PEDS

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?

IgG

he 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, diarrheaUrticaria, angioedemaBronchospasmHypoxiaSeizures

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?

"The best way is to eliminate the food from the diet and then look for improvement."

The parents state they are afraid to have their child vaccinated and ask the nurse for more information. Which response by the nurse is most appropriate?

"Vaccinations are very effective at preventing serious disease and infection."

A nurse is preparing a client for a computed tomography (CT) scan that requires infusion of radiopaque dye. Which question is the most important for the nurse to ask?- "When did you last have something to eat or drink?"- "When did you last take any medication?"- "Are you allergic to seafood or iodine?"- "How much do you weigh?"

"Are you allergic to seafood or iodine?"

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?"

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals?

"It is important to wear the brace now to improve your spinal alignment, decreasing your symptoms."

The nurse is teaching the parents of a 4-year-old client with a peanut allergy about dietary restrictions. Which response by the parents indicates a need for further teaching?"We must be careful with Asian food.""Some hot chocolate mixes have peanuts.""Baked goods often contain hidden peanut ingredients.""We cannot go wrong with barbeque and french fries."

"We cannot go wrong with barbeque and french fries."

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

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

During a mumps outbreak at a local school, a patient, who is a school teacher, is exposed. She has previously been immunized for mumps. What type of immunity does she possess?

Acquired immunity

The nurse is caring for a child with clear nasal drainage, pale nasal mucous membranes, and a horizontal crease on the nose. What does the nurse suspect?

Allergic Rhinitis

The nurse is caring for a male client who is scheduled for a neurologic examination that uses a radiopaque dye. Before the test, the nurse assesses the allergy history of the client and find the client is allergic to seafood. What does the nurse relate the allergy to seafood as?- An allergy to antihistamines- An allergy to radiation exposure- An allergy to morphine- An allergy to iodine

An allergy to iodine

A nurse in the emergency department is examining an 18-month-old with lip edema, urticaria, stridor, and tachycardia. The nurse immediately suspects:

Anaphylaxis.

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?

Apply wet dressings for 15 to 20 minutes, followed by moisturizer

The nurse is caring for a child whose family recently immigrated from a developing country. While completing the admission history, the parents report all the child's immunizations are up to date. Which nursing action is most appropriate?

Ask parents which immunizations have been given.

A school-aged child, who is allergic to bee stings, states, "I think I was stung by a bee outside." Which intervention by the school nurse is most appropriate?Apply an ice compress to the siteAdminister epinephrineDetermine if the client was stungAssess the client for signs of anaphylactic shock

Assess the client for signs of anaphylactic shock

A child allergic to insect stings presents to the school nurse stating, "A bee stung me on the playground." Which action by the nurse is priority?- Notify the client's caregivers and primary health care provider- Assess the client's airway and breathing rate- Administer epinephrine subcutaneously to the client- Locate the stinger and remove it with tweezers

Assess the client's airway and breathing rate

The nurse is caring for a child who is beginning to show signs and symptoms of anaphylaxis. Which intervention would be the priority?

Assessing patency of the airway

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

A child with systemic lupus erythematosus is receiving high-dose corticosteroid therapy over the long term. The nurse would instruct the parents and child to report which of the following? A) Difficulty urinating B) Visual changes C) Joint pain D)

C) joint pain

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

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

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

A 7-year-old boy has been rushed to the clinic with multiple bee stings on his face, neck, and arms. After immediate treatment with epinephrine, which of the following would be the priority?Checking for laryngeal edemaProviding tetanus prophylaxisGiving antibiotics as ordered.Evaluating for fractures

Checking for laryngeal edema

The nurse is educating a child with a peanut allergy about the signs and symptoms of an anaphylactic reaction. The nurse realizes additional teaching is needed when the child identifies which sign/symptom? constipation anxiety nausea itchy mouth

Constipation

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

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

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.

Which of the following drugs should be available for emergency treatment of a child who goes into anaphylactic shock?

Epinephrine

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

Exposure to allergen Rapid immune response Vasodilation Bronchoconstriction Circulatory collapse

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?

Gently roll the vial to mix the medication.

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?

Have epinephrine available.

