Chapter 25 Immunological or Infectious Condition

39. A child has been hospitalized with rubella. Which action by the charge nurse is most appropriate? A. Do not allow pregnant nursing staff in the room. B. Inform the parents that fresh produce is not allowed. C. Place the child on contact isolation precautions. D. Use standard precautions when caring for the child.

ANS: A The most serious consequence of rubella infection occurs prenatally; exposure in utero can lead to cognitive impairment, deafness, eye disorders, cardiac defects, and stillbirth. Pregnant staff should not enter this room. Disallowing produce is not related to this disorder. Contact precautions are not warranted; this disease is spread through the airborne route. Standard precautions are used for all patients.

28. A nurse is assessing a 7-year-old who has white patches inside his mouth. Which question by the nurse would be most helpful to ask? A. "Do you have asthma?" B. "Do you drink milk?" C. "How much soda do you drink?" D. "When you do brush your teeth?"

ANS: A This child's complaint sounds like oral thrush. Often seen in infants, it can also be caused by inhaler use in children with asthma. The other questions are not related.

27. The clinic nurse is assessing a teenage girl who reports fever, chills, sore throat, and extreme fatigue during the last 2 weeks. Which focused assessment should the nurse perform? A. Assess lymph nodes. B. Collect buccal swabs. C. Obtain a urinalysis. D. Palpate the abdomen.

ANS: A This girl's age and symptoms are highly suggestive of infectious mononucleosis. The nurse should assess for swollen and tender occipital and cervical lymph nodes. The nurse should not palpate the abdomen because the spleen, if enlarged, can rupture under pressure. Buccal swabs and urinalysis are not related.

26. A parent brings her child to the pediatric clinic and reports that the child has a rash on one side of his body that reminds her of chickenpox, but is more painful. Which medication does the nurse anticipate teaching the parent about? A. Acyclovir (Zovirax) B. Azathioprine (Imuran) C. Diphenhydramine (Benadryl) D. Intravenous immune globulin (IVIG)

ANS: A This rash sounds like herpes zoster (shingles), which is treated with acyclovir. Imuran is used in autoimmune disorders. Benadryl is used for itching. IVIG is also used in immune disorders.

2. A child is receiving vaccinations at a well-baby clinic. The nurse explains to the mother that the vaccinations provide which type of immunity? A. Active B. Innate C. Man-made D. Passive

ANS: A Vaccinations provide one type of active immunity. Passive immunity is brought about through immunoglobulins, either passed via the mother or given to the child through another means. Innate protection is provided by physical barriers, such as the skin or mucous membranes. Man-made immunity is not a classification of immunity.

5. A 4-month old baby was recently hospitalized with septicemia and now has a severe diaper rash. Which primary immunodeficiency disorder does the nurse suspect? A. Antibody deficiency: B-cell disorder B. Combined deficiency: T- and B-cell disorder C. Complement defect disorder D. Phagocyte defect disorder

ANS: B Combined deficiency: T- and B-cell disorder usually manifests before 6 months of age and includes severe infections such as meningitis and septicemia, diaper dermatitis, and opportunistic infections. Antibody deficiencies are usually seen after 6 months of age. Complement defect disorder is often accompanied by autoimmune diseases. Phagocyte defect disorders include impetigo, mouth ulcers, suppurative adenitis, osteomyelitis, and poor wound healing.

32. A child has been diagnosed with influenza and is prescribed oseltamivir (Tamiflu). Which instruction by the nurse is most important? A. "Do not use aspirin with this drug." B. "Encourage plenty of liquids." C. "Rinse the inhaler after each use." D. "This will cure the flu in 5 days."

ANS: B Common side effects of Tamiflu include nausea, vomiting, GI distress, and diarrhea. The child should drink plenty of fluids to avoid dehydration. Aspirin is not used in children at all due to the risk of Reye's syndrome. Tamiflu is not given via inhaler. The medication is not curative.

23. An immunocompromised child has been admitted to the hospital with Fifth's disease. Which action by the nurse is most appropriate? A. Place the child in contact precautions. B. Place the child in droplet precautions. C. Place the child in protective isolation. D. Place the child on standard precautions.

