Peds: PrepU Ch. 25

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. -Pneumonia last spring; resolved with antibiotics -Acute otitis media, one episode every 3 to 4 weeks over the past year. -Oral thrush, persistent over the past 6 to 7 months -Infected laceration requiring IV antibiotic 2 months ago; healed -Recurrent deep abscess of the thigh

-Acute otitis media, one episode every 3 to 4 weeks over the past year. -Recurrent deep abscess of the thigh -Oral thrush, persistent over the past 6 to 7 months Warning signs associated with primary immunodeficiency include four or more new episodes of acute otitis media in 1 year, recurrent deep skin or organ abscesses, persistent oral thrush or skin candidiasis after 1 year of age. A history of infections requiring IV antibiotics to heal and two or more episodes of pneumonia in 1 year are also warning signs.

The 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? -"Maybe the allergy testing didn't evaluate everything your child is allergic to." -"Does your child get a whipped cream or foam topping on their favorite drink?" -"That doesn't really make any sense if your child is only allergic to eggs." -"Maybe coffee drinks just don't agree with your child's system."

"Does your child get a whipped cream or foam topping on their favorite drink?" Albumin, globulin, ovalbumin should be avoided if allergic to eggs. Some foam toppings for drinks contain these substances and would cause an allergic reaction to the person allergic to eggs. This would be important information to ascertain from the family as they would likely not be aware of this.

The nurse is caring for a child and notes periorbital edema on the left eye with urticaria. Which action by the nurse is priority? -Assess lung sounds bilaterally. -Ask if the child has allergies. -Administer a corticosteroid. -Evaluate fluid volume status.

Assess lung sounds bilaterally. When a child has signs of angioedema, the nurse's priority is to ensure the airway is patent, by assessing breathing sounds, because angioedema can cause laryngeal obstruction and asphyxiation. Evaluating fluid volume status, asking about allergies, and administering a corticosteroid are all actions that could be performed after first ensuring the child was breathing.

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? -Instruct the parents to soak the lesions in mineral oil. -Advise the parents to change the infant's formula. -Encourage parents to avoid feeding the infant peanuts. -Contact the health care provider to request treatment.

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.

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? -Corticosteroid challenge testing -Complete dietary protein restriction -Hyposensitivity testing -Elimination diet

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.

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? -Erythrocyte sedimentation rate -Polymerase chain reaction test -Immunoglobulin electrophoresis -Enzyme-linked immunosorbant assay (ELISA)

Enzyme-linked immunosorbant assay (ELISA) The ELISA test will be positive in infants of HIV-infected mothers because of trans-placentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate in detecting true HIV infection in infants and toddlers than the polymerase chain reaction (PCR). The PCR test is positive in infected infants over the age of 1 month. The erythrocyte sedimentation rate would be ordered for an immune disorder initial workup or ongoing monitoring of autoimmune disease. Immunoglobulin electrophoresis would be ordered to test for immune deficiency and autoimmune disorders.

Which immunoglobin occurs most frequently in plasma and is the major immunoglobulin synthesized during secondary response? -IgA -IgD -IgG -IgM

IgG IgG is the most frequent antibody in plasma and is the major immunoglobin to be synthesized during the secondary response. IgG represents about 75% of all serum antibodies. Most of the newborn's IgG is transferred via the placenta to the fetus. The infant develops passive immunity to antigens in which the mother has developed antibodies. The infant begins to manufacture IgG after about 6 months of age. IgG reaches 50% of its adult level at 1 year of age and full adult level at age 7 years. IgD is only found in about 1% of plasma. Its function is to signal for B cells to be activated. IgA protects the mucus membranes against the invasion of microbes. IgM is the first antibody to respond to infection.

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? -Make an appointment for the child to be seen by the physician within 24 hours. -Inquire about any changes in the child's normal routine. -Instruct the child be brought to the emergency department promptly. -Inquire about when the child's last dose of medication was taken.

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.

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? -hepatomegaly noted during percussion -crackles noted in lower lobes of the lungs -Kaposi sarcomas observed on the skin -enlarged lymph nodes felt with palpation

Kaposi sarcomas observed on the skin 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 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. -Cherries -Peanut butter -Bananas -Pineapples -Squash -Cheese

Pineapples Cherries Bananas 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.

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 -Prophylactic treatment for HIV -Screening for sexually transmitted infections (STIs) -Proper nutrition

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 pediatric client is admitted to the hospital. The primary health care provider suspects a problem with the child's immune system. The nurse anticipates preparing this client for which test initially? -Bone marrow biopsy -Lumbar puncture -Serum blood testing -Stem cell analysis

Serum blood testing When there is a deficiency of immunocompetent cells, an assessment will focus on analysis of blood components, particularly white blood cells, T cells, and immunoglobulin levels. The results of these tests will indicate the need to additional testing. A stem cell analysis would be completed if a stem cell transplant was indicated. This test helps determine compatability. A bone marrow biopsy is done to determine if the bone marrow is healthy and making normal amounts of blood cells. A lumbar puncture is done to collect cerebrospinal fluid for diagnostic testing. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system.

