PEDs Chapt 26 Nursing Care of the Child with an Immunologic Disorder
When evaluating parents' understanding of atopic dermatitis, which of the following statements would you want to hear them voice? a) "Atopic dermatitis follows a streptococcal infection." b) "Hydrocortisone cream may lead to kidney disease." c) "Flare-ups of lesions are not uncommon following therapy." d) "Atopic dermatitis turns to asthma later in life."
"Flare-ups of lesions are not uncommon following therapy." Correct Explanation: Atopic dermatitis may recur when the child is re-exposed to the substance to which he or she is allergic.
To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant? a) "Is there any family history of allergy to penicillin?" b) "Do you have a telephone to call us immediately if she develops trouble breathing?" c) "What do you give her to alleviate itching?" d) "Has she ever had penicillin before?"
"Has she ever had penicillin before?" Correct Explanation: 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 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) "The best way is to eliminate the food from the diet and then look for improvement." c) "We can inject an extract of the food under the skin and see if there is a reaction." d) "We can check the level of antibodies in the blood to confirm the allergy."
"The best way is to eliminate the food from the diet and then look for improvement." Correct Explanation: 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 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." Explanation: 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.
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) "We can't go wrong with hamburgers and hot dogs." b) "We must be careful with Asian food." c) "We must be careful about baked goods." d) "Some hot-chocolate mixes have peanuts."
"We can't go wrong with hamburgers and hot dogs." Correct Explanation: 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. 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.
A child with HIV, weighing 25 kg, is about to receive an infusion of IVIG. The recommended dose is 400 mg/kg/dose. The medication is available in a concentration of 50 mg/mL. What is the proper amount of infusion that the child will receive? a) 1000 mL b) 2000 mL c) 200 mL d) 100 mL
200 mL Correct Explanation: The dose is calculated as 25 x 400 = 10,000 mg. Because the concentration is 50 mg/mL, calculate the volume as 10,000/50 = 200 mL.
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) 12 months b) 4 to 7 weeks c) 8 to 10 weeks d) 2 to 3 months
4 to 7 weeks Correct Explanation: 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.
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) Zidovudine b) Ritonavir c) Abacavir d) Lamivudine
Abacavir Correct Explanation: A fatal hypersensitivity reaction may occur with abacavir. Ritonavir is a protease inhibitor, not a nucleoside analogue reverse transcriptase inhibitor. This drug is not associated with a fatal hypersensitivity reaction. This drug is not associated with a fatal hypersensitivity reaction.
When treating allergies in a child, the nurse is aware that the classification for the drug of choice to control itching, sneezing, and rhinorrhea is which of the following? a) Antihistamines b) Decongestants c) Corticosteroids d) Antibiotics
Antihistamines Correct Explanation: Antihistamines block histamine release and as a result control itching, sneezing, and rhinorrhea.
A 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? a) Immediately transport the child to the local hospital. b) Apply a warm compress to the site of the bee sting. c) Administer epinephrine immediately. d) Notify the child's mother.
Administer epinephrine immediately. Correct Explanation: Epinephrine counteracts histamine release to decrease bronchospasm and difficulty breathing.
A mother brings her 4-month-old infant to the doctor's office due to vesicular lesions that have appeared on the child's scalp and face. The mother says that the child will not stop scratching at the lesions and that she is concerned that he is having some kind of allergic reaction. Which of the following should the nurse recommend to the mother to help reduce pruritus in this child? a) Have the child retested for PKU b) Have the child undergo skin testing c) Apply wet dressings for 15 to 20 minutes, followed by moisturizer d) Put the child on elimination diets
Apply wet dressings for 15 to 20 minutes, followed by moisturizer Explanation: A major consideration in treatment of atopic dermatitis is aimed at reducing pruritus so children do not irritate lesions and cause secondary infections by scratching. Hydrating the skin by bathing or applying wet dressings (wet with tap water or Burrow's solution) for 15 to 20 minutes, followed by application of moisturizer such as Eucerin is helpful. Skin testing is usually ineffective because, although the allergen causing infantile atopic dermatitis may be pollen, dust or a mold spore; it is often a food allergen. Elimination diets can help identify an allergen, but do not directly help reduce pruritus; in any case, a 4-month-old should not be eating solid foods. Because untreated phenylketonuria (PKU) can lead to atopic dermatitis, children with infantile atopic dermatitis need to have a repeat test for PKU to be certain this is ruled out—however, this intervention does not directly reduce pruritus, either.
