles, mumps, and rubella vaccine should not be given

Ans: A, D, E Feedback: 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 (MMR) vaccine

The nurse is caring for a preschool-age child who has been seen in the emergency department for an allergic reaction to stinging insects twice in the last month. What should the nurse instruct the parents to help reduce the child's exposure to insects? A) Keep the child's hair short. B) Keep the child away from the trash. C) Use lightly scented powders and lotions. D) Avoid going outdoors during the heat of the day.

Ans: B Feedback: Children who are allergic to stinging insects should stay away from garbage containers because insects tend to cluster around trash. The length of hair does not impact the frequency of insect stings. The parents should avoid scented preparations such as lotions or powders because these attract insects. The child can go out of doors during the heat of the day but should not go barefoot and should have a fast-acting insecticide handy to use on flying insects.

. Which nursing diagnosis should the nurse use to guide care for a child with allergic rhinitis? A) Risk for fluid volume deficit B) Pain related to sinus edema and headache C) Ineffective tissue perfusion related to frequent nosebleeds D) Disturbed self-esteem related to inherited tendency for illness

Ans: B Feedback: Children with allergic rhinitis may report full frontal headaches that become even more marked with adolescence. Pain related to sinus edema and headache would be the most appropriate diagnosis to guide care for this patient. Allergic rhinitis does not increase the risk for fluid volume deficit. Nosebleeds are not associated with allergic rhinitis. Allergic rhinitis is not severe and should not cause disturbed self-esteem.

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? A) IgA B) IgE C) IgG D) IgM

Ans: B Feedback: IgE is involved in immediate hypersensitivity reactions and is associated with allergy and parasitic infections. IgA is found in saliva, sweat, and tears and provides defense against pathogens on exposed surfaces. IgG is the most frequently occurring antibody in plasma and neutralizes bacterial toxins. IgM lyses cell walls and is early to arrive in the presence of an infection in the bloodstream.

A 6-month-old baby diagnosed with atopic dermatitis has been receiving treatment by the parents. Which approach that the parents are using indicates that additional health teaching is necessary? A) After a bath, the mother applies Eucerin cream. B) To dry lesions, the father applies alcohol to lesions daily. C) The mother gives the baby a daily bath without using soap. D) To aid healing, the father applies hydrocortisone cream to the lesions

Ans: B Feedback: When the atopic dermatitis lesions begin to heal, a skin emollient and moisturizer, such as Eucerin, or baths with a substance to lubricate the skin, such as Alpha-Keri, are prescribed to prevent excessive skin dryness. The parents should be instructed to soak the infant in the bath with the lubricant for approximately 15 minutes. The skin should be patted, not rubbed, dry so lesions are not aggravated. Soap is not to be used for bathing, because it can be drying. Alcohol dries the skin and can be painful to open lesions. Hydrocortisone cream may be prescribed to aid in the healing of the lesions.

. A preschool-age child is being seen for a rash that occurred after the mother applied a sunscreen prior to permitting the child to swim at the beach. For which type of allergic reaction should the nurse prepare teaching materials for the mother? A) Autoimmunity B) Atopic dermatitis C) Contact dermatitis D) Delayed hypersensitivity

Ans: C Feedback: Contact dermatitis is an example of a delayed or type IV hypersensitivity response. It is a reaction to skin contact with an allergen. The allergen causing the irritation is often suggested by the part of the child's body that is affected. The sunscreen caused the contact dermatitis in the patient. Autoimmunity is the result of the immune system to distinguish self from nonself, causing the immune system to carry out immune responses against normal cells and tissue rather than invading antigens. Individuals with atopic dermatitis are prone to all types of allergic responses. Three disorders occur most frequently: hay fever, eczema, and asthma. Delayed hypersensitivity occurs without an accompanying humoral response. This response causes transplant rejection.

A child with allergic rhinitis is prescribed a nasal antihistamine spray. When advising the parents about the use of the sprays, what should the nurse explain about the rebound phenomenon? A) It causes a permanent increase in nasal secretions. B) It causes reflux of gastric contents into the esophagus. C) It causes an increase in nasal secretions after an initial decrease. D) It causes a decrease in histamine release after an initial increase.

Ans: C Feedback: Review with the parents that if nasal antihistamine sprays are given for more than 3 days, a rebound effect can occur. The nasal mucosa becomes more edematous rather than less edematous, and symptoms will appear to worsen rather than improve. The rebound phenomenon does not cause a permanent increase in nasal secretions, reflux of gastric contents into the esophagus, or a decrease in histamine release after an initial increase.