#1 PEDS Chapter47 Nursing Care of the Child With an Alteration in Immunity or Immunologic Disorder

The nurse is reviewing the laboratory test results of a child who is suspected of having systemic lupus erythematosus (SLE). What would the nurse identify as supporting this diagnosis? Select all that apply. A)Positive antinuclear antibody (ANA) B)Increased C3 levels C)Thrombocytopenia D)Leukopenia E)Increased hematocrit

A, C, D 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 caring for a 6-month-old boy with Wiskott-Aldrich syndrome. The nurse teaches the parents which of the following: a) "Don't encourage a pacifier due to possible oral malformation" b) "Do not use a sponge bath for light cleaning" c) "Don't use a tub bath for daily cleansing" d) "Do not insert anything in the rectum"

"Do not insert anything in the rectum" Children with Wiskott-Aldrich syndrome should not be given rectal suppositories or temperatures since these children are at a high risk for bleeding.

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? a) "We can inject an extract of the food under the skin and see if there is a reaction." b) "Skin testing using a patch is probably the easiest method." c) "The best way is to eliminate the food from the diet and then look for improvement." d) "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." Explanation: 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

A child with HIV, weighing 25 kg, is about to receive an infusion of IVIG. The recommended dose is 400 mg/kg/dose. The medication is available in a concentration of 50 mg/mL. What is the proper amount of infusion that the child will receive?

200 mL Explanation: The dose is calculated as 25 x 400 = 10,000 mg. Because the concentration is 50 mg/mL, calculate the volume as 10,000/50 = 200 mL.

The nurse is providing home care instructions for a 13-year-old girl recently diagnosed with systemic lupus erythematosus. Which response by the girl indicates a need for further teaching? A)"I need to wear sunscreen in the summer to prevent rashes." B)"I need to eat a healthy diet, exercise, and get plenty of sleep." C)"I need an eye examination every year." D)"I need to be careful when it is cold; I should always wear gloves."

A. "I need to wear sunscreen in the summer to prevent rashes." The nurse needs to emphasize that the girl should apply sunscreen every day, not just in the summer, to prevent rashes resulting from photosensitivity. A healthy diet, sleep, yearly eye examinations, and protection from cold weather are appropriate measures.

A nurse in the emergency department is examining an 18-month-old with lip edema, urticaria, stridor, and tachycardia. The nurse immediately suspects: a) anaphylaxis. b) systemic lupus erythematosus. c) severe polyarticular juvenile idiopathic arthritis. d) severe combined immunodeficiency.

Anaphylaxis. Explanation: Lip edema, urticaria, stridor, and tachycardia are common clinical manifestations of anaphylaxis.

The nurse is caring for a child who is beginning to show signs and symptoms of anaphylaxis. Which intervention would be the priority? a) Obtaining brief history of allergen exposure b) Assessing patency of the airway c) Administering IV diphenhydramine (Benadryl) d) Administering corticosteroids

Assessing patency of the airway Explanation: The priority nursing intervention is to assess patency of the airway and breathing. If the child is stable, the next step would be to obtain a brief history of allergen exposure. If epinephrine is required, it would be administered prior to diphenhydramine. Corticosteroids would be used to prevent late-onset reactions.

A woman in her fourth month of pregnancy has recently learned that her sexual partner is HIV positive. She agrees to be tested for the virus but asks the nurse what early symptoms she should be looking for in herself. Which of the following should the nurse mention to the client? a) Mild, flu-like symptoms b) Genital warts c) Skin rash d) Vaginal discharge

Mild, flu-like symptoms Explanation: Unlike other sexually transmitted infections, HIV infection rarely begins with reproductive tract lesions. Instead, early symptoms are more subtle and often difficult to differentiate from those of other diseases or even from the symptoms of early pregnancy such as fatigue, anemia, diarrhea, and weight loss. The initial invasion of the virus may be accompanied by mild, flulike symptoms.

Cyclophosphamide

Systemic lupus erythematosus (SLE)

HIV infects the CD4 cells, also known as the ___________ cells

T- helper

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 which of the following? a) The child has polyarticular JIA b) The child has pauciarticular JIA c) The child is at risk for anaphylaxis d) The child has systemic JIA

The child has polyarticular JIA Explanation: 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.

When treating allergies in a child, the nurse is aware that the classification for the drug of choice to control itching, sneezing, and rhinorrhea is which of the following? a) Antihistamines b) Decongestants c) Antibiotics d) Corticosteroids

a. Antihistamines block histamine release and as a result control itching, sneezing, and rhinorrhea.

Methotrexate

arthritis

Protease inhibitors

treatment of HIV as part of 3 drug regimen

The nurse is preparing to administer the child's dose of intravenous immune globulin (IVIG). Which of the following activities by the nurse indicates the need for further education? Select all that apply. a) The nurse is prepared to give acetaminophen to the child b) The nurse is prepared to give diphenhydramine to the child c) The nurse is preparing to administer the medication ventrogluteal site as an intramuscular injection d) The nurse takes baseline vital signs and will monitor the vital signs during the infusion e) The nurse has mixed the medication with the child's intravenous antibiotic

• The nurse is preparing to administer the medication ventrogluteal site as an intramuscular injection • The nurse has mixed the medication with the child's intravenous antibiotic Explanation: IVIG should be given only intravenously and should not be given as an intramuscular injection. IVIG cannot be mixed with other medications. The nurse should closely monitor the child's vital signs during the infusion of the IVIG. The child may require an antipyretic and/or an antihistamine during infusion to help with fever and chills.

