Chapter 25: Nursing Care of the Child With an Alteration in Immunity/Immunologic Disorder

While providing care to a 5-month-old girl whose family has a history of food allergies, the nurse instructs the parents about foods to be avoided in the first year of life. Which response by the parents indicates a need for further teaching? A) "She cannot have any cow's milk." B) "I should continue breastfeeding until at least 6 months." C) "Peanuts in any form should be avoided." D) "Any kind of fruit is acceptable."

"Any kind of fruit is acceptable." The nurse should caution the parents that kiwifruit should be avoided. Other foods to avoid include cow's milk, eggs, peanuts, tree nuts, sesame seeds, fish, and shellfish. Breastfeeding also is recommended for at least the first 6 months.

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

"Does your child get a whipped cream or foam topping on their favorite drink?" Albumin, globulin, ovalbumin should be avoided if allergic to eggs. Some foam toppings for drinks contain these substances and would cause an allergic reaction to the person allergic to eggs. This would be important information to ascertain from the family as they would likely not be aware of this.

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?

"Has your child ever been tested for a peanut allergy?" Explanation: Enchilada sauce is an unexpected food that may contain a form of peanuts (such as peanut oil) that may be causing an allergic reaction in the child.

A nurse is providing dietary interventions for a 12-year-old with a shellfish allergy. Which response indicates a need for further teaching?

"He will likely outgrow this." Older children and adolescents with allergic reactions to fish, shellfish, and nuts usually continue to have that concern as a life-long problem

The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching?

"I can use the egg white when baking, but not the yolk." The parents must understand that their child cannot consume any part of an egg in any form. The other statements are accurate.

The nurse is providing a class for a group of childcare providers. When discussing allergic reactions, which statement by a participant indicates the need for further instruction? A) "Most allergic reactions will happen within a few minutes of eating a problematic food." B) "If a child has previously eaten a food and not had a reaction they are not 'truly' allergic to it. C) "Allergic reactions can happen hours after eating something." D) "In addition to hives some children may also have vomiting and diarrhea when having an allergic reaction to a food."

"If a child has previously eaten a food and not had a reaction they are not 'truly' allergic to it." Previous exposure with no incident does not mean an individual cannot develop a hypersensitivity to a food or other substance. An allergy may develop at any time. The remaining statements are correct.

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

"The epinephrine auto-injector should be jabbed into the upper arm." An epinephrine auto-injector should be jabbed into the outer thigh, as this is a larger muscle, at a 90 degree angle, not into the upper arm. The other statements are correct

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) "We need to adhere to the schedule for routine follow up blood work." c) "The medication is best absorbed with the vitamin C in citrus juices." d) "It is okay to take cyclosporine with dairy products."

"The medication is best absorbed with the vitamin C in citrus juices." Cyclosporine A should not be taken with grapefruit juice but it may be administered with dairy products. While this medication is being used, the patient needs to be monitored for signs of infection and adhere to the schedule for follow up blood tests to evaluate for complications.

While performing an assessment of a patient who is immunocompromised, the nurse notes the child to have thrush in the mouth, tenderness over the spleen upon palpation, and a white blood cell count of 3,000. Which nursing diagnoses will the nurse include in the care plan of this child based on these findings? Select all that apply. A) Ineffective protection B) Risk for imbalanced nutrition, less than body requirements C) Pain D) Impaired skin integrity E) Delayed growth and development

- Ineffective protection - Risk for imbalanced nutrition, less than body requirements - Pain Based on these symptoms the diagnosis of Ineffective protection is related to the decreased white blood cell count; Risk for imbalanced nutrition, less than body requirements, is related to the thrush; and Pain is related to the tenderness over the spleen and the thrush. There is no evidence to support the diagnoses of Impaired skin integrity or Delayed growth and development.

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?

Administer epinephrine immediately. Epinephrine counteracts histamine release to decrease bronchospasm and difficulty breathing.