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) Obtaining brief history of allergen exposure c) Administering corticosteroids d) Assessing patency of the airway
Assessing patency of the airway Correct Explanation: 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 nurse is assisting with skin testing for allergies in a 14-year-old girl. Which of the following 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) Read the test results within 40 minutes of administration c) Apply a local anesthetic to the testing site, as the injections are painful d) Inject the allergens into the muscle of the child's forearm
Be certain that the child has not received an antihistamine in the past 8 hours Correct Explanation: 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.
Nursing students demonstrate correct understanding when they identify which immunoglobin as occurring most frequently in plasma and the major one to be synthesized during secondary response? a) IgA b) IgD c) IgM d) IgG
IgG Correct Explanation: IgG is the most frequent antibody in plasma and is the major immunoglobin to be synthesized during the secondary response.
A child with primary immune deficiency is about to receive an infusion of IVIG. Which of the following is the most appropriate premedication to minimize the reaction? a) Ketorolac b) Ibuprofen c) Diphenhydramine d) Solu-Medrol
Diphenhydramine Correct Explanation: Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.
A child is in the emergency department after a bee sting and experiencing bouts of nausea and vomiting. The patient's blood pressure is 68/40; pulse is 48. The child is hypoxic and dyspneic. Which medication should the nurse prepare to give this patient? a) Benadryl b) Prednisone c) Epinephrine d) Sudafed
Epinephrine Correct Explanation: Epinephrine is the drug of choice to treat anaphylaxis.
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) IgG b) IgM c) IgE d) IgA
IgE Correct Explanation: Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening.
Which is the immunoglobulin associated with allergic reactions? a) IgA b) IgM c) IgG d) IgE
IgE Correct Explanation: IgE is responsible for immediate hypersensitivity reactions.
When teaching about primary and secondary humoral responses, what should the nurse identify as the immunoglobin that is first to appear in the serum? a) IgD b) IgE c) IgG d) IgM
IgM Correct Explanation: IgM is the first immunoglobin to appear in the serum with the primary and secondary humoral responses.
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) White blood cells b) Stem cells c) Lymphocyte T cells d) Antibodies
Lymphocyte T cells Correct Explanation: The thymus is responsible producing lymphocyte T cells. The bone marrow produces stem cells that are capable of differentiating into various blood cells. White blood cells arise from the stem cells in the bone marrow. Antibodies are formed by the B cells.
Which of the following nursing problems could be associated with a child with primary immunodeficiency? Select all that apply. a) Risk for infection b) Delayed growth and development c) Altered skin integrity d) Altered gastrointestinal function e) Altered fluid and electrolytes
Risk for infection Altered skin integrity Delayed growth and development
The nurse is instructing a group of women of childbearing age about HIV during pregnancy. Which of the following should be a priority recommendation in this setting? a) Screening for HIV b) Screening for STIs c) Prophylactic treatment for HIV d) Proper nutrition
Screening for HIV Explanation: No screening mandate has been put forth for HIV, but all pregnant women should be encouraged to undergo this test. Prophylactic treatment would be initiated only once the woman has been screened. Screening for STIs and ensuring proper nutrition are also part of health promotion for women in this age group, but they are of lower priority than identifying HIV-positive individuals.
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 Explanation: 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.
To establish whether the problem is truly a milk allergy in a child who is suspected of having this condition, milk should be reintroduced every 6 to 12 months. a) True b) False
True Correct Explanation: To establish whether the problem is truly a milk allergy, milk should be reintroduced every 6 to 12 months. If the problem is a true milk allergy, signs will recur.
A 5 year old is hospitalized after an asthma attack at school. The child tells the nurse that the janitor had been cleaning in the classroom prior to the attack and that a lot of dust was in the air. The dust that likely caused the attack is known as what? a) allergen b) antigen c) immunogen d) macrophage
allergen Correct Explanation: Mediating substances that are released and cause tissue injury and allergic symptoms are called allergens. An antigen is any foreign substance capable of stimulating an immune response. An antigen that can be readily destroyed by an immune response is called an immunogen. Macrophages are mature white blood cells.
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 which of the following? a) immunity b) autoimmunity c) delayed hypersensitivity d) allergen
autoimmunity Correct Explanation: 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.
A young patient is admitted to the hospital directly from the clinic. The physician suspects a problem with the patient's immune system. What test does the nurse anticipate the physician will order for this patient? a) urine analysis b) blood analysis c) x-ray d) EKG
blood analysis Correct Explanation: When there is a deficiency of immunocompetent cells, an assessment will focus on analysis of blood components, particularly white blood cells.