When evaluating parents' understanding of atopic dermatitis, which of the following statements would you want to hear them voice? a) "Flare-ups of lesions are not uncommon following therapy." b) "Hydrocortisone cream may lead to kidney disease." c) "Atopic dermatitis follows a streptococcal infection." d) "Atopic dermatitis turns to asthma later in life."

"Flare-ups of lesions are not uncommon following therapy." Explanation: Atopic dermatitis may recur when the child is re-exposed to the substance to which he or she is allergic.

To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant? a) "What do you give her to alleviate itching?" b) "Do you have a telephone to call us immediately if she develops trouble breathing?" c) "Is there any family history of allergy to penicillin?" d) "Has she ever had penicillin before?"

"Has she ever had penicillin before?" Explanation: Penicillin is a drug frequently involved in allergic reactions. The reaction occurs after the child has first been sensitized to the drug.

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? a) 0.2 mg b) 0.4 mg c) 0.8 mg d) 1 mg

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 caring for an infant exposed to HIV. The polymerase chain reaction (PCR) test was negative at birth. The nurse tells the mother that the child will most likely be tested again at what age? a) 8 to 10 weeks b) 2 to 3 months c) 12 months d) 4 to 7 weeks

4 to 7 weeks Explanation: Virologic testing for HIV-exposed infants should be done with the polymerase chain reaction test at birth, at 4 to 7 weeks, and again at 8 to 16 weeks. Serologic testing is done at approximately 12 months of age to document disappearance of the HIV-1 antibody

Which of the following would best identify foods to which a child is allergic? a) Hyposensitivity testing b) Elimination diet c) Corticosteroid challenge testing d) Complete dietary protein restriction

Elimination diet Elimination diets involve adding foods slowly to a child's diet so foods to which the child is allergic can be identified.

juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is the most common type of arthritis in kids and teens. It typically causes joint pain and inflammation in the hands, knees, ankles, elbows and/or wrists. But, it may affect other body parts too

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 which of the following? a) Pregnancy b) The birthing process c) Feeding with breast milk d) Sexual contac

Sexual contact Explanation: 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

To establish whether the problem is truly a milk allergy in a child who is suspected of having this condition, milk should be reintroduced every 6 to 12 months. a) True b) False

True Explanation: To establish whether the problem is truly a milk allergy, milk should be reintroduced every 6 to 12 months. If the problem is a true milk allergy, signs will recur

A nurse is providing care to a child with HIV who is prescribed therapy with a nucleoside reverse transcriptase inhibitor. Which of the following would the nurse expect to administer? a) Nevirapine b) Ritonavir c) Efavirenz d) Zidovudine

Zidovudine Explanation: 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 caring for a 4-year-old girl with HIV. The girl is taking nucleoside analogue reverse transcriptase inhibitors (NRTI) as part of a three-drug regimen. The nurse knows to monitor for signs of a fatal hypersensitivity reaction that can occur with which of the following medications? a) Abacavir b) Ritonavir c) Lamivudine d) Zidovudine

a. Abacavir A fatal hypersensitivity reaction may occur with abacavir.

A nursing student correctly identifies the inability to distinguish self from nonself, causing the immune system to carry out immune responses against normal cells, as which of the following? a) autoimmunity b) allergen c) delayed hypersensitivity d) immunity

autoimmunity Explanation: Autoimmunity results from an inability to distinguish self from nonself, causing the immune system to carry out immune responses against normal cells and tissue. Delayed hypersensitivity is when T-lymphocyte activity occurs without an accompanying humoral response. Immunity is the ability to destroy like antigens. An allergen is any mediating substance that when released causes tissue injury and allergic symptoms.

A nursing instructor is preparing a teaching plan for a class about the immune response. When discussing the immune response, which of the following would the instructor describe as being primarily involved in a secondary immune response? a) IgE b) IgG c) IgA d) IgM

b. IgG Only IgM and IgG are involved in primary and secondary immune responses. The main immunoglobulin produced in a secondary response is IgG. With a primary immune response, IgM antibodies peak at 14 days after an initial exposure to an antigen and then decline. This is followed by the production of IgG, which remains high for several weeks. IgE antibodies are involved in an immediate hypersensitivity reaction

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. a) humoral; viral b) humoral; bacterial c) killer; bacterial d) killer; viral

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.

The nursing diagnosis you anticipate that would best apply to a child with allergic rhinitis is a) risk for infection related to blocked eustachian tubes. b) disturbed self-esteem related to inherited tendency for illness. c) pain related to sinus edema and headache. d) ineffective tissue perfusion related to frequent nosebleeds.

pain related to sinus edema and headache. Correct Explanation: Many children with allergic rhinitis develop sinus headaches from edema of the upper airway

When teaching about primary and secondary humoral responses, what should the nurse identify as the immunoglobin that is first to appear in the serum? a) IgM b) IgD c) IgE d) IgG

IgM Explanation: IgM is the first immunoglobin to appear in the serum with the primary and secondary humoral responses

The nurse is providing instructions to the parents of a child with a severe peanut allergy. Which of the following statements by the parents indicates a need for further teaching about the use of the EpiPen Jr.?

