NURS 341 - IMMUNITY/IMMUNOLOGIC (25)

A 2-year-old child has been diagnosed with hemophilia A. What information should the nurse include in a teaching plan about home care? a. If bleeding occurs, apply pressure, ice, elevate, and rest the extremity. b. Childrens aspirin in lowered doses may be given for joint discomfort. c. A firm, dry toothbrush should be used to clean teeth at least twice a day. d. Do not permit interactive play with other children.

a. If bleeding occurs, apply pressure, ice, elevate, and rest the extremity.

What should be included in the nursing care of a 12-year-old child receiving radiation therapy for Hodgkins disease? (Select all that apply.) a. Application of sunblock b. Appetite stimulation c. Conservation of energy d. Provision for expressions of anger e. Preparation for premature sexual development

a. Application of sunblock b. Appetite stimulation c. Conservation of energy d. Provision for expressions of anger

On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. What is the priority nursing intervention? a. Assessing neurological status b. Inserting an intravenous line c. Monitoring vital signs during platelet transfusions d. Providing family education about how to prevent bleeding

a. Assessing neurological status

How has synthetic recombinant antihemophilic factor improved the management of hemophilia? (Select all that apply.) a. Eliminates the need for frequent transfusions b. Can be administered by family at home c. Prevents hemorrhage d. Reduces cost of care of the hemophiliac e. Reduces risk of HIV and hepatitis A and B transmission

a. Eliminates the need for frequent transfusions b. Can be administered by family at home d. Reduces cost of care of the hemophiliac e. Reduces risk of HIV and hepatitis A and B transmission

What should the nurse closely assess in a child receiving a transfusion? a. Fever b. Lethargy c. Jaundice d. Bradycardia

a. Fever

Which statement by a mother may indicate a cause for her 9-month-olds iron deficiency anemia? a. Formula is so expensive. We switched to regular milk right away. b. She almost never drinks water. c. She doesnt really like peaches or pears, so we stick to bananas for fruit. d. I give her a piece of bread now and then. She likes to chew on it

a. Formula is so expensive. We switched to regular milk right away.

What are the classic symptoms of thalassemia major (Cooleys anemia)? (Select all that apply.) a. Hepatomegaly b. Jaundice c. Protruding teeth d. Pathological fractures e. Renal failure

a. Hepatomegaly b. Jaundice c. Protruding teeth d. Pathological fractures

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

A)Fruit juice B)Rice milk E)Soy milk

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

A)Ineffective protection B)Risk for imbalanced nutrition, less than body requirements C)Pain

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

A)Peaches B)Plums C)Carrots D)Tomatoes

The nurse is reviewing the laboratory test results of a child who is suspected of having systemic lupus erythematosus (SLE). What would the nurse identify as supporting this diagnosis? Select all that apply. A)Positive antinuclear antibody (ANA) B)Increased C3 levels C)Thrombocytopenia D)Leukopenia E)Increased hematocrit

A)Positive antinuclear antibody (ANA) C)Thrombocytopenia D)Leukopenia

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

A)Weight appropriate for height

A nursing student is reviewing information about primary immunodeficiencies. The student demonstrates understanding of the material by identifying which immunodeficiencies as affecting only males? Select all that apply. A)X-linked agammaglobulinemia B)Wiskott-Aldrich syndrome C)Selective IgA deficiency D)X-linked hyper-IgM syndrome E)IgG subclass deficiency F)Severe combined immune deficiency

A)X-linked agammaglobulinemia B)Wiskott-Aldrich syndrome D)X-linked hyper-IgM syndrome

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? A)"I need to wear sunscreen in the summer to prevent rashes." B)"I need to eat a healthy diet, exercise, and get plenty of sleep." C)"I need an eye examination every year." D)"I need to be careful when it is cold; I should always wear gloves."

A. "I need to wear sunscreen in the summer to prevent rashes."

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."

A. "She is allowed by law to carry her EpiPen with her; I will talk to school authorities."

What would the nurse expect to find in a male infant with Wiskott-Aldrich syndrome? A)Eczema B)Thrombocytosis C)Lymphadenopathy D)Pneumonia

A. Eczema

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

A. Every 30 mins

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? A)Protease inhibitors B)Corticosteroids C)Cytotoxic drugs D)Disease-modifying antirheumatic drugs (DMARDs)

A. Protease inhibitors

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."