When caring for a child experiencing anaphylactic shock, the most important nursing action would be to a) enhance the action of histamine. b) reverse sympathetic nervous system responses. c) counteract hypertension. d) facilitate breathing.
facilitate breathing. Correct Explanation: The sudden release of histamine with an allergic reaction can cause severe bronchospasm, closing the airway.
The nurse is explaining to a parent some of the basic aspects of the immune system and its functions. She informs them that B cells, also known as _________ cells, will attack __________ antigens. a) killer; viral b) humoral; viral c) humoral; bacterial d) killer; bacterial
humoral; bacterial Correct Explanation: B cells are also called humoral cells and typically attack bacterial organisms. Another term for T cells is killer cells, and they most commonly attack viral organisms.
A young patient comes to the clinic with multiple symptoms of an infection. The nurse realizes that the patient has been seen in the clinic every month for the last 6 months for the same problems. Which body system does the nurse suspect is malfunctioning in this patient? a) cardiovascular b) respiratory c) immune d) gastrointestinal
immune Correct Explanation: Disorders of the immune system include deficiencies of immune substances and function that affect the body's ability to ward off infection.
The nursing diagnosis you anticipate that would best apply to a child with allergic rhinitis is a) pain related to sinus edema and headache b) Ineffective tissue perfusion related to nosebleeds
pain related to sinus edema and headache. Correct Explanation: Many children with allergic rhinitis develop sinus headaches from edema of the upper airway.
Which of the following treatments are common to both systemic lupus erythematosus and juvenile idiopathic arthritis? Select all that apply. a) Antipyretics b) Corticosteroids c) Antirheumatics d) Nonsteroidal antiinflammatories e) Antimalarials
• Corticosteroids • Nonsteroidal antiinflammatories Explanation: Antimalarials are specific to SLE; antirheumatics are specific to JIA. Antipyretics are not typically used for either disorder.
Food allergies have become more and more common in the last few decades. Which of the following are common food allergies of childhood? Select all that apply. a) Cheerios b) Apples c) Milk d) Peanuts e) Eggs
• Eggs • Peanuts • Milk Explanation: 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.
The nurse is preparing an informational brochure about risk factors for immune disorders. Which of the following disease processes can indicate a potential underlying immunologic disorder? Select all that apply. a) Persistent oral thrush b) Occasional rhinorrhea c) Chronic cough d) Illness with a high-grade fever e) Extensive eczema
• Persistent oral thrush • Chronic cough • Extensive eczema Correct Explanation: Occasional rhinorrhea is common and does not indicate an immune disorder. Illness with high fever is a sign of acute illness, rather than a chronic underlying disorder such as immune dysfunction.
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) Bananas b) Squash c) Peanut butter d) Cheese e) Cherries f) Pineapples
• Pineapples • Cherries • Bananas Explanation: 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.
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 Delayed growth and development related to frequent infections Altered comfort related to severity of new illness Inadequate nutrition related to side effects of medication Inadequate adherence to medication regimen related to side effects
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 Explanation: 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.
Place in correct order the steps in the anaphylactic response. Vasodilation Rapid immune response Bronchoconstriction Exposure to allergen Circulatory collapse
Exposure to allergen Rapid immune response Vasodilation Bronchoconstriction Circulatory collapse Explanation: 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 first time a child with hypersensitivity to stinging insects is stung, the reaction is usually anaphylactic shock and, if not immediately treated, death. a) False b) True
False Correct Explanation: The first time a child is stung, the total reaction is probably only local edema at the site. The second time, generalized urticaria, pruritus, and edema may develop. The third time, symptoms may progress to wheezing and dyspnea. The next time, the reaction could be so severe that shock and death result. The progression of symptoms may be slower than this (involving 10 to 12 stings) if the stings occur far apart; if the stings are received close together (1 or 2 days apart, or even 3 weeks apart), the progression to fatal symptoms may occur as early as the second or third exposure.
The nurse instructs a school-aged child who has a bee-sting allergy and his parents on proper use of the EpiPen. What is the order of steps that should be taken if the child is bit by a bee? Remove gray safety cap. Place EpiPen against child's thigh, injecting solution. Grasp the EpiPen with your fist, with black tip pointing down. Hold syringe in place for 10 seconds.