"The EpiPen Jr. should be jabbed into the upper arm" Correct Explanation: The EpiPen Jr. 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 child is scheduled to undergo hyposensitization. The nurse understands that this therapy attempts to achieve which of the following? a) Blockage of histamine release b) An increased level of IgE c) Reduction in allergen exposure d) Increased concentration of IgG

Increased concentration of IgG Explanation: Hyposensitization works by increasing the plasma concentration of IgG antibodies. IgG acts to prevent or block IgE antibodies from coming into contact with the allergen. IgE levels are not increased. Antihistamines block the release of histamine. Environmental control helps to reduce exposure to potential allergens

Guillain-Barré syndrome

The condition may be triggered by an acute bacterial or viral infection. Symptoms start as weakness and tingling in the feet and legs that spread to the upper body. Paralysis can occur.

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? a) IgD b) IgM c) IgG d) IgA

IgG Explanation: IgG is the most frequent antibody in plasma and is the major immunoglobin to be synthesized during the secondary response.

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

"Have you noticed any hair loss or redness on your face?" Explanation: Alopecia and the characteristic malar rash (butterfly rash) on the face are common clinical manifestations of SLE.

A nurse is providing dietary interventions for a 12-year-old with a shellfish allergy. Which of the following responses indicates a need for further teaching? a) "Wheezing is a sign of a severe reaction" b) "We must order carefully when dining out" c) "He will likely outgrow this" d) "He must avoid lobster and shrimp"

"He will likely outgrow this" Correct Explanation: Older children and adolescents with allergic reactions to fish, shellfish, and nuts usually continue to have that concern as a life-long problem. The other statements are correct

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? a) Immediately transport the child to the local hospital. b) Administer epinephrine immediately. c) Apply a warm compress to the site of the bee sting. d) Notify the child's mother.

Administer epinephrine immediately. Explanation: Epinephrine counteracts histamine release to decrease bronchospasm and difficulty breathing.

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 complaining of ringing in her ears. The nurse suspects that the child is experiencing a toxic reaction to one of her medications. Which medication would the nurse suspect? a) Etanercept b) Aspirin c) Corticosteroid d) Methotrexate

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. (less)

Which of the following drugs should be available for emergency treatment of a child who goes into anaphylactic shock? a) Vistaril b) Morphine sulfate c) Meperidine d) Epinephrine

Epinephrine Explanation: Epinephrine (adrenaline) reverses the effects of histamine (severe bronchospasm and edema).

The steps to using an Epipen

Grasps Epipen with black tip pointing downward Forms a fist around the Epipen Pulls off the gray safety release Jabs the Epipen firmly into the outer thigh at a 90-degree angle Holds Epipen in place for 10 seconds Massages site for 10 seconds after removing Epipen

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? a) IgG b) IgE c) IgM d) IgA

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

A child is scheduled to undergo hyposensitization. The nurse understands that this therapy attempts to achieve which of the following? a) Blockage of histamine release b) Increased concentration of IgG c) An increased level of IgE d) Reduction in allergen exposure

Increased concentration of IgG Explanation: Hyposensitization works by increasing the plasma concentration of IgG antibodies. IgG acts to prevent or block IgE antibodies from coming into contact with the allergen. IgE levels are not increased. Antihistamines block the release of histamine. Environmental control helps to reduce exposure to potential allergens.

Question: The nursing instructor is describing the events of anaphylaxis. Place the assessment findings in the order that they would occur from first to last.

Nausea, vomiting, diarrhea Urticaria, angioedema Bronchospasm Hypoxia Seizures Explanation: Initially, a child may be nauseous, with vomiting and diarrhea, because of the sudden increase in gastrointestinal secretions produced by the stimulation of histamine. This is followed by urticaria and angioedema. Bronchospasm can become so severe the child becomes dyspneic and hypoxemic. Continued bronchospasm leads to hypoxia. As blood vessels dilate, the blood pressure and pulse rate fall. Seizures and death may follow as soon as 10 minutes after the allergen is introduced into the child's body.

Alopecia

hair loss

STEPS for the use of EpiPen?

These are the necessary steps for injecting the EpiPen: - First, make sure to hold the device correctly. - Then remove the cap - Next, place the injection tip against the thigh, either directly on the skin or on the clothing - Finally, hold the syringe in place for 10 seconds to make sure the content is injected properly.

A 6-month-old boy has been admitted to the hospital with severe bloody diarrhea. The nurse notes petechiae and eczema with signs of secondary infection. As the nurse documents the boy's history, the parents report easy bruising and prolonged bleeding after circumcision. Based on these findings, the nurse suspects a diagnosis of which of the following? a) Severe combined immunodeficiency b) von Willebrand's disease c) Wiskott-Aldrich syndrome d) Beta-thalassemia major

Wiskott-Aldrich syndrome Explanation: Severe bloody diarrhea, petechiae, bruising, eczema with secondary infection, and prolonged bleeding episodes are signs and symptoms of Wiskott-Aldrich syndrome. Beta-thalassemia major would be manifested by signs of bleeding. von Willebrand's disease would be manifested by signs of bleeding. Severe combined immunodeficiency would be manifested by chronic diarrhea and failure to thrive, persistent thrush, and a history of severe infections beginning in infancy. (less)

a _____________ rash is often an early sign oof a graft-versus-host disease that is developing in response to a bone marrow or stem cell transplant

maculopapular

Cyclosporine A

prevention of refection of renal transplant

in systemic lupus erythematosus (SLE), antibodies react with the child's ___________ to form immune complexes

self-antigen

After teaching a class of nursing students about acquired immunodeficiency, the instructor determines that the teaching was effective when the students identify which of the following as a contributing factor? Select all that apply. a) Immunosuppressive drugs b) Vitamin therapy c) Minor localized infection d) Malnutrition e) Cancer

• Cancer • Malnutrition • Immunosuppressive drugs Explanation: Factors contributing to secondary (acquired) immunodeficiency include severe systemic infection, cancer, renal disease, radiation therapy, severe stress, malnutrition, immunosuppressive therapy, and aging.