ANS: B Fifth's disease is spread through respiratory droplets, so droplet precautions are appropriate. Of course standard precautions should be used with all patients, but this is not enough in this situation. Contact and protective precautions are not needed for this disease.

17. A teenage girl is diagnosed with systemic lupus erythematosus (SLE). Which health promotion guidance is important for the nurse to provide? A. "Acetaminophen (Tylenol) is best for daily pain." B. "Consider adding vitamin D to your daily routine." C. "Plan to choose a career that is sedentary." D. "You should consider elective sterilization."

ANS: B Sun exposure is a frequent cause of SLE exacerbations, so patients with SLE must use sunscreen and avoid prolonged time in the sun. This decreases vitamin D synthesis, which is required to metabolize and utilize calcium, leading to increased risk of osteoporosis. A side effect of steroid use is also osteoporosis, so patients with SLE (women especially) need to guard against this occurrence by adding supplemental vitamin D. NSAIDs are best for the pain and inflammation that accompany SLE. The patient does not have to be sedentary; a balance of rest and activity is needed. Pregnancy is not absolutely contraindicated in the patient with SLE; however, it must be considered cautiously in consultation with the health-care provider.

1. The pediatric nurse explains to a student that which actions are most important in preventing and controlling infections? (Select all that apply.) A. Administering antibiotics B. Educating the public C. Monitoring for outbreaks D. Providing immunizations E. Scheduling physical exams

ANS: B, C, D Prevention and control of infections, especially communicable diseases, centers around surveillance, public education, and immunization.

10. A child has been hospitalized with rubeola. Which actions by the nursing staff are most important? (Select all that apply.) A. Administer ordered antibiotics on time. B. Assess the child for Koplik's spots. C. Ensure the room is dark for photophobia. D. Monitor the child for febrile seizures. E. Report the disease to health authorities.

ANS: B, C, E Appropriate nursing care for the child with rubeola includes assessing the child's mouth for Koplik's spots, providing comfort for photophobia by darkening the room, and reporting the disease to authorities. Rubeola is a viral disease not treated with antibiotics. Fever is moderate and seizures are not usually seen.

7. A nurse is educating a community group of parents about prevention of West Nile virus. Which information does the nurse include in the teaching session? (Select all that apply.) A. All children should be sprayed with DEET before going outside. B. Eliminate standing water around your house, such as in birdbaths. C. Holistic mosquito repellent, such as lavender, is very effective. D. Long sleeves and long pants help prevent mosquito bites. E. The peak season for this virus is late summer to early autumn.

ANS: B, D, E West Nile is most prevalent in late summer and early fall. Standing water is a breeding ground for mosquitoes and should be eliminated. Long sleeves and pant legs help keep mosquito bites from occurring on the arms and legs. Mosquito repellants containing DEET are most effective in preventing mosquito bites. Holistic methods are not as effective. Children under the age of 2 years should not have DEET sprayed onto their skin; rather, it should be applied to their clothing.

20. A patient is experiencing an anaphylactic reaction. Which action by the nurse takes priority? A. Determine what the patient is allergic to. B. Listen to the patient's lung sounds. C. Maintain the patient's airway. D. Provide oxygen at 4 L nasal cannula.

ANS: C Anaphylaxis is a medical emergency. Airway comes first. The patient may need oxygen, but if the airway is not patent, the oxygen will not help. Listening to the lungs and determining the allergen come later.

31. A child is being sent home from the doctor's office with a prescription for azithromycin (Zithromax) for presumed cat-scratch disease. Which instruction to the parents is most important? A. "Be sure to treat your cat for fleas." B. "Don't take this unless the scratch gets infected." C. "Make sure he takes all of this antibiotic." D. "You should not have cats around small children."

ANS: C As with any antibiotic, taking all the prescribed medication is a priority instruction. For some reason, cats with fleas have higher rates of the bacteria that causes the disease, so flea control is important. The other two instructions are not appropriate.

6. A 10-month-old-child is in the pediatric clinic for his eighth ear infection. Which assessment is most important for the nurse to perform on this child? A. Ask the parent about possible allergy testing. B. Assess the child's mouth for oral thrush. C. Graph height and weight on the growth chart. D. Inquire about the health of the entire family.

