NUR 236 PrepU Chapter 47: Nursing Care of the Child With an Alteration in Immunity/Immunologic Disorder

The nurse is caring for a 6-month-old infant with Wiskott-Aldrich syndrome. Which teaching does the nurse provide the parent?

"Do not insert anything in the rectum."

A nurse is providing education to pregnant women diagnosed with HIV. Which statement indicates the need for further teaching?

Pregnancy will accelerate the progression of the disease.

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?

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

The parents of an adolescent tell the nurse, "Our child seems to have allergy symptoms every time we visit our favorite cafe. I don't understand since the only allergy indicated in the testing was to eggs?" How should the nurse respond?

"Does your child get a whipped cream or foam topping on their favorite drink?"

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?

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

The nurse is providing instructions to the parents of a child with a severe peanut allergy. Which statement by the parents indicates a need for further teaching about the use of an epinephrine auto-injector?

"The epinephrine auto-injector should be jabbed into the upper arm."

The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level?

1300/mm3

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 candidiasis (thrush), persistent over the past 6 to 7 months

When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect stings, the nurse integrates knowledge that this response is related to which immunoglobulin?

IgE

Which immunoglobin occurs most frequently in plasma and is the major immunoglobulin synthesized during secondary response?

IgG

The nurse is caring for a school-age child recently diagnosed with an allergy to peanuts. Which nursing action is a priority?

Include the child when discussing foods that contain peanuts.

The nurse is planning a program for community members that focus on the 2030 National Health Goals for allergies and immunologic functioning. What content should the nurse include in this program? Select all that apply.

Promote following safe sexual practices. Discourage the use of intravenous substances. Discuss the role of sexual relations in HIV transmission. Encourage parents to discuss the air quality in the schools with the school district.

The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for a pediatric client with an immune disorder receiving a stem cell transplant. Which action by the UAP will cause the RN to intervene?

The UAP takes a rectal temperature on the client.

The nurse is preparing a care plan for a 4-year-old client newly diagnosed with severe combined immune deficiency. What is the priority goal for this client?

The client will remain free from infection.

The nurse is discussing food allergies with parents of a young child, explaining that a very effective way to determine which foods a child may be allergic to is to implement:

an elimination diet.

The parent of a school-age child comments to the nurse, "Every time my child eats enchiladas at our local Mexican restaurant the child gets a rash. It just does not make sense to me." How should the nurse respond?

"Has your child ever been tested for a peanut allergy?"

The nurse is teaching the parents of a child with a suspected diagnosis of juvenile idiopathic arthritis about the disease. Which statement by the parents demonstrates the need for further teaching?

"If our child does not have a positive rheumatoid factor, our child does not have the disease."

The nurse provides client teaching to parents of a newborn who have questions about immunizations. Which comment(s) by the parents demonstrate knowledge of immunizations? Select all that apply.

"Immunizations may be killed or modified organisms." "Immunizations prevent some types of bacterial infections." "Many vaccines are given in the form of an injection."

The nurse is working with a pregnant client who is HIV positive and has been prescribed oral zidovudine. Which statement by the nurse explains the primary rationale for taking this medication?

"It is to help prevent transmission of the disease to your infant."

The parents of a 5-month-old infant diagnosed with humoral IgA deficiency question the nurse about why the infant was not diagnosed sooner. Which response by the nurse most appropriate?

"Maternal antibodies crossed the placenta and that prevented infections until now."

A child is admitted to the emergency room with dyspnea and hypoxia immediately following a bee sting. What is the first action made by the nurse?

Administer IM epinephrine

The parents of a 3-month-old infant report concerns the infant is irritable, feeds poorly, and has a rash. The nurse notes weeping, crusty lesions on the infant's cheeks and neck. Which action by the nurse is most appropriate?

Contact the health care provider to request treatment.

The mother of a child with myasthenia gravis has called the clinic and reports her child appears very anxious and the child's heart is beating very fast. What action by the nurse is indicated?

Instruct the child be brought to the emergency department promptly.

The nurse is caring for a child who is receiving an intravenous immunoglobulin treatment. The client calls the nurse and reports she vomited. What action should be completed first?

Discontinue the infusion.

A nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread? Select all that apply.

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

The nurse is providing education regarding 2030 Health Goals to reduce the incidence of acquired immunodeficiency syndrome (AIDS) within the community. Which goal will the nurse choose as a primary prevention strategy?

Provide education to sexually active females about proper condom usage.

The parents of a 10-year-old with HIV have never told their child that he has the virus. The child asks the nurse why he is "on so many medications." What action should the nurse take?

The nurse should encourage the child to talk with his parents about his medications.

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:

sexual contact.

The most accurate screening test for the presence of HIV antigen in young children is:

polymerase chain reaction (PCR).

A pediatric client is newly diagnosed with a stinging-insect allergy. Which advice is most appropriate for the nurse to provide this client's parent?

"Obtain your child a medical alert ID bracelet so the presence of the allergy can be identified easily."

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

Eggs Shrimp Peanuts

The nurse is monitoring the labs of a child admitted for an exacerbation of juvenile pauciarticular arthritis. Which lab result does the nurse expect to be elevated?

erythrocyte sedimentation rate (ESR)

The nurse is caring for a child with HIV. The doctor will most likely order which test to monitor the child's progress?

lymphocyte immunophenotyping T-cell quantification

Nursing students correctly label the group of cells whose job is to ingest, engulf, and neutralize pathogens as:

macrophages.

To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant?

"Has she ever had penicillin before?"

Food allergies have become more and more common in the last few decades. What are some common food allergies of childhood? Select all that apply.

Eggs Peanuts Milk

The nurse is caring for a child who is receiving a skin test to determine the presence of allergies. A positive skin test for one particular allergen shows the mediation of which type of immune globulin?

IgE

A pregnant client who is HIV positive asks the nurse if she will be able to breastfeed the newborn. Which response by the nurse is most appropriate?

"Breastfeeding will increase your newborn's risk of contracting HIV."