Which of the following treatments are common to both systemic lupus erythematosus and juvenile idiopathic arthritis? Select all that apply. a) Nonsteroidal antiinflammatories b) Corticosteroids c) Antipyretics d) Antirheumatics e) Antimalarial

• Corticosteroids • Nonsteroidal antiinflammatories Explanation: Antimalarials are specific to SLE; antirheumatics are specific to JIA. Antipyretics are not typically used for either disorder

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 of the following would the nurse most likely include? Select all that apply.

• Eggs • Peanuts • Shrimp Explanation: Foods that should be avoided in children younger than 1 year of age include: cow's milk, eggs, peanuts, tree nuts, sesame seeds, kiwi fruit, and fish and shellfish (ie, shrimp). Carrots, potatoes, and oranges are not considered problematic. (less)

A child with hypogammaglobulinemia is to receive intravenous immunoglobulin (IVIG). What action would not be correct to take? 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

A. Shake the vial after reconstituting it. 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 providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which of the following foods? a) Blueberries b) Pomegranate c) Banana d) Pumpkin

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

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

B. IgG 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.

What is the priority nursing intervention for the child recently admitted with Guillain-Barré syndrome? A. Perform range-of-motion exercises. B. Take temperature every 4 hours. C. Monitor respiratory status closely. D. Assess skin frequently.

C. Although range of motion and skin integrity are also important, the progressive paralysis associated with Guillain−Barré syndrome may lead to respiratory distress/arrest, so monitoring for respiratory involvement is critical.

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? A)Epinephrine B)Corticosteroid C)Albuterol D)Diphenhydramine

C. Albuterol 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.

The school nurse is walking through the lunchroom when one of the children says she started to feel strange after trading lunches with a friend. Which assessment would be most important? A)Asking if she has a rash anywhere B)Checking if she has any nausea C)Determining if her throat itches D)Asking if she has abdominal pain

C. Determining if her throat itches. Asking if the child's throat itches is most important because this aids in determining airway patency, which is always the priority. Asking about a rash, nausea, or abdominal pain can be done after the nurse is certain the child's airway is not jeopardized.

While providing care to a 5-month-old girl whose family has a history of food allergies, the nurse instructs the parents about foods to be avoided in the first year of life. Which response by the parents indicates a need for further teaching? A)"She cannot have any cow's milk." B)"I should continue breastfeeding until at least 6 months." C)"Peanuts in any form should be avoided." D)"Any kind of fruit is acceptable."

D. "Any kind of fruit is acceptable." The nurse should caution the parents that kiwifruit should be avoided. Other foods to avoid include cow's milk, eggs, peanuts, tree nuts, sesame seeds, fish, and shellfish. Breastfeeding also is recommended for at least the first 6 months.

Question: Place in correct order the steps in the anaphylactic response.

Exposure to allergen Rapid immune response Vasodilation Bronchoconstriction Circulatory collapse Explanation: Anaphylaxis typically is a very rapid response to exposure to an allergen. Vasodilation leads to potential circulatory collapse. Bronchospasm occurs simultaneously with other system reactions, also contributing to the life-threatening possibility.

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? a) IgM b) IgE c) IgG d) IgA

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

A group of nursing students are reviewing information about the immune system. The students demonstrate understanding of the information when they identify which of the following being produced by the thymus? a) Stem cells b) Lymphocyte T cells c) White blood cells d) Antibodies

Lymphocyte T cells Explanation: The thymus is responsible producing lymphocyte T cells. The bone marrow produces stem cells that are capable of differentiating into various blood cells. White blood cells arise from the stem cells in the bone marrow. Antibodies are formed by the B cells.

primary immune deficiencies such as SCID and Wiskott-Aldrich syndrome are cured only by ____________ or stem cell transplantation

bone marrow

When caring for a child experiencing anaphylactic shock, the most important nursing action would be to a) counteract hypertension. b) enhance the action of histamine. c) facilitate breathing. d) reverse sympathetic nervous system responses.

facilitate breathing. Explanation: The sudden release of histamine with an allergic reaction can cause severe bronchospasm, closing the airway.

While performing an assessment of a patient who is immunocompromised, the nurse notes the child to have thrush in the mouth, tenderness over the spleen upon palpation, and a white blood cell count of 3,000. Which nursing diagnoses will the nurse include in the care plan of this child based on these findings? Select all that apply. A)Ineffective protection B)Risk for imbalanced nutrition, less than body requirements C)Pain D)Impaired skin integrity E)Delayed growth and development

A, B, C Based on these symptoms the diagnosis of Ineffective protection is related to the decreased white blood cell count; Risk for imbalanced nutrition, less than body requirements, is related to the thrush; and Pain is related to the tenderness over the spleen and the thrush. There is no evidence to support the diagnoses of Impaired skin integrity or Delayed growth and development.

the nurse is assessing a child with complex medical hyistoy that includes fatigue, Raynaud phenomenon, anemia and photosensitivity. The nurse should anticipate that this child may require which treatment? a. antiretroviral therapy b. IVIG C. phototherapy D. corticosteroid

D. This child's symptoms are consistent with systemic lupus erythematosus (SLE), which is usually treated with corticosteroids.

