PEDS CH 26 prep u immunologic disorders
Which of the following would best identify foods to which a child is allergic? a) Hyposensitivity testing b) Elimination diet c) Complete dietary protein restriction d) Corticosteroid challenge testing
b) Elimination diet
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
b) False
he most accurate screening test for the presence of HIV antigen in young children is a) CD4 count b) ELISA c) PCR d) Western blot
c) PCR
Question: Place in correct order the steps in the anaphylactic response.
Exposure to allergen Rapid immune response Vasodilation Bronchoconstriction Circulatory collapse
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) Apples c) Cheerios d) Eggs e) Peanuts
a) Milk d) Eggs e) Peanuts
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) "Has she ever had penicillin before?" c) "Do you have a telephone to call us immediately if she develops trouble breathing?" d) "Is there any family history of allergy to penicillin?"
b) "Has she ever had penicillin before?"
A child is in the emergency department after a bee sting and experiencing bouts of nausea and vomiting. The patient's blood pressure is 68/40; pulse is 48. The child is hypoxic and dyspneic. Which medication should the nurse prepare to give this patient? a) Prednisone b) Sudafed c) Epinephrine d) Benadryl
c) Epinephrine
The nurse is providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which food? a) Pumpkins b) Pomegranates c) Blueberries d) Bananas
d) Bananas
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
d) Diphenhydramine
Which of the following drugs should be available for emergency treatment of a child who goes into anaphylactic shock? a) Vistaril b) Meperidine c) Morphine sulfate d) Epinephrine
d) Epinephrine
Question: 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
Question: The nurse is observing a child demonstrate the use of an Epipen. The nurse determines that the child has performed the procedure correctly. Place the steps below in the proper sequence that was demonstrated by the child.
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
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. Hypoxia Seizures Urticaria, angioedema Nausea, vomiting, diarrhea Bronchospasm
Nausea, vomiting, diarrhea Urticaria, angioedema Bronchospasm Hypoxia Seizures
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) Zidovudine d) Lamivudine
a) Abacavir
Which is the immunoglobulin associated with allergic reactions? a) IgA b) IgG c) IgE d) IgM
c) IgE
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) Antibiotics b) Decongestants c) Corticosteroids d) Antihistamines
d) Antihistamines
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) Phagocytosis b) Decreased vascular permeability c) Lysis of the foreign antigen d) Smooth muscle relaxation e) Chemotaxis
• Chemotaxis • Phagocytosis • Lysis of the foreign antigen
Which of the following drugs should be available for emergency treatment of a child who goes into anaphylactic shock? a) Epinephrine b) Insulin c) Dopamine d) Ephedra
a) Epinephrine
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 check the level of antibodies in the blood to confirm the allergy." b) "The best way is to eliminate the food from the diet and then look for improvement." c) "We can inject an extract of the food under the skin and see if there is a reaction." d) "Skin testing using a patch is probably the easiest method."
b) "The best way is to eliminate the food from the diet and then look for improvement."
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) antigen c) macrophage d) immunogen
a) allergen
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) False b) True
b) True
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) delayed hypersensitivity b) autoimmunity c) allergen d) immunity
b) autoimmunity
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. a) Take baseline vital signs and monitor the vital signs during the infusion b) Prepare to give acetaminophen to the child c) Prepare to administer the medication ventrogluteal site as an intramuscular injection d) Prepare to give diphenhydramine to the child e) Mix the medication with the child's intravenous antibiotic
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
The nurse is discussing food allergies with parents of a young child. She explains that a very effective way to determine which foods a child may be allergic to is to implement a) A food diary b) Allergy skin testing c) A raw food diet d) An elimination diet
d) An elimination diet
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) "Have you noticed any hair loss or redness on your face?" 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) "Do you notice any wheezing when you breathe or a runny nose?"
a) "Have you noticed any hair loss or redness on your face?"
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 information about the child? a) Has polyarticular JIA b) Has systemic JIA c) Has pauciarticular JIA d) Is at risk for anaphylaxis
a) Has polyarticular JIA
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) IgG b) IgA c) IgM d) IgD
a) IgG
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) IgG c) IgD d) IgE
a) IgM
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) Monitor urine for glucose. b) Administer with food. c) Monitor for signs of Cushing syndrome. d) Have epinephrine available.
d) Have epinephrine available.