The nurse is caring for a child who is having an anaphylactic reaction with bronchospasm. The nurse would expect to administer what medication for bronchospasm as ordered? A) Epinephrine B) Corticosteroid C) Albuterol D) Diphenhydramine

Albuterol The nurse would expect to administer bronchodilation inhalation treatment (albuterol) if bronchospasm is present. Epinephrine, diphenhydramine, and/or corticosteroids are administered to reverse the allergic process.

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) An elimination diet. D) A raw food diet.

An Elimination diet The food diary may identify foods the child does not tolerate well, but it lacks the objectivity of the elimination diet. Skin testing usually involves whole proteins and will not test for reactions to food breakdown products. A raw food diet does not apply to allergy identification.

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 what? A. Delayed Hypersensitivity B. Allergen C. Immunity D. Autoimmunity

Autoimmunity Autoimmunity results from an inability to distinguish self from nonself, causing the immune system to carry out immune responses against normal cells and tissue. Delayed hypersensitivity is when T-lymphocyte activity occurs without an accompanying humoral response. Immunity is the ability to destroy like antigens. An allergen is any mediating substance that when released causes tissue injury and allergic symptoms.

The nurse is providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which food?

Bananas The nurse should instruct children and their families to avoid foods with a known cross-reactivity to latex, such as bananas

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? A) Take the client's vital signs. B) Contact the physician. C) Check the physician's orders for an antiemetic. D) Discontinue the infusion.

Discontinue the infusion. Clients receiving intravenous immunoglobulin are at risk for anaphylaxis. Vomiting can signal an allergic response. The first action would be to stop the infusion. The remaining activities are appropriate for inclusion in the plan of care but are not of the highest priority

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) Erythrocyte sedimentation rate B) Enzyme-linked immunosorbant assay (ELISA) C) Immunoglobulin electrophoresis D) Polymerase chain reaction test

Enzyme-linked immunosorbant assay (ELISA) The ELISA test will be positive in infants of HIV-infected mothers because of trans-placentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate in detecting true HIV infection in infants and toddlers than the polymerase chain reaction (PCR). The PCR test is positive in infected infants over the age of 1 month. The erythrocyte sedimentation rate would be ordered for an immune disorder initial workup or ongoing monitoring of autoimmune disease. Immunoglobulin electrophoresis would be ordered to test for immune deficiency and autoimmune disorders

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

Epinephrine Epinephrine (adrenaline) reverses the effects of histamine (severe bronchospasm and edema).

A child is in the emergency department after a bee sting and experiencing bouts of nausea and vomiting. The client's blood pressure is 68/40; pulse is 48. The child is hypoxic and dyspneic. Which medication should the nurse prepare to give this client?

Epinephrine Epinephrine is the drug of choice to treat anaphylaxis.

The nurse on a pediatric unit finds a child having extreme shortness of breath, a swollen tongue, and urticaria on her face and neck. The nurse notices her lunch tray to have a half-eaten peanut butter and jelly sandwich. The client is allergic to peanuts. What is the first medication the nurse should be prepared to administer?

Epinephrine The child is demonstrating an anaphylactic reaction. While all of the medications may be necessary, the first medication to be administer is epinephrine to counteract the analphylaxis.

The nurse is monitoring the labs of a child admitted for an exacerbation of juvenile pauciarticular arthritis. Which lab result does the nurse expect to be elevated? A) Lymphocyte immunophenotyping T-cell quantification B) Erythrocyte sedimentation rate (ESR) C) Radioallergosorbent test) D) Immunoglobulin electrophoresis

Erythrocyte sedimentation rate (ESR) The erythrocyte sedimentation rate (ESR) is an indicator of inflammation; it would likely be elevated during an exacerbation of arthritis. Immunoglobulin electrophoresis determines the level of individual immunoglobulins; it would not be elevated in an autoimmune disease. Lymphocyte immunophenotyping T-cell quantification measures T-cells; this would be used to monitor immunosuppressive disorders. The radioallergosorbent test measures minute quantities of IgE in the blood; it is used for asthma and food allergy testing.