The nurse is administering the prescribed intravenous immunoglobulin to a 10-year-old boy. Which of the following would be most important for the nurse to do? a) Have epinephrine available. b) Administer with food. c) Monitor for signs of Cushing syndrome. d) Monitor urine for glucose.

Have epinephrine available. Explanation: The nurse should have epinephrine available during the infusion in case of an adverse reaction. Monitoring urine for glucose would be appropriate when corticosteroids are being given. Intravenous immunoglobulin does not need to be administered with food because it is being given as an intravenous infusion. Monitoring for signs of Cushing syndrome would be appropriate when corticosteroids are given.

A 5 year old is hospitalized after an asthma attack at school. The child tells the nurse that the janitor had been cleaning in the classroom prior to the attack and that a lot of dust was in the air. The dust that likely caused the attack is known as what? a) allergen b) macrophage c) immunogen d) antigen

allergen Mediating substances that are released and cause tissue injury and allergic symptoms are called allergens. An antigen is any foreign substance capable of stimulating an immune response. An antigen that can be readily destroyed by an immune response is called an immunogen. Macrophages are mature white blood cells.

_____________ is the movement of WBC to an inflamed or infected area of the body in response to chemicals released by neutrophils, monocytes and the suffering tissue

chemotaxis

A child is diagnosed with a food allergy to milk. When teaching the parents about this allergy, what would the nurse suggest as possible substitutions for milk? Select all that apply. A)Fruit juice B)Rice milk C)Yogurt D)Nondairy creamers E)Soy milk

A, B, E 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.

What would the nurse expect to find in a male infant with Wiskott-Aldrich syndrome? A)Eczema B)Thrombocytosis C)Lymphadenopathy D)Pneumonia

A. Eczema 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.

The nurse is providing a class for a group of childcare providers. When discussing allergic reactions, which statement by a participant indicates the need for further instruction? A)"Most allergic reactions will happen within a few minutes of eating a problematic food." B)"If a child has previously eaten a food and not had a reaction they are not 'truly' allergic to it. C)"Allergic reactions can happen hours after eating something." D)"In addition to hives some children may also have vomiting and diarrhea when having an allergic reaction to a food."

B. "If a child has previously eaten a food and not had a reaction they are not 'truly' allergic to it." Previous exposure with no incident does not mean an individual cannot develop a hypersensitivity to a food or other substance. An allergy may develop at any time. The remaining statements are correct.

A nurse is preparing a plan of care for a child with a primary immunodeficiency. Which nursing diagnosis is 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

B. Ineffective protection related to impaired humoral defenses 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.

The child has a peanut allergy and accidentally ate food that contained peanuts. Which of the following findings are clinical manifestations of anaphylaxis? Select all that apply. a) The child's pulse is 52 beats per minute b) The child states that his tongue feels "too big" for his mouth c) The child has developed hives on his face and trunk d) The child states that he feels like he might faint e) The child states he feels might "throw up"

B. The child states that his tongue feels "too big" for his mouth C. The child has developed hives on his face and trunk D. The child states that he feels like he might faint E. The child states he feels might "throw up" Explanation: The following are common signs and symptoms of anaphylaxis: tongue edema, urticaria, nausea, vomiting, and syncope. Typically, the child who has developed anaphylaxis will be tachycardic.

The nurse is caring for a child who is taking corticosteroids for systemic lupus erythematosus. The nurse closely monitors the child based on the understanding that corticosteroids exert which major action? A)They increase liver enzymes. B)They can mask signs of infection. C)They cause bone marrow suppression. D)They decrease renal function.

B. They can mask signs of infection. The nurse understands that corticosteroids may mask signs of infection. Cytotoxic drugs cause bone marrow suppression. Nonsteroidal anti-inflammatory drugs can increase liver enzymes and decrease renal function.

A 16-year-old patient has just been diagnosed with HIV. Which statement by the parent indicates understanding of the diagnosis? A)"It is important for our child to get started on drug therapy for a better chance of a cure of the infection." B)"I must be infected with HIV and passed it to our child while in the uterus for the infection to have occurred." C)"We don't want to face the fact that it is likely our child contracted HIV through sexual contact or IV drug use." D)"Infections as a result of being HIV positive are a low risk since the diagnosis came early."

C. "We don't want to face the fact that it is likely our child contracted HIV through sexual contact or IV drug use." In teenagers, HIV is primarily contracted through sexual intercourse with an infected person or sharing of needles with an infected person during IV drug use. There is no cure for HIV, infants primarily contract the virus from their mothers, and infections as a result of having HIV are not dependent on when the diagnosis occurred.

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: A)difficulty urinating. B)visual changes. C)joint pain. D)rash.

C. Joint pain 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 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? A)B cells B)Antibodies C)Antigens D)T cells

D. T Cells Cellular immunity involves T cells, which do not recognize antigens. B cells, antibodies, and antigens are involved in humoral immunity.