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

The nurse is talking to the parents of a child who has been diagnosed with severe combined immune deficiency (SCID). Which statement by the parents best indicates that they understand their child's condition? A)"He'll need to receive intravenous immunoglobulin routinely." B)"We'll need to prepare him and ourselves for a bone marrow transplant." C)"He'll need to receive several different types of antiviral medications." D)"We'll make sure that he has his EpiPen with him at all times."

B. "We'll need to prepare him and ourselves for a bone marrow transplant."

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

B. IgG

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

B. Ineffective protection related to impaired humoral defenses

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? A)They increase liver enzymes. B)They can mask signs of infection. C)They cause bone marrow suppression. D)They decrease renal function.

B. They can mask signs of infection.

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)Diphenhydramin

C)Albuterol

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

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

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.

C. Cellular immunity recognizes antigens

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

C. Determining if her throat itches.

The nurse is assessing a child with pauciarticular-type juvenile idiopathic arthritis. What would the nurse expect to assess? A)Fever B)Rash C)Eye inflammation D)Splenomegaly

C. Eye inflammation

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: A)difficulty urinating. B)visual changes. C)joint pain. D)rash.

C. Joint pain

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

C. Maculopapular rash

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

C. Swimming

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."

D. "Any kind of fruit is acceptable."

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."

D. "In most cases allergies to peanuts and shellfish persist into adulthood but the others may diminish and disappear."

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

D. T Cells

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? A)Lopinavir B)Ritonavir C)Nevirapine D)Zidovudine

D. Zidovudine

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

D. methotrexate

The nurse, caring for a child receiving chemotherapy, notes that the childs abdomen is firm and slightly distended. There is no record of a bowel movement for the last 2 days. What do these assessment findings suggest? a. Peripheral neuropathy b. Stomatitis c. Myelosuppression d. Hemorrhage

a. Peripheral neuropathy

The nurse is caring for a child with a low platelet count. What skin assessments would alert the nurse to bleeding? (Select all that apply.) a. Petichiae b. Purpura c. Ecchymosis d. Hematoma e. Lymphadenopathy

a. Petichiae b. Purpura c. Ecchymosis d. Hematoma

The nurse notes that a 4-year-old childs gums bleed easily and he has bruising and petechiae on his extremities. Which lab value is consistent with these symptoms? a. Platelet count of 25,000/mm3 b. Hemoglobin level of 8 g/dL c. Hematocrit level of 36% d. Leukocyte count of 14,000/mm3

a. Platelet count of 25,000/mm3

The most recent blood count for a child who received chemotherapy last week shows neutropenia. What is the priority nursing diagnosis for this child? a. Risk for infection b. Risk for hemorrhage c. Altered skin integrity d. Disturbance in body image

a. Risk for infection

Why would the nurse urge the family of a dying 12-year-old boy to include his 8-year-old sister in care? (Select all that apply.) a. She will feel less neglected by the parents. b. She can make amends for past hostilities to her brother. c. She will feel increased helplessness. d. She can express her feelings through care. e. She can experience being supportive of her parents and brother

a. She will feel less neglected by the parents. b. She can make amends for past hostilities to her brother. d. She can express her feelings through care. e. She can experience being supportive of her parents and brother

The family of a child receiving chemotherapy for leukemia should be taught to focus on which aspect(s) of the childs care? (Select all that apply.) a. Using a support group b. Stimulating appetite c. Maintaining adequate hydration d. Continuing with scheduled immunizations e. Reporting exposure to infectious diseases

a. Using a support group b. Stimulating appetite c. Maintaining adequate hydration e. Reporting exposure to infectious diseases

The nurse explains that the COPP medical regimen for the treatment of Hodgkins disease uses a combination of which drugs? (Select all that apply.) a. Vincristine b. Cyclophosphamide c. Methotrexate d. Prednisone e. Procarbazine hydrochloride

a. Vincristine b. Cyclophosphamide d. Prednisone e. Procarbazine hydrochloride

A 6-year-old with leukemia asks, Who will take care of me in heaven? What is the best response by the nurse? a. Who do you think will take care of you? b. Your grandparents and God will take care of you. c. Your mom will know more about that than I do. d. Why are you asking me that?

a. Who do you think will take care of you?

What will the nurse teach the parents of a child with a low platelet count to avoid? a. Ibuprofen b. Aspirin c. Caffeine d. Prednisone

b. Aspirin

What would the nurse include in a teaching plan about mouth care of a child receiving chemotherapy? a. Use commercial mouthwash. b. Clean teeth with a soft toothbrush. c. Avoid use of a Water-Pik. d. Inspect the mouth weekly for ulcerations

b. Clean teeth with a soft toothbrush.