Place in correct order the steps in the anaphylactic response. Rapid immune response Exposure to allergen Circulatory collapse Bronchoconstriction Vasodilation

Exposure to allergen Rapid immune response Vasodilation Bronchoconstriction Circulatory collapse Anaphylaxis typically is a very rapid response to exposure to an allergen. Vasodilation leads to potential circulatory collapse. Bronchospasm occurs simultaneously with other system reactions, also contributing to the life-threatening possibility.

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 knows not to shake the intravenous immunoglobulin, as this may lead to foaming and may cause the immunoglobulin protein to degrade. Reconstituted intravenous immunoglobulin can be refrigerated overnight but should be brought to room temperature prior to administration. The nurse does not need to reconstitute the medication 2 hours prior to administration

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 Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening

When teaching a group of new parents about newborn care and development, which immunoglobulin would the nurse explain as being primarily responsible for the passive immunity exhibited by newborns? A) IgA B) IgG C) IgM D) IgE

IgG IgG is acquired transplacentally, providing the newborn with passive immunity to antigens to which the mother had developed antibodies. IgA, IgD, IgE, and IgM do not cross the placenta and require an antigenic challenge for production.

The nurse is caring for a child who has undergone stem cell transplantation for severe combined immune deficiency. What finding would the nurse interpret as indicative of graft-versus-host disease? A) Presence of wheezing B) Splenomegaly C) Maculopapular rash D) Chronic or recurrent diarrhea

Maculopapular rash The nurse should monitor the stem cell transplant child closely for a maculopapular rash that usually starts on the palms and soles for indication that graft-versus-host disease is developing. Wheezing and recurrent diarrhea are not typical clinical manifestations of graft-versus-host disease. Splenomegaly is associated with hypogammaglobulinemia.

What advice would be most appropriate for the child with a stinging-insect allergy?

Obtain a medical alert ID bracelet so the presence of the allergy can be identified easily. Stinging-insect allergy can lead to anaphylactic shock. Alerting health care personnel to the possibility of an insect sting is important.

The nurse is explaining patterns of incidence and transmission of HIV to a group of adolescent girls. She explains that the risks for this population are much higher because of the possibility of both vertical and horizontal transmission. Horizontal transmission refers to transmission of the disease during which of the following? a) Sexual contact b) The birthing process c) Pregnancy d) Feeding with breast milk

Sexual contact Horizontal transmission refers to person-to-person transfer of the virus. Transmission by feeding with breast milk, birthing, and pregnancy are all examples of vertical transmission.

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

Swimming Swimming is a particularly useful exercise to maintain joint mobility without placing pressure on the joints. Jogging, using a treadmill, and playing basketball would place pressure on the joints of the lower extremities.

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

T Cells Cellular immunity involves T cells, which do not recognize antigens. B cells, antibodies, and antigens are involved in humoral immunity.

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 that the child: A) has systemic JIA. B) has pauciarticular JIA. C) has polyarticular JIA. D) is at risk for anaphylaxis.

The child has polyarticular JIA Explanation: Polyarticular JIA is defined by the involvement of five or more joints, frequently the small joints, and affects the body symmetrically. Pauciarticular JIAs is defined by the involvement of four or fewer joints. Systemic JIA presents with fever and rash in addition to join involvement at the time of diagnosis. The child with JIA is not at greater risk for anaphylaxis.

The nurse is preparing a care plan for a 3-year-old client diagnosed with severe combined immune deficiency. What is the primary goal for this client?

The client will remain free from infection. While all of these are goals for the client, the highest priority for the immunocompromised client is to remain free from infection since she is at a high risk for development of an infection. In the immunocompromised client any infection can be life threatening

What would best identify foods to which a child is allergic? A) Hyposensitivity testing in the arm B) Thoughtful elimination of diet choices C) Corticosteroid challenge testing D) Complete dietary protein restriction

Thoughtful elimination of diet choices Elimination diets involve adding foods slowly to a child's diet so foods to which the child is allergic can be identified. Hypersensitivity, not hyposensitivity, testing is used to assess reactions to certain potential allergens. No need to restrict protein. Corticosteroid challenge testing is used to assess adrenal functioning.

