Chapter 30 Immune Disorders Adaptive Quizzing

A 16-year-old has just been diagnosed with HIV. Which statement by the parent indicates understanding of the diagnosis? "Infections as a result of being HIV positive are a low risk since the diagnosis came early." "I must be infected with HIV and passed it to our child while in the uterus for the infection to have occurred." "It is important for our child to get started on drug therapy for a better chance of a cure of the infection." "We don't want to face the fact that it is likely our child contracted HIV through sexual contact or IV drug use."

"We don't want to face the fact that it is likely our child contracted HIV through sexual contact or IV drug use.

The young girl has been diagnosed with juvenile idiopathic arthritis (JIA) and has been prescribed methotrexate. Which statements by the child's parent indicates that adequate learning has occurred? Select all that apply. "She can take methotrexate with yogurt or chocolate milk." "She may start feeling better by next week." "Swimming sounds like a good exercise for her." "A warm bath before bed might help her sleep better." "We'll need to bring her back in for some lab tests after she starts methotrexate."

"We'll need to bring her back in for some lab tests after she starts methotrexate." "Swimming sounds like a good exercise for her." "A warm bath before bed might help her sleep better."

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

"Humoral immunity is generally functional at birth."

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? Select all that apply. Acute otitis media, one episode every 3 to 4 weeks over the past year. Oral candidiasis (thrush), persistent over the past 6 to 7 months Recurrent deep abscess of the thigh Pneumonia last spring; resolved with antibiotics Infected laceration requiring IV antibiotic 2 months ago; healed

Acute otitis media, one episode every 3 to 4 weeks over the past year. Recurrent deep abscess of the thigh Oral candidiasis (thrush), persistent over the past 6 to 7 months

A preschool-age child is being seen for a rash that occurred after the mother applied a sunscreen prior to permitting the child to swim at the beach. For which type of allergic reaction should the nurse prepare teaching materials for the mother? Contact dermatitis Autoimmunity Delayed hypersensitivity Atopic dermatitis

Contact dermatitis Explanation: Contact dermatitis is an example of a delayed or type IV hypersensitivity response. It is a reaction to skin contact with an allergen.

Food allergies have become more and more common in the last few decades. What are some common food allergies of childhood? Select all that apply. Eggs Apples Peanuts Cheerios Milk

Eggs Peanuts Milk

When providing discharge instructions to a child who was admitted to the hospital following stridor, wheezing, and urticaria after taking penicillin, which nursing action is priority? Advise the parents to have their child evaluated for atopic diseases. Educate the parents about possible side effects of penicillin in children. Question the child about the amount of penicillin that was taken. Encourage the child to wear a medical alert bracelet for penicillin.

Encourage the child to wear a medical alert bracelet for penicillin. Explanation: Oral medications most likely to cause an allergic reaction include antibiotics, acetylsalicylic acid (aspirin), and NSAIDs. Children experiencing stridor, wheezing, and urticaria after taking a medication most likely have an allergy to that medication

Which interventions will the nurse include when caring for a child with an infectious disorder? Select all that apply. Administer antibiotics for all infections. Educate the child and family about infection control. Use appropriate personal protective equipment. Ensure immunization status is current. Provide information about disease transmission.

Ensure immunization status is current. Use appropriate personal protective equipment. Provide information about disease transmission. Educate the child and family about infection control.

Put the following stages of infectious disease in correct order:

Incubation period Prodromal period Illness Convalescent period

A nurse is preparing a plan of care for a child with a primary immunodeficiency. Which nursing diagnosis is the priority? Imbalanced nutrition, less than body requirements related to poor appetite Acute pain related to inflammatory processes Risk for delayed growth and development related to chronic illness Ineffective protection related to impaired humoral defenses

Ineffective protection related to impaired humoral defenses Explanation: 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.

A mother tells the clinic nurse that her family wants to go on vacation this year, but that they are afraid to go to their usual spot because their young daughter has problems with pollen-related allergies. What should the nurse recommend to this mother? Go on vacation in the winter to a cold place. Do not plan a vacation--allergies will make it unpleasant for everyone. Plan the vacation at a time when the pollen count is lowest. Plan the vacation anytime, but bring along plenty of antihistamines.