ANS: C Children with primary immunodeficiencies can often be identified using Modell's 10 Warning Signs, which include failure to gain weight or grow properly. The nurse should assess the child's height and weight and graph it on the growth chart, comparing it to normal values for the child's age. Persistent oral or skin thrush is another sign if it persists past 1 year of age. Assessing for parental views on allergy testing is not related. Because these deficiencies are congenital, asking about the health of the entire family is too vague; it would be important to ask specifically about a history of primary immunodeficiencies, however.

22. A parent calls a pediatric information line to ask about treating sinus congestion in a child. Which suggestion is not appropriate for the nurse to make to the parent? A. Warm facial compress B. Cool-mist steamer C. Sine-Off sinus medication D. Gentle nasal suctioning

ANS: C Common comfort measures for sinus or respiratory problems include a cool-mist steamer, decongestants, and gentle nasal suctioning. A warm facial compress would be more helpful. Sine-Off over-the-counter sinus medication contains salicylates, or aspirin compounds, which are not given to children due to the risk of Reye's syndrome.

25. A child has been diagnosed with a localized herpes simplex virus (HSV) type 1 infection. The nurse is educating the parents on topical acyclovir (Zovirax) ointment. Which statement by the nurse is most appropriate to include during the medication teaching session? A. "Acyclovir can shorten the outbreak." B. "If this doesn't work we can give it IV." C. "This medication will cure the infection." D. "Zovirax must be used for the child's life."

ANS: A Acyclovir and penciclovir (Danavir) can be used to shorten the duration and lessen the pain of HSV infection. It is not curative. IV medication is used for disseminated infection or in children with severe immunocompromise. The medication is used during outbreaks.

13. An adolescent patient is taking combination retroviral therapy for HIV infection. He is not responding as expected. Which action by the nurse is most appropriate? A. Asking why he does not take the medications B. Assessing the patient for noncompliance C. Consulting a pediatric social worker D. Starting a simpler drug regimen for the HIV

ANS: A Adolescents are notorious for wanting to fit in with their peers, even at the cost of their health, and are frequently noncompliant with medication regimens. This is compounded by the very complex nature of multi-drug therapy for HIV. The nurse needs to assess for noncompliance first. Asking "why" questions often puts people on the defensive and may not lead to a truthful response. Consulting a social worker may be needed, but not as the first step. Unfortunately, simple drug regimens for HIV do not exist.

12. An HIV-positive mother wants to return to work because she is feeling well after starting therapy for her disease. She has a 10-month-old infant. What does the nurse advise her when selecting a day care or care provider for her child, who also is HIV-positive? A. "Assess their ability to use standard precautions and properly dispose of diapers." B. "Do not disclose the nature of your baby's disease to the day-care providers." C. "Find out their policy on allowing children who are sick to come to day care." D. "Find out if they consistently wear gloves for all diaper changes they perform."

ANS: A An important concept when caring for babies who are HIV-positive is that diaper changes must include using standard precautions and proper disposal of soiled diapers in biohazard bags and hazardous waste containers. To protect public safety, any day care or care provider the mother chooses must be educated on these procedures. Wearing gloves is not enough. The mother should disclose the baby's illness to protect the day-care workers. Keeping ill children away from her baby is important, too, and most day-care centers have specific guidelines about when sick children can attend. The mother should know these policies and advise the staff to keep her child away from other ill children. But the priority is proper disposal of waste.

1. A nursing faculty member is explaining the pediatric immune system to students. Which statement is correct? A. Children are born with intact immune systems. B. Children's immune systems develop over 1 year. C. Immunity isn't functional until about 6 months. D. Mothers' immunity is babies' primary line of defense.

ANS: A Children are born with an intact immune system. There immune system, however, is immature. Infants do retain some immunity from their mothers from birth until about 6 months. The other statements are incorrect.

38. The day after attending a large birthday party for a classmate, a child breaks out in a rash characteristic of chickenpox. When counseling the parents, which information is most appropriate? A. "Inform all the parents of children at the party that your child has chickenpox." B. "This disease is spread through respiratory droplets, so don't get too close." C. "We can give your child a dose of varicella zoster immune globulin right away." D. "Your child is only contagious for 3 days after the rash first appears."