The nurse is reviewing the medical history of a 4-year-old child. What would the nurse identify as potentially indicative of a primary immunodeficiency?

• Acute otitis media, one episode every 3 to 4 weeks over the past year. • Recurrent deep abscess of the thigh • Oral thrush, persistent over the past 6 to 7 months Warning signs associated with primary immunodeficiency include four or more new episodes of acute otitis media in 1 year, recurrent deep skin or organ abscesses, persistent oral thrush or skin candidiasis after 1 year of age. A history of infections requiring IV antibiotics to heal and two or more episodes of pneumonia in 1 year are also warning signs.

The nurse is assessing children in a physician's office. Which children may have a primary immunodeficiency?

• Child diagnosed with six episodes of acute otitis media during the previous year • Child with oral thrush that is unresolved with treatment • Child admitted to the hospital three times within the last year with pneumonia • Child who has taken antibiotics for the last 3 months without evidence of clearing of the infection The following children may have a primary immunodeficiency: a child with a persistent case of oral candidiasis, a child who has been diagnosed with pneumonia at least twice during the previous year, and a child who has taken antibiotics for 2 months or longer with little effect

The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level? a. 1300/ mm3. b. 1500 /mm3 c. 2000/mm3 d. 1600/mm3

1300/mm3 The number of CD4 T lymphocytes in the blood helps to determine the effectiveness of antiretroviral therapy. Normal is 1500/mm3 in the infant, so anything below that number may indicate that the therapy is not effective.

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) Have epinephrine available. b) Administer with food. c) Monitor for signs of Cushing syndrome. d) Monitor urine for glucose.

Have epinephrine available. Explanation: The nurse should have epinephrine available during the infusion in case of an adverse reaction. Monitoring urine for glucose would be appropriate when corticosteroids are being given. Intravenous immunoglobulin does not need to be administered with food because it is being given as an intravenous infusion. Monitoring for signs of Cushing syndrome would be appropriate when corticosteroids are given.

A nursing student correctly identifies what to be the most serious of all of the immunologic disorders?

Human immunodeficiency virus (HIV) Of the immunologic disorders, HIV infection is the most serious, not only because it is still fatal but also because its spread has been difficult to contain

A nurse is preparing a presentation for a group of new parents and is planning to discuss nutrition during the first year. As part of the presentation, the nurse is planning to address foods that should be avoided to reduce the risk of possible food allergies. Which foods would the nurse most likely include? Select all that apply. Carrots Peanuts Eggs Potatoes Shrimp Bananas

• Peanuts • Eggs • Shrimp Foods that should be avoided in children younger than 1 year of age include cow's milk, eggs, peanuts, tree nuts, sesame seeds, and fish and shellfish (i.e., shrimp). Carrots, potatoes, and bananas are not considered problematic.

The nurse is preparing to administer IVIG to a child who has not received the medication before. What medication should the nurse expect to administer prior to the infusion? A) Solu-Medrol B) Ibuprofen C) Diphenhydramine D) Ketorolac

Diphenhydramine Premedication with diphenhydramine or acetaminophen may be indicated in children who have never received IVIG, have not had an infusion in more than 8 weeks, have had a recent bacterial infection, have a history of serious infusion-related adverse reactions, or are diagnosed with agammaglobulinemia or hypogammaglobulinemia. Solu-Medrol, ibuprofen and Ketorolac would not routinely be administered prior to IVIG

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

Methotrexate Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, are necessary to prevent disease progression. Other agents, such as aspirin and ibuprofen, are helpful with pain relief. Prednisone helps for relief of inflammation.

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.

cellular immunity recognizes antigens. Humoral immunity recognizes antigens and cellular immunity does not. Humoral immunity crosses the placenta in the form of IgG. Cellular immunity involves the action of T lymphocytes, and humoral immunity does not destroy the foreign cell.