Plan the vacation at a time when the pollen count is lowest.

A nurse is promoting vaccine administration. When instructing on the physiological changes, which statement best explains what occurs in the child when vaccines are administered? The child becomes a host for the disease. The child develops a passive immunity. The child develops an active immunity. The child becomes a carrier of the disease.

The child develops an active immunity. Explanation: When a vaccine is given, active immunity occurs which then stimulates the development of antibodies to destroy infective agents without causing the disease.

A nurse is reviewing the medical record of an infant whose mother is HIV positive. Which factor in the maternal history would the nurse interpret as helping to decrease the infant's risk for HIV transmission? High maternal viral load Use of zidovudine therapy during pregnancy Coexistence of another sexually transmitted infection Low maternal CD4+ lymphocyte count

Use of zidovudine therapy during pregnancy

A nurse is talking to parents whose children have immune disorders. What does the nurse identify as causing dysfunction of the immune system? Select all that apply. being underweight exposure to a toxic substance secondary complication from a viral invasion not eating a proper diet congenital problems

congenital problems secondary complication from a viral invasion exposure to a toxic substance

The nurse is educating a child with a peanut allergy about the signs and symptoms of an anaphylactic reaction. The nurse realizes additional teaching is needed when the child identifies which sign/symptom? constipation anxiety nausea itchy mouth

constipation Explanation: Signs and symptoms of an anaphylactic allergic reaction include nausea, anxiety, and itchy mouth. Diarrhea, rather than constipation, is a sign of an allergic reaction.

Which client will the nurse assess first after receiving shift report? A client with serum sickness stating, "I just feel bad all over." A client with contact dermatitis who has blisters and mild edema on the lower extremities A client with human immunodeficiency virus (HIV) whose temperature is 102.2°F (39°C) A client newly diagnosed with allergic rhinitis prescribed loratadine 10 mg

A client with human immunodeficiency virus (HIV) whose temperature is 102.2°F (39°C)

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 reporting ringing in her ears. Which medication would the nurse suspect as a cause for this toxic reaction? methotrexate corticosteroid aspirin etanercept

aspirin

The nurse is preparing educational materials for a group of new parents about allergic reactions. Which specific immunoglobulin should the nurse emphasize as being responsible for these types of reactions? IgM IgE IgA IgG

IgE Explanation: IgE is involved in immediate hypersensitivity reactions and is associated with allergy and parasitic infections.

The nurse is providing home care instructions for a 13-year-old girl recently diagnosed with systemic lupus erythematosus. Which response by the girl indicates a need for further teaching? "I need to wear sunscreen in the summer to prevent rashes." "I need an eye examination every year." "I need to eat a healthy diet, exercise, and get plenty of sleep." "I need to be careful when it is cold; I should always wear gloves."

"I need to wear sunscreen in the summer to prevent rashes." Explanation: The nurse needs to emphasize that the girl should apply sunscreen every day, not just in the summer, to prevent rashes resulting from photosensitivity.

A pediatric client is prescribed methotrexate for the treatment of juvenile rheumatoid arthritis. Which statement by the child's parent indicates to the nurse additional teaching is needed? "It will take 3 to 6 weeks for my child to notice benefits." "If my child develops a fever, I will give ibuprofen." "I will give my child this medication on an empty stomach." "My child will need to have periodic blood work." Exit quiz

"If my child develops a fever, I will give ibuprofen."

A child's mother asks the nurse how likely it is the child will develop asthma because the child's father has asthma. Which response by the nurse is most appropriate? "Asthma can be prevented by avoiding any family allergens." "Your child will develop asthma since the father has asthma." "Immune responses can be genetic and run in the family." "We don't know why children develop immune disorders."

"Immune responses can be genetic and run in the family."

The nurse is teaching the parents of a 4-year-old client with a peanut allergy about dietary restrictions. Which response by the parents indicates a need for further teaching? "We must be careful with Asian food." "Some hot chocolate mixes have peanuts." "Baked goods often contain hidden peanut ingredients." "We cannot go wrong with barbeque and french fries."

