Ch 48
When reviewing the history of a child with suspected primary immunodeficiency, which of the following would the nurse be least likely to find? A)Weight appropriate for height B)Antibiotic therapy for the past 3 months without effect C)10 episodes of otitis media in the last year D)Three bouts of sinusitis within a year's time
Ans: A Feedback:Weight appropriate for height would not be associated with primary immunodeficiency. Rather, failure to thrive is considered a warning sign. Other warning signs of primary immunodeficiency include eight or more episodes of acute otitis media in 1 year; two or more episodes of severe sinusitis in 1 year; treatment with antibiotics for 2 months or longer with little effect; two or more episodes of pneumonia in 1 year; recurrent deep skin or organ abscesses; persistent oral thrush or skin candidiasis after age 1 year; history of infections that do not clear with antibiotics; two or more serious infections; and a family history of primary immunodeficiency.
Which of the following would the nurse expect to find in a male infant with Wiskott-Aldrich syndrome? A)Eczema B)Thrombocytosis C)Lymphadenopathy D)Pneumonia
Ans: A Feedback:Wiskott-Aldrich syndrome is manifested by eczema that usually worsens with time, petechiae, bloody diarrhea, or a bleeding episode in the first 6 months of life. Thrombocytopenia is present. Lymphadenopathy is associated with hypogammaglobulinemia. Pneumonia is associated with severe combined immune deficiency.
A nurse is assessing a child who may have a latex allergy. The nurse asks the child about allergic reactions with certain foods. Which foods if identified by the child as experiencing an allergic reaction would help support the suspected latex allergy? Select all answers that apply. A)Peaches B)Plums C)Carrots D)Tomatoes E)Apples F)Lettuce
Ans: A, B, C, D Feedback:Foods with a known cross-sensitivity to latex include pear, peach, passion fruit, plum, pineapple, kiwi, fig, grape, cherry, melon, nectarine, papaya, apple, apricot, banana, chestnut, carrot, celery, avocado, tomato, or potato. Apples and lettuce are not associated with a cross-sensitivity.
A nursing student is reviewing information about primary immunodeficiencies. The student demonstrates understanding of the material by identifying which of the following as affecting only males? Select all answers that apply. A)X-linked agammaglobulinemia B)Wiskott-Aldrich syndrome C)Selective IgA deficiency D)X-linked hyper-IgM syndrome E)IgG subclass deficiency F)Severe combined immune deficiency
Ans: A, B, D Feedback:X-linked agammaglobulinemia, Wiskott-Aldrich syndrome, and X-linked hyper-IgM syndrome affect males only. Selective IgA deficiency, IgG subclass deficiency, and severe combined immune deficiency affect boys and girls
The nurse is reviewing the laboratory test results of a child who is suspected of having systemic lupus erythematosus (SLE). Which of the following would the nurse identify as supporting this diagnosis? Select all answers that apply. A)Positive antinuclear antibody (ANA) B)Increased C3 levels C)Thrombocytopenia D)Leukopenia E)Increased hematocrit
Ans: A, C, D Feedback:Laboratory findings may include decreased hemoglobin and hematocrit, decreased platelet count, and low white blood cell count. Complement levels, C3 and C4, will also be decreased. Though not specific to SLE, the ANA is usually positive in children with SLE.
The nurse is talking to the parents of a child who has been diagnosed with severe combined immune deficiency. Which statement by the parents best indicates that they understand their child's condition? A)"He'll need to receive intravenous immunoglobulin routinely." B)"We'll need to prepare him and ourselves for a bone marrow transplant.' C)"He'll need to receive several different types of antiviral medications." D)"We'll make sure that he has his EpiPen with him at all times."
Ans: B Feedback:Severe combined immune deficiency (SCID) is a potentially fatal disorder requiring emergency intervention at the time of diagnosis. Gene therapy provides some promise for the future treatment of SCID, but until then bone marrow or stem cell transplantation is necessary. IVIG may be used to help decrease the number of infections until bone marrow or stem cell transplantation can be done. Antiviral medications are used to treat HIV infection. An EpiPen is used for anaphylaxis.
When teaching a group of new parents about newborn care and development, which immunoglobulin would the nurse explain as being primarily responsible for the passive immunity exhibited by newborns? A)IgA B)IgG C)IgM D)IgE
Ans: B Feedback:IgG is acquired transplacentally, providing the newborn with passive immunity to antigens to which the mother had developed antibodies. IgA, IgD, IgE, and IgM do not cross the placenta and require an antigenic challenge for production.