The parents of a preschool age child ask the nurse, "Why are infants and young children are so prone to getting infections?" What is the best response by the nurse? A) "Phagocytosis in the infant and young child is overactive, allowing infections to occur." B) "Infants and young children probably get infections more than adults because they aren't aware of how to prevent infection." C) "It is really unclear why infants and children get infections more than adults." D) "The immune system of infants and young children is weaker than that of adults. The system matures as the child ages."

"The immune system of infants and young children is weaker than that of adults. The system matures as the child ages." Cellular immunity is generally functional at birth, and as the infant is exposed to various substances over time, humoral immunity develops. The infant's phagocytic cells (neutrophils and monocytes) demonstrate decreased chemotaxis, reaching adult levels when the child is several years old. With complement levels being only 50% to 75% of adult levels in the full-term infant.

The school nurse is walking through the lunchroom when one of the children says she started to feel strange after trading lunches with a friend. Which assessment would be most important? A) Asking if she has a rash anywhere B) Checking if she has any nausea C) Determining if her throat itches D) Asking if she has abdominal pain

Determining if her throat itches Asking if the child's throat itches is most important because this aids in determining airway patency, which is always the priority. Asking about a rash, nausea, or abdominal pain can be done after the nurse is certain the child's airway is not jeopardized.

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?"

"Has she ever had penicillin before?" Penicillin is a drug frequently involved in allergic reactions. The reaction occurs after the child has first been sensitized to the drug

The mother of a 5-year-old child with allergies to a variety of foods including eggs, milk, peanuts and shellfish, asks if her child will "always have these problems". What response by the nurse is most accurate? A) "Sadly, allergies to foods will persist." B) "Most children with allergies will outgrow them." C) "We cannot be sure at this point but most children who are allergic to peanuts will not have this allergy in adulthood." D) "In most cases allergies to peanuts and shellfish persist into adulthood but the others may diminish and disappear."

"In most cases allergies to peanuts and shellfish persist into adulthood but the others may diminish and disappear." Foods such as peanuts, milk, soy, shellfish, tree nuts are common allergens. By adulthood many allergies will diminish or disappear. Allergies to shellfish, peanuts and tree nuts often persist into adulthood.

A nurse is assessing a child who may have a latex allergy. The nurse asks the child about allergic reactions to certain foods. Which foods if identified by the child as experiencing an allergic reaction would help support the suspected latex allergy? Select all answers that apply. A) Peaches B) Plums C) Carrots D) Tomatoes E) Apples F) Lettuce

Peaches Plums Carrots Tomatoes Foods with a known cross-sensitivity to latex include pear, peach, passion fruit, plum, pineapple, kiwi, fig, grape, cherry, melon, nectarine, papaya, apple, apricot, banana, chestnut, carrot, celery, avocado, tomato, or potato. Apples and lettuce are not associated with a cross-sensitivity.

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 in the proper sequence that was demonstrated by the child. -Massages site for 10 seconds after removing Epipen -Pulls off the gray safety release -Grasps Epipen with black tip pointing downward -Forms a fist around the Epipen -Holds Epipen in place for 10 seconds -Jabs the Epipen firmly into the outer thigh at a 90-degree angle

-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 The steps to using an Epipen are as follows: Grasp the Epipen or Epipen Jr. with the black tip pointing downward, forming a fist; with the other hand, pull off the gray safety release; swing and jab the Epipen firmly into the outer thigh at a 90-degree angle and hold firmly there for 10 seconds; remove the Epipen and massage the thigh for 10 seconds.

The nursing instructor has completed a presentation on normal immune function. Which statement by a student would suggest a need for further education? A) "Humoral immunity is generally functional at birth." B) "Phagocytosis is the process in which phagocytes swallow up and break down microorganisms." C) "Humoral immunity is immunity mediated by antibodies secreted by B cells." D) "Cellular immunity is cell-mediated immunity controlled by T cells."

"Humoral immunity is generally functional at birth." Normal immune function is a complex process involving phagocytosis (process by which phagocytes swallow up and break down microorganisms), humoral immunity (immunity mediated by antibodies secreted by B cells), cellular immunity (cell-mediated immunity controlled by T cells), and activation of the complement system. Cellular immunity is generally functional at birth, and as the infant is exposed to various substances over time, humoral immunity develops.