ANS: A Children with chickenpox are contagious from 1-2 days prior to the rash erupting until the time when all the lesions have crusted over, usually about 7 days. The parents of this child should inform the other parents about their children's exposure to the disease. The disease is spread via airborne and contact routes. Immune globulin can be used within 72 hours after an exposure in immunosuppressed children.

33. The pediatric nurse explains to a nursing student about the most important role the nurse has in preventing disease. What does this role include? A. Ensuring that immunizations are up to date in all children B. Facilitating research on new forms of immunizations C. Giving reminders about immunizations to parents in clinic D. Scheduling and conducting immunization clinics

ANS: A Immunizations are the cornerstone of communicable disease prevention. The most important role the nurse has related to this topic is to ensure that all children in contact with him or her have vaccinations that are up to date. The other activities can be important components of disease prevention, but are not as important.

37. A nurse is caring for a patient taking lamivudine (Epivir). Which laboratory test is most important for the nurse to assess? A. CD4+ count B. Hemoglobin C. Platelet count D. White blood cell count

ANS: A Lamivudine is used in children with HIV infection or AIDS. It is a nucleotide reverse transcriptase inhibitor. The CD4+ is the critical laboratory value to monitor in these children.

11. A nurse is caring for an HIV-positive child diagnosed with Pneumocystis jiroveci pneumonia who is receiving trimethoprim-sulfamethoxazole. Which finding indicates a possible complication of using this drug? A. Hemorrhagic blisters B. Polyuria C. Severe headache D. Seizures

ANS: A P. jiroveci is usually treated with trimethoprim-sulfamethoxazole (TMP-SMZ), a sulfa drug. A potential complication of this drug is Stevens-Johnson syndrome, characterized by a rash that turns into hemorrhagic blistering, fever, cough, sore throat, nausea, and vomiting. Polyuria, headache, and seizures are not typical findings in this condition.

15. A faculty member is discussing systemic lupus erythematosus (SLE) with a group of nursing students. Which pathophysiological process does the nurse describe as the major problem in this disorder? A. Autoimmune process creates antigen-antibody complexes that damage tissues B. Genetic defect linked strictly to male offspring leading to organ damage C. Limited autoimmune process destroys tissues in specific target organs D. Rapidly progressive disease triggered by hormonal changes such as pregnancy

ANS: A SLE is an autoimmune disorder in which antigen-antibody complexes are formed and deposited widely throughout the body, damaging many organs and tissues. It is tied to a genetic disposition but is not solely genetic in origin; it affects females more than males. The destruction is widespread, not limited to a few target organs. The disease is characterized by exacerbations and remissions.

16. A parent of a child suspected of having systemic lupus erythematosus (SLE) asks why so many blood tests are being done. Which response by the nurse is the most appropriate? A. "Many of these blood tests look for possible organ damage from SLE." B. "SLE is a complicated disorder and is very hard to diagnose." C. "This is a very typical pattern of diagnostic blood tests we usually do." D. "We are also checking for other possible autoimmune diseases."

ANS: A The diagnostic workup for SLE is indeed complex, but many of the tests are done to determine if organ damage has already occurred and to obtain a baseline to which future tests can be compared. The other options are vague and do not really answer the parent's questions.

24. The pediatric nurse is discharging a child diagnosed with cytomegalovirus infection (CMV). Which teaching is most appropriate for this child? A. Ensure adequate rest. B. Keep the child isolated. C. Offer favorite foods. D. Provide plenty of fluids.

ANS: A The most common problem for children during the convalescent phase after acute CMV infection is fatigue. The nurse teaches the parents to ensure the child gets plenty of rest. Adequate nutrition and hydration are always important and are not specific for this condition. The child does not need to be isolated.

6. The family practice nurse counsels parents to avoid giving their child salicylates for fever or mild pain. Which over-the-counter medications does the nurse warn about that contain this product? (Select all that apply.) A. Alka-Seltzer B. Bufferin C. Dristan D. Kaopectate E. Robitussin

ANS: A, B, C, D Many over-the-counter medications contain salicylates. Common medications include Alka-Seltzer, Bufferin, Dristan, and Kaopectate. Robitussin is not on this list.