A 2-year-old is diagnosed with osteomyelitis. Which of the following would you anticipate as a primary nursing intervention to include in the child's plan of care?

Maintaining intravenous antibiotic therapy

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.

A child is admitted to the pediatric unit with osteomyelitis. The child is to be placed on antibiotics. The nurse expects antibiotic coverage to include which of the following as the most common cause of osteomyelitis?

Staphylococcus aureus

A nurse is promoting vaccine administration. When instructing on the physiological changes, which statement best explains what occurs in the child when vaccines are administered?

The child develops an active immunity.

A nurse is promoting vaccine administration. When instructing on the physiological changes, which statement best explains what occurs in the child when vaccines are administered?

The child develops an active immunity. Explanation:When a vaccine is given, active immunity occurs which then stimulates the development of antibodies to destroy infective agents without causing the disease.

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?

The child has polyarticular JIA

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.

The child states he feels might "throw up"• The child states that his tongue feels "too big" for his mouth• The child states that he feels like he might faint• The child has developed hives on his face and trunk

After teaching a group of nursing students about osteogenesis imperfecta (OI), the instructor determines that the teaching was successful when the group identifies which type as the most common?

Type I

A teenager has been admitted to the hospital with respiratory complications related to Duchenne muscular dystrophy. How can the nurse best provide support for the parents, who are the caretakers of this adolescent? a) Assume responsibility for the teen's daily care while accepting input from parents and the teen b) Encourage the parents to assist their child with his activities of daily living while hospitalized c) Teach the parents how to add chest physical therapy to the care they provide d) Provide accommodations for both parents to room-in with their teen

a)Assume responsibility for the teen's daily care while accepting input from parents and the teen

Muscular dystrophy is a result of which cause? a) Gene mutation b) Chromosomal aberration c) Genetic and environmental factors d) Unknown nongenetic origin

a)Gene mutation

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?

autoimmunity

Which of the following strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy?a) Motorized wheelchair b) Manual wheelchair c) Long leg braces d) Walker

c)Long leg braces

A nurse is conducting a physical examination of a 5-year-old boy with spinal muscular atrophy (SMA) type 2. What assessment findings would the nurse expect to find? a) Loss of strength in ankle dorsiflexion b) Pseudohypertrophy of the calves c) Pectus excavatum d) Loss of strength in hip extension

c)Pectus excavatum

How would the nurse best describe Gowers' sign to the parents of a child with muscular dystrophy? a) A waddling-type gait b) The pelvis position during gait c) Muscle twitching present during a quick stretch d) A transfer technique

d)A transfer technique

A child is to undergo testing for suspected muscular dystrophy and is scheduled for the following tests. Which test would the nurse identify as most important to be completed first? a) Electromyogram b) Nerve conduction velocity c) Muscle biopsy d) Creatine kinase

d)Creatine kinase

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? a) Serum potassium b) Sodium c) Bilirubin d) Creatinine

d)Creatinine

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors?

d)Duchenne muscular dystrophy causes progressive muscular weakness that ends in death.

Which condition would alert the nurse that a child may be suffering from muscular dystrophy? a) Upper extremity spasticity b) Hypertonia of extremities c) Hyperactive lower extremity reflexes d) Increased lumbar lordosis

d)Increased lumbar lordosis

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first? a) Swallowing b) Breathing c) Sitting d) Standing

d)Standing

A child has sustained a basilar skull fracture. For which complication should the nurse assess?Select one:a. Transient confusionb. Periorbital ecchymosisc. Headached. Cerebral spinal fluid leakage from the nose or ears

d. Cerebral spinal fluid leakage from the nose

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

A 5-year-old has allergic rhinitis. It would be most appropriate to collect information regarding the child's exposure to which substances?

pollens

When caring for a child experiencing anaphylactic shock, the most important nursing action would be to

facilitate breathing

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

false

The nurse is caring for a child with osteomyelitis who has a leg wound. The highest priority nursing intervention for this child would be for the nurse to:

follow transmission-based precautions.