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) IgA c) IgG d) IgE
d) IgE
Nebulized albuterol should be available to counteract anaphylactic shock. This drug a) counteracts hypotension. b) increases the pulse rate. c) depresses the central nervous system. d) facilitates breathing.
d) facilitates breathing.
The young girl has been diagnosed with juvenile idiopathic arthritis (JIA) and has been prescribed methotrexate. Which statements by the child's parent indicates that adequate learning has occurred? Select all that apply. a) "She may start feeling better by next week." b) "We'll need to bring her back in for some lab tests after she starts methotrexate." c) "A warm bath before bed might help her sleep better." d) "She can take methotrexate with yogurt or chocolate milk." e) "Swimming sounds like a good exercise for her."
e) "Swimming sounds like a good exercise for her." b) "We'll need to bring her back in for some lab tests after she starts methotrexate." c) "A warm bath before bed might help her sleep better."
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) Vaginal discharge b) Genital warts c) Mild, flu-like symptoms d) Skin rash
c) Mild, flu-like symptoms
What advice would be most appropriate for the child with a stinging-insect allergy? a) Arrange for allergy testing for foods with ingredients similar to those in insect venom. b) Join a peer support group to help relieve anxiety about this problem. c) Obtain a medical alert ID bracelet so the presence of the allergy can be identified easily. d) Consult a genetic counselor to reveal other susceptible family members.
c) Obtain a medical alert ID bracelet so the presence of the allergy can be identified easily.
Which of the following nursing problems could be associated with a child with primary immunodeficiency? Select all that apply. a) Altered gastrointestinal function b) Altered fluid and electrolytes c) Risk for infection d) Altered skin integrity e) Delayed growth and development
c) Risk for infection d) Altered skin integrity e) Delayed growth and development
Question: The nurse instructs a school-aged child who has a bee-sting allergy and his parents on proper use of the EpiPen. What is the order of steps that should be taken if the child is bit by a bee? Grasp the EpiPen with your fist, with black tip pointing down. Remove gray safety cap. Place EpiPen against child's thigh, injecting solution. Hold syringe in place for 10 seconds.
Grasp the EpiPen with your fist, with black tip pointing down. Remove gray safety cap. Place EpiPen against child's thigh, injecting solution. Hold syringe in place for 10 seconds.
Which of the following immune cells are disrupted when a child is infected with human immunodeficiency virus (HIV)? Select all that apply. a) Platelets b) Phagocytes c) T cells d) B cells e) Erythrocytes
b) Phagocytes c) T cells d) B cells
The nurse is providing family education about the administration of cyclosporine A. Which response by the family indicates a need for further teaching? a) "We should monitor for signs of infection." b) "The medication is best absorbed with the vitamin C in citrus juices." c) "It is okay to take cyclosporine with dairy products." d) "We need to adhere to the schedule for routine follow up blood work."
b) "The medication is best absorbed with the vitamin C in citrus juices."
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) 0.8 mg b) 0.4 mg c) 0.2 mg d) 1 mg
b) 0.4 mg
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) "1 teaspoon baking powder equals one egg in a recipe." b) "I must not feed my child eggs in any form." c) "1 tsp yeast and ¼ cups warm water is a substitute in baked goods." d) "I can use the egg white when baking, but not the yolk."
d) "I can use the egg white when baking, but not the yolk."
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) Notify the child's mother. d) Apply a warm compress to the site of the bee sting.
b) Administer epinephrine immediately.