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? A)Lopinavir B)Ritonavir C)Nevirapine D)Zidovudine

D. Zidovudine 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.

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

D. methotrexate 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.

The first time a child with hypersensitivity to stinging insects is stung, the reaction is usually anaphylactic shock and, if not immediately treated, death. a) True b) False

False Explanation: The first time a child is stung, the total reaction is probably only local edema at the site. The second time, generalized urticaria, pruritus, and edema may develop. The third time, symptoms may progress to wheezing and dyspnea. The next time, the reaction could be so severe that shock and death result. The progression of symptoms may be slower than this (involving 10 to 12 stings) if the stings occur far apart; if the stings are received close together (1 or 2 days apart, or even 3 weeks apart), the progression to fatal symptoms may occur as early as the second or third exposure

Nursing students are reviewing the events involved in humoral immunity. They demonstrate understanding of the information when they identify which of the following as occurring with complement activation? Select all that apply. a) Smooth muscle relaxation b) Decreased vascular permeability c) Lysis of the foreign antigen d) Phagocytosis e) Chemotaxis

• Lysis of the foreign antigen • Chemotaxis • Phagocytosis Explanation: Complement activation results in increased vascular permeability, smooth muscle contraction, chemotaxis, phagocytosis, and lysis of the foreign antigen

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

Lymphocyte immunophenotyping T-cell quantification Explanation: 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.

A nursing student is reviewing information about primary immunodeficiencies. The student demonstrates understanding of the material by identifying which immunodeficiencies as affecting only males? Select all 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

A, B, D 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 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

A. Every 30 mins 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.

The nurse is talking to the parents of a child who has been diagnosed with severe combined immune deficiency (SCID). 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."

B. "We'll need to prepare him and ourselves for a bone marrow transplant." 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.

The nurse is caring for a 6-year-old with juvenile idiopathic arthritis. The mother states that she has trouble getting her daughter out of bed in the morning and believes the girl's behavior is due to a desire to avoid going to school. What is the best advice by the nurse? a. Refer the girl to a psychologist for evaluation of school phobia related to chronic illness. b. Administer a warm bath every morning before school. c. Give the child her prescribed NSAIDs 30 minutes before getting out of bed. d. Allow her to stay in bed some mornings if she wants.

B. Heat or warmth helps ease the stiffness resulting after a period of inactivity in a child with juvenile arthritis.

After teaching a class about humoral and cellular immunity, the nurse recognizes that the additional teaching is needed when the class states that: 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.

C. Cellular immunity recognizes antigens 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.

The mother of a 5-year-old child with allergies to a variety of foods including eggs, milk, peanuts and shellfish, asks if her child will "always have these problems". What response by the nurse is most accurate? A)"Sadly, allergies to foods will persist." B)"Most children with allergies will outgrow them." C)"We cannot be sure at this point but most children who are allergic to peanuts will not have this allergy in adulthood." D)"In most cases allergies to peanuts and shellfish persist into adulthood but the others may diminish and disappear."

D. "In most cases allergies to peanuts and shellfish persist into adulthood but the others may diminish and disappear." Foods such as peanuts, milk, soy, shellfish, tree nuts are common allergens. By adulthood many allergies will diminish or disappear. Allergies to shellfish, peanuts and tree nuts often persist into adulthood.

The nurse is instructing a group of women of childbearing age about HIV during pregnancy. Which of the following should be a priority recommendation in this setting? a) Proper nutrition b) Screening for HIV c) Prophylactic treatment for HIV d) Screening for STIs

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

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

C. Swimming 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.

A 4-month-old infant born to an HIV-infected mother is going into foster care because the mother is too ill to care for the child. The foster mother wants to know if the infant is also infected. What is the best response by the nurse? A. "It's too early to know; we have to wait until the infant has symptoms." B. "Since the mother is so ill, it's likely the child is also infected with HIV." C. "The ELISA test is positive, so the child is definitely infected." D. "The PCR test is positive; this indicates HIV infection, which may or may not progress to AIDS."

D. The PCR tests for actual HIV genetic material in the child. A positive PCR test indicates active infection.

The nurse is administering the prescribed intravenous immunoglobulin to a 10-year-old boy. Which of the following would be most important for the nurse to do? a) Administer with food. b) Have epinephrine available. c) Monitor urine for glucose. d) Monitor for signs of Cushing syndrome.

Have epinephrine available. The nurse should have epinephrine available during the infusion in case of an adverse reaction. Monitoring urine for glucose would be appropriate when corticosteroids are being given. Intravenous immunoglobulin does not need to be administered with food because it is being given as an intravenous infusion. Monitoring for signs of Cushing syndrome would be appropriate when corticosteroids are given

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? a) Polymerase chain reaction (PCR) test b) CD4 counts c) Enzyme-linked immunosorbent assay (ELISA) d) Platelet count

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 child with primary immune deficiency is about to receive an infusion of IVIG. Which of the following is the most appropriate premedication to minimize the reaction? a) Ibuprofen b) Solu-Medrol c) Ketorolac d) Diphenhydramine

Diphenhydramine Explanation: Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.

A child with primary immune deficiency is about to receive an infusion of IVIG. Which of the following is the most appropriate premedication to minimize the reaction? a) Solu-Medrol b) Diphenhydramine c) Ketorolac d) Ibuprofen

Diphenhydramine Explanation: Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.

A child with primary immune deficiency is about to receive an infusion of IVIG. Which of the following is the most appropriate premedication to minimize the reaction? a) Ketorolac b) Diphenhydramine c) Ibuprofen d) Solu-Medrol

Diphenhydramine Explanation: Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.

What advice would be most appropriate for the child with a stinging-insect allergy?