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: -a raw food diet. -an elimination diet. -a food diary. -allergy skin testing.

an elimination diet. The food diary may identify foods the child does not tolerate well, but it lacks the objectivity of the elimination diet. Skin testing usually involves whole proteins and will not test for reactions to food breakdown products. A raw food diet does not apply to allergy identification.

The nurse is 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 systemic JIA. -has pauciarticular JIA. -is at risk for anaphylaxis. -has polyarticular JIA.

has polyarticular JIA. Polyarticular JIA is defined by the involvement of five or more joints, frequently the small joints, and affects the body symmetrically. Pauciarticular JIAs is defined by the involvement of four or fewer joints. Systemic JIA presents with fever and rash in addition to join involvement at the time of diagnosis. The child with JIA is not at greater risk for anaphylaxis.

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." -"We can inject an extract of the food under the skin and see if there is a reaction." -"Skin testing using a patch is probably the easiest method." -"We can check the level of antibodies in the blood to confirm the allergy."

"The best way is to eliminate the food from the diet and then look for improvement." Food allergies are best identified by eliminating a suspected food from the diet and observing whether symptoms improve. After a time of improvement, the food is reintroduced and if the child is allergic to the food, the symptoms will return. Skin testing with either a patch or intracutaneous injection is ineffective for determining food allergies. Serum antibody levels can be measured but are not specific in helping to determine food allergies.

The nurse is 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? -1500/mm3 -1900/mm3 -1300/mm3 -1700/mm3

1300/mm3 The number of CD4 T lymphocytes in the blood helps to determine the effectiveness of antiretroviral therapy. Normal is 1500/mm3 in the infant, so anything below that number may indicate that the therapy is not effective.

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. -Malnutrition -Minor localized infection -Immunosuppressive drugs -Vitamin therapy -Cancer

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.

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

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

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? -IgG -IgE -IgM -IgA

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

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 -Bananas -Potatoes -Eggs -Carrots

Eggs Shrimp Peanuts Foods that should be avoided in children younger than 1 year of age include cow's milk, eggs, peanuts, tree nuts, sesame seeds, and fish and shellfish (i.e., shrimp). Carrots, potatoes, and bananas are not considered problematic.

The nurse is assessing a child who is experiencing renal complications as a result of lupus. Which finding is of the greatest concern?

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

The nurse is educating an immunocompromised child about the organs that assist in the immune process. The nurse recognizes teaching was effective when the child identifies which organs? Select all that apply. -gall bladder -thymus -liver -bone marrow -spleen

liver spleen thymus bone marrow The major organs of the immune system are the thymus, liver, bone marrow, spleen, tonsils, lymph nodes, and blood. The gallbladder assists with digestion.

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? -"We don't know why children develop immune disorders." -"Immune responses can be genetic and run in the family." -"Asthma can be prevented by avoiding any family allergens." -"Your child will develop asthma since the father has asthma."

"Immune responses can be genetic and run in the family." 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 mother of a child with myasthenia gravis inquires about thymus gland removal. She reports she has read that this is a possible cure for her child. What response by the nurse is indicated?" -"Removal of this gland may not improve your child's symptoms." -"Once your child is 15 this condition can be considered." -"This is a promising treatment and can result in a total cure for your child." -"Removing the thymus gland is not performed in children."

"Removal of this gland may not improve your child's symptoms." Myasthenia gravis is an autoimmune condition. It is characterized by progressive weakness and fatigue. There is not cure. Removal of the thymus gland is recommended by some professionals but the thymus gland and its relationship to this disease are not clear. Removal of the gland may not improve the child's condition.

The 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." -"This medication prevents infection from occurring in your body." -"This medication boosts your immune system so you don't get infections." -"This medication is an anti-inflammatory drug that will help you feel better."

"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.

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. -Sharing contaminated needles -Through breastfeeding -Exposure to blood and body fluids through sexual contact -Perinatally from mother to fetus -Transfusion of contaminated blood -Sharing the same bathroom

-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. It can not be contracted through using the same bathroom. It must be direct contact.

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? -IgM -IgA -IgG -IgE

-IgE 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.