"We cannot go wrong with barbeque and french fries."

The nurse in the emergency department is examining an 18-month-old child who recently received a first dose of penicillin. The nurse notes lip edema, urticaria, stridor, and tachycardia. Which action will the nurse take next? Begin cardiopulmonary resuscitation (CPR). Gather tracheal intubation equipment. Administer epinephrine. Obtain intravenous (IV) access.

Administer epinephrine.

A school-aged child, who is allergic to bee stings, states, "I think I was stung by a bee outside." Which intervention by the school nurse is most appropriate? Apply an ice compress to the site Administer epinephrine Determine if the client was stung Assess the client for signs of anaphylactic shock

Assess the client for signs of anaphylactic shock Explanation: First, the nurse will assess the client for signs of anaphylactic shock and then administer epinephrine if warranted. Epinephrine counteracts histamine release to decrease bronchospasm and difficulty breathing. If there were no signs of anaphylactic shock, the nurse would determine if the child was actually stung. The nurse would apply ice to promote vasoconstriction once the client was stable.

A 7-year-old boy has been rushed to the clinic with multiple bee stings on his face, neck, and arms. After immediate treatment with epinephrine, which of the following would be the priority? Checking for laryngeal edema Providing tetanus prophylaxis Giving antibiotics as ordered. Evaluating for fractures

Checking for laryngeal edema Explanation: Anaphylaxis commonly causes laryngeal edema and impaired respiration

The nurse is caring for an infant who exhibits characteristics of allergies. Which suggestions for the parents are helpful in minimizing allergy development? Select all that apply. Keep the room dust free. Put wall-to-wall carpeting in the room. Avoid perfumes and room fresheners. Use laundry solutions that have as few chemicals as possible. Discontinue cigarette smoking.

Discontinue cigarette smoking. Keep the room dust free. Use laundry solutions that have as few chemicals as possible. Avoid perfumes and room fresheners.

A nursing instructor is preparing a teaching plan for a class about the immune response. When discussing the immune response, which of the following would the instructor describe as being primarily involved in a secondary immune response? IgM IgA IgE IgG

IgG

The nurse is caring for a child undergoing highly active antiretroviral therapy (HAART) for HIV infection. The nurse is preparing to administer the prescribed medication. In addition to the nucleoside analog reverse transcriptase inhibitors (NRTIs) and the nonnucleoside analog reverse transcriptase inhibitors (NNRTIs), the nurse is cognizant that the child will be taking which additional medication as part of the three-drug regimen? Cytotoxic drugs Corticosteroids Disease-modifying antirheumatic drugs (DMARDs) Protease inhibitors

Protease inhibitors Explanation: The nurse understands that the child will be taking protease inhibitors as part of the three-drug regimen for HAART. Corticosteroids, cytotoxic agents, and DMARDs are typically used for the treatment of juvenile idiopathic arthritis (JIA).

Which of the following is inconsistent with the mode of transmission of HIV? Blood Sexual contact Skin contact Mother-to-infant transmission

Skin contact Explanation: Modes of transmission for HIV include sexual contact, mother-to-infant transmission before or around the time of birth, and contamination by blood or body fluids.

The nurse is caring for a newborn whose mother is HIV positive. The nurse would expect to administer a 6-week course of which medication? Lopinavir Ritonavir Zidovudine Nevirapine

Zidovudine Explanation: Children born to HIV-positive mothers should receive a 6-week course of zidovudine therapy. Lopinavir, ritonavir, and nevirapine are medications used for treatment of HIV-1 infections as part of a three-drug regimen.

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? erythrocyte sedimentation rate (ESR) radioallergosorbent test immunoglobulin electrophoresis lymphocyte immunophenotyping T-cell quantification

erythrocyte sedimentation rate (ESR) Explanation: The erythrocyte sedimentation rate (ESR) is an indicator of inflammation; it would likely be elevated during an exacerbation of arthritis.