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 The priority nursing intervention is to assess patency of the airway and breathing. If the child is stable, the next step would be to obtain a brief history of allergen exposure. If epinephrine is required, it would be administered prior to diphenhydramine. Corticosteroids would be used to prevent late-onset reactions.

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) "Skin testing using a patch is probably the easiest method." B) "We can inject an extract of the food under the skin and see if there is a reaction." C) "We can check the level of antibodies in the blood to confirm the allergy." D) "The best way is to eliminate the food from the diet and then look for improvement."

D) "The best way is to eliminate the food from the diet and then look for improvement." Food allergies are best identified by eliminating a suspected food from the diet and observing whether symptoms improve. After a time of improvement, the food is reintroduced and if the child is allergic to the food, the symptoms will return. Skin testing with either a patch or intracutaneous injection is ineffective for determining food allergies. Serum antibody levels can be measured but are not specific in helping to determine food allergies.

The nurse is administering intravenous immune globulin (IVIG). The nurse assesses vital signs and for adverse reactions every 15 minutes for the first hour of administration. After the first hour, the nurse most likely would continue to assess the child at which frequency? A) Every 30 minutes B) Every 45 minutes C) Every 60 minutes D) Every 2 hours

Every 30 minutes The nurse needs to continue assessments according to institutional protocol. Every 15 minutes for the first hour and every 30 minutes through the remainder of the infusion is the standard assessment.

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

• Milk • Peanuts • Eggs Allergies to eggs, peanuts, and milk are common in childhood. Cheerios are made of oats and are not known to be allergenic. Apples also are not allergenic, unlike bananas, which can cause problems for children who have latex allergies.

After teaching a class of nursing students about acquired immunodeficiency, the instructor determines that the teaching was effective when the students identify what as a contributing factor? Select all that apply. A) Vitamin therapy B) Immunosuppressive drugs C) Minor localized infection D) Cancer E) Malnutrition

Cancer Immunosuppressive drugs Malnutrition Factors contributing to secondary (acquired) immunodeficiency include severe systemic infection, cancer, renal disease, radiation therapy, severe stress, malnutrition, immunosuppressive therapy, and aging.

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

Weight appropriate for height Weight appropriate for height would not be associated with primary immunodeficiency. Rather, failure to thrive is considered a warning sign. Other warning signs of primary immunodeficiency include eight or more episodes of acute otitis media in 1 year; two or more episodes of severe sinusitis in 1 year; treatment with antibiotics for 2 months or longer with little effect; two or more episodes of pneumonia in 1 year; recurrent deep skin or organ abscesses; persistent oral thrush or skin candidiasis after age 1 year; history of infections that do not clear with antibiotics; two or more serious infections; and a family history of primary immunodeficiency.

The nurse is planning to administer IVIG to a child for the first time. What actions related to this therapy are indicated?

• After mixing, roll the vial of medication. • Store the vial in the refrigerator until use. • Promote hydration prior to administration. • Medicate with acetaminophen prior to administration. IVIG must be reconstituted. After the diluent is added to the powder, gently roll the vial between your hands to mix. Shaking will damage the medication. Reconstituted IVIG may be refrigerated overnight but should be brought to room temperature prior to infusion. Premedication with acetaminophen may be indicated in children who have never received IVIG. The child should be well hydrated prior to the administration. Adverse reactions should be monitored for within 15 minutes of the initiation of the infusion

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." Food allergies are best identified by eliminating a suspected food from the diet and observing whether symptoms improve. After a time of improvement, the food is reintroduced and if the child is allergic to the food, the symptoms will return. Skin testing with either a patch or intracutaneous injection is ineffective for determining food allergies. Serum antibody levels can be measured but are not specific in helping to determine food allergies.