8. The pediatric nurse is aware of the Core Strategies to reduce the spread of MRSA. Which actions do these strategies include? (Select all that apply.) A. Assess hand-hygiene practices. B. Implement contact precautions. C. Rapid reporting of MRSA laboratory results D. Recognize previously colonized patients. E. Screen all patients for MRSA.

ANS: A, B, C, D There are several core strategies to prevent the spread of MRSA, including assessing hand-hygiene practices, implementing contact precautions, rapid reporting of MRSA laboratory results, recognizing previously colonized patients, and educating health-care providers. Screening all patients is not one of the core strategies.

3. A nurse is caring for an HIV-positive school-age child who is moderately malnourished. Which interventions are appropriate to include in this child's plan of care? (Select all that apply.) A. Assess the oral cavity once a shift. B. Determine the child's food preferences. C. Encourage adequate fluid intake. D. Provide oral hygiene after each meal. E. Teach the parents about tube feedings.

ANS: A, B, C, D There are several good strategies for improving nutrition. Assess the oral cavity for mouth sores that make it difficult and painful to eat. Frequent oral care helps reduce the possibility of these lesions occurring. Adequate fluids will help maintain intact oral mucosa. Of course, giving a child favorite foods will increase the likelihood of the child eating. The risks associated with tube feedings are high and not appropriate for a child with mild to moderate malnutrition.

9. An 8-year-old child is in the clinic and is diagnosed with ringworm. Which medications does the nurse anticipate teaching the child and parents about? (Select all that apply.) A. Griseofulvin (Fulvicin) B. Infliximab (Remicade) C. Ketaconazole (Selenium) D. Naproxen (Naprosyn) E. Salicylates (Aspirin)

ANS: A, C A child diagnosed with ringworm will require teaching regarding antifungal medications. Griseofulvin (Fulvicin) and ketaconazole (Selenium) are appropriate medications to include in the teaching session. The other medications are not used to treat ringworm.

ANS: A, D, E This child has two manifestations referred to as CREST syndrome (Raynaud's phenomenon and esophageal dysmotility). The other three signs are calcinosis (formation of calcium deposits under the skin), sclerodactyly (stiff skin over the hands), and telangiectasias (tiny broken capillaries on skin). Fungal nail infections and oral thrush are not related.

ANS: A, C, E The epidemiological triangle consists of the agent, the environment, and the host. Communicable period is the time during which the child can transmit the disease to others. Virulence refers to the severity of the health problems caused by the agent.

4. The pediatric clinic nurse assesses a child who reports swallowing problems and skin changes on the hands in response to cold exposure. Which other manifestations will the nurses assess for in this child? (Select all that apply.) A. Calcinosis B. Fungal nail infections C. Oral thrush D. Sclerodactyly E. Telangiectasias

ANS: A, D, E This child has two manifestations referred to as CREST syndrome (Raynaud's phenomenon and esophageal dysmotility). The other three signs are calcinosis (formation of calcium deposits under the skin), sclerodactyly (stiff skin over the hands), and telangiectasias (tiny broken capillaries on skin). Fungal nail infections and oral thrush are not related.

2. The nurse is caring for a 15-year-old suspected of having HIV infection. Which laboratory tests does the nurse anticipate will be ordered for this patient? (Select all that apply.) A. ELISA antibody test B. IgA quantification test C. Saliva antibody test D. Urine HIV antigen test E. Western blot test

ANS: A, E The two major diagnostic tests for HIV infection are the ELISA, and if positive, the confirmatory Western blot test. Urine and oral fluid testing is available but is not as accurate. IgA testing is not related.

21. A nurse is working with a student on the pediatric unit caring for patients in contact isolation for infectious diarrhea. Which action by the student warrants intervention by the nurse? A. Changes gloves, performs hand hygiene after touching a contaminated site B. Performs hand hygiene with alcohol-based rubs after caring for patients C. Uses an alcohol-based hand sanitizer prior to putting on gloves D. Washes her hands with soap and hot water when they are visibly soiled

ANS: B After caring for patients with potential or actual infectious diarrhea, hand hygiene is performed using soap and hot water. The other actions are correct.