A nurse is preparing a plan of care for a child with a primary immunodeficiency. Which nursing diagnosis would the nurse most likely identify as the priority? A)Imbalanced nutrition, less than body requirements related to poor appetite B)Ineffective protection related to impaired humoral defenses C)Acute pain related to inflammatory processes D)Risk for delayed growth and development related to chronic illness
Ans: B Feedback:The child with a primary immunodeficiency lacks the necessary immune responses that provide protection from infection. Therefore, the priority nursing diagnosis would be ineffective protection. Imbalanced nutrition and risk for delayed growth and development may be appropriate, but these would not be the priority. Acute pain would be more appropriate for a child with juvenile idiopathic arthritis.
After teaching a class about humoral and cellular immunity, the nurse recognizes that the additional teaching is needed when the class states which of the following? A)Humoral immunity crosses the placenta. B)Cellular immunity involves the T lymphocytes. C)Cellular immunity recognizes antigens. D)Humoral immunity does not destroy the foreign cell.
Ans: C Feedback:Humoral immunity recognizes antigens and cellular immunity does not. Humoral immunity crosses the placenta in the form of IgG. Cellular immunity involves the action of T lymphocytes, and humoral immunity does not destroy the foreign cell.
Which exercise would the nurse suggest as most helpful to maintain mobility in a child with juvenile idiopathic arthritis? A)Jogging every other day B)Using a treadmill C)Swimming D)Playing basketball
Ans: C Feedback:Swimming is a particularly useful exercise to maintain joint mobility without placing pressure on the joints. Jogging, using a treadmill, and playing basketball would place pressure on the joints of the lower extremities.
The nurse is assessing a child with pauciarticular-type juvenile idiopathic arthritis. Which of the following would the nurse expect to assess? A)Fever B)Rash C)Eye inflammation D)Splenomegaly
Ans: C Feedback:With pauciarticular juvenile idiopathic arthritis, eye inflammation may be noted. Fever, rash, and enlarged spleen would be noted with systemic juvenile idiopathic arthritis.
A child with systemic lupus erythematosus is receiving high-dose corticosteroid therapy over the long term. The nurse would instruct the parents and child to report which of the following? A)Difficulty urinating B)Visual changes C)Joint pain D)Rash
Ans: C Feedback:Avascular necrosis (lack of blood supply to a joint, resulting in tissue damage) may occur as an adverse effect of long-term or high-dose corticosteroid use. Teach families to report new onset of joint pain, particularly with weight bearing, or limited range of motion. Complications of systemic lupus erythematosus include nephritis manifested by urinary changes and visual changes. Rash may develop secondary to photosensitivity. These are unrelated to the long-term or high-dose corticosteroid use.
A child is diagnosed with juvenile idiopathic arthritis and is receiving several different medications listed in the medication administration record. Which agent would the nurse identify as being used to prevent disease progression? A)Aspirin B)Prednisone C)Ibuprofen D)Methotrexate
Ans: D Feedback:Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, are necessary to prevent disease progression. Other agents, such as aspirin and ibuprofen, are helpful with pain relief. Prednisone helps for relief of inflammation.
A group of nursing students are reviewing information about humoral and cellular immunity. The students demonstrate understanding of this material when they identify which of the following as involved in cellular immunity? A)B cells B)Antibodies C)Antigens D)T cells
Ans: D Feedback:Cellular immunity involves T cells, which do not recognize antigens. B cells, antibodies, and antigens are involved in humoral immunity.
A child with hypogammaglobulinemia is to receive intravenous immunoglobulin (IVIG). Which of the following would be least appropriate for the nurse to do? A)Shake the vial after reconstituting it B)Premedicate the child with acetaminophen C)Obtain preinfusion vital signs D)Check serum blood urea nitrogen and creatinine levels
Ans: A Feedback:Many IVIG products are packed as two vials, one the IVIG powder and one the sterile diluents. Once reconstituted, the IVIG should not be shaken because this leads to foaming and may cause the immunoglobulin protein to degrade. The child can be premedicated with acetaminophen or diphenhydramine. Baseline serum blood urea nitrogen and creatinine should be assessed because acute renal insufficiency may occur as a serious adverse reaction.
The nurse is administering intravenous immune globulin (IVIG). The nurse assesses vital signs and for adverse reactions every 15 minutes for the first hour of administration. After the first hour, the nurse most likely would continue to assess the child at which frequency? A)Every 30 minutes B)Every 45 minutes C)Every 60 minutes D)Every 2 hours
Ans: C Feedback:The nurse needs to continue assessments according to institutional protocol. Every 15 minutes for the first hour and every 30 minutes through the remainder of the infusion is the standard assessment.
A child is diagnosed with a food allergy to milk. When teaching the parents about this allergy, which of the following would the nurse suggest as possible substitutions? Select all answers that apply. A)Fruit juice B)Rice milk C)Yogurt D)Nondairy creamers E)Soy milk
Ans: A, B, E Feedback:Milk can be replaced with water, fruit juice, rice milk, or soy milk. Yogurt contains milk and some nondairy products such as creamers may contain milk and should be avoided.