Chapter 26: Nursing Care of the Child With an Immunologic Disorder

A nurse is reviewing the history and physical examination of a child diagnosed with juvenile idiopathic arthritis. Which of the following would the nurse identify as often the first sign? A. Fussiness B. Fever C. Macular rash D. Joint pain

A. Irritability or fussiness often may be the first sign of the disease in the infant or very young child

A child is diagnosed with a latex allergy. When developing the teaching plan for this child, the nurse would include which of the following foods to avoid? Select all that apply. A. Squash B. Cherries C. Peanut butter D. Cheese E. Pineapples F. Bananas

B, E, F Certain foods have shown a cross-sensitivity to latex and should be avoided. These include: pear, peach, passion fruit, plum, pineapple, kiwi, fig, grape, cherry, melon, nectarine, papaya, apple, apricot, banana, chestnut, carrot, celery, avocado, tomato, or potato.

The nurse is caring for a 4-year-old girl with HIV. The girl is taking nucleoside analogue reverse transcriptase inhibitors (NRTI) as part of a three-drug regimen. The nurse knows to monitor for signs of a fatal hypersensitivity reaction that can occur with which of the following medications? A. Lamivudine B. Abacavir C. Zidovudine D. Ritonavir

B. A fatal hypersensitivity reaction may occur with abacavir

The nurse is caring for a child who is beginning to show signs and symptoms of anaphylaxis. Which intervention would be the priority? A. Administering IV diphenhydramine (Benadryl) B. Assessing patency of the airway C. Administering corticosteroids D. Obtaining brief history of allergen exposure

B. 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.

A child is diagnosed with severe combined immunodeficiency syndrome. Which of the following would the nurse expect to find when reviewing the child's history and physical examination? A. Weight greater than expected for height B. Elevated IgE levels C. Chronic diarrhea D.Worsening eczema

C. Assessment findings associated with severe combined immune deficiency include chronic diarrhea, failure to thrive, adventitious lung sounds, persistent oral thrush, and low levels of all immunoglobulins. Worsening eczema is associated with Wiskott-Aldrich syndrome.

The nurse is administering the prescribed intravenous immunoglobulin to a 10-year-old boy. Which of the following would be most important for the nurse to do? A. Monitor for signs of Cushing syndrome. B. Monitor urine for glucose. C. Have epinephrine available. D.Administer with food.

C. The nurse should have epinephrine available during the infusion in case of an adverse reaction.

The nurse is teaching the parents of a 4-year-old boy with a peanut allergy about diet and possible unexpected locations of peanuts or peanut oil in food products. After describing this to the parents, which response by the mother would indicate a need for further teaching? a. "Some hot-chocolate mixes have peanuts." b. "We must be careful with Asian food." c. "We must be careful about baked goods." d. "We can't go wrong with hamburgers and hot dogs."

d. The nurse needs to remind the mother that peanut oil might be a hidden ingredient in barbecue sauce, which is commonly used on hamburgers and hot dogs.

The nurse is caring for an infant exposed to HIV. The polymerase chain reaction (PCR) test was negative at birth. The nurse tells the mother that the child will most likely be tested again at what age? A. 4 to 7 weeks B. 8 to 10 weeks C. 2 to 3 months D. 12 months

A. Virologic testing for HIV-exposed infants should be done with the polymerase chain reaction test at birth, at 4 to 7 weeks, and again at 8 to 16 weeks. Serologic testing is done at approximately 12 months of age to document disappearance of the HIV-1 antibody.

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

A, D, F Foods that should be avoided in children younger than 1 year of age include: cow's milk, eggs, peanuts, tree nuts, sesame seeds, kiwi fruit, and fish and shellfish (ie, shrimp). Carrots, potatoes, and oranges are not considered problematic.

