Chapter 30 Peds ?'s

The nurse is providing care to a child who experienced an anaphylactic reaction to an unknown allergen. Which high-risk foods should the nurse question the family about regarding recent consumption? 1. Peanut butter 2. Shrimp 3. Eggs 4. Milk 5. Soda

1, 2, 3

After a severe allergic reaction, an EpiPen is prescribed for the school-age child. Which instructions should the nurse provide to this child's parents based on the current data? Select all that apply. 1. "It is important that your child always has access to this medication." 2. "Your child is too young to self-administer this medication." 3. "If you are able to administer the medication, there is no need for follow-up care." 4. "It is important to check the expiration date on the medication and replace if expired." 5. "Your child should wear a Medic Alert bracelet at all times."

1, 4, 5 Explanation: `An expired EpiPen may have less than desired effects If the child is unable to speak due to anaphylaxis, it is important that rescuers have information about the child's allergies.

An adolescent female client is diagnosed with systemic lupus erythematosus (SLE). Which should the nurse include in the teaching session regarding an activity that should be avoided? 1. Receiving a manicure and a pedicure 2. Washing the hair with shampoo daily 3. Using a tanning bed 4. Attending late night parties and dances

3 Individuals with SLE have photosensitivity, and tanning beds can lead to exacerbations as well as skin damage from sun burns.

The nurse observes a red butterfly-shaped rash that spreads across the child's cheeks and nose. This assessment finding is characteristic of which condition? a. Systemic lupus erythematosus (SLE) b. Rheumatic fever c. Kawasaki disease d. Anaphylactic reaction

ANS: A Feedback A red, flat or raised malar "butterfly" rash over the cheeks and bridge of the nose is a clinical manifestation of SLE.

A nurse in a well-child clinic is teaching parents about their childs immune system. Which statement, made by the nurse, is correct? a. The immune system distinguishes and actively protects the bodys own cells from foreign substances. b. The immune system is fully developed by 1 year of age. c. The immune system protects the child against communicable diseases in the first 6 years of life. d. The immune system responds to an offending agent by producing antigens.

A

An adolescent female client is diagnosed with systemic lupus erythematosus (SLE). Which action by the client indicates acceptance of the body changes that occur because of SLE? 1. Attends school but does not stay for after-school activities 2. Discusses the body changes with healthcare providers only 3. Discusses the body changes with her best friend 4. Only attends small parties at friends' homes

3. Peer interaction is important to the teen. Being able to discuss the changes to her body with a peer indicates acceptance of the changes in her body image.

The nurse observes a red rash that spreads across the childs cheeks and nose. This assessment finding is characteristic of which of the following conditions? a. Systemic lupus erythematosus (SLE) b. Rheumatic fever c. Kawasaki disease d. Anaphylactic reaction

A

Which statement is true regarding how infants acquire immunity? a. The infant acquires humoral and cell-mediated immunity in response to infections and immunizations. b. The infant acquires maternal antibodies that ensure immunity up to 12 months of age. c. Active immunity is acquired from the mother and lasts 6 to 7 months. d. Passive immunity develops in response to immunizations.

A

An adolescent female with systemic lupus erythematosus (SLE) is trying to learn how to live with her illness. What teaching by the nurse is priority? A. Use protection against the sun whenever she is outside, regardless of the season. B. Maintain a high-protein diet to maintain healthy skin integrity and muscle fibers. C. Plan her schedule so she gets at least 10 hours of solid, deep sleep each night. D. Keep a diary so she can document her thoughts and feelings as she adjusts.

A Using protection against the sun whenever she is outside, regardless of the season, is a must to avoid triggers that cause exacerbations.

What is the major nursing concern for a child having an anaphylactic reaction? a. Identifying the offending allergen b. Ineffective breathing pattern c. Increased cardiac output d. Positioning to facilitate comfort

B

What therapeutic management for the patient with systemic lupus erythematosus (SLE) would the nurse expect to include? A. A high-protein, low-sodium diet. B. Corticosteroids to control inflammation. C. Gold salts to suppress the inflammatory process. D. An exercise regimen to build up muscle strength and endurance.

B. Corticosteroids to control inflammation is the current primary mode of therapy.

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. "Do you notice any wheezing when you breathe or a runny nose?" B. "Do you have any shoulder pain or abdominal tenderness?" C. "Have you noticed any new bruising or different color patterns on your skin?" D. "Have you noticed any hair loss or redness on your face?"

