PEDS: Immune
The nurse is providing instructions to the mother of a child who has been exposed to human immunodeficiency virus infection. The nurse should include notifying the health care provider if which symptom occurs in the child? 1. Fussiness 2. Lethargy 3. Irritability 4. Coughing
4. Coughing Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. The mother should be instructed to call the health care provider (HCP) if the child develops a fever higher than 101°F (38.3°C); has vomiting and diarrhea, a decreased appetite, difficulty in swallowing, or drooling; develops rashes or sores on the skin; or has coughing or chest congestion. The mother should also notify the HCP if ear pain, ear pulling, or drainage from the ears occurs; if wounds appear that do not heal; or if the child is exposed to chickenpox. Fussiness, lethargy and irritability are vague symptoms that are nonspecific to the subject of the question.
A health care provider prescribes laboratory studies for an infant of a woman positive for human immunodeficiency virus (HIV). The nurse anticipates that which laboratory study will be prescribed for the infant? 1. Chest x-ray 2. Western blot 3. CD4+ cell count 4. p24 antigen assay
4. p24 antigen assay Rationale: Infants born to HIV-infected mothers need to be screened for the HIV antigen. The detection of HIV in infants is confirmed by a p24 antigen assay, virus culture of HIV, or polymerase chain reaction. A Western blot test confirms the presence of HIV antibodies. The CD4+ cell count indicates how well the immune system is working. A chest x-ray evaluates the presence of other manifestations of HIV infection, such as pneumonia.
The student nurse is presenting a clinical conference regarding human immunodeficiency virus (HIV) in children. Which information should the student include? 1. HIV cannot be spread by hugging, holding, or touching other people. 2. HIV can be transmitted from open wounds but only if there is skin-to-skin contact. 3. HIV is only able to be transmitted from an infected mother to her baby through breast milk. 4. HIV infection cannot be transmitted if a female uses an intrauterine device as birth control.
1. HIV cannot be spread by hugging, holding, or touching other people. Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. HIV cannot be spread by using the same toilet seat, bathtub, or shower; coughing or sneezing; or hugging, holding, or touching people. HIV can be spread from unprotected sexual intercourse regardless of birth control, from sharing of needles, from an infected mother to her baby through breast milk and vaginal secretions during the birth process, or from open wounds if there is blood-to-blood contact.
A child is admitted to the pediatric unit with a diagnosis of acute stage Kawasaki disease. Which assessment findings by the nurse are characteristic of this disorder? Select all that apply. 1. Red throat 2. Cracking lips 3. Conjunctival hyperemia 4. Desquamation of the skin 5. Enlargement of the cervical lymph nodes
1. Red throat 3. Conjunctival hyperemia 5. Enlargement of the cervical lymph nodes Rationale: Kawasaki disease is known as mucocutaneous lymph node syndrome and is an acute systemic inflammatory disease. Assessment findings in the acute stage include fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. Desquamation of the skin, cracking lips, joint pain, cardiac manifestations, and thrombocytosis are characteristics of the subacute stage.
A CD4+ count has been prescribed for a child with human immunodeficiency virus (HIV) infection. The nurse has explained to the mother the purpose of the blood test. Which comment by the mother indicates the need for further explanation? 1. "This test is used to determine the child's immune status." 2. "This test identifies the specific diagnosis of HIV infection." 3. "This test is a blood test that is used to identify the risk for disease progression." 4. "This test assesses the need for Pneumocystis jiroveci pneumonia prophylaxis after 1 year of age."
2. "This test identifies the specific diagnosis of HIV infection." Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. CD4+ counts are used to assess a young child's immune status, risk for disease progression, and need for P. jiroveci pneumonia prophylaxis after 1 year of age. These counts are measured at 1 and 3 months, every 3 months until the age of 2 years, and at least every 6 months thereafter. More frequent monitoring of CD4+ counts is indicated when P. jiroveci pneumonia prophylaxis and antiretroviral therapy are recommended. The CD4+ count is not diagnostic of HIV infection.
The nurse is providing instructions to the mother of a child with human immunodeficiency virus infection regarding immunizations. Which statement by the mother indicates an understanding of the immunization schedule? 1. "The hepatitis B vaccine is not to be given to my child." 2. "My child will receive all the vaccines like any other child." 3. "Family members in the household need to receive the influenza vaccine." 4. "Blood tests are needed before any immunizations are given to my child."
3. "Family members in the household need to receive the influenza vaccine." Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. A child with human immunodeficiency virus (HIV) infection will receive the same immunizations as other children, except for live vaccines. All household members receive the influenza vaccine. Blood tests prior to immunizations are unnecessary and inaccurate.
A 6-year-old child with human immunodeficiency virus (HIV) infection has been admitted to the hospital for pain management. The child asks the nurse if the pain will ever go away. The nurse should make which best response to the child? 1. "The pain will go away if you lie still and let the medicine work." 2. "Try not to think about it. The more you think it hurts, the more it will hurt." 3. "I know it must hurt, but if you tell me when it does, I will try to make it hurt a little less." 4. "Every time it hurts, press on the call button and I will give you something to make the pain go all away."
