47 alterations in immunity/immuologic disorder prepu

Impair complement-dependent antigen-antibody reactions to prevent flares in SLE and juvenile arthritis

Antimalarial drugs: hydroxychloroquine sulfate Funduscopic eye examination and visual field testing every year

The nursing instructor has completed a presentation on normal immune function. Which statement by a student would suggest a need for further education? "Phagocytosis is the process in which phagocytes swallow up and break down microorganisms." "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."

Correct response: "Humoral immunity is generally functional at birth." Explanation: 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 assessing a child who is experiencing renal complications as a result of lupus. Which finding is of the greatest concern? Elevated temperature Elevated blood pressure Hypotension Reduced body temperature

Correct response: 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.

A child comes to the emergency department with difficulty breathing from severe bronchoconstriction. The parent informs the nurse that the child ate a peanut, to which the child is allergic. Which type of reaction is this client having? Type IV: cell-mediated hypersensitivity Type III: immune complex Type II: cytotoxic response Type I: anaphylaxis

Correct response: Type I: anaphylaxis Explanation: Anaphylaxis is an acute reaction characterized by extreme vasodilatation that leads to circulatory shock and extreme bronchoconstriction, which in turn decreases the airway.

Interfere with normal function of DNA by alkylation. For treatment of severe SLE

Cytotoxic drugs (cyclophosphamide) Cause bone marrow suppression. Monitor for signs of infection Cyclophosphamide: Administer in the morning Provide adequate hydration and have child void frequently during and after infusion to decrease risk of hemorrhagic cystitis

cellular vs humoral immunity

Humoral immunity secretes antibodies to fight against antigens, whereas cell-mediated immunity secretes cytokines and no antibodies to attack the pathogens.

Bind to HIV-1 reverse transcriptase, blocking DNA polymerase activity and disrupting the virus life cycle.

Nonnucleoside analog reverse transcriptase inhibitors (NNRTIs): efavirenz, nevirapine

Inhibit reverse transcription of the viral DNA chain

Nucleoside analog reverse transcriptase inhibitors (NRTIs): abacavir, lamivudine, zidovudine

cystitis

inflammation of the bladder

antimetabolite that depletes DNA precursors, inhibits DNA and urine synthesis Do not give oral form with dairy products. Approximate time to benefit in treatment of arthritis is 3-6 weeks

methotrexate (dmard)

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 IgG IgA IgM

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

What nursing instruction would best identify foods to which a child is allergic? Thoughtful elimination of diet choices Hyposensitivity testing in the arm Complete dietary protein restriction Corticosteroid challenge testing

Correct response: Thoughtful elimination of diet choices Explanation: Elimination diets involve adding foods slowly to a child's diet so foods to which the child is allergic can be identified. Hypersensitivity, no hyposensitivity, testing is used to assess reactions to certain potential allergens. No need to restrict protein. Corticosteroid challenge testing is used to assess adrenal functioning.

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

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

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? Immunoglobulin electrophoresis Lymphocyte immunophenotyping T-cell quantification Erythrocyte sedimentation rate (ESR) Radioallergosorbent test)

Correct response: 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 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 sexually transmitted infections (STIs) Screening for HIV Prophylactic treatment for HIV Proper nutrition

Correct response: 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 providing education to the parents of a child prescribed oral cyclophosphamide. Which statement by the parent indicates additional teaching is needed? "I will monitor my child closely for signs of an infection." "I need to give this medication to my child at bedtime." "I will wear rubber gloves if I need to clean up any of my child's body fluids." "My child needs to drink plenty of fluids while taking this medication."

Correct response: "I need to give this medication to my child at bedtime." Explanation: Cyclophosphamide is an antineoplastic medication given to clients. It should not be given at bedtime because infrequent voiding could lead to cystitis. It would be administered in the morning. The client should be monitored for infections and signs should be reported to the health care provider. The medication can pass into body fluids; therefore, anyone coming into contact with such fluids, handling contaminated trash or laundry, or changing diapers should wear rubber gloves. Soiled clothing and linens should be washed separately from other laundry. The client needs to drink plenty of fluids and void frequently to avoid cystitis.