The nurse is caring for a child who is beginning to show signs and symptoms of anaphylaxis. Which intervention would be the priority? a) Assessing patency of the airway b) Administering IV diphenhydramine (Benadryl) c) Obtaining brief history of allergen exposure d) Administering corticosteroids
b) Administering IV diphenhydramine (Benadryl)
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) Methotrexate d) Corticosteroid
b) Aspirin
A child is scheduled to undergo hyposensitization. The nurse understands that this therapy attempts to achieve which of the following? a) Increased concentration of IgG b) An increased level of IgE c) Reduction in allergen exposure d) Blockage of histamine release
a) Increased concentration of IgG
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) Lymphocyte T cells b) Stem cells c) White blood cells d) Antibodies
a) Lymphocyte T cells
The nurse is teaching the parents of a 4-year-old boy with a peanut allergy about diet and possible unexpected locations of peanuts or peanut oil in food products. After describing this to the parents, which response by the mother would indicate a need for further teaching? a) "Some hot-chocolate mixes have peanuts." b) "We must be careful about baked goods." c) "We must be careful with Asian food." d) "We can't go wrong with hamburgers and hot dogs."
d) "We can't go wrong with hamburgers and hot dogs."
A young patient is admitted to the hospital directly from the clinic. The physician suspects a problem with the patient's immune system. What test does the nurse anticipate the physician will order for this patient? a) x-ray b) EKG c) urine analysis d) blood analysis
d) blood analysis
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) killer; viral b) humoral; viral c) killer; bacterial d) humoral; bacterial
d) humoral; bacterial
A nurse is reviewing the history and physical examination of an infant diagnosed with juvenile idiopathic arthritis. Which sign would the nurse identify as often being first? a) Macular rash b) Fussiness c) Fever d) Joint pain
b) Fussiness
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) premedicate with acetaminophen or diphenhydramine. c) begin infusion slowly increasing to prescribed rate. d) assess for adverse reaction.
b) premedicate with acetaminophen or diphenhydramine.
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) 12 months b) 2 to 3 months c) 4 to 7 weeks d) 8 to 10 weeks
c) 4 to 7 weeks
A child is diagnosed with a latex allergy. When developing the teaching plan for this child, the nurse would include which of the following foods to avoid? Select all that apply. a) Squash b) Cheese c) Bananas d) Cherries e) Peanut butter f) Pineapples
c) Bananas d) Cherries f) Pineapples
A child is diagnosed with severe combined immunodeficiency syndrome. Which of the following would the nurse expect to find when reviewing the child's history and physical examination? a) Worsening eczema b) Elevated IgE levels c) Chronic diarrhea d) Weight greater than expected for height
c) Chronic diarrhea
A nurse is caring for an infant whose mother is human immunodeficiency (HIV) positive. The nurse knows that which diagnostic test result will be positive even if the child is not infected with the virus? a) Immunoglobulin electrophoresis b) Erythrocyte sedimentation rate c) Enzyme-linked immunosorbant assay (ELISA) d) Polymerase chain reaction test
c) Enzyme-linked immunosorbant assay (ELISA)
A child with systemic lupus erythematosus is receiving hydroxychloroquine sulfate. Which instruction would the nurse emphasize when teaching the child and parents about this drug? a) Need to gradually taper the drug dosage over time b) Avoiding grapefruit juice when taking the drug c) Importance of yearly eye examinations d) Giving with foods to minimize gastrointestinal upset
c) Importance of yearly eye examinations
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) Complement assay (C3 and C4) b) Immunoglobulin electrophoresis c) Lymphocyte immunophenotyping T-cell quantification d) IgG subclasses
c) Lymphocyte immunophenotyping T-cell quantification
Which of the following treatments are common to both systemic lupus erythematosus and juvenile idiopathic arthritis? Select all that apply. a) Antipyretics b) Antimalarials c) Nonsteroidal antiinflammatories d) Corticosteroids e) Antirheumatics
c) Nonsteroidal antiinflammatories d) Corticosteroids
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) von Willebrand's disease b) Severe combined immunodeficiency c) Wiskott-Aldrich syndrome d) Beta-thalassemia major
c) Wiskott-Aldrich syndrome
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) Ritonavir b) Nevirapine c) Zidovudine d) Efavirenz
c) Zidovudine
What advice would be most appropriate for the child with a stinging-insect allergy? a) Obtain a medical alert ID bracelet so the presence of the allergy can be identified easily. b) Join a peer support group to help relieve anxiety about this problem. c) Arrange for allergy testing for foods with ingredients similar to those in insect venom. d) Consult a genetic counselor to reveal other susceptible family members.
a) Obtain a medical alert ID bracelet so the presence of the allergy can be identified easily.