18. A parent calls a pediatric information line worried about muscular dystrophy because her daughter has new onset of muscle weakness. Which question by the nurse would elicit the most useful information? A. "Does anyone else in your house have this?" B. "Does this seem to come and go sporadically?" C. "Does your child have a rash on her face?" D. "Does your daughter complain of stiffness?"

ANS: C Dermatomyositis is an autoimmune disorder characterized by proximal muscle weakness, a red-purple facial rash, possibly a rash similar to that seen in systemic lupus erythematosus, tender and stiff muscles, voice changes, and dysphagia. The muscle weakness combined with the facial rash would provide the nurse a basis to suspect this disorder. This is not contagious nor is it inherited, so asking about others' symptoms would not be helpful. It is not characterized by exacerbations and remissions, and although stiffness is a common manifestation, that could be indicative of many other conditions.

=40. The pediatric charge nurse receives this report on an incoming admission: a 3-year-old boy with ear and jaw pain, bilateral parotid gland swelling, and mild dehydration. Which action by the charge nurse is most appropriate? A. Do not assign pregnant nursing staff. B. Inform parents that sterility is common. C. Place the child on droplet precautions. D. Place the child on airborne precautions.

ANS: C Hospitalized children who have mumps require droplet precautions. There is no danger to a fetus. Sterility is possible in male children due to orchitis, but it is rare.

10. A nurse volunteers for a disaster relief program and has traveled to an area devastated by a natural disaster. All basic services have been disrupted. When counseling an HIV-positive mother, what is the priority for her 8-month-old infant? A. Availability of family members to help B. Local supplies of immunizations C. Safety of the drinking water supply D. Types of shelter space available

ANS: C If the mother must mix dry powered formula to feed her baby, it is imperative that the water used be sanitary to avoid further compromising the infant and causing infection. The other information is important, but feeding is an immediate need.

19. A patient is experiencing an anaphylactic reaction. Which IV solution does the nurse anticipate will be ordered for this patient? A. 0.45% normal saline B. 5% dextrose in water C. 0.9% normal saline D. 3% saline

ANS: C The fluid of choice in any emergency is an isotonic crystalloid; 0.9% normal saline is isotonic, 0.45% normal saline and 5% dextrose in water are both hypotonic, and 3% saline is hypertonic.

14. An HIV-positive child has low titers after a measles vaccination. She has now been exposed to the disease. Which action by the nurse is most appropriate? A. Administer prophylactic antibiotics. B. Place the child in protective isolation. C. Prepare to administer immunoglobulin. D. Repeat the vaccination as soon as possible.

ANS: C When the immune-compromised child does not show an appropriate response to a vaccination, she should be treated with immunoglobulin if exposed. Repeating the vaccination will not help if the child's immune system cannot mount a response. Antibiotics are not used to treat measles. Protective isolation is not warranted.

8. A nurse is caring for a 5-year-old child diagnosed with Wiskott-Aldrich syndrome. When reviewing today's laboratory results, which finding does the nurse correlate with this condition? A. Hemoglobin: 7.3 mg/dL B. PaO2: 64 mm Hg C. Platelet count: 6,000 D. White blood cell count: 33,000/mm3

ANS: C Wiskott-Aldrich syndrome is characterized by thrombocytopenia, so the low platelet count of 6,000 correlates with this condition. The low hemoglobin could be found if the child has significant bleeding, but is not a specific finding. The low PaO2 is also not directly related, and neither is the high white blood cell count.

36. A patient was hospitalized 2 years ago with a resistant bacterial infection. The patient is admitted for an unrelated problem and placed on contact isolation. The parents question the need for this action. Which response by the nurse is best? A. "It is possible that your child could still contaminate the nursing staff." B. "It's our policy to isolate anyone who has had this infection in the past." C. "This seems distressing for you; would you like me to call the charge nurse?" D. "Your child may be colonized with the bacteria so we isolate until we know."

ANS: D A person who had a bout with a resistant bacteria may be colonized. Many facilities require placing such patients in isolation until this has been ruled out. This is the most factual and informative answer. Contaminating the nursing staff is not really the problem; the nursing staff spreading the organism to susceptible patients is. The nurse should provide information and not just call someone else to explain. Telling the parents that this practice is policy may be true, but does not give them any information.