3. "I know it must hurt, but if you tell me when it does, I will try to make it hurt a little less." Rationale: The multiple complications associated with HIV are accompanied by a high level of pain. Aggressive pain management is essential for the child to have an acceptable quality of life. The nurse must acknowledge the child's pain and let the child know that everything will be done to decrease the pain. Telling the child that movement or lack thereof would eliminate the pain is inaccurate. Allowing a child to think that he or she can control the pain simply by thinking or not thinking about it oversimplifies the pain cycle associated with HIV. Giving false hope by telling the child that the pain will be taken "all away" is neither truthful nor realistic.
The nurse is preparing to administer an MMR (measles, mumps, and rubella) vaccine to a 15-month-old child. Before administering the vaccine, which question should the nurse ask the mother of the child? 1. "Has the child had any sore throats?" 2. "Has the child been eating properly?" 3. "Is the child allergic to any antibiotics?" 4. "Has the child been exposed to any infections?"
3. "Is the child allergic to any antibiotics?" Rationale: Before the administration of MMR vaccine, a thorough health history needs to be obtained. MMR is used with caution in a child with a history of an allergy to gelatin, eggs, or neomycin because the live measles vaccine is produced by chick embryo cell culture and because MMR also contains a small amount of the antibiotic neomycin. The questions in the remaining options are not directed at addressing contraindications to administering immunizations.
The nurse is caring for a child with acquired immunodeficiency syndrome (AIDS) and notes the presence of mouth sores. The nurse provides instructions to the mother regarding maintaining adequate nutritional intake in the child. Which statement by the mother indicates a need for further teaching? 1. "I should weigh my child each morning." 2. "I will offer an iced pop to lick before meals." 3. "Salty foods are very important to maintain an appropriate sodium level in the child." 4. "Milk, juice, or water should really be offered after a meal rather than before a meal."
3. "Salty foods are very important to maintain an appropriate sodium level in the child." Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Salty or spicy foods should be avoided because they irritate mouth sores. The child should be weighed each morning, and calorie intake should be reviewed every 24 hours. If mouth sores are present, the child should be offered an iced pop to lick or ice before meals to numb the mouth. The mother should be instructed to offer foods high in protein and calories and to give vitamin and mineral supplements if prescribed. Milk, juice, and water should be administered to the child after meals because children can fill up on liquids before eating.
The nurse is reviewing the immunization schedule for a child with human immunodeficiency virus (HIV) infection with the mother. Which instruction should the nurse provide to the mother? 1. Immunizations will not be given to the child with HIV infection. 2. The immunization schedule is altered because of the HIV infection. 3. The child and the siblings will need to receive inactivated polio vaccine. 4. The child with HIV infection will start immunizations when 3 years old.
3. The child and the siblings will need to receive inactivated polio vaccine. Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. The mother should be instructed that the child with HIV infection should keep immunizations up to date. The child with HIV infection and the siblings will receive an inactivated polio vaccine because the child with HIV infection is immunocompromised. All household members will receive the influenza vaccine. The immunization schedule would not be altered in any other way, and it is important for the mother to understand clearly the immunization schedule.
The nurse provides home care instructions to the parent of a child with acquired immunodeficiency syndrome (AIDS). Which statement by the parent indicates the need for further teaching? 1. "I will wash my hands frequently." 2. "I will keep my child's immunizations up to date." 3. "I will avoid direct unprotected contact with my child's body fluids." 4. "I can send my child to day care if he has a fever, as long as it is a low-grade fever."
4. "I can send my child to day care if he has a fever, as long as it is a low-grade fever." Rationale: AIDS is a disorder caused by human immunodeficiency virus (HIV) and characterized by generalized dysfunction of the immune system. A child with AIDS who is sick or has a fever should be kept home and not brought to a day care center. Options 1, 2, and 3 are correct statements and would be actions a caregiver should take when the child has AIDS.
The mother with human immunodeficiency virus (HIV) infection brings her 10-month-old infant to the clinic for a routine checkup. The health care provider has documented that the infant is asymptomatic for HIV infection. After the checkup, the mother tells the nurse that she is so pleased that the infant will not get HIV infection. The nurse should make which most appropriate response to the mother? 1. "I am so pleased also that everything has turned out fine." 2. "Because symptoms have not developed, it is unlikely that your infant will develop HIV infection." 3. "Everything looks great, but be sure to return with your infant next month for the scheduled visit." 4. "Most children infected with HIV develop symptoms within the first 9 months of life, and some become symptomatic sometime before they are 3 years old."
4. "Most children infected with HIV develop symptoms within the first 9 months of life, and some become symptomatic sometime before they are 3 years old." Rationale: Acquired immunodeficiency syndrome (AIDS) is caused by HIV infection and characterized by generalized dysfunction of the immune system. Most children infected with HIV develop symptoms within the first 9 months of life. The remaining infected children become symptomatic sometime before age 3 years. With their immature immune systems, children have a much shorter incubation period than adults. Options 1, 2, and 3 are incorrect. Additionally, these options offer false reassurance.