When assessing environmental factors which may cause a pediatric client's contact dermatitis, which would the nurse address? Select all that apply. pine sap cotton underwear exposure to poison ivy zippers and jewelry containing nickel frequent wet diapers

frequent wet diapers exposure to poison ivy zippers and jewelry containing nickel

A child is diagnosed with a food allergy to milk. When teaching the parents about this allergy, what would the nurse suggest as a possible substitution(s) for milk? Select all that apply. fruit juice rice milk soy milk ice cream yogurt

fruit juice rice milk soy milk

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: has pauciarticular JIA. is at risk for anaphylaxis. has systemic JIA. has polyarticular JIA.

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 JIA 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 nurse is preparing to administer intravenous immunoglobulin (IVIG) for a child who has not had an IVIG infusion in over 10 weeks. The nurse knows to first: assess for adverse reaction. begin infusion slowly, increasing to the prescribed rate. obtain baseline physical assessment. premedicate with acetaminophen or diphenhydramine.

premedicate with acetaminophen or diphenhydramine. Explanation: Premedication with diphenhydramine or acetaminophen may be indicted in children who have never received intravenous immunoglobulin (IVIG), have not had an infusion in over 8 weeks, have had a recent bacterial infection, or have history of serious infusion-related adverse reactions

The nurse is attempting to control the infectious process while caring for a client. The nurse changes the client's wound dressing when the dressing becomes soiled. Which link of the chain of infection is the nurse interrupting with this intervention? reservoir mode of transmission susceptible host portal of exit

reservoir

The nurse is reviewing a child's chart and notes hypersensitivity reactions under the diagnosis section. Which additional diagnosis would confirm a type III hypersensitivity reaction? Select all that apply. contact dermatitis systemic lupus erythematosus rheumatoid arthritis atopic dermatitis asthma

rheumatoid arthritis systemic lupus erythematosus Explanation: Examples of type III hypersensitivity include rheumatoid arthritis and systemic lupus erythematosus.

The nurse has received morning report on a group of pediatric clients. Which pediatric client will the nurse see first? a child with IgA deficiency reporting rhinitis a child with HIV who reports feeling lethargic a child reporting coughing, itching, and anxiety a child reporting a vesicular rash with yellow crusts

a child reporting coughing, itching, and anxiety

A nurse is providing care to a child with HIV who is prescribed therapy with a nucleoside reverse transcriptase inhibitor. What would the nurse expect to administer? Zidovudine Efavirenz Nevirapine Ritonavir

Zidovudine Explanation: Zidovudine is a nucleoside reverse transcriptase inhibitor. Nevirapine and efavirenz are classified as nonnucleoside reverse transcriptase inhibitors. Ritonavir is a protease inhibitor.

When reviewing the history of a child with suspected primary immunodeficiency, what would the nurse be least likely to find? antibiotic therapy for the past 3 months without effect three bouts of sinusitis within a year's time 10 episodes of otitis media in the last year weight appropriate for height

weight appropriate for height

When the nurse is instructing on disease transmission, which is noted as the smallest infectious agent known? yeast bacteria fungus virus

virus Explanation: Viruses are the smallest infectious agents known, so small they cannot be seen through an ordinary microscope.

The nurse is interviewing parents of a child who has been diagnosed with severe combined immune deficiency (SCID). Which statement by the parents best indicates an understanding of their child's condition? "Our child will need to receive several different types of antiviral medications." "We will make sure that our child carries the epinephrine autoinjector at all times." "We will need to prepare our child and ourselves for a bone marrow transplant." "Our child will receive antibiotic therapy until the stem cell transplant is completed."

"We will need to prepare our child and ourselves for a bone marrow transplant." Explanation: SCID is a potentially fatal disorder requiring emergency intervention at the time of diagnosis. Gene therapy provides some promise for the future treatment of SCID, but until then bone marrow or stem cell transplantation is necessary.

The nurse is caring for a child with HIV currently taking zidovudine. Which statement by the parent would be the most concerning? "Sometimes my child vomits an hour after taking the dose of zidovudine." "My child reports a headache and strange taste in the mouth most days." "Zidovudine decreases the chance my child will transmit HIV to others." "I am not sure if it is normal for my child to have a tingling sensation."

Zidovudine decreases the chance my child will transmit HIV to others."