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

Ineffective protection related to impaired humoral defenses The child with a primary immunodeficiency lacks the necessary immune responses that provide protection from infection. Therefore, the priority nursing diagnosis would be ineffective protection. Imbalanced nutrition and risk for delayed growth and development may be appropriate, but these would not be the priority. Acute pain would be more appropriate for a child with juvenile idiopathic arthritis.

The nurse has completed an education session with parents of children diagnosed with food allergies. Which statement by a parent would indicate a need for additional education? A) "I have found a website that makes medical alert bracelets in my daughter's favorite color." B) "The grey part of the EpiPen® should never be removed until right before we use it." C) "I will make sure my daughter always has her EpiPen® with her all the time." D) "If we need to use the EpiPen® we will need to notify her physician's office the next business day."

"If we need to use the EpiPen® we will need to notify her physician's office the next business day." If an EpiPen® is used, the child still needs immediate medical attention. EpiPens should be carried with the patient at all times. When administering an EpiPen, the grey safety cap should not be removed until immediately prior to using. Medical alert bracelets or necklaces should be worn by all children with severe allergies

A child is diagnosed with a food allergy to milk. When teaching the parents about this allergy, what would the nurse suggest as possible substitutions for milk? Select all that apply. A) Fruit juice B) Rice milk C) Yogurt D) Nondairy creamers E) Soy milk

Fruit Juice Rice Milk Soy Milk Milk can be replaced with water, fruit juice, rice milk, or soy milk. Yogurt contains milk and some nondairy products such as creamers may contain milk and should be avoided.

A nurse is caring for a 12-year-old girl with a severe peanut allergy. The girl's parents are upset because the school does not permit her to carry her EpiPen with her. It must remain in the school's office per school regulations. Which response by the nurse would be most appropriate? A) "She is allowed by law to carry her EpiPen with her; I will talk to school authorities." B) "Let's file an action plan and keep it in the school office in the event of anaphylaxis." C) "Make sure she wears a medical alert bracelet so that school staff know she has allergies." D) "I will be happy to train school authorities and staff to recognize anaphylaxis."

"She is allowed by law to carry her EpiPen with her; I will talk to school authorities." Public Law No. 108-377, the Asthmatic Schoolchildren's Treatment and Health Management Act of 2004, was passed by the U.S. Congress. This law is intended to ensure that students with severe allergies can carry prescribed medications such as an EpiPen with them at all times. The nurse must contact the school and inform them of this law so that the girl is allowed to carry her EpiPen on her person at all times. The school staff should be trained to recognize anaphylaxis, there should be an action plan on file, and the girl should wear a medical alert bracelet as well. However, the most important action is to notify school authorities of the law.

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 Because Susie has been relatively healthy since she was diagnosed with HIV, the change in her status is likely to cause changes in family coping mechanisms and dynamics that will have implications for the entire family. Next, the nurse needs to address the specific symptoms of the child. With the increased degree of illness and altered coping strategies, the child may have more difficulty with medication adherence, as well as other complications of AIDS-related illness and treatment, such as poor nutritional intake and delayed growth and development

A nurse is assisting with skin testing for allergies in a 14-year-old girl. What should the nurse do to ensure an accurate test? A) Be certain that the child has not received an antihistamine in the past 8 hours. B) Inject the allergens into the muscle of the child's forearm. C) Apply a local anesthetic to the testing site, as the injections are painful. D) Read the test results within 40 minutes of administration.

Be certain that the child has not received an antihistamine in the past 8 hours. Skin testing is done to detect the presence of IgE in the skin, or to isolate an antigen (allergen) to which the IgE is responding or to which a child is sensitive. When an allergen is introduced into the child's skin and the child is sensitive to that allergen, a wheal or flare response will appear at the site of the test from the release of histamine, which leads to local vasodilation. Because this reaction appears quickly, the test should be read in 20 minutes, not 40 minutes. Systemic or aerosol administration of an antihistamine will inhibit the flare response, so be certain the child has not received these drugs for 8 hours before skin testing. Because intracutaneous injections are given just below the epidermal layer of skin (not in the muscle), they are almost painless; thus, no anesthetic is needed.