Immunity

A nurse is planning to give a preschool child an immunization consisting of bacterial cells that have been modified. What is the substance called?

A vaccine

The mother of an 8-year-old child with the diagnosis of acute poststreptococcal glomerulonephritis (APSGN) is concerned that a 4-year-old sibling may also have the disorder. When preparing to explain the disease process the nurse recalls that it is caused by:

An immune complex disorder occurring after a group A β-hemolytic Streptococcus infection

A client who had a kidney transplant develops leukopenia three weeks after surgery. The nurse concludes that the leukopenia probably is caused by:

Antirejection medications

After multiple bee stings a client experiences an anaphylactic reaction. The nurse determines that the symptoms the client is experiencing are caused by:

Bronchial constriction and decreased peripheral resistance

Blackwater fever occurs in some clients with malaria. For which response should the nurse assess this client?

Dark red urine

A client with acquired immunodeficiency syndrome (AIDS) is receiving a treatment protocol that includes a protease inhibitor. When assessing the client's response to this drug, which common side effect should the nurse expect?

Diarrhea

A nurse plans to teach the signs of rejection to a client who just had a transplanted kidney. What sign of rejection should the nurse include?

Elevated blood pressure

A client who just had a kidney transplant is transferred from the postanesthesia care unit (PACU) to the intensive care unit (ICU). The nurse in the ICU should monitor the client's urinary output every:

Hour

During an acquired immunodeficiency syndrome (AIDS) education class a client states, "Vaseline works great when I use condoms." Which conclusion about the client's knowledge of condom use can the nurse draw from this statement?

Ignorance related to correct condom use

The significant other of a client who is dying of AIDS tells the nurse, "Life is not worth living without my partner." What should the nurse plan to do to help the significant other cope with the impending death?

Involve the significant other's support system.

A client comes to the emergency department reporting symptoms of the flu. When the health history reveals intravenous drug use and multiple sexual partners, acute retroviral syndrome is suspected, and a test for the human immunodeficiency virus (HIV) is performed. Which clinical responses are associated most commonly with this syndrome? Select all that apply .

Malaise Swollen lymph glands

A client has experienced an episode of myasthenic crisis. Which of the following may be a precipitating factor of myasthenic crisis?

Omitting doses of medication

A mother is concerned that her newborn will be exposed to communicable diseases when she goes home. While teaching the mother ways to decrease the risk of infection, what type of immunity should the nurse explain was transferred to her baby through the placenta?

Passive natural

The nurse is caring for a client who is receiving azathioprine (Imuran), cyclosporine, and prednisone before receiving a kidney transplant. The nurse explains that the purpose of the medication is to:

Reduce antibody production

A nurse is caring for a client who is a victim of trauma and is to receive a blood transfusion. How should the nurse respond when the client expresses fear that acquired immunodeficiency syndrome (AIDS) may be acquired as a result of the blood transfusion?

Screening for the human immunodeficiency virus (HIV) antibodies has minimized this risk."

A mother brings her 6-year-old child to the pediatric clinic, stating that the child has not been feeling well, is weak and lethargic, and has a poor appetite, headaches, and smoky-colored urine. What additional information should the nurse obtain that will aid diagnosis?

Strep throat in the past 2 weeks

A 5-year-old-child is undergoing chemotherapy. The mother tells the nurse that the child is not up to date on the required immunizations for school. What is the best response by the nurse?

This isn't the best time to finish the immunizations, because your child's immune system is suppressed."

The health care provider prescribes epoetin (Procrit) for a client who has acquired immunodeficiency syndrome (AIDS). When administering this medication, the nurse should:

Use a syringe that has a 1-inch, 25-gauge needle

A nurse is caring for a client with acquired immunodeficiency syndrome (AIDS). What precautions should the nurse take when caring for this client?

Use standard precautions

A school nurse is teaching the parents of school-age children about the importance of immunizations for the childhood communicable diseases. What preventable disease may have the complication of encephalitis?

Varicella

Parents are considering a bone marrow transplant for their child who has recurrent leukemia. The parents ask the nurse for clarification about the procedure. What is the best response by the nurse?

Your child's immune system must be destroyed before the transplantation can take place

A newly arrived Russian immigrant attends the prenatal clinic for the first time. Although she states that she has had immunizations, she does not know which ones. Which immunizations should the nurse recommend? Select all that apply.

Diphtheria Hepatitis B

A nurse is providing counseling to a client with the diagnosis of systemic lupus erythematosus (SLE). What recommendations are essential for the nurse to include? Select all that apply .

Eat foods high in vitamin C. Take your temperature daily. Balance periods of rest and activity.