Which client will the nurse assess first after receiving shift report? -A client with contact dermatitis who has blisters and mild edema on the lower extremities -A client with serum sickness stating, "I just feel bad all over." -A client with human immunodeficiency virus (HIV) whose temperature is 102.2°F (39°C) -A client newly diagnosed with allergic rhinitis prescribed loratadine 10 mg

A client with human immunodeficiency virus (HIV) whose temperature is 102.2°F (39°C) Of the immunologic disorders, HIV infection is the most serious. This client is also exhibiting an unexpected manifestation, which could indicate an infection. The clients with serum sickness and dermatitis are exhibiting expected findings and would be seen last. The client newly diagnosed needs to be seen second to have the medication started and receive education.

Which nursing intervention is priority when caring for a child with HIV? -Review laboratory CD4 counts daily. -Assess pain after invasive procedures. -Assist the child with daily activities. -Administer prescribed medications.

Administer prescribed medications. 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 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? -IgA -IgE -IgG -IgM

IgE 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.

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

Lymphocyte immunophenotyping T-cell quantification Lymphocyte immunophenotyping T-cell quantification is for ongoing monitoring of progressive depletion of CD4 T lymphocytes in HIV disease. The nurse would expect the physician to order a complement assay (C3 and C4) for ongoing monitoring of systemic lupus erythematosus. IgG subclasses measures the levels of the four subclasses of IgG and is used to determine immunodeficiencies. Immunoglobulin electrophoresis is ordered for immunodeficiency and autoimmune disorders, not to monitor systemic lupus erythematosus.

The 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? -"We must make sure that the black tip is pointed downward." -"The epinephrine auto-injector must be held firmly for 10 seconds." -"The epinephrine auto-injector should be jabbed into the upper arm." -"We must massage the area for 10 seconds after administration."

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.

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? -Ritonavir -Zidovudine -Nevirapine -Efavirenz

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

The nurse is 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: -pregnancy. -feeding with breast milk. -the birthing process. -sexual contact.

sexual contact. Horizontal transmission refers to person-to-person transfer of the virus. Transmission by feeding with breast milk, birthing, and pregnancy are all examples of vertical transmission.

The 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? -"That is odd. Does anyone else in your family react that way?" -"Has your child ever been tested for a peanut allergy?" -"Maybe it's an allergy to something else and you just notice after eating there by coincidence." -"Is your child allergic to milk?"

"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.

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

-Have you noticed any hair loss or redness on your face?" Alopecia and the characteristic malar rash (butterfly rash) on the face are common clinical manifestations of SLE. Rhinorrhea, wheezing, and an enlarged spleen are not hallmark manifestations of SLE. Petechiae and purpura are more commonly associated with hematological disorders, not SLE.

The nurse is 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? -Contact the physician. -Check the physician's orders for an antiemetic. -Discontinue the infusion. -Take the client's vital signs.

Discontinue the infusion. Clients receiving intravenous immunoglobulin are at risk for anaphylaxis. Vomiting can signal an allergic response. The first action would be to stop the infusion. The remaining activities are appropriate for inclusion in the plan of care but are not of the highest priority.

The 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? -"Toxic amounts of diphenhydramine can cause this response in children." -"Children with eczema are more likely to have a medication allergy." -"Side effects, such as drowsiness and dryness, do not indicate an allergy." -"Your child is exhibiting signs and symptoms of an allergic reaction."

"Side effects, such as drowsiness and dryness, do not indicate an allergy." Although children with atopic dermatitis (eczema) are more likely to develop a medication allergy, side effects of diphenhydramine (drowsiness, dry mouth, constipation, etc.) can occur normally alongside the therapeutic effect of the medication. Common side effects do not indicate a toxic amount of the medication was given. Signs of an allergic reaction to a medication include: urticaria, angioedema, allergic contact dermatitis, flushing, pruritus, purpura, wheezing and/or rhinitis.

The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for a pediatic client with an immune disorder receiving a stem cell transplant. Which action by the UAP will cause the RN to intervene? -The UAP places a lunch tray in the client's room. -The UAP takes a rectal temperature on the client. -The UAP assists the client to ambulate in the room. -The UAP wears a mask when entering the client's room.

The UAP takes a rectal temperature on the client. Precautions must be taken to protect the client from infection. The RN would intervene if the UAP takes a rectal temperature because this increases the client's risk for infection. The client should not receive rectal suppositories as well. The RN would ensure meticulous oral care is provided and encourage appropriate and adequate nutrition. Delivering a meal tray, wearing a mask when entering the room, and assisting the client to ambulate in the room are all appropriate actions by the UAP.

Nursing students correctly label the group of cells whose job is to ingest, engulf, and neutralize pathogens as: -immunoglobins. -red blood cells. -immunogens. -macrophages.

macrophages. Macrophages (mature white blood cells) engulf, ingest, and neutralize pathogens. Red blood cells do not fight infection. They carry hemoglobin and carry oxygen from the lungs to the tissues. In the immune response, immunoglobulins are antibodies and immunogens are antigens.

