PrepU 15. Immunologic

The client has been prescribed antihistamines and a round of corticosteroids to treat an allergic reaction to an unknown food source. Which statement by the client indicates he understands the allergic condition and medication regimen?

"Corticoteroids help the inflammation that goes along with an allergy." "I may have to undergo intradermal testing to determine what I am allergic to." "Once we figure out what I am allergic to, it is important for me to avoid that allergen."

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."

The nurse is providing discharge teaching to the client with myasthenia gravis. Which statements by the parents of the client demonstrate knowledge of proper care? Select all that apply.

"If my child shows signs of an upper respiratory infection I will contact our physician right away." "We love to take family vacations to Florida, but we will have to find a new vacation spot." "I picked up our child's medical alert bracelet today."

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." If an EpiPen® is used, the child still needs immediate medical attention.

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." 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 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 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 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."

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?

Administer epinephrine immediately.

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.

The nurse is reviewing the results of a rheumatoid factor test of several clients diagnosed with juvenile idiopathic arthritis. Which client would be most likely to demonstrate a positive rheumatoid factor?

Adolescent with polyarticular disease

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

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.

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.

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

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

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

PCR

The nurse is caring for a child presenting with eye inflammation, knee pain, poor appetite and poor weight gain. The nurse is aware that this is which type of juvenile idiopathic arthritis?

Pauciarticular (oligoarticular) Pauciarticular or (oligoarticular) arthritis symptoms include involvement of four or fewer joints; quite often the knee is involved, eye inflammation, malaise, poor appetite, poor weight gain.

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

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 is preparing an educational program for members of the office staff. The topic is the warning signs of primary immunodeficiency. What information should be included? Select all apply.

Two or more episodes of severe sinusitis in 1 year. Failure to thrive in an infant. Two or more serious infections such as sepsis. History of infections requiring IV antibiotics to clear. Warning signs of primary immunodeficiency include four, not two, or more new episodes of acute otitis media in 1 year. Other warning signs include failure to thrive in the infant, two or more episodes of severe sinusitis in 1 year, two or more serious infections such as sepsis and/or a history of infections requiring IV antibiotics to clear.

Drug allergies can cause many types of symptoms. Which might you expect to see in a child with a severe penicillin allergy? Select all that apply.

Wheezing Urticaria Serum sickness

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

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.

When caring for a child experiencing anaphylactic shock, the most important nursing action would be to:

facilitate breathing.

Nebulized albuterol should be available to counteract anaphylactic shock. This drug:

facilitates breathing.

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.

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?"

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.

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?"

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."

The nurse is providing discharge instructions for a client taking a coritcosteroid. Which statements by the parents alert the nurse that clarification of instructions is needed?

"We should be sure to administer the medication on an empty stomach so the medication will be absorbed better." "If the medication doesn't seem to be working, we can stop giving it to our child at any time."

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

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

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

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

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

Corticosteroids Nonsteroidal anti-inflammatories

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 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 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

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.

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

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:

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 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

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 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.

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

Elimination diet

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 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.

A client was admitted to the medical unit for exacerbation (flare-up) of symptoms of systemic lupus erythematosis (SLE). When reviewing the client's chart the nurse notices that the he has a "butterfly rash." The nurse will assess for this rash on what area of the client's body?

Face

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?

Gently roll the vial to mix the medication. The nurse knows not to 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 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 should have epinephrine available during the infusion in case of an adverse reaction.

A nursing student correctly identifies what to be the most serious of all of the immunologic disorders?

Human immunodeficiency virus (HIV)

Which immunoglobulin is associated with allergic reactions?

IgE

A child with systemic lupus erythematosus is receiving hydroxychloroquine sulfate. Which instruction would the nurse emphasize when teaching the child and parents about this drug?

Importance of yearly eye examinations