immunity ch42
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 Explanation: 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 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.
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 Explanation: 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 nurse is caring for a child who is having an anaphylactic reaction with bronchospasm. The nurse would expect to administer what medication for bronchospasm as ordered?
Albuterol Explanation: The nurse would expect to administer bronchodilation inhalation treatment (albuterol) if bronchospasm is present. Epinephrine, diphenhydramine, and/or corticosteroids are administered to reverse the allergic process.
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 Explanation: The PCR is the preferred test to determine HIV infection in infants over 1 month of age. The ELISA is positive in infants of HIV-infected mothers because of transplacentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate at detecting HIV infection in infants and toddlers than the PCR. The platelet count would provide no information about the infant's HIV status. CD4 counts would be used to monitor HIV infection but not to confirm whether the infant is positive or negative for the virus.
A nursing instructor teaches students about the possibility of pregnant women with HIV infecting their fetuses. Which of the following statements by a student indicates the need for further teaching about pregnancy and HIV?
Pregnancy will definitely accelerate the progression of the disease. Explanation: Of the nearly 1,000,000 people in the United States infected with HIV, 25% are female. The infection has become the leading cause of death in women 25 to 44 years. Of every 1,000 women giving birth, 1% to 2% are HIV positive. When the disorder is discovered during pregnancy, pregnancy does not appear to accelerate the progression of the disease.
A group of nursing students are reviewing information about humoral and cellular immunity. The students demonstrate understanding of this material when they identify what as being involved in cellular immunity?
T cells Explanation: Cellular immunity involves T cells, which do not recognize antigens. B cells, antibodies, and antigens are involved in humoral immunity.
A newborn is found to have Di George syndrome and has misshaped ears, a small mandible, and an absent thymus. The nurse recognizes that this condition is associated with which of the following types of immunodeficiency disorders?
T-lymphocyte deficiency Explanation: T-lymphocyte immunodeficiencies involve inadequate numbers or inadequate functioning of one or more types of T lymphocytes; this affects cell-mediated immunity and also, because of helper T-lymphocyte function, possibly humoral immunity as well. Di George syndrome is a chromosomal disorder in which there is deletion of a small piece of chromosome 22. This leads to not only a T cell defect but misshaped or low-set ears, smaller than usual mandible, absent thymus, neonatal tetany, and congenital heart disease.
The nurse is caring for a 6-month-old infant whose mother tested positive for HIV during her pregnancy. The infant had a positive polymerase chain reaction (PCR) for HIV at birth. Which medication would be prescribed for the prevention of pneumocystis pneumonia (PCP)?
Trimethoprim-sulfamethoxazole (TMP-SMZ) Explanation: Trimethoprim-sulfamethoxazole (TMP) is the drug of choice for the prevention of pneumocystis pneumonia. Prophylaxis usually begins at the age of 6 months.
The nurse is explaining to a parent some of the basic aspects of the immune system and its functions. She informs them that B cells, also known as _________ cells, will attack __________ antigens.
humoral; bacterial Explanation: B cells are also called humoral cells and typically attack bacterial organisms. Another term for T cells is killer cells, and they most commonly attack viral organisms.
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 Explanation: 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.
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?
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.
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?
IgG Explanation: 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.
Nursing students demonstrate correct understanding when they identify which immunoglobin as occurring most frequently in plasma and the major one to be synthesized during secondary response?
IgG Explanation: IgG is the most frequent antibody in plasma and is the major immunoglobin to be synthesized during the secondary response.
The nurse is caring for a newborn whose mother is HIV positive. The nurse would expect to administer a 6-week course of which medication?
Zidovudine Explanation: Children born to HIV-positive mothers should receive a 6-week course of zidovudine therapy. Lopinavir, ritonavir, and nevirapine are medications used for treatment of HIV-1 infections as part of a three-drug regimen.