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: -the mother kissing the baby on the forehead -placental spread during pregnancy -blood transfusion products contaminated with the virus -breastfeeding

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 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 immunity mediated by antibodies secreted by B cells." -"Cellular immunity is cell-mediated immunity controlled by T cells." -"Humoral immunity is generally functional at birth." -"Phagocytosis is the process in which phagocytes swallow up and break down microorganisms."

"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 monitoring the labs of a child admitted for an exacerbation of juvenile pauciarticular arthritis. Which lab result does the nurse expect to be elevated? -Radioallergosorbent test) -Lymphocyte immunophenotyping T-cell quantification -Immunoglobulin electrophoresis -Erythrocyte sedimentation rate (ESR)

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 in the emergency department is examining an 18-month-old child who recently received a first dose of penicillin. The nurse notes lip edema, urticaria, stridor, and tachycardia. Which action will the nurse take next? -Begin cardiopulmonary resuscitation (CPR) -Gather tracheal intubation equipment -Administer epinephrine -Obtain intravenous (IV) access

Administer epinephrine The nurse would suspect the child is experiencing anaphylaxis and administer epinephrine. Lip edema, urticaria, stridor, and tachycardia are common clinical manifestations of anaphylaxis. CPR is not indicated; the child is still breathing and has a heart rate at this time. The nurse would want to ensure IV access is obtained and have intubation equipment at hand; however, these are not priority.

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? -"The grey part of the EpiPen® should never be removed until right before we use it." -"I will make sure my daughter always has her EpiPen® with her all the time." -"If we need to use the EpiPen® we will need to notify her physician's office the next business day." -"I have found a website that makes medical alert bracelets in my daughter's favorite color."

If we need to use the EpiPen® we will need to notify her physician's office the next business day." If an EpiPen® is used, the child still needs immediate medical attention. EpiPens should be carried with the patient at all times. When administering an EpiPen, the grey safety cap should not be removed until immediately prior to using. Medical alert bracelets or necklaces should be worn by all children with severe allergies.

The nurse is caring for a school-age child recently diagnosed with an allergy to peanuts. Which nursing action is a priority? -Remind parents to report the allergy to the child's school teacher. -Advise parents the child may benefit from skin testing. -Offer the parents information about a community support group. -Include the child when discussing foods that contain peanuts.

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 working with a pregnant client who is HIV positive and has been prescribed oral zidovudine. Which statement by the nurse explains the primary rationale for taking this medication? -"Zidovudine will help stimulate your fetus's growth during pregnancy." -"It is to help prevent transmission of the disease to your infant." -"This will help halt the growth of your Kaposi's sarcoma." -"This medication will help to restore your coagulation ability before labor."

"It is to help prevent transmission of the disease to your infant." A goal of therapy during pregnancy is to maintain the CD4 cell count at greater than 500 cells/mm3 by administering oral zidovudine, which helps halt maternal/fetal transmission dramatically along with one or more protease inhibitors, such as ritonavir or indinavir, in conjunction with a nucleoside reverse transcriptase inhibitor (NRTI). Kaposi's sarcoma is normally treated with chemotherapy. Women may need a platelet transfusion close to birth to restore coagulation ability. This medication has no affect on the fetus's growth and development.

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? Question the child about the amount of penicillin that was taken. Encourage the child to wear a medical alert bracelet for penicillin. Educate the parents about possible side effects of penicillin in children. Advise the parents to have their child evaluated for atopic diseases.

Encourage the child to wear a medical alert bracelet for penicillin. Oral medications most likely to cause an allergic reaction include antibiotics, acetylsalicylic acid (aspirin), and NSAIDs. Children experiencing stridor, wheezing, and urticaria after taking a medication most likely have an allergy to that medication. The priority nursing action for discharge education is to prevent the child from being exposed to penicillin again, which could be accomplished by encouraging the child to wear a medical alert bracelet. Although children with atopic diseases are more likely to have medication allergies, requesting parents have the child evaluated, is not a priority. Questioning the child about the amount of penicillin taken and educating parents about the side effects of penicillin is not a priority.

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? -Increase the number of schools with an indoor air management system. -Refer at-risk community members to the clinic for HIV/AIDS screening. -Provide education to sexually active females about proper condom usage. -Reduce the baseline level of allergens in dust within homes and buildings.

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 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 -The nurse should suggest to the child to speak with his doctor -The nurse should explain the infection to the child The nurse should tell the parents when they enter the child's room --that their child has a question for them

The nurse should encourage the child to talk with his parents about his medications Generally, children older than 6 years of age will eventually need to have their diagnosis disclosed to them in an age-appropriate manner. They begin to ask questions and often seem to sense that something is going on other than what they've been told so far. Encouraging discussion with the parents is the best first step.