A client comes to the clinic for a physical and asks to be tested for acquired immunodeficiency syndrome (AIDS). Which test should the nurse explain will be used for the initial screening for HIV?

Enzyme-linked immunosorbent assay (ELISA)

In addition to hepatitis B, pneumococcal, H. influenza type B, and varicella vaccines, what should the nurse expect a 20-month-old child who has been receiving immunizations on schedule to have had?

Four DTaPs, three IPVs, and one MMR

A client asks the nurse what advantage breastfeeding holds over formula feeding. What major group of substances in human milk are of special importance to the newborn and cannot be reproduced in a bottle formula?

Gamma-globulins

n addition to Pneumocystis jiroveci , a client with acquired immunodeficiency syndrome (AIDS) also has an ulcer 4 cm in diameter on the leg. Considering the client's total health status, the most critical concern is:

Gas exchange

A nurse has just administered an immunization injection to a 2-month-old infant. What instructions should the nurse give the parent if the infant has a reaction?

Give acetaminophen for fever; call the health care provider if the child exhibits marked drowsiness or seizures.

A nurse is caring for a client with a diagnosis of acquired immunodeficiency syndrome (AIDS). The IV infiltrates and needs to be restarted. What is necessary to protect the nurse when restarting the IV? Select all that apply

Gloves Hand hygiene

While receiving a blood transfusion, a client develops flank pain, chills, fever, and hematuria. What type of transfusion reaction does the nurse conclude that the client probably is experiencing?

Hemolytic

A 5-year-old child who is HIV positive is taken to the health department for immunizations before the start of school. The CD4 count shows severe immunosuppression. What immunizations can the child be given safely at this time? Select all that apply.

Hepatitis A Polio vaccine (IPV) Diphtheria, tetanus, pertussis (DTaP)

A 6-month-old infant is to receive scheduled immunizations. The parents ask why two influenza vaccines are given: Haemophilus influenzae type B (Hib) and pneumococcal conjugate vaccine (PCV). How should the nurse respond?

Hib and PCV prevent different bacterial diseases.

An 18-month-old child has received all required immunizations. What immunization should the nurse explain to a parent will be one of the vaccines required between 4 and 6 years of age?

Inactivated poliovirus

The nurse explains to a client that a positive diagnosis for human immunodeficiency virus (HIV) infection is made based on:

Positive enzyme-linked immunosorbent assay (ELISA) and Western blot tests

A client is admitted to the hospital with a diagnosis of acute Guillain-Barré syndrome. What frequent assessment does the nurse determine is most important for a client with this syndrome?

Respiratory exchange

A nurse is caring for a client with glomerulonephritis. What should the nurse instruct the client to do to prevent recurrent attacks?

Seek early treatment for respiratory tract infections.

A nurse is caring for a 26-year-old client recently diagnosed with human immunodeficiency virus (HIV) and has a CD4 count of 150. The client needs an update on immunizations and asks which ones are needed. Which vaccines are required to comply with the recommended immunization schedule for a client with HIV?

Tetanus, hepatitis B, influenza, and pneumococcal vaccines

A client who is scheduled for a modified radical mastectomy decides to have family members donate blood in the event it is needed. The client has type A negative blood. Blood can be used from relatives whose blood is:

Type A or O negative

A nurse is assessing clients who are to be given the smallpox vaccination. Which client should the nurse remove from the immunization line for medical counseling?

45-year-old woman with breast cancer

An adolescent has been admitted with symptoms of fatigue, intermittent fever, weight loss, and arthralgia, and the diagnosis is systemic lupus erythematosus. The nurse knows that the best intervention at this time is:

Education about diet, rest, and exercise

A client with gastric cancer asks whether the cancer will spread. The nurse identifies that the client is looking for reassurance. When preparing a response to the client's question, the nurse recalls that gastric cancers are most likely to metastasize to the:

Liver and lung.

The parents of an infant ask a nurse why their baby is not receiving the measles, mumps, and rubella (MMR) vaccine at the same time that other immunizations are being given. What explanation should the nurse give about why the MMR vaccine is administered at 12 to 15 months of age?

Maternal antibodies provide immunity for about 1 year.

A newborn's immunization program is started. While discussing the immunization schedule for the first 6 months with the parents, the nurse informs them that infants usually are not immunized against

Measles

The 8-year-old son of migrant farm workers is brought to the county health clinic. He has no history of immunizations. After measles is diagnosed, the public health nurse goes to the migrant camp to search for people with a greater-than-average chance of contracting the disease. What is the name of this variable?

Risk factor