D. "Have you noticed any hair loss or redness on your face?"

A child is having an anaphylactic response. Place in order the interventions a nurse should perform beginning with the initial (highest priority) intervention and ending with the lowest priority intervention. Use the following format for your answers: a. Administer steroids and antihistamines as prescribed. b. Ensure an adequate airway. c. Administer epinephrine as prescribed. d. Administer oxygen. e. Determine the cause of the reaction.

b. Ensure an adequate airway. c. Administer epinephrine as prescribed D Administer oxygen A Administer steroids and antihistamines as prescribed. E Determine the cause of the reaction.

The nurse is providing discharge instructions to the family of a child who experienced an anaphylactic reaction. Which parental statements indicate accurate understanding of the action that histamine plays during this type of reaction? Select all that apply. 1. "Histamine releases IgE antibodies, which help to stop the reaction." 2. "Histamine causes smooth muscle contraction, which causes the wheezing." 3. "Histamine causes increased capillary permeability, which is what causes difficulty breathing." 4. "Histamine causes vasoconstriction leading to respiratory issues." 5. "Histamine causes the destruction of red blood cells, which is why we administer the EpiPen."

2 3 Smooth muscle contraction causes the constriction of the bronchioles, which causes the wheezing and respiratory distress. Increased capillary permeability causes the plasma to leak into surrounding tissues, including the lungs, leading to pulmonary edema.

The client has been prescribed antihistamines and a round of corticosteroids to treat an allergic reaction to an unknown food source. Which statement by the client indicates he understands the allergic condition and medication regimen? A. "The antihistamine will help the nasal swelling I am having." B. "Corticosteroids help the inflammation that goes along with an allergy." C. "I can stop taking my steroids as soon as I feel better in a couple of days." D. "I may have to undergo intradermal testing to determine what I am allergic to." E. "Once we figure out what I am allergic to, it is important for me to avoid that allergen."

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

The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching? A. "I must not feed my child eggs in any form." B. "I can use the egg white when baking, but not the yolk." C. "1 tsp yeast and 1/4 cups warm water is a substitute in baked goods." D. "1.5 Tbsp each water and oil plus 1 tsp baking powder equals one egg in a recipe."

B. "I can use the egg white when baking, but not the yolk."

The nurse has completed an education session with parents of children diagnosed with foodallergies. Which statement by a parent would indicate a need for additional education? A. "I will make sure my daughter always has her EpiPen® with her all the time." B. "If we need to use the EpiPen® we will need to notify her physician's office the next business day." C. "I have found a website that makes medical alert bracelets in my daughter's favorite color." D. "The grey part of the EpiPen® should never be removed until right before we use it."

B. "If we need to use the EpiPen® we will need to notify her physician's office the next business day."

An adolescent client has just been diagnosed with systemic lupus erythematosus (SLE). Following client education about the disease, which statement by the client demonstrates understanding of SLE? A. "SLE is a rheumatic disease that mostly affects my joints." B. "SLE is an autoimmune disorder that I will always have, with times of flare- ups and times of minimal to no symptoms." C. "If my SLE has been found early enough in the disease process, there is a good chance that medication can cure it." D. "SLE only affects my skin. It seldom causes problems in any other organs."

B. "SLE is an autoimmune disorder that I will always have, with times of flare- ups and times of minimal to no symptoms."

The child has a peanut allergy and accidentally ate food that contained peanuts. Which clinical manifestations of anaphylaxis should the nurse expect to find? Select all that apply. 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 he feels like he might "throw up". E. The child states that he feels like he might faint.

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 he feels like he might "throw up". E. The child states that he feels like he might faint.

A nurse assesses a child on long-term systemic corticosteroid therapy for which condition? a. Hypotension b. Dilation of blood vessels in the cheeks c. Growth delays d. Decreased appetite and weight loss

C

What is the drug of choice the nurse would administer in the acute treatment of anaphylaxis? a. Diphenhydramine (Benadryl) b. Cimetidine (Tagamet) c. Epinephrine (Adrenaline) d. Albuterol (Ventolin)

C

A nurse is teaching parents about the importance of immunizations for infants because of immaturity of the immune system. The parents demonstrate that they understand the teaching if they make which statement? a. The spleen reaches full size by 1 year of age. b. IgM, IgE, and IgD levels are high at birth. c. IgG levels in the newborn infant are low at birth. d. Absolute lymphocyte counts reach a peak during the first year.

D