Obtain a Medic-Alert bracelet so the presence of the allergy can be identified easily. Explanation: Stinging-insect allergy can lead to anaphylactic shock. Alerting health care personnel to the possibility of an insect sting is important

A young patient comes to the clinic with multiple symptoms of an infection. The nurse realizes that the patient has been seen in the clinic every month for the last 6 months for the same problems. Which body system does the nurse suspect is malfunctioning in this patient? a) gastrointestinal b) cardiovascular c) respiratory d) immune

immune Explanation: Disorders of the immune system include deficiencies of immune substances and function that affect the body's ability to ward off infection.

A nurse is assessing a child who may have a latex allergy. The nurse asks the child about allergic reactions to 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

A, B, C, D,E 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.

The young girl has been diagnosed with JIA and has been prescribed methotrexate. Which of the following statements by the child's parent indicates that adequate learning has occurred? a) "She may start feeling better by next week." b) "She can take methotrexate with yogurt or chocolate milk." c) "Swimming sounds like a good exercise for her." d) "We'll need to bring her back in for some lab tests after she starts methotrexate." e) "A warm bath before bed might help her sleep better."

D. "We'll need to bring her back in for some lab tests after she starts methotrexate." C."Swimming sounds like a good exercise for her." E. "A warm bath before bed might help her sleep better." Explanation: - The child diagnosed with juvenile idiopathic arthritis should not take the oral form of methotrexate with dairy products. - The approximate time to benefit from methotrexate is typically 3 to 6 weeks. - The child will need blood tests to determine renal and liver function during treatment. - Children with juvenile idiopathic arthritis usually find swimming to be a useful exercise for them because it helps maintain joint mobility without placing pressure on the joints. - Sleep may be promoted by a warm bath at bedtime.

The most accurate screening test for the presence of HIV antigen in young children is: a) Western blot b) PCR c) CD4 count d) ELISA

PCR Explanation: PCR tests directly for the HIV antigen. ELISA and the Western blot test detect the presence of HIV antibodies. The CD4 count is used as a measure of disease status and progression.

The nurse is caring for a child who has undergone stem cell transplantation for severe combined immune deficiency. What finding would the nurse interpret as indicative of graft-versus-host disease? A)Presence of wheezing B)Splenomegaly C)Maculopapular rash D)Chronic or recurrent diarrhea

C. Maculopapular rash The nurse should monitor the stem cell transplant child closely for a maculopapular rash that usually starts on the palms and soles for indication that graft-versus-host disease is developing.

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? a) B-lymphocyte deficiency b) Combined T- and B-lymphocyte deficiency c) T-lymphocyte deficiency d) Secondary immunodeficiency

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

Food allergies have become more and more common in the last few decades. Which of the following are common food allergies of childhood? Select all that apply. a) Milk b) Eggs c) Cheerios d) Apples e) Peanuts

• Eggs • Milk • Peanuts Allergies to eggs, peanuts, and milk are common in childhood. Cheerios are made of oats and are not known to be allergenic. Apples also are not allergenic, unlike bananas, which can cause problems for children who have latex allergies.

The nurse is caring for a child undergoing highly active antiretroviral therapy (HAART) for HIV infection. The nurse is preparing to administer the prescribed medication. In addition to the nucleoside analog reverse transcriptase inhibitors (NRTIs) and the nonnucleoside analog reverse transcriptase inhibitors (NNRTIs), the nurse is cognizant that the child will be taking which additional medication as part of the three-drug regimen? A)Protease inhibitors B)Corticosteroids C)Cytotoxic drugs D)Disease-modifying antirheumatic drugs (DMARDs)

A. Protease inhibitors The nurse understands that the child will be taking protease inhibitors as part of the three-drug regimen for HAART. Corticosteroids, cytotoxic agents, and DMARDs are typically used for the treatment of juvenile idiopathic arthritis (JIA).

The nurse is assessing a child with pauciarticular-type juvenile idiopathic arthritis. What would the nurse expect to assess? A)Fever B)Rash C)Eye inflammation D)Splenomegaly

C. Eye inflammation With pauciarticular juvenile idiopathic arthritis, eye inflammation may be noted. Fever, rash, and enlarged spleen would be noted with systemic juvenile idiopathic arthritis.

A nurse is caring for a 12-year-old girl with a severe peanut allergy. The girl's parents are upset because the school does not permit her to carry her EpiPen with her. It must remain in the school's office per school regulations. Which response by the nurse would be most appropriate? A)"She is allowed by law to carry her EpiPen with her; I will talk to school authorities." B)"Let's file an action plan and keep it in the school office in the event of anaphylaxis." C)"Make sure she wears a medical alert bracelet so that school staff know she has allergies." D)"I will be happy to train school authorities and staff to recognize anaphylaxis."

A. "She is allowed by law to carry her EpiPen with her; I will talk to school authorities." Public Law No. 108-377, the Asthmatic Schoolchildren's Treatment and Health Management Act of 2004, was passed by the U.S. Congress. This law is intended to ensure that students with severe allergies can carry prescribed medications such as an EpiPen with them at all times. The nurse must contact the school and inform them of this law so that the girl is allowed to carry her EpiPen on her person at all times. The school staff should be trained to recognize anaphylaxis, there should be an action plan on file, and the girl should wear a medical alert bracelet as well. However, the most important action is to notify school authorities of the law.