A 6-month-old boy has been admitted to the hospital with severe bloody diarrhea. The nurse notes petechiae and eczema with signs of secondary infection. As the nurse documents the boy's history, the parents report easy bruising and prolonged bleeding after circumcision. Based on these findings, the nurse suspects a diagnosis of which of the following? A. Wiskott-Aldrich syndrome B. von Willebrand's disease C. Severe combined immunodeficiency D.Beta-thalassemia major

A. Severe bloody diarrhea, petechiae, bruising, eczema with secondary infection, and prolonged bleeding episodes are signs and symptoms of Wiskott-Aldrich syndrome

The nurse is reviewing the medical history of a 4-year-old child. Which of the following would the nurse identify as potentially indicative of a primary immunodeficiency? Select all that apply. A. Acute otitis media, one episode every 3 to 4 weeks over the past year. B. Oral thrush, persistent over the past 6 to 7 months C. Infected laceration requiring IV antibiotic 2 months ago; healed D. Pneumonia last spring; resolved with antibiotics E. Recurrent deep abscess of the thigh

A, B, E Warning signs associated with primary immunodeficiency include eight or more episodes of acute otitis media in 1 year (one episode every 3 to 4 weeks results in at least 12 episodes in the past year), recurrent deep skin or organ abscesses, persistent oral thrush or skin candidiasis after 1 year of age. A history of infections that do not clear with IV antibiotics or two or more episodes of pneumonia in 1 year would be considered warning signs.

The nurse is caring for a child with systemic lupus erythematosus. The doctor will most likely order which test to monitor the child's progress? A. Complement assay (C3 and C4) B. Lymphocyte immunophenotyping T-cell quantification C. Immunoglobulin electrophoresis D. IgG subclasses

B. Lymphocyte immunophenotyping T-cell quantification is for ongoing monitoring of progressive depletion of CD4 T lymphocytes in HIV disease

An infant born to a mother who was HIV positive was tested at birth and found to be negative. The infant is scheduled for follow up testing. Which test would the nurse expect to be performed? A. CD4 counts B. Polymerase chain reaction (PCR) test C. Platelet count D. Enzyme-linked immunosorbent assay (ELISA)

B. The PCR is the preferred test to determine HIV infection in infants over 1 month of age

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? A. Reconstitute the medication 2 hours prior to administration. B. Gently roll the vial to mix the medication. C. Store the reconstituted medication no longer than 4 hours in the refrigerator D. Shake the vial vigorously to disperse the diluent.

B. The nurse knows not the 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.

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 need to adhere to the schedule for routine follow up blood work." B. "We should monitor for signs of infection." C. "The medication is best absorbed with the vitamin C in citrus juices." D. "It is okay to take cyclosporine with dairy products."

C. 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.

A child with systemic lupus erythematosus is receiving hydroxychloroquine sulfate. Which instruction would the nurse emphasize when teaching the child and parents about this drug? A. Giving with foods to minimize gastrointestinal upset B. Avoiding grapefruit juice when taking the drug C. Importance of yearly eye examinations D. Need to gradually taper the drug dosage over time

C. When hydroxychloroquine is given, the child should have a fundoscopic eye exam and visual field testing every year

The nurse is reviewing the results of a rheumatoid factor test of several patients diagnosed with juvenile idiopathic arthritis. Which patient would be most likely to demonstrate a positive rheumatoid factor? A. Adolescent with pauciarticular disease B. Young child with pauciarticular juvenile idiopathic arthritis C. Young child with systemic juvenile idiopathic arthritis D. Adolescent with polyarticular disease

D. Adolescents with polyarticular disease would be most likely to have a positive rheumatoid factor. Young children with pauciarticular form may demonstrate a positive antinuclear antibody.

When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect stings, the nurse integrates knowledge that this response is related to which immunoglobulin? A. IgA B. IgE C. IgG D. IgM

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

A group of nursing students are reviewing information about the immune system. The students demonstrate understanding of the information when they identify which of the following being produced by the thymus? a. Antibodies b. Lymphocyte T cells c. White blood cells d. Stem cells.

b. The thymus is responsible producing lymphocyte T cells.

The parents of a child with juvenile idiopathic arthritis bring the child to the emergency department because the child is very drowsy and breathing heavily. The child also has been vomiting and complaining of ringing in her ears. The nurse suspects that the child is experiencing a toxic reaction to one of her medications. Which medication would the nurse suspect? A. Aspirin B. Methotrexate C. Etanercept D. Corticosteroid

A. The child is exhibiting signs and symptoms of aspirin toxicity.