4. A nurse is providing anticipatory guidance to new parents. Which instruction by the nurse will assist the parents in maintaining physical barriers to prevent infection in their newborn? A. Breastfeeding provides some antibodies. B. Ensure your baby is getting enough nutrition. C. Keep your baby away from people who are sick. D. Wash your baby with gentle soap and dry well.

ANS: D All options are sound advice for helping to keep a newborn well. However, the only option specific to physical barriers available to protect against infection (skin, mucous membranes) is to wash the baby's skin with gentle soap and dry it well, helping to keep it intact.

3. A nursing student is learning about the immune system. Which statement about immunoglobulins is correct? A. Adult levels of IgG are reached by the age of 6 months. B. Children are born with adult levels of IgA. C. IgE leads the body's attack against bacteria and viruses. D. IgM is the first type of antibody made in response to infection.

ANS: D IgM is the first antibody made in response to an infection. Adult levels of IgG are reached by 1 year of age. Children attain an adult level of IgA by 5 years of age. IgE is important in the response against fungus spores, animal dander, and pollen.

34. A parent is refusing to have a child vaccinated, preferring to have the child contract the illness and develop "natural immunity." Which response by the nurse is best? A. "I'm sure you know what is best for your baby." B. "I'll have to report you to social work." C. "That practice is dangerous and illegal." D. "These diseases have many serious consequences."

ANS: D Parents do have the right to refuse vaccinations, but the nurse has the responsibility of ensuring the parents have adequate information about the diseases and vaccinations. Informing the parent about possible consequences of contracting a disease is an important part of this job. The nurse should not just acquiesce and say the parent knows best without educating him or her. The other two options are threatening, and it is not illegal for a parent to opt out of vaccinations.

7. A child with a primary immunodeficiency disorder had postimmunization titers drawn. The titers came back low. Which explanation does the nurse give the parents? A. "The immunizations had no effect on the child." B. "This result indicates a hyperactive response." C. "Vaccinations are not needed in your child." D. "Your child's immune system did not respond."

ANS: D The most correct answer is that the low titers indicate that the child's immune system did not respond adequately to the vaccinations. It cannot be determined if they had no effect at all on the child. Although vaccinations did not produce the desired response, that does not mean they are not needed; they just did not work as planned. This child had a hypoactive, not hyperactive, response.

35. A nurse has given an infant a vaccination. Which information is important to document specifically for this vaccination? A. Date of next regularly scheduled immunization B. Drug, dose, site of administration, infant's reaction C. Parental education provided before administration D. Vaccine information sheet given before administration

ANS: D The nurse is legally required to provide the appropriate vaccine information sheet to the parent/guardian prior to administering a vaccination. The other information is important to document too, but is not specific for vaccinations.

30. A child is seen in the emergency department after being bitten by a squirrel while playing outside. Which discharge instruction to the parents is most important? A. "Give acetaminophen (Tylenol) for pain." B. "Have the child rest tonight." C. "Keep the wound clean and dry." D. "Return here in 3 days."

ANS: D This child is at risk of rabies. Because of the disease's potentially fatal course, it is imperative that the child complete the rabies vaccination series. Rabies vaccination is given on the day of exposure, and then again on days 3, 7, and 14. The other instructions are not specific for this disease.

29. A child is hospitalized with a serious bacterial infection. Which assessment finding indicates that the goals for a priority nursing diagnosis have been met? A. Intact skin integrity B. Normal temperature C. Stable weight D. Urine output of 1 mL/kg/hour

ANS: D This urine output is normal, demonstrating that the goals for the diagnosis of risk for fluid volume deficit have been met. The other outcomes are demonstrative of met goals, but do not take priority over a possible fluid volume deficit.

9. A nurse is caring for an infant with an HIV-positive mother. Which statement made by the nursing during teaching is the most appropriate? A. "As long as your CD4+ count is fine, you can nurse." B. "Breastfeeding is OK if you both take zidovudine (AZT)." C. "The HIV virus is not passed through breast milk." D. "You should bottle feed your baby consistently."

ANS: D Vertical (mother-to-infant) transmission can occur via breast milk, so the mother should be taught to bottle feed her baby. The other statements are inaccurate.