Grasp the EpiPen with your fist, with black tip pointing down. Remove gray safety cap. Place EpiPen against child's thigh, injecting solution. Hold syringe in place for 10 seconds. Correct Explanation: These are the necessary steps for injecting the EpiPen. First, make sure to hold the device correctly. Then remove the cap. Next, place the injection tip against the thigh, either directly on the skin or on the clothing. Finally, hold the syringe in place for 10 seconds to make sure the content is injected properly.
A nursing student correctly identifies which of the following to be the most serious of all of the immunologic disorders? a) allergic rhinitis b) contact dermatitis c) HIV d) serum sickness
HIV Correct Explanation: Of the immunologic disorders, human immunodeficiency virus (HIV) infection is the most serious, not only because it is still fatal but also because its spread has been difficult to contain.
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) Importance of yearly eye examinations b) Avoiding grapefruit juice when taking the drug c) Giving with foods to minimize gastrointestinal upset d) Need to gradually taper the drug dosage over time
Importance of yearly eye examinations Correct Explanation: When hydroxychloroquine is given, the child should have a fundoscopic eye exam and visual field testing every year. Corticosteroids need to be tapered gradually over time. Cyclosporine A should not be taken with grapefruit juice. Nonsteroidal anti-inflammatory agents should be given with food to decrease gastrointestinal upset.
A child is scheduled to undergo hyposensitization. The nurse understands that this therapy attempts to achieve which of the following? a) An increased level of IgE b) Blockage of histamine release c) Reduction in allergen exposure d) Increased concentration of IgG
Increased concentration of IgG Correct Explanation: Hyposensitization works by increasing the plasma concentration of IgG antibodies. IgG acts to prevent or block IgE antibodies from coming into contact with the allergen. IgE levels are not increased. Antihistamines block the release of histamine. Environmental control helps to reduce exposure to potential allergens.
A woman in her fourth month of pregnancy has recently learned that her sexual partner is HIV positive. She agrees to be tested for the virus but asks the nurse what early symptoms she should be looking for in herself. Which of the following should the nurse mention to the client? a) Vaginal discharge b) Skin rash c) Mild, flu-like symptoms d) Genital warts
Mild, flu-like symptoms Correct Explanation: Unlike other sexually transmitted infections, HIV infection rarely begins with reproductive tract lesions. Instead, early symptoms are more subtle and often difficult to differentiate from those of other diseases or even from the symptoms of early pregnancy such as fatigue, anemia, diarrhea, and weight loss. The initial invasion of the virus may be accompanied by mild, flulike symptoms.
What advice would be most appropriate for the child with a stinging-insect allergy? a) Arrange for allergy testing for foods with ingredients similar to those in insect venom. b) Obtain a Medic-Alert bracelet so the presence of the allergy can be identified easily. c) Join a peer support group to help relieve anxiety about this problem. d) Consult a genetic counselor to reveal other susceptible family members.
Obtain a Medic-Alert bracelet so the presence of the allergy can be identified easily. Correct Explanation: Stinging-insect allergy can lead to anaphylactic shock. Alerting health care personnel to the possibility of an insect sting is important.
A mother, who is HIV positive, is distraught when she learns that her 6-month-old baby is also HIV positive. The child had undergone open heart surgery as a newborn and had received numerous blood transfusions. The nurse recognizes that which of the following is the most likely means of transmission of the disease to this child? a) The mother kissing the baby on the forehead b) Breastfeeding c) Blood transfusion products contaminated with the virus d) Placental spread during pregnancy
Placental spread during pregnancy Correct Explanation: Although it is decreasing in incidence, transmission of HIV from mother to child by placental spread is still the most common reason for childhood HIV infection in the United States. Children with hemophilia no longer have a high incidence of the disease because blood products are now screened for the virus. HIV is not transmitted by animals or through usual casual contact, such as shaking hands or kissing, or in households, day care centers, or schools. Infection via breast milk is possible but less likely that via placental spread.
An 8-year-old boy is suffering from allergic rhinitis. The nurse should advise his mother to avoid which of the following allergens? a) Penicillin b) Pollen c) Peanuts d) Soap
Pollen Correct Explanation: The allergens that usually cause allergic rhinitis are pollens or molds rather than foods or drugs. Soap is not associated with allergic rhinitis.