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? a) Gently roll the vial to mix the medication. b) Reconstitute the medication 2 hours prior to administration. c) Shake the vial vigorously to disperse the diluent. d) Store the reconstituted medication no longer than 4 hours in the refrigerator

A. Gently roll the vial to mix the medication. The nurse knows not the 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 mother of a child with hypogammaglobulinemia reports that her child had a fever and slight chills with an intravenous gammaglobulin infusion last month. She wants to know what other course of treatment might be available. What is the best response by the nurse? a. Administration of acetaminophen or diphenhydramine prior to the next infusion may decrease the incidence of fever or chills. b. Giving the gammaglobulin intramuscularly is recommended to prevent a reaction. c. Talk to her physician or nurse practitioner about alternative medications that may be used to boost the gammaglobulin level in the blood. D. If the child is no longer experiencing frequent infections, then the IV infusions may not be necessary.

A. Use of antipyretics and antihistamines prior to administration of intravenous immunoglobulin may decrease the incidence of fever or chills with the infusion.

When reviewing the history of a child with suspected primary immunodeficiency, what would the nurse be least likely to find? A)Weight appropriate for height B)Antibiotic therapy for the past 3 months without effect C)Ten episodes of otitis media in the last year D)Three bouts of sinusitis within a year's time

A. Weight appropriate for height 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.

Susie is a 3-year-old with a history of neonatal transmission of HIV and recent diagnosis of AIDS, as manifested by M. tuberculosis infection. To date, Susie has been relatively healthy with few illnesses associated with high fever; she has been developing appropriately and is at the 5th percentile for height and weight. Susie is at risk for all of the following diagnoses. Prioritize the order of urgency of these diagnoses based on the scenario provided.

Altered family coping related to new presentation of significant illness Altered comfort related to severity of new illness Inadequate adherence to medication regimen related to side effects Inadequate nutrition related to side effects of medication Delayed growth and development related to frequent infections Explanation: Because Susie has been relatively healthy since she was diagnosed with HIV, the change in her status is likely to cause changes in family coping mechanisms and dynamics that will have implications for the entire family. Next, the nurse needs to address the specific symptoms of the child. With the increased degree of illness and altered coping strategies, the child may have more difficulty with medication adherence, as well as other complications of AIDS-related illness and treatment, such as poor nutritional intake and delayed growth and development

A mother brings her 4-month-old infant to the doctor's office due to vesicular lesions that have appeared on the child's scalp and face. The mother says that the child will not stop scratching at the lesions and that she is concerned that he is having some kind of allergic reaction. Which of the following should the nurse recommend to the mother to help reduce pruritus in this child? a) Put the child on elimination diets b) Have the child retested for PKU c) Have the child undergo skin testing d) Apply wet dressings for 15 to 20 minutes, followed by moisturizer

Apply wet dressings for 15 to 20 minutes, followed by moisturizer Explanation: A major consideration in treatment of atopic dermatitis is aimed at reducing pruritus so children do not irritate lesions and cause secondary infections by scratching. Hydrating the skin by bathing or applying wet dressings (wet with tap water or Burrow's solution) for 15 to 20 minutes, followed by application of moisturizer such as Eucerin is helpful. Skin testing is usually ineffective because, although the allergen causing infantile atopic dermatitis may be pollen, dust or a mold spore; it is often a food allergen. Elimination diets can help identify an allergen, but do not directly help reduce pruritus; in any case, a 4-month-old should not be eating solid foods. Because untreated phenylketonuria (PKU) can lead to atopic dermatitis, children with infantile atopic dermatitis need to have a repeat test for PKU to be certain this is ruled out—however, this intervention does not directly reduce pruritus, either.

The nurse is preparing to administer intravenous immunoglobulin (IVIG) for a child who has not had an IVIG infusion in over 10 weeks. The nurse knows to first: a) obtain baseline physical assessment. b) begin infusion slowly increasing to prescribed rate. c) assess for adverse reaction. d) premedicate with acetaminophen or diphenhydramine.

D. premedicate with acetaminophen or diphenhydramine. Premedication with diphenhydramine or acetaminophen may be indicted in children who have never received intravenous immunoglobulin (IVIG), have not had an infusion in over 8 weeks, have had a recent bacterial infection, or have history of serious infusion-related adverse reactions. The nurse should first premedicate, and then obtain a baseline physical assessment. Once the infusion begins, the nurse should continually assess for adverse reaction

A mother, who is HIV positive, is distraught when she learns that her 6-month-old baby is also HIV positive. The child had undergone open heart surgery as a newborn and had received numerous blood transfusions. The nurse recognizes that which of the following is the most likely means of transmission of the disease to this child? a) Placental spread during pregnancy b) Blood transfusion products contaminated with the virus c) The mother kissing the baby on the forehead d) Breastfeeding

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. (less)

The nurse is reviewing the medical history of a 4-year-old child. Which of the following would the nurse identify as potentially indicative of a primary immunodeficiency? Select all that apply. a) Recurrent deep abscess of the thigh b) Pneumonia last spring; resolved with antibiotics c) Oral thrush, persistent over the past 6 to 7 months d) Acute otitis media, one episode every 3 to 4 weeks over the past year. e) Infected laceration requiring IV antibiotic 2 months ago; healed

• Recurrent deep abscess of the thigh • Oral thrush, persistent over the past 6 to 7 months • Acute otitis media, one episode every 3 to 4 weeks over the past year. Explanation: Warning signs associated with primary immunodeficiency include eight or more episodes of acute otitis media in 1 year (one episode every 3 to 4 weeks results in at least 12 episodes in the past year), recurrent deep skin or organ abscesses, persistent oral thrush or skin candidiasis after 1 year of age. A history of infections that do not clear with IV antibiotics or two or more episodes of pneumonia in 1 year would be considered warning signs.