The nurse is caring for a child with HIV. The doctor will most likely order which test to monitor the child's progress? lymphocyte immunophenotyping T-cell quantification immunoglobulin electrophoresis complement assay (C3 and C4) IgG subclasses

lymphocyte immunophenotyping T-cell quantification

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? ibuprofen prednisone methotrexate aspirin

methotrexate Explanation: Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, are necessary to prevent disease progression.

The nurse is caring for a client with HIV who is receiving abacavir for treatment. What signs and symptoms will require the nurse to notify the physician? Select all that apply. unusual bleeding drowsiness rash shortness of breath muscle weakness

muscle weakness shortness of breath rash unusual bleeding

The nurse is assisting with skin testing for allergies in a pediatric client. What will the nurse do to ensure the results are accurate? Be certain the child has not received an antihistamine in the past 8 hours Inject the allergens into the muscle of the child's forearm. Read the test results within 40 minutes of administration. Apply a topical diphenhydramine cream to the site following each injection.

Be certain the child has not received an antihistamine in the past 8 hours

The nurse is preparing to administer IVIG to an adolescent. Prior to administration, which baseline lab values does the nurse need to review? Select all that apply. CBC ALT chemistry profile BUN Serum creatinine

BUN Serum creatinine Explanation: Prior to administering IVIG the nurse must assess baseline serum blood urea nitrogen (BUN) and creatinine, as acute renal insufficiency may occur as a serious adverse reaction.

The nurse is assessing a child who is experiencing renal complications as a result of lupus. Which finding is of greatest concern? elevated blood pressure hypotension elevated temperature reduced body temperature

elevated blood pressure Explanation: Renal complications may result from lupus. This may be accompanied by hypertension, making monitoring of blood pressure of the highest importance.

The nurse is educating an immunocompromised child about the organs that assist in the immune process. The nurse recognizes teaching was effective when the child identifies which organs? Select all that apply. thymus bone marrow spleen gall bladder liver

liver spleen thymus bone marrow Explanation: The major organs of the immune system are the thymus, liver, bone marrow, spleen, tonsils, lymph nodes, and blood. The gallbladder assists with digestion.

A pregnant client who is HIV positive asks the nurse if she will be able to breastfeed the newborn. Which response by the nurse is most appropriate? "You should speak to your primary health care provider about breastfeeding." "Breastfeeding passes protective immunity along to your newborn." "Breastfeeding will increase your newborn's risk of contracting HIV." "Since your newborn will have HIV it is okay for you to breastfeed."

"Breastfeeding will increase your newborn's risk of contracting HIV."

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? "That is odd. Does anyone else in your family react that way?" "Maybe it's an allergy to something else and you just notice after eating there by coincidence." "Is your child allergic to milk?" "Has your child ever been tested for a peanut allergy?"

"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.

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

"If a child has previously eaten a food and not had a reaction they are not 'truly' allergic to it

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? T cells Antibodies B cells Antigens

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

Which immune cells are disrupted when a child is infected with human immunodeficiency virus (HIV)? Select all that apply. B cells T cells Erythrocytes Platelets Phagocytes

T cells B cells Phagocytes

The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for a pediatric client with an immune disorder receiving a stem cell transplant. Which action by the UAP will cause the RN to intervene? The UAP places a lunch tray in the client's room. The UAP assists the client to ambulate in the room. The UAP wears a mask when entering the client's room. The UAP takes a rectal temperature on the client.

The UAP takes a rectal temperature on the client. Explanation: Precautions must be taken to protect the client from infection.

The nurse is caring for a child who is taking corticosteroids for systemic lupus erythematosus. The nurse closely monitors the child based on the understanding that corticosteroids exert which major action? They increase liver enzymes. They cause bone marrow suppression. They can mask signs of infection. They decrease renal function.

They can mask signs of infection.

A child with systemic lupus erythematosus is receiving high-dose corticosteroid therapy over the long term. The nurse would instruct the parents and child to report: joint pain. difficulty urinating. rash. visual changes.

joint pain. Explanation: Avascular necrosis (lack of blood supply to a joint, resulting in tissue damage) may occur as an adverse effect of long-term or high-dose corticosteroid use.