The nurse is working with a pregnant client with HIV who is receiving oral zidovudine. What is the primary rationale for this intervention? a) To treat pneumonia b) To help prevent transmission of the disease to the fetus c) To halt the growth of Kaposi's sarcoma d) To restore coagulation ability
To help prevent transmission of the disease to the fetus Correct Explanation: A goal of therapy during pregnancy is to maintain the CD4 cell count at greater than 500 cells/mm3 by administering oral zidovudine which helps halt maternal/fetal transmission dramatically along with one or more protease inhibitors, such as ritonavir (Norvir) or indinavir (Crixivan), in conjunction with an NRTI. If P. carinii pneumonia develops, a woman is treated with trimethoprim with sulfamethoxazole. Kaposi's sarcoma is normally treated with chemotherapy. Women may need a platelet transfusion close to birth to restore coagulation ability.
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) von Willebrand's disease b) Beta-thalassemia major c) Wiskott-Aldrich syndrome d) Severe combined immunodeficiency
Wiskott-Aldrich syndrome Correct Explanation: Severe bloody diarrhea, petechiae, bruising, eczema with secondary infection, and prolonged bleeding episodes are signs and symptoms of Wiskott-Aldrich syndrome. Beta-thalassemia major would be manifested by signs of bleeding. von Willebrand's disease would be manifested by signs of bleeding. Severe combined immunodeficiency would be manifested by chronic diarrhea and failure to thrive, persistent thrush, and a history of severe infections beginning in infancy.
A nurse is providing care to a child with HIV who is prescribed therapy with a nucleoside reverse transcriptase inhibitor. Which of the following would the nurse expect to administer? a) Nevirapine b) Zidovudine c) Ritonavir d) Efavirenz
Zidovudine Explanation: Zidovudine is a nucleoside reverse transcriptase inhibitor. Nevirapine and efavirenz are classified as nonnucleoside reverse transcriptase inhibitors. Ritonavir is a protease inhibitor.
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) Pneumonia last spring; resolved with antibiotics b) Recurrent deep abscess of the thigh c) Oral thrush, persistent over the past 6 to 7 months d) Infected laceration requiring IV antibiotic 2 months ago; healed e) Acute otitis media, one episode every 3 to 4 weeks over the past year.
• 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 Explanation: 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.
After teaching a class of nursing students about acquired immunodeficiency, the instructor determines that the teaching was effective when the students identify which of the following as a contributing factor? Select all that apply. a) Cancer b) Malnutrition c) Vitamin therapy d) Minor localized infection e) Immunosuppressive drugs
• Cancer • Malnutrition • Immunosuppressive drugs Correct Explanation: Factors contributing to secondary (acquired) immunodeficiency include severe systemic infection, cancer, renal disease, radiation therapy, severe stress, malnutrition, immunosuppressive therapy, and aging.
Nursing students are reviewing the events involved in humoral immunity. They demonstrate understanding of the information when they identify which of the following as occurring with complement activation? Select all that apply. a) Smooth muscle relaxation b) Lysis of the foreign antigen c) Decreased vascular permeability d) Phagocytosis e) Chemotaxis
• Lysis of the foreign antigen • Phagocytosis • Chemotaxis Correct Explanation: Complement activation results in increased vascular permeability, smooth muscle contraction, chemotaxis, phagocytosis, and lysis of the foreign antigen.
Which of the following immune cells are disrupted when a child is infected with HIV? Select all that apply. a) Platelets b) Phagocytes c) T cells d) B cells e) Erythrocytes
• T cells • B cells • Phagocytes Explanation: Platelets and erythrocytes are not affected by the HIV virus because the disease affects primarily the immune system.
A nurse is giving a talk to high-school students about preventing the spread of HIV. What does the nurse identify as ways in which HIV is spread? (Select all that apply.) a) Transfusion of contaminated blood b) Perinatally from mother to fetus c) Sharing the same bathroom d) Sharing contaminated needles e) Through breastfeeding f) Exposure to blood and body fluids through sexual contact
• Transfusion of contaminated blood • Perinatally from mother to fetus • Sharing contaminated needles • Through breastfeeding • Exposure to blood and body fluids through sexual contact Correct Explanation: HIV is spread by exposure to blood and other body fluids through sexual contact, sharing of contaminated needles for injection, transfusion of contaminated blood, perinatally from mother to fetus, and through breastfeeding.
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 raw food diet b) Allergy skin testing c) A food diary d) An elimination diet
An elimination diet Correct Explanation: 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.
