Chapter 47 Prep U
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?" "Maybe coffee drinks just don't agree with your child's system." "That doesn't really make any sense if your child is only allergic to eggs." "Maybe the allergy testing didn't evaluate everything your child is allergic to."
"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.
A pediatric client is newly diagnosed with a stinging-insect allergy. Which advice is most appropriate for the nurse to provide this client's parent? "Your child should join a peer support group to help relieve anxiety about this problem." "I recommend you consult a genetic counselor to reveal other susceptible family members." "Obtain your child a medical alert ID bracelet so the presence of the allergy can be identified easily." "Arrange for your child to receive allergy testing for foods with ingredients similar to those in insect venom."
"Obtain your child a medical alert ID bracelet so the presence of the allergy can be identified easily."
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 cannot go wrong with barbeque and french fries." "Baked goods often contain hidden peanut ingredients." "Some hot chocolate mixes have peanuts." "We must be careful with Asian food."
"We cannot go wrong with barbeque and french fries. The nurse needs to remind the parents that peanut oil might be a hidden ingredient in barbecue sauce. Baked goods can be hidden sources for peanut oil and peanuts. Hot chocolate may contain peanuts or peanut oil. Asian foods may contain hidden peanuts. ,v
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? 1900/mm3 1700/mm3 1500/mm3 1300/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 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. Recurrent deep abscess of the thigh Oral candidiasis (thrush), persistent over the past 6 to 7 months Infected laceration requiring IV antibiotic 2 months ago; healed Pneumonia last spring; resolved with antibiotics
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 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 candidiasis (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 helping the parents of a toddler identify foods that are causing allergic symptoms in the child. Which strategy should the nurse encourage the parents to use? Elimination diet Hyposensitivity testing Corticosteroid challenge testing Complete dietary protein restriction
Elimination Diet An elimination diet is a traditional method to detect food allergens. Parents feed the child only foods that rarely cause allergy, such as rice, lamb, carrots, peas, and sweet potatoes, for about 7 days. Then they add, one by one, at 2- to 3-day intervals, foods that are suspected of causing allergy. When a food is introduced this way, the child must be encouraged to eat a lot of it that day. If symptoms occur, the food is then eliminated from the child's meals on a permanent basis. If no symptoms occur, the child can continue to eat the food. Hyposensitivity testing is unreliable with food allergies. Corticosteroids delay hypersensitivity reactions. It is difficult to totally eliminate protein from the diet, and this is not a method to determine the cause of food allergies in the toddler.
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? Question the child about the amount of penicillin that was taken. Encourage the child to wear a medical alert bracelet for penicillin. Advise the parents to have their child evaluated for atopic diseases. Educate the parents about possible side effects of penicillin in children.
Encourage the child to wear a medical alert bracelet for penicillin. 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. The priority nursing action for discharge education is to prevent the child from being exposed to penicillin again, which could be accomplished by encouraging the child to wear a medical alert bracelet. Although children with atopic diseases are more likely to have medication allergies, requesting parents have the child evaluated is not a priority. Questioning the child about the amount of penicillin taken and educating parents about the side effects of penicillin is not a priority.
A school nurse is called to the school cafeteria after a 13-year-old child is reported to have sudden difficulty breathing. The child has a history of asthma and allergies to peanuts. The focused nursing assessment reveals difficulty breathing, inspiratory and expiratory wheezing, swelling of lips, and a rash on the face. The child reports feeling nauseated, having chest tightness, and feeling faint. Complete the following sentence(s) by choosing from the lists of options. The nurse should first address the child's (wheezing, nausea, rash) then (swelling of lips, chest tightness, feeling faint)
Wheezing Swelling of lips The nurse addresses the airway first; wheezing indicates constriction of the airways. The nurse next addresses the child's swollen lips (angioedema) to ensure there is no additional swelling in the mouth that may occlude the airway. Once the nurse addresses the child's airway, breathing, and circulation, the nurse can address the child's nausea. Because the rash does not interfere with the child's airway, breathing, or circulation, and it will resolve once the allergic episode resolves; this can be addressed later. The child's chest tightness is most likely due to the bronchial constriction. Once the airway constriction resolves, the chest tightness should resolve. The child feeling faint is most likely due to the bronchial constriction reducing airflow. Once the airway constriction resolves, the child should not feel faint.
The nurse is caring for a child with HIV currently taking zidovudine. Which statement by the parent would be the most concerning? "I am not sure if it is normal for my child to have a tingling sensation." "My child reports a headache and strange taste in the mouth most days." "Zidovudine decreases the chance my child will transmit HIV to others." "Sometimes my child vomits an hour after taking the dose of zidovudine."
"Zidovudine decreases the chance my child will transmit HIV to others." Zidovudine inhibits the replication of HIV and reduces the possibility of maternal-fetal transmission of HIV, but not from person to person. Although side effects like nausea/vomiting, headache, paresthesia, and altered taste are concerning, the parent's lack of understanding that the child can transmit HIV to others is most concerning because this increases risk of exposure to others.
The parents of a 10-year-old with HIV have never told their child that he has the virus. The child asks the nurse why he is "on so many medications." What action should the nurse take? The nurse should explain the infection to the child. The nurse should tell the parents when they enter the child's room that their child has a question for them. The nurse should encourage the child to talk with his parents about his medications. The nurse should suggest to the child to speak with his doctor.
The nurse should encourage the child to talk with his parents about his medications. Generally, children older than 6 years of age will eventually need to have their diagnosis disclosed to them in an age-appropriate manner. They begin to ask questions and often seem to sense that something is going on other than what they've been told so far. Encouraging discussion with the parents is the best first step.