The nurse is preparing to administer the child's dose of intravenous immune globulin (IVIG). Which actions should the nurse take? Select all that apply.

take baseline vital signs and monitor the vital signs during the infusion Prepare to give acetaminophen to the child Prepare to give diphenhydramine to the child

An adolescent girl has spinal instrumentation surgery at 16 years of age. Immediately after this procedure, the nurse would teach her to:

wait to be log rolled before turning from one side to the other.

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

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant? a) Baclofen b) Botulin toxin c) Lorazepam d) Prednisone

a)Baclofen

The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should she use to best describe this condition? a) Degeneration of muscle fibers b) A demyelinating disease c) Lesions of the brain cortex d) Upper motor neuron lesions

a)Degeneration of muscle fibers

Which finding will cause the nurse to refer a 6-month-old child for further neuromuscular testing?a) Head lag when pulled from supine to sitting b) Bilaterally open rather than closed hands c) Supporting own weight when placed in standing position d) Equal withdrawal of lower extremities from pain

a)Head lag when pulled from supine to sitting

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test? a) Muscle biopsy b) EEG c) Assessment of ambulation d) X-ray

a)Muscle biopsy

The nurse is preparing a 7-year-old girl recovering from head trauma and receiving gastrostomy feedings for discharge from the hospital. Which activity is most important before the child is discharged home?a. determining the parents' ability to administer the enteral feedingsb. preparing a list of home equipment and supplies neededc. assessing the parents' emotional statusd. helping the family to access financial resour

a. determining the parents' ability to administer the enteral feedings

When a child is suspected of having muscular dystrophy, a nurse should expect which muscles to be affected first? a) Muscles of the foot b) Muscles of the hip c) Muscles of respiration d) Muscles of the hand

b)Muscles of the hip

The pediatric nurse practioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this? a) The head is held tilted with limited side-to-side motion. b) The boy rises from the floor by walking his hands up his legs. c) The boy has a large tan skin lesion on his torso. d) Severe lordosis is evident in the lumbar spine.

b)The boy rises from the floor by walking his hands up his legs.

Through which mechanism is Duchenne's muscular dystrophy acquired? a) Virus b) Environmental toxins c) Autoimmune factors d) Heredity

d)Heredity

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:

premedicate with acetaminophen or diphenhydramine.

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

ACD

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?

Abacavir

Given knowledge of muscular dystrophy, the nurse would expect to see which form of this condition most commonly in children? a) Limb-girdle b) Becker's c) Myotonic d) Duchenne's

d)Duchenne's

A client with muscular dystrophy has lost complete control of his lower extremities. He has some strength bilaterally in the upper extremities, but poor trunk control. Which mechanism would be the most important to have on the wheelchair? a) Wheelchair belt b) Antitip device c) Headrest support d) Extended breaks

a)Wheelchair belt

The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as: a) facioscapulohumeral. b) myotonia. c) limb-girdle. d) Duchenne's.

d)Duchenne's.

The parent of a school-age child comments to the nurse, "Every time my child eats enchiladas at our local Mexican restaurant he gets a rash. It just doesn't make sense to me." How should the nurse respond? "That is odd. Does anyone else in your family react that way?" "Maybe it's an allergy to something else and you just notice after eating there by coincidence." "Is your child allergic to milk?" "Has your child ever been tested for a peanut allergy?"

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

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.

eggs milk peanuts

A young child with Duchenne muscular dystrophy is placed on both prednisone and calcium. Parents view these two medications as rather "common" and question their importance for the child. What explanation by the nurse will be most helpful to the parents? a) "Prednisone will stimulate weight gain and appetite. Calcium is needed to ensure adequate supplies for the development of permanent teeth." b) "Prednisone helps to keep muscle fibers strong and delays progression of the disease. Calcium protects against osteoporosis caused by both prednisone and lack of weight bearing." c) "Prednisone will help protect his vulnerable respiratory tract from developing reactive airway disease. Calcium is needed to guard against muscle cramping." d) "Prednisone will protect against nerve inflammation in his hips and legs. Calcium is necessary should dietary intake be insufficient to meet growth needs."

b)"Prednisone helps to keep muscle fibers strong and delays progression of the disease. Calcium protects against osteoporosis caused by both prednisone and lack of weight bearing."