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) Corticosteroid c) Etanercept d) Methotrexate
Aspirin Correct Explanation: The child is exhibiting signs and symptoms of aspirin toxicity. Corticosteroids would lead to signs and symptoms of Cushing syndrome as well as masking the signs of infection. Methotrexate would lead to changes in the white blood cell count, placing the child at risk for infection. Etanercept, like methotrexate, places the child at risk for infection.
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.
Gently roll the vial to mix the medication. Correct Explanation: 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 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) Administer with food. b) Monitor for signs of Cushing syndrome. c) Have epinephrine available. 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.
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) IgG subclasses b) Immunoglobulin electrophoresis c) Lymphocyte immunophenotyping T-cell quantification d) Complement assay (C3 and C4)
Lymphocyte immunophenotyping T-cell quantification Explanation: Lymphocyte immunophenotyping T-cell quantification is for ongoing monitoring of progressive depletion of CD4 T lymphocytes in HIV disease. The nurse would expect the physician to order a complement assay (C3 and C4) for ongoing monitoring of systemic lupus erythematosus. IgG subclasses measures the levels of the four subclasses of IgG and is used to determine immunodeficiencies. Immunoglobulin electrophoresis is ordered for immunodeficiency and autoimmune disorders, not to monitor systemic lupus erythematosus.
The nursing instructor is describing the events of anaphylaxis. Place the assessment findings in the order that they would occur from first to last. Hypoxia Seizures Bronchospasm Urticaria, angioedema Nausea, vomiting, diarrhea
Nausea, vomiting, diarrhea Urticaria, angioedema Bronchospasm Hypoxia Seizures Correct Explanation: Initially, a child may be nauseous, with vomiting and diarrhea, because of the sudden increase in gastrointestinal secretions produced by the stimulation of histamine. This is followed by urticaria and angioedema. Bronchospasm can become so severe the child becomes dyspneic and hypoxemic. Continued bronchospasm leads to hypoxia. As blood vessels dilate, the blood pressure and pulse rate fall. Seizures and death may follow as soon as 10 minutes after the allergen is introduced into the child's body.
The most accurate screening test for the presence of HIV antigen in young children is a) ELISA b) PCR c) CD4 count d) Western blot
PCR Correct Explanation: PCR tests directly for the HIV antigen. ELISA and the Western blot test detect the presence of HIV antibodies. The CD4 count is used as a measure of disease status and progression.
Nebulized albuterol should be available to counteract anaphylactic shock. This drug a) facilitates breathing. b) increases the pulse rate. c) depresses the central nervous system. d) counteracts hypotension.
facilitates breathing. Explanation: Albuterol is a bronchodilator that enlarges the lumen of the airway.
A 7-year-old girl has been battling leukemia and receiving radiation therapy. She is highly susceptible to infections, and the nurse recognizes that this is because she is experiencing secondary immunodeficiency. Which of the following are factors that cause secondary immunodeficiency? (Select all that apply.) a) Severe stress b) Genetic deficiency of B-lymphocytes c) Radiation therapy d) Cancer e) Malnutrition f) Hypogammaglobulinemia related to an inherited X-linked recessive gene
• Cancer • Radiation therapy • Severe stress • Malnutrition Explanation: Secondary immunodeficiency, or loss of immune system response, can occur from factors such as severe systemic infection, cancer, renal disease, radiation therapy, severe stress, malnutrition, immunosuppressive therapy, and aging. Genetic deficiency of B-lymphocytes and hypogammaglobulinemia related to an inherited X-linked recessive gene are examples of primary (congenital) immunodeficiencies, not secondary (acquired) immunodeficiencies.
A 4-year-old child is receiving monthly IgG transfusions for hypergammaglobulinemia. In assessing the child's current health status, the nurse will ask about several aspects of care, including which of the following? Select all that apply. a) Sleep disturbances b) Vacation plans c) Nutritional intake d) Frequency of recent illnesses e) Participation in activities
• Frequency of recent illnesses • Nutritional intake • Participation in activities • Sleep disturbances • Vacation plans Explanation: Evidence of frequent illness is of concern if the child is receiving IgG supplementation. The child with this disorder will have a poor appetite. The child may experience activity intolerance due to fatigue, illness, or joint pain. Sleep disturbances are common in children with immune disorders. The family will need to consider the child's health status and risks of exposure when planning a vacation.
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? Select all that apply. a) Peanuts b) Shrimp c) Eggs d) Carrots e) Oranges f) Potatoes
• Peanuts • Shrimp • Eggs Correct Explanation: 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.