The nurse is teaching the parents of a young child with iron deficiency anemia about nutrition. What food would the nurse emphasize as being a rich source of iron? a. An egg white b. Cream of Wheat c. A banana d. A carrot

b. Cream of Wheat

A child is diagnosed with iron deficiency anemia. What will the nurse explain can occur if this disorder goes untreated? a. Hemorrhage b. Heart failure c. Infection d. Pulmonary embolism

b. Heart failure

Which statement made by a parent indicates an understanding of health maintenance of a child with sickle cell disease? a. I should give my child a daily iron supplement. b. It is important for my child to drink plenty of fluids. c. He needs to wear protective equipment if he plays contact sports. d. He shouldnt receive any immunizations until he is older.

b. It is important for my child to drink plenty of fluids.

The nurse is presenting information on the congentital disorder of hemophilia A. What fact will the nurse include? a. It is seen in males and females equally. b. It is transmitted by symptom-free females. c. It is a sex-linked dominant trait. d. It is a defective gene located on the Y chromosome

b. It is transmitted by symptom-free females.

What will the nurse administer with ferrous sulfate drops when providing them to a child on the pediatric unit? a. With milk b. With orange juice c. With water d. On a full stomach

b. With orange juice

A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain the childrens risk of inheriting this disease? a. Every fourth child will have the disease; two others will be carriers. b. All of their children will be carriers, just as they are. c. Each child has a one in four chance of having the disease and a two in four chance of being a carrier. d. The risk levels of their children cannot be determined by this information.

c. Each child has a one in four chance of having the disease and a two in four chance of being a carrier.

What important focus of nursing care for the dying child and the family should the nurse implement? a. Nursing care should be organized to minimize contact with the child. b. Adequate oral intake is crucial to the dying child. c. Families should be made aware that hearing is the last sense to stop functioning before death. d. It is best for the family if the nursing staff provides all of the childs care.

c. Families should be made aware that hearing is the last sense to stop functioning before death.

An adolescent is diagnosed with Hodgkins disease. Lymph nodes on both sides of her diaphragm have been found to be involved, including cervical and inguinal nodes. Which disease stage is this? a. I b. II c. III d. IV

c. III

A school-aged child is living with a chronic disease process. How would the nurse anticipate chronic illness will effect growth and development? (Select all that apply.) a. Delayed bonding with parents b. Delayed toilet training c. Impaired sense of belonging d. Decreased feelings of independence e. Impaired speech development

c. Impaired sense of belonging d. Decreased feelings of independence

The nurse is dealing with a preschool-age child with a life-threatening illness. What should the nurse remember the childs concept of death is at this age? a. That it is final b. Only a fear of separation from her parents c. That a person becomes alive again soon after death d. An understanding based on simple logic

c. That a person becomes alive again soon after death

A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain. Which type of crisis is the child most likely experiencing? a. Aplastic b. Hyperhemolytic c. Vaso-occlusive d. Splenic sequestration

c. Vaso-occlusive

What is the result of a deficiency of factor IX? a. Thalassemia b. Idiopathic thrombocytopenic purpura c. Hemophilia A d. Christmas disease

d. Christmas disease

The child receiving a transfusion complains of back pain and itching. What is the best initial action by the nurse? a. Notify the charge nurse. b. Disconnect intravenous lines immediately. c. Give diphenhydramine (Benadryl). d. Clamp off blood and keep line open with normal saline.

d. Clamp off blood and keep line open with normal saline.

A child with thalassemia major receives blood transfusions frequently. What is a complication of repeated blood transfusions? a. Hemarthrosis b. Hematuria c. Hemoptysis d. Hemosiderosis

d. Hemosiderosis

A child has just been diagnosed with acute lymphoblastic leukemia. What is the result of an overproduction of immature white blood cells in the bone marrow? a. Decreased T-cell production b. Decreased hemoglobin c. Increased blood clotting d. Increased susceptibility to infection

d. Increased susceptibility to infection

The nurse finds an adolescent with Hodgkins disease crying. The adolescent says, I am so scared. What is the most appropriate nursing response to this comment? a. I understand how you must feel. b. You shouldnt feel that way. c. Is this the strongest feeling youve had today? d. Tell me whats got you scared.

d. Tell me whats got you scared.