A 4-year-old child is receiving monthly IgG transfusions for hypergammaglobulinemia. In assessing the child's current health status, the nurse will ask about several aspects of care, including which of the following? Select all that apply. a) Sleep disturbances b) Frequency of recent illnesses c) Participation in activities d) Vacation plans e) Nutritional intake
a) Sleep disturbances b) Frequency of recent illnesses c) Participation in activities d) Vacation plans e) Nutritional intake
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) Platelet count b) Polymerase chain reaction (PCR) test c) Enzyme-linked immunosorbent assay (ELISA) d) CD4 counts
b) Polymerase chain reaction (PCR) test
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 use a tub bath for daily cleansing" b) "Don't encourage a pacifier due to possible oral malformation" c) "Do not use a sponge bath for light cleaning" d) "Do not insert anything in the rectum"
d) "Do not insert anything in the rectum"
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.) a) Sharing the same bathroom b) Transfusion of contaminated blood c) Sharing contaminated needles d) Perinatally from mother to fetus e) Through breastfeeding f) Exposure to blood and body fluids through sexual contact
b) Transfusion of contaminated blood c) Sharing contaminated needles d) Perinatally from mother to fetus e) Through breastfeeding f) Exposure to blood and body fluids through sexual contact
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? a) "We must massage the area for 10 seconds after administration." b) "The epinephrine auto-injector should be jabbed into the upper arm." c) "The epinephrine auto-injector must be held firmly for 10 seconds." d) "We must make sure that the black tip is pointed downward."
b) "The epinephrine auto-injector should be jabbed into the upper arm."
The nurse is preparing an informational brochure about risk factors for immune disorders. Which of the following disease processes can indicate a potential underlying immunologic disorder? Select all that apply. a) Occasional rhinorrhea b) Chronic cough c) Persistent oral thrush d) Extensive eczema e) Illness with a high-grade fever
b) Chronic cough c) Persistent oral thrush d) Extensive eczema
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. a) Potatoes b) Eggs c) Peanuts d) Shrimp e) Oranges f) Carrots
b) Eggs c) Peanuts d) Shrimp
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) Minor localized infection b) Malnutrition c) Immunosuppressive drugs d) Cancer e) Vitamin therapy
b) Malnutrition c) Immunosuppressive drugs d) Cancer
The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. Which of the following should be a priority recommendation in this setting? a) Screening for sexually transmitted infections (STIs) b) Screening for HIV c) Prophylactic treatment for HIV d) Proper nutrition
b) Screening for HIV
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) Infected laceration requiring IV antibiotic 2 months ago; healed b) Oral thrush, persistent over the past 6 to 7 months c) Pneumonia last spring; resolved with antibiotics d) Recurrent deep abscess of the thigh e) Acute otitis media, one episode every 3 to 4 weeks over the past year.
b) Oral thrush, persistent over the past 6 to 7 months d) Recurrent deep abscess of the thigh e) Acute otitis media, one episode every 3 to 4 weeks over the past year.
The nurse is working with a pregnant client with HIV who is receiving oral zidovudine. What is the primary rationale for this intervention? a) To treat pneumonia b) To help prevent transmission of the disease to the fetus c) To restore coagulation ability d) To halt the growth of Kaposi's sarcoma
b) To help prevent transmission of the disease to the fetus
A 7-year-old girl is rushed into the emergency room after being stung by a yellow jacket in a park nearby. She is nauseated and vomiting and is experiencing itching and swelling on the arm where she was stung. She is having trouble breathing. The nurse recognizes this as which type of hypersensitivity response? a) Type II: cytotoxic response b) Type IV: cell-mediated hypersensitivity c) Type I: anaphylaxis d) Type III: immune complex
c) Type I: anaphylaxis
A mother, who is HIV positive, is distraught when she learns that her 6-month-old baby is also human immunodeficiency virus (HIV) positive. The child had undergone open heart surgery as a newborn and had received numerous blood transfusions. The nurse recognizes that which of the following is the most likely means of transmission of the disease to this child? a) Breastfeeding b) The mother kissing the baby on the forehead c) Blood transfusion products contaminated with the virus d) Placental spread during pregnancy
d) Placental spread during pregnancy