A child was seen in the health care clinic and received an immunization of DPT (diphtheria, pertussis, tetanus) vaccine. One hour later, the mother calls the clinic and tells the nurse that the injection site is painful and red. Which instruction should the nurse provide to the mother? 1. Call the health care provider. 2. Monitor the child for a fever. 3. Return to the health care clinic immediately. 4. Apply cold compresses for 24 hours for 20 minutes at a time.
4. Apply cold compresses for 24 hours for 20 minutes at a time. Rationale: For painful or red injection sites, the nurse should instruct the mother to apply cold compresses for the first 24 hours for 20 minutes at a time and then to use warm or cold compresses as long as needed. The instructions in the remaining options are incorrect. It is not necessary for the mother to bring the child to the clinic immediately, and it is not necessary for the mother to contact the health care provider. Although it may be appropriate to monitor the child for a fever, this action is not associated with the information in the question.
A 3-year-old child with human immunodeficiency virus infection is being discharged from the hospital. The nurse is providing discharge instructions to the mother regarding home care and infection control measures. Which statement by the mother indicates a need for further teaching? 1. "I should discard any unused food and formula immediately." 2. "I need to wash all vegetables carefully before preparing them." 3. "If the nipple becomes soft and sticky, I will discard the nipple." 4. "I will put the clean eating utensils, baby bottle, and dishes in the dishwasher."
1. "I should discard any unused food and formula immediately." Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy.The parents should be instructed to cover unused food and formula and refrigerate. They should also be informed to discard unused refrigerated food or formula after 24 hours. The remaining options are accurate instructions related to basic infection control.
An infant of a mother infected with human immunodeficiency virus (HIV) is seen in the clinic each month and is being monitored for symptoms indicative of HIV infection. With knowledge of the most common opportunistic infection of children infected with HIV, the nurse assesses the infant for which sign? 1. Cough 2. Liver failure 3. Watery stool 4. Nuchal rigidity
1. Cough Rationale: Acquired immunodeficiency syndrome (AIDS) is a disorder caused by HIV and characterized by generalized dysfunction of the immune system. The most common opportunistic infection of children infected with HIV is Pneumocystis jiroveci pneumonia, which occurs most frequently between the ages of 3 and 6 months, when HIV status may be indeterminate. Cough is a common sign of this opportunistic infection. Cytomegalovirus infection is also characteristic of HIV infection; however, it is not the most common opportunistic infection. Liver failure is a common sign of this complication. Although gastrointestinal disturbances and neurological abnormalities may occur in a child with HIV infection, options 3 and 4 are not specific opportunistic infections noted in the HIV-infected child. Watery stool is noted with gastroenteritis and nuchal rigidity is seen in meningitis.
The nurse is caring for a child with a diagnosis of neutropenia. Which nursing interventions are most appropriate for a child placed in protective isolation for neutropenia? Select all that apply. 1. Place the child on a low-bacteria diet. 2. Change dressings using sterile technique. 3. Put flowers in a vase with water before placing in the room. 4. Peel fruits and vegetables before allowing the child to eat them. 5. Allow individuals who are ill to visit as long as they wear a mask.
1. Place the child on a low-bacteria diet. 2. Change dressings using sterile technique. 4. Peel fruits and vegetables before allowing the child to eat them. Rationale: For the hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas species, to which these children are very susceptible. Fruits and vegetables not peeled before being eaten harbor molds and should be avoided until the white blood cell count rises. The child is placed on a low-bacteria diet. Dressings are always changed using sterile technique. Individuals who are ill are not allowed to visit the client.
The clinic nurse is instructing the parent of a child with human immunodeficiency virus (HIV) infection regarding immunizations. The nurse should provide which instruction to the parent? 1. The hepatitis B vaccine will not be given to the child. 2. The inactivated influenza vaccine will be given yearly. 3. The varicella vaccine will be given before 6 months of age. 4. A Western blot test needs to be performed and the results evaluated before immunizations.
2. The inactivated influenza vaccine will be given yearly. Rationale: Immunizations against common childhood illnesses are recommended for all children exposed to or infected with HIV. The inactivated influenza vaccine that is given intramuscularly will be administered (influenza vaccine should be given yearly). The hepatitis B vaccine is administered according to the recommended immunization schedule. Varicella-zoster virus vaccine should not be given because it is a live virus vaccine; varicella-zoster immunoglobulin may be prescribed after chickenpox exposure. Option 4 is unnecessary and inaccurate.
The nurse is reviewing the laboratory results of studies on a 4-month-old infant and notes that the human immunodeficiency virus (HIV) antibody test is positive. How should the nurse interpret this test result? 1. The infant has HIV. 2. Repeat the test in 1 month. 3. The infant is infected with the HIV virus. 4. The mother is infected with the HIV virus.
4. The mother is infected with the HIV virus. Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. A positive HIV antibody test result in a child younger than 18 months indicates only that the mother is infected because maternal IgG antibodies persist in infants for 6 to 9 months and, in some cases, as long as 18 months. The other options are incorrect interpretations of this laboratory result.