A school-aged child, who is allergic to bee stings, states, "I think I was stung by a bee outside." Which intervention by the school nurse is most appropriate? Assess the client for signs of anaphylactic shock Administer epinephrine Determine if the client was stung Apply an ice compress to the site

Correct response: Assess the client for signs of anaphylactic shock Explanation: First, the nurse will assess the client for signs of anaphylactic shock and then administer epinephrine if warranted. Epinephrine counteracts histamine release to decrease bronchospasm and difficulty breathing. If there were no signs of anaphylactic shock, the nurse would determine if the child was actually stung. The nurse would apply ice to promote vasoconstriction once the client was stable

The nurse is assisting with skin testing for allergies in a pediatric client. What will the nurse do to ensure the results are accurate? Be certain the child has not received an antihistamine in the past 8 hours Read the test results within 40 minutes of administration. Inject the allergens into the muscle of the child's forearm. Apply a topical diphenhydramine cream to the site following each injection.

Correct response: Be certain the child has not received an antihistamine in the past 8 hours Explanation: Skin testing is done to detect the presence of IgE in the skin, or to isolate an antigen (allergen) to which the IgE is responding or to which a child is sensitive. When an allergen is introduced into the child's skin and the child is sensitive to that allergen, a wheal or flare response will appear at the site of the test from the release of histamine, which leads to local vasodilation. Because this reaction appears quickly, the test should be read in 20 minutes, not 40 minutes. Systemic or aerosol administration of an antihistamine will inhibit the flare response, so the nurse must be certain the child has not received these drugs for 8 hours before skin testing. Applying a diphenhydramine cream would interfere with the results. Diphenhydramine is an antihistamine medication and should be avoided up to 10 days prior to the procedure.

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

Correct response: A client with human immunodeficiency virus (HIV) whose temperature is 102.2°F (39°C) Explanation: 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.

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

Correct response: Exposure to blood and body fluids through sexual contact Sharing contaminated needles Transfusion of contaminated blood Perinatally from mother to fetus Through breastfeeding Explanation: 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 cannot be contracted by using the same bathroom. It must be direct contact.

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. "Autoimmune disorders may cause you to have a false negative result on the ELISA test." "Since you are a minor, this test is confidential." "The ELISA test is a single test. It does not require you to be tested multiple times."

Correct response: "The ELISA method detects antibodies so a person may have a false negative test for up to six months after exposure. Explanation: ELISA method detects only antibodies, so the test may remain negative for several weeks up to 6 months (false-negative) after exposure. A false-positive may result with autoimmune disease. The ELISA test requires serial testing. HIV test results are confidential.

A 7-year-old client presents to the emergency room (ER) after experiencing an allergic reaction to a bee sting. The client is breathing and able to verbally communicate. The nurse notes the client's pulse 90 beats/minute, respirations are 23 breaths/minute, blood pressure is 100/60 mm Hg, lungs are clear. Which nursing action is priority? Administer epinephrine to the client. Assess the client's oxygen saturation level. Apply ice to the site of the sting. Ask if any medications were given before arriving to the ER.

Correct response: Ask if any medications were given before arriving to the ER. Explanation: The nurse would first determine if any medications have already been administered to this client. The client does not appear to be in distress based on the assessment in the scenario as the vitals are within normal range and lungs are clear. The nurse would expect stridor, wheezing, hypotension, tachycardia, and shortness of breath—among other symptoms—in the client having an anaphylactic reaction. Since the client is stable, epinephrine is not indicated at this time. The nurse would assess an oxygen level; however, this is not priority over determining how severe the client's reaction was. Ice could be applied to the site. This would be most beneficial if done immediately following the sting.

The parents of a child with juvenile idiopathic arthritis bring the child to the emergency department because the child is very drowsy and breathing heavily. The child also has been vomiting and reporting ringing in her ears. Which medication would the nurse suspect as a cause for this toxic reaction? aspirin corticosteroid methotrexate etanercept

Correct response: aspirin Explanation: The child is exhibiting signs and symptoms of aspirin toxicity. Corticosteroids would lead to signs and symptoms of Cushing syndrome as well as masking the signs of infection. Methotrexate would lead to changes in the white blood cell count, placing the child at risk for infection. Etanercept, like methotrexate, places the child at risk for infection.

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."

Correct response: "The medication disrupts the virus life cycle of HIV. This prevents the disease from progressing." Explanation: 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.